COMLEX Level 3 Thoughts

For the COMLEX, I prepared using USMLEWorld, Master the Boards by Kaplan, and the Simmons manual for OMM. I answered every single Qbank question in USMLEWorld and read Master the Boards twice; sadly, I neglected the Simmons manual until the last 1-2 days before the test. That turned out to be a mistake; somehow, in my OMM review, I completely neglected the section on counterstrain and trigger points. There were a good number of questions on the COMLEX asking about how I'd use counterstrain in treatment, and I wanted to kick myself. I remembered "fold it, hold it" but not whether I was supposed to fold around it or away from it. *sigh* It was helpful knowing the innervations for sure; that stuff is always high yield. Overall, however, the COMLEX was, once again, poorly written. The questions were either very easy (i.e. asking how to treat hyperlipidemia when there was only one cholesterol drug in the answers), reasonable, or outright ridiculous like asking which law allows doctors to ____. Where, in what textbook, would I get that info from?! So while I don't think I failed, there's still a part of me that's uneasy about how things might turn out. We'll see what happens; I should get my residents in the next 2 months.

Afterwards I joined several friends for drinks downtown. Unfortunately I do not have the greatest EtOH tolerance and was bright red after 1 and a half beers (one of which was only 4% EtOH). Still, it was nice to be done, and to celebrate my turning 27 (belated) and being done with the COMLEX, I'm going skiing this weekend and attending a Philadelphia Orchestra concert next week. The orchestra concert promises to be awesome; they'll be performing two pieces I'd played in the University Orchestra at UT and I love hearing pieces I've played before.

The downside is that after a wonderful month of ambulatory medicine (which gave me tons of time to study for the COMLEX), I'll be returning to the wards full-time on Monday. Fortunately the medicine team I've been assigned to has been rumored to be laid back, so I don't expect too much trouble. I'm extremely grateful that I've not had been assigned any months of heart failure (which everyone dreads b/c the attendings are pretty malignant; one likes to threaten people's medical licenses if they don't do as they're told). I'm better off away from all that =P

The COMLEX countdown

I am exhausted. Beat. On top of reading Master the Boards by Kaplan I have spent the last two weeks doing 100+ USMLE questions a day, and I'm proud to say that yesterday I finished my last set. All 1377 questions have been answered at least once, and yet I still feel woefully unprepared for the exam next week. For starters, I've barely touched the Simmons manual. On top of that, all the stress and staring at the computer screen that I've been doing is starting to take its toll. I've been getting daily headaches that resolve with Tylenol. I rarely get a good night's sleep, always waking up at least once in the wee hours of the morning before going back to sleep until the alarm goes off. My eyes are constantly tired to the point where my vision starts to blur, which somewhat makes considering my current prescription is 2.5 years old. I went to see an optometrist last week and was told that my vision has worsened.*sigh* Well that sucks. At any rate I won't be able to function if I keep going in my current state, so I'm off to bed early tonight.

Disrespect

The hospital I work at has a "re-entry program" for physicians who have been out of practice for anywhere from 10-30 years. They rotate through different departments, attend morning reports and noon conferences, and have to take an exam at the end of six months in order to get recertified. This month there are two such physicians who attend ambulatory care and doctoring sessions with me and about 10 other interns. One was a surgeon who's now going into general medicine, and another was an internist who left medicine to raise her kids (who are now starting medical school this coming fall). The internist (whom I'll call Dr. H) is friendly enough but naive to a fault. Once when we were asked about feedback regarding what we learned in the day's lesson, she said that her husband (also an internist) told her there were 3 A's in medicine: availability, attitude, aptitude. Sure, that's all good, except that was not what our attending asked. As a result of this (and other times where she brought up things she learned back in the 1970s but no longer apply today), several of the interns in my small group dislike her immensely.

In our ambulatory care sessions, we each have to choose a topic to teach the other people. This afternoon Dr. H presented a powerpoint on tracheoesophageal fistula and how to treat it in the adult patient, since her daughter was born with TEF and now suffers from GERD, scoliosis, and other complications. She had told us last week that her talk would last 40 minutes, but in reality it was close to an hour long. It was a very interesting talk, and for someone who didn't know how to make a powerpoint presentation a few weeks ago I thought she did very well. Even still, TEF is a predominately pediatric issue, and indeed, a good 80% of her talk focused on the diagnosis and treatment of TEF in childhood. I sat near the attending so I paid close attention, but when I looked toward the back of the room where the other interns were, one guy was clearly snoozing while the others were either playing games, texting each other, or reading stories from fmylife.com (not joking here). I don't mean to be hypocritical since I've been known to occasionally play games on my PDA during some talks, but this was a much smaller group and I was sure our attending wasn't oblivious to what was going on.

After the presentation, our attending asked for feedback. One guy said that while he could understand that this topic was very personal to Dr. H, it was too much information to digest all at once. When we were asked if anyone wanted Dr. H to highlight the points of her presentation, there were a lot of shaking heads (everyone just wanted to get the heck out of there). Dr. H then told us that when we start families, we need to decide which spouse is going to stay home with the children. Originally, she said, her husband was supposed to be the caretaker, but when her first child (the one with TEF) was born, she couldn't feed from a bottle so Dr. H, being the only parent able to breastfeed, ended up staying home for the next 22 years. Several of us exchanged looks; what did this have to do with anything? One of my classmates must have snickered a bit, because Dr. H then turned to her and said, "When you have children someday, this is a choice that you will have to make."

To this, my classmate snapped, "My boyfriend and I have talked about it, and this isn't the forum I want to discuss it in." Anyone could tell from listening to her voice that she was pissed off, and fortunately Dr. H didn't say anymore about it. Later several people berated my classmate for being so rude to Dr. H. "Well, she shouldn't be asking such personal questions!" my classmate replied, and that led the others on another discussion on how "stupid" Dr. H was. I kept my mouth shut, but inside I was pretty appalled by their behavior. Dr. H is about the same age as my parents, and even though she's been out of practice for decades, she's still an "elder" (Asians understand this terminology) and deserved basic respect, which few of my classmates showed her today. Sure, her presentation was unnecessarily long, but since the topic was a disease her daughter has, I know she worked very hard on her presentation.

Another of my classmates who was equally stunned by the others' disrespect said it best: "I treated Dr. H the same way I'd want to be treated. If I was up there doing a presentation, I'd want the others to pay attention, too." Honestly, I don't know if my classmates didn't care because she was older or because they just didn't like her, but I have to do a presentation next week and if they made out like they didn't care, I'd be pissed. I'm pretty close to the interns in my small group as well, so hopefully things will go well next week.

In-Service Exam Blues

The results of our inservice exams from last fall are in. Not surprisingly, I didn't do very well, and it wasn't much of a consolation to hear that I was not the worst of the intern class. I'll be taking Step 3 at the end of the month and I don't feel ready at all. Granted, Step 3 won't ask me totally detailed questions like the inservice exam did, but I still worry. *sigh* Oh well. Nothing to do about it now but study.