Good day everyone!
Just on a break today and figured I would get another post started.
Initial Impressions so far? I love it. This semester is honestly a whole lot of fun. Such a different change of pace and style from what I have been used to for the past year and a half on the island. The whole focus changes from Academic to Clinical. While there is still a bit of lecture type stuff going on, the feel is still very much centred around us being able to make sound clinical judgements.
I guess the best first thing to do would be to give a rundown of the schedule for a typical week. So like I said in a previous post sometime, the semester is broken down into two parts. You essentially register for 2 classes when you come to Maine. The first which is essentially ICM 2 runs for the first 2 months. The next course or section of the semester is the Kaplan Course that runs for just about a month. Right now, I have completed two full weeks, the first being paperwork type formality stuff. Second week was the first full normal week, and I am currently in my 3rd week now. Ill give you a break down of what it is like.
Monday: Heavy lecture day. From 9-11 we have a lecture. Each week the topic varies, but it is system based. Last week was Respiratory, this week was Cardio. The lectures are given by a large pool of doctors who's other roles are to facilitate our virtual clinics. We get an hour for lunch from 11-12, then have small group lectures from 12-230. These group are around 10 people each and we meet with a doctor and discuss topics on the current body system that we are on that particular week. We break down the physical examinations, diagnostic tests, treatment, and just general patient management. We start to discuss beyond how to diagnose a patient. All of a sudden we have to start thinking about management and treatment. Not just which drug to use, but proper dosing, cost of treatment, patient financial situation etc. We have to think about when we actually admit a patient into the hospital or if we can send them home with a treatment plan etc. We can no longer just say we would order a CT, Xray, BMP or cultures, we have to actually take into account if we are seeing a patient in a clinic vs hospital, or if the patient has health insurance etc. Its really cool to think beyond just the diagnosis. All these topics we discuss in our small groups. After small group we then have a series of clinical scenarios that integrate pathology. We will be presented with a case, then work through the entire diagnosis, diagnostics, treatment etc. They will provide us with X-ray results, Echo tests, Pathology sections, histology etc. Some of them are pretty tough, the others are simple. It is a lot of fun but can be stressful at times because you are put on the spot on occasion. But its how we learn.
By the end of the day, we are all pretty tired. The day finishes at 5, its dark and winter outside, we are all ready to go home.
Tuesday: Tuesday is Virtual Lab day. We are all put into groups, so your start time may vary. For me I start at 1045. We get to school where we are assigned a partner. One of the two people is assigned to be doctor first, the other is presenter. You then will switch positions on the second room. You knock on the door, inside is a real doctor and a actor patient. When you walk in the room the time starts. The doctor has 20 minutes to take a history, do any physical exams they want to do, diagnose, and provide a treatment plan. We are graded on all of this including our ability to council the patient and explain procedures etc. If we make the patient uncomfortable, if we sit or stand, if we do exams correctly, if we explain procedures etc. Everything is evaluated. At the end of the 20 minutes, the presenter then has 10 minutes to gather any addition information they want and give a comprehensive summary to the real doctor. You then have to provide your own diagnosis with 2 additional differentials. You also have to give your own treatment plan. We do this twice, but change roles in the second room. The presenter is also responsible for writing a SOAP note at the end of the day. We have 30 minutes to essentially write down the comprehensive summary and treatment plan that you verbally gave to the doctor. This is also graded. This is a great experience and a lot of fun. It can be stressful, especially when you can come up with a diagnosis:P This happened to me. Normally you have a few things in mind, but there is always something that makes the lightbulb turn on. It might be a specific physical exam finding, or simple one thing that the patient says. At the end of the day, you always have something you need to say. Some of the cases I have had so far include exercise induced asthma, Infective endocarditis, pre-syncopal aortic stenosis and a few others.
This experience is super important as it is us essentially practicing for our USMLE Step 2 CS exam that we do about halfway through clinical rotations. This is all good practice. The other thing I do on Tuesday is clinical skills lab. Here we practice some more hand on skills that we use as doctors. Last week we did various injection methods as well as placing TB tests. This week we do Intubation and arterial puncture for drawing arterial blood for blood gas analysis. Each week there is a different set of skills that we will work on. For me, I do this from 3-5, so I have a bit of a break after Virtual clinic. Depending on your luck, you get assigned to a group that either does Clinical skills on Tuesday or Wednesday. I get to get it all done Tuesdays.
Wednesday: Wednesday is Grand rounds and Therapeutics. At 8 am we are supposed to show up at the hospital in Maine and sit in on talks given by residents or doctors etc. The topics vary. We are amongst regular hospital staff at that point. The talks are normally about an hour long, at which point we head back to school and have lectures from 10-12. This lecture is titled therapeutics. The topics change from week to week. Last week it was dermatology, this week it is EKG etc. The day ends normally at 12 and we can go do some self study.
Thursday and Friday depends on if you are group A or B. Group A does precepting on these days. Ill talk a bit about my experience with this separately. You have to complete 30 hours in a month. So it is up to you to get this done between Thursday and Friday each week. If you are not in Group A, then you have other lectures which I'm not to sure about. I am in Group A, so I'm not quite sure how it works.
Thats the week! Not too bad if you ask me. This is the regular schedule for the 2 months. The last month is in the Kaplan course and everything changes again. Ill keep you posted with that. Just remember however, that during this time you are supposed to be prepping for Step 1. You are on your own schedule to do this, but you are expected to be prepping. So in the evenings it is not all free time. I mean if you don't want to study you can do what you want, but it is just like St Kitts in that you work well into the evening. Its just that you are know reviewing material and not learning new stuff every day. This is extremely refreshing and feels absolutely amazing to finally be able to go over previous material.
Ill give you a bit of a taste of what I do with my Preceptor, A while back I told you that I was assigned to a general surgeon. When I first got to Maine I went to the hospital and did a bit of familiarization training as well as how to scrub in and remaine sterile during a surgery. I had my first actual session last week. On Thursday I headed to the hospital and checked myself into the OR. Got my scrubs, got prepared and waited until my Surgeon showed up. This was the first time we met. He is a super nice guy and went over the cases for the day with me. He told me a bit about the specifics of each problem, went into the pathology of the diseases a bit then we got prepped. Anesthesiology put the patient under then we got started. I was surprised at how much I was able to do. I figured I would most likely just be observing from a distance, but I essentially took the job of the scrub nurse. I took her position on the table and the Nurse worked through me essentially. She would hand me tools that I would give to the surgeon, I would be suctioning and retracting, holding traction, cutting suture lines etc. I was right in there the whole time! He was good at asking me a bunch of questions and explaining what he was doing. I got to talk with anesthesiology a bit too. This was a super great experience. I cant wait for more. I think this week he isn't in the OR, so instead we will be in the clinic. This will still be a good opportunity to learn. For the school, we are required to write up some notes of a few of the patients we see. So that is really the only thing that you need to do outside of the actual precepting. While I was paired wth a surgeon, other were paired with family docs, internal medicine docs, addiction clinics, sports medicine etc. A whole bunch of different experiences. There is something unique about each specialty and there is no real "better" position. I guess it is mostly based on your interested that makes one better over another. Each has their own particular set of skills the you get to practise or situations you get to experience. I am pretty happy with where I am however.
Thats about it for now. I have yet to explore the area too much, but Ill be sure to do that when I get the chance. I might be going skating next weekend and will surely be doing a bit of research into some possible Ski locations. Ill wait for a bit more snow before I start to figure all that out however.
Thing I've Learned
-There is one benefit to coming to Maine in the winter. We get snow days! Get my first one tomorrow;)
-Movies are a lot more expensive then in SK...
-Getting cash here is annoying.. and expensive
-Being able to use Amazon is great
-It is very very very nice to have a car again
-There are people who think the weather is terrible right now. Please. Just wait
-I feel more and more Canadian when people ask me questions about ice fishing, skating, snowmobiling because very few people have actually done these things.
Cheers,
Mike!
Just on a break today and figured I would get another post started.
Initial Impressions so far? I love it. This semester is honestly a whole lot of fun. Such a different change of pace and style from what I have been used to for the past year and a half on the island. The whole focus changes from Academic to Clinical. While there is still a bit of lecture type stuff going on, the feel is still very much centred around us being able to make sound clinical judgements.
I guess the best first thing to do would be to give a rundown of the schedule for a typical week. So like I said in a previous post sometime, the semester is broken down into two parts. You essentially register for 2 classes when you come to Maine. The first which is essentially ICM 2 runs for the first 2 months. The next course or section of the semester is the Kaplan Course that runs for just about a month. Right now, I have completed two full weeks, the first being paperwork type formality stuff. Second week was the first full normal week, and I am currently in my 3rd week now. Ill give you a break down of what it is like.
Monday: Heavy lecture day. From 9-11 we have a lecture. Each week the topic varies, but it is system based. Last week was Respiratory, this week was Cardio. The lectures are given by a large pool of doctors who's other roles are to facilitate our virtual clinics. We get an hour for lunch from 11-12, then have small group lectures from 12-230. These group are around 10 people each and we meet with a doctor and discuss topics on the current body system that we are on that particular week. We break down the physical examinations, diagnostic tests, treatment, and just general patient management. We start to discuss beyond how to diagnose a patient. All of a sudden we have to start thinking about management and treatment. Not just which drug to use, but proper dosing, cost of treatment, patient financial situation etc. We have to think about when we actually admit a patient into the hospital or if we can send them home with a treatment plan etc. We can no longer just say we would order a CT, Xray, BMP or cultures, we have to actually take into account if we are seeing a patient in a clinic vs hospital, or if the patient has health insurance etc. Its really cool to think beyond just the diagnosis. All these topics we discuss in our small groups. After small group we then have a series of clinical scenarios that integrate pathology. We will be presented with a case, then work through the entire diagnosis, diagnostics, treatment etc. They will provide us with X-ray results, Echo tests, Pathology sections, histology etc. Some of them are pretty tough, the others are simple. It is a lot of fun but can be stressful at times because you are put on the spot on occasion. But its how we learn.
By the end of the day, we are all pretty tired. The day finishes at 5, its dark and winter outside, we are all ready to go home.
Tuesday: Tuesday is Virtual Lab day. We are all put into groups, so your start time may vary. For me I start at 1045. We get to school where we are assigned a partner. One of the two people is assigned to be doctor first, the other is presenter. You then will switch positions on the second room. You knock on the door, inside is a real doctor and a actor patient. When you walk in the room the time starts. The doctor has 20 minutes to take a history, do any physical exams they want to do, diagnose, and provide a treatment plan. We are graded on all of this including our ability to council the patient and explain procedures etc. If we make the patient uncomfortable, if we sit or stand, if we do exams correctly, if we explain procedures etc. Everything is evaluated. At the end of the 20 minutes, the presenter then has 10 minutes to gather any addition information they want and give a comprehensive summary to the real doctor. You then have to provide your own diagnosis with 2 additional differentials. You also have to give your own treatment plan. We do this twice, but change roles in the second room. The presenter is also responsible for writing a SOAP note at the end of the day. We have 30 minutes to essentially write down the comprehensive summary and treatment plan that you verbally gave to the doctor. This is also graded. This is a great experience and a lot of fun. It can be stressful, especially when you can come up with a diagnosis:P This happened to me. Normally you have a few things in mind, but there is always something that makes the lightbulb turn on. It might be a specific physical exam finding, or simple one thing that the patient says. At the end of the day, you always have something you need to say. Some of the cases I have had so far include exercise induced asthma, Infective endocarditis, pre-syncopal aortic stenosis and a few others.
This experience is super important as it is us essentially practicing for our USMLE Step 2 CS exam that we do about halfway through clinical rotations. This is all good practice. The other thing I do on Tuesday is clinical skills lab. Here we practice some more hand on skills that we use as doctors. Last week we did various injection methods as well as placing TB tests. This week we do Intubation and arterial puncture for drawing arterial blood for blood gas analysis. Each week there is a different set of skills that we will work on. For me, I do this from 3-5, so I have a bit of a break after Virtual clinic. Depending on your luck, you get assigned to a group that either does Clinical skills on Tuesday or Wednesday. I get to get it all done Tuesdays.
Wednesday: Wednesday is Grand rounds and Therapeutics. At 8 am we are supposed to show up at the hospital in Maine and sit in on talks given by residents or doctors etc. The topics vary. We are amongst regular hospital staff at that point. The talks are normally about an hour long, at which point we head back to school and have lectures from 10-12. This lecture is titled therapeutics. The topics change from week to week. Last week it was dermatology, this week it is EKG etc. The day ends normally at 12 and we can go do some self study.
Thursday and Friday depends on if you are group A or B. Group A does precepting on these days. Ill talk a bit about my experience with this separately. You have to complete 30 hours in a month. So it is up to you to get this done between Thursday and Friday each week. If you are not in Group A, then you have other lectures which I'm not to sure about. I am in Group A, so I'm not quite sure how it works.
Thats the week! Not too bad if you ask me. This is the regular schedule for the 2 months. The last month is in the Kaplan course and everything changes again. Ill keep you posted with that. Just remember however, that during this time you are supposed to be prepping for Step 1. You are on your own schedule to do this, but you are expected to be prepping. So in the evenings it is not all free time. I mean if you don't want to study you can do what you want, but it is just like St Kitts in that you work well into the evening. Its just that you are know reviewing material and not learning new stuff every day. This is extremely refreshing and feels absolutely amazing to finally be able to go over previous material.
Ill give you a bit of a taste of what I do with my Preceptor, A while back I told you that I was assigned to a general surgeon. When I first got to Maine I went to the hospital and did a bit of familiarization training as well as how to scrub in and remaine sterile during a surgery. I had my first actual session last week. On Thursday I headed to the hospital and checked myself into the OR. Got my scrubs, got prepared and waited until my Surgeon showed up. This was the first time we met. He is a super nice guy and went over the cases for the day with me. He told me a bit about the specifics of each problem, went into the pathology of the diseases a bit then we got prepped. Anesthesiology put the patient under then we got started. I was surprised at how much I was able to do. I figured I would most likely just be observing from a distance, but I essentially took the job of the scrub nurse. I took her position on the table and the Nurse worked through me essentially. She would hand me tools that I would give to the surgeon, I would be suctioning and retracting, holding traction, cutting suture lines etc. I was right in there the whole time! He was good at asking me a bunch of questions and explaining what he was doing. I got to talk with anesthesiology a bit too. This was a super great experience. I cant wait for more. I think this week he isn't in the OR, so instead we will be in the clinic. This will still be a good opportunity to learn. For the school, we are required to write up some notes of a few of the patients we see. So that is really the only thing that you need to do outside of the actual precepting. While I was paired wth a surgeon, other were paired with family docs, internal medicine docs, addiction clinics, sports medicine etc. A whole bunch of different experiences. There is something unique about each specialty and there is no real "better" position. I guess it is mostly based on your interested that makes one better over another. Each has their own particular set of skills the you get to practise or situations you get to experience. I am pretty happy with where I am however.
Thats about it for now. I have yet to explore the area too much, but Ill be sure to do that when I get the chance. I might be going skating next weekend and will surely be doing a bit of research into some possible Ski locations. Ill wait for a bit more snow before I start to figure all that out however.
Thing I've Learned
-There is one benefit to coming to Maine in the winter. We get snow days! Get my first one tomorrow;)
-Movies are a lot more expensive then in SK...
-Getting cash here is annoying.. and expensive
-Being able to use Amazon is great
-It is very very very nice to have a car again
-There are people who think the weather is terrible right now. Please. Just wait
-I feel more and more Canadian when people ask me questions about ice fishing, skating, snowmobiling because very few people have actually done these things.
Cheers,
Mike!