Your Skin Is Burnt, Your Mouth Is Dry, Your Mount Is Lathered; But Alas! You Have Arrived: Updates

I know.

I know...

August 9th, 2011.That was indeed that last time that I provided you, my wonderful readers, with an update. That's right -- that's an astounding 238 days, 5,712 hours, 342,720 minutes, 20,563,200 seconds. Oh how you must have thirsted for the intellectual stimulation! Oh how cerebrally parched you must have become! I can feel it now! The pain. The longing. The indomitable voracity for the continuation of my tale! Well, I am here today because you have, at last, bested the desert of downtime, overtaken the sands of the sojourn; you have reached the closing stretch, crested the final hill, suffered the last of the blazing desperation. I stand here today as your river of respite, your stream of stimulation, your oasis of entertainment. So drink deeply, friends!

Now, I could offer you a number of excuses from the mundane to the miraculous as to why it has been so long. But honestly, let's save us both the time and get right down to the good stuff. The last time you heard from me was at the conclusion of my bold adventures abroad; a lot has happened since then, and I would be as crazy as the fire-breathing shaman to try to cover it all, so let's just focus on some important points.

1. SECOND YEAR
Wow. It sure has gone by fast. Everyone says coming in that medical school gets better as you progress through the years, getting closer and closer to actually treating patients, that which we all came here to do in the first place. So far, I would have to say it has been absolutely true. Though I enjoyed first year enough, these last 8 months have been leaps and bounds better. Rather than focusing exclusively on the basic sciences, classes this year are much more clinical. Naturally we still cover science and physiology, but it most always has a clinical spin to it. The best part is, most of the concepts we cover were already introduced last year, so rather than building an entire foundation of knowledge, this time around we are simply reinforcing. And I have to say, it actually (finally) feels like it's starting to stick. ...Sometimes. For about a week.

Preceptorship has been much better this year, too. If you recall, all students at OHSU participate in the preceptorship program for the first two years, which is essentially a once-a-week, hands-on shadowing experience with a local doc. We spend one year rotating through various specialties (which I did last year), and the other year with a primary care physician, either family practice or internal medicine.This year was my primary care year; I have been working once a week with a family practice doc at a Providence clinic in Salem. It has been a really good experience overall -- it has given me much more clinical experience than my preceptorships last year did. There have been several times where I have seen a patient in clinic with the same condition/medication/symptoms that we had just covered in class, which was especially rewarding.

2. BOARDS
So throughout second year, no matter how focused on studies, no matter how enjoyable and fulfilling the material, second year students are constantly plagued by the knowledge of their upcoming fate: Step 1 of the Board examinations. As I'm sure I've explained before, medical school is broken up into two very different parts. The first two years are almost entirely didactic -- though you get some clinic time via preceptorship, the vast majority of your time and effort is spent in the classroom learning the basic material. After that, you get a taste of the real-world during years 3 and 4, wherein you spend your time exclusively on the wards, rotating through various core specialties (more on this later). But in order to pass from phase 1 (classroom learning) to the second phase (the clinical years), students must first demonstrated their basic aptitude by passing a checkpoint--that is, the first part of the national board examinations. And so that is what I have had to look forward to all year.

The test encompasses everything that you have (hopefully) learned during the first two years of medical school, from anatomy and physiology to pharmacology, biochemistry, genetics, and so on. Questions are typically presented as clinical-case vignettes. The test itself takes an entire day to complete, something like a grueling 8 hours or so. Fortunately, before being forced to face this impending doom, we are given a full 5-week study period to prepare (May 19 - June 24). You can ultimately use this time however you like; most students choose to use the majority of it to study (pretty much 24/7), and then take a bit of time off at the end. Oh, right. I forgot to mention. The unfortunate part of this year is that, after we finish our study period and take the exam, we immediately start in on 3rd year clerkships. So, when I said previously that last summer was the final summer of my life...I meant it.

Well, I decided that I needed some time to recuperate before beginning third year, so I am giving myself 4 weeks to study, followed by 1 week of vacation. We have a week long transition to clerkships starting June 25th and, after that, we sprint headlong into clerkships. It's exciting. It's terrifying. It's coming...

3. CLERKSHIPS
So, speaking of 3rd year, our class was recently all hustle and bustle as everyone put in their requests for 3rd year clerkship scheduling. They gave us 8 different tracks to choose from. Each track consists of the same 8 core-clerkship rotations in various sequences. In other words, all students have to rotate through each of 8 different specialties during third year (plus one elective period). Each clerkship lasts 5 weeks in duration. Most will take place on the hill (at OHSU, Doernbecher or the VA), though some will take place at different hospitals in Portland, as well as various other locations in Oregon. [As a side note, the fourth year clerkship schedule is much more elective and variable, as students attempt to narrow down their interests and ultimately choose a residency to apply for. Much more to come on this later.]

The 8 core clerkships for next year are as follows:
Family medicine
Internal medicine x2
Pediatrics
Surgery
OB/GYN
Rural medicine
Psychiatry

After much anxious waiting, we actually just received our track assignments after coming back from Spring break (a nice belated birthday gift from the teaching services office). My first choice was track C, which was also the top choice for two of my buddies. And what do you know, I got it! And so did one of my friends, though the other one did not, unfortunately. Here is what my schedule will look like next year:

Jun 25 - Jun 29: Transition to clerkship
Jul 4 - Aug 12: Rural medicine
Aug 6 - Sep 7: OB/GYN (Eugene)
Sep 10 - Nov 16: Internal medicine
Nov 26 - Dec 21: Elective (Emergency?)
Jan 7 - Feb 13: Psychiatry
Feb 11 - Feb 15: Continuity curriculum
Feb 18 - Mar 22: Family medicine
Mar 25 - Mar 29: Continuity curriculum
Apr 1 - May 3: Surgery
May 1 - Jun 7: Continuity curriculum
May 6 - Jun 7: Pediatrics

As you can see, in addition to the 8 core specialties, we also have several "continuity weeks", during which time the entire class gets back together for a variety of seminars. My understanding is that these weeks are used, at least in part, to make sure everyone gets effective training in various key skills. Additionally, we also have one 4-week elective block. I am currently planning on doing an emergency medicine elective, though this may change in the future. Also, I noted that my OB/GYN rotation will be taking place in Eugene, which I am really excited about. I requested this rotation because I have heard really good things about it, and one of my buddies will be doing the same rotation there, which will make it all the better. I also asked to do surgery in a community site (outside of Portland), but it doesn't look like I got that. As for other locations, I will find out more specifics later--I will likely do both my internal medicine rotations on the hill (I'm thinking one at OHSU and one at the VA). As for rural, we get to put in our requests for specific sites later, but I'm leaning toward somewhere on the coast or in Eastern Oregon, near Bend.

I am SUPER excited that I got the track I selected. First of all, my rural rotation will be in the summer, which will be great, especially if I get a cool site. It is well known that some rotations are much less time and work intensive than others, and rural is definitely one of them (whereas internal medicine, surgery and OB/GYN are known to be pretty killer). I also wanted to be sure to finish my internal medicine rotations before the elective block because it opens up more options for elective choices, and if I do end up doing emergency, I feel that it will better prepare me for the experience.

On the other hand, I'm quite a bit less excited for the surgery rotation for several reasons. Although I know it will be a fantastic learning experience, and will likely be a lot of fun, surgery isn't something I am currently considering for a career. More importantly, surgeons are notorious for having a certain mentality/attitude (specifically being brash, demanding, demeaning, etc). This by no means applies to all of them, but it is certainly a recognizable pattern. Thus, I am a bit trepidatious for this experience. Internal medicine, on the other hand, I am really excited for, and am even considering pursuing as a career, but am equally fearful for simply due to the massive amounts of time and effort it requires.

But all in all. Come on. This is fantastic. I'm living the dream.



Well, that's going to be it for now. I know there are a plethora of other topics I could cover, endless other stories I could tell; but therein lies the problem -- I simply don't have the time or energy at this time (and, as for those of you determined souls who have stuck it through until now, I imagine you grow weary as well). But I will do my best to update more regularly from now on. At the very least, I'll try my best not to take another ridiculously extensive hiatus.

...But no promises. So before setting out on another quest for knowledge and entertainment, be sure to pack your waterskin this time around. For though I will do my best, I may not always be there to quench your thirst.