Saturday, 26 January 2013

26

For the better part of a day, I was 26 years old. But that was yesterday. And probably again tomorrow, once I slip back into the comfortable and unproductive life I've established for myself.

But today, I am (X-Y) days old

Let X represent the total number of days I'll be alive (and will be determined experimentally).
Let Y represent the number of days I've currently lived (easily determinable).

I'm currently at X-9498. That clock is moving forwards whether I like it or not, so I better do something with it. Make a difference with the difference (I sincerely apologize for that pun). Because life is like a gym membership. No matter what you do, you're going to be charged. Who knows, maybe I'll fix up a fun little digital clock with an Arduino one day.



Anyways.

I've had a growing interest in the Minimalism subreddit. As with many internet communities, noone can agree on what the subreddit represents. Some believe its simply about getting rid of possessions that detract from your life. Others believe its simply about getting rid of as many items as you can and having only a few things define you (such as the 100 Item Challenge). Some believe its a design aesthetic,  others believe its about maximal efficiency, and still others believe its a buyer's guide. Some people post pictures of their bedrooms, looking for feedback or praise. A few harken back to the Minimalist art movement, while others try to create minimalist art or suggest music.

Whatever your definition, I find many of these things calming, especially in a period where I have increased anxiety due to upcoming exams. I have come to appreciate the work it takes to avoid non-food purchases for the last few months. I'm absolutely floored by the minimal work it takes to keep my room tidy (one of the benefits of owning few things). I've learned one can't simply buy a few "zen" things and stick them on a wall and feel at peace. Similarly, I feel that just getting rid of items may help, but it doesn't really give the room 'flow'. It seems that a lot depends on the architecture of the room (big windows being a plus), the landscape, and low background noise. The solution is simple: I need to build a glass cabin in the woods.

Life just feels simpler. Granted, this subreddit hasn't helped with my motivational drive, but I'm hoping my new method of age-counting will help a bit with that.



Anyways.

Pterodactylus has lost the second run fight. That makes me the current champion of legs.



Anyways.

Wednesday, 23 January 2013

Retractions and Reactions

Retraction: My last post erroneously stated that no-one reads this blog. In addition to myself and web crawlers, both people and magical wooden puppets read my thoughts. The Arthur at Ross U Blog regrets the error.




There are some sayings I dislike. The phase "Bad news comes in three's" is one of them. Not because bad news usually comes in one's, but if they occur in a short enough time-span we lump them together into triplets. Not because bad news usually has some silver lining.

Its pretty simple: Bad news actually comes in four's.

Firstly: Christmas cards and gifts that were mailed from Canada have yet to arrive to my domicile. There is a good chance they will never arrive.

Secondly: I received the score for my Comp test and received a 64, when the passing score is a 65. Ouch. Right in the kidneys. More on this later.

Third: I'll be celebrating yet another birthday far from friends and family.

Fourth: Awkward conversations with disappointed parents for the foreseeable future.


I started writing this post several days ago, focusing on post-exam breaks. However, as I began to tease apart the finer details of the causes of exam stress, the whole of the universe began to unravel. Or at least that's what I tell myself when I start writing pages of incoherent rambling. Instead, I've combined parts of that post with thoughts on the Comp examination and studying in general. If it feels disjointed, it only appears so because I applied crazy glue between different paragraphs, thoughts, and recipes for tomato sauce.
---------------------------------------------------------------------------------------
Among topics studied for medical examinations, the Law of Diminishing Returns applies. One can attempt to memorize every protein, cell type, mechanism of action, etc... but:
  • only so many questions can appear on a test
  • some knowledge is considered more pertinent than other knowledge, depending on the scenario
  • examiners tend to ask questions on what they consider more pertinent

Every student takes the Test. In school where grading hierarchy exists, there may also exist the Meta Test. Here, student's efforts are additionally spent trying to determine which topics are High Yield ("HY") and thus most likely to show up on a test. This may includes trying to obtain copies of previous year's tests, leaked concept sheets, 'remembered' questions from previous students, and even behavioral analysis of professors.

Among the many pieces of advice I've heard, the most memorable include:
  • "If Prof P steps away from the podium while speaking about a topic, its HY"
  • "If Prof. Y reads it directly off a slide, its HY"
  • "If its a behavioral problem, always pick the mushiest answer choice possible"
  • "Prof Z typically tests only first-line drugs"
  • "Prof B personally said he would be testing from one of these 4 things..."
  • "Prof A tells pretty girls whats on the test, so we usually send M every semester to talk to him"
Besides the fact that I'm running out of variables and pseudonyms,  some of these pieces of advice were highly suspect (typically the former), while the latter tended to be pretty accurate. Other methods violate the student honor code (but in the case of a high school classmate breaking into a locked office, they may also break local laws). Perhaps expecting a group of intelligent and competitive students to only compete ethically is unrealistic, because in the world of professional [anything], ethics doesn't win you gold medals; it only keeps you from losing a gold medal. Maybe the fact that these students are all competing in the field of medicine (which I've been told holds ethics highly in present day) means that winning shouldn't be everything.

Before I received my Comp score, I personally tried to distance myself from relying on concept sheets and 'remembered' questions, because I believe they interfere with true learning and education. Everything could be important in the right circumstances. But in my observations, friends that utilize these tools have performed well (and even better than I typically do), often for a fraction of the effort. I am (rightfully) an idiot for ignoring all these tools available to me. But are they worth it?

Perhaps raising my grade to an A- would have felt like a nice pat on the back. It would have let me apply to the leadership position in certain clubs and groups, which is a nice talking point when applying to future residency spots. It would have let me apply to do my fifth semester in the Saginaw, Michigan campus instead of the default Miramar, Florida campus. It may have gotten me into one of the more highly coveted track programs that is offered by Ross U. And most importantly, simply having a high grade would be a talking point on my future applications for residency positions. 

I do somewhat regret the choice I made in the past to ignore concept sheets. Residency spots for IMG's don't come easy, and any strong asset in obtaining future positions should be fought for, tooth and nail. My decision in the past were made because of the benefits I saw at the time; however, many of the benefits of a high grade were only gradually revealed. For example, I only found out about the minimum requirements for being a student group leader in third semester, while applying. Track programs were only recently instituted by Ross, in my fourth semester, when they decided that both GPA and Comp performance would play a role in student placement. Faculty only revealed in fifth semester what sorts of information appears in the Dean's Letter.

Do I regret not utilizing concept sheets and remembered sheets for the present? Once again, yes and no. The thought of spending an additional 3 months studying for the Comp is not appealing. Watching friends move on and start rotations 2 months before I do is a righteous bummer. Having to live at home again is like spiritual flatulence: noisy, socially disruptive, and associated with a diet high in beans. But on the bright side, I've completely revamped my knowledge of many biological and disease processes. What was once full of holes and misconceptions from 2 years of studying, forgetting, studying a different emphasis under a different professor, forgetting again, getting disease processes and proteins confused, seeing contradictory lecture notes vs study notes vs textbooks, memorizing associations simply because a professor said to memorize them...I can finally start anew. And I have. My knowledge of the core P's (physiology, pharmacology, and pathology)  has never been stronger, and this is still just the beginning. I have many months ahead to hammer out all the kinks in my memory.

So, applying this pseudo-science and learning about HY topics has its benefits, both for that student's present (allows maximizing time spent studying and minimizing the effects of the diminishing returns) and for that student's future (increasing competitiveness for future applications). But if you are OK with being an ethical 'loser' that ends up happy in less competitive positions, then be ready to live contently, albeit with some regrets.

As a side note: I have read that under our new Dean, Ross is looking to remove the use of the Comp as a barrier to writing the Step, and simply use it to help students identify weak areas. I believe this to be a step in the right direction, but this is only a tiny cog in the machine, and is not unique to Ross by any means. I've spoken with students in other medical schools where the sharing of concept sheets and the like is also commonplace. This report suggests that the problem continues even in the future down in a medical career.

Are there solutions to this problem? Alarmingly, I ask you: do you think this is a problem?

Even more alarmingly: DO YOU THINK THIS IS A PROBLEM?!?!?!?!

Maybe another day, my disembodied readers. For now, enjoy a story being written by a friend of mine, entitled Lovers in a Dangerous Time.


Saturday, 19 January 2013

Gasp!

Egads!

After accepting an invitation to dinner last night, I went to bed feeling like I had forgotten something important. And I had.

Pterodactylus is the winner of the first Run Fight. She runned me right in the run-glands, and I lost after going three days straight without a proper workout.

Her prize: everlasting glory on a blog that noone reads.

Friday, 18 January 2013


I ran on Monday (500C), and got through only half of Tuesday's planned run. Took Wednesday off (because lazyness). My Thursday run was replaced with...a movie.

Pterodactylus ran on Monday, and also ran for half an hour today. As well as some muscle-busting arms workout.

Monday, 14 January 2013

Run Fight Progress #2

Arthur ran today!
Pterodactylus ran today! and apparently worked out her arms.

DID YOU WORK OUT TODAY?

Sunday, 13 January 2013

FFFFFFFFFFFFFFFFFFFFF-

So.

My alarm goes off at 6:30AM. My test is at 8:00 AM.

Its currently 1:30AM.

I have been in bed, trying to fall asleep for 2.5 hours. But my brain won't shut up.

Shut up brain.

One thought after another flies through my head. Randomly. I'm not every worrying about any of the thoughts. I quiet the image of a sock, and instead a coconut takes its place as something to think about.

Breathing techniques have been useless.My usual focusing techniques were useless. But then my overactive brain helped me recall a certain graph involving benzodiazeepnies, barbiturates, and anxiolysis.

And after my third shot of vodka, I'm really feeling a lot less inhibited.

Yeah, this is not a long term solution. Don't try this at home.

Also, the anxiolysis kicked in. Success!

The thoughts no longer race in my mind. Its nice and quiet. I'm still not able to go to sleep, but at least my brain has shut up.

Saturday, 12 January 2013

Run Fight Progress Report 1

Wednesday January 9t
Arthur: no run
Miss Pt: ran

Thursday January 10th:
Arthur: no run
Miss T: no run

Friday Janury 11th:
Arthur: finally ran! And then went to bed early! And then a bug kept flying into his ear and kept him awake for an hour until he found it and smote it!
Ellie: skated with gym class (I'll allow it)

So far, Ellie is winning the run fight by 1 day's worth of run! I'm winning in the study race.

Enjoy some Cool

Friday, 11 January 2013

The Missing Link

Despite my respect for the human brain, there are times when I just drop the ball and miss the most glaring connection. Take Silicosis, for example. Its an occupational hazard involved in sand-blasting, and I just memorized that fact 3 months ago without really bothering to understand why. (Well, keep it mind, it was right next to a disease called Pidgeon Fancier's Lung, which looked way more interesting).

But yesterday, while going through another pathology resource, they laid it out for me. Sand-blasting blasts walls with sand. Silica is a major component of sand. HOW COULD I FORGET THIS? And this isn't the first time. But I'm too embarrassed to post the rest. Fun fact: Silica inhibits phagolysosome fusion-->this increases your risk of Tb!


Unrelatedly, here is a list of drug names that I commonly confuse:

Imipramine
Indapamide
Amiloride
Amiodarone
Amlodipine
Amantidine
Rispiridone
Reserpine
Clonidine/Clozapine

The Phen 4 (phenylephrine, phenoxybenzamine, phentolamine, and phenylzine)

and just as a review:
Imipramine: tricyclic antidepressant (along with clomipramine and amitryptiline). Blocks reuptake of NE. uses include depression.
Indapamide: a thiazide diuretic
Amiloride: K+-sparing diuretic
Amiodarone: a class III antiarrhythmic. AE include pulmonary interstitial fibrosis (not unlike Bleomycin)
Amlodipine: a CCB, similar to Nifedipine. acts on vasculature.
Amantidine: an anti-viral that happens to include dopamine and decrease acetylcholine (hence its use as an anti-parkinson's drug)

Clonidine: a2 agonist in CNS, causes decrease in NE release
Clozapine: 5HT2 antagonist and D2 antagonist

Phenylephrine (a1 agonist),
phentolamine and phenoxybenzamine (non-specific a1 antagonist),
Phenelzine (MAO inhibitor of both MAO-A and MAO-B.

While this isn't wholly correct, its easier to remember MAO as such: MAO-A mainly degrades 5HT and NE, whereas MAO-B mostly breaks down DA. Selegiline is an inhibitor of MAO-B, used in Parkinson's. Phenelzine and tranylcypramine are an inhibitor of both. Used in depression.

Rispiridone is a serotonin 5HT2A antagonist (not unlike Clozapine, Olanzapine, and Aripiprazole). Might see it used in psychosis.
Reserpine, however, prevents the storage of NE in vesicles.

Tuesday, 8 January 2013

Run Fight

Welcome, weary travellers, to this most ancient of battles. Our two Champions will begin a long, possibly fatal, run to the death! but more likely, until one gets lazy and doesn't run for 3 days straight.

In this corner, the proud host of this blog, who will probably lie to you about his progress! Arthur "The Golden Legs".

And our opponent for the near future, the proud host of "Hip And With It, the Mighty Pterodactylus!

Day 1 (January 8, 2013):

Today, I ran for my daily 500 cals.
Pterodactylus also ran for the day.

Tune in tomorrow to see who's given up!

Saturday, 5 January 2013

Check out these pipes

Fun fact: exposure to vinyl chloride increases your risk of angiosarcoma of the liver.
Vinyl chloride is commonly found making PVC pipes.
Angiosarcoma is a metastatic cancer of the blood vessels (which are essentially pipes).
If you make PVC pipes, you'll break your own.

aaaand that's enough mind-wandering for one day.

Friday, 4 January 2013

2013

I tend to hate New Years Eve. Its usually filled with some combination of disappointment, boring parties, and  signals the upcoming end of my holidays. This year's party was so enjoyable that I thought the tide had changed.

Nope.

On New Year's day, I wrote an NBME test to gauge my estimated USMLE Step 1 score. The results were abysmal. Even in topics I had been studying for weeks, I was below average. I spent more than an hour just panicking. Keep in mind, I have a similar exam that needs to be taken in 10 days that my school has deemed mandatory. Furthermore, I am not allowed to write the Step 1 until I pass that exam.

I made a plan. *Cue training montage*

1) Since writing tests appeared to be my biggest weakness, I would do practice questions every day. This is something I tried to implement weeks ago, but the test results were consistently in the range of 50%, and my ego couldn't take that day after day, sooooo I stopped writing them altogether. Yes, I'm apparently not immune to the "if I ignore it, it'll obviously go away" thought process.

2) Finish my study of physiology, which although slow, was taught by the only educator I can rightfully call a teacher in the last 2 years. I have been instructed by many doctors and professors, and while many have been decent educators in their own right and built the stepping stones, only Dr Wazir Kudrath was able to take those stones and build a path. Its unfortunate that this will likely be his last semester teaching UMBR at ross, and even more unfortunate that he is unable to teach in Dominica, where his approach to basic science is needed.

3) Begin studing a combination of the pharmacology out of First Aid (2011) that I have yet to approach. Other students have suggested that First Aid covers all the pharmacology that shows up on Step 1. Dr Kudrath had already covered cardiovascular, renal, respiratory, and neurological pharmacology, but there are additional drugs in each of those respective fields that weren't covered due to limited time. I will add oncology and clotting cascade drugs to go over, as I feel they are important for future use. Finally, I want to review my antimicrobial pharmacology. I have studied these in the past, and I've heard recommendations that antimicrobial pharmacology is best studied in tandem with microbiology, but the limited time means that might not be possible before the Comp.

*I'm just going to interject with a note about how I got another flat tire due to a piece of broken glass, and if I find you throwing glass out of your car, I'm going to find you and make you eat it.

4) My weakest subject by far is pathology. Pathology questions are the largest percentage of questions on the comp and Step 1 (close to 25%), and my score is abysmal in it. I'm not sure what resource to utilize, as going over the entirety of pathology in ~7 days seems impossible. Especially when it involves a 600 page study guide like Rapid Review (compared to THE textbook on pathology, the fabled 1400 page Robbins & Cotran's Pathologic Basis of Disease). I've had friends recommend Pathoma videos, and while I find it somewhat scarce in details and inappropriate for the Step 1, it might do well enough for the Comp. They are pricey, however.

5) Even if I pass the Comp, my estimate of writing the text near the middle of March is going to be pushed back till the end of April. On the plus side, I'll have an excuse to move back to Toronto right as it starts warming up.

6) I'll make adjustments to my Comp date in order to reach my target score of 250. Yeah, 250. If your going to aim, might as well aim high. Unless there's an orphanage at the top of a hill or something.  

*Addendum: actually, my weakest subject is more rightfully anatomy, but it is long, detailed, and has very few questions show up on the Step 1, so while I do plan to master it in the near future....it can wait till April.