October 1, 2014

How to Think on Your Feet

One of my loyal readers and a current third year medical student asked me a question that I know all of us can relate to: how do you think on your feet? For those of you in high school and college this is relevant when a teacher or professor calls on you for an answer in class or for questions after a presentation, but once in medical school, and particularly the clinical years, being able to think on your feet is a crucial skill! In surgery they call it "pimping" - an attending hasn't spoken to you all case until you get into the bowels and then starts hammering you with questions about why this patient needs this procedure, what vessel you're most likely to hit at this particular location, what's the nerve supply, and so on. On medicine the pimping is a little less shotgun style, but you can still be called on for the answer or your opinion on pretty much anything during rounds. And the pimping never ends. Pimping sounds so dirty, so scary! And while it can be nerve-wracking (the unknown element always is), this is just another part of medical education (that some physician teachers actually do really well), and you can own this!

First and foremost - the people you are around, your team, are what will make you or break you. I don't think I can emphasize it enough but the team is everything in medicine, and the team dynamics are key to feeling safe in a space to think on your feet. It's all too easy as a "lowly" medical student to fall into the shadows and not contribute much to the team - in these cases when you get called on for rounds, this may be the first time the team is even hearing your voice! And you will most certainly be terrified and in no mindset to use that amazing mind of yours. Make sure this is not the case. Make you're best effort to get to know everyone on the team - from the attendings and residents to the nurses and social workers. Even if you're only rotating through (as most of us are), these will be your co-workers for at least a week to maybe a month or two, make it enjoyable and get to know everyone! This way, when you get called on in rounds, it doesn't feel like you're being embarrassed in front of an audience of strangers, but instead surrounded by a group of colleagues who are all trying to help. Granted, everyone does not always want to be friends, but rather you make the effort than not. I think this is part of what makes surgery "pimping" particularly scary for most students - many times you're only working with a surgeon once, but if you'll be there for a week it's still so worth it to try and get to know the residents and scrub nurses who will serve as constants even with different surgeons. Just feeling comfortable around someone who is there when you're on the spot will put you a little more at ease.

If you can succeed in the above you'll eliminate a good chunk of the anxiety that comes with thinking on your feet. The rest comes from, you guessed it, preparation! I think we all know that being prepared is the best way to feel confident, and feeling confident is essential to thinking on your feet, but the problem most of us face is that we don't always have the time to prepare as fully as we'd like. The real skill is figuring out how to prepare efficiently.

Let's say you're on rheumatology. Sure every night you could read chapters from a rheumatology textbook in sequential order, but when your attending asks you about your patient's lupus flare, the fact that you spent all night reading about sarcoidosis isn't really going to matter. So read about your patients! If you're in clinic or inpatient, get a list of the patients on the schedule or that your team is caring for and their diagnosis/chief complaint. Target your studying to what you're actually seeing and you'll be more likely to know what's going on when someone puts you on the spot in rounds. As you're doing your reading think of some questions that could be asked on the subject and come up with answers.

Besides being prepared book-wise, it's also nice to know who's going to be asking the questions (which isn't always possible). But especially on surgery, where surgeons are essentially doing the same procedures daily (and therefore have the same set of questions they're used to asking medical students), get the low-down from upperclassmen or people who have worked with him or her before! Some surgeons are all about numbers - statistics and margin sizes and depth, while others are all about anatomy - even knowing something as general as this can help narrow your focus when you're reviewing. Many people also use Surgical Recallfor common facts that are asked. See this post for some other books useful for the wards!

So you've done your focused reading and feel comfortable around your team, but now the moment comes during rounds that you're called on unexpectedly, what do you do? First, breathe. This isn't really a surprise. Hopefully you were listening. Listening is really important. You need to know and understand what was actually asked. Shy away from stall tactics to buy yourself more time - especially on rounds, things need to be efficient, so no one will appreciate that. Also know, though, that it is ok to have a few seconds of silence. Instead of freaking out in your head, use those few seconds to actually think about what you know. Hopefully you've prepared adequately and you will know the answer, but sometimes we are hit with something really unexpected and that's ok too. In these cases it's completely fine to work your way through the problem out loud and if you hit the "and that's all I know about that" point there's no shame in saying so. Chances are someone else will know the answer and can help out, but if not, make sure to offer to look it up and discuss later. We're all learning, and as scary as being put on the spot is, it's almost always meant to teach us something we need to know.

I hope this post could help some of you with thinking on your feet! It's a skill we can all improve on and will continue needing improvement as we transition to different rotations and places. Remember that although we could all read a little more to feel more prepared, the key to feeling comfortable when put on the spot is feeling safe with your team. Get to know them! 

September 29, 2014

Fall Work Layers

Sharing a simple layered look as temperatures start to get cooler! My favorite time of year! Hope you all have a wonderful start to your weeks!

Gap striped shirt (similar here), Charlotte Russe cardigan (similar here), American Apparel pants (here), Bobbles and Lace shoes (similar on sale here), tote bag (similar here)

September 22, 2014

Memorization Tips

Happy Monday everyone! I hope those of you in school feel like things got off to a great start! Many of you have already taken your first exams of the school year (and I'm sure you did great), but one question that keeps popping up is how to memorize so much information in such a short period of time! I hope today I can share some tips that may help some of you take in what feels like a firehose of information!

Read with intent. We all can recall times we read a page only to have to go right back and re-read it because we were thinking about something else while reading or answering text messages or looking up to see what was happening on your TV show. What a waste of time! Try your best to shut out all distractions (I love putting headphones on and just listening to white noise) and really read with the intent to have that stuff stick. Highlight things you need to take notes on, and go back later to take organized notes. Ask yourself questions in your head while you read and try to make connections with information you already know. This style of active reading will really allow you to get a better grasp of the information.

Review and repeat. Try to get your reading for class done the day before, so that class itself can serve as the review session (or a chance to clarify anything that didn't make sense). During class edit any of the notes you had taken. Review these notes again before you go to bed (and after you've done the reading for the next day). Your review list at night will seem like it gets longer and longer but you'll soon find that you're remembering a lot of the earlier material. Don't waste time re-reviewing that until before the exam, instead focus on the stuff you still have to memorize.

Close your eyes, visualize. If you are a visual learner like me, taking organized notes and using figures (either for pathways, organ systems, or anything really) will help as you review material. Pretty soon you'll be able to use these visual aids to remember things (I literally will remember which corner of the page a certain detail was on). Having full pages of notes make this difficult to do - break it up into smaller more digestible pieces.

Use study aids. Some people really like flash cards, and if you're one of them, use them! Make new ones after each class once you've solidified your "notes" on that material. There are lots of apps now that allow you to make flashcards on your iPhone or smartphone, some even have saved libraries of other flashcards that may be applicable to what you're studying. I've never been a huge fan of flashcards but they can definitely be helpful, especially in quizzing yourself. One thing I have always done is take pictures of diagrams or figures I made on my phone and add to a "study" album so I can review those wherever - on the train, at the gym, or in bed!

Say it out loud. I don't know but for some reason actually saying things out loud helps with memorization. Especially if you're memorizing something like a speech or presentation, practice out loud (in a place where no one will mind, haha)! I'm super super corny, so please don't judge me for what I'm about to share, but I sometimes like to act like I'm giving a lecture on the material - it really helps!

Use mnemonics. Especially in medical school where the list of things to memorize is ENDLESS, mnemonics are a med student's best friend. They really are wonderful triggers to help remember lists of things - like the cranial nerves, or the side effects of medications, or the criteria for mania - anything! There are tons of resources online and books (like First Aid) that will have lots of mnemonics - one website I really like is Sometimes simply numbering your lists can be enough - knowing that there are 5 nail findings in psoriasis you need to memorize may be trigger enough.

Understand. At the end of the day, what will help the most with long term memory of any material is to really understand it. You can (and will) forget the minor details at some point if you're not using it all the time, but if you really understand the material you can still work your way through many problems and figure it out.

I hope some of these tips were helpful! What things help you the most with memorization? Would love to hear any of your tips or tricks in the comments section!

(image via)

September 19, 2014

Weekend Wear

Hurray it's Friday! We've got a crazy weekend ahead with Liv's 1st birthday party on Saturday and a race to run on Sunday! Should all be lots of fun, but still requires lots of errands to be run before any of it can happen! Today I'm sharing a simple fall outfit perfect for getting stuff done.

one - cozy cashmere cardigan in my staple grey, found here; two - plaid infinity scarf, found here; three - perfectly simple all white converse, found here; four - to-go mug to keep my much-needed coffee hot, found here; five - broken in blue jeans in a fresh higher waist fit, found here; six - soft leather carry-all, found here; seven - gold initial charm necklace, found here; eight - relaxed white t-shirt, found here.
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