#with the clinical work and starting internships and capstone work and a full class schedule and working with the cohort below us etc etc

[gale-force-storm]

You know, as much as new hyperfixations always mean a hit to my productivity, I will say this one has been a bit of an exception. Not because I'm not constantly thinking about the sad wizard and friends (I definitely am lol), but because lately when I've felt like procrastinating on readings/projects/etc., the thought "Gale would be proud of me for doing it, though" has genuinely motivated me to not put things off as much. The power of an imagined "I know how rough academia can be but I believe in you!" is much stronger than I would have previously expected lol

[caribmdguy]

There were times when I thought I couldn’t get through, was homesick, seriously doubted my ability to learn this stuf, but I somehow managed! First year of med school and MPH is done, and feeling pretty relieved and thankful to have made it this far. So as long as work on the island goes, I’m over half way done now, and am a brand-new MS2. Feels good! So first term MPH, Term 1 med, Term 2 MPH (summer), and Term 2 med are done. I did also start an online MBA starting on Term 1 med, and all of my degree requirements are complete and just waiting on confirmation. I thought it would be a good idea…but it was a lot of work on top of everything…so while I don’t ultimately regret overextending myself it was a beast of a year (technically year and a half). Looking forward, I’ve got terms 3/4 starting this January-tomorrow (really just one very long term, which is 5 1/2 months) and term 5 left on the island. And my capstone and internship to do at some point between now and starting rotations to finish up my MPH. So by early December ’19 I’ll be done in Grenada and back to the states with my wife to study for the Step! AH! Still so far to go.

“Don’t like pizza today, foolish human” -our cat

I’ma look back on how each of the terms went, what I did to study, things I’ve learned. While I’ll do a more detailed post, Term 1 was intense in that you’re still acclimating to life in med school and life on the island a bit. While I thought a lot of my class appeared to drop out (we started with 452 people in the main cohort and ended with 385 in Term 1), anecdotally the people that actually left seemed to do so because acclimation was hard for them-coming down here just wasn’t a good fit. From adapting to a new way of life in a foriegn country away from your creature comforts, to being hopelessly far from family, to being at the whims of the school as large as mine is (easy to feel like just a number)…it all can be super frustrating on top of your actual studies.

And to be real, by now everyone in my circle of friends has had some family/friends problems from back home. Anywhere from breakups with long-term SO’s to deaths in the family. Just not something you think about when you first come down. In this past term an uncle of mine passed away after a long battle with cancer, right before a test. Couldn’t be there for the funeral, couldn’t book a flight that fast and be back for the test, felt horribly guilty for not being there, a bit broken inside because I hadn’t talked to said uncle since he was at our wedding, and it weighted pretty heavily on my mind. Still sat for the test, and while I passed it, it was my worst one by far. But my experience isn’t unique…sadly dealing with these realities is something that anyone has to work through and it’s difficult enough with med school. But being so far from home when things like that happen just makes you feel…completely helpless. By term 2 most people, myself included, were pretty burned out and/or getting depressed. People don’t like to talk about these things but it’s true. And to be fair I don’t think our feelings are unique as med students as all-everyone gets burned out at some point, but being so far away is one more thing to worry about.

I will say that I started to feel more optimistic about my overal situation after term 1. Turns out theres a lot of saftey net here as long as you’re putting in the work and at least get past term 1 (gotta get at least a 69.5 I believe for term 1 but have to keep above 75 cumulative), in that those with academic problems were put into ITI (“Interactive Team Instruction,” a group based learning format) with more one-to-one learning and a more stringent (more class-time) schedule. When they leave for ITI, they’re taken out of the lecture based format group, making the actual class size look smaller than it is. Those that improved were sent back to lecture based format. And a decent amount of people repeat a semester here or there or are given the option to do so to improve their grade. This is super important in term 5 I’ve been told, because it’s mostly reviewing all the things from terms 1-4 to prep for the step, and the school wants you to pass it on the first go ideally scoring over 225 (average last year was 229). That said, last year about 120 term 5’s aparently repeated the term (out of around 900 I believe).

They give a step style test (NBME exam, they write the step and use old USMLE questions) at the end of years 1 and 2 that correlate well with your step score and cover all the material you’ve learned up to that point, and showed us that repeating term 5 boosted those that were struggling to get into this ideal score range to where they need to be to be competitive for residency. While I’m doing pretty well and am not worried about repeating… I really don’t want to be on the island longer than needed. One hell of a motivator-but anything can happen. That’s what I’m most scared of at this point as well as leaving an awesome group of friends behind. It seems like term 4 is super difficult and term 5 is really stressful because of the step style tests that are worth a majority of your grade (along with hospital visits and everything else). So I will say that the drop-out rate isn’t nearly as high as it looks, but there is a pretty big chunk of people that repeate a semester and take longer to complete, making it look much worse than it really is. From all that and what I’ve seen so far, attrition is not that bad here, at least not as bad as I was led to believe coming down. But it’s not the full story. It’s equally fair to say that it’s pretty common to take longer than 4 years to complete from repeating a bad semester.

As per what SGU said, only 14 people completely “dropped” out of the program due to academic reasons this past year, but they were pretty vague about this. This past fall they accepted the largest term 1 class to date, rumored to be at about 1,400 students (now broken up into 9 “colleges” with seperate classes/groupings or something like that, I’m not completely sure), and they reassured us that there is an abundance of clinical spots available to all of us. I was worried before this and rumors started spreading, because thats a huge class, and our class of about 420? will be vying for the same clinical spots as the incoming August class…and I was fairly sure we have about 1,000 clinical spots… but just get through term 5 and kill the step they say. I wish they were a bit more transparent about all of this but for my own sanity I’m removing my skeptic hat and am just going to focus on doing the best I can. And as far as I can tell nobody has ever had trouble getting a clinical spot here so…I think it’ll work out. Staying positive. New years resolution? Get through it and off the island!

Saw Imagine dragons!

haven’t kayaked in a while

and some hiking 😀

Term 2 MPH was not that bad! The only thing that kinda sucked was that it started immediately after term 1 med, as in we finished our last test on a Friday and started classes on Monday. Thankfully they changed things around and began offering many (but not all) classes online, so I was able to do this from home in NY instead of having to stay in Grenada longer. More time with the wife! I stayed an extra week on campus because the ticket prices spike when everyone leaves the island and I waited a bit too long to book this time. But MPH classes are nothing like med classes, and was honestly a good change of pace since medicine is so laser focussed on details and memorizing facts, so it’s easy to lose sight of the big picture from a population/societal standpoint. Lots of reading, discussion posts, essays, and video type presentations. This term was 2 months long with 3 classes (9 credits) and that gave me a little more than a month to “relax” before starting term 2 med.

But I’m a nerd, and always feel like I need to be doing something. So I worked ahead on my MBA program during my break so I’d have less to do while in med school. I did this through Smartly, an online program I discovered while waiting overnight at Charlottesville airport to fly in for Term 1 med. I was actually searching the web for how to do accounting, since I had just filed my business as an LLC and needed to keep more stringent books for upcoming taxes. Super exciting, I know. But I came accross their program like this and they had an open “Business Foundations” course that included accounting fundamentals, and I learned basically what I needed to learn with that, for free, with some extra information that was useful for running a business. Then I found that if you were accepted the program it’s free (seriously, it’s pretty badass), so I submitted all the things you’d normally submit to an MBA program and finished up the Business Foundations course as they use as part of the admissions process.

Accepted-it’s free too!

Part of the Business Foundations course breakdown

I’ll do a post to talk more in depth about my experience with this more in the future I promise. But the low down–>It’s not accredited, first and foremost, by AACSB (although neither is SGU’s MBA), but it’s also very new, with the program launching in 2016, and it does take years to accredit. If you’ve ever used Doulingo before, it’s kind of similar to that. There’s bite-sized 5-10 minute lessons that you can do more or less as you please even on a cellphone, using active learning with a “smartcase” at the end of each block (that are graded). So you can do it in small chunks and work ahead when you have time. They use slack to interact with classmates and there’s some projects to do, along with two major tests. I thought it was a great opportunity to learn more about how to run my business better…man have I been fucking up…and really, learning more about business is a good idea for those in healthcare, especially for anyone dreaming about opening up a private practice one day or doing their part to un-fuck this wretched health system we have in the US. I’m by no means saying that a free online MBA is the equivelent to Wharton, and actually my wife is doing her “real” MBA now so we compare notes on this, but if it’s not going to be your “primary” thing you need to know, why not learn what you need to learn for free, right?

Made my way a begrudgingly back to the island for term 2 med and moved off campus too, which was pretty exciting. Term 2 was overal more difficult feeling than term 1. I’ve been told this is kind of a…theme. While I do think there was objectively more information to learn than in term 1, by now we had already had a better idea of what we were in for, and how to go about studying things. For example, how I study for histology, anatomy, biochemical pathways, and all the rest remained pretty similar to what I had figured out and done in term 1. I already had a study system to work with and had an idea of what I needed to do to learn the things. But by now, with more information coming our way, I had to find ways to be more efficient and constantly adapt and find new or faster ways to learn. I found some useful tools and tricks I wish I would have been using faithfully like I did in term 2 from day one in term 1.

For example, I stopped listening to lectures about halfway through term 2. They did make a major change here, across the board they cut lecture time in half (2 a day instead of 4), and lectures focused on difficult/high yeild topics. They moved a lot of content to “directed learning activities” (DLA’s), which honestly, I loved. Because we did so much more of the DLA’s, which I could rewind on difficult parts and watch over and over, and watch at double speed, I realized I could do the same with lectures since they’re all recorded. I also noticed that a lot of the high-performing people in our class showed up for lecture but studied/did different things, not paying attention. So what I ended up doing essentially is that throughout term 2 I’d “post-read” the lectures by making flashcards on Osmosis (like supercharged Anki, I’ll talk about this more soon), and the next day I’d do those flashcards in lecture, clicking in to get the attendance point. I did feel a bit guilty about this at first but I was technically there anyway.

Then I’d watch the lectures online at 2x speed, effectively saving about an hour-ish of time and working through part of my flashcard que early in the morning. I’m not sure if thats going to work going forward but it worked really well in term 2 in that I saved a lot of time and to be completely honest I think I learned the material better that way, because I could fly through the easy or low-yield things and rewind over the hard parts until I got it. I also cut down pretty significantly on my note taking and focussed a lot of time towards making and doing flashcards, making my own picmonics/mnemonics, reading first aid, and videos. Basically anything to take the more complicated lectures and simplify it. Also prioritized anything that required active recall/learning over passive.

But term 2 was hugely rewarding; I went into med school thinking I really wanted to be a neurologist, and our neuro/behavioral block was a 10 week/3 test beast at the end of term 2. I LOVED it. It was hard, but I did well on it. Everything we learned was highly clinically relevant and brought all the other systems of the body together nicely. I started to see things from the bigger picture. This was especially true while prepping for our BSCE/NBME exam (worth 15% of our grade, the largest of our test grades), which is made by the same people that make the USMLE step 1 exam and is basically a “half” step. In that it’s half the length and about half the content since we havent really delved into pathology in ton of detail yet. For this I reviewed all of the topics we learned in term 1 from a more broad point of view using Osmosis similar to how I imagine I’ll be prepping for the step in another year. We didn’t have a lot of time to do this though, since we still had our psychology block exam and our objective structured physical exam that week. So I triaged–>things I sucked at I tried to go over first. I ended up doing way better on this one than I thought I would, and actually improved my overall grade from what I had term 1. So it was a pretty sweet way to end the term!

With the last test on the books, a fried brain and flight out the next day, getting on that plane back to the frigid north was like a breath of fresh air. I was getting burned out, sleep deprived and missing my family. But alot happened in 2018, and it was time to recharge. The wife even came down to Grenada a little bit before classes start for a vacation, which was perfect!

Time to start Term 3!

First year of med school on the books! There were times when I thought I couldn't get through, was homesick, seriously doubted my ability to learn this stuf, but I somehow managed!