#med ed

[mdrambles]

On a recent shift, I had a 4yo kiddo with a nasty pneumonia who was having increasing work of breathing despite being on treatment for a few days, so they returned to the ED as advised when they started antibiotics.

As part of this reassessment, I brought my POCUS learners to do a lung scan to rule out a pleural effusion/empyema as the reason for worsening respiratory status despite therapy. My learners for this block are less experienced with POCUS, so it takes them a bit longer to get oriented and obtain their images. This little guy was initially very cooperative and chill during the assessment, but of course, once it hit the 5-minute mark or so, he began to get restless. Queue the distraction techniques: MineCraft was pulled up on the Child Life iPad.

At first, this bought us maybe 3-5 more minutes of me slowly coaching my learners through the lung scan, optimizing their techniques and saving their images, talking them through findings, etc. Unfortunately, little dude was getting quite antsy... the longer the scan went on, the more wiggly he got.

"Hey bud, we're almost done! Are you building a house right now on MineCraft?"

"No!" he pouted. "I have no building materials or weapons and it's gonna be nighttime soon. Will you help me?"

So I sat with him, asking him to "teach" me how to play the game while keeping an eye on the POCUS process and offering pointers between questions about the different pixelated animals our patient was encountering in the game. At some point, we had to lift each of his arms to get the lateral views and while he had one hand on his head as instructed, he was directing the sightline of the character while I was physically moving the character around.

Of course... this is when nightfall actually occurs in-game and so half my attention is spent dodging monsters spawning all over the place and the rest of my attention is spent helping my learners complete their images and interpretation.

...Well, in the end, we got the images we needed and my little friend and I only died 4 or 5 times to the scorpions 😅

(I had to review all the images outside the room after to actually get our clinical interpretation... much easier when you aren't being chased by skeletons shooting arrows at you...)

Can't say I expect my adult EM POCUS colleagues to have much experience juggling MineCraft with scanning hahahaha

[drgaellon]

My residents gave me another teaching award!

[doctorspork]

I am frequently overwhelmed by the sheer amount of information I have yet to learn and still feel like I don't really know anything. But today my med students asked me to talk about electrolytes and we spent about a half hour going over this, all of which was new to them, and it was so nice to be reminded that things which are now second nature to me were once new too.

[drawittoknowitmedical]

Pharmacology Glossary: Volume of Distribution

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[medschooltutors]

Today’s RX from birthday boy, #StephenColbert! #MondayMotivation  https://www.medschooltutors.com/blog/get-inspired 

[borborygmus21]

Medical development - the bike analogy

As described by my husband, an engineer.

Pre-Med: you learn about the nuts, bolts and materials that make up a bike; sometimes you go watch people ride a bike.

Pre-clinical med student: you try to learn everything about the bike

Clinical med students: you watch people ride a bike and use a stationary bike to practice.

Interns: you finally get to ride the bike, except with training wheels and supervision

PGY2: you get those training wheels off

PGY3+: now you ride the bike faster

Attending: they do wheelies on the bike, and own the bike

[mdrambles]

Put the probe where the problem is.

A POCUS lecturer

[mdrambles]

🤞🏻

My [hopefully] last exam of my career is done!

So... unless something went terribly wrong (which, tbh, it might’ve), I will be able to retire my “licensing exam” tag forever!!! (Or at least not use it for real-time updates hahahahaha)

More rambles under the cut, and also how I used the viral “Corn Kid” TikTok in a teaching session with actual medical students who will one day be whole entire doctors.

Funny story though--after day 1 of 2 of exam hell, I had a teaching session with my med students that have just started their clinical placements (clerkship). (Side note: I did NOT schedule this myself. If it were up to me, I would not have sandwiched this teaching session between the two extremely expensive days of brain torture.) 

I started them off with chatting a bit about their summer breaks, and then eased into how their transition to clerkship was going. It was kind of neat since I am also going through a [rough] transition into staff so I felt a lot of their sentiments very acutely. They brought up some of the difficulties they were running into, and I helped them into a discussion about some of the stresses and worries they were experiencing. This led into a group reflection on their biggest fears about clerkship, and an exercise in, “Well, what’s the worst that can happen?”

For the most part, nothing! And that’s what helped many of them think through these struggles. I could feel the tension in the room dissipating with each anxiety we confronted.

“I’m stressed about our rotation exams,” one student shared.

Many nodded in agreement.

“Fair, I think we’re all probably here because we experience some amount of exam anxiety. But let’s get into it--what’s the worst that can happen?”

“We fail?”

“Yeah, but then what?”

“We... try again?”

“Yup, and then what happens?”

“Well, we might fail again...”

“Sure, but then what will happen?”

“Uh, I guess we try... another time...?”

“Yep! You keep trying and you will keep learning and you will get there.”

“But... but what about the anxiety?”

I chuckled.

“Okay, so I don’t know if I told any of you this yet, but today was the first of a 2-day exam, which will hopefully be my last big exam ever. And I still get bad dreams about it. Most of this week I dreamed about getting stuck in the subway by some terrible delay and missing it. But last week, I had a really specific nightmare.

“Sitting in the exam, I got to question 22. The question just said, ‘Here’s clue number 1; now find clue number 2′. I noticed people started getting out of their seats but wasn’t sure why; now I felt panicked as I realized pretty much half the room already got up to start looking for this clue.

“Of course, this thing is set up Squid Game style so there’s only 30 of clue 2, and 20 of clue 3, 15 of clue 4, etc. When I got to clue 4, they said there were none left, so I went back to my seat, sweating and panicking.

“At some point I realized that this was only question 22, and it couldn’t be worth all that much, right? So I tried to get to the next question, but I got an error message that said, “Your exam has been terminated because even if you were to get ALL of the subsequent questions correct, you would still fail since you did so poorly on the first 22 questions”. I was shocked.

“An invigilator then peered over my shoulder and told me to pack my things. I asked if I was able to at least try to complete the second day, and they said, ‘No, sorry, you’ve already failed. Good luck next year.’

“...And then I woke up.”

All of my students were gaping at me in a mixture of horror and disbelief.

“Okay, sorry, I know, kinda dark, but let’s just put it this way--sure, the anxiety doesn’t go away, and you can’t control it, but you don’t have to let it control you. I made it past question 22 on the exam today and I felt like everything was gonna be okay. You will get past question 22, too.

“...Also, if you go through your whole rotation and not a single resident or staff tells you that they failed something or had to repeat something during their medical training, they’re a bunch of liars.”

We talked about a few more fears, and another student shared that they were worried about finding the right specialty for them in time to apply for residency. We went through what the worst was that could happen, and also talked a lot about different specialties and different paths in medicine.

“I don’t know if you all have seen it, but my spouse is on TikTok. Most of the time, that means that I see a lot less of him... okay, I’m kidding, sort of, but anyway, there’s a viral video that has something really important to teach you. Y’all know about the Corn Kid?”

Most of them laughed. For the confused ones, I explained, “Basically, a kid who really, really loves corn. And he shares some really great wisdom; he says, ‘Not everybody has to like it for it to be the best’. And that’s important! You don’t have to do a specialty just because everyone else seems to want to. You also don’t have to like everything about a specialty for it to make you happy. Like the Corn Kid says: ‘you just gotta try it’.”

Overall, it was a great session. For anyone out there starting a transition into clerkship, or just starting medical school or residency or fellowship or staff life, you’ve got this. Things are gonna be okay.