Board Report, Part 1

Day 5: Sunday, April 27th, 2008

Today I studied from 7:00 a.m. until 7:00 p.m. For 15 minutes of that time, I was on the phone with the LA dept of water and power; another five I spent on the phone with my mother outside of the library; another 10 minutes was spent talking to some folks who dropped by the study room. The remaining 11 hours and 30 minutes I spent sitting in a room in the library studying the gastrointestinal tract. Anatomy, embryology, physiology, biochemistry, and a start on pathology. About three times I checked my email. Tomorrow I will finish my first pass on GI; then Tuesday it will be on to Endocrine. After that Reproductive. Then Anatomy/Musculoskeletal/Connective tissue disorders. After that? I'll have to check the calender (I don't have it handy right now).

I take Step One of the United States Medical Licensing Exam on June 5th. From now until then, my days are centered on which organ system, which medically-relevant area of basic science, and which sets of questions I will choose to spend my days tackling. Five days in, I have already reviewed a crapload of material. I think of the process as a protracted trip down memory lane, in which all the random diseases, challenging pathways, and pathology slides from the first two years - then a bunch of new stuff - need thorough review, and they also fit into the context of a 350 question multiple choice exam.

In a weird way, this doesn't feel that different from any other exam preparation period. I mean, yes, it's "The Boards," and it is the first time I have put my life on hold (whatever that means, but just bear with me) for a month and a half, but I have this strange feeling that I've been here before. Not exactly when I was studying for the MCAT, not exactly when studying for Organic Chemistry exams, not exactly when I was studying for the AP Chemistry exam (certainly not); but somehow, in the back of my mind, I was preparing all along for this. When I entered medical school, I knew I had signed up for this. In the future, there will be more steps of the boards (albeit ones with much less preparation required), qualifying exams for graduate school, orals, thesis defense, then onto the wards with numerous (difficult) standardized exams for each of the rotations; then more boards; specialty boards. It's a maze. But I knew it was coming...

And I don't know why I'm ready; I don't resent the studying. Maybe it's not so grueling and not so bad as everyone says it is.

Maybe.

Check back with me in a week.

To fellow 2008 applicants and others:

You have been accepted into one or more sexy MD/PhD programs. You have been wined and dined. You have spoken with faculty, heard the pitches of the programs, current and prospective students. You let the taste of the revisit sit on your tongue. You imagine yourself at University X. You will be happy, right? You will destroy Step 1, publish a ridiculous amount of high-impact papers, yield faculty offers before you graduate, become the best clinician imaginable, match into your top residency choice, become a baller PI, an ideal physician-scientist-hybrid at highly-ranked University Y, so on and so forth, yeah? And throw in family life while you’re at it.

You may have a formulated idea of your career and personal trajectory—I don’t. I could go on and list my worries, concerns, uncertainties related to the MD/PhD experience—I won’t. What I want to address, though, is the role of this blog. Echoing Charles’s post, this blog – along with others – is a good first step to motivate, engage, provide open-access to individual experiences related to the MD/PhD training. Soon, I hope to contribute my limited insight to this blog; however, at the moment, I am merely an undergraduate who has a lot to learn, real soon.

Blog Clean-up and Repair

I recently became inspired to make some significant changes to the blog. After meeting several of the first-years-to-be for 2008-2009 for the MSTP at UCLA, several of my discussions revealed that few of us thinks about what it means to be an MD/PhD student (or MD/PhD physician scientist). And although this blog won't bring professional expertise, it will seek to document our experiences and perhaps deliver insight as a result. Because I think it's been said more than once that the ideas we have about why we're in this program are nebulous (and, more often, wholly unknown). I suppose on one hand, that's endemic to the whole pursuit of medicine and careers in medicine.

We spend so much time preparing for medical school - MCAT, college grades, hospital volunteer work, post-bac programs, research involvement, president of the debate team, newspaper writers, tuba in the orchestra - and we tout this resume as representing the "real life experience" necessary to a) be an exceptional physician and b) be better than the next person with the tricked out resume, and c) have some idea of a medical specialty or career focus (e.g. academic ophthalmologist vs. Kaiser Permanente Neurosurgeon vs. next Atul Gawande). And then if we want to be considered for an MD/PhD program, programs want to see an impressive research record. So we essentially straddle everything, often times with the idea that we will be able to do everything. I had this idea - I kid you not - that each day I would spend mornings in a laboratory directing research that successfully incorporated questions from my clinical practice, and then in the afternoon see patients. Throw in a busy travel schedule giving talks all over the country as a pre-eminent, true physician scientist in my field of interest. And I would be paid handsomely for my efforts. And I would have a family life, stay in shape, go on trips, and maybe even run for school board or city council. You know, make a difference in the community.

Then I think the last two years were spent learning basic medicine as much as they were having this grandiose vision of the future - this myth that I could straddle everything, have my cake and eat it too - dispelled by a series of discussions, observations, inquiries, and visits to the University of California highest-paid employee salaries for 2005, as provided by the San Fransisco Chronicle. (In an upcoming post, I'll explain how I started getting interested in surgery. This is not just because Dr. Ronald Busittil - and MD/PhD grad from Tulane university, chair of surgery at UCLA and pioneer of liver transplantation - was basically tied for award of highest paid employee in the UC system in 2005; Basketball Coach Ben Howland is no doubt the far-and-away highest paid employee now. If you're expecting a cynical, "Well that's just silly a COACH would be paid that much!" response then you're not giving me credit enough for understanding economics. Busittil is paid over a million a year because he brings in a boatload of revenue to the hospital. There are other amazingly talented physician scientists who don't get paid that much - and it has to do largely with revenue. Ben Howland - or more precisely his team - brings in a huge amount of revenue for the university. Sometimes I wish I could do footnotes for this post). I don't have any great answers yet about what I want to do or what I should be doing. But I am humbled by the difficulty in focusing on right now (starting my PhD in a couple months, studying for the boards, figuring out how - and with whom - I will be maintaining a bit of clinical work during the research years of this program), especially when the future seems even more daunting. But I still maintain this (UCLA, MSTP, Los Angeles, California, Science, Medicine) is where I want to be and what I want to do. Now what exactly that is eludes me. My preschool teacher - with whom I maintain contact about once a year - says we prepared for this in the sandbox growing up: you know, learning to embrace the tension of not knowing where the perfect spade is, where the caterpillar just went, and whether Sharon will do as you ask regarding the sand-castle you so desperately need to make before snack-time. It's all the same kind of tension when you approach it at a psychological/neurobiological level. So I tell myself: I've been preparing for this since the age of five.

So, what should we expect as we move forward with this blog? First, I've done some clean-up of many of the previous posts. I removed posts I felt were a little too mean-spirited (this includes many I drafted), ones that took some shots at specific folks (this includes many I drafted), and ones that really weren't relevant to the spirit of this blog (this includes many I drafted). Next, Anthony - an incoming member of the class of 2016 - will be joining the team and posting - probably closer to his arrival at UCLA in August.

Until then, join in the discussion on the question of MSTP, identity, and everything that falls through the intellectual cracks.

Coming back...

Greetings, all,

This blog might be resurrecting itself soon enough. I have decided, on the eve (um oops except for usmle step 1) of PhD years, I will begin posting on the MSTP life. Stay tuned. I swear it will return; and there's the possibility of new blood. After all, 2008 is all about change.

--CSH