So it does. 2010 has arrived. After answering some version of, "Where are you in your schooling?" for much of the holiday season, I thought it was high time I checked back in on this blog.
For those of us who matriculated into the MSTP in 2006, this *would* have been the year we graduated from medical school, matched, and became interns. Instead, we are all deep in the PhD phase of training.
Time seems to be flying by. Not too long ago, I would tell people that I'll be in school the rest of my life. Now, I'm halfway (maybe more) through the program. Strange how time plays these tricks. The current line I use is that I'm almost done with a second (four year) undergraduate education. As silly as that sounds -- given that I have focused solely on science and medicine -- it makes some sense. The MD/PhD program is rather disjointed for the first several years, with all of the introductory medical curriculum and exams, followed by the start of the PhD training with all of its introductory programs. And now, as I prepare for the Oral Quals (the "pre" dissertation defense), I feel not so differently from the way I felt when I was about to graduate from college. As I said then, now I really need to learn something.
This is not to say I haven't learned a great deal in the past three and a half years. I have. But I think the same desire to develop even greater skills - in clinical reasoning and in my area of research - speaks to the fact that much of the MSTP training is a preamble for serious intellectual engagement down the road. It isn't the culmination of anything. It's just another stepping stone, an educational interlude before more refinement and specialization.
All the other issues with which I have grappled - the challenges facing scientists today, trying to balance clinical and research interests, and attempting to stay informed about where science and medicine are heading as we begin the second decade of the new millennium - remain important and relevant as ever. And I continue to explore and plan to post about them on this blog.
Also: Anthony and I will try to pick up the pace of our posts in the weeks ahead.
Monday, January 04, 2010
Sunday, October 18, 2009
Things I Appreciate: Very good teachers
A very good teacher doesn’t have to work in academia: people don’t need degrees to teach. I’m going to focus my post on the learning that occurs inside of the classroom, however, for simplicity’s sake.
I have taken courses from two very good professors in college and one in medical school. From the experiences, I have found trends:
Going into the course, there are expectations, high ones. Building expectations requires myth-building, the established lore. When the name is dropped, people respond. A percentage will have negative things to say. But a general, resounding positive aura will prevail over the hours of work and anxiety that follow the class. Students feel overwhelmed by newfound naivety. But everyone else feels the same way, so it’s okay to an extent. And the professor is understanding and knows what the students are feeling: they’ve been there too; they keep on pushing. The expectations are real and are not fulfilled. A lot is learned, but there is always more. The learning continues after the class so that when nostalgia calls, the student thinks about how on point they would be if they sat down on the class today. That’s what a really good professor does.
I have taken courses from two very good professors in college and one in medical school. From the experiences, I have found trends:
Going into the course, there are expectations, high ones. Building expectations requires myth-building, the established lore. When the name is dropped, people respond. A percentage will have negative things to say. But a general, resounding positive aura will prevail over the hours of work and anxiety that follow the class. Students feel overwhelmed by newfound naivety. But everyone else feels the same way, so it’s okay to an extent. And the professor is understanding and knows what the students are feeling: they’ve been there too; they keep on pushing. The expectations are real and are not fulfilled. A lot is learned, but there is always more. The learning continues after the class so that when nostalgia calls, the student thinks about how on point they would be if they sat down on the class today. That’s what a really good professor does.
Thursday, October 08, 2009
Things I Appreciate: Words
Medical school has brought an appreciation for words. For example, I can appreciate the word “appreciate.” The word is thrown around so much, almost making it cliché, yet it continues to carry import. Appreciate implies complexity, often an observation without the knowledge of mechanism. The word is a lame attempt to describe something that we can't, a limit. From one word a sentiment of what it is like to be human explodes. At the same time, medicine (and science and any other field) tries to collapse a myriad of descriptors into neat packages. Consider the words “septic shock.” The words provides parameters of different variables that paint a clear picture of Shit. Words like septic shock allow for effective communication, especially when presenting. Things get spicy, though, when words like appreciate and septic shock, that expand and condense coexist: appreciable septic shock: Oh-Shit.
The Things I Appreciate in Medical School Series
Stay tuned. In the hope of posting more consistently, I've created a theme. Let's see whether I can trick myself into writing on this blog.
Thursday, August 27, 2009
Wednesday, July 08, 2009
Business and Medicine collide
And the results aren't so pretty. But to ignore the trends in medicine and the economics of being a physician is to be on the sidelines. We will all have to be active and informed participants in the arena of medicine and business in the future. Now's as good a time as ever to understand the issues.
(The Groopman/Hartzband piece is here. You need to be at university or other location that has an NEJM subscription to read it.)
(The Groopman/Hartzband piece is here. You need to be at university or other location that has an NEJM subscription to read it.)
Friday, July 03, 2009
brownian motion
I didn't know what to say when I was asked for advice during revisit weekend. I could've told the prospectives which books to buy, what lectures to skip or attend, how to approach PBL, or why you should selectively listen to your classmates and professors. While tiny nuggets of wisdom may have emerged from my mountainous rant, I decided that my advice was specific to my experiences and it wasn't fair to project my MS1 onto the listening. I couldn't provide an answer.
I cannot lie: I inundated Chuck C with a myriad of questions before I matriculated. Most were petty, some were practical, all were motivated by uncertainty. I didn't know what to expect then, and I don't know what to expect now. But I'm not worried. With time, a lot of questions have been addressed, as I have navigated my way through the first year of the MSTP. I tried to express this vague sentiment – intentionally omitting examples – to the revisit-ers. “Just go with the flow” was the gist of my answer. I imagined they were unsatisfied. At least I told them the truth.
I cannot lie: I inundated Chuck C with a myriad of questions before I matriculated. Most were petty, some were practical, all were motivated by uncertainty. I didn't know what to expect then, and I don't know what to expect now. But I'm not worried. With time, a lot of questions have been addressed, as I have navigated my way through the first year of the MSTP. I tried to express this vague sentiment – intentionally omitting examples – to the revisit-ers. “Just go with the flow” was the gist of my answer. I imagined they were unsatisfied. At least I told them the truth.
I've been lazy
It's been a while since I last posted. I'll be honest: I've been lazy. I have a resolution, though, and that involves a series of posts, snapshots of moments or ideas that have rattled around my skull for some time. Let the regurgitation begin.
Thursday, June 25, 2009
MJ
In cased you missed it, Michael Jackson died today.
The UCLA Ronald Reagan Medical Center across the street from my lab was the epicenter, the place paramedics took the unconscious King of Pop, the place where there weaved around for several blocks countless sattelite-dish-toting news vans, and above which a handful of helicopters buzzed incessantly from about 2 pm until dusk.
What a surreal moment it was when I realized he had been taken in full cardiac arrest to the UCLA ED and that the place was about to be swarmed with people.
As I left at around 9 PM this evening, much of the commotion had died down. But the day will have a lasting impression on me. When I walked outside in the late afternoon for a break from my work, I saw a crowd of people gathering in front of the Med Plaza buildings (just south of the hospital). Amidst the honking cars, chatter of voices in all directions, cameras flashing, and newspeople primping themselves for their live reports, I heard a boombox begin, at first softly and then more loudly (and grainily), playing "Thriller." Putting all of the insanity of the moment aside, that to me seemed like the perfect tribute to the triumphant, troubled, and tragic life of MJ.
Goodbye, Michael.
The UCLA Ronald Reagan Medical Center across the street from my lab was the epicenter, the place paramedics took the unconscious King of Pop, the place where there weaved around for several blocks countless sattelite-dish-toting news vans, and above which a handful of helicopters buzzed incessantly from about 2 pm until dusk.
What a surreal moment it was when I realized he had been taken in full cardiac arrest to the UCLA ED and that the place was about to be swarmed with people.
As I left at around 9 PM this evening, much of the commotion had died down. But the day will have a lasting impression on me. When I walked outside in the late afternoon for a break from my work, I saw a crowd of people gathering in front of the Med Plaza buildings (just south of the hospital). Amidst the honking cars, chatter of voices in all directions, cameras flashing, and newspeople primping themselves for their live reports, I heard a boombox begin, at first softly and then more loudly (and grainily), playing "Thriller." Putting all of the insanity of the moment aside, that to me seemed like the perfect tribute to the triumphant, troubled, and tragic life of MJ.
Goodbye, Michael.
Monday, June 22, 2009
Checklists
Here's another piece I meant to post a long time ago. Dr. Atul Gawande discusses the value of checklists in the medical setting. No, not just the checklists interns and residents make for overnights on-call. We're talking institutional checklists, from janitors' to nurses' to physicians' tasks.
Yikes!
And the radiation oncologist behind nearly 100 botched procedures at a Philadelphia VA hospital was/is an MD/PhD on the faculty at UPenn.
There are numerous troubling aspects to this story, poor regulatory oversight within and outside the institution and a fundamental lack of peer review.
There are numerous troubling aspects to this story, poor regulatory oversight within and outside the institution and a fundamental lack of peer review.
An overdue post on the occasion of the start of PhD training, year two
As I start my second year of Ph.D. training and fourth year in the MSTP, I thought it was high time to reflect on the current State of Things. A testament to the busy nature of my research, I started this post on 6/10/09 and just today am revisiting it.
The past year has been filled with what seemed like highs and lows at the time, but reflecting on it now it all seems like low peaks and shallow valleys. In short, it hasn't been all that crazy. And yet I have covered much ground -- I've been all over the place. So I'll cover the past year in numbered form, as briefly as possible.
1. Coursework: as of this moment, I have completed all required courses in Molecular, Cellular, and Integrative Physiology. What's left now are qualifying exam(s) [I have submitted my written qualifying exam, no word yet if I passed...I'm shooting to do orals by the end of the fall quarter], publish, thesis, defend, submit. To have time solely dedicated to research is a huge bonus. But the coursework of the past year has been a valuable part of my training.
Incidentally, the Powers-That-Be have decided that the didactic elements of the two core courses I took (Biochemistry and Cell Biology, Fall and Winter, respectively) this year are the least productive aspects of said courses, and the emphasis is shifting to a more problem-based learning (PBL) format in the future. I think this is a big mistake. Sitting in lectures five days a week covering a large array of biological science research was hugely important in helping me think about my research. Just because it's boring as hell does not mean it isn't (or wasn't) time well spent.
2. Research Progress: one year ago, almost to the day, I began setting up my own patch clamp rig in lab. Since then, I have learned a boatload about electrophysiology, data analysis, cell culturing, radioactivity handling and experimentation, electronics, handyman problem solving, and a little bit of molecular biology. My project appears to be well underway, and my PI remains confident I will finish the PhD by the end of my third year of graduate training. Things are progressing nicely.
What's more, I have made some important realizations about what it means to do research. A recent conversation with a cousin clarified what I mean by this: research can be either boring as shit or deeply meditative. And often times, it's a blend of the two. This is probably the case because research, when stripped of the flowery explanations, is really just making big observations and repeating experiments enough times to convince yourself and the world that results have physical significance. This may explain why I've logged hundreds of hours of patch clamping, performed tons of radioactive uptake experiments, and many of these experiments were the second, third, fourth, or even tenth repeats of earlier experiment.
So it can get really monotonous. But somehow, when things are working, it all seems OK - it's for a purpose. And even when nothing works, it's also OK, largely because outside intellectual joys [clinical activities, cooking, music, exercising, romance, et cetera] occupy more of my time. Something has to get you through the difficult and discouraging times.
And finally, I think the most important lesson from the research part of my training comes out of [Los Angeles Lakers'] coach Phil Jackson's playbook: nothing too high, nothing too low. No matter how exciting the experimental result or promising the progress, there's no good reason to be manic, euphoric, or irrationally dazed with excitement. And there certainly is no good reason to slip into a melancholic stupor if a project isn't working. It all requires disciplined moderation.
3. Clinical work: I have been less and less to the ICU to take nights/overnights of call. This is a function of many more side projects in lab, and yet I plan in the next month or two to make it in for an evening. That I am in this predicament is as much a testament to research consuming my time as it is evidence of the fact that I value my social life. The clinical skills will be there, even if I take call much less frequently than I used to. Plus I'm waiting for my colleagues who will be doing 4th year sub-I's in the ICU, figuring I can be less of a burden to the residents/interns if I'm bothering a med student.
4. Socially: it's all good. Doing a PhD is definitely a full-time job, but somehow all of the quiet (and monotonous) moments make the requirement for super-charged social interactions less than it used to be. I'm at peace with it all, even if my social life is laden with challenges, successes, failures, and everything in between, just as much now as it was before I started the PhD.
The past year has been filled with what seemed like highs and lows at the time, but reflecting on it now it all seems like low peaks and shallow valleys. In short, it hasn't been all that crazy. And yet I have covered much ground -- I've been all over the place. So I'll cover the past year in numbered form, as briefly as possible.
1. Coursework: as of this moment, I have completed all required courses in Molecular, Cellular, and Integrative Physiology. What's left now are qualifying exam(s) [I have submitted my written qualifying exam, no word yet if I passed...I'm shooting to do orals by the end of the fall quarter], publish, thesis, defend, submit. To have time solely dedicated to research is a huge bonus. But the coursework of the past year has been a valuable part of my training.
Incidentally, the Powers-That-Be have decided that the didactic elements of the two core courses I took (Biochemistry and Cell Biology, Fall and Winter, respectively) this year are the least productive aspects of said courses, and the emphasis is shifting to a more problem-based learning (PBL) format in the future. I think this is a big mistake. Sitting in lectures five days a week covering a large array of biological science research was hugely important in helping me think about my research. Just because it's boring as hell does not mean it isn't (or wasn't) time well spent.
2. Research Progress: one year ago, almost to the day, I began setting up my own patch clamp rig in lab. Since then, I have learned a boatload about electrophysiology, data analysis, cell culturing, radioactivity handling and experimentation, electronics, handyman problem solving, and a little bit of molecular biology. My project appears to be well underway, and my PI remains confident I will finish the PhD by the end of my third year of graduate training. Things are progressing nicely.
What's more, I have made some important realizations about what it means to do research. A recent conversation with a cousin clarified what I mean by this: research can be either boring as shit or deeply meditative. And often times, it's a blend of the two. This is probably the case because research, when stripped of the flowery explanations, is really just making big observations and repeating experiments enough times to convince yourself and the world that results have physical significance. This may explain why I've logged hundreds of hours of patch clamping, performed tons of radioactive uptake experiments, and many of these experiments were the second, third, fourth, or even tenth repeats of earlier experiment.
So it can get really monotonous. But somehow, when things are working, it all seems OK - it's for a purpose. And even when nothing works, it's also OK, largely because outside intellectual joys [clinical activities, cooking, music, exercising, romance, et cetera] occupy more of my time. Something has to get you through the difficult and discouraging times.
And finally, I think the most important lesson from the research part of my training comes out of [Los Angeles Lakers'] coach Phil Jackson's playbook: nothing too high, nothing too low. No matter how exciting the experimental result or promising the progress, there's no good reason to be manic, euphoric, or irrationally dazed with excitement. And there certainly is no good reason to slip into a melancholic stupor if a project isn't working. It all requires disciplined moderation.
3. Clinical work: I have been less and less to the ICU to take nights/overnights of call. This is a function of many more side projects in lab, and yet I plan in the next month or two to make it in for an evening. That I am in this predicament is as much a testament to research consuming my time as it is evidence of the fact that I value my social life. The clinical skills will be there, even if I take call much less frequently than I used to. Plus I'm waiting for my colleagues who will be doing 4th year sub-I's in the ICU, figuring I can be less of a burden to the residents/interns if I'm bothering a med student.
4. Socially: it's all good. Doing a PhD is definitely a full-time job, but somehow all of the quiet (and monotonous) moments make the requirement for super-charged social interactions less than it used to be. I'm at peace with it all, even if my social life is laden with challenges, successes, failures, and everything in between, just as much now as it was before I started the PhD.
Sunday, June 07, 2009
Night with the guys, circa 2006
Last night, Jeff, Kevin, John, and I returned to our old stomping ground of Westwood village. We even had liters at "Maloneys." (It's now apparently "Ohara's") That was how authentic we went for it. In three short years, a lot has happened. Half way through medical school, entrenched in research, and John has a ring on his finger. In some ways it seems like just yesterday that we were entering the program, unaware of what med school was going to bring. In other ways, it seems like an eternity.
In any event, congratulations John (and Tiff)! How far you've come. How far we've all come.
(How far we have to go...)
In any event, congratulations John (and Tiff)! How far you've come. How far we've all come.
(How far we have to go...)
Sunday, May 03, 2009
NYC rabble rabble
I'm in New York city this weekend. I applied to several MSTPs out here during the application process but never went to the interviews.
Not that I would have gone here, but it's still worth considering if you can't decide where to apply.
Monday, April 20, 2009
A perfect shade of blue
The sky is a perfect shade of blue, and it is 85 degrees out. I’m sitting here, dressed-down in my tank-top and boxers, wanting to bike westward to smell sunscreen. I have finals tomorrow, so I’ll stay seated for now. My bike is waiting, and I probably would go, but I already went to Coachella on Saturday. I should spend some time studying, I guess.
Friday, April 10, 2009
Good Friday, Stem Cells
I've been trying to come up with a coherent argument about stem cells for a long time. This is probably neither coherent or much of an argument for that matter, but I think it does address two fundamental issues surrounding the lay public's and the scientific community's approach to the issue of stem cells.
Writing this on Good Friday, as a lifelong Christian (raised in the Episcopal Church), my mind has been swirly all day with thoughts of faith, death and dying, responsibility and guilt, betrayal, sacrifice, and sorrow. And whether by accident or by desire, I began thinking about stem cells.
The issue of stem cell research has created a cycle of never-ending morality wars, pitted on one side are the fanatical religious, right-to-life, anti-abortion folks. On the other side are the folks yelling and screaming about how preventing stem cell research is like murdering their sick selves (or friends). Neither side has done much of a good job at convincing moderate people to tilt to the extreme. While it looks like the public is generally open to the idea of government-sponsored stem cell research using discarded embryos originally meant for IVF, they aren't picketing the streets (or using the issue as a deciding factor in elections, with some notable exceptions) in favor of one side or the other. But, as it is with so many other issues, the fringe groups are shaping the public discourse on the issue. They tell us that people either, "support lifesaving research" or "don't believe in murdering embryos that have a chance at life." People talk about stem cell research at parties, and they usually feel each other out (make sure they're on the same side of the issue), and then have a glorious time patting each other on the back for supporting the "most logical and just viewpoint." Even scientists find themselves reduced to conversations in which it is acknowledged that the "Bush administration's and christiantist movement's war against stem cell research has now ended," and that basically is the end of the discussion.
So, the implications of moral wars is that they prevent people from delving deeper into stem cells in a discussion. On a societal level, this makes stem cells an easy wedge issue when we consider health, human disease, health care of the future, and deep dilemmas in medicine. Obviously, people find it much easier to have an opinion on stem cells than they do with regards to the care of the elderly, palliative care, genetic discrimination, or the ethics governing clinical trials of life-saving medicines. How many people get into discussions about the moral and ethical issues of marketing and prescribing anti-cancer chemotherapeutics in only the interest of extending a person's life by several months? How many families are able to candidly talk about their decision to support an elderly relative in making the decision to initiate comfort care measures? Have you ever considered how and whether you would decide to undergo genetic testing? Not that these questions aren't brought up, but my point is that perhaps because they (thankfully) have not become easily-packaged wedge issues, they haven't been picked up by the fringe radicals. (Yes, I know, Terri Schaivo was an exception to this. But while her case was picked up and widely debated in the mainstream media, I don't think anyone really resolved how they felt about the issue, just that it shouldn't have become the circus it did. Maybe this is because I still have a challenging time about thinking about the Terri Schaivo case in the abstract, even if I know exactly what I would do...). In any case, we don't engage in the issue nearly enough. Worst of all, many of the people willing to talk about it boil it down to a one liner such as, "Well they just starved Terri Schaivo to death!" or "How dare those smug conservatives prevent a fair and appropriate withdrawal from care, interfering with the family's privacy like that!" The conflicted persons (and the families who are nevertheless forced to make difficult decisions) fall silent, they can't generate a soundbite in the allotted time on "Larry King Live."
A second phenomenon, which is very much linked to the morality wars, is one of inflated and conflated expectations of who, what, where, how, and why stems cells are. In general, the public and scientists (correctly) believe stem cells to be the starting point of organismal life -- they contain all of the genetic information, cellular machinery, and, in response to external and internal cues, they can give rise to fully developed and genetically identical tissue. It has thus been thought that stem cells have the potential for giving rise to the regrowth and re-engineering of tissue in an ex-situ fashion. Unfortunately, this is a sad over-simplification of what and where stem cells (and our knowledge of them) are in the scientific arena at present. Perhaps this is in part due to the fact that both of the fringes (pro and con) can easily justify their points of view using the simplification. For example, the right-to-life folks argue that adult stem cells can easily be used, and will "do the same trick" as those stem cells derived from the blastocyst of discarded IVF embryos. And the pro-stem cell community states that adult stem cells likely won't answer every question and may lack certain key elements that embryonic stem cells would otherwise contain.
Here's the problem I have: this prevents us from truly understanding what stem cell research is, what it should seek to do moving forward, and it denies us the chance to come up with reasonable expectations about what might happen with future stem cell-directed therapeutics. We're so focused on stem cells as a means to an end: a tool for replacing lost or damaged tissue, implanting new (genetically reprogrammed tissue), or as a way to circumvent the need to undergo transplants. I think to focus so broadly on those goals is a huge mistake. We think simply about what we can make, what we can surgically place or inject into a person, and what we may be able to engineer in the laboratory. How often have people spoken instead of stem cell research as a way to unlock secretes about how organs regenerate in situ? (Or, how organs have the intrinsic ability, given the correct internal and external cues, to respond to injury with regeneration instead of with chronic fibrotic and inflammatory processes?) In other words, aren't stem cells important because they offer an opportunity to unlock the internal and external cues that govern tissue genesis and regeneration? Making new organs can come later, or not. But better understanding how to manipulate what we have (rather than what we might transplant) is a more realistic, down-to-earth expectation I have from stem cell research. Maybe it doesn't sound as sexy. But maybe it's more practical.
Perhaps we should start really thinking about the implications of these issues, and stop bickering about abortions and embryo-killing.
Writing this on Good Friday, as a lifelong Christian (raised in the Episcopal Church), my mind has been swirly all day with thoughts of faith, death and dying, responsibility and guilt, betrayal, sacrifice, and sorrow. And whether by accident or by desire, I began thinking about stem cells.
The issue of stem cell research has created a cycle of never-ending morality wars, pitted on one side are the fanatical religious, right-to-life, anti-abortion folks. On the other side are the folks yelling and screaming about how preventing stem cell research is like murdering their sick selves (or friends). Neither side has done much of a good job at convincing moderate people to tilt to the extreme. While it looks like the public is generally open to the idea of government-sponsored stem cell research using discarded embryos originally meant for IVF, they aren't picketing the streets (or using the issue as a deciding factor in elections, with some notable exceptions) in favor of one side or the other. But, as it is with so many other issues, the fringe groups are shaping the public discourse on the issue. They tell us that people either, "support lifesaving research" or "don't believe in murdering embryos that have a chance at life." People talk about stem cell research at parties, and they usually feel each other out (make sure they're on the same side of the issue), and then have a glorious time patting each other on the back for supporting the "most logical and just viewpoint." Even scientists find themselves reduced to conversations in which it is acknowledged that the "Bush administration's and christiantist movement's war against stem cell research has now ended," and that basically is the end of the discussion.
So, the implications of moral wars is that they prevent people from delving deeper into stem cells in a discussion. On a societal level, this makes stem cells an easy wedge issue when we consider health, human disease, health care of the future, and deep dilemmas in medicine. Obviously, people find it much easier to have an opinion on stem cells than they do with regards to the care of the elderly, palliative care, genetic discrimination, or the ethics governing clinical trials of life-saving medicines. How many people get into discussions about the moral and ethical issues of marketing and prescribing anti-cancer chemotherapeutics in only the interest of extending a person's life by several months? How many families are able to candidly talk about their decision to support an elderly relative in making the decision to initiate comfort care measures? Have you ever considered how and whether you would decide to undergo genetic testing? Not that these questions aren't brought up, but my point is that perhaps because they (thankfully) have not become easily-packaged wedge issues, they haven't been picked up by the fringe radicals. (Yes, I know, Terri Schaivo was an exception to this. But while her case was picked up and widely debated in the mainstream media, I don't think anyone really resolved how they felt about the issue, just that it shouldn't have become the circus it did. Maybe this is because I still have a challenging time about thinking about the Terri Schaivo case in the abstract, even if I know exactly what I would do...). In any case, we don't engage in the issue nearly enough. Worst of all, many of the people willing to talk about it boil it down to a one liner such as, "Well they just starved Terri Schaivo to death!" or "How dare those smug conservatives prevent a fair and appropriate withdrawal from care, interfering with the family's privacy like that!" The conflicted persons (and the families who are nevertheless forced to make difficult decisions) fall silent, they can't generate a soundbite in the allotted time on "Larry King Live."
A second phenomenon, which is very much linked to the morality wars, is one of inflated and conflated expectations of who, what, where, how, and why stems cells are. In general, the public and scientists (correctly) believe stem cells to be the starting point of organismal life -- they contain all of the genetic information, cellular machinery, and, in response to external and internal cues, they can give rise to fully developed and genetically identical tissue. It has thus been thought that stem cells have the potential for giving rise to the regrowth and re-engineering of tissue in an ex-situ fashion. Unfortunately, this is a sad over-simplification of what and where stem cells (and our knowledge of them) are in the scientific arena at present. Perhaps this is in part due to the fact that both of the fringes (pro and con) can easily justify their points of view using the simplification. For example, the right-to-life folks argue that adult stem cells can easily be used, and will "do the same trick" as those stem cells derived from the blastocyst of discarded IVF embryos. And the pro-stem cell community states that adult stem cells likely won't answer every question and may lack certain key elements that embryonic stem cells would otherwise contain.
Here's the problem I have: this prevents us from truly understanding what stem cell research is, what it should seek to do moving forward, and it denies us the chance to come up with reasonable expectations about what might happen with future stem cell-directed therapeutics. We're so focused on stem cells as a means to an end: a tool for replacing lost or damaged tissue, implanting new (genetically reprogrammed tissue), or as a way to circumvent the need to undergo transplants. I think to focus so broadly on those goals is a huge mistake. We think simply about what we can make, what we can surgically place or inject into a person, and what we may be able to engineer in the laboratory. How often have people spoken instead of stem cell research as a way to unlock secretes about how organs regenerate in situ? (Or, how organs have the intrinsic ability, given the correct internal and external cues, to respond to injury with regeneration instead of with chronic fibrotic and inflammatory processes?) In other words, aren't stem cells important because they offer an opportunity to unlock the internal and external cues that govern tissue genesis and regeneration? Making new organs can come later, or not. But better understanding how to manipulate what we have (rather than what we might transplant) is a more realistic, down-to-earth expectation I have from stem cell research. Maybe it doesn't sound as sexy. But maybe it's more practical.
Perhaps we should start really thinking about the implications of these issues, and stop bickering about abortions and embryo-killing.
Friday, March 27, 2009
The Curse of the Match List
It's 1645hrs on a Friday afternoon in late March. If I'm writing a post, it means either a) there isn't enough lab work for me today, b) I'm avoiding my lab work, c) both, or d) happy hour is nigh. Maybe some combination of all the above.
I recently finished all the rigorous lecture-based coursework for the graduate phase of my training. All that is left is to tweak my project to get an impressive enough quantity of data, do some tutorials with individual faculty members, take some more seminars, do qualifying exams (both written and oral). So, there's a ton more to do.
But something about this time of year always makes me feel so optimistic and forward looking. That something is the match list. In three pages, I can browse the future hospital, program, and specialty of every graduating senior in the medical school class. It looks, without question, quite impressive. And this year, I'm looking at names of people I know, people with whom I attended parties, with whom I compared notes about how to study for exams and how to make it through difficult stretches with research. Granted, nothing can prepare me for the match list next year, in which my first and second year colleagues will be the beneficiaries of The Match.
The problem I have with scrupulously looking over The List is that it allows for a thought experiment that eerily reminded me of what I did when finding out about my older friends and their successes in applying to medical school. Mulling over the final product of the labor of others takes time, but worse, it's like Facebook stalking someone [1]. You sum up a person based on a nifty quotation, a photograph, a really impressive status, or any number of other inane metrics. With The Match, one does the same kind of simplification/idealization. It's toxic. It allows me to say, "Well, because I have a similar board score to Mildred, or better research credentials than Jose, or more impressive clinical skills than Felipe, I surely can get into otolaryngology at UCLA as well!"
Perhaps the internal dialogue above is most indicative with the problem many of us (especially yours truly) have when we look at the achievements of others. We can't but help project onto/into/through ourselves. To do so with The Match not only makes a decision based on years of work and on many challenging moments of reflection seem boiled down to a single line on a PDF accessed securely through the medstudent website. It shouldn't be. So I guess my concluding emotion on The Match for MSTPs graduating this year is, "Well done, guys. Looks like you matched to impressive programs." And for at least one student, I know he matched to the specialty and institution of his choice. That's something worth celebrating.
-----------------------------------------------------------------------------------------------
1. Yes I've facebook stalked before. Not something I'm proud of, but at least I'm willing to admit it. I could probably write a small opus about the feelings I've had during (and with regards to) FB stalking.
I recently finished all the rigorous lecture-based coursework for the graduate phase of my training. All that is left is to tweak my project to get an impressive enough quantity of data, do some tutorials with individual faculty members, take some more seminars, do qualifying exams (both written and oral). So, there's a ton more to do.
But something about this time of year always makes me feel so optimistic and forward looking. That something is the match list. In three pages, I can browse the future hospital, program, and specialty of every graduating senior in the medical school class. It looks, without question, quite impressive. And this year, I'm looking at names of people I know, people with whom I attended parties, with whom I compared notes about how to study for exams and how to make it through difficult stretches with research. Granted, nothing can prepare me for the match list next year, in which my first and second year colleagues will be the beneficiaries of The Match.
The problem I have with scrupulously looking over The List is that it allows for a thought experiment that eerily reminded me of what I did when finding out about my older friends and their successes in applying to medical school. Mulling over the final product of the labor of others takes time, but worse, it's like Facebook stalking someone [1]. You sum up a person based on a nifty quotation, a photograph, a really impressive status, or any number of other inane metrics. With The Match, one does the same kind of simplification/idealization. It's toxic. It allows me to say, "Well, because I have a similar board score to Mildred, or better research credentials than Jose, or more impressive clinical skills than Felipe, I surely can get into otolaryngology at UCLA as well!"
Perhaps the internal dialogue above is most indicative with the problem many of us (especially yours truly) have when we look at the achievements of others. We can't but help project onto/into/through ourselves. To do so with The Match not only makes a decision based on years of work and on many challenging moments of reflection seem boiled down to a single line on a PDF accessed securely through the medstudent website. It shouldn't be. So I guess my concluding emotion on The Match for MSTPs graduating this year is, "Well done, guys. Looks like you matched to impressive programs." And for at least one student, I know he matched to the specialty and institution of his choice. That's something worth celebrating.
-----------------------------------------------------------------------------------------------
1. Yes I've facebook stalked before. Not something I'm proud of, but at least I'm willing to admit it. I could probably write a small opus about the feelings I've had during (and with regards to) FB stalking.
Sunday, March 15, 2009
Sit on top of the mountain...
I helped host a beer hour on Friday afternoon in my department. It was the usual host of suspects: faculty, grad students, post-docs, lots of beer and pizza, and inhibitions dissolved.
I'll keep this brief, for once.
I can't help but think, as an MD/PhD student, people think of me in a vastly different way than they do about graduate students. I'm not sure why, exactly, but:
1. They think we're really crazy. No, really crazy, obsessed, ambitious, etc.
2. They say things like, "When you're done with getting both degrees, you'll need to sit on a mountain top for a year and smoke lots of pot."
I couldn't "take a year off" (what does "taking a year off" mean anyway?).
How about just a weekend?
P.S. Really working hard in grad school is similar to studying for boards. Research can easily become your life. And according to people who do science PhDs, it almost should become your life. Just saying.
I'll keep this brief, for once.
I can't help but think, as an MD/PhD student, people think of me in a vastly different way than they do about graduate students. I'm not sure why, exactly, but:
1. They think we're really crazy. No, really crazy, obsessed, ambitious, etc.
2. They say things like, "When you're done with getting both degrees, you'll need to sit on a mountain top for a year and smoke lots of pot."
I couldn't "take a year off" (what does "taking a year off" mean anyway?).
How about just a weekend?
P.S. Really working hard in grad school is similar to studying for boards. Research can easily become your life. And according to people who do science PhDs, it almost should become your life. Just saying.
Monday, February 02, 2009
Just a heads up
For anyone coming to UCLA for an interview, if you're arriving from LAX and plan on taking the Westwood FlyAway bus, be aware that the fare is now $5.00 (exact change required) and the hours are 6am - 11 pm (this used to run until 1 am). I realized this during a rather unfortunate hour of waiting at LAX last night that ended in a $40.00 cab ride home. For more information, here is the LAX flyaway bus website. Click on "Westwood." Of course, you can always send us questions at mstpla at gmail dot com.
Saturday, January 24, 2009
Learning and trying not to forget
I can't help but think I took the red pill when I decided to enter the MSTP at UCLA. I had no idea what I would find, but I knew it would be too much to grasp at first. Or ever. And yet, two years and seven months into it, I'm starting to see the beauty of this journey all over again.
One might imagine that I'm about to launch into an (albeit weak) attempt at philosophizing [1] about the experience that is MSTP at UCLA. I am not. I just want to share some of my sentiments, now that I feel firmly entrenched in the PhD phase of my training. And I want to say that, while I do not endorse any one way at how to go about this, I will invariably focus on issues as they pertain to my roadmap. But others (Jeff, Anthony, et al) have much different roadmaps in mind, and I think they are finding similar satisfaction [2].
Which is to say the following: I do an overnight of call [3] in the Fourth Floor East Medical Intensive Care Unit (MICU) in the Ronald Reagan UCLA Medical Center (RRUCLAMC). I've watched numerous central and radial arterial lines get placed, I've seen a couple patients die, I've attempted (and failed) to draw an arterial blood gas, I've watched (and sort of helped with) endotracheal intubations, I've run when the words "Code blue team, code blue team," go up over the loudspeaker in the middle of the night. I've seen the spectacle of a patient being cardioverted during and acute atrial fibrillation episode, I've sat in on family meetings for parents whose grown children are dying, I've seen the same patients, in the units for months at a time, while pressors, ventilators, oxygen, blood, blood products, plasma, dialysis, fluids, antibiotics, keeping them alive for weeks and months longer than seems even possible [4]. In short, I've obtained a crash course into one of the most exciting and indeed "critical" areas of inpatient medicine, the ICU.
I started doing this unofficial-ICU-call-longitunal rotation in November, and I have since been in the unit, usually on a Friday night into saturday midday, every other week. I generally will arrive at campus on Friday morning at 7-7:30 a.m., do work in the lab until late afternoon/early evening, and then a call night begins [5]. I began this work when my class schedule prevented me from continuing my once-a-week clinical exposure. Logistically, the MICU call was the only way to continue some clinical exposure.
There's another reason, too. If you recall [6], I had become frustrated with some of what I had learned about scientific research. Basic science, it seemed, suffered from the same failings that evidence-based medicine (EBM) does, or of empirical and non-data-driven clinical care. And I was asking myself a series of questions about what I had gotten myself into [7]: Why was I doing this? Am I forgetting everything I learned in the first two years of medical school? What am I really trying to do?
I don't have answers to those quasi-philosophical questions, but the beauty of the last several months is that I don't even need answers to them. The ICU work, as infrequent (Q2wks) and humbling as it is (I really don't know shit [8]), has filled a small void. Somehow, since this has started, my research has flowed a little more nicely -- maybe because I take advantage of the time I am in lab, or maybe because I get a twice-a-month dose of why I am doing all of this. This isn't just the "I want to help people" sentiment. Certainly, when you watch young and old patients alike fading away from devastating illnesses, you can't help but feel some sense of sadness, sympathy, or frustration. But there's also this sense that, both at a very basic level (mechanisms, molecules and targets, animal models) and from the clinical perspective (drugs, monitoring schemes, preventitive measures) there are astounding amounts of work to be done by physicians, scientists, and physician-scientists. And this is not just for the new sexy cancer drugs, not just for the new stenting procedure for cardiac or neuro patients. I'm talking about really understanding the effects of endotoxin (LPS)-mediated septic shock. I'm talking about further nailing down what causes and how to treat Adult Respiratory Distress Syndrome (ARDS). Medicine spends a lot of time - in the hospital, the ICU - well documenting and observing these phenomena via critically low blood pressures, decreased oxygen saturation, multi-organ failure, positive disseminated intravascular coagulation (DIC) laboratory values, the list goes on. Physicians spend sleepless nights managing these patients. Researchers, who see around the corner to translational medicine, want to challenge assumptions that are in the textbooks and clinical references with fresh new experiments.
Not to belabor a point, but both medicine and research have much to contribute. I think that's cool, and I still want in [9].
Several final points:
Ultimately, the great challenges of medicine are not unlike the great challenges of our economy. We are still trying to figure out what causes disease, and yet we are treating diseases nonetheless. It's sort of like going with a one trillion dollar bailout to a problem without knowing exactly what caused the crisis in the first place and thus without quite knowing what to fix. Said Warren Buffett:
The answer is nobody knows. The economists don’t know. All you know is you throw everything at it and whether it’s more effective if you’re fighting a fire to be concentrating the water flow on this part or that part. You’re going to use every weapon you have in fighting it. And people, they do not know exactly what the effects are. Economists like to talk about it, but in the end they’ve been very, very wrong and most of them in recent years on this. We don’t know the perfect answers on it.
Replace "economists" with "physicians" or "scientists" or both. Needless to say, the quotation is more than applicable to how we approach numerous diseases. Our information is incomplete, our assumptions have been (and will continue to be) proven wrong. But you must keep flowing the water. Our basic sense of humanity requires it.
And so, more than ever, the MD/PhD path is for me. The rest is a mystery.
-----------------------------------------------------------------------------------------------------------------
1. The difference between philosophizing and sharing sentiments is sort of like the difference between using data to generate an exciting new model for some physiologic process (say a pictogram of vesicle fusion) versus simply sharing some exciting data. I would argue that here, and in most writings on this blog, we're simply trying to present our data, our observations, de novo, roughly as they happen and our thoughts about them (the data, observations) crystallize a bit. I doubt there's an MD/PhD or MSTP graduate out there who could package the experience into a philosophical model.
2. It doesn't matter what position you do it in, just that you're doing it...at least that's what she said.
3. This is a misnomer in my case. Medical students don't get "called." Case-in-point: two "calls" ago, the resident and intern with whom I was taking the overnight received a page from the Emergency Department for a patient w/ Diabetic Ketoacidosis needing to be admitted to the ICU. The resident claims she tried to wake me up by knocking on my door. "But you had my pager and cell phone number." But she didn't call. A weak knock, a med student doesn't respond, and it's just as well -- I get an extra hour of sleep, and it took the resident and intern no longer than thirty minutes to work the patient up and admit her to the unit. It probably would have taken twice as long if I was "helping." Which is also to say the following: medical students generally don't contribute much, especially if they aren't part of the ongoing care of patients (i.e. are on a rotation or a sub-internship, where they actually contribute little tasks to the medical team). Coming in for a night of call as a (quite inexperienced) medical student generally doesn't result in much help to anyone, except himself. It's this strange feeling of importance (white coat, "helping" make medical decisions) while being utterly inconsequential.
4. Or humane. Or natural. Or fair.
5. Sometimes a resident's page indicates a new admission, and at 4:30 pm I'm rushing out of lab to the ED, in scrubs and a white coat and feeling unsure of my uniform and skill set.
6. Go back to some previous posts, most recently one containing the sentence, "Yawn," or the phrase, "selling out but for less money," and you'll get the idea.
7. Admittedly, the risk of becoming overtly philosophical is highest at this point of the post.
8. If you really want, recall that I wrote these same words in a post during the first week of first year of medical school.
9. That's why I joined an MSTP. In some ways, this post feels like I'm re-writing my personal statement explaining why I want to join a medical scientist training program.
One might imagine that I'm about to launch into an (albeit weak) attempt at philosophizing [1] about the experience that is MSTP at UCLA. I am not. I just want to share some of my sentiments, now that I feel firmly entrenched in the PhD phase of my training. And I want to say that, while I do not endorse any one way at how to go about this, I will invariably focus on issues as they pertain to my roadmap. But others (Jeff, Anthony, et al) have much different roadmaps in mind, and I think they are finding similar satisfaction [2].
Which is to say the following: I do an overnight of call [3] in the Fourth Floor East Medical Intensive Care Unit (MICU) in the Ronald Reagan UCLA Medical Center (RRUCLAMC). I've watched numerous central and radial arterial lines get placed, I've seen a couple patients die, I've attempted (and failed) to draw an arterial blood gas, I've watched (and sort of helped with) endotracheal intubations, I've run when the words "Code blue team, code blue team," go up over the loudspeaker in the middle of the night. I've seen the spectacle of a patient being cardioverted during and acute atrial fibrillation episode, I've sat in on family meetings for parents whose grown children are dying, I've seen the same patients, in the units for months at a time, while pressors, ventilators, oxygen, blood, blood products, plasma, dialysis, fluids, antibiotics, keeping them alive for weeks and months longer than seems even possible [4]. In short, I've obtained a crash course into one of the most exciting and indeed "critical" areas of inpatient medicine, the ICU.
I started doing this unofficial-ICU-call-longitunal rotation in November, and I have since been in the unit, usually on a Friday night into saturday midday, every other week. I generally will arrive at campus on Friday morning at 7-7:30 a.m., do work in the lab until late afternoon/early evening, and then a call night begins [5]. I began this work when my class schedule prevented me from continuing my once-a-week clinical exposure. Logistically, the MICU call was the only way to continue some clinical exposure.
There's another reason, too. If you recall [6], I had become frustrated with some of what I had learned about scientific research. Basic science, it seemed, suffered from the same failings that evidence-based medicine (EBM) does, or of empirical and non-data-driven clinical care. And I was asking myself a series of questions about what I had gotten myself into [7]: Why was I doing this? Am I forgetting everything I learned in the first two years of medical school? What am I really trying to do?
I don't have answers to those quasi-philosophical questions, but the beauty of the last several months is that I don't even need answers to them. The ICU work, as infrequent (Q2wks) and humbling as it is (I really don't know shit [8]), has filled a small void. Somehow, since this has started, my research has flowed a little more nicely -- maybe because I take advantage of the time I am in lab, or maybe because I get a twice-a-month dose of why I am doing all of this. This isn't just the "I want to help people" sentiment. Certainly, when you watch young and old patients alike fading away from devastating illnesses, you can't help but feel some sense of sadness, sympathy, or frustration. But there's also this sense that, both at a very basic level (mechanisms, molecules and targets, animal models) and from the clinical perspective (drugs, monitoring schemes, preventitive measures) there are astounding amounts of work to be done by physicians, scientists, and physician-scientists. And this is not just for the new sexy cancer drugs, not just for the new stenting procedure for cardiac or neuro patients. I'm talking about really understanding the effects of endotoxin (LPS)-mediated septic shock. I'm talking about further nailing down what causes and how to treat Adult Respiratory Distress Syndrome (ARDS). Medicine spends a lot of time - in the hospital, the ICU - well documenting and observing these phenomena via critically low blood pressures, decreased oxygen saturation, multi-organ failure, positive disseminated intravascular coagulation (DIC) laboratory values, the list goes on. Physicians spend sleepless nights managing these patients. Researchers, who see around the corner to translational medicine, want to challenge assumptions that are in the textbooks and clinical references with fresh new experiments.
Not to belabor a point, but both medicine and research have much to contribute. I think that's cool, and I still want in [9].
Several final points:
Ultimately, the great challenges of medicine are not unlike the great challenges of our economy. We are still trying to figure out what causes disease, and yet we are treating diseases nonetheless. It's sort of like going with a one trillion dollar bailout to a problem without knowing exactly what caused the crisis in the first place and thus without quite knowing what to fix. Said Warren Buffett:
The answer is nobody knows. The economists don’t know. All you know is you throw everything at it and whether it’s more effective if you’re fighting a fire to be concentrating the water flow on this part or that part. You’re going to use every weapon you have in fighting it. And people, they do not know exactly what the effects are. Economists like to talk about it, but in the end they’ve been very, very wrong and most of them in recent years on this. We don’t know the perfect answers on it.
Replace "economists" with "physicians" or "scientists" or both. Needless to say, the quotation is more than applicable to how we approach numerous diseases. Our information is incomplete, our assumptions have been (and will continue to be) proven wrong. But you must keep flowing the water. Our basic sense of humanity requires it.
And so, more than ever, the MD/PhD path is for me. The rest is a mystery.
-----------------------------------------------------------------------------------------------------------------
1. The difference between philosophizing and sharing sentiments is sort of like the difference between using data to generate an exciting new model for some physiologic process (say a pictogram of vesicle fusion) versus simply sharing some exciting data. I would argue that here, and in most writings on this blog, we're simply trying to present our data, our observations, de novo, roughly as they happen and our thoughts about them (the data, observations) crystallize a bit. I doubt there's an MD/PhD or MSTP graduate out there who could package the experience into a philosophical model.
2. It doesn't matter what position you do it in, just that you're doing it...at least that's what she said.
3. This is a misnomer in my case. Medical students don't get "called." Case-in-point: two "calls" ago, the resident and intern with whom I was taking the overnight received a page from the Emergency Department for a patient w/ Diabetic Ketoacidosis needing to be admitted to the ICU. The resident claims she tried to wake me up by knocking on my door. "But you had my pager and cell phone number." But she didn't call. A weak knock, a med student doesn't respond, and it's just as well -- I get an extra hour of sleep, and it took the resident and intern no longer than thirty minutes to work the patient up and admit her to the unit. It probably would have taken twice as long if I was "helping." Which is also to say the following: medical students generally don't contribute much, especially if they aren't part of the ongoing care of patients (i.e. are on a rotation or a sub-internship, where they actually contribute little tasks to the medical team). Coming in for a night of call as a (quite inexperienced) medical student generally doesn't result in much help to anyone, except himself. It's this strange feeling of importance (white coat, "helping" make medical decisions) while being utterly inconsequential.
4. Or humane. Or natural. Or fair.
5. Sometimes a resident's page indicates a new admission, and at 4:30 pm I'm rushing out of lab to the ED, in scrubs and a white coat and feeling unsure of my uniform and skill set.
6. Go back to some previous posts, most recently one containing the sentence, "Yawn," or the phrase, "selling out but for less money," and you'll get the idea.
7. Admittedly, the risk of becoming overtly philosophical is highest at this point of the post.
8. If you really want, recall that I wrote these same words in a post during the first week of first year of medical school.
9. That's why I joined an MSTP. In some ways, this post feels like I'm re-writing my personal statement explaining why I want to join a medical scientist training program.
Friday, January 23, 2009
Applicant/prospective OPEN THREAD
In lieu of some posts that are brewing in my head (ICU post, research progress post, other details about the "pretentious" MSTP life), this post is an open thread for applicants and other individuals interested in MSTPs, either at UCLA or in general. So feel free to post away, and we'll offer our thoughts when/if relevant.
Friday, December 26, 2008
Bring it, Block III
Block II introduced the physiology of three organs and how they work together as a system: the heart, the center of the universe; the kidneys, the organ with mysterious forms of regulation; and the lungs, keeping our blood red, not blue or purple (inside joke). The hardest part of the block, though, was parsing the material from lecture, picking and choosing the relevant details, and reassembling it into something more coherent, digestible, which wasn’t that bad. I can’t complain. I enjoyed the material, as long as I didn’t think about it for too long, because when I tried to understand an elusive, mechanistic detail not covered in class, the set of rules given to me failed. What did I expect? Two weeks studying an organ, treating it as something autonomous is risky business: there are who-knows-how-many parameters playing around in the quicksand. So the moral of the story is to have fun learning by picking your intellectual battles: I believe a smart, compassionate student can be selectively apathetic, when appropriate.
Last post I alluded to the holy-grail, the well-intended cliché of balance. I’ll be honest: I wasn’t that successful. Sure I protected an hour here and there for pleasure reading, a weekend free of studying, etc. Something was missing, though: medical school was still dictating my schedule. After talking with my classmates, who have given this issue some thought, I’m teased with the idea that maybe medical school can work around my schedule! So I’ve come up with a New Year’s Resolution: be more promiscuous. *gasp!* This means I’m going to talk to a PI (yes, I have an attractive prospect), attend some lab meetings, read some papers, maybe start a baby experiment!?!?! I also want to read more, write significantly more, volunteer a little, explore my gastronomic talents, and enjoy the culture around me (e.g., the Hammer Poetry Series each Tuesday). I’m ambitious. We’ll see. But I’d like to end the post with a little, hacked-up blurb by the poet Allen Ginsberg that left me inspired to try a little harder. I hope you too can share something from his words, which I feel can be applied to anything you think is creative:
“The parts that embarrass you the most are usually the most interesting poetically, are usually the most naked of all, the rawest, the goofiest, the strangest and most eccentric and at the same time, the most representative, most universal… The cure for that is to write things down which you will not publish and which you won’t show people. To write secretly… so you can actually be free to say anything you want… You really have to make a resolution just to write for yourself…, in the sense of not writing to impress yourself, but just writing what your self is saying.”
Last post I alluded to the holy-grail, the well-intended cliché of balance. I’ll be honest: I wasn’t that successful. Sure I protected an hour here and there for pleasure reading, a weekend free of studying, etc. Something was missing, though: medical school was still dictating my schedule. After talking with my classmates, who have given this issue some thought, I’m teased with the idea that maybe medical school can work around my schedule! So I’ve come up with a New Year’s Resolution: be more promiscuous. *gasp!* This means I’m going to talk to a PI (yes, I have an attractive prospect), attend some lab meetings, read some papers, maybe start a baby experiment!?!?! I also want to read more, write significantly more, volunteer a little, explore my gastronomic talents, and enjoy the culture around me (e.g., the Hammer Poetry Series each Tuesday). I’m ambitious. We’ll see. But I’d like to end the post with a little, hacked-up blurb by the poet Allen Ginsberg that left me inspired to try a little harder. I hope you too can share something from his words, which I feel can be applied to anything you think is creative:
“The parts that embarrass you the most are usually the most interesting poetically, are usually the most naked of all, the rawest, the goofiest, the strangest and most eccentric and at the same time, the most representative, most universal… The cure for that is to write things down which you will not publish and which you won’t show people. To write secretly… so you can actually be free to say anything you want… You really have to make a resolution just to write for yourself…, in the sense of not writing to impress yourself, but just writing what your self is saying.”
Saturday, October 18, 2008
Symposium '08 In Review
Yesterday evening, drowned in glass after glass of wine, the 2008 UCLA MSTP 25th Anniversary Symposium drew to a close.
Yawn.
I believe that conferences - no matter how much excitement they generate - are designed to suck the life out of anyone. To sit through 30+ research talks, have UCLA catering responsible for two day's worth of food intake, and then to become "inspired" to do Great Things when it's all over is impossible.
A more substantive, reflective post to come later. Or not.
Yawn.
I believe that conferences - no matter how much excitement they generate - are designed to suck the life out of anyone. To sit through 30+ research talks, have UCLA catering responsible for two day's worth of food intake, and then to become "inspired" to do Great Things when it's all over is impossible.
A more substantive, reflective post to come later. Or not.
Wednesday, October 08, 2008
Block I Redux: Several hours post-open-book completion
Group dynamics are the ultimate mind-fuck, especially when you are knee-deep in them, with some awareness but not enough to reel yourself out the whole mess. Take middle school and Magic Cards, high school and pervasive faux-ness, college and Natty Ice, and now medical school and anxiety.
The correlation coefficient between exams and anxiety in medical school is approximately 0.99..., and that’s for the pass-fail system. I’m sure pass-fail grading has significantly dampened the anxiety-experience at UCLA, but it still exists because medical students are great at worrying and making you feel like you need to worry as much as they are because no one wants to be That Person who failed Block I.
Block I was an experience, and now that it is over, now that I’m finished test-taking and predicting how comprehensive the block-heads expect my knowledge to be re. the complement system, embryology, etc., I can press the rewind button and revisit these past eight weeks that have progressed oh-so-fast.
I can summarize Block I succulently: Shit, I have learned a lot. Before medical school, I took courses severely detached from medicine like quantum mechanics and NMR spectroscopy. Had you asked me a question about histology, the progression of cancer malignancy, adaptive and innate immunity, I would have responded with blinking. Now I can attempt to provide a bare-bones, over-simplified solution. But hey, something is better than nothing.
Baby steps, I’m telling myself. One step down, two more years’ worth to go. Now that I have grounded myself, my next goal is to balance myself. Medical school throws a lot of information at you. And you are supposed to examine this body of knowledge, as thick a body it is, and be able to manipulate and know the ins-and-outs of this body. I want to please this body, but I am only human, and I can do so much. I need pleasing too. So what’s the plan? I want to find the balance between learning what others expect me to know and what I want to know.
Med-school-Anthony has a lot of learning ahead of him; outside-med-school-Anthony has a lot of maturing ahead of him. My training will influence both spheres, but life exists outside of medical school, despite what some of our classmates may think.
The correlation coefficient between exams and anxiety in medical school is approximately 0.99..., and that’s for the pass-fail system. I’m sure pass-fail grading has significantly dampened the anxiety-experience at UCLA, but it still exists because medical students are great at worrying and making you feel like you need to worry as much as they are because no one wants to be That Person who failed Block I.
Block I was an experience, and now that it is over, now that I’m finished test-taking and predicting how comprehensive the block-heads expect my knowledge to be re. the complement system, embryology, etc., I can press the rewind button and revisit these past eight weeks that have progressed oh-so-fast.
I can summarize Block I succulently: Shit, I have learned a lot. Before medical school, I took courses severely detached from medicine like quantum mechanics and NMR spectroscopy. Had you asked me a question about histology, the progression of cancer malignancy, adaptive and innate immunity, I would have responded with blinking. Now I can attempt to provide a bare-bones, over-simplified solution. But hey, something is better than nothing.
Baby steps, I’m telling myself. One step down, two more years’ worth to go. Now that I have grounded myself, my next goal is to balance myself. Medical school throws a lot of information at you. And you are supposed to examine this body of knowledge, as thick a body it is, and be able to manipulate and know the ins-and-outs of this body. I want to please this body, but I am only human, and I can do so much. I need pleasing too. So what’s the plan? I want to find the balance between learning what others expect me to know and what I want to know.
Med-school-Anthony has a lot of learning ahead of him; outside-med-school-Anthony has a lot of maturing ahead of him. My training will influence both spheres, but life exists outside of medical school, despite what some of our classmates may think.
Sunday, September 28, 2008
Depression as a Terminal Illness
Clinical depression is not just "feeling down." It's a debilitating illness, particularly when it becomes refractory to any treatment. Consider Dave Wallace's final days.
Maturation and Graduate School
I have thought extensively of last about what constitutes a person's "growth" during graduate school. If you have read any of my previous posts, you would imagine that a certain degree of cynicism is inevitable; frustration with experiments either working or not; and unique to the MD/PhD course, trying to remain faithful to the clinical aspects of our careers remains both a priority and dilemma. These are fairly concrete issues that have arisen, and their answers tend to be straightforward: work through the difficulty with experiments (adapt, invent, etc), accept cynicism but don't let it be your downfall, and try try try to get into the clinic once in a while (even if all the forces that be seem diametrically opposed to you in that quest).
I think there is something deeper that graduate research and training does, however. In my estimation, there are several areas in which the maturation we undergo in graduate school manifests.
If we consider the format of graduate training - let's say under the broad umbrella of any of the biomedical sciences - it's the first time in our lives (save for those who took any significant time off from school) that we have significant freedoms. Our schedule (save for a couple of classes) has very little structure. Our work day does not begin at 9 am or end at 5 pm. We don't have "required sessions," "small groups," "doctoring meetings," "preceptorships," "labs"; In many cases, we can take off from lab at a moment's notice if something comes up. We can work very hard or not at all. It really is up to each of us. This is quite a departure from the first two years of medical school as well as from undergraduate years. I'm not saying that during those periods there weren't different levels of engagement or attention (certainly there's a huge spectrum in college, and to a lesser degree medical school), but much of the responsibility and potential successes associated seemed built into the system. Rarely would a person finish undergraduate training early, and certainly not with medical school. And showing up for and doing well on exams (given at specified, pre-planned times) reflects on doing an appropriate amount of work in the time alloted. Graduate school, while having all the same features, seems wide open. Each day in lab - though part of a quest for finding and/or executing a thesis project - can be spent pushing the limit withe experiments; going just one more hour, finding time for one more set of experiments, staying a little later to make sure cells will be ready for the next day of work. As I have begun to find out, a willingness to "push harder" does make a difference. It takes a project from its very nascent stages to being well-developed and sufficient for a thesis. Don't get me wrong, I'm not saying this happens in one "magical" day, but if you pile on enough "push" days, progress is inevitable.
While the desire, and the willingness, to push hard - beyond fatigue, frustration, and failure - is certainly one of the pillars of graduate training, another important aspect that is unique to the training emerges. Many students who enter graduate science programs (and this is certainly the case with MD/PhD-MSTP training environments) have already developed an ability to execute experiments, analyze data, and write-up their results. Obviously, improving on this basic skill set becomes an essential component, but the next major hurdle is one I term to be Full Synthesis. In graduate school - if the training and product that results are satisfactory - then the ultimate goal is to be able to understand where research is at the present, propose a series of experiments, experimentally execute them, and then effectively interpret the results and propose new directions. Getting to this point, I think, is one of the most difficult leaps to make in all of our training; and while certainly we may not be proposing Nobel Prize-winning research in our first attempt at Full Synthesis, we can at least be faithful to the effort. I still struggle mightily with this, because the desire to piggy-back on the ideas of others or search for answers to questions we haven't really asked yet both become traps. I find myself at an interesting cross-roads in this sense. I'm working on a couple of inter-connected projects in the lab, and although I have a firm grasp of the experimental approach I am using and I know a good deal about data analysis, I have yet to really come up with "brilliant" new ideas either for how to analyze the data or craft new experiments to test ever-evolving hypotheses.
Don't get me wrong -- I'm not expecting for the goal of Full Synthesis to be achieved anytime soon. I know it is usually one that comes closer to the end (rather than the beginning) of graduate school; but I'm just saying that it builds in this frustrating tease - this notion that there's a level of intellectual engagement with our work, experimental and analytical command of our work, and an ability to see it all come together in the ultimate "Eureka!" moment. Maybe it will never feel like a "Eureka!" moment, and instead it will resemble something more of a "Duh!" Maybe. I don't think it really matters what the emotions are in the moment. What matters, I think, is that we honestly appraise our abilities now and that going forward we be willing to take on new challenges and responsibilities; we must learn (and dare) to "push" and "synthesize."
I think there is something deeper that graduate research and training does, however. In my estimation, there are several areas in which the maturation we undergo in graduate school manifests.
If we consider the format of graduate training - let's say under the broad umbrella of any of the biomedical sciences - it's the first time in our lives (save for those who took any significant time off from school) that we have significant freedoms. Our schedule (save for a couple of classes) has very little structure. Our work day does not begin at 9 am or end at 5 pm. We don't have "required sessions," "small groups," "doctoring meetings," "preceptorships," "labs"; In many cases, we can take off from lab at a moment's notice if something comes up. We can work very hard or not at all. It really is up to each of us. This is quite a departure from the first two years of medical school as well as from undergraduate years. I'm not saying that during those periods there weren't different levels of engagement or attention (certainly there's a huge spectrum in college, and to a lesser degree medical school), but much of the responsibility and potential successes associated seemed built into the system. Rarely would a person finish undergraduate training early, and certainly not with medical school. And showing up for and doing well on exams (given at specified, pre-planned times) reflects on doing an appropriate amount of work in the time alloted. Graduate school, while having all the same features, seems wide open. Each day in lab - though part of a quest for finding and/or executing a thesis project - can be spent pushing the limit withe experiments; going just one more hour, finding time for one more set of experiments, staying a little later to make sure cells will be ready for the next day of work. As I have begun to find out, a willingness to "push harder" does make a difference. It takes a project from its very nascent stages to being well-developed and sufficient for a thesis. Don't get me wrong, I'm not saying this happens in one "magical" day, but if you pile on enough "push" days, progress is inevitable.
While the desire, and the willingness, to push hard - beyond fatigue, frustration, and failure - is certainly one of the pillars of graduate training, another important aspect that is unique to the training emerges. Many students who enter graduate science programs (and this is certainly the case with MD/PhD-MSTP training environments) have already developed an ability to execute experiments, analyze data, and write-up their results. Obviously, improving on this basic skill set becomes an essential component, but the next major hurdle is one I term to be Full Synthesis. In graduate school - if the training and product that results are satisfactory - then the ultimate goal is to be able to understand where research is at the present, propose a series of experiments, experimentally execute them, and then effectively interpret the results and propose new directions. Getting to this point, I think, is one of the most difficult leaps to make in all of our training; and while certainly we may not be proposing Nobel Prize-winning research in our first attempt at Full Synthesis, we can at least be faithful to the effort. I still struggle mightily with this, because the desire to piggy-back on the ideas of others or search for answers to questions we haven't really asked yet both become traps. I find myself at an interesting cross-roads in this sense. I'm working on a couple of inter-connected projects in the lab, and although I have a firm grasp of the experimental approach I am using and I know a good deal about data analysis, I have yet to really come up with "brilliant" new ideas either for how to analyze the data or craft new experiments to test ever-evolving hypotheses.
Don't get me wrong -- I'm not expecting for the goal of Full Synthesis to be achieved anytime soon. I know it is usually one that comes closer to the end (rather than the beginning) of graduate school; but I'm just saying that it builds in this frustrating tease - this notion that there's a level of intellectual engagement with our work, experimental and analytical command of our work, and an ability to see it all come together in the ultimate "Eureka!" moment. Maybe it will never feel like a "Eureka!" moment, and instead it will resemble something more of a "Duh!" Maybe. I don't think it really matters what the emotions are in the moment. What matters, I think, is that we honestly appraise our abilities now and that going forward we be willing to take on new challenges and responsibilities; we must learn (and dare) to "push" and "synthesize."
Wednesday, September 24, 2008
Nobel Laureates and Teachers
Today, I am joining a group of students having lunch with Nobel Laureate Erwin Neher. Dr. Neher won the 1991 Nobel Prize in Physiology or Medicine for his discovery of the patch clamp technique. The lunch discussion will no doubt provide titillating clues into the genius of Neher, his work over the years, and where he sees science going in the future. As someone who has been working on patch clamp experiments for the past three months or so, and as someone who sees how useful and revolutionary the technique is (and was), I stand in agreement with the thousands of scientists out there who marvel at his work over the years. He indeed contributes to science, medicine, academia, industry - to name a few areas - in innumerable ways. There's almost no debating the "greatness" of a person like Neher.
As I described my schedule for the day to someone this morning, she remarked, "Wow, that is so cool that you get to meet someone who has obviously done so much in the world; someone who's impact has been so immense." For whatever reason -- in part because this discussion was in the context of discussing topics in the first year of the medical school (described by some as "tutoring") -- that description instantly focused my attention on the role of teachers. Teachers spend their time - if they are college professors - doubling as researchers and lecturers/discussion leaders. In the high school or related setting, they focus primarily on introducing concepts, explaining difficult connections, and assessing student performance over time. But regardless of where teachers work and what exactly are their responsibilities, I think (and this certainly isn't a revolutionary idea) they can have an impact on the world that, much like work that warrants a Nobel prize, is not limited in its scope or seriousness.
If I had to choose three elements of my life that I credit with where I am today, I would choose 1) my parents, 2) my good fortune to live in the USA, and 3) my teachers over the years.
That is to say, it's hard to overstate the importance of teachers. Regardless of what I plan to do in the future, being a teacher -- in whatever capacity -- will be a part of my vocation.
I'm as impressed with a nobel laureate as I am with a game-changing teacher. I'll revise this post after the lunch to see if this sentiment holds up.
Update (4:00 P.M.): Sentiment holds up. Neher was great, everything I expected. And the teachers in my life continue to be up there with the Nobel laureates.
As I described my schedule for the day to someone this morning, she remarked, "Wow, that is so cool that you get to meet someone who has obviously done so much in the world; someone who's impact has been so immense." For whatever reason -- in part because this discussion was in the context of discussing topics in the first year of the medical school (described by some as "tutoring") -- that description instantly focused my attention on the role of teachers. Teachers spend their time - if they are college professors - doubling as researchers and lecturers/discussion leaders. In the high school or related setting, they focus primarily on introducing concepts, explaining difficult connections, and assessing student performance over time. But regardless of where teachers work and what exactly are their responsibilities, I think (and this certainly isn't a revolutionary idea) they can have an impact on the world that, much like work that warrants a Nobel prize, is not limited in its scope or seriousness.
If I had to choose three elements of my life that I credit with where I am today, I would choose 1) my parents, 2) my good fortune to live in the USA, and 3) my teachers over the years.
That is to say, it's hard to overstate the importance of teachers. Regardless of what I plan to do in the future, being a teacher -- in whatever capacity -- will be a part of my vocation.
I'm as impressed with a nobel laureate as I am with a game-changing teacher. I'll revise this post after the lunch to see if this sentiment holds up.
Update (4:00 P.M.): Sentiment holds up. Neher was great, everything I expected. And the teachers in my life continue to be up there with the Nobel laureates.
Friday, September 19, 2008
Friday in LA
It's a beautiful Friday, late summer/early fall kind of day. It's sunny, 82 degrees, with 34% humidity at 12:25 pm.
...and this is an average kind of west L.A. day.
A more substantive post to come.
...and this is an average kind of west L.A. day.
A more substantive post to come.
Tuesday, September 16, 2008
Six Years
As Anthony's latest post ("Let's not insulate ourselves") hints, the Pomona community -- and indeed the world of literary scholars, readers, writers, and otherwise interested persons -- was beset this past weekend with unspeakable tragedy. We lost the writer of a generation and a teacher of profound meaning to his students.
I write not to reflect on Dave Wallace; I never studied with him, and I have no unique insights to share. While he inspired me, in many ways, to continue to write after entering the MSTP at UCLA, I can't speak to who DFW was as a person. And so I won't try to reminisce or eulogize. But I have some thoughts on death, dying, grief, and how they don't simply bespeak unimaginable tragedy. They - in sum total - offer us some clues into the human experience: the very act of living.
Six years ago today - two weeks into my freshman year of college - a good friend of mine (fellow musician, tennis player, serious student of science and math) was killed in an automobile accident. He was a man of immense promise, who, in his first few days of college was plucked from the earth.
I can remember the entire sequence of events immediately after his death in chilling detail. The message from my roommate. The frantic phone calls. The confusion: was he still alive? Where was he? He's gone? Oh, my god.
The reality: the tears, the shock, the horror. I remember my friend and sister picking me up from Pomona, the drive home to South Pasadena. The vigil at the High School. I remember then staying stoic for an entire week - between the shocking revelation of his death and his memorial service - and then in an instant succumbing to overwhelming emotion. I recall playing the violin for my friend, a musical ode to a fallen artist.
Another week passed. And then I returned home again - two weeks after he had died - this time to see my friend committed to eternity in the ground below.
To return to the sequence of these events still shakes me to the core. Here I was, all of 19 years old, in the midst of the newness of college, and my friend was dead. Certainly, the rest of his friends and I faced an immense collective loss; but my own mortality was suddenly in the forefront of my mind.
As the young (and the old) tend to do, I spent the days, weeks, and months pondering my own life. What would happen if, in a split second, my life were to end? What kind of mark would I have made, and (perhaps most importantly to me at the time) how would people remember me? I recall thinking about this question frequently when walking across the quad at Pomona, during long runs, and sometimes after an evening of drinking as I faded off to sleep. I (and indeed many of my friends) felt robbed - we were robbed of a good human being, a person who made us laugh, smile, and wonder what he would do next; and we were robbed of our innocence and invincibility. Just when we were beginning to gain our intellectual footing on life, and when our minds and bodies were starting to reach unison in their maturity, our new-found stability and confidence was shattered.
Death was indeed difficult for me to swallow. While of course initially it was a question of justice - just how "wrong" it all was - that was just the first stage. Eventually, I returned to reality and could easily note the world is devoid of justice for millions upon millions of persons. The next step was fragility. Could I be next? Just as with the injustice in the world, I too learned to live with the fragility of life. Next was the live life to the fullest ethos so many people talk about. Again, while this seemed an impossible creed to follow, I soon realized that living life to the fullest was just another expression for authenticity. And who the hell can claim that he really ever reaches total and perfect authenticity? (To this day, it is, like total nirvana, an admirable but unattainable goal).
I guess as that first year began to pass, I gradually turned the corner with my grief. (In fairness, I cannot imagine, and in fact know, that this was not the case for his family. For parents, the overwhelming grief that accompanies the loss of a child is thought to last at least five years before any sense of normalcy can be possibly achieved.) For me, the year ushered in a gradual weathering of my temperament. I was a little bit more introspective, and little less worried about how I looked or what I was doing, and my journeys were a little more personal. Of course, this all seemed to be somewhat at the expense of my social connections during year one at Pomona. (Somehow I was a little disconnected from everyone else, and it wasn't until my third year that a core group of friends would be established.)
In that first year, there were hints that, in spite of the indescribable feeling of loss, I was becoming liberated from some of the innocence of life. This indeed sounds like a contradiction-in-terms. But I think that by going to the dark place of death -- seeing your friend lying in state just a month after he was vibrant, alive -- while staying engaged in life, I began to relish in the act of living. Of course I still wept for my friend. I weep several times a year when I remember him - I wept today for a few moments. But I also love the life I am living and the life that I am capable of living. It's not just a sense of "you never know how long you have to live" kind of feeling that drives this. It is the idea that, in the face of grief and sadness, happiness and ecstasy, or anything in the middle, there is a vital energy we all possess. It's an energy my friend had - it was this energy that drove me to weep for him; but it is also an energy that made me look inward. It made me acknowledge the fragility of my life, reassess the impact of my actions, and my relationships with others. It helped me to love others more fully and gladly, and it in turn made me less afraid to talk about my love for others and express it genuinely.
I still don't think I understand anything better; let's just be clear on that. After all, understanding such questions as "When is it our time?", "What is it like in death?", "What is a meaningful life?" are impossible to answer. I guess realizing that, and accepting the somber reality of death in the presence of our lives, makes the act of living less burdensome. We cannot - in our human existence as it stands - truly understand the nature of questions that science, medicine, philosophy, politics, literature, history, and mathematics have never been (and never will be) able to answer.
But, I do think our minds can evolve - our perspective can become richer and the context in which we ask these questions is capable of generous expansion. As evidence of the Epiphany-in-progress that is life, I recently had a dream about my friend. In it, I swear the premise was that he had never left. I couldn't touch him, and we had non-verbal conversations (almost telepathic, I guess), but he had not left. As I tried to make some meaning out of the dream, I reasoned that this all came back to the "energy" of my friend. Both his energy and my energy come from the same divine elements of the universe. And maybe, just maybe, what happened six years ago has helped me to begin to realize that the very energy that makes us unique (and what makes us grieve for our fallen comrades) is energy indivisible from our own. It forever binds us to them, and them to us. It keeps them in our dreams, and transforms our lives. And it is ubiquitous and limitless in our world--it sets us free.
I write not to reflect on Dave Wallace; I never studied with him, and I have no unique insights to share. While he inspired me, in many ways, to continue to write after entering the MSTP at UCLA, I can't speak to who DFW was as a person. And so I won't try to reminisce or eulogize. But I have some thoughts on death, dying, grief, and how they don't simply bespeak unimaginable tragedy. They - in sum total - offer us some clues into the human experience: the very act of living.
Six years ago today - two weeks into my freshman year of college - a good friend of mine (fellow musician, tennis player, serious student of science and math) was killed in an automobile accident. He was a man of immense promise, who, in his first few days of college was plucked from the earth.
I can remember the entire sequence of events immediately after his death in chilling detail. The message from my roommate. The frantic phone calls. The confusion: was he still alive? Where was he? He's gone? Oh, my god.
The reality: the tears, the shock, the horror. I remember my friend and sister picking me up from Pomona, the drive home to South Pasadena. The vigil at the High School. I remember then staying stoic for an entire week - between the shocking revelation of his death and his memorial service - and then in an instant succumbing to overwhelming emotion. I recall playing the violin for my friend, a musical ode to a fallen artist.
Another week passed. And then I returned home again - two weeks after he had died - this time to see my friend committed to eternity in the ground below.
To return to the sequence of these events still shakes me to the core. Here I was, all of 19 years old, in the midst of the newness of college, and my friend was dead. Certainly, the rest of his friends and I faced an immense collective loss; but my own mortality was suddenly in the forefront of my mind.
As the young (and the old) tend to do, I spent the days, weeks, and months pondering my own life. What would happen if, in a split second, my life were to end? What kind of mark would I have made, and (perhaps most importantly to me at the time) how would people remember me? I recall thinking about this question frequently when walking across the quad at Pomona, during long runs, and sometimes after an evening of drinking as I faded off to sleep. I (and indeed many of my friends) felt robbed - we were robbed of a good human being, a person who made us laugh, smile, and wonder what he would do next; and we were robbed of our innocence and invincibility. Just when we were beginning to gain our intellectual footing on life, and when our minds and bodies were starting to reach unison in their maturity, our new-found stability and confidence was shattered.
Death was indeed difficult for me to swallow. While of course initially it was a question of justice - just how "wrong" it all was - that was just the first stage. Eventually, I returned to reality and could easily note the world is devoid of justice for millions upon millions of persons. The next step was fragility. Could I be next? Just as with the injustice in the world, I too learned to live with the fragility of life. Next was the live life to the fullest ethos so many people talk about. Again, while this seemed an impossible creed to follow, I soon realized that living life to the fullest was just another expression for authenticity. And who the hell can claim that he really ever reaches total and perfect authenticity? (To this day, it is, like total nirvana, an admirable but unattainable goal).
I guess as that first year began to pass, I gradually turned the corner with my grief. (In fairness, I cannot imagine, and in fact know, that this was not the case for his family. For parents, the overwhelming grief that accompanies the loss of a child is thought to last at least five years before any sense of normalcy can be possibly achieved.) For me, the year ushered in a gradual weathering of my temperament. I was a little bit more introspective, and little less worried about how I looked or what I was doing, and my journeys were a little more personal. Of course, this all seemed to be somewhat at the expense of my social connections during year one at Pomona. (Somehow I was a little disconnected from everyone else, and it wasn't until my third year that a core group of friends would be established.)
In that first year, there were hints that, in spite of the indescribable feeling of loss, I was becoming liberated from some of the innocence of life. This indeed sounds like a contradiction-in-terms. But I think that by going to the dark place of death -- seeing your friend lying in state just a month after he was vibrant, alive -- while staying engaged in life, I began to relish in the act of living. Of course I still wept for my friend. I weep several times a year when I remember him - I wept today for a few moments. But I also love the life I am living and the life that I am capable of living. It's not just a sense of "you never know how long you have to live" kind of feeling that drives this. It is the idea that, in the face of grief and sadness, happiness and ecstasy, or anything in the middle, there is a vital energy we all possess. It's an energy my friend had - it was this energy that drove me to weep for him; but it is also an energy that made me look inward. It made me acknowledge the fragility of my life, reassess the impact of my actions, and my relationships with others. It helped me to love others more fully and gladly, and it in turn made me less afraid to talk about my love for others and express it genuinely.
I still don't think I understand anything better; let's just be clear on that. After all, understanding such questions as "When is it our time?", "What is it like in death?", "What is a meaningful life?" are impossible to answer. I guess realizing that, and accepting the somber reality of death in the presence of our lives, makes the act of living less burdensome. We cannot - in our human existence as it stands - truly understand the nature of questions that science, medicine, philosophy, politics, literature, history, and mathematics have never been (and never will be) able to answer.
But, I do think our minds can evolve - our perspective can become richer and the context in which we ask these questions is capable of generous expansion. As evidence of the Epiphany-in-progress that is life, I recently had a dream about my friend. In it, I swear the premise was that he had never left. I couldn't touch him, and we had non-verbal conversations (almost telepathic, I guess), but he had not left. As I tried to make some meaning out of the dream, I reasoned that this all came back to the "energy" of my friend. Both his energy and my energy come from the same divine elements of the universe. And maybe, just maybe, what happened six years ago has helped me to begin to realize that the very energy that makes us unique (and what makes us grieve for our fallen comrades) is energy indivisible from our own. It forever binds us to them, and them to us. It keeps them in our dreams, and transforms our lives. And it is ubiquitous and limitless in our world--it sets us free.
The (unfulfilled) promise of personalized medicine
This recent piece in the NY times outlines one of the current follies in biomedical research. The idea -- sift the human genome and find common, widespread variations that explain some of the most common diseases -- sounded great; in fact, it was downright sexy. But one researcher thinks that's a bunch of rubbish, and that the current (and very expensive) approach isn't working. And some of his rationale is rooted in the logic of rigorous genetic and evolutionary theory.
Not to sound cynical or say "I told you so," but personalized genomic medicine sure sounds a lot like a science project for which many of its conclusions (we'll know what causes X cancer and Y vascular disease) would be highly anticipated at the start of the study.
At any rate, this is food for thought, and we invite the discussion to continue in the "comments" section below.
(Plus, the article is an interesting look into a scientist who has blended population genetics with, in my best estimation, anthropology...)
Not to sound cynical or say "I told you so," but personalized genomic medicine sure sounds a lot like a science project for which many of its conclusions (we'll know what causes X cancer and Y vascular disease) would be highly anticipated at the start of the study.
At any rate, this is food for thought, and we invite the discussion to continue in the "comments" section below.
(Plus, the article is an interesting look into a scientist who has blended population genetics with, in my best estimation, anthropology...)
Sunday, September 14, 2008
Fooling everyone, including ourselves
Science is mighty clever. For a discipline that prides itself in having objectivity and brutal honesty, Science has a lot of dirty little secrets.
Consider news reports that come out -- "Scientists discover X may be linked to Y!" -- and instantly a series of articles state the seemingly indisputable claims that accompany the headlines. Famous researchers go on TV programs, touting the revolutionary results they have obtained, and people marvel at the progress and excitement such work generates.
Beneath the surface, however, is something far more sinister. I will say, and object as you wish (please comment as you see fit) that many of these Amazing Discoveries were a foregone conclusion even before the experiments were done. The answer has a lot to do with the National Institutes of Health (NIH).
Consider how the NIH gives out funding -- it requires that researchers have interesting questions, capable of extensive investigation. Of course they also require that a huge opus of work has already been done on a topic. In so many cases, the finished product is close in sight, and the $1 million + of an RO1 grant rewards the background work much more than it motivates researchers to uncover new, surprising, shocking findings. Being bold - trying outlandish experiments - requires the all-too-rare funding from the Howard Hughes Medical Institute, or from small "seed grants" from the NIH. I don't propose how this gets fixed, but I see a problem in how hard it is to be bold.
I recall a conversation I had with a research mentor early in my training during my undergraduate days at Pomona. I complained that, because I wasn't clear what the point of my research was in a particular area (I was attempting to look at oxygen toxicity in obligate, anaerobic hyperthermophiles - you can understand the contradiction in terms), I probably wouldn't see meaningful results. He explained, "It's easy to obtain and publish results when you know what you're looking for. It's much harder (and braver) to ask questions that no one has ever asked before and then attempt to make sense of experimental results...such results have no real context, but that's real science." I think I understood his point -- the real richness of science is in the truly uncharted, the rarefied air, the untasted vintage. But is such risk-taking conducive to the present world, where we are so pressed for time and money? That I cannot answer. And yet I suspect the scientists who really "get it" (the nobel laureates, the inventors, the pioneers) probably think that there is no other way to do science in spite of every imaginable obstacle convincing them they need not be bold. Maybe.
Returning to the concept of "clarity v. opacity," I think I can claim clarity on one issue: I refuse to submit to a career in either science or medicine where I cannot be bold in my approach and vision. I won't just sit in a lab, with a series of predictable and interesting projects and RO1s to get funded. I refuse. I won't just sit in the hospital or clinic and see patients every day without some sense of adventure or risk-taking. I don't want to do "translational" research if all it means is that target X that we study is related to disease Y. That's not translational. It's correlative and it's pandering. It's like saying, "Well since LA is next to Mexico, everyone who lives in LA has foreign policy experience." Translational research, for which I have a passion, must transcend the traditional boundaries of science and medicine. It must have an infinite growth mindset. It can't just answer the associative question of, "is this applicable to that?"
Research, for me, has to be bold: for it to survive in my restless soul, it must ask new and unheard-of questions. It must, or I will find another way to channel my creativity. Because writing RO1s, sitting in a lab, and pondering how to squeeze more money out of the NIH is not my idea of a career. It's just a less lucrative way of selling out.
Consider news reports that come out -- "Scientists discover X may be linked to Y!" -- and instantly a series of articles state the seemingly indisputable claims that accompany the headlines. Famous researchers go on TV programs, touting the revolutionary results they have obtained, and people marvel at the progress and excitement such work generates.
Beneath the surface, however, is something far more sinister. I will say, and object as you wish (please comment as you see fit) that many of these Amazing Discoveries were a foregone conclusion even before the experiments were done. The answer has a lot to do with the National Institutes of Health (NIH).
Consider how the NIH gives out funding -- it requires that researchers have interesting questions, capable of extensive investigation. Of course they also require that a huge opus of work has already been done on a topic. In so many cases, the finished product is close in sight, and the $1 million + of an RO1 grant rewards the background work much more than it motivates researchers to uncover new, surprising, shocking findings. Being bold - trying outlandish experiments - requires the all-too-rare funding from the Howard Hughes Medical Institute, or from small "seed grants" from the NIH. I don't propose how this gets fixed, but I see a problem in how hard it is to be bold.
I recall a conversation I had with a research mentor early in my training during my undergraduate days at Pomona. I complained that, because I wasn't clear what the point of my research was in a particular area (I was attempting to look at oxygen toxicity in obligate, anaerobic hyperthermophiles - you can understand the contradiction in terms), I probably wouldn't see meaningful results. He explained, "It's easy to obtain and publish results when you know what you're looking for. It's much harder (and braver) to ask questions that no one has ever asked before and then attempt to make sense of experimental results...such results have no real context, but that's real science." I think I understood his point -- the real richness of science is in the truly uncharted, the rarefied air, the untasted vintage. But is such risk-taking conducive to the present world, where we are so pressed for time and money? That I cannot answer. And yet I suspect the scientists who really "get it" (the nobel laureates, the inventors, the pioneers) probably think that there is no other way to do science in spite of every imaginable obstacle convincing them they need not be bold. Maybe.
Returning to the concept of "clarity v. opacity," I think I can claim clarity on one issue: I refuse to submit to a career in either science or medicine where I cannot be bold in my approach and vision. I won't just sit in a lab, with a series of predictable and interesting projects and RO1s to get funded. I refuse. I won't just sit in the hospital or clinic and see patients every day without some sense of adventure or risk-taking. I don't want to do "translational" research if all it means is that target X that we study is related to disease Y. That's not translational. It's correlative and it's pandering. It's like saying, "Well since LA is next to Mexico, everyone who lives in LA has foreign policy experience." Translational research, for which I have a passion, must transcend the traditional boundaries of science and medicine. It must have an infinite growth mindset. It can't just answer the associative question of, "is this applicable to that?"
Research, for me, has to be bold: for it to survive in my restless soul, it must ask new and unheard-of questions. It must, or I will find another way to channel my creativity. Because writing RO1s, sitting in a lab, and pondering how to squeeze more money out of the NIH is not my idea of a career. It's just a less lucrative way of selling out.
Let’s not insulate ourselves
It has been a while since I last wrote on this blog. The reason is silly: I have been expecting significance, a greater meaning from my posts. So here I go:
I am five weeks deep into medical school. The five weeks have been fine. Medical school is medical school. Nothing incredible, nothing amazing, nothing horrible. It has its pros and cons, just like any other program. But I am not writing to rant or rave about my education. Not yet. I am writing to let something out. Bear with me, please, as I struggle with some thoughts.
America is supposed to be a country of ideas, a country where ideas rule, where reason wins. Sometimes the ideas are wrong, propagating a wave of –ists that we are more than ready to forget. The compassionate American will recognize the problems and face them, address them, and challenge them.
I knew a compassionate American. To me he was a teacher, a role-model, an inspiration. I admired the way he used his words to explore what it means to be human, what it means to be an American, living the fuck-ed-ness of our society. He explored lines of thought that the average American prefers to seal off, pretending they do not exist, under the cover of our flag.
This compassionate American hanged himself two days ago. Am I disappointed? Yes. What will I do? Try to be compassionate. Ideas live on, as long as we want them to, right?
I am five weeks deep into medical school. The five weeks have been fine. Medical school is medical school. Nothing incredible, nothing amazing, nothing horrible. It has its pros and cons, just like any other program. But I am not writing to rant or rave about my education. Not yet. I am writing to let something out. Bear with me, please, as I struggle with some thoughts.
America is supposed to be a country of ideas, a country where ideas rule, where reason wins. Sometimes the ideas are wrong, propagating a wave of –ists that we are more than ready to forget. The compassionate American will recognize the problems and face them, address them, and challenge them.
I knew a compassionate American. To me he was a teacher, a role-model, an inspiration. I admired the way he used his words to explore what it means to be human, what it means to be an American, living the fuck-ed-ness of our society. He explored lines of thought that the average American prefers to seal off, pretending they do not exist, under the cover of our flag.
This compassionate American hanged himself two days ago. Am I disappointed? Yes. What will I do? Try to be compassionate. Ideas live on, as long as we want them to, right?
Saturday, July 26, 2008
Clarity and Opacity
I have a habit of declaring that moments in life offer clarity and re-invigorate (and re-define) the purpose behind what I do. Take, for example, my relationships: a series of dates, phone calls, e-mails, and then finally "what are we?" discussions lead to relationship bliss - the moments culminate to define The Relationship as it is. Or in MSTP training: good exam scores, successful grant applications, exciting results in lab, engaging clinical experiences might lead one to say The Career is a purpose-driven existence as a physician scientist.
But what if all along - instead of clarifying or defining - the milestones and the progress actually mean more questions rather than answers? What if tension builds rather than resolves?
I find this happening to me quite regularly. On one hand, things have been going pretty well -- I made it through the first two years of medical school without any major problems, the boards (at least step 1) is done and I passed, research has started (I'm learning new techniques, trouble shooting, etc) and I am funded for grad school (very lucky to have gotten an NRSA)...and I've managed to do a little bit of work in the clinic. So all-in-all, this sounds like The Career scenario above. Except that I don't feel like anything is really clarified. Rather, I see my future as quite unknown. Industry, consulting, purely clinical, purely research, policy, NIH, ahhh! I really have no clue what I will end up settling on for a career.
I think part of this dilemma (and total lack of vision for the future) stems from the nature of the first two years of the MSTP. On one hand, we are consistently medical students for the first two years. On the other hand, our program directors (and our desire to enter the PhD phase of the program with some obvious direction) require that we start thinking about our research goals; i.e. with whom will we rotate, into which program will we enter, and so on...So it's hard to firmly decide. We straddle the fence.
And now in the PhD phase, while it is tempting to completely immerse myself in research, I find myself inexorably drawn to the clinic for work every other week. Although it's for just one morning or afternoon, the experience re-affirms for me the uniqueness of my training plan. To not do this, in my mind, would be heresy; let's face it, we're doing these programs because we believe in the (tantalizing) possibility of translational research. How can we firmly believe in that if we're unable to give up two mornings or two afternoons each month to brush up on our clinical skills?
Indeed I have found my clinical experiences - interspersed within the beginnings of my research training - to be engaging and vital to my perspective on being a physician-scientist. But just as I have lacked clarity to this point, so do such experiences perpetuate the inevitability of opacity as status quo for the MSTP trainee.
But what if all along - instead of clarifying or defining - the milestones and the progress actually mean more questions rather than answers? What if tension builds rather than resolves?
I find this happening to me quite regularly. On one hand, things have been going pretty well -- I made it through the first two years of medical school without any major problems, the boards (at least step 1) is done and I passed, research has started (I'm learning new techniques, trouble shooting, etc) and I am funded for grad school (very lucky to have gotten an NRSA)...and I've managed to do a little bit of work in the clinic. So all-in-all, this sounds like The Career scenario above. Except that I don't feel like anything is really clarified. Rather, I see my future as quite unknown. Industry, consulting, purely clinical, purely research, policy, NIH, ahhh! I really have no clue what I will end up settling on for a career.
I think part of this dilemma (and total lack of vision for the future) stems from the nature of the first two years of the MSTP. On one hand, we are consistently medical students for the first two years. On the other hand, our program directors (and our desire to enter the PhD phase of the program with some obvious direction) require that we start thinking about our research goals; i.e. with whom will we rotate, into which program will we enter, and so on...So it's hard to firmly decide. We straddle the fence.
And now in the PhD phase, while it is tempting to completely immerse myself in research, I find myself inexorably drawn to the clinic for work every other week. Although it's for just one morning or afternoon, the experience re-affirms for me the uniqueness of my training plan. To not do this, in my mind, would be heresy; let's face it, we're doing these programs because we believe in the (tantalizing) possibility of translational research. How can we firmly believe in that if we're unable to give up two mornings or two afternoons each month to brush up on our clinical skills?
Indeed I have found my clinical experiences - interspersed within the beginnings of my research training - to be engaging and vital to my perspective on being a physician-scientist. But just as I have lacked clarity to this point, so do such experiences perpetuate the inevitability of opacity as status quo for the MSTP trainee.
Saturday, July 19, 2008
Open-ended
Note: this post is part fiction, part non-fiction; interpret as you please.
Q—
A— I’m doing well, thanks. Yourself?
Q—
A— That’s good. Well, first year of medical school, I’m excited, yes. It starts August fourth.
Q—
A— I’m not sure. I guess in high school the interests started to form, but I’d rather not rattle of my personal statement. I do remember, though, being placed on the medicine or science track by my high school teachers and advisors.
Q—
A— I don’t want to use the word with a negative connotation. The idea behind track is complicated, and I’m currently struggling with it. In any case, I’m fortunate to have received that type of attention in high school. I was privileged, and I was-slash-still-am naïve.
Q—
A— I was particularly naïve coming out of high school because I had a lot of expectations of college. You know how it goes. It’s been clichéd in a gazillion trashy teen movies and novels. Not that I’ve been exposed to any of this.
Q—
A— An example? Well it’s simple. I though college was about the individual. I thought college was about me, about what I would gain. I thought I would be a sponge, only a sponge. People would feed me, and I would grow without a saturation point. My carrying capacity was supposedly infinitely large, a natural wonder.
Q—
A— Are you making fun of me?
Q—
A—It wasn’t completely my fault. High-school counselors, teachers, peers, literature enabled the creation of a place, College, where the Emersons, the Individuals, created things bigger than themselves.
Q—
A— Entering college I expected of expectations. I was confused, had no idea about what the next four year entailed, so I made things up. The expectations were formed by ill-informed conceptions, filtered and collected by someone who didn’t have an accurate description of reality. Because I didn’t really know what to expect, I formed new expectations, and from these expectations I expected new things, new ideas. I was day dreaming, falling into a recursive trap.
Q—
A— I know I’m being vague and abstract.
Q—
A— So what happened in college? What really happened is I-did-not-suffocate-the-universe-with-my-immensity-because-I learned-that-college-was-not-about-the-College-or-the-Individual. I went to college for a liberal arts education, and I took courses that interested me, and then, thanks to friends, advisors, professors, and mentors, I was given incredible opportunities that started me on the MD-PhD track.
Q—
A—The Emerson-ian-half of Anthony did not like tracks. Tracks specialized my education, thus preventing the formation of a black hole. The realistic-half of Anthony understood that track were a good fit and provided a lot of opportunity, a crap-load, some might say. But it is important to note that the Anthony-of-the-past created a dichotomy between the tracked and un-tracked self.
Q—
A— The answer to that question is way above me. Ask someone else.
Q—
A— The bottom line is that this self is very privileged. Throughout my life, my parents, my friends, my acquaintances have fulfilled themselves by fulfilling me, and now it’s my time to fulfill others. I’m not totally ready yet, but I’m getting there.
Q—
A— Yes. I think medical school will be a nice step forward. I know I will have people to trust and people can trust in me. The support will be there, not just for me, for everyone. I’ve already volunteered myself. Outside of what I just said, I don’t know. I don’t know what the next eight years of my life will entail. I don’t know what to expect, and I don’t want to expect, for reasons you’ve weaseled out of me.
Q—
A— So, long story short, I’m ready to start medical school. I’m excited to start medical school. Along with all this excitement, though, follows some anxiety. Anxiety that stems from the excitement of so many opportunities and resources placed in front of me. An anxiety that is a bedfellow with expectations, because in part the anxiety is an expectation, and I don’t want to believe it is true.
Q—
A— I’d rather not talk about it now. I guess it’s something I’m going to have to find out sooner or later.
Monday, July 14, 2008
The applicant creates an application, which is then digested by a committee and reconstructed back into an applicant (whew!)
I decided not to do a summer rotation. Instead I spent a month and a half traveling around
It has been five months since my last MSTP interview, and I am glad the process is over. At this time last year I was thinking about my secondaries but not filling them out, instead concentrating on summer research. I watched as the number of forms- and essays-to-be-completed added up, reaching 15. I waited and waited until I achieved an appropriate headspace, after finishing my summer work, and resumed the application process, which lasted way too long when final decisions were sent out in middle March.
Now that I’m a veterano, experienced in the ways of interview gaffes, I’ll share my opinion regarding the application process. My opinion is pessimistic. My opinion is jaded. Whatever.
The key to the application process is to think like a car salesman, a damned good one, so good that she can write and speak about herself in a way that is seamlessly authentic, an anti-car-salesman, but because the illusion of authenticity is manufacture, in essence, the best applicant is the anti-anti-car-salesman. Enough with the meta-jiberish—I’ll save it for later.
The applicant needs to separate herself from others, create hype about her potential, and promote herself as a worthy INVESTMENT to the medical-scientist community. That being said, absurd stats (MCAT, GPA, # of pubs, etc.) are nice but not necessary because LOR’s, and personal statements and experience are equally important, and not quantitative. With that said, I can think of two rough tiers of assessment in the application process. (Feel free to add more factors that I’m forgetting.)
Tier One: MCAT, grades, LOR’s, personal statement, research experience
Tier Two: number of publications, clinical hours, extracurricular
The application selection process is complex. I have no idea what goes on behind the scenes. I could speculate about formulas to achieving interviews and acceptances, but I won’t. What I will say is, be smart with your words, tie your narrative with your career goals, be the anti-anti-car-salesman. But N.B., the anti-anti-car-salesman (okay, now for an invented acronym: aacs) is not bad. The aacs is genuinely interested in a career as a medical-scientist. The aacs is passionate about research and medicine, and wants to contribute to society. The aacs is confident, has a sense of direction, a career trajectory, and can create links between basic science and translation research. Often the aacs is so good that they have even fooled themselves.
Anyway, I have digressed into potentially worthless metaphor, but if I can give one piece of advice, the ideal applicant will create an application that constructs an applicant, perceived by the individual reader and collective committee, with confidence, passion, and sense of service. The applicant should be a master of words.
I think I have given myself a headache now, so I am signing off for now. I may post soon about my thoughts regarding the start of MS1 (August 4th!).
Monday, July 07, 2008
Q and A, part 2
Another question from a visitor to this blog:
I've a few questions about the MSTP program. More specifically, how your application process went. I'm wondering what sort of laboratory/clinical experience you had before applying to your program? What were your MCAT scores? Also what did you study in your undergraduate years?
I'll start with the quicker stuff first.
In terms of MCAT scores, I'm happy to give a range of scores (it's not really necessary to give individual scores, because everyone is different and the test will be different than it was in 2005 in terms of average scores, etc). Of the people I know in the program (including me) here are some scores:
34, 37, 36, 38
(I don't include writing because I'm not sure a single person remembers his or her writing scores...and people, especially MSTP folks, really don't care much about it).
My research experience began the summer after my freshman year and continued until I graduated. (I went to Pomona College in Claremont, California - Pomona is a small liberal arts college with active researchers in Biology, Chemistry, Physics, and Mathematics; I was a Chemistry major with a Biochemistry emphasis - there was no Biochemistry major when I attended Pomona). To be honest (because on applications it is easy to claim continuity of research) I probably worked an average of a day every other week during the year and then ~10 weeks during the summers; however, I worked in spurts, so some really meaningful experiments and results were still performed and obtained, respectively, during the years. I was fortunate to be funded as a researcher starting after freshman year - I wasn't a tech or a dishwasher, so I had a project of sorts early on, and it developed into a story that comprised two publications and a senior thesis.
I think there's a major take-home about my research experience: I could discuss my research formally and informally early on because I had a project I was invested in from the start. And so, when it came time to interview for MSTPs when I was a senior, it was second nature to talk about research. For the most, this helped me during my interviews. That said, I had a rocky start with interviews (UCSF, for example; though I would say some of that had to do with getting interviews with 'difficult' individuals, to put it nicely). So I would suggest getting your story straight - figure out how to explain the experiments you did, the background/motivation behind the work you did, where it fits into an interest in medicine, and what you see yourself doing in the future. There are no correct answers in this, but earnest and well-informed ones are rewarded with thick acceptance packets in March or April.
Don't let the fact that I (or others) have done quite a bit of research discourage individuals who have spent less time in a lab -- your commitment to a project, grasp of the subject matter, performance in classes, and letter from PI can all help if the amount of time is lacking. And if you feel you're not quite there with your research experience, by all means consider taking a year off. (In any event, admissions committees will want to know what you did if it wasn't research. If you were still trying to find your passions, and research is what you landed at, taking more time is never a bad thing).
As I said above, I was a Chemistry major at Pomona; thus I took a variety of classes related to my major (calculus series, physics, Gen Chem, O-chem, P-chem, P-chem lab, Analytical Lab, Biochem, Bio-organic chem, Analytical chem, NMR spectroscopy, senior thesis, independent study) and those for biology/med school (Genetics, Cell and molecular biology - this is a misnomer, as Pomona's intro course has now been correctly re-named cell biology and cell chemistry; and DNA repair and human disease. Being that Pomona is a liberal arts college, I also studied some classics (greek literature, lower levels), art history, music (I played in the orchestra throughout my time at Pomona and studied in the music department on solo and chamber music), shakespeare. I'm not rattling this off to be impressive - most Pomona students do this and more (there is a bit of a grade inflation problem at the school) - but instead to say that people (read: MSTP admissions committees) like this kind of diversity in courses, with also a clear commitment to some major - which doesn't necessarily have to be science. Case in point, a soon-to-be second year in the UCLA MSTP was once-upon-a-time a humanities major at a small liberal arts college. She did post-bac work, research at the NIH, and now is passionate about becoming a physician-scientist.
I spent about 2 months at the Pomona Valley Hospital doing one evening a week of bed changing, patient escorting, and other mindless tasks. But I got a sniff of medicine, and I liked what I was sniffing. My most exciting moment there, incidentally, was as a patient with a subluxated (a.k.a. dislocated) knee-cap.
Ahhhh - the application process. I'm not sure where to start. I think the short answer is that when I started my application, I felt like I really believed in being a physician-scientist, and so answering questions that asked me to expound on my belief in research and medicine weren't that difficult. It didn't hurt that I was forced out of physical activity for a month after the knee injury. I will try to add some other thoughts about the application process in more detail in a later post; for now, I seek some R and R before a busy day in lab tomorrow.
I've a few questions about the MSTP program. More specifically, how your application process went. I'm wondering what sort of laboratory/clinical experience you had before applying to your program? What were your MCAT scores? Also what did you study in your undergraduate years?
I'll start with the quicker stuff first.
In terms of MCAT scores, I'm happy to give a range of scores (it's not really necessary to give individual scores, because everyone is different and the test will be different than it was in 2005 in terms of average scores, etc). Of the people I know in the program (including me) here are some scores:
34, 37, 36, 38
(I don't include writing because I'm not sure a single person remembers his or her writing scores...and people, especially MSTP folks, really don't care much about it).
My research experience began the summer after my freshman year and continued until I graduated. (I went to Pomona College in Claremont, California - Pomona is a small liberal arts college with active researchers in Biology, Chemistry, Physics, and Mathematics; I was a Chemistry major with a Biochemistry emphasis - there was no Biochemistry major when I attended Pomona). To be honest (because on applications it is easy to claim continuity of research) I probably worked an average of a day every other week during the year and then ~10 weeks during the summers; however, I worked in spurts, so some really meaningful experiments and results were still performed and obtained, respectively, during the years. I was fortunate to be funded as a researcher starting after freshman year - I wasn't a tech or a dishwasher, so I had a project of sorts early on, and it developed into a story that comprised two publications and a senior thesis.
I think there's a major take-home about my research experience: I could discuss my research formally and informally early on because I had a project I was invested in from the start. And so, when it came time to interview for MSTPs when I was a senior, it was second nature to talk about research. For the most, this helped me during my interviews. That said, I had a rocky start with interviews (UCSF, for example; though I would say some of that had to do with getting interviews with 'difficult' individuals, to put it nicely). So I would suggest getting your story straight - figure out how to explain the experiments you did, the background/motivation behind the work you did, where it fits into an interest in medicine, and what you see yourself doing in the future. There are no correct answers in this, but earnest and well-informed ones are rewarded with thick acceptance packets in March or April.
Don't let the fact that I (or others) have done quite a bit of research discourage individuals who have spent less time in a lab -- your commitment to a project, grasp of the subject matter, performance in classes, and letter from PI can all help if the amount of time is lacking. And if you feel you're not quite there with your research experience, by all means consider taking a year off. (In any event, admissions committees will want to know what you did if it wasn't research. If you were still trying to find your passions, and research is what you landed at, taking more time is never a bad thing).
As I said above, I was a Chemistry major at Pomona; thus I took a variety of classes related to my major (calculus series, physics, Gen Chem, O-chem, P-chem, P-chem lab, Analytical Lab, Biochem, Bio-organic chem, Analytical chem, NMR spectroscopy, senior thesis, independent study) and those for biology/med school (Genetics, Cell and molecular biology - this is a misnomer, as Pomona's intro course has now been correctly re-named cell biology and cell chemistry; and DNA repair and human disease. Being that Pomona is a liberal arts college, I also studied some classics (greek literature, lower levels), art history, music (I played in the orchestra throughout my time at Pomona and studied in the music department on solo and chamber music), shakespeare. I'm not rattling this off to be impressive - most Pomona students do this and more (there is a bit of a grade inflation problem at the school) - but instead to say that people (read: MSTP admissions committees) like this kind of diversity in courses, with also a clear commitment to some major - which doesn't necessarily have to be science. Case in point, a soon-to-be second year in the UCLA MSTP was once-upon-a-time a humanities major at a small liberal arts college. She did post-bac work, research at the NIH, and now is passionate about becoming a physician-scientist.
I spent about 2 months at the Pomona Valley Hospital doing one evening a week of bed changing, patient escorting, and other mindless tasks. But I got a sniff of medicine, and I liked what I was sniffing. My most exciting moment there, incidentally, was as a patient with a subluxated (a.k.a. dislocated) knee-cap.
Ahhhh - the application process. I'm not sure where to start. I think the short answer is that when I started my application, I felt like I really believed in being a physician-scientist, and so answering questions that asked me to expound on my belief in research and medicine weren't that difficult. It didn't hurt that I was forced out of physical activity for a month after the knee injury. I will try to add some other thoughts about the application process in more detail in a later post; for now, I seek some R and R before a busy day in lab tomorrow.
Friday, July 04, 2008
Q and A
In the previous post, an anonymous reader posted the following question:
There are a lot of people applying for this program for the wrong reasons, like top residency, free medical school and etc... What do you have to say to those that lack the passion to do translational research?
I agree that many people do apply for MSTPs for the wrong reasons; it's also true that people apply to medical school alone, law school, podiatry school, dental school, graduate school, and so on for the wrong reasons. In the case of MSTP students doing so, I have a feeling the decision comes back to haunt them. The problem is this: 1) either you enter such a program, realize the research isn't for you, and then opt out after two years or 2) you go forward with graduate training knowing all along that research isn't for you. Both cases are undesirable. In the first case (two free years of medical school), a big reason for why you were admitted to medical school was that you were an MSTP student, hoping to do research and receive clinical training. If that goes away, what remains? Clearly, if a student had not dropped out before then end of second year of medical school, then research rotations had to have been done; and if this were the case, what does such a student tell residency directors asking what they did for the time between years one and two? "Uh, I was in the MSTP and decided it wasn't for me..." -- that has to be about the opposite of the supposed "MSTP boost" that MD/PhD students are known to benefit from on their residency applications. So while it could be a little bit harmful, the major consequence of dropping out of the dual degree program is the lack of benefit from research training and the distinction it provides you in contrast with the rest of your medical school colleagues.
In the second example (going forward with research with no intention to do it one day), the draw-back is personal and the suffering can be immense. Graduate school - as I am beginning to realize - can be approached from many different angles, and effort varies across a wide, wide spectrum. Poor effort generally means a long PhD, and I would venture to guess it is more common in students who really didn't want to do a PhD in the first place (but liked the idea of having two degrees after their names)
. I can say that I've done the math, and for individuals who choose to suffer through the PhD just for the sake of it, MSTP is not more beneficial financially even in the short-term after medical training is complete. A short time in a middle-of-the-road paying sub-specialty (presumably) outside of academia (since these people sort of swear off research after residency) will make up most of the difference that staying in the MSTP would have offered.
Alas, I'm not exactly answering the question. In the two above cases, I argue that it just doesn't much make sense to be in an MSTP for the more superficial and/or personal suffering reasons. But what to say to someone who lacks a passion for translational research?
I think that is a difficult question. The cynical response to the question would be that a person lacking a passion for translation research is a realist. In many fields, the true promise of translational research is far from reality, and so the absence of "passion" could be a recognition of a lack of feasibility in many areas. On the other hand, a more idealistic response would be this: the future (and don't ask me when, I'm like John McCain on this one, I don't do timetables) of medicine will be translational (read: stem cells, genomic/proteomic medicine...) and to not have some kind of passion is like fatally dooming a career before it starts...or something like that.
More than likely, what I would say to a person lacking a "passion" (and we'll say for research, translational or otherwise) is this: this program is not for you, and figuring it out sooner rather than later will be of great benefit to your career.
This is, of course, not to say that one must have a vision of the future well mapped out prior to entering medical school. In fact, as long as there is some passion for research, the rest can figure itself out. In my case, I find the future to be wide open. I knew I wanted research training, and I felt that there was no way I could have decided between straight medical school and a straight PhD program. Somehow, I will connect the passion for the two together, even though I haven't figured out a plan at this point. So maybe I'll go to an internal medicine + sub-specialty fellowship into postdoc and then look for positions in academics. Or maybe I'll go the surgery route and find ways to be more of a collaborator with persons solely dedicated to research. Or maybe I'll go to residency and then consult for biotechnology companies. Or whatever. The point in this case is that I couldn't imagine my life at this point without medicine or without research. Both are a part of who I am.
I should also add that in today's funding environment of the NIH - shitty - it doesn't hurt to have a researcher's best insurance policy, an MD; when people in my lab/department first mentioned it, I thought they were joking - always poking fun at the med students. But then I realized they weren't kidding. People are getting royally screwed right now because the NIH budget was slashed so that we could (warning: irrational half sentence rant to follow) go fight some stupid war in the middle east. People who have been funded for more than a quarter century on the same R01's not getting the easy renewals they once did, and there has been quite a shake-up in academia. Not to say that there aren't options for straight PhDs, but making it isn't easy and might take post-doc'ing and slave laboring in graduate school that rivals the length and effort involved in obtaining a dual degree. Oh yeah, and medicine is kind of screwed as well. Although some say it's doomed, I would say it's just entering a long and awkward phase of puberty. It's growing male breasts right now, has acne and spotty facial hair, and it gets irrationally upset and needs large amounts of sleep and its experimenting with masturbation (it's kind of screwing itself right now). Being a professional in medicine, research, or both will be better in the future; when that is, and how it manifests, who can say? But I'm glad to be in both.
There are a lot of people applying for this program for the wrong reasons, like top residency, free medical school and etc... What do you have to say to those that lack the passion to do translational research?
I agree that many people do apply for MSTPs for the wrong reasons; it's also true that people apply to medical school alone, law school, podiatry school, dental school, graduate school, and so on for the wrong reasons. In the case of MSTP students doing so, I have a feeling the decision comes back to haunt them. The problem is this: 1) either you enter such a program, realize the research isn't for you, and then opt out after two years or 2) you go forward with graduate training knowing all along that research isn't for you. Both cases are undesirable. In the first case (two free years of medical school), a big reason for why you were admitted to medical school was that you were an MSTP student, hoping to do research and receive clinical training. If that goes away, what remains? Clearly, if a student had not dropped out before then end of second year of medical school, then research rotations had to have been done; and if this were the case, what does such a student tell residency directors asking what they did for the time between years one and two? "Uh, I was in the MSTP and decided it wasn't for me..." -- that has to be about the opposite of the supposed "MSTP boost" that MD/PhD students are known to benefit from on their residency applications. So while it could be a little bit harmful, the major consequence of dropping out of the dual degree program is the lack of benefit from research training and the distinction it provides you in contrast with the rest of your medical school colleagues.
In the second example (going forward with research with no intention to do it one day), the draw-back is personal and the suffering can be immense. Graduate school - as I am beginning to realize - can be approached from many different angles, and effort varies across a wide, wide spectrum. Poor effort generally means a long PhD, and I would venture to guess it is more common in students who really didn't want to do a PhD in the first place (but liked the idea of having two degrees after their names)
. I can say that I've done the math, and for individuals who choose to suffer through the PhD just for the sake of it, MSTP is not more beneficial financially even in the short-term after medical training is complete. A short time in a middle-of-the-road paying sub-specialty (presumably) outside of academia (since these people sort of swear off research after residency) will make up most of the difference that staying in the MSTP would have offered.
Alas, I'm not exactly answering the question. In the two above cases, I argue that it just doesn't much make sense to be in an MSTP for the more superficial and/or personal suffering reasons. But what to say to someone who lacks a passion for translational research?
I think that is a difficult question. The cynical response to the question would be that a person lacking a passion for translation research is a realist. In many fields, the true promise of translational research is far from reality, and so the absence of "passion" could be a recognition of a lack of feasibility in many areas. On the other hand, a more idealistic response would be this: the future (and don't ask me when, I'm like John McCain on this one, I don't do timetables) of medicine will be translational (read: stem cells, genomic/proteomic medicine...) and to not have some kind of passion is like fatally dooming a career before it starts...or something like that.
More than likely, what I would say to a person lacking a "passion" (and we'll say for research, translational or otherwise) is this: this program is not for you, and figuring it out sooner rather than later will be of great benefit to your career.
This is, of course, not to say that one must have a vision of the future well mapped out prior to entering medical school. In fact, as long as there is some passion for research, the rest can figure itself out. In my case, I find the future to be wide open. I knew I wanted research training, and I felt that there was no way I could have decided between straight medical school and a straight PhD program. Somehow, I will connect the passion for the two together, even though I haven't figured out a plan at this point. So maybe I'll go to an internal medicine + sub-specialty fellowship into postdoc and then look for positions in academics. Or maybe I'll go the surgery route and find ways to be more of a collaborator with persons solely dedicated to research. Or maybe I'll go to residency and then consult for biotechnology companies. Or whatever. The point in this case is that I couldn't imagine my life at this point without medicine or without research. Both are a part of who I am.
I should also add that in today's funding environment of the NIH - shitty - it doesn't hurt to have a researcher's best insurance policy, an MD; when people in my lab/department first mentioned it, I thought they were joking - always poking fun at the med students. But then I realized they weren't kidding. People are getting royally screwed right now because the NIH budget was slashed so that we could (warning: irrational half sentence rant to follow) go fight some stupid war in the middle east. People who have been funded for more than a quarter century on the same R01's not getting the easy renewals they once did, and there has been quite a shake-up in academia. Not to say that there aren't options for straight PhDs, but making it isn't easy and might take post-doc'ing and slave laboring in graduate school that rivals the length and effort involved in obtaining a dual degree. Oh yeah, and medicine is kind of screwed as well. Although some say it's doomed, I would say it's just entering a long and awkward phase of puberty. It's growing male breasts right now, has acne and spotty facial hair, and it gets irrationally upset and needs large amounts of sleep and its experimenting with masturbation (it's kind of screwing itself right now). Being a professional in medicine, research, or both will be better in the future; when that is, and how it manifests, who can say? But I'm glad to be in both.
Tuesday, July 01, 2008
New beginnings...
As a first year PhD student, I'm close to being smack-dab in the middle of our program. So it's with some sense of surprise that I got the following recently:
"...On behalf of UCLA, I'm extending an official offer of admission to the Graduate Division. You have been singled out from a pool of exceptionally qualified and talented applicants in a rigorous and highly competitive process. Your selection recognizes your academic accomplishments and potential for advanced scholarship. Let me add my personal congratulations to those of your family and friends..."
It turns out that when we go from the first two years of medical school into graduate school, we have to "apply" to our graduate programs. It's sort of fun to get letters like these when you did nothing but fill out some online forms stating your date of birth, city of origin, country of citizenship, etc...I suppose I could rant about how these form letters cheapen the meaning of such an acceptance to a person who was actually waiting for it, but whatever, there's no need.
I will continue some of my boards thoughts and offer some perspectives about the transition to graduate training when I finish the back-log of laundry I have at the moment.
Good luck to all incoming first years and folks applying at the moment!
"...On behalf of UCLA, I'm extending an official offer of admission to the Graduate Division. You have been singled out from a pool of exceptionally qualified and talented applicants in a rigorous and highly competitive process. Your selection recognizes your academic accomplishments and potential for advanced scholarship. Let me add my personal congratulations to those of your family and friends..."
It turns out that when we go from the first two years of medical school into graduate school, we have to "apply" to our graduate programs. It's sort of fun to get letters like these when you did nothing but fill out some online forms stating your date of birth, city of origin, country of citizenship, etc...I suppose I could rant about how these form letters cheapen the meaning of such an acceptance to a person who was actually waiting for it, but whatever, there's no need.
I will continue some of my boards thoughts and offer some perspectives about the transition to graduate training when I finish the back-log of laundry I have at the moment.
Good luck to all incoming first years and folks applying at the moment!
Tuesday, June 10, 2008
E-mail list!
As I have mentioned a fair amount, we're attempting to keep this blog going. In the spirit of this, we'd like to keep any readers updated as to when new posts go out, and of any other goings on. As such, we have set up a new e-mail address, where you may subscribe to our email list - just send an email to mstpla@gmail.com with the subject line reading "subscribe," and we'll keep you up to date. And of course any inquiries, comments, concerns, etc may be sent to this address as well.
Post-Mortem Board Report
Every time I thought I was going to come home from the library and create a blog post on studying for the boards, I found something else to do, such as:
1. Eat canned black beans for the 5th straight evening.
2. Drink my ration of 2 glasses of red wine.
3. Watch a round-up of the best NBA playoffs in years and constantly remind myself I was not watching this because the studying was for a good cause.
4. Try to furiously send text messages to all the non-med-school people I knew and beg them to go out with me on the evenings I ended early and was taking some R&R (I wasn't too successful at this).
In any event, no posts would arrive after the first. Perhaps that is most illustrative of The Experience of studying for the USMLE step 1. I like to think of it as being transported into another dimension for, give or take, six weeks time. Everything else in your life has to take a breather. Well, at least that was my approach; which brings me to my next point. However much you (or I, or anyone else for that matter) hear things from other folks who take the exam, the most important point you can reach is that of personal enlightenment - the point where you have some idea of how your experience will play out, you have a plan for yourself, and you know how to stick to it. With that, I offer the following impressions not as a guide for others (you will probably not need to study immunology as much as I did (I still am hopeless with those Ts/Bs/Natural Killers/Langerhan, etc) nor will you likely be compelled to carry "Grays Anatomy for Students," with you to the library), but as some insight into the growth and discovery that I think makes the studying for step 1 (get ready for this) a worthwhile experience that builds character.
[I should first offer the following disclaimer: I am painfully and painstakingly superstitious about my examination performance - just ask any of my friends - so one should not read into this post as a reflection of success or bitter failure on my part; the exam was reasonable, fair, but I still could have bombed it. So until about July 15th, don't ask me how I did or assume one way or the other. Thank you. You may now diagnose me with one of the personality disorder cluster types (A, B, C, with sub-categories)].
And so, I begin with Charles' first three Ramblings on the USMLE step 1, as (un)commissioned by http://mstpla.blogspot.com:
1. Physical ailments are an inevitability, but not necessarily irreversible. Studying for 15-16 hours a day (which, according to the folks that "primed" us for boards studying at UCLA, is about 7-8 hours too many a day) takes a physical toll. For me, the most significant were lower back pain (a.k.a LBP or Mechanical Back Pain), a bizarre, bilateral fungal infection on my elbows (which Kevin helped me diagnose based on the fact that a short course with topical corticosteroids made the tinea markedly worse), double vision (a.k.a. diplopia) at, consistently, hour 13 each day, near-crippling dominant hand pain secondary to furious annotation of "First Aid 2008," two upper respiratory tract infections (I had not had a single sore throat or cough for two years prior), and of course self-limited gastroenteritis secondary to dining at the hospital cafeteria. Oh I forgot - my derrière was absurdly sore on several occasions; it didn't matter that the chairs in the library rooms we of outstanding comfort (and their height could be easily adjusted). Somehow the human body has trouble sitting for so long. Or I am particularly sensitive or allow undue chafing to get the better of me. Don't worry, friends, there were no short or long-term complications of the pain.
2. On more than one occasion, my friends and colleagues accused me of being two "hard-core," in that I would, at the two-weeks-before-the-exam peak of my studying arrive at the graduate reading room at 6:30 a.m. and study (with food to accompany at appropriate times) until around 10-10:30 p.m. I vehemently disagreed most of the time. If I was happy, not excessively fatigued (during the last couple of weeks, you can probably get away with 6-6.5 hours of sleep and be fine), and able to focus, what was the problem? And furthermore, one becomes inevitably stressed out during the last part of the studying experience (you feel you have to know everything and you know a fraction of it), and so I could imagine a much worse approach would be to slack-off (but feel rested and rejuvinated), and then come to the library with an insurmountable deficit of time and effort. I suppose if one is prone to becoming ignorant and blissful, the latter approach is appropriate. I am not one of those who has either ignorance or bliss during exam preparations. I thought of it like this: How am I going to feel right after the exam? If I put in less than "100%" of the effort I could, such a moment would be neither satisfying or enjoyable (and probably frustrating, filled with "could haves" and "should haves.")
One caveat to all of that: about three days before the exam when I repaired to my folks place in Pasadena for the final stretch (at some point, the toxic environment of medical students studying for step 1 in the same vicinity is too much), I hit a wall. I was unfathomably fatigued, for whatever reason, and it showed: I had just contracted my second upper respiratory tract infection of the six weeks, I had done a set of practice questions where I score ~20-30% below my average at the time, and I was hopelessly behind on my daily schedule for getting through endless amounts of last minute pharmacology and pathology images. I must thank my mother for observing me as I began to eat another fine home-cooked meal, who said, "You know, you really need to get some rest. You're going to be a disaster on exam day. Just go to bed in the next 30 minutes (which would have been 10 pm), and start back at it tomorrow." Going to bed and catching up on some sleep was the best thing I could have done. The next day, I was rejuvinated, was able to return to the 6-6.5 hour sleep schedule, and my mind was sharp (enough) on exam day.
3. I suppose #2 inevitably leads me to my next point. Flexibility is a must-have in the boards studying. Think of it as a healthy exercise in self-regulation (important concept in psychology and psychiatry) - dealing with not getting through that which you have planned for the day, a less-than-ideal score on a practice test, and so forth - that is not just necessary but also vital to keeping sanity in the process. There's enough riding on this whole experience, and stressing out over whether you got through 35 versus 37 pages of renal on a certain day doesn't need to be one of the areas in which that happens. Schedules can be modified. I know that for me, I had to trim down my expectations for final reviewing when all was said and done. It's just not feasible to memorize every word on every page of first aid. Better to take the triage approach to the material at the last minute. On the morning of the exam, I knew that the neurocutaneous disorders (like tuberous sclerosis and neurofibromatosis) were weak in my memory. And so I reviewed them for ten minutes. It turned out that doing that was beneficial - I got a question on tuberous sclerosis on the actual exam. Had I thought reviewing all of First Aid was feasible, I might not have helped myself at all...
More thoughts to come. Fellow Step 1 takers, what are your thoughts? Please comment and let's continue the discussion.
1. Eat canned black beans for the 5th straight evening.
2. Drink my ration of 2 glasses of red wine.
3. Watch a round-up of the best NBA playoffs in years and constantly remind myself I was not watching this because the studying was for a good cause.
4. Try to furiously send text messages to all the non-med-school people I knew and beg them to go out with me on the evenings I ended early and was taking some R&R (I wasn't too successful at this).
In any event, no posts would arrive after the first. Perhaps that is most illustrative of The Experience of studying for the USMLE step 1. I like to think of it as being transported into another dimension for, give or take, six weeks time. Everything else in your life has to take a breather. Well, at least that was my approach; which brings me to my next point. However much you (or I, or anyone else for that matter) hear things from other folks who take the exam, the most important point you can reach is that of personal enlightenment - the point where you have some idea of how your experience will play out, you have a plan for yourself, and you know how to stick to it. With that, I offer the following impressions not as a guide for others (you will probably not need to study immunology as much as I did (I still am hopeless with those Ts/Bs/Natural Killers/Langerhan, etc) nor will you likely be compelled to carry "Grays Anatomy for Students," with you to the library), but as some insight into the growth and discovery that I think makes the studying for step 1 (get ready for this) a worthwhile experience that builds character.
[I should first offer the following disclaimer: I am painfully and painstakingly superstitious about my examination performance - just ask any of my friends - so one should not read into this post as a reflection of success or bitter failure on my part; the exam was reasonable, fair, but I still could have bombed it. So until about July 15th, don't ask me how I did or assume one way or the other. Thank you. You may now diagnose me with one of the personality disorder cluster types (A, B, C, with sub-categories)].
And so, I begin with Charles' first three Ramblings on the USMLE step 1, as (un)commissioned by http://mstpla.blogspot.com:
1. Physical ailments are an inevitability, but not necessarily irreversible. Studying for 15-16 hours a day (which, according to the folks that "primed" us for boards studying at UCLA, is about 7-8 hours too many a day) takes a physical toll. For me, the most significant were lower back pain (a.k.a LBP or Mechanical Back Pain), a bizarre, bilateral fungal infection on my elbows (which Kevin helped me diagnose based on the fact that a short course with topical corticosteroids made the tinea markedly worse), double vision (a.k.a. diplopia) at, consistently, hour 13 each day, near-crippling dominant hand pain secondary to furious annotation of "First Aid 2008," two upper respiratory tract infections (I had not had a single sore throat or cough for two years prior), and of course self-limited gastroenteritis secondary to dining at the hospital cafeteria. Oh I forgot - my derrière was absurdly sore on several occasions; it didn't matter that the chairs in the library rooms we of outstanding comfort (and their height could be easily adjusted). Somehow the human body has trouble sitting for so long. Or I am particularly sensitive or allow undue chafing to get the better of me. Don't worry, friends, there were no short or long-term complications of the pain.
2. On more than one occasion, my friends and colleagues accused me of being two "hard-core," in that I would, at the two-weeks-before-the-exam peak of my studying arrive at the graduate reading room at 6:30 a.m. and study (with food to accompany at appropriate times) until around 10-10:30 p.m. I vehemently disagreed most of the time. If I was happy, not excessively fatigued (during the last couple of weeks, you can probably get away with 6-6.5 hours of sleep and be fine), and able to focus, what was the problem? And furthermore, one becomes inevitably stressed out during the last part of the studying experience (you feel you have to know everything and you know a fraction of it), and so I could imagine a much worse approach would be to slack-off (but feel rested and rejuvinated), and then come to the library with an insurmountable deficit of time and effort. I suppose if one is prone to becoming ignorant and blissful, the latter approach is appropriate. I am not one of those who has either ignorance or bliss during exam preparations. I thought of it like this: How am I going to feel right after the exam? If I put in less than "100%" of the effort I could, such a moment would be neither satisfying or enjoyable (and probably frustrating, filled with "could haves" and "should haves.")
One caveat to all of that: about three days before the exam when I repaired to my folks place in Pasadena for the final stretch (at some point, the toxic environment of medical students studying for step 1 in the same vicinity is too much), I hit a wall. I was unfathomably fatigued, for whatever reason, and it showed: I had just contracted my second upper respiratory tract infection of the six weeks, I had done a set of practice questions where I score ~20-30% below my average at the time, and I was hopelessly behind on my daily schedule for getting through endless amounts of last minute pharmacology and pathology images. I must thank my mother for observing me as I began to eat another fine home-cooked meal, who said, "You know, you really need to get some rest. You're going to be a disaster on exam day. Just go to bed in the next 30 minutes (which would have been 10 pm), and start back at it tomorrow." Going to bed and catching up on some sleep was the best thing I could have done. The next day, I was rejuvinated, was able to return to the 6-6.5 hour sleep schedule, and my mind was sharp (enough) on exam day.
3. I suppose #2 inevitably leads me to my next point. Flexibility is a must-have in the boards studying. Think of it as a healthy exercise in self-regulation (important concept in psychology and psychiatry) - dealing with not getting through that which you have planned for the day, a less-than-ideal score on a practice test, and so forth - that is not just necessary but also vital to keeping sanity in the process. There's enough riding on this whole experience, and stressing out over whether you got through 35 versus 37 pages of renal on a certain day doesn't need to be one of the areas in which that happens. Schedules can be modified. I know that for me, I had to trim down my expectations for final reviewing when all was said and done. It's just not feasible to memorize every word on every page of first aid. Better to take the triage approach to the material at the last minute. On the morning of the exam, I knew that the neurocutaneous disorders (like tuberous sclerosis and neurofibromatosis) were weak in my memory. And so I reviewed them for ten minutes. It turned out that doing that was beneficial - I got a question on tuberous sclerosis on the actual exam. Had I thought reviewing all of First Aid was feasible, I might not have helped myself at all...
More thoughts to come. Fellow Step 1 takers, what are your thoughts? Please comment and let's continue the discussion.
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