I’ve been at loss of words for the last year or so. Everything I loved being involved with and the people who I want to spend time with were stripped away with a busy schedule. Everyone warned us that medical school is difficult and time-consuming. I may not have experienced the mountains of books that others feel is necessary nor have I had any all-nighters learning every little bit of our lectures. This is, by no means, due to a quick understanding on my part. I just feel like it doesn’t matter to me as the vast majority in our class or any other medical student that exists. I never put doctors on a pedestal or felt that this was “the only thing I could ever imagine myself doing”. Medicine is a means to an end for me. But the more time I’ve spent learning about it, the less I feel that it will truly take me where I want to go. Medicine truly is a full-time job and if you do not commit yourself entirely to excelling in the profession (due to the simple fact that people’s lives rest in your hands), then maybe it isn’t for you.
I started this blog hoping to find more of a balance during this journey. And due to the nature of medicine, I feel like I’ve lost it. Maybe I’m not ready to grow up and commit to one profession. Undergrad was such a special time where options for courses were endless and you could adapt your schedule to fit in things that you loved and it was a blank slate for whichever path you wished to venture down. Not having control over your school schedule or having to continuously focus your time and effort on weekly quizzes and mindlessly waiting for your next break is not what I imagined for myself for 4 years. The reason why I say I’m not ready to grow up is because I enjoy immediate gratification. When I find something I love, I want to drop everything and focus on that. It’s an irresponsible way of thinking because I won’t always be immersed in a career where I feel euphoric and passionate 24/7. But how do I know whether I will feel that way at all in the future? How do I know there is not more out there that I just didn’t give myself time to explore before choosing a career? Med school admissions allow students to now come in with any background with no pre-requisite courses and the MCAT caters to more people with a diverse set of sections. If only I could have waited until now to apply, I may have been a bit more content with my life before committing or I may never have applied at all.
Next year, while I am scheduled to partake in a 9-month rural clerkship in a small town, I wonder if it would be best for my own mental well-being and sense of identity to take time off to find what I’m looking for or at least pursue interests that were left behind at the start of medical school. Maybe doing that 2-year social work degree may light a spark underneath me, or maybe I need to broaden my scope in fields of anthropology or nutrition or business, or maybe I just need a year off to travel and spend time with loved ones and focus on helping myself before I can fully attend to helping others. Either way, everything is just a question mark. Who I am, where I should be right now, what direction I want to head in, and ultimately, what will make me happy. Everyone should have something in their lives that both keeps them up at night thinking about and gets up jumping out of bed each morning to do. It’s time I have that in my life too.
As you know, I’ve found myself interested in many fields outside of medicine. A beloved colleague and friend of mine recently showed me the book: “Careers Beyond Clinical Medicine” by Heidi Moawad, MD. With our 2nd year just around the corner, it made me consider what options we have with combined degrees at UofA. UofC, for example, prides itself on the Leaders in Medicine program, which allows students to participate in a multitude of degrees concurrently with their MDs. Below is a brief list of programs with the UofA that may be of use for my classmates, incoming 1st years, and potentially future students who want to jazz up their education:
- MD/PhD. One program we’re exposed to from the get-go because some students may apply to this program along with their MD applications. This fully-funded program allows students to participate in a PhD between years 2 and 3 for, generally, 4 years. An advisor mentioned that 6 years of funding are given to students so if the PhD is completed in the 4 years, the funds spill over into clerkship. Not a bad plan if you plan your career as a clinician-scientist. This program is limited to the UofA for doing your PhD but spans out throughout any faculty and department at the university so generalists like myself can expand our knowledge into other fields of interest that may complement our clinical (or not-so-clinical careers).
- MD/MBA. A unique combination, in the Canadian medical context, that provides medical students the opportunity to gain skills in business and management that are very useful in medicine. Whether you want to manage your own clinic, work for companies or consulting firms, or just need that extra year to consider your future, this is a pretty sweet deal. Biggest pros for this program are that it is a one-year program (as opposed to 2+ in other MBA streams) and that we don’t need to write the GMAT to get accepted. Having already dealt with the MCAT before and knowing how dreadful it is to prepare for standardized tests, this is something worth looking into.
- MD with STIR. STIR = Special Training in Research. This isn’t necessarily a combined degree, rather a way to formally recognize one’s research efforts during their summers. If a student completes 24 weeks of research over 2 summers along with other written and oral requirements for the STIR program, it will be recognized on their degree and transcript. This might be useful if students are already planning to pursue research during these years and want to take it the next step or for those who do not want to commit to an MSc or PhD but still enjoy research. It is arguable whether or not this may be something to impress residencies during CARMS but worth pursuing if you are interested.
- MD with extra time off? This definitely will not show up on your degree but certainly something that some students have and will do during their program. Many will take time off for other academic or extracurricular pursuits, possibly get married or have children, delay a year to be able to couples match with their partner, travel, or just take time from the stresses of the program and life. When I spoke to our Dean, they mentioned that if students want time off for any reason, they will be granted. This sounded great, especially if I wanted to pursue a degree in another university. For example, I flirted with the idea of doing an MPP or MSW but they were at UofT and UofC, respectively. So I couldn’t do it as a special program in our degree, but would have to apply, get accepted, take time off, complete that, then come back. Some people have used this opportunity for Rhodes or Fulbright Scholarships as well.
Evidently, medicine provides the opportunities to become well-rounded professionals by allowing students to pursue other programs in the university or take time for their own professional or personal development goals. Although I’ve missed the deadline to do the MD with STIR last year, the other options are things I am seriously considering. With extra time off, I may even pursue an MSc or MA if I am not ready for a PhD. In an upcoming post, I’ll share what fields I want to pursue if I did go down the research path! Hopefully this isn’t the only medium to share with the class that I won’t be with them in 3rd year but let’s see how things go 😉
One of the most controversial and dynamic areas of research, that also seems to be making very little progress in knowledge translation: nutrition. An article recently came out about the need for Canada to update it’s food guide, especially seeing that it was the 2nd most downloaded government document (after tax forms). It made me question what is going on! It is so clear that nutrition is one of the, if not the, most critical components of our life that impacts our health. Even when people are trying to get their health back on track, diet takes precedence over physical activity. The logic being that people can easily change their caloric input than caloric output (getting rid of the cup of rice at dinner at 200 calories is less effort than walking for 60 mins). Research is clear that major chronic conditions are due to lack of proper nutrition. Diabetes, heart disease, obesity, etc. are attributable and may be addressed through changes in our diet. So why aren’t we taught enough of this in our curriculum?
I love the role that dietitians have in primary care and the community for patient care. If I had to go in a direction other than medicine but restricted to healthcare, that would be the path I go down. But I still feel that nutrition should be a large portion of our curriculum. I’m sure the culture of medicine has changed extensively due to pharmaceutical influence and politics doesn’t help either. What doctors advise doesn’t always fit in with the updated research. You still hear many reference the Food Guide or promote low-fat foods. But do we blame doctors for that? Is the information really taught? Or is the research even reliable? Industries have so much influence in what is classified as healthy. When the shift towards low-fat came about after ridiculous Ancel Keys’ research, there was a universal fear of fat and we gave in to sugar-laden foods with preservatives. Now look at what’s happened? Western countries have terrible epidemics and their influences on developing nations is ruining traditional cultures of whole local food diets.
Personally, I’ve had issues with weight since we moved back to Canada. Our family never had much in Africa or Pakistan so food was a precious gem for the wealthy. When they moved here, the ability to indulge with family around a table met a social and psychological need of theirs that was taken from a young age. Esteem rose and so did the readings on our scales. Diabetes and hypertension struck many family members and being so ingrained in our life and culture, I don’t see any improvement. I feel into this cycle from grade 2 onwards and in the last few years, have taken some initiative to educate myself and pursue some changes in my life. Vegetables were not a common staple in our lives, but I’m getting them in. Caloric and portion control were a big no-no but now its necessity. Giving up fast food and other unhealthy foods is always a challenge but I’m glad to see some changes in my health overall. Only from nutrition was this possible. Even if I can’t help my family change much, I can use some experiences to help patients in the future and make sure my kids have some healthy behaviours growing up. It’s a work in progress but work worth doing.
We’re starting 2nd year with GI block which should include nutrition but in first year, we only had 1 full lecture on diabetes nutrition and partial mentions of sodium and fat intake in cardio block. I’ll be more critical or forgiving after GI but until then, I want to push for more nutrition in our curriculum.
With the refugee crisis as a huge part of our lives over the last year or so, I’m happy to share the work that our faculty developed to educate healthcare professionals about refugees. I was not aware of this resource until now because I hadn’t invested much time in learning about refugee health before my experience in Ottawa. It would be interesting to see if we could create similar resources for working with Aboriginal or inner city communities but maybe it just hasn’t come up or won’t come up for not being sexy enough of topics. Complaining about our #meded limitations can be for another day but just enjoy this lecture series 🙂
How do we quantify our impact in the world? For some reason, this has been on my mind quite a bit lately. When I see my peers achieving extraordinary things like getting a Rhodes or Schwarzman scholarship or getting acceptances to Harvard or participating in the Olympics, it makes me reflect on my own achievements. Is it healthy to compare myself to these marvels of nature? Depends. If I do it out of envy and jealousy, it’s wrong. Instead, I’m finding myself comparing and considering what the meaning of all of this is. Should these be my goals and everyone else’s as well? Is it fair to compare our outcomes when our background and access to opportunity differed? What does it mean to be “great” or excel at something? In our personality psychology class, we learned about immortality. There is a form where we leave behind a legacy in the form of our children and future descendants, and one where we leave behind a legacy of what we’ve achieved. So I begin to wonder what I’ll be leaving behind and if that even matters…and I don’t mean whatever lunatic spawns I end up reproducing.
I’ve always had a terrible balance in life of having high expectations of myself but being the laziest person around. My girlfriend and parents have always bugged me about it as well. So much potential growing up, but I find what I like and focus on that instead – and by focus, I mean read a couple articles or watch a documentary and then be distracted by something else. Never end up going the extra mile. The worst part is that I began to accept getting into medicine as my biggest accomplishment. Not that I don’t appreciate this opportunity, but after a while, I never looked past that to other things in the immediate future. Was this it? Did I have nothing else to push myself for? When I hear people my age or younger accomplishing much more, I wonder what I need to really to focus my efforts on. The aforementioned awards or universities would be great things for anyone to get but aren’t and have never been my goal. But then what is?
It’s especially hard in medicine to quantify your success and impact. Yes, you can say you’ve performed X cataract surgeries or Y colonoscopies as a measure of how much you were able to do. But what in primary care? How reliable is a measure of “reduced my patients’ BP by an average of _____” or “had follow up appointments _/100 times giving me a success rate of _%”? There is so much fluidity and when I consider what my specific interests are in vulnerable populations, it’s even harder to quantify. I think it’s eating at me a lot more because I’ve always been a numbers person…or at least a compromise of letters and numbers like in algebra or calculus. I love seeing direct, measurable changes and when those become salient, it becomes easier to consider some cause to the effects. I will always love qualitative work but much deeper, I need to see numbers change. So how do I measure impact in my own life? I could count how many lives I saved? But in preventive care, that’s kind of hard. Ok, maybe how many years I prolonged their life? Nah. What if my goal isn’t to prolong their life but ensure they have the highest quality years of life left? Hmm. What about someone who wants physician-assisted suicide from his or her chronic pain or terminal illness? What do I count then?
Maybe it’s just a phase. Knowing that life is never black-and-white or quantifiable will ease into my understanding with time. I just want to gauge how I am doing with my life so I have a net positive effect in this world and I’m not just sucking up oxygen, food, water, and other resources without some return. I want the world to gave a solid return on investment for providing to me what I need. How do you evaluate what you do and bring to the table when it’s so complex? Some people want to bring about world peace. What does that mean? When you want there to be less suffering, how do you measure that? I feel so naïve with questions like these because the answers are either “no one knows” or “you set the parameters for what that means to you” or “someone’s researching that”. Whether I’m memorable or not, I want to know that I left a dent that catalyzed something good. I want to know that there was a void somewhere in this world that my personality and efforts could even slightly fill. I want to know that I’m working towards something of worth and benefit for my family, others, and myself. What does this all mean? What is my impact? What should be my impact? What will be my impact? What’s yours?
Unreasonably long rant and constantly going in circles but sometimes I need to say it and sometimes others need to hear it.
The acronym of PNME does not really do justice to what it is about or what it even means. This program at the UofA is a “get your feet wet” approach to rural medicine by giving students a month’s placement in a rural setting in the beginning of 2nd year. I haven’t had my eye on rural as part of my formal education but a lot of what it encompasses might be beneficial for my career. Rural medicine offers breadth of exposures and skills gained, integration of and engagement with the community, and ability to work in resource-limited settings. As a hopeful family doctor, rural is one of the best disciplines to learn and practice in. The amount of responsibility and knowledge that these physicians hold is something that is necessary when you may be one of a handful of doctors in that community. Where could I take this in my own life? I plan to work with FNMI communities on reserves or rural communities or northern centres for some of my career, and definitely hope to incorporate practice on an international scale. Even my current supervisor, who trained in rural medicine but works in an inner city clinic, delivers babies at an urban hospital once a week because she is competent enough from her training to do so. Clearly, there is enough application of what rural has to offer.
Now for PNME. The four placements this year were Grand Prairie, Peace River, Barrhead, and Sylvan Lake. I haven’t been to any of these places before but because I have some responsibility to help with my grandparents in Edmonton, I chose to stay close (Barrhead or SL) and ended up getting placed at SL. We don’t get details for a few weeks but from what I know, we have our small group sessions within our group of 4 who are placed there and have a preceptor from that community. Good and bad of this program? Good is that it’s all vodcasted so already being an expert at that will be an easy transition (if any) and that we’re allocated plenty of time and resources to shadow. The only bad thing is that we have all of our GI block anatomy labs compressed into one week so if I didn’t hate anatomy enough already, there you go. Other than that, I think it’ll be a great time! I know who else is placed with me in SL so I’m excited to see how our month goes.
Summer research. Something that undergrads and meds either love or hate, but everyone feels they just need to do it. During first year of undergrad, I definitely felt the pressure to take a step up against my peers by getting a summer position and thought it was at least one thing to get off my “checklist” for med school. It was a solid project with good exposure to proposal writing and literature reviews, as well as focus group interviews and analyses to be used for poster presentations. The best part was the extra time on the side I had to look into other topics of interest that related to it. That really catalyzed my involvement in future projects. I knew I didn’t have to do more research but I just found projects that would expose me to areas that are of personal interest and would be beneficial in my profession. So it transitioned away from doing it because I had to, to doing it because I wanted to (plus it was some form of income during the summer months). And a quick piece of advice for readers: don’t waste your time in projects that you think will impress med schools because they really don’t care. I did all my work in offices that were qualitative in nature and never came out with a single publication. If you’re a wet labber, own it and do that. If you’re a statistics lover, find your place in that. If you’re a social scientist or love qualitative work (like me), do that. Just because your project isn’t about microbiology of a disease or contains clinical trials or has no relevance to the medical profession doesn’t mean they won’t value it. Find your time to learn about all aspects of the research process. If one project was about data analysis and presentation, find another that will teach you about writing proposals or ethics or developing a project from the start. But please, don’t force yourself into something that you don’t like just because you think that will impress med schools. Research was the reason I fell into social justice work and vulnerable populations. Cardiac surgery was still on my list in undergrad, but when I learned about barriers for immigrants and harm reduction practices in my summer research, I decided that my path in medicine will be to address these issues in populations that society has pushed aside. It showed me that there is more to the money and prestige of a speciality that I dreamed about since I was 12. I can say that research is why I am who I am right now.
Anyways, so I’m back at this work again in summer. Main reason was definitely to help pay off some of the travelling I did this summer. But luckily I got a chance to work with the inner city research team I was with last summer. Last year, we evaluated the clinical team’s interventions with their inner city patients by interviewing them. This year, it will branch off of that and find ways to implement a managed alcohol program at the hospital. I encourage you all to read into managed alcohol programs that exist and see how such a controversial idea can be transformative in people’s lives. Giving an alcoholic some alcohol. That’s pretty much the concept. But as confusing as it may be, alcoholics may have developed a physical dependency on it so they require alcohol to avoid withdrawal symptoms. How can you expect someone to get anywhere in life when that monkey is always on their back and it forces them to steal alcohol, drink hair spray and hand sanitizer, or go into seizures without that proper dosage? If you give them a place to stay with rules and regulations to ensure they play a role in their own recovery and provide controlled prescriptions of alcohol each hour of the day to prevent withdrawal symptoms, then you can (1) allow them some medical and psychological stability in their lives, (2) keep them in a safe controlled environment where the consumed beverage is monitored – especially when non-beverage alcohol like hand sanitizer could be dangerous to their health, and (3) be a point of access to get help for housing, ID, medical care, social supports, and recreation so they can reintegrate and be on an actual road to recovery. We need to stop being moral judges of other people’s lives. Alcoholism and addictions are medical conditions, not a choice. Only a small fraction of users of substances become addicted. That is often controlled by environment, genetics, and biology. So I always try to create a parallel to diabetes. Diabetes is multifaceted in its origin of diet, lifestyle, genetics, environment, etc. People can do all the wrong things and never get it. People can do all the right things and get it. Same with addictions. So why can we not provide alcohol or harm reduction supplies (at the least) as a means to avoid symptoms and keep them safe when we provide insulin for diabetics? I consider patients of both conditions to be equally at fault of their diagnoses by understanding that there are so many factors at play. So lets stop the judgment and focus on a humanistic approach. Help people because they are human beings and everyone has some universal connection to everyone else. Use evidence-based approaches and cost-benefit analyses instead of a subjective moral compass that may be so backwards that it does harm to the users, taxpayers, and the rest of society.
It has been a while but May was my opportunity to travel abroad and unwind from regular stresses in life! In the past week, however, I got a chance to partake in the Summer Institute in Refugee Health that takes place at uOttawa every two years. 20 or so students from across Canada get this opportunity and it really opened my eyes to a demographic that I haven’t had much exposure to. I have worked with immigrants in the past, predominantly in teaching English and helping with youth programming, but nothing that specifically addressed refugees.
The first three days were meant to be focused on speakers discussing certain topics regarding refugee health and the programs that exist in Ottawa. More than just education, it was a chance to really develop a model to take back and establish a refugee health initiative in our own schools. Some of the topics included using interpreters in clinical settings, nutrition and health literacy, medical interviewing of refugees, MSF missions, and mental health in this population. We ended off with a weekend workshop on Narrative Exposure Therapy (NET), which is a trauma-centred care approach to habituating fears related to traumatic experiences in people’s lives. Each topic was something that we could learn about, take back to our schools to develop into programs, and utilize when we’re practicing physicians. With the Syrian refugee crisis and global migration patterns nowadays, these are things that physicians and health professionals should start to become familiar with. Depression, anxiety, and PTSD are already important conditions to address but when language, culture and socio-economic barriers make the access to healthcare that much more difficult, there is needs to be proper training to manage it.
Being part of this week was a real blessing to help me with future patients, but the most valuable aspect was just being able to hear the stories of these families. How can someone so similar to us go through such traumatic experiences like war and having to escape human trafficking? There is this universality that exists within everyone. I felt like I saw those things by looking into a parent’s eyes as they speak about their children or what their goals and dreams are for their families future or what worries them at night. I really began to appreciate what my own family went through coming to Canada and seeing what they had to face along this journey just so we could have a better life. Not only that, you feel connected to this global community that we’re part of because they bring a piece of their own countries when they come here and you are able to interact with people that you may never have gotten a chance to before. It really brings the notion that ‘global health exists in our own backyards’ more clarity and motivates me to incorporate this population as part of my career focus in the future as well.
I really encourage students who will be entering medicine in 2017 to look into this program and apply! I didn’t have much experience with this population but I was curious and I was determined to learn about them. There were lots of social events as well and the people you meet have similar values as you so that solid relationship is built immediately. Even for only being with them for 5 days, these strangers really feel like family. And not going to the Reception House for a session this morning and having to head to the airport was a tough thing for us all. If you have any questions about the program in detail or specifics that I learned about, please let me know!
One thing about writing in a blog is that it allows taboo topics to be out in the open and there is a pretty big one that needs to be mentioned, particularly with the next class of med students finding out their fate in the next 2 months. Med school is fun. Lots of new people to meet, fun professors to keep material exciting, clinical opportunities, social events, free time, etc. What gets lost in this picture of any premeds paradise is mental health.
We recently had a cool initiative by the 2nd year students that resembled PostSecret where anonymous notes were submitted by medical students and some were showcased in a presentation. Luckily, mine was there too. You don’t really feel the effects of something like this until you see your own and know that came across to their group that this is something that comes up in our class. Unfortunately, we saw a lot of secrets that were pretty tough to see. Mental health concerns, suicidal thoughts, feeling isolated and out of place, and so on. When I had the opportunities to speak to some of our classmates, I found out that there is a lot of mental health issues. Lots of students needed to speak to our UME or Learner Advocacy and Wellness office, or have to see peer support or professional counsellors or mental health professionals, or have even mentioned thoughts of self-harm and suicide. I was completely blown away by this because medicine is “meant for” the Type A, alpha, cream-of-the-crop students. Right? When you speak to others, you notice that they are all very confident and happy and seem to be at peace in their lives. Not to be taken negatively, but there is definitely a macho culture that exists in our class. But when you hear about what they’ve been going through, you become aware that this is all just a front. Not everyone is doing amazingly academically or is brushing off stress like its nothing. The ones who come across as happy are actually some of the ones who are seeking help. But then why is everyone so scared to be open about it? Why is there a culture that demotes people who just couldn’t handle it and need help? Why are we in a profession where we give up years of our lives to help our patients but don’t see an opening to help each other? I’m glad that mental health within med school is getting more attention and advocacy from students and faculty, but it’s sad to see what this program continues to foster.
I know a post like this won’t do much but I want people who are applying to medicine to realize that there is a lot of issues behind the scenes that you need to be ready for. Make sure you keep ties with your family and old friends, find time to be physically active or de-stress in whatever ways you need, and make time for yourself. We’re only in first year but we already see this problems arise and it’s terrible knowing that we have so many years left to go.
This post was also for our classmates. Keep using the resources on campus and in the community if you need help and don’t shy away from asking our classmates for the same. You have a supportive network but just need to find people who are willing to be non-judgemental and give you their time to help. There are lots of people in our class who did find this blog and know who I am, and if anyone is reading this that feels what I’ve mentioned above, don’t be afraid to talk it out. Being able to talk about the inner conflict I had between medicine and the social stuff that I enjoy way more is my own method of handling life’s stresses and gives me a good outlet. It’s also for others who may feel like they don’t know why they’re here or what direction to head in to know that it is okay. And I’m glad I received messages and comments from others that have benefited from this as well. Anyways, hopefully this opened some doors for people to be more accepting of themselves and seek the help they need. I just hope that things change in our class and the next class won’t deal with it as much as we did.
It has been some time since the last post but as a brief update, we’re in the last month of our first year 😀 and we’re just finishing up the Pulmonary block this coming Friday. As discussed before, I’ve settled nicely into the plans for Family Medicine or Public Health Preventive Medicine residency in my future and I’m about 99% sure that I will be heading in that direction in 3 years time. HOWEVER, one part of internal medicine still appeals to me and that just so happens to be Pulmonary!
I grew up with asthma and actually had a few scares as an infant to where I was hospitalized for it. It’s been in my family as well, and I recently found out that some family members actually had TB back in Africa too. Lungs have been a critical part of my health and I understand what its like to have these exacerbations when I’d be outside at recess or have to go into a dusty room or during gym class. I would understand what its like when a patient says “my chest feels tight” or “I’m short of breath” or if I hear them wheezing. So in one regard, I can see myself doing a pretty good job in this speciality. Another thing is that pulmonology fits into a lot of my interests: chronic disease, global health, environmental health, etc. Chronic diseases like asthma and COPD are important to address and it’s nice to have some follow up with patients over a longer course. Global health incorporates many infections that occur and I definitely see myself engaging in the fight against TB. Not only on a global scale, but when you see it exist in Aboriginal communities, inner city, incarcerated people, and immigrants/refugees. And finally, the big issue of our time: climate change. Being in Alberta, you’re aware of respiratory conditions that may be a result of our fossil fuel industry but when you consider the ridiculous amount of smog in China or pollutants and toxins in the air or other environmental health concerns, pulmonology would play a huge role in addressing these health matters.
The only downside is having to endure 3 years of internal medicine during residency and that I’d prefer outpatient work rather than being on the wards (which is less negotiable in internal medicine specialities).
Either way, there is a glimmer of hope! Pulmonology has been fun to study, I understand the mechanics and chemistry behind the conditions, and it’s relatively limited in the conditions that occur so I can truly become an expert on them. Chest X-rays are still a bit of a nuisance but that’s part of the process. But for all my FM and PHPM fans that read this, don’t worry 🙂