The Differential: Medscape Med Students Blogs

Why Bother Learning Something We'll Lose?

Jeff Wonoprabowo -- During high school I took three years of Spanish. I thoroughly enjoyed it and really wanted to spend a year abroad to become fluent with the language. Unfortunately, when I got to college, I desperately wanted to finish in four years. My year abroad ended being sacrificed. In my final year, I did take Spanish 101 and 102, more for the fact I knew they would be easy A's.

Two years removed from graduation, I'm sad to say that I feel I wasted all that time studying Spanish. I haven't used it at all. Sure, I might remember some words and phrases here and there. I can probably still conjugate the present tense of most regular verbs. But I can't remember the vocabulary. I turn on Spanish television and I get nothing. Well, the actors are pretty dramatic, so I suppose I can get something.

The other day I was standing in line at the Argentinean Consulate when the lady behind me started talking to me in Spanish. I looked at her, puzzled. She repeated her question. I tried to piece together what she was saying but the only thing I got was "Koreano." I assumed she was asking if I was Korean. Well, I finally apologized and told her I couldn't speak Spanish after which the conversation ensued in English. But I couldn't help feeling frustrated that I couldn't even understand a simple question after more than 3 years of Spanish classes.

Language is just one of the things that you have to use, or else you lose it. And this got me thinking about medical training. This year, as with most first year medical students across this country, I took General Anatomy. As far as I know, I won't have any anatomy classes during second year. But Step 1 of the USMLE exam will cover General Anatomy. It worries me that I will go through an entire year without ever having an Anatomy lecture. I guess I am going to have to continually review myself whenever I find myself with that elusive "free time."

I also thought about the practice of medicine. This year, I heard a talk by a cardiology resident. He said that while he was tempted to go into surgery, he found the clinical skills of surgeons to be lacking. Most wouldn't be able to properly auscultate a patient. He had chosen cardiology because the cardiologists he had witnessed all impressed him with their clinical abilities.

One could debate the merits of having surgeons equally competent in wielding a stethoscope as they are with scalpels. It is probably not really important for surgeons to retain this skill. After all, they are called in to do their specific job -- to cut open a patient and fix an immediate problem. If a patient requires auscultation, then his or her internist should be able to do this or refer the patient to a cardiologist.

But doesn't it seem like a waste of time, money, and -- well -- medical training to just let a skill atrophy? Would time in medical school be better spent training students in the specific specialties they are interested in? Why bother teaching a student proper auscultation skills if the student is heading into Ophthalmology? I wonder, is there a better way to train our doctors of tomorrow?

In his book, Complications: A Surgeon's Notes on an Imperfect Science, Dr. Atul Gawande writes of Shouldice Hospital in Ontario, Canada. The surgeons there are experts at hernia repairs. That is all they do. Day in and day out, the doctors do nothing else but repair hernias. What may be surprising to most American medical students is the backgrounds of those who operate at this clinic. A few of them have never even completed a surgical residency. But they have trained extensively at repairing hernias. This clinic, Dr. Gawande writes, has a far higher success rate for their operations than any other place in the world. Why? Because they only do one thing, and they do it amazingly. Can this be applied to medical school to cut down on the massive amounts of information that medical students are force-fed each day?

Don't Be a Jerk

Colin Son -- I’ll let you in on a little secret: providers in hospital settings can be really antagonistic towards each other at times. The same as any workplace, I suspect. Only in the hospital you’re sometimes dealing with life and death, not who ate your sandwich out of the break room refrigerator.

Here the surgery chief resident argues with the medicine attending whether this or that patient on the medicine service should get surgery. Here the ENT resident argues with the surgery critical care fellow whether the patient should be admitted on the ENT service or the trauma service. Here interventional radiology argues with medicine whether attempting a percutaneous mass biopsy is appropriate.

In the academic public hospital setting, the ones doing the arguing are often the residents since they’re the ones who essentially run the various services. As I get closer to residency, I’ve started to wonder how I’ll handle such situations.

Let me say that these heated debates over patient care aren’t necessarily a bad thing. You would hope that everyone involved would be advocating for what they truly believe is in the patient’s best interest. When that is the case, then arguing things out can be a good thing. The point is, there are truly times as a resident when you (or your staff) feels strongly about something and you need to hold your ground.

Such can be tough. I am not a Type A personality. I imagine myself a year from now, in a situation I’ve seen my residents in more than once:

I’m a month in and on call and some shunt kid who is cranky or not feeding well comes into the emergency room. Before the overworked and tired emergency medicine doc even gets the head CT he gives me a call. Down in the ER the conversation comes to a head with something like this from the EM attending, “You’re going to admit this patient.”

Well maybe, but it isn’t exactly his place to be saying something like that at this stage of the work up and it certainly isn’t his decision to make. No one in such a situation wants to be a pushover and nod their head, so that their chief has to call or come in and fight the battle.

At the same time, residency is a grueling ordeal and tends to "harden" more than a few people who journey through it. You don’t want to be a jerk and then suddenly the EM doc is waking up your attending at home.

I’ve got a chief right now that no matter where I end up I’d like to imitate in such encounters. I don’t think we’re merely talking about basic social skills here either. I’ve witnessed too many residents stumble when navigating antagonistic situations in the hospital. Playing the middle ground -– being an advocate for your patients and your service, while also not getting heated -– is a skill. Maybe being aware of that fact is the first step in mastering it.

No Sleep 'til Brooklyn

Kendra Campbell -- My mind is currently filled with an amalgamation of excitement, fear and a feeling of accomplishment. A few days ago I found out that I passed the USMLE Step 1 (yay!). That once seemingly huge and insurmountable obstacle is now nothing more than a blip on the radar screen behind me. For a few days, I basked in the satisfaction of having a profound sense of achievement.

Today, I took the final exam for my psych rotation. I can proudly say that I finished my first rotation in the States, and judging by the marks on my evaluation, I did an outstanding job. So, that is behind me now as well.

Just when I felt like I could let out a huge sigh of relief and sit back and relax, I had a bomb dropped on me. I’m currently living in Baltimore, Maryland, and had hoped to do all or most of my clinical rotations here. My school has affiliations with many different hospitals all over the country, and around five of them are in the Baltimore area. When I received the paperwork with my rotation schedule for the next nine months, all of the relief and relaxation made a furious exodus from my body, and was immediately replaced with fear and anxiety.

I found out that I was scheduled to begin a surgery rotation in Brooklyn, NYC in three weeks, and that I’d be spending almost a year finishing my rotations in Brooklyn and two other cities in NYC. There was a point in my life where this information would have made me immensely happy, but I’m not currently at that point. You see, my partner and I just recently moved into an apartment in Baltimore. All of my earthly belongings are here. And that’s not the bad part. My partner is starting a graduate art program at a local university just a few blocks away. His program begins in September, and lasts for two years. So, what this means is that he won’t be able to come with me to NYC. Not only that, but practically speaking, I won’t be able to bring either of my dogs to the city. In just a few weeks I’ll have to leave my partner, my dogs, my apartment, all of my friends and family, and most of my belongings behind.

I’m still in the midst of working with my advisor to get some of my rotations scheduled in this area, but I’m not sure if it’s going to work out. If it doesn’t, I will be spending anywhere from nine to seventeen months away from everything familiar to me.

There is a part of me that is very excited about this upcoming adventure, but another part of me is scared to death to leave my life behind. One of the reasons that I chose the school I’m attending is because I knew that it would involve a lot of travel. I got to live in a foreign country for almost two years, and I knew that my clinical rotations could be scheduled at many hospitals throughout the country. But I think I forgot to take into account the effect of having to be separated from my loved ones (partner and doggies!). I’m questioning whether the adventure of travel is worth the sacrifice of leaving my loved ones behind.

But, I know that I’m up to this, and that I have overcome many larger obstacles in the past. So, I will just keep telling myself that, as I pack a small portion of my belongings into my two pink suitcases and hop on the bus to Brooklyn to discover what lies ahead.

Guess I'll Go Eat Worms

Ben Ferguson -- I came across some old papers the other day in the bowels of my file cabinet and thought I’d share some excerpts.

Dear Mr. Ferguson:

      I have reviewed your application to [our school] for admission in 2004. I regret to inform you that we will not be able to grant you an interview. We have received a very large number of applicants (over 5,000) for 100 places in the first year class…

Mr. Ferguson,

      Admission to [our school] has become more competitive in recent years, particularly due to a continuing increase in the number of outstanding applicants. While we regret any disappointment you may feel with regard to your medical school plans, we are sorry to inform you that, after careful review, we will not be able to give your application further consideration…

Dear Mr [sic] Ferguson:

      The Comittee [sic] on Admissions of [our school] has carefully reveiwed [sic] your application to the 2004 entering class. Unfortunaetly [sic], we cannot grant you the admission at this time…

Dear Benjamin,

      The Admissions Committee has carefully reveiwed [sic] your application to [our school]. The Committee regrets to inform you that we are unable to offer you a place in the 2004 entering class…

Dear Benjamin:

      I am writing to share what I believe will be disappointing news. The Admissions Committee of [our school] has considered with care your application for admission. Unfortunately we are unable to offer you a place in our next entering class…

Dear Mr [sic] Ferguson,

      The Committee on Admissions of [our school] has completed its review of your application. It is with great regret that I inform you that we will be unable to offer you an interview. This is a disappointment, as much for those who are responsible for the decision as it may be for you, the candidate who is turned away…

Dear Applicant:

      We will not be considering your application for the Entering Class of 2003 [SIC!] any further. You have our best wishes for continued success in all your educational pursuits…

A few thoughts, four years passed:

1. All in all, there were 15 of them, alongside two acceptances, two waitlists, and one *RANKED ALTERNATE* [emphasis theirs]. Following my submission of the primary application in early October, they came in droves between December 19 and April 1, most as the point of first written contact from them to me. There is nothing quite like waiting more than six months for some schools to confirm they’ve received your primary application by sending you a letter rejecting your primary application. Going through this odyssey makes you realize unexpectedly that schools that pay attention to you during the application process might also pay attention to you while you’re a student there, and so it becomes more important than most people expect.

2. Having typos -- and mentions of blatantly incorrect application years -- in rejection letters really seems classless to me, especially when you consider that identical letters probably go out to >85% of the people who apply to any given school.

3. Save for changing a few words here and there, these letters are all exactly the same. They feature regret, remorse, careful and thorough consideration, best wishes offered, and, ultimately, unsuccessful attempts at making you feel like something of a winner while simultaneously smashing your dreams and explicitly telling you you’re not good enough for their school. Some were a full page long and some not even a full paragraph, but does it ever really matter to you, as an applicant, how complex and intense an admissions committee ordeal is?

4. Try to check your mail as often as possible while applying. It may drive you nuts -- you’ll already have been nuts anyway -- but this way you reduce the risk of receiving more than a few rejections all on the same day, which can really get you down.

5. The day you get your first acceptance and the day you get into your dream school will be some of the best days of your life. Go have some champagne, but be careful -- they may both be on the same day, the greatest day of your life.

Seekers

Thomas Robey -- Anyone who watches television has heard of drug seekers. From “House” to the news, examples abound of prescription pain killer abuse. Who hasn’t heard of the high profile pundits and Hollywood "who's whos" getting into trouble because of addiction? I have to wonder if these interest stories are painting an accurate picture of drug use and abuse. Something tells me there’s something more to the story. The drug and research minded blogger DrugMonkey brought to my attention an interactive map detailing trends in pain killer consumption in America. And while it’s hard to gather whether this map correlates best to street use, addiction or even just prescribing habits, total use is clearly on the rise. Thanks to media coverage of pain-killer use, it’s plausible to look at this map and think only about the white-collar narcotic users.

Other people abuse prescription pain meds. For me, these are the wrenching cases. If I follow a career working as an ER doc in a public hospital, I’ll be a seeker myself -– a seeker of patches for a broken heart. It’s only been a week and I’m already trying to suture in my first.

Back when I was entrenched in a life of cell culture, pipettes and animal colonies, my weekly dose of medicine was as a volunteer STD counselor at a free medical clinic for homeless teens. My job was to be an information portal. I helped kids live safer, told them if they had gonorrhea or that they were HIV negative (thankfully, all my consults gave this result), and could point them in the direction of other community resources. Many of these kids used illegal substances. Harm reduction and motivational interviewing were my modi operandi. I wasn’t connected with prescription or other medical issues, and I certainly was not involved with pain control -– as a matter of policy the clinic never distributed or wrote scripts for narcotic pain meds.

The outcomes of this volunteer experience were:

* I now love working with homeless young people.

* I can talk with kids about sex and drugs.

* I feel like I understand a little more than the average bear about the complexities of homelessness, especially in the teen and young adult population.

It’s this last point that has already gotten me into trouble. Now that I’m working in a county hospital ER, I’m encountering these same kids (even the same individuals) in an entirely different capacity. No longer am I simply an information portal; I’m responsible for their health. Previously, I could aspire to be a friend so that the information was more relevant to them. “Friend” drops much lower on the physician’s priority list, especially when the patient is aiming to take advantage of a perceived friendship for gains in conflict with their own good health.

An opiate addict will pursue any opportunity to acquire substance to sate his craving. This includes finding friendly doctors. Helping the medical student find a vein for an IV makes the student feel good, and improves the chances of receiving IV pain meds. Walking in the door wearing a cervical spine collar (even if it is medically indicated) may help the doctor sympathetically overlook a not-so-distant history of polysubstance abuse. In this setting, it’s not good enough to try to be friends with the patient. Can you trust an addict with pain meds? I don’t think so. Addiction removes the capacity for trust. There’s always something more important to an addict: the addiction. That’s why I reminded the attending of my patient’s recent heroin and cocaine use before he prescribed oxycodone. After my shift (and after his discharge from the ER), I noticed that my patient’s 3/5 strength (can’t move against gravity) during my exam had changed to full capacity. As I watched him pick up a bag and step onto a bus, my feeling of vindication quickly was at war with guilt for not deciphering the patient well enough to offer some sort of medical or social help.

But does this mean that providers need to erect walls around caring for addicted patients? Personally, I think walls and policies would cause me to limit the amount I care for my patients, thereby limiting the quality of their care. My goal is to get it in my head that being a bad guy to them is as helpful to their health as sating their needs. I think it’s going to be tough -– even tougher when I’m the one signing prescriptions.

This entry is dedicated to Mavis Bonnar, an advocate for homeless teens for the better part of three decades.

My Fair Doctor

Jeff Wonoprabowo -- My little sister has been on a classic film spree. She announced to me that she wanted to see all the movies that had won an Oscar for best film. She also bought an Audrey Hepburn 3-Pack DVD that contained Breakfast at Tiffany's, Roman Holiday, and Sabrina.

Okay, I'll admit that I too am a fan of Audrey Hepburn, Julie Andrews, and other great actresses of Hollywood's golden era. They seem to convey so much in the subtle facial expressions or tone of voice -– something that I fail to notice with so much CGI/special effects these days. Well, being the awesome big brother that I am, I used my Netflix subscription to order another one of Audrey's famous films: My Fair Lady.

At almost three hours in length, My Fair Lady is a pretty long movie that traces the journey of a poor flower girl as she is transformed under the instruction of Professor Higgins into a genuine Lady. The process is long and arduous. It's filled with frustration as well as comical moments. The audience watches as Eliza Doolittle sheds tears and then as she recites phrases like "The rain in Spain falls mainly in the plain" or some other nonsense about hurricanes in Hereford and Hampshire trying to properly emphasize each syllable to the professor's satisfaction.

It's sort of like the transformation that is required of medical students. They say medical school changes you. It changes the way you think, speak, and act. It changes who you are. And it’s supposed to do exactly that. It takes the raw material in the form of an eager, optimistic, and sometimes-naive college graduate and transforms it into a newly minted MD who is probably more than just a little nervous about starting internship.

During orientation and registration our school administrators told us that by the end of just the first year we would notice things differently. We would see and hear things through different lenses.

I am kind of surprised at how true that statement turned out to be. There are words and phrases now floating around in my noggin that I never knew existed.

Mnemonics wander idly through my mind. Sometimes I don't even remember what they are for. There are words like "LARP" (describing the path of the Vagus nerve) and phrases like "army over, navy under" (suprascapular artery over and nerve under) and "To Zanzibar By Motor Car" (branches of the Facial Nerve).

Prior to the first year, I had never heard of the phrase "differential diagnosis." Well, on second thought, I did often hear Dr. House ask his team what the differential was. But it kind of flew over my head at the time.

Evidence-based medicine now means something. Before, it just sounded cool. I was a science major. I knew that evidence was good. Now, I still think it's good. But I'm not too fond of searching through the literature for the latest studies trying to determine a link between statins and preventing Alzheimer's disease.

Whenever I go to a restaurant I watch the waiters. Why? Because in Anatomy class I kept hearing about a waiter's tip that can present with injury to the upper roots of the brachial plexus. I still have yet to see a waiter walking around with the so-called "waiter's tip." But it hasn't stopped me from trying to find one.

Wal-mart is no longer just a convenient place to pick up supplies. It's also a great place to pay close attention to customers' faces and gaits. I might be able to identify a walking example of some neurological deficit I learned about in lecture.

As far as medical education goes, I'm just a baby. Or, to tie in with my intro, I'm just starting my training with the good professor. I'm still raw and crude. But even after MS1, I'm glad to report that there's progress.

In about a month, right after Labor Day, my second year will officially begin. I'll try to enjoy my last "free" summer. In the meantime, like Eliza Doolittle, I'll try to faithfully recite the precious tidbits of information that the dear professors have imparted. However, it's probably a little bit harder than talking about rain falling on Spanish plains in that oh-so-elegant British accent.

The Times They Are a Changin'

Ben Bryner -- Dr Jules Dienstag, dean of medical education at Harvard Medical School, wrote an excellent op-ed suggesting changes to premedical education (free here) in this week's New England Journal. (Contrary to this blogpost’s title, Bob Dylan has not weighed in on the issue. Sorry.) Dean Dienstag’s article has been getting some attention due to his suggestion that a full year of organic chemistry might be overkill, which is kind of like suggesting that a big scoop of ice cream on a hot day might be yummy.

Some people think that organic chemistry is a crucial part of the curriculum because it "weeds out" those who won't be able to hack it in medical school. Of course, this is the wrong approach to designing premed education; there's too much important knowledge to be gained in college and school that setting up barriers without further educational value is a terrible idea. Challenging but useful classes will be the cornerstone of premedical education, and if any "weeding out" really needs to be done, it can be done by the demands that a pre-med be involved in research, volunteering, shadowing, etc on top of classes. Successfully juggling all these demands is more impressive (and more akin to what a medical student has to do) than being able to push around electrons.

I've got no hatred toward organic chemistry; it's interesting on some level and I've had classes that were much worse. But organic chemistry has really only come in handy once during medical school, and that was when I used my textbook to kill a bat that had gotten into my house.

I'm certainly no expert on education. But here would be my suggestion for the ideal mandatory pre-med curriculum, (setting aside the problems of finding enough resources to teach these classes and their compatibility with med school curricula):

1 semester general chemistry

1 semester organic chemistry

1 semester biochemistry

1 semester math

1 semester statistics

1 semester physiology

1 semester cell biology

1 semester genetics

2 semesters of other biology electives

1 semester economics or ethics

2 semesters writing (at least some with a scientific focus)

This sounds like a lot, but it would fit with most requirements for majors (I took statistics and economics to fulfill my major requirement, English was required for everyone, and I still took several more science courses) and is about the same amount of time required in absolute terms. I think it would also be OK for schools to allow some of these classes to be taken during the senior year, with the offer of admission contingent on passing them. And it's pretty reasonable to expect premeds to carry a very full courseload -- it only gets busier from there -– and to take advanced, rigorous versions of these classes.

Dr. Dienstag draws the line at teaching things like ethics, health policy or health economics in college, arguing that med schools are better equipped to do things like that. Sure, colleges aren't going to bring students fully up to speed on those health-specific issues. The problem is that in my experience, med schools have too few resources to systematically teach the general principles of those fields. Instead, ethics and health policy and economics have been haphazardly thrown at us in random hour-long lectures throughout the four years. Part of the problem is the lack of planning and time devoted to the topics, but part of the problem is that lots of students at this stage don't have the background to dive in to a discussion of health-specific economic issues. Thus my suggestion that the fundamentals of some of these areas be required. Also, in the era of evidence-based medicine, med students clearly need a background in stats that med schools aren’t providing.

This gets at the heart of what colleges and med schools do best: colleges are great at helping students build broad frameworks, and med schools are good at adding on specific information in given areas and helping students develop specific new skills. The times that med schools run into a much greater obstacle, in my opinion, is when they try to teach concepts in areas where some people have an extensive background and others have none. (This also extends to the challenge of teaching empathetic interactions with patients, which is another topic).

Dr Dienstag hints at the possibility that the traditional forms of requirements of pre-med education will “give way to more creative and innovative courses that span and unite disciplines.” I hope so. Just as work hour restrictions have forced residency programs to trim as many nonessential activities as possible from their trainees’ routines, premedical education needs to be reshaped into a rigorous but broad program to prepare future doctors. Given the immense amount of time that future physicians devote to their training, and the overwhelming volume of knowledge they need to acquire, there’s really no time to waste.

Embarrassing Yourself

Colin Son -- Embarrassing yourself is part of life; part of medical school as well. Nowhere is this likely better demonstrated than the third year. Considering so many third years are within a month of starting their clinical lives on the wards and in the clinics, I thought I’d share one of my proudest moments.

It was my second month of third year. I was a week into a rotation on neurology, which wasn’t going too badly. I didn’t do a whole lot and the hours were good. This was kind of a blessing as I studied for the internal medicine shelf exam. And it is in this scenario that I got off one day at about four in the afternoon and made my way to my apartment. Apparently I fell asleep on the couch. Even in the grip of an "easy" rotation I guess I found myself a little pooped. At some point in the following two hours I managed to make it to my bedroom and the comfort of my bed, although I don’t particularly recall the journey.

When I woke up it was well past seven o’clock with light streaming through my bedroom window. It didn’t take much realization to prompt me out of bed and towards the bathroom and my toothbrush, in a flash. We started rounding at seven o’clock. The last thing I wanted was to impress my resident by being late, being a slacker on what was already a none-too-rigorous rotation. I’m sure I cursed myself, maybe even out loud, as I pulled out scrubs which I found littering my bedroom floor.

I raced down the street towards the hospital. At least I lived relatively close. It was two steps at a time up to the ninth floor; I didn’t really feel I could wait for the elevator. Up at the team work room I found no one and I figured they were already out seeing patients.

I gave the other student on my team a call. “Where are you guys?”

And she said, “Uh, I’m at home making dinner.” After a pause, “Why?”

I stood there dumbfounded and looked out the workroom window at the largely empty hospital parking lot below.

“No reason,” I said as it dawned on me what had just happened. “You have a good night,” and then I hung up.

Yeah, it was seven o’clock but not in the morning. I had slept a mere three hours before popping up and convincing myself, in my haste, that I was late for rounds.

Across town, standing over some boiling water and pasta no doubt, my fellow student was no doubt shaking her head as she put her phone down.

I walked to the elevators with a little slunk in my step and contemplated slapping myself upside my own head. I realized how empty the hospital was, how the sun must be in the west, that I didn’t really feel like I had slept more than twelve hours. It all made sense, except somehow it hadn’t for the whole twenty minutes it had taken me to race to the hospital.

The next day I had to explain to my partner on the team that strange call and I also let my resident in on my little screw up. Everyone got a good laugh.

Hey, I wasn’t late. I was dedicated enough to my rotation to come in extra early.

I Have a Dream

Kendra Campbell -- Going to a medical school in the Caribbean has some drawbacks, but it definitely has its benefits. Rather than launching into a laundry list of positives and negatives, I’m going to focus on something that I recently noticed: My school has an incredibly diverse student population. Since I was immersed in the environment on an isolated island, I never fully appreciated just how diverse it was. U.S. schools also have students from diverse backgrounds, experiences, education levels, and ages. But the profound difference at my school was the variety of ethnicities I saw on campus.

I’m currently nearing the end of my first clinical rotation in the States, and I made quite an interesting observation a few days ago. During a lecture, I finally got to meet medical students from other medical schools. Several local universities send students to the hospital where I’m rotating. I was surprised to find out that they were quite similar to the students from my own university. However, there was one profound difference: they were all white.

Of course I know that these students represented only a small sample of med students from U.S. universities, but the difference was nonetheless quite fascinating. At the table sat students from both Caribbean and U.S. medical schools, and the Caribbean students were quite a bit more diverse.

I’m not the first person to make this observation. I won’t go into the statistics, but I know that U.S. medical schools have a much smaller percentage of minority students than do Caribbean schools. The Association of American Medical Colleges (AAMC) has been aware of the less-than-optimal percentage of minority medical students for years. In fact, they have a program devoted to trying to increase the numbers of minorities in medicine.

There are many reasons why Caribbean medical schools attract and accept more minority students, but one of the obvious reasons is that they have different acceptance standards. Caribbean schools are more likely to accept a student with a lower MCAT score or GPA. Because of many reasons that I won’t go into here, certain minority groups don’t have access to the same educational resources as do other students, and sometimes this means that their scores might be lower. This issue is obviously very touchy and much more complicated than I can elucidate in a short blog entry, but the difference does in fact exist. The numbers don’t lie.

I’ve written before about the need to create a diverse physician workforce. It’s something that I adamantly believe in. I just can’t accept that certain barriers exist, which prevent the enrichment of the field of medicine with a more heterogeneous group of folks.

Please excuse me for using this tawdry metaphor, but I have a dream that some day I will be sitting again at a table with my fellow colleagues, and I’ll enjoy the presence of a more diverse group of individuals: diverse in body, spirit, and mind.

CV Guide

Ben Bryner -- If I may pick up where Thomas left off in this post about personal statements, another one of the important elements of an application to med school (or residency) is getting your CV or resume together. (Review a discussion of CVs vs. resumes from the good people of the NIH here.) You don't technically need a formal CV to apply via AMCAS, the med school application service, or for ERAS, the US residency application service, since you upload descriptions of all your activities and experience to their websites and the program compiles a "CV" for you. But it's easy to adapt a CV to this purpose. And you do need a CV to give to people who are going to write your letters of recommendation. Plus, they're good things to have at your actual interview if necessary (to hand to the interviewer or to go over beforehand to make sure you bring up all the activities you want to remember).

There's not much to it besides gathering together the important stuff you've done, organizing it into meaningful categories, ordering it in reverse chronological order, trimming the explanations down to make it fit in your target zone, and then slapping your name and contact info on the top. Of course it’s time-consuming, and updating it is one of those not-fun activities I tend to procrastinate on. It plays kind of the same role that cleaning my room did was when I was a kid.

Anyway, you can find some good examples online, as well as some good tips. My advice, which you'll certainly hear elsewhere too: Pick a good font. It should be very readable, but getting away from Arial and Times New Roman is nice. Just don't use something like Comic Sans. (While it's hard to specify the very best font for a given situation, it's often easy to pick the worst for that situation: Comic Sans).

The other thing that lots of people will tell you to do is use "active" words in your CV. These words, like "spearheaded," "quantified," and "reorganized" make you seem more action-driven and emphasize all the things you can do. Our med school counselor sent around a list of these "action words," and you can find an alphabetized list here. Note though, that you should only use words that truly fit the action you're trying to describe. Have someone else read it if you're not sure how much sense it makes.

None of this is really anything new. So I'm going to do something different: I thought of a list of words not to use. Like the lists of "power words," this list isn't meant to be comprehensive, but rather to give you a sense of what words are good and what ones aren't.

Here are just a few words to avoid:

humiliated

crumbled

capitulated

absconded

indicted

fumbled

twiddled

undermined

swabbed (especially in the phrase "swabbed the deck;" this is an unimpressive entry-level task for pirates, and should never be used in a CV that will end up in the hands of a residency director, or in the hooks of a pirate captain)

hogtied

guesstimated

Bonus: Poor Adjectives for your CV

dainty

malodorous

perky

catastrophic

bitter

fancy

unexciting

apocalyptic

If several of these words were in your CV, then better to catch them now rather than later. If none of them were in your CV, then I'm sorry to have wasted your time, but I hope you can see the larger point. Your CV is a great opportunity to let your accomplishments shine, to prove to the world that you can do all the things you claimed in your over-the-top personal statement. Put in the time to create a solid CV so that all the work you put into your activities comes across, duly impressing the people determining your fate.