The Differential: Medscape Med Students Blogs

What Would You Give?

Anna Burkhead -- Donating your long hair for cancer patient wigs? Easy.

Donating blood? Easy.

Donating platelets? Easy, I hear, though it takes a little time.

Donating bone marrow for a stranger? Do-able, if you have guts. And Xanax.

Would you donate a kidney?

Recently I met a non-medical person who, during our conversation, told me that he was donating a kidney in the next month. The surgery was scheduled, his plane flight was booked. “Is it your sister? Dad? Cousin? Childhood friend?” I asked. “No,” came the answer. This person’s kidney was going to be transplanted into a total stranger.

“You know you only have two, right?” Of course he did. “You know it’s a big surgery, right?” Of course he did. This person appeared to know all the gory details of a nephrectomy, short of seeing it firsthand, as I have. The only flaw that I could find in his plan was that he was planning on taking only one week off of work, and the surgery was happening in Texas.

“What if you have kids someday, and one of them needs your kidney?” He had an answer for that too, albeit an optimistic one. He said that if the world progresses in the way he hopes, some stranger will generously donate his kidney to the child, as he was currently in the process of doing. “That’s a big risk,” I thought to myself.

I consider myself to be a generous person. Without hesitation I would donate regenerable body parts such as hair, blood, platelets, and bone marrow. However, when it comes to donating an organ like a kidney, only family and close friends need apply, and even some of y'all might not be eligible.

That statement may sound selfish to some people out there, as I’m sure it did to this man I had the conversation with. But if I’m going to give up an organ of which I have only two, I’m going to be pretty strict with my criteria. I want to know that my donation will be taken care of. I want to know that medications will be taken as prescribed. I want to know that doctor’s appointments will be attended as scheduled.

My interaction with this person made me feel a bit selfish for not wanting to open my own Gerota’s fascia, divide my renal vessels, and hand over one of my two precious urine-makers. But people, it’s a kidney!! What would you give?

Discussing Burr Holes Over Pizza

Colin Son -- It is easy to get consumed in the world of medicine while in medical school. Back home, the boys and girls I study with, go out for drinks with, sit and watch the football game with are all fellow medical students. That may be especially true, such as in my case, if your family is composed of healthcare professionals as well. Even a phone conversation with my mother is likely to devolve into talk of patients in her intensive care unit or on my current service.

It becomes second nature.

I am currently, however, out in Los Angeles, hanging out with old college friends who have become investment bankers or construction managers or sports reporters. Old college friends who, for good reason, don’t know a meningioma from someone’s spleen. And I’ve found that I’m lapsing into an age-old healthcare professional sin of talking about bodily functions and diseases and other things I take for granted everyday in the hospital and which, I easily forget apparently, are not so polite out in the real world.

It is interesting how acclimated medical students, nurses, physicians and other healthcare workers get to the human body. Yet even something as non-graphic as describing a Burr hole, drilling into a patient’s head, draws squeamish responses from many outside the healthcare sector. Especially over a deep dish pizza.

It is a tough corner to be put in. Often times my adventures, and I use the term loosely, in the hospital become the center of conversation; especially when I’m with a group of friends who are not involved in healthcare. There is something still mythical and fascinating about the practice of medicine. Especially surgery. Especially neurosurgery. And yet you tip-toe a line of maintaining interest and being polite.

So, I’ve gotten better over the past month at choosing my words, even when what I want to say is the most fascinating and interesting thing I’ve ever seen in the operating room.

Something a little odd has happened as well, though. The observation of the above has, in a small way, renewed my respect for the practice of medicine. It has been my stated goal to never cease to be fascinated by whatever specialty I choose. While I admit that a little acclimatization is inevitable, I hope I never lose at least some wonderment staring at someone’s brain, the seat of their soul -- no matter how many cranis I am a part of performing. And watching the interest, even in the form of a little disgust, from my friends who are not neck deep in the study of medicine has reminded me of what a gift it is to see and be a part of what I am, even if it sometimes from the periphery as a medical student.

Sometimes it is just difficult to capture that for people who are not there to see it in person, without making them think twice about what they’re eating. I’m working on it, though… at least as long as I’m out here in Los Angeles.

Old School vs New Tricks

Lucia Li -- "Nothing that is worth knowing can be taught."

One of my first-year supervisors told me that I’d be lucky if I remembered even 20% of the stuff I learnt in medical school. I think he was intending to cheer me up, but I remember thinking that if I was going to forget 80% of what I learnt, I really hoped it would be that stuff about ribosome units and mitochondria, and not the stuff about hearts and brains.

The first 3 years of our course are filled with lectures and lab-work, and the sum total of patient contact in those years is about 12 hours. Some of this basic science is a bit more obviously relevant than other parts… anatomy and physiology and pathology. Others still seem a bit obscure. Whilst I lost sleep as an undergrad trying to remember Gibbs free energy equations, my friends at other medical schools lost sleep over cases on heart attacks.

Inevitably, people ask what’s the point? The current drive is towards making medical courses more directed and cuddly, with the 4 new UK medical schools all providing integrated courses. Buzzwords such as "Problem-Based Learning", "Student Selected Components", etc., pervade. When the GMC (the UK professional regulatory body for doctors) came to inspect the Cambridge course, they asked us a lot about what we thought about the heavily scientific nature of the course and its relative paucity of early clinical experience. Apparently, we surprised them with our enthusiasm, prompting them to ask, "Did they pick you guys [to meet us] because you’re so positive?" No, actually.

Why wouldn’t we be supporters of our course? First of all, I’d imagine most of us knew what we were getting ourselves into when we applied, and most of us have enjoyed Cambridge because of, not in spite of, its scientific nature.

Second, I really believe that all this emphasis on early clinical exposure is a bit overrated, whilst science is underrated. You don’t make medical advances without research and scientific principles, and you can develop a bedside manner and good examination skills just as easily at the age of 21 as at the age of 18.

Diversity of experience should be celebrated in medicine, and part of that is the differing medical course styles. Yes, until a year ago, I knew more about guinea-pig hearts and Drosophila genetics than about how to examine a patient. But, as long as you’re competent at the bedside, I doubt anyone really cares where you graduated from 10 years down the line. Besides, all those random facts come in pretty useful in pub quizzes…

How to Have a “Better” Clinical Rotation Experience

Kendra Campbell -- I just finished reading the book, Better, by one of my favorite authors, Atul Gawande. In the afterword, Gawande gives his list of “Suggestions for Becoming a Positive Deviant.” I absolutely agreed with all of his suggestions, and it inspired me to write my own list for making your clinical rotation experiences “better.” Here are some tips that have worked well for me thus far:

1. Don’t be afraid to complain. Today, at the end of a lecture, a surgeon asked us how our rotation was going. Everyone pretty much replied “okay.” Then (knowing that we were all holding back our negative remarks), he asked us to be honest and speak up about the things that we didn’t like. In true med student form, everyone remained silent. I broke the ice and offered up a piece of constructive criticism. Eventually, everyone else chimed in with their own complaints. He reminded us that we need to be vocal about giving feedback. I actually agree with Gawande, that sitting around with colleagues and complaining all the time is a horrible idea. However, providing constructive criticism to the powers that be shows that you care, and shows that you’re not afraid to take a stand.

2. Introduce yourself to everyone. Of course, in med school we are taught to always introduce ourselves to the patient. This is obviously important. But how often do we take the time to introduce ourselves to the nurses? How often do we just walk up to someone and ask them for something, without introducing ourselves first? I’ve learned that an introduction can go a long way. And as Gawande mentioned in his book, getting to know someone by asking them a more personal question is also a fabulous way of making friends, not to mention making the hospital more of a fun place to be.

3. Stand out. As Ben Bryner pointed out in his recent entry, standing out can come in handy in many ways. Even without my pink hair, I tend to stand out in a crowd of med students. It’s not even always an intentional thing for me. But when it comes to making good impressions on attendings, residents, and patients, standing out can be a great asset. Not to mention when it comes to getting letters of recommendation down the road. Know what is unique about yourself, and use that to your advantage.

4. Smile. Smile. Smile. A smile can be worth a million words. I always try to smile at people as I pass by. When I walk past a patient’s room, even if I don’t know them, I give them a friendly smile. Obviously, there are times when a smile is inappropriate. But for the most part, a friendly smile can brighten someone’s day, make them feel more relaxed, and show them that you care. Even if you’re tired and have had a hard day, try to spread some joy with a nice contagious smile.

5. Get your money’s worth. You’re paying a lot of money to be trained and learn from your clinical rotation. Even though you’re expected to do a lot of work, you’re paying for the experience! Learn as much as you can, and remember that the point of the rotation is not to be tortured or to just “make it through.” You are there to learn, and you’re paying money for that privilege! You’ll never have this kind of experience again, so make the best of it!

6. Make friends with your fellow students. This tip seems pretty obvious to me, but some people seem to ignore it. Get to know your fellow students. Not only can this make the rotation more enjoyable, but it can also come in immensely handy. When an attending asks you a question and you blank, how awesome is it to have a good friend whisper the answer in your ear?!

That’s all I can think of for now. To all you fellow students out there doing your clinical rotations: good luck and try to make your experience even better!

Eloped!

Thomas Robey -- Medicine introduces a whole new language to medical students' vocabularies. Many of you would agree with me that learning a dictionary's worth of words is one of the hardest parts of medical education. Now in the midst of my language immersion experience, I've discovered a bonus of learning a new lexicon. Medicine not only invents new words -– it borrows them for its own use. My favorite of these new uses is the verb "elope."

To be fair, elope has two meanings in most online dictionaries. The first is the standard use regarding marriage. "Elopement to Las Vegas" puts one image in your head; "They eloped to save money," another; elopement in the context of parental disapproval yet another. There's a generic meaning of the word separate from matrimony, which is "to leave without permission or notification; escape."

Those of us who have worked on psychiatry wards or in emergency departments have learned this alternate definition. Let's say your floridly psychotic patient has responded well to the risperidone you've initially compelled her to take, then convinced her to take. Now she's asking you for the meds. (This is the story of my current psychiatry clerkship, by the way.) At our hospital, as patients progress to discharge, they can ask for increasing freedom. In my state, over the course of their stay, patients may transition from involuntary hold to a consented involuntary admission to a voluntary treatment. In parallel with this fluid legal status, patients may leave the locked floor escorted by staff (level 2), family (level 3), or other patients (level 4). This usually works out fine. On very rare occasions, however, patients are advanced a little too quickly. Someone on level 4 could encounter triggers on the outside. If, for example, your patient passes the corner across from the county hospital where crack is bought and sold, he may hatch a plan on his next level 4 release to leave the hospital and score a hit. Indeed this happened with one of my patients last week. I returned to work Monday to discover that the patient had actually only been admitted for 1.5 days, when I had been caring for him for about 10 days! It turns out he spent Friday night on a crack vacation, and checked back in on Saturday... What's the medical term for that? Elopement. Part of me thinks that the first physician to use the term had in mind some titillating scenario. I'll leave that question to the medical etymologists.

The psych ward isn't the only place I've heard the diagnosis of elopement. In the ED where I worked, next to the bins that say, "medicine," "surgery," and "peds" where you pick up new patients' charts, there's a bin labeled "LWBS." I didn't use this bin until I had a patient come in who had smoked a sherm. Unless you live in California, where PCP is accessible, most sherms are cigarettes dipped in embalming fluid (formaldehyde, etc.), and unlike the usually credible resource linked above, smoking (non-PCP) sherm is not usually "a lot like being totally drunk on acid and meth at once." In my experience (as an observer, of course!), smoking embalming fluid leads to verbal latency, paranoia and aphasia at best, and unresponsiveness, paralysis, and arrested breathing at worst. Perhaps the folks who get the "good" high stay away from the hospital. But I digress. Per the patient's history, he smoked a joint passed to him while watching a football game. He didn't know what was in this cigarette. He did remember waking up in an ambulance on the way to my favorite ED. I got his story, but he refused to let me put in an IV, draw labs or rehydrate him. He certainly did not permit a urine sample. He believed I was in cahoots with the cops, and when I returned with my attending, he was nowhere to be found. Hospital security pointed him out across the street (on the aforementioned crack corner, actually). I asked if he wanted care; he advised me to shred the documents associated with his stay. Instead, I dropped my note in the LWBS bin. My attending explained that he had eloped; medico-legally, this amounts to his having Left Without Being Seen (LWBS).

Whenever I learn a new meaning of an old word, I like to test out its use. Sometimes this verbal experimentation crashes and burns. Like how I got AMA and elopement confused for about two weeks. (In the ED, to leave AMA, the patient must sign a form indicating she understands her condition and the risks of leaving.) Other times, I'm quite happy with the outcome. As part of my psych clerkship, I take evening call in the psychiatry emergency services (PES) section of the ED. Nights in the PES are usually a trip, and it's a great place to see acute psychiatric problems. Last week it was slow. We had one patient who was clearly sick but was worked up in the first hour of my shift. All that was left to do for him by 8:00 was to write an affidavit for an involuntary hold, and wait for the county designated medical health professional to see him. With my final in a few weeks, I was anxious to use the downtime efficiently. Without a patient to see (and learn from) and without a quiet place to study, I was out of luck. Like the patient scheming his escape from the psych floor to score some crack, I was looking for any open door to bolt from the PES. Talk about empathizing with patients. As soon as the attending noticed I was not in a position to help the residents, she said, "you know, you don't have to stay until the..." Sometimes it's best to not let your supervisor finish that sentence. When I called my wife to see if she could pick me up, I excitedly told her I had eloped from the PES and needed a quick getaway.

I Want To Make a Difference

Jeff Wonoprabowo -- I'm worried about how I feel about the upcoming November Presidential elections. I'm worried that I will be so frustrated that I decide not to vote.

At the moment, I'm not sure who I'm going to vote for. This coming election may very well be the first presidential election I vote in. But I can't stop feeling like my vote won't matter. That's why I didn't vote in 2004. And that may be the reason I have lost some of my excitement about this election.

For all the talk of change during this election season, how much change can my vote bring about? I don't live in a swing state. I live in the Golden State. It's a state where McCain doesn't have much of a chance of winning the 55 electoral votes.

It doesn't really matter who I vote for. Whether I vote for Obama or McCain, California will still send its 55 votes to the Democrats (I've heard that California is considering giving its 55 electoral votes to the candidate that wins the popular vote). The sense of my-vote-doesn't-matter is not encouraging.

That worries me. Because while thinking about this political situation, I started wondering about a medical one. In a course called Understanding Your Patient, we learned about teaming with our patients to bring about change -- change in behavior, diet, lifestyle, or even just taking medications. Compliance, our professor told us, sounded like a word that a ruthless dictator might use. Doctors shouldn't be forcing change upon patients. Lasting change requires a patient to decide that change is what he or she wants. Teaming with our patient is the most effective method to bring long-lasting results.

But what happens when I have a patient who is non-compliant? What happens when my 55-year-old patient with 40 pack-years refuses to quit even though the biopsy comes back positive for lung cancer? And what happens when I get a patient desperately needing a liver transplant who cannot get over his drinking problem?

When I inevitably find myself in a hopeless situation because a patient cannot or will not follow the healthcare plan, then what?

It'll be a situation where my "vote" means nothing. And I'll feel frustrated, I'm sure. In the political arena, I am considering not voting. In the medical arena, I'm not sure what I'll do because I've never been in that situation.

I'm worried about how I feel about the upcoming November Presidential elections. I'm worried that my feelings about voting might carry over into patient care -- that I'll get so frustrated I decide not to care.

Choosing a Medical School

Ben Bryner -- Interview season for med schools is getting underway; it's a nerve-wracking experience getting interviewed because the stakes are rather high, but it's an exciting time to see what the future may hold. Other Ben has made a great list of things to consider when choosing schools at which to apply and interview, and I agree with it. All of those factors are important when making decisions about where to go to school. But there's nothing like taking a look around the place to get a feel for it.

Maybe the most important thing to notice about a school is the overall attitude that most people seem to have there. This was a huge factor in my decision to go where I did; everyone seemed to be very upbeat and happy. You can also tell something about the school just from the number of students you run into. The number of applicants present for an interview day ranges from just a handful to a huge roomful, so you have to take that into account. But if a school can only manage to convince a couple of students to show up and say hello to a large group, that's not as encouraging as a big group of students stopping by to say hello and get some free food.

I remember interviewing at several schools where lots of students showed up at lunch to answer questions, some where only a few did, and one school where I think I met only two or three students. Most schools have a tour led by students, which is a great opportunity to ask questions while you get a glimpse of the place where you could be spending the next four years of your life. This last school, though, just had someone working in the office take us around the campus, and it was a lot less interesting. Even if it's your tenth interview and you're tired of wandering around medical schools, the tour guide can often be a good resource. For one thing, you have enough time with them to ask questions that require some thought, like "what makes this school different?" or "what do you wish you knew before you started?" Or, if you get a tour guide that's painting what you think is too rosy of a picture, you can ask something like "What are the things you like least about this school?" A thoughtful response is pretty useful, since you can put their praise in context.

Speaking of tours, one thing to pay attention to on your tour is the presence of construction. If the campus is busy with new buildings going up, that's a good sign that things are going relatively well at the school. If the most complicated construction project you see is some kids building a tower with Legos in the waiting room, that doesn't bode as well for the future of the school. Most of the time you'll get a tour of at least one of the hospitals you will be working in at that school. Most hospitals probably look more or less the same, but this is a time where you'll want to find out as much as you can about the clinical component of the curriculum. If you get a chance to talk to a clinical-level student, make sure you seize the opportunity to ask them as much about the rotations as you can. It's easy to get a feel for the preclinical (usually the first two years) curriculum, but I would argue the ways the third and fourth years are set up, and the quality of and expectations on rotations, matter even more. So if you get a chance to talk to a fourth-year, grab onto them and ask questions. If someone gives you the email address of a third- or fourth-year, follow up on it and ask how their rotations are going.

Whenever I'm leading a tour I try to make sure we see the hospital cafeteria. It's a decent place with a wide range of choices if limited variability, and it has an especially nice view of the leaves changing color in the fall. It may sound like a waste of time to see that, but you spend enough time there during third year that it's definitely worth considering. Maybe not to the point that I'd choose one school over another solely on the basis of the cafeteria, but it's fine to make that part of your overall evaluation of the place. Obviously you should pay attention to the presence of study rooms, computer labs, and other med student-specific study facilities for those same reasons.

And on the way back from an interview you should take the time to write down your thoughts. You can do this in a standardized way, like making up a form to record all your thoughts about the school in various categories (for example, "coziness of lecture hall seats," "number of students in anatomy lab groups," "number of weeks I think it would take to find my way around this building," etc.) This is fine, but more important, in my opinion, is writing down the impressions you had about the place, the things that differentiate it from the other schools you've been to (or if it's early in the season, things you think are different and want to pay attention to at other schools), and what was really exciting about the school. No matter how thrilling that detail of that school's small-group case discussions seems at the time, by the time you do a few more interviews each school will start to blur together. Needless to say, it's embarrassing to make your decision, matriculate, and then show up the first day of school expecting to be at a completely different institution, so take the time to write down everything you can about the school as soon as you get a chance to sit down.

Medical Specialties From a Student's Experience

Lucia Li -- "Medicine is learnt at the bedside."

The grass, in the case of medical education, probably is greener on the other side. As students, we don’t have to do evil paperwork. But then we don’t have the inconvenience of being paid, either… Already through my attachments, I have been surprised (both pleasantly and unpleasantly) by the difference between my expectations of different specialties and reality. At the same time, I know that specialties are very different for a doctor than they are for students.

What makes a good attachment for students? For me, it’s nothing too miserable, staffed by good people who like to teach, well-organized, coherent patients… oh, and time off to pursue student-like activities.

Here are my winners and losers of specialties to be in as a student.

The losers:

Oncology – My housemate, currently doing this attachment, informs me that she had never really experienced true vicarious depression until this time. We’re taught to be empathetic in our clinical communication skill courses and to say such helpful sentences as "I understand" and "I can see that must have been difficult for you." But, when you can do nothing as a student but say such platitudes, your own ineffectiveness and inability to help is blindingly apparent.

Care of the Elderly – It has to be said, this specialty is generally staffed by the most jolly and eccentric of doctors. The bow-tie wearing and ancient Greek-quoting kind. However, whilst there were some real gems, it was very frustrating to see what is essentially social care carried out by doctors because there was no one and nothing else.

The winners:

Orthopedics – In our hospital, all the orthopedic surgeons are happy. Seriously happy. Not just your average, I’m-contented happy. But a proper, I-love-getting-up-in-the-mornings happy. And their specialty involves cool toys and gruesome operations that students can really get involved in. However, what really sealed it for me was probably the CD they played when we were in theatre; anyone who plays the best of the 90s whilst screwing pins into knees has my respect.

Psychiatry – I have no aspirations whatsoever to be a psychiatrist, but this really was a fun specialty. Where else do you have patients that tell you they don’t think the world is real, or have the police involved in coaxing people out of peculiar hiding places? Plus, psychiatrists have the comfiest chairs in their offices.

I’m sure I’ll change this little ranking system as I see more specialties. But for now, I’m heading back to the land of happy people.

Tough Decision

Colin Son -- I’ve been away from blogging for a week. Away rotations will do that. Away rotations will also put you in tough positions at times.

For a recap, I want to do a pretty competitive surgical subspecialty and I’m doing two months of sub-i rotations at away institutions. Right now I’m out in Los Angeles. There are unique and inherent challenges with an away rotation. Moving into a new health care system, with unique ways of doing things, and honing in on some sort of rhythm on a pretty quick timeline is a challenge.

Not all of the challenges are inherent. Some are self created.

I got back today from a wedding. I was in the wedding and it was important that I was there. I love the bride and groom and I wouldn’t have missed the wedding short of an emergency. Taking time off from an away sub-I, however, is nothing short of taboo. The program I’m at right now was very polite and didn’t call me out when I asked for the weekend off, but I know that flying to Georgia this weekend leaves a bad impression. There are many goals of an away rotation but it is arguable that the most important is to demonstrate your work ethic and stamina. Taking time off is a little contradictory to that goal.

I realized that, but after weighing that and my dream of matching this March versus my commitment to some of my closest friends and their wedding, I made my decision.

I was lucky in the way the situation was handled. If I failed to impress my away rotation program, at the least they were polite and understanding about my decision. That might be a bad way to describe it. What I mean is that they weren’t confrontational or upset.

I knew that this wedding was coming for six months, but I don’t buy the argument that if I have a weekend commitment I know about, that it is somehow rude to the away rotation program to schedule a rotation during that period.

Let us not forget, if my goal is to impress, the main goal of the away rotation program should still be to serve as an educational experience for the visiting student. Hard to believe my brief time off hurt my educational experience.

No need to get offended, even for something as taboo as a visiting student asking for time off.

There is another argument I’ve heard around that I’m taking an opportunity away from another visiting student. If I know I’m going to do something unsavory for my chances of impressing and since there are a limited number of visiting student spots, that I should give up a spot to someone else. Maybe. In this case, my away rotation has fewer visiting students than available spots right now. So no one is missing out.

Bad form or not, I have no regrets. And by the way, the wedding was awesome and I have never been happier for the bride and groom.

A Medical Student Is...

Jeff Wonoprabowo -- There seems to be a public perception that medical students are all brilliant, Type-A, assertive individuals. If that were true, wouldn't one expect a physician population with those same three characteristics? Pretty much any nurse will be more than happy to talk about working with some -- to put it nicely -- not-so-brilliant doctor. So I must either conclude that not all medical students are brilliant, or that a number of students enter medical school smarter than when they leave. I prefer to accept the former. Besides, if I am a little like other medical students, then the former would have to be true. Because while I may occasionally have flashes of those traits, sometimes lasting only seconds at a time, I would not consider myself a brilliant, assertive, or Type A person.

But there are two things I have noticed about medical students. I'm sure, like all generalizations, there are exceptions (and I do acknowledge the possibility that I am the exception and I'm just describing myself). But again, from what I've noticed and observed, most of us share these two traits: 1) We're cheap, and 2) we're lazy. Here's a few of the instances that have confirmed these observations:

Most of us are cheap -- but only because we have to be. We're diving deeper into debt each year ($40,000 - $50,000 for those relying solely on loans at private schools), and we don't really have time to take on a side job. Living with less-than-desirable funds is a huge influence on our lives.

So how do you get a large group of medical students to an event? That's easy: free food. Just set the food out and the swarming begins. One of our professors loves bringing in snacks when he lectures. He's one of the class favorites. His lectures are pretty good, too. I often don't rush up to grab a handful of crackers, licorice, or cookies because, well, I'm lazy.

Most interest group meetings always include free meals. If I remember correctly, I've heard of three events in the past two days that will be offering free meals.

And one professor (neurologist) holds Bible studies once a week during lunch (yes, I do go to a Christian medical school). Lunch provided. The lecture hall is usually pretty full. Tomorrow is Indian food. I think I'll make my way over there for some food -- physical and spiritual.

A classmate told me that he buys Stater Brothers (a grocery store) gift certificates at the Student Services Center. They charge $92 for a $100 gift certificate. I don't know why I haven't heard about this before, but I think I'm going to be generous and buy myself a gift certificate.

Our Microbiology course director has decided that he wants to make classes more interactive. He ordered personal response devices, similar to these. The system records our responses and displays a graph showing how many students selected each answer. He wanted all the second years to go to the Dean's office and sign one out, but because of a mix up, we didn't get the email telling us to do so. So he brought them to class and told us to go sign them out at the office. A couple classmates strongly suggested we just pass around a paper on which we could all sign our names and write down the ID number of our device. It almost seemed like we collectively refused to walk to the dean's office.

Well, after thinking about it while writing this piece, maybe I shouldn't call myself and other students cheap. Financially responsible might be the more appropriate term. And we're probably not all that lazy. The last example is just medical students thinking efficiently. We conserve energy when we can.

By the way, has anyone else seen these traits in medical students? Or am I just transferring what I see in myself onto those around me? What words would you use to describe medical students? (Notice my attempt at audience interaction? See, I learned something from class.)