Mount Mitchell, Contra Dancing, and the Roller Derby

Amidst our numerous "shelves," there is hope. Time in Asheville has not been all work and no play. As the sun comes out and the warm spring weather melts away the lingering work-ethic, the time has finally come to get out and smell the roses. Last summer was wrought with three months of Surgery and OB/GYN, two of the more time-consuming rotations. And with the religious fervor that I tackled six weeks in the OR, last summer was a wash for trekking, exploring, and general tomfoolery. I followed those 12 weeks with studying for the GRE, applications, and diving head first into the continuity curriculum, thus the weather turned before I knew it. But no more! In the background I hear those famous words from John Keating a la Dead Poets Society:

"They're not that different from you, are they? Same haircuts. Full of hormones, just like you. Invincible, just like you feel. The world is their oyster. They believe they're destined for great things, just like many of you, their eyes are full of hope, just like you. Did they wait until it was too late to make from their lives even one iota of what they were capable? Because, you see gentlemen, these boys are now fertilizing daffodils. But if you listen real close, you can hear them whisper their legacy to you. Go on, lean in. Listen, you hear it? - - Carpe - - hear it? - - Carpe, carpe diem. Seize the day boys, make your lives extraordinary."

Seize the day, and so I shall. I am thus inspired.

Carpe diem is my motto for the spring, as I realize I only have a few more months in beautiful Asheville before I must head north on a new adventure. I started March with a 11 mile hike to the top of Mount Mitchell, the tallest peak in the U.S. east of the Mississippi River. It stands more than 6,600 feet (over 2,000 metres), surrounded by the Pisgah National Forest. I trekked with a cohort of Pharmacy students, leaving at a leisurely hour of about quarter til eleven. What turned out to be a beautiful hike (see picture, above) became even more memorable for the 4 mile detour we took around the mountain. We ended up travelling two miles horizontally off the beaten path for no reason whatsoever (except our own incompetence), and two miles back. Our now 15 mile excursion ended just in the nick of time, with the sun completely set as we finished the last 30 minutes of trail. I was sore for days.

This was followed by Thursday nights at Warren Wilson College, featuring "Contra Dancing," which I can only describe as line dancing on steroids. The first 30 minutes of each evening is a "lesson" for all novices. Of course, we were late, so I had no chance to learn any of the steps. Instead I was thrown in head-first, pink button-down and loose fitting jeans vs. hipster. I snapped, I popped, I crackled. Line dancing, meet Lil John and the Eastside Boyz. I am here. I danced, I laughed, I sweated, and I kept my shoes on (no way I was going barefoot on that disgusting gym floor). I picked partners who were willing to teach a nube; we square/line/whatever-it-is danced away. All I can say is you should YouTube and Google it before you try; I wish I had done so beforehand.

Finally, no matter where you live, if the Roller Derby is in town then attendance is mandatory. The first bout of the year featured the Blue Ridge Rollergirls (the AVL home team) vs. the Carolina "Hurticanes." It was a no contest bruiser, as Calasmity Jane, the most awesome Jammer alive, led the charge against a much weaker and inferior opponent. Not even Holly Wanna Crack Ya could fend off the relentless onslaught. I may have to pick schools based on Roller Derby teams... and cheering for the Boston "B" Party could be the grain of rice that tips the scale in favor of a Harvard degree (and I'm sure there's contra dancing in Boston as well...).

So, carpe diem. In the months to come, multiple hikes are planned (Looking Glass, etc.), good food will be consumed (latest amazing restaurant, The Admiral - the duck breast was exquisite!), and bucket list items need to be checked off. A full day at the Roller Derby is set for May, and an upcoming weekend with my parents here in Asheville will be another wonderful diversion.

Oh captain, my captain!

Shelf Season

True to life, everything has its pluses and minuses. I've enumerated quite a few of the positive aspects of the Asheville Longitudinal Curriculum in earlier posts, but as the year ends, we are overwhelmed by the sheer number of tests we have to take. At the conclusion of each clerkship, most medical schools require their students to take a "shelf exam." Why they are called "shelves," I have no idea, but these are the subject exams for each individual specialty. For each clerkship we are required to take a 100 question multiple choice exam related to that field (although the questions come from other fields of medicine as well and are often obscure/esoteric). In the traditional model, students do six weeks of a specialty, then take a shelf; another eight weeks of that, then a shelf; another four weeks... you get the picture.

In Asheville, on the other hand, this structure would be impossible. Since we do all of our clerkships together (essentially), we take all our shelves at the end of the year. So starting on March 20th, we began the never-ending season of tests, aka "shelf season." We started with Psychiatry, then comes Neurology, Pediatrics, Family Medicine, Outpatient Medicine, and Inpatient Medicine. The culmination of all these exams is Step 2; a clinical version of the Step 1 exam. Basically it's a combination of all the NBME subject tests: eight 1-hour blocks of 44 questions. This test is on June 27th. So between now and June, that's...

Step 2 + 6 Shelves = (8 x 44 Qs) + (6 x 100 Qs) = 952 Multiple Choice Questions

Add in the Surgery and OB/GYN shelves we took earlier in the year, and that's a total of almost 1,200 Qs. Isn't fourth year going to be wonderful when the total number of multiple choice tests will be ZERO??

What complicates this picture is all the odds 'n ends and nick-nacks that we must finish up from here on out. Tidying up all the loose ends. Oral exams in Pediatrics and Psychiatry, extensive H&Ps for this and that, extra half-days, etc. All of this indoors work when it is finally 70 degrees and sunny... almost every day! Happy Hour is sooo much more tempting when it is outside at the Wedge drinking a pitcher of Payne's Pale in the warm sun. Children frolicking across the grass, hipsters playing cornhole, and a cool breeze from the south caressing the nape of your neck...

But no, I would prefer to study for more and more multiple choice tests.

I should say, however, that all of these tests being at the end are actually a blessing in disguise. Beginning in January, all of the clinical experience really started to crossover into each individual clinic. Learning the preventative guidelines for lipid and cholesterol management in Family Medicine really started helping me counsel my Internal Medicine patients. Working with Psychiatric patients made it easier to recognize people with underlying depression and anxiety in all my other clinics. All the medicine has begun to intertwine and mesh, which makes studying for these tests much easier. Instead of just focusing on one specialty, I can bring in my experience from all 8 clerkships into each question. This would be much harder if I was in block scheduling (but obviously, we are the outliers).

It is also a blessing because I will not have to study much at all for Step 2. These months and months of reading and practicing multiple choice questions are gearing us up for the second part of the national board exams. Thus, I am taking Step 2 just a week after our last shelf exam, and only a few days after our final day of clinic. I will spend most of this time relearning OB/GYN and Surgery, since those are the only two specialties I won't have studied in the past 3 months.

So with that being said, it's off to Bywater for good company and a Greenman Porter... followed by some Neuro questions.

Harvard Kennedy School of Government

Dear Robert:

Congratulations! I am pleased to offer you admission to the Harvard Kennedy School as a member of the Master in Public Policy (MPP) class of 2014. My colleagues and I very much hope you’ll join an exceptional group of people by answering the echo of President John F. Kennedy’s call to “ask what you can do.”

We get a spectacular group of applicants to the Kennedy School. It is often hard for our team of faculty, staff and students to make the final choices. You are among the talented and diverse group we have singled out on the basis of your intelligence, your leadership, and your commitment. If you choose to enroll, you will be excited, challenged, supported, sometimes frustrated, and ultimately empowered by the faculty and curriculum, by the astonishing array of people who speak in our Forum, by those in the School and the community who provide opportunities outside the classroom, and most of all, by your fellow students. They all share a desire to make the world a better place by thinking systematically and creatively, by leading with insight and conviction, while holding themselves to the highest standards of excellence and integrity—all of this, because they know the issues matter so much.

I am always inspired by the impressive academic capacity and leadership prowess that students bring with them to the Kennedy School. I believe we can work together to strengthen and sharpen those talents. Your predecessors, who are now our alumni, are doing extraordinary things. They are leading multinational organizations like the World Bank. They are mayors and ministers and legislators. They work in emerging nations or inner cities. They are social entrepreneurs and they are policymakers. They lead in government, in civil society, and in business. Amid all this diversity, the one thing they all share is that they care about something larger than themselves. At a time when many choose to turn away from the problems facing our world, they seize the opportunities to find solutions. All of us here at the School would be proud if you would decide to join us.

I’m sure you have many questions. Some of them are likely answered below. You will receive much more information about the Kennedy School in the coming weeks. In the meantime, take some time to celebrate. And then I hope to hear that you’ll be joining us for the experience of a lifetime.

Sincerely,
David T. Ellwood, Dean
Scott M. Black Professor of Political Economy
Harvard Kennedy School

Woodrow Wilson School at Princeton

Dear Mr. Swendiman:

Congratulations! The Woodrow Wilson School has strongly recommended your admission to the Graduate School. Accepting their recommendation, I am pleased to offer you admission beginning with the 2012-2013 academic year.

Your official admission materials should be arriving in the mail within the next few weeks and will answer many of the questions you undoubtedly have. By common agreement with the Council of Graduate Schools, all applicants have until April 15, 2012 to advise the schools to which they have been admitted of their decision to accept or decline their offer of admission. Please note that our deadline is 5:00 p.m. Eastern Standard Time on April 15, 2012. Naturally, we are eager to hear from you sooner. Therefore, should you decide not to accept Princeton’s offer, we would especially appreciate hearing from you early, as we then may be able to admit other candidates from our wait list.

Welcome to Princeton University!

Sincerely,
William B. Russel
Dean of the Graduate School

Wednesdays

Hump day. Given our schedule, this was aptly named. Once I get through Wednesday afternoon, the rest of the week is all downhill. The hump, though, is 4 hours of lecture - my worst nightmare (so, why again am I signing up for another year of school?!?). Lecture is what I so strenuously avoided the first two years of medical school. Almost every lecture was video captured, allowing me to watch all our professors at up to two times the speed. Some professors, who had especially slow, monotonous voices, could even get sped up to just under 3x. That saved time and energy (and allowed me to sleep in very often). But, here there is no more lecture capture. One o'clock to 5:30 pm every Wednesday is back in the classroom; and with only eight students, falling asleep is completely out of the question. No dark corners in which to "rest one's eyes."

One thing I've noticed as I've gotten older is that I can no longer sit still. I honestly think my attention span was a better when I was in 1st grade than it is now. I'm very fidgety in a lecture setting. I tap my foot. I move around. I rub my neighbor's shoulders. Maybe I rub my neighbor's thighs (at least Dan's). I struggle to pay attention. It takes all of my concentration to keep-on-keeping-on (which has gotten more difficult as the year has progressed). The good thing, though, is that most of our lectures are "case-based." This means that the discussion revolves around the presentation of a patient's illness, and we work though the evaluation and management together. That keeps me involved and engaged. PowerPoint, on the other hand, is a different story.

On another note, I spend each Wednesday morning in Internal Medicine (IM). IM is the backbone of medicine, and it's one of the most important third year clerkships (if not the most important). Every specialty, no matter which one we chose, needs to know their medicine. Makes sense, since that is the field of study for physicians. Therefore, it is the broadest in scope. I actually work in a practice that is Medicine and Pediatrics, so I get to add kids into the mix. Prevention, growth and development, diagnosis, and management: IM is all-inclusive.

IM is also the clinic where I get the most outside continuity. I have followed patients to psychiatric appointments, to surgery, and met a number of them in the Emergency Department. This has been particularly rewarding, since I get to spend quite a bit of time with them in the clinic as well. I only see a handful of patients each morning, which has given me the opportunity to get to know each patient personally. I have specifically worked on developing my skills for weight management, smoking cessation, counseling about lab results, and developing a differential diagnosis.

One of my patients, in particular, shows how the continuity experience is extremely satisfying. Over the past several months, this individual has stopped smoking, lost weight, improved his/her liver and cholesterol profile, and has accomplished all these lifestyle modifications without the help of pharmacotherapy. It has been a true pleasure working with this person, continuing to motivate and being so impressed with my patient's drive. Of course, this is not the course with many (or most?) patients, but it is wonderful seeing a patient reach their personal goals, with or without medication. You don't see this if you only spend 4-8 weeks in a clinic or in the hospital; there's not enough time for real improvement. I've seen this patient at least 4-5 times since the beginning of the year, and I always look forward to seeing him/her on my schedule. If I didn't participate in a longitudinal curriculum, would I ever get to have this experience in medical school?