I'm already having anxiety dreams about the USMLE Step 1.
Last night, after having taken the dreaded test, I opened up the envelope with my score and saw "188" staring back at me. 188 is on the border of passing and failing, depending on the national performance for that test and recent tests. The national mean is somewhere around 222, one standard deviation above the mean is somewhere around 140-145, and a top score is 270.
Needless to say, I was horrified. In my dream, I was trying to assimilate the fact that I would not have the residency of my choice and would not even be able to go into the specialty of my choice. It was very traumatic.
I accurately predicted my MCAT score in a dream a week prior to the exam, but the Step 1 is still 4.5 months away. Maybe 188 is what I'd get if I took the exam a week from now - that wouldn't be so bad. An astute classmate friend noted that the dream can't be true because we get our scores by e-mail, not snail-mail. As silly as that sounds, it makes me feel better.
The USMLE Step 1 is a stressful exam - there's a lot riding on it. It's perfectly natural to have feelings of anxiety about it, even this early. What's most important, though, is that this anxiety is handled in a healthy manner.
Sunday, November 28, 2010
Thursday, November 25, 2010
Registering for the USMLE Step 1
Medical students must sit for Step 1 of the United States Medical Licensing Exam (USMLE) after they have completed their first two years of didactic learning and before they can enter into clinical rotations. Students at the University of Colorado School of Medicine take the exam a bit earlier than most other students around the country because the Powers that Be decided to shorten Year 2 in order to lengthen Year 3 - a decision for which I'm grateful.
So, while most medical students take the USMLE Step 1 around June or July, I will be sitting for mine in April.
The registration process is quite involved. First, I had to go to the National Board of Medical Examiners (NBME) website, create a username and password, and enter in my basic information. This allowed me to print out a "Certification of Identification and Authorization" form (complete with a 2"x2" picture of myself reminiscent of medical school applications), which had to be signed by the Dean's office and mailed into NBME. I just recently received an e-mail from NBME:
Next, I will be getting something in the mail from NBME that will allow me to schedule my Step 1 exam within that eligibility period.
This whole rigamarole is much more involved than what I remember going through to sign up for the MCATs. Jumping through these hoops has had the effect of making the looming threat of the USMLE Step 1 exam that much more real. It's coming up soon.
So, while most medical students take the USMLE Step 1 around June or July, I will be sitting for mine in April.
The registration process is quite involved. First, I had to go to the National Board of Medical Examiners (NBME) website, create a username and password, and enter in my basic information. This allowed me to print out a "Certification of Identification and Authorization" form (complete with a 2"x2" picture of myself reminiscent of medical school applications), which had to be signed by the Dean's office and mailed into NBME. I just recently received an e-mail from NBME:
Your USMLE Step 1 Certification of ID/Applicant Authorization has been received.
Your registration is complete.
Your eligibility period is Mar 1 - May 31, 2011.
Next, I will be getting something in the mail from NBME that will allow me to schedule my Step 1 exam within that eligibility period.
This whole rigamarole is much more involved than what I remember going through to sign up for the MCATs. Jumping through these hoops has had the effect of making the looming threat of the USMLE Step 1 exam that much more real. It's coming up soon.
Wednesday, November 24, 2010
Thanksgiving
I took my metabolism exam a day early and flew home for Thanksgiving. The exam was originally scheduled for Wednesday morning at 8:00 am, but Dr. Michaels kindly allowed students to take it at two other times to accommodate travel plans. I'm curious about how common this is at other medical schools, having students take an exam at different times and un-proctored. Regardless, I am very thankful that the administration places such trust in us students.
It feels good to free from medical-school-related-responsibility, even if it is just for 5 days. I don't realize how stressed and focused I am on my studies until I'm not studying anymore.
It feels good to free from medical-school-related-responsibility, even if it is just for 5 days. I don't realize how stressed and focused I am on my studies until I'm not studying anymore.
Monday, November 15, 2010
Metabolism + Psychiatry = Eating Disorders
The metabolism and psychiatry curricula converged last week with a discussion on eating disorders. Having spent 4 years studying the neurobiology of anorexia and bulimia nervosa with Dr. Walter Kaye at the UCSD Eating Disorders Treatment and Research Program, I was naturally curious as to how the topic would be presented.
Dr. Kenneth Weiner (who heads the Eating Recovery Center here in Denver) gave a one-hour lecture during which he commented that this one-hour lecture is the extent of our contact hours throughout medical school touching on eating disorders. Further, according to Dr. Weiner, internal medicine residents get a grand total of 8 hours of lecture on eating disorders. Perhaps I shouldn't be shocked by those figures, given how much material there is to cover and the limited space in the curriculum. The lecture itself is one I've heard dozens of times before - still very interesting given that Dr. Weiner has his own style of presentation and his own vantage point of eating disorders quite distinct from Dr. Kaye's.
The lecture was followed by an interview (in our regular psychiatry small groups) with a patient recovering from an eating disorder.
Dr. Kenneth Weiner (who heads the Eating Recovery Center here in Denver) gave a one-hour lecture during which he commented that this one-hour lecture is the extent of our contact hours throughout medical school touching on eating disorders. Further, according to Dr. Weiner, internal medicine residents get a grand total of 8 hours of lecture on eating disorders. Perhaps I shouldn't be shocked by those figures, given how much material there is to cover and the limited space in the curriculum. The lecture itself is one I've heard dozens of times before - still very interesting given that Dr. Weiner has his own style of presentation and his own vantage point of eating disorders quite distinct from Dr. Kaye's.
The lecture was followed by an interview (in our regular psychiatry small groups) with a patient recovering from an eating disorder.
Monday, November 8, 2010
Is high-fructose corn syrup really all that bad for you?
Having just finished the digestive organs unit (covering the gastrointestinal tract from mouth to anus including the liver, pancreas, and gall bladder), we're now learning how those nutrients are metabolized after they're taken up into the body. It's actually very interesting material because it is applicable to everyday life. Our metabolism professor Dr. Besseson says that "Nutrition is just applied biochemistry."
One nutritional controversy that has been in the news for the past few years (and has spawned new marketing campaigns from various food companies) is whether or not high-fructose corn syrup is bad for you - or in more apocalyptic terms, one of the underlying causes of America's obesity epidemic. Here is my attempt at an explanation that is accessible to the lay person.
First, some background. Common table sugar (sucrose) is a disaccharide (two sugar subunits stuck together); specifically, it is one glucose and one fructose molecule stuck together. They are broken apart by enzymes and absorbed in the small intestine before they can be broken down for energy.
There are two key points to consider. The first is how glucose and fructose are absorbed by the small intestine. The absorption mechanism for glucose is tightly regulated by insulin, whereas the absorption mechanism for fructose is not. What that means is that the presence of insulin allows for more glucose uptake, but fructose uptake will keep going regardless of whether insulin is present or not.
The second key point to consider is how glucose and fructose are biochemically broken down to make energy. Glucose enters the glycolysis pathway (i.e. the breakdown of glucose into energy), the activity of which is tightly regulated by.... you guessed it, insulin. In contrast, fructose by and large enters an alternate pathway that allows it to avoid a key regulatory step of glycolysis and produce energy regardless of whether the body is signaling a need for that energy.
As you might imagine, this might be problematic. First, you have fructose absorption even if you don't really need it; second, you have fructose breakdown into energy even if you already have all the energy you need. Then, why don't you get fat when you eat fruit? I asked this question in class, and the answer is simple: quantity. A person eating fruit will feel full and stop eating the fruit, making it less likely that he or she will over-eat.
Here's the crux of the issue: a person eating high-fructose corn syrup is able to eat large quantities of concentrated fructose before feeling full. So, it's not necessarily that high-fructose corn syrup per se is bad for you, just that it's much more likely that a person will eat more of it than he or she really needs, which in turn leads to obesity and all of its adverse health problems.
----
I hope that was clear enough for everyone. Also, I'd appreciate hearing from anyone who can add anything to my understanding of the metabolic consequences of high-fructose corn syrup.
One nutritional controversy that has been in the news for the past few years (and has spawned new marketing campaigns from various food companies) is whether or not high-fructose corn syrup is bad for you - or in more apocalyptic terms, one of the underlying causes of America's obesity epidemic. Here is my attempt at an explanation that is accessible to the lay person.
First, some background. Common table sugar (sucrose) is a disaccharide (two sugar subunits stuck together); specifically, it is one glucose and one fructose molecule stuck together. They are broken apart by enzymes and absorbed in the small intestine before they can be broken down for energy.
There are two key points to consider. The first is how glucose and fructose are absorbed by the small intestine. The absorption mechanism for glucose is tightly regulated by insulin, whereas the absorption mechanism for fructose is not. What that means is that the presence of insulin allows for more glucose uptake, but fructose uptake will keep going regardless of whether insulin is present or not.
The second key point to consider is how glucose and fructose are biochemically broken down to make energy. Glucose enters the glycolysis pathway (i.e. the breakdown of glucose into energy), the activity of which is tightly regulated by.... you guessed it, insulin. In contrast, fructose by and large enters an alternate pathway that allows it to avoid a key regulatory step of glycolysis and produce energy regardless of whether the body is signaling a need for that energy.
As you might imagine, this might be problematic. First, you have fructose absorption even if you don't really need it; second, you have fructose breakdown into energy even if you already have all the energy you need. Then, why don't you get fat when you eat fruit? I asked this question in class, and the answer is simple: quantity. A person eating fruit will feel full and stop eating the fruit, making it less likely that he or she will over-eat.
Here's the crux of the issue: a person eating high-fructose corn syrup is able to eat large quantities of concentrated fructose before feeling full. So, it's not necessarily that high-fructose corn syrup per se is bad for you, just that it's much more likely that a person will eat more of it than he or she really needs, which in turn leads to obesity and all of its adverse health problems.
----
I hope that was clear enough for everyone. Also, I'd appreciate hearing from anyone who can add anything to my understanding of the metabolic consequences of high-fructose corn syrup.
Saturday, November 6, 2010
Alcoholics Anonymous, Part 2
The Alcoholics Anonymous meeting I went to this afternoon was pretty much what I expected it would be: a bunch of people sharing the ways in which alcohol has destroyed their lives and seeking strength in others in the group to remain sober. The setting: a community center basement that looked like an Elk's lodge from the 1970's with fake wood panel walls covered by yellowed posters of motivational phrases like "Live and let live." Everyone in the group was in their 50's or 60's and looked like they had lived hard lives.
The group was led by a sweet lady, a Betty White look-alike. I never would have guessed that she's a recovered alcoholic. She started the meeting by asking if anyone wanted to share anything with the group. When no one said anything, she shared her own thoughts: basically that she is grateful that God brought her to Alcoholics Anonymous, grateful for the people who she has met through AA, because otherwise she is sure she would be dead.
Then other people shared. Each person opened by saying "My name is John Doe, and I'm an alcoholic." Or a recovering alcoholic, or a recovered alcoholic. Everyone then said "Hi, John Doe!" And when that person was done sharing, everyone said "Thank you, John Doe!" Just like in the movies.
Most everyone had similar I-would-be-dead-now-if-not-for-AA stories except one woman who must be in her 40's but looked at least a couple decades older. She told us how she's stuck on Step 4, how she just can't seem to get the pen on the paper. She had been in and out of AA over the years but is determined to make it through all 12 steps this time. I watched her as she spoke. I could see the desperation in her eyes; I could feel her sincere and desperate desire to quit drinking in the way she spoke and held herself. But I also saw fear and hopelessness that can easily lead her back to drink.
I don't know how her story will play out, but I did recognize how valuable Alcoholics Anonymous is to her efforts to stay sober. She has a clearly defined goal right now: to make a searching and fearless moral inventory of herself. Beyond that, she has a pathway to recovery laid out before her, providing her with goals to work toward. But I don't know whether she has a good sponsor. It's my impression that a good sponsor is key to a lasting recovery.
Eventually, the group leader asked if I wanted to introduce myself and share anything. I told the group that this was my first AA meeting; before I could finish my sentence, everyone was clapping! I went on to say that I was there not as an alcoholic but as a medical student with the purpose of learning more about Alcoholics Anonymous. Everyone was very welcoming.
The meeting wrapped up with everyone in the group holding hands in a circle and saying a prayer. It's a good thing that I was prepared for the spiritual aspect of AA because it would have caught me off guard otherwise. Multiple people in the group said that the two most important things in their life are God and sobriety and that they wouldn't have sobriety if it weren't for God. Interestingly, these same people also commented on how they were initially uncomfortable with the spirituality that is so integral to Alcoholics Anonymous. I can see how spirituality is a double-edged sword: while a person's relationship with God can be a powerful modifier of behavior, the idea of God can be off-putting to many people for a variety of reasons.
Overall, I think it was valuable to actually experience an AA meeting. I now have a better appreciation of both the strengths and limitations of Alcoholics Anonymous.
The group was led by a sweet lady, a Betty White look-alike. I never would have guessed that she's a recovered alcoholic. She started the meeting by asking if anyone wanted to share anything with the group. When no one said anything, she shared her own thoughts: basically that she is grateful that God brought her to Alcoholics Anonymous, grateful for the people who she has met through AA, because otherwise she is sure she would be dead.
Then other people shared. Each person opened by saying "My name is John Doe, and I'm an alcoholic." Or a recovering alcoholic, or a recovered alcoholic. Everyone then said "Hi, John Doe!" And when that person was done sharing, everyone said "Thank you, John Doe!" Just like in the movies.
Most everyone had similar I-would-be-dead-now-if-not-for-AA stories except one woman who must be in her 40's but looked at least a couple decades older. She told us how she's stuck on Step 4, how she just can't seem to get the pen on the paper. She had been in and out of AA over the years but is determined to make it through all 12 steps this time. I watched her as she spoke. I could see the desperation in her eyes; I could feel her sincere and desperate desire to quit drinking in the way she spoke and held herself. But I also saw fear and hopelessness that can easily lead her back to drink.
I don't know how her story will play out, but I did recognize how valuable Alcoholics Anonymous is to her efforts to stay sober. She has a clearly defined goal right now: to make a searching and fearless moral inventory of herself. Beyond that, she has a pathway to recovery laid out before her, providing her with goals to work toward. But I don't know whether she has a good sponsor. It's my impression that a good sponsor is key to a lasting recovery.
Eventually, the group leader asked if I wanted to introduce myself and share anything. I told the group that this was my first AA meeting; before I could finish my sentence, everyone was clapping! I went on to say that I was there not as an alcoholic but as a medical student with the purpose of learning more about Alcoholics Anonymous. Everyone was very welcoming.
The meeting wrapped up with everyone in the group holding hands in a circle and saying a prayer. It's a good thing that I was prepared for the spiritual aspect of AA because it would have caught me off guard otherwise. Multiple people in the group said that the two most important things in their life are God and sobriety and that they wouldn't have sobriety if it weren't for God. Interestingly, these same people also commented on how they were initially uncomfortable with the spirituality that is so integral to Alcoholics Anonymous. I can see how spirituality is a double-edged sword: while a person's relationship with God can be a powerful modifier of behavior, the idea of God can be off-putting to many people for a variety of reasons.
Overall, I think it was valuable to actually experience an AA meeting. I now have a better appreciation of both the strengths and limitations of Alcoholics Anonymous.
Alcoholics Anonymous, Part 1
Alcoholics Anonymous partnered with our psychiatry and ethics programs last month to educate our class about the organization: what it is and is not, its history, and its mission. I knew very little about AA except from what I've seen in movies and TV shows (admittedly not the best sources). For example, I was surprised that AA is entirely apolitical, making no contributions to candidates and taking no stances on propositions or legislation. I was also surprised by the spiritual (not religious) character of AA, as is apparent in their iconic Twelve Steps:
In addition to this informational lecture, we were also given an assignment to attend an AA meeting. The idea is that we should have a good understanding of what AA is all about if we will be referring our patients to AA. For example, AA may not be so great for a staunch atheist.
I will be attending my first AA meeting this afternoon. It was surprisingly very easy to find a meeting. I found the Denver Area Central Committee of Alcoholics Anonymous website simply by googling "Denver alcoholics anonymous," then I clicked on the "meetings" tab. There are dozens of meetings every day around the Denver metro area, each one with its own flavor.
I have mixed feelings about attending an AA meeting. On the one hand, I'm very curious about what it will be like and the kinds of people I will meet. On the other hand, I wonder whether my presence will make some people there feel uncomfortable. Apparently it's common for health care professionals to sit in on open meetings to learn more about AA. Listening to some of my classmates talk about their experiences at AA meetings, I realize that it's a crapshoot as to what my meeting will be like. In fact, we were taught that we should instruct our patients to attend multiple meetings until they find the one that's right for them. So, I basically have no idea what to expect from my AA meeting this afternoon, and I'm going into it with an open mind.
1. We admitted we were powerless over alcohol — that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
In addition to this informational lecture, we were also given an assignment to attend an AA meeting. The idea is that we should have a good understanding of what AA is all about if we will be referring our patients to AA. For example, AA may not be so great for a staunch atheist.
I will be attending my first AA meeting this afternoon. It was surprisingly very easy to find a meeting. I found the Denver Area Central Committee of Alcoholics Anonymous website simply by googling "Denver alcoholics anonymous," then I clicked on the "meetings" tab. There are dozens of meetings every day around the Denver metro area, each one with its own flavor.
I have mixed feelings about attending an AA meeting. On the one hand, I'm very curious about what it will be like and the kinds of people I will meet. On the other hand, I wonder whether my presence will make some people there feel uncomfortable. Apparently it's common for health care professionals to sit in on open meetings to learn more about AA. Listening to some of my classmates talk about their experiences at AA meetings, I realize that it's a crapshoot as to what my meeting will be like. In fact, we were taught that we should instruct our patients to attend multiple meetings until they find the one that's right for them. So, I basically have no idea what to expect from my AA meeting this afternoon, and I'm going into it with an open mind.
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