Part of any good medical student's preparation for boards includes a bank of practice questions that not only helps you simulate the real deal, but tutors you along the way.  QBanks give you a team of experts who dedicate their lives to mimicking the logic, knowledge base, and testing style of the Step tests.  For just $135 dollars, I have USMLEworld on my side, quizzing me and telling me why I'm wrong every step of the way.

But the purchase of a QBank gives you more than computerized flashcards.  They keep track of everything for you.  Though I might wince at the fact that I get less than 50% of the questions on pharmacology right, it's still comforting to know that if I get tired of studying, I can procrastinate by analyzing my weak areas.  I can see how I'm doing by subject or question type.  They even give me a percentile based on all the other USMLEworld QBankers that are out there.  This also means that for every explanation, I get a percentage of other users that answered this question right.  If I get a question wrong, I can take comfort in the fact that 78% of other students also got it wrong.  In general these percentages vary from the hardest questions, ~20% answered correctly, to the highest I've seen: 77% got it right.

Recently as doctors come under more and more scrutiny with respect to our humanity - you know, those fuzzy things like bedside manner, healthcare inequalities, and ethics - these topics have also worked their way into the Step.

I was shocked to find that as I waded through a problem set on cardiology, a question popped up about my ethics.  The scenario: you recently treated and saved the life of one of your patients who had suffered a myocardial infarction.  In order to show his gratitude, he shows up at this next appointment with an expensive antique watch to thank you.  What do you do?  I was excited.  STEP I WAS TURNING INTO A CHOOSE YOUR OWN ADVENTURE!

However, unlike past chose your own adventure books, times when no one is looking and you can indulge the guiltiest pleasures, USMLEworld was watching.  I dutifully chose the option to "thank the patient for the gift, but politely decline."  I suppose I should credit my parents as, at least according to the Step I, I was a morally upstanding citizen.

When I went to review my questions, like the rest of its friends, the ethics question also told me how many of my colleagues had chosen the right answer: 58%.

3/22 - 4/26 - minimal posting until then

Hey all, in case you're curious, my little sister is currently back in Taiwan for the first time in her adult life.  She's writing a blog that captures the hilarity of the child-adult status that many of us have when we return to our country of ancestry.

Check out her latest post on finding language exchange partners which couldn't help but make me laugh:
http://emilyrobin.weebly.com/

One of the things that heartens me is the growing focus that transgender issues have received in the past few years. While it's important that we don't ignore the obstacles, stigma, and danger that transgender folks still face everyday, I do think that progress within popular culture has been significant. These days, universities have and consider gender-neutral housing, a concept that was completely foreign a decade ago. News pieces are written from a sympathetic angle. Even Oprah talks about it:

The factors that have allowed transgender issues to gain acceptance are probably complicated and I haven't studied them (I haven't even read about them). Things that come to mind might be the growing acceptance of the LGB community and thus an increased ability to explore even more “taboo” issues; a more open curiosity or willingness to play with sexuality and gender boundaries; and I'm not sure how, but I'm pretty sure that somehow hollywood and the fashion industry are somehow involved.

The health care field hasn't been immune to this and the issue of transgender care is exploding within our discipline as well. As Dr. F, an old, married to a woman, white guy who wears sweater vests said to me with serious, straight face, “Transgender care is really hot right now.” As a medical student, it certainly feels as though that's the case; anyone who's at all liberal wants to talk about transgender care. Obviously, it's about time.

Out of curiosity (and in case my own perceptions were ill-founded), I did a quick PubMed search for “transgender care” by year of publication. The number of articles published since the early 1990s has exponentially increased by 16 fold, while in comparison the search for “gay care” has only doubled in the same amount of time.  While perhaps not the most rigorous of studies, it does seem to indicate something.

However, it does make me wonder. For an institution that is so often conservative, and, incidentally, still categorizes transgender as a psychiatric illness (homosexuality was removed in 1986), why the sudden focus and trend towards acceptance? Certainly, I think whatever forces have allowed transgender issues to have a larger space in popular culture affect the medical community, but I think there's also something else at play.

When I think about society's discussion about healthcare in the United States the first three things that come to mind are: cost, insurance coverage, and fat people. Personally, I think about cost, obesity, and healthcare inequities. As these conversations continue, it seems like more and more, the US is accused of relying on expensive technology and medications to solve our problems instead of low cost, behavior interventions.

But most doctors are scientists. We weren't born to counsel people about their nutritional habits, we were born to diagnose and heal disease! Figuring out how to get people to make lasting lifestyle changes is difficult. Confronting the implicit bias that pervades our society, medical community, and ourselves is hard work and messy. Transgender care is a developing field that uses surgery and pills, all while addressing the needs of a marginalized community: that's everything we love about medicine wrapped up in an easy, feel-good package.  I think it's telling that while we're all gung-ho about the physiologic treatment of transgender folks, there isn't much accompanying interest in the psychiatric effects of living in a society that stigmatizes you.

I don't mean to rain on anyone's parade.  I think it's fantastic that we finally have an interest in caring for a community of folks that have been marginalized and ignored for far too long. Just don't be type II diabetic AND transgender; we don't feel like dealing with that.

As M2 year draws to a close, there's a lot of energy running around the class. Discussions about class schedules, ideal step studying schedules, passing on extracurricular leadership to the M1s, and feeling the pressure to get your life in order before studying and third year begins, seem to have the class in a tizzy about something everyday.

I think dating a M3 has buffered me from most of the stress. After seeing someone else go through it all already, it seems less scary and less big. Of course there are also material benefits, like having her step I books passed down to me

However, as we enter the last sequence before our study period begins, I too am starting to feel a bit anxious. How will it feel to study all the time? The score you get pretty much determines what specialities are open to you. Most schedules look like: wake up, eat breakfast, study, eat lunch, study, work out, eat dinner, study, sleep. Most schedules don't have weekends, though there are a few days off sprinkled through.

It seems like there are a few different psychological responses:

Masochistic Studiers: They remind me of the teammate who loved sprint practice for the sheer badassness of it. They know it's going to suck, but they revel in it and when they're done, they'll tell war stories.... I never liked sprint practice. Sprint practice to me was waking up entirely too early and making myself feel way too uncomfortable for way too long all before the sun had risen. My favorite part of sprint practice was when we were doing partner sprints and I could watch my partner run. Every moment they were running was a moment I wasn't running. Unfortunately, I could never sustain their enthusiasm.

Born and Bred: Their parents are doctors. Their great-great-grandfather founded the American Medical Association. Since they've always known they've wanted to be a doctor they graduated from college and came straight to medical school. Step I is an important rite of passage; it's an exciting to chance to finally synthesize all the information that they've been learning for the past four years! …. My grandfather studied math while marching in the infantry in China.  Under such conditions, he never made it past geometry. The last thing I ever did that involved the AMA was drunkenly hit on a previously straight woman while at a conference.

Eeyores: These folks usually didn't major in any sort of science during undergrad. They might have taken time off before coming to school because they wanted to explore other things. They wish that the “touchy-feely” side of medicine counted for more on standardized exams. Studying for 12 hours a day makes them miss humanity and prose and beauty and love.... This may or may not be me.

Though, at the end of the day, I suppose there's really not much to complain about. While it's more stressful than the cushiness of a nice 9-5, and it does seem like our professional lives hang in the balance, it's also true that many folks work 12 hours day with low pay and dehumanizing conditions. Sitting around and reading books for 12 hours doesn't seem that bad. I mean, you can even wear your pajamas if you want.

lessons learned:
[1] it's hard work being second generation
[2] sometimes, the perpetuation of ignorance is our own fault

Incidentially, this is also how the dish, "chop suey" was invented and integrated into American culture.