Why you should go to conferences.

Last year I went to around ten conferences, symposiums or special lectures. I left each of them carrying something new, something important (no I don’t mean all the pens…Or a GoPro*). I left each of them feeling inspired in some way, often pushing my post-conference imaginings to be more ambitious and feel more exciting (I should admit they were always quite grandiose). It felt as though I would go home with more understanding of the possibilities, always in awe of the breadth of options for future doctors.

I must admit I often left feeling hungover and a few kilos heavier.

The events ranged from local lectures at ANU through to national conferences in major cities. My favourite speakers for the year were the ABC’s Norman Swan (Future Thinking Symposium in Canberra) and Sydney HEMS doctor Brian Burns (Rural Medicine Australia in Sydney**). Yes I even did the subtle ‘loiter discreetly by the stage’ at the end of their presentations for questioning and pestering. Some conferences were aimed at students but for the most part we would be mixing with a room full of doctors. The general chit chat never left me feeling unwelcome or unimportant, however I would always be very aware that I was lightyears behind in terms of experience.

As a student it’s easy to focus on exams and assignments – I equate this to staring at your feet. Staring at your feet is boring. Your feet are never far away, they’re always looming in your peripheral vision, you have to have them, they even make you feel pretty shitty when you get up close to them. Yep, feet sure are like exams.

Going to conferences gives you the chance to raise your head and look around. To look at something other than your feet. My friends and I fell in love with the clear vision. We enjoyed forgetting about our feet and charged off to go conferences in our holidays, even in the week before our final exams. We would hear amazing medical stories from modest rural GPs at the conference drinks and in the next sentence be offered ‘to come out to my practice over the summer’. For these things I am very grateful as we have since seen that these are people who follow through on their offers.

Unfortunately, I can’t possibly pass on the inspiration in words on a blog page. The inspiration and new found ambition is as much about the setting and the atmosphere in which you sit, as it is about the words you hear. The inspiration is also individual. Not everyone got the same kick that I did as Dr Burns took us through strategic breathing exercises. Not everyone rooted for Dr Swan as he pushed speakers for explicit explanations of the murky messages they were hoping would pass as implicit and therefore go unnoticed.

The point of this post is simply to say that you must go.

Go so that you can experience your own awe and inspiration. So that you can open your eyes to the opportunities out there and meet the people who are able to grant you access to these opportunities. Scour the websites and various social media sources for upcoming conferences. Chase funding from the local and national student societies. Enter competitions with ‘conference entry’ as the prize. Grab your classmates, book bulk accommodation (bulk means cheap), car pool for transport.

There may be other ways to be inspired (podcasts and other blogs perhaps) but I believe there is no better way to package the inspiration, networking and opportunity that conferences enable.

And yes, there will be many pens.

*Perhaps the best material object that I left a conference with was a GoPro. This was courtesy of winning the 5k Fun Run at the Rural Medicine Australia Conference in Sydney. They called out “Woohoo you just won a GoPro!!” as I crossed the finish line…. I what??? Needless to say I was pretty bloody happy my competitive edge got the better of me.

**I just about hit the “red zone” (in joke for those who were there or have heard of the zone concept from the book ‘On Combat’) when Dr Burns starting laying it down on stress inoculation and critical care medicine in the retrieval setting. For those interested in finding out more on this go check out Scott Weingart’s EMCrit podcast (http://emcrit.org/podcasts/motr-mike-lauria/).

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Do things that scare you.

A few years back I was in my car driving from Sydney to Canberra, it was raining and cold (a usual story for that part of the world). I couldn’t seem to stop the windows from fogging.

I was churning through podcasts to pass the time. Somewhere along the highway, around Goulburn from memory, one of the podcasts grabbed my attention a little more forcefully than the others. I see now that this was a truly influential experience. Not because of the podcast, but rather because of the book it led me to read and the challenges it posed for me.

The point of today’s post is not to summarise the podcast, nor is it to analyse the book (I will put links to both of these things at the bottom for you). Instead, the point is to discuss a single basic idea they promote. The point of this post is to suggest that the idea below is critical when it comes to a medical education.

Do things that scare you.

The podcast led me to a book called The Flinch, written by Julien Smith. The Flinch is an uncomfortable read, it lays you bare. The words strip away excuses, they expose insecurity and a lack of readiness to abandon comfort. To quote from the first page of the book, “The book is about how to stop flinching. It’s about facing pain”.

The ‘flinch’ that Smith refers to is that innate jump at a scary circumstance. It’s the jump that gets you running away from the lion. Smith asserts that these days our flinches are over-active. That we flinch at harmless things – public speaking, exams, performing in front of your peers or your mentors. In everyday life our flinches are unnecessary and limiting. Some people are affected more than others. The Flinch preaches the need to re-train our innate flinch, to re-calibrate the set-point for a flinch to be warranted, to re-establish what things are actually ‘scary’. To do this, Smith takes us through a series of challenges. He asks us to face some fears.

Opinion: if you have an overactive flinch, taming it down is a must if you plan to make it through med school.

The situation that sticks in my head is week one of clinical teaching at our medical school. To set the scene… You are being told that this next skill is perhaps the most important thing you will do with patients within your career. The clinician emphasises that it is going to take years to get good at this skill and even then, you will make mistakes. You find out that the skill it to take a patient’s history. You think to yourself ‘Geez, how hard could that be?’. Next thing you know you are sitting in a small tutorial room with your classmates. A volunteer patient walks through the door as the tutor asks for a volunteer. FLINCH.

Heart rate starts climbing. Sweaty palms in full swing. Downward spiral of negative thoughts.

There is a fundamental question raised in Smith’s book. Why do harmless things, things like the chance for structured learning and direct feedback that I’ve described above, scare so many of us? And beyond this the book poses the challenge to us. Re-train this ‘habit’ by exposing ourselves to harmless instances of fear and we will benefit. Re-train yourself to remove unnecessary flinches.

As a medical student, fear will shelter you from opportunities, from experience, from feedback and development. Being that person who volunteers to go first provides tremendous benefits.

When facing fears starting small is the key. Smith urges us to consider facing ‘scary’ things with no possible detrimental outcome. He wants you to take a cold shower (managed almost a year of that – Canberra winter got me eventually). He wants you to smash a mug (really? a perfectly good mug? I still flinch when I think about this one). He asks you to speak to a stranger (welcome to every day in medicine for the rest of your life). He wants you to escalate these things appropriately to the point where you are more comfortable, less afraid, more confident.

I attempted to adopt these ideas, along with always having a desire to seek challenges. I did the cold showers for a stint, I smashed the mug (only once), I spoke to strangers repeatedly. I became more comfortable, less afraid, and developed more confidence. I didn’t stop there, I continue to face flinches when I see them. Often I start stripping off for a shower and shudder at the thought of a cold shower. I take this as a sign that the flinch is back and force myself into the icy water. I say yes to all things possible, regardless of a grumbling fear, a racing heart or some sweaty palms. Now when I hear a call for a volunteer I quickly call out “I’ll have a go”. Not because I’m cocky or greedy but because I feel the need to keep the flinch at bay.

I believe that keeping the flinch at bay will lead to opportunities, experience, feedback and development. I believe that we need to find things that scare us and that being brave is about finding those things, having that fear, but doing them anyway.

Be brave, it’ll be worth it.

Podcast – http://robbwolf.com/2011/12/20/the-paleo-solution-episode-111/

Book – http://raouldify.files.wordpress.com/2011/12/2011_1203-the-flinch.pdf

How to study. Effectively.

I started writing post number two as I sat outstretched in the enormity of row 23 on flight FJ915….. We were in the exit row. We were on the way back from our honeymoon.

Yep, life is pretty good sometimes.

I had a foggy head (the result of a lingering hangover from the final day efforts to sample all the wine on the list). I managed to start, and then place on pause, what will likely become three or four different blog posts in the coming weeks. Giving in to the dizzying effects of the turbulence, I vowed to write more successfully, more definitively (or maybe just manage to finish a post) when suitably caffeinated – en la mañana.

So to today’s post, a more effective and definitive post.

This is an adaptation of a short presentation I gave to a fresh-faced and eager group of medical students early in 2014. We affectionately refer to them as ‘Firsties’ and the title of the talk was ‘Firsties Formative Prep’ (aimed at their first medical school exam a few weeks – the formative). I hope to lay out in a few simple rules that I try to follow in my study. These are the rules that I’ve figured out/been taught/wished I’d started following sooner/am still trying to figure out how to do etc. They are rules that do not dictate the step by step of studying (add a comment if you want me to provide that information) and this is by no means as exhaustive list. I see merit in their application to learning medicine and hope some will suit your style.

Rule 1: Set informed goals (and do not do a single thing unless it falls under one these goals)

There is a buzz in our medical school about the concept of learning objectives, different levels of objectives, use of objectives to plan assessment items etc (and the Australian Medical Council uses these outcomes in decisions about the accreditation of our schools). I won’t go down that tangent except to say that learning objectives, for the most part, are given to us. These objectives go full circle when they are used to decide our exam questions.

To state it simply, set your goals (or write your questions – more on that soon) based directly on these objectives and if you find yourself working on things that are not encompassed in the objectives – STOP! Make a note of what you were doing and come back to it after exams.

I struggled early on when studying. I struggled mostly because the medical world is so full of cool sh^t. It’s all fascinating. I would catch myself buried in a textbook, in a chapter nowhere near the topic I intended on looking up for clarification. Do not get caught in this trap. Or if you do, acknowledge the interest, enable the fascination and then get back on track. There are quite literally hours of interesting reading that could come out of each lecture and when you add up the hundreds of lectures we sit through there is simple not enough time.

SMART goals (Specific, Measurable, Achievable, Realistic, Timely – http://en.wikipedia.org/wiki/SMART_criteria) are well known and effective so read into that if it is news to you. My point is not to lay that information out. My point is to remind you to be clever when setting your goals (base them on learning objectives and areas of weakness) and be honest with yourself about whether what you are doing is actually helping you achieve one of these goals (if not then stop).

Rule 2: Get your own routine (and be consistent, not crazy, it will pay off come stuvac)

I won’t preach to you about when to study in the day, how much time to poor into your study, when you review and revisit lectures etc etc. I have studied with a lot of different people so far and always tried to take note of how other people work. The single thing that can be distilled from all of these observations is that all people work differently. Further, all people change their strategies as they go, always looking for something more effective.

The point that I will stress here is consistency. No amount of cramming in the final week before an exam can make up understanding gained from consistent, and effective, study. Yes it will help (and I certainly still practice the 16 hour days of cramming before exams) but you cannot get the depth of understanding gained from consistent and progressive work throughout the semester. Decide a routine early on and stick to it. Assess as you go whether it is being effective. Change it if it is not. Map out the specifics as you go and tick them off once they’re done.

(A side note here for those with significant others – Medicine is all consuming. You will neglect your partner and become the inattentive person you probably made fun before UNLESS…. You communicate your plan, talk to with your partner about the upcoming busy weeks, book in date nights, put your exams on the calendar, ask for their support and encouragement, talk about what this should look like. You’ll figure out the specifics of this. It took me a long time to figure it out. Do it early. Do it honestly).

Rule 3: Question and answer ONLY (do not waste your time with summaries you will never read)

I spent the first six months of medical school writing lecture summaries that I was immensely proud of. They were detailed yet easy to understand. They had pictures and tables, they were brilliant. I spent hours writing them (on average probably two hours or so per lecture – sometime up to four hours), hoping they would set me up for effective study come exam time.

I never opened them again.

Despite being all the things mentioned above, they were simply not useful when it came to studying for exams. If I tried to open summaries and read through them I fell asleep, if I went looking for specific points I couldn’t find them. I always ended up just opening the lecture slides and reading through the more succinct (although never as clear) dot points they provided.

John in the year above me (the student we were all in awe of) put me on the right path. He preached question and answer format. For everything. This was a scary concept at first – ‘so I don’t even write a summary?’. But I took the plunge.

I dropped the summary format. I sat in lectures writing questions rather than taking notes. I went home and answered the questions rather than summarising the points. It was transformative. I realised within a few lectures that in answering my questions I got my summaries. By getting me head thinking in questions and answers it became clear what the main concepts within each lecture were. Perhaps most importantly, the two hours I had been spending summarising the lecture was cut down by half, or by two thirds, or even more.

I believe that each time you need to recall information you’ve been taught in medical school it will be in the form of a question (exam questions, questions from consultants on the wards, questions from patients). Not once will a consultant ask you to summarise a concept for them, they will grill you on details. I think it is more effective to do all your study in question and answers. I think it is more specific and more time efficient.

Rule 4: Do the uncomfortable things (effective study is more frustrating than fun)

Humans are described as creatures of comfort. We seek the comfortable in situations where we have choice. Applying this to study, when there is the choice between studying something that makes you feel good or something that makes you feel uncomfortable we will choose the former. Every single time.

The comfy topics are the ones we know. My background as an exercise physiologist means that I love muscles, I love talking about types of contraction. Holy sh&t do I get excited about anaerobic thresholds, VO2 etc etc. As a creature of comfort I would find my way to topics like this completely subconsciously. I would happily explain them to my classmates, happily review them again ‘just to be sure’. Moreover and more importantly, I would steer far away from that sick feeling I got when I opened the page to genetics, to histology, to anything to do with chemistry. Gosh do I hate chemistry. I frequently got frustrated and gave up because I did not know these things well (and still don’t). I did not know these things well cause I avoided them, I avoided their discomfort.

The uncomfortable topics are invariably the ones you need to study most.

I think I’ve made my point here. You need to police yourself. Be aware of how you respond to different topics (yes Mum I am eluding to some of the mindfulness you so love) and force yourself to work on the uncomfortable topics while not completely neglecting the feel good areas.

That’s it folks.

Blog number two done and the resolution still on track. Inevitably these rules will not suit everyone, they will likely be downright bad for some but I do I hope that some get benefit from these concepts that have delivered me safely through the first two years of medical school.

Welcome to a new resolution.

Welcome to a new resolution.

I set out on the stereotypical ‘New Years Resolution’ in 2014. By the time I sat dozing through the fireworks at the end of the year I had gotten almost all the way there and was happy to call the box ticked (more on that soon*). I’m not often one to feel proud but I was about this achievement.

Starting a blog is not my attempt to become a writer. I’m a medical student with dreams of becoming a doctor. My eyes and passion are firmly set there. After a few years of study and the beginnings of a promising career I left my job as an exercise physiologist and ventured off into medical school unsure of what to expect and whether I would sink or swim. I’m not sure that I’m moving through the water like Thorpe, but I am at least confident now in my ability to float in this vast ocean that is a medical education.

This year will be my third in medical school and marks the transition to the ‘clinical’ years. I’m anticipating the return of the ‘deep-end’ feeling. I had better remember how to tread water.

I write today not to be profound but to set clear my goal for this blog.

I recently read an article in which an enormously successful, productive, and efficient businessman preached that all efforts, explanation and useful facts should be recorded. Long-winded emails explaining technical details should not see only one recipient (an action of which I have often been guilty). Instead, a little extra time should be spent simplifying them and turning that email into something that will make it to more eyes, will be comprehensible to more people. Most importantly, it should make it to others who will benefit.

The goal of this blog: Publish the simple explanations, the light-bulb moments, the little facts and knick-knacks that I find useful during my medical education. I will do this in an effort to disseminate them to more eyes, more brains, more people. To inspire. To educate.

This blog will be the point of publication for the bits, pieces and musings from my remaining time as a medical student. It will be my outlet and it is my resolution for 2015 to write and publish something every week.

I hope it brings something to your table.

*My 2014 New Years Resolution. I like to run. Not because I’m particularly great at it, but because I like the challenge. Speed doesn’t really interest me, I’m about distance. So far the furthest is 101.5km but on the cards somewhere will be the elusive 100 miler… Anyway. For 2014 I wanted to be consistent. What could be more consistent than every day right? So, ‘Can I run every day?’ was the question I went into 2014 asking.

The answer: I ran on all but four days of the year. Three of the missed days were down to pure forgetfulness and one was after a family emergency. I ran multiple times on many days and clocked up that 101.5km on one of the days (took me 12 hours 42 minutes and yes I still ran the day after), and managed a very late night run each time I stumbled home after a night on the town.