Thursday, September 25, 2014

It starts...

Hey everyone, I know Lindsay has kept most of you up to date about the goings on down here in Miami, but I thought you might like to hear things about medical school and such from me as well! 

So far I have been LOVING the school. Miami seems to have a lot of great things going on here and I am constantly thinking of how this expereince (while rough at times with things like our terrible rent and being away from family) is going to ultimately make me a better physician.

 So during the summer I took three classes, intro to public health, epidemiology, and biostats. Some things I liked about those classes and some I did not but the overall expereince I had was a positive one. The summer courses focused on educating us on where medicine and public health relate and where they diverge. One thing we spent considerable time doing was learning about public health research and how to effectively critique and interpret results of research. The whole medical profession is moving towards "evidence based medicine". Basically the concept of practicing screenings and interventions that have been shown to have the largest health impact. Focusing on theses areas of practice help drive down medical costs and assist healthcare in general run more efficiently. This probably sounds very intuitive but in the real world public health and medicine (i.e. the one on one doctor patient relationship) dont always get along. For example lots of public health research is coming out saying that invasive pelvic exams (not the pap smear just the pelvic exam) are actually not needed in asymptomatic patients because they rarely find anything useful. So a natural step is to say "hey docs stop performing pelvic exams, you are wasting resources (gloves, instuments etc) and taking up time you can be seeing other patients" both of which cost money that the patient ultimately has to cough up. In contrast physicians all have experiences where an asymptomatic patient was given a pelvic exam and something non-benign came up. So naturally the docs say "I am not going to put my patients at risk by not performing something as simple/easy as a pelvic exam". So who's right? Ultimately we need to drive down costs and the numbers are supportive of discontinuing pelvic exams, but a doctor doesnt care about numbers his patients are people to him. Thus comes the interesting dichotomy into which UM's MD/MPH program fits. They openly discuss these problems with us and often times told us we have to learn to "wear two hats". One hat is as a physician where we are focused and responsible for our patient, the other hat we wear is the public health hat where we analyze systems, practices and policies to ensure the greatest benefit comes to our communities. Anyway, enough propoganda about that for now. As you can see though I am already appreciating the unique education I am getting and it's exciting!!

 So I'll give you a walk through of a typical day for me right now. I'll try to get some pictures on here now and again, but I dont have any I have taken right now so I grabbed this one from google.

So everyday I jump on this little puppy and make my way to school. Its called the Miami Metrorail and where we live is about 5 blocks from the southern most station the metrorail stops at. The train ride takes about 30mins so I usually listen to music, an audiobook or go through flashcards (especially when we have an exam coming up).

 Lately I have been going to the gym before class with a first year student in the regular MD track who went to BYU. We just met up after starting school down here, his name is Brent and we have become pretty good friends. Class typically starts at 8am, so this means I usually get up at 5am, bike to the metrorail and ride the train to campus. I usually get there at about 6:30am and we exercise till 7:30. I then shower and go to class which usually goes till about 3pm. Then its study for an hour and go home for dinner at 5pm. After getting the kids down I try to help Lindsay with the dishes and clean-up before heading back out to study on the undergrad campus which is closer to our house than the medical campus. Lindsay has posted some pictures on the blog of the undergrad but I will post this one of the library where I usually spend my time in the evenings.

I usually study till about 10pm, then come home get ready for bed and crash at about 11pm. Thats really about it. Its pretty much the same most days with a little fluctuation here and there depending on my schedule.

 We have obviously started the regular MD classes now so no more MPH curriculum till next summer but we have plenty to keep us busy! Right now we are covering gross anatomy, histology, biochemistry, embryology, and cell biology. We took our first test on Monday... I passed but it was tough! I am hoping to do better in the future. Many people are saying all you have to do is pass because residencies and board scores dont require anything else but I want to make sure I am learning the material as best I can! So we shall see. Which brings me back to reality, I should really get back to studying!!

 Love you all!!! I miss you TONS!


  1. Thanks for updating us on medical school. I enjoy hearing all about it. I'm glad to hear you did OK on Monday's test. I was praying for you.

    Miss you Sterling!


  2. Wow thanks for the update Ster! It's interesting to see Miami from your point of view! I had evidenced based practice as a class this past summer too! Haha so I get everything you're talking about. I love it, but it doesn't seem to be changing very quickly in the real world. For example, I volunteered at a flu clinic last week and before it started the RN that organized the whole thing taught
    The students how to give an IM injection. She included aspirating the needle, cleaning the skin with alcholol, and pinching the skin.. All of these are old practices and the CDC recommends against them all. We had just learned the technique of shots during the summer yet after she walked away I told my classmates how we really do it and reminded them of the current research but one said "I'm just gonna do it like she said" I almost died!!!! No wonder practice isn't changing!

  3. Oh, and by the way, I didn't do any of those things! I followed cdc guidelines so yay for evidence based practice! A few of us that are willing are going to have to push others to change habits and ineffective practices

    1. It is SO TRUE! The biggest propogators of out of date practices are the older generations. Its nice to hear you took the higher road. Its difficult when your instructors are out of date and even more so when your peers decide not to adhere to now standard of care but it has to be done. Enormous amounts of research go into refining standards of care. If we dont use them we are wasting valuable knowledge and doing our patients a disservice.