Exams and Experimentation

You would think that after over a year and 12 major exams blocks with nearly 50 exams, I'd be used to it. But I'm not. Like some vestigial, deep, primitive brain implantation, my "fight of flight" activates on the Saturday before exams. It's nerve wracking and no amount of medication, cheesecake or shock therapy seems to avert the inevitable stress of the not knowing. And the first ones of the term are definitely the worst cause we haven't got a clue how the new profs are going to test.

It's sort of a game, with some sport, but I know that it is a means to an end. Deep in side I know that it's just another hurdle and I can almost rationalize the reasons for this ancient torture called testing, but clearly this is not a good way to create physicians. My hindsight as an educator is very valuable, but also very damning. This process is just not right, productive, educational or inspiring. Thank goodness I actually love the science. And I do.

This term too is full of contrast. I'm quite sure I have both the best classroom professor I've had in a long time, and the worst. I'm fortunate on one hand, but it is unfortunate that there is still the misguided notion that great and learned physicians who are likely wonderful bedside teachers are automatically good classroom professors and course directors. To the contrary, it is almost predictable that the opposite is true. Real teaching, and course management is a completely learned, non-innate skill. It is not automatically bestowed upon the MD or DO graduate at any time during training. But as long as there is ego, and the paternalistic belief that it is automatic, we'll end up with very learned men and women, muddling their way thru being teachers. Too bad, this time, I have to be the guinea pig to testing the theory, once again.

Quake, Oil & Storms

Recent natural and natural events have quaked me out of study into writing again. I've been so slack keeping up with the blog. Which only means I've been actually studying and not been dragged hither and yon by attention diverting distractions.

I didn't really know about it until I friend, who lives in the Western U.S., asked me about it. Seems that anyone who doesn't live this way believes that the Caribbean is the size of New Jersey. Yes, we (collectively the Caribbean) got "quaked", but didn't feel it WAY out here in the NE Caribe; At least not that I know. On Thursday, May 28, 2009 at 03:24 AM, and earthquake With magnitude of 7.4 hit in the far western Caribe, off the coast of Honduras. Beyond the great rum they produce, seems that Cuba shielded this side of the Caribe from any major effects.  It was centered right offshore and did some damage including killing a several people. There was lots of talk about it here, but to my knowledge it wasn't felt at all. It did stimulate my thinking about our vulnerability to various and sundry forces. We never heard about it officially at school, no sirens were heard, not much of anything to indicate a problems at any time. And while we may never know, reports of the water level in Puerto Rico dramatically receding as much as 50 feet raised from the deep recesses of my memory all the training I got while living in Hawaii about tsunamis. We would be clearly vulnerable.

This same week, a potential unnatural disaster also happened. We had an oil spill. On Saturday, May 23, there was a large oil spill originating from a tanker vessel moored at the Single Point mooring just outside the Northern Reserve of the Statia National Marine Park.
The mooring is used by large tankers that are too large to moor up to the Terminal pier to receive or deliver crude oil. It happened at 1:45pm , and it ultimately got pretty big...4 km x 500 meters.

And then, it happened AGAIN, just 3 days later! On Tuesday, May 26, at 5:30am, there was another spill originating at the Single Point mooring. This one much smaller, but it really brought home how much impact this oil facility could have. A major spill could have serious effects for the island's environment and economy. The same spills, with currents running a different direction could destroy the reef here.

And to further my joy, hurricane season is about to start. Reminds me I have to stock up on water again since I almost ran out during a 5 day suspension of port services after our almost direct hit from Omar the hurricane. The storm blew in tons of sediment into the harbor and we couldn't get nothing from no place, no how. We truly are dependent on the lifeline of barges, and shipments.

But I have first major exams of the summer term, another potential unnatural disaster, to keep my mind off of spills and quakes. Is this a great island, or what??

Deliberate Though and Creation

Sometimes life feels like a train wreck.

But from the ashes often arises great knowledge.  If you don't go willingly, away from the tracks, life experience and education beats you into submission...in a good way. It's actually a pleasant surprise once you recognize that the "change" and growth is both beneficial and welcomed. At the terminal stages of this process, you begin to recognize and develop abilities to handle life factors slightly better than before. I've seen that reflected in the many students and faculty around me over the past year. The most successful appear to be those who can think specifically and deliberately , communicate that thought to themselves and others, and create a different reality for themselves and those around them.  They have become "authors" of their lives.

But to create something in the physical world, it is imperative to create the idea in your mind. Those people who best contribute to the whole in this microcosm of school, have the ability to create the reality in their mind first, they effectively create whatever it is they are thinking in the world around them. This deliberate thinking becomes the tool to create the physical reality, because to create something in the physical world you first must create an idea in the mind...getting the mind "right" or thinking straight about that thing.

But thinking straight isn't a right wrong thing. It's not about thinking in alignment with others, or consistent with any dogma or belief system. It's merely making decision in creating our reality on what is the best thing for everyone involved, conducive to peace, consistent with empathy and identifying the humanness in those around us in which we slog thru life. Thinking straight maybe making decision even when risky given the current state of affairs in the "apparent" world.

I understand that not "thinking straight" and making wrong decisions leads to failure. Those thoughts are usually not "created", not made; We just manage to fall in to them because of our laziness and willingness to fall into the thoughts of others or circumstances around us. If thinking is straight the chances of making wrong decisions are greatly reduced. Deliberate, straight thinking is thought we actually and specifically create.

Deliberate, straight thinking is not about memory and creating thought from our experiences and past. It is not about thought created of our fears of the future. It is about the deliberate creation of though based on our best selves, greatest wants for the greatest number of people, and our yearning to be more directing of our lives. It is about becoming the source of our thoughts and thus our lives.

When you are the "source" you are creating thought. It doesn't have to be original or profound except to you. The only rule, it must be you creating the thought. Once you start this process, you remove yourself from the world working on you and your thoughts and you begin to work on the world with your thoughts...you become the source.

You can originate a thought that is neither a response nor a reaction to anything that has happened or gone before. Deliberate thinking, like any ability, improves with practice. It has been the goal of various meditative practices for years.

If you think you're beaten, you are.
If you think you dare not, you don't.
If you like to win, but think you can't,
It is almost certain you won't.
If you think you'll lose, you're lost.
For out in the world we find
Success begins with a fellow's will.
It's all a state of mind.
If you think you're outclassed, you are.
You've got to think high to rise.
You've got to be sure of yourself before
You can ever win a prize.
Life's battles don't always go
To the stronger or faster man,
But sooner or later the man who wins
Is the man who thinks he can.

So how do we tackle this thinking problem and straighten it out? How do you get your thinking straight?  We are all capable of deliberate thinking, and source awareness. When we step out of our ego (brain based, emotional, indoctrinated by others, physical perceptions, imitation, survival) we can move steadily toward the creation of though deliberately, and being more of the source in our lives...generate creation in the physical world.

Start small. "I feel the best I've ever felt." Work up. I am going to be a competent, confident, versatile physician.

And on we go

Up the river I course like Blue Man...

It's really strange seeing people who I know getting ready to leave school and move into the world or the next "step". They seem to be everywhere here, hanging out with little to do except study for the big exams coming. That will be me soon, but I don't think I'm ready. But on we go...

It's been a typical start this term. Shaking the cobwebs of the lazy break attitude and getting into the swing of studying again this weekend will be the first hurdle. It's already building to volume that I know are challenging to many, but I still hear things I "know", or at least vaguely remember, from my practice and former education. Amazing how some things stick.

Yet too, I am continually amazed at how much I don't know, never learned or did by menu or guideline instead of understanding the real "why". Such is the more technical education of my past. I don't think I put anyone in danger, but the "oh wow's" seem to come with greater frequency...or am I just paying more attention? I don't know but I'm loving this part of the learning.

I have to admit that learning at this stage is simply more economical, efficient, and profound. I'm more ready to learn and more excited about learning, than ever before. I never got this excited about my education in education. I walk out of class now and feel energized, jolted into what can be, what will be...and that is just a pure, unadulterated rush. One that I'm sure many, many cannot, will not ever feel in their lives. Poor souls.

And so it begins...

I am poised on the great precipice of summer term and yet another battle for academic excellence and survival with the great "it".  Muhahaha! It is "me" against "it"!

I feel like if I make it sound like the great novel I'm more likely to pursue it with the passion it deserves. Actually I'm hoping it all comes together, there are enough students to pay the bills another term and that there is yet another delay in the implementation of the Netherlands taking over this paradise. It is a race against time, money, politics, power, learning, teaching skills (or the lack) and that which I know not (or know and have forgotten).

More Studying

The most important educational factor in medical school this term will likely be what organism? Algae! That little green plant stuff too small to make a decent salad.

The headlines tell the story...

Algae Plume Reaches Caribbean

This one "plume" is big and covers a wide expanse of Caribbean water. So big in fact, that it can be seen on satellite images from space.  It started in early April and appears to have begun as nutrient rich runoff fresh water flow from South America...likely from the Orinoco River, which exits Venezuela's northeast coast or directly from the Amazon river further south. 

While difficult to notice from the surface to the untrained eye, the water is eerie green around the island. Upon entering the water it feels like you are descending into pea soup...cloudy green water noticeable to those of us used to swimming normally in crystal clear blue water. "They" say it is starting to break up, but you'd never know it.  A short swim yesterday proved "them" to be wrong. The water is still too cold to cause up/down currents in the water to break up the mass. "Them "must not be swimmers or divers.

It is dramatic how the color of the water has changed. I dove a wreck in 90 feet of water about 2 weeks ago and it was really thick green. Pretty interesting to dive in different conditions on a wreck, but I wouldn't want to make a habit of it. You can see the now (Left, green) photo of the prop and one before the plume about 3 months ago (Right, blue). The photos are at the same depth, with same camera, with same settings and almost exactly the same lighting conditions. Dramatic effect on visibility and feeling of the dive.

And the fish LOVE it...it's a buffet! So while the diving and swimming visibility is less, the amount of fish on the wreck is especially high. The little ones love the algae and the big ones love the little ones. Hunting and eating for fish is further enhanced at the wrecks and ledges of reefs. So while the clear inviting waters are gone for the moment, we are seeing fish we've not seen in some time. NICE! One dive master said, "so thick we had to physically push them out of the way".

So as the plume (or bloom as many call it) continues, and makes swimming a bit more dangerous (sharks, and barracuda love to feed in the murky waters), studying may be the natural alternative to getting eaten by a confused carnivore. I am glad though that I could experience the conditions at least once, but I am looking forward to clear conditions again.

Break

It's not Saturday Night Fever, or Dengue Hemorrhagic fever...it's Rock Fever. "Rock Fever" is a subtle combination of subjective and objective signs and symptoms that often are not truly experienced until you separate from the source of the fever...the island. Once the possibilities of drive thru burgers, steaks of known origin, and other such comforts take hold, the true nature of the fever becomes apparent. I miss access.

It's not really the getting that is so important, but the knowledge that access is possible is often enough. I walk thru Costco near home, and I understand that the possibility of buying and devouring one of those wonderful cakes is possible. The mere possibility is better than the eating, digesting and the effects of the high blood sugar to follow (well maybe not completely better).

Access is a quality of life that is universally experienced at some level by all free people. Access is only denied to those incarcerated by the judiciary or by the geographical situation they find themselves. The latter contributes to the disease of Rock Fever.

So I drive thru where I might not drive thru otherwise, and stuff my self with the Taco Bell knowledge that soon again I won't be able to do so. My fever will then return, and I'll be immersed in the near end of my time on the rock...one of the most wonderful experiences of my life. And I can't wait to get back and get started again.

Wonderful State of Mind

The waning moments before finals for this term are upon us. Hard to believe I've been here almost a year already, but it has really flown by. When I contemplate where I am today compared to a year ago, I'm sure glad I took that leap of faith into the abyss and thank my family and friends for their support.

It's not been without it's moments, and it's not been the easiest thing I've done in my life, but overall this was a great decision, and I love where it's going. Break in a short bit will be welcomed, but I'm looking forward to coming back and finishing up this part of the process and heading toward national boards part 1.

And, I got a chocolate bunny this past week that I just ate for breakfast...so everything looks wonderful from the buzz of chocolate, caffeine, and sugar

Tenacity

Tenacity: The capacity to move forward without allowing "bumps" in the road (or falls) deter you from your goal; doggedness: persistent determination; See "Lance Armstrong"

So, 2 days after major orthopaedic surgery to repair his busted up clavicle, Lance was on a bike training. The x-ray is evidence of how severe the break was (noted to be in 4 pieces) and how much metal was placed. This surgery took hours. And to be out training within days is amazing let alone against recommendations of the surgeon.

But, that's why he's Lance right? I'll never complain about an injury again.

Scared

It's good to be scared. It means you still have something to lose.

I feel is almost daily, and it's not obtrusive or debilitating. It's just there. It's that genetic or learned implant of the limbic system that has us watchful and protective, like a gazelle drinking from the African stream, knowing the cheetah drinks there too.

Finals are like that cheetah, off in the distance, slowly sauntering toward the stream. I'm drinking quickly, as much as I can before I have to engage it. Sometimes you feel like you have more time than other times (Like now).

Don't wonder why people go crazy. Wonder why they don't. In face of what we can lose in a day, in an instant, wonder what the hell it is that make us hold it together.

Happy Passover & Easter

It is that time of year. It's a 4 day holiday here, and this place will shut down Thursday afternoon for the weekend to celebrate Easter. A mini seder tonight, and hopefully sunrise on an Atlantic beach on Sunday. There are plenty of wandering goats to slaughter here, and I am the first born, but I don't think I'll be doing any paint jobs this week. I don't think my landlord would appreciate it anyway.

But I want to wish everyone a Happy Passover and Easter...the time of the year where Old Testament  meets New...

The last supper, a Passover seder...

It is a great time to reflect on the blessings and wonderful people in our lives, and appreciate the depth of our history and heritage.

I Can See the Light

We have been BLESSED and visited by the angel of healthcare!! OMG...the arrival of new prof of pathology, and experiencing his first lecture left me in awe, breathless and energized. He's sooooo GOOD!! Just when you think things can't get any worse, they get better. And I don't know who is responsible for getting him here, but we are so grateful for this breath of intellectual, teaching and professorial fresh air. In the words of an administrator, we move from embarrassment to the light.

Whew!! It's about time! We really needed this.

Only 2 weeks until finals and then a needed break for home. I'm so going to enjoy this one after this last assault. Can't wait to see everyone, eat my fave foods and ready my brain for summer term. And after today, I'm actually looking forward to summer term. That's a great feeling.

Aye, Fame

You know you are getting old when your fave bands are being inducted into the Rock Hall of Fame. Two of my them are being inducted...Jeff Beck and Metallica. Ugh!

As a new police recruit, I was assigned to Kevin, a senior training officer. Kevin was cool, calm and let me make mistakes to learn the craft of keeping the peace. He also introduced me to Metallica cruising the streets on those late midnight shifts or running radar sitting the median of the highway. We could just pick up a distance FM station from a neighboring state, high in the mountains. It was a treat and a great way to stay awake on those quiet nights. Thanks for introducing me to the rockingest band and some of the most fun air guitar sessions ever.

Oh ya, school....two more weeks until finals and break. I am ready for some U.S. food, drive thru, and chillaxin with family and friends. The courses haven't changed much. The painful transition of course instructors has just drifted into total powerless numbness. It just is what it is, and in the words of a physician friend of mine now in practice...just get thru this part to "pledge the fraternity" that is medicine. The daily struggle is more a daily drift wherever the river takes me. Too close to tip the boat. In the meantime, the diving has been AWESOME!

"All these words I don't just say, and nothing else matters..."

Soon enough!

I'm not really counting down. It'll get here when it gets here. I am really enjoying school and life here. I relish in everyday and the learning has been pretty good as we shift to more study alone and small groups. They less I've expected of the profs, the better it feels. They are, for the most part, useless. Medical school could be all self study and we wouldn't miss a thing. Alas, the ones that add value are all gone now :( Sad really.

Studying, Really!

I'm really studying :)

Learning vs. Reality

Regularly we attempt to learn content that is constantly in flux and subject to change, even before we learn it. This phenomenon is built into the system of education that is medical school. There is a built in delay from reality, to national board testing that almost requires that we learn "old" information in the first two years so we can "pass" a board exam that was effectively written, validated and released during the past 2 years. Confused? When I sit for my Part 1 USMLE board exam in early 2010, that information being tested will have been "current" in 2007-08...it's just how the system works to write, review, validate, test, store and assemble questions and exams.

Flash to now...I'm learning content that is both text based (in itself 2-3 years old via publishing standards) and trying to integrate that with my current knowledge and new knowledge about patient care that we read about everyday (about the only reason I'm sorry for the Internet). So as we learn about the disease of ovarian cancer, the data is in continuous flux. Today I read....

Investigators disagree about value of combination screening to detect early-stage ovarian cancer. (3/20) reported that researchers in the UK, who are conducting "the largest randomized controlled trial of ovarian cancer screening to date," are saying that, used together, "both the cancer antigen 125 (CA125) blood test and trans-vaginal ultrasound might be capable of detecting early-stage ovarian cancers." But, researchers at the University of Alabama-Birmingham maintain that the screening regimen "fails to discover the cancer in its early stages and often results in unnecessary surgery," HealthDay (3/20) pointed out.

The question is what will be current knowledge on my board exam in 2010 when I am taking the most important test of my life to get to the next stage of my medical education...rotations? This guessing game of sorts, and preparing for an exam is understandable, but a bit bizarre and more about the test than anything else. I'll learn how to be a practitioner later.

The next Bozo instructor that tells me he or she is not teaching to the test should be fired right on the spot. It's ALL about the test! I can't move to the next phase of this educational process without passing that exam. I'll learn about current ways of thinking after Step 1 (and then unlearn it a few years when I have to take Step 2). I'll learn about doctoring in my residency. In the meantime, focusing on the massive amounts of "old" content is enough. If you give me one more cutting edge study or minutiae point of information that has nothing to do with anything but showing me how much you know (or test me on it, God forbid) in this part of my education, I'll SCREAM!

Crunch

The week before exams, people change. Beyond the nervousness of the exams and content, this time there is an air of "I've got no clue how this prof tests". The field of medicine is so huge, even within the course disciplines and testing shouldn't be a guessing game. This exam, for many of us in all the terms, it is. So beyond the content, which isn't hard, is the unknown of new teachers and methods (changed mid-term). Students are more isolated, and pensive this block and frankly I don't blame them. It's crunch time...with an edge.

But I went swimming in the Caribbean today and saw my first octopus...a big Caribbean Reef Octopus. Beyond the exercise and getting the "stress" out of my shoulders and working out, the thrill of the animal was amazing. I actually spotted him when a stingray (a common sight where I was) cruised by him and they scared each other. The ballistic movement of both  threw up some sand and caught my eye. It was cool and got my mind off "crunch", even for a moment.

It Doesn't Fix Easily

I try. I really try. Every day it's a new start and an effort to work with what God gave me. Psalm 118:24 says, "THIS IS THE DAY THE LORD HAS MADE". I try to maximize all that is provided and cerebrally know that it's a blessing to have this opportunity and focus. But this system is broke and it won't fix today, tomorrow or for many, many months to come. By then I'll be gone.

Valuing Teaching

An outstanding article appeared recently in the "New Physician" journal from the American Medical Association. It sort of summarizes my frustration with the education I've witnessed here and heard about for years. But here at a "teaching" institution with minimal research, and publication pressures on faculty, I expected different. But what I realize is that school administrators and instructors who are not now, and have never been educated in "teaching" don't even know where to start. The classroom in medical school IS the "last frontier" in need of change.

MEDICAL EDUCATION VS. MEDICAL EDUCATORS

After 100 years of bold strokes, improving the training of medicine’s teachers still requires investment
The New Physician, January-February 2009  by Pete Thomson - Volume 58, Issue 1

---

“Revolutionary would be if a medical school succeeded in truly valuing the teaching mission.” -Dr. Kenneth Ludmerer

**"...one element of medical education only recently began to change, and it may not change much more without support from medical schools themselves and an attitudinal shift in physician culture. That element is the recognition and promotion of teaching skill in the medical school classroom."

**“What would be revolutionary would be if a medical school succeeded in truly valuing the teaching mission.”

**"Generations of medical school faculty and administrators have held to the idea that teaching as an art is a waste..."

**"...the delusion that knowledge of subject matter automatically makes a good teacher...At the higher-education level, very few faculty are really taught how to teach."

**"...we have an obligation and responsibility to prepare our teachers to teach.”

**"...medical students are medical school consumers and, as such, are entitled to demand great teachers and great teaching. But excellence in medical teaching matters the most to the ultimate consumer: the patient population."

**"...medical education has a lot to learn about teaching..."

Nuff said...just nice to hear someone else say it.

Long Time

I know it's been a long time since my last post. Lots of stuff has happened and I've been very busy with school, but I hope that regularity will now follow.

Teachers continue to come and go. Classes are unpredictable and sometime unintelligible. School is reorganizing with new administration punctuated by school functions and events. Island life never really changes but offers peace in the form of diving and hiking for me. Looks  like we are open in Summer, but beyond that is anyone's guess.

I think it's time for some Buddhist balance and perspective.

"If we use our human life to accomplish spiritual realizations, it becomes increasingly meaningful.  Thus by using our human life for gaining spiritual realizations we can solve all our human problems and fulfill all our own and others' wishes. What could be more meaningful than this?"- Spiritually I'm still in the "right" place and finishing the basic science years is still the "realization".

"The real source of happiness is inner peace. If our mind is peaceful, we will be happy all of the time, regardless of external conditions, but if it is disturbed or troubled in anyway, we will never be happy, no matter how good our external conditions may be." - I'm not quite there yet. I still have expectations that are not fulfilled, but I'm getting better at realizing that school can never provide everything we need. How close they come is a matter or daily gradations.

"If we respond to difficulties with a positive or peaceful mind, they would not be problems for us. Eventually we might even regard them as challenges or opportunities for growth and development. Problems arise only if we respond to situations with a negative state of mind. Therefore if we want to transform our life and be free of problems, we must learn to transform our mind." - Sound so easy, but the exam we take at the end of this process is make or break, and all important. It is hard not to hang that success or failure on what happens now, but "positive and peaceful" is clearly the goal. That school can provide everything we need is a delusion, a bad mental habit, and that habit can be broken.

"Delusions are just bad mental habits, and like all habits they can be broken. With no delusions remaining in our mind, there is nothing that can disturb our inner peace and joy."  - Gyatso