lukeli’s posthaven

Wow, time really flies when you finish all your M4 requirements. Since my last post, I completed my Medicine Sub-I and my Neurosurgery ICU rotation. Just yesterday, I completed the last set of quiz questions for Advanced Medical Therapeutics (AMT), the required M4 online course, and since my AMT project requirements are done, I am essentially done for the year (minus three electives in February, March, and April). I don't even need to go on any interviews for the time being; since the Air Force match results are released on December 14 and since I would have to withdraw from the civilian match anyways if I got into an Air Force program, all of my civilian interviews are scheduled for January. Bottom line: I'm living the good life, working out regularly, keeping up with my TV shows. Heck, I might even start blogging on a more regular basis.

[Part of the good life: fried frog legs at the Dexter Pub. Nomnomnomnomnom.]

As the end of medical school approaches, enjoyment of M4 year is also coupled with the realization that I'll be starting residency soon. This is both exciting and daunting. Exciting because my Sub-I rotation gave me a taste of the satisfaction that comes with being a (relatively) independent doctor with (nearly) full patient responsibilities. Daunting because I know my current level of knowledge isn't going to cut it for much longer. Right now, I bask in the admiration of underclassmen who marvel at my understanding of psychiatry (admittedly a bit narcissistic), but having the time to attend various psychiatry talks and to watch various online psychiatry lectures also helps keep me grounded by showing me just how much more there is to learn.

I'm not even talking about the prospect of essentially memorizing the DSM (I imagine that will naturally come about with more clinical exposure and more clinical practice); I'm talking about the need to add depth to my knowledge. The stereotype of psychiatry is that it's a field of hand-waving medicine ("we give you this pill and you magically stop hearing voices"). What is becoming more apparent, though, are the advances that are beginning to shed a light on the pathophysiology of psychiatric disease. All throughout med school, we had a cursory introduction to the receptors, neurotransmitters, etc. that are involved in mental illness, but I have to admit that those topics took a backseat to learning the patterns of symptoms that make up a diagnosis or the broad categories of medications used (SSRIs, TCAs, typical antipsychotics, atypical antipsychotics).

No more. To quote Dean Wooliscroft in this year's State of the School address: "The status quo will not continue." As a resident, and even more so as an attending, I will have to have a better understanding of neuroanatomy, various brain circuits, and how psychiatric medications exert their therapeutic effects. It will no longer be good enough to simply recognize a particular class of medications; I will need to start differentiating between members of the same class, to distinguish their particular properties, in order to be able to justify prescribing one over the other.

With these thoughts in mind, I particularly appreciated a recent post from "Insights on Residency Training," the JournalWatch blog run by chief residents in family and internal medicine. The author was reflecting on how the nature of learning changes, from pre-med to med school to residency. I was a bit relieved to see some of my current habits already matching with some of her suggestions ("Look up answers to your questions, not just subjects you are instructed to read about." "Start some sort of filing system for helpful articles or handouts." "Register for free e-mail alerts from Journal Watch."). What really stuck out, though, was this piece of advice: "We are all naturally curious people who want to be the best doctors we can be. We cannot help but learn. We should have a bit more faith in the process and trust that when we’re spit out the other end of residency, we will have acquired enough knowledge to be good doctors."