Suture

I am currently a medical person. This is how I self-describe - most recently at a drive-thru when asked if I was a doctor ("Not yet; just a medical person.") But in my previous life, I was an education person.

There is an education guy named Vygotsky who talked a lot about the 'Zone of Proximal Development'. It's the idea that learning happens best when you keep the task just barely above the comfort range of your learner. Let 'em get a few right, then they get one wrong, you help them fix it, and then the task gets a little harder and repeat. Gradually, the learner gets better.

One of the nice aspects of surgical education is the tight nature of the teacher/student thing. I start sewing, I'm holding the needle backhand - "flip that" - and I'm standing wrong - "turn your body". Put a few in, then how do I...? - "needle in subcuticular, bring it through the skin, and tie the knot". I like it, it works. I feel a lot of the time like a toddler of surgery, but I'm getting a little bit less hopeless every day.

In any case, the fact that I have that scaffold is pretty key - because left to my own devices, everything would be too frustrating to do.


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Here There Be Zebras

There is some little tricks to responding to pimp questions. Ideally, you know the right answer and you state it with conviction. The other 90% of the time, your best bet is to offer some useful knowledge that shows a reasonable chain of logic. Failing that, your best bet is to tell the questioner "I don't know" directly.

The worst possible option is to mess up the second option and give an unreasonable chain of logic that draws randomly from your fund of knowledge. It is possible to use basic science to support the correct answer; it is generally not possible to derive the correct answer, a priori, from the basic sciences.

Some medical students master these rules quickly. Some, to the chagrin of everyone around them, do not. It becomes very painful to be one of the other medical students in the room...


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Winter is Coming

I do a lot of reading. By necessity. In the past few minutes, I have had to look up Goodsall's rule, Gadolinium contrast use in pregnancy, and what Kocher won the Nobel prize for. This is not a joke; I was asked about each of these today, and I didn't know. Maybe if he had won the prize in the last century or so, I would have had a shot...

As a matter of pride, however, I am also trying to do a certain amount of non-academic reading. It somehow feels like a defeat to do 100% UpToDate reading over the course of a week. So I've been reading a little bit of George RR Martin - the guy popularized by HBOs 'Game of Thrones'. They're long books that are kind of like Lord of the Rings but with more realistic wound progression... and also boobs.

In any case, the whole thing makes me glad to live in a society that has no kings, indoor plumbing, and polymerase chain reaction syphilis detection. Don't take that shit for granted.


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Reality Recap

I recently had the privilege of taking (or 'sitting for', if you prefer the formal style) the NBME shelf test for medicine. This gave me the privilege of doing (or 'suffering') about 1200 USMLE World questions in medicine to try to get prepared for that test. It may have kinda worked - results are outstanding as of right now.

I like UWorld, but she is a fickle mistress. You need to be in the right mindset to deal with it. There is a pretty dastardly mix of questions that are 1/2 hard, 1/4 easy, and 1/4 tricky (which look like easy questions right up until you get them wrong). And there are certain keywords that pretty much guarantee a widowmaker steeped in apocrypha.

Maybe there are immigrant orphan IV drug users that get better than 18th century medical care - they are not heavily represented in the Q-banks.


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ESPN Legal

Today 06:45 - Surgery Orientation.

Today, Now - Trying to avoid accidentally napping to avoid screwing up sleep schedule for tonight/tomorrow morning. Moderate success.

As I'm sitting here avoiding the accidental nap, I've been watching the 24 hour shouting sport heads (not to be confused with the shouting political heads on the other channels). I feel like ESPN is a hair's breadth away from starting up a legal sister network to just cover things like NCAA violations, union lockouts, and shooting oneself in the leg. I would watch it. I basically am now.

Next up, Mike Wilbon and Harvard Professor Emeritus of Constitutional Law Eugine Glick...


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Brand Loyalty

Luckily, I've gotten down to a more manageable number of patient - it was touch and go there for awhile. This has given me a little bit of time for extracurricular activities such as preparing for the shelf and paying attention to lectures.

Did I say 'extracurricular'? Well, maybe 'subcurricular'. Or 'paracurricular'?

Anyway, I heard in lecture the other day that generic thyroid hormone is not bioequivalent. The name brand is actually better if you need to control the dose really tightly.

I was not surprised. I've been to a grocery store. I know that Frosted Flakes are supposed to be sold by a tiger. As a child, and to this day, I have always been really uncomfortable with some 'Sugar Flake' knockoff sold by Sammy the Sugar Ssssnake. That is not how it is supposed to be. It's difficult to put into words, but obviously Tony the Tiger knows the market and his product. I trust him. This other guy is just some drawing done to fool kids who haven't seen enough commercials. The brand name cereal is just better - not in any objective way, it just is.


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Risk / Benefit

Sometimes there is no single right way to do things, but there is sure as hell a wrong way to do it. Actually, it happens quite often. Yesterday, for example, there was some debate as to whether or not you should wash your hands before or after shaking hands with a patient. My personal thought is that the patient has touched themselves at least everywhere that you are going to during the exam, so it really doesn't matter to much if you touch their hands after washing yours. Your mileage may vary.

However, all can agree on wrong ways of going about hand hygiene: eg - just skipping it, spitting on your hands and wiping on your pants, or demanding that the patient sterilize their skin so that you don't contaminate your hands. All wrong positions.


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