FREAKY FRIDAY

Yeah. You know what I wish we could do is have a Freaky Friday where like you and I change, you know, change lives for a day.

What would you do in a day? Hi everybody, and welcome to the podcast. This is Generations MD. My name is Stephanie, and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. Hey, hey, I have become the antithesis of everything that I've rejected.

Oh wow, that is a strong statement.

I'm wearing scrubs everywhere.

Oh, you're one of those.

I have tried not to, and I try to put clothes in my car, but then I wear them, and then I'm like, uh, I— because I'll go into the hospital and then like I'll want to do— the other day I wanted to do a workout class at like 6:30 or something, and I was like, oh, maybe I'll have time to go home and change. So I signed up for the class and then I didn't, so I'd have my friend bring me clothes.

But you had to walk in in your scrubs.

I had to walk into my scrubs, then go change like quickly. And then, and then afterwards I didn't want to like— I didn't know the next time I was going to see her, and I just feel like I was gonna forget if I brought them home and washed them and brought them back. So I was like, oh, I just need to— like, I was like, I'd rather just give these to you now.

So you gave her back— so I gave her clothes.

Well, I put it in a bag, but like— but so I gave it back to her. And yeah, then I had to re-put on my scrubs when I was dripping in sweat. And the, like, hospital scrubs too, surgical scrubs. Oh, so not even like good ones. But yeah, so It's, it's sad. It's disappointing. I'm unhappy with myself. I feel gross. I'm wearing scrubs right now.

Yeah, you are.

But I mean, I, I'm starting to understand the other side a little bit.

Um, you know, it's just a practical thing. It's different. I mean, sometimes it's like, look, this just was handy. I had to do this. Now there's some people, so for example, a salesperson came by my office the other day who was wearing scrubs. And he was like, he sold these Watchman things that cardiologists use in patients in their, and you know, anyway, it's an interesting device and everything, but like, There's no reason in the world for him to be in scrubs when he's coming by my office to try to, he was asking if I wanted like a lunch or something for him to like, I don't know, do, he said he's strictly on the education side. So why is he in scrubs? And I have to admit, like, I was, well, actually I was kind of thinking, you know what, I bet people mistake him for a doctor all the time, like way more than they ever think that I'm a doctor. And I know exactly why he did it because it easily made him able to get past the front desk to kind of talk to me. And I know that's what he does in these doctor's offices. He walks in and he knows that they're gonna mistake him for a doctor and then he gets in to talk to the doctor, which I just find really annoying. Um, part of the game, man.

Live in a capitalistic world, got to do what you got to do.

To do what you got to do, pretend to be a doctor so that you can talk to a doctor. But you know, from your perspective, I mean, sometimes it's just not very convenient to, to be in your nice comfortable scrubs, change into uncomfortable clothes to like go into the store or whatever.

No, I'm not even changing. I mean, if I will take off my scrubs the second I can, I feel gross in them. It's Like I don't want to, but yeah, if I'm running into the store or whatever, but like, I, sometimes I would get let out at a certain time and I would wanna go study at a coffee shop and it's like, I don't wanna sit there in my scrubs, in my dirty hospital scrubs. The hospital's so dirty. I actually feel less dirty in my surgical scrubs because like I would, like was scrubbed in for the most of the stuff.

So I see you were all clean in there.

I was all clean, but. But yeah, but I mean, at this point it's kind of like, yeah, I— it's— you don't always have— you don't always have clothes around, and there's things that— things you got to do.

Yeah, you just kind of go in give up mode. That's, that's where you are.

Yeah, that's where I am. So I, I finished my internal medicine rotation, and now I am on my surgery rotation. So I feel like I can give a full, full debrief on my, um, on internal medicine.

Yes, let's hear it.

Um, well, you know, my first rotation, arguably one of the most challenging, um, in regards to like the workload outside of the hospital because the shelf exam is all of medicine. I've already done 40% of UWorld now after my—

wow—

yeah, for the year, um, after this rotation. So that was honestly the biggest stress in it. Um, so I'm glad to like have that behind me, but like putting that part aside and just talking about the actual like medicine part of the rotation or like in the hospital. Um, I do think that it was an 8-week rotation, so it was 2 months. I got to see 2 different hospital systems. I had like 7 different attendings throughout it. And it, the dynamic really changed based on the attendings I was with and the residents that I was with. I was really grateful I had like great people around me the whole time, like attendings and residents. I definitely had friends who didn't have that experience. So it is just like, it is kind of crazy, like how much your experience is, a result of the— I mean, residents especially, um, but like attendings as well. Um, it's kind of crazy how like one person might like something but they just had a really bad experience on it and like they're never gonna go into that field.

They're never gonna consider it after that. No, it's really, it's really terrible.

Um, but yeah, but I mean like besides that, I mean, and I am, and it's, it's hard because I don't really have anything to compare it to. So other than my week on surgery, but like in general, it just felt like a lot of sitting around talking about nothing, just talking about nothing. And it's very cerebral, which I feel like medicine is the complete opposite of surgery. Like, it is— medicine is so cerebral. You can talk about hyponatremia for 2 hours and you can just sit there and look at these labs and just talk about it, develop a plan, which I did like some of that and thinking about it, especially in the academic setting. And honestly, I will say that in conjunction with having this first shelf exam done, Um, and then also just getting exposed to a lot of stuff for my first rotation was, is a huge advantage. And I do, I highly recommend anybody to do, if you can, to do internal medicine first. Now I might think of that, think about it differently at the end of this year when I'm studying for Step 2 and some of that like, uh, more specific IM knowledge has kind of creeped away, but like as of right now, I feel like I am. Ahead of the game in regards to rotations because I already have done IM.

Hmm.

So because it is, you do have time to sit there and think. And for me, that really helped my learning. Like you really, it's a lot more student-driven, I guess, in the sense that you, you do have responsibilities. Like you have your patients that you go see and then you have to like think about it and develop a plan versus something like surgery. You're not in there really doing the surgery. Like you're learning some sort of things, but you're not like, you don't have your patients, you're not, your focus is less targeted and it's more kind of all over the place. So I think, and you're not like really involved in the decision making. No, no, not at all. Yeah. So I think in regards to like thinking about things and learning, learning about different pathologies, cuz in order to make the decisions and kind of assess everything, then you have to understand what's going on. So I think that that is a huge advantage. Also, just logistics-wise, like chart checking, being able to do stuff efficiently, understanding how the hospital works. Now that the new interns are here, just 2 days ago was July 1st, um, like me having already been at, in the hospital, understanding the EMR and everything, I'm like, I am now helping the residents out like the new interns with a lot of that little— a lot of those little things, which I think just like, I don't know, it just helps everybody out.

That's helpful. Well, so I remember one argument for not doing like IM first was that if you did another rotation, you could kind of learn like the job of being a third year, like learning the system, learning the EMR, that kind of stuff, so that when you got to IM, you were learning lots of internal medicine. Um, but it seems like it wasn't that hard to— I mean, you could kind of do all of that, it sounds like. Learn internal medicine and learn the system, the EMR, and all that.

People act like we're not in our 20s and have used technology forever. Like, we can figure Epic out in an hour. Like, it's not like— I mean, it's about— but no, but no, it's about the flow. So yes, But the flow on other rotations is just different. Like I'm trying to think of one, maybe pediatrics, which I haven't done, would be similar. But then yeah, it like OB-GYN, you're not really chart checking the same way. I'm not really chart checking the same way now. So I do think that like every flow is different and, you know, I still don't have, I, you know, I, I still at the end didn't have like a really good system of how to efficiently do it in the best way. Like, I tried some different things, but I still think even if I did do other rotations and also did IM, then, then did IM, then like, I still think I would— it would still take a learning curve to figure out the flow.

So each rotation you have to kind of learn that no matter what. Yeah, yeah, that's what you're saying. Yeah. I mean, for us, you know, we didn't have EMRs— that had not been invented. Um, so I remember just like learning how to write a note. That was the whole thing, was like, well, you gotta— when you— if you learn something else, then you can learn how to write a note and all of that. I don't know, it's not that hard to write a note. Oh well, it didn't seem hard to me now, been doing it for a long, long time.

Yeah, no, I think that that's a learning curve too, but I, I think that IM is the best place to learn how to do it also because you have the time. Like if you start on Family Med and you're trying to learn that, it's only 4 weeks, so it's like you don't really have that time. IM is a longer one. I will say maybe Pediatrics is probably similar, but Pediatrics you're going to a lot of different sites too. This is just for my I guess that's— this is more specific to my school, but like just looking at it overall, if you know you're going to be in the same place or doing the same rotation for 8 weeks, I think the time is important. Um, but, and yeah, and writing a note and presenting— people, yeah, yeah, you know, on other rotations didn't do that. And I think IM is the best place to learn how to do that so that you can do it for your other rotations when it's I don't know, less, less, um, emphasized and just something that like, like I was asked to write a note on in surgery and honestly it's so busy I like didn't even get to it, but luckily I know how to do it so I can just get it done so that it's not like a whole thing.

Yeah, yeah. Um, you know, we'll, we'll find out more about this as you go through all of your rotations and stuff, but I do feel like your school has a lot of opportunities for patient care in a lot of different ways. I think that there are some medical schools who don't have as much opportunity for all of the different things that your school does. So, um, anyway, well, we'll see as you go through all your different rotations if any of that changes. But, um, you know, that's— that is so important for people who are looking at a medical school and trying to figure that out, um, being in a really big place like the Texas Medical Center is, um, you know, it's pretty nice. You got a zillion different hospitals.

I remember when I was looking at medical schools and people were talking like advantages of being at a big school versus a small school, and they're like, oh, well, at a big school you're just gonna be a small fish in a big sea, and like you're not gonna be able to, to do as much because there's so— because you, you know, you're at the bottom of the barrel. There's med students, there's that interns, PGY-1, 2, 3, 4, 5 fellows, attendings, like, but there's so many people, like, we're still completely understaffed and like, there's still a million, there's still like hands that need to be there. So like, I don't, I, I, I think the percentage of your impact isn't changing at like a small, like, I, do you get what I'm trying to say?

Yeah, I do. I mean, cuz basically there's places where it's a smaller hospital. Um, and people say, oh, that's good, you get to do more. Well, that's true, except that like the, the number of residents and everything compared to the number of patients in that still might be a higher pers— like it may be a different, a different ratio than it is like for you guys. My point is you guys have lots and lots of hospitals, lots of patients, and so you're spread out amongst all of those different places, whereas someone else, it might be a whole smaller system, but there's you know, there's still a lot of people that need to get their training.

So yes, something on this line that I have realized through just doing at least one rotation and just being in the middle of third year is they talk about this kind of in, in theory, and you hear this a lot, but like, I'm really seeing that you have to take advantage of the time that you have to do things. And like, you are really in charge of your own education.

Like, there's—

they kind of have systems in place that say like, when you finish this rotation, you should have seen these, you know, different types of pathologies, you should have done these certain procedures. But like, there's not really any— nobody is gonna say, okay, you didn't finish this rotation because you didn't do a paracentesis, or you didn't— you're not gonna finish this rotation because you didn't do an LP. Because, you know, if you didn't have the opportunity to do it, then you're not going to do it. But if there is an opportunity to do it, you have to do it, and you have to be like, hey, I want to do this. And like, I— the worst that they can tell you is no. And I don't think that you should ever feel like you're overstepping to ask to do anything. Like, even, you know, in surgery right now, it's like, oh, can I, can I 'Can I do it?' Like, 'Can I do the surgery?' 'Can I do the surgery?' No, but no, hon, you cannot. But I still, I still think that that is way better than not being too scared to ask to do anything, because you get to a point where then that's— that was your only opportunity to do something, and you're gonna go through the rest of third year, you have all of your other rotations, and And then you're gonna do, okay, you have your sub-I, so that's like 8 weeks that maybe you'll see something, maybe you won't, maybe you'll get to do something. You don't know, like it, you might not have an opportunity. And then all of a sudden you're starting and you're an intern and like you, you have never done something before, like procedure-wise or, or like pathology-wise. Like you've never seen something like you not. You haven't taken on a patient who, I don't know, has had a sickle cell crisis and you need to know how to manage their pain. Like, it is truly like you— so much of your education is in your hands.

You got to be proactive. But it's also, I mean, as you experienced, if you get the chance to do that one thing that time and that was your first time doing it and somebody showed you how to do it, well then the opportunity sometimes comes up again and now you're kind of the expert. Yeah, you do know how to do it. And then you And you know, they say see one, do one, teach one. But you know, then you get the opportunity to— again, maybe, maybe you're assisting somebody else doing that, but now you're starting to learn how to do that better and better. And but you have to— yeah, you've got to take those opportunities when they come and, you know, be a little bit— I mean, just be proactive.

I was just kind of thinking about it in a way, like I was kind of getting a little frustrated because I, I felt like it was kind of like the system's fault. And in regards to, you know, people— and older doctors talk about this— might be like kind of a generational thing. Like, I feel like I've talked to older doctors and they're like, they don't let you guys do anything anymore. It's like, don't touch the patient and don't do this. And, and I feel like it's like that on pediatrics a lot. Like, it's like, okay, no, don't— like, you know, don't do anything. Like, we don't trust you guys, whatever. And which, you know, maybe to some extent it's changed a little bit. Like, I feel like back in your day you guys were kind of— I don't know, you just have that story about you in the VA like chopping off some guy's cyst or something as a third-year medical student, right?

Like, no, that was an intern when I did that. Okay, that was the guy who said that that procedure, uh, hurt more than getting shot.

Yeah, okay, I mean, that's a little bit different, but I feel like maybe— I mean, you guys didn't have standardized patients. You weren't like You know, I think there's some sort of rhetoric that like we're a lot more babied and kind of like our hands are being held too much and we're, you know, to protect the patients and us and all of that, which maybe is like that to some extent. But I'm thinking about on the other side, like as an attending, I am not gonna tell a student to do anything. I'm not gonna ask a student to do a procedure. Because yeah, I don't trust them, but like if they come to me and say, hey, I really want to do that lumbar puncture, then, then I'll be like, okay, maybe. But if they don't say, hey, I want to do that, this lumbar puncture, I'm not going to tell them that they can do it, you know what I'm saying?

Yeah. And you know, and as an attending, I mean, varies depending on what specialty and all that, but like, I mean, they're trying to just do their job and get home and out of there as well. And it's a hell of a lot faster for them to do things themselves.

I mean, on surgery closing, right? Right? Like, just like no one, because it takes so long for the students to do it and they are not going to say, hey, can you close this? Unless you ask. I mean, maybe some will, but like, yeah, it's gonna take triple the amount of time for me to suture something up than for somebody else to. So if I don't say, hey, I really, can I, can I just try closing? Then they'll be like, they'll either be like, no, sorry, like, I just got to get this done, or they'll be like, okay, like, yeah, you can do it, I'll let you throw a stitch or two and we'll see. Yeah, pretty much. But still, it's like, if you don't ask, then you're just gonna stand there the whole time and do nothing.

Yeah, yeah. I didn't really want to, I just kind of want to get out of there, go get something to eat.

I, by the time it's closing, then yeah, but, um I, I don't— I would much rather be doing something than just standing there. And that's why I've been a little bit more like just kind of— I'm just grabbing a tool and kind of holding something back because then like you feel like you're contributing. Yeah. And like, you know, obviously I don't want to be in the way, but I feel like I'm— I can understand the what's happening and what needs to be done. Like it's so mechanical and so just like if, if there's a hole and the hole needs to be open, then just hop in there and open the hole and then move based on where the hole need— where they need to see. You know what I'm saying? Like, I feel like it's just very like—

makes sense.

Yeah, it makes sense. Yeah. Which again, I was just kind of positive. I am—

I was just like holding a tractor and kind of daydreaming and like looking off and just hoping they didn't ask me a question.

No, I like— I feel like— I don't know, this— I've only been in like— I've only done this for like 3 days, so I thought it'll probably be me, but by in a couple weeks.

So yeah, you know what I wish, uh, we could do is have a Freaky Friday where like you and I change, uh, you know, change lives for a day.

What would you do in a day?

Okay.

You know what a day in my life is right now versus a day in your life? We gotta do, we gotta do a TikTok on this because a day in my life right now is I wake up at 4 AM.

4 o'clock in the morning.

And I get ready, I drive over to the hospital, uh, like 4:30, I get there by like 4:50, I go in.

You're at the hospital before 5 AM?

Yes, that's the goal.

Um, and this is already not working for me.

And then get in there and start chart checking by 5:00. Um, and then get my bucket ready with all of my supplies for wound care.

Wait, your bucket? My bucket.

This is how it works. You got your bucket that's labeled with your team color. I'm Team Silver and I have my bucket. And then, um, And the interns are there. We're in the intern room, whatever, like charge, I can't get anything ready. Then the PGY-2 and PGY-3 come and then we go and we round very, very quickly running to all the patients on surgery. And you know, the PGY-3 goes in, then the 2, then the 2 interns. And then there's me in the back with the bucket and I'm holding this bucket with all of this stuff that's kind of like flopping around. And then I also in my other hand have my phone with the translator. On because like, because like everyone speaks Spanish. So it's like I have to have the translator ready to go. So I have the translator in one hand. Then sometimes like, you know, there'll be something like I need to do the wound. So then I'm like, or they'll be like, can you take a picture of this for their chart? So then I like have the translator in my hand and then I'm also trying to get to the app to like try to take the picture. And then I'm just like, yeah, so that's it. So we walk around and do that.

I'm already not seeing that I'm going to be really good at this, but go on.

Yeah, no, you're going to be like, you can't even get like your bag out of the overhead bin on, um, like in when you're getting off the plane without dropping things all over the place and just causing a whole scene.

You would have been so embarrassed, by the way. Uh, when I was on my trip, I, I was, there were many times where things were falling around.

Oh my God.

I was like, I'm so glad my family's not here to witness this.

Like getting, putting your bag through TSA and you're just like the stuff's flopping all over the place and it's— oh, sorry, I just— like, no, this is all before 6 AM. So anyway, 5:45 to 6, do that, and then 6, go to, uh, like rounds with everybody, and then 7, go into the operating room, do cases, come out, see what needs to be done, get home in the evening. Sleep, repeat. What does your day look like?

Do a workout class in there somewhere too, don't you?

Yeah. Yeah. When, when you can, when you can.

Yeah. Well, my day starts off— well, today my alarm went off at 7:30, woke me up out of sound sleep and woke up. And then Dad said, okay, you ready for a latte? And I said, yes, please. So he went and got me a latte and brought it to me in bed. Well, I slowly sipped my latte and started to wake up. Yeah, then I finally got dressed, checked my emails and such, got dressed, went to go work out, putzed around some more back at home, took a shower, came over here to the office, ate my lunch at 11:30, and then we started podcasting here at 12. And, um, that's all I've done so far.

Nice.

Nice.

Well, yeah.

Yeah.

What would you do in a day in my life then?

Wait, like what would you do in mine or what would I do in yours?

What would you do in mine?

Do everything that you're doing. Go there on rounds. I think it would be really funny. And then, uh, You know, oh, I think I go into the surgery like scrub in there for like 5 minutes and then I'm like, mm, okay, can we just cut right here? Just kind of show me in surgery for a while and we'll pretend that that lasted for hours and hours. Then I'm like, all right, time to cut, leave. I could—

you don't want to close them up?

No, they'd be like, oh, do you want to close them? Like, let's get out that staple gun. Staple gun was always my favorite. Um, yeah. And then, uh, but I could do the presentation on rounds, could present the patient.

They don't have time for that on surgery unless you're gonna do like, we're just running to— because I've looked at the other day, I was like, I can't, you know, again, coming from IM, it's like they do, you know, your— the whole day is these presentations, hours and hours and hours of this. And on surgery, when you round, you know, same number of patients, 10, 15 You're running to the— we do it in 15 minutes. Like, it's literally 5:45 to 6, and we run into the room. Like, as we're going over there, then there's like, okay, this patient, like, you know, they're stable. They're— or, you know, they fevered last night, they're kind of sick. We're gonna get antibiotics and we're gonna consult medicine. Yeah, I know, literally. And then, and, um, you know, but I think they're okay. No surgical intervention.

Yeah. Our job is done.

Pack their wound and move on.

Yeah. Yeah.

Well, um, it's just crazy that this is all like the same, like, I don't know, it's just, it's all so different.

Yeah. It's a different, yeah, it's a different philosophy on, on lots of those things, but you have so far had very like stereotypical, uh, stereotypical internal medicine. Right now, getting some stereotypical surgery. 100%.

It's the bread and butter, baby. This is like the— yeah, for sure.

You're on general surgery guts and butts.

Guts and butts. Yep.

That's what they like. You know, one thing I will say that is different from when we were in school— so we did 3 months of internal medicine and 3 months of surgery. And both of those, I did 2 months of general internal medicine and then 1 month of a specialty. And same thing with surgery, 2 months of general surgery and then a month of a specialty. So I had, um, cardiology as my specialty in internal medicine. Then I had neurosurgery for surgery.

A lot of schools do do that, which I think is— I think it's good to do a specialty in IM because there's so many subspecialties that we just don't get exposed to at all.

Yeah, yeah. And then you really do see, like, like cardiology, for example, is a little bit of a blend of internal medicine and surgery because they're very procedurally based. And so Um, so that's like— I think it's, it's really helpful to see that, particularly if you think you want to do one of those subspecialties. Um, you kind of need to be exposed to it. And again, I guess you can do a, a sub-I in that, like, during your fourth year. Um, but it's important to kind of like— people need to know if they want to do one of those specialties, because otherwise they, they know they don't want to do general internal medicine, and so they they, you know, so they're not going to apply internal medicine unless they can figure out one of those specialties that they might want to do. So I don't know, I do feel like I wish, like, I wish primary care would, like, do a little better sales pitch to the students.

Yeah, I mean, it's hard.

It's a tough sell anyway.

It's a tough sell anyway. And it's so hard when, like, like, even me, what I'm thinking, if I wasn't thinking, like, so long-term and stuff, it's like Oh, it seems, you know, surgery seems cool and it's like you're doing stuff and all of that, but then it's like you really think about it, it's like, you really want to do this like forever? And then, and also it's like, like I'm like hopping into different cases and seeing different stuff. I'm like, oh, that's awesome. But like many of the surgeons just do the same thing over and over again. So like, it's like, I, I just like can't imagine and like doing that. Um, but yeah, uh, one more comment I do have is, uh, let's see, today is— today is July 2nd, yesterday was July 1st, and I do not recommend anybody going to the hospital at the beginning of July if you can avoid it.

They say that don't get sick in July, and then there's lots of people who are like, okay, don't be so hard, everybody's you know, everybody does need to be— to learn. Although it does seem like it's not a great system where everything changes at the same time.

Yeah, and I— it shouldn't just all be— well, this is the problem, is that interns run the hospital, and when the interns switch, then every— then the hospital goes downhill because they— it's just like this indentured servitude thing. It drives me absolutely insane, the point that they make us pay for med school and then They work the interns like crazy, and they are doing everything. They are literally running the hospital. And yeah, when they don't know how to do stuff and nobody wants to take the time— I mean, they will take the time to teach them— then like the hospital doesn't run.

Yeah, stuff just does not get done.

But it is crazy. Like, I mean, come— I— but really, coming off a fourth year when you're doing absolutely nothing And then going again to my point of like, you— this might be the only time that you're gonna get exposed to— if you want to do surgery and you're in a surgery, uh, rotation, then yeah, you'll have your sub-I for again another month, 8 weeks, and then you're us— you're a surgery intern. Like, you like are in there doing stuff. So it's like, it's just you don't really all of a sudden, I don't know, it's just you don't have that much time, which I think, again, I totally agree with the schools that are pushing to have students in the hospital early and stuff.

But, um, but yeah, yeah, that's, uh, I don't know, it is, I don't know, there's, there's flaws with every system, uh, you know, every time you try to like make changes and do things. I mean, we were talking about that with your friends when we were at the lake or whatever. I mean, just that whole thing of like, okay, well, you know, we try to get students in the hospital like when they're a first-year med student.

You can't do that.

That's—

you gotta—

you just don't know enough.

You gotta learn this stuff for sure. You gotta do the work. You gotta learn the stuff. You gotta get through it. But like, I do think that there's other ways to do it, but that's a whole separate conversation. So also like a part of this too is, um, getting these evaluations, which are done differently in every rotation. I'd like to speak on this. For internal medicine, it's just your attending, like the basic thing, the attending evaluates you. So, you know, a lot of this is weird dynamics of getting somebody to like you. I do feel like being a third year, um, is, it feels like I'm a personality hire because I can't do anything. I'm just there. And my job is literally just like, I'm kind of just cracking jokes honestly, and kind of just like getting the, like you know, getting— trying to be helpful but getting people to like me. Like, it really feels like I'm like— it feels like I'm a personality hire. But also on surgery, since we're not really with the attendings a lot, like, we're really just with the resident. Like somebody said, it's like it's you and the intern versus the world is how somebody— how somebody put it. But, um, like, since we're not with the attendings, then we have the residents evaluate us and we have to ask them. So like, and on Ubigain, they even have a QR code that they hold up and just have to be like, hey, can you please leave me a review?

It's like a Google review. Yes.

And it's so, so it's so awkward to get these reviews. But, and then also some of these, like, again, I, I told you guys I had 7 different attendings on IM. I had one the first week and somehow she was assigned my, my final eval. And I mean, she like, we got along great. But again, that was my first week on my first rotation. Like, you know, she doesn't know how I did the rest of the time. Like, she saw me once and then checked out and she had, she definitely had no idea who I was when she was, um, doing my review. And honestly, I want to read it because it's just funny. Stephanie did well with his assignments. She worked hard, was sincere in his work. She is good team player. She can do better with her assessment and plan as she continues to advance transition as fourth year. I'm not a fourth year. I am a female. That was my— that is what's going to be going on my final evaluation, uh, letter to residency programs.

So, well, let me tell— let me read to you my letter. By the way, I'm looking— so I had this file that I had stuff from residency and med school and even like my applications to med school, which I believe you had dug through at one point at the very beginning of this podcast. But, um, but I saved these different things. I kind of have a feeling that I only saved some of the good stuff. I think if stuff wasn't good, I think maybe it got pitched. I don't know. But, um, okay, this is, uh, July of 1994. Dear Ms. Blom, at its recent grading session, the Department of Medicine faculty met to consider your performance in the basic medicine clerkship for the spring quarter of 1994. Your final grade is superior. Ah. Yeah, so that's like honors for you guys. Like, that's an A. We had superior, high satisfactory, satisfactory, and then like unsatisfactory. So superior.

For your evals or like for your overall grade?

Well, I'll get to that. So my final grade is superior and it has been transmitted to the registrar. You tied for rank number 12. Oh. Of the 27 students taking the basic medicine course. "clerkship during this quarter." I was feeling good, and it wasn't even number 12, I tied for number 12.

Yeah, how many people tied for number 12?

Like maybe 10 of us?

27 people tied for like 12, you know.

Um, but listen to this, your own written examination score was 610, range of 295 to 690, the mean was 513.

Wow, okay.

I know, sounds pretty good. And it contributed to 22% of your final department That's huge.

So that's a difference. 22% of your final was that test. Yeah, us it's 50 or 48.

Wow.

So it's just different.

Yeah, the, um, your— I guess then it says your case histories test score worth 11% was 10. I don't know what that means. The other 67% was determined by your day-to-day ward and clinical performance as rated by faculty and house staff. Selected comments from these faculty and house staff are: very good student, conscientious, keen, and knowledgeable.

Nice.

If you have any questions about your experience, please arrange to see me at your mutual convenience, blah blah. So conscientious, keen, and knowledgeable. Who uses the word keen? Like, what does that mean? I don't know. I really don't know. It's not a word that I've ever really used a lot of, but very—

just a— I was gonna say copy and paste, but I guess they didn't have that back then. Just something that— the same thing they said.

Yeah, yeah, did not. So, um, anyway, so, so that was— but it, it, it's funny how you don't really— I don't know, I didn't really remember. I remembered like it It seemed like it went okay. But, you know, really, I think that I did well on that test, which still though, it was only— the tests totally were like one-third of the grade instead of half.

Yeah.

I don't know. I don't know if that's better or worse though, because like how you do on the words. I mean, like you talked about, it's so subjective depending on who it is that's grading you. And some, you know, some people give everybody good, you know, good stuff and some people give everybody bad stuff.

So for sure, for sure. Like, that's, that's why it just— the whole thing shouldn't be graded. Like, it's just like, I don't know.

But yeah, yeah, I don't know. I don't know which a lot of schools do now too.

But then, yeah, people like, uh, Baylor doesn't have a, uh, Baylor has pass/fail curriculum like the whole 4 years, which I didn't realize until recently. But, but then like whenever a student does something, like I have some friends who go there, then some of the older faculty will be like, oh, that's a product of the pass/fail curriculum right there. Just like, okay, right?

Because it just assumes if you, if you're not doing something for a grade, then you're not going to do it well, right?

Yeah, I mean, yeah, I don't know.

Um, that's, you know, I came off of this, uh, I took a trip to Portugal, everybody, um, did this yoga retreat, and, uh, it was all, all very good time and everything, but You know, I wasn't doing it for a grade, and yet somehow in the back of your mind you're like, I'm gonna get knocked off for poor attendance at this thing.

Well, that is— that's a product of being in medicine. I was— I was talking to my little cousin Lily, who's starting her freshman year of high school, and she was talking about like the stress about getting into high school and her grades as like in middle school. And I was just thinking like, wow, I've been worried about grades for 15 years and I'm not even done. Yeah, like, it's just, it's just me. Like, yeah, that's in— that, that, that has an impact on, on your life, you know?

Yeah, you're always just like, I want to get an A, you know, I want to get that whatever. But, and, and as we'll get to later in the podcast, I found all my residency evaluation things. And, you know, in residency you don't get grades, um, and really they do, they do an evaluation of you at the end of these because you still do rotations throughout residency And, you know, part of it is just so they're making sure that you're meeting your marks, um, because, you know, they— people do get fired from residency if they're not, you know, if they're not progressing the way they should. Although, man, I don't know, I feel like you'd have to be pretty bad for them to want a hole instead of you being there, you know. Being down a resident is pretty tough. But same thing though, but they don't want somebody who is incompetent, you know, graduating from their residency program and going off into the world. So I mean, really, the point of the evaluations is just to to see if there's something that you need to work on and they need to—

which is what eval should be, you know.

Right, right, it's supposed to be just for you personally, but, um, but still when you get this evaluation and they don't give you any grade, or at least they didn't, maybe they do now, um, it's still like, you know, you're still just reading it like, oh, you know, okay, I wanna, I wanna see what they said about me, and I don't know, it's It— I don't know, it's very— yeah, it's all very ingrained in you.

Do you have them all still? That is so funny. You just have these like affirmations of people. That is so like med student coded. You just collect— like, you just like, oh, these people said I was good, I'm just gonna collect them and keep them in my back pocket whenever I need— whenever I need to look. All these doctors said I was good.

They did. Lots of people like me. Lots of people like me.

Um, box and just bring them out when you're feeling down, right?

Okay. I have not looked at these in all these years. One of the things that I— they— whenever we did a procedure, we wrote it down on this little card that was like an index card that was called a green card. And you did that because when you're applying for hospital privileges, you had to prove that you did like X number of lumbar punctures or whatever if you were trying to get privileges for that. But, but so I just kind of threw all this stuff in there. But, um, The— so then I have my whole dean's letter. And so we can, uh, as you do your different rotations, we'll see what the— what, what, what, what things they pulled out of mine. But here's, here's what surgery said about me: high satisfactory. So I didn't get a superior, I got a high sat, like basically B. Acceptable as a house officer, a good solid student, hardworking. That's honestly pretty high praise coming from a surgeon, right?

100%. You know, I say like, if they tell you good job, you know you're actually doing a good job.

Yeah, yeah, the, uh, and like psychiatry had the longest one, uh, but you know, you figure the psychiatrist, they're probably just a little more worried, they've got more to say about it.

For sure, for sure.

So, um, but yeah, and just, you know, one more thing, I— my overall class rank in my med school was 32 out of 175.

Nice, that's pretty good. Yeah, that is pretty good.

I honestly did not realize it was that high.

Um, so trying to redeem yourself from the 502 situation.

Yeah, still, I think that was— that, that was an error. All right, well, I think that's a wrap for now. You got to get back, uh, to work or something.

Yes, yes, I do, I do.

And I gotta go to the lake. Yep, there we go.

Well, thanks guys for listening. Uh, you can find me on TikTok at generations.md and my mom at Dr. Davis PGY30. And on Instagram @generations.md, and you can email us at askgenerations.md@gmail.com. And we'll talk to you guys soon. Bye!

Bye!