NOT CLINICALLY RELEVANT!

Somebody said that I was given neurology vibes, which I thought meant I was nerdy, but Stephanie said that's actually cool.

I think so. I don't know why they said that. Clearly they didn't watch the whole video because you didn't know any neurology questions. Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie. I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother.

Hi. Hi.

So we've had. If you haven't seen our social media on TikTok and Instagram, we've been posting some reels where you try. Try to do my ANKI cards. So I'm studying for step one, which is the first round of boards, which typically you take in the middle of your or at the end of your second year of medical school. So it's a lot of, like, basic science stuff, just very kind of worthless. So, yeah, the first two years of medical school, you're in the books, you're studying. You're studying, like, the pathways behind all the different stuff. Like, do you actually think that that's worthless?

No, I don't think it's worthless. I. I mean, I think I've said this before. I do agree with understanding all the building blocks to the human body. And then when there's pathology, you understand what has gone wrong if you understand the building blocks. And so all of that is good. And conceptually, it's important to understand that. But the mind. Well, the level of minutiae that you get tested on is really kind of absurd.

Yeah. So we were doing some of the Anki cards, and it would be like, what chromosome is.

Well, yeah, it was. Yeah, it was a question about hemochromatosis. And that's great. And that's an important thing to know. It's actually relatively common. It's something I see, something I look for. And I do check for the HFE gene to see if people have that. And. And so all that's good. It's important to know what hemochromatosis is, you know, what, what happens, why it's dangerous, blah, blah. Okay, check for the gene. And then what chromosome is that gene on? Like, what in the world difference does that make?

Yeah, yeah, it doesn't. But I mean, I think on one side of things, that's what someone was saying. Uncle Pete, I think, was saying that that is what sets, like, doctors apart from nurse practitioners or PA or other kind of. Because they skip all of that.

Okay. So, yes, it is. It really is important to Understand how things work. Not just, oh, when this is wrong, we do this. That is somewhat the way some people get trained to think. Like, okay, when this is wrong, this is what we do. This is wrong, this is what we do. And you know, the problem with that is if you don't understand why you're doing something, you can't understand this particular case. Oh wait, that's different. The. I mean, just as an example of that, when I was a resident working in the ICU and somebody was coming in after having an overdose of an antidepressant and I was saying, and anyway, one of the treatments was that we had to keep their. We had to try to like keep their ph in a particular range. Now I can't even remember what it was. Maybe we tried to alkalize them something. Anyway, we were trying to keep their PH in a particular range. And so I had to order arterial blood gases to be done in the ICU on this patient. We had had two and they were in the normal range. So then I was tinkering with the thing, titrating it, trying to get it outside of the normal range. Well, the nurse called and said, well, I discontinued that order because the you. It was, it was within range. So I didn't think you needed to keep doing blood gases. And I was like, I don't know. I know that normally that would be fine. If somebody's blood gases are fine, you don't have to keep checking it. But I wanted it to be outside of the range. So it's just. And you know, when you understand the mechanism of action, why you're doing what you're doing, then then you can understand why sometimes it's different from other situations.

Yeah, yeah. But knowing the chromosome, I guess, no.

I, I cannot see like why. I just don't see why that's could be important.

Unless you are looking at a karyotype.

Well, I mean, I guess if you're looking for certain genetic abnormalities. Yeah.

Or like just okay, that's on chromosome. I mean there's sure. Oh, like Alzheimer's is significantly more common in patients with down syndrome because there's a gene on chromosome 21 that is an Alzheimer's positive gene. So it kind of like that.

Yeah, yeah. That's clinically relevant. Yeah, yeah. So there could be some times where some of that is relevant. I feel like that's the. When they're doing those Anki cards, they're really just, they're just kind of trying to trip you up because you already know all of the regular stuff. And then they're just kind of trying to add more stuff.

That's the thing is, like, it'll. That's like what the practice questions are too.

Or the.

I mean, what the test is, is it'll be like, okay, like, you get the diagnosis, and then, okay, you get the treatment. And then it's like. But it's not even. It's not the diagnosis, it's not the treatment. It's like the antidote to the treatment or whatever the thing is.

Right, Right. And they do that too in my. In my board classes that I have to keep. Well, not classes, but the test questions that I have to do. I have to do 25 test questions every quarter, which doesn't sound that hard, but it's pain, and you have to go through. And it's the same thing. I'm like, okay, they show me an ekg, I'm like, oh, I see what's wrong there. Oh, yeah, there's a diagnosis. Oh, yeah, there's the treatment. And then what is the prevalence of that thing in this population? I'm like, okay, well, I don't know that.

Yeah, that's also. There's a ton of genetic questions on step one, too. It'll be like, okay, you get the diagnosis, and then you know the. That it's like the HFE gene on chromosome 6. But then it's like, what's the inheritance pattern? And you're like, but not even what's the inheritance pattern? Then it'll show you a pedigree and be like, okay, well, what's the odds of this person getting this thing? So you have to know the diagnosis. You have to know the. Whether it's also zone dominant or autosomal recessive or whatever. And then.

Yeah, yeah, and then that. And. And part of the stuff that is really frustrating as well is that this is all timed. You know, you only have so long for each question. And so you really have to be able to figure that out super quick. And some things are time sensitive in medicine. A lot of things are not time sensitive, especially for me in outpatient medicine. I mean, there's lots of times where I see a patient and I'm like, you know what? I've just gotta. I gotta think about this. And I tell them that, Let me think about this. I will get back to you with, you know, a few other ideas. I just gotta. I just gotta mull it over and research it and then come back. It's not that time sensitive. So that's what's just sort of frustrating is Having to know all of that stuff just so, so fast again, that's easily something you could look up.

Yeah. We had to take our first step practice test, and I. I went. I had to go back to the basics and started drawing out punnett squares, just a simple punnett square. And I was like, man, I feel like I shouldn't. I should. I should just know it. I should just know. Okay, that's 25. Because this. But I was like, you know what? I'm just going back, back to the basics, back to the punnett square.

But I mean, so. But that is an example of like, when you. You can go backwards because you know how to get to this thing. It's not like you just have it memorized.

Yes.

So it, you know, I guess I. The thing that I think is a little bit. And all education is going through this. People are really going to have to figure out what do people really need to know. I mean, memorizing lots of names and dates in history classes and I mean, there's a lot of stuff that's like, okay, it's just. It's not that important to know what year this thing happened because it's just so easy to find that information now. You really got to focus more on concepts and critical thinking rather than just memorization.

Yeah. And I'm not an education expert by any means, and I don't know what the right thing is, but I. I just know I've always just hated the busy work stuff and just having to just do stuff that it just doesn't seem to matter. And now that there's AI and a lot of stuff that can just do it for you, I'm hoping that they're moving away from doing all that busy work stuff.

Yeah. From so much memorization. Yeah. It would be nice. I mean, and also I just feel like in medicine, man, the way you learn is by seeing stuff, seeing patients with different things. So I feel like it would be nice at some point in the future if they shortened those first two years down. I think that you. They could not go into so much detail about certain things and then have you just spend more time on your clinical rotations.

Yeah. And some schools kind of do that a little bit. But back. So what I used to study to get all these little details because the truth of the matter is that we have to know all of these little things is I do anki, which is space repetition, flashcards. So space repetition, spaced repetition. Yeah. So, like, depending. I'll get a certain. I'll get a flashcard. One day, and if I know it, then I won't see it again for another three days. And. But if I get it wrong, then I'll see it again and then I'll see it again the next day. So it's just based on you kind of just say, yes, I knew this card or I didn't know this card. And you're, you see that card as frequently as you see it more frequently if you get it wrong, more and less frequently if you get it right more. So that's how we get kind of all these little details down. But what were you doing? How did you get without Anki, without that sort of flashcards that are already made for you? How in medical school did you get down the little details?

Well, you know, I mean, we made our own flashcards in a lot of ways. And, and I guess even as you're saying that, I'm like, well, that's probably what I used to do. I would make my own flashcards and then you would have like a pile and you would say, oh, these are the ones I know. And so you would put those over into this other pile. And then these. Oh, wait, I missed that. Let me put that in this pile so that I can do these more. And then these you might throw back in there just to refresh your memory. So I did do, I did do flashcards. We also did this with quizzing each other. You know, you had to be each other's anki. So we'd get together and you'd sit there and ask questions to that person and they would ask questions to you. And sometimes you do it in a, a group of multiple people.

But like, I'll have like 800 flashcards a day.

Yeah, we didn't do anything like that.

You're writing down all of this stuff. It just seems like a lot. Did people ever have decks that they already made that they would give to somebody else?

I don't remember doing that. That doesn't mean it didn't happen. But I don't remember doing that. I do remember one guy typing some stuff out on a computer. He had a computer, fancy person, and he had typed out this list of all of these terms that we needed to know. Now, he didn't have the definitions next to him next to it, but that way you could just sort of like quiz each other. Like, you would say this term and you would describe it or whatever it was. And I remember we, I printed it out on our dot matrix printer that we had. And in those, in those days, like you had to like pull apart the pages. So it came out as just like one long sheet of paper, basically. I mean, it had perforations. You know what perforation is?

Yeah, yeah.

So it was basically like, you know, would have been maybe like 20 pages. Well, okay, maybe it was like 10 pages long and. But it was all like connected. And then I took it and I taped it up on my wall after the test just so that I could look around and be like, man, I knew all that stuff.

That's super weird.

Some decoration in my beautiful little apartment.

Oh my gosh, that does. Sometimes, like right before the test I'll go and I'll reread my own notes and be like, look at all this stuff that I know. And that helps me be a better test taker.

Yeah, I. And so I did a lot of, you know, taking down notes and then I would look over those notes and then I would take notes on those notes and then take notes on those notes. Like just the stuff that I didn't know each time. And so I went from having this big stack of notes to like smaller, smaller, smaller, until I got it down to like one little page of just the stuff that I still needed to know. But I always thought that was funny because you would go back like a couple of notes ago and you're like, oh my God, I can't believe I didn't know that then. Like that's so obvious.

I don't know.

Yeah, yeah. And then I'd have it down to like one little, one little square that I was like staring at as I was walking to school. I'd be just like, like, oh yeah, okay, that thing. And then still like even looking at it like right before the test. All right, all right, put it away. Time to go.

Yeah, I was telling my friend that I, I only look at my own notes. Like 12 hours before the exam. I'm only looking at my own notes. Things that I already know. I feel like that makes me a better test taker. And one of my friends was saying that she's like, ah, that probably sounds like a better idea. Cuz I just will turn to a random page of first aid and just try to like memorize it really quick right before the exam of like something she doesn't know. And then she'll walk in and be like, man, I don't know anything.

Terrible idea.

But I mean that is what I do now to, to study is I make my, my. I do it on my iPad. I used to in. Well, the way that I study now actually the reason I started doing this was because I took this experimental psychology class in undergrad, and our professor said that you can have a cheat sheet. And he was like, you can put anything you want on one piece of paper, like, for the first exam. And then for the last exam, he was like, you can only have this tiny little note card. But he was like, I promise you, you're not even gonna look at the sheet of paper during the exam because you spent so long trying to fit everything on this page.

Yeah.

That you already know it. And I took that with me, and ever since that class, like, my sophomore year, and I'm like, okay, well, I'm just gonna do that for. I'm gonna make, like, a quote cheat sheet for all my other exams and just try to fill everything in on one piece of paper, and then I'll know it for the exam. And now I do it, like, on my iPad, because I'll take pictures of other, like, diagrams and stuff. So now it's a lot longer, but I still, like, will condense down, condense down while I'm doing practice questions. And certain things that keep coming up that'll make them bigger, like, on my piece of paper, and then things that aren't super emphasized, I'll make smaller and kind of condense it down to a couple of pages. So, yeah, it's still the same thing. It's just.

Yeah.

On my iPad.

Yeah. I think that. I mean, that Anki stuff is pretty cool. I think what is really nice about that for you guys is that sometimes you're like, okay, I just have 15 minutes, and so let me just get something done in 15 minutes. I think that's a really good use of a small amount of time. That. That was something, you know, I couldn't do tons again, unless I had really made a lot of flashcards. But I don't think I made tons and tons of those flashcards. But that's, you know, that is kind of nice.

Yeah. Yeah.

And then we did. I mean, we also just did lots of practice questions. I think that was the other main way we studied. You know, you just. You get the old exams and do those practice questions and just keep, you know, especially as the test got closer, you just do practice, practice, practice, and hopefully, you know, the stuff.

But yeah, talking about clinical relevance, though, like, when do you think stuff started to kind of come together? Like, when you got in the hospital and, like, when were you like, oh, I. I actually am. This stuff is practical.

Yeah. You know, the way we did the first two years was different from you because you guys really study systems. We didn't do it like that. We started studying. The first year was like, biochemistry and anatom and stuff like that. That was really just like, okay, this is how the human body works when everything's working. And then second year, we had pathology and pharmacology and some of those classes. So it was like, okay, now when there's, like, disease, this is. This is what happens. So, yeah, it's just. It's a slow process of everything kind of coming together. And then. Then, yeah, you're on your rotations and you see something and you do. You can. You can put it all together. You're like, oh, yeah, okay. That person has a murmur and they have heart failure. And this is why. And so you do. Then it. It makes sense. It's like it's kind of clicking back from all of that. All of that information that's in there.

You're like, my preceptors said, you know, you just. You have all this shit that you just shove in your brain, like, big dumpster. And then you got to go in there and you got to pull stuff out of the dumpster.

It's true.

One doctor who I worked with told me. Which is true.

It is true. Just stuff that in there. Yeah. And I'll. And, well, and so that's what happens. So you're on your clinical rotations, like, you're on your pediatric rotation, and a patient has cystic fibrosis. And so then you're like, okay, let me go back. And then you do. You go back and read about cystic fibrosis, and you. And then you remember it. It's kind of coming together. It makes sense. And then you do lots of present. You're presenting that case to the other med students attending in the residence, and you better have read up on cystic fibrosis, because then they're going to start firing a lot of questions at you. And that's when you're really synthesizing that information, and they're watching to see how you are synthesizing that information. But you do get a chance generally to read up on those things and really relearn it in a way that is clinically relevant.

That's important, I guess.

Yeah.

Because I feel like if someone just. If I went and saw a patient and then they start, like, firing questions off about cystic fibrosis, I'd be like, well, this. And the. The sodium in the. Like, yeah, like, yeah, I don't mucus. But pile up. Like, I. But if I went back and I read it a little bit. I'm like, oh, yeah, okay. This is like the mechanism. This is this. And this is why this drug works or whatever.

Yeah. And that's. And you're not expected to always remember. I mean, you can't remember every single thing off the top of your head. And so that's. And that's what they're looking for you for too, is that you are prepared on rounds. So, you know, you got assigned that patient the day before you went home that night, you read about it the next morning on rounds. You're presenting and you hopefully can make a coherent presentation. And same thing when you're on your surgery rotation. A lot of times, you know, like, what surgeries you might be scrubbing in on. You know, like you might know the night before what surgery you're going to be scrubbing in on the next day. And so that's a chance to study about, you know, what that surgery is. You know, really studying the anatomy of what's going on. Although, I don't know, you got all these retractors and you're looking down this hole and then they're like, what's this vessel right here? You're like, I don't know. So that can be, that can be kind of tough. But, you know, you just have to like, know the general area and then make your best guess and then watch them make fun of you. Even if you, if you get that right, they will just keep asking you questions until there's stuff that you don't know so that they can make sure that you feel bad about yourself. Medical training, Medical training, bullying, Same thing.

Just loving you.

Yeah, people really did like me on the Tik Tok. It got a lot of views and people said, I love her. I saw that. And there were a lot of likes on that comment too.

Well, people were also, I mean.

No.

One was like, oh, you, you should know that, like as a doctor, when.

We were there was like, there's a couple, but I'm just like, whatever that person is like, not even in medicine. Yeah.

I mean, I can't. So we kind of started a trend too. We're going back to talking about the, the Anki Tick tock. Some other people are doing it with their parents who are like nephrologists and other like specialties. You are, you do have a more wide. Because you're family medicine.

Yeah.

I feel like people who yeah. Are like, oh, yeah.

Once you get like way deep into your specialty, you're just like, I mean, they don't even. I mean, they're not ever thinking about hemochromatosis.

Yeah.

So they really have no idea. But. Yeah. But let's see. What other comments did people say? Oh, everybody wanted to know what specialty I was. Somebody said that I was given neurology vibes, which I thought meant I was nerdy, but Stephanie said, that's actually cool.

I think so. I don't know why they said that. Clearly they didn't watch the whole video because you didn't know any neurology questions with no idea about any of that stuff.

Okay. Well, yeah. And then. Oh, a lot of people thought I was emergency medicine. Oh, really? Yeah.

I didn't see that.

So. Yeah, but people. They did. And lots of people saying, like, oh, yeah, I'm a fourth year med student. I didn't know any of this either. So that was. That was somewhat validating. No, it's hard, too, because I'm also just not used to doing questions that quickly either.

It also is not fair because I know the course cards. Like, I. Like, if you haven't seen that card before, it's not like you're seeing that out of nowhere. Like, you go through it and, like, there's cards that you know. Like, I know the bank of cards, and I know the answer to that thing. That. That's why you were saying, like, well, I can't read your mind. How am I supposed to know that that's the answers? Because, like, that's that card.

Yeah.

That's the answer to that card.

Right? That's. Yeah. Like, some of those questions that I still have memorized from med school, like, you go rabbit hunting in western Kansas. What's the answer?

I don't know.

Tularemia. Tularemia. Tularemia. If you ever see a question that starts with, you are rabbit hunting in western Kansas. And then they also say something about having lymphadenopathy. And the answer, but all you need to know is rabbit hunting. Yeah, me neither. But I'm gonna watch for it. If I ever see somebody that has been rabbit hunting in western Kansas, I think that's partly from being in med school in Kansas.

Yeah.

I don't know. I have to ask my Kansas colleagues if they ever saw a case of tularemia.

I really don't know what that is.

Perhaps they were looking for it all the time. I don't know. That was. That question came up just, like, over and over on our practice questions on a lot of different tests somehow. I don't know. That was. That was A good one. But yeah, some of those other, those flashcards, I'm just like, I don't even know what, what's the question? It's not. If it were multiple choice, it would be a lot easier to get.

Well, yeah, yeah. But also. Yeah, it's like you don't really have time to think about it because you do so many a day that it's just like, all right, next, next, next.

Well, I'm going to do an Anki deck of my stuff and then I'm going to give it to you and we're gonna see how you do.

Well, I mean, eventually I should be at your point, but I'm a second year, so I don't know.

Well, I just need to like, I need a deck to study for a bit. I just need to brush up a little bit on some of that stuff. A lot of it's like, oh, it's right there, it's right there. But I haven't thought, thought about it in 30 years. Yeah.

Which is fair. Which is fair. Okay. Well, yeah, I made this just talking about things we posted on Tik Tok. I made this one Tik Tok about how I was scared about coming to medical school because I was scared that I was going to waste my 20s. I feel like in undergrad and stuff. I, I think I was told this and I guess I really, I thought about it, but I was like, oh, well, I don't want to graduate from college, then go straight into med school and then I'm not going to be able to have any fun. I'm not going to be able to enjoy my life while I'm young and I'm not going to be able to kind of do what I want to do because I'm going to be so I'm going to be studying so hard and in school and I. It was just this idea that you're going to have to sacrifice so much time, which again, I'm only a second year and I understand, like, obviously there's residency and all of those things, but I do think as we were talking about yesterday, I think in any high paying career path there is that like initial grind that you have to do.

Yeah.

And I don't feel like I'm wasting any time.

I feel like you're getting to live your life to the fullest. Yeah. And I think now I bet there's a lot of medical students who are wasting their 20s. You know, they are holed up in a little area and just studying all the time and feeling guilty for Going out and having fun. I, I think there are really people who do that and it's a shame because it's certainly not going to make them a better doctor.

And you can do that. And I mean, I think even you can go in another career path and still like be working, working, working. It doesn't have to be just this career path. I mean in regards to, yeah, you're going to be behind on the financial side of things. If you want to go right out of college and make a lot of money, then going to med school is not the best option for you. So you are falling behind on that sense of things. But I, I still feel like, I think everyone, even my friends and other career paths are just at such different financial stages in their 20s that it just doesn't really seem like I don't know such a difference. So yeah, I don't know. I think that like, yes, we work really hard, but if you're the type of person who likes working really hard then and like achieving things, I think you still get to do that, but then also balance it with still having fun with these like minded people who are doing the same thing as you.

Yeah. And when you really do, I mean obviously nobody likes like studying a bunch of dumb details for step one, but you do feel like, okay, this is, this is really what I want to be doing. And, and medical school starts off being a little bit further away and then with each step you get kind of closer and closer to doing the stuff that you want to be doing. So that's why, you know, people are like, oh, well, wait till you get to third year. It's so hard. I mean, no, it, third year is so much better because you, you actually get to be in the hospital seeing patients. Yeah. You're there for a lot of hours, but it's, it's what you want to be doing. And so it's fun and exciting.

Yeah. And I think that I, in regards to just being able to enjoy life and having fun, I feel like versus college, when you're on that pre med track and there's a lot of insecurity about what your career path is going to look like because you haven't gotten into med school, you have this kind of insecurity and like this kind of, or at least I did of being like, okay, well I, you know, I really have to study for this exam because my whole career is, is on this.

Yeah.

But now, I mean obviously there's specialties and stuff, but like I feel so much less pressure. I'm Like, I just have to do this stuff and then I know I'm going to be a doctor, so. And I know people can push themselves to if they want to do a super competitive specialty or whatever, but either way, like, you're going to be a doctor.

Yeah, yeah. It's totally different once, once you're into medical school, it does, it just relieves tons and tons of that pressure because also when you're a pre med, you're staying really hard and you want to be a doctor, but you're also in the back of your mind, you're like, okay, but if that's, that doesn't work out, then what am I gonna do? And so it, it's very, I think there's just so much, so much stress with that. So if any pre meds are out there listening, we feel you. We know it's tough. It's gonna get so much better.

It will get better. Yeah. All right, well.

Oh, but the, just that's what, what will friend of the pod said. He said, you know, you. That he kind of felt like his wife thought that his wife was a doctor, he's a writer, that she said, oh yeah, you sacrifice your 20s for your 40s and now they're actually getting close to their, they just got to their 40s and now they say it's totally worth it. But again, I don't think you really sacrifice your 20s. It's, I mean, what do you, what else would you be doing out? Like clubbing?

I mean. Yeah, I don't, I don't know. I don't know. Because also if you're, if you're still working really hard, then like some of my friends who have really intense jobs and make a lot of money, they, they're not able to spend their money because they are working all the time.

Yeah. Yeah, there's no, I don't think there's any great easy formula for total happiness with any of that stuff. If you're not, especially at that age, if you're not working hard towards something, lot of times it's hard to feel really good about what you're doing.

100%. Yeah.

So. But then when you get to be my age, you just coast along.

On that note, on that note, we're going to keep coasting. You guys know where to find us. We're going to make some more Tik Toks and Reals. So follow us on Instagram Tik Tok Generations md And if you have any questions or interested in being a guest on a podcast, you can email us at askgenerations md@gmail com and we will talk to you soon. Bye guys.

Bye.