How Empathy Declines in Clerkship

An interesting (albeit far from robust) finding in the literature on medical education is that empathy tends to drop like a rock in the 3rd year of medical school. This is obviously not true for everyone - in particular, those coming in with high empathy tend to maintain their empathy levels better than those starting with lower empathy - but declines can be seen throughout the spectrum.

It's one thing to read about on paper, it's another thing to experience first-hand. Without a doubt, I believe my level of empathy - both internal and expressed - has fallen this year. I'm not happy about it and actively working to develop habits to bring it back up, but I can't deny that it happened. Especially on my final rotation through surgery, I caught myself tolerating or even engaging in behaviours I would have considered unacceptable a year ago. Part of addressing this setback in my ability to be a competent, empathetic physician involves identifying the causes of my decline in empathy. Here's what I've come up with.

1) Role Models

Medicine is hierarchical. We learn from those ahead of us and model our behaviours after our superiors. When the staff and residents we train under fail to show empathy, or when we're simply never around when they do demonstrate it, it conditions us students to de-emphasize empathy in our actions as well. I've seen such a spectrum, from exceedingly empathetic physicians and residents, to exceedingly unempathetic physicians and residents, but most fell somewhere in a neutral area. They'd be empathetic when convenient and when it was obviously useful for their sake, but wouldn't put in the effort when empathy was inconvenient or when the benefit was primarily for the patient's sake.

Monkey see, monkey do.

2) Ain't Nobody Got Time For That!

Medicine is busy and very fast-paced. There is constant pressure to do more with less time. The problem is, empathy takes time. It doesn't have to take a lot of time, especially for practiced individuals, but being unempathetic is undoubtedly faster than, you know, actually connecting with patients. When workflow is not set up to allow for empathetic communication, it becomes the first thing to go. Priorities in evaluation or compensation play into this, as students, residents, and staff are far more likely to benefit by being fast than by being empathetic. Ultimately I think being an empathetic practitioner leads to higher job satisfaction, and there are some small awards in medical school, residency, and practice for consistently demonstrating empathy, but the main external incentives are still in favour of going fast above being a compassionate, empathetic practitioner.

3) Active Discouragement

It's less common than the above examples, but there were times where being empathetic was actively discouraged. There are some practitioners who don't believe in empathy as a useful clinical approach, at least not in all situations. I have experienced a physician essentially yelling at a patient for being overweight. I was once called out for being too empathetic in a situation where my supervisor believed it was unnecessary. In fairness, there are absolutely circumstances where overt empathy needs to be toned down or even eliminated because it ends up being counterproductive. In psychiatry, for example, practitioners do need to be conscious about being too overtly empathetic because it can harm the therapeutic relationship. Yet, I found that about half the instances where empathy was being discouraged, the justification was more about convenience than about what was in the best interests of the patient. I found these pressures against empathy easiest to resist because they were so overt, but it was a pressure nonetheless, and contributed to a culture in some parts of my medical training that clearly did not value empathy in medicine.

4) Exhaustion

The spectre hanging over all of this is the chronic exhaustion inherent in much of medicine, particularly during training. Sleep deprivation distorts people's natural emotions, affecting mood, memory, and overall cognition. One notable effect is to make people irritable. Irritability isn't incompatible with empathy, but it certainly makes it a lot harder. Empathy requires a degree of emotional self-regulation and irritability reduces the degree to which emotional self-regulation is achievable. Sleep deprived practitioners can still keep it together, but that control is not as endless as it is in rested individuals. It does make me understand one of the less-appreciated coping strategies for exhaustion - maintaining calm around patients, but being quick to anger around learners, fellow physicians, and other healthcare professionals - though those actions don't exactly help the culture of medicine overall.

There is a second meaning to the title of this section. Compassion fatigue, the challenge of caring about the 100th patient suffering with a given illness with the same intensity as the 1st, is extremely common among healthcare practitioners. It's difficult to avoid, as we become accustomed to the tragedies of illness we encounter on a daily basis, but which are completely novel for our patients. I find this particularly common with conditions that are merely disruptive, rather than debilitating or fatal. When morbidity and mortality are common experiences, empathy for those who are inconvenienced is hard to muster. A truly empathetic person should be able to cut through this fatigue - after all, empathy doesn't mean feeling the same way as another person, but rather understanding they way they feel, even if you wouldn't having similar emotions in the same circumstance. Nevertheless, empathy is easier when your natural emotions more closely align with those of your patient, and compassion fatigue often causes that alignment of emotions between physicians and patients to slowly widen over time.

Solutions

I have no easy answers for reducing this decline in empathy through clerkship. On a personal level, I try the standard approaches - getting a bit more sleep, spending time with people outside of medicine to ground myself a bit, keeping mindful of my actions, and using reflective techniques like this blog. The medical profession in Canada has started putting an emphasis on physician resiliency and I do believe these efforts can be beneficial in preserving empathy through training.

However, the problem isn't with the people going through medical training - many of my fellow classmates enter medical school as some of the most grounded and resilient people I've met. Falling empathy is a systemic problem and requires a systemic solution. Reforming the medical system to allow for sufficient rest, and then to prioritize empathetic communication, will take hundreds of changes, both large and small. The good news is that if we can make enough change, the positive effects will propagate. Hierarchy in medicine means negative qualities persist from generation to generation, but so do useful qualities. The more empathy supervisors show, the more empathy learners will as well. In the meantime, individual-level interventions will have to suffice.

Likes and Dislikes in Surgery

For non-surgeons, the surgical rotations are always a bit of a trial. The surgical/medical divide is real so spending months on the other side of it can be a challenge. I guess clerkship's worse for the surgical gunners though - I only spend 3 months or so in surgery, but they spend almost all of clerkship out of it!

Anyway, continuing on with my series, here is what I liked and didn't like about my surgical rotations.

1) I get bored during operations

I encourage everyone to step into an OR or two early in pre-clerkship. Surgery, despite it's terrible job market and long hours, is still very competitive overall and it's worth knowing whether you may need to push for it as a potential residency option. My guideline is that when you step into the OR, unless it's something obscure and weird, you have to love what's going on. Being interested isn't enough - the road to becoming a surgeon is too long and arduous to sustain mere interest, you need to be enraptured by the whole thing.

The first time I stepped into the OR I was, at best, mildly intrigued. I knew at that stage that I wasn't a surgeon. Now, after months in there, I'm downright bored. I understand the basics of what goes in the OR and the details don't interest me in the slightest. Definitely not a surgeon.

2) Love the surgical attitude towards medicine

When it comes to medical management of patients, nothing beats the typical surgeon attitude - they're clear on what they do and what they don't do. What they do they do quickly and efficiently. No debating things back-and-forth for half an hour - a decision gets made that's that. That does mean some things they probably could/should handle they pass off to others and, in an ideal world, physicians would take responsibility for the totality of their patients, not just the parts they want to manage. However, the alternative I've seen has been physicians trying to do too much and stepping on each others' toes, creating confusion for patients and providers alike. Again, in an ideal world, stronger communication between physicians would occur to address this problem, but clearly defined roles can be an enormous benefit whether proper communication occurs or not.

3) Don't love the surgical attitude towards people

Surgeons can be judgmental. Really judgmental. Of patients, of physicians (especially non-surgeons), of other healthcare staff. Don't get me wrong, physicians in general are fairly judgmental as a group, but surgeons seemed to be more blatant about it. Some of the attitudes and statements bordered on unprofessional. As with most places, it was a distinct minority who were the main culprits in these activities - in fact, some of the best staff and residents I've worked with were on my surgery block. However, that minority was entrenched enough and vocal enough that they seemed to influence the overall culture. A physician or resident who was needlessly harsh on a patient, subordinate or colleague was often encouraged or at least tolerated. On the opposite side, kindness and understanding were occasionally mocked. I have no doubt that these were meant as jokes without maliciousness, but that seems a distinction without a difference - in either case, a negative attitude towards others was fostered.

4) Long hours, little sympathy

It goes without saying, but hours in surgical specialties are LONG. 10 hours at the hospital is a short day. 12 is typical. 13 is within the normal range. All told, on average and after considering things like travelling to the hospital or doing the bare minimum to perform my clinical duties, I had between 10 and 11 hours of my own time for non-call days. That's as little as 10 hours to eat, sleep, study, exercise, spend time with my SO and my dog, and pretend to be a normal human being. I mostly ended up shorting myself on sleep and exercise to preserve a tiny amount of time with my SO and to study. It was sheer exhaustion and I feel like it's going to take a long time to recover from this level of fatigue.

Of course, as a student, you get zero sympathy. Residents work even longer hours, with more responsibility, and have been doing it for years. Staff went through the whole process and still tend to work long hours deep into their careers. Moreover, it wasn't too long ago when students had it much, much worse. Still, better doesn't equal good, and we're still a long, long way away from having anything resembling reasonable working hours in surgery.

5) Camaraderie

Surgical departments are small. There aren't that many staff and the number of residents coming through each year is considered large if it hits half a dozen. Many surgical residency programs take only one or two each year. Over the 5+ years, it does become obvious that the staff and residents end up knowing each other well. The residents especially seem to understand that as hard as it is to get through their residency, they're in it together. The best way I can describe surgery is like being in a frat, with both the good and the bad that come with it. The familial, laid back atmosphere was definitely a positive, and in sharp contrast to some larger specialties that weren't nearly as closely knit.

6) The Happiness Test

Are surgeons happy? Nope.

Ok, ok, it's not that clear cut. Many seem to really enjoy their work, especially when they're at the staff level and in the operating room. Yet, by and large, I didn't see many overly happy people. Frustration and exasperation were common occurrences. I wasn't the only tired person there, it was obvious on the faces of some residents and staff. They were determined and resilient, but it's hard to call someone happy when they're still in the middle of the fight.

The Debate Under the Debate

One interesting aspect to come out of the Ontario tPSA debate is suggestions coming out from all corners about how to reform our healthcare system to address current funding shortfalls. Some ideas are new and innovative. Others have been around for some time and return to the surface when the debate about funding returns to prominence. This post is about the latter.

1) User fees paid to the government

One often-discussed option for easing the burden of healthcare on the public pocket is the idea of user fees. This represents money paid by patients for each interaction with the healthcare system, typically a small amount like $10. The idea is partially to help cover healthcare costs, but mostly to discourage patients from visiting physicians and thereby reducing demand for healthcare. Anyone truly sick will often happily fork over $10 for the service, but the hope is that unnecessary visits will be less frequent.

The problem here is that patients often don't know the difference between a necessary visit and an unnecessary one. We go through a lot of training to figure out that difference and it can still be a subjective call. Missed visits that are necessary can not only reduce health outcomes, but can increase costs in the long run as cheaper preventative or maintenance care is replaced with expensive interventions on illnesses that arise or progress that might not have otherwise. Reducing low-cost interactions but increasing high-cost interactions with the healthcare system are not a great way to save money.

User fees also represent a tax on the sick and disproportionally hurts the poor. So, for both moral and practical reasons, Canada has generally fought to avoid user fees paid to the government.

2) User fees paid to physicians

A bit of a twist on #1, with fees going to physicians themselves rather than the government. The notion here is that if physician incomes must fall, we should be able to supplement incomes with user fees. This idea has many of the same drawbacks as with user fees paid to the government, but with some caveats. Importantly, individual physicians presumably understand their patients' situations better than the government and can adjust the user fees accordingly. That might comprise forgiving fees for poorer or sicker patients, or perhaps increasing them for those clearly abusing the system. User fees might be thus better tailored to their original intent of reducing unnecessary visits.

The added downside to this set-up is that it creates a conflict of interest for physicians. Physicians would benefit financially regardless of whether the user fee they charge is helpful. User fees could be used as a means to punish patients who have real medical needs but are perceived as troublesome. The fees could even be used as a way to try to push patients out of a physician's practice by making it financially burdensome for the patient to see that physician.

3) Parallel private care

I could (and probably should) do an entire post about introducing privately-funded healthcare into Ontario. The argument for private care in the current setting is that it activates unemployed or underemployed physicians to ease the financial burden on public institutions while shortening wait times for important but non-emergent conditions such as hip replacements. I have no doubt that private healthcare would be good for physician employment prospects. By providing a mechanism for increased funding into healthcare, I also don't doubt that wait times would come down on average, though some people would benefit more than others.

However, I don't think there would be any relief on the public coffers. Fully-public healthcare is remarkably efficient, saving significantly relative to private care by minimizing administrative costs, advertising costs, and profits. Countries that allow significant private care (as opposed to private insurance that, with subsidies and regulations, functions very similarly to publicly-funded care) tend to have equally high public funding of healthcare. The US government spends about as much on healthcare as Canada's government. Private care tends to increase overall spending on heatlhcare without decreasing public spending or making significant gains in health outcome measures, albeit potentially better on some process measures. Notably, a lot of that extra money goes directly to physicians. Private clinics compete for the best physicians and are able to afford them at higher prices, which in turn puts pressure to increase physician salaries in the public sector. It's a win for us, but likely not a win for the economic or physical health of Ontario or Canada.

4) Salaried physicians

The government's objection to the current set-up is that they really don't have any final control on physician supply or utilization. They have some power, but ultimately any qualified physician can set up practice in Ontario and work as hard as they want, billing as much as they want, provided they can demonstrate their billings are legitimate. This leaves a lot of uncertainty for the government's finances with only some indirect methods - such as reduced residency positions - to influence physician billings. One solution to this dilemma is to simply replace the current model of physicians as independent consultants, to one where all physicians are employees, purposefully hired and placed on a salary. This eliminates any uncertainty in physician numbers or cost per physician, while providing guarantees for physicians themselves in terms of compensation.

I'm sympathetic to this approach, especially with the side-benefits that would undoubtedly be included for physicians. Working conditions would come under higher scrutiny, while pensions and benefits would be on the table, something not really possible in the current set-up.

There are some major downsides, however. Salaried physicians are not nearly as productive as non-salaried employees. There's far less of an incentive to push patients through when you get paid the same for seeing 15 patients a day as you do seeing 25. Making up that productivity gap would be extremely expensive, though some patients would undoubtedly benefit from the increased attention. Salaried physicians would also be difficult to administer. Physicians do a lot of ground-level management of their practices, whether it's paying for staff or arranging clinic space or ordering supplies. That's difficult to fit in a salaried model where physicians are more directly governmental employees and not independent consultants. The Ontario government could (and may want to) take over individual clinics, but that means a lot more administrative work to pay for, essentially taking on what physicians normally pay in overhead costs. This could be worked around depending on how a salary model is set up, but it wouldn't likely be a simple process.

Conclusion

Funding physicians is hard. The economics of healthcare are complex and don't behave like other services or commodities. Any arrangement will come with some trade-offs. When faced with the dual priorities of optimal care for minimal dollar, balancing these trade-offs is no small feat and there are no simple answers. Unfortunately, simple answers always rise to the surface when the current system shows signs of weakness, as any healthcare funding system inevitably will. These approaches could have a place as one component to a broader plan, but likely aren't feasible on their own. A careful consideration of all policy options is necessary, understanding that no individual approach will likely be sufficient in isolation.

Clerkship Done

Two days ago, on Friday, I had my last day of my clerkship. Well, the core rotations at least, with electives still to come.

I expected to be happy, even elated finishing up on Friday. Instead, I was just tired. It was the end of a 12 hour shift, the same as the rest of the week. Due to electives concerns, extra-curriculars, and general life stuff, I'd been sleeping about 2 hours less per night than I normally need to feel rested. My final rotation was useful and all the people were extremely nice, but it wasn't a specialty I consider all that interesting either. Combined, I was running on fumes by the end of the day Friday. Knowing that the residents were all working even more than I was didn't exactly help - it's hard to feel justified in being tired when everyone around you is working with even less sleep.

In any case, I was pretty miserable. I felt even worse knowing that it should have been a very happy time, that I should have felt good about my accomplishment of at least minor significance.

Fast forward to today. Saturday I had an all-day event related to one of my extra-curriculars. It ended up being an equally tiring day. Still didn't get much sleep the night before. Still had basically a 12 hour day. Still had a lot of other life stuff going on. Yet Saturday was spent on an event I enjoy doing, an activity I voluntarily chose to do. I finished the day equally exhausted, but happy this time around.

I'll have a lot more to say about clerkship in the next few days and weeks. I'm glad to being moving onto the stage where I'll have a modicum of control over my activities. I complain - a lot - about having long hours and being worked too hard while in medicine, especially in clerkship, but that's not really what bothers me. I worked hard to get into medical school and loved every day of it. What gets to me about medicine now is that I'm working so hard and for so long on things I don't care about, or don't consider overly useful. When I do get to spend my energy on productive activities, on work that I enjoy and chose to participate in, it's far easier to keep going forward with enthusiasm and passion.

In the end, I'm thankful to be done clerkship. It gets me one step closer to the career I signed up for at the beginning of medical school.

Still, after 12 months of rotations through just about every field in medicine, I'm mostly thankful for a day that is truly "off", for some rest and relaxation. I get a week off and I intend to take full advantage.

Addendum - Just before publishing this post, I wound up unintentionally falling asleep on the couch for 3+ hours. Woke up feeling more rested than I have in months. It's going to be a good week.

Ontario tPSA - Reasons to Vote "Yes", Reasons to Vote "No".

I've been fairly upfront about my opposition to the tPSA as it currently stands. I believe it's a step in the wrong direction. That said, I've had a chance to read and listen to those who support the deal, and there are some very valid arguments to discuss from the "Yes" side. I thought I'd take a minute to lay out the points that got me closest to considering a "Yes" vote, as well as a bit more that I've posted previously about why I'm still not convinced.

The Best Argument I've Heard For The tPSA

There are good reasons to vote "Yes" to this agreement. The most convincing arguments I've heard have tended to follow this general train of thought:

1) The tPSA provides the most funding we can reasonably expect to get for physician services over the next 2 years and almost certainly provides the most funding overall for the next 4 years.
2) The tPSA provides us the best chance at binding arbitration for the next deal in 4 years' time, while providing meaningful third-party oversight for the remaining negotiations in the interim.
3) The tPSA provides incentives for the OMA (not individual physicians) to push for policies that hold down physician costs.
4) The tPSA provides some protections for physicians or physicians-in-training on what I would consider relevant but comparatively small side-issues.

I accept and agree with all these arguments. Combined, they make a reasonable case for voting "Yes" to the tPSA, particularly in the short-term. If I was nearing retirement, I'll be honest in saying I'd have a hard time voting this deal down. I think the OMA has made some major missteps in negotiating with the Ontario government and promoting its position to the public, but I'm doubtful that these would be ameliorated in any significant way by rejecting the tPSA or changing the OMA/negotiating team. For the next 4 years, as bad as this deal is, we're not going to get much better by rejecting it.

Why I Will Still Vote "No"

Put simply, I will vote to reject the tPSA because our healthcare financing problems - as well as my financial stake in the healthcare system - last longer than 4 years. And at the end of those 4 years, we could be in a very, very bad situation. We've never had a total cap on physician services before. Consenting to it now, even under some duress, makes it that much harder to eliminate later. Eventually it may be recognized as bad policy, but that could be a long way down the road, decades from now.

I've described before why a collective hard cap is such a bad idea, but let's put some numbers to the theory. To keep up with demand for physician services, we'd need to increase a collective cap on billings by 3-3.5% each year. To keep up with inflation as it currently stands, we'd need an additional 1.5-2% per year increase on the cap, plus an equal increase in fees for each billing code. In sum, we'd need a 5% increase in the cap, plus 1.5-2% increase in actual income just to break even in real terms.

It's incredibly easy for the Ontario government to spin this to the public as a 5% increase in salary, even if it's simply a cost-of-living adjustment plus funds for enough new physicians to keep up with population growth and aging. It's much harder for the OMA to explain why it's not a 5% raise. Binding arbitration would help, as any arbiter should understand these points well enough. However, the government's trump card - that they can't afford such a high increase for budgetary reasons - is hard to refute. There will always be a need to save money on healthcare, that's the nature of healthcare economics. Even a reasonable, informed arbiter may not believe a 5% increase in the cap is justified.

The problem is that we'd need a 5% raise in the cap each and every year, with each and every deal. If inflation or healthcare usage increases, that number has to go up. Anytime we fall below that, billing compensation drops and incomes drop even further as overhead costs are largely static and can't be easily reduced.

Rejecting the tPSA means short term losses for physicians, likely sizable ones. I'm comfortable with that. Ontario physicians on the whole make a bit more than we should when looking at national and international comparisons. The Ontario government does have a short-term budget problem that needs to be addressed and physician compensation is part of that. Ontario physicians can afford a hit to their incomes, even a reasonably substantial one, so long as we get back on a sustainable path. Accepting the tPSA means sparing ourselves short term pain but at the risk of larger long term losses, possibly permanently holding down physician salaries long past the point of reason or good economics.

Conclusion

When we talk about a sustainable healthcare system, we need incentives for all parties to push for sustainable funding mechanisms and to behave in taxpayers' and patients' best interests. The tPSA provides incentives for the Ontario government and individual physicians to do the opposite, giving only the OMA a loose incentive to push for reasonable policies. Bleeding physicians slowly is not sustainable, does not encourage physicians to behave responsibly with government funds, and in the long run will likely hamper access to important services for Ontario patients.

The cap will likely overwhelm future discussions between the OMA and Ontario government, distracting from more important matters. The "Yes" side has presented the tPSA as a pathway to more evidence-based policies in future negotiations. I don't believe that we're likely to get well-crafted policies by accepting such a poorly-constructed one as the backbone of this agreement.

One big flaw in my argument I must acknowledge - we could reject the tPSA and still end up with a global physician budget. If we don't win the right to binding arbitration and fail to rally the public to our cause, or if we win binding arbitration but fail to convince the arbiter, we could still be stuck with a global cap on physician billings. However, if we accept the tPSA, I believe we all but guarantee such a cap will exist for the foreseeable future. I cannot consent to that.

The Ontario tPSA - A Flurry Of Information

Well, it's been an interesting week or so for Ontario physicians. The tentative Physician Services Agreement (tPSA) outlined by the OMA was bound to be controversial from the offset, but I don't think many were predicting the situation would get this acrimonious this quickly. A lot of information has been flying around about the tPSA, not all of it true, most of it unhelpful, and virtually all of it biased in one direction or another.

Here's what I've been able to piece together from reading everything I can on the subject and talking to some people directly.

1) Whoever you provide as a proxy must vote the way you indicate.

That goes for the OMA too. The OMA's initial communications implied otherwise, but they confirmed to both me and now to the OMA members publicly that preferences are indeed binding and that no other substantive measures can be brought forward. Talking to those within the OMA in one form or another, the explanation for this apparent attempt to deceive seems to come from incompetence rather than intentional deception. For this reason, I've chosen to let the OMA represent me as my proxy, despite voting against the tPSA. I'll be keeping an eye on my own vote to ensure my wishes are respected. If they aren't, it sounds like the Coalition of Ontario Doctors will be more than happy to sue the OMA on my behalf.

2) The OMA doesn't particularly like this deal either.

With the sheer volume of one-sided marketing the OMA is putting out about this deal, you'd think they really like what they agreed to! Well, I don't think they do. They've been brushing aside their own reservations in order to whip up support for the vote - which all else aside is a terrible way to convince on-the-fence people that you hear their concerns - but I think those on the inside really do see this as the best option they're going to get. They'll be the first to admit that it's far from what they'd prefer and privately more than a few will admit it's below what they think is fair. The OMA sees physicians as powerless to get a better deal, however, and accepted the tPSA on that premise.

3) Trust in the OMA is low. Trust from the OMA is lower.

It's fairly clear to any half-interested observer that the OMA is not well-liked right now. Physicians don't even believe the OMA will execute a fair vote, let alone fight on their behalf. Lots of conspiracy theories abound about the OMA's true intentions or allegiances. For their part, the OMA doesn't seem to like many of the physicians they represent either. There doesn't appear to be much belief that rank-and-file physicians can be trusted to behave like reasonable adults. The OMA's negotiation and marketing with respect to the tPSA reflect this mistrust. That's not to say that the OMA is trying to work against its members or anything that nefarious, but there appears to be an attitude that being completely open and honest with members will only make a viable deal more difficult to obtain.

4) Both sides claim moral high ground, but vested interest prevail.

There are plenty of people on each side who are voting the way they are for noble reasons. However, the groups supporting or opposing the tPSA most vigorously clearly have reasons to do so beyond the overarching merits of the agreement. On the "No" side, there are a lot of high-earning specialties who would be the hardest hit by any deal which seeks to reign in the salaries of wealthier physicians, something both the Ontario government and the OMA appear to support in principle. On the "Yes" end, there are groups deeply connected to the OMA who would benefit professionally from continues ties with the OMA and/or the Ontario government. I don't doubt the sincerity of most individuals' convictions in this debate, but it's worth noting how often a person's opinion on the tPSA happens to line up with what will benefit them the most.

I'll follow up shortly with a more substantive post on the tPSA considering the new developments. For now, I'll continue to try to learn a lesson from this whole mess - namely that communication, especially with colleagues, is a tricky business, but absolutely vital to working together in our healthcare system.

Western Student Ultrasound Symposium

Been exceptionally busy over the last week or so, for personal and professional reasons. I have a ton of posts in the works, but haven't had much time to actually sit down and get them done.

One of the things keeping me busy lately has been my involvement in the Western Student Ultrasound Symposium. I'm immensely proud of my time over the past 4 years with this event, essentially since its inception, so get ready for some shameless plugging!

Ultrasound, specifically point-of-care ultrasound (POCUS) has become increasingly important in medical practice. For those in Emergency Medicine and Anesthesiology, it's practically required. For those in General Surgery, Cardiac Surgery, Internal Medicine, and Pediatrics, POCUS comes up reasonably often, particularly in certain subspecialties of these disciplines like critical care. As ultrasound technology has become more powerful and less expensive, it has been all the more convenient to use it in everyday practice, whether that's performing a quick diagnostic test or for assistance with a procedure.

It's a great teaching tool as well, particularly when it comes to anatomy. Cardiac anatomy is a lot easier to understand when you can actually see it beating, then move your ultrasound probe around to see what it looks like from different angles! In addition, while neither specialty uses POCUS itself, both Obstetrics and Diagnostic Radiology have to be pretty proficient in ultrasound techniques, so learning the principles of the technology at an early stage has its advantages. I'm applying to Family Medicine this coming CaRMS cycle and will take a lot of what I learned through POCUS into my residency, even if I only ever use an ultrasound machine on my Emergency Medicine rotations.

Why do I bring this up now? Well, the Symposium this year is only a few weeks away, to be held in London on August 20th. We've had a few last-minute cancellations, and have an open spot or two for medical students of any training level. It's an easy way to add something meaningful to your CV in preparation for CaRMS, as well as a skill to your repertoire for residency.

Sign-ups for interested medical students can be found here: http://www.cvent.com/d/dfqt0l

There is a cost, which we try to keep to an absolute minimum. We will have billeting for those coming from out of town. I'm happy to answer any further questions for those who may be interested!

What about for those not yet in medical school? We restrict the Symposium itself to medical students, but there are opportunities for pre-meds as well. In particular, we ask for pre-meds to help us out as volunteer patient models for scanning. I did this myself before starting medical school!

As a patient model, you're right in the middle of the teaching, so there's lots of opportunities to learn. We do all the work of organizing the Symposium, so volunteers' only responsibility is being models for scanning, no extra work. It's also a great chance to interact with medical students, see a bit of what they learn, and to ask questions about how they find medical school - I try to give our volunteers every opportunity to ask me questions about medical school, from admissions to residency applications, one-on-one for those who are interested.

Sign-ups for pre-meds interested in volunteering can be found here: https://docs.google.com/forms/d/e/1FAIpQLSeGp0aNGPt89NGFWuuchV1dUYe4loqcaIrYFgJDSCHGYi40eg/viewform?c=0&w=1

Ok, that does it for the shameless plugging for now. Will try to get back to a more normal posting schedule soon!