ÈËÆÞÖгöÊÓƵ

Harjit and Busha with Brian Colburn

Harjit: Ready, set, go. Okay. We're talking today with Brian Colburn, a third-year. Welcome to the Bundle of Hers. We're really happy to have you here.

Brian: Thank you. I'm happy to be here as well.

Harjit: So I know Brian from doing my undergraduate degree in bio engineering. We met I feel like the very first class of bioengineering, and you actually knew . . . we had a mutual friend, Hayley, and she introduced me to you and I was so excited to meet you. I think I was really attracted to your personality because you are such a kind person. So I was like, "Oh . . ."

Bushra: That was literally so cute.

Harjit: So I was just like, "I need to be friends with this person because he seems awesome." So, Brian, again thank you for being our first guest.

Brian: Yeah, of course.

Harjit: Tell us your story.

Brian: Okay. So like Harjit said, I did bioengineering for my undergrad, and that was kind of like the big reason why I kind of decided to do medicine. In the back of my mind, I kind of had an idea that I might want to do it in the future, but once I did bioengineering, I really liked doing that and thought I might actually want to make a career out of that.

So not until after probably . . . I mean, probably a month before I graduated is when I decided I actually wanted to do medicine. And I even worked in industry for a little bit over at Bard Access Systems. And I just found that I was missing interacting with people because you didn't do a whole lot of people interaction when you're in like industry and the labs. So I kind of missed that aspect of it.

Bushra: I notice there's like a lot of people who majored in bioengineering at the School of Medicine. I feel like that's a route that a lot of people take. Is that what you've noticed too?

Brian: I've noticed that too. There's at least handful in my class, and I think it's just kind of gaining more popularity. You kind of get that mix of science and engineering. I don't know, I think it's just kind of a good way to get into medicine.

Bushra: A lot of people with good problem-solving skills, I think.

Harjit: Yeah, I think that's kind of like the scale they hone into us, is how to solve a problem. I approach a lot of things, even medical-related things, in that kind of mindset. If there's a problem, find a solution, make it better.

Brian: Yeah. Same type of thing.

Harjit: Do you want to kind of take us through medical school? Like, what are things you love about being here and what are things that you wish there was more of?

Brian: Yeah. So I immediately loved medical school even from year one. I loved learning the science behind everything. I think that was a big draw to me, was just the medical science, medical knowledge. I know a lot of people get really kind of down in first and second year just because you're not seeing as many patients all the time, but I still loved that aspect of it.

But now that I'm in third year, I actually have found that, you know, the patient aspect of it is so much better. Although I do like the medical knowledge that you gain in first and second year, nothing beats going in and talking to patients every day. That's one of the things I think I was missing in the first and second year. You've got to do ELOs, you know, first and second year. ELOs are just the, you know, clinic setting. You guys can explain ELOs, I guess.

Harjit: Yeah, we just did one yesterday. Oh my gosh.

Bushra: It was the first time that we had to present to our CMC preceptors. Well, mine didn't go so well, as well as I thought it should have, because I don't necessarily have a flow yet, and so I kept tripping over my words like, "How should I say this?" And I have a really nice CMC facilitator, so it wasn't as painful as it could have been, but I just felt like I didn't know what I was doing. But it's good that we get to practice, but now I'm learning that I need more practice.

Brian: Yeah. I mean, a lot of these skills are very new to us when we first start, and you just get more and more practice as you go and you become confident in those skills, so you'll keep doing them. You'll do a lot of presentations.

Bushra: Do you feel more comfortable doing them now as a third-year?

Brian: Yeah. So in third-year in surgery . . . I just got off my surgery rotation, so I did a lot of patient presentations. I would do at least two or three in the morning to, like, a chief resident and the intern. And then also they had a Monday conference every week where I would have to present to two attendings and the whole team. And then in clinic you're presenting the four or five patients you see, so you get a lot of experience with presentations, physical exam skills, and just talking to patients in general.

Harjit: That's great. Can you give me kind of like an overall reflection of your second year, things that you've learned, lessons that you think that we should have as rising second-years or starting now, right?

Brian: Yeah, you guys are second-years now. I would say that you learn probably the most you're going to learn in second . . . well, that's not accurate. I guess you just learn a lot in second year. You learn a lot of the pathology. You're going to learn a lot of disease processes. And I think second year is all about putting things together and really kind of understanding the whole body, which is really, really fun.

It is hard, though, just because you're in class so much and, you know, that initial excitement of first year kind of starts to wear off a little bit and it makes it a little tougher. But you always find, you know, a new topic that you're interested in, and there's always something from each topic you're interested in that keeps you going.

Yeah, it's a lot of learning, but it's probably the most interesting medicine that you're actually going to be learning. Because first year is a lot of normal histology, normal systems, normal physiology, whereas all of second year is pathology. So it's kind of the cool stuff.

Bushra: I think also with second year you have, you know, the impending step one exam, and so that's always in the back of everyone's mind, I think. So it's kind of, for me, I'll speak for myself for me, at least just trying to figure out how I am going to study for class and study for step one at the same and just kind of balance the two. I don't know. What is your thought on that?

Brian: So for me, I just really focused on learning the material really well for class. I think they have a really good curriculum here that sets you up to do well on your board exam, step one, if you take the time to really learn the material.

So I didn't really start studying for step and for class until January. But everyone takes different approaches to that, but I think the biggest thing is to focus on doing well in your classes initially.

Harjit: Yeah, because we need to pass those classes before we get to step one, right?

Brian: Yeah.

Bushra: One thing before the other.

Harjit: First, coming into second year, I was excited to come back from the big break, but right now I'm feeling a little bit of the pressure. I feel like a lot of the times I'm hearing about step so much and then I'm hearing about classes so much. So what's your advice on having a level head about both things?

Brian: So I think a lot of it is just doing your own thing, like not worrying about what other people are doing and having confidence in what you're doing, and also still doing the stuff you like to do outside of school. So I did a lot of yoga. I would see a lot of the actual first-years at the time in core power yoga. So just staying active, doing the things you love while you're also studying for class is super important, or else if everything's consumed by school then it's going to drive you crazy. So I think you need to have a healthy balance between, you know, life and school.

Harjit: Yeah, and another thing that we're kind of looking forward to is I think rotations. So is that something we should even be thinking about right now?

Brian: I think it's a good thing to be excited about. It's another one of those kind of light at the end of the tunnel type of things. You know that you have a big step exam coming up. And especially in spring when you're actually planning out your schedules and kind of planning around what electives you're going to be doing, you have that excitement. It kind of helps you get through step and kind of see that you are getting super close to starting your rotations. So I think it's a good thing to be excited about that and kind of think about that.

Harjit: Okay. So should we meet up with the counselors? Who works with that?

Bushra: Advisors.

Harjit: Advisors, sorry.

Brian: Probably not until when you guys start actually planning them. You'll have a class meeting as well where they kind of talk about step one and also how to plan around your rotations. But everyone that I've talked to has said that the order of your rotations really doesn't matter that much. So I don't know, it's nice to think about them, but I don't think you should put too much thought into planning how they go about, but just being excited about them in general, if that makes sense.

Harjit: That's sounds great. Yeah. I'm so excited for that. I think it's keeping me going through this year, you know?

Brian: Yeah, it gives you that motivation.

Harjit: Although, yesterday was kind of scary. I also did my in-patient ELO, and basically that's just we meet patients in the hospital, see what's going on with them, take a history and physical, and then present back to our preceptors who are basically our teachers for CMC, which is a clinical . . . it's like Clinical Medical . . .

Bushra: I don't know what it stands for. I don't think anybody does actually.

Harjit: What does it stand for?

Brian: For what one?

Harjit: CMC.

Brian: CMC? I have no idea what it stands for.

Bushra: No one knows.

Harjit: Oh my gosh, no one knows.

Brian: Clinical Medicine Curriculum? I don't know if that's right.

Harjit: I think so. Ding, ding, ding. We have a winner.

Chloe: Clinical Method Curriculum.

Harjit: Okay. So CMC is Clinical Method Curriculum. Yay, we finally figured out what that was. Sometimes we just go to class and we're just like, "We need to learn how to be a doctor. Oh my God, I need to take this and I need to take this."

Brian: Plus, there are so many three-letter acronyms. You can't keep them all straight.

Harjit: I know. It drives me insane. Okay. So you talked about all the great things and kind of how you approached second year, but could you also talk about things that were difficult, maybe even mistakes you made, and things you wish you did differently.

Brian: Yeah. So I would say the most difficult part, especially of second year, is just finding that motivation to continue studying. I think, for me, it was really big not having, you know, that first-year excitement during second-year because, yeah, first year you're so excited to do everything, to see everything. You just get through it. You're able to study very effectively, and then second year you kind of get into your groove of things and although that makes it easier to go and study, you just don't have as much of that excitement and motivation to keep you going.

Bushra: So I feel like that started early for me. My motivation dropped drastically within the last week I feel like, so I'm trying to ramp it back up for the next couple of days.

Brian: Yeah, you'll be great. It comes in waves. That's what I keep telling everyone, that during second year, it's kind of a roller coaster ride. You definitely have some very exciting moments and then you have some kind of lows where you just kind of have to try and find that motivation to study. But I would say that's the most difficult thing.

In terms of things I would do differently, I don't think I would honestly. Like, thinking back to it, I think I studied pretty effectively. I didn't stop studying until January, which I think was the right approach for me. But I think you know what you need to do by second year in terms of how you study, and I think you just keep that going into second year and make small changes. But I think ultimately you just have to have confidence in what you're doing. That's a lot of second year.

Harjit: I think keeping up that confidence that "I can do this," I think it's like you have to find this internal determination type of streak. You have to just be determined to get through. And I think that's how most of us got here in the first place.

Brian: Perseverance, really.

Harjit: Right. So what would you say were your boosters to get back up to studying again? Like, what kind of things helped you get that re-motivation?

Brian: Again, I think out and exercising and re-evaluating and figuring out how much time I'm spending in school versus my real life. And if I felt like I was too strongly focused on school and, you know, forgetting about my outside things, then I would force myself to do some fun things. I know, force myself. Or just take a weekend off and watch, you know, movies or TV or something. Listen to yourself, and when you need a break, you need a break sometimes.

Harjit: So any last-minute advice for second-years that maybe you would tell yourself a year ago?

Brian: Just keep working hard. I mean, I know it can suck at times. Like, it's going to be pretty crappy when you're studying for step and everything, but it's so worth it. By the time you're on third year, you're doing all the things you wanted to do, you're seeing patients, and it's just so much better. Just keep that motivation up and keep going.

Bushra: Well, thanks for your time, Brian, and we're glad to have you here with the Bundle of Hers.

Brian: Thank you guys. I was happy to talk with you.

Harjit: I know. I'm so happy you could make it out for this, our interview or talk. Or don't put that in.

Bushra: Or put it in. Who knows at this point what will make it and what won't?

Margaux and Leen with Nancy Ann Little

Margaux: It's hard to track you guys down, the third-years.

Nancy Ann: Psych is the time to do it.

Margaux: We have Nancy Ann in the studio with us as well, and Leen and I are going to be asking her a few questions. Nancy Ann, welcome to our show.

Nancy Ann: Thank you for having me.

Margaux: Thanks for joining us. It's been hard to track down some third-years, but I'm glad you could find some time. So to start, would you like to tell our listeners a little bit about yourself, like how you got into medicine and your journey to get to where you are today?

Nancy Ann: Yeah, so I have a father who's a physician, so doing medicine was always in the back of my head. But I am someone who can be pretty cautious, and so I wanted to really make sure it was right for me. So I actually worked as a teacher for a few years, exploring that as a career, but eventually just made my way back to medicine. And before my MCAT expired, just hopped on the med school train as fast as I could.

Margaux: And you're in third year now. Which rotation are you in?

Nancy Ann: I am currently in psychiatry after I finished up OB. So then I'll head onto electives.

Margaux: And how do you like either of those, or how are you enjoying psych?

Nancy Ann: So I am finding psych very difficult. I find it to be very emotionally taxing and it requires . . . so my favorite thing about psych is how much people-watching you get to do. You really work on your observation skills and your analysis skills but the challenge of psych sometimes is that I've realized I'm not a very patient person, and so I don't necessarily get that immediate feedback that I get in some other areas.

So one thing that's awesome about medical school is that it teaches you what your assets are, but it also reveals your weaknesses and you have to figure out how to balance yourself in a way that's sustainable.

Margaux: Interesting. So is there anything you would've done differently in second year then to prepare for this experience if there's an opportunity to do such?

Nancy Ann: Yeah, so I would say hands down, the most important thing to do in your first two years of medical school are to take care of your mental health. Admin likes to harp on this all the time, but I think it is so critical because if you are not taking care of yourself, you can't learn. And if you can't learn, then you can't take care of your future patients.

I think a lot of people in medicine have a lot of pride and have a lot of perfectionistic tendencies. And so, admitting to yourself the importance of mental health can be really scary. But I would say if you do anything, please take care of your mental health.

Margaux: What did you do during second year to kind of manage and take care of your own mental health.

Nancy Ann: So I think staying connected to student wellness was beneficial.

Margaux: The club?

Nancy Ann: More so than the club, I utilized just meeting with the therapists on campus. Meeting with a therapist on campus regularly is definitely a wonderful resource that we have access to.

Additionally is finding friends that you're able to talk openly with because you can feel really alone in medical school. It's a very taxing journey. And so, taking the opportunity to find those friends that you can confide in. And sometimes it can be, you know, bitching about your mental health struggles. Sometimes it can be about, you know, taking pills every day and how that can be difficult to confront.

Margaux: Like pills for depression?

Nancy Ann: Pills for depression or . . . you know, they can be whatever medicines you need. It can be about the burden that you feel as a friend with mental health struggles. It can be about the annoyance of relying on going to regular meetings with healthcare providers. Whatever it is, it helps having people you trust as an outlet.

Whether you think so or not, there are people in your class, in your life who are there and willing and able to talk with you, but kind of having the bravery and feeling safe enough to do so can take a while.

Margaux: No, I think that's really insightful. And like you said, we tend to be more perfectionists in medical school and I think that adds its own stress to it. And just being able to be open and honest with each other and maybe normalize that everybody has these sorts of feelings will be important.

Nancy Ann: Absolutely. The only other thing I would say is that I think most people come into medicine with altruistic intentions and they want to give and they don't want to take. They don't want to be a burden. But if there's ever a time to ask for help, ask for help in medical school. Ask your family. Ask your friends. Like, if you need someone to make you lunch for a week, ask for help. If you need someone to drive you to school because you're too stressed, ask for help. It can feel trivial and you can feel like a burden, but I have no doubt that all of the wonderful, well-intentioned people who are in training right now will give back in time.

Margaux: Thank you. That gives me warm fuzzies inside. I really like that. So I guess the question that all of the second-years have been asking to get advice on is board steps. So we have our step one board coming up at the end of second year, and I guess the big hot topic question is how did you study for it and how did you manage the normal curriculum and studying for boards?

Nancy Ann: So my study strategy was very poor. I chose procrastination, which I don't recommend.

Margaux: Don't we all? We all are familiar with that.

Nancy Ann: But I would say the big thing that I did throughout second year was that I tutored, because I found that I don't get super motivated to study for tests, but I get super motivated to work for other people and help other people. And so, I would be so excited to spend three hours prepping for a tutoring session, but I was not excited to spend three hours doing flashcards.

Margaux: Fair.

Nancy Ann: So a big thing that I relied on throughout the year was tutoring. Additionally, I did force myself to do flash cards, but because I hate flash cards, what I would do is I would take them out on walks every morning. And so, I would get outside and I would be active and I would just, you know, do a two-mile walk and hit my phone and be kind of antisocial, but I would kind of do what I needed to do to stay healthy.

Margaux: That's great. Leen, you're planning on tutoring this year, aren't you?

Leen: Yeah. Actually, I really like what you said. I'm the same way in a sense. I came from a teaching background, so just sitting there doing flashcards, that sounds horrible.

But here's a question for you. A lot of second-years are looking for tutors. You know, I guess we got so used to having these third-years now tutoring us in first year. How would you go about second year without tutors in the sense . . . or maybe between each other for group studies? What do you think of that?

Nancy Ann: So I would say that it can be really frustrating to kind of lose some of the support that tutors can provide. And honestly, as a tutor, sometimes I think that a lot of what you're giving is giving structure. Saying that you're a cheerleader is too trivial, but you are providing some accountability to your tutees. And so that I think is what you can be looking for from your peers when you no longer necessarily have a tutor in your life.

Margaux: We blame the third-years. It's all your fault.

Leen: Just so you know.

Nancy Ann: So, you know, if you choose to do some group study, be really intentional. Like, "Let's come and let's teach each other. I'm going to tackle topic X. You are going to tackle topic Y, but let's be really diligent about each setting aside a certain amount of time to teach each other in an efficient, concise way," instead of just slowly, painfully reviewing some lectures and inevitably failing to get through much material at all. So be intentional, make a plan, and give people assignments to come prepared to do.

Leen: When do you usually start board prep in the sense you get all the extra material you see in First Aid and Pathoma, and when do you actually start incorporating that for your boards study? I think a lot of second-years right now are struggling, "Do I study for boards, or do I put boards with M&R?" And studying for M&R is boards, you know? How did you balance that?

Nancy Ann: I would say that to do both at the same time was pretty unfeasible for me, so I always prioritized class. That's just the way my brain works. I have to understand something well the first time if I have any hope of being able to review it in the future. So I always focused on class.

What I wish I had done in retrospect was throwing just a tiny bit of review. For example, Host and Defense was very hard for me. And so, when I encountered H. pylori in M&R, if I had just thrown in re-watching the sketchy video, that would have been 5 or 10 minutes and it wouldn't have felt too burdensome, but it would have been meaningful review at the time. But hands-down, I focused on class first and dealt with boards later.

Margaux: I'm glad you said that because I've been feeling guilty about not being able to study for both, and like you, I've been prioritizing class. But when I see my other classmates studying for boards so heavily, it almost makes me feel like I'm not doing the right thing. So thank you for validating that.

Nancy Ann: I know it can be very anxiety provoking to just watch other people doing different things than you and feeling guilty or stressed or whatever that feeling is. But just make sure that you surround yourself with people who are willing to encourage you and accept you. It's healthy to be competitive in some respects, but just remember to have people that you're competitive with who inspire you to be better and not who bring you down.

Leen: That's great advice. Actually, I think that really resonates with a lot of the second-years. I think we're all . . . you know, that first week of school, we're like, "What are you doing? Are you using First Aid? Are you putting Pathoma? Are you putting it together? What are you doing? Questions? Question bank? Are you buying this? Save UWorld? Don't you save UWorld?" It's been hectic to say the least.

Nancy Ann: I think it's absolutely good to ask what other people are doing. Especially ask older people what they did, because I know I had First Aid for about nine months and I literally didn't know what to do with it, and so I did not open it because I was just terrified.

Margaux: Oh, yeah, we're all there.

Nancy Ann: Finally, you know, something I realized that worked for me was that I would take First Aid and instead of taking Pathoma notes in Pathoma, I would take my Pathoma notes in First Aid. And that was a way for me to slowly open First Aid and not have a panic attack because it was just so big.

Margaux: That's really smart.

Leen: I felt enlightenment right there. I felt that in my soul. I was like, "Oh, that's what I should do. Oh, perfect."

Margaux: Aside from the academics and studying for boards, how has second year either prepared you or left you struggling to be successful in third year when it's all application of what we're supposedly learning right now?

Nancy Ann: So there are some aspects of third year that you will not be able to prepare for and stressing about them right now won't make it better, and so maybe I shouldn't even be talking about them. But for example, if you're looking at the electronic medical record, there's always just going to be a lot of bumps in the road in learning to navigate it. And expecting to go in knowing how to navigate it is pretty unreasonable.

What you can be in second year is flexible and adaptable and eager to learn, because those are inherent skills and an attitude that will serve you well in third year so you can be ready to deal with whatever is thrown at you.

So I think in terms of your learning in second year, people like to say, "We're just studying for a test." But while that is an aspect of your medical education, it's so critical that you have a good depth of understanding of the material in first and second year. Because, you know, now we're throwing drug names about a million miles a minute, and so if I'm able to sort these anti-psychotics that are first generation versus second generation quickly in my mind, then I can be prepared to interact with a patient and answer questions readily for other providers and for the patients in a much more fluent manner.

Additionally, medicine requires a lot of analysis and creativity. So the better you understand the pathology, the physiology, the better of a problem solver and thinker you'll be as a provider. And that's what inevitably our job will be. That's what we're being paid to do, or will be paid to do.

Margaux: Hopefully.

Leen:I think that's what we're doing, right? What are your thoughts on CMC and preparing you for third year?

Nancy Ann: So I liked having a clinical skills curriculum in the first and second year because I am someone who is often very anxious about what is going to come. And so just knowing that I knew where to place a stethoscope on the chest was very reassuring to me. Because I came in with very little medical knowledge, so I really appreciated feeling a little bit more like a doctor, you know, knowing how to do a neuro exam. Like, even though I didn't use it day to day, I found it very empowering to know that I had tools in my back pocket that I was slowly acquiring and didn't have to cram right before third year.

Additionally, the clinical skills curriculum allows you to get out into clinics. And I really tried throughout first and second year to go to clinics, probably on average twice a month. Early on about once a week, but towards the end about once a month. Because that just reminded me why I was doing medicine and it was a huge relief to know that I had purpose, because studying for a test never felt purposeful to me.

Margaux: I feel that.

Nancy Ann: Get out into clinic if you can.

Margaux: Great. Yeah, there are lots of volunteering opportunities available to us to have those experiences, which I think is great.

So another thing that second-years are looking forward to is in the spring when we actually get to decide our rotations and the pattern of them, and there's a lot of debate about does it matter the order that you do them and how do you go about picking them. What does that process look like and how did you do it?

Nancy Ann: Just be prepared in third year to like anything. I, for example, was not expecting to like OB very much, but it was my first rotation, which theoretically is not when you want to have your potential career in third year. But I loved it and I learned so much and I have really no regrets about how I performed in that rotation despite, you know, poor grades or whatever. So just be prepared to learn and love anything throughout the year.

I give this with a grain of salt. I would say maybe rank high to have electives late in the year. I know one trouble that I have had is that I have electives very early in the year, and so I'm not doing things that I'm truly interested in.

Now, taking my own former advice into account, I may end up falling in love with them, but I know that things that are theoretically high on my list I can't do in September of my third year.

Margaux: Well, Nancy Ann, thank you so much for reassuring us and giving us your great advice. It's been wonderful to have you in the studio with us.

Nancy Ann: Thank you so much for having me, and take care of yourselves and take care of each other.

Margaux: Thank you.

Nancy Ann: Have good year.