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Second Year of Medical School – Mission Complete
The second year of medical school is now over. It long in experience, but quick in retrospect. I mean, after all, when you're tumbling down a hill it feels like it's taking relatively forever. Medical school goes at an often unforgiving pace, whether you like it or not, for better or worse, and richer or poorer — there's adages about medical school, one of them is, "The days are long, but the weeks are short".
Third year orientation starts at the end of May, rotations then start the first week of June. In between then and now, I'll have my board exam. It'll be one of three: STEP 1 (in May), STEP 2 sometime next year, STEP 3 as a physician.
I've learned a lot in the last two years, and I look forward to learning more. It's also time, as always, to work on paying things forward. I'm going to swing back to the medical campus, we have a high school mentoring program. It's been sort of tough losing a Friday, as I usually don't get much "scholastically" accomplished. But, honestly, I'm not sure if I'm really that great of a mentor. I'd argue that I may get more out of it than them, they bring a lot of "energy". Today, we'll do workshops on vital signs. Vitals are a lot more interesting when you know how to interpret and integrate the information. A few weeks ago, we took them up to the anatomy lab to show them hearts and brains. It's easy to neglect how much you've learned, until you thoughtlessly put your gloved hands into the brain bucket, and can take Q & A from knowledge thirsty teenagers about pathophysiology.
Anyways, I came home after the exam to eat breakfast. Before exams, fight or flight kills my hunger, so I just nimble on something give my brain something to work with during the exam. This one exam was particularly stressful, it was the last one, and if I failed it I'd be re-taking this exam while studying for STEP 1. All went well, and I'm going to enjoy my little weekend off. I better get going, have to hope back on the train to get back to the medical campus!
I'm taking a posting hiatus, until mid-May, to focus my time either studying or enjoying the dwindling free time I have left.
Good luck to everyone applying to medical school. MS1 students, hang in there, you're almost there!
My Schedule 3rd Year Medical School
Schedule's out!
Just 7 more days till the end of pre-clinical education. I'll take my board exam (STEP 1) in May — it's mandatory in our program that you take STEP 1 prior to starting 3rd year, regardless of your score.
STEP 1 is a big deal, I look forward that exam also being over. I started studying for it sometime in October of last year, or rather I started "priming" to study for it by doing board exam practice questions. Once school is over, we'll have a dedicated study period to study.
This last spring break, coincidentally my last spring break of my life, was spent re-studying the first year of biochemistry and its relation to pathology in various diseases. For those 5-days during spring break, business days, I did a standard 9 AM – 6 PM schedule. Given yesterday, I started working on things at 8 AM and finally wrapped things up around midnight, I found the 9 to 6 schedule to be quite tolerable. After 6 PM, I took the rest of the night off (usually), I've started to learn how to play they keyboard. Since I moved from California, I left my hobbies behind, including music. I sort of played the guitar, so while on vacation, I thought I might as well be terrible on the keyboard as well. My days were wrought with biochemical pathways, and my satiety was filled in the night by "music" time. During my actual dedicated board studying period, I hope to maintain some type of balance.
Today, as posted above, our 3rd year schedules were given to us. Although we put in our preference, it was more or less a lottery system and some black box algorithms that decided our schedule. In general, we get the latest cutting edge pager technology (a 90's motorola), our "work" week is capped at 80 hours per week, some nights on call, a few 24/hr shifts here and there — as you might deduce, not all rotations are built like this. No matter the schedule, we get a dashing pager as a consolation prize. I'm not too broken up about my schedule, mostly because I still feel humble to be allowed to do this type of stuff, but also because I got a lot of the important things I wanted:
- Away rotations aren't too crazy – I have several away rotations, but only one of them is a journey. My farthest one is about 1.5-2hr (one-way) public transit ride away from my home, and I don't own a car (45-55 min drive as estimated by Google Maps), and it's likely the other person on my rotation doesn't have a car either. Should be fun.
- I got Ob/Gyn first, I'm both nervous and excited. We were told that at our site, there's a good chance that every student will get to deliver a baby at least once. That's pretty crazy. The rotation will have a mixture of birth, prenatal care, and surgery. The schedule will be rather hectic but the work rewarding. I wanted to just jump straight into the medical fire, so I got what I wanted there.
- The rest of my rotations are either at the medical campus I attend or somewhere not too far.
- I don't need to do my traveling away rotations during the winter time! Last year, we got about 10-feet (nearly 3-meters) of snow, as a city we likely weren't ready for 8-feet of it, and so transportation came to a dead stop.
- I get to do some work at the VA. Sometime last year, I went to the VA for a nursing shadowing program. The VA gets a lot of flack in the press, but not all are created equal, and bad press doesn't affect their dedicated to patient care (even if not adequately supported). Again, the nursing staff was awesome!
- For internal medicine, my finale, I'll get to revisit the same cardiology wards I spent time in for the last several months. I also look forward to the other departments I'll rotate through along the way. And finally, although I didn't plan it, it's sort of fortuitous that I have internal medicine last, because that's around the time I need to take STEP 2 (the other part of my board exam), it'll be a good refresher.
It wasn't really all that long ago that I was drowning in uncertainty about my life. I've had many jobs during college, and after, some of them even "required a degree". So, I look forward to going back to work. I presume, just like the rest of the path to medicine, they'll be a lot of ups and downs. I'm sure I'll have great days and terrible days as a 3rd year, as I repeatedly learn by making mistakes. How else would we learn?
I look forward to what's ahead, I'll keep you updated!
If you have any question, feel free to ask in the comments or by email at firstname.lastname@example.com
Helpful [hopefully] Links/Articles for Premeds Applying to Medschool
So, I'm still re-arranging the blog around in attempts to make it easier to navigate. But as things pile up, my board exam is coming up, courses, and random things I took on, so it's going to take a while to get things how I'd like them [here]. I am actually on vacation, and I thought I'd do some background editing here. But, instead the instinct to survive took over, and I'm doing some board review (biochemistry, yay!). However, as people are applying soon and you may be one of them, thus I thought it'd be helpful to just gather-up some articles I wrote:
The General Schedule and Requirements for Applying to Medical School
Medical School Admissions Guide – if you take two things away from this whole page, 1) apply early to medical school and 2) buy the Medical School Admissions Guide access for your application year!
How I Studied for the MCAT – feel free to use or ignore anything you'd like
How Much Did Applying to Medical School Cost Me?
More on Costs, and How I Went Into [more] Debt Just to Apply!
Personal Statement Drafting and Planning Phase
Six Simple Rules to Accomplishing a Draft
Making a Personal Statement Review 'Committee (part 1) and part 2
Personal Statement Editing Phase
Editing and Composition Planning
Pitfalls to Avoid While Writing Your Personal Statement
Even More Tips on Things to Avoid (article written after a round of reviews)
Example Personal Statement
Mine. – Sorry, I do have a trove of personal statements on my hard drive, but I only have permission to really put my own personal statement up. If I edited your personal statement, and you'd like you're to go up here too just let me know.
Medical School Application
Small Blurb on Deadlines and Status Changes
Tips on Getting Letters of Recommendations
Primary Application Samples (mine)
Work Activities Section of Application – especially important for nontraditional applicants!
Tips on Preparing for Secondary Applications
More Info Secondary Applications
Secondary – Diversity Essay (one of the 'harder' essays), Community Essay, Greatest Weakness Essay
Medical School Interviews
My Limited Interview Experience – went on 5 interviews [across the country], declined a couple mostly due to budget constraints.
Elevator Speeches – optional read
Good luck and Best Wishes!
Clerkship Coming Up
It's well into February, many premeds have just taken (and are starting to receive their scores), physician interns are well on their way to transitioning to their "resident" status, 4th year medical students are out on their residency match game, 3rd year students have been kidnapped by their clerkships, 2nd year medical students across the country are starting to (or have) select their clinical rotations for (3rd year) clerkship, 1st year students are completing their "twelve labors", and premedical students are fueling the fire for the next generation of physicians — some have just received their MCAT score, either way it went, congratulations because it shows commitment it's a big deal to have the guts to sit for it. What about attendings? Well, they're attendings, so they're off being badasses and wearing sunglasses somewhere, long white coats flapping heroically in the wind all the while.
Where am I in this spiral towards doctoring? Well, in 30-some days, I'll finish the 2nd year of medical school and have already chosen the preference for my rotation order:
All the rotations above are mandatory, with the exception of the one marked elective i.e. Radiology. We had a choice between emergency medicine, radiology, or time for research work. At this point in time, I've conducted two cardiology department projects; one of the projects the PI wants to publish and I was invited to be a co-author. I'm pretty excited for this, when I was an undergrad I completed research projects before, and have done a few conferences here and there, but I've yet to publish a manuscript. The great news is that the second project, a pilot, secured our team an appreciable grant to develop our project. Unfortunately, my PI is also leaving to another institution as they're interested in his work, he's been trying to coax me to follow him their for residency (more on that at another time). There was another lab I was considering (heart amyloidosis, we're a center for its treatment), but at the advice of some physicians I've decided to use my elective for something more "clinical". This elective I've decided to take radiology, the next year I'll probably opt for emergency if given the opportunity.
As a first year student, I still remember shadowing the trauma team. Well, it started off as shadowing, until we got slammed and I started taking histories (first month of medical school). A young lady had a likely pelvis crush injury, and we weren't sure if she had perforated any bowel nor if she could walk. A lot of things happened that night, at some point I was sent up with the residents for a consult with radiology on the crush patient. When we were invited into the darkened room filled with huge monitors, I saw not only the scans from our patient but many others. I saw the difference in knowledge between myself and the doctors, the resident and their attendings. I think that was the first time I relieved how important radiology was. I'm not really aiming to be a radiologist, but I do want to be good at interpreting.
I've also elected, but still awaiting to see my schedule, to have most of my clerkship rotations at Boston Medical Center network. We have to do one "away" rotation, some people have elected to do rotations in sunny California, I'm going to do my "away" rotations in this state. I'm from California, there'd be some irony in me doing my away rotations towards home, would there? With any luck, as I don't have a car nor want another, I hope I'm sent to a rotation that's far enough away that I can use the provided school residence for living here in Massachusetts. There are rotations in the limbo zone, rotations far enough away to be difficult to get to, yet not far enough away that housing is provided — if that's the case I might have to purchase a car, indeed a mutual loss for Gaia.
And lastly, I'm considering returning to California for vacation this summer. I've had time off, but I technically haven't had a "vacation" since I started medical school. That includes not returning to California. I'm both excited and oddly nervous, it's only been a couple of years, but I'm sort of afraid to see what has changed — less in location and more in relationships. Will I come off as a jerk? Have I changed? They told us we would, and I know I have. For the last two years, I've talked to nothing but medical students and doctors, am I even interesting to talk to anymore? I'm really excited to escape the medical student persona, it'll be one of the last chances that I can, and I really hope none of my friends ask me questions about bowel movements. Fingers crossed.
My Education, Our Education
I woke up throughout the night, each time I attempted to estimate the time till sunrise using the ambient light that slowly invaded my room. I wasn't particularly anxious about the upcoming day, instead I think it was the fear of the impending jolt from the alarm that bothered me. Or, maybe it is more so that I live with other people and I hate the idea of waking them up with me. Either way, I woke up well before my alarm to shut it off. Checked the weather, a balmy Boston 20 F (-6.7 C), awesome — it was time to start the day.
Today, was the start of our Renal module. However, I don't go to class, with the exception of discussions, patient sessions, and skills sessions etc. Instead, I watch later, at my own schedule. There are lot of ways to do medical school, and to each their own. For myself, I was going to the Cardiology unit of our hospital to go on rounds. Right now, I'm doing my first conceptual pass (hopefully 1 of 2) through cardiology for STEP 1. So, I took advantage of opportunity to concurrently round on cardiology inpatients.
I'm not sure if it's realistic to do this for each block that I review, but so far it seems like an interesting spin on things. But, I figured I'm already paying an exuberant amount in tuition, might as well get as much as I can out of the experience.
So, earlier that morning, the cardiology team was to see 16 patients; a lot of them were overnight admissions. The team consisted of two cardiology attendings, one interventional cardiology fellow, two cardiology residents, and three medical students (including myself). This amounts, to what I can only imagine from the position of the patient, as staring at people like they're in a fishbowl. I learned a lot of things since the first time I did this in the summer: read-up before coming, bring scrape paper, penlights are worth gold, try or nothing will happen, and pee whenever allowed to (bathroom strongly suggested). However, I'm still learning a lot of things when allowed on these excursions. Through lecture, I've been "exposed" to the material for most organs and a myriad of drugs. However, in internal medicine those random one off facts I marked on multiple choices became patients where I needed to know about amyloidosis** subtypes AL, AA, and TTR came up, gout vs pseudo gout (and the beloved crystal birefringence question) and their drug side effects, side effects of calcium channel blockers and their indications including selectivity, was Takayasu vasculitis causing the patients chest pain, vasculitis[?] and the dermatology consult, pheocytochroma (the adernergics strike back!), which medications cause Lupus like symptoms, hypertension management (should have brushed up on JNC-8), epidemiology of chronic kidney failure (remember, it's the first day in renal medicine), and did I say vasculitis? It was a long day, but I got a warm pat on the back, and I was asked when am I coming back? To which I replied, "Day after tomorrow". I returned home, watched the day's lecture that I missed, did some practice questions for boards, and read up on the things that I felt I should have known, and looked up a few things I saw that day.
That night before returning to the hospital, I wrote down a list of goals for myself so I wasn't just hanging out and stayed aggressive about my education. The cardiology exam, at least how it's taught here, is pretty hands on and intimate (interestingly, a lot of patients say they enjoy the attention):
- Check for splinter hemorrhages on every "likely" patients' fingernail beds — heard it was a thing, would like to see it myself.
- Palpate as many pulses as I can get my hands on, especially the patients with Atrial Fibrillation or peripheral vascular disease — I was really bad at the "difficult to find" lower pulses, I need to get better at this for the future. So, I thought if I feel a ridiculous amount of pulses I'll be someone useful in a room later.
- When given an ECG, interpret it — I'm pretty decent, i.e. I can do the stuff they taught us in class; but, seeing a cardiologist interpret these things is magical. As an undergrad, I still remember trying to read an ECG in Physiology, I remember being blown away by even the concept of the leads. Accordingly, my favorite portion of physics was the electromagnetism section. Under the direction of a phenomenal mentor, I went onto do electrophysiology projects; there I interpreted ion channels, and gained a little confidence in looking at squiggly lines. This past summer, I had to drudge through a hundred or so ECGs to screen patients for a study. Now, thinking back it's sort of funny, it's not all that dissimilar than what I learned in freshman physics when I was working with circuits.
- Appreciate as many murmurs and abnormal JVPs as possible, including appreciation of Kussmaul's sign — I remember going through murmurs the first time, I was absolutely horrible at them. I recall going to a workshop for murmurs, a physician cardiology fellow said, "It's really hard to appreciate the differences of the murmurs, until you hear your first one and identify it on a patient". She was right. Though, I'm not a murmur master, I can finally tell the difference between murmurs and the maneuvers necessary to amplify them. About JVPs, when I was a premed my grandmother past away, just before she passed away I saw her grossly elevated JVP myself. Dr. Google told me what it meant, so I'm comfortable with appreciating their significance; I just want to make a habit of appreciating them (just in case).
- Get more aggressive about checking for pitting edema, including attempting to better grade and describe its character.
- Follow-up on critical patients to see if the presented planned for therapy had the luck of a good outcome — I could do this by doubling back after rounds, or simply hoping onto my laptop from home to check-up on patients the team is assigned to; i.e. patients I'm allowed to follow. One of my favorite patients we visited passed away, Friday night, just as the attending bitterly predicted. Some patients got better, the amyloid patient was being prepared for discharge, a few were scheduled for catherization, and one had died.
- Pay attention to the management of the kidneys — I'm currently in Renal Medicine courses, so I should try to keep in mind that I still need to pass that exam later. Not surprisingly, there was a lot of between Renal and Cardiology Medicine: a lot of people with heart failure also have kidney problems. So, I'm paying more attention to goals of removing or adding liquid volume to patients. There's been a good amount of overlap between class "take home points" and the stuff I see on the floor about titrating diuretics is applied to the patient I will lay hands on.
- Be more cordial with patients, especially when I've heard they haven't had visitors for a while — one of the first things you notice going in cardiology assigned patients is their cognitive decline, and sadly I've noticed it's also the time where some stressed families distance themselves from the patient. A large part of the cardiology exam includes assessing patients' cognitive level, while not discounting biases (including our own), their education level, and their health literacy.
I returned to the hospital, this time I given a locker in cardiology to keep my stuff safe I was told. The day before, I wrote down everyone's names so I wouldn't forget who's who. I'm really bad with names, though great with faces — I'm trying to get better at the former — that morning I forgot to throw this on my checklist, to be better at names, but I made the update. I set off to complete my check-list, I did.
Now, I don't ask "What the hell is that drug, and what does it do?", I wonder to myself what's the indication for using it and removing it off of patients medications list. I've seen a variety of patients, with a variety of attitudes about their situation: some of them beautiful some of them spiteful. Over these days, I heard my first tricupsid regurgitation; or rather, I appreciated my first definitive regurgitation — in fact, I was bombarded by murmurs, so that it was no longer an exotic finding. Listening to the jumble of words and lab values for patients became less daunting of a task. I now feel less bogged down by the language of medicine and instead I'm looking forward to the transition from classroom to hospital floor. Perhaps it's my gift for holding my bladder, given that I don't have to do any of the heavy lifting yet, I like rounds and the complications and the piles of medications to think about. Given I was hoping to just be a doctor in the future, it's surprising to see that previous work in data entry and another later entailed backend electronic database management come to use with the electronic health record navigation. I'm a little sad to see the skill come into play, but, I'm ready for electronic record drudgery so often bemoaned (and rightfully so, given the context). Because the senior medical students above me were great, they were essential to my experience and learning. And as usual, from them, I'm left hoping to meet the standards they set-forth. The learning went all the way around, the residents learned how to teach better from the attendings, the attendings learned an extra tidbit from "research questions" done by others. And me, well, I learned from everyone: I have a lot more work to do, but I'm going in the right direction.
**reference: amyloidosis is actually pretty rare, but we're a center for amyloidosis so the incidence here is high, i.e. less esoteric of a fact and not just warped medical-pimping.
Probing People and Updates
So, I just had a test on how to use all of this stuff:
- one reflex hammer
- one 128 Hz C note tuning fork
- one 512 Hz C note tuning fork
- one Littmann Cardiology III stethoscope
- in the bag, there's an ophthalmoscope and an otoscope that also check the nose should you change speculums
- in reality, with the exception of the stethoscope and the reflex hammer, and perhaps a tuning fork I expect most things to be found in patient rooms so I don't haul this stuff around
Next year, or rather towards the end of my 3rd year as a medical student, I'll take STEP 2 of my board certification. You're expected to know how to use the stuff in the above picture and show off your clinical prowess in other ways. My school year ends in less than 3 month! It's hard to believe that in less than 3 months I'll be heading towards the 3/4th point of finishing medical school — I pick my 3rd year rotations (including elective rotations) in a few weeks. It seemed to have taken so long to have gotten here, and yet it seems to be flying by a lot quicker than expected.
Anyways, with all that aside, to prepare for the 3rd year we performed a 250-point physical on a standardized patient. Over winter break I had illustrious dreams of practicing the physical, way before the deadline I contemplated, perfecting my craft. This didn't happen. But, at least temporarily, I did lose the bags under my eyes. This was a small life-cycle victory for myself. I was able to practice, just the day before the exam, once with a classmate and multiple times with my partner — it's a time consuming process, I still owe her dinners till this day to make up for it. Mike, my standardized patient was also a great person to examine. Likely well into his mid to late 50's, Mike was well built (likely more muscular than I, not that I'm all that impressive of a norm) and a talkative native of Boston; accent included. I invited him to talk the whole time, though there are times where quiet is necessary, I find examining patients while they talk to be a lot more natural than probing them and reaching into their nether regions in stone-cold silence. Mike told me he's into sports, so we spoke about sports while I give him a physical from head to toe (literally). The most difficult part of the exam was that I actually don't watch or care about sports, with the exception of the Olympics (oddly enough, I haven't missed any for the last 12 years). I grew up in a sports loving family, if you didn't play sports you were considered weird, I played: baseball, basketball, football, and even golf. I fell out of love with watching sports a long time ago, just quitting cold turkey. But, I know the buzz word things to talk about in sports conversation. Though, somehow, sometime later we got into a conversation about our mutual love for the smell of Christmas trees. Yes, specifically the smell, how else to test cranial nerve I?
After the exam, while emphasizing my lack of knowledge, I told him 'off the record' that one of his arteries was bounding more than I would like. I asked him if anyone had ever told him something like that before, he said in fact they had. The finding could have been benign, but after we spoke he agreed it'd be best if he'd go ahead and check it out. He asked for a mole check, did the basic ABCDE, and seemed like just a normal mole — apparently, others he asked were also in agreement. Besides some typical features found with aging, he was perfectly healthy except for a slightly non-malignant high blood pressure that he was concerned about because he's historically 120/80. He cared about his health, I could appreciate that. We spoke more about that, I asked him more about his substance use, in this case coffee that he remembered drinking (2-3 cups a day). We agreed that at his next visit he'd skip the coffee and then see if he's back to normal, then take things from their with his doctor.
It's funny, when I started the exam, I had heard that this is just a dry-run: you just have to speed through the 250-point checklist like they're a car at Jiffy-Lube. Instead, I was met by a man, a patient who actually was both teaching me and hoping to get a medical benefit from the examination. And for me, that felt a lot more natural: me trying to give him a benefit. I'll try to remember that as I practice my skills with patients in the coming days.
Today, we just finished our Rheumatology unit, I enjoyed it more than I expected. It was challenging, but a fair unit. During that unit, I went back to refresh myself on medical microbiology (Sketchy Medical, First Aid and UWorld questions). Some days I'm scheduled at a local community health center, we're farmed out to a lot of places but I was fortunate to pull one that's easy to get to. We're now required to have one clinic day where we see patients, where we perform a battery of histories and physical examinations. I'm looking forward to returning to clinic, it does take some time out of my study schedule but it helps to remind me of why I want to do this in the first place. Though, I prefer being in a more intensive setting, so I'm also schedule to hop onto cardiology wards this coming week the day after the health center. As such, I decided to start reviewing cardiology again in my board studying schedule this weekend. Given that I've rounded with this attending before, my PI (he's an Atrial Fibrillation (AF) specialist), I'll review the basics before I show up: drugs (their indications and side effects in regards to), certain high yield risk analysis scores like the CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk, ECGs, murmurs, etc. With the cardiology team, it's quite large, and there's a lot that needs to get done so I don't expect to be called on or present. But, I feel I should at least put in the effort to understand the answer that my seniors are being politely pimped about; it does seem at least common courtesy. Knowing stuff helps me pretend I know what's going on, it's an important strategy.
Tuesday, we start Renal Medicine. Should be a tough course, though it's pretty much just a down hill slide from here as long as I keep on schedule. Thus, I'm looking forward to it and the patients and experiences I'll incidentally meet along the way.
Student Doctor Network and Unsafe Spaces
If you're a premedical student, it's very likely you've heard of Student Doctor Network (SDN). If you haven't, just as a quick history, SDN was founded in 1999 in attempts to fill the unmet need in advising for many aspiring physicians. It sort of sounds like a lofty, if not nebulous mission, and a goal that is easily lost on the current state of "access to information". If you're too young to remember what Oregon Trail was, and with the current adult use of the internet being around 85-87%, it's hard to imagine a time before the internet for context of the access to information at the time:
- 1996: 23% of US adults went online
- 1997: 36% of US adults went online
- 1998: 41% of US adults went online
Pew Poll
As access to the internet was still blooming and more importantly "content", however at that same period of time there was a large gap between those who seemed to know how to get into medical school and those that don't. Around this time, 1999, access to the big three MCAT prep companies often meant heading to the library: Kaplan (est. 1938), The Princeton Review (est. 1981), and Examkrackers (est. 1997, a baby company at the time, had a 100 registered prep students). In that period, if you wanted to know information about the MCAT you had to have a buddy that took the MCAT. Didn't have a decent advisor? Tough.
This was long before the time of Twitter, and even several years before the first global hit social media "Friendster" was founded. Indeed, if you were a premed, the days before the internet were dark times if you weren't "in the loop". Because of SDNs victory at being the torch in the night for some, SDN must be given credit where it's due.
However, the experience that both enhances and perhaps detracts from the premed experience are the pre-allopathic forums. When I was still an early premed, I heard whispers of this foretold website I could visit where I could learn how to apply to medical school the "right way". Although I had no intention to post yet, I remember being very excited, I think I made an account immediately. At the time I used the site, I was still a community college student — I hadn't taken any of the premedical prerequisites yet (I took them all at a university I transferred to). Being no stranger to forums and message boards, I felt comfortable forum FAQs and utilizing the seemingly unknown by new users search function. Because of this I think I stayed away from what is ubiquitously and now arguably haphazardly as trolling — "trolling", a term that has lost it's oomph, while it used to refer strictly to the succubus like internet user destroying others' lives for attention, it's now used as a pejorative for any dissent against the major opinion. Though, user board nuance terms aside, over time, I found like any standard distribution: most people who post are fine, if you move far away enough from the norm, and there's a minority of both jerks and excellent people. The more you skim, the more jerks you find, it's merely a properly of statistics known to any populous message board — see 4chan, for gamers old gamefaqs (general discussion) and Shoryuken, and for the modern man and woman Reddit. Thus, it's easy to just dismiss the negative experiences felt by some on SDN as "par for course". The new movement and very ironic movement, the anti-PC police, might even want to say you still wear diapers for being flustered.
When I first found SDN I wasn't yet sure about medicine, though only a movement held by a few with "garbage" arguments, I quickly found that there was an almost anti-underrepresented minority tide. At the time, I recognized that it wasn't a safe space for me to mature as an young African American male with no role models around to put things into perspective. It wasn't really until after I had already at least gained one admission spot that I felt comfortable freely perusing SDN, I thought why freely stay somewhere where you're not welcome — instead, I did all of my MCAT/admissions prep via Google and books, and any advice I could catch along the way.
However, what lies within the "garbage" of SDN posts is a lot more insidious. Even with the most open mind, and turning a blind eye to the rampant 'joke' sexism and womanizing of seeming pubescent boys, it's hard to humor the recent posts where the killing of Tamir Rice was being justified and the work of civil rights allies were mocked. When I was admitted into medical school, across the nation there were only 514 other black males also admitted across the country — around the same or less than in 1978. Though, why this stuns analyst is somewhat of a mystery. Regardless of race, unless you're in the minority, a successfully matriculated premed's parental income statistically will come from the upper middle class. There's a correlation between scores, including the MCAT, and parental income/capitol. For the average American, their capitol and family net worth is based on their house ownership. From the 1930s until 1968, the federal government specifically excluded African Americans from federal home loans — delaying the amassing of family wealth. Even afterwards in 1988 and 2013, in Boston and Philadelphia respectively, suits and evidence brought forward of intentional segregation and discrimination. So, even working hard and being able to afford a house doesn't promise being able to secure a loan. So, it's not to say that the African American middle class (and missing African American applicants) aren't trying, it's more so that they've tried for decades and have failed to gain traction until very recently. But hey, its not reasonable to expect everyone to dive into law and socioeconomics, nor do I expect people to realize that even being a black Harvard Law professor still affords you little hope for a safe space (his own home).
With that being said, the African American community (and really many people who happen to be in the SES category) have much to gain from the free resource SDN offers. Therefore, it comes with great solace to admit that when it comes to recommending using SDN, especially if you're a PoC, do so with great reservation. As a minority and former premed, if I had stayed on Student Doctor Network because of how discouraging the general tone was for minorities; I probably would have never applied to medical school. And really, I suppose the part that disappointed me wasn't that there was a dissenting opinion than mine, nor did I think I was a special snow flake that needed protection. Instead, it was the disappointment of thinking that this was my potential peers that affected me. I'll even admit in my limited experience thinking SDN was "truth", subconsciously, this scared me off the track of pursuing medicine. Eventually, I feel in love with the "hard science" crowd, and just assumed I'd pursue a PhD. Later, though I had already been accepted into grad programs, I changed my mind and decided to apply to medical school after a mentor convinced me that I let others psyche me out — that was my own failing in not believing in myself and letting negative echoes get to me. However, in the end, SDN will eventually have to come to terms that the site where professionalism is supposed to be exemplar has members that join in the ceremonial stabbing of premed Ceaser.
And as one, I can only say in solidarity with the poll towards SDN, "Y tu Brute?"
Though, in the modern age, SDN may continue to live on with its useful archive while some premedical students continue to gravitate towards safer spaces to escape having their soul ripped out. And, what does it say when one of the most popular spring boards for premedical students doesn't function as a safe space for people of diversity (including financial SES ORM). If this doesn't bother you, and you benefit from the status quo, bravo to you. But, do know that some are steered away from potential opportunities because of their lack of safe space that you are so entitled to in the locker room of life. And it wouldn't be fair to ever suggest, without evidence, that SDN steers minorities away from medicine. However, because there's no evidence that it's particularly helping in terms of diversity — diversity goes beyond race, and are not merely "cards to be played" — we can only wonder what type of positive effect the forums could have had diversity were guaranteed the same "safe space" enjoyed by the majority/typical applicant.
Twitter Premed Opinin Poll of SDN Use and Value

subset: commoncrawl


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Obama will visit Flint, Michigan on Wednesday to meet with residents who've lived with contaminated water.
A recent cheating scandal at Harvard University got Colin Diver thinking — and writing, in the Boston Globe.
Diver, a former president of Reed College, writes in an opinion piece that to prevent cheating, schools shouldn't focus on policing students.
Rather, they should create a culture of academic honor that holds students and faculty accountable to one another and decreases emphasis on grades.
Throughout the week, Here & Now is looking at the impact a raise in the minimum wage would have on states, the federal government and workers.


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68 passengers arrive by Damascus- Qamishli –Yerevan flight
April 17, 2013 - 19:53 AMT
PanARMENIAN.Net - Damascus- Qamishli -Yerevan flights will henceforth operate on a regular basis, the manager of Syrian Airlines Yerevan office said.
In conversation with a PanARMENIAN.Net reporter, Svetlana Hovhannisyan said 68 passengers arrived, 12 departed by the first flight.
The flights will operate every Tuesday, 03:10 am, with one-way ticket price set at AMD 165 000, with two-way ticket to cost AMD 245 000.
Syrian Airlines operated Damascus- Latakia-Yerevan flights following the suspension of flights to Aleppo, with the last flight scheduled for February 5. According to Ms. Hovhannisyan, no information was provided as to the flights to Aleppo and Latakia.
Top stories
"Inspections revealed that the information is a mere provocation and is completely false," the National Security Service said.
Meeting Clooney at the airport was Aurora Prize co-founder, philanthropist and entrepreneur Ruben Vardanian.
Around $304.000 was transferred to the special bank account, opened by the Karabakh government, on April 19.
The report suggests that the crime index amount to 31.11% in the country, with the safety index totaling 68.89%, accordingly.
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Air strikes hit refugee camp in Syria as fighting rages on United Nations aid chief Stephen O'Brien said he was horrified and sickened by what had happened and called for an investigation.
Massive wildfire in Canada forces thousands of evacuations The wildfire has already forced precautionary production cuts or shutdowns at about a dozen major facilities.
North Korea stages once-in-a-generation political event Thousands of delegates are meeting for a choreographed show of support being seen as an unofficial coronation.
Several hurt as shots fired in Germany's Frankfurt Police said that someone opened fire from a passing car and witnesses spoke of up to a dozen shots being fired close to the main police station.


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@Real_ESPNLeBrun wrote:Pittsburgh has signed Rob Scuderi
4 years, 13.5m
Would have liked this as a two-year stopgap, even a three year wouldn't be too bad.
Not sure how I feel about 4 years.
Moderators: Three Stars, dagny, pfim, netwolf
@Real_ESPNLeBrun wrote:Pittsburgh has signed Rob Scuderi
helmespc wrote:So #4? #5? #45? What'll it be?
the wicked child wrote:Boom. I'm happy.
Froggy wrote:so a bit over 3mil a year? good signing.
Azkar wrote:so now we have like .75mil to sign 3 players?
dogwithshftyeyes wrote:congratulations to the 2014-2017 stanley cup champion pittsburgh penguins!
Shakes wrote:Azkar wrote:so now we have like .75mil to sign 3 players?
Trade(s) coming.
Rocco wrote:Bylsma did a fist pump when he realized this signing meant he wouldn't have to actually use Despres in the lineup.
Users browsing this forum: BleuLineLady, DelPen, DontToewsMeBro, farnham16, FLPensFan, Hugo Stiglitz, Inkio, jwest21, Kevintripod, Liverlips, mnpensfan, Pitts, Sigwolf, sil, Steve, topshelf66 and 71 guests


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In an effort to minimize employee-absence costs, more employers are dumping traditional absence policies in favor of paid time-off (PTO) plans. Such plans lump together time-off benefits (sick days, vacation days, personal days, etc.) into one leave bank. Last year, 42 percent of companies surveyed by Mercer Human Resource consulting used PTO plans, up from 30 percent in 2000. Plus, the percentage of employers that give employees the opportunity to buy and sell vacation days rose from 15 percent in 2000 to 24 percent last year. Young workers are often willing to buy more vacation time, while older workers often cash in extra time-off benefits.
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- Death of a salesman: How to revive your sales-customer relationships


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Walker, Texas Ranger 1993 | TV Show Watchlist
Season 9, Episode 9 Child of Hope
First Aired: December 9, 2000
Alex comes down with a case of baby fever after a frightened young mother abandons her infant son with the caring DA. Elsewhere, the Rangers follow a trail of dead bodies to the leader of a vicious gang of ex-convicts. Trivette: Clarence Gilyard. Gage: Judson Mills. Sydney: Nia Peeples.
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- Premiered: April 21, 1993
- Rating: TV-PG
- Premise: An action-oriented modern-day Western about a Lone Star lawman who relies on martial arts to subdue bad guys. Walker's unsubtle butt-kicking ways are often at odds with those of his partners, who favor a more cerebral way of dealing with criminals. This wa… (more)
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Walker, Texas Ranger: Season 6
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text: See, the problem is that kind of meta would sort of work if this was the same, darkly comedic show it was when it first started. But once it became all Up With People, it sort of lost the right to have that edge about stuff. The show has never been able to figure out how mean-spirited it wants to be in its current incarnation and when you have a spazz like Murphy at the helm who bows to and then insults fans with equal tactlessness, it's bound to be a fucking mess.


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Einstein's Garden returns to nurture your curiosity, making inspiring encounters with science and nature an essential part of your GM16 adventure!
Look out the window, folks – spring is a-comin' in! The birds are a-chirping, the daffodils are a-sprouting and and we've got a freshly picked, bumper batch of 22 BRAND NEW names to add to the bountiful selection already adorning this year's bill...
Get the bigger picture: we've teamed up with the brilliant Little White Lies once more to bring thought-provoking dramas, cult favourites and family-friendly features to our 24-hour Cinedrome.
Something is stirring in the Jungle. This year at Green Man, kids (and their adults) can let their imaginations go wild in a jungle-themed paradise!
We're bringing our interactive debate about the fight against Cancer to London, thanks to the lovely folks at Camden Market!
Wishing you all a very happy St David's Day - and we celebrate by unleashing a cosmic swathe of bands who join the #greenman16 line-up. Twenty-two more bands, yes please…
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text:
New York Mets ace and former Herd starter R.A. Dickey was named the National League Cy Young Award winner on Tuesday night. The knuckleballer is now one of six former Bisons pitchers who also have won a Cy Young Award, joining Cliff Lee, Bartolo Colon, C.C. Sabathia, Dwight Gooden and Ferguson Jenkins.
Gooden was the only pitcher who won the award before pitching for the Bisons.
Dickey was 20-6 with a 2.73ERA in 34 games and 33 starts with the Mets last year. The righty struck out 230 batters in 233.2 innings of work with five complete games and three shutouts.
Dickey's fantastic season in Queens came two years after his time with the Bisons. He started the 2010 campaign with the Herd and was 4-2 with a 2.23ERA and two complete games. One of those starts was arguably the most impressive pitching performance in the history of Coca-Cola Field. On April 29, 2010, Dickey pitched a one-hit complete-game shutout against the Durham Bulls. In that 4-0 win, Dickey allowed a lead-off single before retiring the final 27 batters he faced.
The Bisons now have six former players with Cy Young awards with Dickey joining Colon, Lee, Sabathia, Gooden and Jenkins.
Colon, who tossed the only no-hitter in the Bisons modern era in 1997, won 21 games for the Los Angeles Angels in 2005. Sabathia pitched one game at Coca-Cola Field on a major league rehab assignment in 2006 and won 19 games with Cleveland the following season. Lee went 22-3 with a 2.54ERA with the Indians in 2008 to take home the honor. He toed the slab for the Bisons in parts of three seasons: 2002, 2003 and 2007.
Dwight Gooden collected his hardware for the Mets in 1985 before making major league injury rehab assignments with the Bisons in both 1998 and 1999.
Jenkins, the only pre-modern era pitcher on the list, pitched for the Bisons in 1962. Nine seasons later, Jenkins went 24-13 with a 2.77ERA with the Chicago Cubs.
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- Delays force Hartford to move three series
- Dodgers' Urias fires six no-hit innings for OKC
- Swanson rips four more hits with Mississippi


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Keyword Results for 'bangladesh'
Bangladesh SC scraps 16th amendment to Constitution May 5, 7:01 pm
Dhaka, May 5 (ANI): The Bangladesh High Court has scrapped the 16th amendment to Constitution, which empowered the Parliament to impeach the Supreme Court judges for incapacity or misconduct.
Bangladesh SC upholds Rahman Nizami's death sentence May 5, 3:54 pm
Dhaka, May 5 (ANI): Bangladesh's Supreme Court on Thursday upheld the death sentence of Jamaat-e-Islami leader Motiur Rahman Nizami, dismissing his review plea against the gallows for war crimes, paving the way for his execution.
Dhaka, May 4(ANI): U.S. Assistant Secretary of State for South and Central Asian Affairs Nisha Desai Biswal on Wednesday held discussions with senior Bangladesh Foreign Ministry officials on combating terrorism and extremism.
New Delhi, May 4 (ANI): Anil Ambani-led Reliance Power has won approval of the Bangladesh Government for the first phase of the 3,000 megawatt LNG-based power plant.
Dhaka, May 3 (ANI): The Singapore Ministry of Home Affairs on Tuesday announced that eight Bangladeshi men working in Singapore, planning to stage terror attacks back home, have been detained.
Hindu tailor killed in Bangladesh, IS claims responsibility May 1, 12:44 pm
Dhaka, May 1 (ANI): A day after a Hindu tailor was killed in Bangladesh's Tangail district which the Islamic State (IS) claimed responsibility for, three unknown persons have been sued in connection with the killing.
Dhaka, Apr. 30(ANI): Bangladesh Prime Minister Sheikh Hasina has accused the BNP-Jamaat nexus of committing secret killings with the objective of toppling her Awami League-led government.
BNP assures cooperation to govt. in combating militancy Apr 29, 3:46 pm
Dhaka, Apr. 29 (ANI): The Bangladesh Nationalist Party (BNP) has said it is ready to cooperate with the government with its experience in combating militancy in the country.
`Apologetic` Shahadat Hossain seeks Bangladesh return Apr 28, 8:14 pm
Karachi, Apr.28 (ANI): Bangladesh fast bowler Shahadat Hossain, who was banned from the game after being charged for torturing an 11-year-old maid, has apologised to the nation for what he described to be his `misdeed` and appealed to allow him to return to the cricket.
Australia likely to tour Bangladesh in 2017 Apr 27, 8:16 pm
Melbourne, Apr.27 (ANI): Australia are likely to tour Bangladesh next year to play the two-match Test series, which was postponed last year due to safety and security concerns.
Bangladesh professor's murder suspect surrenders Apr 27, 6:04 pm
Dhaka, Apr. 27(ANI): Anwar Hossain Ujjal, the prime accused in the murder of Rajshahi University Professor A K M Shafiul Islam, surrendered before a local court here on Wednesday over a year after evading arrest.
US envoy to Bangladesh calls for global fight against terrorism Apr 27, 3:33 pm
Dhaka, Apr. 27 (ANI): United States Ambassador to Bangladesh, Marcia Bernicat, has said Dhaka alone cannot fight terrorism, adding everyone needs to come together and join the fight.
Dhaka, Apr. 27 (ANI): Underscoring the need for thorough investigation into the recent killings to bring criminals to justice, the European Union (EU) has urged the Bangladesh government to ensure freedom of expression as a fundamental human right and to promote respect.
Two teachers jailed for insulting Islam in Bangladesh Apr 27, 1:33 pm
Dhaka, Apr.27 (ANI): A Bangladesh court has jailed two teachers for making derogatory comments about Islam and the Prophet Muhammad.
AQIS claims responsibility of Kalabagan twin murders Apr 26, 4:33 pm
Dhaka, Apr. 26 (ANI): The Bangladesh unit of al-Qaeda in the Indian Sub-Continent (AQIS), Ansar Al Islam, has reportedly claimed responsibility of murdering a LGBT magazine editor Xulhaz Mannan and his friend in Kalabagan.
Leading gay rights activist 'hacked to death' in Bangladesh Apr 25, 9:59 pm
Dhaka (Bangladesh), Apr. 25 (ANI): A leading gay rights activist was among two people hacked to death on Monday at an apartment in Bangladesh capital Dhaka.
Amar Desh editor placed on five-day remand in Bangladesh Apr 25, 4:23 pm
Dhaka, April.25 (ANI): A Dhaka court has placed Mahmudur Rahman, editor of Amar Desh newspaper on a five-day remand for interrogation in connection with an alleged plot 'to kidnap and kill Prime Minister Sheikh Hasina's son Sajeeb Wazed Joy'.
Dhaka, Apr.25 (ANI):Student bodies blocked a key intersection area of the Shahbagh area ?over what they called the government's failure to arrest the killers of Comilla college student Sohagi Jahan Tonu.
Dhaka, Apr.24 (ANI): An alleged activist of Islami Chhatra Shibir was detained in Bangladesh in connection with the murder of Rajshahi University professor AFM Rezaul Karim Siddiquee.
BNP chief Khaleda to hold workers' rally on May 1 Apr 24, 3:07 pm
Dhaka, Apr. 24 (ANI): Bangladesh Nationalist Party (BNP) chairperson Khaleda Zia will hold a workers' rally in Dhaka on the occasion of Labour Day on May 1.
Dhaka, Apr. 23 (ANI): United States Ambassador to Bangladesh Marcia Stephens Bloom Bernicat on Saturday said that Washington is committed in continuing efforts to protect factory workers of Bangladesh.
Bangladesh varsity professor killed by miscreants Apr 23, 2:57 pm
Dhaka, Apr.23 (ANI): A professor of the English department of the Rajshahi University (RU) in Bangladesh was killed by trespassers in the Shalbagan area of the city this morning.
Hindu temple desecrated in Bangladesh Apr 22, 6:41 pm
Sylhet (Bangladesh),Apr.22 (ANI): A temple frequented by the minority Hindu community in Sylhet, Bangladesh, was recently desecrated by some miscreants.
BSF guns down Bangladeshi cattle trader Apr 18, 4:57 pm
Dhaka, Apr.18(ANI):Indian Border Security Force (BSF) has gunned down a Bangladeshi cattle trader on Roumari border in Kurigram last night.
Dhaka, Apr.17 (ANI): A Dhaka court has rejected a petition filed by Bangladesh Nationalist Party (BNP) chairperson Khaleda Zia to cross examine yet again the investigation officer of Zia Charitable Trust graft case.
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What slayer album sold the most copies?
kgb answers » Arts & Entertainment » Music Artists & Songs » What slayer album sold the most copies?
Tags: solid gold, abyss, slayer
Thursday, February 02 2012
Source: http://www.sing365.com/music/lyric.nsf/Slayer-Biography/C6987C4AD33D4CCC482568AA002445BA
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Diazepam 5mg tablets.
Expired 8/31/09. If I could still take it.
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Union-Tribune owner's war of escalating insults
Yet another spin-off rumored if Gannett prevails
Matt Potter 4:30 p.m., May 2
Bird aficionado Karen Straus discusses and demonstrates the spotting scope/iPhone technology that she uses to photograph wild parrots and other birds, and discusses her observations of wild parrot behavior.
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Greeley Central senior Hannah Escobar, 18, performs during a dress rehearsal of the play "The King and I" last week. The spring play begins at 7:30 p.m. Thursday at the Greeley Central High School auditorium, 1515 14th Ave. in Greeley. The play also will have three other shows — one on Friday and two shows Saturday. For tickets and more information, call Christy O'Connell-Black at (970) 348-5093.
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Home > News > World
Wednesday, 5 February 2014 | MYT 3:50 PM
BERLIN (Reuters) - The U.S. National Security Agency (NSA) bugged the phone of former German Chancellor Gerhard Schroeder from at least 2002, a German newspaper reported on Wednesday, compounding the most serious row between the allies in a decade.
The reason for the snooping was Social Democrat (SPD) Schroeder's opposition to the U.S.-led invasion of Iraq under then President George W. Bush, the Sueddeutsche daily said, citing U.S. government sources and NSA insiders.
"We had reason to believe that (Schroeder) was not contributing to the success of the alliance," the newspaper quoted one person with direct knowledge of the monitoring as saying.
Reports last year about mass surveillance in Germany, in particular of Merkel's mobile phone, shocked Germans and caused Berlin to push, so far in vain, for a 'no-spy' deal with Washington.
Since then, it has been widely suspected in Germany that the NSA had bugged governments preceding Merkel's but this is the first concrete report that offers evidence and it stems from information from former NSA contractor Edward Snowden.
Schroeder, who headed a coalition with the Greens between 1998 and 2005, said he was no longer surprised.
"At that time I would not have entertained the idea of being monitored; now I am no longer surprised," Schroeder told the Sueddeutsche Zeitung.
Germans are especially sensitive about snooping due to their experiences in the Nazi era and in Communist East Germany during the Cold War when the Stasi secret police built up a massive network of surveillance.
Merkel said last week that Berlin and Washington were still "far apart" in their views on the NSA's surveillance of Germany but that they remained close allies.
(Reporting by Madeline Chambers; Editing by Stephen Brown)
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Sending the same ornament to different places? If you order more than one of an item and want them shipped to different addresses, please order them individually. We will ask you for the individual shipping addresses later in the ordering process.
Colorful Glass Wizard of Oz - Set of 4 Christmas Ornament
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