The power of herd immunity
How do vaccines prevent disease -- even among people too young to get vaccinated? It's a concept called "herd immunity," and it relies on a critical mass of people getting their shots to break the chain of infection. Health researcher Romina Libster shows how herd immunity contained a deadly outbreak of H1N1 in her hometown. (In Spanish with subtitles.)
By Romina Libster

My first day of medical school was just a lecture about financial aid (which is extremely chaotic at my school). I see why it needs to be done, but all my other schools (for undergrad and grad) just sent us an online required loan counseling thing to do.

Also, some (a lot?) of my classmates seem much more awkward than I am (and I’m like the most introverted person I know)! Maybe it’s just first day nerves. My hands were definitely shaking this morning lol

On the other hand, I’ve been sent the topic for my first assignment and it’s orthopedics related (yay!) so I think I’ll google/wiki stuff until I’m less underwhelmed by school…

Lessons from First Year

Disclaimer: This is not an exhaustive list. These are just some things that I personally learned during my first year of medical school. I also have included some links to books and resources that I used as a first year medical student, but by all means, you can search for cheaper/older/online editions of these resources (I sure did). I wrote this post over several weeks, so it’s sort of all over the place. Apologies. This is just some things I wish I could tell myself on that first day of medical school.

1. You [probably] won’t be #1 in your class anymore. And that’s okay.

2. Anatomy lab isn’t going to be that bad. Just eat a good lunch beforehand because when you’re 4 hours deep into it and holding up a heavy, literally dead weight leg and your tummy is growling and your group dynamic is falling apart… you won’t be happy.  

3. You’re going to mess stuff up in anatomy lab. It’s okay, this isn’t surgery. So don’t be upset when you realize that in the process of removing the rib cage, you chomped right through the diaphragm. He didn’t need it anymore. Move on.

4. Take the advice of medical students, especially the M2s. They just survived it.

5. If you need an afternoon of laying in bed, eating popcorn, and watching Grey’s reruns (or whatever your favorite guilty pleasure is), then do it. Take you breaks. This is a marathon, not a sprint.

6. Feed your head: talk to professors about topics and issues that challenge or inspire you. 

7. Feed your heart: If something inspires you, hold onto it. If a patient’s story moves you, if it brings you to tears, then hold onto that. That’s why you’re here in the first place: the stories of others. Write them down (mind privacy of the patient, though). 

8. Forgive yourself for your crappy studying days. You have intentions to study all day. You really listen to music and snuggle in your bed a lot. You glance at a few notes. By 11pm, you’re feeling guilty about your lack of productivity. Have some tea, forgive yourself, and realize that tomorrow is another day. 

9. An hour is not enough time to get serious studying done. Go to the lunch talk. 

10. Draw it out. That pathway that seems impossible, that enzyme cascade you keep staring at… draw it out, draw it again, draw it without looking at it.

11. Ask for Starbucks gift cards for birthdays and holidays. Because caffeine.

12. There are going to be people in your class, sometimes even your friends, who are super smart and you think they’re doing great, but are actually failing one or more of the classes. Wipe that shocked look off of your face, medical school is hard. 

13. There are people who are good at hiding their negative emotions, but are really hurting. Be kind to everyone as much as possible.

14. Offer to help, but don’t patronize.

15. If you need help, do not hesitate to seek it. This goes for academics as well as your mental health. 

16. Just go to the gym. Just go for that run. You’ll feel better for it. No, seriously, put that book down and go.

17. DO NOT talk badly about your grades in front of other people. For example, “ugh, I’m so stupid, I only got a 70 on that test! So many stupid mistakes…” because someone who got a 60 might overhear you. 

18. NONE OF THE PEOPLE IN YOUR MED SCHOOL CLASS ARE STUPID. NONE. NOT YOU, NOT HER, NOT HIM, NOT ANY, OKAY?! Socially awkward? Probably. Not a good test taker? Maybe. But not not not stupid.

19. Oh so you made a really cool drawing that has helped you really learn a difficult concept? Share it with you classmates. You never know who you can impact by doing this simple task.

20. Summer research? Be realistic because the summer flies by. You might think you have time, but you don’t. Work efficiently.

21. Shower cry. Okay, this may seem so depressing and scary, especially for those soon-to-be MS1s. But honestly, I know several other med students who would take a shower as a study break and just have a good, cathartic, cry. Let it out.

22. Shadow when you can! Take advantage of the extra time that you have during first year (although it feels like you have zero time) to shadow in the fields that interest you. Get a feel for what their day is like, their lifestyle, the specialty in general.

23. Get multiple pairs of scrubs for gross dissection lab. Wash them often. Throw them away at the end. Ew.

24. Anatomy flashcards: study on the bus, waiting in line, getting a pedicure, whatever.

25. BRS physiology. This saved me. The BRS series are very concise books about the subjects, written in bullet points with important graphs and diagrams. I highly recommend going over the BRS chapter several times prior to the test, because if a bullet point confuses you, then you need to dig deeper into the concept and study it more.

26. Practice questions. Do them early, as you study a block rather than the night before the test. Do as many as possible. There are tons and tons of resources on this. For example, I used Gray’s Anatomy for Students  and the Michigan quizzes for anatomy questions. I used Physiology Pretest for physiology questions.

27. For anatomy, I also loved having two books: one color atlas (I used Netter), and one that shows pictures of cadavers. I would learn the structures from the bright, colorful, and well-labeled Netter Atlas. Then, when I felt that I knew them well, I would bring out the book with the cadaver pictures and go through them again. Why? Because when you open your cadaver, it ain’t bright and colorful in there. Things run together. Muscles aren’t intact fully. It can be confusing.

28. Get some more professional clothes, get them for all seasons. Get comfortable, professional shoes. Get a small notepad that will fit into your white coat. These are essential for clinic days or shadowing. 

29. Speaking of clinic days or shadowing, take notes, ask questions. Look up the diseases and diagnoses that the patient had once you get home. These real cases help to solidify concepts.

30. Drink water. Take your vitamins. Treat your body well. 

31. Take 10 minutes every day to clean something in your apartment. Again, the tunnel vision will make you think that you have no time to do anything but study. Ten minutes, that’s it.

32. Get organized. This goes for you school supplies, your folders on your computer, your books, your clothes, everything. Make daily activities as simple and streamlined as possible. 

33. Pay attention during orientation! So, you’ve sat through 3 hours of boring presentations on where you can park, the library hours, and student health. But at least know where you can access information online or who the go-to person is for IT, the library, student health, academic office, etc. There is always this sense of urgency in medical school that didn’t exist in undergrad because your daily agenda simply does not have the same amount of free time.

34. For the first time in my life, I started actually scheduling haircut appointments at regular 8 week intervals. It’s important to look well-groomed and put together, especially in professional settings. So, whatever your hygiene routine is: get the schedule down early so it won’t get away from you. (In college, I would go 5-6 months without a haircut sometimes. Hello split ends.)

35. Tea. Don’t go for that 5th cup of coffee. Have some tea instead. It’ll give you the caffeine boost that you need during that study session without giving you the jitters. Try alternating and switching up your caffeine source. 

36. Listen up: get First Aid. Get it early. Study it alongside your lecture material. Not only is it another resource for you, but when it comes time for the step review, it won’t be the first time you’ve seen a particular diagram or chart on a subject. 

37. Write your mnemonics for things in the relevant sections of First Aid. 

38. Colorful pens, nice notebooks, fun highlighters. Go all out, you’re going to be spending a lot of time with these items, so you might as well get the good stuff.

39. The decent sized whiteboard is great for: writing things over and over, erasing them, and writing them again, drawing diagrams, making flowcharts, drawing out the anatomy. I also knew a girl who just got a giant roll of white paper, like the things cheerleaders used to make banners with in high school. Whatever works for you.

40. Medical school is toxic. The pace is unnatural. Some people will be rotten. Things are not going to be all unicorns and rainbows. 

41. Sometimes, you’ll find yourself questioning why you came to medical school while your friends travel Europe or get married.

42. Someone in your family will hear you talking about your anatomy class and start asking you about this mole on their back, or a rash on their kid. You’re not a doctor, yet. You can answer their questions, but emphasize that you’re not a doctor and you actually know nothing. You’re Jon Snow. Remember that.

43. Oh, you went to google the name of a drug you didn’t recognize and you black out, and 10 minutes later you’re on Facebook. You don’t have time for this nonsense in medical school. Try this app

44. So and so in your class will get a divorce.

45. _____ and ______ will start dating, but you’ll see him with this other girl in your class.

46. Someone will have a family member die, go home for the funeral, and not come back.

47. People will drop out. They’re smart and their grades are stellar, but they hate it. And they’ll leave. Someone else will love it and they’ll fail out. 

48. Remember how lucky you are to be where you are.

49. Petty drama will still exist in your class, try not to be involved in it.

50. Granola bars. Trail mix. Snacks that fit in the white coat pocket.

51. Don’t wear your white coat in places that you don’t need to be wearing your white coat.

52. It’s 11pm the night before a big test. Sleep. Medical school examinations are not blunt recall of information that you had in undergrad. You’ll need a well-rested body and mind to solve the problems and recall information on the tests.

53. High and yield. If something isn’t “high yield,” don’t focus on it. Your study sessions should be honed in on what is most important, most high yield concepts first. Details come once you have these concepts down.

54. Volunteering at the free clinic is actually quite amazing, you can learn a lot if you pay attention.

55. Cramming isn’t going to work for you like it did in college.

56. You’ll have to study on the weekends now, too. Sorry, boo.

57. You can still go out and have fun, lounge on the beach, or see a movie. It just requires more planning and scheduling.

58. “I don’t need to write this down, I’ll remember it.” Biggest lie you’ll tell yourself.

59. If lecture doesn’t help you learn, then don’t go.

60. You’ll diagnose yourself with a AAA or hyperthyroidism or a brain tumor. You’ll panic for about 4 seconds until you realize that many med students do this. You’re probably fine.

61. Don’t buy any books until you’ve heard what the previous year’s students have to say.

62. Summer before MS1? Go on vacation. Spend time with your family. Do not crack open a single medical textbook. DON’T. I see you poking around in First Aid, STAHP IT.

63. Easy on the Red Bull, okay. 

64. Earplugs. During tests, during study sessions, while you sleep. Get them. Tune the world out.

65. Noise-canceling headphones for watching lectures, youtube videos, or just for background music.

66. THIS on noise-canceling (or regular) headphones while studying. I prefer rain+ocean waves. I can’t study with music as well. 

67. YouTube videos! I made a post before about the incredible Armando Hasudungan and his helpful youtube videos. Additionally, you can search almost any topic that you’re struggling with on youtube and watch educational videos. Also, add “Step 1″ to the search bar and BAM, high yield city.

68. Make your dentist appointments, get your car inspected, stock up on shampoo, toothpaste, and toilet paper. Try to be prepared as possible prior to the semester’s start so that you’re not running out to the store as often. 

69. A big study desk that’s clean and well-lit. 

70. Prioritize. Medical school will eat up all of your time. Make time for the people you care about. However, realize that you won’t be lounging around every single weekend with your buddies. Getting through medical school requires you to put medical school as your top priority. Your day will revolve around classes and studying. Please explain this to your friends and family early on. Busy is an understatement. 

71. Fasten your seat belts. Med school is wild and weird, but enjoy it because you’ve worked hard to get where you are. Congratulations and welcome! 

One of the most difficult things about studying abroad is the language part(dreaming of a world where everyone knows english 😇). I found out last year that I have dyslexia( whoa!! I’m not an complete idiot🎊🎉😅, just a bit slow). But we only do 3 mandatory years of language at my school, so my last exam is in September!!! Just a couple of months left!

Medical school teaches you how to be 100% person. As a future doctor, you have to be intelligent - of course. You have to be truly devoted, strong, confident yet humble and ready to work harder than you could’ve imagined ‘till now. You have to be striving for perfection, because you can’t afford to be 99% right. You are either 100% right or 100% wrong.
—  My professor of Internal Medicine on ‘Introduction to Internal Medicine’. 

It’s up to you now. I’d like to share something with you.. You know that feeling when you need to study and you’re just not feeling it, but you think if you watch a movie or eat some chocolate or watch TV or YouTube or do anything else you’ll get that epic motivation and stay all night awake studying? That stupid thought “I’ll do it later”? Well let me tell you, when you get that feeling, DON’T run away from studying, because even when you finish procrastinating and doing things you like, that motivation will not come, you will feel the same and want to procrastinate more! So, when you are not feeling like studying, remember that you’ll not be feeling it even when you finish procrastinating, so forget that “I’ll do it later”, sit down and STUDY HARD! I know it is hard, I know exactly how you feel in that moment when you have to study but you reeeeally don’t want, but believe me, you will feel sooooo much better when you finish, and success actually will motivate you! Good luck and don’t give up! :)

Side Effects May Include....

While attending medical school, you may experience:

1) Insomnia

2) Narcolepsy (exacerbated by professors who are only capable of reading slides in a monotone voice)

3) Caffeine-induced anxiety attacks

4) A drastic increase in your use of profanity (at least in your mental dialogue; may be exacerbated by pending exams)

5) Mental hangovers aka the emotional and intellectual inability to give approximately 0 f**ks the day following exams

6) Chronic single-ness (and an inability to find anyone worth dating whose idea of a relationship doesn’t involve hooking up on a first date)

7) The appearance of speaking in tongues, especially when around non-medical family and friends

8) Rarely, students have reported weird and sudden bouts of euphoria, typically following an aha! moment, a fulfilling clinical encounter with patients, or otherwise being reminded of why you put yourself through this utter torment in the first place

Why we don’t answer medical questions online.

Why it’s bad for you:

  • We could be anyone; this is the internet, after all. You believe that anonymous internet medipeeps are doctors, but they may not be. If you don’t know someone’s name and number, can you really trust them with your health? It’s risky to trust information from unnamed and unverified sources.And that includes us!
  • You also don’t know if we have any undeclared interest in particular treatments. I might be telling you to take drug A because I’m actually working for said company.
  • Many medblrs are still medical students or very junior staff. Which means that although we know a lot about many things, we are by no means qualified to take on our own patients and offer health advice without supervision in our day job. And if we can’t do something in real life, we’re not able to do it online either.
  • We don’t get anywhere near enough information to make a decision in most anonymous health-related asks. But we can’t bring you back to ask for more information.
  • When you see your healthcare provider, a lot of things happen. They take a detailed history, including asking lots of questions about things you may not have considered to be related to your problem. It’s much harder for us to ask all the right questions if you send an anonymous ask.
  • They then they examine any body system they think is relevant. This is sometimes enough (for the kind of things we see the GP about), but often they will need to order some blood tests and occasionally further investigations.  There is a lot of information we can only get through seeing and testing you.
  • If your situation is complicated, you’ll still need to see a doctor in real life, who can do the right tests and refer you to the right speciality.And without all of the above, there is a very real chance that we may miss something that shouldn’t be missed.
  • Sometimes the only way you can diagnose something serious is with a very thorough history and examination, and the right investigations. A history may make you suspect something serious, but it never confirms it.
  • If we reassure you that you’re OK because we don’ know the whole story, you will probably put off going to the doctor, where otherwise you may well have decided to attend. This may mean that you get diagnosed and treated later. Which could have serious consequences.
  • Some topics require asking a specialist in that field, and even a trained doctor in another field may not be very helpful. A medical student or a nurse aren’t the same as a cardiologist, who is not the same as an orthopaedic surgeon.
  • Your health is important, and your concerns are real. Therefore you deserve to have the full MOT if you are seriously worried about your body, not just some anonymous person reading a few lines and telling you you’re probably OK (but should go to the doctor anyway). You are not ‘bothering the doctors’ if you get yourself checked out.

Why it’s bad for us Medblrs:

  • By answering a medical question, you’re asking us to take a certain level of responsibility for you. Both ethically and legally.
  • If we mistakenly told you your symptoms weren’t serious, but they actually were and and something bad happened to you, we would blame ourselves. Believe me medics blame themselves a lot.
  • We’re under strict legal frameworks of what we can and can’t do. And most frameworks would suggest that taking responsibility for strangers on the basis of hastily written asks would be a bad idea for all involved.
  • You could sue us because something bad happened to you, even if you neglected to metion loads of relevant symptoms. You probably wouldn’t, but there are lots of people who sue for all sorts of reasons and if we answered enough questions, we’d probably be sued eventually.
  • Bearing in mind that we don’t have to answer asks as part of our degree or job, we’d be on a shaky footing legally when it came to defending our actions. Most of us are not legally covered for it.
  • As students or juniors, we don’t take our own patients. We’re not allowed to take responsibility for the treatment of patients in different departments or under different teams, let alone random anonymous strangers online.
  • Some of us struggle with depresison and anxiety, and the stress of taking on resonsibility for someone’s health and possibly life outside of the legal framework we are comfortable working in can be triggering.
  • Nobody is obligated to work for free; and anyone with experience and training has spent a lot of time and money to get there. Answering medical questions looks suspiciously like work for free. There is a difference between someone volunteering to work for free and free work being foisted on them.
  • When we work in hospital, it’s as part of a team. We have seniors we can double-check with when we’re out of my depth or dealing with something we haven’t seen before.
  • But online we can’t exactly ask our seniors or tutors ‘This random person on Tumblr gave me an incomplete history, but can you advise?’ because they wouldn’t take responsibilty for someone who is not their patient. And that would leave us with nobody to turn to if we had questions. Which would mean worse advise for you.
  • GPs see patients alone, but they’ve had years of training on how to diagnose serious things out in the community, and when tto refer to hospital. They still refer to hospital a lot, because even they can’t find everything out by themselves.

I’m not against senior clinicians (like some of our medblrs) choosing to answer health-related asks; Anyone who is a fully trained clinician to a level deemed competent to take their on patients has every right to use their expertise in their field as they see fit. When done right, it can be useful.

But I feel it can be difficult for junior medblrs to reply to asks, and I’m worried that there’s a pressure for many of them to answer asks that they don’t feel is within their competencies at this point in time. None of you have to answer a single clinical question that relates to the asker’s health; you have a right to say that you are not yet comfortable, or trained, to do it. 

This is not about specific medblrs or specific asks; please don’t feel that you’ve done anything wrong if you’ve asked or answered such a question. I just wanted to make clear that if someone feels they shouldn’t, or can’t answer a question, it is not because they don’t care or don’t respect the person who asked it. If we tell you to see your doctor, we’re not trying to be flippant or lazy.  

(Edited the last paragraph for clarification)