21 June 2013

Inactive Crohnie

I had a colonoscopy on Monday and was told that as far as the doctor could tell I had no active disease! Woot Woot! Of course, the doctor said this right before he told me that the scar tissue around my ileocecal valve is so bad that he couldn't even take the scope in my ileum where Crohn's resides. My nurse informed me before my exam that I would get pictures from the procedure, which I could post on Instagram at my discretion. Hmm.. tempted, but I would feel a bit scandalous putting a picture of my bare gut on the Internet. So instead of a picture of my scarred ic valve, you get to see an image of the poster I stared at as I waited for my procedure to start.

No active disease make this girl very happy! The only set back now is that despite having no active Crohns in my visable intestines, I continue to experience weird symptoms (nausea, fatigue, bloating, pain). Without getting into too much detail, I've traced these strange symptoms to my diet, with sugars being the biggest culprit.

This discovery spurred investigation into various diets - Candida diet, The Maker's Diet, paleo, clean, raw, you name it. Basic principles to follow:
1. Refined sugars are not good for your gut and are likely the cause for many modern diseases.
2. Be careful with grains and starchy foods (how you're careful depends on the diet).
3. Drink plenty of water.
4. If you're experiencing crazy symptoms, you may need to eat very very basic/clean for a couple weeks in order to normalize your blood sugar level and gut flora.
5. No one will want to come over to your house for dinner (especially dessert) during that time.
6. Most of the diet is temporary, but some basic principles may, out of necessity, turn into habits.

Good thing my husband is doing his first rotation on the coast! I'm sending my entire home inventory of sugar-laced food for him to snack on while I attempt to jump start this diet process in his absence. At that point I will be challenged with not breaking my diet at work and in my spare time discovering a way to reverse scarring.

17 June 2013

How is the USMLE Step 1 Scored?

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I mentioned earlier this month that my second year med school student is studying intensely for his board exams to be taken before he starts rotations at the end of June. Test day has already arrived for fellow students, and we have heard some dejected reports. I know these students - they are incredibly smart, have studied for many long hours, and proven on practice exams that their study plans were helpful. These are students that are getting honors in classes at Western University - COMP NW. I was more than surprised to hear them say that the board exam was so hard they were sure they had failed. Besides making us nervous, it made me think that the scoring of the exam must not be simple (example of complicated: GMAT scoring algorithm).

Its not simple! The USMLE Step 1 is a test sponsored by the National Board of Medical Examiners (NBME). The board exam consists of 322 multiple choice questions taken over an 8 hour time frame. The final score is shown as a three digit number with the maximum score on the Step1 being 300. According to the sources I referenced, it is impossible to get above a 295. A passing score is around 188 (passing score changes periodically), but students typically aim high for 245. The NBME isn't clear on how the exams are scored, but from my research it is clear it is not based solely on the number of questions answered correctly. From what I read, the exams may be scored based on how you compare with other test takers' performance in the three months prior to your exam. Since each test is comprised of different questions, NBME uses "equating" in the final scoring in order to make sure score results are comparable for students across the country.

Are you confused yet? Yeah, me too! The main fact I discovered is that the exam is so difficult it is NOT uncommon for students to leave the exam feeling like they have completely bombed it. I've heard mention of double negatives and purposeful trickery in question wording. One former medical student wrote that of the seven exam sections, the anatomy section was so advanced that many currently practicing surgeons would be surprised with the content.

These facts were only a slight relief, if that, to my med student husband. It was however, immensely relieving for me! Test scores take three to four weeks to be announced, so I would rather spend that whole time temporarily relieved. Regardless, I remain positive that my med student will perform to the best of his abilities, and we will have an adventure no matter his scores. Not to mention a Man of Steel movie celebration when he's done!

USMLE Outline of Step 1 Exam
USMLE forum discussion from 2008
National Board of Medical Examiners
USMLE Frequently Asked Questions
More recent forum discussion

10 June 2013

Just in Time to Save the World

I'm taking a final exam tonight! This semester in my MBA I took a supply chain management class. The professor's focus was teaching us how to think as a manager of a supply chain. Rather than memorizing various theories and SCM terms, we reviewed international case studies, best practices, and read articles describing what good supply chains look like. I typically associate SCM with manufacturing products - hard labor and the machines that make it easier. The average CEO has now deemed me naïve, as I am beginning to realize that supply chain management is more about efficiency and logistics which can be applied to all businesses and services.

In our class, we had many discussions about a for-profit company's role in social and environmental accountability as well as sustainable resources. Because of public demand and an understanding that future resources means future profits, the business world is paying more attention to this topic. It was interesting to read about how the whole supply chain (even the distant second cousin supplier) will take initiative to improve the quality of the product or ensure a sustainable future, like in this food safety example (link) or this response to a disaster (link).

As discussed in the linked article about the disaster, more companies are moving to just-in-time distribution, meaning they keep little inventory on hand in order to reduce waste and overhead cost of keeping a safety stock. In order to be successful in this, companies must have a vast network of trusted suppliers, and sometimes parallel suppliers providing the same cog in your product to hedge risk. This network is often outsourced overseas, to the disappointment of many.  But Thomas Friedman, author of the book The World is Flat, has found that these international supplier networks improve international standards of living, require trust and commitment from the entire chain, and thus keep the countries of these networked countries out of war. He calls it, in his book, the Dell Theory of Conflict Prevention and says this:
All this makes SCM more intriguing to me and I'm now looking into how SCM relates to the non-profit world, like in this article (link). I would love the help if you have ideas! I'm also curious what best purchasing practices are when it comes to extreme couponers, because I would love to see my product of choice on the shelf more often. Haven't been able to find any articles on that yet.

07 June 2013

2013 Strawberry Festival Parade

Lebanon, Oregon has a few things going for it, including the Strawberry Festival which takes place the first full weekend in June. Each year the Strawberry Festival is centered around a theme. I remember our first summer in Lebanon the theme was Strawberries in Paradise, which featured more than one float with a gambling theme (pair of dice...). You are going to smile at this year's festival theme - it was "Strawberries of the Round Table." I'm not sure who was inspired with the knowledge that strawberries were a favorite treat of King Arthur, but the participants in the parade should be rewarded for their creativity with the theme!

In fact, it's hard to choose a favorite. There was the knight riding a bike, trailing his captured dragon friend. I was pleased that the Boys and Girls Club won first place for their float featuring animated strawberries... as knights... battling a realistic animated dragon. Seriously impressive! There was also some parade features with no aparent relation to the round table, such as an electric guitar weilding viking, square dancers, and pirates.

I only stayed for the first half of the parade (it is a LONG LONG parade, and was a hot day!), but I was thoroughly entertained. Another successful celebration of strawberries, Lebanon!

03 June 2013

Med School Update: Step 1 Prep

If you've found yourself thinking recently, "I wonder what Scott is doing..." keep this picture in your mind.

This needs to be documented. I really didn't think it was possible, but Scott is indeed studying more for his board exams that he ever did for each of his courses. Scott likes to say this emphatically, mentioning that he also thinks he's learning more through board study than he ever did in his classes. I'm not sure that is the best addition to that sentence.

Board exams are crucial (though I generally like to downplay this fact when I'm talking to Scott so as not to amplify the pressure)! Osteopathic medical students typically take two different board exams between their second and third years, the USMLE Step 1 and COMLEX Level 1. Students must pass the board exam in order to move on to clinical rotations with hospitals and clinics. Even more than that, these first board exams will determine your residency options (insert pressure here). This first board exam score is one of the largest factors that residencies consider, even more so than grades from the first two years or your second boards taken after the third year.

So this relaxed image of Scott with his computer, study guides, and snack of choice really isn't unusual for the month of May. In fact, he posted this picture to his Facebook and he received comments from student friends like, "That's me, except with a bag of milano cookies." Here are some board exam resources we are aware of:

  • Doctors In Training (DIT)- a scheduled study course that Scott purchased in order to improve exam scores. Scott bases his whole day off what DIT recommends he review that day.
  • USMLE World Step 1 QBank- a question bank that was provided by Western University COMP-NW to Scott and all of it's students
  • Acland's Anatomy- a series of videos that review human anatomy and function
  • Pathoma- an online video subscription discussing pathology
  • Kaplan Step 1 course- Western University COMP-NW purchased the microbiology and pharm sections of this course for their students
  • Picmonic- Scott purchased temporary access to this tool of lovely mnemonics that help med students remember diseases by way of their photographic memories
  • Study with Substance P- audio files created by a now resident describing what is important to know for Step 1

That said, here is a day in the life of Scott from May until the end of June when rotations begin (excluding Sundays):

7:30 Am     Wake up and take USMLE World quiz, 25 questions
8:30 Am     Eat breakfast while watching hours of DIT videos
12:30 Pm   Eat lunch and take another USMLE World quiz over DIT subject matter
2:15 Pm     Go to the gym during PTI (SportsCenter, of course), with study resource for multi-tasking
3:00 Pm     Observe and Serve (Scott insisted I include his daily act of service for me. Today=dishes)
3:30 Pm     Hours and hours of videos, trying to break up the monotony, but continuing on one system
6:00 Pm     Katie time eating dinner, playing Ticket to Ride on the iPad, and reading scriptures
8:00 Pm     Picmonic study
10:00 Pm   Kaplan videos to review microbiology and make flashcards, until he's too tired to see

Method to determine the effectiveness of Scott's schedule - test scores. COMP NW hosted a practice exam on Tuesday this week and Scott more than passed. A nice feeling, for sure! We will be sure to update when exams and subsequent celebrations are over.