New Series: Mexican Advertising

Ok, enough with the serious posts already before y’all think that I sit around in a corner rocking back and forth under the stress of it all. I will start a new series of things I find in local ad rags, newspapers, etc. that show interesting slices of life here, particularly those things which one would find odd coming from someplace other than Mexico.

The inaugural post is an ad for a cough medicine. Or an expectorant. I’m not sure what it is, but thankfully I don’t have to worry because the ad basically says they have me covered (English translation in the photo was added by me, not in the original).

Let’s see…honey: no medicinal qualities to speak of in terms of cough reduction. Guafenisin: no real medicinal qualities to speak of in terms of cough reduction. Decisions, decisions.

Ah but with an expectorant, when your kids do cough, it’ll be productive, so someone at Vick’s in Mexico said, “Let’s make a phlegm-enabling agent that looks like phlegm so buyers know what it’s for,” and this product was born. Do these people have something against dextromethorphan? You’ll get better results with that if you want to reduce cough, but honestly, I don’t usually see it around here. Codeine works as well, but there might be a little nipity-nip from the parents at bedtime, too.

How do you study?

One of the biggest things I’ve been thinking about lately has been study habits. This semester was supposed to be easier than last (according to students in 2nd year, partly because of classes like behavioral science and nutrition) but I have not seen it that way at all.

I am a bibliophile–I’ve collected textbooks for subjects I don’t even have and may never have, simply because they’re interesting (Half-Priced Books has taken way too much of my money), so it’s no surprise that my first study instinct is to read the textbook faithfully. Sure, I’ll skip a part that’s clearly extraneous for the interest of time (Guyton and Hall comes to mind), but some of the most rewarding time is spent just reading, highlighter in hand, marking those few items I think are important/worth going back for further review. Note the word few. One of the reasons I don’t buy as many used textbooks as I would like to is because of incomprehensible highlighting to the point where non-highlighted text is the minority. Multicolored highlighting on the same block of text is especially baffling.

In a perfect world, I would do the following:

1. Read the textbook, highlighting important points not to miss
2. Review my class notes which usually come in PowerPoint format, considering the above
3. Make my own notes, mixing the two sources
4. Use BRS or other good review book to make sure nothing important is left out
5. Review my notes
6. Make flash cards on those things which I think are necessary for memorization details
7. Further review of my notes, perhaps re-reviewing BRS
8. Look at PreTest/online quizzes/old school tests if available

If I were to follow that plan with the time I currently spend studying, I’d probably get halfway through #4 before exam time. Remember that I’d have to do this for EVERY class, and there’s really no let-up in things to be done; I’d have to essentially be near perfect with my time management to get this done, and I ain’t close to being halfway there. Basically what gets sacrificed is the review, and that’s where the real “stickiness” of the material should be. I feel I’m still going over relatively new material almost all the way up to the test instead of reviewing, mastering, and taking it “to the next level.”

I don’t have first-hand knowedge of attending any other medical school, but I have a feeling that ours is lacking in prepping us for the USMLE in terms of rigor, consistently deciding to administer tests that have already been given (in various forms) that reflect the professor’s or department’s objectives. Often times I feel compelled to do learn the material well for its own sake, make sure and focus on what I think will be on the exam to get a good grade, but at the same time not think that just because omitted from our course objectives or that it didn’t get tested on I can let it slide. All of this can make for a level of performance and expectation that basically leaves nothing out if you want to excel, and that is stressful as all hell.

So to my medstudent and recently graduated readers, how do/did you study during this time? What gave you the most return for your time, and what changes did you have to make? I’ll post again on what I think are technological advantages and obstacles in learning (ie, laptops, PDAs, Internet, etc.) for me, and see what else that uncovers.

Why I hate groups and why I’m a social outcast

I said it: I can’t stand group activities. Those people with whom I’ve worked or are working in groups that happen to be reading this, I promise it’s not personal. I just prefer working by myself or with one or two other people of my choosing, but rarely more than that, and even then, selectively. My experience has almost always been that it was not the best use of my time either because of a different academic focus/seriousness or because socially it just didn’t gel.

It’s hard being in medical school. It’s hard being in medical school in another country, away from the support system of friends and family, much less your own country/language/culture/laws etc. etc. To add salt to the wound, it’s even harder to be here in your 30s going to school with classmates in their early-to-mid 20s; the difference in attitude, perspective, maturity, *cough*energy level*cough*–it can be hard sometimes. To add lime to the salt already in the wound, I’m fat and sometimes (unbeknownst to me) hard to get to know, because a) I’m fat, and/or b) I usually get misconstrued for being upset or something like that. Sometimes (b) is naively assumed because of (a), which is a silly oversimplification, apart from not even being true. Besides, aren’t all fat people supposed to be jolly?

I never did have a lot of patience in general, and I think with age, like your telomeres, it just gets shorter and shorter; there’s nothing you can really do about it, except fight the good fight against biology and “eat it” sometimes for the sake of social decorum. I feel frustrated because I always feel I have no time, and since time is so valuable, when my time is wasted (unfortunately, a nearly daily event at school) it’s doubly frustrating, because I’m thinking not only of what isn’t being done but what COULD be done if I weren’t there. I don’t want to be one of those harried med students too busy to do the simplest things in life because they are gunning for the top grades. I do strive for a balance, a harmony, and a sense of satisfaction for a job well done. However, I have this little voice inside me that irrationally says that if I say “Good job!” or something else that is approving, then the slacking will begin, the rationalization of not having to this or that will set in because, well, “I did a good job–surely I deserve a break,” or whatever.

I often want to study with others to help keep me on my toes, to help mix up my study patterns/time somewhat, just to add variety to an otherwise slogging task, if nothing else. This desire, contrasted with the easy frustration, high standards, social awkwardness, etc. provides a constant stressful dichotomy that’s not really resolved. It expresses itself like my intense mental drive to be as good as I can be clashing with my ubiquitously expressed slacker gene over which I seem to have no control, just variable management. I seem to constantly meet/know two kinds of people: 1) people with whom I get along great, could have fun and hang out with but have differing academic standards/levels/seriousness/etc. such that I think group/tandem studying would be ineffective or unbalanced, and 2) people with whom I think group study would be mutually beneficial, academically, but are too engrossed in their own lives to really have anything left to share, time-wise, for studying. These individuals are consumed with self-study or have something else in their lives taking all their out-of-class time–something understandable like their own family or something perhaps more incompatible with my current lifestyle, like excessive partying–that prevents me getting together with them in spite of a potentially productive session. (I am, of course, ignoring the people with whom I wouldn’t get along regardless and I’m definitely not counting the ever-hated, low-yield group “We’re all meeting at so-and-sos to eat/study, come along!”) In all situations, nobody has ever asked me to study with them in a 1:1/2:1 fashion, so it’s not like I’m turning down invitations and being picky. In fact, I have asked others to join in with them but then not get asked when the time came. I’m not hurt by this, but I do wonder–is it me? I refuse to believe that anyone in my class who halfway knows me actually thinks I wouldn’t be a positive academic contribution to a study session, so I’m left to wonder, am I just too “out there” for most people? Am I intimidating, too old, smelly, boring, overly-serious…I have no idea.

All I know is that here in Mexico, you already seem like you are going through too much on your own–life in general, as well as thrown to the wolves in terms of disorganized class materials–to not have the help from friends (as opposed to the “natural” cutthroat medschool environment) sharing and supporting each other, welcoming opportunities to spread the wealth and the work. I’m trying my best to work harder and smarter, but I’m also trying to not live in a box either. It seems simultaneously studying and socializing would fit that bill perfectly; it hasn’t happened yet.

San Miguel Trip, Part 2

(continued from previous post)

We got up in the morning, grumbling there was neither coffee nor breakfast, but I smelled coffee, so I went downstairs. There was some pan dulce (sweet bread) and coffee already brewed, so I took a piece, two cups and cheerfully presented Claudia with coffee and bread, happy to start my day with SOMETHING. As you will read later, this coffee was not for us and I was essentially in blatant violation of B&B rules.

For our first day in San Miguel de Allende (San Miguel or SM for short from now on), I really just wanted to hit all we could: museum, churches, plazas, etc. It was very clear very soon that this town is several things we wouldn’t necessarily have known:

• tiny (not a bad thing)
• mountainous hilly
• impossible to drive anywhere in an extended cab truck due to streets made in the 1700s
• absolutely chock-full of Americans and other foreigners, perhaps even outnumbering the local population
• holiday weekends are taken seriously here in terms of people and activity

We found some decent parking at the top of a large hill and planned to walk downwards, but I met some Americans who spoke of a sceneic overlook further up the hill. 10 minutes and 100 beats/min HR increase later, I found nothing but more stairs and more curves, so I cursed out loud and made my way back (in the photos, you’ll see the stairs). You have to be WAY in shape to do anything long-term in this town. Sure a cab is 20 pesos anywhere you want ($2 bucks–no joke), but everybody walks. There was an 80+-year-old man I passed along the hill (yes, I passed him, thank you very much!) who was using a walking stick and carrying pan dulce back home, but that’s probably a daily thing for him, but I was a few ectopic beats away from a needing a defibrillator, walking at a 45 degree angle up the hill.

Breakfast was at Correos Cafe, across from the Post Office (correo is “mail” in Spanish), and it was far and away some of the best cafe de olla I’ve ever had. Cafe de olla is a Mexican preparation of good, strong coffee, frothed milk, cinnamon, anise and special somethings that make for a morning drink that will cure any mood. The rest of the day was simply spent walking, looking, listening, absorbing–taking the city in, going wherever the mood struck us. I’m a huge planner, but for some reason, I just didn’t plan this trip to the ‘T’ (note our driving experience). As such, I had the slight anxiety not knowing what to do, but also experienced the rare occaision of the freedom to not have pressure to do anthying in particular since I didn’t know what it was I WASN’T going to get to do/see/etc. I have to definitely do this way again. Maybe.

We saw several impromptu parades, a driving ad for a bullfight, went to the museum (which was actually a disappointment, but they don’t charge, so I’m sure it’s limited by that), walked and walked, and hung out at the town square, people watching.

Dinner was spent at a nice restaurant, and in spite of repeated bloody filet mignon when Claudia specifically asked for medium well (when a steak goes back because it’s twiching, moo-ing rare, perhaps returning a plate full of dark red blood less than 5 minutes later indicates you haven’t left the ‘rare’ stage quite yet) we were well taken care of by the manager to interesting conversation and a comped dessert of the best flan I’ve ever had. All in all a good day…

…Which is why the following morning was such a bust. I wake up in the morning at 8:00 and smelling coffee, went downstairs to get some. Buenos dias, I said to the B&B lady. She looks at me, “Yes?” “Um I just want some coffee,” I say eyeing the half-full pot.

“Breakfast is at 9:00,” she snapped. “OK,” I say slowly and deliberately, “I just want coffee.” I’m the one w/o coffee, and she seems to be the one who isn’t getting it.

“Breakfast will be served promptly at 9:00; coffee will be available then.” It took all my self-control not to just say “Whatever,” and walk over to pour myself a cup in defiance. I have never stayed at a m/hotel–and I’ve stayed in some bad ones–that didn’t at least have a coffeemaker in the room or some ready made stuff out in the lobby in a thermos dispenser if nothing else with little 6 oz cups. I’m not complaining about not getting Splenda or half-and-half–we’re talking total deprivation of the most basic element of hospitality. If I wanted rules and attitude, I’d go home and visit family. I’m on vacation here.

Long story short, I got my weak coffee at 9:00 with breakfast. We left shortly thereafter and headed back to Guanajuato (although we took the autopistas back!). I was looking forward to take pictures of the mines, mountains and churches, but traffic was so bad when we got there, it ate up most of our in-city time. We got info to go back, but next time we’re taking the bus: $157 dollars in gas and tolls could have bought us round trip bus tickets for both of us with plenty left over, and had the whole stress of the drive out of our hands.

San Miguel Trip, Part 1

Sorry for being late posting, but as soon as we got back, I had to massively study for a physio exam on cardiac physiology. I hadn’t studied pretty much anything since Thursday night, so I was a bit rusty, but I figured rusty was all it would be. It wasn’t until I was well into studying that I realized, “Hey, I don’t remember seeing that!” and other such confidence uninspiring thoughts. Sooo…..here I am, two days later, trying to catch up with everything, so this will be long, but hopefully worth it. Pull up a beer, a chair or whatever.

Friday: Halo tournament. This was a BLAST! There were I think 12 people and we were split up among 4 XBoxes (and XBox 360s for a couple of lucky classmates) in three different rooms. I learned that my ADD is alive and well, thank you, since It’s damn near impossible to keep track of 6 teammates much less them and the other team in games like Capture the Flag. Slayer, or simply, “Red team kills Blue team and vice versa” is about all I can handle. I play the hell out the single player game, but multi-player is a different animal and I often have not the stamina for watching out for everything all the time.

Saturday: WAY late start to San Miguel de Allende after dropping of Lola at J’s (Thanks again!) and tending to last-minute affairs. Traveling through Leon was mostly autopista (toll roads that are much better, comparable to US highways usually) and uneventful, and we proceeded to Guanajuato. At this point it was dark and we had a decision to make: go the “short” way on the map, through Dolores de Hidalgo but have no autopista (we had wanted it to be light still at this point) or the much longer way, but have bigger, better roads. Being already late, we opted for the former.

Mistake. I don’t know exactly how long it is to Dolores Hidalgo, but it’s about 50km and took us over an hour, since I averaged about 30 mph. The roads were so windy, I don’t think there was more than 10 second stretches that I wasn’t turning the wheel one way or the other. Add to the steep grades and oncoming rigs on a two-lane mountain road with no guardrail, and the flexor compartments of my forearms were getting an extreme isometric workout. (Bonus points for integrating info from last semester…yay me!) We finally made it through, cursing the lack of info the map gave us (the State of Guanajuato has a weird habit of posting signs that say “Welcome to City!” and it’s really another 5-6 miles before you see anything, which made us concerned we missed something) and for taking the wrong way.

When we made it into San Miguel de Allende we hit hoppin’ Saturday night traffic. I phoned my classmate and friend A. whose mom lives there I was in town and she said she’d meet us at a particular church. It took us 10 minutes to go about 8 blocks. We then took a “tortuous” route (I’m on integration fire!) looking for the colonia where the B&B was, then finally just hired a cab for us to follow. (walking distance to the center of town, my ass!) B&B lady was pissed because we arrived late and that screwed up her social plans. Um, sorry, I told you to go out and I’d call your cell…but nooooo..you wanted to do it your way. We then find out that she no longer serves bkfast on Sundays in spite of saying so on the web page. She seemed entirely unconcerned about the fact that half of B&B is BREAKFAST and anybody who knows me knows that there are two things I need in the morning: breakfast and coffee, in that order of importance (not in consumption). We were shown to our room, which was very nice, typical B&B style, except the bed was a thin mattress on a wooden box. Unfortunately, this is not atypical in this country, but after such a hard road trip, I wanted more than essentially a futon to sleep on, but my head hit the pillow and that’s all she wrote.

(continued later)

Back

I’m back, all is well — will post trip stuff later this evening when I get home. 

Mini-Vacation

Here in Mexico, there’s a holiday for Benito Juarez‘ birthday (all you need to know as a non-Mexican and/or history buff about him is Cinco de Mayo–party on) and we are getting a 4-day weekend as a result. Even though I have a physiology exam on Wednesday when we get back, I am determined to take a few days off and travel. We are going to San Miguel de Allende in the state of Guanajuato which I’ve heard is a wonderfully colonial, old-style town with lots of historic and scenic sites. Most people who are going anywhere are going to the beaches of Puerto Vallarta/Ixtapa or Manzanillo (5 and 3 hours away, respectively) but as much as I love the water, I want to take pictures and enjoy scenery.

Soo…I’ll be gone until late Monday, but I plan to write some in between and you should hear from me then. Hasta luego!

I MATCHED!!

I actually wore a shirt that went with my pants today!

Congrats to all those who matched their residency programs today and best of luck to all those involved in the scramble. I will be biting my nails in a few years, but until then I wish everyone well.

At least it’s not an essay exam

I have my wife’s sister and distant relative as houseguests this week since they are on Spring Break from the US. It’s my sister-in-law’s first time here, and they are trying to get in all they can. It’s been a bit trying because she’s loud and doesn’t really always get that I have to study. It hasn’t been that bad, and lately they’ve been keeping themselves busy, which is good since Claudia can’t really be a chauffeur across whole city either.

So the other guest, who is a public school teacher of many years (don’t know what level) asked what kind of exam I had the other day since I mentioned I had one. “Behavioral Science,” I said.
“What’s that?”
“I thought it would be like an intro to psychiatry but it’s more like basic clinical psychology — we kinda spend more time talking about definitions and theories. We set the stage to talk about clinical things but then move on to the next topic before we get anything interesting [to me, anyway].” I didn’t dare mention the movies.
“Oh. I meant what kind of test is it, like essay or multiple choice…”
“Oh, sorry. Multiple choice, definitely. Our boards are all multiple choice tests, so they’re patterned after them.”
“Oh that’s good; multiple choice tests are so much easier. At least they aren’t essay exams. I hate essays.”
(fighting urge to say, “What?!? Do you want me to show you my USMLE First Aid book? The question is practically an essay, lady!”) Showing complete decorum, I replied, “Well, actually many times I’d prefer an essay test, that way I could at least say what I knew on a topic rather than deal with being all right (20%) or all wrong (80%). A MC test can be really difficult splitting hairs with the answers.”
Not budging, she replied, “Well, I know that when I would take a MC test, if I saw a word or something that reminded me, I’d remember the answer.”
“And that is precisely the trap they lay every time,” I thought to myself. But all I said was, “Yes, it does help sometimes,” and left it at that.

People who aren’t exposed to this level of sadistically rigorous testing (I sure as hell wish I wasn’t) just won’t understand, I know better than to be haughty or defensive about it. However, it did sort of jar me back into the “real world” and made me yearn for a time in my recent past and hopefully not-too-distant future when I’m past this maniacal “prove yourself on paper” phase of my training.

Futility

Warning: rant follows.

I don’t like speaking badly about my school since 1) I obviously attend it, and 2) I don’t want to set a complaining tone on this blog or in my life in general, particularly about things I have no control over, but damnit some things here piss the living hell out of me, and since this is my blog representing at least partially some sort a “diary” for me, I have to get this off my chest…

I am appalled at our Behavioral Science course.  I shouldn’t be, because the quality of teaching here is all-too-commonly subpar, leaving one to fill in important gaps, always left to fend for one’s self with little direction, etc. but this really takes the cake.  We have a midterm on Monday and to date (which is three weeks) we have watched 3 full-length Hollywood feature films–The Doctor, I am Sam, and As Good as It Gets–in the guise of “learning,” I can only assume.  There’s no need for this. By my estimation,  maybe 50% of the class has been actual lecture, but even then it consisted mostly of reading PowerPoint slides of bad English word for word.  I’m embarassed to admit this publicly, but I have to.

I can understand watching movie clips of various types of psychopathology depicted in movies and then discussing at that moment the clinically relevant signs, but to watch an entire film over days is ridiculous.  Discussions, when they do happen, are often an incoherent free-for-all and done in groups (something else I detest) rather than being directed by the instructor.

There are, as I see it, numerous problems with using popular movies as pysc subject matter.  First, many people including myself have seen these movies already.  This means we have preconceived ideas about the characters, their problems, etc. which can significantly influence how we’d interpret their clinical signs and symptoms.  Second, movies often generalize and/or exaggerate people for artistic license and characterization.  For example, there will be someone who is obviously and unambigously narcissistic, depressed, OCD, or whatever.  Obviously, we need to learn the clear-cut before the nuanced, but viewing a clip of a videotaped clinical inteview or anonymous patient actor would be far better, in my opinion.

I am also ever-frustrated at having to deal with mandatory attendance for our lectures.  Look, if you need me to be there for whatever bullshit reason (they claim it’s because of US Dept of Education regulations yet no one in the history of time has ever been able to prove/quote anything to that effect from the US side), fine; I’ll play your game and show up, and I’ll actually listen and learn when/if the lecture helps me.  Regardless of whether or not I’m furiously scribbling class notes (don’t get me started on lack of scribing–”Why have it when we have to be there anyway?”  Grrr…) or playing with a MySQL database, I keep to myself and don’t bother anyone, respecting those around me.

Why then does a professor say, “Look, those of you not paying attention: if you aren’t going to be listening just leave,” knowing we are a captive audience?  Either let us go without penalty or mind your own fracking business what I’m doing.  I find most of the lectures to be too slow anyway and lose interest quickly after, oh I don’t know, the 3rd example or after about 10-15 minutes of PowerPoint dictation.  It’s hard to pay attention when there’s often so little substance with which to do so.

Let me be clear about something: I am making a huge distinction between the pace of an individual lecture and the pace of a course.  I may be unchallenged for about an hour or so, once I “get it” early on, but that is not the same thing as truly mastering the material with full knowledge of the subject matter; I still gotta pay my dues and study diligently if I want to excel. If I slack off for even a couple of days (see my “Halo” post a few days ago) I’ll feel that need to catch up really quickly so as not to get unmanageably behind.  In fact, I think the strongest argument for shortening the classes is because often the 2nd half or about 50% overall of most courses is repetative or not strongly pertinent to the most important objectives.  If we really do have to be in every class two hours, I’d love a format where the 1st half is lecture and the 2nd half is problem solving/application/pertinent, well-moderated discussion with a breadth of easier and more challenging problems/issues.

Or that’s the way I’d do it.  Change in any institution is hard, but here in Mexico’s patriarchal, old-school mentality, progressive ideas are shot down for the sole reason of “That’s not the way it’s done”/”When I was in school….” Oh well, I can dream, and sometimes that’s all I feel I have to keep me going.