Medical School Highlights: Year Three

Photo by  Hush Naidoo  on  Unsplash

Photo by Hush Naidoo on Unsplash

Master’s Degree? Done.

Amazing birth apprenticeship? Check.

Boards? T-6 days.

Year three of medical school ended with a flourish. This year was like sitting in a rollercoaster waiting for it to reach the top of the first big drop. I am more than half way done with my medical education! I’ve been a student in higher ed for seven years now, and I only have two years left. It really is all down hill from here.

My time in the classroom is coming to a swift end. This coming year I will be completing the remaining block courses—the bulk of my didactic education—this coming year. For the next two years, I will be working on the natural childbirth class series and will complete a couple business and medical law classes. But that’s it. I really can list off what’s left, and it’s starting to feel like a short list!

Highlight #1: Clinical Nutrition Internship

One of the requirements for my master’s degree was completing an internship. I really lucked out by getting placed with a certified nutrition specialist (CNS) who works out of a physician’s office. When I wasn’t with the nutritionist, I hung out with one of the doctors and was able to obtain valuable preceptorship experience too. The best part of the internship was creating and teaching an evening class on addressing cholesterol through food choices. I didn't realize that I really like teaching until I sat down with the participants and started talking. It made me realize that community classes are a great way to engage and make a little cash on the side. And the wheels in my head started turning…

Highlight #2: objective structured clinical examination 1 (OSCE 1)

Prior to entering the clinics as a secondary medical intern, you have to pass OSCE 1. These exams are known by a couple different names, and every medical student takes them (even veterinary schools have similar exams!). On exam day, I packed a clipboard and my white coat down to OHSU and waited in a long hallway with a dozen of my classmates. When the speaker overhead (the voice of god, we laughingly say) gave the go-head, we each stepped into an exam room to meet our patients under the supervision of cameras bolted to the ceiling. We only learn the chief complaint (the reason for the visit) five minutes ahead of the start time, so studying entailed going through dozens and dozens and dozens of common, urgent, and emergent primary care complaints and practicing related physical exams.

It was terrifying. But only initially. The fear slipped away quickly, and it felt like an every day, no big deal visit. I got excellent feedback from my standardized patient (who said she couldn’t tell I was nervous) and my proctors (both of the deans of my program). The experience definitely showed me areas to improve, because, hello, still a student—but it showed me that yep, I can do this, and I have the potential to be really good at this. I like feeling like I am in the right place.

Highlight #3: First Secondary Rotation

I was placed at NUNM’s other primary care facility in Beaverton. It’s a lot smaller than the main clinic and feels more like a regular doctor’s office because there’s only one shift on at a time. Multiple appointments still occur at once and every thing is going 100 mph, but that is what makes it fun. And it’s primary care, so you never really know what’s going to present in office.

I was only one of two secondary interns and the primaries often had their hands full, so there were times when I got to jump into a primary role and run a visit. The team was a perfect constellation of funny personalities and smarty-pants minds, and I could not have had a better experience. Clinic is where the magic happens and the thousands of hours in the classroom finally pay off.

Highlight #4: Family Medicine Preceptorship

Spring term was probably the most loaded, panic-inducing, busiest term I have ever had. It started off really rocky. I found out that I was three elective credits short to complete my master’s degree, due to a massive miscommunication about how electives work as a dual student. But I was absolutely going to finish that degree in spring 2019. Ultimately though, I was taking too many classes, and I will never ever ever ever do that again.

However, I was blessed this spring term and landed a preceptorship with an ND midwife in Gresham. I got to observe a steady stream of primary care and pediatric patients in a beautiful, multidisciplinary clinic. Sometimes it’s really hard to describe what it feels like to be a student doctor, when literally every little thing is interesting and important, but I think it’s sometimes like eagerly drinking out of a 5000 gallon cup while surrounded by the best, most delicious foods you have ever seen and you’re drinking the best drink you’ve ever tasted but you know you have to eat the food and then you’re worried you won’t finish and every thing may or may not be on fire? (The fire is stress, FYI.)

This preceptorship was amazing, and I am so thankful the doctor entertained all of my questions, even the extraneous ones. I was enjoying drinking out of the 5000 gallon cup. There is so much to know. Even as I progress through the ND curriculum and learn more and more—it’s a pittance compared to what is learned through years of clinical practice. Experienced doctors and patients who are willing to share their time with us students are so valuable to medical education.

The well child visits were my favorites, especially the ones for children that she delivered. Naturopathic midwifery is so special compared to other disciplines. Not only do you get to catch the babies, but you get to watch them grow up and take care of the family too.

Highlight #5: Mental Health Education

Two of the classes I took this spring were the Psychology and Mental Health block and a class on eating disorders and intuitive eating. I have always been fascinated by psychology and loved diving into it and seeing how mental health plays a key role in pretty much every physical health outcome. Mental health is an arena where naturopathic medicine can really shine too, because there are so many validated, evidence based, non-pharmacological treatments available, many of which naturopathic physicians are specifically trained to do. A physician I admire once told me that I should absolutely strive to be comfortable managing and treating depression and anxiety—regardless of whether or not I do primary care—because they are so incredibly common.

Food relationships and eating disorders made an interesting bridge between mental health and nutrition, because, based on what I know now, disordered eating habits and broken food relationships abound, similar to anxiety and depression .Taking a course on eating disorders provided my other “a-ha!” moment. I really care about seeing people heal their relationships with food because the way we feel about food and our bodies seeps into every other part of our lives. For now, I am not sure if I would ever want to provided medical management for an active eating disorder. I believe that should be left to people who specialize in treating eating disorders. But I think I could be an eating disorder informed practitioner—someone who could recognize the need for a specialist referral and know how to not trigger a relapse. It’s going to take more time and education, but I would like to achieve that.

Year fourth started the first week of July for me. I was scheduled to begin my birth apprenticeship in September, but the medical center had a student schedule change and asked me to start July 2nd. I didn’t even think I was going to get this apprenticeship in the first place. I feel so blessed to be there. The doctors are incredible, and naturopathic midwifery feels like it’s where I need to be.

Some of the big events for year four, starting this summer:

  1. Attending births, lots of them

  2. I will be taking nutrition counseling clients. That’s right—I started a business! I’m tying up some loose ends after I take boards, but I should be ready at the end of August or the beginning of September.

  3. Minor surgery, pediatrics, and IV therapy blocks (heck yeah)

  4. Launching an online nutrition education course (fingers crossed). I’ll probably release details in a couple months. I will need alpha and beta testers!

  5. Integrative primary care/mental health rotation at Pacific University’s student health center

  6. OSCE 2, the primary intern entrance exam