I am sitting in one of the most beautiful architectural marvels I have ever seen: the iconic Rose Main Reading Room of the New York Public Library. A thoughtless turn of the head while stretching my neck and I catch a glimpse of centuries of knowledge in their primordial form — first edition journals and volumes neatly displayed in stacks of thousands. I could look up and be mesmerized by a scene that is reminiscent of a trip I once took to the Sistine Chapel in Rome, with a ceiling inlaid by golden frames sculpted around angels and flowers that adorn portraits of rose-colored clouds.
But I do not. I am instead studying for my boards and repetitively reading about Bacteroides fragilis and glycogen storage disorders. A headache builds as I enter my seventh hour of studying that day, and even then I wave the headache away as I try to recall the mechanism of how amitriptyline reduces chronic pain from tension headaches. My sandpaper eyes are forced to stay open as my ciliary muscles try to accommodate my struggle.
Indeed, studying is a struggle.
As medical students, we are no strangers to studying. To get into medical school, we must first do relatively well in undergraduate classes and receive an acceptable score on the Medical College Admission Test, or MCAT. Afterward, we continue to take exams during our preclinical and clinical years in medical school, with boards and licensing exams to follow for the rest of our careers. Indeed, between the time we enter medical school to when we emerge as attending physicians, we will have taken well over 30 exams. But my current adversary is considered one of the most important exams we take as future physicians. The first national board medical exam, Step 1, is the equivalent of the SAT to high school students. It is a strong determining factor for medical residencies and serves as one of two major quantitative measures of a candidate’s appeal — the other being clinical grades.
And so I study. I greet the sun and see past its farewell each day with my study guide in hand. Flashcards accompany my meals and walks have functionally become DVT prophylaxis rather than enjoyable excursions. I try my best to remain focused and keep what I learned three weeks ago from falling through the seemingly ever-expanding sieve that is my brain. But this is what I’m supposed to do. I’m supposed to study so I can take this test. But even as I repeat this mantra, something is off.
When I decided to come to medical school, I did so because of two broad reasons: I wanted to help others and I loved learning medicine. Just two years ago, I would gleefully read the latest articles on neuroscience or immunology in my spare time and marvel at the complexity of our bodies. I took joy in understanding how much there was to learn and loved the challenge of learning. In my mind, every opportunity to learn was a chance to become a better doctor. But while those patterns continued in medical school, my enthusiasm slowly began to temper as I found myself reading more out of obligation than enjoyment. And it was through this insidious slope that I found myself, here today in this beautiful library, woefully anticipating how much there is to still learn. Even as these thoughts continue to percolate, I remember there was once a time when I would have taken a brief pause after every new fact and whistled in appreciation.
So I stop.
I try to whistle, at least metaphorically.
I crank my head up and force these tired eyes to appreciate this library. The ceiling is truly beautiful. I turn to the history engraved to my left. Colors of aged red, mysterious blue and forest green sharpen into focus. And then, as I slowly move my field of vision back to my books, I take a deep breath. I strive to look beyond bullet points of information and recapture some of the wonder I once had. I think about the extraocular muscles I just used, the atelectasis my sigh just prevented, and the prefrontal cortex that helped me synthesize these thoughts.
Studying will always be a part of medicine. The onus is on us for why we study. There are exams, of course, and these milestones can be as much a measure of our fatigue as they are of our professional progression. But we can choose to appreciate what we learn as a privilege. We can eagerly study in anticipation of being better physicians and scientists, all while marveling in the wonderment of it all.
All we need is a reminder to take a moment and look up.
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About the Author
John Choi is a lactose intolerant medical student who believes in the power of sharing stories and regretfully loves cheese.
This is usually somewhere between the end of the first and second year of graduate school. The examiners are a committee made up of faculty members, who prepare questions on both general aspects of the student’s field of study and specific topics pertaining to the student’s thesis in order to assess their readiness to continue the bulk of their thesis research.
![quote: [The body] is the vessel that God has given souls to walk around in. Therefore, to try to keep the body as healthy as possible is itself a holy act.](https://biomedicalodyssey.blogs.hopkinsmedicine.org/files/2017/04/judaism-medicine-quote-2.jpg)
This responsibility toward the other similarly motivates Maya Siegel, a third-year medical student. When asked about how her religious beliefs influence her decision to pursue a career in medicine, Siegel responded, “Social medicine and systems of injustice affect our patients... I am also motivated by Tikkun Olam, the concept that the world was created imperfect, and we as humans are required to work to make the world better.” Compelled by the importance of tradition, ritual and community in the lives of her Jewish peers, Siegel is active in the Jewish Students Association at the Johns Hopkins University School of Medicine as well as in the local Jewish community in Baltimore.
Because these contagious behaviors are so ubiquitous, we often don’t realize what strange phenomena they are. If I were to throw a ball at you, you would instinctively flinch and cover your face, but a person standing near you would not flinch as well. Contagious itch, in contrast, occurs because visual signals from nearby peers engage numerous brain regions that then modulate connections usually reserved for direct, reflexive signaling. The root of these actions is generally attributed to “
The authors went on to apply cell-type specific targeting, which allowed them to activate and inactivate GRP+ cells using a variety of advanced molecular biology techniques. By working with mice genetically engineered to express either a light-inducible or light-repressible protein only in GRP+ neurons, the authors were able to specifically activate or inactivate only the GRP+ neurons by exposing them to a specific wavelength of light (called optogenetic manipulation). They then showed that specific activation of these neurons resulted in a significantly increased scratch response when the animal was viewing another scratching mouse, while optogenetic silencing or ablation of GRP+ neurons resulted in a significant decrease in this imitative behavior. By demonstrating both positive and negative control of this behavior through GRP+ neurons, their role is shown to be integral to contagious itch in mice.
I had never felt less prepared to talk to a patient in my life. I was running on two hours of sleep and had been out of my clinical rotations for almost 10 months; however, when someone called out for a doctor and no one moved, I stood up, knowing that a little knowledge and experience are better than none. When I reached the patient, he was completely unresponsive to the screams of his terrified wife. His head was tilted back, his jaw was slack and his eyes were rolled back into his head. Almost thirty seconds after I reached him, his eyes re-focused, and he regained consciousness, with no memory of the event. His wife explained that he had done the same thing two minutes before, which had prompted her initial cries for help.
In 2015, a group of Johns Hopkins medical students began investigating the factors that contribute to a successful outpatient educational experience for students in the neurology clerkship. They presented their 
Surprisingly, the majority of physicians (74 percent; n=32) had 42 percent more RVUs per clinic session when a medical student was in clinic, compared to the same clinic without a medical student. This increase is most likely because in the time that the student sees the patient, attending physicians can simultaneously see a second patient or finish patient notes. Furthermore, the RVUs per clinic session significantly increased as the number of patients that students interviewed, presented and documented increased.
Fortunately, Mr. M. is not in any danger because Mr. M. is a mannequin. But this is no mere plastic simulacrum. Mr. M. really does have a pulse. He has lungs that inflate to lift his chest. He can be shocked, intubated and examined for neurological deficits. Mr. M. is a $100,000 machine built for simulating emergency medicine. And he is also a forgiving instructor to green second-year medical students just learning to translate textbook medicine to the hospital bedside.
To better prepare soon-to-be third-year students for the rigors of hospital medicine, the Johns Hopkins faculty developed the Transition to Wards course. The three-week class concentrates its efforts on common early stumbling blocks faced by medical students. Students review the interpretation of frequently used diagnostic tests, revisit the principles of biomedical ethics, train in basic procedural skills and learn the steps for initial management of an acutely ill patient.
