Boonshoft Blogs

For the Patient
Nivine El-Hor ’18
January 3, 2018

My fourth year began with my one month Sub-Internship (Sub-I) in the adult Intensive Care Unit (ICU). For those unfamiliar, as sub-I’s, fourth year medical students are typically given similar responsibilities as an intern (first year resident) in acting as the primary provider and communicator for their patients. This invaluable experience helps medical students enhance critical thinking and decision-making before entering residency, because it allows students to participate in all aspects of care including: evaluating, examining, diagnosing, treating, and managing the patient (of course with supervision).

I had been in the ICU a few times on clerkships during 3rd year for a few of our patients for extra monitoring, and had come to form my own assumptions that it was an intimidating place filled with lots of machines, chaos, and irreversible sickness. The view I had painted was one of fear, exhaustion, and sadness. However, like most things in life, you never know what something is truly like until you experience it. I admit that some of the ways I had envisioned the ICU were inescapable and true. However, once I learned how the ICU operated and understood how tough situations and complex decisions were thought out and managed in a piece by piece manner, my perspectives about this part of the hospital significantly changed and this ended up being one of my favorite rotations to date.

In the ICU, I saw the delicate tug between fragility and resilience in patients. The individuals on these units are often very sick, fighting for their lives. It is remarkable to see patients who you thought were not going to make it, suddenly improve after caring for them for weeks, creating a truly joyful moment for both the medical team and the family. Unfortunately, there were also many patients who did not make it despite our best efforts. However, as a team we had the privilege of caring for and providing comfort until the end to allow them to pass in peace and with dignity.

I saw first hand the difficulties in sometimes separating emotions from clinical medicine when trying to make decisions. This highlighted the significance of communication and transparency with patients, their families, and within medical teams to allow patients to live the end of their lives in the most comfortable way possible based on their morals, beliefs, values, and what matters most to them.

I came to realize the ICU embodies qualities of a patient and family centered environment. For those patients who are unable to voice their choices of medical care, family members become integral members of the team by giving input about their loved one’s perceived wishes (or what they think the patient would have wanted), which helps guide our decisions regarding how much or how little intervention to proceed with. Open communication with the family plays an important role because that allows the family to build a more trusting relationship with the team. This then translates into better patient care because the family is more comfortable and better able to make decisions about what is best for the patient, which can sometimes mean using minimal intervention to sustain life and keep the patient comfortable near the end.

Families coming together to make decisions on behalf of their loved ones at the end of life placed me in unfamiliar and uncomfortable situations, yet allowed me to realize the importance of these intimate, tough conversations. As medical students in the first two years, our focus is learning how to diagnose, maintain health, and treat. Rarely are we taught about end-of-life topics in the pre-clinical years and the ethical and complicated dilemmas that tend to come with such situations. Exposure to these clinical situations occurs during clerkships. At first it is hard to let go of the mindset that we should use all the tools at our disposal to sustain life, rather than accept that in some scenarios additional medical interventions may be futile and cause more harm than good, especially when the intervention will not change the outcome or prognosis and further hinder quality of life.

In addition to the medical treatment, this rotation further emphasized the equal importance in compassionately supporting, comforting, and being there for the patient and their family members. Even if medically nothing else can be or should be done, listening, empathizing, caring, spending time with the patient, hearing stories from family members and investing in the patient beyond illness can create a sense of healing.

The fast-paced, dynamic, busy environment of the ICU kept me on my toes. Constant learning, partaking in family discussions with our team and other sub-specialists, observing and performing procedures, understanding how ultrasound aids in diagnosing and decision-making, and having the support of the palliative care team allowed for an intense, rewarding experience.

Year 3 Reflections
Nivine El-Hor ’18
September 6, 2017

Third year was: life-changing. Through a yearlong journey of self-reflection, I learned both a great deal about the art of medicine and myself.

Below are some things I learned during my third year of medical school:

1.  Embrace uncertainty.

2.  Don’t stand idle during any rotation--jump in whenever you’re allowed to…there’s no harm in asking to participate, because more often than not the answer will be, yes!

3.  Pay attention to techniques--there is something to be learned from every resident and attending you work with.

4.  Seek and say yes to opportunities during rotations--it may be the first and last time you ever do or see something as a medical student and future doctor. 

5.  Give thanks and appreciation to those that teach you. The foundation of what we know is shaped, in part, by the pre-clinical years and the foundation of how we practice is shaped by the residents, attendings, and patients we interacted with during third year who dedicated their time to teach and guide us. 

6.  Build confidence, it’s a process.

7. Learn from your classmates.

8.  Keep an open mind. You might surprise yourself.

9.  You know more than you think, but you also don’t know everything so take every moment as a learning opportunity. That’s why we’re lifelong learners.

10. Take interest…it goes a long ways.

11.  Be mindful of your classmates’ chosen specialties! Just because their choice isn’t right for you, doesn’t mean it’s not right for them. We need doctors from all fields to take care of people.

12.  Efficiency will come with time, but you have to “master” the rules before you can “break” them.

13.  With practice comes ease.

14.  Get ready to discover new things about yourself, and grow in ways you never expected! 

Miracles are Born
Nivine El-Hor ’18
September 1, 2017

I completed my final rotation of third year with Obstetrics/Gynecology (Ob/Gyn), which felt, by far, the quickest clerkship of the year, perhaps due to the fast-paced nature of the field. I’ve enjoyed aspects of all my rotations this past year, and pleasantly found Ob/Gyn to be a wonderful mix of all the rotations combined. I found it rewarding to spend two months on services dedicated to women’s health. 

My experience began with two-weeks on the Gynecology-Oncology service. Having just finished surgery, I felt comfortable in the OR; however, about 95% of the surgeries were robotic, a contrast to my prior rotation. I saw first-hand how satisfying this sub-specialty can be through its impactful improvement in the health of women, yet also witnessed the difficult conversations and heartbreaking nature of this field.

I then moved on to a private practice for two weeks, a great experience from the hours, to the learning, to the patient interactions. Jumping from gynecology to obstetrics throughout the day kept things interesting and interactive, and allowed me to see the integrative aspects of both fields side by side. Sometimes in the morning we’d be delivering babies and doing hysterectomies, and then in the afternoon we’d be in the office managing acute, follow-up, and emergency visits. There was never a dull moment given the daily flexibility and action.

Following outpatient, I headed to Labor and Delivery (L&D) for one month. As a high school student, I had the opportunity to observe a few deliveries through a program at my school, which were defining moments in confirming my desire to go to medical school. As a result, I had been particularly looking forward to this rotation since first year, and found it both humbling and just as fascinating, if not more, to experience it on the other side as a medical student.

When L&D got busy, it got busy and intense. It was often a mix of emotions in one day from the happy, sad, and in-between. The opportunity to assist in births was the highlight of the rotation and partaking in those moments were truly beautiful experiences. I saw a lot of high-risk situations necessitating immediate action and saw how different teams effectively worked together to manage and coordinate care for both mother and baby during those stressful, vulnerable times. Overall, I got to dabble in various aspects of Ob/Gyn and had a great time!

Last, but not least, on to…The Final Year! :)

Unexpected
Nivine El-Hor ’18
May 30, 2017

The end is near-I’ve officially completed 5 out of my 6 core rotations! I recently finished my surgery rotation and I’m shocked by how much I enjoyed it, given my fear and worry about it before even beginning third year. I learned so much, worked with fantastic residents and attendings, and had an overall great time. Up until my surgery rotation, the operating room was somewhat of an unfamiliar, mysterious territory, and immersing myself in this experience left me more knowledgeable and comfortable with surgery concepts, management, and diagnosis.

My rotation started with a two-week orthopedic sub-specialty elective. I learned quite a bit of useful skills during my time there that helped with the rest of my rotation in the weeks to come, such as surgical knot tying. I saw hip and knee replacements, carpal tunnel releases, hand surgeries, lots of joint injections, and much more. I hadn’t realized the scope and breadth of orthopedics, and I gained an appreciation of the field after my brief immersion in it.

My next stop--two weeks of trauma surgery. This was by far the most demanding part of my rotation, especially the very early to late hours (and where I experienced my first 24 hr on-call shift). I participated in the synchronous chaos of admitting, stabilizing, and working up an individual experiencing some kind of trauma or coming in with an acute indication for emergency surgery. Here I learned two important things: always wear your seatbelt and eat fiber to help keep the colon healthy.

I ended my rotation with 4 weeks of general surgery. I participated in a variety of different surgeries and had opportunities to jump into vascular, cardiothoracic, ENT, bariatric, surgical oncology, and reconstructive plastic surgery cases. All year, I was used to seeing and diagnosing things from outside the body, speculating what was going on inside. This rotation allowed me to literally feel pathologies and diagnoses from the inside, giving me a tangible view and putting me in even more awe of the complexities of the human body. The intimacy of feeling a beating heart against my palm, remembering the feeling of atherosclerosis pinched between my fingers, and holding a malignant tumor in my hand are sensations and experiences I will carry with me forever.

I didn’t think I’d like the tactile nature of this field; however, with practice comes ease, and everyday I was pushed out of my comfort zone. By the end, I enjoyed being “hands-on” by helping with procedures, suturing, and much more. Surgery can place an individual in a vulnerable position, but I saw how patients gave their utmost trust to their surgeons, reminding me it is a privilege to practice medicine and participate in patient care. The idea of opening someone up can be unsettling, but this rotation gave me a different perspective into how pain can be alleviated, how suffering can be diminished, and how illness can be cured through surgery.

Despite my mixed feelings prior to this rotation, feeling the most sleep-deprived and exhausted I’ve ever been during the rotation (combination of long hours and unpredictability); I certainly surprised myself after the rotation by enjoying surgery as much as I did. I’m thankful there are people out there that dedicate their lives to this important, rewarding field.

Last, but not least, onto…

Obstetrics/Gynecology! 

Butterflies in your Ears and Fruit Loops in your Belly
Nivine El-Hor ’18
February 28, 2017

Four rotations down-wow! Pediatrics finished up on Friday and I had a great experience interacting with both the kiddos and parents :) This was an 8-week rotation split between inpatient and outpatient. I had inpatient first, and started off my first 4 days of it on night shift at Dayton Children’s, which was really fun (despite the difficulty to stay awake once it hit 3am…even with the hourly snack consumption :P). I absolutely loved taking admissions down in the ER and working up patients, which reminded me of how much I enjoyed that aspect in internal medicine as well. From neck abscesses, to infantile seizures, pyelonephritis, and RSV, a variety of things were to be seen during the middle of the night.

A week later, I joined the inpatient day team. Pediatric pathology is so diverse and it was challenging, yet interesting to learn about and manage illnesses through a pediatric lens after having spent the first two years and most of 3rd year learning adult medicine. Kids tend to bounce back fairly quickly and it was nice seeing them get better after a short stay in the hospital. Pediatric rounds were so different than I’ve ever done them before because they were patient-centered rounds. This means we presented how the patient was doing, what we thought was going on, and gave a plan moving forward at the bedside. This is helpful for families and patients because it allows them to actively participate with us and ask questions during rounds to provide the best care.

Four weeks later, I began my outpatient rotation at the Wright-Patterson Air Force Base (WPAFB). As a civilian, it was a neat opportunity to rotate here and I had a great time, as there was ample opportunity to engage in different experiences. I spent the majority of my time doing general outpatient, which allowed me to become more comfortable in tailoring my interview and physical exam skills to the pediatric world. I spent a few days in the nursery, which gave me a preview into Ob/Gyn because the pediatric nursery team was typically in the delivery room. It was incredible how much variation I experienced in one day sometimes, from labor and delivery, to circumcisions, to neonatal resuscitation, to acute outpatient visits and well-child checks. I also had the opportunity to work with pediatric dermatologists, cardiologists, neurologists, and endocrinologists while on my outpatient rotation, which provided an overall well-rounded experience.

I learned a tremendous amount during this rotation (mostly new information, some trickles of old), got to see pathologies in the clinical setting I’ve only read about in textbooks, and confirmed my desire to work with children and families in some capacity. Pediatric patients are a special population…they add joy and happiness to the day with their smiles, silly actions, and cute conversation.

This rotation was topped off with a nice study-free weekend of cooking/baking, watching movies, hanging out with friends, and relaxing before the next stop….

Surgery!  

Halfway to go!
Nivine El-Hor ’18
January 26, 2017

What a semester it has been - I’ve officially completed half of 3rd year! After internal medicine came family medicine (FM) and then psychiatry. The transition felt particularly smooth because internal medicine (IM) laid the foundation for all to come, which allowed me to fine tune and add to my expanding medical knowledge in my subsequent rotations.

Although quite similar, unique differences between IM and FM definitely stood out. The biggest change was the 100% outpatient experience in family, as compared to the almost 100% hospital experience in IM. My placement was at the FQHC outpatient residency site, where I had the opportunity to work one-on-one alongside most of the FM residents. Although working with a different resident each day presented its own challenges, I enjoyed this method because I learned how to approach the same medical problem or procedure through different angles and styles.

I found the fun and rewarding aspects of FM to be continuity of care. I saw several of the same patients get better over a few weeks, and patients we admitted to the hospital directly from outpatient, I happened to see the next day on a one-day FM inpatient rotation.

FM has quite a few procedural aspects and I was fortunate to have attendings and residents who encouraged my participation so I could get the full hands-on-experience. Pelvic exams, suspicious mole and skin tag removals, and giving flu shots pushed me out of my comfort zone but in the end made me more comfortable in how to perform them. Although fast paced, family medicine highlighted the importance of getting to know and understand patients beyond their medical problems and into the social realms, which is something I value and want to integrate into my future medical career no matter which specialty I end up going into.

Family Medicine gave me a slight preview into mental health and was a nice segue into my third rotation...psychiatry! I enjoyed it quite a bit, and was lucky to experience the inpatient, consultation, and outpatient aspects of this field. My favorite was inpatient as I found it tremendously rewarding, intriguing, and exciting. I appreciated the amount of time I had to converse with patients (sometimes two hours!) which helped me get to know and help them better over several days. It was quite remarkable to see patients improve over a period of days to weeks via inpatient group activities, interventions, and medication adjustments. The psychiatry rotation further reinforced that taking care of and healing the mind enhances every aspect of one’s life, both medical and non-medical alike.

Three rotations down, and three more to go!

On to Pediatrics! 

The Clinical Journey Begins!
Nivine El-Hor ’18
October 11, 2016

I recently finished up my first rotation—Internal Medicine (IM). Of all the rotations this year, this one is by far the longest…three whole months!

I have to admit the transition between second year/step 1 study period to the start of clinical rotations had its natural hardships. Getting used to the typical nature/pace of what real life medicine is like (rather than passively reading from a textbook), figuring out when to study (and wishing for more time to do so), (even more) lack of sleep, and learning/navigating the hospital system and understanding my role within it wasn’t easy at first. It all definitely took time and patience to get used to, making me reminisce about second year and wanting to go back, but now I can wholeheartedly say (coming from a person who enjoyed the first two years of med school)…third year is even better, especially once you get used to how things work (until you switch rotations again :P).

I began my clinical journey on the general inpatient hospital service for four weeks, moved on to inpatient neurology for two weeks, jumped to inpatient cardiology for two weeks, went back to general inpatient for two weeks, and ended with general outpatient for two weeks. I had humbling patient experiences, and residents that challenged me in ways that allowed me to become more confident in my opinions about diagnoses and plans, making me feel like a part of the team.

Although my brain was stuffed with step 1 information, I found myself frustrated by not knowing a lot of clinical knowledge (I guess that’s the point of M3 year), but I eventually learned the importance of “time” in medicine…each day you know more “clinical pearls,” random facts, and guidelines than you did yesterday…the learning continuum. Each year in medical education has its time and place for a reason, and remembering I was an M3, not a third year resident helped keep things in perspective. A wise resident once told me, “ Don’t worry—I have six years on you, that’s a long time in medicine!”

I enjoyed inpatient very much; something I never thought would happen. It was exciting to be on-call, and enjoyable to piece together and ponder clinical information to put a diagnosis together. As a clinical student, I now better appreciate the human body as “one” and integrated rather than merely separate organ systems. Internal medicine gave me a glimpse of medicine I’d never experienced before, and exposed me to clinical situations marked by moments of frustration, happiness, sadness, and everything in between.

Now…on to Family Medicine!

Year 2 Reflections
Nivine El-Hor ’18
August 25, 2016

Someone once told me, “Second year goes by like the snap of a finger.” It couldn’t have been truer. Many things happened in so little time. Challenges, obstacles, enjoyable, fun moments, and lots of learning pretty much sum it up for me.

Below are some things I learned during my second year of medical school:

  1. Everything makes more sense. Even your notes from first year (so use them!)
  2. Sometimes things don’t work out the way you want them to or don’t work out at all. It’s OK. Learn from it and be better next time.
  3. Family and friends will seek you out even more for questions and concerns. You will “try” to answer them by flipping through your textbooks as you chat on the phone and end up diagnosing them with things they don’t actually have.
  4. Seek help. Seek advice. Seek mentorship. Don’t be afraid to do so.
  5. Put yourself out there and get out of your comfort zone.
  6. You WILL have time, especially if you continue working on time management.
  7. It’s more enjoyable than first year.
  8. Be involved in extracurricular activities you’re passionate about because time is limited and you want to spend it well.
  9. Find what you’re interested in outside of studying and don’t be afraid to try new things.
  10. Make time for your health. It really makes a difference.
  11. Keep moving and don’t look back.
  12. Try not to overly worry about the things you can’t control/wait until it’s time to do so.
  13. Agonizing over STEP 1 is not necessary because as you are studying for your main classes you’re technically studying for STEP 1! Turns out the third years were right when they said it was too soon to start freaking out about STEP 1 at the beginning of second year… 3 months before the school year ends and study period starts is a different story though :P 
  14. It will be over before you know it. Literally. And you will think to yourself “I guess it really wasn’t that bad after all.”

 

The Good Things
Nivine El-Hor ’18
January 16, 2016

Nivine-1.pngI have no idea where the time has gone, let alone what happened the day before yesterday or last week because everything is like a giant blur in my mind. It is now the second semester of second year!! Wow!!

After all of the nerve-wrecking things I heard about second year, my fear and anxiety levels about it were sky high before it had even begun last July! I came in with all these buzz words floating around in my mind that I had heard over and over again: “hard,” “busy,” “fast,” “tired” “scary,”  “STEP 1,” which are words that can definitely define a second year experience (or any year really) to the fullest, and words I can’t deny experiencing the effects of on many days. However, despite, all the “bad” things about second year, no one ever told me about all the amazing components that can encompass second year — what an enjoyable experience it has turned out to be so far. Such as:

I value that each course this year is its own topic. Example: Neurology course, Psychiatry course, Hematology Course…where you can really delve in and learn the material full-heartedly — one system at a time.

Nivine-2.pngI love that I got to go back home to Ann Arbor to visit friends and family practically every month for a few days first semester! Something I DEFINITELY didn’t think would’ve been a possible thing to do second year.

I enjoy how fascinating each subject is, and find it incredible how much there is to learn (and keep learning) about an organ system!! I am grateful that there’s time to spend with great friends, which last semester included things such as visiting Young’s Dairy Farm (a place with delicious ice cream!), watching movies, playing board games, and trying out new restaurants…

Nivine-3.pngI cherish those random “days off” that we get to study, and especially when I get a full or partial three-day weekend (and there have been many!) where I can sleep in till 10am.

I appreciate that I got a three-week winter break…where I got to spend most days catching up with friends and family. The most exciting part was where I got to enjoy Magic Kingdom with my mom and fulfill my life-long dream of visiting the Harry Potter theme parks!! (best part of second year hands down :P)

That said, the “negative buzz words” that clouded my mind have now been blanketed with words such as “enjoyable” “challenging” “amazing” “fun” “exciting” and yes, even “relaxing,” which I didn’t even think would’ve been a possible way to describe second year back when I started in July!

Summer Flashback
Nivine El-Hor ’18
September 11, 2015

Six weeks of M2-done! Already flying by like summer did. My summer between M1 and M2 was perhaps the busiest, yet the most educational “vacation” I’ve ever had. I spent six weeks of my summer completing my required electives-the first two weeks spent doing a pediatric GI rotation at Dayton Children’s and the last four weeks spent doing a family medicine rotation in my hometown. Each clinical experience had its unique aspects and I learned so much by being in two incredibly different, yet sometimes-similar environments. It was refreshing to learn outside of the classroom and rewarding to see many of things I learned during first year applied in the clinic. However, it has been even more powerful when my summer experiences have started to come into play during second year and I’m able to tie in what I’m learning to what I observed during shadowing. 

My schedule completely flipped when I started my GI elective because I spent around 8-9 hour days at the hospital, which had a different feel to it than the routine of go to class and study all day. Surprisingly, my exhaustion levels reached maximum capacity than during the normal school year because I wasn’t accustomed to the demands of clinical practice, but I felt like I got a glimpse of what typical days would like in the future—fast, busy, long, yet exciting and worthwhile.  I had the opportunity to observe most of the pediatric GI specialists and each of their unique approaches to patient care. I enjoyed the variety that the field of GI provides—from consults, to physical exams and follow-ups, to being in the OR doing colonoscopies… you really never get bored! I valued the opportunity to listen to the dialogue between the physician, parents, and children and the process in which one comes up with a diagnosis, and follow-up care thereafter.  One of my favorite experiences included the time when a GI physician let me get a glimpse of third year. I had the opportunity of having an in-depth talk with a parent about her child’s symptoms, collect all the relevant information and then summarize my findings to the physician and try to come up with a diagnosis before he went in to see them. Feelings of nervousness and excitement ran through me because this was my first time interviewing a non-standardized patient, but it was nice to use my ICM interviewing skills in a real setting!

After finishing up my GI elective, two days later my AHEC family medicine rotation began. I worked at an integrative health care clinic in Ann Arbor, which immersed me into a very unique and different approach to medicine—to the extent that I hope to apply some of the techniques and strategies that I learned here into my future medical practice.

The clinic uses an integrative approach by combining both traditional and alternative medicine to provide patients with more options and guidance. An integrative approach seeks to understand multiple factors from different bodily perspectives that could cause the said symptoms; therefore spending more time with patients is critical to improving their well-being to understand everything that is going on to connect the pieces. For many new and returning patients, we spent a minimum of 30-45 minutes discussing health concerns with them. I had many patients express to me how appreciative and full of gratitude they were to have a doctor spend this much time with them.

This experience showed me how an integrative approach can benefit some patients immensely as it provides them with more personalized choices geared toward their health when other traditional therapies do not seem to work for them. Thus, having the opportunity to see first-hand how this gives patients the benefit of attaining more health care perspectives and options by integrating conventional and alternative medicine to maximize their health care taught me that there is more than one correct way to practice medicine when balanced correctly. Further, I valued the give-and-take relationship between doctor and patient that I saw during my time at the clinic. This patient-centered approach further underscored the importance of allowing patients to a be a part of their health care conversation, allowing more information to be gathered to make patients more comfortable with their health care choices.

Many lessons taught, many things seen, and much more knowledge and facts gained this short summer than I would’ve thought possible!

Year 1 Reflections
Nivine El-Hor ’18
June 24, 2015

As I reflect back on my first year of medical school, I can’t believe how fast it flew by. From various experiences, opportunities, knowledge gained, and individuals I’ve met, this was by far the most transforming year of my life. Every moment is still so vivid, clear in my mind, yet such a blur because all year it felt as if I was riding a high-speed train that has now suddenly come to a halt—until M2 year that is! BSOM provides its students with so many unique opportunities and I’m so glad I had the chance to experience many of these things to enrich my medical school experience during year one.

Below are some things I learned during my first year of medical school:

  1. Take it one day at a time. Immersion in each moment will allow focus on one thing at a time and reduce the feeling of being overwhelmed. Be present in the moment no matter what you are doing and don’t think about what is coming next/what you have to do after until it’s time to do so.
  2. Don’t be afraid to change study habits from one class to another or even during a class because each class is different and requires a unique approach.
  3. You can and will do it even when you think you can’t. Other people know you can do it when you think you can’t. Believe in yourself. You will amaze and surprise yourself each and everyday.
  4. Every minute is precious—use time wisely. Seize every free minute, hour, day, weekend, to visit or call family and friends, do something fun, go to the gym, watch a movie, relax, sleep, etc. Sense of time changes in medical school. The days are long but the weeks are fast. Time never stops. Use each moment to your advantage.
  5. Just go for it. Studying comes first, but that doesn’t mean life has to stop. Go to events, conferences, and meetings…anything that interests you because these are the things you will remember.
  6. Inquire! You won’t know if you don’t ask! Talk to older students to get advice and tips for each new class and medical school in general because that will give you some direction into what to expect and new ways to approach learning.
  7. Stay on top of the material and don’t get behind, because playing catch up is hard to do. It’s possible to get through the material. Try to learn the material well the first time and when reviewing, because in the end we’ll be using this information for life. Don’t give up when something doesn’t make sense and make sure you spend time on what confuses you—don’t ignore it.
  8. Build relationships for now and for later.
  9. Ask for help and don’t be afraid to do so, especially when facing problems, or trying to make decisions. Talk to family, friends, and advisors for advice and second opinions. Find at least one mentor you can rely on. You don’t get through medical school alone. People want you to succeed—don’t be afraid to seek advice and share your emotions and feelings when it’s sometimes easier to just ignore the problem and bottle it in.
  10. Just breathe and medical on.