Category: Uncategorized

Blog: Preparing for the Worst

My journey towards becoming a paramedic is not without its significant doubts.  I suppose I can take comfort in knowing that many people feel similar doubts when embarking into new career/life-paths.  Kevin Hazzard’s book “A Thousand Naked Strangers” opens with several chapters of how anxious he felt at the idea of being a medic and the responsibility it entails (book review forthcoming).

My fears are certainly not unique.  I have the typical worries around imposture syndrome, whether I can hack it physically, mentally, emotionally, and whether I’m good enough to get accepted into a very competitive program.  I also have spin-off worries concerning whether I will achieve a work-life balance with a future family, what toll my experiences will have on me, whether I can leave work “at the door” when I come home, whether I will be affected by mental health issues caused by work, etc.

Heck, I even worry that I won’t be able to stomach it because I’ve never seen anything graphically bad.  The three worst things I’ve seen are: 1.) a pedestrian struck by a car that I had to then treat; 2.) that time I broke my ankle with a hairline fracture; and 3.) that time I treated a guy who put his elbow through a window in rage.  In each of the cases, there was some blood (and bone from the window), but overall the outward injuries were fairly tame.

I’ve tried to mitigate this by following medical Instagram accounts that shows graphic medical procedures and injuries.  My hope is to desensitize myself from the shock of what I see so I can bypass those initial visceral reactions.  Likewise, I chose to read Hazzard’s book to learn more about what kind of horrible things I can expect to see.

But, there are some things you can’t prepare for.  Or, worse yet, there are things you didn’t anticipate being a problem.

I came across two blog posts recently  (written by the same author on two different sites) that discusses exactly this case.  I won’t spill too many of the details as I think it’s valuable to read the posts for yourself.  But the one I want to briefly mention here is where the author discusses the impact a ringing phone can have.

Imagine what it was like for the first responders at the recent Orlando mass shooting as they worked inside the club around all the deceased victims.  Keep in mind, there were 49 victims who died that night on scene.  49 people with families who likely heard about the tragedy on the television.  49 families who might have called to make sure their loved one was “ok.”  49 families who kept calling when no one picked up.  Imagine what kind of toll that might have on a person as they walk among the bodies.

It chills me just typing this.

There are things I might experience that I’ll never be prepared for.  These are things that worry me as I lay the groundwork to change careers.

Please, go read the blog posts for yourself.

The Sounds of Silence on The Happy Medic

The Worst Things I’ve Ever Felt As A Paramedic on Uniform Stories

 

Blog: Update on Diagramming – Active Learning

Back in my post about diagramming as a study strategy, I made reference to recent studies showing the effectiveness of long-hand writing and its correlation with retention and recall.  One of the  things I love about working at a post-secondary institute is I a.) mix it up with very smart people who teach for a living; and b.) have access to a well-funded library.

I love university and college libraries!  I don’t always make adequate use of their vast resources, but when I need them, they have my back.  For instance, my institute recently negotiated access for its employees to use Lynda.com.  As a nerd who loves to learn, this made me very happy.

Part of my job involves program review and quality assurance, which is outside of my educational wheel house.  Recently, I’ve been exposed to the concept of Active Learning Strategies as a method of engaging students in the classroom.  For instance, a passive learning strategy would be for students to read a textbook and learn the definitions of key words and concepts.  An active learning strategy would have the students read the text, then take those same key words/concepts and draw them in a relationship tree to show how the various parts fit together.

If you have access, I suggest you check out “Active learning strategies: three activities to increase student involvement in learning” by Catherine Wilcoxson Ueckert and Julie Gess-Newsome in The Science Teacher journal (75.9, Dec. 2008; p47.).  There, the authors discuss, as the title says, three alternative approaches to student engagement in the science classroom.  While these approaches assume a classroom, instead of a solo learning project like what I’m encountering, I think you can still extrapolate on the learnings and apply it outside of the traditional classroom.

Stay Awesome!

Ryan

Blog: Hubris and Good Grades

I have a confession: I’m great at BSing.  The polite way of describing this is that I’m very clever.  An awesome way to describe this is I’m resourceful.  But at the end of the day, I’m good at making stuff up on the fly.  I accomplish this because I’m able to absorb a lot of facts and data in a short amount of time.  The result of this is that my output and achievements are not always reflective of the amount of effort that appears to go into a result.

This habit started in high school.  Until this point, I worked hard on my home work.  My parents were very good at instilling (and monitoring) the discipline in me to do well.  In 10th grade, I was given the option to move to an enriched mathematics course because I had performed well the year before.  However, it was the beginning of the end in terms of my mathematical achievement for one very simple reason: there were no homework checks.

You’d think this shouldn’t be a problem, but it was my Achilles’ heel.  No homework checks meant I didn’t need to do my homework every night.  My young mind had missed the connection between progressive practice and performance during assessments.  My grades slipped.  I still graduated high school with good marks; marks that gained me entry into a good Canadian university.  But my work was less perspiration and more inspiration.

I bring this all up because I had an insight last night while studying for my respiratory system test.  Until now, I’ve been progressing through the course at around two chapters* every week.  That performance, comes with a footnote:

  • I registered for the 12-week course for a January start, but I found a loophole that my time wouldn’t start until I wrote the first test. I spent 3-4 months reading the textbook at the public library and was able to get ahead by 4 or so chapters before I “started the course.”

What appeared to be a reasonably diligent pace came because I was ahead of the game.  But, because I didn’t keep pace with the rate at which I was writing tests, I eventually caught up and now I’m trying to read two  chapters per week and write those tests the following week.  In principle, this shouldn’t be an issue.  But it’s proving to be a challenge.

In a real sense, I’m becoming a victim of my success.  Thus far, I’ve done well writing tests, and so when it comes time to prioritize study time, I’m finding myself placing its priority lower than other, seemingly more pressing concerns.  My rationale is “I should be studying, but I’ve done well so far and this other thing I’m stressed about requires my attention to get on track.”  And so, the other thing (relationship time, my two jobs, my volunteer activities, and yes, relaxation) will take priority over studying.  It’s the old Important/Unimportant/Urgent/Non-Urgent matrix.  I’m letting the things  that are Urgent take priority over the things that are, arguably, more important.  This matrix could be the topic of a future article.

What does this look like?

  • Friday – “I work tonight at my other job, so let’s relax because it’s the weekend.”
  • Saturday – “I should study, but today I’ll run errands, spend time on my relationship, indulge in R&R, etc.”
  • Sunday – “I should study, but I’m squeezing more long-distance relationship time in, spending time with friends that I don’t see during the week, dreading the work week, etc.”
  • Monday – “I should start studying/reading chapters for Monday’s test, but I also have commitment x/y/z.”
  • Tuesday – “I’ve bitten off more than I can chew, so how can I squeeze more efficiency into studying?”
  • Wednesday – “How many times can I review my notes during the work day before I write my test, grab a bite to eat, then go to my night job?”
  • Thursday – never used efficiently…
  • Rinse and repeat.

Because I haven’t had to rely on a structured 7-day schedule for studying but am now 70% through the course, that lack of planning has finally caught up to me and is putting me in a crunch.  I’ll have to grind out the last three or so weeks of the course, but this unsustainable practice is a lesson in why it’s important to work hard while also working smart.

Stay Awesome,

Ryan

PS – after drafting this post, I read an excellent, short meditation on the difference between IQ and DOT (discipline, organization, and thoughtfulness).  I’m happy that I’m not the only person who wrestles with this.

Blog: Writing Tests vs. Mastery

Last week, I did something pretty awesome.  I scored 100% on my second comprehensive test for the biology course I’m taking.  Comprehensive Test 2 covered the five chapters on the nervous system, the endocrine system, the cardiovascular system, special senses, and blood.  Thus far, each of the tests I’ve written follow a predictable pattern, where the first half of the test is some version of true-false, fill in the blank, multiple choice, and matching questions, then the second half of the test is split usually between short answer and labeling a diagram.  Understanding this format allows me to structure my studying to answer these questions.  I know that the bulk of the points will be found in the diagram and short answer, so if I can memorize the structural components (from my diagramming study cards) and their functions (from my development of mental schemas), I can usually work out the rest through context, associations, etc.  With this approach, I don’t have to memorize every tiny bit of information because I can make educated guesses based on available information.  This is the same approach that is coached when you are preparing for intensive exams, like SATs and GREs.  You don’t need to know everything; you just need to know enough to eliminate the impossible and approximate the answer enough to make a choice.

On one level, this has yielded huge dividends for me in studying.  Thus far, I’ve completed two-thirds of the tests, and in 13 tests, I’ve only scored below 90 on three tests (86, 87, and 89).  Everything else has been 90% and above.  It’s a lot like the pareto 80/20 rule – I focus on the smallest batch of material that creates the greatest value.  It’s efficient – I don’t need hours upon hours of work invested into the project.

Yet, I have a huge nagging problem with this approach.  If I’m being honest, the conclusion I wrestle with is that while I’m doing great in this biology course, the only thing I can be sure of is that I’m really good at writing tests.  But, does that mean I’m gaining any level of mastery over my material?

I’ve been thinking a lot about the idea of mastery and apprenticeship.  I intent to read Mastery by Robert Greene over the summer, and I’ve read So Good They Can’t Ignore You and Deep Work by Cal Newport, all of which tackle the concept of learning and mastery of material.  I value going beyond superficial understanding and reaching towards mastery.  In paramedicine, I see this as the bridge that allows you to adapt in the field beyond doing first aid.  You connect ideas and have a deeper understanding of the situation.  You are more adept at observation and can digest more details and facts; you can make better diagnoses because you can acquire and process more information.  At least, this is what I believe at this point.  I could be horribly off the mark.

If my goal is to be House but in an ambulance, then I feel like being good at writing tests gives me a false sense of accomplishments.  It’s too early to determine if I’m “getting it,” but it’s something I need to be mindful of.  One problem with my undergraduate and graduate experience is that I lack the discipline to do truly deep thinking and work.  I am very clever, and have thus far skated by on having a good memory for facts and connecting ideas.  But I also feel like a bit of a fraud, or more charitably, a dilettante.  Being clever won’t be enough to help save lives.  To do that, I’ll need something more than wit.

Study Strategies #4 – Diagramming

My study habits have come a long way since I first entered university.  In high school, there was less of a reliance on reading textbooks for information, and instead textbooks helped explain concepts that were duly taught during class.  The most you would often get out of a textbook was the bank of practice questions assigned for homework.

When I entered university, it was the first time I owned my course textbooks.  I could do what I wished with the pages (assuming I had no intention to resell the book after the semester).  Yet, if you thumbed through my textbooks from first and second year, you’ll see the pages are still unmarked and relatively pristine.  And yes, I am a pack rat and still have my textbooks from 10-years ago.

It wasn’t until my sophomore year that I began to annotate my  textbooks.  It started with encountering words I didn’t know the definition to.  I would underline the word, then copy the dictionary definition at the bottom of the page.  From there, I began underlining key ideas, starring important paragraphs, and eventually I would jot keywords in the margins to allow me to scan a page to understand what was being discussed.  This practice eventually carried over to my personal reading.  Now, if you open books I’ve read over the last five or so years, you’ll see this practice used fairly frequently.

Studying biology is proving to be a special case, because in addition to reading the text book, I am required to explain how certain systems function, fit together, and are structured.  I’m a visual and systems learner: I learn best when I can visualize a concept and understand how the various parts work together.  So, to learn the body, to label diagrams on tests, and to explain physiological processes, I have turned to diagramming when I make my flashcards.

Studies have suggested that students who write notes longhand have better recall than students who take notes on laptops.  It is believed that the act of handwriting information triggers better encoding of the information and better recall both in short-term and long-term follow-ups.  I believe some of the same processes are at work when you are learning materials from a book.  Underlining or highlighting material for retention is passive and requires little cognitive work to process compared to copying information.

This is not to suggest that there is only one way to study.  Many people have many styles of learning.  What we can generalize from this, though, is that forcing yourself to engage with the material actively (i.e. copying information, summarizing the text, creating flashcards) will help with recall in most people over engaging with the material passively (i.e. reading and highlighting the text).

 

You do not have to be an artist to diagram.  Trust me.  You can still diagram using stick figures so long as the information you are drawing is meaningful to you.  In the example below, I was trying to figure out a way to easily remember all 11 systems of the body.  I broke the systems down into body regions, and memorized the number of systems per region to help me remember which systems were primarily located where.

  • 1 Head – Integumentary (outer skin) System
  • 2 Head – Skeletal System
  • 3 Head – Muscle System
  • 4 Head – Nervous System
  • 1 Neck – Endocrine System
  • 1 Thorax – Lymphatic System
  • 2 Thorax – Cardiovascular System
  • 3 Thorax – Respiratory System
  • 4 Thorax – Digestive System
  • 1 Pelvis – Urinary System
  • 2 Pelvis – Reproductive System
http://rhuckle.tumblr.com/post/136887273846/im-studying-human-anatomy-and-physiology-at-the

The reason I find diagramming helpful the most is because encoding the information becomes easy when you have to create spacial relationships between parts of the whole.  For biology tests, you often are required to label diagrams.  You can try to brute-force the recall by memorizing the individual parts and what order the fall on the label lines.  When you are forced to draw the parts, you must make sense of how the pieces fit together if you are to get the proportions correct.  For all the parts to fit on your diagram, they must be spaced correctly.  This is incredibly useful when you must go back to label the parts, because you know how each part connects by virtue of your drawing them out.

Diagramming can be a powerful tool to help you learn material quickly and efficiently.  It does take longer than simply underlining or copying out blocks of text, but if you invest the time, it will pay off come test time.

Stay Awesome!

Ryan

*Sources

Mueller, P. Oppenheimer, D. The Pen Is Mightier Than the Keyboard: Advantages of Longhand Over Laptop Note Taking. Psychological Science June 2014 vol. 25 no. 6 http://pss.sagepub.com/content/25/6/1159

Problems with EMS Infrastructure and Technology

This episode of Last Week Tonight with John Oliver aired last week, but I thought it was worth sharing as an irreverent but also serious aside.  I am still early in my attempt to navigate the world of emergency medicine, so I am broadly exploring all sorts of topics.  While my aim is to become a paramedic, I also acknowledge that taking a silo’d approach often leaves gaps that harm people.  When there are serious issues with how a service gets deployed to help people, you end up with a lot of avoidable mistakes, like those highlighted in the video.  I hope you had a great long weekend!

 

Stay Awesome,

Ryan

Study Strategies #2 – Make it about you

A common complaint you hear from students who study abstract concepts is that it’s hard to wrap your mind around ideas that you don’t have immediate (visceral) experience in.  I say this as a person who has an undergraduate and a graduate degree in philosophy; abstract ideas are my bread and butter.  Studying biology falls somewhere in the middle of that field – we all have a body that is a biological system, but outside of our subjective experiences of stimuli and physiological responses, we don’t have a lot of access to the inner mechanics of how the body operates.

(In my humble opinion, philosophy falls to the right of the image… Image: XKCD: https://xkcd.com/435/)

While this tip might be harder to apply in philosophy, a useful trick I’ve tried using recently is trying to break down anatomical and physiological processes in terms of my own personal experience.  Depending on your background, there are a number of ways you can cash this out, but I’ll give you three examples of where I’ve applied my past experiences and hobbies to learn key ideas and concepts.

1.) First Aid

The biggest crossover with studying biology I’ve had is from my experience in first aid.  During my undergrad, I joined a campus first aid team.  It was a team of student volunteers who actively trained throughout the year and covered shifts for events on campus.  Because we trained above the standard first aid level, we would get into topics that required some level of understanding the organism at the physiology level.  To understand how CPR mimicked the beating of a heart, we would learn how a normal heart functioned; to understand how shock affected the body, we would understand the cardiovascular, respiratory and nervous system operated; etc.

First aid is a stripped down version of what paramedicine is, so the two naturally dovetail with each other.  As I work my way through the course material, I’m able to see the connections between the medical interventions I was taught as a first aider and the biological systems the body uses to maintain healthy function (or, related to emergency medicine, how the body adapts to compensate for a loss of homeostasis).

2.) Lifting Weights

This example draws on a narrow set of my course materials, but it still cuts broadly through the textbook.  When you move out of the rookie phase of lifting weights, you naturally drift towards learning about anatomy and physiology.  As of writing this post, I completed a test last week where I labelled a diagram of the posterior superficial muscles entirely based on my experiences with weight-lifting.  As you dive deeper into exercise science, you are exposed to all sorts of cool applications of biology.  You learn about the gross skeletal and muscular anatomy, you learn about cellular metabolism and the use of ATP in muscle contractions, about how micro-tearing of tissues builds muscle and bone density, how nutrition affects the body, etc.  Even learning about exercise recovery helps deepen your exposure, such as learning about massage therapy, stretching any fringe forms of therapy, such as myofascile release and chiropractic medicine.

3.) That time I broke my ankle

A few years back, while out walking the dog during the first snowfall of the season, I was attacked by a roving horde of snow-ninjas who managed to put me down hard.  By that, I mean my foot slipped on a patch of ice, my ankle pivoted, inverted and my bodyweight came down on my ankle.  At the time, it seemed like a sprain because I was able to stand on the ankle and walk down the hill for help.  After a trip to the hospital and a follow-up, x-rays determined that I had a fine fracture in the fibula and I had displaced the talus bone.  It was recommended I have surgery to set the bones back into place with a series of screws and a plate.

The surgery was uneventful and the recovery went as predicted, and I’m now back to 99% (the occasional cold night makes my ankle stiff at work).  There is an element of black box magic that happens when you recover from a broken bone.  You receive a cast, are told to reduce movement for 6 weeks, then rehabilitate the muscles.  Recently, when I was studying the chapter on bones, I learn what happens in those six weeks.  It’s freaking awesome!

Assuming you can see the image above (being new to blogging, I’m not sure what’s considered fair-use for copyright materials – safe to assume, that image is not my creation), you can see the general phases of how bone gets repaired by the body.  When I learned about the process of osteogenesis, I was able to remember the phases of bone repair base on my lived experience of breaking a bone and healing from surgery.  It’s a hard and painful way of learning medicine, but it’ll stick with you!

These are a few examples of how my experiences help me make sense of the complexities of human anatomy and physiology.   What are some of the ways you make the material relevant to your life?  Let me know down below.  Hopefully it’s nothing as bad as physically injuring yourself!

Stay Awesome,

Ryan

Pass the Salt – Public Health and Hidden Prophylaxis

At this stage of the game, almost everything I’m studying comes with “OH! That’s so cool!” moments.  For as weird and complex as things that we engineer are, they pale in comparison to just how marvelous our bodies are.  Through eons of evolution, our bodies have developed finely-tuned, complex systems to keep us going.  In general, our bodies are fairly robust and can tolerate a wide variety of environmental pressures because our bodies have adaptive mechanisms to bring the body into homeostasis, or physiological balance.  Without our conscious thought, our body will enact certain measures to protect us, such as breaking down bone matrix to release stored calcium, or shunting blood from the extremities during extreme cold to protect vital organs.  However, sometimes our bodies need some help.

Humans, in our marvelous capacity, migrated into all sorts of areas that we were not adapted to naturally.  Evolution selects for traits that best ensures reproductive survival in particular environmental conditions.  But evolution is slow in humans because we reproduce fairly slowly, so we often take a long time to develop protection against environmental changes.  To help mitigate harm, modern society has adopted many practices to ensure populations are protected from certain diseases and conditions.  Over time, we grow accustomed to the new norm and collectively forget what life was like before the intervention was introduced.  This is why I find public health so fascinating – there are so many systems built into western societies that we take for granted that were enacted to address specific diseases.

 

Goiters

At the moment, I’m studying for my endocrinology chapter test, so I’m learning about the complex systems of glands and hormones our bodies use.  When I say it’s complex, I mean it’s COMPLEX!  Outside of the nervous system, the endocrine system is what is responsible for keeping our body functioning.  It finely tunes our internal conditions to preserve homeostasis.  It does its best, but sometimes it needs some support.

Vitamin and mineral deficiencies can have dramatic impacts on our bodies.  One in particular is iodine deficiency.  In certain geographic areas, iodine is scarce in the food supply.  This problem doesn’t exist where diets are rich in seafood or foods grown in proximity to saltwater.  However, in the interior regions of North America, iodine is less common in the ground, so the nutrients are not absorbed into the local vegetation.  Humans need iodine in their diet for, among other things, healthy thyroid functioning.  The cells of the thyroid uses iodine in part of protein synthesis, so when iodine levels are low, protein synthesis is stalled and extra material accumulates in the tissues.  This leads to an enlarged thyroid, also known as a goiters.  This effect is so common among people with iodine-deficiency that large geographic populations exhibit similar physical characteristics.  In the United States, the phenomena was so common that the “goiter belt” was used to describe areas of the country where people commonly had the affliction.  In addition to physiological problems that arise from atypical thyroid functioning, iodine-deficiency also can result in impaired cognition.

As a public health measure, it was proposed that iodine be added to table salt, as was done in other countries like Switzerland.  Within a short amount of time, incidents of goiters declined and IQ scores were improved in goiter belts.  The practice is now common in developed nations, but according to estimates iodine-deficiency still afflicts some 2-billion people worldwide.

The funny irony with public health initiatives is that we often forget why the measures were enacted in the first place when we are no longer exposed to the diseases the prophylaxis was implemented to address.  This collective-forgetting of the harm our populations were once exposed to then leads to foolish rejections of those very policies that help keep us healthy, whether it’s rejection of vaccines or decrying fluoride in drinking water.  Legitimate questions of long-term exposure effects aside, knee-jerk reactions to chemicals and scientific illiteracy is reversing decades of public health initiatives that keep us healthy.  The hidden world of public health — when it works, you don’t even know it’s keeping you alive.

So, that’s why my table salt is iodized!  Cool!

Stay Awesome!

Ryan

 

Welcome and First Post!

Hello and thank-you for stopping by my page!  I’m Ryan and as of this writing I am a hopeful future candidate for a path into paramedicine.

In a future post, I will go into a little more detail about who I am and my story into why I want to be a paramedic, but for now I will try to paint a picture of what I want to do with this website.

I’m looking to do a career shift and plan to apply to colleges early next year to be admitted into a paramedic program here in Ontario, Canada.  To date, I’ve been working on a number of fronts to prepare myself for my application – I’ve been organizing my finances to give myself a leg-up to return to school, I’ve been exercising to prepare my body for the job, and I’m currently taking a distance education course to get the biology credit I need to satisfy most school’s program pre-requisites.

While there is some element of vanity in this, I think this site would be a great opportunity to chronicle my journey.  I think writing about the things I do professionally and learn along the way will not only help me become a better paramedic, but it might also help educate and inspire others along their journeys.  I’m a student at heart and I love to share the things I learn along the way.  Despite my baser instincts towards laziness, I think this site might help push me to work a little harder.

I hope you find value in this passion project of mine, and maybe we can learn and laugh along the way.  For now, let’s just see if I can put some momentum on this beast.

Stay Awesome,

Ryan