Posted in Health, medical school, news

First Year Medical Student Dilemma….Do I Really Need to Buy the Expensive Diagnostic Equipment for Class?

Medical school is no joke. It’s one of the most expensive degrees out there.  And before one starts, they are asked to purchase equipment for their first year training that can total over $1000.  Most students are expected to purchase at minimum the following:

  • Stethoscope
  • Otoscope/Opthalmascope Set
  • Monofilament
  • Reflex Hammer
  • Light source/Pen light
  • Watch
  • Bag for items

So for year’s I’ve been asked how imperative it is that they spend the money?

Why the debate?  Well many students argue the following:

  • Most clinic settings have equipment on the walls (except for stethscope of course)
  • Most student’s can’t carry all their equipment around on clinical rotations since it’s not practical
  • Most schools train their students in groups so does each one need to purchase the items or can they share amongst a group?
  • They’ll only use the eqiupment once in class and never again in their careers.

However, arguments for purchasing the equipment include the following:

  • Your school may require it
  • Some clinics have broken equipment and you will be the one student who is ready to jump in
  • It’s advantageous to have a set at home later to use for practice on family members
  • Most of us doctors do still have our sets from medical school and its a great momento

What if I can’t afford the new equipment?

Before going online to buy second hand equipment that may not work or have a warrenty, I suggest:

  • Asking your school if there are any student discounts or scholarships to help finance the purchase
  • Ask the school if equipment can be purchased as a small group
  • Borrow (or rent for a nominal fee) from an older medical student
  • Ask your course instructor if all items need to be purchased or if some are elective

Whatever you do, however, do not go cheap on your stethoscope. You will use it thousands of times in your training and cheap ones do not do as good a job. And as a medical student lives will be at stake and your stethoscope is one of your most important tools.

Discounted items can be found here at

Finally, congrats on getting into medical school!!!!  xoxoxoxo


ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook


Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.




Posted in Education, Health, medical school, students

Creating your MSPE Characteristics for Residency Applications

For those medical students applying for residency, the student needs to provide a short list of “noteworthy characteristics” that are not listed elsewhere in their application.

The Association of American Colleges (AAMC) explains what the “noteworthy characteristics” are:

This section includes information intended to help a residency program selection committee review applicants holistically to achieve a residency class that brings a diverse set of background experiences, characteristics and perspectives.
• Provide a maximum of three characteristics highlighting the most salient noteworthy
characteristics of the student.
• This section should be presented as a bulleted list. Each characteristic should be described in 2 sentences or less. Information about any significant challenges or hardships encountered by the student during medical school may be included.
• Lengthy biographical descriptions are not recommended due to the time required for review and because these details can be found in other sections of the applicant’s portfolio (e.g., ERAS application, personal statement, letters of recommendation, interviews).
• The identification of the noteworthy characteristics can be done by each student in consultation with a designated mentor or advisor, or by the MSPE author.

So in essence, they are no more than 3 short entries highlighting a unique quality and why you possess that quality.  Even though they say a “maximum of 3” do not just write one.  I would suggest writing three.  By the time the program director reads these three short sentences, they have a better picture of you as an individual.

Topics that you can draw your characteristics from include:

  • Missions done
  • Places traveled
  • Raising a family while going to school
  • Creating a charitable/community event
  • Passion, hobby, talent
  • Personal or family challenge
  • Why you chose your research project
  • Life experiences
  • Honors and Awards
  • Leadership positions that you held and what you impressive task you completed

These are usually written in third person.

Examples of these may be:

  1. As an avid traveler (or having completed a mission), Mary is fluent in Spanish, which has helped her communicate with many of her patients during training who were Spanish-speaking only.
  2. Having come to the United States as a small boy, Ti learned English and the American culture at a young age, making new friends and excelling in his school work.
  3. John served as Events Coordinator for the ACOFP and organized a water and sunscreen passout to homeless people at risk of dehydration, heat illness and skin cancer last summer.
  4. Ryan is an avid pianist and has performed at multiple venues including local adult day care centers and charity galas.
  5. Having seen her grandmother battle lung cancer, Jaime worked with other students to put up tobacco hotline numbers on university campuses.
  6. After Breana had a scare with an abnormal skin lesion, that fortunately was not skin cancer, she devoted additional patient education on how to screen for skin cancer with many of her patient interactions as a student.
  7. Lisa participated in multiple marathons, including the Boston Marathon, completing all of them.
  8. Mark lost over 50 lbs when he discovered a plant-based diet, and now educates patients on how inclusion of vegetables is paramount to a healthy diet.
  9. Scott’s academic strength was exemplified by making the Dean’s List during both years of Basic Science, and choosing to tutor other younger students when he moved on to his clinical years.
  10. Maya actively practices yoga and many times has held yoga and meditation workshops for students after school.

So as you see you can be as creative as you wish, and don’t be afraid to “brag.” This is your time to toot your horn and make yourself stand out!  You are applying for the job of your life….prove to them you are exactly what they need for their residency program.


ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook


Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.


Posted in Education, Health, medical school

Data Gathering During a Patient Encounter Made Easy

A Peek into How Doctors Think – An Introduction to “Columns”

Anyone who is on their path to becoming a successful physician needs to be able to take a good history and perform a thorough physical.  However in this day and age, patient care is performed in a very speedily process and thus the boards test a medical student on how succinctly they can perform a patient history.

Thus students and licensed medical providers need to be adept at “data gathering” no matter what the patient presents with.  Our job is to figure out what’s going on, no matter how difficult the task, and do so quickly.  So how do we accomplish this?

We start by looking at the cause and then breaking down what could be occurring resulting in that cause, or in other words, forming a differential diagnosis.  So if someone has chest pain, one may form a differential consisting of heart attack, pericarditis and costochondritis. But other issues may be at play such as a pneumonia or an esophagitis.

So when we look at a person with chest pain, we consider all the body parts or causes that could be causing the symptoms.

Hence with a patient presenting with chest pain, one would consider a cardiovascular cause, pulmonary cause, gastrointestinal cause, musculoskeletal cause, and even psychiatric cause.

This is the basis of forming one’s columns. For every chief complaint we form columns either mentally or on paper and then ask associated symptoms (or pertinent positives or negatives) to determine which column we’re in.  Usually a few “power questions” will help discriminate which column you are in. Once you hit the correct column you will ask further questions along that line.

book cover 2

True there are many more questions we could ask than just the “power questions,” but during a time crunch we need to ask very specific ones to determine if we are on the right track.  If we receive multiple “no”s along a column, we know to move onto the next column.

Hence if a patient with chest pain denies dizziness and diaphoresis or sternal pain upon palpation but admits to cough, shortness of breath and sputum production, we have just narrowed down the chest pain patient to a pulmonary cause as opposed to assuming it was cardiac in nature. Then we would continue down the pulmonary column, thinking our differential may be a pneumonia/bronchitis/pulmonary embolism, and ask about hemoptysis, fever, chills, etc.

So for each patient one must create columns depending on the chief complaint and then ask power questions to help focus down your differential.

Now these columns can also assist with the physical exam component of data gathering.  If the above patient presenting with chest pain could have a cardiac/pulmonary/GI/musculoskeletal condition, one would examine his heart, lungs, upper abdomen and palpate the sternum and ribs.

For an added bonus, the columns can additionally assist one in forming their differential for the SOAP note. 

Chest pain r/o

  • Pneumonia
  • Bronchitis           
  • PE
  • MI
  • GERD
  • Costochondritis

If a case involves a not so clear-cut symptom, columns could be used as well.

For example a patient presenting with hair loss.  If one complains of hair loss, a variety of differentials could be at play.  One column could be an endocrinology source (such as hypothyroidism or diabetes), another could be psychological (such as stress or trichotillomania), a third could be medications (such as chemotherapy agents), and a fourth could include genetics.  Narrowing these down with power questions could exclude non-contributing columns.

So whether it’s a direct body system or cause, columns help one focus down the differential and allow an easy visual that enables one during a timed test to think quickly and know which questions to ask.

Again these columns are instituted after the History of Present Illness in which a student obtains onset/chronology, palliative/provocative factors, quality of symptoms, radiation, severity and timing (OPQRST).

They will be written down in the SOAP note after the HPI.  

Example:  Mary is a 25-year-old female presenting with acute onset right foot pain.  It began 6 hours ago after she went for a job. Ice provides some relief but walking on it worsens the pain.  The pain is sharp, constant with a severity of 7/10. She denies fever, chills, open wounds, swelling, redness, temperature changes, numbness or tingling.

Since during this step in the history most medical students find it challenging to know “which questions to ask.”  The columns and power questions simplify this.

To learn this method to improve one’s data gathering skills click here.


Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.