Melissa Palma, a recent fourth-year matcher out of the University of Iowa Carver College of Medicine in Iowa City, IA, graces us with her expert advice on succeeding in medical school and beyond.
1. Tell us about yourself: Where are you from? What is your undergraduate degree and where did you receive it? Did you do anything between undergraduate and medical school?
Melissa Palma: I grew up in Waterloo, Iowa and graduated from the University of Iowa with a degree in biochemistry with a minor in Spanish in the spring of 2011. In the fall of the same year, I began medical school at the University of Iowa Caver College of Medicine. I have far too many future goals to be realistically feasible. Following residency, I plan on practicing family medicine in an urban, underserved community or at an academically affiliated community health center. I would love the opportunity to be involved with mentoring and teaching students through the Office of Diversity and Cultural Affairs at a medical school. I also hope to continue to be involved with global health and health policy initiatives.
2. What residency program will you be joining and where?
MP: I will continue my post-graduate medical education at the Greater Lawrence Family Health Center in Lawrence, MA. The family medicine training in Lawrence is a very unique program, located in a small city with a large proportion of patients from the Dominican Republic. The program has an amazing integrated Spanish-language curriculum designed to produce graduates fluent in both the language and culture of our patient population.
3. Looking back on your medical school experience, what would you say to the young and naïve “first-year you”?
MP: Take care of yourself to prevent burnout. Don’t give up on your hobbies, interests, or everything else that makes up who you are. Rely on your family, friends, and especially fellow classmates for support when you need it. Building good habits now to keep yourself healthy and balanced will become even more important during residency training, when time will be even more limited and patients’ lives will depend on your ability to function at high levels.
4. What things did you do that you believe were valuable to succeed the first two years in the classroom?
MP: In addition to joining any interest groups or volunteer activities that really speak to you, try to volunteer at a free medical clinic or shadow physicians in a specialty you are considering early on. Being connected to patient care during the first two years can remind of you all the reasons why you decided to come to med school. When you see those principles applied in real life, it can re-inspire you to learn the latest biochemistry pathway of the week.
I joined a weekly Step 1 tutor group during second semester of M2 year in order to familiarize myself with the exam material and have a cursory pass through First Aid. During my month of intensive studying prior to taking boards I was happy to supplement with Pathoma, but completing question banks like UWorld was definitely the most valuable tool.
Also during the preclinical years, learn the art of bringing Tupperware to school to store lunch meeting leftovers. That extra Thai food from the latest FMIG meeting turned into three dinners at home on many occasions. It’s pretty much how I fed myself during the first two years of med school.
5. What things did you do that you believe were valuable to succeed the second two years through clinical rotations?
MP: As a medical student on the wards, your job is to learn how to navigate the culture and proceedings of the hospital. Be confident and organized in your presentations; it is how you will communicate with other clinicians in the future. Don’t be afraid to say, “I don’t know,” or “I didn’t ask that question” to an attending. They do not expect students to have all the answers or do everything correctly, and they will be happy to teach you if you indicate interest.
Keep a running list and ask for teaching topics when the opportunity arises in the afternoon following rounds if you’re not admitting a patient. You are now the advocate for your education, so be prepared.
Read about your patients and look up guidelines or journal articles after you see an interesting case or clinical presentation. The information will stick with you much better when you are applying it to a specific patient you took care of. Learn when you can be helpful to the team by writing notes or seeing patients, but know that your residents really mean it when they say you can go home.
6. What things did you do during your four years of medical school that stuck out or particularly impressed your residency program?
MP: For the past four years, I have been highly active as an executive board member for the University of Iowa Mobile Clinic whose main mission is to provide health care to medically underserved populations in Iowa City and the surrounding areas, especially Spanish-speaking and undocumented patients in rural Iowa. As a board member, I implemented a new patient navigator program to improve continuity of care at multiple sites and developed new protocols and coding for improved electronic medical record usage.
I have been an active participant in the Global Health Distinction Track at my medical school. Following M1 year, I spent three months in Lima, Peru conducting research on the Ponseti Method, a non-surgical treatment of clubfoot, one of the most common causes of disability worldwide. While in Peru, I completed an epidemiological risk factor survey of clubfoot and interviewed physicians identify needs to establish a national clubfoot treatment program. My work was supported by the Ponseti International Association, based at the University of Iowa Hospitals and Clinics, which later allowed me to present my research at the national Consortium of Universities for Global Health conference.
7. What things were unhelpful or you wish you hadn’t done in medical school?
MP: I think it was difficult, especially first year, to figure out how to disentangle feelings of self-worth derived from obtaining the highest grades. After all, being at the top of our classes was how we all got into medical school in the first place. While it does vary greatly by specialty, as long as you pass everything comfortably your pre-clinical grades will be weighted less than the combined picture of your USMLE Step 1 scores and clinical clerkship evaluations.
8. What was your level of involvement in research and other extracurricular activities, and your opinion on how important that involvement is?
MP: All of my extracurricular activities were centered on a common theme of addressing health disparities within different communities. My advice to students is to find something you are truly passionate about, whether that is research or teaching or gourmet pie baking, and become deeply involved with that organization.
In addition to the previously mentioned volunteer and research activities, I am a volunteer patient examiner at the local Free Medical Clinic. I was part of a committee to screen the documentary “The Waiting Room” during M1 orientation to explore healthcare access at an Oakland, CA community hospital ER, an activity that is now part of the formal curriculum.
I have also been heavily involved with initiatives through the Office of Diversity and Cultural Affairs, specifically SNMA and LMSA. I have organized and was a speaker for several lunch talks for these groups. By presenting at regional conferences and attending national conferences, I was able to learn from experts in the field on a myriad of topics related to health policy and health equity.
9. What attracted you to your chosen specialty?
MP: I always knew that I was interested in a primary care field. My two favorite rotations in medical school were pediatrics and OB/GYN, but I felt that in practice I did not want to limit my patient population to solely general pediatrics or gynecological issues. I had the hardest time deciding, but after attending the national AAFP conference in Kansas City and meeting with thousands of other like-minded people with broad clinical interests, I couldn’t imagine myself anywhere else.
As physicians, we have entered a profession rooted in service to alleviate suffering, and I consider it our personal and professional duty to utilize our positions of privilege to advocate for our most vulnerable patients. Interviewing in family medicine programs, across the country it was so inspiring to meet other physicians, residents, and applicants with similar goals and interests.
10. What attracted you to your residency program?
MP: I first heard about the Lawrence Family Medicine program after signing up for the AAFP National Conference, which has an annual exposition hall exhibiting hundreds of residency program directors and residents from across the country. Prior to the conference, I received a postcard in the mail from a program billed as “a place where your idealism will be nurtured and will even grow.” In addition to touting its in-depth Spanish language curriculum, high-volume obstetrics, innovative Centering Pregnancy group visits, and global health opportunities, I was especially drawn to the program’s deep commitment to the oftentimes-marginalized community of Lawrence, MA.
11. What things did you do to maintain your sanity in medical school?
MP: Find a community of friends or family who will support you when you need it. I have a close-knit group of friends in medical school, and we have potlucks, game nights, or social events together on a regular basis. Whether that support comes in the form of a sympathetic listener, someone to bring you comfort food during a rough week, or a mentor who will guide you when everything seems uncertain, medical school is too grueling and difficult to tough it out alone.
Take advantage of opportunities (and often funding) to travel to conferences, learn from inspiring speakers, and meet your future colleagues. If you can arrange it, don’t worry about the exams or taking time off from clerkships. Attending an AMA conference in Hawaii for four days during my M2 year to present research, go snorkeling, and eat authentic Spam musubi was absolutely worth performing a little worse on my pathology exam the next week.
Once again, continue some of the interests and activities you have previously enjoyed. You don’t need to put your life completely on hold during medical school. I’ve been lucky enough to continue taking ballet and yoga classes on a semi-regular basis, which has become an integral part of my wellness routine.
12. The floor is yours — what do you wish to share with current medical students?
MP: No matter how difficult and discouraging certain parts of medical school may be, keep in mind that everything is only temporary. Even in the midst of studying for weekly tests or the daunting test block, set small goals to make an insurmountable task more manageable. Even when you are arriving at 5:30 a.m. to get the numbers on your surgery rotations, know that you are only there for a few weeks at a time and have the extreme privilege of witnessing the next Whipple procedure as a student. Year after year, you will progress to the next stage of your training and ultimately at the end of it all you did it. You will become the doctor you always wanted to be.