Med School Merit Badges:

tackling stress in health care trainees at the grass roots

Case Presentation

It happens sooner or later to every medical student. Sometimes, you're lucky enough to
escape your fate until your first year of residency or even beyond. But sooner or later, you
find yourself hungry, sleep-deprived and clueless, covering the medical ward on the tail
end of a holiday weekend. And then, just when your energy and morale seem to have
reached their nadir, a delirious alcoholic vomits on your shoe. Delightful, particularly while
wearing the ventilated plastic clogs which have found their way into standard hospital chic.
However, there is still extra topping to be added to your special holiday Sunday; ten
minutes later, you are called to a stat delivery on Obstetrics, where your toes are
predictably bathed in warm amniotic fluid followed by...something else. And it is then, five
hours before you are due to go home, with no change in shoes or socks in sight, that you
begin to feel most isolated and alone. I'll never make it through this, you lament. Even if I
do, no one will love me or accept me into their home with feet smelling like mine! No one,
not since Vesalius illustrated page 190 of De corporis hum ani, had such foulness thrust
betwixt their toes as I! Why didn't I just do that MBA?

And then, as you slump dejectedly in your chair at the nursing station, the grizzled R2 ER
resident wanders by, seeking from whence the smell. She stops, looks down upon your
misery and proclaims, "Oh hey! 'Body Fluid Hat Trick'...congrats!" and rummages around in
her white coat pockets for a moment. From within, she produces a sticker with an
irreverent (and appropriately illustrated) cartoon which describes your current predicament.
Without asking permission or even questioning the events that led up to your current state,
she slaps the sticker onto your lapel and leaves, mumbling over her shoulder, "Nowhere to
go but up".

And suddenly, you don't feel so alone any more.

Purpose

The Med School Merit Badges are a humorous set of stickers, available pre-printed or in electronic
format for print-on-demand. They are meant to serve as a simple morale booster for med students
and residents of all stages and specialties. It is well recognized that medical education is a long
process and carries with it its own specific set of stressors [1]. Medical trainees experience a
special brand of Hard Times and more than their fair share of Weird Events. Students often cite a
sense of being overwhelmed and isolated, as if some of the unavoidably negative moments they
experience are theirs alone. As a profession, we have sometimes dealt with this by way of the "war
stories" that get shared between students, supervisors and support staff, often late at night when
things finally get <gasp> quiet on the wards and in student lounges. As in turns out, though, a fair
number of these stories get recycled and there are common themes and experiences that appear
to be almost implicit in med school training.
That being the case, the stickers have been culled from the experiences of many doctors and
nurses, both those in progress and those who have graduated. These experiences have been
caricatured and captions have been added. The themes are universal enough that sooner or later,
every trainee can look at them at say, "That happened to me too!". And in doing so, hopefully they
will feel that:

A) They are not the only one who has had vodka-soaked spaghetti vomited onto them by a patient
at three in the morning on a Sunday AND
B) They may be able to successfully cope with it; someone else has clearly had it happen to them
too and lived long enough to make fun of it on paper.

However, the point of the stickers goes further than just having trainees print them out for
them selves and stick them all over their locker for fun and bragging rights. Everyone in the
medical education system is encouraged to photocopy or print out a set and then, when they notice
one of their colleagues or classmates going through a particularly hard week of call [2], find an
excuse to "award" that other person with a relevant Badge. Part of the challenge of any difficult
undertaking (such as medical school) is the mistaken sense that no one else knows what you're
going through. A Merit Badge, firmly affixed to the inside of your lab coat, the cover of your
notebook or the back of your palm pilot, can serve as a tangible reminder that at least one other
person noticed, and cared...that you got vomited on.

Instructions for use:

The stickers are provided in .pdf format and are downloadable at several locations including
www.healthcarerocks.ca . As well, email requests for the files can be filled by the authors [3]. The
files are readable by an Windows machine using Adobe Acrobat, or by any Macintosh. The
graphics are formatted to print out correctly on standard Avery 2"x4" address/shipping labels [4].
These are readily available at most stationery and department stores, and can be printed upon
using any ink jet or laser printer. In a pinch, they can also be printed out on regular paper and then
cut and pasted onto a surface if one is sufficiently crafty. Since the labels are generally purchased
in packages of 25 sheets or more, it is far more economical for a batch to be made up at once, ie
by an undergraduate class executive or admin secretary, and then distributed to interested parties.
The Med School Merit Badges may be freely reproduced and distributed with authorship intact,
under a Creative Commons copyright .

References

[1] White Coat, Mood Indigo: Depression In Medical School, N Engl J Med 2005; 353:1085-1088,
Sep 15, 2005
[2] Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion,
JAMA. 2005 Sep 7;294(9):1025-33
[3] www.healthcarerocks.ca and healthcarerocks@gmail.com
[4] www.avery.com product code 5263 or equivalent
 NOSOCOMIAL IATROGENIC HARRISON'S INSTITUTIONAL
HYPERLACRIMOSIS
ALBINISM SYNCOPE HYPOCHONDRIA INCEST

I experienced I didn't see the light of

sudden, I fainted during I studied it I hooked up with:
the sun for 72 hours
uncontrollable straight clinical practice on Monday a med student
tear duct spasm and contracted a resident
it on Tuesday a staffperson
a nurse
confidential Med School Merit Badges Med School Merit Badges Med School Merit Badges Med School Merit Badges
med student/resident sponsored by sponsored by sponsored by sponsored by
help line: 1-866-HELP-DOC www.healthcarerocks.ca www.healthcarerocks.ca www.healthcarerocks.ca www.healthcarerocks.ca

CRUSHING PEDAGOGIC PBL 101 SIMIAN COPROPHAGE

(Panic Based Learning) COOTIES
DEBT-PAIN PARASOMNIAS (aka Scut Monkey)

osis
tospir
A) Lep nlos
) E h lers-Da
B
pus
C)  Lu
of
D) Allbove
t h e a
e of
E) nonbove
the a

I fell asleep When in doubt, I got these from

My debt in thousands in class or choose C I wonder if a patient.
exceeds my weight in the wards there's a fellowship
in pounds available in Scut? Want some?

Med School Merit Badges Med School Merit Badges Med School Merit Badges Med School Merit Badges Med School Merit Badges
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 DIETARY SBL 101 DELTA-WAVE
A.B.C. (Shame- Based SINK OR SWIM
(Airway, Breathing, CONSULT!) TRIATHLETE LOBOTOMY
Learning)

re
ctu
Pun
mbar
Lu FOR
DUMS
DUM
I've gone 16 hours without You'd rather
I received consuming any calories I didn't know... See One
two more consults AND and thanks to my have a bottle
Do One, Teach One in front of me...
while answering I've eaten nothing but sugar, supervisor, now (but don't be sad,
starch & caffeine for 48 hours everyone cuz two outta three
the first AND JAMA. 2005 Sep 7
KNOWS ain't bad) ;294(9):1025-33
I've eaten an entire I didn't know
meal in 5 minutes flat
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BUNGED A.O.D. NECROMANCER THE PIMP EL MATADOR

(Angel of Death)

I did not excrete I caused a Code Blue I brought back I knew something I stuck a sharp object
for 12 hours just by walking someone who was my supervisor into myself or
Yay me! into the room VSA longer didn't know! my colleague
than 10 minutes
Oopsie!

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