Thursday, February 27, 2014
1. Check out the FREIDA website on the AMA if you're applying for a residency in the US
2. Read blogs about people's medical training and their residency experiences. It's really eye opening
3. Read forums about different specialties. You'll learn about how much they earn, how much they work, as well as the good and bad things of those fields
4. Ask residents. If they're friendly, they'll talk to you and speak candidly about their experience as a resident. A few residents will have switched fields and be able to really give you great advice on the positives and negatives of their former field.
5. Attendings are helpful to ask, but their view is definitely different from a resident. They're already on top, and life is much better for them. They'll probably be able to provide more advice on the future of a specialty and in what direction it's moving
6. Try out what medicine is like in private practice during an elective if you can, and not just in an academic setting. You'll get a better feel for both that way. Many people miss the team aspect of an academic hospital where there are medical students and residents instead of just the attending and a PA or NP.
7. Always try before you apply. You'll be surprised by how many people change their minds after doing an elective. I definitely felt that way after my hematology/oncology month. I know a lot of people who were hardcore-set on surgery but ended up applying for radiology.
8. Shadow doctors when you get the chance. I managed to a few times during basic sciences and it was a great experience.
Experience will only help you when it comes to choosing a field. Some other questions you can ask yourself are:
1. Can I see myself teaching topics in this specialty and enjoy it?
2. Do I like reading the scientific literature about this field?
3. Am I excited to go to rounds/OR/clinic every day in this field?
4. Can I see myself doing this when I'm 40, 50, 60 years old?
You always hear about the lawyer who quit to go become a chef or the guy who didn't choose to go onto a residency because they wanted to go into business instead. I'm not sure if those people had their heart in their former career, but you know they found something they're more passionate and excited about.
Soon I'll write an entry on the decision to apply to medical school. Cheers
Sunday, February 23, 2014
Really the reason I wanted to become a surgeon was because I was interested in surgical oncology and trauma. I thought the idea of operating was really cool, and I got a few procedures under my belt during my surgery rotation. I drained abscesses on children and adults in an operating room, closed laparoscopy ports all the time, injected lidocaine near surgical incision sites, and closed everything from a laceration on the entire length of the hand to an entire C-section dermal closure.
I've done a lot of camera driving and retracting on everything from a cholecystectomy to congenital diaphragmatic hernia repair on a 30-something week baby.
So why don't I want to be a surgeon?
Mostly because the surgical residency didn't align with my interests. I wasn't excited enough about vascular, CT, plastics, and abdominal surgery to be happy as a surgery resident, I figured. My interests within the field were too narrow.
I also got tired of saying to everyone "I wish I was there!" or being texted by people saying they missed me, and just how I kept missing out on everything and major life events. Residency will be hard anyway and being a doctor means making sacrifices all the time, but I don't want to spend almost a decade in a field where my interests just don't align. I kind of felt that a lot every time I was draining butt abscesses at 11pm almost every night.
I'm more interested in the medicine side of things, and it's good I realized it. On the surgery service, while I liked that all the diagnostic testing was at a minimum, everything was just so procedural and my intellectual needs weren't being met.
Where was the new medical literature on this and that? At least at my institution there wasn't a lot of discussion on the new drug that could really help people in the ICU, with this kind of infection, or that kind of condition.
I just don't have the passion for laparoscopic hemicolectomies, and I don't daydream about cutting into pilonidal cysts at 3am.
You are good for surgery residency if:
1. You're single, or your partner and children are okay with hardly seeing you
2. You like working 30 hours at a time at the very least (After intern year)
3. You really like the GI tract and get excited about the 100th cholecystectomy or perirectal abscess on the patient who has really poor healing
4. You're fine with the idea of doing an intense 5 year residency, 1-2 years of research after that, and a 2-3 year fellowship after that before finally becoming an attending
5. You won't feel stressed out by working 16+ hour days (during intern year, longer after that) and then having to take the ABSITE every year which is one factor determining how competitive you'll be for a fellowship in the field you choose
6. You're okay with chronic diseases for which there is currently no cure. I used to think surgery fixed everything, but it doesn't cure Crohn's disease nor cystic fibrosis. Just because you transplanted a liver or kidney doesn't mean the patient is cured (they have to be on immunosuppressants and are prone to graft failure)
7. You're okay with a very intense work environment. Many surgeons are kings or queens of their OR and it is a high-discipline environment with little room for error
8. You're okay with hearing all the people on the surgery service vent a lot about it and say they either want to switch out or will go into surgical fellowships that have better hours. I hardly hear of any younger person saying they want to stay in general surgery
9. You understand you won't only be a specialist surgeon. Surgical oncologists don't live off of cancer surgery alone. You will still be doing a lot of lap choles and hernias
10. You love hernias. You fantasize about open hernia repair and laparoscopic hernia repair is the most amazing thing to you.
11. You love the rectum, colon, anus, doing colon irrigations, disimpacting fecal matter, doing emergency laparotomies and cutting out necrotic intestine
12. You're okay with constantly having to prove yourself to your superiors (this happens at all levels in medicine, but particularly surgery because of such little room for error and how busy the servicse are)
13. You have an interest in CT, vascular, abdominal, transplant, pediatric, and plastic surgery. You have no choice on what rotations you want on a general surgery residency, so you better truly enjoy them, or at least like the majority of the rotations
14. You've met people who switched out of surgery into a different field and you're not dissuaded
I just want to help people narrow down residency choices, so you're not trapped in one you don't like and at the same time someone who really loves surgery misses out on a surgery position. It happens a lot.
Anyway, happier entries in the future! Cheers
Saturday, February 22, 2014
So there's a lot of literature on caffeine and the cardiovascular effects. I've included a review and I encourage you to read more scientific literature on it (not anecdotes from websites with photos of really muscular dudes on them).
I thought taking caffeine before running was stupid when I read that it can cut up to 20% of coronary blood flow to your heart (that's the blood your heart muscle needs to work and survive).
It's also thought to increase the work your heart has to do by working as an adenosine antagonist (adenosine is very important in coronary blood flow autoregulation).
Also be wary of caffeine pills. I wasted money on some and stopped taking them because I have no way to know what certifications or protocols the manufacturers adhere to. Better safe than sorry.
Don't put things in your body if you don't know it's safe and don't waste money on detox garbage because your kidneys and liver are amazing at detoxification already.
Here's a review for now from the National Institute of Health site called pubmed.
Tuesday, February 18, 2014
In my experience, it has been the most stress from academics I've ever experienced in my life. Easily about twice that of university. If I could estimate how much work it is, I'd say I was studying or in class for 120 hours a week during basic sciences. I was pretty stressed the entire time too.
Here is some advice to help you deal with the stress:
1. Eat right. Not just square meals, but watch your calorie intake. So much studying leads to inactivity and it's even more stressful when you're gaining weight.
2. Cardio exercise. Even if it's 15 minutes a day. It'll help boost your mood and be a good distraction. Treat exercise like it's not an option.
3. Either avoid or join other med students. Find what's best for you. I studied on my own because other medical students stressed me out with their own stress, and I felt better just studying at my own pace. I scored above average on nearly every basic sciences exam because I did what was right for me, not what Jack or Princess Rapunzel said was the best study strategy.
4. Make friends with an upperclassman. They've been through it and will usually be helpful and encouraging.
5. Find a mentor or role model among the faculty. They're someone to talk to and it's a boost for your morale if you have something to aspire to.
6. Wake up earlier so you have some time to listen to music, do something enjoyable, and eat. You won't be getting a lot of time for yourself or for moments of quiet once you start medical school. I think this can help you stay balanced for the most part, because medicine is a grind (and I haven't even started the most intense part).
7. Eat dinner with your significant other or friends. Meal time is a time to bond and relax. Just about everyone needs a sense of community and companionship.
8. Don't complain, don't stress too much, and know that you'll get past it. Studying and exams is not as stressful as performing surgery or working in a busy ICU with very sick patients.
9. Youtube. Really. Find funny videos and take breaks. While humour won't stop ventricular fibrillation, it'll help you cope with stress and remind you that you're not an emotionless study robot. I really recommend the Key of Awesome for their great parodies of pop music.
Good luck to you all. Feel free to comment with any questions or concerns. I hope to be your guide in your medical training. cheers
Tuesday, February 11, 2014
Anyway, a big thing I wanted to talk about was managing your stress and anger during medical training. This is because embarking on medical training can automatically bring a lot of stress into your life.
While yes, I've done my psychiatry rotation, but this isn't professional medical advice or anything. I just wanted to talk about stress and anger. Fortunately, I've never required anger management, and hopefully you won't either.
There's a quotation that more or less says "Anger is temporary insanity," and I definitely think that when people get angry, they're not as rational as they are. Some people get so angry that all they just vent, verbally, physically, or both, and they aren't thinking about the consequences it can have.
So what's stressful about medical school and medical training?
The list would be infinite, but the biggest sources of stress are the expectation to perform, to match into a good residency in a location you want, the stress of 18-30+ hour periods of work with exams thrown on there, trying to save lives at critical points in the shock room, floor, operating room, the hierarchical nature of medicine, helping patients who are getting close to the point of no return, dealing with irreversible diseases, and balancing your social, family, and romantic life on top of all that as well as maintaining your own health.
It's pretty stressful, and I can't really do it justice without illustrating things with a really long post. You just kind of have to live it to experience it.
So how do we manage it all and avoid a meltdown?
Become positive. It sounds really shallow, but it's the most simple solution. Here's some examples:
Problem: You gained a lot of weight because you haven't had the time to take care of yourself and you just see yourself gaining more weight.
Solution: Exercise is not an option in today's world, you have to get around to doing it somehow if you're physically able. Get up earlier in the morning so you have that extra time to work out. The 15-20 extra minutes of sleep won't help you feel more rested when you're chronically sleep deprived as it is. Get out there and get moving.
Focus on how great you'll feel after losing weight and its positive effects on your cardiovascular physiology.
Problem: Everything in medical training is stressful and spilling over into your social life.
Solution: Don't complain. Some people just complain non-stop and just because others aren't commenting about your complaints, it doesn't mean that doesn't stress them out in turn. It pushes people away and it makes you look negative and like someone with poor coping skills.
Think about what you can do to change things, and adapt. Exercise, do a sport, read, take a break, anything positive to release that stress. Medical training is like living in a foxhole in a war: you don't stop getting bombarded with problems.
There's a quote in Band of Brothers that I apply to medical training: "We're paratroopers, Lieutenant. We're supposed to be surrounded." In medicine, people are sick, things are complicated, and life isn't simple. If it were, we probably wouldn't need medical care.
So, accept that medical training is complicated, work hard and expand your knowledge so you get better at it, to the point it becomes manageable. Adapt and stay positive. Find things in the day that make you happy: like bringing your food from home, exercising to lose weight, listening to your favourite music on the way to and from the hospital, and make time to meet up with your friends, even if it's a few minutes in the hallway.
Your stress management is important, not only for you, but for those you love. Imagine one day you find someone who love telling you "What if things get worse and you're so stressed that we don't talk anymore?"
In your medical training, you're going to find yourself missing in that group photo because you're working, tagged in facebook photos of your baby or an event (because you weren't there and people want you to see the photo).
You'll miss out on people growing up, getting married, etc, and that'll surely play into your stress management.
As far as anger goes, it's the one emotion you're never supposed to show in the workplace. There are times I have been talked to and mocked because I'm the medical student and lowest in rank, but I never said anything to retaliate. And it actually has helped me, because some times it was just in jest but I thought it was actually meant to be spiteful and humiliating.
Anger doesn't make people like you more, and no one ever says "Oh you know that one really intense, mean person? I really like that they're mean. They're great." Medical training is intense and demanding, and you don't need to stress other people out.
I'll write an entry on managing tough personalities and how to work with them, it'll be pretty long with some examples.
As other things, if you're angry: try to find a solution that will make you feel better. Examples include: getting to the hospital earlier so you have more time to round, round faster and be more efficient, etc. Get to the root of the problem and fix it by being proactive, talking to someone with the power to resolve that conflict, etc.
A lot of medical training is "here you go, deal with it," and you just have to endure it. Anyway, I'll try to include more entries along the lines of this with examples. I just want people to know they're not alone, and that the people around them are affected by their stress levels too.
keep working hard for your patients, and keep working hard to take care of yourself
Monday, January 27, 2014
Hey friends. As we all know, the match is soon. I wonder how many medical students know what they're getting themselves into, though.
The second most important question to ask before applying to residency (the first being what to apply for, of course) is what the job market is going to be like in the future, and what to expect as far as what kind of practice will be available (private practice on your own, joining a group, working in an academic setting, working at a government hospital, etc).
Sure, a lot of people just matched ophthalology and urology, fields which are really competitive and prestigious, but what kind of future are we looking at? What's going to happen to reimbursements for eye injections, TURPs, and so on? Money might not be everything, but it certainly can be for people with almost half a million dollars of student loans.
You can search online specifically for speculation on the future of different specialties regarding income, but here is some general information I gathered from program directors, doctors in private practice, and surgeons in academic practice:
1. Big cities are saturated with specialists. It will be hard to carve out your own niche in NYC, LA, or other big cities. Also, everyone prefers the doc who has more experience than a new guy to do their procedure, etc.
2. If you do find an opening in a big city, it might be with a group. Being the junior member of a group means taking more call, covering more, and a smaller salary
3. A lot of fellowships take internal candidates who have really gotten to know and impress their senior faculty
4. Similarly, a lot of groups employ residents (to serve as an attending when they graduate) who have impressed their senior members and are well-known to them (it's a safe business practice)
5. Non-competes become an issue. Find out the rules specific to your state
6. You might find yourself competing with practices filled with PAs and NPs if you're looking at going into primary care
So, a lot of finding a job is based on who you know and your reputation. Just because you got that really competitive residency doesn't mean you can choose where your job as a doctor will be. That's the reality of practicing medicine in the US, it becomes all about connections when it comes to finding a job.
I tell it like it is and I don't give people false hope or empty encouragement. My job is to help guide you and keep from becoming a person who says "well, I wish I had known that before."
Cheers, and stay upbeat and hard-working.
Friday, January 17, 2014
"You don't need to be a genius to do well in college. It's all about time management," my good friend told me when I was starting my university studies. In my experience, this has been very true. All you need to do is spend time working hard.
The same applies to medical school. If you don't have a great short term or long term memory, then keep repeating your study material more and more times, even if that means staying up late or waking up early. You still need to sleep, but if you're struggling, sleep the minimum you need to retain information and feel functional, and work hard.
Medical school is hard and unforgiving, but you can't give up.
Now say you have a full day of studying, how do you make the most of your time?
The Stopwatch Method:
Pretty simple. All I do is hit Start on my stopwatch when I start studying, and pause it when I'm taking a break. I do this throughout the day, and I can quantify how much I've studied.
The Timer Method:
Depending on how hard I need to study, I set a timer for 1-2 hours and hit Start. When the time is up, I let myself take a break, and repeat.
These tips should help you stay on track and structure your study a little better.
It's all about time management. Additionally, I advise against staying up the entire night studying, especially before an exam. Your classmates who do it might seem really hardcore, but the truth is, doctors who don't sleep can't focus well and they make mistakes. So get into the habit now of being rested before exams and that will help you form the habit of resting before a procedure or getting involved in patient care.
For those on clinical duties: People who are too tired are playing with their patients' lives. Live by that.