Thursday, January 15, 2015

being on call: or how to gradually ruin your body

Being on call is rough, especially when it's something you're not interested in.  I think the system of being on for 30+ hours is a little insane, especially with a lot of acutely ill patients.

Sure, the continuity is good, and you get to see how "episodes" of patient illness play out.  It just takes a toll on you physically.  I stay up all 30+ hours because going into a call room on a hard bed with sandpaper sheets is awful and actually ruins my morale a little.

I hate sleeping in a call room and feel much better just staying awake, working and reading articles. The hospital is my home away from home now, and is going to be from now on.  Rough, but I'm determined to find a way to make it less awful.

A way to make call better is rounding probably around 10 or 11 pm and talking to the nurses and seeing if they have any concerns.  I think being proactive helps a lot.  I know some nurses who know about a problem or an issue and don't tell you right away.  Asking them before you round helps a lot.

It helps a lot too if you're cross-covering on patients who aren't yours.  I like to catch up on patients a second time (first through the covering doctor) as I start the night, then if things are quiet, go see what I can do to help the nurses.

The worst parts of call are waiting for the attending to show up and waiting for rounds to start when you've already spent 28 hours on service.

Maybe things will get better as I get better at taking call.  I'm not sure if I'll ever condition my body to do well with call, but there's always hope

Sunday, January 4, 2015

Happy new year, student doctors and everyone!

Happy new year, everyone.  I've been gone for a few months because I've been so busy and spending a lot of quality time with friends and family.

I'm really thankful for all of you who keep reading my blog even though I get really busy.  Your thoughtful comments and your continued readership keep me coming back.

I need to finish up my entries on each separate rotation and what my typical schedule and duties were like.

If you have any questions on med school: how to get in, how to thrive, how to manage loans, let me know and I'll help.

Happy new year

Saturday, December 13, 2014

How to interview for residency

Hey readers.  It's been a pretty long time since my last post but I've been able to catch some time to relax tonight and write.

I'm thankful for the amount of interviews I've had and I'm ready to get the rest done. 

I've been to a few interview seminars but didn't find them to be helpful.  Here are some quick tips:

Clothing:
1.  Wear a charcoal grey suit.  Black is ok, but a little too stark and serious.  If you wear a black suit, try to wear a French blue or powder blue shirt and a matching tie.
2.  Ladies, don't wear skirts that go mid-thigh when you're sitting.  You're at an interview and not at the club
3.  For the guys, shoes with laces are more traditional and look way better than slip on shoes, even if they're leather.  You never know how traditional your interviewer will be.  I prefer to wear square toed shoes, but I went with some nice, more formal Oxfords.

Questions:
1. Don't ask stuff that you can find out on the website
2.  Ask residents about call schedules, because some might do 5 calls a month, while others will do just night float weeks, etc. 
3. Low yield, lame questions are like "What's the cafeteria like?"
4.  A way to ask about how intense workload can be is by asking how big a SICU or MICU team is.  If it's 40 beds and only 2 residents, that can be too much work
5.  Ask what changes are coming to the program
6. Ask what changes have already been made recently
7.  Ask things that are important to you:  how much trauma experience there is, if there is a lot of transplant available, what the program does to help residents pass their board exams and do really well on them
8. Ask residents how vacation works, not the program director

Other:
1. Be nice, be polite.  Take a seat when you're told
2. Keep good eye contact.  I shouldn't have to say that, but if you don't keep eye contact, you look dishonest and disinterested
3. Interact with the residents, be friendly, engage them and ask questions
4. Be nice to the secretaries/coordinators, be friendly to them
5. Review your application and know it very well.  Be able to speak intelligently about your research.
6.  Don't oversell your role in a rotation or project because people find you and they tell others
7.  Assume program directors talk about you to other program directors

Friday, November 7, 2014

A breath of air in med school

I've hit the point in med school where I have managed to have a few days off and relax.  4th year is really great, but the days that I have been working were not too bad as compared to when I was just starting my rotations. 

I am really fortunate to have been interviewing for residency and I have had all great experiences so far, even though I do feel a little nervous the night before the flight when I'm packing.  It's just natural, I guess.

Anyway, I feel like I can finally breathe and relax, especially after Step 2, working so hard to get all my recommendation letters in, and working on demanding rotations.  I'm fortunate I am happy with my scores and evals and grades and can relax.  I think medical training is a lot like swimming underwater: pretty competitive and you're constantly working hard and placing all kinds of demands on yourself and it is all pretty intense until you get a break and can surface for air, as short as the break might be.

Cherish every single minute of free time you have, when you can breathe in the crisp autumn air and not have a worry or concern in your mind. 

Med school is a place where you unfortunately have to keep making sacrifices until your good score comes back.  The hard work pays off, but try your best not to burn out in the process.

I'll be writing more and more, likely when I'm waiting for a flight or this or that, but I haven't forgotten about you guys.

Thank you for reading my blog and let me know if you have any questions

Wednesday, October 8, 2014

Step 2!! aghh!@@

I finally have some time and energy to write about Step 2.  It was kind of a beast at first, then got better for me as I worked my way through the exam.  I'm just not about 8 hour exams, you guys.

Step 2 actually makes me think of the ABSITE the surgery residents take: 95% clinical, with a few questions here and there about pathophysiology and mechanisms.  I thought it'd be all clinical, but there's still that pathophysiology/physiology aspect.

Honestly, the best way to study for Step 2 is to do timed UWorld Step 2 questions, timed blocks so you learn the pace and get to cover as much as you can.

The First Aid Step 2 book is really basic and doesn't delve into everything you need to know, so I
would supplement it with UWorld.

As for how important Step 2 is for matching, I honestly think it depends on what your programs/specialty think.  Some people say "well, it's more of a clinical test, and you're a clinical learner, so we don't weigh it as much"  or some people might say "If you did great on Step 1, Step 2 isn't a big deal."

Then I hear about how different programs use Step 2 to rank you.  It's crazy and I can't provide enough insight yet, but hopefully I will match and be able to better inform you.

Good luck and study hard, everyone

Tuesday, October 7, 2014

starting on the residency interview trail/NRMP outcomes

All my hard work has been paying off.  My first interview is soon and I've been so fortunate to have been offered so many interviews already.

I've never been so excited in medical school, and it's a great feeling that all the physical harm I've done to my body being a medical student (48+ hour days with little to no food/water/bathroom breaks) is amounting to something.

If everything goes without a hitch, I'll match into my specialty since the NRMP charting outcomes for my specialty indicate I have a pretty good chance with my Step score and number of interviews.

I just have to interview well and and rank wisely.

Here are the NRMP match outcomes:

http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

if you're going to see a physician assistant or a nurse practitioner

You should change your mind if there's no attending physician at that place.  I'm not here to stir up fear, but in this past week there's been a missed diagnosis of cancer, overly liberal administration of antibiotics (including the less-than-optimal kind and for way too long), wrong dosing, and minimal following of guidelines at best.

There's a lot of ego around here, especially with the NPs who talk down to the residents and medical students, when the NP then gets criticized for not having a thorough enough history and physical exam, as well as a "very superficial" assessment and plan.

I feel like an NP is more of a "physician extender" than a physician replacement, same goes for PAs. Doctors go to medical school to study from Cecil's, develop a strong foundation in physiology, pathophysiology, pharmacology, side-effects, nuances in the physical exam, and then they go onto do residency and maybe fellowship where they're in charge of using their minds to take care of the sickest patients.  Not to mention they have to take the USMLE Step 1, 2, 3 and take board certifications in their specialty.

I feel like the NPs are at the level of a third year medical student, and the PAs more along the knowledge and skill level of a 4th year medical student.  Their physical exams and histories are all done with checklists (so a high school kid could do it), and there's little to no thought about a differential diagnosis.

I haven't had an NP or PA been able to tell me what the latest guidelines are on management of  X or Y, and I never hear them explain why they're recommending a certain dose, why they chose that antibiotic, and why they chose to treat for that amount of time.  It's just "because that's how it is," or "why don't you google it?"

I'm sure there are great NPs/PAs out there, and I would really like to work with them.  This environment is just too much for me, really.  Too much for me because it's all "voodoo medicine," where people don't prescribe this or that because of one isolated incident, or because they heard a scary legend at a party.

Evidence-based practice is what needs to be going on here, no "oh I heard this can cause Stevens-Johnson syndrome" or "I've just seen this work better."

Just to add, there doesn't need to be just an attending physician there, but someone who is really good and thorough and passionate about patient outcomes.

Nurses are trained to do, doctors are trained to think.

If a nurse wants a million letters after his/her name and wants to practice medicine, they should go to medical school.

I feel bad for all the patients who have been the victim of medical mistakes because of mid levels. I'm not saying midlevels are the worst or that doctors are perfect (because many make many mistakes), but I just can't trust someone to take care of me if they haven't gone through medical school and residency.