Decision 2012 – Rank Order Lists & The Possible Prematch

Yesterday marked the end of the interview season for me and I could not be more relieved. After visiting 15 places over 12 weeks, I could hardly distinguish one program from another. Some had friendlier faculty, some had tastier lunches; some had nicer NICUs, some boasted better benefits. Even as I neared the end, I couldn’t help but wonder how I was going to be able to make my Rank Order List based on half-day snapshots of programs on their best behaviors. I knew which places were going to be at the bottom of my ROL (often before the interview day was even over) but the trouble now was deciding which should be at the top. Should I give more weight to university programs or community-based programs, free-standing children’s hospitals or hospitals within hospitals, programs closer to Queens or programs further from home? Was a “good feeling” enough to push a smaller, less prestigious program ahead of one with a better reputation? Do I have to be at an institution that does ECMO?  What about salary? What about fellowship placements? What about availability of eligible bachelors? How could I make a decision about not only a 3-year commitment but possibly the course of my future based on such limited information?

12 Resolutions, その2

Mere days after lamenting the fact that my Japanese skills have been withering from neglect, I discovered that a PGY-1 at my current hospital is wonderfully fluent. I was delighted, but also a little jealous. While it is pretty awesome to chat (even while getting the ‘wth?’ looks two non-Japanese people get when speaking Japanese), I couldn’t help but notice how ペラペラ his 日本語 was and how nicely he’s been able to maintain it, despite also being a medical intern, while my 日本語 is nowhere near as 綺麗 as it once was. I couldn’t even say ‘residency’*.

Now, I find I’m even more committed to brushing up my skills (español también!) – I wonder if there are any medical-themed 漫画、アニメ or ドラマ** that I can get a hold of…

*研修期間「けんしゅうきかん」kenshūkikan
**preferably ones starring 滝沢秀明

12 Resolutions for 2012

So, I was just talking with my dad and my little bro about New Years’ Resolutions and I realized that I wasn’t so great last year about keeping mine (especially the one about being a more faithful blogger, sorry!!) so I think I should try to aim for at least 90% adherence to the resolutions for the upcoming year. That means that I should stick to 10.8 (let’s round up to 11) of the following 12:

1. Read something to do with medicine and/or health care every single day

One of the things that stuck with me from surgery rotation was Dr. C’s admonishment that as medical professionals, we should be reading at least an hour a day, no matter what. I probably spend over an hour reading every day but romance novels, blogs and amateur fiction probably aren’t going to make me more valuable to my patients. Hopefully, one of my other resolutions will help me stick to this endeavor.

2. Be ready to take to Step 3 by May 30th

Step 3 is the final USMLE required before one is eligible for an official medical license. Once can’t apply for it until after one receives a medical degree but since only a portion of this exam is devoted to pediatrics, it would be nice to get it out of the way before the start of residency so that I can spend my intern year focusing on the good stuff. Studying for this exam will also help me stick with resolution one since it will make sure that I’m reading something medical (and learning something new or reinforcing something I already know) every day.

3. Strengthen my language skills

On my past few rotations, I’ve been one of the few people who was able to communicate well with Spanish-speaking patients and that has garnered me praise from the attendings and residents, not to mention interest from residency program directors. However, I find I’ve been coasting by on my above-average español and I’d like to push past the plateau and become fully fluent. The trouble is, it’s tough to find resources (especially free ones) at my level. I’d welcome any suggestions. Meanwhile, my 日本語 has fallen from 上手 to まあまあ from lack of use. I’d really like to get it back up to speed. If that means making time for manga, dramas and anime, so be it.

Decision 2012 – ‘Tis the Season

When I submitted my ERAS application on September 1st*, it was with the hope that out of the 70 pediatric residency programs to which my credentials were sent, one or two might be interested or even mildly curious and decide that out of the hundreds (thousands?) of applicants, they’d like to meet me. Never in my most optimistic musings did I imagine I’d receive the response I have had. Of the 70 programs to which I sent my application, 19 20 have invited me to interview. This is the very definition of blessed. Or maybe just lucky.

Blood on my Gloves – Surgery Core, その2

After 12 weeks of surgery, I have learned a great many things. I’ve listed some pearls below:
1.. Doctors treat patients, not CTs or X-rays
2. To be a good physician, one must make anatomy and physiology their bread and butter
3. To be a good surgeon, one might have to be a little crazy

The No-Meat Fast

I am pleased to report to all the cherished readers of this blog that I have passed Step 2 CK! Unfortunately, I didn’t achieve the 95 or above goal I’d been reaching for but I was able to improve upon my Step 1 score and for that, I’m pretty happy. Once again, the USMLE World Self-Assessment Exam was an excellent predictor of my actual score (I scored 2 points higher on the sim exam than I did on the real thing). I could’ve been a bit more diligent and honestly, I wish I’d had more time to dedicate to study isolation but still, I’m not unhappy with how it turned out. Had I managed a 95, I’d say I was proud of myself but with my 89, I’m content.

My cousin (who is one of my best friends and my faith role model) happens to be a very talented preacher and one of the things he often mentions in his teachings is fasting. Usually, I kinda zone out when talk of turning down one’s plate comes up. I guess I’m greedy and I sort of wondered why prayer wouldn’t be enough. When my more religious pals would talk about fasting for their high holy days, I’d admire their fortitude and self-control but think that I could never be devoted enough to do it.

After CK, I was pretty anxious about my performance. I hadn’t gone through UWorld at least 2 times, I hadn’t watched any bootleg test prep videos and the week before the exam, I succumbed to study fatigue and randomly slacked on question blocks to watch old episodes of Buffy the Vampire Slayer and The Powerpuff Girls. I was really at a loss on how not to fall into depression or go insane worrying that I’d failed when the idea of fasting came up again.

I began to consider the rationale behind fasting and something occurred to me that I hadn’t thought of before: the idea of sacrifice. It seemed like one of the main points of fasting was to make a sacrifice of something as an offering to God, a practice practically all the religions I’ve studied have in common. The end goal could be something as profound as strengthening one’s spiritual relationship but it could be something as simple and secular as a request. Instead of just wishing or hoping for something, one could make a pact – ‘I’m willing to sacrifice x for Your help with this one, God. I’ll make an offering of trust to back it up’. With this in mind, I decided to try this undertaking. For a little over a month, I became, essentially, an ovo-lacto-vegetarian. I vowed to give up meat until I received my step score.

Operative Management – Surgery Core

Today is the beginning of my penultimate semester of medical school. It also happens to be the beginning of the second half of my surgery core. Up until this point, I’ve generally found something to enjoy about every rotation in which I’ve had the opportunity to participate. This time, it hasn’t been easy.

Surgery core at Wyckoff is divided into 6 two-week modules: Surgery Clinics, Day Call, Wound Care, OR, Ambulatory Surgery and Night Call. Clinic and Wound Care have been the least intense modules, generally allowing one plenty of time to study/de-stress in the evenings. As I mentioned before, day call is comprised of 14 days straight of twelve hour shifts (usually preceded by a week of clinic with no break in between). Night call is reportedly similar to day call but students are allowed to take one day off per week and are only required to attend morning lecture and grand rounds, not afternoon lectures, so as to rest up for the night shift and not go insane. One may have the opportunity to scrub in on an emergency operation during day call and/or night call but for the most part, the OR action primarily occurs during the OR and Am Surg weeks. Over the course of those four weeks, students are required to scrub in on at least 10 and observe at least 20 surgeries.

Part of the reason it’s been difficult to find things to enjoy over the past 6 weeks probably has to do with the general atmosphere of surgery, which while occasionally congenial (especially among the residents/interns), can be downright hostile. Things tend to be tense when you’re constantly in fear that you’ll be pimped to death or screamed at by an attending.* The expectation seems to be that we must know everything except how to actually perform surgeries. Everything else pertaining to bodies and/or diseases is fair game. Case in point: yesterday, two students in my group were drilled on Fournier gangrene while scrubbed in on a totally unrelated procedure. None of us had ever heard of Fournier gangrene until yesterday. In addition, there doesn’t seem to be a way to gauge one’s performance. We haven’t received feedback or grades on any of the assignments or quizzes we’ve had thus far and I’ve heard that hardly anyone makes it out with an A, which is pretty disheartening.

Nonetheless, there are a few cool things about surgery – I got to assist on a few chest tube insertions and staple the incision from an open appendectomy. Today, I’m going to observe a brain biopsy and scrub in on a BKA. I hope these little things will be able to sustain me for the next 5.5 weeks…

*Witnessing these incidents is also quite traumatic

Cold Feet

A peculiar thing happened after I received my first invitation to interview for residency. Watching the sun set over Brooklyn on a J train headed into Jamaica Center, I decided to check my email and there it was, waiting in my professional inbox – the possibility of a PL-1 position in the University at Buffalo’s pediatric residency program. Initially, I was dumbfounded and then, elated (I printed out the email and stuck it on the refrigerator) but then, doubts began to set in (it’s just an interview; scores of other applicants were invited for only 17 spots, what if I fail CK and they rescind the invitation? Why on Earth would they want me???) and then, I had a massive attack of indecision. Did I really want to commit my life to peds? Did I really want to deal with sick babies and zany parents every day? What about family medicine, where I could still do well-child checks, adolescent medicine and possibly dermatology? It suddenly seemed like every other field of medicine had endless possibilities but peds was a path from which, once set upon, one would never be able to veer. As soon as I accepted that invitation, I could practically hear the echo of a dozen doors slamming shut.

Matchmaking

So much for keeping promises. Just dropping in with a very exciting announcement – today at 8:00 am Eastern, ERAS goes live! Good luck to all the 医師の卵 participating in the 2012 match season. I’m sure everyone taking part probably already has their credit card at the ready but don’t forget to register at NRMP as well.

While I have had tons of stuff going on recently, I’ve had very little time and now that I’m in the midst of 14 days straight of 12 hour shifts (Surgery day call), free time will continue to be in short supply. In addition to a proper update on how surgery core has been going, stay tuned for tips on how to rock Step 2 CS (I passed!), what to do & what not to do for Step 2 CK (waiting on that score…), an account of how peds core went and more!

Things of Epic Importance

Never let it be said that I don’t keep my promises. I vowed in January to update once per month (and twice per rotation) and by God, I’ll stick to it! Well, last month’s updates didn’t really touch upon how awesome my MFM elective at Maimonides was (I’ll get to that) and at this point, I’m 2/3rds of the way through my peds core but the awesome stories will have to wait because on August 17th, I will be taking an exam of epic importance – the USMLE Step 2 CK. It’s taken me a while to really get into extreme study mode but as the fateful date approaches, I am getting more nervous diligent and trying to really study until my eyes bleed. The other epic thing on the horizon is the NRMP which goes live on September 1st – I’ve been trying to get my things together on ERAS but I’ve still got a lot of work to do. Hopefully once the CK is done, I’ll be able to take some time and really check in. Until then, please enjoy this fun game and this cautionary tale. And wish me luck – this is serious business from here on in.