MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'NJBMD's Blog from Student Doctor Network' source. Sun, 19 Oct 2008 14:14:45 +0100 http://uvamedicine.wordpress.com/2008/10/03/playing-the-waiting-game-and-keeping-your-sanity/ Timing You scrambled around and made sure that every one of your writers of your letters of recommendation did their respective jobs. You started your Personal Statement early and left plenty of time for editing and corrections. You started to fill out your AMCAS application as soon as it was available and you made sure that there were no mistakes. Finally, on the first day that you could, you pushed the submit button and the “waiting game” started. You had heard that in every circumstance, early application is the best strategy for success in getting into medical school. So now, you find that it’s early summer, school is out, and you are in for the wait. Starting the Wait Your next hurdle is to receive word that your AMCAS is verified. This can take six weeks or more if there were no mistakes or lost transcripts and can often take much longer if things are not moving efficiently. This step has to happen and it can cause worry if things are delayed. I can tell you that, in terms of medical schools, early summer is a non-time in terms of admissions. Most of our time is spent on getting the current class underway and gearing up for the start of receipt of new applications. For us, that early lag of time between when you can submit your application and verification is vacation time, organization time and just plain much-needed down time for us in terms of application review. It is also the time when we try to put the finishing touches on the class that is set for the new year. The best strategy for you at this period is to make a folder for each school that you have applied to. In this folder, you will place copies of your personal statement, copies of any completed secondary applications one they have been received and completed and copies of any correspondence that you receive from that school. You can also put an envelop on the front of the folder with a copy of your itinerary once you have made travel plans for your interview. In any event, start making the folders and securing a safe place for them. The next thing to do is make and Excel spreadsheet. On that sheet, you should make a book for each school that you have applied to. You will eventually log every date and every receipt of correspondence that you will receive. You columns should go something like date received, date sent, and date of school’s receipt. (Needless to say, anything that you send to a school should be sent by certified mail with receipt notification). Repository services such as Interfolio will also post dates of when they send your materials and when they were received. You definitely want to make sure that you keep your application materials and correspondence with each school very organized and safe. Plan B Plan B is what you will do if you are not accepted. In the business of medical school acceptance, nothing is a certainly except you won’t get accepted to a school if you don’t apply there. Acceptance, even if you have submitted an application with a 4.0 uGPA and 45 MCAT is not assured for anyone. It is wise to have a carefully though out and planned Plan B. From experience -mine and others- the more elaborate and complete your Plan B, the less chance you will have to use it. Start planning and working on you Plan B. Financial Aid Forms Right after you have submitted your AMCAS, you should begin and complete your FAFSA forms. You will need to obtain a financial aid transcript from every school that you have attended whether or not you received financial aid.  If you are not applying for scholarship or financial aid for medical school, you can skip this step. When you complete your FAFSA, have the results sent to every school that you have applied to. This will save you time in the long run. If you are not accepted, having your financial aid information sent is not going to make a difference one way or the other. If you are accepted late, having your financial aid information already in place can save plenty of headache when school starts. Senior Year If you are an undergraduate, you want to plan a strong senior year. I know that “senioritis” sets in and you are tempted to want to coast because you are done with MCAT and done with the majority of your courses but don’t do this. Take some seminar courses and expand your knowledge base or take some research courses and pick up some valuable skills. My senior year of university was spent writing and presenting my honors thesis work. This was actually great experience for me and propelled me into the world of research scholarship. Use that senior year to shore up any possible deficiencies that you might have and to finish strong. This is also a prime time to begin a solid exercise program. My biggest regret in medical school was that I didn’t stay in good physical condition. If I had kept up with my conditioning, I would have been an even more efficient student and a student with far less stress. Take this time to start and hone a solid aerobic exercise system that you can complete in 30 minutes to 1 hour each day. It can be as simple as taking three 10-minute brisk walks or climbing a couple of floors of stairs until you work up to 14 floors daily (only up direction counts). Even today, I make sure that I do at least 14 floors up every day. I can find steps pretty easily and do a couple of floors between cases or when I need a break from my desk. Early Fall By this time, you should be keeping your senior coursework strong and completing all secondary applications within one week of receiving them. Another thing that you need to do is go to a professional photographer and have some professional head shots taken of you in your interview attire. You will need these for many secondary applications and you will need them later for things like USMLE application. Don’t use a cheap “Passport photo” service. These cheap services will take photos that make you look like you have been in prison. Use a professional photographer and groom yourself as if you were going for interview. That secondary application should look polished and professional. Once you have chosen a good photo from the proofs, have several passport-sized sheets made and keep these in a safe place. Again, as soon as you complete and post a secondary, make a copy and place this in the folder for that school. It’s a good idea to make a copy of everything that pertains to each school including things from their website (names of deans of admissions, names of admission coordinators) along with dates of any phone conversations. Also place copies of any e-mails that you have received for each school. Interview Time Most schools spend July and August reviewing applications and interviewing Early Decision applicants. You can expect to receive notification that you are complete but not much more information from your schools. Early Decision applicants have to be notified by September 1 so their applications are processed first. After the first couple of weeks of September, some of the earliest regular applicants may be notified of acceptance by some schools. If you receive a notification of invitation to interview at this time, this is great but don’t read anything into not receiving an invitation to interview. At this point, it is way early and you should be either working on Plan B or working diligently on your coursework. In short, don’t start obsessing about timing. Many schools will not even begin interview session until late October and early November. Again, if you applied in early June, it will have been a long time. Don’t get crazy and don’t begin to call schools. If you have received a “complete” notice, then you wait. Find something else to do. If you have an interview notification, then work on your travel plans and logistics. Elsewhere on this blog, you will find posts about traveling to interview. If you haven’t heard from any school by the end of October, consider applying to more schools. If you were in the very early applicants, you may need to broaden the number of schools that you have applied to. A major mistake that many applicants make is overestimating their competitiveness for medical school. If you are not securely above the averages for matriculants (uGPA 3.65 and MCAT 31) then you likely need to add more schools. If you are above those averages, you can hold but you probably should have head from schools by now. If not, make sure that your application materials have arrived. Holiday Time You applied early and haven’t received any interview notifications. Yes, it’s easy to fall into the trap of being depressed  but this is the time to plunge into the holidays and not get insane. Yes, I know that it’s only your future here but you cannot do anything more at this point. I will repeat in all caps for emphasis, YOU CANNOT DO ANYTHING MORE AT THIS POINT. If your application is complete then you have to wait. It’s a good time to plan your trip home for the holidays and take a breather from coursework. January and February These are very heavy interview months. You may find that the interview invitations will roll in at this time. Again, there is still plenty of time to receive an interview and receive an acceptance. This is also a time when many of the early interviewers will begin to receive acceptances. If you have done a couple of interviews but received no acceptance, don’t panic here either. Again, work on and finalize your Plan B. If you are a dedicated reader of The Student Doctor Network, don’t obsess over the fact that others have been accepted but you are still waiting. Timing is out of your control and dependent on things like the number of applications received by the schools that you have applied to and the competitiveness of those applications. The only thing that you can do at this point is WAIT (dread). March and April By the beginning of April, some folks will find themselves on wait lists and without an acceptance. This is not entirely a bad situation though you may want to make a decision as to whether you will begin to collect the things you need for reapplication. If you need to do things like re-take the MCAT, you need to have gotten started on your study and planning for the test. You can’t wait too late and you can’t do a re-take without some significant review and preparation. The worst thing that you can do is post an MCAT retake with a mediocre score. If you are on a wait list, remember that there is a huge wait list movement on and after May 15th. May 15th is the date when people cannot hold multiple acceptances. I always advise folks to release acceptances as soon as they have either been accepted by their first choice or when they have made the decision as to where they want to attend. I released my acceptances by the third week of February because I had made my decision. I am sure that five people were grateful that I did that because they were able to get in that year. May and later In general, after May 15th, you are not likely going to gain acceptance. There are exceptions, especially the schools with rolling admissions but by this time, you should either have an acceptance or gathered your materials for reapplication. You can look at my previous post on when to give up on application to medical school but if you don’t have an acceptance by now, you likely need to take an objective look at your competitiveness and do some application upgrading. If you need more coursework, this is a good time to get registered for post bacc work. If you are planning to enter a SMP (Special Masters Program), then you need to get busy fast. These SMP programs have deadlines too. In short, these may become your new Plan B and you need to get to work. If you are on a waitlist at this point, it will not hurt you to go ahead and plan on reapplying. Sure, you will lose the money of submitting your application but if you are not accepted off of a wait list, you will be happy that you reapplied early. If you reapply, change everything that you can change about your application. Do not apply to the same schools with the same application materials. We do compare old and new applications. If you were unsuccessful and submit the same unsuccessful application materials, you are most likely not going to be successful next year either. The average matriculant uGPA and MCAT scores have always gone up. Also, unless a school tells you that you need more extracurricular activity, you likely don’t need to add more here either. Finally You may want to look into the following: Getting the services of a professional pre-med counselor. For nontraditional applicants who have been unsuccessful, this is money that will be well spent. Taking more undergraduate coursework to raise your uGPA. If you are significantly below 3.5, you likely need a year or two of more coursework. If you have an MCAT score below 28, you need a re-take period if you are applying to allopathic medical schools. Making sure that you have applied to a wide range of schools. If you only applied to schools in the Northeast, you may want to go out of that region. You need a minimum of 10 schools if your are a strong applicant and 15 to 20 if you are less than competitive. Don’t thumb your nose at osteopathic medical schools. If you are under the averages for allopathic but your uGPA is above 3.2 and MCAT above 27 but less than 30, you stand a good shot at osteopathic medicine. If you get into osteopathic medical school, you can have the same career as attending allopathic medical school. If you want to be a physician, they are definitely the way to go.        (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1851329 Sat, 04 Oct 2008 01:08:08 +0100 1851329 http://uvamedicine.wordpress.com/2008/07/18/why-i-chose-surgery-part-1-and-part-2/ Part I (an earlier post) I can vividly remember starting my third year of medical school. My school chose our third-year schedules for us and I remember some of the angst of my fellow classmates when our schedules were posted during the summer between our second and third years. I was in the midst of a wonderful Pathology fellowship that I had received for scoring very high in my Pathology course. I was assigned to various Medical Examiners offices and to the Pathology Departments of a couple of very large teaching hospitals. I had been spending the summer doing everything from crime scene investigation to transfusion medicine to bone marrow transplant. It had been a great summer. I was very strongly considering Pathology and Transfusion Medicine as my specialty. I stopped by my Dean of Academic Affairs office and was told to wait for my USMLE Step I scores. The school had received them before I had received them. I took a deep breath because I really hadn’t prepared myself for facing the prospect that I might have failed that test. I sat in a chair outside the Dean’s inner office and ran a couple of scenarios as to what I would do if I had failed. I would quickly sign up for a retest and I would only miss one rotation at the start of third year. Since I was doing Pathology, I could study in between cases and get my preceptors to help me with covering the material. The Dean came out and handed me a sheet of paper. I had to just sit there in disbelief. Not only had I passed, I had done extremely well. I was on my way. It was hard to hold back the tears of joy because I had studied about two and a half weeks for Step I. My fellowship had the requirement that I take Step I by the second week in May and my last exam from second year was on April 28th. I would be starting third year and I would be starting third year on Pediatrics with one of my best friends as my rotation partner. Life was good… I found out later that two people from my class did not pass USMLE Step I. It was very sad because one girl ran down the hall screaming and sobbing when she received her score. That put loads of people on edge. I started third year on Pediatrics. It was a good rotation and I received Honors. I really enjoyed taking care of patients and I was very popular with the residents because I could place IVs and draw blood. I had also spent loads of time with an excellent pediatric pathologist so I knew my congenital defects inside and out. I could interpret cath reports and I was quite comfortable in the Pediatric Intensive Care Unit. I had been a Pediatric-Perinatal Respiratory Therapist before starting medical school so the interns found me quite useful. My second rotation was Psychiatry. This was one of my best required clerkships. I knew that I wasn’t going into Psychiatry (you know these things early) so I was free to enjoy the rotation and pick up anything that I could. My preceptor was an excellent Consultation-Liaison Psychiatrist who exposed us to everything from the wards for the criminally insane to hard-core substance abusers to schizophrenics and other stuff. I earned another Honors grade and got some excellent experience. I learned above all that I was not crazy, my friends are not crazy because I spent loads of “quality time” around people who were genuine crazy. My third rotation was Family Medicine. I had a great preceptor who even delivered babies. This rotatations was entirely office based but I learned to do prenatal exams and care for entire families. I also learned how and when to refer which is great stuff to know. My preceptor was extremely brainy and “pimped” me on just about everything. Turns out this was a good test for USMLE Step II because we either discussed or I had to report on most everything in Family Medicine that was on the shelf exam or on USMLE Step II. I received Honors for this rotation but decided that I really did not enjoy being out of the hospital too often. I also did not enjoy the slow pace of the office. Holiday break came and I was happy to be done with shelf exams and rotations for five weeks. I knew that Surgery was coming up and my friends had warned me to be ready for two months of pure hell. The rotation is designed so that you spend your first month on General Surgery on one of two services: Trauma or General Surgery. I drew Trauma out of the hat and I received the condolences of my classmates. I figured, “you can do anything that you want with me but you can’t stop that clock.” No matter how bad, in four weeks, it would be over. I was hooked on Surgery from my first case. It was a total colectomy with four females operating. My chief resident was female, the junior resident was female, the attending was female and I was female. We talked about shoes and Chanel suits during the case. I tied tons of knots and helped the junior resident close the incision. It was heaven. I found out that I loved Trauma and I couldn’t wait to be on call every third day. I had the time of my life and I loved everything about surgery. My next month was spent on ENT and then on Cardio-thoracic and Vascular Surgery. I scrubbed every case that was assigned to me and many cases that were assigned to some of my colleagues. I became hooked on Vascular Surgery during that rotation. I loved the detective atmosphere on Vascular and loved taking care of the patients. My chief resident on Vascular taught me some great pearls about making sure that even with an amputation, fashioning a well-constructed stump can make the difference between ambulating and not ambulating for the patient. It was great stuff. After Surgery, I rotated through OB-Gyn. I hated everything about this specialty. This rotation became my only High Pass during third year. I just couldn’t get into delivering babies and I wasn’t thrilled with tubal ligations. I wasn’t thrilled with spending too much time in the clinics and offices. The one bright spot was the Gyn surgeries which I excelled at. I learned the surgical anatomy like a sponge but I knew that this was not going to be the specialty for me. I finished up on Medicine and Neurology. This would be my final sixteen weeks of third year. I was fortunate to have medicine last because this made study for USMLE Step II a snap. I totally enjoyed Medicine and Neurology but my heart was back in surgery. All of my Pathology experience really paid off because I aced these rotations and moved onto fourth year. My faculty adviser was chairman of surgery and helped pave the way for my entry into this specialty. I was also co-president of the Surgical Society during my fourth year which also helped. My USMLE scores were good so this helped too. I had some awesome interviews and I landed at a great residency program. My experiences began there and they keep on. As I continue to write, I will be posting more of my experiences. Part 2 Why I chose Surgery. As I moved through medical school, I knew that any specialty that I would enter had to have the following aspects: Ability to have long-term relationships with patients Ability to see every type of patient under a variety of circumstances Practice in office, clinic, hospital, intensive care, operating room and emergency department. Ability to handle a wide variety of clinical conditions Ability to deal with both acute and chronic conditions Ability to perform many procedures The only specialty that met all of those requirements for me was Surgery. I also loved the aspect that I had to utilize my knowledge of both medicine and physiology to the surgical patient both preoperative and postoperatively. This was very appealing for me. I also utilize pathology and biochemistry to a great degree especially in my teaching of surgery and surgery practice. Again, this made surgery a very attractive specialty. I definitely started out in residency with a strong interest in vascular surgery. Not only were the vascular surgical patients among the sickest in the hospital on any given day, I also loved seeing the immediate aspects of my work. Once you increase blood flow to an extremity that had previously been lacking blood flow, you see the immediate effects both good and bad. I also liked becoming very familiar with wound care and the healing of chronic wounds. I had heard about the “surgical personality” and that some surgeons were very difficult to deal with but that never became a factor in my choice of specialty. I don’t care if the devil himself is teaching me if the teaching is good. Fortunately for me, that was rarely the case and my knowledge base expanded exponentially with every year of training. Good teaching is good teaching and good faculty allow you to grow and learn from both them and your mistakes in a constructive manner. I also found that I could profit from the mistakes of others at time too. The other factor that did not deter me from surgery was the horror stories that I had heard about the residency experience. Yes, sometimes I had to work long hours but those long hours yielded some of the best teaching of my life. Yes, I did miss parties and social events but that happens with any aspect of medicine and comes with the territory. Physicians often work long hours taking care of patients who are sick. If you don’t like to take care of sick patients, medicine/surgery is not the career for you. Finally, I have a very good life. I do something that is very interesting and I give my patients 100% at all times. I have encountered some physicians who were psychotic, neurotic, dishonest, unprofessional, racist, sexist, anti-Semitic and just down right stupid. The interesting thing is that I am none of those things and my life is good.  Good will goes out from me to my patients and it come back to me in droves. Yes, I work very hard and under extreme conditions at times but I have been blessed with an even temper and a love of my fellow humans. If you choose a specialty, choose for what you know that you will enjoy doing in most aspects for the rest of your life. If not, you have many years of misery ahead of you. Conditions of practice will change and your income is largely based, not in how hard you work, but on what third-party payers are willing to pay for your services. If you can’t deal with this aspect of your chosen profession, get out as soon as you can. If you choose a specialty because the rest of your classmates were in awe of you, you are likely going to be very unhappy in that specialty. Specialty choice is personal and your classmates will not be entering residency or practice with you. You, and not your classmates, will be the person at 0400h who is admitting that patient with the chronic condition, thousands of medications and multiple needs. You have to love that aspect of medicine/surgery as much as you love the other aspects of medicine/surgery. Finally, you have to be a ethical and honest person. Showing up at the church door every Sunday does not make you a moral person if you know that deep inside yourself, you couldn’t be honest with yourself, your patients or your colleagues. You may not ”like” everyone that you work with or work on but you have to have respect for them and give them your best. In short, you can’t be having a “bad day” unless you are on vacation. If you are prone to allowing external influences to influence you internally, you are going to have a difficult time medicine/surgery. Especially with surgery, you will find yourself multi-tasking, juggling six or seven balls at once, shifting up and shifting back on a daily basis. That’s the nature of the work and the challenge of the work. If you can’t do this, surgery is going to be tough for you on a regular basis.  In short, I have never had a day that was strictly “routine” unless I was just teaching for the entire day. Finally, take some time and get to know yourself and your career needs because after all, this is YOUR career. Your parents, your significant other, your classmates or anyone outside of yourself, can’t make this decision for you. You have to know your competitiveness for certain specialties (forget derm if you struggled with every aspect of medical school including boards) and you have to have a good idea of how competitive you are for programs within that specialty. Also, remember that while residency is when you will hone your skills, it is a short period out of the length of time that you will actually practice those skills. Again, I heard that surgical internship was the worst time on earth but I actually enjoyed my experiences during internship. I heard that surgical residency was the worse time on earth but it wasn’t. No residency program is going to be perfect but unless you encounter dishonest or illegal activity, you can live with residency. The clock is always ticking and time passes (quickly in most cases). Residency requires hard work and hard study. In my case, during my first two years of residency, I studied far more than at any point in medical school in addition to getting my work done. At times, I was “bone tired” but I made myself read and study (minimally for 30 minutes daily). No, I didn’t get to the gym as often as I would have liked and I didn’t hang out late at night (outside the hospital) but I did live pretty well and my significant other saw as much of me as he could stand anyway. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1638022 Fri, 18 Jul 2008 17:46:09 +0100 1638022 http://uvamedicine.wordpress.com/2008/07/12/you-can-go-home-again/ This is going to be one of those posts about a nice experience that I had in the last couple of weeks. A few weeks ago, I was covering for one of my colleagues who was out of town at a meeting. He asked me to stop by an outlying hospital to check on one patient that he had there. This patient was going to be hospitalized for at least another four of five days and I was happy to look in on him for my friend who would do the same for me if necessary. The patient was out of the room having a diagnostic study completed in the radiology department. A very distinguished gentleman was patiently waiting for him to return. He sat in one of the chairs at the bedside with a magazine on counter-terrorism (spy business). The magazine immediately caught my eye as someone I had known many, many years ago, was an expert on counter-terrorism and a writer. I introduced myself and said that I was the covering physician for my colleague who was out of town. The gentleman said that he was told that I would be the covering physician and introduced himself as a relative. I told him that his loved one would be back from radiology in a couple of minutes and that I would wait. I also mentioned my old friend who was a writer and who was a counter-terrorism expert. It turned out that this gentleman knew my friend’s writings very well. Their paths had crossed many times in the past. He was also able to tell me that my friend had moved to another state from when I knew him and that I should get in touch with him. I made a note on my “rounding sheet” with my friend’s name and about that time, the patient returned from radiology. A week or so went by and my secretary asked me about the name on the rounding sheet. “Was this a new patient?” she asked. I had to laugh and tell her “goodness no” but the name of someone that I knew in my “other” life long before medical school and even before graduate school. I told her of my life before college teaching and medicine and said that I had thought about the person from time to time but had no contact. I told her of the patient’s relative and she looked up my friend’s phone number, leaving it on an index card on my desk. Last Sunday, while I was finishing up some of my paperwork, I called my old friend. He was not available at that time but he returned my call about 45 minutes later. I must admit, I was very happy to hear my friend’s voice. He sounded much the same but was a very nice reminder of how everything in my life has prepared me for this profession. I believe that he was surprised that I had entered medicine and surgery because they were so far away from my previous life but I am reminded of how small our word is and how much one phone call from an old friend can just be one of the nicest things to happen. I hope my friend’s life has been as rich and rewarding as mine. There isn’t a day that goes by that I don’t pinch myself to make sure that I am not dreaming. I really love my work and taking care of my patients. I am honored that they place their lives and health in my hands and I never find this job routine. Even something as simple as doing a favor for a friend who was out of town has brought just a little extra joy in my life and the renewing of an old friendship that I thought long past. Enjoy the little things in life as they are precious (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1616556 Sat, 12 Jul 2008 21:24:28 +0100 1616556 http://uvamedicine.wordpress.com/2008/05/17/personal-statement-101/ Writing a personal statement can be a daunting task for many people who are not familiar with the process. By definition, a personal statement is something over which, you have total control. This is your area in the application process to make sure that any evaluator has a complete understanding of your ideas. Unfortunately, many people have great difficulty with expressing their ideas in a clear and concise manner. The key here is that your ideas give a complete and clear picture of you as an individual person. Characteristics of Well-written Documents Any well-written document contains an introduction or presentation of a hypothesis, evidence to support that hypothesis and a conclusion. If you have clearly stated or presented your case and evidence, the conclusion should be very easy to write and should stay in the mind of the reader. Unfortunately, conceiving and writing an introduction is the most difficult portion of personal statement writing for most people. A well-written document is easy to outline or present in outline form. This is why starting with an outline is not a bad strategy for writing any document from personal statement to term paper. Outlines should be logical and should help your ideas from from one to the next as you present your evidence or data to support your original thesis or hypothesis. Most people mistakenly place too much information in their outline which makes their document difficult to understand after it is written. Your outline should be brief and should leave plenty of room for you to “flesh out” your evidence. A well-written document contains good grammar and word usage. If your reading and writing skills have been “dumbed down” to the state of text messaging and sound bites, you are going to have a very difficult time getting your skills back up to a standard that is acceptable for a university-educated person. Being able to understand and utilize text messaging is quite useful in today’s world of electronic communication but make no mistake, trying to use the same methods of communication to a professional school admissions committee that you would use to your “chums” is not a good strategy. A better strategy is to become literate in every level of writing and communication. Getting Started To get around the difficulty of getting started on your personal statement, write down a list of words or phrases that describe you as an individual. You can certainly start anywhere with anything such as your “likes” and “dislikes”, your favorite activities, activities that you enjoy daily or do not enjoy, or persons that have strongly influenced you. This “idea” list need not be detailed but should be as descriptive or related to you as possible. For example, if you listed your Uncle Andy as the person who had a strong influence on you, then under a subheading, list the characteristics and you and Uncle Andy share in common. If you can’t list any, then Uncle Andy did not have much of an influence on you. If Uncle Andy was the person who helped you through a difficult struggle, then list some of the specific things that Uncle Andy helped you to gain insight that helped you through your difficulties. Do not list autobiographical data such as I was born in Las Angeles California on December 1,1983 and grew up in San Jose. I am certain that a couple of hundred folks were born in LA on that date and several million have grown up in San Jose. Those are not unique factors though growing up in San Jose may have had a profound influence on you as a person but you have to list the things about growing up in San Jose that have molded you into the person you are today. Were there any sentinel events that shaped you interest and drive to pursue medicine as a career? Many people have gone through a life altering illness or experienced the emotions of the illness of a loved one. If you use this type of experience to weave your personal statement, you have to be sure that you carefully weave this event into your character and experience. It is your experience that you need and want to elucidate. Take Your Time with this Document Writing your personal statement is something that needs to take many drafts and many revisions. It’s a good idea to allow a minimum of five people (who know you well) to assist you in the editing of this document. If one or two of your personal statement readers are excellent writers, then you will be fortunate indeed. Allow them to objectively critique your document and allow them to change things. It is definitely certain, than you cannot be objective when you are attempting to write about a personal issue. This is where a good editor can help you clearly express your ideas and thoughts especially if they know you well. The last thing that you should do is send your personal statement for edit to someone who does not know you or copy a personal statement from a website or service. By sending your personal statement to a stranger, you run the risk of them plagiarizing your material. You also give up some measure of your privacy which may come back to cause problems in the future. If you copy a personal statement from another person or allow a “service” to write your personal statement, they may be writing the same statement in the same style for several people. This can leave you open to plagiarism which will “tank” your chances of getting into medical school. Admissions committees have plenty of resources for detecting plagiarism at our disposal. Don’t take the risk or leaving yourself open to this type of error. It is far better to write your own statement, in your own style than to copy anything or allow anything to be written for you that you present as your own work. While ghost writers are common in today’s world of celebrity authors, if you are not a celebrity, then you should not use a ghost writer. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1450460 Sat, 17 May 2008 18:36:28 +0100 1450460 http://uvamedicine.wordpress.com/2008/05/08/specialty-selection-and-matching-part-ii/ This post is a continuation of the previous post and will feature more aspects choosing a specialty and matching into that specialty. How competitive are you for your chosen specialty? Medical student love to entertain the idea that once they have graduated from School X or School Y, they are going to be sought after for by program directors across the country. This might be true if you have done extremely well in your studies and on your board exams but in general, program directors look for people who have a solid work ethic, have an interest in treating patients and have the academic ability (as evidenced by performance in medical school/board exams) that they are going to be able to master the knowledge that the specialty demands.  If you have done the “bare minimum” to get through medical school and have just above the minimum pass on your board exams, you are not going to be very competitive for high end university programs or the surgical specialties. Many of the high end university non-surgical specialty residency programs are not going to be interested in you if you have attended medical school overseas unless you have multiple publications and extremely high board scores (even in that case, Americans who have graduated from medical school in this country are likely going to have an advantage.) Every program director in this country is looking for the best potential residents out there period. It is your job, no matter what your medical school performance, to convince the program and faculty that you are well suited for them. Along those same lines, every program that interviews you is not going to rank you. If you have applied for residency and received under 10 invitations for interview, it is likely that you are not going to match into that specialty unless you either apply to more programs and to a greater variety of programs across the board. This situation usually happens when a candidate is marginal for a particular specialty and applied to high end programs only in that specialty. If you are again, not a particularly distinguished graduate of your medical school, apply to programs across the board (community and university affiliated). Make sure that you have received at least 10 solid interviews in those programs across the board. There is nothing wrong with applying to some “reach” programs but you need to apply to some “non-reach” programs too. On the other hand, if you have applied to 20 programs and you have 20 interviews, you can probably cancel some of your later interviews as long as you have enough programs to rank the ones that you would seriously want to be your future residency program. Some of the things that you need to take out of the equation are the comments from your fellow medical students. Everyone “hears” things about programs but if you visited the program, had a great interview experience and feel that you loved the program, location and all vibes, then rank that program. Even though you only get to see what the program “wants” you to see on interview day, unless you felt there was something very sinister that remained hidden, your impressions about a program are generally fine. Program Problems Programs that have undergone a leadership change are not necessarily bad programs.  Sometimes leadership changes are the “shot in the arm” that a program needs to go from good to excellent. If you happen to interview at a program that has a recent change in leadership, look carefully at the enthusiasm for training and education of the new (or interim) program director/chair. If enthusiasm is lacking, avoid the program. Programs with a large turnover of residents are definite red flags. If you see a program were most of the people who start do not finish there, something is wrong. It may be problems with workload, administration, resident support, working atmosphere or any number of things. Be sure that you ask any program about the percentage of people who start that finish. If they change the subject or even hedge on this question, mark them in the “questionable” category. Programs that use the resident staff as “assistants” rather than programs that are dedicated to resident education and professional advancement are also problematic. Residency is teaching and the attending staff should have some strong teaching ability. A good measure of this is how the residents conduct themselves during your interview day. They should be unhurried and available to you for questions. They should be able to answer your questions without hesitation.  Make sure that you speak with a good cross section of residents at every training level especially the PGY-1s and the ones that are about to graduate from the program. Speak with the lab residents too. Places that have very poor facilities can also be a major problem for you. Try to see where the call rooms are located and if they are private and clean. As a resident at any level, you do not want to share a call room with either medical students or other residents. As an on-call resident, you should have meals provided and a place to keep your things such as a locker. Residents are employees but they have a crucial role in the running and management of hospital patients. If the rule is that the attending calls the resident, tells them what to write and then completely manages the patient while the resident does the paperwork and discharge dictations, you are not going to have a good learning experience at that program. Some Final Thoughts Application for residency is NOT the same as application for medical school. Program directors know that if you have finished medical school, passed your boards without too much difficulty and have a good work ethic, you are likely going to be a good resident. You don’t have to “pad” your curriculum vitae with things like extracurricular activities and club memberships but you should have good solid interest in the specialty that you hope to enter. You should also have a very objective assessment of your competitiveness for a particular specialty/location. If you are not competitive, research (only if it is meaningful) can help you a bit but all of the research in the country (with the exception of a Nobel Prize) will not get you into Dermatology if you are in the bottom half of your class. Also, don’t choose a specialty because your father and grandfather expect you to be a particular specialist. If they were orthopedic surgeons and you would rather die than be in the operating room, then don’t choose orthopedic surgery. You will be miserable and you will likely become a miserable orthopedic surgeon.  If you love family medicine, then carefully choose good family medicine programs that seem to be a great fit for you both program size and location. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1429371 Thu, 08 May 2008 22:08:25 +0100 1429371 http://uvamedicine.wordpress.com/2008/03/25/matching-and-specialty-selection/ This is likely to be a multi-part posting but I thought that I needed to start to address this topic at some point. Speciality choice can be quite difficult for many medical students because some schools never quite spend much time on how to choose a speciality. This choice can be a source of life-long misery or it can become like a marriage with deep and passionate love in the early years only to be replaced with a wonderful familiarity that is both surprising and satisfying at the same time. The wrong way to choose a speciality is based on what you will believe will be potential income. While it’s generally true that surgical specialties are better paying than primary care specialities, this is not always the case especially if you find that you just don’t enjoy surgery and surgical procedures after a while. Anesthesia has become very popular in the sense that people feel that this speciality pays well and had less hours than surgery but a description of Anesthesia as “hours of boredom punctuated with seconds of sheer terror” can be pretty accurate at times. Many people find that this aspect of anesthesia far outweighs any monetary rewards. Another wrong way to choose a specialty is by how wonderful your medical school experience was in that particular rotation. While you may have loved your residents and interns, you may have not loved the patients that you were treating. This can make for a miserable residency experience and an even more miserable practice experience. As you rotate through your required third-year clerkships, you may want to pay close attention to the types of patient that each speciality treats. Do you enjoy a long-term relationship with your patient and handling of chronic problems? If this is the case, then family medicine and internal medicine may be of interest to you. Do you enjoy treating only female patients? This brings to mind OB-Gyn but you may find yourself drawn to internal medicine with a track in women’s health. Do you enjoy procedures? You may want to investigate the procedure-heavy specialties such as anesthesia, radiology, orthopedic surgery, ophthalmology and invasive cardiology. You might also place any of the surgical specialties in this category. Finally, do you enjoy the outpatient treatment of patients? This might lead you to emergency medicine as EM spend most of their practice time dealing with outpatient issues with a bit of trauma thrown in. Dermatology is also a specialty that has far more outpatient care than inpatient care. Psychiatry can also go into that category. Pathology tends to appeal to individuals who love to study tissues and medical problems. Pathologists do not treat inpatients and pathologists perform few procedures other than those pathologists who subspecialize in tissue banking and transfusion medicine. If study and evaluation of tissues and medical problems are appealing to you, look into pathology. Another way NOT to choose a speciality is by what your classmates have to say about a particular specialty. Don’t be drawn into the “the smartest people in medical school go into derm so derm is the best specialty”. This might not be the case for you if you don’t enjoy the scope of practice of the dermatologist. While dermatology is a competitive specialty, you may not enjoy much about this speciality other than the look on your classmates faces when you announce that you want to pursue Derm. The telly shows such as “House”, “ER” and “Scrubs” have also tended to glamorize certain specialties. Do keep in mind that telly watching is for entertainment purposes. There is little reality to any of these shows no matter how compelling the characters and patient situations. These shows are written by people who are generally not in medicine with input for practitioners. These shows are written with entertainment factor built into them. Most of actual medical practice is not entertaining. As you study through medical school years one and two, you are creating the foundation upon which you will enter your third year. It is during that third year that you will be exposed to different specialties and their patients. It’s good to keep an open mind during third year. Do not feel pressured to decide upon anything if you don’t have an idea of what type of specialty might be of interest. I can tell you from experience, that I generally liked every rotation that I encountered during third year. Basically, I enjoy the practice of medicine and patient interaction. I saw plenty of very interesting pathology and patients on OB-Gyn but I didn’t particularly find this specialty appealing other than how I could learn to differentiate pelvic problems from abdominal problems in the course of seeing patients. I loved my Psychiatry rotation and found the expertise of my preceptor far greater than any clinician that I have dealt with to date. I developed a very strong appreciation and high degree of respect for that multitude of psychiatrists out there that just do a good job taking care of their patients. While psychiatry was not for me, it was an awesome rotation that brought a depth of understanding as to how many medical and surgical problems might present with psychiatric symptoms. As you go through first and second year, take the time to join one of two specialty exploration/interest groups at your medical school. By joining these groups, you ca expose yourself to residents and attendings that can assist with your exploration of their specialty. It is participation in these types of specialty interest groups that can allow you to keep your focus when you feel that you just can’t look at another histology slide or review another article for biochemistry. Also keep in mind that certain specialties do require a high level of academic achievement in medical school. I have often spoken to medical students who have struggled with a course or two in medical school who feel like doors have closed for them because they won’t be competitive for a dermatology residency. My first inclination when I speak to theses folks is to find out if they actually understand the scope and practice of dermatology. If they do have this understanding, are there other less-competitive specialties that will satisfy many of their need? In the vast majority of cases, the answer is yes. Finally, as a close to this little essay which is like a part one of this issue, if you know that you are not particularly competitive for a speciality that you feel you can’t live without, spend some quality time with the program director/department chairman of that specialty at your school. Try to figure out if you have some options that can increase your competitiveness for said specialty such as research. There might even be a possibility of finding a program or two in that specialty that might be in a less desirable location and therefor less competitive. Don’t listen to anyone except yourself when it comes to your needs in terms of the practice of medicine. In the end, it doesn’t matter what you classmates say about the specialty that interests you. It’s how you feel about what you are interested in practicing and your suitability for said specialty. It’s also about your attentiveness to your academics/boards too. If you had a slow first year, try to have a strong second year. If you had a weak second year, then try to have a very strong third year. In short, you can decide at any point, that you are going to upgrade your work ethic and performance. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1327648 Tue, 25 Mar 2008 20:22:08 +0100 1327648 http://uvamedicine.wordpress.com/2008/03/13/dealing-with-patients-you-might-not-like-for-whatever-reason/ I received a call about a consult for placement of a temporary dialysis catheter in the Medical Intensive Care Unit. When I arrived I quickly scanned the chart (coagulation profile, patient’s medical information etc.) and entered the room of the patient who needed the temporary dialysis catheter. Just before I entered the room, one of the resident physicians pulled me aside and said, “This guy weighs 500 pounds and let himself get to this point. On top of that, he smells. I just want to warn you to have your gas mask ready”. He laughed and I “thanked” him for the information and entered the room.  Lying in the bed was a 500+ pound gentleman who was restrained and mechanically ventilated. In one hand was an intravenous line which was leaking intravenous fluid. He had a very large abdominal pannus (apron of adipose tissue), multiple scars on both arms and both legs with both legs having open venous stasis ulcers that had become infected. I walked up to the bed and spoke to this patient to explain to him that his kidneys were failing and that he was going to need to have a dialysis catheter to help them along. He nodded to me but I wasn’t sure he could understand. I explained what I was going to do and that it might be uncomfortable but I would use as much local anesthetic as needed.  The nurse told me that the small intravenous line in his hand was not going to be adequate and that it was the only source of IV access that the patient had. It was tenuous at best. I asked if the patients family was present and the nurse said that they were in the waiting room. I told the nurse to gather the equipment for both a central venous line and a temporary hemodialysis catheter insertion while I went to speak with the patient’s family.  The patient’s wife was sitting in the waiting room with her daughter. She was tearful and spoke lovingly about her husband. She said that as he gained more and more weight, he became immobile. Finally, she said that nothing could get him out of his room and that she had difficulty getting him to comply with medications for diabetes and hypertension. She said that he would become angry and depressed when she attempted to help him with his personal hygiene or care of his venous stasis ulcers. I explained the need for the central venous line and the temporary hemodialysis catheter. I also explained the risks and benefits of the placement of these lines so that she could make an informed decision. She asked me to do what I could to help her husband get back to health. After washing my hands and washing the areas of the patient where I intended to insert the catheters, I used a portable ultrasound machine to locate both the subclavian vein and the femoral vein. Both were fairly deep because of the large amount of subcutaneous fat that was present in this patient. I was able to mark off some landmarks and get to work. With the aid of a couple of nurses, I used adhesive tape to tape as much of the patient’s fat out of my way so that I could get to my intended target. After 30 minutes, I had inserted a central venous line into this patients left subclavian vein after taking about 20 minutes to carefully prepare the site. The more time I spent in prep, the easier it would be to get the line in under the best and most sterile conditions. I also had asked the nurse to give the patient a small amount of sedation so that the whole experience would be a little less alarming. I then turned my attention to the femoral vein. Since temporary hemodialysis catheters were very large, I chose a long catheter and moved closer to the inguinal ligament as the vein would be larger there. As with the subclavian vein, I used a large amount of adhesive tape and three nurses to hold this gentleman’s large fat pannus out of the way.  I inserted the line and had great blood flow and return. I also carefully secured the line with locking tape and sutures. I wanted to make sure that the patient would not be able to easily “pull” the line if he became disoriented and unrestrained. I also gave the local anesthetic plenty of time to take effect as most patients are pretty still if they are comfortable. After a chest radiograph to confirm that my lines were in good position (with no pneumothorax), I phoned the nurses to let them know that the lines were safe to use. I also had “blocked” the hemodialysis catheter with an anticoagulant and thus I let the hemodialysis department know that this line was ready for use. I spoke with the patient’s family and let them know that the procedures, while taking a couple of hours, had gone well. For the next three days, I went into the intensive care unit to check on the those lines and make sure that they were working fine. I spoke with the residents who kept congratulating me on “getting the lines in the whale” and laughing about this patient’s body habitus. On the third day, I didn’t see the joke and I didn’t see where calling this man a “hippo”, “whale”, or anything other than a sick patient was necessary. I asked them why they felt obligated to demean this gentleman that they didn’t really know (because he had been intubated) and they were charged with treating.  One of the residents said that he just doesn’t like “fat” people because they don’t take care of themselves and won’t follow his direction. He said that they could follow a good diet, exercise and not end up using up our precious health care resources for something that they “did to themselves”.  Another resident said that he could “stand” the smell of the venous stasis ulcers and that he had to get out of the room as quickly as possible.  While I appreciated their honesty, I couldn’t help wondering why they didn’t have a problem with treating an alcoholic or a drug addict who had become ill because of self-inflicted abuse of a substance.  I had encountered some “skin popper” IV drug abusers who had multiple cutaneous abscesses that smelled far worse than a couple of venous stasis ulcers. I find it difficult to blame the patient for their disease. In my mind, just as a diabetic can’t make insulin, a morbid obese patient has a metabolic problem that is not under their control. By the time a patient winds up weighing 500 pounds, all personal control is lost. If you couple the massive weight with psychiatric disorders such as depression, one finds a very difficult and challenging patient with multiple problems that need to be addressed. I can’t just afford to “like” or “dislike” any of my patients because they need my help and not my judgment. Two weeks later, I received a call from the hemodialysis unit secretary. The nephrologist wanted me to stop by the unit so that I could “speak” to this patient. He was off the ventilator and was not going to need hemodialysis as his renal function had greatly improved. When I saw him, he said that he remembered my speaking to him in the ICU.  I was amazed that he would remember me with his condition but he remembered how I explained everything that I was going to do for him and how I spoke to him with respect. I later heard from his attending physician that he entered a rehab center and was on his way to losing 100 pounds. His hypertension was greatly improved and his diabetes was managed by diet. Though he had a long way to go, he was moving along on his journey. Hearing this made me remember why I went into medicine in the first place. It is simply to help people regain their health. I can’t make judgments on my patients because “there but for the grace of God, go I”. I have been given the privilege and opportunity to touch the lives of thousands of people. I have also been given the trust of those thousands to also have only the best of intentions when I treat them. This is what makes medicine like no other career on earth. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1300786 Thu, 13 Mar 2008 17:50:21 +0100 1300786 http://uvamedicine.wordpress.com/2008/02/03/what-do-you-want-from-a-career-in-medicine/ I am often asked why I decided to pursue a career in medicine; starting at a later age and with many demands both mentally and physically. Quite simply, I knew that I would enjoy those mental and physical demands because I love working with my patients to identify and help solve their health problems. When a patient walks into your clinic, office or you encounter them in the hospital, the most amazing relationship develops that you will ever experience. A person walks into your life and puts their health and trust into your hands. This trust means that you give your best knowledge in terms of figuring out their needs and meeting them.Too many people will confuse what they see on the telly (House, Dr. Kildare, Gray’s Anatomy,Ben Casey, Scrubs, ER) with what is the actual reality of being a physician. There is little “glamor” in this job but there is loads of personal satisfaction in winning those hundreds of little “victories” that you will win over the course of a day. There is also the knowledge that if the health care system continues along the road that it has taken, you are going to make less money for every day that you work in the practice of medicine. The question that you need to ask is “am I willing to work this hard for this career?” If you can answer this in the affirmative no matter what the future holds, then likely you will have a satisfying career in medicine. In no other career are you asked to be out of the work force for essentially 8 years just to be able to enter a job where you will be making less than minimum wage with an average educational debt of more than $150K. In no other career is your income totally dependent on the policies and regulations of private industry, government regulatory agencies, Congress and state governments. You have no control over what reimbursement will be for your services (those reimbursements have been cut every year in the name of holding down costs) while your costs of maintaining your practice have continued to increase dramatically.  Primary care (Internal Medicine, Family Medicine, Pediatrics and OB-GYN) have seen their ranks shrink in popularity among graduates of American medical schools for a number of reasons not the least of which is the extremely high costs of medical education, rising interest rates on loans and decreased pay. Those people who are yet to enter medical school and those who are yet to graduate face even more challenges in terms of just being able to make a living (purchase a house, pay off educational loans, open a practice). If you are not yet in medicine/medical school, you are likely (unless you enter the armed forces) not going to be able to afford to enter primary care because of past educational expenses. Along with that, add the fact that if you are not a very strong performer in medical school, you won’t be eligible for residency in one of the “money” specialties and thus, you will be scrambling to make a living even if you are able to get into medical school. The American Medical Association has been extremely slow to organize and speak for the needs of the young physician. Most of the people (and I am thankful for their efforts) that are able to lobby, have been established physicians in specialties such as opthalmology who can afford to take a day away from practice because their loans are paid off and their homes are purchased and their children have their college education paid for. They have little in common with the newly minted physician who has a young family, a 10-year-old car from residency and a $2,000 a month loan payment in addition to rent (mortgage if they are lucky)and office overhead expenses.  I remember my cousin, who is a neurosurgeon state back in the early 1990s that she had to make a minimum of $10,000 per week in order to keep her office door open.  I am sure that number has increased (increased malpractice costs and office costs) while her payments have been decreasing. In the face of this, why would anyone want to enter this career? How would anyone afford to enter this career? The answer to these questions are not easy but they are expensive both in time and energy. The truth of the matter is that you had better know as much about the day-to-day practice of medicine before you enter your pre-med curriculum because by the time you have finished your first two years of medical school, you have racked up too much debt to be able to do anything else. Little is taught about practice management/investment/finance either in medical school or residency. Medical school  prepares you for residency and residency prepares you for practice. Some people want residency programs to include more about practice management, marketing and finance but along came the 80-hour work week restrictions and thus, most residency programs are still scrambling to make sure that they can include all of the experiences that residents need to learn just to practice let alone add to what they need. The business of medicine is very complicated and growing more complicated daily with policy changes at both the federal and state level. It takes many hours to keep up and keep yourself informed. This gets back to what do you want from a career in medicine? Financial/job security isn’t out there anymore. Definitely respect and admiration are not out there anymore. Hard work, long hours of study and personal and financial sacrifice are definitely out there and ahead. i caution anyone to look long and hard at this career because it’s not easy and there is no relief on the horizon.  Be very, very sure that you have a realistic idea of what day-to-day life is like for physicians who are coming out today and not what you see on the telly. None of those shows are remotely close. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1198222 Sun, 03 Feb 2008 16:32:10 +0100 1198222 http://uvamedicine.wordpress.com/2008/01/20/when-do-i-give-up-on-medical-school/ Introduction I was speaking with a group of undergraduate pre-med students who asked me when I thought someone should “give up” on seeking admission into medical school. My first inclination was to say that if medical school and medicine is your “dream” you should never “give up”. I thought a bit about what might be behind the question and I thought it might make a good essay topic for my blogs. “Should” I have never been a person who dealt in “shoulds” in terms of what might be the best situation for anyone’s life and life pursuit. If you want something and if really desire something, then pursue that “something” and make sure that you are in the best possible situation to achieve your goal. Any realistic (and the emphasis here is on realistic) goal is achievable in taking small steps daily toward it. Certainly, you cannot possibly reach anything if your are not moving “toward” it. Long-term The pursuit of admission to medical school and medicine is a bit like having more than 100 pounds to lose. You have to be consistent with your work on a daily basis or you are not going to see results. This means that everything “counts” and you can’t afford to “slack” or you won’t reach your goals. Your undergraduate work is an opportunity to set yourself up with solid and disciplined study skills that can take you into medical school and beyond. It is also an opportunity to learn how to learn and master coursework. Just as daily exercise and diet modification will lead you closer to losing that 100 pounds (ounces at a time), daily preparation/study and mastery of your coursework will lead you closer to your goal (one semester at a time). As you have probably heard, this is not a “sprint” but a “marathon” and like a marathon, you can’t just lace up your running shoes and expect to finish a 26.2 - mile race without some daily training and preparation. If you are not comfortable with long-term goal achievement, then use your undergraduate to obtain the characteristics that will make you comfortable with long-term goal achievement. Overcoming difficulties There are plenty of physicians out there who didn’t start off strong as an undergraduate. Perhaps they had some maturity problems or perhaps they just didn’t have the academic skills for the pre-med coursework but the important thing is that they kept their goals in mind. If something is not working for you in terms of getting your coursework mastered, then change it. You can decide at this very minute -even if you are on the verge of dismissal- that you are going to turn your academics around “by any means necessary”. The process of doing this “turn-around” can be a huge asset in terms of making you competitive for medical school but you have to be successful. Just thinking about getting your academics together (like dreaming about losing 100 pounds) won’t make it happen but taking some active steps toward changing your methods will get results. Many students have gone from extremely low undergraduate performances to getting themselves competitive but the process is not easy or short. Again, it’s back to the daily and consistent work with constant checkpoints to make sure that you are keeping on track. Enlist the assistance of any study skills courses at your school; enlist the help of peer tutors; enlist the help of a good academic adviser. In short, get help from any resources that you can find. Often, your school’s counseling service can help you identify resources at your school that can help you. You have to take the first steps and be willing to make some changes. Why not make the changes because what you are doing is either successful or it’s not? Just remember,  undergraduate “GPA damage control” is a long and expensive process. If you know this going in, then you can prepare yourself for the long haul. Again, medicine is not a sprint, it’s a long-term goal. “Deal-breakers” There are some things that are very, very difficult to overcome. I place things like academic dishonesty, felony convictions and substance abuse problems. Most medical schools, even if you are sitting there with a uGPA of 4.0 and an MCAT of 45, are not going to be very interested in you with these things in your background. If you have a substance abuse problem, get it taken care of long before you anticipate entry into medical school. There are excellent substance abuse programs out there and you can’t hide from your problems forever. Medical school on any pharmaceutical substance (other than pharmaceuticals prescribed by a physician within the guidelines of established medical practice) is expensive and heading for a crash either physically or legally. Neither of these are things that a  prospective medical school would like to deal with. In short, take care of what you need to take care of and educate yourself so that you can handle life without drugs of any kind. If you “think” you have a problem with tobacco, alcohol, uppers, downers and any other illicit substances, then you have a “problem”. Get your “problems” solved as soon as they are identified. Living in the “Real “World You are going to read (and hear) stories out there about John or Jane X who got into Medical School A or B with a GPA of 2.5 and an MCAT or 20. Those John and Jane X’s are very, very unlikely to be real people. The  average uGPA for medical school matriculants in 2007 was around 3.65 and the average MCAT was around 31. This means that the further from those average on the low side that you are, the lower your chances of admission. Admission to medical school with a uGPA of 2.5 is not impossible but it is improbable since the uGPA averages have been increasing every year. Get your uGPA as high as you can period. Get the highest MCAT score that you can period. There are also folks out there who would believe that if you are an URM (Underrepresented Minority) in medicine, that you can get into medical school with drastically lower GPAs/MCAT. This is simply not the case because you have to have something in your application that shows you are capable of mastery of a challenging medical curriculum. If you are a URM and far below the uGPA/MCAT averages, then you likely don’t have a competitive application. Do what you have to do, to make yourself competitive and be prepared to take some years to get this done. I don’t care what your ethnicity/race is, you still have to be able to get through medical school if admitted. Admission is no guarantee that you will complete medical school. If you uGPA/MCAT is low, get yourself competitive by whatever means you have at your disposal. But when do I “give up”? You must answer this question for yourself. Preparation, application and matriculation in medical school is a very expensive process. How much time and money do you have? If you are a re-applicant, what you have you done to significantly improve your chances of admission? Just reapplying to medical school to “show them that you really, really want this” is not enough. You have to make some improvements on your application before you spend that money to reapply. Again, take a realistic look at what might have kept you out and get it improved. If your application didn’t work this year, rework everything that you can rework before you submit for a future year. If you are reapplying to the same schools, you especially need to change and improve everything about your application that can be changed. Get fresh letters of recommendation, rewrite your personal statement (I don’t care how wonderful you believe it is, it didn’t work) and take more coursework if your uGPA is very low. Retake the MCAT if that is holding you back. (Beware though, retaking the MCAT and scoring lower can be a death blow). What ever you do, be sure to make it an improvement and not a change for the worse. Looking at other career options Some people believe that if they explore other career options such as physician assistant, nursing or physical therapy, that they are somehow giving up their dream. Nothing could be further from the truth. Explore other careers and have a realistic appraisal of how competitive you are for those careers. You may find that one of those careers better suits you in the first place from the standpoint of time of schooling to what your actual interests/motivation for medicine might be. I am not advocating for anyone to seek to be a physician assistant, nurse or physical therapist because they “couldn’t get into medical school” but I am advocating that you should have a career back-up that you can love and pursue. You may not be competitive for physician assistant, nursing or physical therapist or you may not be interested in these great careers but you can’t make an honest decision without career exploration first. You may find again, that these careers are a great option for you and a better option than medicine. Parting thoughts Finally, be willing to let any of your advisers take a long and hard look at your competitiveness for medical school. If you don’t get in, get input from any and every excellent resource that you can find. Your goal is success on reapplication and you want to do everything that is within your grasp to ensure your success. Only you can tell when it’s time to move on to another career option and it’s YOUR life to live as you wish. Enlist any and all help that you can to get what you both need and want out of life. The pursuit of becoming an excellent physician is a long goal. There will be people along the way who will tell you what you “can” and “cannot” accomplish. If you know yourself, and have faith in yourself, you know that you can accomplish anything that you want. You have to be willing to “run your own race” and take care of your own “needs”. There are as many routes into medical school as their are medical students. If you should decide that you don’t want to pursue medicine, then that’s the best decision for you. Don’t let your life’s dream be anyone’s other than your own. It takes a fair about of courage to stand back, take a realistic appraisal of where you are and make the decision to move on to something else. The other thing to consider is that getting into medical school does not have an age limit. Just because you decide not to continue with the pursuit next year does not mean that you can’t do something else and revisit medical school application three, four or even ten years down the line. As long as you have the desire, the stamina and are willing to earn competitive credentials, then give yourself a couple of years to decompress before you dive back into this process.  If something doesn’t “click” for you in 2006, it might “click” in 2009 because you are a different person with a different perspective. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1163764 Sun, 20 Jan 2008 17:22:56 +0100 1163764 http://uvamedicine.wordpress.com/2008/01/06/shadowing-me/ Some people have asked what may be expected of a pre-med student who is shadowing a physician. I thought that I would write a bit about what I provide and expect on this shadowing experience. The expectations of the physician and the experience of the shadower definitely vary but I hope that this description provides those who have not shadowed with some things that might make the experience better. Legal Matters I have a confidentiality sheet that all pre-medical and medical students must sign before shadowing me. It outlines the confidentiality rules such as you may not disclose the name, condition or any other identifying information of any of the patients that you encounter during the shadowing experience. It also outlines that your may not write on any patient document while in the hospital and it outlines that you will observe all rules and regulations as you are directed by the staff of the hospital. These rules are for protection of the privacy of my patients and are pretty clearly outlined before you come to the hospital. Dress I ask that shadowers dress in business attire for the experience. This includes suits for males and suit or dress and jacket for females. I don’t ask for white coat because I seldom wear one. I have a badge that identifies you as a Student Observer that you will wear on your jacket along with a name tag.  My patients expect that you will be professionally dressed and they are made aware of your presence. If I am going to be doing any procedures that you will be observing, I obtain their permission before you are allowed to observe anything. The staff is quite aware that I have shadowers from time to time and are very helpful in terms of making you feel comfortable. They understand the process and are happy to help me make sure that you have a good experience. What I expect you to do I expect you to have some expectations of what you want to achieve in participating in this experience. You should write down a few objectives and have these ready for me to go over with you. Are you there to learn about my specialty? Are you there to learn about the practice of medicine in 2008? Are you there to discuss your chances of admission into medical school? Are you there because you need an additional letter of recommendation for medical school? In short, jot down a few objectives for your visit and have them handy. I expect you to bring a copy of your Curriculum Vitae (resume). If you have a photo attached, so much the better but I take a digital photo of you and place it with my copy of the signed Confidentiality sheet. If I am writing a letter of recommendation, I like to look at the photo and make sure that I remember the person correctly. Sometimes people will ask for a letter several weeks after their shadowing experience and I like to make sure that I remember the person. I also like for you to bring a copy of your Personal Statement (PS) and the medical schools that interest you. I usually read your PS before we begin the day and I often offer tips for making the document stronger. I also can provide some information about specific schools that might be helpful to you. I can also suggest particular schools that might be a good fit for you too. Again, I add your PS and schools list to the folder that contains the documents that I have mentioned above. The Day I usually have people shadow on a day that I am in the hospital ,clinic and teaching. While it’s a long day, it usually gives the shadower a good experience. I usually have folks come on the day when I am not on call and have a lighter procedure day. I want to you see some cases but I also want you to have plenty of time to ask questions and understand as much about my practice as possible. I also will send you a list of the cases that I have scheduled and a brief description should you want to do some research before you observe. Over lunch, which I provide, we usually discuss your career plans and I answer any questions that you might have. Again, I usually have taken a look at your CV, PS and schools list. If you are yet to take the Medical College Admissions Test (MCAT), I usually offer some tips about preparation for this very important exam. Since you will likely sit in on one of may classes, I usually give you a copy of my lecture notes so that you can follow along. The class is a great time for you to meet some of my pre-clinical medical students or some of the third-years that are on my service. They usually have loads of hints and suggestions about application to medical school. When the day is done, usually about 5 pm (just before evening rounds), I usually go over any questions that you might have and any expectations that you have of me that we haven’t gone over during lunch. If you need a letter of recommendation, I ask that you provide a deadline for me so that I can make sure that you letter is out in a timely fashion. Most shadowers get a chance to participate in morning rounds, a few cases, in my clinic and sit in on a class or lecture. I think that while the day is pretty full for you, it gives you a fairly realistic idea of what this profession involves. After all, this is your shadowing experience and you have a short period of time to make the most of your experience. I also feel that you need to have exposure to the daily routine of what I do so that you can compare your shadowing experience with me to others that you might have. Again, this gives you a more realistic experience. Finally, I do have people who come back for a second day sometimes. These folks usually have shadowed me early in their undergraduate career and now want to spend a little more time working on buffing their application before they submit it. I certainly do not ever have a problem with this. I definitely recommend that people shadow at several stages in their undergraduate career as sometimes the shadowing experience can hone your desire to pursue medicine if you were unsure the first time around. Good sources of names of physicians who will allow you to shadow are the local medical societies in your locale. Most local medical societies will have lists of physicians who will work with you. I know that in many large metropolitan areas the city medical society will make all of the arrangements for you. This was how I was able to shadow several physicians before I entered medical school. Another source of physicians who will allow you to shadow would be any medical schools that are nearby. You might contact the individual clinical departments of the medical schools which may be able to match you with the name of a physician or two that would allow you to shadow. Other resources are your family or personal physician who may provide this service or know a colleague or two that might allow you to shadow. The important things to do are: Have a list of objectives that you want to accomplish on this visit. Find out what the dress code will be, what time you are expected to finish and what the daily agenda will be. Have a copy of your CV, personal statement and list of schools if possible (attach a small passport-sized photo) to your CV. If you need a Letter of Recommendation, be sure to provide a deadline, an address as to where the letter should be sent and if the letter is going to an individual or a committee. The last thing is to enjoy your experience being mindful of the person who is allowing you to shadow them. This means being mindful of the confidentiality of their patients and send a letter of thanks when you are done. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1132244 Sun, 06 Jan 2008 19:27:25 +0100 1132244 http://uvamedicine.wordpress.com/2008/01/05/academic-excellence/ For many people in both medical school, graduate school and undergraduate school, this is the beginning of the second semester (or quarter). If you are new to your academics, then you finished the first semester/fall quarter with some academic achievements (good or bad) and learned some things about yourself. Since this blog is about strategies for success in medicine (getting into medical school, staying in medical school and other things associated with medical school), I though I would post a note or two about making changes that can enhance your Academic excellence. Doing well in academics is something that can be mastered with practice. It comes out of having a strong and solid approach to what you have to master in terms of knowledge and it comes out of having a high comfort level with the learning process. If you always feel that you are somehow “not going to be able to get everything learned” or that ” the course is too hard”, then your beliefs can become a self-fulfilling prophecy. There is no task, no matter how great or how formidable, that cannot be approached by taking small steps every day until it is conquered. You have to be willing to “chip away” on a daily basis and note your progress on a daily basis in order to see that you are handling the larger task in smaller steps.  Let’s take Organic Chemistry for as an example. At the beginning of the year, your professor hands you a syllabus that outlines the lecture schedule, laboratory schedule and exam dates in addition to what is expected in terms of how you will be graded in the course. Usually your grade is the result of your grades on some combination of exams and projects. Armed with this information, the first thing that you need to do is make a master subject calendar of lecture topics and test dates. Also include things like “one week to Exam 1 ” and “2 weeks to Exam 1″ along with “3, 2 and 1 week to project due”  so that when you look at your calendar daily, you know exactly how much time you have to master the knowledge for the material on your exams/projects. The next thing to do is look at your reading and problem assignments each week for your lectures/topics. Some topics have many problems and some don’t have so many problems. Divide and conquer here by looking at the amount of time alloted for each topic. This should give you a good idea of the importance of each topic. Your textbook is a good resource in terms of looking at how much time and space it devotes to a particular topic. For example, look at functional groups of organic compounds. This is a topic that can be divided into families with the simpler families being presented first and the more complicated families being presented later. You can use your text to add upon your knowledge base. The other thing that you want to do is be sure that you are prepared for each lecture. Don’t go to class with the idea that you can sit there, listen to the lecture and learn what you need for mastery. You need to know something about the topic before you hear the lecture. The best way to do this is to read about the topic before you hear the lecture so that you know something about the items that will be presented. Don’t every walk into a lecture “cold” as 50% of your actual studying can be done in your preparation for you upcoming lecture. The other 50% comes in your digestion of both the reading and lecture in addition to any problems that were assigned. A point about problems and problem solving. With any problem that you are given, try to figure out what learning concept is behind the problem. For example, look at the wording of a problem and then review the concept that applies to that wording.  Consider the problem, in diabetic ketoacidosis, glycerol is primarily used for what? To answer this problem, you need to know something about the biochemical derangements that take place in diabetic ketoacidosis. In diabetic ketoacidosis, the patient is acidotic which implies that ketone bodies have been released and have lowered the pH of a patient’s blood. What else do you need to remember? You need to remember that while the blood sugar is high, the patient does not have adequate insulin which allows glucose to enter the cells and undergo glycolysis and be used for fuel. That leads you to thinking about why the ketone bodies are out in the blood stream in such high quantities in order to cause acidosis. This because the brain primarily, needs to have a constant fuel supply and in the face of a huge amount of glucose in the blood, none of it can be used by the brain because there is no insulin to allow the brain cells to take up the glucose. Now what do you need to know about diabetic ketoacidosis in addition to the above and that is that fat is being catabolized into acetyl Co-A that is being used to make the ketone bodies and that the fat comes from the breakdown of stored triglycerides into fatty acids and glycerol. The fatty acids can undergo beta oxidation to acetyl Co-A and then shunted into ketone bodies but the glycerol goes to the liver as a substrate for gluconeogenesis or the making of glucose. In the face of large amounts of glucose in the blood, the diabetic can’t use that glucose to feed their brain and thus they are making more glucose in addition to ketone bodies which are acidic. This is the concept behind this problem and why you need to approach problems like this or questions like this from many different angles rather than just memorize the answer.  You have to be able to master the concepts so that in any manner you are questioned, you can figure out the correct answer not attempt to rely on you memory. The next thing that you must think about is that you have all of the tools that you need to master your coursework under the conditions that work best for you. Don’t compare yourself to anyone in your class. Some people are visual learners (tend to sit in the front of the class) and some folks are aural learners (tend to sit in the back to avoid aural distractions). Most folks use a combination of both visual and aural and thus learn best when they utilize both methods. If you are a visual learner, then make a brief outline of the material to be covered in lecture and take a note here and there. Don’t try to write down every word that the professor says but watch how the material is presented and fill in your notes later. If you are an aural learner, listen to the lecture and take a note here and there. Listen for inflections in the professor’s voice. Listen for key phrases such as “in summary” or lists of important topics. If you worry that you will miss something, take a small digital recorder with you and record the lecture. You can then upload it to your lap top and it’s there if you need to review concepts. In short, if you have managed to get through first semester, you have every tool that you need to excel second semester. You may need to adjust some of your study habits or you may need to fine tune others. The important thing is not to dwell on what anyone else in your class does but to do what you need to get the results that you want. There is no class invented that could not be mastered because after all, someone had to come up with the facts and concepts for the professor to present. Don’t go into any of your courses with preconceived notions that the course is too “touch” or is a “weed-out” course. The coursework is there for you to master and you have to figure out how you will master it. Another common mistake that many students make is relying on their perceptions of the professor’s like or dislike of them personally. No one who is lecturing actually cares about you as a person. They don’t have a personal relationship with you, and if they do, it doesn’t matter in terms of the presentation of the material to be mastered. The material is there and it doesn’t care about you or the professor or whether or not you “like” or ”dislike” the subject matter. If you spend the dollars in tuition, then that alone should be enough for you to have a vested interest in mastery of the material that is presented. In short, you need to get your tuition dollar’s worth out of this class for whatever reason. Whether you ”like” or “don’t like” the way the professor talks, looks, or anything else has no relationship to how you deal with the material that is presented. The professor is not your main source of knowledge but someone to help you navigate (by their experience) though mastery of this class.   Finally, you can decide in this very instant, that you will change your “thinking” in terms of how you approach your coursework. You can approach your coursework from a point of fear and trepidation or you can approach your coursework from the standpoint of “hit me with your best shot because I can hit it back and score”. You can decide to toss old habits of trying to “cram” at the last minute and replace them with solid organization and daily study. You can decide that you will either adapt a lifestyle and study style that will allow you to become an excellent scholar or you will continue to do what you have been doing that doesn’t get the academic achievement that you want. The key point is that you are the complete master of your thoughts, actions and reactions. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1131792 Sat, 05 Jan 2008 20:28:36 +0100 1131792 http://uvamedicine.wordpress.com/2007/12/23/what-to-do-if-you-dont-get-accepted-into-medical-school/ Let’s say that you have submitted your application and it’s late in the year. You have received no invitations for interview and since it’s now April, your chances of getting invited for interview and gaining acceptance are getting slimmer and slimmer. What are you going to do now? Since the day that you entered undergraduate studies, you have contemplated the study of medicine but at this point, it’s looking like you are not going to be a member of the upcoming year’s starting medical classes. What are you going to do? Your current application The first thing that you need to do is pull out a copy of your current application and take a long and objective look at it. Was your personal statement well-written and an accurate reflection of your goals in medicine? Did you illustrate strong extracurricular activities that showed your interest in your fellow humans? Was your undergraduate GPA competitive within the context of the schools that you applied to? Was your scores on the Medical College Admissions Test competitive within the context of the schools that you applied to? What can you do about improving your application? If you contemplate reapplying for next year, the first thing that you have to do is upgrade any and all things that were a liability for you in the current year. This might mean taking a course or re-taking the MCAT and making sure that your score is significantly higher. This means reworking your entire application including revamping your personal statement. If your application didn’t work for this year, it’s not likely that it is going to work for you next year. The major reason that people do not get into medical school is overestimation of their competitiveness within the context of the pool of applicants to the schools that they applied to. The applicant pool Every year since I have been working with medical school admissions, two things have been generally true. The undergraduate GPAs/MCAT scores of the applicant pool have been increasing and the number of application to my two schools have been increasing. We attribute the increase in the number of applicants to the generally poor economy and we attribute the increase in academic scores to both grade inflation (at some colleges ) and an increasing number of folks who use test prep companies for the MCAT. We are well versed in the undergraduate schools that practice grade inflation and we look very carefully at the patterns in the MCAT scores.  Larger applicant pool and higher uGPA/MCAT scores mean that we are using much of the entire application to make our decisions as to whom we will invite for interview. The URM myth Both of my medical schools have about 1% URM representation in any given class. It is entirely a myth that being an Underrepresented Minority in Medicine is an automatic entry into medical school no matter what is on your application. We just don’t “hand out” seats in our freshman medical class for having a certain ethnicity. One of the prime forces for us is making sure that every student who is admitted will successfully get through four years of a very tough curriculum. The material to be mastered knows no color or ethnicity. In the past, with our admissions formula, we have been pretty fortunate in that our graduation rate in four or five years is greater than 99%. In general, those people who graduate in five rather than four years have some extenuating circumstances that have prevented them for continuing with their class not because they were not well-qualified in the first place. Feelings that you are somehow inferior This turns out to be a huge factor in whether or not a re-applicant will be successful on the second try. There are far more applicants than seats in medical school period. If you don’t get in, it is generally because you were not a good “fit” for the year in which you applied or you made some poor decisions in terms of the schools that you applied to again you were not a good “fit”. You can reassess you situation, change the things on your application that you can change and reapply stronger. There is very little difference in a student who is accepted and a student who is not accepted in any given year. You would be quite surprised to learn how close many “rejected” students actually came to an acceptance. Those folks who are wait-listed were definite acceptances but were a bit further down the list in terms of being offered a seat. They are definitly “alternates” but we just felt more strongly about the people who were offered admission. Graduate school In general, if you are NOT interested in graduate school, don’t undertake a graduate degree to enhance your application. If you have developed a passionate interest in Public Health or Business and you can complete your degree in one year or so, then obtain an MPH or an MBA but don’t look to these degrees to make you more competitive for medical school if your uGPA/MCAT was low. If you elect to enter a Special Masters such as the Special Masters in Physiology (offered at many colleges/university), you can definitely enhance your chances of admission if you perform well in this type of a program. In addition, you will have some graduate training that can be used if you don’t enter medical school. These Special Masters generally have you taking the same coursework as medical students and can show that you are capable of handling a tough medical school curriculum. These programs are ideal for candidates who are just a bit below average (3.2-3.5) uGPA range or those who had a great deal of difficulty with the MCAT but higher uGPAs. Retaking the MCAT If you scored below that magic “30″ or had a severly lopsided score say 13 in PS, 12 in BS and a 5 in VR, then retaking that exam with solid preparation and remediation in your lower scoring areas might be a good idea. One of the things to consider is that you must shore up your deficiencs and be sure that you have done something major before you re-take this exam. Nothing can tank your application faster than several mediocre MCAT scores. While some schools will take your higher scores at each re-take and use a composite, most schools (includng mine) do NOT do this. If you retake, make sure that you are going to score higher period. Also remember that most people do not accomplish a higher score so you definitely need to do something different in terms of prep in order not to wind up with a lower score. Timing It is definitely true that the earlier you apply, the better your chances. Meet and exceed every deadline and in the case of reapplication, be early period. You can’t procrastinate on this one. As soon as you have decided to reapply, start getting your materials together for an early submission of your application. Most of the time, the difference between waitlist and acceptance is the timing of the application. Resolve that you are going to be proactive about getting your application done and that you are going to upgrade everything that you can upgrade within the time frame that you have between application cycles (this is not an infinite amount of time) Reapplication time is also a good time to explore other career opportunities outside medicine especially if you are well below the averages for accepted students. One has to be realistic about their chances of acceptance if you are sitting on a uGPA of  2.9 or an MCAT score of less than 28. Sure some students in the past have gotten into some schools with those scores but most applicants with these numbers are automatically “screened out” of may medical schools. The other thing is that everyone is NOT going to become a physician no matter how great the desire. There are just too many applicants for seats. Also do not make the mistake of thinking that you will become a Physician Assistant or enter Nursing as a substitute for medicine. While these are great careers, they are not the “same” as medicine. These careers can be extremely rewarding and satisfying but enter these careers because you have decided that they are a good “fit” for you and that you will enjoy them. Getting into Physician Assistant school is quite competitive and not a stepping stone into medicine. It is far likely that if you were not competitive for medical school, you are not going to be competitive for PA school.  Above all, if medicine is your dream, you will do whatever it takes to accomplish it but you need to be sure that you are upgrading your application with each reapp and that you are being realistic in terms of you competitiveness. Just reapplying does not increase your chances of acceptance in itself. Most people who reapply do something significant to upgrade their application. Make sure that if you elect to reapply, you do the upgrade. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1114061 Sun, 23 Dec 2007 17:27:53 +0100 1114061 http://uvamedicine.wordpress.com/2007/12/14/a-memorable-patient/ I have been thinking about some of my more memorable patients these days. I especially remember one of my younger surgical patients from when I was a junior resident. I was on the Colo-Rectal surgical service, which was one of the more interesting rotations that you can have a resident. Colo-rectal surgeons handle just that, diseases of the colon and rectum that have to be treated surgically. One of the nice things about the service is that the colo-rectal attendings were among the most personable and knowledgeable of my junior years. They loved to teach and they loved to have us involved in their cases at every step. One day, a gentleman presented to clinic for the final scheduling of his upcoming surgery. He was a young man (less than age 40) with a very low rectal tumor that we knew was cancerous. His presentation had been rectal bleeding and when his primary care physician found the tumor (it was palpable on digital rectal exam), he immediately referred the gentleman to our clinic for workup and surgery. At this point, the workup was complete: CT Scan, blood work and chest film. We reviewed everything and the patient was scheduled for AM admission, given pre-op orders and sent home to report back to the hospital two days later. Two days later, we greeted the patient and his wonderful wife in the holding area. They had followed the prep instructions to the letter and he was cleared by anesthesia for the case that we would be doing. We had planned an abdominoperineal resection which involves wide excision of the rectum to include the lateral attachments and pelvic attachements and the creation of a colostomy. In the performance of this procedure, abdomen is opened and examined to see the extent of spread of the disease if any. Since we had a CT Scan that was two weeks old, that showed no evidence of spread of disease to other organs, we were confident that we would be able to remove the tumor, fashion a colostomy and get this patient on to recovery. To have a colostomy at such a young age is life changing but to die of rectal cancer would be a tragedy and thus the patient was eager to get the surgery over with and get on with chemo and his recovery. He had been very eager to learn about colostomy care and life with this procedure. We open the abdomen and to our shock, the cancer had spread to his liver. As I moved my hand over the liver, the extent of the numerous tumors was quite evident. We all scanned the CT to see if we had missed something but we had not and neither had radiology. The tumor did not show on the CT Scan. At this point, I helped my chief resident close the abdomen while our attending went to deliver the devastating news to this patient’s wife. The cancer was unresectable and the patient had little chance of living more than a few months with the extensive liver involvement. The next day, we ordered another CT Scan and sure enough, there were multiple tumors throughout the liver in addition to the tumor in the rectum which really hadn’t changed much in size. The next two days, I rounded on this patient and wrote notes. I made sure that his pain was under control and I met many of his relatives who were just wonderful and very grateful for everything that we had done for the patient. I felt horrible because we all wanted to do more but there wasn’t anything more that could be done from a surgical standpoint. On post op day 3, the patient was ready for discharge from the hospital. He was scheduled to see a wonderful oncologist and the possibility of enrollment in an experimental protocol was there but still, it was difficult to see this situation. A week later, the patient came back to clinic for removal of his surgical clips. His incision was well healed and he joked about the small shave prep that had been performed. His lovely wife said that every day she had with her husband was a gift because he had been badly injured in an accident three years earlier and given little chance of survival but he did. She said that she was so happy to take him home and that he was a well-loved man. I heard that this patient died peacefully at home six months after the surgery. His wife sent us an obit notice and wanted us to see that she had directed all donations go to the American Cancer Society. She thanked us again for the great care and the time that she had with her husband. Those words stung then and they still sting as I think of that lovely family from time to time. It is always patients like this patient that remind me to give my best always. We don’t know if we will be the last physician or the physician that will make an impact on our patients. This patient gave me so much by just putting his trust in our team. I see him often when I have to deliver bad news to a family or to a patient and I hope that he is at peace. His wife said that his death was peaceful and that his 10-year-old child was with him as was his mother and father. I can only hope that all of my patients can leave behind their disease in peace when the time comes. I am certain that the oncologist made sure that he was pain free as much as possible. It’s this time of year when I think of some of my more memorable patients. The ones who show me how to live by being a great example with their lives. I am a very fortunate physician. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1096344 Fri, 14 Dec 2007 23:55:46 +0100 1096344 http://uvamedicine.wordpress.com/2007/11/22/thanksgiving/ Thanksgiving actually starts the major holiday season around most undergraduate, medical schools and residency programs. As an undergraduate, you realize that the fall semester is heading for a close as there is very little time left before semester finals. As a medical student, Thanksgiving means a welcome respite from the intensity of coursework and as a resident, you know that you are going to get at least one day off from working the wards. In residency, you quickly learn that either you are working the actual holiday or you are off. Everyone can’t be off and your administrative chief makes sure that holiday time is equally distributed among the staff. Sure, you want to be there to sit down with your family but it just isn’t possible for everyone to have every holiday off as people get sick on every day and at any time during those days. Sometimes you will not be able to go home for a holiday visit to be with your family. I never particularly minded working on a holiday as long as I had one day to sleep in late. My idea of the perfect holiday is sleeping until 7am; getting up and drinking my coffee in front of the telly as I watch CNN. I know this sounds boring but residency taught me to appreciate the days where I can just do nothing (or a few things and at a very slow pace). I now appreciate going to places like Cancun or Key West where I can lie on the beach and appreciate the sunrise or the sunset. Before residency, my idea of a vacation was to head down to Belize and spend a week diving with friends or spending a week playing tennis. Now, just lying around or clubbing in a new city are my ideas of great ways to spend time off. My other favorite vacation activity is to catch up on my reading or get ahead in terms of reading. As a physician, I make sure that I read at least 30 minutes each day and one hour on the weekends. I always have a journal with me to read as I am waiting or on those call nights when I just can’t fall asleep. I have a monthly check list of journals that I definitely read such as Nature Medicine and New England Journal of Medicine (in addition to my specialty journals). Like exercise, if you make journal reading a habit, it become part of your life. I make notes on articles that I will use in my teaching or articles that I want to incorporate into my practice. As a medical student, I made sure that I read every review article in New England Journal of Medicine and every case report. My faculty advisor encouraged this practice on our first meeting as we became acquainted during orientation week. It became as much a part of my life as brushing my teeth each morning. I also found that I acquired the “language” of medicine more quickly as I kept up with my reading. No matter how much studying I was doing, my journal reading was a welcome change of pace from the daily grind of mastery of coursework. As an undergraduate and graduate student, I read journals regularly. This was a means to become a participant in departmental meetings and discussions. As an undergraduate, we had regular journal discussions in our laboratory research meeting. As a graduate student, I was expected to lead those journal club discussions. In short, as a pre-med student, you need to make sure that you learn to read and critique scientific literature. If you anticipate a career in medicine, you have to be able to evaluate journal articles and keep up with the literature of your practice. This is not something that you learn to do overnight but a skill that is developed with practice. Once you become a medical student, gone are the days that you can just sit passively and regurgitate information given in course lectures. You will be expected to question information and make sure that information that you give out to patients will be accurate and up to date. Most of the information that finds it way into textbooks is already dated by the time the textbook is published. Those of us who write book chapters scan scientific literature regularly and include updates but there is a time-lag between the completion of a book chapter and the publishing of a text. It is up to you, to make sure that you are caught in that time-lag as a practicing physician. Holidays spent in the hospital are usually break-neck busy (the time passes rapidly) or very slow. If I was having a slow day, I took the time to read, rest and socialize with the staff that was working. This is just my way of spreading some “good will” around the place. In short, someone has to work and I generally didn’t mind working a holiday. My family wasn’t going to vaporize if I missed Thanksgiving or Christmas dinner and I saved the calories so that I could splurge on New Year’s Day. This was always my personal preference and my colleagues continue to appreciate this. Part of being a member of a health care team is realizing that the world does not center around you. There will be times that you will miss family gatherings to take care of your patients. If this is something that you can’t do without getting a bad attitude, then medicine is not for you. There will be times when you “draw the short straw” and have to work on an important holiday. Sure, it’s not your preference but grumbling all day and whining all day will not help your attitude or your situation. Make the best of it and get your work done. For me, I never forget that it is a privilege to take care of people who need my help. I can certainly acknowledge that the situation is not my preference but that’s the end for me. I set about the task of going merrily about my job and spreading some good will. After all, I chose this profession and I knew going in, that there would be holidays that I would be in the hospital the entire day. It is part of the life that I happily chose and I alway remind myself on Thanksgiving to be thankful that I have been allowed to practice medicine every day not just on non-holidays. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=1046014 Thu, 22 Nov 2007 16:41:30 +0100 1046014 http://uvamedicine.wordpress.com/2007/10/31/selecting-medical-school-applicants-for-interview/ Many medical schools are in the “thick” of the process of screening applicants and selecting those applicants that they wish to invite for interview. This process generally falls along the lines of first, making sure that the applicant meets the minimum requirements for said medical school in terms of undergraduate grade point average (undergraduate GPA) and scores on the Medical College Admissions Test (MCAT).  While most medical schools will review the entire application, in terms of figuring out how to get 8,000 -10,000 applications pared down to a workable number for closer scrutiny, we screen by undergraduate GPA and MCAT scores.  There just is not a better way to make the preliminary cut than these two factors.  In the case of those who do not make the preliminary cut, we generally send these applications for a secondary screen by administrative staff who are looking for criteria that we have flagged so that many of those cut by the undergraduate GPA /MCAT screen might make it back into the secondary screen if our administrative staff keys in on something in the personal statement, coursework or letters of recommendation that we should discuss in the admissions committee. Those applications who DO make the preliminary screen are divided among the admissions committee members who read every work on the application and decide if we want to invite the applicant for interview. In short, do we want to meet this applicant? Would they be a good fit for our medical school? Do they show promise of being able to get through our very demanding curriculum? Do we want to know more about this applicant? In short, we invite applicants that we strongly feel will make good physicians based on the material that is present in their AMCAS applications. That being said, as applicants are filling out those AMCAS applications, they need to be sure that the information in the AMCAS is as accurate as possible and as clear as possible. Many people have been rejected for interview based on a poorly written personal statement. These rejected applicant may have had the GPA/MCAT score but neglecting to write a strong personal statement is like heading out on a long automobile trip and draining the oil out of your engine. You  are just not going to get very far even if your engine appeared to be in great shape. You need to have a well-written and coherent personal statement. On the other hand, a great personal statement/letters of recommendation will not make up for very poor academics. If your academics are poor, take the time to get them as high as possible keeping in mind that the average undergraduate GPA for medical school matriculants is 3.6/4  and the average MCAT score is 30 with no single score less than 8.  Some schools may have considerable variation around their means but my medical school does not. Are schools “forgiving” of a poor undergraduate start but a very strong finish? To a certain extent this is true but there are academic “holes” that can be too deep to climb out of without years of “damage control”. In short, if medicine is your goal, work diligently and consistently at a high level. Don’t count of anything being “forgiven” and keep in mind that no allopathic medical school in this country is searching for applicants. We have far more applications than we need. We try to make sure that every application is screened at least twice before sending out that dreaded rejection letter. This is a monumental task that seems to take longer and longer each year.  Again, keep in mind that one of my medical schools received more than 10,000 applications for 110 spots in the entering freshman class last year. This year, we have already broken last years numbers. There are just too many good applicants out there. As I read through the applications, I always look at how many hours of coursework an applicant has taken in any given year as well as the grades earned. In addition, I look at the content of those hours. If a student took three laboratory courses in one year and managed to earn a 4.0 GPA versus a student who took one lab course along with general education requirements and barely managed a 3.0, I tend to look more favorably on the first student.  We also make allowances for things like full-time employment versus full-time student. We look at the age of academic work. A student may have earned high grades 10 years ago but without recent academic work or a recent MCAT score, we generally will not offer admission. Many things change over the course of ten years including the ability to jump into a very demanding academic challenge. In most cases, we ask for some recent coursework in addition to MCAT scores not more than three years old. In terms of multiple MCAT attempts, we tend not to accept students who have more than three attempts. If a student retakes, we expect the score to go up. If not, that is usually a signal that the student wasn’t prepared on any of the attempts. To keep taking that exam and scoring mediocre scores is generally a very bad idea. If your first score is not what you wanted, do a thorough analysis of your performance and correct your deficiencies. To just keep taking that test without doing additional preparation or changing your method of preparation, is not using sound judgment no matter what your undergraduate GPA. Graduate school GPA does not overcome a poor undergraduate GPA. As a graduate student, you are expected to maintain a minimum GPA and you are expected to do well. While earning a graduate degree can enhance your application, there are huge differences between graduate school and medical school.  In the case of special masters programs that are specifically designed for pre-medical students who need application enhancement, you need to do very well in these programs. Just taking the coursework will not work, you have to take the coursework and make yourself “stand out” from the rest of your classmates in these programs. It goes without saying that we scrutinize the performance of special masters students very carefully and take into consideration strongly, your letters of recommendation from your SM professors. I have written the above so that those folks who are in the process of contemplating application to medical school might definitely understand how important it is to have a complete and strong entire application. You are considered within the context of how competitive you are with the rest of our applicant pool and how competitive you are with the national applicant pool. We are given AMCAS data as it becomes available and we adjust our standards according to the data that we receive. For the past five years, undergraduate GPAs and MCAT scores have been increasing. We don’t expect that this trend will reverse. The number of applicants had increased slightly this year. We don’t’ know if this is a national trend or just a trend for our school. In general, many people look at medicine as a very lucrative career and seek out admission to medical school for this reason especially when the national economy is not as strong as in previous years. (Source: NJBMD's Blog from Student Doctor Network) NJBMD's Blog from Student Doctor Network blogs http://www.medworm.com/rss/comments.php?id=995201 Wed, 31 Oct 2007 16:53:27 +0100 995201 http://uvamedicine.wordpress.com/2007/09/30/some-perspectives-on-teaching/ I have been teaching some Physical Diagnosis skills over the past semester and I have learned many things. First, I learned that I was taught by some extremely skilled preceptors back when I took this course in medical school. My preceptors’ sole objective was for me and my classmates to become excellent diagnosticians and observers. The better we looked, the better they looked and to this end, they taught us well. In short, I have great examples to emulate and I strive every day to live up to those examples. It is no accident that when one attempts to teach something, one becomes stronger and more secure in their own person