One more week at the VA

The last two weeks have been educational, but it's been hard work. I'm finally getting the hang of H&Ps, the whole ward-based thing and the VA system. I think it's taken me a little longer than it should have because I had very complex patients that I've followed since about Day 1. Usually students handle 1-2 patients that are bread-and-butter cases. They take 3-4 hours to do a thorough physical exam, interview the patient, write it up in a History & Physical note and do the research for the assessment & plan (differential diagnoses, evidence-based care, studies supporters the plan, etc.). Whereas I've been generally doing SOAP (progress) notes on patients who have been here a long time with up to dozen problems, sometimes trying to juggle 6 patients as an MSIII. So my research has been cut pretty short.

Now we have a new Resident who is much more organized. She is giving us appropriate patients and managing logistics tightly. We can't talk to the interns until after morning rounds with the Attending so that they can get their notes in beforehand. We don't pick patients, they are assigned. Stuff like that.

I am actually looking forward to another IM rotation now that I'll have a much better idea how to manage my time and know what's expected. Plus I'd be smarter about working with Attendings. Our team's Attending is a bigwig and he can be pretty intimidating. But if you do the research, read up on your cases and listen to his didactics you can learn a ton.

My biggest time sink in the last week or so has been Maricopa County hospital screwing up my surgery rotation in January. I've had to scramble to find a new January rotation, and basically rearrange my rotation schedule in order to get a ward-based Peds rotation. I really feel I need the academic setting and resident team environment at least once for each core area.

After a zillion phone calls and another spreadsheet, I'm crossing my fingers that a program in Toledo comes through. Free housing, good residency program and a big hospital with lots of patient volume and interesting pathology. January my Peds rotation would be in the ER with Peds residents and February would be surgery in the general surgery residency program. If that works out, I'll still have a March rotation to play with before heading to Show Low, AZ for rural Family and Surgery for the last two four week rotations of MSIII year. Those should be great rotations where I get a lot more freedom to do stuff.

The other time sink has been preparing a PowerPoint case presentation for last Tuesday's small group didactics. My presentation went well enough that I tied for "the best" and have to present it to the whole class at the end of the year. I kind of over did it because I had a very interesting CHF case that really got me interested in Diastolic vs. Systolic HF, their relative mortalities and differences in medications. It's pretty current news so my supporting articles were very recent.

Last night the family and I met several of my classmates and their families on campus for dinner. It was fun playing volleyball with the kids while talking shop. OB/Gyn next sounds great month, but an awful commute and a lot of work, again. Everyone seems to be narrowing in on residency options and getting eager for school to be done with.

Feedback on my latest residency thoughts was very positive. Ft. Collins, CO and Ogden, UT are my two top choices atm. Once I get my MSIII rotations squared away, I need to schedule audition rotations at both of these places for next fall. I can't wait to check out the programs and talk to the current residents. I also want to see if it's really possible to have a couple procedure days a week in rural Family for minor surgeries like hernia repair, tubule ligations and C-sections. That feels like the key for an enjoyable Family career.