Derm Rotation

I'm just about finished with a very short Derm rotation. My Preceptor leaves for France tomorrow morning around 11am. I've probably only been at the rotation for 6-7 days out of the scheduled two weeks. Both Mondays I had Boards tests, then my Preceptor was gone last Friday and he leaves early on Tuesdays.

Even so, I'm bored to tears with cosmetic dermatology. The only thing that is still interesting is the Scottsdale hotties that come for TBE (Total Body Exams) wearing thongs. Actually today we had a couple more medically interesting cases: a very mild Mycosis Fungoides; a Dermatofibromasarcoma case; severe Psoriasis; and a women with horrible cutaneous Sarcoid that may have new onset Ovarian Cancer due to the immunosuppressants used for the Sarcoid.

But most of the two weeks has been freezing stuff with NO2, burning stuff with one of three lazers or prescribing meds (typically antibiotics, steroids and Vit A derivatives for acne). Throw in a couple a Botox injections, a few chemical peels and several cyst removals and you have a complete picture.

We move very fast, seeing about eight patients per hour. My Preceptor is an old-timer with thirty years in dermatology including many papers and even textbooks chapters. But he at the point where bedside manner isn't his strong point: nor is teaching. The one thing he's determined I learn on this rotation, after I mentioned it, is how to differentiate Actinic Kerotosis from Seborrheic Keratosis (known as barnacles). He says he's still practicing because he enjoys it, but you get the feeling he just wants to work through all the days' patients as quickly as possible.

Don't get me wrong, Derm is a great lifestyle and if I had the opportunity it would be hard to pass up a good residency. They make a ton, do lots of procedures, have no call and work whatever hours they want. Plus there's lots of cool new drugs, lasers and procedures (Mohs surgery) they get to use. But the competition is ridiculous and I would get bored to tears in a year or two.

When it comes right down to it, the thongs are no match to the vanity of these patients spending huge sums to reduce wrinkles, freeze rough spots and burn out hyperpigmentation.

USMLE Step 2 - Done!

Wow, that was hard. It is hard to describe, but the main stressor was the time pressure. I rarely felt like I had time to think through problems. And when I did, I paid for it by being rushed at the end. My third block of 46 questions, right after I took lunch, I had to literally guess on the last 2-3 questions because I didn't even have time to really read the questions. From then on I stayed more focused on getting through the questions, but I still had to go with gut feels a lot!

In talking with a classmate, he had the same experience so I can only hope that the time pressure will even out the grades for all but the fastest readers. It sure was drudgery though, the whole time I had to stay 100% focused to speed through vast amounts of information in the question stubs. The environment wasn't helpful either. I used the same Prometric site as I did for COMLEX but this time there was loud people, cold rooms and interruptions from staff to slow me down and distract me.

The questions were different than I expected as well. There were a fair number of easy ones that I could nail quickly, but the detailed ones were intense. Instead of 4-8 options that are related and picking based on fine details, this was vast amounts of information to filter through in order to pick one of several unrelated options. For example, instead of picking one connective tissue disease based on asthma symptoms, you had a life story presented and had to decide if cancer, connective tissue or chronic kidney failure was the underlying condition. Yuck!

I just hope that I did as well as Step 1. I certainly won't be adding my USMLE scores to me ERAS application until I see my scores. That's the one advantage of being a D.O. I have to submit COMLEX scores, but they aren't top notch or my USMLE scores are good I can submit those as well.

Now it's time to get all the paperwork and logistics done for my rotations. I received my ER shift schedule from Arrowhead tonight and it looks ok. It will interesting to see how four 7pm - 7am shifts messes with my circadian rhythm. Lots more to do before that starts around the house. I still have to send out Thank You notes to my LOR authors, then there's a ton to be done on my ERAS application. Tonight I need to relax a bit though.

One observation worth closing with is that for Step 2 I don't feel so emotionally drained. Last summer, after Step 1, I was burned out for weeks. This time around, I'm still looking forward to studying for my upcoming EM rotations. I can't wait to start learning what I expect will be my future profession - really learning what I'll be doing after residency!

COMLEX Step 2 done!

What a joke! The test seemed like something written for amateurs by amateurs. I hate to day it, but it didn't seem like a "real" doctor's test to me. I certainly won't hold COMLEX Step 2 scores, no matter how high, in any esteem. I actually am glad I'm taking USMLE Step 2 next Monday so I can say I'm a real doctor.

One classmate was in tears today when her test (at a different location) didn't have of the graphic and picture exhibits! My pictures were so grainy they weren't much of a help anyway.

I hate spending another $500 and another week of studying, but I feel the USMLE should be a much better measure of where I stand in my education. I'm sure I passed COMLEX, so the score doesn't matter. However, the USMLE score will count, so it's going to be a long week.

My Derm rotation starts in the morning. Hopefully I can get some short days and do more USMLEWorld practice tests as well as go through Boards & Wards one more time. Bottom line is that I just want to equal or surpass my Step 1 score so Program Directors (PDs) don't have any excuse to throw out or demote my application.

On a funny note, Becky had an employee make some interesting medical decisions - kinda like the guy I had last year in Urgent Care who DROVE past up multiple hospitals and urgent cares while having a heart attack because he wasn't sure his insurance covered him! The guy today left a message over the weekend that he wouldn't be in because he was "sick" with chest pain and a numb arm. Well he calls today from the ICU(!) saying he's had a heart attack, but is trying to continue managing inventory from his hospital bed. The nurses want to take away his cell phone though. They told Becky not to upset him because they are trying to settle him down as he's currently not stable enough to go to the cath lab and get his stent put in!!

It just cracks me up! The guy knows he had heart problems, waited four hours to get in the hospital, has an unknown amount of heart damage, is so unstable he could go into cardiac arrest at any time, but he still won't give up the cell phone and office responsibility.

On to acne, rashes and botox...

Two days to Step 2

It's been a stressful two weeks since my last post. So much for Step 2 being this easy obstacle to rotations and the Match. The old saying of; "Two months, two weeks and a #2 pencil" for Steps 1, 2 and 3, respectively, doesn't feel very accurate right now.

The diet is long forgotten, and I'm maybe getting in two workouts per week. I study for eight to ten hours and then decompress or work on my ERAS application and Residency spreadsheet.

The thing that has really humbled me, or beaten me down to be more accurate, is the USMLEWorld question bank. I'm about 2/3 through it and feeling good if I can get percentiles in the high 50's or low 60's. According to online "calculators" this puts me at about 217, or well below my Step 1 score. So much for improving on my Step1 scores and looking even better for interviews.

At this point, I'm just hoping to equal my Step 1 scores so I don't have to make excuses for drops in my scores. Even though I'm not studying 16 hours a day, I think I'm studying in an organized way with good focus.

My plan is to spend the weekend focusing on OB/Gyn and Peds for COMLEX 2 on Monday. Then next week I'll finish any of Crush that I haven't gotten through a 2nd time and spend the majority of my time on practice questions.

As with Step 1, I'm just hoping to pass COMLEX but excel on USMLE. It's the test that counts for all but one residency that I'm considering.

This whole humbling experience is certainly making me second guess my decision to take Step 2 now instead of after the Match. Yes, I'm going to be happy to not have it hanging over my head during audition rotations, but it sure would be less stressful to take it when all I needed is a passing grade.

Not much else going on in my life or brain currently. I've been updating my spreadsheet a bit and nailing down transportation and lodging for my audition rotations. So far everything is looking pretty good expect that one place I have high hopes for doesn't take D.O.s according to EMRA's web site. I have a call in to verify that I'm not wasting a trip and a lot of money to go out there, because otherwise that would be a VERY expensive Letter Of Recommendation (LOR), assuming I get one.

Not a lot else going on. Took a break today to see the new Harry Potter movie with the family. Otherwise studied Crush. One upside to my "plan" for all this is that I have used Boards & Wards as my main review book and spend a lot of time fixing mistakes and adding pertinent additions to the margins. So for Step 3, during my first year of residency, I should be able to just study from this book.

I'm supposed to start my two week Dermatology rotation next week. I hope the Preceptor is very understanding and gives lots of time off. It looks like I'll have Friday before the USMLE off for sure. Then after the USMLE on the 23rd it will be time to jump into the ERAS applications web site and start preparing to wow the EM program directors.