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.
Thursday, July 26, 2007
Monday, July 23, 2007
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!
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!
Monday, July 16, 2007
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...
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...
Friday, July 13, 2007
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.
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.
Saturday, June 30, 2007
Feeling like John McClane
I thought Step 2 was supposed to be easier. After several hundred questions into my practice question test bank (USMLEWorld), I'm not feeling very confident. I was hoping to be hitting at least 60% and 10% higher than the average for students using the questions. But I'm at about 50% and a few percent lower than the average. It sure makes it harder to motivate yourself to study the long hours and takes more tests. I haven't seen any improvement in the last two weeks.
COMLEX is two weeks from Monday and I still have to review three books and answer 1500 more questions. Actually answering them is easy, it's going through the detailed explanations and trying to learn what you missed that takes forever.
Now I'm just hoping to get the same or better score than I did on Step 1. Adding 5 or 10 points would be great, but I'm playing defense at this point.
Went to see the new "Die Hard" movie with Colton tonight and had a good time. Watching John McClane get beat up on screen was a nice relief from getting mentally beat up - and very humbled. You certainly don't get through these exams with illusions about your own intelligence.
I don't have much mental of physical energy for housework or working out. I'm going to try and get in a 35 miler tomorrow. But I haven't gone swimming in a couple weeks. And the yard looks like crap.
On the good side, my rotations look solid and I'm happy with my choices. I completed of my residency application Personal Statement and my Emergency Medicine (EM) Dean/Advisor is reviewing it for me this week. The spreadsheet is looking pretty close to complete with 40+ programs worthy of applying to.
That's about it. Life feels a lot like last summer with another monumental set of Boards that rules your life for a time. Then I'll have four months to really focus on and learn EM back in the clinical environment while trying to impress Residents and Attendings. It will be playtime compared to Boards.
COMLEX is two weeks from Monday and I still have to review three books and answer 1500 more questions. Actually answering them is easy, it's going through the detailed explanations and trying to learn what you missed that takes forever.
Now I'm just hoping to get the same or better score than I did on Step 1. Adding 5 or 10 points would be great, but I'm playing defense at this point.
Went to see the new "Die Hard" movie with Colton tonight and had a good time. Watching John McClane get beat up on screen was a nice relief from getting mentally beat up - and very humbled. You certainly don't get through these exams with illusions about your own intelligence.
I don't have much mental of physical energy for housework or working out. I'm going to try and get in a 35 miler tomorrow. But I haven't gone swimming in a couple weeks. And the yard looks like crap.
On the good side, my rotations look solid and I'm happy with my choices. I completed of my residency application Personal Statement and my Emergency Medicine (EM) Dean/Advisor is reviewing it for me this week. The spreadsheet is looking pretty close to complete with 40+ programs worthy of applying to.
That's about it. Life feels a lot like last summer with another monumental set of Boards that rules your life for a time. Then I'll have four months to really focus on and learn EM back in the clinical environment while trying to impress Residents and Attendings. It will be playtime compared to Boards.
Friday, June 22, 2007
Slow ramp up to Step 2
I really trying to get back into 12-hour a day studying for Boards, but the motivation just isn't there. I'm doing just ok on USMEWorld test questions, so I know I need to study harder. I also need to get back into working out regularly.
I guess I've used the last few days to take a break. I pretty much just vegged out over the weekend and played a PC game called Gothic 3. Monday Becky and I went to see The Police in concert (not the best, but fun for folks that grew up in the 80's).
Still trying to get final confirmation on my rotations before I start buying tickets. But the phone have been sidelined by a visit to the Vet, working with a sprinkler guy on repairing our system and watching the boys in the morning. I even had my first bike flat in AZ today and wouldn't you know it, I had to get a rescue from Becky. My replacement CO2 cartridges weren't threaded, so they didn't work the same manufacturers nozzle!
I guess it's time to get into gear. Put the hassles and delays behind, and get focused. I took my first practice tests in awhile today at my old desk in the 24-hour study lounge. I may just move back in tomorrow and start leaving all my books there. The third years will be leaving soon for rotations and the new PAs haven't discovered it yet, so I've almost got the place to myself.
I guess I've used the last few days to take a break. I pretty much just vegged out over the weekend and played a PC game called Gothic 3. Monday Becky and I went to see The Police in concert (not the best, but fun for folks that grew up in the 80's).
Still trying to get final confirmation on my rotations before I start buying tickets. But the phone have been sidelined by a visit to the Vet, working with a sprinkler guy on repairing our system and watching the boys in the morning. I even had my first bike flat in AZ today and wouldn't you know it, I had to get a rescue from Becky. My replacement CO2 cartridges weren't threaded, so they didn't work the same manufacturers nozzle!
I guess it's time to get into gear. Put the hassles and delays behind, and get focused. I took my first practice tests in awhile today at my old desk in the 24-hour study lounge. I may just move back in tomorrow and start leaving all my books there. The third years will be leaving soon for rotations and the new PAs haven't discovered it yet, so I've almost got the place to myself.
Friday, June 15, 2007
No more AZCOM classes ever!!
Wow. Just finished the MSIV (fourth year) final. Feels better than I expected. It was very stressful the last few days. Kind of Deja Vu from the second year tests. We had three weeks of lectures eight hours a day. In the end, about 70 hours of testable material. The handouts wouldn't even fit in a 4" 3-ring binder!!
Some of the material was good, but a lot was mediocre or worse. So I skipped most of the classes and studied for Boards the first two weeks. Made it through Crush and about 20 hours of Kaplan lectures. This week, I've skipped most of the lectures to go through the handouts. Luckily, as with the third year final, classmates banded together and signed up to make reviews of individual lectures. On our class website, at least 2/3 of the lectures and reviews that highlighted material the guest lecturers emphasized - or even outright said would be testable.
I got through my first reading yesterday around noon! And the material was so fragmented and disconnected that it was very hard to synthesize. We covered OB/Gyn, RadOnc, Renal, Ophtho, Heme problems, Immunology, transplant surgery, GU surgery, Ortho surgery, Peds ortho, Peds emergencies, Onc emergencies, Neuro and much more. I made it through the reviews and my highlighted material once more just in time for the test at 8am. Adding to the stress was the fact that last year they had to give back 25 questions because it was so tough and they didn't want to fail anyone.
That last point will be tested again this year. So classmates didn't take this very seriously. They aren't going to hold you back, and it isn't going to affect your residency applications at all. But who wants to have to take it again? Or do whatever torture Clinical Education thinks up?
On a good note, it looks like my rotations are coming together. I feel pretty confident that they will all come through. Some calls on Monday, then time to start planning logistics like housing, flights and transportation. And time to start studying hard for Boards!
The downer for the week was third year results came out and I didn't do as well as I hoped. I did ok, but failing the stupid surgery tests the first time, somehow pissing off the Attending at the VA and just doing ok on everything else hurt my class standing. I did average for the class on the OCSE (even though I got lots of compliments when I reviewed my notes with the Prof?!?), MSIII final, COMLEX and remaining post-rotation exams.
If I had to do again, I would have spent more time studying Clinical Ed's stupid objectives instead of studying my patients and what the Attendings asked of me. I don't like being locked in to someone else's study schedule when I could learn more from the Attendings on the job. I respected my Attendings (in general) more and enjoyed the freedom to study topics that came up in UpToDate. Oh well, I don't think it's going to change anything. It's just too bad our school doesn't have Honors for rotations, because I think that would have really helped me.
Now it's time to sit back and enjoy the weekend. I will get back into my workout schedule - including a nice long bike ride. Hopefully my vision will come back after three intense weeks of didactics! Then it's time to buckle down for Step 2 Boards.
I believe I have a much better game plan for the next year than I did for third year. At this moment OHSU and Carolinas are probably my top picks for Emergency Medicine residency. So I'm feeling pretty good about the immediate future.
Finally, it was interesting to hug friends this morning and realize many of us won't see each other again until graduation. Most of us are going out of state for at least some of our audition rotations. With no classes and only four post rotation exams (Neuro, IM, EM and Critical Care) we're more likely to bump into eachother on the wards than anywhere else. So it was a lot of farewells and "good lucks" for Boards, audition rotations and interviews.
Some of the material was good, but a lot was mediocre or worse. So I skipped most of the classes and studied for Boards the first two weeks. Made it through Crush and about 20 hours of Kaplan lectures. This week, I've skipped most of the lectures to go through the handouts. Luckily, as with the third year final, classmates banded together and signed up to make reviews of individual lectures. On our class website, at least 2/3 of the lectures and reviews that highlighted material the guest lecturers emphasized - or even outright said would be testable.
I got through my first reading yesterday around noon! And the material was so fragmented and disconnected that it was very hard to synthesize. We covered OB/Gyn, RadOnc, Renal, Ophtho, Heme problems, Immunology, transplant surgery, GU surgery, Ortho surgery, Peds ortho, Peds emergencies, Onc emergencies, Neuro and much more. I made it through the reviews and my highlighted material once more just in time for the test at 8am. Adding to the stress was the fact that last year they had to give back 25 questions because it was so tough and they didn't want to fail anyone.
That last point will be tested again this year. So classmates didn't take this very seriously. They aren't going to hold you back, and it isn't going to affect your residency applications at all. But who wants to have to take it again? Or do whatever torture Clinical Education thinks up?
On a good note, it looks like my rotations are coming together. I feel pretty confident that they will all come through. Some calls on Monday, then time to start planning logistics like housing, flights and transportation. And time to start studying hard for Boards!
The downer for the week was third year results came out and I didn't do as well as I hoped. I did ok, but failing the stupid surgery tests the first time, somehow pissing off the Attending at the VA and just doing ok on everything else hurt my class standing. I did average for the class on the OCSE (even though I got lots of compliments when I reviewed my notes with the Prof?!?), MSIII final, COMLEX and remaining post-rotation exams.
If I had to do again, I would have spent more time studying Clinical Ed's stupid objectives instead of studying my patients and what the Attendings asked of me. I don't like being locked in to someone else's study schedule when I could learn more from the Attendings on the job. I respected my Attendings (in general) more and enjoyed the freedom to study topics that came up in UpToDate. Oh well, I don't think it's going to change anything. It's just too bad our school doesn't have Honors for rotations, because I think that would have really helped me.
Now it's time to sit back and enjoy the weekend. I will get back into my workout schedule - including a nice long bike ride. Hopefully my vision will come back after three intense weeks of didactics! Then it's time to buckle down for Step 2 Boards.
I believe I have a much better game plan for the next year than I did for third year. At this moment OHSU and Carolinas are probably my top picks for Emergency Medicine residency. So I'm feeling pretty good about the immediate future.
Finally, it was interesting to hug friends this morning and realize many of us won't see each other again until graduation. Most of us are going out of state for at least some of our audition rotations. With no classes and only four post rotation exams (Neuro, IM, EM and Critical Care) we're more likely to bump into eachother on the wards than anywhere else. So it was a lot of farewells and "good lucks" for Boards, audition rotations and interviews.
Monday, June 04, 2007
It's official, I'm an MSIV!
Well it took much longer than anticipated but we finally received our grades today on both our standardized patient exams (OSCEs) and our MSIII final. I did ok on the final and am satisfied with the grade. Not a stellar accomplishment, but I easily passed.
I also passed the OCSEs as well, but it wasn't as pretty. I did fine on the history gathering portion of the test and middle of the class on the physical exam, but in the third on the plan portion. One consolation is the grades for the latter seem to be stacked together tightly. Forty spots in class rank on the plan grade were separated by only four percentage points.
Tomorrow morning at 8 am we have an hour review of the OSCEs and I'm sure this is going to be a very vocal, lively discussion of grading methodology. The biggest disappointment is that the feedback I received wasn't very helpful. I hoped to see copies of our SOAP notes with hand written notes including suggestions, corrections, etc. But this may be WAY too much to expect from our Clinical Education department.
As for everything else, I'm skipping a lot of class to study for Step 2 Boards. I feel pretty good about my study strategy: know Crush and Boards & Wards cover-to-cover, watch 120+ hours of Kaplan lectures and do at least the 2300 question bank I've purchased from USMLE World. I'm sure UpToDate, Wikipedia and other resources will help where explanations to questions I get wrong aren't detailed enough, but this feels like the right amount of study material.
As for the missed lectures, well I just hope that I can read the lecture notes next week before the final for a day or two and pass the stupid MSIV final. I also have to pass Wednesday's OMM practical, but the review made it seem like a pretty low key affair. Hopefully two hours of technique review tomorrow night will be enough.
At the same time I'm trying to nail down audition rotations. Arrowhead in CA looks locked in for August, after the Boards. Then it's a Peds ER rotation at MUSC (Med U. of SC) in September. October is still up in the air, but I hope to get either the Tufts or UMass EM programs. Both are in MA outside of Boston and could give me nice Letters of Recommendation (LORs) from a NE ER physician - very useful for any residency applications in that area. Finally, November looks like Carolinas, a NC EM program that has a great reputation. It's later than I would like, but the only slot I could get.
It's kind of nerve racking wondering how many programs to apply to, how many to audition at, what baggage the DO degree carries, and what randomness factor plays into all this. I sure wish there were more West Coast programs worth applying to. Of the 25 or so programs I have listed in my spreadsheet at the moment, only 3 or 4 are in the West, 1 is in the Midwest and the remainder are in the East.
It's also a pain to think about spending another three months away from the family entirely and an additional one only coming back for weekends. But with all of the aforementioned questions hanging over me, it seems like the best way to create a rank list for the Match that will get me into one of my top three choices.
I also passed the OCSEs as well, but it wasn't as pretty. I did fine on the history gathering portion of the test and middle of the class on the physical exam, but in the third on the plan portion. One consolation is the grades for the latter seem to be stacked together tightly. Forty spots in class rank on the plan grade were separated by only four percentage points.
Tomorrow morning at 8 am we have an hour review of the OSCEs and I'm sure this is going to be a very vocal, lively discussion of grading methodology. The biggest disappointment is that the feedback I received wasn't very helpful. I hoped to see copies of our SOAP notes with hand written notes including suggestions, corrections, etc. But this may be WAY too much to expect from our Clinical Education department.
As for everything else, I'm skipping a lot of class to study for Step 2 Boards. I feel pretty good about my study strategy: know Crush and Boards & Wards cover-to-cover, watch 120+ hours of Kaplan lectures and do at least the 2300 question bank I've purchased from USMLE World. I'm sure UpToDate, Wikipedia and other resources will help where explanations to questions I get wrong aren't detailed enough, but this feels like the right amount of study material.
As for the missed lectures, well I just hope that I can read the lecture notes next week before the final for a day or two and pass the stupid MSIV final. I also have to pass Wednesday's OMM practical, but the review made it seem like a pretty low key affair. Hopefully two hours of technique review tomorrow night will be enough.
At the same time I'm trying to nail down audition rotations. Arrowhead in CA looks locked in for August, after the Boards. Then it's a Peds ER rotation at MUSC (Med U. of SC) in September. October is still up in the air, but I hope to get either the Tufts or UMass EM programs. Both are in MA outside of Boston and could give me nice Letters of Recommendation (LORs) from a NE ER physician - very useful for any residency applications in that area. Finally, November looks like Carolinas, a NC EM program that has a great reputation. It's later than I would like, but the only slot I could get.
It's kind of nerve racking wondering how many programs to apply to, how many to audition at, what baggage the DO degree carries, and what randomness factor plays into all this. I sure wish there were more West Coast programs worth applying to. Of the 25 or so programs I have listed in my spreadsheet at the moment, only 3 or 4 are in the West, 1 is in the Midwest and the remainder are in the East.
It's also a pain to think about spending another three months away from the family entirely and an additional one only coming back for weekends. But with all of the aforementioned questions hanging over me, it seems like the best way to create a rank list for the Match that will get me into one of my top three choices.
Sunday, May 27, 2007
I'm an MSIV!
OK, I'm not actually an official MSIV (Med Student fourth year) yet. We haven't results back from our OSCE (observed patient exams) or MSIII finals on Wednesday and Friday, respectively. But I feel pretty good about both. It was a long week of studying for the latter with many of my classmates back in the cafeteria with the MSIIs (actually now MSIIIs) studying for Step 1 Boards.
So now it's a nice 3-day weekend (for Memorial Day) to work on my EM residency spreadsheet and try to nail down audition rotations. I've applied to several programs for Fall rotations, but only have August really nailed down. Arrowhead in Colton, CA is the only DO program I plan to apply to and it's in driving distance so I can see the family on the weekends. The others are out of state and, if I get all three, would mean another long season away from the family.
I'm also doing my best to get back into shape. Swimming is going well, other than missing Friday. I still have a few hours to get a workout in today. Biking is coming along slowly. I've been taking 25 mile rides once or twice a week plus spinning for 40 minutes her and there for about three weeks. Yesterday I pushed it up a notch and did a 52.5 miler solo. It was painful when I bonked at about 25 (only had a water and a glass of OJ prior) so I stopped for Gatorade and a snack. That really helped. I think I went through five 16oz water bottles in just over 3 hours at close to 100 degrees.
I'm loving my Garmin 305 even though I'm using less than half the features. It's cool to see your ride on the desktop software and then overlaid on Google maps. However, I went a little on the HR zone, speed and cadence alarms and those got a bit annoying.
It all must be doing something. I'm down to 208lbs from 220 in Fort Wayne 5-6 weeks ago. I've got nine more weeks until I rotate at Arrowhead. I hope to be back to my pre-med weight of 195 by then. Emergency is one those jock/granola/outdoorsy kinda of specialties where being in good shape will certainly help me feel like I belong.
Along with work on my EM program spreadsheet, I need to start thinking about Boards - and start using my online question bank (USMLEworld) to take practice tests. It's not nearly as stressful as Step 1 last year, but I'm aiming for 600 on COMLEX Step 2 and 230 on USMLE Step 2. The numbers are arbitrary but both represent about a Standard Deviation over the means. Improvements over my slightly lower but quite respectable Step 1 scores will look good for applications.
Back to my EM day dreaming...I mean research.
So now it's a nice 3-day weekend (for Memorial Day) to work on my EM residency spreadsheet and try to nail down audition rotations. I've applied to several programs for Fall rotations, but only have August really nailed down. Arrowhead in Colton, CA is the only DO program I plan to apply to and it's in driving distance so I can see the family on the weekends. The others are out of state and, if I get all three, would mean another long season away from the family.
I'm also doing my best to get back into shape. Swimming is going well, other than missing Friday. I still have a few hours to get a workout in today. Biking is coming along slowly. I've been taking 25 mile rides once or twice a week plus spinning for 40 minutes her and there for about three weeks. Yesterday I pushed it up a notch and did a 52.5 miler solo. It was painful when I bonked at about 25 (only had a water and a glass of OJ prior) so I stopped for Gatorade and a snack. That really helped. I think I went through five 16oz water bottles in just over 3 hours at close to 100 degrees.
I'm loving my Garmin 305 even though I'm using less than half the features. It's cool to see your ride on the desktop software and then overlaid on Google maps. However, I went a little on the HR zone, speed and cadence alarms and those got a bit annoying.
It all must be doing something. I'm down to 208lbs from 220 in Fort Wayne 5-6 weeks ago. I've got nine more weeks until I rotate at Arrowhead. I hope to be back to my pre-med weight of 195 by then. Emergency is one those jock/granola/outdoorsy kinda of specialties where being in good shape will certainly help me feel like I belong.
Along with work on my EM program spreadsheet, I need to start thinking about Boards - and start using my online question bank (USMLEworld) to take practice tests. It's not nearly as stressful as Step 1 last year, but I'm aiming for 600 on COMLEX Step 2 and 230 on USMLE Step 2. The numbers are arbitrary but both represent about a Standard Deviation over the means. Improvements over my slightly lower but quite respectable Step 1 scores will look good for applications.
Back to my EM day dreaming...I mean research.
Tuesday, May 22, 2007
Third year rotations over!
I finished RadOnc/Research last Friday and actually passed my Family "shelf" test the same day. I studied pretty hard for the latter and it paid off since it was a very hard test. Wish I had a better score, but passing is passing at this point.
RadOnc is for the most part off my radar. I like it, the lifestyle, income and tech is great. But Emergency is probably a better for me, and certainly for our family. So instead of studying for the Third Year Final on Friday, I've been working on EM spreadsheet and trying to finalize audition rotations for the Fall. I have a couple lined up, Arrowhead, CA in August and Christiana in November, but am still working on Tufts for October.
It's just so hard to get into studying anymore. I spend an hour or so reading EM posts on Studentdoctor.net this evening reliving the Match (March madness) for the Fourth years. Pretty scary and seems like EM is getting pretty competitive. Looks like I'll have to list a lot of schools to make sure I don't end up scrambling for a residency spot.
My diet is going pretty well. I'm under 210 for the first time in awhile. I'm swimming regularly and getting in decent shape. I'm also fitting in more than one road bike workout a week. I just installed the Garmin Edge 305 and am having a blast with it using a tenth of the functions (HR, GPS, cadence, etc.). It feels great to get out there and I can't wait to get my legs back after several years of studying. Only 15 or so pounds to go.
Time to get back to studying the 60 lectures were going to be tested on this Friday. At least its not as stressful. It just doesn't feel like grades matter at this point. I have my OSCE tomorrow which is a test of four patient encounters. The actors/patients grade us and then our chart notes are graded. I'm pretty much winging it. It I fail either, I just try again. No long term consequence for these. Step 2 in July is another story though...
RadOnc is for the most part off my radar. I like it, the lifestyle, income and tech is great. But Emergency is probably a better for me, and certainly for our family. So instead of studying for the Third Year Final on Friday, I've been working on EM spreadsheet and trying to finalize audition rotations for the Fall. I have a couple lined up, Arrowhead, CA in August and Christiana in November, but am still working on Tufts for October.
It's just so hard to get into studying anymore. I spend an hour or so reading EM posts on Studentdoctor.net this evening reliving the Match (March madness) for the Fourth years. Pretty scary and seems like EM is getting pretty competitive. Looks like I'll have to list a lot of schools to make sure I don't end up scrambling for a residency spot.
My diet is going pretty well. I'm under 210 for the first time in awhile. I'm swimming regularly and getting in decent shape. I'm also fitting in more than one road bike workout a week. I just installed the Garmin Edge 305 and am having a blast with it using a tenth of the functions (HR, GPS, cadence, etc.). It feels great to get out there and I can't wait to get my legs back after several years of studying. Only 15 or so pounds to go.
Time to get back to studying the 60 lectures were going to be tested on this Friday. At least its not as stressful. It just doesn't feel like grades matter at this point. I have my OSCE tomorrow which is a test of four patient encounters. The actors/patients grade us and then our chart notes are graded. I'm pretty much winging it. It I fail either, I just try again. No long term consequence for these. Step 2 in July is another story though...
Sunday, May 06, 2007
RadOnc
I took the first two days of this month's Radiation Oncology research rotation to nail the Surgery shelf test. They only told me that I passed, but I'm sure that I did much better this time. No stupid questions trying to redefine anatomy on this version of AZCOM's homemade tests.
I also spent a lot of time catching up with classmates while suffering through on campus didactics. I sure didn't miss the boring lectures during the last four months. However, it was great to hear how everyone is doing, what they are planning on going into, rotation experiences, etc.
Then I was pleasantly surprised to learn that my Preceptor this month is letting me see interesting patients and get in on the cool procedures. I even got to see how a dosimetry plan is generated by the physists for external beam treatment of breast cancer. The best part so far though was helping to insert brachytherapy catheters into guys' perineums and womens' breasts. We then deposited (temporarily or permanently) radioactive sources like Iodine131 into specific catheters at specific locations in the lesions. They actually had most of the surgical "cool" factor to them, but no suturing or Bovey aroma. On the most recent no urologist was present, so I did their job of placing all the catheters.
Most of my time though is spent reading through patient records and filling out research surveys for each one. We are trying to publish the largest post-prostatectomy external beam radiation therapy study to date. So it's a lot of paperwork, but I have the opportunity to get my name on a published study. The office is the largest private RadOnc group in the country and they enter more patients into studies than any RadOnc group in the country, including Universities! So I think they know what they are doing.
This Friday I'm going the St. Joe's office to see their Gamma and Cyber Knife systems. That will be awesome, and it will allow me a chance to ask the Attending what is happening with the paper I submitted to him a few months ago for publishing. I had a minor contribution with a classmate, but any published papers look good.
After almost two weeks doing RadOnc and learning that one of our fourth year students matched RadOnc at Drexel, I think it is much more doable. It would mean 60+ applications, hopefully 5-10 interviews and then a move to who knows where. But the Docs in my office feel I have a shot at RadOnc and should go for it.
At this point, I'm trying to decide whether to try for both RadOnc and EM in the Match or just EM. Going after both means more applications, more expensive interviews and probably listing a couple RadOnc programs as my first and second choices then seeing what happens next March. If I stick with EM, I might be able to get an early contract at a DO program and skip all the time, expense and stress of the Match. The Arrowhead, CA program I'm going to rotate at in August may just work into that plan. However, the income, technology and patient contact of RadOnc is very attractive. I'm tempted to try for RadOnc to see what happens with EM as my backup.
I just finished a bike ride with my attending this morning. We started at his brand new 3800sf house in North Scottdale. What a place! According to Zillow.com, nothing in his zip code goes for less than a million, even the lots start at $500k. And he's less than two years out of residency! He laid out how his contract works with two years guaranteed income then full partner. It's a pretty good gig, and the Docs all say that likely changes to medical reimbursement shouldn't have a huge negative impact on RadOnc. I have a hard time believing there won't be some decreases when procedures can easily run from $100k to $200k, but even a 10% decrease in reimbursements would leave RadOncs as some of the best paid Docs in medicine.
My thinking at the moment is to audition at Arrowhead in August, hopefully Maricopa ER in September and a RadOnc program in October (one that has 2+ slots for non MD/PHDs, if such a thing exists). I may need to double book November with both a RadOnc and an EM program, doing the RadOnc rotation if it's still in the running.
I hate to make things so complicated, but I'm not ready to up on a shot at RadOnc yet either. Two more weeks to go on this rotation along with a lot of studying for the Family shelf test. There's always a chance, however slight, that things will become clearer.
I also spent a lot of time catching up with classmates while suffering through on campus didactics. I sure didn't miss the boring lectures during the last four months. However, it was great to hear how everyone is doing, what they are planning on going into, rotation experiences, etc.
Then I was pleasantly surprised to learn that my Preceptor this month is letting me see interesting patients and get in on the cool procedures. I even got to see how a dosimetry plan is generated by the physists for external beam treatment of breast cancer. The best part so far though was helping to insert brachytherapy catheters into guys' perineums and womens' breasts. We then deposited (temporarily or permanently) radioactive sources like Iodine131 into specific catheters at specific locations in the lesions. They actually had most of the surgical "cool" factor to them, but no suturing or Bovey aroma. On the most recent no urologist was present, so I did their job of placing all the catheters.
Most of my time though is spent reading through patient records and filling out research surveys for each one. We are trying to publish the largest post-prostatectomy external beam radiation therapy study to date. So it's a lot of paperwork, but I have the opportunity to get my name on a published study. The office is the largest private RadOnc group in the country and they enter more patients into studies than any RadOnc group in the country, including Universities! So I think they know what they are doing.
This Friday I'm going the St. Joe's office to see their Gamma and Cyber Knife systems. That will be awesome, and it will allow me a chance to ask the Attending what is happening with the paper I submitted to him a few months ago for publishing. I had a minor contribution with a classmate, but any published papers look good.
After almost two weeks doing RadOnc and learning that one of our fourth year students matched RadOnc at Drexel, I think it is much more doable. It would mean 60+ applications, hopefully 5-10 interviews and then a move to who knows where. But the Docs in my office feel I have a shot at RadOnc and should go for it.
At this point, I'm trying to decide whether to try for both RadOnc and EM in the Match or just EM. Going after both means more applications, more expensive interviews and probably listing a couple RadOnc programs as my first and second choices then seeing what happens next March. If I stick with EM, I might be able to get an early contract at a DO program and skip all the time, expense and stress of the Match. The Arrowhead, CA program I'm going to rotate at in August may just work into that plan. However, the income, technology and patient contact of RadOnc is very attractive. I'm tempted to try for RadOnc to see what happens with EM as my backup.
I just finished a bike ride with my attending this morning. We started at his brand new 3800sf house in North Scottdale. What a place! According to Zillow.com, nothing in his zip code goes for less than a million, even the lots start at $500k. And he's less than two years out of residency! He laid out how his contract works with two years guaranteed income then full partner. It's a pretty good gig, and the Docs all say that likely changes to medical reimbursement shouldn't have a huge negative impact on RadOnc. I have a hard time believing there won't be some decreases when procedures can easily run from $100k to $200k, but even a 10% decrease in reimbursements would leave RadOncs as some of the best paid Docs in medicine.
My thinking at the moment is to audition at Arrowhead in August, hopefully Maricopa ER in September and a RadOnc program in October (one that has 2+ slots for non MD/PHDs, if such a thing exists). I may need to double book November with both a RadOnc and an EM program, doing the RadOnc rotation if it's still in the running.
I hate to make things so complicated, but I'm not ready to up on a shot at RadOnc yet either. Two more weeks to go on this rotation along with a lot of studying for the Family shelf test. There's always a chance, however slight, that things will become clearer.
Friday, April 20, 2007
Fort Wayne Emergency Medicine
Finished up my week in the ER yesterday with the best day of the week. It started slow like the rest of the week, but about 10 am we had four ambulances arrive with fifteen minutes. We had some interesting cases like a 14 year old gymnast that had fractured her back and a guy that almost cut the tip of his finger off. I was able to suture the latter back together after injecting a bunch of anesthetic (big hands).
The best part though, was talking to a couple of the ER Docs I hadn't worked with until yesterday. I learned some very interesting things about ER and medicine in general. First, ER Docs typically make what they can bill the hospital for. So a Doc serving a poor population is going to make far less than a Doc serving a fully insured population - like half as much! So ER is in a very good position to benefit from any national health care plan. Even $20 or $30 per patient is better than the $0 they get today from those patients.
On a more scary note, a few ER Docs that have made a killing in the past by "owning" the hospital contracts with busy trauma hospitals. They then created partnerships and locked out any other Docs. By selling ownership into partnerships or just hiring ER Docs on salary and skimming off the top, a few made millions at the expense of their fellow EM Docs! Sounds like EM Residents need to watch out for secretive and closed book partnerships - especially in this age of mega-partnerships of EM Docs.
One of the two Docs finished his EM Residency then decided to do an Anesthesia Residency. After practicing a couple of years, he decided the overnight call every third night or so and poor lifestyle were too much of a sacrifice and went back to working ER! That was eye opening.
The other Doc works pseudo-Locum Tenens: he works odd shifts at four of five hospitals in a couple of Midwest states. His advice was that EM is great because it still allows you to do so different things. Not only do you have a controllable lifestyle, you aren't trapped (as I had assumed) into being a hospital ER employee for ever. Like a lot of creative Family Docs are doing, you can open a "wellness center", do cosmetic or low income medicine, etc. That is, if you don't fill your off time with hobbies like travel, investments, missions or sports you can start a profitable part0time business. It was very exciting to learn that there are still many opportunities opened in medicine if I get burned out or bored with shift work.
The last thing we discussed was Osteopathic EM Board certification versus Allopathic. It sounds like Osteopathic Residency programs allow you to sit for either Board test. So I could do the four year program at Arrowhead's Osteopathic Residency program, but sit for the Allopathic Boards. The difference between them is that the Allopathic Boards is more recognized internationally and probably required to teach at any Allopathic Medical school. The Osteopathic Boards would be required to teach at any Osteopathic school presumably. However, either allows to you practice anywhere in the U.S.
The first three days this week were in the Dupont ER were slow. Felt like an urgent care clinic with the ability to admit the most serious patients. I basically just did a lot of history taking, looking at labs and X-rays/CTs and hoping to see something interesting coming in on the monitors. Yesterday was a nice change and really peaked my interest in EM again.
This happened at the same time I was having great dinners with the Family residents courtesy of local drug reps. Wednesday we had a ton of pretty good sushi at the "best" sushi place in town. Lat night it was a top-rated steak place. The shrimp was ok. And I only got a few strange looks for being the only one of about 50 people not ordering red meat. The residents here are great people, so it was hard to admit my preference for EM as they were soft selling the program to me.
Today I slept in and am just getting started studying surgery. Less than 24 hours left in Fort Wayne. Kind of bittersweet. I can't wait to see the family, but I like the people here and am facing a very hard three months upon my return. We got our Clinical Education schedule from AZCOM this week and I can definitely see why the previous med classes despise the Department. My early summary of tests was a bit optimistic. I have Surgery and Family shelf tests, then a week later third year finals - one written and one with standardized patients. Then we get three weeks of 8 to 5 didactics immediately followed by our fourth year written final! The following four weeks I get to cram for the Osteopathic and Allopathic Boards. Seven tests in about 12 weeks.
My opinion during first year that Clinical Ed is probably the worst run Department at AZCOM has only been reinforced over the last year. Speaking of, before I study for these tests I have to make up (i.e. Lie) my logs for this rotation by inputting a bunch of ICM-9 and CPT codes on Clin Ed's worthless intranet site. They take up so much of our time and teach us nothing. And after ten years they still can't get us decent clinical rotations. The only redeeming value is a few superstars like Linda, the MSIII rotation coordinator who works her butt off for us.
The best part though, was talking to a couple of the ER Docs I hadn't worked with until yesterday. I learned some very interesting things about ER and medicine in general. First, ER Docs typically make what they can bill the hospital for. So a Doc serving a poor population is going to make far less than a Doc serving a fully insured population - like half as much! So ER is in a very good position to benefit from any national health care plan. Even $20 or $30 per patient is better than the $0 they get today from those patients.
On a more scary note, a few ER Docs that have made a killing in the past by "owning" the hospital contracts with busy trauma hospitals. They then created partnerships and locked out any other Docs. By selling ownership into partnerships or just hiring ER Docs on salary and skimming off the top, a few made millions at the expense of their fellow EM Docs! Sounds like EM Residents need to watch out for secretive and closed book partnerships - especially in this age of mega-partnerships of EM Docs.
One of the two Docs finished his EM Residency then decided to do an Anesthesia Residency. After practicing a couple of years, he decided the overnight call every third night or so and poor lifestyle were too much of a sacrifice and went back to working ER! That was eye opening.
The other Doc works pseudo-Locum Tenens: he works odd shifts at four of five hospitals in a couple of Midwest states. His advice was that EM is great because it still allows you to do so different things. Not only do you have a controllable lifestyle, you aren't trapped (as I had assumed) into being a hospital ER employee for ever. Like a lot of creative Family Docs are doing, you can open a "wellness center", do cosmetic or low income medicine, etc. That is, if you don't fill your off time with hobbies like travel, investments, missions or sports you can start a profitable part0time business. It was very exciting to learn that there are still many opportunities opened in medicine if I get burned out or bored with shift work.
The last thing we discussed was Osteopathic EM Board certification versus Allopathic. It sounds like Osteopathic Residency programs allow you to sit for either Board test. So I could do the four year program at Arrowhead's Osteopathic Residency program, but sit for the Allopathic Boards. The difference between them is that the Allopathic Boards is more recognized internationally and probably required to teach at any Allopathic Medical school. The Osteopathic Boards would be required to teach at any Osteopathic school presumably. However, either allows to you practice anywhere in the U.S.
The first three days this week were in the Dupont ER were slow. Felt like an urgent care clinic with the ability to admit the most serious patients. I basically just did a lot of history taking, looking at labs and X-rays/CTs and hoping to see something interesting coming in on the monitors. Yesterday was a nice change and really peaked my interest in EM again.
This happened at the same time I was having great dinners with the Family residents courtesy of local drug reps. Wednesday we had a ton of pretty good sushi at the "best" sushi place in town. Lat night it was a top-rated steak place. The shrimp was ok. And I only got a few strange looks for being the only one of about 50 people not ordering red meat. The residents here are great people, so it was hard to admit my preference for EM as they were soft selling the program to me.
Today I slept in and am just getting started studying surgery. Less than 24 hours left in Fort Wayne. Kind of bittersweet. I can't wait to see the family, but I like the people here and am facing a very hard three months upon my return. We got our Clinical Education schedule from AZCOM this week and I can definitely see why the previous med classes despise the Department. My early summary of tests was a bit optimistic. I have Surgery and Family shelf tests, then a week later third year finals - one written and one with standardized patients. Then we get three weeks of 8 to 5 didactics immediately followed by our fourth year written final! The following four weeks I get to cram for the Osteopathic and Allopathic Boards. Seven tests in about 12 weeks.
My opinion during first year that Clinical Ed is probably the worst run Department at AZCOM has only been reinforced over the last year. Speaking of, before I study for these tests I have to make up (i.e. Lie) my logs for this rotation by inputting a bunch of ICM-9 and CPT codes on Clin Ed's worthless intranet site. They take up so much of our time and teach us nothing. And after ten years they still can't get us decent clinical rotations. The only redeeming value is a few superstars like Linda, the MSIII rotation coordinator who works her butt off for us.
Sunday, April 15, 2007
Fort Wayne Family Residency
The second week of inpatient family went great. I can't say enough great things about Dr. Connerly and the FP residency program here at Fort Wayne. I'm surprised it's not a lot more competitive than it is. Everyone talks about the Memorial program in South Bend as the big competition, but the only reason they are competitive is that they pay $11,000 a year more than Fort Wayne! And Fort Wayne pays relatively well, it's just that Memorial is the top paying FP program in the country. Oh, and you do sports medicine with the Notre Dame football team :).
Fort Wayne is better, from what I can tell, in terms of didactics, Night Float, hours for moonlighting, opportunities for moonlighting and pathology (tertiary ctr vs. community ctr). The Residents are trying to address the pay difference. And the Program will have a brand new 30,000 sf clinic open next May and a new regional hospital they will be moving into starting next year and completing in 2011. I even got on local TV this week with a few Residents, the Program director, hospital CEO and Mayor to announce the new building project at a press conference.
Speaking of pathology though, I saw the worst case of lymphedema ever here. It was elephantitis like we saw in Path class from photos taken in Third World countries. Oh, it also smelled like necrosis. We eventually got 19 liters of fluid off him so he could walk again! That's about 45 pounds off one leg! It still probably weighed 80 to 100 pounds, but he could get around with a walker when I left the service.
This is an environment where I could feel comfortable learning inpatient medicine. No comparison with the VA hospital.
Last week I was at St. Joe's hospital for OB/Gyn. It has been a great refresher. I delivered a couple babies, did lots of pelvic exams, did a couple circumcisions, got in on one C-section and rounded on lots of new moms and babies. I saw 14 year olds give birth, nuchal cords and even got to suture a very large second degree tear. We even had one nuchal cord rupture, one shoulder dystocia (with a fractured clavicle) and one muconium aspiration. As at Parkview over the past two weeks, the Residents and Attendings have been terrific. The main Attending, Dr. Pebble, is an admitted dinosaur.
Dr. Pebble is a Family physician that does general anesthesia, general surgery, Gyn surgery, OB and has his own family practice! He's like a walking legend. I bet there's less than a dozen docs like him left in the country. Heck, he even does anesthesia for friends doing heart surgery and learned laproscopic surgery on his own! Oh, did I mention he's also very cool and a great teacher?
I started getting gentle pressure to apply to the program if I decide on Family. I also attended a drug rep dinner and a welcome back party for one of the Docs returning from Iraq. It was a chance to meet many of the existing Residents and some of the new ones coming on next year. Everyone was very friendly. I also had a chance to hear more about ER work as a family doc. One of the Family Residents has an offer for $126 an hour plus benefits as a hospital employee in a small community. No call, no pager, 36 hours a week and a reasonable mix of day and night shifts. Not bad!
I'm presently studying for my second try at the surgery shelf exam. I missed passing the last one by two questions. After a conference call with the Dean, I would have passed if I hadn't changed some answers! I didn't criticize him for the poorly written questions, mostly because these results don't play into our Residency applications. It's just pass or fail. Kinda sucks anyway, because I had hoped to be studying Emergency for next week and/or Boards which will help for my last shelf exam - Family Medicine. I now have to take that after the last rotation.
In the next three months, I have two shelf exams, one standardized patient exam, third year finals and two sets of Step 2 Boards! Gotta love medical school, especially as a D.O. I had planned on just taking our required Osteopathic COMLEX Step 2 Board exam, but fourth year friends who just matched said that we need to take the Allopathic version (USMLE Step 2) if we are planning to apply for anything vaguely competitive, such as Emergency. So that's more stress, more time and another $500! This D.O. thing is sure getting expensive and time consuming. I mean I like OMM (manipulative medicine), but twice the Board tests, about twice the money (private vs. a state school) and 200+ extra lecture hours is adding up.
On the plus side, I did get to do some soft tissue techniques and HVLA on a couple of the MD Residents, which they loved. It's a handy skill for family, friends and patients but I'm not sure it's worth the cost at this point.
I forgot to mention the weather. It's been snowing the last few days! Very wet and windy. We finally got some sun this weekend. One of the Docs mentioned Fort Wayne is in a convergence zone of the Great Lake and Canadian weather patterns so it actually has fewer sunny days than Seattle! They made a new record earlier this year with 96 days of cloudy weather - yuck!
One more week in the ER. I'm sure missing the family, especially over the weekends. At the same time I'm concerned one week in the ER just isn't enough time to make a 20-year career decision. By the time I get to EM audition rotations in the Fall, changing directions will be much more difficult. I'm just going to try to make the most of next week, starting Monday at 9am...
Fort Wayne is better, from what I can tell, in terms of didactics, Night Float, hours for moonlighting, opportunities for moonlighting and pathology (tertiary ctr vs. community ctr). The Residents are trying to address the pay difference. And the Program will have a brand new 30,000 sf clinic open next May and a new regional hospital they will be moving into starting next year and completing in 2011. I even got on local TV this week with a few Residents, the Program director, hospital CEO and Mayor to announce the new building project at a press conference.
Speaking of pathology though, I saw the worst case of lymphedema ever here. It was elephantitis like we saw in Path class from photos taken in Third World countries. Oh, it also smelled like necrosis. We eventually got 19 liters of fluid off him so he could walk again! That's about 45 pounds off one leg! It still probably weighed 80 to 100 pounds, but he could get around with a walker when I left the service.
This is an environment where I could feel comfortable learning inpatient medicine. No comparison with the VA hospital.
Last week I was at St. Joe's hospital for OB/Gyn. It has been a great refresher. I delivered a couple babies, did lots of pelvic exams, did a couple circumcisions, got in on one C-section and rounded on lots of new moms and babies. I saw 14 year olds give birth, nuchal cords and even got to suture a very large second degree tear. We even had one nuchal cord rupture, one shoulder dystocia (with a fractured clavicle) and one muconium aspiration. As at Parkview over the past two weeks, the Residents and Attendings have been terrific. The main Attending, Dr. Pebble, is an admitted dinosaur.
Dr. Pebble is a Family physician that does general anesthesia, general surgery, Gyn surgery, OB and has his own family practice! He's like a walking legend. I bet there's less than a dozen docs like him left in the country. Heck, he even does anesthesia for friends doing heart surgery and learned laproscopic surgery on his own! Oh, did I mention he's also very cool and a great teacher?
I started getting gentle pressure to apply to the program if I decide on Family. I also attended a drug rep dinner and a welcome back party for one of the Docs returning from Iraq. It was a chance to meet many of the existing Residents and some of the new ones coming on next year. Everyone was very friendly. I also had a chance to hear more about ER work as a family doc. One of the Family Residents has an offer for $126 an hour plus benefits as a hospital employee in a small community. No call, no pager, 36 hours a week and a reasonable mix of day and night shifts. Not bad!
I'm presently studying for my second try at the surgery shelf exam. I missed passing the last one by two questions. After a conference call with the Dean, I would have passed if I hadn't changed some answers! I didn't criticize him for the poorly written questions, mostly because these results don't play into our Residency applications. It's just pass or fail. Kinda sucks anyway, because I had hoped to be studying Emergency for next week and/or Boards which will help for my last shelf exam - Family Medicine. I now have to take that after the last rotation.
In the next three months, I have two shelf exams, one standardized patient exam, third year finals and two sets of Step 2 Boards! Gotta love medical school, especially as a D.O. I had planned on just taking our required Osteopathic COMLEX Step 2 Board exam, but fourth year friends who just matched said that we need to take the Allopathic version (USMLE Step 2) if we are planning to apply for anything vaguely competitive, such as Emergency. So that's more stress, more time and another $500! This D.O. thing is sure getting expensive and time consuming. I mean I like OMM (manipulative medicine), but twice the Board tests, about twice the money (private vs. a state school) and 200+ extra lecture hours is adding up.
On the plus side, I did get to do some soft tissue techniques and HVLA on a couple of the MD Residents, which they loved. It's a handy skill for family, friends and patients but I'm not sure it's worth the cost at this point.
I forgot to mention the weather. It's been snowing the last few days! Very wet and windy. We finally got some sun this weekend. One of the Docs mentioned Fort Wayne is in a convergence zone of the Great Lake and Canadian weather patterns so it actually has fewer sunny days than Seattle! They made a new record earlier this year with 96 days of cloudy weather - yuck!
One more week in the ER. I'm sure missing the family, especially over the weekends. At the same time I'm concerned one week in the ER just isn't enough time to make a 20-year career decision. By the time I get to EM audition rotations in the Fall, changing directions will be much more difficult. I'm just going to try to make the most of next week, starting Monday at 9am...
Sunday, April 01, 2007
First week in Fort Wayne
Yup, people are nicer in rural America. Fort Wayne isn't small, at about 250,000, but it has a small town feel. As with most of the Midwest, it lacks the outdoor activities I'm used to, but it's a nice size. And whereas the music was scene in Toledo was Country and Ghetto, here it's just Country. Not my favorite, but it's easier to overlook than awful traffic, mean people and outrageous home prices.
As for the medicine, the Residents and Attendings are some of the best I've worked with so far. I'm really impressed by this Family program so far. A PYGII (2nd year Resident) wants to do OB/Gyn when she's finished. The Program has managed to get her 69 C-sections so far!! Her husband wants to do Emergency. The two understand they will have to live in a small community, probably under 50,000, most likely. But it's an attractive plan.
The hospital, Parkview, is a tertiary care (Trauma Level II) center for a big area and even here Family Medicine Docs handle much of the ER. There's an acute care ER where they have to have an EM Boarded Doc on at all times. But five FM graduates of this program help to staff the three ERs.
Yes, my schizophrenia has returned and I seem to change my mind a couple times a day. But when we take new admits in the afternoon and I do an H&P in the ER I always up thinking EM. In fact, I've got Arrowhead's EM program lined for a September "audition rotation". And I filled out my paperwork for Maricopa's ER rotation before anyone else so I should be able to get August there. One more ER rotation in October or November at an East Coast program, like Christiana or Augusta, should do the trick. Then I'll just have to apply to 30 or so Programs and interview at no less than 12 to "guarantee" a spot without scrambling.
We usually get together around 7am, divy up new patients and get updates on our ongoing patients from the Night Float Resident. Then we see patients and round until 10am when we have Attending Rounds. These are relaxed and great educational lessons by Dr. Connerly. We then have a quick lunch and put in our new orders (from Dr. Connerly's input) before two of the three Residents head to Clinic. The other student and I stay with the Resident on "Call" taking new admits until 6pm when the Night Float Resident comes in for turnover. Night Float is a great system!
This is how to learn about Medicine! I have no desire to be a Hospitalist, but this program really teaches FPs how to be Docs. They only have two half days of clinic first year, then a day and a half second and third years, but they still acquire way more than the required number of patient encounters for the FP Boards. The time most programs spend in Clinic, these guys spend learning procedures, internal medicine and electives in OB, ER, scopes, etc. And for students it's great as well. We even get to write orders and dictate notes. This is my first opportunity at either, and it feels like a huge head start on Internship.
Finally, I'm really glad to have a car. It's required since my apartment is a few miles from the hospital and I'm going to be doing OB and ER in different hospitals. But regardless, I don't want to be trapped like I was in Toledo again. I'm studying in a coffee shop with free WiFi at the moment. Had time to get a haircut and drop off dry cleaning yesterday. And a few days a week I'm swimming at a local pool for about $1.50 a session.
As for the medicine, the Residents and Attendings are some of the best I've worked with so far. I'm really impressed by this Family program so far. A PYGII (2nd year Resident) wants to do OB/Gyn when she's finished. The Program has managed to get her 69 C-sections so far!! Her husband wants to do Emergency. The two understand they will have to live in a small community, probably under 50,000, most likely. But it's an attractive plan.
The hospital, Parkview, is a tertiary care (Trauma Level II) center for a big area and even here Family Medicine Docs handle much of the ER. There's an acute care ER where they have to have an EM Boarded Doc on at all times. But five FM graduates of this program help to staff the three ERs.
Yes, my schizophrenia has returned and I seem to change my mind a couple times a day. But when we take new admits in the afternoon and I do an H&P in the ER I always up thinking EM. In fact, I've got Arrowhead's EM program lined for a September "audition rotation". And I filled out my paperwork for Maricopa's ER rotation before anyone else so I should be able to get August there. One more ER rotation in October or November at an East Coast program, like Christiana or Augusta, should do the trick. Then I'll just have to apply to 30 or so Programs and interview at no less than 12 to "guarantee" a spot without scrambling.
We usually get together around 7am, divy up new patients and get updates on our ongoing patients from the Night Float Resident. Then we see patients and round until 10am when we have Attending Rounds. These are relaxed and great educational lessons by Dr. Connerly. We then have a quick lunch and put in our new orders (from Dr. Connerly's input) before two of the three Residents head to Clinic. The other student and I stay with the Resident on "Call" taking new admits until 6pm when the Night Float Resident comes in for turnover. Night Float is a great system!
This is how to learn about Medicine! I have no desire to be a Hospitalist, but this program really teaches FPs how to be Docs. They only have two half days of clinic first year, then a day and a half second and third years, but they still acquire way more than the required number of patient encounters for the FP Boards. The time most programs spend in Clinic, these guys spend learning procedures, internal medicine and electives in OB, ER, scopes, etc. And for students it's great as well. We even get to write orders and dictate notes. This is my first opportunity at either, and it feels like a huge head start on Internship.
Finally, I'm really glad to have a car. It's required since my apartment is a few miles from the hospital and I'm going to be doing OB and ER in different hospitals. But regardless, I don't want to be trapped like I was in Toledo again. I'm studying in a coffee shop with free WiFi at the moment. Had time to get a haircut and drop off dry cleaning yesterday. And a few days a week I'm swimming at a local pool for about $1.50 a session.
Sunday, March 25, 2007
Flying to Fort Wayne today
Surgery ended just fine. Dr. Greco let me do more incisions, my sutures were looking better than ever and I wielded the Bovey decently. It's only been two days and I'm already missing the OR. There's something special about that place.
You, as the surgeon, are the boss as only a Navy Captain on the high seas can experience. The patient's wellbeing is your direct responsibility so you govern everything that happens. Unlike a Captain, you use your hands and mind to fix someone. You have to stay on top of meds, coags, fluids, nutrition, co-morbidities, H&H, pain, patient comfort (they can't feel abrasions) and more. And of course, it's fairly technical. There's some old tech (forceps, scissors) mixed in with a ton of new tech (Ligasure, GIA, A-grams, mesh, etc.).
I still believe the sacrifice is too great on family to go through five years of Jedi Knight/monk training (total dedication). Plus I'm long past my twenties. So it's kind of a sad farewell to the specialty. I may have rotations in surgery during Residency, and I may get opportunities to first assist for my patients in practice, but I'll never look through my mask/visor at my double-gloved hands in someone's abdomen with the sense that this could be my career.
The shelf test on Friday was ok, but some questions were ridiculous. As an example, one asked what anatomical anomaly causes hernias. Uhm, what kind of hernia? Incisional and spigellian are rectus sheath defects. Direct Inguinal are tranversalis fascia. Indirect Inguinal are from a patent process vaginalis. You get the idea...
I think I passed, and that's really all that matters. But I learned so much surgical knowledge and skills, I had hoped to do really well. Our Clinical Education is too amateurish for fair assessment, hence the Pass/Fail grading system.
The boys did very well in their first "real" swim meet yesterday. Now we have times for them to beat next season. In Phoenix the season ends in Spring because it's too hot to hold outdoor meets in the Summer! They really like their coach, so they will probably swim through the summer. This assumes Becky and I can work out childcare between her job, my didactics and Boards preparation and both of our work-out schedules. After the meet we prepared for Connor's 11th B-day sleepover. Any remaining time I've spent preparing for the Fort Wayne trip.
Becky and I are determined to get into better shape and lose some weight, but it's difficult with my travel. I read that there's a pool I can use in Fort Wayne, and I'll have a car. Plus the hours shouldn't be the 80+ schedule of surgery. Regardless is going to be a long month of hospital food, uncomfortable beds, new people and jobs, etc. I just hope that the three weeks of Family and one week of Emergency will give me the information and firsthand experience necessary to decide which specialty is the best fit.
I still have to finish the paperwork for my research rotation after Fort Wayne. I'm looking forward to the reduced hours, close proximity and return to some research. But I really hope the exposure to RadOnc will be enough to rule it out or make me 100% sure it's worth the effort to go for. The 70 or so spots across the country are so competitive you have to prepare extremely well for interviews and applications. I just heard that one of our MSIV classmates was thinking Psych and changed to RadOnc late, then matched at a great program! I have to find out who it is and talk to this person.
Almost forgot, I spent time with the radiologist in Show Low checking out what they do. I love the interventional part of it. Placing tubes, running A-grams and nuclear studies, placing rads guided markers and lines, etc. But they spend a lot of time in dark rooms with big screens rapidly talking into their microphones. Procedures with actual patients are their breaks. They try to dictate 100+ studies per day. I'm too much of a people person to be happy in Rads.
Of course Rads has reasonable hours and makes a truckload of dough. I think Rads, Derm and Anesthesia are examples of overpaid specialties. They all make more than surgeons while surgeons have more responsibility, at least as long residencies, higher malpractice, worse hours and more stress. And Medicare wants to reduce their compensation 25% in the next few years! That just doesn't make any sense at all.
An hour or so until we drive to the airport. I sure hope this month is going to be worth it...
You, as the surgeon, are the boss as only a Navy Captain on the high seas can experience. The patient's wellbeing is your direct responsibility so you govern everything that happens. Unlike a Captain, you use your hands and mind to fix someone. You have to stay on top of meds, coags, fluids, nutrition, co-morbidities, H&H, pain, patient comfort (they can't feel abrasions) and more. And of course, it's fairly technical. There's some old tech (forceps, scissors) mixed in with a ton of new tech (Ligasure, GIA, A-grams, mesh, etc.).
I still believe the sacrifice is too great on family to go through five years of Jedi Knight/monk training (total dedication). Plus I'm long past my twenties. So it's kind of a sad farewell to the specialty. I may have rotations in surgery during Residency, and I may get opportunities to first assist for my patients in practice, but I'll never look through my mask/visor at my double-gloved hands in someone's abdomen with the sense that this could be my career.
The shelf test on Friday was ok, but some questions were ridiculous. As an example, one asked what anatomical anomaly causes hernias. Uhm, what kind of hernia? Incisional and spigellian are rectus sheath defects. Direct Inguinal are tranversalis fascia. Indirect Inguinal are from a patent process vaginalis. You get the idea...
I think I passed, and that's really all that matters. But I learned so much surgical knowledge and skills, I had hoped to do really well. Our Clinical Education is too amateurish for fair assessment, hence the Pass/Fail grading system.
The boys did very well in their first "real" swim meet yesterday. Now we have times for them to beat next season. In Phoenix the season ends in Spring because it's too hot to hold outdoor meets in the Summer! They really like their coach, so they will probably swim through the summer. This assumes Becky and I can work out childcare between her job, my didactics and Boards preparation and both of our work-out schedules. After the meet we prepared for Connor's 11th B-day sleepover. Any remaining time I've spent preparing for the Fort Wayne trip.
Becky and I are determined to get into better shape and lose some weight, but it's difficult with my travel. I read that there's a pool I can use in Fort Wayne, and I'll have a car. Plus the hours shouldn't be the 80+ schedule of surgery. Regardless is going to be a long month of hospital food, uncomfortable beds, new people and jobs, etc. I just hope that the three weeks of Family and one week of Emergency will give me the information and firsthand experience necessary to decide which specialty is the best fit.
I still have to finish the paperwork for my research rotation after Fort Wayne. I'm looking forward to the reduced hours, close proximity and return to some research. But I really hope the exposure to RadOnc will be enough to rule it out or make me 100% sure it's worth the effort to go for. The 70 or so spots across the country are so competitive you have to prepare extremely well for interviews and applications. I just heard that one of our MSIV classmates was thinking Psych and changed to RadOnc late, then matched at a great program! I have to find out who it is and talk to this person.
Almost forgot, I spent time with the radiologist in Show Low checking out what they do. I love the interventional part of it. Placing tubes, running A-grams and nuclear studies, placing rads guided markers and lines, etc. But they spend a lot of time in dark rooms with big screens rapidly talking into their microphones. Procedures with actual patients are their breaks. They try to dictate 100+ studies per day. I'm too much of a people person to be happy in Rads.
Of course Rads has reasonable hours and makes a truckload of dough. I think Rads, Derm and Anesthesia are examples of overpaid specialties. They all make more than surgeons while surgeons have more responsibility, at least as long residencies, higher malpractice, worse hours and more stress. And Medicare wants to reduce their compensation 25% in the next few years! That just doesn't make any sense at all.
An hour or so until we drive to the airport. I sure hope this month is going to be worth it...
Wednesday, March 21, 2007
One year to go for the Match
The MSIV medical students from around the country received the results of the Match last week. Actually the military, married and osteopathic students had earlier matches, but by now everyone should know where they are going come June.
That means the countdown for my class has begun. As usual I'm having a hard time studying for my Surgery shelf test on Friday because my tunnel vision is focused on residency programs. I have my EM draft spreadsheet, but need to research the programs so I can rank them. Even though I'm not decided on Emergency Medicine (EM) I have one audition rotation scheduled in September at an Osteopathic program. Now I need to schedule another EM rotation at an East Coast allopathic program. Along with EM at Maricopa County in Phoenix, that will give me a well-rounded CV with a good assortment of Letters of Recommendation (LORs).
As for the rotation, it's going very well. I hung out with one of the radiologists yesterday afternoon, and while I love the money and lifestyle, I couldn't do it. They fly through imaging consults, dictations and studies in the "pit" (e.g. dungeon) with too few patient encounters for procedures in between. Dr. Greco called me in late for an acute appendicitis. It was a great case of a week long ruptured appendix. He let me cut, suture and break-up some of the nasty pus pockets. She had a lot of co-morbidities but she should do just fine after a week of ventilation, antibiotics and open abdominal wound packing. I love surgery. It's just too bad it's such a sacrifice lifestyle-wise. I might even overlook my somewhat advanced age if it wasn't an all consuming profession. 5am until 6pm on normal days with overnight call once or twice a week is just too much.
I went home over the weekend. The family and I went to Body Worlds 3 on Saturday and had a great time. Colton got bored after an hour and a half of my detailed explanations on the anatomy, physiology and pathology of the cadaveric displays, but Connor pretended to be interested for another hour or so. Colton summed it up by saying; "being a surgeon would be pretty cool." While there I ran into a couple AZCOM fourth years. They had a big post-Match party Friday and most students were very happy. Twelve had to scramble for residencies, but it sounded like many of them didn't list enough choices and "blackholed" themselves.
We then enjoyed a 96 degree March afternoon in Phoenix and went to dinner at some friends' house. We had Tucker and his family over on Sunday for a relaxing day of barbequing and chatting.
I drove back to Show Low on Monday taking the long route through Globe and was again amazed by the beautiful scenery. Until you see Sedona and the eastern mountain ranges (Superstition, Mongollan, White) you have no idea how beautiful a state this is. Phoenix is really one of the ugliest places in this state.
Finally, I officially changed my last rotation of this year from rural family here in Show Low to research with Dr. Reed, the RadOnc I shadowed in second year. He's doing some research with the help of one of my classmates and mentioned could use mine too. It will be close to home, an easy schedule (convenient for Step 2 Boards studying) and give me a chance to ask Dr. Kresl if he's ever going to publish the case study I did with a fourth year classmate on Gamma Knife therapy. The only downside is that I have to go back to campus for didactics every other Tuesday. Oh well...
That means the countdown for my class has begun. As usual I'm having a hard time studying for my Surgery shelf test on Friday because my tunnel vision is focused on residency programs. I have my EM draft spreadsheet, but need to research the programs so I can rank them. Even though I'm not decided on Emergency Medicine (EM) I have one audition rotation scheduled in September at an Osteopathic program. Now I need to schedule another EM rotation at an East Coast allopathic program. Along with EM at Maricopa County in Phoenix, that will give me a well-rounded CV with a good assortment of Letters of Recommendation (LORs).
As for the rotation, it's going very well. I hung out with one of the radiologists yesterday afternoon, and while I love the money and lifestyle, I couldn't do it. They fly through imaging consults, dictations and studies in the "pit" (e.g. dungeon) with too few patient encounters for procedures in between. Dr. Greco called me in late for an acute appendicitis. It was a great case of a week long ruptured appendix. He let me cut, suture and break-up some of the nasty pus pockets. She had a lot of co-morbidities but she should do just fine after a week of ventilation, antibiotics and open abdominal wound packing. I love surgery. It's just too bad it's such a sacrifice lifestyle-wise. I might even overlook my somewhat advanced age if it wasn't an all consuming profession. 5am until 6pm on normal days with overnight call once or twice a week is just too much.
I went home over the weekend. The family and I went to Body Worlds 3 on Saturday and had a great time. Colton got bored after an hour and a half of my detailed explanations on the anatomy, physiology and pathology of the cadaveric displays, but Connor pretended to be interested for another hour or so. Colton summed it up by saying; "being a surgeon would be pretty cool." While there I ran into a couple AZCOM fourth years. They had a big post-Match party Friday and most students were very happy. Twelve had to scramble for residencies, but it sounded like many of them didn't list enough choices and "blackholed" themselves.
We then enjoyed a 96 degree March afternoon in Phoenix and went to dinner at some friends' house. We had Tucker and his family over on Sunday for a relaxing day of barbequing and chatting.
I drove back to Show Low on Monday taking the long route through Globe and was again amazed by the beautiful scenery. Until you see Sedona and the eastern mountain ranges (Superstition, Mongollan, White) you have no idea how beautiful a state this is. Phoenix is really one of the ugliest places in this state.
Finally, I officially changed my last rotation of this year from rural family here in Show Low to research with Dr. Reed, the RadOnc I shadowed in second year. He's doing some research with the help of one of my classmates and mentioned could use mine too. It will be close to home, an easy schedule (convenient for Step 2 Boards studying) and give me a chance to ask Dr. Kresl if he's ever going to publish the case study I did with a fourth year classmate on Gamma Knife therapy. The only downside is that I have to go back to campus for didactics every other Tuesday. Oh well...
Thursday, March 15, 2007
Career schizophrenia
Today was another decent day medically. Assisted on bilateral inguinal hernia repairs in a one-year-old boy. Scoped a true Ulcerative Colitis.
Even heard a good joke related to specialties. Where do you hide a dollar bill from a:
Internist... taped to his patient
Surgeon... with his wife
Orthopod... in a book
Plastic Surgeon... no where, he'll find it anywhere
I'm still coming back from yesterday's disappointment's. Had a long conversation with one of my preceptors about specialties and the future of medicine. If you spend any time looking at the numbers you can get very pessimistic. I'm starting to feel a little jaded just as many Docs and professors predicted would happen during third and fourth year. My biggest angst at the moment is that I don't feel any specialty truly "fits" and I've got start making some plans for fourth year audition rotations quickly.
I hope it comes to me quickly...
Even heard a good joke related to specialties. Where do you hide a dollar bill from a:
Internist... taped to his patient
Surgeon... with his wife
Orthopod... in a book
Plastic Surgeon... no where, he'll find it anywhere
I'm still coming back from yesterday's disappointment's. Had a long conversation with one of my preceptors about specialties and the future of medicine. If you spend any time looking at the numbers you can get very pessimistic. I'm starting to feel a little jaded just as many Docs and professors predicted would happen during third and fourth year. My biggest angst at the moment is that I don't feel any specialty truly "fits" and I've got start making some plans for fourth year audition rotations quickly.
I hope it comes to me quickly...
More fun in Show Low
It's been a great two and a half weeks in Show Low. I like the place and it's been a valuable learning experience. Moreover, it's been pretty relaxing. I haven't spent much time in clinic or rounding on patients here at the hospital. On slow days, like yesterday, I've been able to spend some time in the ER learning more about Emergency Medicine.
EM in this rural environment is interesting. You get to know the locals well (too well in some cases) and do a lot of procedures. I think compensation is pretty good as well. The specialty "feels" pretty good. But I'm not totally convinced. I still have questions about burnout, why none of the EM docs like to do procedures and how the EM "business" is set up. I had a conversation regarding the latter yesterday and was surprised to hear the Docs here have their own businesses and charge the hospital for their services. There's almost no overhead, so the compensation is higher than, say, Family Medicine. But I'm not sure who sets wages, how vacation time, overtime (extra shifts) and retirement benefits are set.
Yesterday was fine educationally, but a real downer career wise. I thought I had an EM rotation set up at UCSD for the last rotation of the year. I even talked with the EM coordinator and she said the Program Director was fine with my rotation, so it was a "done deal". Then I got a voice mail a few hours later that the UC bureaucrats nixed the rotation because I am only a third year student. I grabbed the FP rotation here in Show Low I had previously scheduled. But I'm disappointed that I'm going to spend my one elective this year in Family Medicine. I'll have three Family rotations under my belt already and no exposure to EM, anesthesia or radiology!
My fourth year rotation schedule came through yesterday as well. I only recognized two names from the list I submitted for the lottery last month. In talking with a classmate, I'm not the only one feeling screwed. Moreover, I received a reminder that my LORs for Maricopa County rotations are now late and may jeopardize those fourth year rotations. Ugh! Time to hound my Docs about the LORs they promised. And possibly time to start calling EM (or gas/rads) Docs about simply shadowing them for my last rotation this year.
As for surgery, the week and a half since my last post has been great. I've burned three gallbladders off patients' livers. I've intubated a few times and run into a couple very challenging anatomies. I've assisted in three thyroidectomies now, three more than last month. I was given the opportunity to remove an appendix so I got some firsthand experience with a GIA - a VERY fancy stapler that laparascopically places four rows of staples and then cuts down the middle of the rows. If surgery didn't have such an awful lifestyle, torturous residency and mediocre pay it would be very enticing. If I was ten years younger, you still couldn't keep me away.
Oh, in the ER I even stitched up a young lesbian's forearm after a self-inflicted serrated knife wound through part of her brachioradialis muscle. Fun stuff!
Finally, the wife and kids spent the weekend here with me. We had a good time hanging out Saturday and skiing Sunday. The skiing here was a bit icy in the morning and slushy in the late afternoon, but quite respectable. Connor took a little longer to remember how to balance, but by lunch both boys were bombing down the mountain. Dr. Greco, my preceptor, even managed to find me on one of my solo runs from the top. I think he's the best boarder I've seen so far. Even with his iTunes going and Bluetooth earpiece ready to pick-up any emergencies (he was on call!) he flew down the mountain with amazing grace. Typical surgeon, he doesn't do anything halfway!
This weekend we take the kids to BodyWorlds and I get a year older. If I can keep swimming 3-4 times per week and lose a few pounds, maybe the birthdays won't be such a downer. I love not having traffic here in rural Show Low. I get up at 6am, am in the water by 6:20, out by 7:10 and back at the hospital in scrubs ready for surgery by 7:30am! At 6500 ft above sea level, I can only do 1800 yards, but hope to get up to 2k in the same time by next week without sucking air too badly.
Friday, March 02, 2007
First week in Show Low
Just got back to the family in Phoenix after a great week in Show Low, AZ.
First, the town is great. One of those hidden gems that you know will be overgrown in the next few years, but is the ideal size now. It's 3-4 hours outside of Phoenix with weather like Colorado: lots of sunny days, seasons, trees/vegetation, and skiing/mountains nearby. Only thing missing is the ocean, but even that is only 7 or so hours away (Rocky Point, Mexico).
The medical training is great as well. The surgeons are laid back, and because I've had some surgery now, they are letting me do a ton. It also helps that there's no other students or interns to share procedures with. The highlight of the week is 4 intubations, Lap dissection of a gallbladder from the liver and first assisting on some cool surgeries like Lap Nissens (wrapping the stomach around the esophagus to eliminate hiatal hernias). I'm also getting much better on my knots. Interupted knots are second nature and I'm getting the hand of fancy buried-knot, subcutaneous sutures.
I'm not managing patients or doing much clinic time, so it's mostly just OR time and reading on my own. The staff at the hospital, outpatient surgery clinic and surgeons' office are great. Even the apartment is a huge improvement over Toledo. Becky and the boys are planning to join me next weekend in Show Low to see the town and get in a day of skiing. I think Becky will love the drive. It's so scenic you begin think Arizona is a beautiful state and Sedona isn't an accident.
Lots are errands to finish up this weekend: logs, test schedules, evals and possibly a change in my last rotation this year. I'm looking pretty hard at Emergency Medicine and would like to change my last rotation, rural Family here in Show Low, to an EM rotation. My roommate is doing the rural FP rotation and I just don't think I will learn as much regarding specialty choices versus spending a month in an ER. I may even get to do a couple ER shifts in Show Low this month, then in Ft. Wayne next month to get a taste of the job.
I've had some great conversations with classmates regarding FP versus EM. My roommate this month and one of my class friends (whose wife happens to be my kids' piano teacher) are both in the same position, trying to decide between specialties and individual programs. I need to get started on the spreadsheet and phone calls regarding about 6 western and 6-10 eastern EM programs that look intriguing at first glance.
Maybe the best thing about this rotation is that I have a car and can drive to a pool every morning. I found out about it on Tuesday so only got in two swims, at a very reasonable $2 per session. But I feel so much better with even a meager two workouts. The swims felt awful (I'm horribly out of shape) but I felt great afterwards. Without mornings free until the first surgery (around 8am usually) and a car, I should be able to get in 3-4 weekday swims plus some kind of activity on the weekend.
Time to get some rest back in my own bed.
First, the town is great. One of those hidden gems that you know will be overgrown in the next few years, but is the ideal size now. It's 3-4 hours outside of Phoenix with weather like Colorado: lots of sunny days, seasons, trees/vegetation, and skiing/mountains nearby. Only thing missing is the ocean, but even that is only 7 or so hours away (Rocky Point, Mexico).
The medical training is great as well. The surgeons are laid back, and because I've had some surgery now, they are letting me do a ton. It also helps that there's no other students or interns to share procedures with. The highlight of the week is 4 intubations, Lap dissection of a gallbladder from the liver and first assisting on some cool surgeries like Lap Nissens (wrapping the stomach around the esophagus to eliminate hiatal hernias). I'm also getting much better on my knots. Interupted knots are second nature and I'm getting the hand of fancy buried-knot, subcutaneous sutures.
I'm not managing patients or doing much clinic time, so it's mostly just OR time and reading on my own. The staff at the hospital, outpatient surgery clinic and surgeons' office are great. Even the apartment is a huge improvement over Toledo. Becky and the boys are planning to join me next weekend in Show Low to see the town and get in a day of skiing. I think Becky will love the drive. It's so scenic you begin think Arizona is a beautiful state and Sedona isn't an accident.
Lots are errands to finish up this weekend: logs, test schedules, evals and possibly a change in my last rotation this year. I'm looking pretty hard at Emergency Medicine and would like to change my last rotation, rural Family here in Show Low, to an EM rotation. My roommate is doing the rural FP rotation and I just don't think I will learn as much regarding specialty choices versus spending a month in an ER. I may even get to do a couple ER shifts in Show Low this month, then in Ft. Wayne next month to get a taste of the job.
I've had some great conversations with classmates regarding FP versus EM. My roommate this month and one of my class friends (whose wife happens to be my kids' piano teacher) are both in the same position, trying to decide between specialties and individual programs. I need to get started on the spreadsheet and phone calls regarding about 6 western and 6-10 eastern EM programs that look intriguing at first glance.
Maybe the best thing about this rotation is that I have a car and can drive to a pool every morning. I found out about it on Tuesday so only got in two swims, at a very reasonable $2 per session. But I feel so much better with even a meager two workouts. The swims felt awful (I'm horribly out of shape) but I felt great afterwards. Without mornings free until the first surgery (around 8am usually) and a car, I should be able to get in 3-4 weekday swims plus some kind of activity on the weekend.
Time to get some rest back in my own bed.
Saturday, February 24, 2007
Back home...finally
The trip home wasn't too eventful. I gained even more appreciation for the book Surgical Recall, a pocket-sized 700-page book in Q&A style that really covers a lot of basic surgery territory. Even with all the hours in the air I've only read about 200 pages, but hopefully I'll get more read in the next few weeks.
It was sure nice to get home and see the family. We just hung out and didn't worry too much about chores, homework (mine or the kids) or packing. Got caught up on Gray's Anatomy and I hope the weird afterlife scenes are over.
So now it's Sunday and I have to start on the To Do list: new tires, wash, packing and all the post rotation logs and evals. I've had enough time to think back on the last month now that I sum up the experience as a good rotation, where I learned a lot (got my tuition's worth) but one I probably could have done equally well closer to home. I'm still miffed about my Maricopa paperwork mix-up that resulted in my losing that rotation. However, that whole situation is what allowed to have the excellent Peds ER rotation. I'm not sure I would be looking so closely at EM if had gone as planned.
The surgery rotation ended with a few good surgeries, more office hours and a couple in office I&D type procedures. The Attendings and Resident were very complementary in their feedback and interested in our feedback. I'm fairly confident of getting a decent evaluation.
Tomorrow is day one on a new job again. I drive to Show Low (on new tires I hope) at 6am for rural surgery. We see how well the last month prepared me to step in and really start participating in surgeries. Every indication I gotten from the three surgeons I'll be working with is that I should be able to do a lot more than just cut sutures, staple and steri-strip.
It was sure nice to get home and see the family. We just hung out and didn't worry too much about chores, homework (mine or the kids) or packing. Got caught up on Gray's Anatomy and I hope the weird afterlife scenes are over.
So now it's Sunday and I have to start on the To Do list: new tires, wash, packing and all the post rotation logs and evals. I've had enough time to think back on the last month now that I sum up the experience as a good rotation, where I learned a lot (got my tuition's worth) but one I probably could have done equally well closer to home. I'm still miffed about my Maricopa paperwork mix-up that resulted in my losing that rotation. However, that whole situation is what allowed to have the excellent Peds ER rotation. I'm not sure I would be looking so closely at EM if had gone as planned.
The surgery rotation ended with a few good surgeries, more office hours and a couple in office I&D type procedures. The Attendings and Resident were very complementary in their feedback and interested in our feedback. I'm fairly confident of getting a decent evaluation.
Tomorrow is day one on a new job again. I drive to Show Low (on new tires I hope) at 6am for rural surgery. We see how well the last month prepared me to step in and really start participating in surgeries. Every indication I gotten from the three surgeons I'll be working with is that I should be able to do a lot more than just cut sutures, staple and steri-strip.
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