I think one of the neatest experiences of residency interviews is visiting the various cities and programs with your classmates. It brings back memories of elementary school field trips. It is so nice to bump into a classmate at the airport or at the interview. It reminds me that we are all in this together.

Furthermore, the hospitality of classmates and friends has made the traveling better than I expected. However, I still get a bit nervous each night before an interview. I find myself struggling to find reasons as to why I would want to attend that specific program, or to come up with good questions to ask during the interview. On the interview day, things usually work out alright.

Anyways, I will have to write some posts on this whole interview process when the tour is finally over. There are so many things I wish I had known before starting residency interviews. Hopefully, I’ll get around to it…

• What should you bring in your luggage and how to pack like a pro
• How to minimize your costs and save money during your CaRMS tour
• Why preparing for your interviews is essential
• Key questions you must be able to answer and how to ace your interview
• Making a good first impression
• Enjoying your CaRMS tour – sightseeing, eating, rest
• Reflecting on the programs and how to come up with a rank order list

The show goes on!

Starting this weekend, I begin my cross Canada CaRMS tour. It is an understatement to say I am feeling more stressed than usual.

• 7810 km
• 10 Residency Programs
• 6 Cities
• 2 Specialties (IM, FM)
• 1 Match (hopefully)

I’m pretty happy about the number of programs I have received interviews for. It’s a 60-40 split between Internal and Family. I will be only interviewing at cities I think I will be happy living in. I have been preparing responses to typical interview questions the last few days. Sometimes, I feel overwhelmed. I haven’t felt this anxious since my medical school interviews.

Hopefully, I will try my best to enjoy the process. I’ll be sure to let you guys know how it goes, once these next few weeks are finally over with…

What makes the biggest difference to your health? According to Dr. Mike Evans, a  family medicine professor at St. Mike’s Hospital, exercising for just 30 minutes a day can have a big impact on your health!

Staying active during medical school is one of the hardest things to do, especially during clerkship. When you’re working 40, 50, 60 hours a week and have lots of material to study for, the last thing you might have energy for is exercise. I myself gained ten pounds – and not the good kind of weight – during my third year of clinical rotations. I am only now starting to return to my normal weight.

What I have found is that you have to make your health a priority, even amidst your busy schedules! I have put together some tricks I have gained over the last two years. According to this video, all you need is half an hour a day. I hope you find these simple tips helpful.

1) Take the Stairs, All the Time

According to this humorous CMAJ article titled “Elevators or Stairs?” taking the stairs at work saves an average of fifteen minutes each day! And that doesn’t even include the calories burned or health benefits gained from it. Time saving and healthy!

2) Exercise at Home

Finding the motivation to head to the gym can be difficult at times. Do whatever you can to overcome exercise barriers. Simple push-ups and sit ups are easy exercises to start. There are so many home exercise programs on the Internet that not having the right equipment or space should never be an excuse.

3) Make Exercising a Priority

If you don’t think staying fit is important, you won’t be able to stay fit. During my first few clinical rotations, I prioritized studying and sleeping over my health. That however only made me more fatigued and tired. I later discovered, a quick fifteen minute run would boost my energy levels and help me focus more clearly.

Similarly, I discovered that setting aside time for exercise made me spend my other time more effectively. Since I had a tighter schedule, I procrastinated less and did what needed to be done sooner.

4) Drink Lots of Water

Carry a water bottle around. Know where the water fountains are. Dehydration makes you sluggish. Your voice can become raspy and your expressions dull. Avoid caffeine and alcohol if it’s not necessary.

5) Pack Your Own Lunch / Dinner / Late-night Call Snacks

Your appetite becomes blunted if you eat the same food from the cafeteria each day. Packing your lunch is such a simple way to control your calories and save money too. When I cook dinner, I usually aim to make more food so I can pack the leftovers for lunch.

If I have the time, I try to prepare several batches of meals on the weekend and freeze them for the week.

Snack on vegetables and fruits throughout the day. Putting some carrots, cucumbers, or celery sticks in a ziplock bag and then pocketing it in your white coat or bag is a good idea. Small meals throughout the day prevents major food binges after work.

6) Exercise with Others

Be accountable to your friends and partners. Make exercising a social outing! Choose sports you like to play, sign up for intramurals, establish common goals. One of the best things I ever did was sign up to do a half-marathon with other people in my class. I had never run such a distance before, but having other people motivate you for race day made training for it fun!

Let me know if you have any easy to implement healthy / exercise tips too!

I don’t profess to having the healthiest lifestyle as a medical student. In fact, my clerkship year was downright bad for my body. Luckily, you learn from your experiences and you try to avoid making the same mistakes. I know residency (which will be in a half a year’s time) will be much more stressful and busy than clerkship was. Hopefully, I will be able to gain a better work-health balance moving forward. 

Do you spent too much time on pre-med/medical forums?

I know how addictive premedical forums can be. I used to lurk them all the time. I discovered premed101 and SDN in high school while searching for medical school information. There were other sites like College Confidential and Student Awards that I frequently visisted too. When I found these forums, it was like I had stumbled upon a trove of knowledge. Quickly, I read through hundreds of threads on what I needed to do to best improve my chances for medical school. I began visiting the forums daily, I registered and began posting too. In fact, I created one of the most viewed threads that has been stickied and still in use today, “ FAQ: What are my chances?” I was addicted.

And then I got into medical school. I was thrilled, I had achieved what I set out to do and I thought that these forums had given me that extra advantage. But looking back now, I’m not sure if it was all that beneficial. Here’s why I think why reading premed forums are not as helpful as I thought they were and why I have stopped reading them regularly since.

1) It’s a Big Time Sink

It’s easy for you to waste hours reading all the posts and replies that people write. Although you may feel like you are getting good information, it isn’t  helpful if you put those ideas into action. All that time spent reading forums could be spent doing things that actually improve your chances of getting into medical school. Studying for your classes, volunteering, becoming a more well-rounded person.

After a while, threads became repetitive. People asks the same few questions over and over. What are my chances, what do I do if I get a bad mark, how do I study for the MCAT. Once you have your answers to these questions, I found that were wasn’y much additional value to be gained. So I stopped reading and began using my time better.

2) There is a lot of Wrong Information

Remember, the majority of posts made on these forums are by anonymous people. You don’t know their credentials, reliability, or even motives. You can’t be sure if they are even telling the truth or not. Furthermore, a lot of information out there is outdated and outright wrong. Not all posts are made equal.

Stick around forums long enough and you often notice a herd mentality on certain stances. It almost seems like there are certain do’s and don’ts of being a premedical student. I want to tell you there is no right way of being a premed/medical student. I know because I did things that were unconventional. Phrases such as “Take your MCAT after your second year when you complete your pre-requisites” or “Don’t do a summer research project and study for the MCAT at the same time.” If I had listened to the advice I had found on these forums, I would have probably disadvantaged myself.

Take home point – learn to critically think about what other people tell you, because not everything will be right for your own situation.

3) It’s just like a Pre-med Club, but perhaps worse

One thing I avoided like the plague in undergrad was the pre-med club. This was something I knew I didn’t want any part of. I’m sure pre-med club can be of benefit to certain people, just not for me. The last thing I wanted to have was neurotic classmates asking about my grades and MCAT scores.

Then I realized that premed forums were in a way an online version of the premed clubs. Cut-throat, secretive, competitive, neurotic, anxious, except with the added disadvantage of anonymity. The majority of users were friendly, but the bad ones could be real downers. You are a product of who you surround yourself with, and the last place I wanted to hang out was with gunner premed students.

What am I currently doing instead?

1) Cut back and set limits

I no longer read premed forums on a regular basis and I have yet to miss out on anything big. I have more free time to spend on activities that matter to me – studying, exercising, spending time with friends and family.

Instead, when I do get an inkling to see what people on the forums are talking about, I limit myself to 15 minutes once a week to peruse the forums. I pick only a few threads to look at and perhaps write two to three replies. That’s it. In a way you get to see the best of that week, you spend less time sifting through garbage and you spend more time on threads that interest you.

2) Read Medical Blogs

If you like keeping up with the internet buzz but feel forums are a bit too monotonous, I highly recommend picking a few good medical blogs to read. I only read a small handful myself, with less than a dozen subscriptions in my RSS feeds. I have found that blog posts are often more well thought out than discussions found in forums.

Be warned though that they can be quite addictive to read too, and it’s important to set some boundaries of how many and how often you want to read them.

3) Pursue Interests outside of Medicine

My motivations are still to be the best doctor I can be, but I know that there is more than just medicine in my life. Perhaps after surviving medical school, I understand it more clearly now. Premed forums are a niche market, they focus in on an already narrow subject. When you spend too much time on these forums, you begin to lose sight of the big picture and see that there’s more life than getting into medical school.

Take it from someone who is almost on his way out of medical school, being a well-rounded individual is important for your health and happiness. It is ironic that medical school has an ability to turn so many well-rounded applicants into highly trained but narrow individuals at the end of four years. Similarly, don’t let your undergrad experience be all about getting into medical school. Finding some other interests will make you a more rounded applicant to medical school anyways.

So I hope you make it one of your new year’s resolutions to cut back on reading premedical forums and more time doing things that are productive!

Early on, I decided I would not let my schooling be the determinate of my education. Instead, I set out to learn from the best minds in the worlds, and made it a goal to read good books. I decided to read 52 books over the course of a year, one for each week. Although I fell short of that goal, I ended up reading a total of 42 books that year, many of which introduced me to new ideas and changed my world views. I still try to average a dozen or so books a year.

For instance, reading Richard Dawkin’s The Selfish Gene inspired and taught me more about evolution than any of my biology classes. My classes in physics became way more interesting after reading Richard Feynman’s adventures on learning and being inquisitive. For psychology, I “enrolled” myself in a Harvard course on Happiness. Due to my premed scheduling, I was unable to take any economics courses, but through extracurricular reading, I’ve gained at least a basic understanding of how market forces work.

Reading good books changed the way I thought about the world more than my university courses did. Well written books are often the results of years of research and experiences. They are much richer in content and thought out than blog posts or news articles. If you haven’t gotten into the habit of reading outside of the classroom, I would recommend you start right away!

I have created a books section on this website with a list of  books that I have personally read and recommend. I’ll be sure to add to the list and write reviews whenever possible. Although medical school can be quite busy and there is a lot of medical reading that needs to be done, I still try to find time for leisure reading.

With the holidays coming up, try to find time during your break to read something outside of academics. It might just be the best thing you could do for your education.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Many times in the last year I have seen patients suffer from inappropriate medical decisions. Metastatic cancer patients who receieve aggressive treatment despite of the physical, emotional and financial costs associated with it. A 94 year old post stroke brain dead patient being kept alive in the ICU by a ventilator and triple-pressor support because the family did not want to withdraw care. Dieing can be a messy thing.

In undergrad, I read a book titled “How We Die“ by Sherwin Nuland, a physician practising at Yale, that challenged many of my pre-med notions of death. Particularly, it helped me understand how little mastery we have over our mortality and that death is a natural process of life.  People are always eager to tell you how we should live but few broach the topic of how we should die.

One of the tasks we do as a medical student whenever we admit a patient is to determine their code status. We ask questions that people are unfamiliar with. What should our medical team do if anything was to happen to you. If your heart stopped beating, do you want us to perform CPR? If your lungs stopped breathing, would you want a tube passed through your throat to help you breathe? Discussing code status is an often misunderstood topic. Many patients and families find it difficult to approach the subject.  Does this mean the medical team is giving up? Does it mean the patient won’t receive any help if anything was to happen? What the patient and their families often fail to understand is the difference between quantity and quality of life. Many times in the course of a disease, our medical interventions cross over from benefiting the patient to harming them.

During my Internal Medicine rotation, an attending taught me to be specific with my do not resuscitate orders. Explain what each aspect of their code status meant and clarify each point. No CPR, No ICU, No Intubation, No Heroic Measures.

Death is a terrifying event for patients and their families. I know my views on it have changed this last year after repeatedly seeing death firsthand. What I’ve learned is that we shouldn’t be afraid to talk about death. As health care workers, we spend most of our time talking about possible treatment options, even when there is none left. We don’t spend enough time explaining realistic outcomes to patients and discussing what their final wishes will be. Are we continuing treatment for the benefit of the patient or are we causing suffering to spare the emotions of those that are living. Becoming a doctor is more than just learning about how to save lives. In the process, you learn to respect human life and the complexities associated with it, and you begin to understand the possibilities and limitations of our art.

- focus: a simplicity manifesto in the age of distraction – by Leo Babauta of zenhabits

- Best New Year’s Resolution? A ‘Stop Doing’ List – by Jim Collins

- Better - by Merlin Mann (author of InboxZero)

I am now in my fourth and final year of medical school. Perhaps with some hindsight, I now see how distracting medical school really was at times. The clubs we were involved in, the group study sessions, the meaningless emails, the trivial tasks. You regret some of the priorities you sacrificed, your health, your hobbies, your friends and family.

From here on out, I am choosing to make my daily life simpler. I want to take on less tasks in hopes that I can do my important tasks better. I have unsubscribed from medical blogs that I don’t really enjoy reading, and spent a bit more time reading around the patients I see. I spend less time in my inbox and more time with friends. On this blog, I am focusing less on advertising and revenues and more on writing and reflection. I am slowly minimizing my distractions so I can focus on things that do matter.

Are there things in your life you can simplify? What’s distracting you from doing your best work?

Having survived the CaRMS 2011 Application Submission Deadline, I was going to share some of the lessons I’ve learned from this stressful experience. Overall, I think I did most things well but could have done many things better. Thankfully, you only apply for residency once… (hopefully). Here are some of the lessons I learned.

1. It’s Ok to Highlight Your Best Traits! – It definitely felt strange having to sell yourself. It was like applying to medical school all over again, but this time with more on the line. List all your accomplishments, talk about strengths mentioned in your clerkship evaluations, describe all the activities you did. You want to put your best foot forward, not shoot yourself in the foot. Don’t be afraid to brag and boast as much as you can, but do it discretely.

2. Start Planning Early – It’s never too early to start planning. First and second year medical school is a great time to start thinking about residency. Know which specialties you want to apply to and which cities you could live in. Keep track of all your leadership, volunteer and research activities. Update your CV annually. It was able to complete the activities section quickly because I had carefully recorded all my activities and interests in the years before.

3. Be Organized- When the Applicant Web Station (AWS) went live and all the program descriptions were up, I spent an hour creating a master excel sheet to help me stay on top of things. I listed all the programs I was going to apply to along with their descriptions, requirements, essay questions, number of references needed and personal comments.

I also created a checklist of things to be done, a tracking sheet for my references and a timeline of the whole application process. This streamlined my application and enabled me to concentrate on the task at hand, without worrying about what to do next.

4. Get the Best References Possible – Ask all your preceptors you did a rotation with to write you a strong reference letter. That way, when it comes time to apply you’ll have more referees to choose from than required. Ask months in advance. Send your referees packages with your CV, evaluations and clear instructions.

A good reference letter is one that highlights your strengths, is written by someone who knows you well and from someone who has some influence. Don’t be afraid to ask for a reference letter from someone you didn’t spend a lot of time with, often times you only need a day or two to impress someone. Also, ask all your referees to complete their letters online. It’ll save you money and a lot of stress wondering if your letter has arrived at the CaRMS office yet.

5. Take a Professional Photo – Good lighting makes a big difference. You are applying to a professional job, look the part! Plus you can use this photo for the next twenty years or so… at least that’s what all my residents and preceptors seem to have done.

6. Milestones are there for a Reason – Milestones are suggested dates of when parts of the application should be completed. They are there to remind you to not leave everything to the last minute. In general, they mark out a good timeline to follow. If you keep up with them, you’ll be pretty stress free.

7. Don’t CRaMS! – Unfortunately, milestones are only “suggestions” and I found myself cramming a lot of writing in the final week of the CaRMS application. Suffice to say, it was a stressful final week.

8. Get Some Rest – Coupled with the fact that I was still on clinical rotations, I ended up sleeping less than 5 hours (sometimes 3-4hrs) a night during that last week. If you can, I suggest taking a week, either the final week or a week or two before, off to get your CaRMS application done. Also, don’t stay up writing when you can barely keep your eyes open. I’ll guarantee you will write better and grammatically correct sentences after a good night of sleep.

9. Get a Second (Non-medical) Opinion – Ask your friends and family to look over your application. Does this letter represent who you are? Does it sound like the person they know? Try to avoid getting too many classmates and other applicants to look over your stuff. They will have their own skewed view of the CaRMS process and may not offer you the best advice.

10. Don’t Go Looking at Other People’s Applications – The more applications you look at that aren’t yours, the harder it will be to be yourself. You’ll be influenced by what they are saying in their letters or how they have formatted their application. Focus on your own application and your true self will come through.

Just ten simple tips to make the whole CaRMS application process a bit smoother. Actually the whole process was pretty straightforward minus the personal letters. Speaking with residents, they say it’s a lot better for the R-3 match because all your previous documents are saved in the CaRMS systems. Plus most fellowship and +1 years only requires a one-page letter and you apply to fewer schools. Oh how I don’t look forward to CaRMS round 2.

Every week in medical school, we have a class that focuses on how to be a good doctor. In this class we discuss how to take a history, what your posture should be like and how to empathize with patients. At this point in our education, our class generally finds the material confusing, considering we know nothing about anatomy and disease. How does listening to their concerns about their daily function going to help us heal them? How does talking to their family have anything to do with treating a disease? It all seem cryptic until, you’re on the other side.

My Grandpa was hospitalized a few days ago. He had just finished his Sunday afternoon lunch when he started having a shortness of breath. With each breath, there was an increasing pain in his chest. An hour later, he couldn’t breathe. When he was brought in to the hospital, the doctors discovered his right lung had collapsed due to a tension pneumothorax. My Grandpa is 86 years old and has had declining health in the past year. The doctors put in a 22 French chest tube into my Grandpa’s chest and moved him to the ICU. The last time I had been in a hospital was when I saw my Grandma lose her fight to cancer.

As medical students, we sometimes get desensitized from what it means to be sick and how it affects a family. We learn about all sorts of strange diseases in our lectures and labs and we spend enormous amounts of time studying them. After many hours in the library, we understand their pathology, biochemical reactions and common treatments, but we often forget how sickness impacts a patient’s life and their family members.

Even though I am a medical student who understands the science and complications behind my Grandpa’s collapsed lung, I was weak when I heard the bad news. I was overwhelmed with fear and worries. I asked about my Grandpa’s condition and if he would get better. I Google’d his condition and looked for answers. I hung on to every word from the doctor’s mouth. I was just as helpless as any other person.

It is from these experiences – when you become the patient and their family member – that the value of our patient-care classes become meaningful. I want a doctor who is competent AND can explain to things to me clearly and patiently. I want a doctor who will listen to our concerns and will work with us according to our values. Who will take the time to go over everything and ask if there are any other questions. A doctor who not only treats the disease but also heals the patient and their families.

I hope this feeling of uneasiness and nervousness stays with me throughout my journey through medicine. I want to remember how serious sickness can be and how it can cause family members to fly in from all around the world to unite with a loved one. I don’t want to forget how much of an impact illness can have on a family and how scary losing someone can be. I don’t know how my Grandpa will be. He is old and has lived a full life, but I want him to stay… if even for just a bit longer. I still want to talk to him and have dinner with him while listening to his crazy stories. If he passes away, I know my family and my aunts and uncles and cousins will grow more distant.

I don’t want to forget my Grandpa and Grandma. I don’t want to forget what it’s like to be a patient or to be dealing with a sickness in a loved one.