Life as a Medical Student

Infectious Disease

2012-02-12T13:30:00.000-07:00

One of the perks of emergency medicine, OBGYN and surgical rotations is wearing scrubs to work. Between these specialties and vacation it has been a year since I last wore a dress shirt and tie on my rotations. Despite being a little less comfortable, it brings a different sense of professionalism to the game.

Avoiding Disease

Currently rotating on a medicine specialty, infectious disease, I am learning more than ever before, the importance of antibacterial, antifungal, antiviral and antiparasitic medications. I knew there was a lot to know before, but I am now reminded of that fact where it counts, at the bedside. Every day we round on patients who have serious infections including tuberculosis, HIV, meningitis and more. When the patient's infection fighting army can no longer handle the battle, we are called in to bring the reserve armory. Donning special masks, gowns and gloves protects both the patient and ourselves from the exchange of harmful bugs during discussion and examination.

Washing hands is a necessity and stethoscopes are cleaned routinely on this service. If we are not careful, we can be the source of somebody's newest infection at which point it doesn't matter what your tie looks like -- keeping it secured is not a bad idea so it's not dragging through the patient's wounds and dressings. Medicine is a lot like figuring out a good puzzle, both in making a diagnosis and providing the right treatment regimen. Infectious disease aims to find the perfect medication for the job so we are not firing shotguns at thumbtacks every time building resistance to the arsenal we have available. It is a thought provoking field that can have a significant impact on patient outcomes as long as we don't let the disease bug them too much.

Question of the Week

Which of the following drug classes is responsible for both nephrotoxicity and ototoxicity?

A. Carbapenems
B. Penicillins
C. Tetracyclines
D. Aminoglycosides
E. Quinolones

Answer & Explanation

Words of Encouragement

2012-02-06T00:44:00.000-07:00

Running towards the finish line, this blog post comes as the 200th, a point that seemed so far away when I hit 100 and even farther when I started writing here. As medical school comes to an end, it seems there are many things to celebrate among board exams, graduation, residency placement, friendship and family.

Fatherly Thoughts

Like a cheer from the sidelines, my father recently wrote me:

I am reminded that you are at a point in your career akin to that moment when a roller coaster crests on its ponderous first climb -- a tipping point with amazing views; where the 360 degree view is the best and breathtaking. For once, maybe only once, you find yourself at a vista point looking behind you (if you have that clarity of mind and the inclination), but especially checking out with breathless heart-pounding anticipation what's about to come. Stretched before you is a winding and precarious-looking path. You can't see it all or how it resolves itself, but you comfort yourself knowing that people survive it every day.

It's a rare defining moment where the natural course of gravity grabs the baton from a methodical and clacking power that lifts you ponderously. Gradual. Ploddingly precise. Unaffected in its destiny, but tension-inducing nonetheless. Then, in the next heartbeat, it happens. Kinetic energy takes over with free abandon with its all too familiar "here we gooooooo" careening dive. You're on a course zooming into the still-unknown hope, happiness and fulfillment on a ride that is sure to thrill and keep you on the edge of your seat.

Buckle up. Be proud. Take in the fleeting moments. Don't forget to breathe. Don't forget to cheer. Don't ever doubt that you are on the right track. And keep coming back for more of what thrills you.

It's interesting to explore the extent of the memories of your program and the interviews. For me the beginning of it all when you were young and had an eye on a frog. Heck! The entire run of you growing up and becoming Dr. Batt.

Thanks for being there for me and the family, for being the person you are and especially for the hundreds and even thousands of people who you will uplift, comfort and heal in the future.

Thank you, Dad.

Question of the Week

A 54 year old male was hospitalized for a pneumonia and placed on broad-spectrum antibiotics for 14 days. Subsequently, he developed diarrhea, fever, and crampy abdominal pain. What is the most likely diagnosis?

A. Diverticulitis
B. Colon cancer
C. Melanosis coli
D. Pseudomembranous colitis
E. Familial polyposis syndrome

Answer & Explanation

Interviewing for Success

2012-01-29T07:00:00.034-07:00

Guest post from Dr. Joseph Mazzei, D.O., Medical Director, BodyLogicMD of Chicago

Interviewing for residency programs can be a pressure-packed, daunting task. Try to take a deep breath, relax and keep it simple. The process is necessary, affording you the opportunity to find a program that fits your needs, while each program finds residents that fit their needs.

Advice from Experience

The most important thing remember during each interview is to be yourself. You could stress yourself out trying to determine who a particular program wants you to be or you can try to act like someone else in order to land a spot - however these tactics will not serve you well in the end. An interview that is less than genuine will hinder your performance during the actual interview and potentially throughout the residency. For example, if a residency program places great emphasis upon your participation in research, and you are not interested in doing research, this is not a good fit for you. You may want to be in the program because they possess a great reputation, but their reputation may not be the best thing for you. It would be best to find a program that fits you, rather changing who you are to fit the program. This does not mean, however that you should not care about what a particular program is looking for in a resident.

Another important aspect of your interview is to be knowledgeable about their specific program. It is very important to be prepared. The more you know about the residency, the better equipped you will be to ask intelligent questions, gain information about the program and sell them on why they need you in their program. Asking questions is important. There are nuts and bolts questions, like “How much will I get paid?” or “How much call will I have?” and other similar questions. These can be answered by the human resources personnel.

During the interview, you want to ask questions that mean something to you and the people in charge of deciding whether or not you will get into the program. For instance, you may have a strong interest in public health and are interviewing for an internal medicine program. You might ask, “I understand that you have a center for HIV treatment at your hospital. I have worked with this population in the past and have a strong interest in expanding my experience in this area. Will I have the opportunity to focus on this area of medicine during my time as a resident?” Questions like these open the door for you to talk about yourself and your unique qualities. It shows you are motivated and have taken time to learn about their program - you are not just going through the motions of multiple interviews. Interviewers see a lot of people - you need to know what makes you stand out from the other candidates and let it shine - give them a reason to choose you over anyone else. These questions also offer you the opportunity to gather more information about the program and determine if it is the right fit for you. Remember, the interview process is a two way street.

Be certain to ask about all the aspects of the residency, such as the work environment and community. Resident programs are trying to find people they want to spend the next several years with, i.e., people they enjoy being around. You will be spending a great deal of time with your fellow residents, therefore it is a good idea to choose residents who “play well with others.”

You may also want to consider inquiring about the social aspects of residency. For example, you might ask, “I want to work in an environment where residents are supportive of each other. Is the environment thought of as friendly and are their planned social events for residents and staff?” This shows that you want to be a part of their community. If this is important to the residency and you, it is a good question to ask. I had a buddy in medical school that was applying out west and was an avid rock climber. He asked during his interview if any other residents were into rock climbing. It turns out that the residency director was a big time rock climber and was very happy to welcome someone with common interests into his program. Again, be yourself. Be genuine.

When I interviewed with what turned out to be my residency program, the interview panel was pressing me on my grades in medical school. I was an average student with average board scores, however I had other qualities that I felt were my strong points. During the interview, several members of the interview panel, wanted to know if I had any excuses for my average grades - were there family stresses, illnesses, or other circumstances that interfered with my academic performance? I explained that I was proud of my medical school performance and that my goals were not to achieve high scores on tests, but to get the most out of my journey through medical school, which I achieved. They continued to press me on this. I knew a few things about this program. Residents were required to train at over 10 different sites at high volume emergency rooms in the Inner City. They needed someone who could adjust to new environments on a regular basis. They needed someone who was open-minded, flexible and who could learn best with hands-on experience and without rigid structure. They did not need people who only felt comfortable with their face buried in a book. They needed a person who could get along with a variety of personalities. I learned this from talking with residents within the program before my interview. I felt this would be the type of program that would benefit me the most and allow me to succeed. I responded to their questions about my grades by respectfully stating that if they are simply looking for a book smart student with high grades, then I am not the right person for their program. I then discussed what I had to offer and why I would benefit their program. There was a short silence and the next question came from the residency director. “What do you like to do outside of medicine?” he asked. I told him that I liked to brew beer, which we talked about for the next ten minutes. I was later offered a spot.

My advice can be summed up as follows: know the program, know yourself, and be yourself. Things will work out.

Joseph Mazzei, D.O.

Medical Director, BodyLogicMD of Chicago

www.bodylogicmd.com

Question of the Week

During a laparoscopic procedure for a patient with a history of pelvic inflammatory disease and suspected Fitz-Hugh-Curtis Syndrome, what classic finding would you expect to see on the liver?

Answer & Explanation

In Stitches

2012-01-22T12:32:00.001-07:00

Eat, sleep, and breath medicine. That's how medical school is for so many who live through it. We get so caught up in the world of bacteria and mutant cells that we forget to live a little. The years in medical school are filled with crazy first experiences and stories that we would be wise to remember forever. Some moving, others hope inspiring and then there are those that just leave you in stitches.

Medical Memoirs

It wasn't long ago that I was traveling the country with countless hours on flights and layovers. I felt fortunate and honored that Dr. Anthony Youn had contacted me about his latest publication In Stitches, his medical school memoir. It gave me something to do during those long trips and kept me amused as I could so easily relate to his medical training experiences.

Now, I'm not normally much of a reader, but I was surprisingly drawn to the reminiscing of a fellow medical professional. A clever chronology of events, short stories and laughable themes kept me reading until I finished only days after beginning. Dr. Youn's adventure, and misadventure, portrayed the development of his character through inner trials and external challenges. As a young man slaving away to make his father happy, he realized along with his father that happiness can only come from following our own dreams. Achieving big goals requires a sense of confidence, boldness and stamina; all of which develop over time through humorous and touching events.

It was the perfect time for me to read his tales as I had been through the classwork, clinicals and would soon be starting residency. As a practicing plastic surgeon, he lives in the light at the end of the tunnel that is finally coming into view for me. No matter how difficult school becomes, at least there will be some great stories in the end. I think he sums it up well in this small paragraph:

Thanks to my small circle of close friends, my focus, work ethic, and drive to succeed, I slowly grew up. I entered medical school a shy, skinny, awkward nerd with no confidence, no game, and no clue. I came out, four years later, a man.

For someone entertaining the thought of attending medical school, current students, or one just wanting a glimpse into the life of a medical student, I would recommend this memoir.

Question of the Week

When inflating the balloon on a Foley catheter what is the proper solution to use and why?

Answer & Explanation

Medical Sub-Specialization

2012-01-15T21:33:00.000-07:00

Returning home to Las Vegas after touring the country means it's time to go back to rotations as usual. Fully expecting to hit some of the core specialties, I was surprised when I was assigned to urogynecology as an OB/GYN rotation.

Urogynecology

Initially, I expected to be listening for fetal heart tones, delivering babies and controlling irregular menstrual cycles. When first learned of the specialty, there was not much guesswork as to the line of work we would be dealing with: incontinent women and prolapsed organs. It is so specialized, that it would be similar to finding a surgeon that only operates on right hands. The patients we see are generally very satisfied with their outcomes after surgery, probably because it changes their lives significantly.

It's exciting to think these last few rotations will move faster than any before as things are rolling downhill with great momentum. Experiencing sub-specialized medicine definitely keeps the study topics to a minimum when all I can focus on is the rank list and match. At least there are some aspects in every field of medicine that can be used in emergency medicine. So I am looking for opportunities to gain from this rotation those things that will be pertinent to my future specialty. Needless to say, but this has been a uniquely educational month with far fewer babies than I had imagined.

Question of the Week

What are the symptoms of urinary incontinence?

Answer & Explanation

Residency Interviews - In Summary

2012-01-08T18:13:00.000-07:00

Looking back over the last five months of 2011, I realize how busy life really was during that time. It seems that I was always on the road working towards the next step and getting ready to meet the next goal along the path. The bittersweet sunset to all the travels, new locations and challenging interviews has come and is now a memory.

Interview Season

Sometimes the numbers say it well:

1 Board exam
2 Case reports written
3 Coasts
4 Clinical rotation sites
5 Months
13 States
14 Residency Interviews
25,468 miles traveled

View Larger Map

It was a lot of road and air time, which I always thought would be fun. At first it was, but as time went on it became very exhausting living out of a suitcase and never in one place for too long. I met great people along the way and was able to visit some fantastic places which can be seen in the links below:

August
September
October
November - Part 1, Part 2
December - coming soon

One might think from my photos that I wasn't doing much in the way of rotations at hospitals, but I would prefer to maintain some patient privacy while working. With all that excitement and stress behind me, it is time to prepare for the less adventurous yet fear provoking Match. In a week's time I will be submitting my rank list for residency programs and within a month hopefully hearing good news. It is just a matter of time at this point, but at least things are moving along well.

Question of the Week

What programs are the forerunners in your rank list?

Answer

Residency Interview - The Fourteenth

2012-01-01T07:00:00.064-07:00

Strategic scheduling of my last interview of the season allowed me to squeeze in a Miami Beach mini vacation at Mount Sinai Medical Center. Of course I had to make a stop at the beach to recapture the benefits of natural sunlight the rest of the nation doesn't get during the winter months.

Mount Sinai Medical Center

Suited up for my last interview and enjoying the Atlantic coast sunrise flooding over the Biscayne Bay, I made my way to the bay-side hospital. Once a month the emergency medicine residents hold their weekly conference at Ryder Trauma Center associated with Jackson Memorial Hospital. After the guest lectures and resident presentations we stopped downtown Miami Beach for lunch with a couple residents. Once returned to the hospital, we toured the facility which has some of the best patient-room views I have ever seen!

As the holidays were around the corner, only a couple students were being interviewed, offering more time for questions during interview sessions. I first met with the assistant program director with whom I had worked during my rotation months earlier. In addition to the generalized questions posed, I was presented with a series of clinical case scenarios. It was friendly discussion and an opportunity to see where I stand in my learning pursuits as well as my approach to problem solving. Similar scenarios spilled over into the following interview with the residents. Open communication and the welcoming attitude were greatly appreciated at this well known program.

On this day of new beginnings, we contemplate where to direct our efforts in seeking happiness for the year to come. With interviews a thing of the past, it is time for me to focus on the decisions that will affect the rest of my career. The excitement of new adventures, challenges and aspirations is welcomed as I step forward into this time of transition, of reinventing myself. Happy New Year!

Question of the Week

What strong characteristics have you seen in other programs that attract you?

Residency Interview – The Thirteenth

2011-12-25T16:09:00.000-07:00

The anticipation for this day was growing throughout the interview season as many students spoke highly of the hospital and potential opportunities well before I had a chance to see it for myself. Lehigh Valley Health Network incorporates a number of hospitals in the Lehigh Valley region of Pennsylvania. If the size of the lettering has anything to do with the caliber of the program, they are off to a good start.

Lehigh Valley Hospital

Our day started with a short presentation of the program and the large group of interviewees was divided to spread the masses. The interviewing half had four stations with two interviewers each. As there were so many stations and interviewing students, these sessions were not excessively long which left plenty of opportunity to ask questions and provide answers. With couches in every room, the tension was definitely less than most and certainly more comfortable than other programs offered. Between program director, assistants, clinical faculty and ancillary staff many of the common interview questions were exhausted rather quickly. I definitely appreciated meeting the majority of the teaching staff and being able to ask specific questions of those holding particular responsibilities.

At lunch we all sat in our formal-wear lining the tables of the cafeteria learning everything we could from current residents. It was a moment to relax and really determine if we felt as though the program would be a good fit for us personally. Satiated, we made our way to the shuttles for a tour of the medical facilities. State-of-the-art simulation labs that modeled patient rooms, healing decorations and quarantine-prepared spaces were among some of the unique features we observed. Much of the remodeling benefits both the patients and staff. Fellowship, research and altruistic opportunities were in abundance. The emergency medicine program monopolizes one facility and shares responsibility for another. Being accredited trauma centers, they see a number of pediatric and adult cases that smaller facilities may not.

Being this late in the interview season, it was somewhat difficult to maintain a sense of enthusiasm that was obvious at the onset. Nonetheless, this program definitely elicited a sense of excitement as it has so much education to offer including well-trained emergency physicians. I can only imagine that the upcoming residency match will bring them some of the strongest applicants from around the world.

Question of the Week

What do you like to do when you are not working?

Suggested Considerations

Residency Interview - The Twelfth

2011-12-18T18:00:00.000-07:00

After a rejuvenating weekend in Philadelphia, my morning commute took me across the beautifully blue Benjamin Franklin Memorial Bridge into New Jersey where I found the UMDNJ School of Osteopathic Medicine. Interviews would be ongoing throughout the day and I was fortunate to have mine early, leaving the remainder of the day to explore the surroundings.

University of Medicine and Dentistry of New Jersey

I joined the in-progress round table discussion between students and residents while waiting to be called for my formal interview. It was an opportunity I had become familiar with through the course of previous interviews; probing the minds of current interns and residents as to their thoughts on the program. When used accordingly, these can usually be a solidifying factor in choosing for or against a program. Knowing how current residents feel towards faculty, facility and curriculum is a vantage point that cannot be overlooked. On this particular day, they were very positive about the program and spoke highly in this regard.

It did not take long before I found myself across the table from my interviewers: the program director, an assistant director and the manager of the emergency department. These men, sage in their years and thoughtful in their remarks were attentively looking for the next residents to fill their intern class. In their professional and experienced manner, they described characteristics of loyalty, integrity and honest above all else that they sought. For them, a cohesive residency would be an effective one. I was impressed by their warmness and desire to truly provide their residents with the best program possible. My questions were respectfully answered and I was told what to expect in the coming weeks approaching the Match.

Shortly after interviewing, we joined the interns for a tour of the hospital. All facilities are community based without trauma designation. The hospital we toured was relatively clean, organized and efficiently run from what I observed. Although the interns were helpful, it would have been nice to have an upper level resident join us to answer questions interns were unequipped to field. Overall, our interview day was relatively short, yet I felt that it was a strong contender on my list of residency programs.

Question of the Week

What are you looking for in a residency program?

Suggested Considerations

Residency Interview - The Eleventh

2011-12-11T20:28:00.000-07:00

With my trusty rental car ready to go and a seven hour drive ahead, I braved the New York traffic. At first the stop and go nonsense was getting to me, but it made the Pennsylvania countryside drive well worth the effort. The open road, starry night and blaring music were a perfect recipe for calming the interview tension.

Conemaugh Memorial Medical Center

I arrived after midnight and found my hotel to be quite comfortable for the few hours before waking to interview. The sun was up, fog filled the rolling Allegheny mountains and a crisp winter air was obvious as my breath condensed the air before me. It was a beautiful drive into the small valley town of Johnstown, Pennsylvania where I found my way to Conemaugh Memorial Medical Center. It is an impressive Trauma I medical center that stretched over multiple blocks on the side of a mountain and was busy even for the early morning hours.

We were greeted by the emergency medicine staff and invited to join the conference sessions already in progress. I enjoyed the interested participation of residents and faculty who seemed very much like a family in discussion. This program is pioneering an approach to the curriculum by reading the current journals in place of textbooks which tend to be years behind. It is a novel approach and seems to be effective from their initial assessments.

Individual interviews started shortly thereafter with one member of the faculty in three separate interviews. The first I was surprised to be invited to ask questions, which was an obvious deviation from the normal interview process. In fact there were no questions asked by the interviewer! As I went on to meet with the program director, he again provided me answers to my questions, yet asked none. I was astonished that I had made my way through two "interviews" and no questions were asked of me. Was I missing something? Are they getting the information they need about me? My third interview started along the same lines, but I was not going to let my line of thought lead the entire discussion. After one question, I stopped to offer time to my interviewer. His questions were unique, not related to medicine and more along the lines of how I approach an answer. When those were exhausted, he promptly provided me with a case similar to an oral board. I am happy to report that I passed with an appropriate diagnosis.

The interviews were followed by lunch and a tour of the facilities. I was surprised at the business of the hospital in such a small community setting. We even made our way to the helipad which had a beautiful view of the surrounding valley. This program is located in a neat location with all the benefits of a trauma center. It is willing to find new ways to approach learning and ensure competency in its residents all while maintaining the important family ties. It is one program I will not regret visiting.

Question of the Week

If you were to go on vacation between medical school and residency for two weeks, where would you go, what would you bring, what would you do and who would you bring with you?

Residency Interview - The Tenth

2011-12-04T17:57:00.000-07:00

After a transcontinental flight from the West, I found myself in the Long Island rain of New York heading to a pre-interview dinner on the town with the emergency medicine residents of Good Samaritan Hospital.

Good Samaritan Hospital

The table full of appetizers surrounded by residents and students full of questions. It was beneficial learning how residents cope with work, manage their time and invest in their future careers. It was definitely preparatory for the interviews.

We started the day later than most interview days which helped those of us who traveled through multiple time zones. Morning conference was a faculty or resident presentation with ensuing discussion. We had a detailed tour of the emergency department. I was most surprised by the rooms divided into two by a curtain, effectively doubling the bed space. Aside from the tight quarters, it appeared that work was unimpeded and frantically busy. Between trauma, pediatric and adult services, Good Samaritan is one of the busiest EDs on Long Island. The EM program is notably heavy with research and presentations commonly winning the majority of competitions attended.

After a brief overview of the program and surrounding area, we had lunch with the residents and faculty. We were then off to interview. Three separate interviews, each in panel format composed of three faculty and residents. The atmosphere calm, to the point and mutually educational. The area is culturally diverse, hospital continuously active and personnel readily available making this residency a strong place to establish a professional foundation. It was not until I was back in the car headed towards metropolitan New York that I got a taste of vehicular congestion, an avoidable yet frustrating association with this part of the country.

Question of the Week

What is your favorite movie?

Suggested Considerations

Keep On Keeping On

2011-11-27T22:29:00.000-07:00

Just when I finish my last audition rotation and get ready for a supposed month of vacation, I realize that interviews are still in full swing. With only a couple days of down time at home, I will soon be preparing for my next adventure on the east coast. All this travel, preparation and match anxiety has me worn out.

Performance Exhaustion

Working in the spotlight for months on end with few days in between shifts and plenty of loose ends on those days off, the moments of relaxation are nice to come by. I feel like everything is just move, move, move until there is no more energy to move. The alarm goes off, back to work, hit the road and repeat. I remember well the warnings last year's seniors gave about becoming exhausted throughout the interview season. Experiencing the long hours of peak performance and never knowing who is watching, I feel the fatigue setting in just as foretold. I can only hope that my efforts thus far and in the coming weeks will pay off come match day in mid February.

The excitement of traveling and visiting new cities is great, though it's equally rivaled by feelings of inadequacy and trepidation. I have met wonderful people in all these places, learned a great deal about the world of emergency medicine and thoroughly enjoyed my time exploring potential residencies. It's been a mixed bag of vacationing and working where the lines cross from time to time blurring the extremes of either. I really enjoy not knowing what is next or how things will turn out. It keeps an element of surprise around long enough to make things exciting. But all things being told, I am starting to realize a sleep deprivation that resembles those long days in class followed by nights of endless study, something I thought would only be a memory of the first years in medical school. In reality it is a lifestyle associated with this profession as I am quickly learning.

Question of the Week

Now that there is a light at the end of the tunnel, when do you actually become a doctor?

Answer & Wishful Thinking

Residency Interview - The Ninth

2011-11-20T06:00:00.002-07:00

It wasn't long ago that I visited this program for the first time doing an elective month in emergency medicine. Now six months later, I find myself on the hospital campus interviewing for a potential residency position. The interview is not only one day of suit-wearing anxiety, but a month long process of showcasing myself on every shift.

Arrowhead Regional Medical Center

After an evening out with the residents, it was not hard to see that their laid-back demeanor fit their in-hospital character well. It was as though friends were gathering rather than a professional undercover interview session over dinner. At one of the earliest interviews yet, the ties, suit coats, and slacks all found their way to the department office and patiently waited for formal interviews to begin. For most, there was no travel involved as we were already working at Arrowhead for the month. Taking turns, we were shuffled through four interviews separated by a lecture session and lunch.

My pre-lunch interviews were more energetic than the food-coma-induced afternoon interviews. The first encounter was brief with a couple of the attending faculty members. They tried to glean a perspective of performance under pressure during work situations and how we destress when not on the clock. I enjoyed the brevity and direct line of questioning they presented as it kept the mood fresh. Next up was a session with the junior residents, most of whom I have worked with in the department. Again the mood was inquisitively jovial with an opportunity to express myself outside the realm of work-place medicine. The encounters felt natural and low pressure despite the expectant nervousness associated with any interview of significance.

We then joined the rest of the residents in lecture to discuss case reports and teaching points recently experienced in the department. The cohesive nature of this group was evident as senior and junior residents worked together to respectfully formulate answers and discussion topics. Lunch was served and we made our way back to the interview chairs to finish out the day.

I was called to meet with the senior residents, two of which I had worked with previously. We recalled various experiences together treating interesting patients and elaborated on my desire to pursue a career in emergency medicine. Their conversation was welcoming and decisive as they look for students to carry on the legacy of their residency program. Shortly thereafter, I sat with the program director and another resident detailing my thoughts on the program thus far and why I wanted to be a part of it in the near future. None of the relationships were blurred between professional and informal, yet there was an overwhelming sense of family familiarity. All in all, ARMC is comfortable and inviting, as I would hope every potential employer would be.

Question of the Week

What happens when you get mad?

Suggested Considerations

Residency Interview - The Eighth

2011-11-13T06:00:00.003-07:00

Missing the snowstorm by a week, remnant evidence of its passing was still visible when I visited the country's northeastern city of Philadelphia. A short distance on the outskirts of the metropolitan limits was one of the community based hospitals in the Aria Health network.

Aria Health

I could not be more grateful for the generosity this program demonstrated. Their original invitation to interview a day earlier had to be turned down as I was visiting another program then. They accommodated my schedule and let me interview among students vying for another specialty the following day. At first, I felt mildly out of place as the line of thought, desired characteristics and program highlights were foreign to me during discussion and presentations. In the end, we were all students looking at a program from different angles which provided interesting insight.

As the lone emergency medicine interviewee, I was whisked away early to interview with the program director who I found as calm and kind as the treatment I had already received. We discussed the usual interview topics, how they intend to expand their program and what they have to offer. Shortly thereafter, a couple of the residents had their go at my application and put me in the proverbial hot seat. It, too, was as relaxed as my initial interactions leaving me feeling welcome and at ease with the experience.

A teaching session with the residents was led by local physicians in various specialties. Apparently, the medical institutions in the Philadelphia area are very open to sharing faculty in support of advancing medical education. This attitude creates an environment of community among health care facilities, providers and students all for the better. We toured the hospital with the residents who further answered questions about the program and health network. Despite being a smaller community hospital, the personality and character carried by the employees, residents and faculty was appreciable in my decision making. I really enjoyed my time in Philadelphia and exploring what this program had to offer.

Question of the Week

What can you bring to this program?

Suggested Consideration

Residency Interview - The Seventh

2011-11-06T15:03:00.002-07:00

Only one day into my new rotation I found myself standing in the long line at the airport awaiting security checkpoints before the sun reached the horizon. I would be spending the rest of the day in transit from one coast to the other losing hours fast as we crossed numerous time zones.

St. Joseph's Regional Medical Center

Waking up at 5am on the east coast was a rough task when my internal clock was screaming it was still 2 in the morning. My anxiety driven agenda helped get me out of bed, dressed and to the hospital in time to follow the medical staff into the underbelly of the large hospital. Recent construction has foot traffic rerouted on the outside, but the inside looked like a contemporary museum or lounge. Welcome to St. Joseph's in the heart of Paterson, New Jersey. Our morning started among the residents in a newly constructed auditorium reviewing cases and discussing medicine. Refreshments from the in-house Au Bon Pain worked our palates into submission before a tour of the facilities.

Among other things, the renovations have brought a whole new tower to the campus with state-of-the-art ICU, floors and revamped emergency department. Everything was so clean, colorful and busy. With various fellowships available, the latest technologies and seemingly satisfied residents, this program puts up quite a fight for a leading residency. Despite being an accredited Trauma II center, they have their fair share of trauma with what sounds like a procedure intense training. There is no lack of pediatrics and they are even gearing up for a geriatric oriented emergency unit, one of the first in the country.

Interviews were conducted after a lunch with residents in a panel format that consisted of program director, assistant program director, department manager, and resident. I felt at ease throughout the process and was intrigued by the clinical case exercise. It was done in the style of an oral board exam, something I have never practiced. Despite my travel fatigue, my answers portrayed my personality and came across the way I would have answered in a no-stress situation. I left feeling this program was a shining star among programs and was honored to interview as a guest on their campus.

Question of the Week

If one were to ask a friend of yours what one weakness you have, what would it be?

Suggested Considerations

Residency Interview – The Sixth

2011-10-30T06:30:00.002-06:00

Only a couple states away my alarm sounded early enough to get me moving in the right direction. Sheer terror came over me, however, when I realized I would be driving across time zones putting me at risk for being an hour late to my destination. Needless to say, but I may or may not have driven a little faster than intended

Genesys Hospital & Health

Between the early morning hours and minimal traffic, lost time was quickly made up and I arrived in time for the afternoon interviews. The brisk breeze and color changing trees was a relaxing welcome to Genesys Hospital near Flint, Michigan. Walking in the hospital felt more like finding myself at a hotel lobby. The smells of a busy food court, music from a self-playing grand piano and visually pleasing flowers filled the foyer just beyond the doors. I quickly questioned if I had gone to the right place. Noticing the other suited students, it was apparent I was not lost.

After a brief meet-and-greet over lunch, the program director provided an overview of the day and residency program. We then divided accordingly to our respective interviews. One by one we met with the program director, assistant director, department manager, director of clinical education and chief residents. Each focused on various aspects of the interview including teamwork, leadership, extracurricular activities, and business aspects of medicine. This style was new to me and I tried to take advantage of the opportunity by not repeating answers. I will admit, however, that it felt as though the process was longer since these interactions were so numerous, yet the total time commitment was less than most programs. Well done Genesys.

There was plenty of time to interact with residents and have questions answered in a no-pressure setting. They took us on tours of the emergency department, hospital and associated athletic club. All were very busy, which I did not initially expect by the surrounding rural-esque environment. Genesys lived up to the great things I heard all the way across the country in Las Vegas and I’m glad I had the opportunity to visit their program in person.

Question of the Week

What non-medical book have you read lately?

Suggested Considerations

Residency Interview - The Fifth

2011-10-23T21:33:00.002-06:00

The sun was still sleeping when I arrived at the hospital for my early morning interview. Having only worked a handful of shifts, getting to the emergency department was not a problem. Finding the interview room in time might be.

St. James Hospital & Health

Fortunately, I found the program director as he entered the building suited and ready to interview. A couple days prior I responded to a call on the medical floor to see if I could be of help before my shift ended. The resident in charge was unable to pass an endotracheal tube through the vocal cords and as luck would have it, I found myself at the head of the bed finishing the job. It didn't take long for the program director to catch wind of the event and in the moments before the interview it became a topic of discussion. Good thing for me...the patient was still living.

Only another student and I would be interviewing that day for one of the largest emergency medicine residencies in the country. After a short presentation about the St. James program, its many hospitals spread across the Chicago community and various local highlights, we sat for our individual interviews. They were short and to the point allowing the chief residents, director and me an opportunity to learn about each other and the program. Despite having nine hospitals in the system, we only toured the Olympia Fields facility where the interview took place.

The remainder of the morning was consumed by a didactic session with the current residents, faculty and guest lecturers. Being near a city with so many hospitals and residency programs, they are privileged to have recognized physicians lecturing on a regular basis. As quickly as it had begun, the day seemed over and it was already time to start my afternoon shift. I think it would be helpful to see some of the other facilities, but the residents trickle through my rotating ED enough to get an idea of their character. I continue to be impressed by their caliber, friendliness and hard work ethic. Since my childhood stomping grounds are miles away, this program definitely has an added bonus when it comes time to make a residency decision.

Question of the Week

If you could meet and have a discussion with any person alive or dead, who would it be and what would you discuss?

Suggested Considerations

Residency Interview - The Fourth

2011-10-16T10:54:00.002-06:00

Despite being invited to meet with the residents for dinner before interview day, I was not be able to join them due to a drive through Ohio's more rural parts. It was probably for the better since I was still wrapping my head around an interview early in that afternoon.

Doctors Hospital

The west side of Columbus, Ohio felt very similar to my childhood stomping grounds; the suburban unencumbered traffic patterns with residences and businesses lining the streets. Prepared to leave my hotel early, I met another interviewing student at breakfast. We are not hard to spot as anxiety is obvious, professional attire the norm and portfolios a calming distraction. Doctors Hospital seemed to be at the center of community health with a steady flow of people coming and going. Dressed in standard suit and tie form I made my way into the educational building for the weekly didactic session among residents, faculty and fellow interviewing students. It was comforting to see other students I had met on the interview trail, once again proving how small the community within a specialty truly can be. I found the discussions by teaching staff and guests to be rather enlightening. To top off the morning session, we finished with a splinting lab before heading to the conference room for interviews.

After brief introductions were made by all in attendance, half of the group toured the facility while the others interviewed. The facilities were impressive. With so many residents in house, they have their own lounge with a mini fitness center and sleep rooms. The simulation lab was extensive and appeared to be well used by those in training. The ED was super clean, but did not seem to be as busy as one would expect for the middle of the day. One nice feature is that all the gurneys are the OB/GYN type, so that finding one when you really need it would not be a problem. The rest of the hospital was either on its way to being remodeled or in the process of getting the upgrade.

One of the strengths of this particular emergency medicine program is their involvement with the local community emergency crews. It seems that they are very involved in both ground and flight transport with regular training sessions to help educate regularly. On the flip side, with so many residency programs in one facility there are the expected clashes when one service wants to get their fair share, but has to step aside to let another service take over. In this sense, the program does not have unopposed care of all their patients. Nonetheless, trauma and pediatrics were external rotations done at inner city hospitals that get high patient volumes and acuity. With the tour complete, we started the individual interviews.

The interview was conducted by the program director, his assistant and three residents. It was a very laid back session with free-flowing conversation and questions. To my surprise, amid the questions an EKG was given to me to diagnose and manage the patient. Fortunately, I had some understanding of the tracing and could formulate an educated response and treatment, thus effectively "saving" the patient's life. This interview was somewhat unique in that the questions asked were not all typical of an interview I have experienced. They definitely required some thinking on my toes and hopefully provided insight into who I am as a person even if they weren't always well formulated answers. Overall, I left the program feeling good about the experience and enthusiastic about its potential.

Question of the Week

If you were given a large sum of money and could no longer work in medicine, what type of work would you do?

Residency Interview - The Third

2011-10-09T11:00:00.001-06:00

The long autumnal drive from Chicago to Michigan was calmingly pleasant with beautiful weather and fall leaves changing colors all around. It was just what I needed to relieve the anxiety of another interview day on the horizon.

Sparrow Hospital

Driving through the streets, the college town feel greeted me as students busily went about their evening activities and the MSU campus seemed to remain lively even after the sun had set. I would soon be meeting some of the emergency medicine residents at Sparrow Hospital for dinner the night before my interview. The food was good and the residents friendly. Being the knowledgeable experts about their program, they answered our questions and introduced the program with great excitement. It was a perfect opportunity to get the inside scoop on a city and facility I knew little about. To make our stay that night more comfortable, reservations were made for us to stay on campus at the Kellogg Center, a business style hotel which was definitely a welcome opportunity.

After a brief meeting in the morning to highlight the program we had two personal interviews conducted by the program director and the assistant director. It was a comfortable exchange discussing program attributes and myself as a candidate. Afterwards we toured the main and secondary hospitals. I was amazed at the state-of-the-art feel as much of Sparrow was recently built. The emergency department was larger than any I had seen in my travels and seemed to have an endless supply of rooms. This undoubtedly met the demands of the community and appeared to do so in a great setting. There was ample time with current residents to have our questions answered and to really understand the underpinnings of the program. With a strong curriculum, experienced core faculty, wonderful facilities, and a supportive community this program definitely put on a great showing. The icing on the cake was a quick trip to the rooftop helipad that overlooked the city, simply beautiful.

As a final wrap-up to the day, we were invited to dine with residents and a member of the faculty. By this time, all of our questions had been answered and it was just a matter of getting "that feeling" of knowing it was the program; a decision that is too early to make. I am pleased to have experienced this program first-hand as it was rather enlightening.

Question of the Week

Where would you like to be in 10 years?

Suggested Consideration

Residency Interview - The Second

2011-10-02T13:33:00.001-06:00

At the beginning of the month-long rotation I was told to be ready for a spontaneous interview sometime throughout the month. Without much warning we would be pulled aside to discuss with program leaders the program and ourselves. However, I didn't think it was going to be three separate interviews on three different days.

Kent Hospital

As a courtesy gesture towards the students who rotated at the site, we were asked to not dress in formal attire. Needless to say, interviewing in jeans and a hoodie was comfortably welcome albeit a little awkward. The first sit-down session was with the chief resident, laid back and somewhat formal in questioning. It was a good way to get an idea about the program from a resident's perspective. Then the department manager pulled us aside later in the week to get to know us and our thoughts about the program. The following week the residency director met one-on-one to finish the interview process. I would imagine when formal interviews are held, it is a little more compact and rigorous, but since we had an entire month to demonstrate ourselves, there was little need doing so.

I was happily surprised with my experience at Kent Hospital. Having never really visited the Northeast and Rhode Island in particular, it was quite the adventure to be newly exposed to both in such a high-stakes way. The faculty, staff and even patients were among some of the nicest people I have met in my travels. The department itself was one of the cleanest, roomiest and most organized that I have visited. With those qualities, it made sense that a community hospital would always have a full ambulance bay unloading new patients. Although the visiting students did not get to see the ancillary rotation sites for this program, we were informed that the following hospitals are among the list: Tuft Medical Center, Massachusetts General Hospital, St. Barnabas Hospital Bronx, St. Anne's Hospital, Children's Hospital Boston, Women's and Infants, and Butler Hospital.

I left the program feeling invigorated about emergency medicine and the upcoming match experience. On the interview trail, it seems that faculty know other faculty at various programs and the rotating students will show up time and time again. As we rotate around the country and interview for residency positions, students run into each other at various sites proving how small the world within a specialty can be. All in all, despite having three individual interviews for one program, I enjoyed the opportunity of experiencing first hand what this program had to offer.

Question of the Week

Why do you want to do _____ (insert your specialty of choice)? Why do you want to come to _____ (insert the interviewing program)?

The above are guaranteed questions in just about every residency interview.

Residency Interview - The First

2011-09-25T10:21:00.000-06:00

Just coming off of night shifts, I had a difficult time falling asleep and the anxiety of an interview the next day didn't make things any better. In total I think I may have slept four hours before my alarm sounded at 3am.

St. Barnabas Hospital

I shuffled about my morning activities while the world around me still slept and the crickets chirped. It had been a while since I knotted a tie, but this morning it went on with no problem. I was out the door by 4am and on the road for an early morning cruise to New York. My destination, St. Barnabas Hospital in the Bronx, roughly three hours away. Traffic was nonexistent and the morning fog was the worst obstacle. The hurried feel of New York was obvious as I approached the hospital with people mulling about and a full ambulance bay. I had arrived for my first residency interview.

I was fascinated by the inherent antiquity of the buildings, it gave a sense of being well established in the community. The only person in a suit, I stood out like a sore thumb among those in scrubs and street clothes as I walked the campus. It was apparent that I was there on official business. Shortly after finding the morning meeting place, the faculty lectures and student case reports consumed the early hours of this program introduction. These were followed by a tour of the emergency department and hospital before grabbing lunch that was provided for Employee Appreciation Day.

While it was difficult to digest lunch due to the building anxiety, we conversed with residents and other interviewees about the program. One by one we made our way into the "hot seat" for our personal interviews in front of a panel made up of two residents and two faculty members. The questions were focused around the program and my submitted application, both of which I felt comfortable discussing. I was then given time to ask about the program and before I knew it, we were shaking hands and parting ways. It was a breath of fresh air to have my first interview behind me. I definitely enjoyed the experience and look forward to more like it as I explore the world of emergency medicine residencies.

Question of the Week

You have diagnosed a patient with a terminal illness or must give grave news. How would you share this new information with your patient?

Suggested Consideration

Night Shift

2011-09-18T13:45:00.000-06:00

As I drove home in the early hours of the morning, I was greeted by rays of sunshine peeking through the clouds and flittering on the surface of the harbor waters. Where many people cringe at the thought of staying awake all night to fulfill a work related responsibility, this was my reward for making it through another evening at the hospital.

Call of Duty

The night shift happens when most of the community should be sleeping, yet somehow the hospital emergency department seems to stay lively at all hours. It amazes me sometimes what people will present with at three in the morning; a nagging cough, an ankle injury from the day before or chronic pains that could have been treated during the day at a clinicians office. On the other hand there are those that tend to celebrate the evening hours with brawls, imbibing their favorite alcoholic beverages or driving who knows where at that sleepy hour. So without fail, the emergency room staff assemble to assuage their complaints and injuries. In all honesty, it is not always easy to remain stoic about their complaints as a good laugh helps us stay awake and it just seems uncanny that someone would rather be at the hospital than in their own bed sleeping. Nonetheless, there will be someone there to meet the responsibility of caring for the night owls of the world in that time of need.

Of course there are true emergencies that present to the ED on occasion. The hum-drum feeling can quickly become pell-mell as resources are combined to make a difference for the people that need them most. In a coordinated effort treatment is rendered to expedite the care of the individual in question while the ankle sprains and hang nails take a back seat to the action. The night shift seems to be a different breed of caffeine guzzlers and adrenaline junkies, but when the night has come to an end, everyone scatters to catch up on their sleep and enjoy the serenity of the quiet morning hours before the rest of the world makes their morning commute.

Question of the Week

A 17 year old female is brought to the emergency department by her sister because of pruritic symptoms around her fingers and toes that is worse at night. On exam there are visible excoriations from repetitive scratching. The patient has been living in a women's shelter for several months. She has no past medical history, is not on medication and has no known allergies. A biopsy is taken from the intertriginous space between her fingers. What is the name of the organism responsible for causing her problem?

A. Herpes simplex type I
B. Staphylococcus aureus
C. Sarcoptes scabiei
D. Candida albicans
E. Streptococcus

Answer & Explanation

A Time for Celebration

2011-09-11T11:29:00.000-06:00

Last week may have marked the last exam of my official educational career...assuming I passed. While I can think of no more depressing way of spending my 30th birthday than sitting for a medical school board exam on a rainy day in a foreign city, the celebration of being done was thoroughly enjoyable even if it was only a modest party for one.

Moving Right Along

All I could think was, "finally this exam is done." It has plagued me for so long trying to concentrate on rotations and applying to residency programs. With any luck I will have passed and can move on to worrying about interviews and the upcoming match. It seems like just yesterday one of the upperclassmen was telling me how fast medical school would go by. Of course at the time I couldn't believe the semester would ever come to an end. And now, looking back, we have been so busy that I barely noticed the elapsed time. Although we have not quite reached the summit of this experience, it is definitely in site and attainable at this point.

Reflecting on 30 years seems rather farcical and I wonder if the 20 some years of education has really paid its dividends. Does that mean that medicine can be considered my second career? At this point, I think I am ready to move on to career mode and at least realize a little of the benefits from all of this training even if that means more responsibility. But I am getting ahead of myself. I have yet to be officially told the examination was a success and I still have interviews to attend. Now, more than ever, is the time to sprint to the finish and focus on keeping my game face. There will be more time to celebrate later, but it was nice to pit-stop for a moment and feel human again.

Question of the Week

A 25 year old medical student who was PPD-negative when starting medical school tests PPD-positive after her first ward rotation. As her physician, what is your first step in managing this patient?

A. Repeat the PPD
B. Check her liver function
C. Obtain a sputum sample for culture
D. Order a chest roentgenogram
E. Order a urine culture

Answer & Explanation

Special Occasions

2011-09-04T06:52:00.001-06:00

Some 2,500 miles away, my grandparents will be getting up in a few hours to go about their daily activities including opening their email and finding this delivered to their inbox. They just celebrated a wedding anniversary and today is Grandma's birthday. I want to dedicate this post to them as they have been so supportive throughout the years and especially during medical school.

Grandparents

The first chapter of my career in medicine started on their basement stairs when I was just a child. As the story goes, I am almost done with another chapter in this never ending book. In days, I will be taking another board exam and in weeks I will be starting interviews for residency. Like their significant milestone anniversaries, I am trudging past a few of my own, making small advancements that bring me steps closer to a goal I've had for so long. My grandparents have been there every step of the way, cheering me on, following my progress and feeding the cereal craved fiend inside. If I ever needed something, they were the first to offer a helping hand and always graciously generous when meeting those needs. It's too bad they are already taken, because I think everybody could benefit from the best grandparents in the world.

Through retrospective analysis, I have come to realize one of my weaknesses over the years. In short I have become a "yes" man. When a person requests my services, I have the hardest time turning them away and do what I can to provide for their need. Now I think I know where that comes from. So, Grandma and Grandpa, I want to thank you for all your support, for giving selflessly to see me succeed and for having the best cereal and treat stash I could ever imagine. You two are fantastic and I love you for who you have been in my life and the lives of others. Thank you for your examples of what genuinely caring people can do in this world. I hope you had a wonderful wedding anniversary and Grandma, HAPPY BIRTHDAY! I love you both and thank you for being such an integral part of who and where I am.

Question of the Week

A medical student writes a blog about his fantastic grandparents who are celebrating some incredible moments in life. Which of the following is true about this dedicated, hard working couple?

A. They are celebrating their 62nd wedding anniversary
B. Crossword puzzles are no match for them
C. They are the best grandparents ever
D. They still know how to have a good time
E. All of the above

Answer & Explanation

Education Beyond the Classroom

2011-08-28T18:00:00.044-06:00

Learning the tricks of the medical trade comes from lots of exposure to lectures, books and hands-on experience. Initially we are expected to be attentive to professors who create a basic foundation and then pick up the rest on our own time through personal study and discussion with colleagues. When it comes to the clinical setting, the direct form of teaching dissipates and we carry more of the responsibility to be self taught. Yet there remains plenty of room for a student-teacher relationship. [Classroom at the Washington University School of Medicine 1943]

Learning Through Respect

In speaking with one of the residents at the program I am visiting, he reminded me that not all physicians remember what it is like to be a student. They have forgotten the basics and want to be identified as one who no longer has to be "at that level" of training. In doing so they often seem to have a chip on their shoulder, teach very little to students and ignore even the existence of students trying to be friendly. So doctor, my morning greeting was not an attempt to waste a breath of air, it was intended to be pleasant and acknowledge your existence in hopes that perhaps you would acknowledge mine. Little things like that are what really set a tone in my opinion. It standardizes a sense of mutual respect and understanding allowing for potential growth beyond that point. Maybe it is perceived as a "brown-nosing" tactic wherein I am gunning for a response. Whatever the case, I thought it was a simple common gesture in human interaction. What do I know, I am just a medical student.

Medical students just learn to grow thick skin. Patients give you grief because you are the first person willing to listen to their complaints and desires. After hearing out the patient, the student finally presents to the residents who are the first to think you have set them back because "you must have been delivering a baby in there." If you are not thinking what they are thinking, they will let you know without hesitation that you are wrong. But this mode of action comes from their superiors too. The attendings are looking at them in a similar light but may not always say so out loud. So it only makes sense that the residents become calloused and project their troubles onto the medical student who will smile, be pleasant and always take a verbal lashing for the ever coveted passing grade. All the while the student is thinking, "why do I pay good money to be demoralized in front of patients and coworkers?" We know our end goal and will walk through the gauntlet to get there, even if that means we will be red in the face a few times.

Once in a while, however, there are those who will remember the emotional strain medical students experience. In their wisdom, the residents will slow down and teach or maybe even learn something because we are all in this together. What one person may have recently studied, the other has not heard in a while. This resident remembers the efforts students are making to impress and succeed even if they fall short once in a while. The effects of the classroom extend beyond those four walls into the community and clinics. It has the potential to reside within each relationship we have for better or for worse. I refuse to let my education be compromised by those who have forgotten how a patient teacher can influence an eager student.

Question of the Week

A 24 year old medical student admires and begins to pattern her life after her surgical mentor. Which one of the following defense mechanisms does she exhibit?

A. Introjection
B. Projection
C. Rationalization
D. Identification
E. Conscious Control

Answer & Explanation