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The Residency Interview- like dating, but worse!

Residency interviews are like a series of first dates only worse. Unfortunately, you can’t have your friend call you to bail you out because you’re not enjoying yourself. You have to sit through each powerpoint presentation on why each residency program is far superior to all the rest and pretend like you haven’t heard the same spiel from every other program. Here’s some advice on how to excel on your residency interviews.

 

 

1. Be the best version of yourself

When I asked my dad for advise before my first interview he said, ‘just be yourself’. I looked back at him incredulously and he corrected himself by adding, ‘maybe just tone it down a little bit’. This could also easily be titled ‘hide the crazy’. Be yourself but don’t come on too strong. Be the person your dog thinks you are.

 

 

2. Know what you want…and share the important details

I wanted a residency program with a strong cardiology program in a big city in the northeast. Sure, I left out the ‘northeast’ part when I interviewed in Pittsburgh and Miami. And it was a little awkward when I mentioned my interest in pursuing cardiology to the one program that didn’t have my desired fellowship. Kind of like the time I met a Tinder date at my favorite Brooklyn hipster bar only to learn that she ‘doesn’t drink’. My point being that you should know what is important to you and know what is a deal breaker. Just don’t shoot yourself in the foot in the process.

 

 

3. Have interests outside of medicine

It really doesn’t matter what hobbies you have. You can be a tequila aficionado, coffee connoisseur, or an amateur chef. Sure, on a medical residency interview its good to mention your interests and long-term goals in medicine but it gets old after a while. Just think how many other applicants talk about how much they love saving lives. We get it. You want to be a doctor. Just remember to show them who you are outside of what is inside your application.

 

 

4. Prepare for the most commonly asked questions

This shouldn’t have to be mentioned but I’m going to do so anyway. Your interview day should not be the first time you think of your answer for the most frequently asked questions like (1) tell me about yourself, (2) where do you see yourself in 10 years, (3) what would you have done in life if you didn’t pursue medicine, (4) why this specialty, (5) what are your biggest weaknesses/strengths. Talk these out with your friends. You don’t need to memorize your answer. In fact, don’t. It will sound memorized. Just make a few bullet points about things you want to mention.

 

 

5. Use every question as an opportunity to sell yourself

I’m not sure if you knew this or not but sometimes during the presidential debates the candidate doesn’t always answer the question they were asked. They use the question as an opportunity to talk about something important that they want to convey. You should do the same with your interview. For instance, on one interview I was asked ‘if you could be any type of animal, what type of animal would you be?’. There wasn’t one right answer but there are certainly wrong answers. I said, ‘a bee’. After the interviewer looked at me funny I explained ‘bees are intelligent animals proficient at fulfilling their individual tasks for the betterment of the hive much like how in medicine each specialty must work together and communicate effectively for the betterment of the patient’. This specific answer might be catered to internal medicine and the primary specialties so it might not go over so smoothly on an orthopedic surgery interview but you get the idea.

 

 

6. Make them remember what you said, not how you dressed

How you dress is kind of like your personal statement. You just want it to keep you par with the other applicants. You have very little to gain by being risky with both your personal statement and how you dress but unfortunately a lot to lose by trying to show off. Blend into the background of black and grey suits or skirts and laugh when the program director makes  the old joke ‘oh wow, a colorful bunch!’.

 

7. Send a ‘thank you’ after the interview

Many programs told me about a study that showed many applicants changed their rank order list based on post-interview communications. As such, most programs have a strict ‘business only’ communication after the interview. This means that they will answer questions that you have about their program but shouldn’t tell you much more than that. Regardless, send a thank you e-mail. Hand written letters are okay too. After each interview remember to write down something memorable that you talked about so you can include ‘I enjoyed discussing what we would do with our lottery winnings. Do you mind sharing with me where that elephant sanctuary was in Thailand that you recommended?’ (Yes, this actually happened. The interview went pretty well).

 

8. Take notes after the interview and keep a running rank list

Each program begins to blend together after each interview. Make note of important things you like and dislike about each one. You’d be surprised at how good/bad some hospital cafeterias are.

 

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Applying for Internal Medicine Residency by the Numbers

Interview seasons is stressful and expensive. I hope that with this info-graphic that medical students will be able to have a rough estimate of how much it costs to apply to residency and where they can save some money. Additionally, the timing of my interview invitations and rejections give a rough timeline of when fourth year medical students should be hearing from programs or conversely when they should be freaking out because of a lack of interviews. Enjoy!

Infographic Final_corrected

 

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Study Tools During Clinical Years

Your two years of classroom basic sciences are drastically different than your clinical years. Studying in your first two years is somewhat easier because your primary responsibilities are all geared towards taking tests, culminating in the USMLE or COMLEX. Third year sucks because you are still studying for step 2 but fourth year hits that sweet spot between ‘done studying for tests’ mentality and ‘almost got a job’ swagger. These were my favorite resources that I used outside of my step studying.

 

 

Maxwell Quick Medical Reference

Super small and lightweight. This is great for beginners on the wards. It comes with a pocket eye chart which is probably the only place you will find eye charts in hospitals. Also comes with good on the go guides for shorthand notes and labs.

 

 

Pocket Medicine

The purple book is an intern’s favorite friend and mighty helpful too for med students. I don’t know when the new version is coming out but I didn’t feel like waiting for it. If nothing else, it’s a quick reference guide to everything you will see in the hospital. Differential diagnoses, work-up, treatments, etc. Pocket guides are also available for surgery, OB/GYN, peds, and such. I am going into internal medicine so I chose not to get any other pocket guides but google away if you want them.

 

 

Journal Club App 

Just buy it. It is the best $5.99 I spent in med school. This app provides concise and easy to journals that changed patient standard of care. You can also check them out for free online at Wiki Journal Club. Cardiology Trials is also a good site specifically aimed at cardio stuff.

 

 

UpToDate

It’s like Google for doctors! Okay, I’m starting to be redundant but its a great site that I’m sure you use already.

 

 

Moleskin Classic Notebook

 

 

Did I miss anything? What apps or resources have you used s/p step 2?

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Best Resources to Destroy USMLE Step 2 CK

*Disclaimer: Below are my favorite resources with associated links. If you like my blog please use the links to buy any books on Amazon or services (Picmonic, OnlineMedEd) as I receive a small referral fee that helps me keep this blog up and running! I only listed products I trust or and/or used*

Question Banks

The purpose of doing practice questions is to find your weaknesses in order to guide your study process and  to get you inside the head of question writers. Hopefully you figured this out already since you most likely already took step 1. However, I found studying for step 2 CK to be more difficult than step 1 because of the other obligations that MS3 requires. Question banks are also great on the go. Long subway to your friend’s apartment on the upper east side? Do a question set on the train. Bored in between lectures? Practice questions. Lost your resident and don’t feel like going back to the floor? Practice questions. Practice questions? Practice questions! Here are the practice questions I used.

USMLE World

Still the gold standard when it comes to practice questions. There is no way around it. You can read the message boards on Student Doctor Network and they all reiterate what I find to be true. That UWorld is the end all and be all when it comes essential resources for Step 2 CK. Some students will argue that UWorld and a review book are the only resources you need for step 2 CK and for the most part that is true. I completed UWorld in its entirety once. Then I completed all of the questions I got wrong (which was nearly half of them). Then I continued to do full question sets until test day so I ended up doing UWorld two and a half times. I highly suggest it.

Kaplan

Kaplan is the other major question bank out there. I used to do Kaplan questions with my friend who preferred not to ‘waste’ UWorld when he studied for his clinical clerkship exams. Just like step 1, a major advantage of Kaplan to UWorld is that they tell you exactly where this topic or subject is located in the most popular review books. I enjoyed using Kaplan but chose not to invest more money in another review book when I could borrow my friends’ PreTest books instead. That being said, I haven’t heard terrible things about Kaplan.

PreTest

I took step 2 during the second week of my first elective rotation in cardiology. So the bulk of my serious step 2 studying was done during my 8 week surgery core and subsequent 4 week surgery elective. I took a practice test and I did terribly. Like embarrassingly bad. And my worst subject was surgery. I had completed all of the UWorld surgery questions and ran through them all a second time. I wasn’t being lazy either. I read through and studied the answers to each question but I just wasn’t making any progress. My friend suggested I try pre-test and I loved it. Pre-test gives you over a thousand questions for each clerkship exam. In some regards they go into far too much detail than you actually need for your step exam and cover a much wider scope of subjects than UWorld alone…but that’s exactly why I used it. You can finish all of the UWorld or Kaplan questions for the smaller subjects like psych and pediatrics quite quickly. These books expose you to a lot more pathology that other qbanks don’t cover. I highly suggest using this resource for in between lectures, after you finish a specific section of UWorld, or if you just want more high quality practice questions. Just beware that they are not NBME format. So I would shy away from them when it comes closer to test day

Practice Tests

The purpose of practice tests are to find your weaknesses and to exploit them in order to maximize your score. Basically, study what you suck at! That’s the point of doing practice questions and that’s the point of doing a practice exam. So you can tell if your study process is working or not. For instance, after I started dedicating more and more time to study my weakest subject, surgery, my score began to creep up. I found that the number of questions I got wrong in other subjects continued to stay relatively stable but I was able to decrease the number of surgery questions I got wrong from 20, then to 12, then to 8, and on my last practice test I literally got zero surgery questions wrong. My point is that you can’t just keep taking practice tests to see what score you would get on step 2. That’s great and you should do that but you have to remember that the purpose of taking a practice test is to evaluate your weaknesses and to strategically focus on them. Okay, now I can get off my soap box.

NBME

NBME is the gold standard because they are written just like the real test. You have to use these wisely because there are only a limited number of them. Additionally, I believe that it is worth the ten extra dollars to purchase the expanded feedback. This option grants you the ability to see which questions you got wrong. Annoyingly, they don’t tell Sure you can screen shot every single question if you really want to (unlike UWorld Self Assessment) but this is so much easier and also doesn’t mess with your ability to recreate test day.

USMLE World- Self Assessment

The only reason this resource isn’t above the NBME practice exams is because there is only one USMLE World Self Assessment (UWSA). Both the NBME’s and the UWSA are only half as long as the real thing but the advantage of the UWSA is that they are like UWorld question sets. You are given full UWorld style explanations of each question, both the questions you get correct and incorrect alike. I chose to make this my last practice test because I was able to utilize these four individual question sets like they were new questions that I was able to review afterwards.

Review Books

I encountered a few problems when I chose which review book to utilize. My ideal review book would have everything in it already. Explanations from UWorld, differential diagnosis categorized by both chief complaint as well as pathophysiology, best initial test, most accurate test, best initial therapy, maintenance therapies, and alternative therapies. I never found that type of book. So go to the book store and check them out for yourself before you buy them.

Master the Boards (MTB)

I liked MTB for the same reason why I disliked it. Its brevity is nice when you just want a quick and dirty answer but it leaves you hanging at times when you want more detailed UWorld style explanations (seriously, why can’t someone just put UWorld in a book format already?!). Between UWorld and MTB you are guaranteed to pass step 2 because they cover all of the high yield stuff but be prepared to annotate the shit out of it. Bonus tip: use MTB for step 3 instead of the step 2 CK version. It’s got a few extra gems in there and it’s really not all that different from it’s step 2 cousin. This way you won’t have to start all over again for your next step.

First Aid for the USMLE Step 2 CK

First Aid was my step 1 bible but I didn’t use it for step 2 CK and I regret that decision. I borrowed this book a few times from my friends and I liked it. It mimics the step 1 version quite well. Again, I did not use this as a primary resource but I would encourage you to check it out.

Step Up to USMLE Step 2 CK

I used Step Up to Medicine (SU2M) for internal medicine only and did not use Step Up To USMLE CK because I disliked SU2M so much. If MTB has too little information then this is the complete opposite side of the spectrum. It has long winded explanations of every subject in bullet format. Some people liked that but it wasn’t for me.

Lecture Material

Lectures were less valuable to me for step 2 than for step 1. I just didn’t have enough time to sit down and watch video lectures. My favorite way to study was to simply review whatever disease my patients had that day. Every once in a while however I just didn’t know something and needed someone to spell it out for me. These are the resources I used for those moments.

Online MedEd

This is by far my new favorite resource that I utilized for step 2. Online MedEd uses a reverse classroom style of teaching with whiteboard based lectures. Lecture videos range in length and subject matter but are amazing resources for both step 2 and for the wards. For instance, one day I was feeling a little lost about fluid management so I went to the library and threw on the fluid management videos. I went back to the floors with a better grasp of what I was doing and didn’t feel like such an idiot. I especially liked the algorithmic way of thinking they employ. I watched every video and would do it again in a heart beat.

Doctors in Training (DIT)

I loved DIT for step 1 but it just didn’t do it for me for step 2. I didn’t have hours and hours to watch videos everyday, nor did I have the energy for it (that’s why I liked OnlineMedEd a little bit more because their videos were short and to the point). What I still loved about DIT was that they remind you of what you may have forgotten. The pre-lecture and post-lecture quizzes are gold. It wasn’t for me but doesn’t mean you shouldn’t at least check them out. Not to mention they’re great guys to follow on Twitter.

Kaplan Lecture Videos

I got my hands on these videos and they were fantastic. Conrad Fischer at his best. If you liked Kaplan for step 1 then you will like them for step 2.

 

Miscellaneous

The other stuff that doesn’t fit into a pretty category like the stuff I already mentioned.

The Successful Match: 200 Rules to Succeed in the Residency Match

This book is pure gold and I highly recommend it to anyone and everyone going through the match process. It provides analytical data on the match. The author provides objective data on a subjective subject like what characteristic traits different program directors like to see in their candidates the most in each respective specialty. This book provides advice on everything from writing your personal statement, the most commonly asked interview questions and the best way to answer them, what type of programs you should be applying to, who you should be asking for letter of recommendations from, and so much more. It was my most valuable resource before and during interview season. You won’t regret this investment. In fact, your friends are going to want to borrow it. Mine did.

 

UpToDate

Most medical schools provide this for you and it was easily my most often used resource during my third and fourth year of medical school. It’s like Wikipedia for medicine when Wikipedia doesn’t do a good enough job at explaining something. Or when someone points out that Wikipedia isn’t ‘a reliable resource’. Anyway, it’s amazing and I love it. Bonus tip: click the ‘summary and recommendations’ tab to get a quick snapshot of the article you’re checking out.

Picmonic

If you used Picmonic for step 1 then you should keep using it for step 2. I talked about Picmonic before and it still rings true. Every time I thought about brain tumors, tumors of the bone, any vasculitis, developmental disorder, and everything from biochemistry my Picmonic note cards would pop into my head. I’ll probably be that one resident who puts a Picmonic mnemonic in the presentation slides for morning report. I don’t ‘like like’ Picmonic. I love them.

*Use my link to get 30% off your Picmonic subscription!

Blueprints

Blueprints is like PreTest because they are good for shelf exams but not so much for dedicated step 2 CK studying. I highly disliked Blueprints because it was so long but others liked it for that exact same reason. Each chapter gives you a few bolded key words, tables and figures and explains the topic in great detail (again, too much detail in my opinion). The book ends with 100 NBME style questions with long explanations. I liked PreTest more because of how succinct it was but I have friends who, again, had the complete opposite opinion. To each his or her own.

Tablet > smart phone

If you don’t have a tablet already I would highly recomend purchasing one. If you are short on cash you do not need to purchase an iPad. There are tablets out there for under $100. Sure they aren’t as pretty but all that you realy need them for is accessing UWorld. Yes, you can simply use your smartphone instead of buying another piece of technology but unfortunately every time you have your phone out people will think you are texting. I remember once when I was on my phone doing a UWorld question set while I waited for the operating room to be cleaned and a nurse called me out for ‘texting instead of taking care of my patient’. Said patient was actually sitting next to me in her bed on her phone playing ‘2048’. She was trying to beat my high score and was failing miserably. Anyway, my patient kindly told the nurse to ‘kindly fuck off’. She was one of my favorite patients ever. Moral of the story: if you are on your phone people will think that you are texting no matter if you are using it to cure cancer or are actually texting.

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How to Prepare for the Comp

Here is how I approached the comp and used it to help prepare me to succeed on step 1 of the USMLE.

 

It’s just a practice test

At the end of the day the comp exam is a practice step 1 exam and nothing more. I took five practice exams when I studied for step 1 and step 2 respectively. These were NBME practice tests and were just like the comp because the comp is a practice exam that is meant to show you were you stand. Sure, it will suck if you have to retake the comp but your end goal is to crush step 1! So don’t worry about passing or failing the comp. In the long run it doesn’t matter if you pass or fail. If you fail, it means that you aren’t ready to take step 1. And hey, I passed the comp on my first try but I certainly wouldn’t say I was ready for step 1. I still required two more months of studying in order to get my scores up.

 

Pass the comp but focus on step 1

Back in my day we had 4 weeks to study for the comp after our fourth semester final. I understand that times have changed but my study strategy should still ring true. My strategy was simple: I wanted to pass the comp so I didn’t have to worry about it after I left the island. However, at the end of the day the comp doesn’t really matter. All that matters is crushing step 1. No residency program will know if you passed or failed your comp exam but they will certainly know what you got on step one.

 

Don’t try and study everything

It doesn’t pay off to try and study everything before you take the comp because there simply isn’t enough time. During my third and fourth semester I was using the Kaplan step one question bank to study for the NBME final exams so I chose to use a Kaplan diagnostic test to see where I stood. Turns out I sucked at everything but there were certain subjects I was particularly bad at. As I suspected, my best subjects were ones that I had just studied for my fourth semester final. Strategically, I chose not to study these subjects and hoped that I would remember them when I took the comp. Instead, I focused on a few organ systems that I was particularly bad at, specifically pulmonology, nephrology, and gastroenterology. I also chose to focus on cardiology because it is the single organ system that takes up the largest composition of questions on step one.

 

Start studying for step one when you start studying for the comp

When I left the island I had already studied four organ systems (the three I sucked at plus cardio). It wasn’t sufficient enough to allow me to skip them during my two months of preparation for step one but it gave me one hell of a head start. Again, it doesn’t matter if you pass the comp or not. Sure it will suck if you have to take it again but you have to keep the long-term goal in mind of not just passing step one but crushing it. Passing step one might get you a residency but killing step one will get you an amazing residency.

 

And do practice questions. Lots of practice questions.

The more practice questions you do the higher you will score. There is simply not way around it. By the time I took step 1 I had completed half of the Kaplan qbank once, all of UWorld, and all of the questions I answered incorrectly in UWorld once which comes to a grand total of 3,000 questions or so. Some people did all of Kaplan, UWorld, and one or two other qbanks but I personally felt like that’s overkill but everyone is different. UWorld should be the minimum though.

Practice questions will not replace your studying but instead should supplement and guide you in which topics you need to study. Practice questions show you your weaknesses and give you topics to go back and study. I suggest one full question set which should take you one hour followed by three hours to review those questions. Then study for four hours in the afternoon after an hour break. Then eat, sleep, repeat!

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Medical Student Sunday Interview with Daily Medicine

The following interview was originally published on Daily Medicine, a blog full of quotes, ideas, lists, and general knowledge. Check it out for your daily dose of medicine!

In the first “Medical Student Sunday” of 2016, Daily Medicine Blog welcomes fourth year medical school student Marc Katz! Many of you have asked me for a look into a Caribbean medical school and now the chance has come to meet a great student from Ross University. Soon he will be matching into a residency spot and I can not wait to congratulate him. Until then, peek into his life through this candid interview:

 

Who are you to the world?

I’m a first generation American born to South African immigrants, a fourth year medical student currently finishing up my last few interviews for residency in internal medicine with plans to pursue a fellowship in cardiology. I also run a blog, MyKatz, where I advice pre-med and medical students about the hidden curriculum of medical school and try and teach others through my mistakes and experiences. My hope is that I can one day I can use my blog as a medium to educate my patients and expand their understanding of disease, health, and wellness. When I’m not in the hospital or library you can find me playing basketball at the gym, playing Call of Duty, finding a new show to watch, or reading a new book in the park. Right now I’m finishing up Scar Tissue by Anthony Kiedis and the next book on my list is The Man in the High Castle. My cousins told me that the show the book is based on is really good so I want to try and read it before I watch it. It’s the same way that I got into Game of Thrones. Except for GoT I binge watched the first two seasons and then didn’t want to wait for the next season to come out next year so I just read the books instead.

 

What has been your journey to medical school? (Were you a traditional or non-traditional student? Did you always want to be a doctor? Etc)

I went straight from undergrad at SUNY- Binghamton to Ross University School of Medicine. I didn’t realize I truly wanted to pursue medicine until my junior year of college so unfortunately my GPA was ever so slightly below average when I was applying. Ross accepted me for the fall semester so I jumped at the opportunity to start my medical career.

Although my grandfather was a well-respected pediatric surgeon in South Africa I was never really pressured into pursuing medicine. It just kind of happened. I blame the years of watching ER growing up. Fun fact, Christiaan Barnard, the man who performed the first successful human-to-human heart transplant in the world, was my grandfather’s resident!

 

What is it like attending a Caribbean medical school? (A lot of students ask me this and I would love a more detailed answer to this particular question)

I loved attending Ross University! It was an amazing experience to study abroad in such a beautiful country. Sure, we had some annoyances. Dominica’s water filtration system was gravity. So when it rained heavily it would trudge up mud and our water would be turned off. I remember walking home from the gym and it started to pour. Lo and behold when I got home I had no running water. Luckily I prepared for this situation and I had a nice shower with bottled water the day before my exam. But it’s not all bad. My strongest memories are those spent with the friends I made on the island. Attending medical school in Dominica is like going to war because only those who experience it can truly understand what it’s like. I spent almost every waking moment with the friends I made on that island for four semesters straight. I seriously wouldn’t have gotten through medical school without my island family and I’ll love them forever for it. Just please don’t tell them I said that. It would be sooo embarrassing if they knew.

 

To you, what is the hardest part of medical school?

Hell, where should I begin? I almost appreciated being on a literal and figurative island during my first two years of med school. We had no distractions and nothing to do besides study…and maybe drink. So focusing on my studies wasn’t difficult but figuring out how to study was. It took me a few weeks to realize how I study best and it was my first major hurdle in medical school. It’s also been the basis of a few blog posts I’ve authored, like How To Study In Medical School, because of how important it is during any graduate education. The next part, actually studying, is even worse.

You have an average of five to six hours of lecture material every day followed by five to six hours of studying every day. It sucks and there is no shortcut. Thankfully I’m a huge nerd and I enjoyed learning about most of the material, but let’s be real…nobody actually enjoys memorizing the enzymatic steps of the Kreb’s cycle.

 

What is a normal day like for a 4th year medical school student?

I actually wrote a blog post about the day to day life of a third year which you can check out here, The Day To Day Schedule of a Third Year, but I’ve never been asked about fourth year before because there really is no ‘normal day’ of a fourth year medical student. The day-to-day life of a fourth year really depends on the rotation and the individual. I’m willing to bet someone who is going into a surgical residency might have a completely different clinical schedule than I do. I wanted to tour everything internal medicine has to offer so my fourth year schedule has been cardiology, nephrology, hematology & oncology, a medicine sub-internship, gastroenterology, pulmonology, and I’ll be finishing up medical school with an HIV/AIDS elective. Some rotations work you hard and keep you long hours while others let you enjoy your last year of freedom before residency starts. So in that regard fourth year is kind of like third year…you’re just slightly less of an idiot.

Fourth year also includes interview season and it leaves you tired and drained during November and December. That being said, my fourth year has been my favorite year of medical school so far. I’m not constantly anxious about having to go study for step one or step two and there aren’t any more tests, just patients. So I finally get to be self-driven about studying and pursue learning about what interests me. I’m just really excited for residency to start. And for my trip to South East Asia with my friends before residency starts.

 

What is the best advice you ever received?

Never yell at the food staff before you get your food and always pay for your date’s meal. Though I have a feeling you meant it with regards to medicine. If that’s the case then I must admit that the best advice I’ve been given isn’t all that original. I distinctly remember two different people telling me the same advice for two different reasons.

As a third year I was growing frustrated in my attempts to impress my attending whom I wanted a strong letter of recommendation from. And as a fourth year on my medicine sub-internship I was growing frustrated by my patient’s family’s indifferent attitude about the medical care of their loved one. In both instances my roommate and senior resident, respectively, gave me the same advice that was applicable to both situations. They told me to provide and coordinate the best possible care for my patient.

Instead of trying to read my attending’s mind I simply focused on taking care of my patient. I did what I could to make someone feel better everyday. I learned that I can sleep at night knowing that at the end of the day I did everything in my power to take the best care of my patient to the best of my abilities.

 

What qualities in a shadowing pre-medical student impresses you? 

The most impressive pre-med students are those that are awake. Seriously, if you’ve got a heartbeat, a smile on your face, and a skip in your step then you’re already better than half the kids I’ve seen. I remember my favorite pre-med student that was shadowing a surgeon I was working with for the month. During surgery she would diligently write down notes about things she wanted to look up later. She would come back with information that she looked up and asked us follow up questions. When we were waiting for rooms to be cleaned she asked to go watch other surgeries. She showed us that she wanted to be there by being engaged. She was visibly excited to be there and it made my day more fun when she was around. They are the same values and characteristics that make for a good medical student. You can read more about what qualities in a shadowing pre-medical student impress me the most in my blog post, Premeds: How To Shadow Like a Boss.

 

What do you like to do for fun?

Does brunch count as a hobby? Well besides drinking coffee, Bloody Mary’s, and mimosas, I also like to visit my brother at Barclay’s Center where he works and try to go to as many Brooklyn Nets and Islander’s games as I can. I’m also currently trying to knock out my New York City bucket list just in case I don’t match here. By the way, turns out the MOMA closes at 5:30pm during the week in case you wanted to go. Made that silly mistake last week. Still trying to find time and someone to go to the top of One World Trade Center with.

 

Do you have a few tips for medical school students & premeds?

I have too many tips for medical students and premeds! I could preach for days about mistakes I’ve made en route to medical school and how to avoid them as well as how to succeed in medical school. But I do have one real piece of advice for premeds and medical students alike and its not going to be very popular with your friends or family. It is to be selfish. Nobody else is going to make your medical education as their number one priority. That is your job. You are going to miss birthdays, anniversaries, weddings, holidays, parties, and average day to day moments that your friends and family will spend together. You on the other hand should be in the library or hospital studying. As I’ve stated before in a post about The Match, you need a strong step score in order to get past residency program filters and the only thing standing in your way is you. So be selfish and go study.

That being said, if anyone reading this has a more specific questions you can always comment on my blog and ask me a question here or tweet at me at @MarcKittyKatz and I’ll do my best to get back to you as soon as I can!

 

If you are in a relationship, how do you handle balancing school and a committed relationship? 

I am probably the worst person to ask about this…because science is my lady. Just kidding! My life isn’t that sad. I am currently single but I can comment that having a relationship during medical school is totally doable. Tons of classmates of mine met their significant others on the island and during rotations. In my humble opinion, you just have to be honest with yourself and your partner about your med school obligations and make your relationship a priority. It’s just like when people say ‘they don’t have time to exercise’. Nobody in medical school has an extra hour or two in their day but you can make time to exercise and you can make time to date and have a relationship. You just have to make it a priority. I mean, it’s not like it’s going to get any easier in residency. And when in doubt, swipe right.

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Categorical vs Preliminary

After med school comes residency where young doctors learn how to actually be doctors. But not all residencies are the same. In general, there are two types of residencies that students can apply for, ‘categorical’ and ‘preliminary’ positions. Categorical spots offer full residency training for their specific field of choice in order to become board certified. Preliminary positions only offer one or two years of training.

Categorical positions are a guaranteed job and it’s what every applicant shoots for. Earning a categorical position means that your application process is over until you apply for jobs or fellowships in order to further specialize after you complete your residency. Each residency training program has different lengths. Internal medicine, family medicine, and pediatrics are three years a piece. General surgery, and otolaryngology are five years. Psychiatry, pathology, and obstetrics and gynecology are all four years.  Technically dermatology, anesthesia, neurology, opthalmology, diagnostic radiology, and radiation oncology are also four years. However, these residencies are actually three years long in their respective specialty after completing a one year preliminary year.

One might apply for a preliminary position for a few reasons. The biggest being that some advanced residencies require a preliminary year, such as those mentioned earlier. For instance, most anesthesia residencies require one preliminary year before a young doctor finishes their final three years of residency specifically training in anesthesia. The other big reason students apply for preliminary positions is as a backup. Prelim positions secure you one year’s worth of paid experience. For instance, a student might apply for both categorical and preliminary positions in their respective specialty depending on the strength of their application. Surgery is a notoriously competitive field so even a strong applicant might go unmatched. Thus, many students apply to both categorical and prelim positions in the hopes that if they don’t match into a categorical position that they will at least have one year to figure out their next move.

But a prelim spot at a program doesn’t secure you a categorical spot next year. Most residencies and programs don’t have second or third year prelim positions and you need a categorical position to finish residency. So if I apply to internal medicine only and receive a prelim spot I would be happy because I have a definite job for one more year but I would still be anxious because my future would not be certain. I would have to go through the match one more time to earn a categorical position somewhere.

If you’re looking for more information on this subject Wash U explains the basics pretty well. So do Doctors in Training (DIT). But my favorite post on this subject is from RK MD- a tech savvy anesthesia resident.

 

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What is ‘The Match’?

Are you in medical school? Sick and tired of explaining the process of step exams, clinical rotations, the interview process, and the dreaded match algorithm to your friends and family? Send them this post before you go home for the holidays and hopefully everyone will have a better idea as to when they can start calling you doctor if they haven’t done so already.

First let me recap the med school timeline for you so we’re all on the same page. The first two years of medical school are the basic sciences. It’s the classic classroom experience where we learn all of the science behind the medicine. This takes roughly two years and culminates with step 1 of the US Medical Licensing Exam (USMLE). Or the COMLEX (Comprehensive Osteopathic Medical Licensing Examination of the United States) level 1 if you are in an osteopathic school.

Now if you have a friend, family member, cousin, or are simply Facebook friends with a med student then you have likely heard of these exams. Or at least heard us complaining about studying for them. So what can possibly make these tests so important that we take months off to study for them? Although stellar board scores alone won’t secure you an interview they can certainly ‘pose a problem when they are significantly below the mean. Board scores have become ‘a threshold that must be achieved in order to receive an invitation for an interview’ (3). It’s a way to weed out thousands of applicants to a smaller pool of hundreds of interviewees to a handful of residents depending on the program and specialty.

Each specialty can be loosely broken down into highly competitive, moderately competitive, and less competitive specialties based on information obtained from previous residents who matched into each one respectively. Highly competitive specialties including dermatology, neuro surgery, orthopedic surgery, plastic surgery, radiology/oncology, radiology, urology, opthalmology, and otolaryngology. Moderately competitive specialties include emergency medicine, OB/GYN, and general surgery. Less competitive specialties include family medicine, internal medicine, neurology, pathology, and psychiatry (3). One of the important pieces of data used to signify each fields competitiveness is the average board score of matched applicants into those respective fields. More competitive fields can use a higher cutoff. So again, a high board score doesn’t guarantee you anything but a low board score can filter you out of the process.

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For instance, The following graph is taken from the 2014 National Resident Match Program (NRMP) data that is available online here.

step 1

This chart “displays the step 1 scores for matched US seniors and independent applicants by specialty. The horizontal bars are median values for successful applicants and the vertical lines show the interquartile ranges (the top and bottom scores of applicants). Scores are generally higher for more competitive specialties, but there is still substantial overlap when specialties are compared” (1). The same thing goes for step 2 scores. You have to do well and, on average, everyone does better on step 2 than step 1. In 2014, the average step 1 score for matched applicants was 230 and the average step 2 score was 243 (1). Here’s the step 2 chart:

step 2 scores

And if you were wondering to yourself, ‘what the hell is an independent applicant’ the answer is anyone who isn’t graduating from a US allopathic medical school. That includes students from Caribbean schools and also American D.O. programs (1)

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Okay, so you finished your first two years of medical school, wrote your step 1 exam, finished your third year of medical school, and wrote your step 2 exam. Now what? At this point you start applying for residencies. A survey performed by the American Medical Association (AMA) of 1,000 fourth year medical students from US allopathic programs from the showed that students applied to an average of 36.4 programs.

apply

This is where the dichotomy between ‘US senior applicants’ and ‘independent applicants’ is really staggering. Caribbean medical students are known to apply to upwards of 100 programs. Personally, I applied to 144 programs for internal medicine. So what’s so important about interviews these interviews? To answer that question we go back to the NRMP match data which shows that the greater the number of interviews you have the greater chance you have to match (and not be unemployed come July 1st).

contiguous rank list

This chart for internal medicine shows an applicants probability of matching based on the number of contiguous ranks. Contiguous ranks means that when it comes time for an applicant to rank programs, that the programs on an applicants match list is in the same specialty. Meaning that programs that you rank one through five are all in internal medicine. Not internal medicine and pediatrics. And in order to get that contiguous rank list you need interviews.

10 interviews seems to be the magic number that most students strive to surpass. What’s the probability of matching if an ‘independent applicant’ like myself gets 12.3 interviews? It’s still above 90% and I’d take those odds any day in Vegas. So 10 interviews seems to be the magic number that most students strive for. That still means that there are students out there who have 10 interviews and don’t match but your likelihood increases with the more interviews that you get.

So how does ‘the match’ work? It’s a complicated computer algorithm similar to what sororities use during rush (you know, minus the computer algorithm). Applicants make a list of the programs they want to go to, each program makes a list of which applicants they want, the information goes into a computer algorithm, and the algorithm spits out the match. Watch this 2-minute video to really understand it:

 

 

So in summary, get good board scores so you aren’t filtered out, score at least 10 interviews, don’t be a weirdo on the interview, and hope that you match. On Monday, March 14th applicants find out IF they matched. This gives unmatched applicants a week to participate in the SOAP (supplemental offer and acceptance program) and attempt to fill unmatched residency spots. Then on Friday, March 18th applicants across the country find out WHERE they matched. Then come July 1st, new interns start nationwide. Happy holidays!July 1st

 

 

1- Charting Outcomes In The Match. Characteristics Of Applicants Who Matched To Their Preferred Specialty In The 2014 Main Residency Match. 5th ed. Washington, DC: NRMP, 2014. Web. 23 Dec. 2015.

2- LWW,. “Going “Fourth” From Medical School: Fourth-Year Medical Stu… : Academic Medicine”. N.p., 2015. Web. 23 Dec. 2015.

3- Katta, Rajani, Samir P Desai, and Samir P Desai. The Successful Match. Houston, Tex.: MD2B, 2009. Print.

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Where in Dominica Should I Live?

A new semester is starting at Ross University and that means a whole lot of first semester students need to find somewhere to live. I’m certain that there are other students out there who will tell you differently but I will share with you my advice on where to live in Dominica.

First off you should know that a family friend of mine told me where I should live first semester and I ended up staying there for all four semesters on the island. I lived at Old Avies Ville because it was cheap and was in a good location. Rent is relatively cheap at around $500/month. Other places can run you close to a grand. I personally didn’t want to waste a lot of money on rent in Dominica because I knew I wanted to come back and waste a lot of money on rent in New York. I will admit though that a few of my friends paid around $800 to $1,000 in rent per month but they got what they paid for. One apartment complex right next to The Barn provides you a Caribbean view and really is a much nicer apartment than I lived in. Other places were much closer to campus and the only gym on the island. Again, I would choose to live somewhere cheaper the first semester and then figure it out once you are actually living on the island for the following semester.

As for location, Old Avies is situated down the road from my favorite grocery store Picard Grocery. There is another grocery store, IGA, that is down the road and is closer to what you might picture when you think of a grocery store but when you have to walk your groceries all the way back to your apartment it only takes one sweaty stroll with heavy grocery bags to appreciate the  convenience of Picard Grocery. As one of my favorite blogs, From Louisiana to Dominica, about life in Dominica explains ‘you will get to know the stores quickly and figure out which places sell which goods’. So in my humble opinion it was nice having Picard Grocery up the road from me.

Besides a grocery store, Old Avies is also down the hill from ‘The Barn’, my favorite study spot. It’s also down the hill from Tomato’s restaurant/bar, Tulip’s bar, and the main campus. All of those locations are within a ten minute walk from Banana Trail where Old Avies is situated. Old Avies Ville also provides cleaning services on Monday, Wednesday, and Friday so I would normally cook my weekly meals on Sunday, Tuesday, and Thursday. Old Avies also has drop off laundry services on the premises, and a small pool that one or two residents would use to swim laps in the morning.

It’s newer cousin, New Avies Ville, is up the hill and is a little bit more expensive. When I visited friends who lived in the New apartment complex I found that it was a little bit prettier and maybe a little bit bigger but not worth the couple hundred dollar price tag increase. So live in Old Avies Ville your first semester and then go see your friends apartments and figure out what your priorities are. Lastly, I never had any trouble with payments or with safety while living there. Just lock your door when you leave your apartment and don’t walk down that sketchy, poorly lit part of town late at night.

Here are some links that might help:

My next post will go over what you should bring in your barrel to the island! Good luck on your upcoming semester and congrats on starting your first semester of medical school!! And as always, happy studying.

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The Day To Day Schedule of a Third Year

An incoming first year medical student asked me, “what is the day to day schedule like in medical school?” To begin with, I want to differentiate the two halves of your medical school education. The first half is spent in the classroom and the second half is spent in clinical rotations. In this post I will be discussing the day to day schedule during your clinical years, specifically your third year (because fourth year is basically like senior year of college).  Now before you scroll down to see the day to day hourly schedule of a third year medical student I have a few caveats about your third year clinical rotations to reveal.

Everyone’s experience is different. 

During the first two years of medical school, regardless of what school you attend, everyone basically learns the same stuff. The information that you are eventually are tested on during your United States Licensing Exams (USMLE) is standardized regardless if you went to an Ivy League school or a Caribbean one like me. So the first two years of didactic lectures are pretty similar in every medical school. This standardized experience of your first two years of medical school is grossly different compared the second half of your schooling. You can be from the same school and be in the same rotation and have completely different experiences during your rotations, and there’s a number of reasons why. You works with different residents, different fellows, and different attending physicians and each one of them will share with you something unique. Not to mention that you end up seeing entirely different pateints. There is simply no way for everyone to have the same experience. Ultimately, although you might have the same schedule as your colleagues, your experience can be considerably different.

Each respective rotation is different

My third year core rotations consisted of the following: 6 weeks of pediatrics, OB/GYN, psychiatry, and family medicine, and 12 weeks of internal medicine and surgery and each rotation’s schedule was completely unique. Just think about how different the day to day life of a surgeon is compared to a psychiatrist. The same is true when it comes to your schedule. More so, each hospital’s respective rotation experience can vary widely between the hours you work, number of patients you see, balance between autonomy and supervision, and how much the residents and attending physicians are willing to teach. So take the following daily schedule with a grain of salt because it is mainly applicable to my internal medicine rotation that I completed in Brooklyn, New York.

Here’s my daily internal medicine schedule

  • 7:00am. Handoff from the night team. Pick up a new patient.
  • 7:00-9:00. See patient(s). Write note. Talk to the cute nurse. Look up how to treat my patient. Talk to my patient’s actual nurse. Present and discuss my patient with my resident. Prepare presentation for rounds.
  • 9:00-10:30. Round with my team. Present my patient. Discuss assessment and plan with the attending. Make updates to my patient’s treatment plan.
  • 10:30-10:35. Find that piece of paper that you wrote everything down on and then subseqently lost.
  • 10:35-10:40. Find your team that you lost while you were trying to find the piece of paper that you just found.
  • 10:40-11:30. Play it cool. They wouldn’t have noticed if you left altogether. Update my patient’s note. Call consults and check if lab-work results are back and interpret them if you can.
  • 11:15-12:00. Lunch. Attempt to resist drinking second cup of coffee.
  • 12:00-1:00. Lecture of some sort.
  • 1:00-1:15. Go get that second cup of coffee. Remind myself to stop trying to stop drinking coffee.
  • 1:15-4:00. Go say hello to my patient. Make sure labwork, radiology, and procedures were ordered. Call people to make sure it gets done. Eventually ask my resident, ‘if there is anything else I can help with’ and hope that they don’t need something faxed. God I hate fax machines. Seriously, why do they still exist?? I think its punishment for all the years of attitude I gave my parents when I wouldn’t help them find the ‘TV/VIDEO button’. Side note, when are TV/VIDEO buttons going to be a thing of the past?
  • 3:00-3:05. Complain about my research project.
  • 3:05-3:30. Work on my research project.
  • 3:30-4:00. Find someone to procrastinate with. Find someone to annoy if they won’t procrastinate with you.
  • 4:00-6:00. UWorld.
  • 6:00-7:30. Home, relax, gym, shower, eat.
  • 7:30-8:30. Review UWorld or watch Kaplan videos (Thank you Conrad Fischer and Online MedEd)
  • 8:30–midnight. Beer, Netflix, Xbox, read something non-medical, and lament over how little I got done today. Repeat tomorrow.