Tag: family medicine

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How To Prepare for Intern Year of Residency

One of the most frequently asked questions that I receive from medical students is about how to prepare for their first year of resident. It parallels one of the most common fears among medical students in that they will not be adequately prepared for day one of residency. It’s a valid concern because you will never truly be ready for intern year but if you’ve made it this far in your training then you are likely ready enough. Almost everything you learn intern year isn’t taught in medical school because you have to do actively do it to learn it. At least that’s what I thought until I came across OnlineMedEd.. It’s the only resource I’ve found that actually prepares medical students reasonably well for intern year. Again, nothing is going to make you fully prepared but this is as close as you’re gonna get.

 

I started using OnlineMedEd during third year of medical school

OnlineMedEd is an amazing resource with videos that help explain complicated topics that overlap real world experience with the textbook. They do an amazing job of translating all of that USMLE step 1 material into actual practical knowledge so you can look sharp on all of your third year rotations. I would watch a few before each rotation started and it showed. Dustin and the OnlineMedEd team also drill home all of the important facts that are frequently tested on step 2 CK. Sure, nothing will ever replace UWorld but OnlineMedEd gives it a run for it’s money. Start using OME early and often.

 

A curriculum for fourth year medical students

Your fourth year of medical school is a magical time especially after interview season is over and your rank list is finalized. You’re basically just waiting to graduate and planning your vacation to South East Asia. It is all to easy to fall into a trap of laziness and forget that you are going to be a full fledged doctor in 6 short months (well technically you’ll be an intern but a doctor nonetheless). If you dedicate yourself to the structure of OnlineMedEd during your fourth year you will have a dedicated curriculum that keeps you fresh and sharp on the wards. Sure, you’re still gonna forget a lot before intern year starts but at least OnlineMedEd will get you into some good habits.

 

It prepares you for intern year

My advise to all of my fourth year medical student is always the same- go home because life is too short to be spent in the hospital watching me type notes and at least one of us should see the sun today. I also tell them that the best way to be a good intern is to develop good habits while you are still in medical school. The dirty truth about residency is that you don’t need to be all that intelligent to be a good intern. You simply need to be efficient, thorough, and work hard. The sooner you develop habits that enable you to work smarter, and not harder, the better off you will be. OnlineMedEd has developed a fantastic Intern Boot Camp that helps you do exactly that. If I could do my fourth year all over again I would use the Intern Boot Camp and test out what does and does not work for me while I was still on the wards in the hospital. That way when I show up day one of residency I at least had a system that I knew worked for me. It’s like when I had to learn how to actually study in medical school- I wish I didn’t have to go through the process of figuring out what works best for me. I wish I knew how to study more efficiently back in undergrad. Likewise, take the time to learn the ropes of what it takes to be an intern while you are still a medical student.

 

Start studying for step 3

Ugh I know. Sorry for bringing up the USMLE’s again but you have to get it over with eventually. I’ve written extensively about when you should take USMLE Step 3 as well as how to study for USMLE step 3. If you use OnlineMedEd during your fourth year of medical school you will get a head start on it. You don’t need to use OnlineMedEd as your primary study aid but it will certainly help cement concepts in your head and make it easier for you once you start your dedicated step 3 study period as you transition from medical student to resident.

 

They also have great study products

Last thing I’ll mention are their study aides. The Intern Guide Book and the Quick Tables Book are great study tools for medical students. They succinctly provide you with a ton of well organized material. You have to fill in the blanks and annotate it just like any guide book. But if you are going to use OnlineMedEd then these books are essential as they go hand in hand with some of the videos. Just like any resource, the more you use it the more results you get from it!

 

So if you are interested in using OnlineMedEd check them out here: OnlineMedEd.

 

*Full disclosure: sponsored content. That being said, I only support brands that I believe in.*

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The life of a family medicine intern who failed step one

Thanks for taking the time to let me interview you…again. I introduced my readers to you a few months ago in an interview about the residency application and interview process. Specifically about how it’s still possible to match after failing step one. Fast-forward to today and we’re both about six months into intern year. So what is it like to be an intern?

My pleasure! I’m so glad to share more with your readers. Being an intern is great. It’s not as scary as people make it out to be. I’m learning so much working on different services and with different attendings.

 


 

What has been the most rewarding part of being a family medicine intern?

As cliché as this may sound, the best part is feeling that I’ve helped someone. Knowing that I’ve touched a patient and made their day a little better makes me smile – whether it is addressing depression that has been overlooked and neglected for decades or reassuring an anxious first time mom-to-be that her pregnancy is safe and viable.

 

 

What has been the most frustrating part of residency?

Lack of flexibility with my schedule can get frustrating… More frequent than not, I cannot commit to social events, like dinner with friends on a Friday night or holiday parties. Luckily everyone around me is understanding of my rigid schedule and they’re cool with me scheduling get together on average 3-5 weeks in advance.

 

 

What has been your most challenging aspect of residency?

One of the internal questions I wrestle with daily is “am I good enough?” Am I learning enough? Am I giving my best to my patients? After years of schooling and studying, it’s easy to take time to relax and fall into a lull of complacency. Integrating study time into a full time residency is my challenge.

 

 

What was your biggest fear going into intern year? Have they come to fruition? How have you dealt with those issues?

I think my biggest fear was that I would be a completely incompetent physician and my residency would regret hiring me. I’m glad to say, that hasn’t come up yet. Every new intern comes in with fears, it is normal and to be expected. People are aware that you’re climbing a steep learning curve. Self-reflection was my preferred way to deal with my fears. I even visited a psychologist for a session just to talk out loud about this new chapter in my life (settling in a new place, moving in with my boyfriend, having real responsibilities at work, no longer being a student, “officially” moving from Canada, etc…)

 

 

What are you hours like? What’s a typical day for a family medicine intern?

There are usually two types of “typical” days: at the hospital or at the clinic. Hospital days are almost always longer than clinic days. A day in the hospital can range from 8-13 hours, whereas in the clinic or with private physicians I can clock in 7-10 hours. It’s hard to describe a regular day for me because it varies depending on which rotation I’m on. I could be working a 10h shift in the emergency department, helping manage a service at the Children’s hospital, seeing patients at my clinic, or working on a consult service at my hospital.

 

 

What do you do outside of the hospital to keep your sanity?

When I’m outside of the hospital I try and disconnect. I have always been a big proponent of separating work life and home life. My parents rarely talked about work when they were at home. I intend on following suit. I relish in wandering the aisles of the grocery store, strolling through the mall, calling my friends with no purpose other than to catch up, and planning how I will spend my next vacation.

 

 

How often do you exercise? More or less compared to before residency started?

I’m embarrassed to admit that I exercise MUCH less than before residency. At this point, I barely exercise once a month. Shameful, yes I know. I ended up canceling my gym membership because I simply was not going. I wish I had established a more diligent work out habit before starting residency but now I value sleep more.

 

 

How often are you able to see your family or significant other?

My family lives 9+ hours away so I see them max once a year. I haven’t been great at calling my mom very often but I try and touch base with home once a week or once every other week. My boyfriend and I moved in together before the start of residency. We’ve been good at making a point to have one activity a week – going out to dinner, opening a bottle of wine at home, going for a long walk near the woods. As with any relationship, you have to make it a priority and dedicate time and energy.

 

 

How are you handling the debt?

Money management is always a work in progress. Budgeting and number crunching was essential to me. I found it insightful to hash out on paper how much I got per paycheck then subtracting my fixed and variable expenses. It helped me see where my money was going and I would be more mindful of my spending as to not go into credit card debt.

 

 

When do you plan on taking step 3?

I have my Step 3 scheduled in April 2017. I’m nervous as with any exam but my goal being to pass regardless of the score is somewhat comforting.

 

 

What’s it like having the responsibility of teaching medical students?

I haven’t fully grasped yet this responsibility. I’m trying to keep my own head afloat! Since I don’t feel at this time that my medical knowledge is all that phenomenal, I make a point to teach my students about the art of medicine. I like to show them my approach to difficult subjects, how I weave humor into interviews, and my use of analogies to simplify medicine to patients.

 

 

In retrospect, with the knowledge that you have now, are there any questions you would recommend to medical students to ask during their interviews?

I would encourage medical students to ask programs what kind of support they have in place to help residents through the years. Do they have board review courses? How do they handle resident burn out? What support will they offer if you score below average on the yearly in service exam? While some students may fear that asking these questions show weakness on their part, I think it is important to know what is available to you in your new work place.

 

 

Speaking of medical students, do you strongly feel that there is anything you wish you did differently while you were in medical school that would have better prepared you for residency?

I don’t think there is anything that I would do differently per se. As a student, I took full advantage of the various opportunities offered to enrich my learning by attending conferences, going to drug rep talks, and striking up conversations with other physicians. I would encourage students to do the same. You never know what you will learn and you never know whom you might meet.

 

 

For the current medical students reading this, what general advice do you have regarding residency?

For medical students approaching residency, I urge you to enjoy the process. Although residency and the match are riddled with stress, anxiety, and uncertainty, have faith and trust the process. Everything happens for a reason and you will end up where you are meant to be. I know it is easier said that done to relinquish control but things will happen the way they were intended to. You will get out of residency what you put in. Your attitude and outlook are the biggest factors in your satisfaction with residency.

 

 

 

Thank you so much Emily for taking the time for this interview. I know there are plenty of other students out there who have come short on big exams like the USMLE’s or COMLEX and it’s encouraging to see someone else who still managed to match and continues to succeed in residency.

 

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Spotlight Interview: a family medicine resident who failed step 1

Emily Chan is a Ross University graduate who successfully matched into her top choice residency program. However, it wasn’t an easy route to residency. As a Canadian citizen she could only apply to programs that would sponsor her visa. Oh and she also failed USMLE step 1. Here’s her story.

As a close friend, I know you pretty well. Can you tell my followers a little bit about yourself? Who are you professionally? Who are you outside of the hospital?

I’m from the beautiful area of Niagara Falls, Canada. True to stereotype, I am polite, love maple syrup, and say “eh” often. I received my Bachelor’s in biomedical sciences at the University of Montréal – in French.

Professionally, I am a hard worker and a team player. I show up to the office or the hospital with a smile and do my best. People have described me as a problem solver because I will come up with quick solutions for anything.

Outside of the hospital, I indulge in my hobby of cooking and baking. Nothing makes me happier than sharing good homemade food with friends. I also attempt, with varying degrees of success, to justify my paid gym membership even though I hate working out.

You matched into your top choice family medicine program. That’s an amazing accomplishment. Why did you choose to apply to family medicine?

Thank you! It is the most amazing feeling. I knew since I was 12 years old that I wanted to be a family doc. I’ve always loved talking to people and listening to stories about themselves, their families, and their lives. I believe that every personality fits in a certain branch of medicine. How will you know? Trust me, you’ll just feel it, you’ll know. Family medicine was my perfect fit.

Where are you from originally? Did you want to match in the US or Canada? Did you experience any extra hardships trying to match in American programs as a Canadian?

As a Canadian, I knew the odds were not in my favour across the board. Many factors influenced my choice to not pursue a Canadian residency. Canada made it very difficult for me to apply (poor matching stats, inconvenient availability of mandatory tests, and difficulty to obtain Canadian electives). I felt that if my own country made it so challenging for me to come back, then I wasn’t going to put up a fight. Instead, I concentrated all my energy to match in the US. I am very glad my strategic gamble paid off. Yes, you face discrimination because as a resident you will require a visa. I was ineligible to apply to many programs because they did not want to deal with the headache of visas. Disappointing, sure, but I don’t blame them.

Speaking of hardships, I remember the day that we all received our step one scores. You and I, along with three close friends of ours, were living together in Florida. I remember the moment when you came downstairs from your room and told us what every medical student dreads to even think of. That you failed step one. What happened? Why do you think you failed? Were you doing poorly in school? Did it come as a shock to you?

Oh that dreadful day… It was awful! I was so glad to be surrounded by friends like you when I found out I failed. You all rallied around me in a big group hug and reassured me that everything was going to be ok.

Failing Step 1 was a huge blow and I did not expect it at all. Granted, I’m not the strongest student so by no means did I expect to have a stellar score. I just expected to pass. So when I learned I was a few points shy of passing, I was crushed. I had done fine in school up to that point. I never failed any tests on the island, never repeated a semester, and I even passed the comp on the first try. Everything suggested that I’d be fine.

In hindsight, I realized what I thought was enough preparation for the test ended up being insufficient. To tackle Step 1 a second time around, I had to prepare more than ever before.

What was step 2 CK like for you? What steps did you take to make sure you didn’t make the same mistakes again?

Step 2 CK was definitely better than Step 1. I will say, all the self-doubting and insecurities resurfaced when I was prepping for Step 2. I spent 6 months studying and even delayed my test till October – meaning I applied to match without a CK score. As anyone and everyone will tell you, it’s best to apply to match with a full and complete application but mine lacked the CK. It was a risk I was willing to take. I absolutely could not afford to fail a second USMLE exam. Aside from doubling the time I dedicated to study, I got weekly tutor help to go over questions on UWorld that I got wrong. I also made sure that I took plenty of practice tests.

How many programs did you end up applying to? How many categorical? How many preliminary? How many interviews did you end up going on?

I applied to every single FM program in the US for which I was qualified. All categorical, no prelim. I spent a little over $3,100 on my 140+ applications. In the end, I only had 2 interviews. Yes, you read that right, two interviews. One interview was where I did all my core rotations in 3rd year. I got the other interview because I clicked well with residents from that program while attending the AAFP National Conference. I knew from the get go that on paper I was less than stellar so I worked hard on networking. I attended family medicine residency fairs like it was going out of style. In 12 months, I attended 3 residency conferences.

What was match day like for you?

Every medical student will tell you that match day is a nerve-wracking day, and for me, it was no different. I was hoping to match but I also mentally prepared myself that there was a good chance I would not match. When I learned that I successfully matched, I cried tears of joy and relief. Knowing that I beat the odds was the most incredible feeling. It validated all the people along the way who believed in me and said I would make it. I now had proof that outside people (not just family and friends) believed I was worthy of pursuing this profession.

I know we’ve talked a lot about a major weakness in your application but what do you think were your greatest strengths about your application? What set you apart from the other applicants?

Academia has never been my forte. I knew clinical years were my time to shine. It’s what I do best; it’s where I feel most comfortable. I worked diligently and was rewarded with A’s in all my core and elective rotations, except surgery. I genuinely connected with my attendings and they wrote me beautiful letters of recommendation. My strong LORs were undoubtedly a key component to my match success. I’ve always been a people person so interviews came naturally to me. When applying to medical schools, I had 4 interviews and was accepted to all 4. I knew I had strong interview skills. I harnessed that same energy and left my 2 residency interviews feeling confident.

The fact that you failed step one, the proverbial kiss of death to any applicant’s dream of obtaining a residency, but still managed to match into your top choice family medicine program is quite an accomplishment. In closing, what advice would you give to a medical student who failed or didn’t do well on step one?

I want people reading this to say to themselves, if she can match her top choice in her dream specialty with a 203 Step 1 score, a 215 Step 2 score, and only 2 interviews, I can do it too. One failure does not define you. You will encounter people along the road who will encourage you to quit medicine (one of my Ross professors counseled me to pursue non medical careers) or take time off (I was strongly encouraged to delay my graduation date and my match by a year) or give up all together. Take all that advice as fuel to prove them wrong.

Thank you Emily for bravely sharing your inspirational story. You are proof that it is possible to fail USMLE step 1 and still earn a residency. I’m sure it was an emotionally tumultuous path and taught you a lot about yourself along the way.

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UPDATE: Unfortunately due to the high volume of requests to speak with Dr. Chan I can no longer forward her private email. If you have questions for her please comment below. After sufficient questions have been posted we plan to release an updated blog post with the most frequently asked questions. Thank you for your understanding.

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Now Is The Time To Develop Your Style With Patients

I’m thankful that my first rotation was family medicine out in Youngstown, Ohio. Youngstown is a small town halfway between Cleveland and Pittsburgh. Everything moves a little slower out there compared to what I’m used to in Brooklyn and Manhattan. Similarly, my family medicine rotation as a whole was slower and calmer compared to my other rotations. I didn’t see any emergency conditions or an excessive number of rare pathologies in the doctor’s office I rotated through. I saw routine diseases that affect the majority of Americans- hypertension, diabetes, chronic pain, concerning moles and freckles, so on and so forth.

While I was in the doctor’s office I didn’t necessarily learn about the pathophysiological mechanisms underlying these diseases. That’s not what my physician primarily taught me. I had to dedicate time to study that stuff on my own. Instead, my attending taught me the art of practicing medicine.

What still strikes me today is how well my attending knew his patients. He had entire families coming to see him. We would check grandma’s blood pressure, grandpa’s blood thinners, mom’s thyroid hormone levels, dad’s sugars, and give a vaccine or two to the kids and send them on their way with new scripts and clean bills of health. But he also knew which grocery stores had the cheapest, or sometimes free, medications. With a patriarchal nurturing tone, he would warn his patients not to end up spending too much money at the big chains because they often offered free or bargain-priced medications that a majority of their customers needed as a ploy to get them in the door. He reminded me of my dad telling me to behave before a night out with my friends after an exam.

And the sincerity was a two way street. On many occasions patients would offer my attending help repaving his driveway or moving an old tractor from a ditch with the same nonchalant manner of someone asking to please pass the water from the other side of the dinner table. It was like a tight-knit community out of a corny television commercial. I mean, I had always heard that people are much nicer in the Midwest, or just about anywhere outside of New York for that matter, but are people seriously this nice?

After my six weeks in Ohio came to a close I moved to Brooklyn to complete my third year rotations. I started with psychiatry. My first psych patient came to the office for routine pre-surgical clearance for a gastric sleeve operation. Most patients are required to start a weight loss regimen to help smooth the post-surgical transition and increase the surgery’s success rate. After I finished conducting my portion of the patient’s history, the patient and I joined my attending in his office.

My attending got up from his comfortable reclining padded leather chair that you would expect to find in a psychiatrist’s office and joined us on the other side of his desk. He moved the third empty chair and positioned it to make a small triangle with the patient and me before sitting down. He sat, paused, acknowledged both of us, and asked the patient how she was doing.

Our patient was excited that she was continuing to lose weight and my attending was proud of her too. You could feel that he genuinely cared. It was like they were gym buddies encouraging one another.

The patient was cleared for surgery leaving my attending and I alone for a few fleeting seconds before the next patient was called in. Without looking up from a paper on his desk he remarked, ‘By the way, I liked how you interacted with that patient”. Stunned, I kind of just gazed at him unsure if he was joking in the most extreme of sarcastic ways or if he was actually being serious. Realizing I should probably say something I finally asked him, “What do you mean? I didn’t say anything”. He answered simply, “Yes. But you listened very well”.

His comment made me realize that the warm comradery, earnest candor, and trusting temperament wasn’t unique to Ohio or to family medicine but is intrinsic to all high quality caring physicians. It allowed me to recognize the art of the physician as the exquisite ability to convey trust and compassion not only through what you say but how you say it. By using your eyes, your attitude, and your posture alongside what you actually tell your patient.

That art takes time and practice to perfect. There are physicians who have been practicing medicine for longer than I’ve been alive. Their ability to connect with patients and make them feel comfortable, safe, and heard is engrained in their routines through decades of practice.

As a medical student and future physician, now is the time to develop your personal style of how you interact with your patients. How do you want to be perceived when you walk into your patient’s room? How do you want to make your patients and their families feel when you discuss their health or treatment options? As a physician, how do you want to be remembered? These are questions that only you can answer but you can start figuring that out now. Actively observe how your attendings, residents, and even your peers interact with their patients. Mimic what you like. Avoid what you don’t.

Ultimately, how you interact with your patients is part of your style. It’s a reflection of your attitude and personality. It has the ability to affect the people around you, including your patients, and can be greatly beneficial, or conversely detrimental, to your career. So start developing that style now. And whatever you do, do it with confidence.