Tag: Residency

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The Difference Between An Intern and a Senior Resident

At my hospital, we call first year residents ‘interns’ and all of the second and third year residents are the ‘senior residents’. It makes it easier for everyone in the hospital when you introduce yourself as ‘the intern’ or ‘the resident’. It set’s different expectations right from the get go. The biggest difference I’ve noticed between an intern and a resident is the following:

Now take a step back all the way to medical school where you don’t even know what you don’t know. It’s absolutely terrifying. You finish two years of classroom lectures and two years of clinical rotations and are eventually given a degree that essentially says ‘I know enough medical stuff to not kill someone’. And then on day one of residency you’re given 10 patients and realize they didn’t teach you any of this stuff in medical school. And that’s normal and okay. I still barely know what I’m doing everyday (I know, not really what you want to hear from your doctor).

My point that I’m trying to make to any medical student or intern reading this is that residency is terrifying at times and you won’t be okay. For some reason people don’t acknowledge this fact. That you are going to freak out at some point along the way either from anger, anxiety, fear, or all of the above. Just know that it’s going to get better.

I remember my first rapid response. A patient was in new onset atrial fibrillation with rapid ventricular response with a heart rate in the 180’s.  He was hemodynamically unstable with oxygen saturation dropping into the low 80’s in front of my eyes. I arrived to the patient’s room and there’s one nurse getting a new EKG, another two nurses placing a new IV and drawing labs and an arterial blood gas, another nurse helping the respiratory therapist adjust the ventilator settings, as well as the rest of the floor nurses gathered outside the patient’s room to witness what was going on. “Oh good, the resident is here!” one nurse exclaimed. And then all of a sudden everyone turned and looked at me for guidance. Oh, and did I mention that this was the first time I had ever met this patient before? I was just covering overnight.

Thankfully this situation happened later on in the year so I was comfortable handling it. Not to mention I love being the center of attention and hearing the sound of my own voice so I live for these kind of moments. Ultimately the patient did fine and we resolved the underlying issue (mucous plugging caused hypoxia which induced a.fib which caused hypotension and altered mental status so regular deep suctioning would prevent this in the future).

Looking back at that rapid response, I would never have felt ready to handle that type of situation if you asked me during my first few months of residency. Even halfway through intern year I still would not have been nearly as confident in my medical knowledge or even in my ability to handle the stress of the situation. It is normal to be overwhelmed. You are only one month into residency. We don’t expect you to be full fledged attending physicians yet (again, I’m still figuring stuff out on the fly half the time). Just promise yourself to be better tomorrow than you were today. At the end of the day that’s all we can ask for. Micro improvements each and every day.

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What I Keep In My White Coat (mostly snacks and an iPhone charger)

I’ve written a lot about the philosophy behind surviving and thriving in residency. Which is great and all but it doesn’t help you when you forgot to charge your phone last night and you’re already operating at 20% battery. Here’s what I use on a day-to-day basis as an internal medicine resident as well as what I keep in my white coat (or hidden somewhere on the floor) to make my day to day-to-day life easier (and fully charged).

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How To Write Your Residency Personal Statement (And a copy of mine!)

Initially inspired by a blog post from LifeOfAMedStudent.com about how to write your residency personal statement I wanted to share a few tips and tricks on how to write a great personal statement. By no means is the following all inclusive as the complete scope of writing your personal statement is beyond just one blog post. But hopefully any of my followers from medical schools in the Caribbean, United States, or around the world wondering how to write a residency personal statement will have a little bit more guidance. Oh, and also a copy of mine. So here are a few pearls of wisdom about how to write your residency personal statement.

 

Read ‘The Successful Match 2017: Rules for Success in the Residency Match’

I’ve pushed this book before and I’ll do it again now because I truly feel that it was the best book to read when applying for residency with regard to understanding the process. It explicitly spells out objective data about the match based on surveys filled out by program directors. No hearsay. Just facts. It’s a big book but you don’t have to read it from cover to cover in one sitting. Snag a copy and peruse through it when you need it because it helps you during each step of the residency application process, including the personal statement.

 

 

Just stay par

Don’t let your personal statement harm your application. In my opinion, personal statements aren’t going to get you an interview that you wouldn’t have gotten otherwise. However, a really bad personal statement might kill your application like a shot of potassium to the heart. You want your personal statement to keep you par. So don’t use overly eloquent wording or try and reinvent the wheel. Be conservative and try to just hit onto the green. Don’t go for a whole-in-one.

 

 

You are applying for residency- not medical school or a fellowship

When you applied to medical school you were expected to draw on past experiences that made you want to be a doctor. This is not that time. We already know you want to be a doctor. They want to hear why you want to become a specific type of doctor. Write about why you want to go into your specific field. Additionally, don’t get ahead of yourself by writing about fellowship opportunities. Sure, you might only be going into internal medicine so you can become an interventional cardiologist. But you need to sell yourself on why you want this specific specialty right now. Just remember what job you are applying for.

 

 

Know your audience

Are you applying for orthopedics or pediatrics? Because I’m willing to bet that those personal statements are going to be quite different. Not because of the style of the essay but because of what attributes those essays will convey. Surgical residencies generally value ‘compulsive, high energy, confident, hardworking, committed’ applicants while pediatrics value ‘team players, well-organized, well-rounded, flexible, positive attitudes, and flexible’ applicants1. Organize your personal statement to convey attributes attractive to your respective specialty.

 

 

How to design your personal statement

Further detail of how to construct your personal statement is outside the scope of this blog post but let me give you the basic foundation. First you need a backbone. It’s that story you think of when people ask you why you went into medicine and it should be something that happened during your clinical rotations. You know, something you probably made a Facebook status or Instagram post about. Next, you need to think a about which attributes you want to put on display (i.e. what attributes do you have that your future specialty finds attractive). Then tie those attributes back into the backbone of your story to build the rest of your skeleton. Then close it off with a strong summary and don’t be shy to tell them what you want! Here’s an example of a rough outline:

  1. Paragraph 1: I have 3 attributes that make me an ideal candidate for this specialty. For instance, this one time…
  2. Paragraph 2: I demonstrated attribute number 1 when I did this
  3. Paragraph 3: Then I used attribute number 2 when I did that
  4. Paragraph 4: And then I displayed attribute number 3
  5. Paragraph 5: I want this specialty and attributes 1, 2, & 3 make me an ideal candidate for it.

Optional: in your closing paragraph tailor your personal statement to a specific program. I personally didn’t do this…but I also applied to way too many programs. My advise is to do this for one or two programs if you know with 100% certainty where you want to match. It can be exhausting and not worth the effort to do it for every single program.

 

 

Size matters

Make your personal statement one page. It will be visually appealing to the eye and will be short enough to keep the reader’s attention. Don’t forget that the program directors are reading hundreds of personal statements. You don’t want to bore them to death.

 

 

Make them want to meet you

Personal statements are the epitome of the humble-brag. You’re being asked to humbly tell a compelling story that paints you in a positive light. That doesn’t mean your personal statement has to be a bore. You want to make the reader want to meet you. You strike that balance with two main elements- (1) having a unique story and (2) the manner in which you tell it.

For instance, a goal I set in my personal statement was to paint a picture of a patient without sharing the underlying diagnosis. And just like clockwork every program director who brought up my personal statement during my interview asked me the same question, “what was the diagnosis?”.  So write vividly about an impactful experience and make them want to meet you (even if they just want to know if they got the diagnosis correct).

 

 

Lastly, check out a copy of my personal statement from when I applied to internal medicine in 2015:

While screaming incoherently and sprinting off of her boarding flight my patient suddenly collapsed. She was immediately brought to the hospital where I was given the responsibility of her care. I remember her well because her case inspired me to pursue internal medicine as a career. I was intrigued by her unique presentation, motivated to understand the pathophysiology of her illness, and humbled by her family’s fears. My leadership experience and enthusiastic persona helped me overcome challenging scenarios while I provided quality care to my patient. Overall this experience cemented my decision to apply for an internal medicine residency, especially after my first day on her case.

My patient had been suffering from strange psychiatric manifestations, labile blood pressures, and recent-onset echolalia and athetosis. Walking into her room I immediately noticed her multiple family members at her bedside. My previous leadership experience had prepared me for this scenario. I had to communicate complex concepts that I intrinsically understood to individuals who saw it as alien. Although healing my patient’s illness was my paramount priority, I also had to effectively communicate my plan with her and her family in order to make sure that they felt that I heard their concerns and that they were safe in my care. I discussed my assessment and plan with my patient and her family while they peppered me with questions about her case. Their initially palpable anxiety began to abate as I answered each of their questions. It was heartwarming to have a positive impact on this family and showed me the value of possessing effective communication skills in building the patient-doctor relationship.

I left the room and a calm, focused tenacity propelled me to find an underlying cause. It was exciting to explore such a seemingly unrelated constellation of symptoms and it is one of the reasons why I enjoy the prospect of internal medicine. General internists have the opportunity to diagnose and treat patients with illnesses affecting them from head to toe. For my patient, every organ system was a potential culprit and I excitedly dissected each clue to find a potential suspect. Eventually though I found myself scratching the back of my head, staring blankly at the puzzling results of my patient’s lab work and sought help from more experienced minds.

Working with my resident and attending physician we were able to find the epicenter of my patient’s autoimmune battle. I took it upon myself to research the biochemical mechanism of her disease process and was happy to see that even my experienced attending physician was interested in learning about the disease pathophysiology. It showed me that every day in medicine is a school day because there is always something new to be learned no matter how much experience you have. After two months of medical management my patient was stable enough to fly and continue treatment at home. It was awesome to see the impact that treating patients medically can have on their quality of life and I look forward to learning the intricacies of the medical management of chronic illnesses during residency.

Ultimately, this case stroked my interest in internal medicine and illustrates why I will be a unique candidate for an internal medicine residency. My amazement at the body’s innate ability to harm and heal itself fuels my passion for understanding the underlying mechanism of disease and conversely of wellness. I am able to communicate in a clear and concise fashion with laypersons and medical professionals alike. Being a safe physician is a top priority of mine as well. Although I am confident in myself, part of being a safe physician is knowing your limits and asking for help when you need it, both of which are qualities that I possess. In the end, I’ve become cognizant of the fact that that the best way to practice medicine is to care for your patient, both physically and mentally. My unique perspective and skill set leave me with a strong foundation for future growth as a medical professional and I am excited to continue my medical education through an internal medicine residency.

 

 

1- Katta, Rajani, Samir P Desai, and Samir P Desai. The Successful Match. 1st ed. Houston, Tex.: MD2B, 2009. Print.

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Medical Training Doesn’t Get Easier. You Just Get Stronger

I don’t think I’m ready for my second year of residency. As second years we have to cover the PCU (progressive care unit),  a step down unit in between the general medicine floors and the medical ICU (intensive care unit). We have to cover all of the rapid responses, situations in which patients are unstable and look like they are in impending doom, as well as codes for the entire hospital, situations when the patient is literally dead already and we have to work to bring them back. On top of that, our general responsibilities on the medicine floor services go from doing most of the grunt work to leading the decision making and overseeing and teaching our intern and medical students. None of this was in the medical school brochures. But you know what, neither was everything I’ve learned intern year of residency. Or in my third or fourth year of medical school during clinical rotations.

As I’ve progressed through my medical training I’ve found that the written curriculum is just as vast as the hidden curriculum. The learning curve is steep and it’s terrifying. I still encounter situations on the day to day basis that I have never dealt with before. And you know what? I’m still standing and so are my patients.

So to the recent medical school graduates waiting to start residency on July 1st: trust your instincts. It’s going to be difficult and there is nothing you can do to prepare for it. Read up if you want but don’t go nuts preparing for the unknown of residency. Have faith that, at times, you will feel inadequate, anxious, terrified, and not quite ready. Take solace that you are not alone in experiencing those emotions. It is normal and you will be okay.

Because you’re never fully ready for the challenges that lie ahead. You just have to be ready enough.

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When You Should Take USMLE Step 3

I’m about to finish my first year of residency. Although I might not be ready to be a resident I sure as hell am ready to not be an intern anymore. Intern year of residency is exhausting. There’s no way around it. And studying for yet another seemingly pointless USMLE is the last thing anyone wants to do after a long day in the hospital.  Here are some tips to help you figure out when you should take USMLE step 3:

 

Does step 3 even matter?

Yes and no. It truly depends on what you plan on doing with your medical degree. If you don’t plan on specializing it is hard for me to see how your step 3 score will impact your ability to get a job. Especially when you have to pass a board certification exam in your respective field in order to practice.

But if you are looking to pursue a fellowship then you might not want to ‘just pass’. The 2016 NRMP program director (PD) survey asked fellowship PD’s the importance of various factors when looking at applicants. They rated importance of each factor from 1-5 with 5 being very important. Let’s take a look at a graph from the 2016 NRMP PD survey that shows which factors PD’s across every specialty found to be the most important when selecting applicants to interview:

interview 1

And now which factors were most  important in ranking applicants:

ranking 1

Ultimately, step 3 isn’t the most important factor. But it is still a factor. Additionally, each specialty is different. A vascular surgery fellowship program is clearly looking for something different than what a sleep medicine fellowship program is looking for (take a look at the data yourself if you know what fellowship you’re interested in: Results of the 2016 NRMP Program Director Survey). But in general, there are more important things than step 3 when it comes to fellowships. I would err on the side of caution however and make sure it isn’t important. Meaning, don’t score so poorly that they end up looking at your score and make it a big deal. Let it be just another check mark on your application. Something to keep you on par with other applicants.

 

 

What is your specialty?

Generally speaking, USMLE step 3 is skewed in favor of primary care fields like internal medicine and family medicine. The majority of the test is composed of medicine topics. So medicine residents see a lot of what is on the test in everyday practice. This means that medicine residents can probably wait until the end of intern year and study intensely for 2 months or so and take it and pass. Essentially, waiting till the end of intern year won’t hurt you much. However, for anyone going into specialties like pediatrics, psychiatry, OB/GYN, or surgery I suggest you take it as soon as humanly possible. Some of my colleagues from medical school even took it the first month of residency. Their program even gave them a month of ‘research’ to study for it. So for anyone not going into a primary field like internal or family medicine you should, for the most part, take it as soon as possible.

 

 

Should you take step 3 before before residency starts?

Depends on a few factors. First off, can you afford it? Step 3 costs $875. Second, you need to graduate prior to even applying to take USMLE step 3². So unless you graduate early and have a considerable amount of time prior to starting residency I wouldn’t even put the thought in your head. Trust me, during residency the last thing you are going to be thinking is ‘I wish I studied more before residency started’. But what you do prior to starting residency is up to you. So unless you are required to take step 3 prior to starting residency I would hold off on taking it until during residency.

 

 

What does your intern year schedule look like?

For the most part you only need 2 months or so to study for this exam. So find a period in your schedule when you are on a lighter service. For me that was in December right before Christmas when I had a week of clinic followed by a week of vacation and three weeks of elective followed by another week of clinic and a notoriously light general medicine service. So I had ample time to study. Find a time in your schedule that will allow you about two months of time to study.

 

 

How should you study for USMLE step 3?

That’s an entire blog post in and of itself. Keep on the look out and subscribe so you don’t miss it!

 

 

What other questions or concerns do you have about taking USMLE step 3? Comment below!

 

 

 

1-  (2017). Nrmp.org. Retrieved 23 May 2017, from http://www.nrmp.org/wp-content/uploads/2017/02/2016-PD-Survey-Report-SMS.pdf

2- Federation of State Medical Boards. (2017). Fsmb.org. Retrieved 24 May 2017, from http://www.fsmb.org/licensure/usmle-step-3/faq#g1

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Surviving Residency: 5 Tips You Didn’t Know You Already Knew

Residency is hard. Anyone who tells you differently needs a stat GI consult because they’re full of it. You will be tired physically, mentally and emotionally, regardless of what specialty you enter. The rewards of the job are sometimes short-lived and unpredictable, but their depth have the capacity to outweigh the dull and monotonous daily drudgery. One year after the Match, and nearly eight months into residency, here’s my advice to surviving, thriving and enjoying residency.

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Build a positive mindset

The first year of residency and happiness are not always synonymous. In fact, being a happy doctor is sometimes an oxymoron — but it doesn’t have to be. It is entirely too easy to get sucked into the whirlpool of negativity during an average day in the hospital. You can’t control the events that happen around you but you can control how those events impact your mood. Arming yourself with positive mindset isn’t going to make your day any shorter but it might make it more bearable, dare I say even enjoyable.

 

 

Don’t neglect your mental or physical health

Being healthy isn’t one big decision. It’s multiple small choices that you make every single day. Eating healthy and exercising regularly won’t be easy during residency. You’re going to be tired and going to the gym might not sound that enticing, especially in the beginning of residency. You aren’t going to have extra time in your day to exercise or meal prep — you have to make time. So take a dose of your own medicine and make your physical and mental health a priority.

In that same regard, remember that asking for help, whether it is for patient care or for your own mental health, is a sign of strength, not weakness. Mental health issues like depression, anxiety or stress management aren’t things that you can just shrug off or ‘snap out of.’ You wouldn’t ask a cancer patient to ‘toughen up’ or ‘fight through it’ and you shouldn’t accept anything different from psychiatric issues either. Seek out help early and often. It might save your career or your life.

 

 

Maintain your support system

The corniest line of interview season, that your co-residents are the best part of residency, is also the truest. Just like during medical school, nobody else quite gets what you are going through. Your co-residents are with you in the trenches day in and day out. Whether you like it or not, you will spend more time with these people over the next few years than anyone else in your life. Embrace your new adopted family but also don’t forget about the family that helped you get to this point.

Make your friends, family and significant others a priority in your life and set realistic expectations with them. It’s unfair of you to agree to plans you know you can’t keep. Likewise, your loved ones have to understand your time constraints. Your relationships are two-way streets. Don’t let them crumble.

 

 

Just say, “I don’t know”

A mentor of mine once told me that knowing what you don’t know is one of the most valuable characteristics of a good physician. On day one of residency, you will not be expected to know all of the answers. However, you are expected to be able to collect the appropriate information and find someone who can point you in the right direction. So when a patient, nurse, resident or attending asks you a question and you don’t know the answer, simply say ‘I don’t know.’ At the end of the day, everyone around you will be happy to hear you admit that you don’t know something instead of trying to make something up. It shows honesty, integrity, and a capacity to put your ego aside. Remember that the only thing worse than an overconfident resident is a dishonest one.

 

 

Don’t worry, it gets better

The first few months of residency are the worst. Everything is brand new and it’s terrifying. But it gets better. The next few months of residency come around and you realize that it’s actually still pretty terrible. Okay, most of intern year is literally the worst. But it gets better.

You figure out the EMR and stop getting lost in the hospital. You learn to coordinate with the social workers and case managers. You figure out how to diagnose and treat bread and butter illnesses more efficiently. You start to make friends in other specialties. You never stop being tired but you learn to function with less sleep. You calibrate to a new sense of normal and realize that the only thing different from day one of residency is you. Trust that with each passing day you are becoming a better physician.
Ultimately, none of this advice is Earth-shattering or anything you didn’t already know — and that’s exactly the point. You’ve been preparing for this moment for years and there isn’t much else you can do to prepare yourself for the year to come. So if you remember nothing else just remember to trust your instincts, stay hydrated, remember to eat, sleep when you can, and always do what is right for the patient. Now go save some lives, doctor.

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Residency Lifestyle Essentials

During residency time is money and I have neither. These products and services helped me save a little bit of both.  Also I found a new favorite pair of shoes.

 

Subscription Services

Amazon Prime: Try Amazon Prime 30-Day Free Trial

If nothing else, free two day shipping is worth it. Spending the money up front for Prime might even save you money when you consider shipping costs. Or you can try it out for free for one month. Just don’t forget to cancel it if you know you aren’t going to renew it.

 

Or if you’re thinking of ideas for a loved one who is about to start residency consider it as a gift: Shop Amazon – Give the Gift of Amazon Prime

 

Fresh Direct

Groceries delivered to your door. What more can I say? The prices aren’t bad and they deliver the next day at set times that you get to choose from. Sure, I don’t get to peruse the aisles and get things that I don’t need but I also don’t need to put on pants. So it’s a win-win for everybody. Click the link above for $50 off your first two orders. You’ll also hook me up with some free groceries for myself. So sign up with my code so I can eat lunch this week. My parents will appreciate it.

Fresh-Direct

 

 

 

 

 

 

Coffee


 

 

Clothing

Allbirds

For #girlmedtwitter, #gaymedtwitter, and anyone who wants to look like a surgeon. These go great with scrubs while you’re the hospital and can even be routinely thrown in the washing machine once they get dirty. I’ve never advertised for shoes before but these are now the only pair I wear. Did I mention they’re literally the comfiest shoes I’ve ever worn? You won’t be disappointed.

allbirds

 

 

 

 

 

 

 

I’m always looking for new products or services to make my life more convenient. What are your residency or lifestyle essentials?

 

 

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What To Do Before Starting Med School & Residency

What to do before starting medical school is one of the most commonly asked questions I hear from students about to begin their first semester of medical school. It’s the same question that I wrangled with after graduating medical school before starting my internal medicine residency. Here are my top three things to do with your last remaining days of freedom before starting medical school or residency.

 

 

Travel

Before starting residency I explored Thailand for two weeks and my only regret is that I didn’t stay longer. Traveling is a source of sustenance for the soul that can never truly be satiated. Traveling pushes you out of your comfort zone and forces you to grow as a person. You learn a lot about yourself when you remove your familiarities and submerge yourself in another culture and society. Who knows what a few weeks in another country will do for you. Go get lost so you can find yourself.

 

 

Nothing

As a resident we average one day off per week each month. That means we get, at minimum, four days off per month and sometimes that’s exactly what you get. So during residency, when you finally have free time on your hands you are often forced to be productive despite your zeal to just stay in bed and sleep all day. You have groceries to buy, laundry to fold, and an apartment to clean. Not to mention that research project you’re working on because you want to go into a competitive specialty. The work never stops. And after medical school you think your days of studying are over but  step 3 and your specialty specific board exams always loom in the background. So if you want to sit and do nothing before you start medical school or residency then go sit and do nothing. You earned it and you don’t have to explain yourself to anyone.

 

 

Work

Med school is expensive and residency doesn’t pay too well so it certainly won’t hurt if you can muster up some extra cash while you can. I worked as the most overqualified AP bio tutor prior to starting residency. A friend of mine worked at our medical school as a standardized patient. A colleague of mine worked as a scribe in the emergency department. There are opportunities out there if you seek them out. Ultimately everyone’s financial and social situations are unique and you may not have the luxury to choose to work or not, let alone go on a vacation. For instance, the extra money I earned prior to residency helped me pay for my vacation while my friend who was a standardized patient used his money that he earned to pay for step 3 while my colleague used his extra money to pay for his kid’s braces. So work if you can but don’t overdo it. You don’t want to squander these last few weeks of sanity and freedom if you can afford to.

 

 

Take USMLE Step 3

Okay this is residency specific and should only be performed if you have so much extra time on your hands that you can do the aforementioned (1) Travel, (2) Nothing, and (3) Work and then still have more free time before starting residency. I would not advise anyone to take step 3 in lieu of traveling or doing absolutely nothing. Step 3 isn’t a particularly difficult test in my opinion. However, it is difficult to find the time and energy to study for it during residency. So do yourself a favor and if you have the time and money to take step 3 then register for the test, finish UWorld, and take it already (more detailed post on how to prepare for step 3 and when to take it is in the works).

 

 

What did you do the summer before medical school or residency?

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Intern Interview Spotlight Update- The Life of a Pediatrics Intern

Prior to starting intern year I interviewed Zack Manier about the residency application and interview process. Today he is six months into his intern year, the first year of his pediatrics residency at The Children’s Hospital at St. Peter’s University Hospital in New Brunswick, NJ. I sat down with Dr. Manier to find out what it’s like to be a freshly minted medical doctor.

Thanks for taking the time to let me interview you again. I introduced my readers to you a few months ago before we both started residency in an interview about the residency application and interview process. Fast-forward to today and we’re a little more than six months into intern year. What’s it like being a doctor?

Ummmmm…so many feels. Important, accomplished, nerve-wracking, busy, overwhelmed, stimulated, stressed, anxious, lost, rewarding, powerful, prolific…shall I go on?

 

That sounds like the all too familiar. So what’s the most rewarding part of being a pediatrician?

Honestly, the gratitude from the parents. Hearing parents (and even adolescent patients) compliment me or compliment me to an attending saying things like “best doctor we’ve had” (yes, that’s happened…I’m not just bragging) is so amazing. It makes all the times I feel completely stupid and useless worth it. Also, definitely having parents ask to specifically have me as their child’s doctor and come to my Thursday afternoon office hour. Clearly my competence (or confidence) is showing, and that is just as rewarding.

 

 

To contrast that story what has been the most frustrating part of residency?

Continuing to be at the bottom of the totem pole. “Yay, I’m a doctor now and no longer a student! I’ve moved up in the ranks!” Wrong. You’re back on the bottom. You’re just the intern. And yes, interns still do [female dog] work. Definitely not as much as when I was a student, but it happens. Oh, and overnight nursery pages. It’s frustrating, but hey…that’s the way the cookie crumbles, right? Now I want a cookie…

 

 

Ah, answering pages. Grey’s Anatomy made it always seem like every page was life and death. Turns out its more often that the patient is having too few or too many bowel movements. So what about residency do you find most challenging?

Trying to be confident with my decisions and not just looking to my senior for everything I’m unsure of (even though they are the best and are always happy to help). I’m not a student anymore. I’m not supposed to just ask my senior to do everything. I have to do it. It’s on me now. I make the phone calls. I order the medications. I call the attendings in the middle of the night. I tell the parents that Child Protective Services is taking their child away. I decide a baby’s respiratory status is improved enough to discontinue oxygen. And if that baby decompensates? It’s on me now. That’s something that you have to realize from day one…you’re a doctor now. This is the start of the rest of your career.

 

 

Our jobs can indeed be quite humbling and terrifying at times. Can you speak on what your biggest fear going into intern year was? 

 Probably what I just discussed above…that even though, yes, you have your seniors…you have to make your own decisions and become a self-sufficient physician. It was hard a first, but I quickly realized I didn’t have a choice. I couldn’t be passive (not that I am that type of person anyway). You have to. That made that fear dissolve within the first two months.

Also, one fear that I’m sure everyone shares…feeling incompetent. You’re going to enter feeling like you know nothing, especially when you’re put on the spot. I imagine that’s what tabula rasa feels like. But magically, somehow…from somewhere…the answers pop out. Your hand starts writing the corrects words. You’re entering medications like you’ve been doing this for years, and you start to realize you know more than you think. The knowledge is there…you just have to apply it.

Thankfully, my co-interns were/are all in the same boat. Having them around and spending time outside of the hospital with them to talk and vent (and drink) have helped to depress those fears.

 

 

Ah your co-interns. As corny as it sounds, I’ve found that they truly are the best part of any residency program. You spend so much time with them in the hospital that it’s nice to enjoy their company too. Speaking of hours, what are yours like? What’s a typical day for a pediatric intern?

This is obviously institution-dependent, but I guess I’ll give you a little snapshot into mine…

It all depends on the rotation. ER is just 18 shifts/month, and we basically make our own schedule— clutch. Lighter rotations like nursery and neurodevelopment as well as outpatient electives are typical M-F 8-5, with weekend floor calls here and there. Floor sucks. Floor sucks everywhere. Sign-out is at 6:30am, and intern sign-out to the oncoming evening intern is at 7:00pm. Yes, that’s 12+ hours a day, usually 6 days/week. Morning report every morning from 8-9am, noon conferences daily from 12-1pm, grand rounds from 9:30am-10:30am every Thursday, and my office hours (or continuity clinic) Thursday afternoons.

Oh, and nights…nights are great. We specifically do 3 sets of 2 weeks of nights as interns, which are 7pm-9am Sunday-Thursday. Which means weekends off (for the most part). Lovely.

My institution is (amazingly) different in a way…interns get every Friday night off. Every one. For the entire year. All eight of us. Those nights…we drink and complain. I also usually get at least one entire weekend off per month, and use that time to get the hell out of New Brunswick for sanity purposes.

 

 

Speaking of sanity, what do you do outside of the hospital to keep it? 

I guess I covered a lot of that above. But yes…relax, drink, travel…in that order. I need it. We all do. Get close with your interns. Go out when you can. If not to drink then for dinner. Vent. Complain without your seniors around. Even if you think you’re in the most amazing place at the start (which I did), you will start to realize the flaws as you become familiar with the inner-workings and the politics. Every institution has them. And you need close people to talk about it with. That’s what we do. I can’t stress enough how important it is to be close with your co-interns, or as in my case, even your second (and sometimes third) years. Also, I get away when you can. I have friends and family all over, and getting out of the little hospital bubble with all your (likely) hospital friends is necessary to stay sane. Plus, I’m in the cold…I hate the cold. Winter sucks. I go to Miami every chance I get.

 

 

That’s great advice. How about exercising? How often do you find yourself exercising compared to before residency started?

This will be a short one. I don’t. I exercise the same amount as before, because I didn’t. Should I? Definitely. Quite honestly though, my feet hurt (I hate dress shoes). And after the day is over, I want to be horizontal. In my bed. Am I complaining? Yes. Do I plan to change this soon? Yes! You can’t be a doctor (especially a pediatrician) promoting health and wellness when you don’t do it yourself.

 

 

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

This is something I struggle with daily. My family is in one city, my SO is in another, and I’m in a third. So when I get the chance, where do I go? To see my SO. It’s a hard decision, but I’m used to being away from my family…I went to college out of state, medical school internationally, and I haven’t lived at “home” in almost 10 years. It’s difficult being apart from my SO, and we need frequent visits to maintain our relationship, just like all long-distance relationships. Thankfully, we see each other at least monthly (whether I go there or he comes here), and Facetime is a live-saver. Since I moved to NJ in June, I haven’t been back home. My family did come visit for Thanksgiving, and I’m currently writing this on the plane home for Christmas. Holidays and occasions…that’s been pretty typical for seeing my family over the past years.

 

 

How are you handling the debt?

Debt? What’s that? Oh, right…I mean, the cronies automatically take money from my account monthly, and I don’t think about it. And that’s all I have to say about that.

 

 

When do you plan on taking step 3? 

Bleh. Adult medicine. I don’t want to study it. It’s like, I want to take it and get it over with so I never have to study adult medicine again, but at the same time…I don’t want to start studying adults again. But alas, I must. I’m either taking it mid-February or end of April, as those are the times that work with my lighter rotations. I’m getting UWorld for Christmas (yay, adulting), so I’m about to start on that. Mainly, I don’t want to spend the $900 or whatever is it to take the exam. I’d rather spend it on drinks. Medicine is a damn money pit, ya know?

 

 

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

I love it. It’s great. I’ve tutored in the past and was a head anatomy TA in medical school, so it’s something I enjoy. It’s also nice to have attendings tell me that medical students compliment me and enjoy working with me. They don’t think I’m dumb! However, it is sometimes hard to give them full attention as the intern…especially on floor when it’s super busy and I have one million things to do. That’s what the seniors and attendings are for.

Also, pro-tip: get the medical students to follow your patients. That’s what I do. Why? Because on floor rounds, the student presents and gets pimped, not me.

 

 

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

Other than all of the medical knowledge, you mean? I don’t think there is anything that I now wish I had asked…I pretty much knew what I was getting into, and I feel like it’s on par with my expectations. The most important thing is to ask the resident’s if they’re happy. We won’t lie. We really do tell it like it is. And definitely ask how they feel they attendings are and what their relationships are with the attendings. It will make a world of difference. I’m fortunate enough to have amazing attending physicians. It’s something I have been bragging about to all the interviewees this season. Like, you know how in medical school or residency even there are those physicians that people are “scared” to work with or grumble about being placed with? Yeah, we don’t have any. None. I would say 90-95% of ours are absolutely amazing, and the rest are good but ever-so-slightly more intimidating. That might be the best part of my residency. Definitely ask about that.

 

 

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?

My one and only regret is not taking USMLE Step 3 prior to residency. I was going to, but I ended up drinking and traveling instead. (A common thread here, clearly) So, if you have time, seriously consider taking it. It will save you a load of stress and annoyance later, when that is the last thing you have on your mind or want to deal with. Otherwise, just be proactive. Act like a resident on rotations, not a student or a shadow. Ask to do procedures, to see extra patients, to write notes, to have your H&Ps checked and reflected on, to stay later, to make phone calls. These are all things you have to do as a resident, and the sooner you start, the better. These are all things I did, and not only did it get my outstanding grades and letters of recommendation, but it also significantly prepared me for residency. If you have all of these things (mostly) down before starting, you can focus on expanding your knowledge and being the best provider for your patients you can be.

 

 

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

First and foremost, the last line I just said. Be the best provider you can be FOR YOUR PATIENTS. That’s what it’s really about, and why (most) of us all are in this profession. It’s for the patients. Check your egos at the door. This isn’t about you, it’s about them. The rest…the knowledge, the fearlessness, the confidence, the competence…that will come with time. But your patients always come first, no matter what.

 

 

Zack, thank you so much for taking the time to let me interview you. I appreciate your words of wisdom and motivation.

Check back next week for my next intern interview update. And as always subscribe so you don’t miss out!

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The Life of a Pediatrics Intern

I sat down with a first year resident in pediatrics to find out what her life is like as a pediatrician in training. Here’s what she had to say.

 

 

I’m getting flashbacks of interview season but can you tell my readers a little bit about yourself?

Hello readers! I’m Sarah with an h, currently working as a 1st year pediatric resident at Cooper University Hospital in South Jersey. I’m a born and raised Jersey girl from a middle class family right outside of Philadelphia. I grew up playing soccer which I played at Widener University, a small private college in Chester, PA. The only medical blood in my family is my mother who is a NICU nurse. My original major at Widener was nursing, but halfway through my sophomore year I realized there was SO MUCH to learn and I wanted to continue my education past my four undergrad years. I switched to pre-med and it was at that point that my advisor told me about Caribbean medical schools, which accept applicants year round and geared more to the less traditional student like myself. I attended Ross University in Dominica, West Indies where I had the most amazing experiences and made lifelong friends. While I feel I did not get as many residency interviews as I would have liked because I went to a foreign medical school, through hard work, perseverance and constant contact with the programs I was interested in I wound up matching to my top ranked residency at Cooper back home in South Jersey.

 

 

So we’re about a quarter of the way through intern year and you’ve been a doctor for about four months. How’s it feel?

I feel like I’m finally settling into my role as a decision maker. The first couple months it was difficult transitioning from a closely monitored medical student to a doctor being pressed for urgent decisions and orders to be placed. I had to fight the urge to call a senior resident when being faced with medical decisions for several weeks before I felt comfortable in my new role. Even decisions I KNEW were correct, I suddenly became much less sure of when I was the one writing the order or telling the nurse which dose of medication to give. You are immediately thrown into the role as a team leader, which is daunting but extremely rewarding. I’m now at a place where I feel much more comfortable with my knowledge base, but know I have a long road to go.

 

 

What has been the most rewarding part of being a pediatrician?

Hands down seeing my patients’ laugh, smile or feel better. People always ask me what I love about my job, and it’s 100% the kids. The connections I make with children and their families make a 14 hour day all worth it. It can be one thank you, or one hug, or a colored picture and suddenly my hectic day where I haven’t sat down is put into perspective. It is so rewarding to be a part of the connections between the patients, to see the sigh of relief when they realize they’re not alone, and to be a part of an amazing team of medical personnel from social workers to physical therapists to nurses. Sometimes it’s surreal to think about what a critical role you play on that team. I am so grateful for the opportunity I’ve been given to positively impact children and there isn’t a day that goes by, even if it’s just for a brief moment, that I don’t remember that.

 

 

What has been the most frustrating part of residency?

I think a lot of frustration during residency comes from having a life and schedule that is no longer your own. Just know that for however long your residency is, mine being 3 years, you are more or less signing over your freedom. It sounds harsh, but when you look at it that way it makes you appreciate the time you do have off!

I went into residency with that outlook, and I found myself far less frustrated with the long hours.

The thing I would say I struggle with the most is disagreeing on medical care with other residents, more importantly my senior residents. Residency is a hierarchy, post graduate year 1 (PGY-1), PGY-2, PGY-3, and then fellows and then of course your attending. Medicine is also not black and white. Yes we have guidelines and peer reviewed articles, but in all honesty until I became a resident I didn’t realize how much of medicine was up to your own discretion.

Turns out, my treatment plan isn’t always the same as my senior residents. I think it’s important for interns to be prepared for differences of opinion and to know there is no one right answer in medicine. Like a bad USMLE question, it’s your job to choose the MOST correct answer, grapple with the opinions of other people around you, but ultimately do what is best for your patient. This is not as clear cut as you’d think, so pick and choose your battles and surround yourself with a strong support system.

 

 

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

The hours vary depending on what rotation you’re on. There are more intense rotations which require 80+ hours and some less intense rotations where you work 40 hours a week or less. I feel that most programs do a good job of interspersing the two types of rotations so you have some time to breath in the middle of your tougher one.

For me, being on the “floors” or a pediatric hospitalist is the rotation that requires the most time and not only mental but emotional energy. Days start at 6am when you rush to get all of the vitals, history, updates and see all of your patients before rounds. The day ends at 7pm, but you usually have 2-3 hours of notes after that (14-15 hour days if anyone was keeping count). And you also have to remember you’re taking about two to three 12-hour weekend shifts per month.

But keep your head up! I’m in outpatient Behavior and Development now and I’m working a regular 9-5 (and some days less!).

 

 

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

Anything BUT medicine! I love doing guided meditation, which you can find on YouTube. I find the less time I feel like I have, the more that means I need to meditate. I hang out with my friends, I read non-medical books, I go to music shows, I go out to eat, drink and be merry. I travel on my vacation weeks. It’s so important to remember to do the things you love to do. So have a good idea of what makes you happy (outside of medicine) before you start residency and never lose sight of that.

 

 

What has been your most challenging aspect of residency?

Time management has probably been the most difficult for me. Not just in the hospital, but managing being a good resident, friend, sister, aunt and daughter. And going grocery shopping, keeping my apartment clean and bills paid. And on top of that studying enough to keep up with your own specialty, what you’re interested in, and preparing for the USMLE. It always feels like you should be doing more. Deep breaths throughout the day help.

 

 

The average medical school graduate finishes their schooling with roughly $160,000 of debt. How do you plan on paying it off?

The government really helps us out. They have amazing repayment plans you can enroll in now, which you can talk to your loan provider about. I’m currently enrolled in the Public Service Loan Forgiveness plan with an income-driven repayment plan. What that basically means is that if I work for a non-profit hospital and pay 10% of my income for the next 10 years, all of my loans are forgiven. It’s something to think about when ranking residencies, because this plan only applies to non-profit organizations. There are a lot of other plans available so definitely something to talk to your financial aid counselor or loan provider about!

 

 

You grew up playing soccer. In fact, that’s where we met! So you’ve always been an active person  How much are you exercising these days compared to before residency started?

Significantly LESS. Like I say, if exercising is one of your passions, you really have to set aside protected time for it. I try to just work exercise into my daily routine. I set a goal of 15 sets of stairs a day when I’m on floors. 100 squats any time before I take a shower. Stretching anytime you have the space to bend. Drink TOO much water. Take deep breaths throughout the day. Even if you don’t feel like you can be your most fit self, you can always lean in the direction of health.

 

 

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?

Honestly, no. I wish I could have done more elective rotations in the hospitals where I wanted to match, but for insurance reasons Ross University students couldn’t rotate in the states of NJ and PA. But it’s absolutely something you SHOULD do if possible. And if you have the opportunity to rotate in a hospital where you’d like to match, to try to be in the hospital on the floors because some of the subspecialties are pretty far removed from the doctors and residents who make up the bulk of the program.

Take your role seriously, because the type of student you are is the type of doctor you will eventually become. And every skill you’ve learned will help contribute to making you the best doctor you can possibly be, regardless of what rotation you’re on.

But most importantly I enjoyed myself. That’s something I tell all my medical students now, just take time to really enjoy your role and learning experience because it’s a big change once you enter residency.

 

 

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

The biggest fear was that I’d be a bad doctor. I’m sure people want to know more specifics, but really just that I would not be able to help my patients, or know what to do, or what to say, or that I wouldn’t be as good as the other interns. Luckily, these have NOT come to fruition! Turns out, you know a lot more than you think you know. And a lot of what patients’ need to hear is that they’re going to be ok and you’re here for them no matter what. And the other residents aren’t my competition, they’re my biggest allies. I go to work every day knowing that I am here to do the best I can for my patients. With that motivation, a good team, and a lot of hard work, you have all you need to succeed. Never forget WHY you’re doing this.

 

 

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

As an intern, you feel so overwhelmed by your work and getting used to everything yourself, you almost feel like you don’t know enough or have enough time to really make any difference in their education. But I found that just carving out a little time to explain how I’m approaching certain patients or problems, or how I like to write notes can help contribute to how they will eventually practice. And every single one has been SO grateful for the time. If they ask me a question I don’t know, I say let’s look it up together. I try to incorporate them into the team, ask them something I don’t know that they might, or ask them to look certain things up so we can learn together. It’s so rewarding when you see a student you taught succeed on rounds or pick up new interviewing techniques they saw you do.

 

 

When do you plan on taking step 3?

I plan on taking Step 3 mid-April, which is a little more than half way through my intern year. I tried to coordinate taking the test with a month I was on a lighter rotation. I know people who took it before residency started which I commend. I knew I wanted that time to celebrate, travel, and enjoy myself so it was not an option for me. I feel like it takes a good 6 months to settle into your new role as a resident, so I would recommend sometime before or after that period.

 

 

For current medical students, what advice do you have for residency interviews?

Just be personable. I think the questions are just a formality. I really feel interviewers are just trying to see if you can hold a conversation and will fit well with the other residents. I would ask questions about the interviewer, “Where are you from? What do you like to do in the area? What brought you to this place/position?” Start a conversation. Be a real human. Actually get to know the person.

 

 

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

Take DEEP breaths as often as you remember and DRINK plenty of water !!!

 

Thank you so much for taking the time for this interview Sarah!

 

And keep on the look out for a follow up interview with a family medicine resident who failed step one.