Saturday, April 23, 2016

The Co-Interns!

I had meant to post this photo a very long time ago, but only got the pictures this week. These are all my co pediatric interns at UT-Houston.

Tuesday, March 29, 2016

List of Child Neurology Programs that are Caribbean Friendly

Hey guys! Hope everyone had a very happy Match Day! Congratulations to all who are about to join the ranks. Due to the popularity of my IMG friendly pediatric program list, I decided to add a similar list for child neurology programs.

In general, child neurology is not an intensely competitive field. There are about 70 programs in the country (almost all university based) ranging from 1 to 5 spots available per year, however most programs will only have 1 or 2 openings. Child neuro tends to be field that is very international graduate friendly because it just hasn't garnered enough attention from US students, so if you are a foreign medical graduate (FMG) with strong step scores and good letters of recommendation, you can essentially get an interview at any program in the US.

If you are coming out of the Caribbean however, there is always that issue of stigma. Because so few people from the Caribbean match into child neurology, I could not put as extensive a list together as I hoped, but I can offer the list of places that gave me the opportunity to interview.

Without further ado, these are the programs that gave little old St. Maarten me a shot:

-Tufts Medical Center Program (Boston, MA)
-University of Mississippi Medical Center Program (Jackson, MS)
-St. Louis University School of Medicine Program (St Louis, MO)
-Duke University Hospital Program (Durham, NC)
-Wake Forest University School of Medicine Program (Winston-Salem, NC)
-SUNY Health Science Center at Brooklyn Program (Brooklyn, NY)
-University at Buffalo Program (Buffalo, NY)
-Cleveland Clinic Foundation Program (Cleveland, OH)
-St. Christopher's Hospital for Children Program (Philadelphia, PA)
-Medical University of South Carolina Program (Charleston, SC)
-University of Texas Health Science Center at Houston (Houston, TX) ->MATCHED
-University of Texas at Austin Dell Medical School Program (Austin, TX)
-University of Virginia Program (Charlottesville, VA)

Obviously the above programs are some of the best pediatric programs in the country so your 2 years of general peds training is extremely strong. And what most people don't realize is.... if for some reason you have a change of heart and want to stay general pediatrics, no one is going to force you to finish 5 years of child neuro. You can finish off as a categorical pediatric resident, and coming from the Caribbean and ending up at program like these- I'd say you did very well for yourself.

I ended up ranking 18 programs and UT-Houston was actually third on my rank list. I had a hard time deciding between UT, UVA, Duke, SLU for my top spot and on multiple occasions each had seen #1, but by the time my rank list was due, I had settled for UVA first, Duke second, and UT-Houston third. I could not be happier with the way things turned out.

Sunday, October 18, 2015

The Residency Interview - Some Tips, Questions to Prepare for

Your application is in and now you just wait for the interview requests (and rejections) to roll in. Sometimes you get a wave of interviews right in the beginning, sometimes things stop all together and then there may be another wave later one. It's hard to tell. Everyone, every program, every specialty is different.  But you will get interviews and rejections from the moment you submit your application till the end of January.

Once you get that interview you have to decide how important that program is to you. If you're getting many interviews and have a lot of great options, I would schedule interviews you care less about earlier to use as a practice run. Personally, my first interview was easily my worst interview. I was nervous, I did not have any cases prepared, and I was just unsure of how the day would be. After a couple of interviews, I got the hang of it and I definitely hit my stride. On the other hand, if you get few interviews and every single interview is important and you have to nail it every time, I'd schedule them a little later to allow for more time to practice with friends or family.

The following are the most frequently asked questions I encountered on the interview trail.
Questions to prepare for:
1. Tell me about myself.
2. Tell me about your medical school
3. Why the Caribbean?
4. What are your strengths? Your weaknesses?
5. What do you like to do for fun?
6. What do you anticipate being the hardest part about residency?
7. What are you looking for in a program?
8. Why do you like this program?
10. Tell me about an interesting case you saw.
11. How have you directly impacted the care or management of a patient?
12. Tell me about the research you've done. (If you've done research, know every aspect of it front and back because they will for sure ask you about it)

Interview outfit. Honestly people, it doesn't matter that much as long as it fits you, you're clean/neat, and professional. Ladies, you do not need to wear a suit. I wore a knee length dress and blazer for all my interviews. I had a fitted blue dress I wore with a grey blazer, and a black dress I wore with a brown blazer. I wore pointy toed heels (which I was told was a huge no), but you know what? I got so many compliments on my interview outfit from program directors, fellow interviewees and my interviewers. Do not look slutty under any circumstances. High necklines and knee length skirts and dresses!  Guys, you guys have to wear your suits, I'm sorry. But again, make sure if actually fits you, and it's clean. Blue, black, pinstripes, its all fine. Wear a slightly exciting tie if you want a conversation piece, it's not going to hurt you as long as it's not outrageous. But honestly, people are superficial beings and if you look good, you're already winning points without even opening your mouth.

Always be on time. Always. Over prepare if you have to.

Be nice, courteous, polite to every single person you encounter. Be friendly to the secretaries, the coordinator, the janitors, the kitchen ladies, the other interviewees, the residents etc. Everyone knows each other and one bad word about you from any of them, you bet you will be eliminated from that rank order list. Program directors will often times ask residents, the coordinator, others for feedback about your personality and behavior throughout the day.

If you go to resident dinners the night before, its okay to have a drink. Maybe even a second drink, but nothing more. This goes without saying but don't get drunk. You're there to get a sense of the program and what it would be like to be working/having fun with these folks for the next 3+ years of your life.

Be excited for god's sake. You're interviewing at an awesome program. Be happy! Be curious! Smile. Positive vibes can easily be picked up and people respond favorably.  

Write a thank you card to the program director or send a thank you email. I tried to do this with everyone I met with, but it gets hard. For my child neuro interviews, I'd meet with 8 or so attendings between pediatrics and neuro. Eventually I just started emailing the program director or any interviewers who I had a particularly good connection with. 

If you are worried about the number of interviews you are getting or you haven't heard from a particular program you really like, EMAIL THEM if they have not already rejected you. It cannot hurt you, only help. Email the coordinator or director and ask for an interview because you love that program for X, Y, and Z and think it would be a worthwhile interview for all parties involved. They may kindly decline you, ignore you, or maybe just go ahead and give you that interview. I recommend waiting till about early-December to do this. If you go too late, there may not be any interview days left, but you don't want to ask too early either. Many programs try to offer interviews to people who they want and believe will actually come to their program. Nowadays, it's so easy for applicants to just hit a check box to any program without any real consideration of going there.

That's all I got for now. Good luck everyone! If you're at UT, drop a line.

Benji had some tips he posted last year regarding the interview process, which I agree with--> Check it out here

Sunday, August 30, 2015

The Quick and Dirty Guide to Breastfeeding: What a Resident Should Know

Why encourage breastfeeding?
1. It’s personally cheap, no need to spend all that $$$ on formula
2. Breastfeeding is associated with a lower incidence of obesity.
3. Breast milk confers extra immunologic protection through a variety of immunogenic proteins, immunoglobulins, and oligosaccharides, THUS…
 Breastfeeding has been associated with a decreased risk of otitis media, diarrhea, lower respiratory tract hospitalizations, hospitalizations in general, and deaths, including death from SIDS, which also means…
à It’s cheap for society!!!  Significant public health savings!

What’s in breast milk (and how is it different from cow’s milk formula)?
Colostrum, secreted in the first several days of life is particularly high in secretory IgA.  Transitional (3-4 days of life) and mature (2-4 weeks) human milk, however have higher protein, fat, and lactose content. Mature human milk contains 70% whey protein to 30% casein protein (vs. 18% whey to 82% casein in formula) for easy digestion, 20% non-protein nitrogen including nucleotides (vs. 5% and ZERO nucleotides in formula), and predominately long chain fatty acids including DHA (vs. predominately medium chain fatty acids in formula).  Both have lactose as the major carbohydrate.

How long and how often should infants’ breastfeed?
Most infants feed for 10 to 15 minutes per breast, with some initially feeding up to 30 minutes on each side every 2 to 3 hours.  Be sure to let mom know that she needs to empty one breast before starting on the next because milk closest to the nipple is called FOREMILK and has a higher water and protein content compared to the HINDMILK which has higher caloric and fat content.  Once baby stops feeding, make sure to have mom begin the next feed on the side she ended with (keeps things even)

Signs of successful breastfeeding:
The baby is making swallowing sounds, is satisfied after feeds and is alerting every 2-3 hours to be fed. Infants should regain their birth weight by 2-3 weeks of age and gain 20-35 grams per day thereafter.

If that doesn’t happen, consider…
A poor latch. It will lead to nipple pain, poor transfer of milk, prolonged feeding, and an unsatisfied baby with poor weight gain.  Infrequent bowel movements can be a sign that there is insufficient milk intake.  Discomfort with initial latch is common but pain should not persist through nursing.  If possible, observe the infant nurse while in the office, and check if the areola is in the infant’s mouth. If the latch is observed to be good, then attention should turn to the mother’s milk supply.

And how about that milk supply?
Mother’s should begin breastfeeding ASAP because prolactin levels may diminish after as little as 16-24 hours without nursing after birth. Colostrum, rich in IgA antibodies, is the first fluid produced in lactating mothers and the volume is quite small  (5-15 mL/feed), which encourages frequent feeds and increased milk production. Milk production begins 1-5 days (average 3 days) after birth and production is determined by supply and demand. The more often mom breastfeeds/pumps and empties her supply, the more often milk will be produced.

Who may have difficulty breastfeeding?
 Not women with small breasts, not women with large breast, not even women with fake breasts, but possibly for women with a history of breast reduction depending on whether the main ducts were severed during the procedure, women with flat or inverted nipples, or women with no change in breast size during pregnancy.

What supplements are needed for the newborns who are exclusively breastfed?
1.     Vitamin D! AAP recommends infants take 400 IU daily.
2.     IRON, man: 1mg/kg/day of elemental iron is recommended for exclusively breastfed infants over 4 months of age (those not taking iron containing foods)

Which commonly used antibiotic causes mom to temporarily stop breastfeeding?
Metronidazole. It is an in vitro mutagen and it is recommended mom discontinue breastfeeding for 12-24 hours if a single-dose therapy is given.
To check for other medication interactions with breast milk, please visit LACTMED

How about that alcohol and caffeine?
Breastfeeding mothers aren’t recommended to consume alcohol when breastfeeding but on occasion they may have one alcoholic beverage, but must wait 2 hours before resumption of breastfeeding.  As for coffee, moderate levels of caffeine have not shown to be harmful to nursing infants.

What is the AAP’s recommendation on the minimum duration for exclusive breastfeeding?
The AAP recommends a minimum of 6 months of exclusive breastfeeding.  After that age, infants should be supplemented with complementary foods that are rich in iron and screened for the need for fluoride supplements.

Breast Milk Storage:
Room Temperature – 6-8 hours (3-4 in a warm climate)
Back of the fridge – 5 days
Freezer compartment- 2 weeks
Regular Freezer with its own door- 3-6 months
Deep Freeze – 6-12 months

Wednesday, July 1, 2015

First Day as a Working Doctor

The long white coat
July 1st. The start of a new chapter. The unofficial day that all new interns start working and realizing their dreams as doctors. Also the day we realize how little we know. I'm already a week into work since my program started us on June 24th. It was a nerve-wrecking couple of days just learning the computer system and where everything is and what's expected, but so far so good. Luckily, I'm starting with an elective for chronic care and palliative services at Children's Memorial Hermann Hospital. It still hasn't sunk in that this is real yet. I still feel like a med student.