So interview season is about to be in full swing. I sent out my application via the Electronic Residency Application Services (ERAS) on September 15th, all my letters of recommendation are in, my Step 2 CK arrived last Wednesday (passed with a solid 226), and my MSPE letter is about to be released on October 1st. I'm going to devote a lot more posts over the next several weeks on tips for the application process, personal statement, and letters of rec that should be beneficial to all students applying next year, because apparently I'm doing something right. In 2 weeks I've already received 8 interview requests!
As Caribbean students, we are told that we are doing well with interviews if we get a request for every 10 rejections... those are disconcerting stats. And we are also told that if we can get 10 interview requests, we should match somewhere! Seeing that October is the big month for receiving interview requests/rejections, we'll see how things shake out the next couple weeks. I will be sure to keep you updated xx
Monday, September 29, 2014
Wednesday, June 25, 2014
Oh, by the way, I'm in ENGLAND!
 |
| First weekend at the Epsom Derby |
I've never met nicer, more polite, unpretentious people and they're surgeons!
Step 2 CS- How to Pass and What to Expect
I took my exam back on March 24th. I refrained from writing a post about this only because I was terrified I had failed and didn't want to lead you astray with some tips/tricks/ me basically telling you to cool your jets when in fact I failed myself. But today is not that day. No. Ladies and gentleman, today is the day I tell you all that I PASSED. And it literally took three months and one day to get my score back.
--So the story with CS is this:
When you feel so emboldened, go on the ECFMG website and access your OASIS and fill out/ pay for the damn test. You drop $1480 (subject to increase) and get a 1 year window to take it. A week or two later, you get an email with your scheduling permit.
Next step is picking the testing site and date you wish to take CS. There are 5 testing sites in the country: Philly, Chicago, Houston, Atlanta, Los Angelas. Many of my peers told me Philly was the "hardest" site, that people were difficult, impolite, and I should take it in Atlanta since it's "easiest". Well, I didn't listen and decided to take it in Philly since I was only living in New York at the time. It was a quick 2 hour drive from the city and I stayed overnight at the Sofitel Philadelphia which is a 12 minute drive from the center. The hotel gave me a complimentary car/driver to take me to my exam in the morning, which was very nice of them. For lodgings walking distance from the test, a lot of people stay in the Sheraton University City Hotel. But honestly, the prices between the two hotels was $30 at the time and the Sofitel is right in downtown Philly spitting distance from fun restaurants/bars/shopping/theaters/pretty buildings, and I slept in what was in the top 3 beds I've ever slept in. Seriously, if you are taking the exam with a friend or two and don't mind paying at extra $15 for a better hotel/location/times, then I can't recommend the Sofitel enough.
For other hotels walking distance and travel info check out what the USMLE people have to say, just over --> here.
--What to do for preparation?
Buy a book. Either get the First Aid for the USMLE Step 2 CS or the Kaplan USMLE Step 2 CS Core Cases. I chose the latter for no particular reason and I think it was fine overall for my prep. Read the book, cover to cover at least once. Practice cases with a partner should you wish to do so. I did not find this necessary, so I didn't practice with anyone. And I literally read the Kaplan book once. I read it the last 4 days before I took my exam. I don't recommend this. I was petrified I didn't know anything. To feel somewhat good about going into the test definitely read the book a couple times, and practice cases with a friend.
OR
If you are coming off an ER rotation where you were taking tons of histories/physicals and doing notes every 15 minutes, this is the greatest form of prep anyone could hope for. I had just finished two weeks in the Peds ER a couple weeks prior to the exam and just knowing how to ask all the relevant questions and doing the focused physicals in the space of a few minutes was gold. I didn't plan it this way, I just got lucky without even realizing when I scheduled my CS. You do the same exact thing in the actual test. So regardless of where you are in your rotations, if you've done/just finishing ER, just take the test.
--What to do the day before the test?
GRAB YOUR STETHOSCOPE, WHITE COAT, SCHEDULING PERMIT, CONFIRMATION NOTICE, and ID before setting out. Then drive/fly/take the train at a reasonably early hour and enjoy the day in whatever city you chose to go to. I drove down to Philly from New York on an early Sunday morning and arrived to the hotel by 10:30 am. I went alone, which was oddly exciting for me. My room wasn't ready yet so I spent a couple hours checking out the sites/shops. I grabbed lunch and a couple beers at the Nodding Head Brewery and Bar. All the taps are beers they brew there and I was pleasantly surprised by the selection. After that, I admit I was a bit buzzed and went to my hotel room and had a nap in the greatest bed known to man. I woke up and finished reading the cases in my Kaplan book for the first time (again, don't do that! Do as I say, not as I do). Once that was done I ordered room service, watched a movie, and called it a night.
--What happens test day? (This is the Philly experience)
BRING YOUR STETHOSCOPE, WHITE COAT, SCHEDULING PERMIT, CONFIRMATION NOTICE, and ID. Show time starts at 8 am so I suggest getting there a half hour or 15 minutes before. You check in with a nice lady in the front desk and then you are assigned a number. You walk into a square room lined with chairs with numbers on them and you just go and sit at whatever number you were assigned. People are in the other chairs and everyone is sort of staring at the ground or at the walls, trying very hard not to make eye contact with anyone. It's awkward. It's okay. These people will become your friends.
Your name will get called and they give you two number paper things to pin to your white coat. After everyone's pinned, you go to another room to store all your belongings and you watch a quick video on how the day will go. You learn all the rules, what to do, what not to do, they give you time to check out the table and other equipment that's put in each room. There's no need to bring food because lunch and snacks are provided.
You are given a clipboard, 12 sheets of paper (one sheet for each case) and a pen and then everyone lines up to go out into the hallway with all the mystery doors. There are 6 doors on each side of the hall, and every door has a corresponding desk next to it with a computer to write your notes. There's a sliding panel on every door with the name, age, chief complaint, and vitals of the patient you're about to see. When the proctor calls time, you are allowed to open the panel and read all the information. Jot it down on your paper and once you're ready you FIRST KNOCK and then enter the room and say Hello Mr/Mrs so and so and introduce yourself as Dr. (ENTER NAME HERE). You know how the rest goes. You get strictly 15 minutes to take the history, do the physical, and to counsel the patient and tell them what you are thinking/what tests you will be ordering for them. Once you leave the room, you get any left over time from the interview plus the additional 10 minutes to write your note. The note includes the HPI, physical, differential diagnoses, supporting findings for that diagnosis, and labs/tests you want to order. If you guys want to know what the note looks like, USMLE was kind enough to offer a practice note here.
You will do 5 cases in a row, then break for lunch. Do 4 more cases, then break for a snack. And end with the last 3 cases and you're free to go! People normally get out around 4 pm.
How is it scored?
CS is Pass/Fail only. There are no numerical scores. It's broken down into Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP). If you fail any one of these sections, you fail the exam. If you do really well in one area, it does not make up for doing poorly in another.
If you are a native English speaker you obviously pass the SEP portion of the exam. To do well in the CIS section, you just need to be friendly. Be kind, be professional, SMILE (if its the proper situation), if a patient is in obvious distress, offer and do anything that will make them a little more comfortable whether it be shutting off a light in migraine cases, or letting someone lie down who is in pain. BE GENTLE when you do the physical exam. Deep palpation of the abdomen on a fake patient is not necessary and actually quite mean. If you can manage to be a decent, sociable human being you should also pass this section of the test which I believe is weighed most heavily. It is the patient him/herself who grades you on this portion. Lastly, for ICE, a physician will look over your note and decide how your gathering of information/physical led you to the 3 or so diagnoses you list. If the thought process seems reasonable and if you are fluent in your note, this should also be easy enough to pass. You don't necessarily have to get the diagnosis correct. I think there were about 4 cases I missed and one case in particular where I had absolutely no idea of the diagnosis. I don't think this portion is as important though because I know of students who wouldn't even get to the diagnoses or the tests ordered in a couple of their cases because they spent so much time on the HPI. And guess what? They still passed.
--My thoughts on the experience overall
I was scared before, I was scared during, I was petrified afterwards. I swore I failed. Opening my email today and seeing "your score report is available" made me want to die (dramatic, I know). You can't imagine the wave of relief the swept over me when I saw that sacred word: PASS.
I'm not sure what it is about this exam, but everyone I have spoken to doesn't feel great afterwards. Yeah, it's nice to be done and that part of your studying is over with, but everyone knows that they forget something in in each of their cases. People wouldn't do a certain maneuver for the physical. They would forget to ask a certain question. They didn't have enough time to complete the note. As I said earlier, there were a few patients where I wasn't sure what they had! And to top it off, I consistently was the first person done in each of my interviews. The other students would spend the full 15 minutes with each patient and for whatever reason I'd get everything done in 10-12 minutes and be the first one back out in the mysterious hallway of closed doors. I'd smile sheepishly at the proctor, that sort of like "yea, I'm done wayyyyy too early... AGAIN" and sit down to write my note. I had no trouble finishing my notes because of all the extra time I had, but I had this unsettling feeling that I didn't talk/counsel enough to my patients.
For Philly in general, I thought the center was great. I thought all the proctors and people who worked there were lovely. Very friendly, approachable, eager to help out. I felt like the patients were quite nice as well. I'm not sure why people say it's the hardest of the test centers, but I really did have a good experience there. Flying out to another site if you're in NYC isn't worth it.
--Tips
1. Don't forget to wash your hands every time. And as you're doing it, why not look over your shoulder a bit and have a little non-medical banter with the patient. That ish builds rapport.
2. If someone is thirsty, in pain, hating the light, do whatever is easy to make them more comfortable. Offer water. Offer them to lie down or stay standing. Offer to shut the light off. Offer them the world.
3. When doing the physical don't be overly concerned if you're listening in the right location, if you really see anything in the ear, or actually feel a dorsalis pedis pulse. Do the motions. Try your best of course, but just do the motions. These are all healthy people. You're not finding anything on them anyway. The only thing on the physical that patients can fake is pain/tenderness. Just go with it.
4. Counsel them on anything really. Everyone's got some bad habit. If your patient smokes, ask them if they have thought about quitting. If they drink more than 2 drinks a day, CAGE them. If they don't exercise, tell them to. If the patient is actually overweight in real life (as awkward as it is), tell them about living and eating healthier. When you are counseling, please be as polite and conscious of their feelings as possible.
5. At the end when you tell the patient what you think they have, it's okay to be unsure about it. Doctors aren't 100% perfect in real life. Say it could be a number of things (you are free to tell them your differential), but saying that you want to run tests, do imaging before making a definitive diagnosis is fine! Say it, be honest.
6. Be prepared to wait a lifetime for your score. They say it takes about 2 months, but it took 3 months for me. There are window periods of when you take the exam and a window of when you should be getting scores. Score reporting for 2014 can be found here.
--So the story with CS is this:
When you feel so emboldened, go on the ECFMG website and access your OASIS and fill out/ pay for the damn test. You drop $1480 (subject to increase) and get a 1 year window to take it. A week or two later, you get an email with your scheduling permit.
Next step is picking the testing site and date you wish to take CS. There are 5 testing sites in the country: Philly, Chicago, Houston, Atlanta, Los Angelas. Many of my peers told me Philly was the "hardest" site, that people were difficult, impolite, and I should take it in Atlanta since it's "easiest". Well, I didn't listen and decided to take it in Philly since I was only living in New York at the time. It was a quick 2 hour drive from the city and I stayed overnight at the Sofitel Philadelphia which is a 12 minute drive from the center. The hotel gave me a complimentary car/driver to take me to my exam in the morning, which was very nice of them. For lodgings walking distance from the test, a lot of people stay in the Sheraton University City Hotel. But honestly, the prices between the two hotels was $30 at the time and the Sofitel is right in downtown Philly spitting distance from fun restaurants/bars/shopping/theaters/pretty buildings, and I slept in what was in the top 3 beds I've ever slept in. Seriously, if you are taking the exam with a friend or two and don't mind paying at extra $15 for a better hotel/location/times, then I can't recommend the Sofitel enough.
For other hotels walking distance and travel info check out what the USMLE people have to say, just over --> here.
--What to do for preparation?
Buy a book. Either get the First Aid for the USMLE Step 2 CS or the Kaplan USMLE Step 2 CS Core Cases. I chose the latter for no particular reason and I think it was fine overall for my prep. Read the book, cover to cover at least once. Practice cases with a partner should you wish to do so. I did not find this necessary, so I didn't practice with anyone. And I literally read the Kaplan book once. I read it the last 4 days before I took my exam. I don't recommend this. I was petrified I didn't know anything. To feel somewhat good about going into the test definitely read the book a couple times, and practice cases with a friend.
OR
If you are coming off an ER rotation where you were taking tons of histories/physicals and doing notes every 15 minutes, this is the greatest form of prep anyone could hope for. I had just finished two weeks in the Peds ER a couple weeks prior to the exam and just knowing how to ask all the relevant questions and doing the focused physicals in the space of a few minutes was gold. I didn't plan it this way, I just got lucky without even realizing when I scheduled my CS. You do the same exact thing in the actual test. So regardless of where you are in your rotations, if you've done/just finishing ER, just take the test.
--What to do the day before the test?
GRAB YOUR STETHOSCOPE, WHITE COAT, SCHEDULING PERMIT, CONFIRMATION NOTICE, and ID before setting out. Then drive/fly/take the train at a reasonably early hour and enjoy the day in whatever city you chose to go to. I drove down to Philly from New York on an early Sunday morning and arrived to the hotel by 10:30 am. I went alone, which was oddly exciting for me. My room wasn't ready yet so I spent a couple hours checking out the sites/shops. I grabbed lunch and a couple beers at the Nodding Head Brewery and Bar. All the taps are beers they brew there and I was pleasantly surprised by the selection. After that, I admit I was a bit buzzed and went to my hotel room and had a nap in the greatest bed known to man. I woke up and finished reading the cases in my Kaplan book for the first time (again, don't do that! Do as I say, not as I do). Once that was done I ordered room service, watched a movie, and called it a night.
--What happens test day? (This is the Philly experience)
BRING YOUR STETHOSCOPE, WHITE COAT, SCHEDULING PERMIT, CONFIRMATION NOTICE, and ID. Show time starts at 8 am so I suggest getting there a half hour or 15 minutes before. You check in with a nice lady in the front desk and then you are assigned a number. You walk into a square room lined with chairs with numbers on them and you just go and sit at whatever number you were assigned. People are in the other chairs and everyone is sort of staring at the ground or at the walls, trying very hard not to make eye contact with anyone. It's awkward. It's okay. These people will become your friends.
Your name will get called and they give you two number paper things to pin to your white coat. After everyone's pinned, you go to another room to store all your belongings and you watch a quick video on how the day will go. You learn all the rules, what to do, what not to do, they give you time to check out the table and other equipment that's put in each room. There's no need to bring food because lunch and snacks are provided.
You are given a clipboard, 12 sheets of paper (one sheet for each case) and a pen and then everyone lines up to go out into the hallway with all the mystery doors. There are 6 doors on each side of the hall, and every door has a corresponding desk next to it with a computer to write your notes. There's a sliding panel on every door with the name, age, chief complaint, and vitals of the patient you're about to see. When the proctor calls time, you are allowed to open the panel and read all the information. Jot it down on your paper and once you're ready you FIRST KNOCK and then enter the room and say Hello Mr/Mrs so and so and introduce yourself as Dr. (ENTER NAME HERE). You know how the rest goes. You get strictly 15 minutes to take the history, do the physical, and to counsel the patient and tell them what you are thinking/what tests you will be ordering for them. Once you leave the room, you get any left over time from the interview plus the additional 10 minutes to write your note. The note includes the HPI, physical, differential diagnoses, supporting findings for that diagnosis, and labs/tests you want to order. If you guys want to know what the note looks like, USMLE was kind enough to offer a practice note here.
You will do 5 cases in a row, then break for lunch. Do 4 more cases, then break for a snack. And end with the last 3 cases and you're free to go! People normally get out around 4 pm.
How is it scored?
CS is Pass/Fail only. There are no numerical scores. It's broken down into Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP). If you fail any one of these sections, you fail the exam. If you do really well in one area, it does not make up for doing poorly in another.
If you are a native English speaker you obviously pass the SEP portion of the exam. To do well in the CIS section, you just need to be friendly. Be kind, be professional, SMILE (if its the proper situation), if a patient is in obvious distress, offer and do anything that will make them a little more comfortable whether it be shutting off a light in migraine cases, or letting someone lie down who is in pain. BE GENTLE when you do the physical exam. Deep palpation of the abdomen on a fake patient is not necessary and actually quite mean. If you can manage to be a decent, sociable human being you should also pass this section of the test which I believe is weighed most heavily. It is the patient him/herself who grades you on this portion. Lastly, for ICE, a physician will look over your note and decide how your gathering of information/physical led you to the 3 or so diagnoses you list. If the thought process seems reasonable and if you are fluent in your note, this should also be easy enough to pass. You don't necessarily have to get the diagnosis correct. I think there were about 4 cases I missed and one case in particular where I had absolutely no idea of the diagnosis. I don't think this portion is as important though because I know of students who wouldn't even get to the diagnoses or the tests ordered in a couple of their cases because they spent so much time on the HPI. And guess what? They still passed.
--My thoughts on the experience overall
I was scared before, I was scared during, I was petrified afterwards. I swore I failed. Opening my email today and seeing "your score report is available" made me want to die (dramatic, I know). You can't imagine the wave of relief the swept over me when I saw that sacred word: PASS.
I'm not sure what it is about this exam, but everyone I have spoken to doesn't feel great afterwards. Yeah, it's nice to be done and that part of your studying is over with, but everyone knows that they forget something in in each of their cases. People wouldn't do a certain maneuver for the physical. They would forget to ask a certain question. They didn't have enough time to complete the note. As I said earlier, there were a few patients where I wasn't sure what they had! And to top it off, I consistently was the first person done in each of my interviews. The other students would spend the full 15 minutes with each patient and for whatever reason I'd get everything done in 10-12 minutes and be the first one back out in the mysterious hallway of closed doors. I'd smile sheepishly at the proctor, that sort of like "yea, I'm done wayyyyy too early... AGAIN" and sit down to write my note. I had no trouble finishing my notes because of all the extra time I had, but I had this unsettling feeling that I didn't talk/counsel enough to my patients.
For Philly in general, I thought the center was great. I thought all the proctors and people who worked there were lovely. Very friendly, approachable, eager to help out. I felt like the patients were quite nice as well. I'm not sure why people say it's the hardest of the test centers, but I really did have a good experience there. Flying out to another site if you're in NYC isn't worth it.
--Tips
1. Don't forget to wash your hands every time. And as you're doing it, why not look over your shoulder a bit and have a little non-medical banter with the patient. That ish builds rapport.
2. If someone is thirsty, in pain, hating the light, do whatever is easy to make them more comfortable. Offer water. Offer them to lie down or stay standing. Offer to shut the light off. Offer them the world.
3. When doing the physical don't be overly concerned if you're listening in the right location, if you really see anything in the ear, or actually feel a dorsalis pedis pulse. Do the motions. Try your best of course, but just do the motions. These are all healthy people. You're not finding anything on them anyway. The only thing on the physical that patients can fake is pain/tenderness. Just go with it.
4. Counsel them on anything really. Everyone's got some bad habit. If your patient smokes, ask them if they have thought about quitting. If they drink more than 2 drinks a day, CAGE them. If they don't exercise, tell them to. If the patient is actually overweight in real life (as awkward as it is), tell them about living and eating healthier. When you are counseling, please be as polite and conscious of their feelings as possible.
5. At the end when you tell the patient what you think they have, it's okay to be unsure about it. Doctors aren't 100% perfect in real life. Say it could be a number of things (you are free to tell them your differential), but saying that you want to run tests, do imaging before making a definitive diagnosis is fine! Say it, be honest.
6. Be prepared to wait a lifetime for your score. They say it takes about 2 months, but it took 3 months for me. There are window periods of when you take the exam and a window of when you should be getting scores. Score reporting for 2014 can be found here.
Thursday, March 20, 2014
Study Aid for Shelf Exams and CK
For those of you studying for any of your shelf exams (minus OBGYN) or for the CK, these lectures and powerpoints are a great high yield tool from San Antonio School of Medicine. I feel like it's a perfect run through everything. It should benefit you most once you already have a good grasp of the foundations.
--> http://som.uthscsa.edu/StudentAffairs/thirdyear.asp
--> http://som.uthscsa.edu/StudentAffairs/thirdyear.asp
Wednesday, March 19, 2014
Pediatrics at Bronx-Lebanon Hospital
My fourth and last core in New York City. After 15 months of living in the city, I'll be moving out in a week.
I've been absolutely abysmal at keeping this blog updated throughout the year and I'm sure there are plenty of questions people have about clinical life post-island and for whatever reason, I still hold out hope that I'll actually produce some answers for you all sometime soon. It will be more like a generalized comparison between clinicals and basic sciences, but I think that's better than nothing. I remember being on the island and being utterly oblivious about the situation. It's not like you talked to anyone on rotations really... once people leave St. Maarten, they might as well be dead because you never hear from them again (only half-true).
Ah, but alas, still saving that discussion for a rainy day. Today we talk peds.
Pediatrics. Pediatrics. What can I say about pediatrics in the Bronx? Lots of asthma. A whole hell of a lot of asthma. A good amount of Sickle cell in there too, but man tons of asthma.
This has definitely been my strictest rotation, scheduling-wise. Getting through and understanding the service your on, the lectures you have, and the hours for an after school program (just implemented) that you must attend made me bleary-eyed. The rotation is 6 weeks total, in which you spend 2 weeks on the floor for inpatient (1 week days, 1 week nights), 2 weeks in the pediatrics ER (1 week days, 1 week nights), 1 week in a general pediatrics outpatient clinic, and 1 week at the pediatric subspecialties outpatient clinic at POE. You have three days in the nursery and 1 day in the PICU somewhere sprinkled in all that.
You will have morning lectures at 8 am pretty much every day (Tuesdays are ground rounds) and sometimes they even schedule afternoon lectures around 3 pm. And then on select days of the week, you will have to leave which ever service you are on at 2:45 to go help out at an after school program in one of the neighboring schools and you stay there till 5 pm. And I believe that's about it for the schedule.
As luck would have it, I started my first two weeks in the outpatient clinics. Because my first week was essentially orientations and snowstorms I only spent one day in the subspecialty clinic. This made me a little sad because you go to POE (only 3 stops away from BLeb) and you can follow which ever attending you like in the specialty that interests you. I could have gone to peds cardio, immunology, heme, pulm, etc. etc, but I figured why not go to peds neuro since that is what I'm seriously considering for my career. It was an interesting day complete with children with seizure disorders, autism, and abnormal brains, and the attending Dr. S enjoys teaching, so which ever questions I had for him, he was happy to oblige me.
Week 2 was my triumphant return to the Tiffany Clinic. If you remember, I did my 3 weeks of outpatient for Family Medicine there and had a wonderful experience. Turns out that little blog post I wrote a few months back caught the notice of the family medicine department at Bronx Leb. Seems like the resident(s)/attending(s) weren't too happy with what I had to say about my inpatient experience and have subsequently complained about me? I don't know. Apparently a student brought the post to their attention for whatever reason. I realize I write openly and freely on the internet with my name attached. I want to be honest about my experiences, and I try to be respectful while I relay them, but hey if you rather make me hold a phone for you instead of doing something useful with my time, I'm going to have something to say about that. ANYWAY, all the lovely ladies at Tiffany enjoyed my blog post about the place haha. The nurses, secretaries, office managers, are wonderful there. They are definitely a fun, warm, friendly group of people who know how to make people comfortable. Incidentally, I had my 27th birthday on my last day there and they bought me balloons and card. I had made a tres leches cake so we pretty much had a party.
The pediatrics attending there, Dr. M, is great. I've never seen someone so happy and excited about every single baby, toddler, and child she saw. Honestly, it's infectious. I couldn't help but smile and laugh whenever I saw her examine a baby and if you work with her you will know exactly what I mean. As a medical student working with her, she will allow you to see, speak, and examine the patient yourself first. Once you're done, you go to her and present the patient as you would with any attending and then you discuss what he/she may have and what you want to do for the patient. Then you both see the patient together and she ultimately ends up writing the note. It had been a few months since I last presented a patient so I was pretty rusty during my week with her, but I appreciated the freedom she gave me.
Weeks 3 and 4 were spent in the ER. Easily the two busiest weeks of the entire rotation because you are seeing a never ending stream of patients from the moment you walk in. When you are on the week of nights things do tend to quiet down by 1-2 am but you can have a few stragglers stream in every other hour or so. On days... its crazy. Madness. Depending on which attending you are working with they will ask which patient you want to see, then you call them through the loud speaker, bring them to an examination room where you do a history and physical. Once that's done you present to your attending and then you see the patient together and formulate a plan. You write the note and then you call the next one. Of all the rotations I've done, this is the first time I felt like I was truly being useful and actually learning a lot on the job. You are worked like a resident in the ER and honestly, there is no better way to learn than being thrown into that type of environment.
Weeks 5 and 6 was the floor. The inpatient peds unit in Bronx might be the nicest wing in the hospital. It's relatively small with about 16 beds and 4 beds in the PICU, but the halls are brightly painted, the children's play area is sun-drenched with panoramic views of the Bronx, and it's complete with toys, blocks, computers, video games, and a piano. During lunchtime I would go off and play the piano for some of the patients.
When you're on the floor at night you get to do at least one admission yourself, and you present to the attending the next morning during rounds. On days, you just basically do scut work for the residents like running blood to the lab, helping out with blood draws, calling to make appointments. After rounding in the morning, there isn't much happening since the residents are busy doing discharges or blood work. Teaching is better during the days, however, as attendings will teach during rounds or take an hour in the morning or afternoon to go into a topic at length. One of the more friendly attendings I worked with, Dr. M, is highly intelligent, shrewd, and a wonderful teacher. You can tell she really enjoys teaching both the medical students and residents alike, and all the information she imparted was practical and clinically oriented. Listening to her for the last three days made me wish I had more teaching sessions with her throughout the rotation. She was happy to answer any questions, and there was such an approachability to her persona, it was just refreshing rounding with someone like her. Anyone who is fortunate enough to work with her should take advantage of her knowledge and experience.
Things I didn't like about the rotation:
1. Attendance sheet. You are given an attendance sheet at the start of the rotation and are required to have someone sign it for you everyday to say you were present for that day. I forgot about this sheet a lot of the time and I felt pretty silly the few times I had to pull it out and ask my attending to sign it. I know attendance has been a problem for students in the past, but the way I see it is, we are adults responsible for our own decisions. We are roughly paying $5000 a month to live and work at these rotation sites and if we really choose to throw that money away by not coming, not learning, not doing the work we should be doing, then that's our own terrible judgement working for us.
2. Getting 6 Evaluations from 4 attendings and 2 residents. That's a lot of evaluations. And often times it's from people you've only worked one or two days with. Who can really judge your qualifications as a doctor in those few hours? Some people can make great impressions and others have a harder time of it, and I'm not sure how fair it is to those people.
Overall:
This is an excellent rotation for lots of hands-on experience and learning. You honestly work like a first year resident through quite a bit of it. And it also provides many learning opportunities. I enjoyed the majority of the small group lectures we had, as well as the mini teaching sessions during rounds. I recommend this rotation for anyone interested in pursuing pediatrics as a career.
For the lazy man, maybe this one isn't quite for you.
I've been absolutely abysmal at keeping this blog updated throughout the year and I'm sure there are plenty of questions people have about clinical life post-island and for whatever reason, I still hold out hope that I'll actually produce some answers for you all sometime soon. It will be more like a generalized comparison between clinicals and basic sciences, but I think that's better than nothing. I remember being on the island and being utterly oblivious about the situation. It's not like you talked to anyone on rotations really... once people leave St. Maarten, they might as well be dead because you never hear from them again (only half-true).
Ah, but alas, still saving that discussion for a rainy day. Today we talk peds.
Pediatrics. Pediatrics. What can I say about pediatrics in the Bronx? Lots of asthma. A whole hell of a lot of asthma. A good amount of Sickle cell in there too, but man tons of asthma.
This has definitely been my strictest rotation, scheduling-wise. Getting through and understanding the service your on, the lectures you have, and the hours for an after school program (just implemented) that you must attend made me bleary-eyed. The rotation is 6 weeks total, in which you spend 2 weeks on the floor for inpatient (1 week days, 1 week nights), 2 weeks in the pediatrics ER (1 week days, 1 week nights), 1 week in a general pediatrics outpatient clinic, and 1 week at the pediatric subspecialties outpatient clinic at POE. You have three days in the nursery and 1 day in the PICU somewhere sprinkled in all that.
You will have morning lectures at 8 am pretty much every day (Tuesdays are ground rounds) and sometimes they even schedule afternoon lectures around 3 pm. And then on select days of the week, you will have to leave which ever service you are on at 2:45 to go help out at an after school program in one of the neighboring schools and you stay there till 5 pm. And I believe that's about it for the schedule.
As luck would have it, I started my first two weeks in the outpatient clinics. Because my first week was essentially orientations and snowstorms I only spent one day in the subspecialty clinic. This made me a little sad because you go to POE (only 3 stops away from BLeb) and you can follow which ever attending you like in the specialty that interests you. I could have gone to peds cardio, immunology, heme, pulm, etc. etc, but I figured why not go to peds neuro since that is what I'm seriously considering for my career. It was an interesting day complete with children with seizure disorders, autism, and abnormal brains, and the attending Dr. S enjoys teaching, so which ever questions I had for him, he was happy to oblige me.
Week 2 was my triumphant return to the Tiffany Clinic. If you remember, I did my 3 weeks of outpatient for Family Medicine there and had a wonderful experience. Turns out that little blog post I wrote a few months back caught the notice of the family medicine department at Bronx Leb. Seems like the resident(s)/attending(s) weren't too happy with what I had to say about my inpatient experience and have subsequently complained about me? I don't know. Apparently a student brought the post to their attention for whatever reason. I realize I write openly and freely on the internet with my name attached. I want to be honest about my experiences, and I try to be respectful while I relay them, but hey if you rather make me hold a phone for you instead of doing something useful with my time, I'm going to have something to say about that. ANYWAY, all the lovely ladies at Tiffany enjoyed my blog post about the place haha. The nurses, secretaries, office managers, are wonderful there. They are definitely a fun, warm, friendly group of people who know how to make people comfortable. Incidentally, I had my 27th birthday on my last day there and they bought me balloons and card. I had made a tres leches cake so we pretty much had a party.
The pediatrics attending there, Dr. M, is great. I've never seen someone so happy and excited about every single baby, toddler, and child she saw. Honestly, it's infectious. I couldn't help but smile and laugh whenever I saw her examine a baby and if you work with her you will know exactly what I mean. As a medical student working with her, she will allow you to see, speak, and examine the patient yourself first. Once you're done, you go to her and present the patient as you would with any attending and then you discuss what he/she may have and what you want to do for the patient. Then you both see the patient together and she ultimately ends up writing the note. It had been a few months since I last presented a patient so I was pretty rusty during my week with her, but I appreciated the freedom she gave me.
Weeks 3 and 4 were spent in the ER. Easily the two busiest weeks of the entire rotation because you are seeing a never ending stream of patients from the moment you walk in. When you are on the week of nights things do tend to quiet down by 1-2 am but you can have a few stragglers stream in every other hour or so. On days... its crazy. Madness. Depending on which attending you are working with they will ask which patient you want to see, then you call them through the loud speaker, bring them to an examination room where you do a history and physical. Once that's done you present to your attending and then you see the patient together and formulate a plan. You write the note and then you call the next one. Of all the rotations I've done, this is the first time I felt like I was truly being useful and actually learning a lot on the job. You are worked like a resident in the ER and honestly, there is no better way to learn than being thrown into that type of environment.
Weeks 5 and 6 was the floor. The inpatient peds unit in Bronx might be the nicest wing in the hospital. It's relatively small with about 16 beds and 4 beds in the PICU, but the halls are brightly painted, the children's play area is sun-drenched with panoramic views of the Bronx, and it's complete with toys, blocks, computers, video games, and a piano. During lunchtime I would go off and play the piano for some of the patients.
When you're on the floor at night you get to do at least one admission yourself, and you present to the attending the next morning during rounds. On days, you just basically do scut work for the residents like running blood to the lab, helping out with blood draws, calling to make appointments. After rounding in the morning, there isn't much happening since the residents are busy doing discharges or blood work. Teaching is better during the days, however, as attendings will teach during rounds or take an hour in the morning or afternoon to go into a topic at length. One of the more friendly attendings I worked with, Dr. M, is highly intelligent, shrewd, and a wonderful teacher. You can tell she really enjoys teaching both the medical students and residents alike, and all the information she imparted was practical and clinically oriented. Listening to her for the last three days made me wish I had more teaching sessions with her throughout the rotation. She was happy to answer any questions, and there was such an approachability to her persona, it was just refreshing rounding with someone like her. Anyone who is fortunate enough to work with her should take advantage of her knowledge and experience.
Things I didn't like about the rotation:
1. Attendance sheet. You are given an attendance sheet at the start of the rotation and are required to have someone sign it for you everyday to say you were present for that day. I forgot about this sheet a lot of the time and I felt pretty silly the few times I had to pull it out and ask my attending to sign it. I know attendance has been a problem for students in the past, but the way I see it is, we are adults responsible for our own decisions. We are roughly paying $5000 a month to live and work at these rotation sites and if we really choose to throw that money away by not coming, not learning, not doing the work we should be doing, then that's our own terrible judgement working for us.
2. Getting 6 Evaluations from 4 attendings and 2 residents. That's a lot of evaluations. And often times it's from people you've only worked one or two days with. Who can really judge your qualifications as a doctor in those few hours? Some people can make great impressions and others have a harder time of it, and I'm not sure how fair it is to those people.
Overall:
This is an excellent rotation for lots of hands-on experience and learning. You honestly work like a first year resident through quite a bit of it. And it also provides many learning opportunities. I enjoyed the majority of the small group lectures we had, as well as the mini teaching sessions during rounds. I recommend this rotation for anyone interested in pursuing pediatrics as a career.
For the lazy man, maybe this one isn't quite for you.
Subscribe to:
Posts (Atom)