bluedevilmike

Yeah, I was basically wondering whether a surgeon could do a medical fellowship, just for the extra expertise.

Bigredmed

If you'd just asked me that question, I probably would have told you it doesn't happen, and with the ACGME wording, it's obvious it doesn't. Certainly, people are always able to pursue their interests, but as far as formal training...doesn't appear to be. I'm sure that at academic medical centers there are a lot more opportunities for this sort of cross pollination, and so you can get an orthopod interested in something like osteomyelitis working with the ID people on some sort of research and the like. But other than that...it looks like you'd have to be one of those odd balls who ends up switching residencies midway through or who just piles residencies on top of one another (I've heard stories of this happening where people end up having gone through a residency and fellowship only to decide that they need to complete another residency) in order to make that happen.

bluedevilmike

A couple of my professors have multiple residencies and multiple fellowships. (One is Pediatrics, Neurology, and Genetics.) Was wondering how well the medicals stacked on top of the surgicals. Apparently not that well. Thanks for the reference.

Bigredmed

Brief update:

Applying for away rotations is a pain...a lot of meaningless paperwork to fill out and signatures to track down. I'm planning for that peds month out west and I had to get the signature of my HOME peds department education coordinator, the signature of my advisor, and the signature of my home College of Medicine program coordinator just to get permission from my school to apply for the spot. Then I had to get the program coordinator's signature again for the other University's paperwork, show a complete vaccination history, a negative PPD (and the one I had just done in January was NOT sufficiently current for them), do a HIPAA post test, and then send a non-refundable deposit, and there's still the chance that I may not get approved for the elective...

[/rant]

lethargytm

So whats the process for applying for residencies if you match up?

Bigredmed

I will discuss applying to residencies and the rest of the NRMP in more detail as I go through the process.

Bigredmed

Finalized Schedule received today. Follows pretty much as described in post #1 except that I didn't get my medicine sub-i at the University hospital, instead doing it at the community hospital which is attached to my medical center (the two hospitals merged to form one massive hospital system about 10 years ago). Not sure what the implications will be, like if I have a resident to work with or not, as I don't think the physicians are considered academic staff docs. But we'll see. This might actually work out to be more beneficial in some ways as I may get more responsibility.

Still waiting to hear back from the school I'm hoping to do my away rotation at. Would definitely like to know sooner rather than later, so I can finalize plans either way. I have a sinking feeling that the cost of my airline ticket out there is going up by the day...If I don't get it, I'd like to know so that I can find something else to do that month.

GoldShadow

How exactly does a sub-internship work? And what kind of responsibilities might you get as a rotating med student, especially if there might not be a resident for you to work with?

Hopefully your away rotation works out, but if it doesn't, what else could you do during that month? Would you have to search for another peds rotation somewhere else, or do something else altogether?

Bigredmed

So normally (at least what's normal at my school) on an academic service medicine service as a third year the hierarchy looks like this:

Attending Physician
Supervising Resident (at most places, you can't supervise until the second half of your second year)
Intern #1 (taking half the patients) Intern #2 (taking the other half)
3rd year medical student x2 each taking 2-4 patients (depending on the expectations of the residents and attending)

At my school, third years basically are playing doctor, there are no real consequences, and the expectations vary throughout the year - early on it's enough to just get a thorough history and physical, but as the year progresses, you need to develop your ability to create a reasonable differential, then come up with appropriate labs/tests to run, and finally appropriate, but general, treatment plans, followed by more specific plans. Certainly the development of these skills are concurrent, but happen at various rates. Any first year student can order shotgun lab tests, the key is limiting it to appropriate ones. And there are certain drugs that I picked up on dosing regiments very early on, while others, I'm still whipping out my pda and looking up on epocrates. But with so many levels in between the third year, and actual treatment decisions, I really felt like I was simply playing a game.

A sub-intern falls on the "intern level" - functions the same, but takes fewer patients than the interns will. So if there is 15 patients on a service, the sub might get 3, and the interns will each take 6. The sub-i is a chance to work like an intern, but with the expectation that you won't be as efficient, and that you'll need a little bit more help from the supervising resident (ie, like in having all your orders signed. There's a little less oversight, the expectations are higher, but the oversight is there to make sure nothing slips through the cracks.

What I'm unsure of is how this service I've been assigned to is organized. I'm 90% sure the docs on it are community based, volunteer faculty. I have no idea if they have residents. I think it's a real possibility that it might just be me on service, with 2 or 3 attendings. There are definitely some benefits that could exist - a lot more responsibility, a chance for more one on one teaching, taking on a bigger patient load, fewer zebras/more bread and butter work. But on the other hand, it could also mean a lot more work, varying levels of expectations, the lack of that extra layer of insulation in the safety net, less really interesting cases, and so on.

Of course on the other hand, it could be just like a normal service on the University side and I'm making too big of deal about it being on the community side.


As for August...I won't be looking to go elsewhere. It was a pain enough as it was to get just the one application out, and the only reason I was going there was because my buddy is starting his residency program out there and it made for a great situation - one of my best friends, a cheap place to stay, a chance to go someplace else. If I had to try to figure out housing on top of everything else...uggh...no thank you. If it falls through, I'll see what other peds openings are available at my home school, and go from there.

lethargytm

good luck. im jealous

Princess'Dad

Blue
Critical Care is a surgical (and medical and anesth and ped) fellowship. It is really intense medicine if you want.

Bigredmed

Update with only 9 days of third year remaining...

If you can believe it, I'm still waiting to hear from my away rotation. I imagine they're probably trying to finalize their own student's schedules, but I'm not sure why they can't say 'we'll let you know at the absolute latest on this day' and then I can stop being so anxious about it...

In preparation for the possibility that I won't get the spot, I've penciled myself in to two peds rotations - in August, I'll do peds cardiology and September I will drop radiology in favor of a peds sub-i. I'd really like to take the rads month, but there's really no where to put it. I could change my adult pulm month (December) but the Department of Radiology doesn't offer anything during December (the rotation has a reputation for being easy to skip out of, so it's possible they've been burned by people leaving for residency interviews).

Earlier this week we had a meeting about the Electronic Residency Application Service (ERAS) and the NRMP. Two separate entities (which is a little annoying) and you have to pay for both. Overall, the process seems a bit more overwhelming than the AMCAS...not sure if that's the unfamiliarity or the actual amount of work to be done.

Starting to think about LOR's...lots of meetings to set up. I have one letter lined up from my attending on in-patient medicine, he's the former Dean of Students at my school, so I figure even though I'm not that buddy-buddy with him, he worked with me for a month and knows how to write the letter. I have to set up meetings with the current Dean of Students to get my Dean's Letter ready, as well as the Department Chairmen for both Peds and Medicine. So there are a lot of things to handle and get scheduled. I'll see how my July goes and I may try to get a letter from one of my attendings that month, and the same goes for whoever I work with in Arizona or one of the Peds Cardio staff if that's where I end up. I'll also likely aim for getting one with one of the hospitalists on my peds sub-i in September if that's what I end up doing. From our meeting they said you can only send 4 LOR's to a single program, but if you have more, you choose which letters are sent where through the ERAS. This is helpful for me, since I can tailor those appropriately to either the peds or med/peds programs. Apparently you can also upload as many personal statements as you'd like, and then send specific ones to specific schools. Supposedly someone a couple years ago at my school had 47 different personal statements. I think I'll probably have just two, one specific for peds, one for med/peds...

Costs are already starting to add up, looks like $200 just as a base - $60 to sign up, $60 to actually have your applications sent (up to 10 programs) then an additional $8 for each program 11-20. After twenty, the costs increase. I think after 30, it becomes something like $25 for each additional school. This doesn't include the cost for signing up for the NRMP...

So that's where it stands right now. I'll probably be putting together my CV this weekend (I'm on-call Sunday, so I'll have some free time probably), and I'll be thinking about my personal statement, which is probably going to take some elements of my medical school personal statement.

Bigredmed

Been enjoying my one week of vacation between third and fourth year immensely. Broke up with the girl I was dating last week (it was fairly mutual...she was a fun-hater), and totally had a weekend she would have been less than pleased with, but I thought was awesome.

Best news came today. Finally heard back from my away rotation and they accepted me for a peds critical care month in August. Took forever, but at least it worked out. I was visiting the student run clinic one of my friends at another med school helps out with to see how they do things when I got the call. Will buy airline tickets thursday and look into rental cars and such. Just glad to have that wrapped up. I get to keep my rads month and keep everything just the same. Still might try to squeeze a peds cardio month in though if I can.

Princess'Dad

Bigred.
I assume from above that you are going into peds?

If so, why do your 4th year electives in peds? You should do them in unrelated fields such as rad or surgery or ER

You will get enough peds in your residency. As an advisor, that is one mistake I see all the time.

Do do one rotation at the place you want to do your residency in, but do the rest in different areas

Bigredmed

I'm looking very hard at med/peds, but will apply to peds programs at places I'm interested in that lack med/peds programs.

My current month is a medicine sub-i, because my med/peds advisor wants me to make sure that I like the medicine part enough to make it worthwhile. It's going okay, but the experience is pushing me in different directions - in part because I'm not on an academic inpatient service, but with a private clinician/volunteer faculty, and the rotation is very heavy on clinic time (an extremely, extremely busy clinic at that, which hampers any sort of teaching time).

My away rotation next month is exactly that, an audition month.

I do understand your point, and I am taking a rads month, a month with our student-run clinic (I was an executive board member for the clinic as an M2), and a month abroad in Australia. December is currently an Adult Pulmonary Service, but I might change it. January is blocked for interviews, February is Australia, March is Peds Pulm (which I again might change) and April is essentially a vacation month, but as an M4 TA, I will have commitments throughout the year including weekly meetings with my M1's, grading of assignments and being present to grade the OSCE's for the M1's and M2's on multiple Saturdays throughout the year. It was either do that, or complete a basic anatomy dissection over the course of three days and have the rest of the month off anyways.