Bigredmed

Brief update:

July - not quite what I was expecting. It ended up being a good month, and I will be getting a LOR from my preceptor for the month, which is what I really wanted. I learned a lot too, but I didn't get to do as much as I would have liked.

August - I'm out on my away rotation in the Western US. I'm in the PICU and I'm LOVING IT. This week has shot Critical Care to the top of my fellowship choices. I'm trying to keep my enthusiasm on an even keel in part because my attending is really awesome this week, and I know that can impact a lot of my feelings toward the specialty. Good attendings can really make all the difference in the world. That said, I think this is really what I want - to work with kids, deal with complex problems, and do some procedures. I've come to realize that while I would enjoy some long-term continuity of care stuff, it's not as important to me as the other things. Critical Care also has the advantage of a little more consistent lifestyle, and I'm also finding myself thinking of some possible research questions that I could pursue. I think this is pretty important since most fellowships require some research - in some cases up to half of the time in fellowship (18 months) is spent on research.

So yeah, things are really good. I need to work on my residency apps and stuff this month, but I might be able to get away with waiting until the middle of September. I'll have a lot more time when I get back home.

Princess'Dad

Bigred.
Critical Care: be it NICU or PCIU or ICU is one of the most challenging and rewarding rotations. You have the sickest and can make a differance - but you also have the most deaths which may affect you.

It sounds like you like kids. Make sure you do a NICU rotation at some point. If you like physiology too, they are pure "black boxes" that don't have other things affecting what they are supposed to do. Plus in your "follow-up" comments, unlike the other icus, PICUs usually have alumni days where you can follow up on your kids many years later.

Bigredmed

On my way home, on a layover at DIA.

The rest of my month was equally as awesome. One of the weeks was kind of a cluster due to an attending being stuck abroad when he was supposed to be in the unit. But I weathered that well and my interest in critical care is confirmed. The attendings that followed that first week were REALLY good, though perhaps not quite as amazing as the one I had the first week, so I'm confident that it wasn't just her effect. I got really good comments from the residents I worked with, and ended up with a really good med student partner for the last three weeks who I worked with extremely well. I can certainly imagine her being a gunner in the right circumstances, but we had a good system that pushed us both to work hard, and I know we both benefited from it.

I will be getting a letter of rec from the attending I had the last week (she was on thursday to Friday, including a full weekend on call...so I got to see her alot.

ERAS, the residency equivalent of AMCAS opens tomorrow to actually submit applications - but not all programs begin accepting applications right away - some wait until the 15th and others until the first of October. I've spent a moderate amount of time getting information into the system, but have yet to upload my personal statements, as it's still in that final tweaking stage. I have a couple versions I'm toying with, and the process just takes some time.

I have a meeting with our Peds Chairman next week, and he will be writing one of my letters as well. Most of the Chairmen at my school do this, operating with the mindset that they should do all they can to help students reach their goals, but it seems that's not always the case elsewhere. The med student I worked with in the PICU wants to do OB/GYN and said her chairman doesn't do letters unless she's actually worked with the student. It was interesting see the differences between the two hospitals.

I'd say I'm about 90/10 at this point critical care vs cardiology/pulm, but that might be generous in terms of cards or pulm. We got a lot of consults from those specialties in the PICU, and I have to say that I just wasn't as enthused about them as I thought I might have been. They're still interesting, but my reflex excitement to them wasn't as strong or intense as critical care was.

It may be a bit of of editorializing on my part, self selecting the aspects I like most about Critical Care as evidence of my desire to do it in the future, but I'm really excited about it. Most of the residents (Anesthesia, ED, and Ortho) I was hanging with socially smirked when I said I wanted to do PICU (most smirked when I said I was doing peds to begin with) and then brought up any number of reasons why it was a poor choice, and on most occasions, when I thought of their criticism, it was actually something that I either liked, could see myself doing, or even if not enjoyable (like talking with families about withdrawing care) were things that I'd much prefer to have be my responsibility. (In regards to the withdrawing care discussions...I've been in several, and to be honest, I wished the attending or resident would have let me do it, because I honestly believe I would have done a better job...)

Anyways, that's where we stand. I start Diagnostic Radiology on Tuesday...going in at 8:30 is going to be akin to sleeping in for me at this point.

As an administrative note, when I do start talking about specific programs, I'll only refer to them as Program A, B, C etc. They may get a few other identifiers but I won't be naming programs by name. I think that saves my anonymity and will allow me to be a little bit less restrained in my comments. Obviously I've tried to keep my current location masked to a certain extent (though I think you could probably figure it out), and if you are extremely interested in a certain location, PM me and I'll decide on a case by case basis who gets to be privileged to that information.

Bigredmed

Oh, and PrincessDad - I wasn't particularly fond of physiology during M1 year, but I have to say...that when it had a direct clinical implication in the PICU, it was much more interesting.

Princess'Dad

Bigred,
Chairmen's letters are helpful -- but see if one of the people you worked with is FCCM. Have them call buddy at program you are interested in. The old boy network is still the main selection help.

Bigredmed

Update:

Currently on Diagnostic radiology, which has it's pluses and minuses to be sure:

Pluses:
+ we spend two days each in ultrasound, GI, Nuclear med, Interventional, Mammogram, bone, CT, Neuro, and Chest, so we get to see the whole gamut of what radiologists do.
+ I'm pretty much done at noon everyday
+ they have a decent lecture course everyday
+ the principles of radiology book is excellent

minuses
- with only two days in each section, every resident starts off by saying "you're not going to learn how to read ______ in two days", so you sit around and watch them read films...
- ...which is insanely boring
- the attendings and residents want to get done with all their work, so they dont' really take time to teach during the day except for small points that will make their lives easier when you're a physician.
- they don't really care if you show up or when you leave (which is also not a bad thing).
- most of the radiologists shut down when you tell them that you're not going into radiology. Only the resident who was previously a neurosurg resident continued to talk to me after I told her I was headed towards peds critical care.

All in all, so long as I pass, I'm okay with the month. I've gotten a little better with films, I have a better idea on what to order in the future, and the book and lecture series have been helpful. And who doesn't like getting every afternoon off. And even though I want to bang my head against the wall when I'm there, at least I don't have to worry about ever wondering "what if I had done radiology?".

In other news, I submitted my ERAS application on Monday. I sent 21 apps on this first round, and am debating on whether to send about 4 more. I'm going to continue to look at possible places, but 21 should be plenty for me to at least get matched. I already have 3 invitations to interview, and an interview at my home school already set up for November. There's little to no chance that I'd stay here (I won't say never...extenuating circumstances could always pop up I suppose), but it'll be good to have that as my first interview so that I can practice.

Other than that...I signed up for USMLEWorld yesterday and have done a couple blocks of questions cold, with mediocre results. I just have to review things is all. I had one friend who scored 33 points better on Step 2 than she did on step 1, so I'm hopeful I can have a significant increase.

GoldShadow

Radiology sounds interesting, done by noon!

All I know about ERAS is that it's the residency matching service. How exactly does the process of applying work? Just looking for some general information/overview I guess.

When do you take Step 2? And how long do med students generally have to study for it?

Bigredmed

Yes, I get to leave by noon...the radiology residents of course don't....

ERAS is somewhat similar to AMCAS - lots of demographic information, you basically fill out a CV. Some of the more annoying aspects of the medical school application process have been removed, although I only know how it works for US Med Students, there could be variations for independent applicants as well as IMG's. There are unlimited spots for experiences which is is appropriate (considering some applicants using it are well established physicians or MD/PhD, etc). You don't have to fill in your transcript course by course, the personal statement has more available characters but everyone keeps it to less than a page usually, LOR's are sent to your medical school, then you get to pick and choose which ones go to which programs. You can upload multiple personal statements if you want, then select which ones go to which programs (which I would have found necessary had I ended up applying to med/peds as well as peds).

The one key difference is that of the Dean's Letter or Medical Student Performance Evaluation (MSPE) as it is now called...everyone still call's it the dean's letter. Your Dean of Students will write out an evaluation of you, include comments made during your third year clerkships and your rotations early on in the fourth year, along with any comments about problems with your medical school journey or exceedingly high accomplishments. Dean's Letter's aren't released to programs until November 1st for regular match. Not sure how those work for people doing early match programs though.

But the thing is, at least for peds, is that a lot of programs offer interviews even without your complete application in, and certainly without the dean's letter. That likely plays a role in their final ranking on you on their match lists, but they need to fill spots and if you're interested, then they want to get to see you and how you'd fit in. Certainly for the more competitive programs and definitely the more competitive specialties, there are more applicants than spots, and so they're pickier. Some of my friends looking to do things like ENT and radiology and such have no interview invites yet, and wont' for at least a couple more weeks while programs wait for their numbers to rise so they can get a good handle on where people relate to one another.

I take step 2 in November, both CK and CS. I'm starting on doing a little bit of studying now, but October will be my big month. I'm taking a class that's kind of unique to my school which is an extension of our small group sessions we have while on outpatient medicine. Those cases were PBL on steroids, and at a much quicker pace. They were also much more focused on interpretation of data and making the next management decision. The fourth year cases are a little bit more complex, a lot more "disease X in the presence of condition A" sort of stuff, as well as a lot of review on EKG's and some other things. My friends who took the class and then took boards said it was an immense help, though they didn't necessarily get the amount of time to study on their own that they wanted to.

The axiom I heard while studying for Step 1 was - 5 weeks for step 1, 5 days for Step 2, and a BAC below 0.5 for Step 3 (or at least don't take it while post-call). I had a very average score on Step 1, which I was happy with, but it would be nice to score better. Historically, my school tends to do about 12-18 points better on Step 2. I had one friend who scored 33 points higher from Step 1 to Step 2, so I should have some gains. Whether that will really make a difference in my residency selection/choices, I don't know but it couldn't hurt. In the end, because I'm taking it a little bit later, whatever impact it could have had (good or bad) is attenuated. The thing is that people with super good scores on Step 1 will take Step 2 after match lists are in (don't want to risk getting a lower score), while those with lower scores, or at least less competitive scores for what they want to do, will take it earlier. Me, I'm pretty average, going into a field that has pretty average scores, so I'm okay, and it just comes down to whether or not I can get interviews at some of my "reach" programs.

my$0.02

I passed Step 3 post-call (then, NBME, part III). While it's not recommended, taking Step 3 post-call does simulate decision making under sleep deprivation.

(After taking part III, I wondered if people who failed part III should be driving automobiles.)

desi_chick

i cant wait till i get into med school..i know its ALOT of work..but i mean its worth it.

Bigredmed

Update...

I realized I left off one of my programs when I submitted my application the first time, so I submitted to them last week.

So with 22 programs, I have 9 invitations to interview so far, with 6 interviews set up, some even with travel and hotel booked (actually, most of the peds programs pay for your hotel, but the more competitive specialties this is not always the case). I've yet to hear from the top three places I want to hear from, but have a couple programs I'm excited about that I've set up interviews with.

Anyways, it's still pretty early (as my friend doing derm was very adamant about today), and I'm already approaching a point of critical mass where statistically I <i>should</i> match without issue. I feel that if I interview at 10 places, it shouldn't be any problem (besides I interview extremely well).

Bigredmed

Up to 14 invitations after this week. Still nothing from my top three.

7 interviews are confirmed, plus I'll set up two more on Monday for the programs in my hometown (more to appease my parents than anything else - I'm on a vacation month in January so it doesn't really matter much).

Hopefully next week pulls in some of the ones I really want to hear from.

In scheduling news, I thinking that I might alter my M4 TA month - April - and change it to an general peds private practice. My peds clerkship (which my school has since revised) included a week of private practice, and I had a great time with the docs out there. One of them had been a pediatrician in town since the early 1960's! He's now even taking care of grandchildren of some his first patients! That one week taught me an enormous amount (and I know now that I wasn't even that good at the time - it was my 9th week of third year). I'm still weighing the options and probably will decide in January. It wouldn't be a very taxing month, and I'm sure those docs out there would be understanding of it being the last month of med school and all, but it would provide some extra exposure in preparation for being an intern.

PrincessDad - do you have any thoughts? I know you said earlier about trying things that I wouldn't otherwise be exposed to, which this is pretty much doing the opposite, but I'd like to know what you think.

hope4freeride

As a faculty member at a top 20 medical school ( I also coordinate our 4th yr student elective in our specialty), I would highly discourage anyone doing an "audition" elective in any specialty. If your performance is substandard(I have seen MANY students who were) and you believe that you can overcome academic weakness by "dazzling" everyone by showing up, or if you appear to be overly impressed with yourself(even if you are academically strong) that will also be apparent to everyone and can only hurt your chances of matching at your dream program.
The 4th yr of medical school should never be squandered to get "vaycay" time. It should be used to strengthen and build upon skills learned in the 3rd year. Too often, I see students who are permitted to do as many as 3 electives in the same specialty,usually as away (audition) rotations, when they should be taking those rotations in other specialties that will enhance their skills when they embark on their intern year.
Regardless of the specialty selected, all 4th yr students should do a month of emergency medicine and a month of ICU work,even if the school does not require it.

Bigredmed

Got my first rejection today - Oregon Health Sciences U. They were one of my top choices and I was really hoping that I'd get a chance to see their program. I knew that OHSU is a very popular place because of Portland, and so it's not entirely surprising.

I do have 16 invites, but I did withdraw from one program already - it was a program that I had thrown on at the last minute, and after further examination, I realized they had 8 months of Q4 call...all the other programs I'm looking at are 6 months or fewer of Q4. One program I'm interviewing at is q6-7 (it's a busy night though, but still, only once a week? that's totally doable). I'm definitely not opposed to working, but it seemed excessive when no place else is that intense. Plus it was one of the few places that didn't fit my warmer climate standard that most of my other locations possess.

Only 5 more programs to hear from - 1 that I really want to interview at (and will be very disappointed if I'm rejected), 1 that I'd be thrilled to hear from, 1 I'm fairly indifferent to, 1 that I've heard is otherwise malignant (but is a great location), and 1 that I'd be shocked if I got an interview from, but not really worried about getting rejected (kind of wondered why it hasn't happened yet actually).

My first interview is on November 11th at my home program.

Bigredmed

Took Step 2 Clinical Knowledge today...much easier than Step 1 in my opinion and was a much shorter day (at least for me) even though there are more questions on Step 2 (8 blocks of 46 questions compared to 7 blocks of 50 on Step 1).

I studied a decent amount for it leading up to it, but mostly focused on my weak areas (derm, rheumatology, hematology, and nephrology) in the last week. Of course, as is always the case, I ended up with very few questions in any of those areas (which really surprised me about rheum).

I think I did fairly well, students from my school have historically done significantly better on Step 2 than on Step 1. Some of my friends have gained as many as 38 points on Step 2. I'm expecting an increase and would be disappointed if my score didn't go up at least 10 points. 15 would be solid and 23 would be awesome. But in the grand scheme of things, it's not going to make that big of deal.

Dean's Letters were released on Saturday, so the final say from programs will be coming shortly. Have had a couple rejections in the past couple days. None were surprising or unexpected. Still waiting two more programs...including the place I am most hoping to hear from...but at this point I realize the timing of things and so it won't be a surprise if they reject me. I am very excited about a number of places I have interviews, so I'm not worried.

First interview is on Tuesday. Peds is a nice specialty to interview for - every place has a resident dinner the night before, and all my programs are paying for my hotel rooms. This is not the case for some of my friends, so I'm thankful. It makes things much easier and much cheaper.