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Why people dislike pre-med students

The top five reasons to dislike pre-med students are listed in a recent Wired article. The most interesting part to me, however, were all the comments generated in the discussion. This was apparently the author's intent:

These are sweeping generalizations that are intended to provoke a heated debate, so try not to get too offended.

Ya think? Why in the world would any former pre-med student (including myself) get offended when we're globally accused of not having intellectual curiosity and running organizations into the ground.

I'm not going to lie and say I never came across pre-med people who fit these characterizations, but I think you could substitute any highly-competitive student here (engineering, law, poli-sci) and get the same result. While I agree that the medical student admissions process is a broken system, being a dilweed isn't something that's unique to those going into the medical profession.

I'd also be remiss if I didn't mention this little gem:

Perhaps, instead of separating the brightest students from the rest, pre-med programs weed out all but the few who are willing to give everything up -- hobbies, athletics, even their curiosity -- for the sake of a high-paying job as a body mechanic.

I've heard that "body mechanic" line quite a few times and every time it's gotten under my skin. Nothing against mechanics, but to simplify the art of medicine like this is just ignorant. I would challenge anyone with this belief to follow a local physician around for a day or two, then let's see you honestly say this.

Days are nights and nights are days

Good thing Julie is around or this place would be all but abandoned...

Peds ER has been it's usual beast and I'm running low on sleep as well as motivated time to actually sit down and write. Just about the only thing I've been up for lately is messing around with my Virb profile and browsing through groups on the site.

As a rotator I've gotten more than my fair share of late night/overnight shifts and as such have reverted back to my old days of staying up all night and sleeping during the day. I've noticed that although the work comes easier than it did back when I was a med student, the hours seem much, much longer. It's been a trip especially since I've also had a delivery already this month and another couple that should go down in the next couple days.

Getting them in and getting them out

Considering that most of my patient encounters last a minimum of 15 minutes and have gone up to over an hour, it's a shock to see how quickly things run at a surgeon's office. The surgeons I've worked with up to this point literally just walk in (sometimes without even closing the door behind them), march straight to the surgical wound/injury, poke around a little bit, say "it looks good" or "I don't like the way this looks," instruct an MA/nurse to schedule a follow-up appointment and then just waltz right out. I've been in on encounters that last less than a minute, and I think the longest one was something like 10 minutes, and that was only because the surgeon had to read some insurance paperwork.

A bumpy EHR road

As I mentioned earlier, we're currently in the process of moving from paper charts to an electronic health record over at the Family Practice Center. We're only two days in, but I'm happy to report that it's actually gone a lot more smoothly than I had expected. What's more important is that it seems like everyone has kept a positive attitude about all of the adjustments we've had to make and all of the unplanned problems we've come across.

Put the paper charts away

Tomorrow the Family Practice Center takes the wraps off of its electronic health record and "goes paperless" for the first time. This has been a long time coming and I'm super excited that we're finally leveraging technology for patient visits. No more lost charts, no more lugging around half broken manilla folders, no more jotting down scribbled notes...it should be great. Not to mention that i'll be able to answer messages and review patient charts from home and refilling medications will be a simple point and click process

I feel for those who are slower with the keyboard than the pen and for those afraid of using computers, but it's time to get with the 21st century. After a few weeks worth of training I think everyone in the office has gotten acquainted with eClinicalWorks and should be fine on day one...barring those inevitable first day mixups. Besides, the real test is going to be how long it takes for us to fully migrate away from the aforementioned paper charts and get all of our templates up and running.

Only one week to go

I'm down to my last week on the ICU service, and it's gonna be a doozy. I received the good fortune of having almost twice the amount of night float shifts as all of the other interns, so this last week will be all graveyard...and I mean that literally as well as figuratively. We have a lot of real real sick patients on the service and it's only a matter of time before several of them break that thin thread holding them stable.

Never in synch

I noticed something today while rounding that I've actually been frustrated about for some time. Why is it that when time is of the essence and I just want to get home on the weekend that my attending decides he wants to make rounds a giant teaching exercise? All during the week when we have plenty of time we do speed rounds and just get through the patients. Then we sit around during the afternoon and mop up miscellaneous work when we could be doing as much learning as we could handle. But no, that's not when the teaching happens. It happens over the weekend when we are understaffed and have to see more patients and really don't want to be in the hospital in the first place. Why can't we ever just be in synch with the attendings on this? I appreciate and really do need the learning, but I know there are plenty of other times it can get done. I'm not going to be the resident that suggests we do speed rounds on the weekend, so it looks like this isn't going to change any time soon.

Recruitment season

You gotta love this time of the year. Senior medical students across the nation have had all of their interviews and are now thinking about how they will rank the programs they've visited. This is where we the residents step in. I've spent the last couple of days writing notes to the applicants I've met and ate dinner with and have been fielding phone calls from those who have last minute questions that they forgot to ask while they were visiting. It's actually pretty fun because I can vividly remember being in the same position all of these students are in. Making your choice of residency program is a very big deal and there are lots of factors to consider. Will I have to move? Will I get along with the people in the program? Will I graduate with the tools I need to practice medicine the way I want to? Is there free cafeteria food? ;-)

Today was the beginning of our second-look weekend, which is basically the time when we try to "seal the deal" with the people who have shown the most interest in our residency program. This morning we hung out and played some tackle football, and I'm already sore (I also managed to squeeze in a couple games of tennis and shoot hoops...we're having great weather around here). I'm off in a few minutes to a swanky hotel where everyone will be enjoying an open bar and then a great dinner. This is just day one, however, because tomorrow morning we are going to be feasting on a breakfast that is legendary for being absolutely delicious. I'm already looking forward to next year...

New routine

I've been trying this new thing the past couple of weeks and I'm really starting to get the hang of it. What I've been doing is printing out journal articles that are relevant to patients I've seen in the office or followed peripherally and then reviewing them, making notes, and filing them away in a drawer at work with labels. If I think about it, this really is something that I should have been doing as part of my job, but for some reason I wasn't motivated before to get it going (yeah, I know that's called laziness). It's shameful to say that all of this was spurned not by my insatiable thirst for knowledge, but rather because I thought it would be cool to have an organized file of a bunch of relevant medical topics. I saw some of my senior residents keep a similar file, and I was drawn to the labeled folder tabs and all of the cool office supplies that I would be able to buy to maintain such a collection.

Life in the family practice center

I spent the past month and will spend the rest of this one in the Family Practice Center. Last month I had my service month, which basically meant that I was taking care of the patients who were admitted by family practice in the hospital wards. The good was that compared to the internal medicine service our patient census was much smaller, the bad was that our patients seemed to be in much worse shape. Whenever an admit came in I could expect the patient to have a multitude of medical health problems and that either one or several of them were uncontrolled. I'm not sure if it's because of the patient population or something that we are doing wrong with our management, but the admissions were either really soft or complete train wrecks.

Blowing the dust off

People told me that my month of pediatrics was going to be a busy one...

It's been a while since I've written on here, and for that I apologize. For those of you still tuned in, here's a quick recap of what's been going on for the past couple of weeks:

I've been working my ass off over at the children's hospital. There are a lot of sick kids this time of year, but what really makes the day busy is the high turnover rate that you get with pediatrics. Kids will come in really sick, but improve quickly while in the hospital. That means a lot discharges and admissions throughout the course of the day. On my busiest day I discharged 12 kids and admitted 14, which needless to say was the day from hell. Calls have been brutal on this rotation, with admissions usually coming in at the worse times. I mentally prepare myself to not get any sleep, but that doesn't help when it's 4am and I've got two admissions yet to come in. Pages come from the floor at all hours of the day and night, and usually for things that could have been easily taken care of hours earlier. There's been many a night when I had the opportunity to write on here but was just too beat up to do so.

How do you know your child has a fever?

Five answers I've been given that don't hinge on a temperature taken with a thermometer:

1. "He looked hot."
2. "She didn't drink her milk as fast."
3. "Her brother had a fever."
4. "I put a potato peel on his foot and it turned black because it was sucking out the heat."
5. "I don't know."

Deliver your own babies from now on

Tomorrow brings with it my last day on the OB service, which will actually be a sad thing because of the great time I had working with my OB compatriots. It took me a while to gain the trust of the more senior residents, but once they saw I was somewhat competent and willing to put in the work I was welcomed with open arms. I've met some great personalities on this service and I look forward to running into people in the hallways or the cafeteria. There's nothing I appreciate more than residents who know how to have fun and know when to turn it up a notch and get work done.

Another satisfied patient

Reading this quip on dooce made me more upset than it probably should have. Not upset at Heather herself, but more so at the public perception that doctors are callous, aloof, and just generally out of touch with people in general. I have no hard evidence to say either way if this is true or not, but it upsets me that there are people who have had bad experiences with their physicians leaving them with this impression.

I'm in a profession where my contact with other people comes at the moment when they are at their most vulnerable. The words that I use to talk to them could be remembered for years or even a lifetime...heavy responsibility to say the least. I'm here to say to Heather and all of you out there who've had a doctor say something dickheaded or insensitive to you: It's not all of us and it's not the norm. With all the years of medical training, the clinical cases named only by initials or symptoms, the patient charts plastered with medical record numbers and ICD-9 codes--well, it's easy to lose track of why we do what we do.

Most of us really do try our best though, and even though you might only hear horror stories, remember that we're just like you. Overworked, sometimes frustrated, always pulled in different directions, doing our best with what we have, wanting to make a difference and leave a mark. It's not because we're doctors that we sometimes don't use tact...it's because we're human. This isn't an excuse, just a reality in a life that isn't perfect.

Things about me that have changed since I started my intern year of residency

1. I walk three times faster.
2. I eat all of my meals in around 3-5 minutes...even when I'm at home.
3. I feel like my leg is constantly vibrating.
4. My handwriting is getting sloppy.
5. I believe weekends to be nothing more than a myth.
6. I look forward to sleeping more than I do eating.
7. I get confused and/or feel incompetent at least once a day.
8. I speak in abbreviations.
9. I covet nice pens.
10. I consider waking up at 5:20 in the morning to be "sleeping in."

Where's Izzy? He needs to give this patient a hug

Another rotation down, many more to go. My days of being a surgeon are now behind me...not that I was ever really a surgeon in the first place. Most of my month was spent doing floor work and consults, with the occasional trip to the ER. I can't really complain though, because I wasn't really interested in getting into the OR. The trauma calls and surgical teams were more than enough excitement for me.

I'm thankful to be moving on, though I must say I'll miss the residents I was working with. Surprisingly, I really lucked out when it came to the team I was on. I had the easiest surgical residents to get along with in the entire hospital and have nothing but great things to say about the way they treated me as a rotator on the service (despite the title of this post, which was a common line thrown my way whenever I walked into a room full of surgeons...I guess you can't expect a family practice resident to get away without any ribbing whatsoever).

I knocked out nine surgical calls and didn't have a single person die on my watch, which as an intern on call is pretty much all you can ask for. I wish I had some exciting stories to tell about my nights on call, but for the most part it was just prescribing pain and nausea meds for post-op patients. I had a handful of people complain of chest pain (no MI's thankfully), had one patient take a nose dive off a bed, and had one person who needed to be ruled out for PE. The rest of the calls that I received (every 20 minutes like clockwork) were either for blood sugars or other minor things that I was easily able to handle.

I've got one day of OB under my belt so far, but it was a quiet one that didn't involve any deliveries. I'll write more about my new rotation in the upcoming days, for now I'm going to enjoy what's left of the rare long weekend.

Taking it one day at a time

I'm quickly finding that if I try to think ahead during my intern year I immediately feel overwhelmed and wonder how the hell I'm ever going to get through this. For survival...for sanity, I'm going to have to live in the moment and take things one day at a time. That's yet another learning process for me, because I'm more of a long-term kind of person and I tend to jump three or four steps ahead of the present.

My first surgery floor call went better than expected, which is a rarity for me. It also makes me worried that the next one will be a hellish ordeal beyond description. I still can't shake the feeling that I don't know enough. I'm tired in ways I never imagined so I'm going to cut this entry short. There's a lot I still want to say, but now I find myself not wanting to pour everything out.

Scattered PGY-1 notes

It's been a month since my graduation and I still haven't gotten used to the title. I don't ever use it when I sign things outside of the hospital and it feels strange to have people refer to me as a doctor. This past month has included a lot of orientation, a lot of organizational meetings, and getting a lot of things sorted out. There's also getting paperwork done, benefits sorted, and passing certification courses for neonatal resuscitation and advanced life support for obstetrics.

(For the benefit of those of you who don't know how a family medicine residency works, I wanted to give a quick run-down of what I'll be doing for the next year and what I can look forward to in the years to come. If you already know how all of this works, I'd suggest just skipping this part and expanding the post to read the rest.)

Family medicine has a three year residency program that basically runs the gamut of a lot of different specialties. In my first year I'm doing three months of family medicine, two months of obstetrics, two months of pediatrics, one month of medicine, two months of critical care (ICU/CCU), one month of ER, and one month of surgery. Throughout the whole year I'm also taking care of my patients at the family medicine center during specific half-days of the week.

Since it is my first year, all of my months are required and I have no electives. As a second year I'll have some more flexibility in choosing my specialty months, and I'll be seeing more patients in an office setting. In my third year I'll mainly be taking care of my family medicine patients and doing elective specialties.

Saying goodbye to good friends

With residency rapidly approaching for many of my friends, the time has come for them to pack up their things and move to their new homes. It's a bittersweet affair because they're excited to finally be starting, but we'll all be separated by long distances and long hours of working. I'm going today to help one of my dearest friends move out of her apartment. This will probably be the last time I see her for quite some time...

Dr. Izzy and the long white coat

The flurry of family activity is finally over. My medical school training is finally over. I'm now a doctor.

It really still hasn't set in yet, and I wonder how long it's going to take before I'm comfortable with the mantle of being an MD. I don't feel any different than I did a few days ago. I'm not smarter, more mature, or even more confident...this transition has been a few years in the making.

My graduation was really a day dedicated to my parents. It's hard to describe what it felt like to look into the audience and see them smiling at me, especially considering all the years they sacrificed to make sure that I had the best of everything and every opportunity to succeed. I honestly could have never have done it without them. Your hard work paid off mom and dad...I made it. Thank you.

For those of you who are unfamiliar with how a medical school graduation works, check out the photo album i've set up. I've described a lot of the ceremony through the picture captions.

Advanced cardiac life support testing

Today I completed the second day of my ACLS training and received a license that will last me for the next two years before I need to be re-certified. For those of you who don't know what is involved with ACLS testing, just think about your normal CPR class and then add in medication, intubation, EKG reading, and other hospital protocols. The reason why I'm writing about this is to gripe about the current system of testing and how it varies so much from hospital to hospital.

The course is offered through the American Heart Association and they are the entity that provides the textbook and review materials along with the written test that must be passed for certification. Along with the written test, however, different hospitals where the ACLS course is offered have requirements that are specific to their program. These specific requirements must also be met before certification is granted. In the course that I took, we not only had to pass the 33 question written test provided by the AHA, but we also had to complete a 20 strip EKG fill-in test, a 40 question general fill-in and matching test, and go through skill stations where we had to run a megacode, participate in a megacode as a group, and do CPR/use an AED. Now I have no problem doing all of this work because I know it'll make me more prepared when an emergency rolls in the hospital, but what ticks me off is how different courses can be even for hospitals less than 10 minutes away.

So this is what cattle feel like

For those of you who aren't familiar with it, the USMLE Step 2 Clinical Skills exam is a test us medical types must pass before starting our residencies in the hospital. My medical school requires us to pass an identical test named the Clinical Skills Assessment before graduation, so of course I'm of the belief that dropping an extra $1,000 for the Step 2 CS exam is tantamount to a shakedown. Besides the ridiculous price, the great thing about this test is that it's only offered in five select US locations, so if you're not immediately near any of these testing centers you'll have to add on travel costs. This was a test originally designed for foreign medical graduates so that their interaction/rapport, communication, and their clinical acumen with patients could be observed. This is the first year that US medical students are required to take this exam (Any surprise that I'd be in the first round? I thought not.) along with the clinical knowledge exam, which is your run of the mill multiple-choice exam. For those of you who haven't taken it yet (I'm sure there are a few of you out there) here's my experience...

ATL here I come

I'll be leaving tomorrow afternoon for Atlanta and my USMLE STEP 2 Clinical Skills Exam. It'll be a 12+ hour drive, but my iPod will keep me entertained and Jatster will be along for laughs (we're taking the test on the same day). A recap of the trip and the test experience will follow when I return on Friday. Until then, have a great week everyone.

The learning curve of a physician vs. patient care

In a January 28, 2002 piece, Dr. Atul Gawande wrote in The New Yorker about the conflict that exists between providing physicians-in-training with experience and giving patients the best possible care.

In medicine, there as long been a conflict between the imperative to give patients the best possible care and the need to provide novices with experience.

Like the tennis player and the oboist and the guy who fixes hard drives, we need practice to get good at what we do. There is on difference in medicine, though: we practice on people.

I've included quotations from the article interspersed with my own reactions from reading it. I'd love to hear what the rest of you think about this topic.

Fancy ways to pronounce words when you're a physician

I've heard each of these during medical conferences and had a chuckle. The longer a physician has been in practice and the more highly he/she is regarded, the more likely you will be to hear these variations.

centimeter = SON-o-meter

processes = PRO-cess-es

skeletal = ske-LE-tal

capillaries = ca-PILLARIES

eosinophils = EO-no-sinophils

Next phase ready to begin

It's good news all around today. I got my first choice of residency and so did Tim. The all-important news came at exactly 1pm today and we've been celebrating ever since talking about all the great things we're going to do while in residency (yeah I know, don't worry that'll wear off soon enough). If you've read his post on our school's match-day festivities you'll know why Tim and I decided to opt out of "all the fun." I'd rather have a more subdued celebration with close friends and family anyways.

What's funny is that this morning our apartment went from a complete pig sty to spotless courtesy of all the nervous energy surrounding match-day. Not only did Tim manage to clean the whole apartment, take out around 20 or so bags of garbage, and wash the dishes...he also managed to clean his room (I believe this to be the first time he's ever seen the floor in that room). That may not sound strange to you, but for anyone who knows how lazy this guy is, this is huge news. I'd be completely in favor with lighting a nervous fire under him at least once a week.

Today will be a day I'm sure I'll remember for years to come as the beginning of my professional road. It was nice to share it with a good friend like Tim...congratulations amigo, I told you there would be some major ass-kicking today.

UPDATE: To the person who came across this blog by searching for "where did I match?" I'm sorry I couldn't provide you with an answer, but I'm sure you made it into a fine program.

Did you match?

As Tim has already mentioned, today was the day all us med students found out whether or not we matched with a residency program. What's funny is that the title of this entry was also the subject heading of the email I received to give the good news. I think that "MATCH RESULTS" would have been a more appropriate title, but what do I know.

Last night wasn't too stressful for me considering that family practice isn't the most competitive residency out there, but there's always that small part of me that wonders "what if" and thinks the worse. One step down, many many more to go. On Thursday I'll find out which program rolled the dice on me ;-)

Congratulations to Tim and all of the other hot-shot medical students who matched today, we'll be celebrating soon enough.

Reality checkup time

Being that I'll be changing health insurance in a few months I decided to go ahead and get a checkup...the kid of checkup that I should ideally be having every year but haven't had in around four years. No need to tell me how irresponsible I am, I've told patient after patient that they need to have regular checkups.

I can vouch for the fact that people in medicine are often the worse when it comes to health maintenance. We hardly ever follow our own advice (usually the excuse is we're "too busy") and feel content to have an exasperated laugh after we've seen a patient who's let some aspect of their health go wildly out of control. I'll admit my own hypocrisy.

I fully expect to hear some bad news tomorrow and receive a scolding for the way in which I've taken care of myself. I know how the talk goes...in fact, I could probably mouth along in my head as the doctor runs down my risk factors. It'll be embarrassing to be the "non-compliant" office visit. I can see the note in my chart now, and I cringe at how it'll remain in there for someone to reference during my next office visit.

If there is a bright side to all of this it'll be that maybe now I'll be able to mouth along to the reply that my patients give me when I see them.

Interview #7

Pros:
- Unopposed program with a laid-back atmosphere
- More hands-on experience to be had, fits with my learning style
- More one-on-one teaching
- Good salary/benefits

Cons:
- Program does not have a well-known reputation
- Hospital is small and patient population not as diverse
- Electronic medical records not on the horizon
- Older facilities and no prospect of electronic medical records

Impression:
The only people who say good things about this program are the people who are in it, which is worrisome but understandable because of the small size of the hospital. I love how laid back the atmosphere is, and the fact that in the hospital you're treated like a doctor and not an intern from your very first day. The set-up is much more compatible with my learning style being that it's more hands-on/doing vs. listening.

Be careful out there

Being that I'm currently on trauma service, the posts around here have been few and far between. I'd apologize, but those of you who are regular readers know I hate being away for extended periods of time and only do it when I have no other choice. Anyways, I just wanted to remind all of you that it's still winter in most areas of the country and that ice is everywhere. I've seen more people in the ICU due to falls than I could have ever anticipated. Whether its coming out of the grocery store, walking out of the bar with friends, or going from the garage to the house, watch where you are going and pay attention to small patches of ice.

Interview #6

Pros:
- Large program with a lot of opportunities
- Diverse patient population and lots of pathology
- Would give me a flavor of both an opposed and unopposed residency program

Cons:
- Program is so large that it's impersonal
- Because the hospital is large patient rosters are enormous
- FP residents are mistreated by other residents in the hospital
- I wouldn't feel comfortable with the current crop of residents
- Benefits are the worse I've seen for any program

Impression:
Here's the perfect example of a program that looks great on paper but fizzles out in practice. My three years of residency would be a living hell at this program. I'm sure I'd learn a lot, but by the end I would be so miserable that I'm not sure it would be worth it. I won't rank this program for fear of actually getting in...

More bad reasons to bring your child to the ER

1. For crying for a half hour, then sleeping, then crying again (infants tend to do this)
2. For vomiting...once
3. For a stuffy nose
4. For having a temper tantrum
5. Because you want him to have a drug test
6. For a "bug bite" that occurred over two months ago
7. For a knee injury that was so severe your child was able to play two basketball games with it
8. For a complaint of stomach pain...even though he's currently eating cereal and asking for a popsicle
9. For a "fever of 99-point-something degrees"
10. Because you're going on a vacation and you "want him seen by a doctor" before you leave.

Remember that the ER stands for emergency room...which indicates that only people with emergencies should be using it. Before you dress up little Billy and take him in, think to yourself: "Is this something that I can make an appointment for with little Billy's primary care physician and take care of tomorrow?" If your answer is yes, take little Billy's coat off and stay home.

Interview #5

Pros:
- Program is in the area I would ideally like to practice in

Cons:
- Apparently malignant staff
- Resident personalities for the most part very stiff
- Associated with a hospital that breeds a hostile environment
- Poor hospital facilities
- No prospects of moving to electronic medical records

Impressions:
This is the interview that I knew was bound to happen sooner or later. Two of the attendings were very confrontational. One of them questioned me as if he didn't believe my CV and insulted my intelligence on more than one occasion. The other said I would be "a gamble" and that I "better not screw up step 2 [USMLE]." I knew I wasn't going to rank this program 30 seconds into my first interview.

They're not even worth wasting any time writing about.

Interview snafu

Apparently one of the programs I applied to was under the impression that my interview was to start today. This was news to me, especially considering I had made sure it was scheduled back-to-back with another program in the same area. Since these hospitals are quite a distance away from me, I wanted to save driving time and gas money. I feel bad about the whole misunderstanding, but I'm sure that the person making the schedule got confused somehow. Making it worse is the fact that an alumni was going to take me out to dinner and give me the heads-up about the program, and I think he rearranged his schedule to fit me in under this incorrect date. Hopefully I can reschedule, but I've been unable to get ahold of anyone all day today.

Interview #4

Pros:
- I know the program REALLY wants me there
- The program director is a great advocate for the residents and the program
- My FP role-model is one of the attendings
- I know the hospital well
- Residents get training in practice management
- I will have connections to the AAFP and leadership opportunities

Cons:
- I'm not as fond of the hospital
- The reputation of the program is still improving
- The cafeteria is horrible

Impressions:
I was very impressed with the case that the program director made. He made it very clear that I was wanted in the program and made me feel like he would go to bat for me whenever I needed it. The physician who was responsible for my final decision to enter family practice is one of the attendings and would be a great source of support. My decision is now made very difficult.

Interview #3

Pros:
- I know the program wants me there
- I get along with the current first and second-year residents
- The staff knows and likes me
- I know the hospital well
- I'll be working in a new practice center

Cons:
- Because I know the hospital so well, I know what services I'll loathe being on
- The work schedule will be more hectic
- I'll spend three years seeing a few faces I'd rather be far away from and a certain face that I don't think I could ever work with again

Impressions:
What an interesting interview day. It felt like the program did everything in their power to make me NOT want to choose them for residency. The residents in charge of hosting the candidates were nice, but the absolute worse choices from how well I know the rest of the staff. The dinner with the residents turned out to pretty much be a bust, only two residents attended and then we had to cut the night short because they had to get home by a certain time. I really do like the program, but I think I set them up in my mind to be better than they really are. I've come away with a different view of them as a candidate than I did as a student.

Interview #2

Pros:
- Comfortable and laid-back atmosphere
- Manageable schedule and hours
- Hospital is solvent and expanding
- Emphasis on community medicine
- High starting salary
- Great perks

Cons:
- Not my preferred area to work
- Although nice, I have a feeling about the resident director
- It almost seems like there are too many perks...it makes me wonder why they have to offer so much

Impressions:
Initially I was turned off because my interview was started two days early at around 10pm when a resident called me and started asking questions. I can't deny that the perks and pay are nice draws, as well as the fact that the hospital is doing well financially and growing. The atmosphere in the hospital felt real laid back and all the residents I talked to were happy with the program. The area where the hospital is at brings me some bad memories, but that's something I can get over.

2004 Medical Weblog Awards

I guess it was just a matter of time before this happened. There's now an official poll (complete with people already trying to stuff the ballot box) where you can help honor the best of the medical blogosphere. There's a few different categories, so go and nominate your favorite medical reads and then make sure to come back and vote for the winners.

The 2004 Medical Weblog Awards

My medical school experience in a nutshell

(while walking in the halls of the hospital)

Me: "...it's all about professional courtesy man."
Tim: "Whatever"
Me: "I'm serious, as long as you respect people they will respect you back."
Surgical Resident: (while walking toward me) "Dipshit."

Somtimes I swear that my life is a sitcom...without the laugh track.

Interview #1

Pros:
- A top private family practice center
- Affiliation with a top children's hospital
- Many research opportunities
- Lots of educational opportunities and workshops provided in-house
- FP program well connected and respected in the hospital
- Program can be custom tailored
- Diverse patient population

Cons:
- High inpatient load with no caps
- Horrible hours and post-call procedures
- Competitive atmosphere
- Less "perks" (no PDA, no bonuses, lower than average salary)
- Residents expected to do a greater than normal amount of teaching
- A good deal of travel time will be needed to get to peripheral centers

Impressions:
The interview itself went well, the program director said that they would love to have me at the center. The fact that I'm bilingual would be a plus because of the hispanic patient population and the fact that the only other spanish-speaking resident is leaving after this year. I was able to handle all the questions thrown at me and I didn't hesitate in answering any of them. The hospital is large and FP patients are spread throughout, so handling a large census could prove difficult.

Interviews begin tomorrow

So here I am on the eve of my first interview and I'm wondering what I'm in store for. I've asked around and gotten a general impression of what I should be expecting, but I my worrying nature is kicking in. I usually make a good impression during an interview, so I shouldn't be all that concerned. What I'm really wondering is how I'll be able to get a proper "feel" for the program I'll be visiting. Everyone is going to be "on their best behavior" and making things sound as good as possible, so I'll be trying to weed through the PR and get down to brass tacs. You can only read about a program so much, It'll be nice to see things first hand, take a walk through the hospital, and meet some of the residents I'd be working with. We'll see how it goes...

Radiology Elective

Yesterday my days of "sleeping in" ended when I started my radiology elective. Everyone that I've met so far has been pleasant and it should be a good month for me, especially considering it'll get shortened with the holidays and interviews. Besides the fact that I wanted to brush up on my chest x-ray reading, part of the reason I wanted a radiology elective this month was so that I'd have time to continue studying for Boards. A lot of my time is blocked off to "independent study," which means I should be able to get some good reading in. Couple that with the fact that Radio is typically known 'round these parts to not be the most demanding elective and you have a perfect recipe for juggling all the end of year hassle together.

Yes this is still a medical student weblog

I guess it's about time I put up a "medical post" around here eh? Part of the reason I haven't blogged much about medicine recently is because I'm on something of a holding pattern now. This has been my month off from rotations, which means I'm supposed to be studying for my Step 2 USMLE exam (the amount of studying getting done is another matter altogether). This is also the time of year when most fourth year students are starting to go through the interview process.

How to succeed as a medical student on clerkships and electives

From one student to others who may be starting out, I decided to jot down the things that I thought were key to having a successful clerkship/elective rotation. While in medical school you'll hear a lot of different things about what you should and shouldn't do, and legends and tales of students who didn't and what happened to them. I can assure you all of the tips that follow come directly from my own experience and are not exaggeration or legend. This list is by no means authoritative, but I wanted to write down the things that would have been nice for me to read when I was first starting out (and didn't have to pay for in one of those overpriced and overrated "what you should do" books that you can find everywhere). Those of you who have also gone through the drill, please feel free to add your own thoughts and advice in the comments.

Med student blogging: MIA?

I forget how I came across Nick's post over at Blogborygmi, but I can't help but commenting on it with a post of my own. He asked where all of the medical student bloggers are hiding, because there is a relatively small number of us writing when you compare to other professionals-in-training such as law students. Mary, a law student who writes at Naked Furniture had even picked up on this, and both her and Nick had come up with ideas about why there is such a discrepancy in numbers. I can't argue with their reasoning.

I happen to have a few of my own hypotheses, however.

They're out there

Working in a hospital gives a person a skewed view of society. You're exposed to a different subset of society that you would have no way to recognize...even if they were your neighbors. There are a lot more unstable people in this world than you would think. I know I've been surprised at how many I've come across. Here's two stories to show you what I mean.

Grand Rounds Archive

A new Grand Rounds is posted every Tuesday. For those of you who've missed a week or want to re-read without having to hunt around for the links, Grand Rounds permalinks are listed below in descending order. If you're interested in reading my own medical musings you can find them here.

Upcoming:

Vol. 3, No. 25 - Week 129 (03-13-07) hosted @ Science Roll

Vol. 3, No. 24 - Week 128 (03-06-07) hosted @ Grunt Doc

Current:
Vol. 3, No. 23 - Week 127 (02-27-07) hosted @ Musings of a Dinosaur

Previous:

Vol. 3, No. 22 - Week 126 (02-20-07) hosted @ Pure Pedantry

Vol. 3, No. 21 - Week 125 (02-13-07) hosted @ Chronic Babe

Vol. 3, No. 20 - Week 124 (02-06-07) hosted @ Tales from the ER and beyond...

Vol. 3, No. 19 - Week 123 (01-30-07) hosted @ Envisioning 2.0

Vol. 3, No. 18 - Week 122 (01-23-07) hosted @ Signout

Vol. 3, No. 17 - Week 121 (01-16-07) hosted @ Six Until Me

Vol. 3, No. 16 - Week 120 (01-09-07) hosted @ Dr. John La Puma

Vol. 3, No. 15 - Week 119 (01-02-07) hosted @ Musings of a Distractible Mind

Vol. 3, No. 14 - Week 118 (12-26-06) hosted @ Blogborygmi

Vol. 3, No. 13 - Week 117 (12-19-06) hosted @ Nurse Ratched's Place

Vol. 3, No. 12 - Week 116 (12-12-06) hosted @ Anxiety, Addiction and Depression Treatments

Vol. 3, No. 11 - Week 115 (12-05-06) hosted @ The Antidote

Vol. 3, No. 10 - Week 114 (11-28-06) hosted @ Dr. RW

Vol. 3, No. 09 - Week 113 (11-21-06) hosted @ Doctor Anonymous

Vol. 3, No. 08 - Week 112 (11-14-06) hosted @ The Rumors Were True

Vol. 3, No. 07 - Week 111 (11-07-06) hosted @ MSSP Nexus

Vol. 3, No. 06 - Week 110 (10-31-06) hosted @ Dr. Hebert's Medical Gumbo

Vol. 3, No. 05 - Week 109 (10-24-06) hosted @ Health Care Law Blog

Vol. 3, No. 04 - Week 108 (10-17-06) hosted @ EmergiBlog

Vol. 3, No. 03 - Week 107 (10-10-06) hosted @ Unbounded Medicine

Vol. 3, No. 02 - Week 106 (10-03-06) hosted @ RDoctor Medical

Vol. 3, No. 01 - Week 105 (09-26-06) hosted @ Healthline/Enoch Choi

Volume 2:

Vol. 2, No. 52 - Week 104 (09-19-06) hosted @ Tundra Medicine Dreams

Vol. 2, No. 51 - Week 103 (09-12-06) hosted @ Diabetes Mine

Vol. 2, No. 50 - Week 102 (09-05-06) hosted @ Clinical Cases and Images Blog

Vol. 2, No. 49 - Week 101 (08-29-06) hosted @ Protect The Airway

Vol. 2, No. 48 - Week 100 (08-22-06) hosted @ The Examining Room of Dr. Charles

Vol. 2, No. 47 - Week 99 (08-15-06) hosted @ Hospital Impact

Vol. 2, No. 46 - Week 98 (08-08-06) hosted @ Mexico Medical Student

Vol. 2, No. 45 - Week 97 (08-01-06) hosted @ Inside Surgery

Vol. 2, No. 44 - Week 96 (07-25-06) hosted @ Medical Humanities

Vol. 2, No. 43 - Week 95 (07-18-06) hosted @ ChronicBabe

Vol. 2, No. 42 - Week 94 (07-11-06) hosted @ DonorCycle

Vol. 2, No. 41 - Week 93 (07-04-06) hosted @ Rangel, MD

Vol. 2, No. 40 - Week 92 (06-27-06) hosted @ MedViews

Vol. 2, No. 39 - Week 91 (06-20-06) hosted @ Psychological Perspectives

Vol. 2, No. 38 - Week 90 (06-13-06) hosted @ The Haversian Canal

Vol. 2, No. 37 - Week 89 (06-06-06) hosted @ The Medical Blog Network

Vol. 2, No. 36 - Week 88 (05-30-06) hosted @ KidneyNotes

Vol. 2, No. 35 - Week 87 (05-23-06) hosted @ Parallel Universes

Vol. 2, No. 34 - Week 86 (05-16-06) hosted @ Doc Around the Clock

Vol. 2, No. 33 - Week 85 (05-09-06) hosted @ Aeitology

Vol. 2, No. 32 - Week 84 (05-02-06) hosted @ Polite Dissent

Vol. 2, No. 31 - Week 83 (04-25-06) hosted @ Health Business Blog

Vol. 2, No. 30 - Week 82 (04-18-06) hosted @ Fat Doctor

Vol. 2, No. 29 - Week 81 (04-11-06) hosted @ Anxiety, Addiction and Depression Treatments

Vol. 2, No. 28 - Week 80 (04-04-06) hosted @ UroStream

Vol. 2, No. 27 - Week 79 (03-28-06) hosted @ NHS Blog Doctor

Vol. 2, No. 26 - Week 78 (03-21-06) hosted @ Healthy Concerns

Vol. 2, No. 25 - Week 77 (03-14-06) hosted @ GeekNurse

Vol. 2, No. 24 - Week 76 (03-07-06) hosted @ Emergiblog

Vol. 2, No. 23 - Week 75 (02-28-06) hosted @ A Chance to Cut is a Chance to Cure

Vol. 2, No. 22 - Week 74 (02-21-06) hosted @ Doctor Andy

Vol. 2, No. 21 - Week 73 (02-14-06) hosted @ Intueri

Vol. 2, No. 20 - Week 72 (02-07-06) hosted @ Science and Politics

Vol. 2, No. 19 - Week 71 (01-31-06) hosted @ Barbados Butterfly

Vol. 2, No. 18 - Week 70 (01-24-06) hosted @ Kevin, MD

Vol. 2, No. 17 - Week 69 (01-17-06) hosted @ Grunt Doc

Vol. 2, No. 16 - Week 68 (01-10-06) hosted @ Clinical Cases and Images

Vol. 2, No. 15 - Week 67 (01-03-06) hosted @ Random Acts of Reality

Vol. 2, No. 14 - Week 66 (12-27-05) hosted @ The Health Care Blog

Vol. 2, No. 13 - Week 65 (12-20-05) hosted @ Medpundit

Vol. 2, No. 12 - Week 64 (12-13-05) hosted @ In the Pipeline

Vol. 2, No. 11 - Week 63 (12-06-05) hosted @ The Examining Room of Dr. Charles

Vol. 2, No. 10 - Week 62 (11-29-05) hosted @ Over My Med Body!

Vol. 2, No. 09 - Week 61 (11-22-05) hosted @ Code Blog: Tales of a Nurse

Vol. 2, No. 08 - Week 60 (11-15-05) hosted @ Mr. Hassle's Long Underpants

Vol. 2, No. 07 - Week 59 (11-08-05) hosted @ MSSP Nexus

Vol. 2, No. 06 - Week 58 (11-01-05) hosted @ KidneyNotes

Vol. 2, No. 05 - Week 57 (10-25-05) hosted @ Hospital Impact

Vol. 2, No. 04 - Week 56 (10-18-05) hosted @ Diabetes Mine

Vol. 2, No. 03 - Week 55 (10-11-05) hosted @ Doulicia

Vol. 2, No. 02 - Week 54 (10-04-05) hosted @ Haversian Canal

Vol. 2, No. 01 - Week 53 (09-27-05) hosted @ DocNotes

Volume 1 - The Inaugural Year:

Week 52 (09-20-05) hosted @ Soundpractice

Week 51 (09-13-05) hosted @ Sneezing Po

Week 50 (09-06-05) hosted @ Corpus Callosum

Week 49 (08-30-05) hosted @ Healthy Concerns

Week 48 (08-23-05) hosted @ Straight From the Doc

Week 47 (08-16-05) hosted @ Circadiana

Week 46 (08-09-05) hosted @ Dr. Emer

Week 45 (08-02-05) hosted @ Alois, MD

Week 44 (07-26-05) hosted @ Pharyngula

Week 43 (07-19-05) hosted @ Aggravated DocSurg

Week 42 (07-12-05) hosted @ Shrinkette

Week 41 (07-05-05) hosted @ Medical Connectivity

Week 40 (06-28-05) hosted @ Health Business Blog

Week 39 (06-21-05) hosted @ A Chance to Cut is a Chance to Cure

Week 38 (06-14-05) hosted @ Red State Moron

Week 37 (06-07-05) hosted @ Medgadget

Week 36 (05-31-05) hosted @ Dr. Sanity

Week 35 (05-24-05) hosted @ The Chaplin.News

Week 34 (05-17-05) hosted @ Galen's Log

Week 33 (05-10-05) hosted @ Azygos

Week 32 (05-03-05) hosted @ Mudfud

Week 31 (04-26-05) hosted @ Dr. Tony

Week 30 (04-19-05) hosted @ Living the Scientific Life

Week 29 (04-12-05) hosted @ GruntDoc

Week 28 (04-05-05) hosted @ Polite Dissent

Week 27 (03-29-05) hosted @ Over My Med Body!

Week 26 (03-22-05) hosted @ The Well-Timed Period

Week 25 (03-15-05) hosted @ Respectful Insolence

Week 24 (03-08-05) hosted @ Hospice Blog

Week 23 (03-01-05) hosted @ Intueri

Week 22 (02-22-05) hosted @ Catallarchy

Week 21 (02-15-05) hosted @ Sumer's Radiology Site

Week 20 (02-08-05) hosted @ Enoch Choi's Medmusings

Week 19 (02-01-05) hosted @ Daily Capsules

Week 18 (01-25-05) hosted @ A Chance to Cut is a Chance to Cure

Week 17 (01-18-05) hosted @ Waking up Costs

Week 16 (01-11-05) hosted @ Chronicles of a Medical Madhouse

Week 15 (01-04-05) hosted @ Rangel, MD

Week 14 (12-28-04) hosted @ CodeBlog: Tales of a Nurse

Week 13 (12-21-04) hosted @ Code Blue Blog

Week 12 (12-14-04) hosted @ Parallel Universes

Week 11 (12-07-04) hosted @ The Examining Room of Dr. Charles