2016

Well, it’s a new year. And the fact that it’s now 2016 means that it’s almost the class of 2017’s turn to gear up for residency applications.

How is my residency application prep going, you ask?

Oh, it’s going great. I totally know what I’m doing.

< Lays fetal >

But seriously, I’m a bit overwhelmed. I still need to:

1. Figure out for sure what field I want to go into (the fact that this is #1 on the list is not a good sign)
2. Write my Personal Statement for the field I want to go into (again, not 100% sure what I want to do)
3. Get at least 3 great Letters of Recommendation
4. Take COMLEX Level 2 PE and CE sometime this year
5. Set up audition/elective rotations

With regards to #1, I’m about 70% set on the specialty I think I want to go into. The only problem is that I haven’t had my rotation in it yet. The issue this brings up is that I’m kind of blindly figuring out 4th year without really having concrete experience in this specialty. Is it possible that I’ll hate it and I would have applied for all these audition rotations in it for nothing? Yes. Does this scare me? A little bit, but to be honest I’ve pretty much ruled out almost everything else.

With that being said, I’ve been looking through VSAS at potential programs to apply to. I can already tell this is going to be a huge pain:

1. Some programs require proof of taking the USMLE if you’re a DO student with a strict score cut-off. DO students who have only taken COMLEX are not considered
2. Some programs want DO students to pay 5x more to submit a VSAS application compared to an MD student. We’re talking about $1,000+ just to submit an application.
3. Some programs require multiple letters of recommendation as part of the application
4. Some programs want you to also submit a copy of your Personal Statement (yeah because we’ve all typed one out already)
5. Some programs want a statement of interest specific to their program
6. Each program has it’s own health forms that need to be filled out and signed by your PCP. They’re all different.
7. Some programs won’t review applications until late spring-early summer, which means we won’t hear back from them until the beginning of M4 year. Waiting to hear back from those programs perhaps weeks before my planned audition rotation is going to be a lot of fun and not at all stressful.

 

I can tell that this is going to be a fantastic year.

-NB

Pens

“Hey, I need to use your pen”

My attending snaps her fingers in front of my face

“Oh yeah, of course” I quickly grab my pen from my white coat pocket and place it in her impatient hands. It’s one of those big Pilot pens. I use it all the time.

She grabs a printed script, scribbles her signature, and freely tosses my pen on the keyboard. It clatters loudly.

I’m going to get that back, right?, I think to myself. Surely she’s going to remember to give it back to me at the end of the day. I’ve had that pen forever. It’s my best pen and they don’t make that model anymore.

It soon becomes more and more apparent that she forgot it’s my pen. By noon she had pocketed it in her white coat. The interesting thing was that there were other pens lying around, she would just selectively use my pen to sign off the prescriptions.

The day goes on and I start to accept the fact that I’m about to lose my favorite pen forever. Maybe I should just let it be, I think. It’s just a pen.  Patients come and go. My attending continues to use my pen to sign off prescriptions.

Hours pass and it’s now dark outside. My attending tells me to go home since the last patient cancelled.

“Okay great. I’ll see you tomorrow. By the way, can I get my pen back?”

I said it without thinking. She stares at me for a second as if trying to process what I just said. The edges of her mouth slightly curl upwards – her version of a smile.

“Of course. It’s a nice pen by the way”

I know it’s a nice pen. That’s why I wanted it back.

She hands me back my pen.

The next day, I placed my nice pen in the inside pocket of my white coat and placed some slightly less-nice decoy pens for display in the outside pocket. Amazingly, my attending needed to use one of my pens again. I handed her a decoy pen, which she used for the entire day. I thought about asking for it back when she sent me home, but didn’t want to seem like I’m some kind of pen-freak and let it go. I was still kind of sad since even though it’s not my best pen, it’s still a pretty awesome pen. I actually ended up buying a 3-pack of it after I got the first one because I liked it so much.

At the time I thought this was okay. Giving up one of my less-nice pens is not a big deal. However, my attending has asked me for a pen two other times. Essentially what has happened is that she has lost an entire 3-pack of my slightly less-nice decoy pens within a 3 week period.

Now I have to go buy a 60-pack of BIC pens to serve as decoy to my decoy pens.

At least I still have my nice Pilot pen.

-NB

Ready, Set, Go.

My class can now officially access VSAS, or Visiting Student Application Service. This is what we’ll be using to help us schedule our elective and audition rotations for our last year of medical school.

I don’t know what field I want to go into. I’m still deciding between about 4 specialties, so I can’t exactly start planning for my fourth year just yet. At this point, I really wish I explored some specialties and subspecialties earlier on. I should have looked at some things in more depth, especially those that we don’t have a core rotation in (I’m looking at you, rads and neuro).

I’m trying to make the most out of all this by taking advantage of any opportunities that come along to check out other specialties. Surprisingly, I’ve gotten to see a decent amount of radiology during some of my rotations, in addition to several of the internal medicine subspecialties like infectious disease, nephrology, and cardiology. If anything, I’ve learned that just asking the attending to go see or do something usually results in a “Yeah sure, go ahead”.

All that being said, not knowing what I want to go into is eating me alive. I actually feel more stressed out than I’ve ever been. I think I’m just scared of picking  the wrong specialty and having to deal with it for the rest of my life. It’s really a race against time. I need to figure out what I want to do by March when programs start accepting applications for elective rotations. The problem is that most of the specialties I’m considering are those that I haven’t even rotated in yet. I didn’t think my M3 schedule was bad, until now. I’ve had such a primary-care-heavy M3 year so far that I haven’t had the chance to look into the more competitive and more specialized areas of medicine…

It feels like this year is going by faster and faster and all I want is for it to slow down so I can catch my breath.

-NB

Updates

I passed my COMLEX, what a relief. With all the horror stories of students in my class scoring 100-200 points below their last practice test and subsequently failing the real thing I’m glad that I won’t have to take that 9 hour exam ever again.

Next up: USMLE Step 1. I’m not going to lie, at this point I am completely burnt out. I’m working my ass off during rotations so I can get good evaluations, and I’m also studying for my shelf exams. Here at NSU, part of the requirement to receive Pass with Honors for a rotation is to honor the shelf exam. I’m going to point out that the shelf exams are not like the regular exams given during M1-M2 year. They’re nationally administered exams by the NBOME and you’re given a score based on how you did against other third year DO students. If shelf exams and rotation grades weren’t enough to worry about for third year, it’s also recommended that we study for Level 2/Step 2 as we go through our rotation months. So the question is, how the hell am I supposed to study for Step 1, Level 2/Step 2 while trying to also do well on my shelf exams?

I don’t know, I’m still trying to figure it out.

By now many of you are probably wondering why I’m even considering still taking the USMLE Step 1. Why not focus my efforts on my shelf exams and Level 2/Step 2? You’re right, I should. It would make things a lot simpler. A large part of my reasoning why I still want to take it is that I don’t know what I want to be when I grow up yet. I don’t want to have my “ah-hah!” moment sometime next year and then think, “Oh crap, if I had taken Step 1 and done well, it would have opened more doors when applying for residency in this specialty”. Of course, the key here is that I do well on Step 1. It won’t mean anything if I take it and get a crappy score. If that were to happen then I would have dug a hole for myself. Not only would time have been wasted on studying for an exam I didn’t do well in, but that time could have been spent getting better shelf scores or preparing more for Level 2/Step 2. In other words, I would have completely screwed myself over. When it comes to taking any of the USMLE exams as a DO student, the thing is that it’s all or nothing- if you take it, you need to do well.

So, yeah, I’m scared.

Am I going to sink or am I going to swim?

DRE

Attending: Alright Mr. Smith. I’m going to check your prostate, so drop your pants and lean over on your elbows on the table there.

Patient (visibly uncomfortable0: Ohhh god…I really do not like these…do I have to?

Attending: I mean, I’m not going to make you do something you don’t want to, but it is a quick and easy way for me to check your prostate and to see if there’s any blood in your stool.

Patient: ..Ughhh…Okay…Fine…

Attending: Okay, take a deep breath in. You’re gonna feel some pressure.

Patient: Okay…< inhales deeply >

Attending: Actually wait. Stop.

Patient: ………………….

Attending (turning towards us): Medical students, tell me what the contraindications are for doing a digital rectal exam

Other M3: Uhm…anal fissures? Hemorrhoids? Lots of anal bleeding..?

Attending: Noo..

Me: Uhh..if you have no fingers or if the patient has no anus.

Attending: Yes, and, if you have no glove!!!

The three of us laugh. The patient is still butt naked, leaning over on his elbows, looking at us like he wants to kill us.

Rotations, month 3

I have the following conversation with almost every patient:

What school do you go to?

Nova

Are you an intern?? Like in Grey’s Anatomy?

No. I’m a medical student.

What year are you?

Third

So then how many years until you’re done?

One more year after this

And how many years for training?

Depends on what I specialize in

So then what do you want to specialize in?

I don’t really know

How are you liking it here so far?

(If the attending is not in the room): It’s good, I like it

(If the attending is in the room): It’s great, I love it!

We’re three months into rotations, about to start our fourth. I still haven’t had my “Ah-hah!” moment. I still don’t know what to do. In order to make myself feel a little productive, I’ve recently made a short list of things that I might consider doing:

• Emergency medicine
• Anesthesiology
• Obstetrics/gyn
• GI
• Infectious disease
• Something surgical

The M4s are now in the midst of the residency application cycle. I’m going to be doing the same thing in less than a year and I don’t even know what to specialize in. Most people tell me to do IM because at least there are a bunch of fellowships I can sub-specialize in and if I end up not liking one thing then I can “just do another fellowship”. To be honest it doesn’t sound like the greatest idea to me. A student I rotated with said that I should do ortho because I “like to fix things”, and a patient of mine told me to do EM because I seem like I’ll become “the kind of doctor that doesn’t tolerate any BS” (thanks…I guess?). It kind of sucks not really knowing what to go into because I’m trying to figure out logistics for audition rotations and it’s kind of hard to do that if I don’t know what to audition in.

Anyway, I’ll just sit here and wait for my board scores. I guess if I do awful I’ll add psych onto my list.

kidding.

-NB

Rotations and Boards

An accurate representation of what it’s like studying for boards while trying to survive a tough rotation:

For those of us who decided it’s not worth taking the Leave of Absence, we’re basically trying to make board studying work with rotations. It’s not as impossible as I thought it would be, but it’s still been a bit of a struggle. I try not to complain about it since I chose to do this to myself. The only real silver lining is that rotations solidify what I’m studying in First Aid, Pathoma, DIT, etc. I definitely don’t have study time like I did during my dedicated studying period- on some days I can’t study more than a couple hours. Not to mention I still need to do well on my rotations, so some of the “free” time I have is taken up preparing case presentations and looking up things that I’ll probably get pimped on… So to all my classmates going through the struggle of studying for boards while doing rotations, I feel you. It’s rough but I’m going to be optimistic and say that in the end, this was better for us.

The deadline to take the COMLEX (USMLE is not mandated) for our school is the end of September, with some exceptions. September starts tomorrow, so yeah I’m kind of freaking out now. I’m supposed to take a practice COMLEX exam sometime within the next week. I’ll be really panicked if I score about the same as my first practice test which I took in June. To push the exam back and go through the hell of board studying while doing rotations only to have minimal improvement on a practice test months later will be a horrible situation. To be honest I have no idea what I would do if that happened.

Brb, I need to go breathe into a paper bag.

-NB

The First Two Weeks of Clerkships

I noticed that for the past two years, I’ve have some kind of post that summarizes the first two weeks of the new academic year. When I was an M1, it was The First Two Weeks of Medical School at NSU. When I was an M2, it was The Start of M2 Year. So, as an M3, it’s only fitting that I make another one of these posts and call it The First Two Weeks of Clerkships.

I’ve been on my rotation for 2 weeks now. It’s been crazy.

But at the same time, it’s amazing. What really blows my mind that I can see patients with disease processes that I’ve only read about in books. Up until rotations started I’ve never actually heard an aortic stenosis, or seen a person completely yellow with jaundice, or help dress a massive lesion. I think the craziest thing is that I’m actually somewhat responsible for patients with actual health concerns- I have to go speak with a new patient and ask them pertinent questions so that I can report back to my resident/attending. If I forget a question, I get sent back to do it again. The nurse will ask me about the team’s assessment and plan- when are we switching to PO? Are we planning on switching the antibiotics now that the urine cultures grew different bacteria than we expected?  And the patient and their family ask about the condition. What exactly is a stroke? Why isn’t my dad a candidate for surgery? I mean..I just finished M2 year a couple months ago, and yet the difference between M2 year and M3 year is huge. The change is great. I’m stressed out 90% of the time, but overall it has been a wonderful experience. I’m seeing a lot, and most importantly, I’m learning a lot. Being a good clinician is definitely an art form and that’s clear to me now more than ever.

I thought it would be interesting for the reader if I went back and answered my own pre-clinical questions that I had in my last post. It’s only been about two weeks but I’ve surprisingly gathered enough exposure on my rotation to thoroughly answer these.

Is my attending going to be a jerk?

No. My attending is nice, but he’s very no-nonsense/cut the BS/lets-get-to-the-point kind of doctor. I can tell it annoys the crap out of him when he asks someone a question and they give this super long detailed explanation for something when they literally could have just answered yes or no.

That being said, that doesn’t mean he doesn’t pimp us. We get grilled all the time. You can’t prepare for them, at least not all of them. The good thing is that not knowing the answer is fine. However, we do get told, “How about you look that up and give us a presentation on it tomorrow?” a lot, which I’m assuming is the super nice way of saying, “How the hell do you not know that by now?”. I’ve had to give two presentations so far, which is more than the other students in my group. Awesome.

Will the residents and attending actually take the time to teach me things, or are they going to expect me to know what to do on the first day?

This was pure luck of the draw, but both my resident and attending take the time to teach. There are some things that they definitely expect me to know as an M3, but in the case I don’t know it or don’t remember, then there isn’t any scolding or yelling. That’s a good thing, since I’m not sure my fragile M3 heart could survive getting yelled at by a physician.

Is there going to be an M4 that can show me the ropes?

Also pure luck, but I had an M4 with me for the first couple days who was super helpful. She showed me how to use the EMR system, how to present, what the schedule is like, and gave me some general advice for M3 year. There was also an M3 that started rotations several weeks before me, so he also helped me out a lot.

How exactly do I work the EMR system?

I was having a hard time when I first started using the EMR system we have at my site but having practiced for 2 weeks now, I’ve gotten pretty proficient. Once in a while someone will see me struggling to type a note and will give me a useful tip.

When am I going to eat?

At home. At least, in the beginning it was like that. For the first couple days I didn’t have time to eat lunch or dinner at all. The only meal I had would be some cereal in the morning before I left and then I wouldn’t have another meal for over 12 hours. It kind of scared me because I was afraid I would pass out from exhaustion. Something that has helped is bringing snacks and keeping them in my scrub pockets or white coat pocket. When I actually have a chance to breath I’ll sneak off somewhere where no one can see me and shove a bunch of snack into my mouth. It sounds horrible but it’s gotten better over the last week or so. Nowadays I can usually find a little bit of time to grab some lunch real quick. I usually still bring snacks if I’m on call though.

Will I have time to pee urinate?

Your resident tells you to take a quick 2 minute break. Do you choose to pee, or do you choose to eat? I choose to eat.

Jokes aside, I actually drink less water now so I don’t have to go to the bathroom as frequently. I feel kind of dehydrated at the end of the day but it’s a necessary sacrifice.

What if a patient codes on me?

Yeah, two weeks in and we’ve already had a code blue. Actually we’ve had several. Basically we run into the room and try to help where we can. Being a lowly M3 I usually just stand out of the way and watch as the doctors, nurses, and techs yell at each other. It’s madness.

What if I get ridiculed in front of everyone?

I haven’t gotten ridiculed, but I’ve said and/or done some pretty stupid things that were embarrassing. Only thing to do is to just learn from them and move on.

What if my attending thinks I’m an idiot?

My attending still asks me questions, so that makes me believe that he thinks I’m at least somewhat capable as a medical student. However, if my attending does think I’m a idiot, that also wouldn’t surprise me, so…yeah I have no idea. I’m planning on asking for a mid-rotation evaluation to see how I can improve. Hopefully that will be more insightful.

What if my patients don’t like me?

Unlike some people I’m not an awkward shell of a person with no empathy, so..my patients actually like me

What if I don’t know the proper medical term for something?

The other day one of our interns said, “the patient is peeing okay” and we all cringed. The attending looked annoyed. It’s definitely professional to say the proper medical term when possible. I haven’t had an experience where I don’t know the medical term for something..yet.

What if my coat pockets rip because I have too much crap in them?

I used to carry a ton of things in my pockets. However, after seeing the M4s and other M3s and what they carry, I’ve emptied my pockets quite a bit.

How much professional attire should I buy to minimize doing laundry?

I have enough shoes/pant/shirt combos for about 10 unique outfits. To my surprise, we don’t have to wear professional attire everyday so I’ve actually been able to go through almost 3 weeks of rotations without using up all of my professional attire combos. Just to be clear, I have done laundry multiple times in the past several weeks. I’m not a degenerate.

Should I wear a bullet-proof vest under my professional attire in case another student tries to gun me down?

In case you couldn’t figure it out in my last post, this was one of my non-serious questions. Unfortunately, it turned out that I actually should have worn a bullet-proof vest because gunners gonna gun. Not to go into too much detail, but I can’t believe the lengths some people go to in order to make themselves look good and make you look bad. It’s pathetic and sad. Speaking with some other students both at my rotation site and at others, this doesn’t seem like an uncommon occurrence. The only thing that helps is other people (i.e. students and physicians) also seeing through the BS.

There are a bunch of stories I could talk about, but for the sake of time (which I’m really short on) I won’t go into them. I’m studying for boards while on rotations, and yes, it’s as horrible as it sounds. Rotations has been giving me a good clinical perspective by which to approach some of the questions, but I’m definitely not banking on that to help my score. Anyways, I’ll probably be back in a couple weeks. I have to go study some heme.

-NB

Pre-M3 year thoughts

It’s my last several days of M2-M3 limbo. It kind of sucks..I really liked being an M2. I knew how NSU works, I knew where I was supposed to go, I knew what to expect for our exams, and I got to help out M1s and give advice about pre-clinical classes. But, now I’m going to be an M3, where I’ll be entering a whole new arena. I’m going to be completely clueless. I’m going to have to regurgitate information verbally instead of on a multiple-guess styled exam. Everything will be different. I’m excited, but I’m nervous too. It reminds me of how I felt prior to starting medical school.

With rotations coming up so soon, I’ve been having a lot of thoughts about what I’m supposed to expect. I’ve obviously never done this before so the only thing I have to go off of are stories from other students and reading anecdotes online. After hearing about how other students’ rotations went, I have several pre-clinical anxiety-induced questions:

Is my attending going to be a jerk?

Will the residents and attending actually take the time to teach me things, or are they going to expect me to know what to do on the first day?

Is there going to be an M4 that can show me the ropes?

How exactly do I work the EMR system?

When am I going to eat?

Will I have time to pee urinate?

What if a patient codes on me?

What if I get ridiculed in front of everyone?

What if my attending thinks I’m an idiot?

What if my patients don’t like me?

What if I don’t know the proper medical term for something?

What if my coat pockets rip because I have too much crap in them?

How much professional attire should I buy to minimize doing laundry?

Should I wear a bullet-proof vest under my professional attire in case another student tries to gun me down?

Some of those questions are serious.

I went on amazon and bought things that I’ve heard M3s should have for rotations. Small notepads, black pens, colored pens, and pen lights, amongst other things specific to my rotation. I think I’m pretty stocked up now. I probably should order another white coat too. I should have done that earlier (i.e. anytime within the past two years).

I’m going to be making a Clinical Page on the menu but it won’t be ready or accessible for probably another 6 months or so. It’ll basically be an M3 survival guide meant to help out all M3s, not just those at NSUCOM. I’ll also add my Step 1 experience around that time if I feel like it/have the time to add another page. We’ll see. Maybe I won’t even have time to add the Clinical Page. I’ve heard rotations are crazy.

In the meantime, check back once in a while to see if I’m liking M3 year. I have no idea what I want to specialize in yet, so I’m going to try to be open minded about every rotation. I have some classmates that came into medical school with their mind set on a specialty and they’ve stuck with it through the years. How did they know so definitively that xyz was what they wanted to specialize in? Sometimes I can’t even decide what I want to eat for lunch, and when I do finally decide, half the time I wish I ate something else. I’m totally screwed, aren’t I? I hope one day during rotations it just hits me and I’ll have a “Ah-hah! This is what I want to do for the rest of my life!” moment.

Anyways, wish me luck! Into the abyss I go.

-NB

The Struggle Is Real

Yes, I’m still alive (barely)

I realize I haven’t posted in a while. The truth is there hasn’t really been anything of interest to report. I’m not going to school since we’re done with class and I haven’t done anything since school ended. I wake up, I study for boards, I eat, I sleep. Rinse and repeat. That’s what I do. Every. Freaking. Day. At one point I didn’t leave my apartment for a whole week. The only reason why I even had to leave was because I had completely run out of food and coffee. Also, I have no idea what day of the week it is anymore. It’s either Wake-up-and-panic Day or Wake-up-and-panic-slightly-less Day.

Studying for boards sucks, some days more so than others. Once in a while I’ll do well on my question blocks and be like, “Yes! I’m making so much progress!” and then the next day my percentage will go down again and I’m just like

It’s a love-hate relationship. Mostly hate.

On the brighter side, my cumulative performance graph shows that I’m slowly making improvements. I can’t emphasize the word “slowly” enough. It has taken me months to bump my average up. I took a practice test after school ended as a baseline, and another one after going through most of the material. I saw a moderate increase in my scores, but I’m not where I want to be at this point in the game. I talked to some upperclassmen and my friends at DO and MD schools. They only confirmed what I knew has to be done: I have to push back my exam dates.

We’re officially in June which is the unofficial boards month. There’s a circulating rumor that our class went a little crazy and over 80% of us registered for both the COMLEX and the USMLE. Compare that to the usual 30-40% seen in other years. Honestly I think it’s a huge exaggeration. Even if 80% of us originally planned on taking both exams, it sure isn’t 80% anymore- many students who originally said they were taking both board exams ended up only signing up for COMLEX or canceling their USMLE last minute. At the least, many people are pushing their exams back. I’m still planning on taking both, for now.

I admit that it’s kind of discouraging to see so many of my classmates decide not to take the USMLE. It kind of makes me feel like I’m all alone in this, especially since so many of my immediate friends aren’t taking it. The only thing that’s preventing me from completely going insane is having a support system outside of school.

Another rumor that seems to be flying around is that a ton, and I mean a ton of people requested to have the month of July off. Our rotations are supposed to start July 1st, so requesting July off counts as an official Leave of Absence (read: it goes on your residency application). I’ve heard 60-70 people requested a LoA. Apparently, this number is usually 2-3 people a year max, but, again, my class is *special*. I think what happened was that some people had a legitimate reason for taking the LoA (family obligations, personal medical issues), and other students got wind of how those students got extra board study time. Eventually the whole thing just turned into “Wait, I can get a whole month of dedicated studying back if I talk to a faculty member and get July off? That sounds like a good deal”. Honestly I’d be lying if I said I didn’t think about it. Having a whole month of dedicated at this point would be huge. In the end though, I decided against it. The cons aren’t worth it, especially since I don’t actually have a legitimate LoA reason other than to study for boards.

Switching gears here, the other day I went back and looked at some of my older posts. I had a good laugh at my post from M1 year about our first anatomy exam. I can’t believe we used to freak out about anatomy. Here we are now as soon-to-be-M3s about to take our board exams that will, for the most part, determine the fate of our professional lives. No big deal, no pressure. It only covers everything we’ve learned so far in med school. It’s funny seeing how I was as an M1 and what I was stressing about at the time. Oh how things change.

Anyway, I thought I’d end this entry with this image. It’s the same one I used in my post about our first anatomy exam. It seems fitting. I might have thought M1 year was hard back then, but studying for board exams is a new kind of hell. I don’t know if it can actually get worse than this.

As a side note, I am so, so, so sorry for all of you soon-to-be-M1s that now have to take Micro in the Fall in place of anatomy. That class was one of the more difficult ones of M1 year and it sucks that they switched it on you guys. I’m planning on bringing back the Courses page I originally had up after I finish cleaning it up.

Lastly, for all the people that have emailed me in the past month, I swear I’m not ignoring you. I’ll get back to you as soon as I find my soul that I probably lost somewhere in the immuno section of my First Aid book.

-NB