Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "advice to med students"

My advice to you: 

  • get a comfortable couch or desk chair. You will spend a lot of time sitting down and reading.
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  • get a copy of First Aid now and review it as you go along. 
  • come up with a standard snappy comeback for the aunts and uncles who will insist on asking you “so are you still single?” at EVERY FREAKING family gathering
  • get ALL the Goljan bootlegs (ask a second year. They’ll hook you up) 
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  • get some butcher paper and draw out the giant biochemical pathway chart with everything all interconnected. Hang it on your wall and stare at it for 15 minutes every day until you can see it behind closed eyes. 
  • dedicate a few t-shirts that you are “so over” to cadaver lab. Your good clothes will appreciate it. Goodwill scrubs are also excellent for this. 
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Any advice for an incoming med student? Like what was first year like & any tips/hints to help survive??  — lifeofastudentdoc

Part I: What will it be like?!

There will be lots of smart people there. Most of them will be smarter than you, or at least they’ll think they are. Being around smart people all the time will send you into a constant fluctuating state of confidence and crushing self-doubt. image

On the first day you will go home and crack open a book, read for 8 hours, and remark to yourself, “this ain’t so bad.” On the 4th day of such reading, you will start calculating how much debt you will be in if you quit on day 5. 

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You will learn an entire new language made mostly of gibberish, Latin, and acronyms. Get to know your -ologies, your hypers- and hypos-, and always pronounce the word the way your professor does, even if there’s a perfectly acceptable alternative pronunciation.

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What should you write / not write in your personal statement? How do you write something that will make you stand out?

If you stick to these guidelines, you will have personal statement that will stand out for sure. 

DO: 

Tell a story. Use narrative. Stories are so much easier for your reader to pay attention to and remember. And if there’s one thing you want to come out of your personal statement, it’s for people to remember you. 

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Use examples rather than blanket statements. Everyone knows you want to go into medicine to help people, but don’t just say that. Tell a story of a time you helped someone and relay how it affected you. 

Relate your outside interests to medicine. How has your love for sports/dance/music/mission work/travel/etc affected and strengthened your love for medicine? How will those interests make you a better doctor?

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- Leave ‘em guessing. Don’t tell your whole life story, but tell enough about your life or interests to make the reader want to find out more. That’s the stuff that makes for a good interview. Believe me, interviewers don’t want to just ask you all the same stuff you’ve already written.

Brag on yourself a little. The AdCom is looking to be impressed. Ask your friends what your best qualities are, and talk those up in your personal statement. 

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Talk about your personal experiences that have influenced you to go into medicine. But also be aware that everyone has a sick family member story, and that those stories are pretty common in personal statements. 

-  Give reasons why other careers are not for youSure, you love science. We get that. Go deeper. Why do you need to be a doctor of all things? Why is teaching chemistry not for you? Why didn’t you go to nursing school? 

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Remember that you can tailor your personal statement to each program. If you’re applying to a program that has a very distinctive feature, you may want to talk about how that feature interests you. But don’t throw that same statement out to every school. 

Ask for help when you get stuck. Check out Roheet’s (theBiopsy) service called LeanOn that helps folks like you with personal statement writing. It’s worth the price for sure. 

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DON’T

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How do you like move from med school to residency and internship do you have to apply or like get asked or do you just show up? -anon

how does one chooses a hospital to do you residency on? like barring the MATCH system, how do you choose your “dream” hospital? -anon

Man, I wish you could just show up on July 1 and hit the next step like transitioning from middle school to high school. That’d be awesome. In reality though, the road to residency is a bit like dating, or at least what I would imagine dating to be like… 

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1. You decide you want to be a [insert specialty here, but I’m gonna use Family medicine as an example] doctor.

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2. You fill out a lengthy personality profile application online, which includes a personal statement that tells all about why you want to be a family doctor.

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3. You facebook stalk do internet research on all the available programs and narrow the long list down to the ones you’re interested in dating. You do this by geography, reputation, program curriculum specifics, and of course, website aesthetics. 

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I sort of have a standard question I ask myself when it comes to dealing with people in all situations: Who am I serving? Your answer to that question will have a lot to do with how you handle people and difficult situations.

If you are serving yourself, you will be easily frustrated with people who don’t do what you want them to do or situations that don’t go your way. If your purpose is to make yourself happy, then anytime someone comes along and challenges your momentary happiness, you’ll be angry.

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If you are serving others’ happiness or well-being, as many in medicine claim to do, you may start out with a bit more patience. Just as you would with your spouse or your children, you are able to take more of their junk because you are working for their good. But eventually this can wear on a person too, especially when others aren’t appreciative of how you serve them or when they expect more than you can give. When things don’t work out or something bad happens to the person you’re serving, you blame yourself. This situation can be tough too.

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Then there’s another level of service. Personally, I do my job for Jesus. I can’t let him down any more than I already have, and he expects nothing from me. If I do my work for him, he is pleased regardless of the result. He is perfect when I’m inadequate. I can still do things for myself and others, but ultimately, it’s all for him. If I allow him to direct my path, I don’t have to worry about whether things will go my way or not, because they’re going to go his way, which is perfect. If I serve others, it brings him glory. I’m not sure how others get through life trying to live up to their own or others’ expectations of them.

EDIT: as I said above, I’m not sure how those of other faiths or no faith live up to others’ expectations. I tried to think of a PC alternative to Jesus, but in my mind there is none. For me it kept coming back to serving self or others if Jesus wasn’t the ultimate answer. But my friend aspiringdoctors has promised to offer her own atheist/nonthiest perspective as well, so stay tuned.

  • Don’t ask a thousand questions. If your question can be answered easily with an app, Epocrates that mess. Ex: Is vancomycin metabolized renally or hepatically? 
  • Ask some questions. Show the resident that you are at least minimally interested in learning. You don’t have to love the subject, but at least ask questions pertinent to your patient’s care or your eventual specialty. When I’m with a surgeon, I don’t ask her which retractors she prefers for bowel cases, but I do ask her what the indications for surgery for peripheral vascular disease are, because I’ll have to refer those patients to her. 
  • Be seen reading. You could read the same article 50 times for all we care. We’re probably not checking the titles. But we do want to see you reading. 
  • Don’t be afraid to say you don’t know. People will pimp you until you get a question wrong, so don’t feel like you’re a failure if you say you don’t know. We’re trying to assess your knowledge base so we don’t teach stuff you already know. 
  • Fourth years: if you’re doing a sub-I or “tryout” rotation, ask them at the very beginning what is expected of a student. Their expectations may be drastically different than at your program.
  • Ask the back up to teach you if the intern is busy. Likely, the upper level has more free time available and the intern is already super stressed out trying to get stuff done. 
  • Read up on your patients’ conditions. If the attending pimps the resident and they don’t know the answer, they’re asking you next. 
  • Even residents who were gunners hate other gunners. So just don’t be one. If the resident tells you to go home at 4:30, for heaven’s sake, go home. They probably have run out of things to teach you for the day, and they have work they need to get done with peace and quiet. If they tell you to leave, they’re not going to rat you out for leaving early. 
  • Get to know your resident as much as you can. Don’t take up work time, but when there’s downtime, don’t disappear immediately. Have a conversation. 
  • Stay out of the way. This will be hard to do because you will always feel like you’re in the way. I still feel like I’m in the way as a resident.
  • If there are no chairs available and a nurse, attending, or resident needs one, you are expected to give yours up. This is something I still practice, and it weirds me out when nurses offer me their chairs. 
  • Don’t steal the resident or attending’s computer. And don’t log them out. 
  • Don’t misrepresent yourself to your patients. They should understand that you are not a doctor yet. 
  • Be a team player. Don’t fight other students for procedures or throw them under the bus. If we perceive that you are trying to tear down your fellow students, our opinion of you will automatically fall. Help other students when they’re slammed. Remember, attendings are looking for good things to say about you in a letter of rec, and programs love residents who are easy to work with.
  • Don’t try to teach your resident. We already know you’re smarter than we are. You’re closer to step 1 than we are. But we have plenty to teach you. 
  • Ask your residents for advice about residency applications, clerkships, whatever. It’s flattering to us. 

Since a lot of you are about to start the clinical part of your training, and I’m about to get med students for the first time, I figured I’d put together a little how-to (in 3 episodes) with the help of my fellow residents.

  • Take initiative with your patients. Know all their info: what meds they’re on, their labs, their histories, etc.
  • Check back on your patients in the afternoon. Follow their labs or tests done during the day and think about what needs to be done about them. Otherwise you’ll find that a ton of stuff has happened the next day and you’ll be out of the loop. 
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  • Have your notes written before the resident rounds so they can read them and hopefully give you feedback on them.
  • Always attempt to write an assessment and plan on your notes, no matter how simple it is. “Continue current management” is usually not an acceptable plan. What needs to be done before this patient can go home? 
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  • In surgery, always ask permission (preferably from the attending) to scrub in. I do this still as a resident. If they say yes, get your gloves and gown for the scrub tech because they’re probably not prepared for you. 
  • Ask to do procedures, but don’t expect to get them. The residents are always first in line. If it’s a procedure they’re confident doing and they have time to teach you, they’ll probably let you do it. 
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  • If we ask if you want to do a procedure, always say yes. Even if you don’t want to. 
  • In the outpatient setting, always offer to help write the note. Rarely will a resident turn you down, and you will really help them out. They will still review and change it, but it will definitely help.
  • Be available. You don’t have to be a shadow, but don’t expect your resident to call you for admissions/procedures/check out, because she will forget. If you haven’t heard from the resident in a while, check back in with them. She may have forgotten you were around and might send you home early!
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I am a senior in high school and I want to become a doctor, but medical school seems… Tiresome and depressing. I feel like once I get there I’ll be so isolated and alone that I will give up. How does one handle that? It just seems so daunting to me. But medicine is my passion and I don’t want to give it up! -scienceofthes0ul

Well friend, you have judged medical school correctly…sort of. It absolutely can be tiresome and depressing, and it is at times (and residency moreso). But the cool thing is that when you’re tired and depressed, most of your friends are probably feeling the same thing. 

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That doesn’t sound very comforting, but it kind of is. You will be surrounded by people who are just as miserable as you are, and they can empathize with you and you can use each other to get through. It’s funny, I spent less time with my friends in med school than I did with friends in undergrad, but I was much closer to my med school friends, and I think it’s because of this miserable dynamic. 

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Take my best good friend, for example. We somehow managed to get every 3rd year rotation together, which was a godsend. She kept me sane, for real. And during our 4th year when we parted ways for much of the year, we still called each other almost daily to share crazy patient stories, catch up, and commiserate. 

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But just in case you’re not lucky enough to find a best good friend in med school, here are some tips to avoid isolation, depression, and burnout. 

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Hey fourth years, how great has fourth year been for you? Amazing right? I told you it would be. Like all good things, fourth year must come to an end, and the beginning of that end is, of course, RANK LISTS. Rank lists are due February 20 (and if you didn’t already know this, you need to step up your game yo), and I’m sure you guys are all freaking out about them a little bit. 

A close friend of mine e-mailed me recently about her rank list decision making, and she said, 

I have been expecting to have a “big moment” of sorts where the lights come down from heaven and God says “this is where you are supposed to go.”

We all hope for that feeling. That moment when it’s all clear.

So far, that hasn’t happened for her, and I imagine it hasn’t happened for many of you. I had my own little rank list crisis last year (btw, I matched my first ranked program, but I won’t tell which of those two it was), so I totally understand the frustration and the worries and fears associated with making this list that will determine the course of your next 3-7 years. 

So here’s a little advice to consider in your decision making:

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Hey! Did you do any additional extra-curricular activities or work experience while in med school to help you with your residency applications? What sort of things would increase your chance of getting a competitive residency position? -gokulan

If you look at the NRMP’s data on which factors are most important to program directors in deciding whether or not to offer an interview to an applicant, extracurricular experiences are pretty low on the list. The thing that matters most is grades. After grades, the most important things are letters of rec from respected doctors in your specialty and a good personal statement.

There are 2 things to consider when applying to residency: 1) how competitive your specialty is, and 2) how competitive your top program is. If you’re applying to a no-so-competitive specialty (like those in primary care), you may not need super high scores compared to the med school population at large. However, if you want a good program within your specialty, you want to be on the above average score range for your specialty. To check the average step 1 score for your specialty, click here

Extracurriculars, unfortunately, don’t do much to boost low grades when applying to residency programs (unlike applying to med school). Where extracurriculars really come into play is showing your interest in your specialty. If you are applying for internal medicine but all your activities are things like March of Dimes, Jerry’s Kids, St. Jude’s and Ronald McDonald House, programs may question your dedication to adult medicine. If your school has an interest group for your chosen specialty, you should be involved in it. If you like research, your research should probably have a place in your specialty. It’s a little harder for the surgical subspecialties. Most surgeon hopefuls choose to spend their extra time in the OR, working their butts off for good letters of rec.

So what did I do? I’m interested in family medicine, specifically global medicine and in rural and underserved populations, and I was applying mostly to programs that offered an emphasis in these things. So I did rural medicine rotations, free clinic electives, and mission trips. I worked in my school’s free clinic, helped plan our mission trip, and was an officer in our family medicine interest group. 

Hey, so I’m in med school right now. However, it’s getting to that point where I have to take my Step 1s and start thinking about residency. How hard is the process overall? Is it as stressful, difficult, and overcomplicated as all the people on the forums make it out to be? As a side note, I am in a foreign medical school right now, and I’m hoping to get back to the States as… something. We’ll see when I get to clinicals. - tinypasserine

The residency application process is no more painful or difficult than the med school application process. Actually, it may be a little easier.

The AAFP has a pretty decent Timeline/Checklist thingy to help you organize and plan your application process.  

I think it probably is a little more complex for foreign medical grads, but since I went to school in the US, I don’t know all the ins and outs of that process. I would check out ERAS’s page for IMGs for that info.

Also, disregard Student Doctor Network. For everything. Go with the TOADs. We will not steer you wrong. 

Are you in the end of your second year? Because that’s probably a little early to be thinking seriously about residency. But here’s what you can do at this point:

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wayfaringmd:

get-going asked: What’s a good way to not be a gunner? I’ve realized looking at your and md admissions descriptions for gunners that I am one, and I don’t wanna be!

My suspicion, get-going, is that you are not a gunner. Why? Because gunners don’t worry about being gunners. They just gun away. Like I said before, all high achieving people are a little type A, but you only become a gunner when you take it to the extreme. Also, why avoid being a gunner? Because they’re obnoxious, they make other people’s lives miserable, and they make school unnecessarily stressful. So here are some tips. 

1. Keep your grades to yourself. No one cares about your grades except other gunners, and they don’t need to know. 

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2. Don’t ask other people their grades. If they want to tell you, they’ll tell you. 

3. Don’t even ask “how did you do” or “are you happy with the test?” If the person didn’t do so well, you’re embarrassing them by even asking. 

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4. Don’t answer a question unless it is asked directly to you.

5. Do not ever ever ever ask a fellow student a question you already know the answer to. Leave the pimping to the professors. The one exception is if the student asks you to quiz them. And even then, don’t be a jerk. 

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get-going asked: What’s a good way to not be a gunner? I’ve realized looking at your and md admissions descriptions for gunners that I am one, and I don’t wanna be!

My suspicion, get-going, is that you are not a gunner. Why? Because gunners don’t worry about being gunners. They just gun away. Like I said before, all high achieving people are a little type A, but you only become a gunner when you take it to the extreme. Also, why avoid being a gunner? Because they’re obnoxious, they make other people’s lives miserable, and they make school unnecessarily stressful. So here are some tips. 

1. Keep your grades to yourself. No one cares about your grades except other gunners, and they don’t need to know. 

2. Don’t ask other people their grades. If they want to tell you, they’ll tell you. 

3. Don’t even ask “how did you do” or “are you happy with the test?” If the person didn’t do so well, you’re embarrassing them by even asking. 

4. Don’t answer a question unless it is asked directly to you.

5. Do not ever ever ever ask a fellow student a question you already know the answer to. Leave the pimping to the professors. The one exception is if the student asks you to quiz them. And even then, don’t be a jerk. 

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1. Work like crazy until interviews are over. Then chill like you have never chilled before.

2. Store up that vacation time for the end of the year if you can. Moving takes 3 times as much time and effort as you think it will.

3. Do an away rotation (or three!). Even if it’s not at your top program, it will teach you a lot about other hospital systems and will help you figure out what you like and don’t like in a program.

4. Pick one piece of clothing in your interview outfit that will make you memorable. It can be bling, but tasteful, of course. Maybe shoes with a little pizzazz. For me, it was a scarf. Guys, go with a brightly colored tie (again, mad points for the bowtie) or pocket square if you’re classy like that.

5. Be nice to the hotel staff and support staff at residency programs you’re applying to. If you’re rude, it may come back to bite you. People check up on that sort of thing.

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