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.

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 "med school"
Every day you get to sleep, study, or have a social life, but you can never do more than one thing per day.

Words of warning from a local surgeon to med students RE: surgery residency. 


Since it’s Med School and Residency Interview Season, I give you a lil something to help you prepare. 

  1. Tell me about yourself.
  2. What are your strengths (3)?
  3. What are your weaknesses (3)?
  4. What qualifications set you apart from other applicants?
  5. How have you done in medical school/undergrad?
  6. Explain your ranking in your third year.
  7. Which rotation gave you the most difficulty and why?
  8. What is the best experience you had in med school/undergrad?
  9. What is the worst experience you had in med school/undergrad?
  10. Describe a clinical situation you handled well.
  11. Describe a clinical situation which didn’t go as well as you would have liked.
  12. What error have you made in patient care?
  13. Why did you choose (specific specialty or medicine in general)?
  14. What are the negatives of (specialty)?
  15. What problems do you think the specialty/all of medicine faces currently and in the future?
  16. What do you consider important in a training program or medical school?
  17. Why have you applied to this program?
  18. What if you don’t match/ get accepted? What is your backup plan?
  19. What are your future plans (after residency; 10 years from now)?
  20. Do you have research interests?
  21. Will you pursue a fellowship?
  22. With what types of people do you have trouble working?
  23. With what types of patients do you have trouble dealing?
  24. What do you think a good doctor should be like?
  25. What do you think a good resident should be like?
  26. Why did you choose to go to [school X]?
  27. What programs are at the top of your list?
  28. How do you deal with stress?
  29. How do you handle heavy workloads?
  30. How do you deal with balancing multiple tasks?
  31. What are your hobbies?

It’s that time of year again…

Asker Anonymous Asks:
Hey sorry if this is really stupid but could you go into more detail about the match and residency programs? i really want to be a cardiologist but what happens if i am not matched with a cardiology residency program? thank you!
wayfaringmd wayfaringmd Said:

I will be posting a big guide to residency programs soon, so stay tuned for that.

Cardiology isn’t a residency program. It’s a fellowship (to be explained in coming post), which is more years of training after residency. So you would have to do 3 years of internal medicine residency and then apply for a cardiology fellowship for several more years of training. If you didn’t get accepted into a fellowship, you could practice as an internist and keep trying to get in each year to cardiology. 

Now if you don’t get into the residency specialty that you picked, like internal medicine, it’s a little more complicated. We have this thing called the Scramble where programs that don’t fill all their spots and students who didn’t match into a residency program get thrown back into the fancy computer algorithm once again and you basically get a second chance to match in the same year. If you go through the scramble and still don’t match, then you have to try again the next year. This is more common for people who shoot for really competitive specialties like radiology, ortho, ophtho, anesthesia, or derm, but it still happens in primary care too.

Some people also opt to scramble into a different specialty rather than wait a year. Some people who are going for the really competitive specialties will try to scramble into internal or family medicine and use the first year as a “prelim” year and then try to reapply the next year for the specialty and already have some experience under their belts. 

Asker Anonymous Asks:
So, I have a question. I'm wanting to become a doctor and I understand that every med student has to do rotations in different areas. However, when it comes to residencies, does everyone do a residency in an ER? The ER intimidates me so much and I don't know if I would be able to do well. I am not against working in a hospital, just not the ER. I'm also super reserved, quiet, and I'm not an adrenaline junkie. Are there any other options for residencies?
wayfaringmd wayfaringmd Said:

In residency you rotate in whatever specialty you pick. So if you don’t want to be in the ER, don’t pick and match at an ER residency. However, some other specialties will require you to do a month or two rotation in the ER. Specialties like: Family Medicine, OB, surgery, Internal Medicine, Peds (it would be all Peds ER though).

It’s not bad though. The ER attendings know that we’re not training to be ER docs, so we don’t usually manage the big traumas (but a surgery resident would). We do manage medical emergencies though. Honestly, my ER rotations were like 4% adrenaline and 96% non-panicky stuff. 

But trust me, the prospect of working in the ER was terrifying to me as a premed. But once you learn a bunch of medicine and get used to the environment, it’s not so scary. 



"Foot in mouth disease,"

"Hoof and mouth disease,"

"Hand to mouth disease,"


"Handy foot disease."

Proof that all doctors were once stupid: when I was an M1, an upperclassman got hand-foot-mouth disease from his kid and I asked someone if he kept livestock because I thought it was hoof and mouth disease… my how I have grown. 

So I recently switched undergrad programs and because I’m so busy and don’t know anyone in my new program yet, I worried that I’m gonna end up as a lone wolf. So I was wondering if you ever struggled with solitude, given that med school and residency are so time and energy demanding? Or perhaps making and maintaining friendships came naturally to you? Thanks for answering, and keep posting! :) -pseudonymous-md

Oh dear, did you ask this at the right time. 

Let me explain a little about myself: I am an extroverted introvert. I can do well in groups (for a short period of time) if I’m comfortable with the people, but I’d prefer to be with just 1 or 2 at a time, and I definitely don’t mind being (and actually need to be) alone a lot of the time.  I am just extroverted enough that I am friendly with people and make friends (in a very Facebook sense of the word) easily. But like a true introvert I have few really close friends. And I’m a terrible maintainer of friendships. I usually wait for a friend to send me an “are you still alive” email, and then I’ll email back and forth 3 or 4 times before dropping it again for another 6 months. 

So being an introvert, I do value my alone time to a degree. I can tolerate a lot more alone time than some could and actually look forward to it a little on my really busy rotations. But with that being said, know that Wayfaring gets lonely too. Whoa, I’m about to get all introspective and raw with emotions and feelings and other such touchy feely junk that makes Wayfaring uncomfortable in real life. Good thing this isn’t going on the internet for nearly 10,000 people to read or anything. 

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As a current medical student in the armed forces, a lot of emphasis is placed on leadership as a way of life, not as something to be “checked off” on a residency or medical school application. I happen to be pretty shy and soft-spoken, and I don’t eloquently vocalize my ideas on the fly like many extroverts and practiced students can. How can I develop my leadership skills as an introvert, and how can a quiet student get noticed in a positive way during rotations? -lisypants

Remember that leadership involves much more than words. Good leaders live out the principles that they hope to pass on to others. It is possible to lead quietly and lead well. 

A good way to get noticed as a med student is being a great team player and encouraging the others on your team to do well too. Practically, this means showing up on time, never complaining about work, getting your crap done in a timely manner and then offering to help others when they’re behind. That stuff gets noticed. 

Being pimped is difficult for introverts. If you’re like me, your brain flickers the blue screen of death when an attending asks you a point-blank question.


So if you have a hard time being noticed by answering all the questions, at least be seen reading. Then jot down questions after you read to ask on the wards so you don’t have to come up with spontaneous questions. Also, write thorough, thought out SOAP notes. Even if an attending never mentions them to you, I promise you they’re being noticed. 

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Any tips on how to get the "cadaver lab" smell off? Sometimes I feel like I still smell like it after I shower...
wayfaringmd wayfaringmd Said:

It’s probably not you that stinks. It’s probably your nose. The smell can stick in your nose even after you’ve showered. 

Sniff a dryer lint sheet or lemon (or lemon scented candle). They’re strong enough to usually wipe out the smell. 

Hey! I was wondering, how did you study in third year? For us we spend 1 week on each “system” so we had our first week on cardiology, and I noticed we get very few lectures and a lot of it is just learning on the wards. It seems like we’re just expected to do our own readings and figure stuff on our own!? Any advice!? -mediocremedstudent

Well, mediocremedstudent, welcome to your first taste of being a doctor. 


In the real world, doctors have to do this silly stuff called continuing medical education. It’s one of those little requirements for maintaining board certification and licensure. And guess what? No one holds your hand. You are expected to do readings on your own and learn on your own. Sure, there are lectures and conferences that will spoon feed you material, but you have to dig around and find those for yourself too. 


Welcome to being a grown up. 

Third year is your introduction to real live medicine. You’ve read the book stuff. Now you have to learn how it translates into real life. On the wards, there’s no set syllabus. There’s no “examine 5 COPD patients, admit 5 chest pain rule outs, diagnose 5 strokes.” You don’t just learn by watching docs treat patients. You gotta pick it up as you go along. Every single patient you see can teach you something.

So when you interact with a patient, write something down about their case that you don’t understand. Why did they have XYZ exam finding? What was that new drug the doc prescribed? Why did they adjust their insulin that way? How did the patient present, and what other diagnoses are in the differential? That’s how you find stuff to read. For each new diagnosis you encounter, read up on it - how it presents, how it’s diagnosed, and how it’s treated and what evidence-based guidelines you can find. 


Now where you find that information to read is also up to you. Ask questions of your attendings and residents (if they’re not up to their necks in work).


UpToDate is my jam. Most hospitals these days have access to it. The Blueprints and Step Up review books are also good. Ask someone who is ahead of you or who has already been on the rotation you’re on to recommend a book for you. Your down time on wards should be spent reading to replace that formal teaching time you’ve lost. 

4th Year Med Student: Wayfaring, what can I do now to really prepare me for intern year? I don’t wanna look stupid. 

Wayfaring: Pretend that you’re an intern now. Take responsibility for your patients. Know everything there is to know about them. Read their old reports, dictations, and labs, even if you don’t think they apply right now. Think hard about what evaluation you would do to figure out their problem. Think about how you would treat them — not just the medication, but the dose too. You wanna be a good intern next year? Be a good intern this year. 

Hey there! I'm a current M1 and am already feeling the pressure to perform in the top. We had our first test, and I passed, but didn't get a great grade. We do have a P/F system, but my grade still placed me in the bottom half of our class (though just barely). I'm worried because I keep seeing posts about how some people can never make it out of the bottom in med school due to the high caliber of students. In your experience, was this true? Or do you think lots of hard work pays off in the end?
wayfaringmd wayfaringmd Said:

Oh my - I’ve had this in my drafts and forgot to post it! Sorry bout that!

Of course it’s true that some people never make it out of the bottom. Someone has to be the bottom. Everyone can’t be on top. Being on the bottom of the top 2% of people in academia is still pretty great. Think about that. You beat out tons of people to get into medical school. Even at the bottom, you’re still at the top overall. 

I never paid much attention to class rankings in med school. We were told that only the top 10% got reported (at least at my school) anyway. I’m sure I was somewhere around the middle to lower end, but it didn’t really matter cuz I got in to my #1 residency program. 

Every school has a bottom. Even Hopkins has a bottom. People on the bottom still match and still get jobs and still enjoy their residency programs. But you have SOOOO much more time left, friend, so don’t worry about your rank yet! You haven’t taken any Steps and you haven’t done clinical rotations yet! 

After evaluating an elderly man in the ER with vomiting…

Wayfaring to 4th year med student: So what’s your differential for this guy?

Student: Well I clicked a button on the ER template and it put in a differential for me. It said GERD, gastroenteritis, appendicitis, cholecystitis, pancreatitis. 

Wayfaring: image

 But the point of a differential is to think of things that could be causing the patient’s problem, not to fill a blank on a form. So considering that you have actually evaluated the patient and the computer hasn’t, what’s your differential?

Student: Well um…

Wayfaring: Considering his nausea and vomiting?

Student: ok, gastroenteritis, food poisoning, GERD…


And his age and other medical conditions?

Student: uh, medication side effect, UTI, esophageal stricture…

Wayfaring: and his distended abdomen and abdominal pain?

Student: constipation or impaction, bowel obstruction, bladder obstruction, bowel ischemia…


Wayfaring: and considering his cachexia and weight loss?

Student: Oh yeah, the cancer. 

Wayfaring: image

And now you see why we don’t let the computer think for us. 

Asker quietbang Asks:
Hi- I'm currently in my third year of a 5 year program, and I'm getting ready to apply to med school. I'm a wheelchair user- I have an SCI and rheumatoid arthritis- and many people don't think that wheelchair users should be doctors. I want to be a doctor so I can be a positive influence in the lives of children with disabilities and their families-- should I say that in my app? Or should I give another reason that doesn't disclose my disability? They'll find out when they interview me anyway.
wayfaringmd wayfaringmd Said:

Absolutely you should say that! 

As far as I know, schools cannot deny you admission on the basis of your disability. Unless it would completely prevent you from doing your duties as a med student or doctor. And your personal statement is all about YOUR personal experiences, so if your medical history has influenced your decision to pursue medicine, you should definitely talk about it! And who better to be an advocate for patients with disabilities than a doctor with a disability? 

Asker Anonymous Asks:
Hi! I'm a 30 year old freshman with kids and a husband. Over the last few years It's become clear that I can't shake my interest in medicine. I love the use of science for healing. It's absolutely beautiful. Unfortunately I feel selfish and indulgent considering pre-med with the intention of applying to med school. It's a really long road to drag my family through. In your opinion, at my age, am I fooling myself thinking that I could start a career as a doctor?
wayfaringmd wayfaringmd Said:

It’s certainly not too late to start a career in medicine. There’s a guy in my program who didn’t start college until his mid-30s and is now a 2nd year resident! From what I’ve seen, the non-traditional students tend to be the best ones because they’re the most driven and serious about their studies, plus they have some life experience under their belts. 


It’s gonna be hard though. It was super hard going through it single, so I’m sure going through it married will be tough. But you have a built-in support system, which is awesome! And people do it all the time, so don’t feel like you’re the only one. 

If going back to school makes you feel selfish, you need to have a talk with your husband and kids. More than once. Like before the beginning of each semester. They’re a part of your life, and their opinions count too. If they are fully supportive of your aspirations, then go for it! You still have several years before you have to decide about med school, so y’all have some time to see how things work with you being in school.  



if there is one thing med school has really taught me to appreciate it is the post-ten-hours-of-holding-it-in pee/poo.

wish i had done bladder control exercises in high school or something man

Things not usually spoken of…but very seriously true.

Especially if the hospital bathrooms are a bit manky.

Hence the importance of finding your secret bathroom. It’s like the room of requirement, guys. It’s been there all along in a fairly obvious place but no one has been using it and it’s wonderful.