medical school

*i have achieved a complete understanding of the male and female endocrine systems*

~_~

Cool!

http://www.imbruglia-inside.com/smiley_headbang.gif

pharm, renal, and endo finals today

TIME OUT, kevin otm

now u know why we are so moody ; )

it's true, my condolences u_u

I took my renal exam today too, weirdly. (And reproductive, with all the male and female endocrine components thereof, is on Tuesday.) Normally if a lecture seems like a barrage of information without any coherence, I figure that staring at for long enough will eventually make it all sink in. And then I had to try to learn the various causes of Nephritic and/or Nephrotic Syndrome, and yeah, I dunno, that just never happened. It all just faded into a blur of "This disease is associated with this kind of IgG/IgA/IgM/C3 deposit and occurs in this kind of patient and presents with this set of symptoms" and it was just a wall of stuff to memorize. It was kinda disappointing. I think it is mostly that so much about most of the diseases is unknown, so all anybody can really tell you is that somehow the alternative complement pathway gets activated or whatever, and next thing you know you're peeing blood.

Still, one more week of exams, then one more quarter, then boards, then 3rd year! This will all be worth it when I can finally tell someone "Yeah, second year sucks, but third year makes up for it" like I have heard 1000000 times.

sweet jaysus it is the ~3/4 LOTTERY~ all week, ppl are just going bananas

Is that for clerkship scheduling?

yup

I got the front end of year 3 sorted which is most important for me

What are you doing first?

so, new this year is a policy that says we don't have to take the boards before doing rotations. I think you can do a max 18 weeks before it's mandatory.

what this means for me is: three week intersecession between year two and Period 1 (six week clerkship) will be total vacation, maybe a bit of board prep. then do Med 1 right off the bat, which will go thru June. take the next six week block off and study for the boards. this is double handy for me cuz a) med 1 "counts" as prep imo and b) I've got a wedding to go to in late July (I'm actually officiating lol) and I want more than the zero days off a clerkship would allow. so step 1 in second week of aug

period three is surg 1, followed by an uncertain two weeks, then ortho.

Whoa, that is way different than our schedule (Step 1 before July 1, four twelve-week blocks, all further subdivided into components). Although I guess that is a better scheduling arrangement for when the long-rumored USMLE changes come and you have to take it after 3rd year instead of 2nd.

ah we are responsible for our own scheduling. it's a bear, everyone is camped out with their laptops waiting for the next selection round

some clarification:

the main "unit" in 3/4 is the six-week Period. There are 8/year, with 4 add'l weeks of wiggle room, split between the winter holidays and the three-week "intercession" that follows the end of year 2 (basically the first three weeks of May).

not every clerkship is six weeks (EM is four, eg), so there is a parallel sequence of 4-week blocks that don't, obviously, line up precisely with the beginning and end of the six-week periods. Throw in the odd 3-weeker and yr 2-week surgical subspecialties, and it gets (O)_(O) very fast.

NOW superimpose a course-selection system that is lottery based: the class is randomly split into, oh, say, ten cohorts. these cohorts are given access to the online scheduling system during strictly defined time windows. yesterday we were given four "rounds," today we had four, thursday we have four, and friday we have three. after that, you can access to the website anytime to shuffle things around (as sites/blocks open up).

the scheduling bugbears so far have been:
1) step 1 (most ppl are taking it ASAP, at the end of period 1 (ie - before July 1), which means that the available period 2 rotations went like hotcakes
2) interviews: everyone's likely taking December of year 4 off, so that compresses the interest in the blocks immediately before/after
3) "free time"/electives: if you want to do any int'l stuff/research/etc then it behooves you to get required shit out of the way ASAP (ie by the end of Y3). if you're lucky/aggressive, you can be done with school COMPLETELY by February of Y4, and just str8 fukkin chill until July. My friend Corey did this and she made a pretty convincing case for it.
4) residency concerns: future GPs/internists/peds ppl can basically do w/e the fuck they want with their schedules, because it just don't matter. EM/ortho ppl ought to have gotten audition/away rotations under their belt before interviewing, which means displacing some of the required stuff they'd probably like to take in y3 and replacing it with electives. no finishing early, less flexibility for y4 goofing off.
5) step 2: CW seems to vary wildly. some are like "it's pass/fail basically, just take it at the end of the month you've set aside for interviews and don't sweat it." others say that it's best to get it over with ASAP before you forget everything from yr non-electives. still others say that scheduling should depend entirely on your step 1 score: bad step 1 = take step 2 ck BEFORE residency applications so you can buff yr resume a bit. good step 1 = take it AFTER interviews so you don't run the risk of a bad score suddenly making you look lazy and less attractive. i'm gonna take it in oct of y4, after residency application, and immediately after a 4 wk med/peds rotation w/2 weeks of off-time for studying. maybe this'll be overkill, who knows, who cares.
6) sanity: i'm taking psyche in the summertime (y4) because fuck it, man, it'll be easy and i want to enjoy the weather. i've got two weeks free after Surg1 that were unplanned, but maybe i won't bother filling them because surg1 is reputed to be exhausting. peds is (supposedly) to be avoided in the winter because a) all the kids have the same thing and b) you will, too.

sweet mother that is a long post

Pssssht I am not opposed to a long post. Details are where the MAGIC is.

I am like 99% sure we go like this:

1) Must take Step 1 before the start of 3rd year (July 1)

2) 3rd year breaks into quarters
--6 weeks of OB-GYN and 6 weeks of Pediatrics (I think there are multiple sites you visit in each 6 week block, I'm not sure)
--12 weeks of surgery, divided into 6 weeks of general surgery and 3 2-week blocks of surgical subspecialties (ortho, neurosurg, transplant, urology, etc. etc.) Surgery is apparently a notorious beast of a time-eater, and you figure out fairly quick if surgery is for you or is not for you.
--12 weeks of medicine, with the option to do 6 weeks at GU Hospital + 6 weeks at Walter Reed or 4 weeks at GU + 4 weeks at Washington Hospital Center + 4 weeks at Virginia Hospital Center.
--Smalls, 6 2-week blocks of everything else (Neurology, Psych, Family Med, etc. etc.), except for Emergency Medicine, which is for 4th year.
--Three week Christmas break, plus one week in between end of 4th quarter and start of 4th year = 52 weeks.

There are like one million strategies for dividing these up (don't do what you want to do first, because you'll be terrible vs. do what you want first because they won't know any better and they'll grade you easier). You can't take Surgery and then immediately do Medicine, or do Medicine and then immediately do Surgery, I think because prior experience with this turned people into zombies at the end of the 2nd one. Ob-Gyn is supposed to be really demanding also, but Peds isn't.

3) Same basic approach to Step 2 CK (If you suck at Step 1 or if the residency you want to do forces you to, do it early enough in 4th year to put it on your applications, otherwise shove it to the side, because it is not hard to pass). Although seriously the Step 2 Clinical Skills, if one of the five cities in America were not Los Angeles (aka cheap excuse to go home for a few days!) I would be pissed. Seriously five cities! What is that? smh

4) 4th year has only two requirements: a month of Medicine AI, and a month of Emergency Medicine, and you can do this at any time in the year. None of this gets scheduled until 3rd year. We get I think everything from Thanksgiving to New Year's off for interviews, and can also take time off from a rotation to do that if necessary. You also generally do the AI for the specialty you want to do up front, and then aways , and then you fill up the rest of fourth year with whatever electives you choose.

5) Somehow by virtue of the passage of time they give you a diploma and are an actual doctor. \o_O/

whoah @ "smalls"!!!!

neuro, psyche, and fam are all required six week rotations here!

wait correction. psyche is six weeks fam and neuro are four. but there's a four week primary care req in addn to med I/II (both six weeks).

surg and sug specialties comprise ten weeks altogether but don't have to be done in succession (some ppl are doing their subs as their FIRST rotation!).

how many dang sites do you have? pretty sure the reason they give s so much license is to evenly distribute the load on training sites. which is sorta weird since, for a relatively small city, MSP is up to it's eyeballs in hospitals and healthcare.

(heck of iPhone typos)

also did not realize that there were only five CS sites. glad Chi is one of em---cheap excuse to visit bros imo

We have five major affiliate hospitals (including the University Hospital), I think, plus there are a bunch of affiliate sites you can do certain rotations at. We have to share the metro area with GW and Howard, plus we split Reed with USUHS and I think some of the suburban Virginia ones with VCU. It is kind of a mess but w/e. Do you guys share anything with Mayo or are they all just tucked away in Rochester the whole time?

I went back to check and apptly I misspoke about smalls, it is 4 wks Psych, 4 wks Family Med, 2 wks Neurology and then 2 wks of something else from like anesthesia and derm and radiology and PM&R and all that. So it is less flexible than I thought, which is actually kinda good because I didn't want to do some of those. (I would rather do 4 weeks of Neuro, but I can always do more in 4th year.)

I've got a bro at the mil school. tell him I said hi. he is from MT and a weird and excellent dude.

4) residency concerns: future GPs/internists/peds ppl can basically do w/e the fuck they want with their schedules, because it just don't matter.

can you explain this to me? are these guys like the jocks or something? what is considered the most demanding specialisation? surgery? (not trolling, here, genuinely interested)

nah, it's just that your more competitive residencies tend to demand that their applicants meet criteria that are either deemphasized or irrelevant to primary care. like, emergency medicine program directors want (according to an article I read in Academic Medicine, given to me by someone on the faculty) prospective residents to do an "audition" rotation---that is, if I want to have a shot at getting into the EM program at Cook County, it would be in my interests to schedule an away rotation there sometime before interviewing in my fourth year. thus, i gotta do EM at home early (and well), and apply for the away rotation, which often requires a few months of lead time.

primary care programs, on the other hand, have their requirements met by the standard curriculum that MS3/4 students are expected to complete for graduation.

what are the more competitive residences?

generally, the "lifestyle"/ROAD to happiness specialties are among the most competitive:

Radiology, Opthamology, Anesthesiology, Dermatology. And, increasingly, Emergency Medicine (never on call, 15/days a week, 3 days on/off, excellent pay, etc).

Also, things like plastics and ortho are competitive, though not exactly for the same reasons (everyone's still making a shitload of money, but surgery simply cannot compare to the work from home aspect of rads or derm's 30hr work week).

After that, it varies (IMO). The main point i was making though was simply that yr PCC specialties don't have to focus as much on scheduling because they don't need to have covered certain material/gotten letters from relevant clerkships before applying. whereas: just talking to a girl who wants derm BAD and is freaking that she won't get one of the very few derm slots in Y3, which is necessary for her to do advanced work/get the right letters before applying early in Y4.

also, attn C-L et al: http://journals.lww.com/academicmedicine/Fulltext/2009/03000/Selection_Criteria_for_Residency__Results_of_a.24.aspx

Awwww now I kinda feel like I have to do 10 points better on Step 1 than I thought. Oh well.

Scratching my head over "wants to derm BAD."

I mean not to harsh on derms but I dunno dying to have that as your med career seems kinda lame to me.

Like you might as well be an MBA or something.

https://www.youtube.com/watch?v=mGFoAX2Rf6g

The ascent of dermatology into the realm of Most Competitive Residencies is basically a social science PhD dissertation waiting to happen. (I could not do it myself--when I considered doing a PhD, it was about admissions processes and the MCAT, and maybe the USMLE--but yeah someone should do this in history/anthropology/sociology of medicine.) Essentially, the residency is short, the hours are not nearly as brutal as anything surgical, or even the other medical specialties, so people can have a life outside medicine, and there is a ton of stuff you can do private pay (Botox etc.) that is a gigantic profit center, so the money destroys everything but like plastic surgery (whose residency is much more difficult). Telemedicine is also an option, which permits more freedom of where to live. Derm seems to be the most efficient pathway to success and fortune in medicine.

There are also people who are super-excited about dermatology in general. I don't know why.

Question: if you have big-time melanoma what sort of doc treats you? Oncologist?

Who Treats Melanoma?

Often, a team of doctors and other health care professionals with special skills will work together to treat melanoma. This team may include:

Dermatologist: has special training to diagnose and treat skin problems
Surgeon: performs operations to repair or remove parts of the body
Medical oncologist: specializes in diagnosing and treating cancer; he or she may be your main doctor and the one who heads up your health care team
Radiation oncologist: specially trained to use radiation to treat cancer
Plastic surgeon: specializes in reducing scarring or other visible results of treatment

yeah this chick is basically straight up: derm means that i will make BANK and can be a mom and live in the burbs. she's sweet but also the most stereotypically suburban minnesotan person i have ever met (blonde blue-eyed thick accent, is "weirded out" easily, works out all the time, would be vapid if she wasn't so smart, etc)

i don't get it. i mean, she basically admits that she has no interest in dermatology as, like, a SCIENCE, just as a life.

Ha, I like how the role of the dermatologist in that is to be like, "Yep. That sure is melanoma. Well, my job here is done." It makes sense that the oncologist would be the lead, since the primary concerns are gonna be lymph node involvement and metastasis like most other cancers.

i will say tho that the derm lecturers we had were CRAZY about dermatology and the skin as an organ. very capable cheerleaders, imo. but they're academics and probably got into derm when it was just a sub of internal medicine, and not the horrible profession it is now.

before i decided that immuno was the place for me my other big idea was derm. volunteered at a clinic for about four months and just - basically so much stuff about derm is rad and visible in an interesting way. gbx's lecturers otm.

yeah, see, that's the thing: it IS cool (so is the eye!! so is imaging!!), which is why it's doubly infuriating when someone is by all accounts (imo) utterly disinterested, intellectually, in the specialty they're gunning so hard to get (this gal cleans. up.).

saw a weirdo erosion when i was shadowing at a clinic for NAmerican alcoholics---you could actually look at it and go "yup that is through X layers and visibly advancing." medical/physiological processes made, as you said, totally visible.

haha i remember @ the same time i was volunteering there was a long travails of the ruling class piece in the nyt abt how like harvard med students couldnt get (desirable) derm residencies bcuz they were so competitive now. after that i stopped thinking derm was a reasonable path but i still think its cool.

even really basic derm treatments like removing moles is tactile and ~interesting~ i think? esp in the sense that there is clarity and precision to it. i least i think so?

Well my dermatologist spends her days writing Retin-A scripts and hawking IPL. Seems uber-boring and not even very medical. She may as well be selling Avon or something.

I think with every specialty, there will be some people who are like "That is the least interesting thing I could ever imagine doing" and some people who have that moment where they see themselves doing that thing for the rest of their lives. I know lots of people who think orthopedics isn't very interesting, and TONS of people who have ruled out neurology already, but ortho and neuro are 1 and 2 for me. And like, at this point I have zero interest in private practice, and a strong desire to keep a foot in academic medicine, but there are way way more people who would prefer to have an office somewhere and never put up with med school bureaucracy again.

yeah, academic med is only interesting to me (at this point) as means to be an educator, really. i really like teaching/instructing, so staying involved with an Institution is sort of appealing. otoh, i could just, you know, teach kids how to do bike maintenance once a week and maybe feel just as fulfilled, who knows

in other news: i've been bouncing between ortho, EM, and peds as possibilities (lol that basically covers everything) and today a brief conversation with a classmate about EM and a visit to a good friend's Meet Our Residents page (he's pgy2) suddenly crystallized my decision to at the very least structure my initial schedule around EM. also funny: when i mentioned that one of the tertiary benefits of EM is the short residency for an old guy like me, the dude was like "you're 29? you're even older than all the people i regularly make fun of for being old!"

also had our last day of internal medicine mini-clerkships (once a week, interview/phys with a single patient, 5-10 min presentation at the end of the day), and my preceptor said some very flattering things, which has me feeling pretty chuffed iirc. thank god he can't see my grades :o

i'm just getting into the good stuff in my neuro course and it's definitely the most interesting science class i've taken in pharm school, not including public health which i loved

oh god so now i'm skimming the FIRST AID GUIDE TO THE WARDS and they're saying that you should chedule yr EM rotation near the end of yr third year because you'll have covered most of the material in your other stuff, and will thus be better informed. which is of course otm. i, however, enthusiastically scheduled it as my fourth rotation (after Med I, Surg I, and an ortho elective), even though the draft/lottery meant there were plenty of slots available in the spring.

now i'm worried i'm gonna fuck up/not be impressive and i really want to get a good LOR (esp since i'm going through HCMC, which is the OG EM program in the country, and highly respected) :(

why i'm worrying about this now and not, say, studying for my impending GI exam is beyond me, but w/e

it's amazing, the first two years i've been *yawn* w/e when my classmates starting sounding careerist, and now i'm getting totally mercenary about planning my future.

I was just at a Surgery Interest talk thing last night and they were like "honestly it doesn't matter when you do what you're planning to do; any reasonable instructor is going to know that people doing a rotation early are still going to be mostly clueless, and adjust accordingly." And man did I ever need to hear that. (All of the panelists were coincidentally people who did surgery 1st to get it out of the way and then loved it way more than they had expected.)

Most of the awesome docs and fourth years I've ever talked to were just like "Show up, be enthusiastic, work hard, and admit when you don't know what you're doing", whereas most of the people who are like "behold my secret formula" were kinda douchebags. Hopefully that means something.

that IS reassuring tbh.