Choosing a Specialty

My favorite part of my job is teaching. There, I’ve said it. Yeah, it’s cool picking apart diseases and mix-n-matching treatment regimens for the optimal balance of cure and side effect. I love hand-holding people through concepts that are far beyond their educational level and helping patients and families make impossible decisions with uncertain data.

But give me a new third-year medical student who’s been dropped in the middle of the hospital for her First Real Rotation Ever, and I am just in heaven. I love teaching med students.

One of the things I love the most is helping them figure out what flavor of doctor they want to be. Third year is all about sampling it all, and experiencing what actually happens in the various medical specialties. You rotate through Surgery. You rotate through Internal Medicine. You rotate through Family Practice. You rotate through Anaesthesia. You rotate through Psychiatry. In fourth year, you’re supposed to be narrowing it down to your most likely options for residency.

Thinking of Quitting

Question:

Medical school and residency can be tough physically, mentally, and socially. What's the best way to get through those tough times when all I want to do is quit?

Response from Sheila M. Bigelow, DO
Resident Physician - Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio




Depression in Medical Students

Medical school and residency are some of the biggest challenges of our careers. Along with the good, exciting times come the hard, rough times. Long hours, little sleep, and a high-stress environment all create the perfect storm. These feelings can fall anywhere in the spectrum from burnout and depression to suicidal thoughts and suicide attempts.

Post-Exam Remorse and Realizations

PhotoCredit: Well.Blogs.Nytimes.com

I just made it out of an Exam this day and I just woke up right now. Being in Medical School, the stress of taking an exam and the usual remorse of not studying enough is not an unusual feeling. You can say that it's a cycle that will repeat over and over again and nothing will ever make you become immune of it. It's become of this that I realized a few things that I'd like to share to everyone that you may not or may have realized already:

1. Things don't always work out as you planned in Med School. I've realized this lesson each time I do things and in fact I can fairly conclude that it should be part of a Medical Student's life. It is the norm rather than the exception. There are far too numerous factors that can be in play that will make our lives as uncertain as it's already is ranging from self-deserving consultants, toxic-bringing residents, inconsiderate professors, unsupportive classmates, uncooperative family or your own lazy self. 
2. You cannot give up. After a disappointing exam, you pick yourself up and move on. There is basically nothing you could do about it anyway that you should have done before the exams. It's already too late to undo things that have past and energies are better spent on preparing for things to come. So stop moping, eat your comfort food or have a satisfying sleep, then get over it.

Accepting the Inevitable

All are in the mood of merrymaking, decorations are everywhere, I hear carols on the radio, even the TV is singing Merry Christmas, and yet here I am, with my handy dandy notebook, notes, highlighter and ballpen - STUDYING for my exams on the day our vacation ends.


It's not uncommon I guess for medical students to miss out on important events, be late on occasions or having no idea at all of happenings all around them. With the constant wave of exams and lectures, with the unending reports and case studies, it's easy to say that medical students cannot afford to care for anything else than studies. It may be depressing to think about it but it's the reality of being and wanting to be a doctor. In fact, it can safely be concluded that it would be terribly worse during internships, residency or even after practicing as consultants. 

The Art of Expectations in the Emergency Room

This article caught my attention as an intern once relayed to me his experience in the Emergency Room wherein the patient, after all that had been done for them, complained and maligned the interns and the staff of the ER. As unfair as it may seem, the disconnect between patient's expectations against hospital protocol may well be the very reason of this incidences. Or I may be wrong... nevertheless, this article is worth reading...


The Art of (Emergency) Medicine

Jeffrey Wonoprabowo, Medical Student

I had seen the patient. I had come up with my assessment and plan. I discussed it with a senior resident and now it was time to present it to the attending. As I wrapped up what I thought was a fairly decent patient presentation, my attending asked me what the patient wanted. I stammered. What the patient wanted? Wasn’t that obvious? They come in to the Emergency Department with a chief complaint and we’re supposed to fix it. Right?

Recovering from a Bad Evaluation

Question

I received negative feedback from my most recent rotation, and I'm trying not to freak out. What should I do?

Response from Alisa R. Gutman, MD, PhD Psychiatry Resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

It's no secret that medical students are used to doing things right, so there are few things as difficult as being told that you've done something wrong. Even worse is getting serious negative feedback in writing. Here are some tips for learning from a negative evaluation without letting it rewrite how you see yourself.

Dumbest Midnight Calls

Emergencies can arise at any time; this is exactly why there are doctors on call through the night. However, many inconsequential, obvious, and downright bizarre telephone calls can come in the small hours. In a recent discussion on Medscape's Physician Connect (MPC), an all-physician discussion group, doctors discussed some of the weirdest and most memorable of these consultations.

Pediatricians bear the heaviest burden when it comes to fielding what some of them have termed "sleep-wakers." Parental concern, of course, is laudable: A parent with an obvious question during daytime hours might be considered thorough, but a father calling at 3 AM asking whether his 5-month-old son's breasts are too large is something else entirely. The pediatrician who handled that worried father commented, "I had to put the phone on mute while I collected myself. I've never laughed so hard at 3 AM. It took me forever to convince this 'manly man' father that gynecomastia is normal in male newborns."

Weathering the Storm

It was July 1—my first day of fellowship. I was assigned to the cardiac ICU at Hopkins Bayview, the same unit where I had taken my first call as an intern and where I had run my first code.

Moments after receiving sign-out, an overhead page sounded, "CICU fellow, pick up line seven-five."

It took me a moment to realize that the call was for me. I picked up the phone.

"I'm calling from the emergency department. You need to get down here, stat. We have a patient in VT storm."

"VT storm?" I asked, with a squeezing sensation in my stomach. "Are you sure?"

Could Facebook Get Me in Trouble?

Question:

Like many of my friends, I enjoy using Facebook, Twitter, and YouTube. How can I keep my online presence professional and in accord with patient privacy rules?

Response from Megan L. Fix, MD Associate Residency Director, Emergency Medicine, University of Utah, Salt Lake City

Facebook, Twitter, and other social networking Websites are fun, and your online identity can be informative to future employers, patients, or colleagues. But involvement in social media can also get you into trouble if you aren't careful. Here are some suggestions for safeguarding hospital and patient privacy and your perceived professionalism online, both as a student applying for residency and as a medical professional.

To Cry or Not to Cry

Considering the tragedies that occur daily in the hospital, there are plenty of reasons to stop and cry, but should you? After talking with colleagues about this and being in many difficult conversations, the simplest answer is that if crying fits for you and for the situation, it can be positive in its ability to strengthen existing bonds. If tearing up in public is not your thing, don't go there.

As a palliative medicine physician, I encounter many sad, difficult, and trying situations that test my emotional stamina daily. In fact for some physicians, it may be that visceral connection to another human that attracts us to medicine. I was surprised in residency when I first discovered that ''breaking bad news'' and ''compassionate honesty'' led to praise and gratitude from patients and families who would cry, be angry, and eventually come to a certain peaceful but sad acceptance of dying. Using my medical knowledge to guide patients and families through this was personally rewarding and occasionally emotionally difficult, but I never cried in these meetings. But then, I also am firmly planted in the second half of the answer above: I don't cry in public.

Increased Opportunities for International Medical Students

May 11, 2011 — As of April 15, 2011, only 12,200 H-1B petitions have been filed — a much lower number than in years past — indicating that H-1B visas should be available for international medical graduates (IMGs) through March 2012, creating increased opportunities in the United States. H-1B visas are a skilled worker's visa.

Employers "are not able to just offer H-1Bs willy-nilly," a US State Department official told Medscape Medical News. "They have to prove that the foreigner has certain skills that they cannot find in the normal employment pool."

A total of 85,000 H-1B visas are awarded per year to IMGs and other non-US citizens with professional-level credentials. H-1B visas enable IMGs to be employed in the United States for up to 6 years as trainees in their specific field. They are issued by the US Citizenship and Immigration Services, a branch of the US Department of Homeland Security.

Preparing for Residency

Question

My internship is coming up soon and I'm nervous. What can I expect?

Response from Geoffrey A. Talmon, MD Assistant Professor, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska

Medical students spend 4 years waiting for the magic of graduation day. My own graduation ceremony made me feel like a transformation had occurred in me and my colleagues. We put on our robes, wore costume-like hoods, and heard a lot of Latin words. Soon after, my parents and nonmedical friends started calling me "doctor" and asked medical questions with more frequency. I remember feeling a twinge of excitement when I started signing checks with an "MD" after my name. Throughout all of it, though, I was terrified for July 1, the start of my internship. Nothing particularly magical -- no epiphanies of knowledge or confidence -- had occurred when I received my diploma, and I had heard plenty of stories about "intern mistakes."

10 Unwritten Rules About Surviving the Third Year

We took the boards after second year and celebrated our achievements. Overnight, we became third-year medical students. The beginning of a new world awaited us as we wore our white coats and strode through the doors of the hospital. Excitement, mixed with a sense of uncertainty, lingered in our minds. We were unfamiliar with the hospital environment.

There are many reasons to celebrate being a third-year medical student. Medicine becomes more practical and hands-on; there are no more endless lectures packed with information. You get to "play doctor" and meet the patients you read about in the books. You apply what you've studied -- or at least see it applied practically to real patients. You experience different aspects of medicine that will help you decide what you want to do for the rest of your life.

Unfortunately, there are also reasons to feel anxious about third year. You will miss having a flexible schedule. As a second-year medical student, your attendance was not mandatory, and you had the luxury of listening and relistening to lectures in the convenience of your own home. In third year, however, rotations are more like work: You never want to be late. If you are on surgery rotation, you have no option but to be there at 6 AM or earlier for the entire rotation. And because you're not in a classroom you no longer have a structured schedule. In addition, you and your classmates will get different experiences and learn different things. You will be tired after rotations and you won't feel like studying at the end of the day. Many third-year students will tell you it is vacation time. Should you believe them? No!

Self-Starter on Clerkships

Question

Halfway through my third year, I realized that my biggest weakness is that I'm not enough of a self-starter. I am somewhat anxious and shy, and if I'm not asked to do something, I tend to stand around watching. How can I get over my shyness and take initiative without getting in the way or being really obnoxious?

Response from Alisa R. Gutman, MD, PhD Psychiatry Resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

You’ve hit on a common concern for rotating medical students: how to be active and interested without coming off as annoying. Being naturally shy can make it even more challenging to take the initiative.

First, your team knows that medical students have different dispositions. You're not expected to be bubbly if you're reserved or outgoing if you have social anxiety. But one lesson you should learn during your inpatient months is that your home personality should not necessarily match your work personality. Being a professional means knowing how to leave your personal life at home. Likewise, shyness has no place in the hospital as it pertains to interacting with your residents and attendings. To your team, shyness can look like disinterest or even boredom.

Surviving Medical School

PhotoCredit: drsharma.ca 

Remember when you were a premedical student in college? It seems like a century ago for many of us who have just completed the first year of medical school. It feels that way because our lives have changed dramatically. Normal life seems to have vanished, and suddenly, 24 hours in a day are not enough to get through the enormous volumes of information that we are expected to learn for every exam. It seems virtually impossible. We barely have time to eat or sleep.

Medical school is not the end of the world. Take it from us, 2 students who have been there, when we say that medical school is what you make of it. Do not let medicine define you; instead, you should tailor medicine to your lifestyle. Otherwise, you might become overwhelmed by the demands of your new life and lose the sense of why you chose medicine in the first place.

Studying Tips

"I hate studying," admits Carl Streed Jr., a student at Johns Hopkins University School of Medicine in Baltimore, Maryland. "I don't know how to do it well," he continues. "And apparently it's required in medical school."

Streed lamented his difficulties with studying on The Differential, a popular Medscape blog for medical students. He asked other students how they master the large volume of material that begins to accumulate on the first day of medical school, and he invited them to share their thoughts on the discussion board. Over 220 readers responded.


Many students offered their own secrets to studying. Of course, studying efficiently is partly a matter of getting motivated, as many hinted. There is no single best technique to study: rather, the method you choose will depend on what sort of learner you are, what type of material is presented in class, and how interested you are in the topic. The main challenge is to figure out what works best for you.

That said, you may find some of their specific advice very helpful:

Job Satisfaction in Geriatrics

I am often asked by my patients, medical students, residents, and even my colleagues, "Why did you choose to go into geriatrics?" The answer is not simple. Much like the patients I care for, my reasons for practicing geriatrics are complex and nuanced. They have a great deal to do with my underlying values as a physician. That said, I will do my best to describe why I chose Geriatrics and why medical trainees should consider it as a career path.

The oldest of the US "baby boomers" generation turned 65 on January 1, 2010. Every day for the next 19 years thereafter, another 10,000 baby boomers will turn 65. To put this in perspective, this is the equivalent of a Boeing 747 airplane full of baby boomers turning 65 every hour. By 2030, the country's population of "senior boomers" will double to an estimated 71 million individuals.

Making Most of Surgery Rotations

Question

When rotating on a busy surgical service, how can I be helpful and show that I am interested without getting in the way?

Response from Sarah N. Bernstein, MD Resident, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital, New York, NY

In the surgical subspecialties, physicians are usually busy from dawn until dusk, and you may find it difficult to find your place and understand the expectations of the rotation. Just remember that your primary goal is to learn and get as much exposure to the subject as possible. If it is not an area of interest, remember that this may be the only time in your career when you observe particular aspects of this area of medicine. Therefore, you should still try to see as much as possible. If you plan to pursue surgery as your specialty, this is your time to learn the basics and show your enthusiasm. I'm sure each teaching hospital is a little different, but here are some general pointers:

Scheduling Your 3rd Year Clerkship

Question

In what order should I schedule my rotations? What are the best strategies?

Response from Megan L. Fix, MD Assistant Professor, Tufts University School of Medicine; Director, Medical Student Education, Maine Medical Center, Portland, Maine

Your third year of medical school can be exciting and also daunting. Many students ask what the "best" schedule is for their third-year clerkships. Although there is no right answer, there are a few guidelines that can be helpful.

The Forsaken Specialty

PhotoCredit: guardian.co.uk

Abstract and Introduction
Introduction

As a medical student I found that most other students thought that psychiatry was not a true profession—the consultants sit and sip tea, talk nonsense, and nobody ever seems to gets better. No blood test confirms what is wrong. No imaging shows the diagnosis. Simply put, ward rounds that consist of sitting in a room and chatting just didn't seem like "real medicine" to most of my peers. Psychiatric patients were people to be mocked, feared ("you were left alone with them?"), or ignored. Revision for objective structured clinical exams and written papers was left to the last minute because it was "only psych."

I don't know why I thought this would be different when I qualified. Perhaps the "doctor" title would equate to being surrounded by those who understand, appreciate, and respect psychiatry? Goes to show that a label does not define how you act.