Well...THIS IS IT! I finally know what I'm going to do with my life! :)
Coming into medical school, pediatrics was what I 100% wanted to do. Even before medical school, I thought that I "knew" that I needed to work with kids. Before I decided on medicine, I thought that maybe I would be a kindergarten teacher, than a high school science teacher, than a pediatric audiologist...Basically, I knew I needed to work with kids. However, once I got to med school, things changed. I realized 1) liking children wasn't enough to make you like the field of pediatrics, and 2) there were so many fields of medicine that I found fascinating. Specifically, the second I realized how much I loved OB/GYN and how much I enjoyed the 80+ y/o population on my internal medicine rotation, I started questioning everything about what I wanted to do with my life. So, once I FINALLY got to my fifth rotation, I couldn't wait to start the rotation that I knew would ultimately decide my future.
If you have been reading my past blogs (OB/GYN and Family Medicine), you might know that this rotation was really the deciding factor. If I absolutely loved Pediatrics, like I hoped I would, then that would be it. If I hated it, than I would do OB/GYN. If I liked Peds the same amount as OB/GYN, I would consider doing family medicine, as this would give me a little exposure to both fields, along with my beloved 80+ year-old crew. Even though I really don't love adult patients, especially the cirrhotic/heart failure/copd/anxiety/depression/substance abuse male population, I thought maybe the ob, gyn, and peds would make up for it. So, you can see how crucial this rotation was for my life decision making process.
The rotation is basically split in 2: 4 weeks outpatient, 4 weeks in-patient. Further, one week of inpatient is newborn nursery and one week of outpatient is "speciality week." I had a less than ideal schedule, because I started with specialty week and ended with the busiest shift (in patient floor), but what can you do?
Week 1: Specialty Week. Since my first day of the clerkship was orientation, I got 4 days in Specialty week. I was able to rotate through Peds Hematrology/Oncology (which I loved), Peds Orthopedic Surgery, Allergy/Immunology, and Peds Emergency Medicine (which I also loved). Overall, I enjoyed the week, but it was a little weird to start with specialities, as I had yet to actually examine a normal healthy child.
Week 2-4: Out-patient pediatrics. Starting this rotation, I thought the part that I would hate about pediatrics would be well-child visits. From my other colleagues, I have heard that the first few were fun, but they got old fast...well, i couldn't disagree more! I loved everything about out-patient pediatrics. I love that your day is split so that (roughly) half your patients are well-visit check ups and half are sick visits. I loved having a conversation with the parents and the children about what was happening in their lives. I loved how excited new parents were bringing their 4 day old child in to the doctor. I loved counseling parents and children about anticipatory guidance and health maintenance. At this point, I became pretty confident that pediatrics would be my chosen field, but I was not ready to commit until I had a little in patient exposure.
Week 5: Newborn Nursery. THE BEST WEEK OF MEDICAL SCHOOL! Seriously. How can anyone rotate through the newborn nursery and NOT want to do pediatrics? Your day is basically split into three. First, you go in, round on your babies - meaning, you go to the parent's room, ask them how the night was, look at some nursing notes to make sure there we no problems, and do newborn exams all morning. Have I convinced you that its awesome yet? No? Ok, let me keep going. The second part of the day is rushing over to L&D for any high risk deliveries. So, you get to still be involved with both vaginal and cesarian deliveries, but once the delivery occurs, you get handed the baby and provide whatever care the only-seconds-old infant needs. Its. so. fun. Have I convinced you yet? No? Ok how about this... the third part of the day is all procedural. Between Circumcisions and Frenulectomies, the number of mini-surgical procedures you do makes the day go by crazy fast. Finally, guess what happens when there is downtime? You go to the nursery, pick up a baby, sit in a rocking chair and cuddle/feed the babies. Yup, pretty awesome. It truly was the perfect combination of fun newborn exams, patient education (with family discharge planning), obstetrics exposure, and procedures. I LOVED IT ALL.
Week 6-8: In-patient pediatrics (1 week night, 2 weeks days). I really really liked these weeks too! Pediatrics is a really awesome field because you do get to apply the medicine that you learn in the first two years of medical school. I felt like many times when I was on Surgery or OB/GYN, I ignored so much of what I learned in school, because they are surgical specialities and not "medicine" specialties. Even though Pediatrics is still a specialty, the parts of medicine that aren't focused on as much (copd, heart failure, cirrhosis) just happen to be the things in medicine that I don't particularly enjoy anyways. Further, the variety of the patients we saw was quite impressive. From the 6 weaker who was admitted for Failure to Thrive, to the 6 year old with Cardiofasciocutaneous Syndrome, to the 17 year old sickler, to the 4 year old with HSP, the variety of patients we worked with was enough to keep me intrigued and interested, while being able to avoid the adult diagnoses that I don't really care about. Also, although pediatrics is known to be a field with fewer procedures, there was still a good number of caths and LPs that would satisfy some desire in me for procedures, if i do end up choosing the hospital as my chosen area in pedatrics.
So, thats it folks! I am pretty dang excited to finally have a future! Although I have NO clue if i want to do general pediatrics or subspecialize or if i want to work in outpatient or inpatient, at least I know which field i am (hopefully) headed for residency! So, if all goes well, in 1 year, I will be Dr. Van Stavern, MD, Pediatric resident! Cross your fingers!
Showing posts with label m3. Show all posts
Showing posts with label m3. Show all posts
Tuesday, May 6, 2014
Sunday, March 23, 2014
Pediatrics Research Day
Last Wednesday, my research group had the opportunity to do a poster presentation at the 13th annual Pediatrics Research Day at the Breslin Center in East Lansing, MI. It was a great day, filled with speakers from the NIH, Rainbow Babies Children's Hospital, the University of Iowa and Children's Hospital of Detroit. We had talks on Pediatric Academics in the 21st century, Cardioprotection mechanisms for pediatric cancer treatments, and genetic approaches to restoring CFTR function. We also had 6 wonderful oral presentations by Pediatric residents, an undergraduate researcher, and a veternarian. These oral presentations were fantastic; I especially was intrigued by one resident's work with Serotonin-knock out rats that involved surgical manipulation of the ileum to apply acetic acid and observe wound healing mechanisms with the serotonin knock out v. wild type rats - fascinating! Lastly, there were 62 posters presented at the conference. It was inspiring to be around so many people interested in Pediatrics and conducting new and exciting research to better the field.
Our project was a collaboration of six students and our research mentor, Dr. Gold. The project is relatively new, as we have only been collecting data for about 8 weeks, but we thought it was still interesting and important enough to make a poster and get our data out there. It was great to talk about our research to attendings, residents and other students and getting feedback about how our next steps should fall with the project. Ultimately, we left with a good idea of where to go and finished the day feeling optimistic about our project's design and future.
The last portion of the day was the closing remarks and awards ceremony. They would be giving out 1 award for the best oral presentation and five awards for the top poster presentations. They started with oral presentation, awarding the top prize to a deserving resident. Moving on to the posters, they began calling the top 5 names - First was a resident, Second was a a resident, Third was a resident, Fourth was a resident, Fifth....was us! Our group poster had won an award of distinction! It was such an honor, especially with our research having very preliminary data and especially because we were the only students that were recognized with this award. What a great day!
Saturday, March 22, 2014
Specialty Search: Family Medicine
CLERKSHIP #4 = FAMILY MEDICINE
When Wednesday arrived, we got our schedules and assigned clinics. I would be spending about 1/3 of my time on campus at the "clinical center" where most of the docs we worked with during our pre-clinical education practiced. This was awesome for two reasons - 1) it was literally 3 minutes driving distance from my apartment and 2) the faculty were very used to working with students. I would be also be spending 1/3 of my time in a community clinic in Lansing with a doc who I heard great things about from our coordinator. Lastly, I'd spend 1/3 of my time in the Family Medicine Residency Clinic in Mason, MI. This clinic was about a 20 min driving distance (which was kind of a bummer), but there would be only 2-3 residents at a time with me being the only student. This meant I would get pulled in to all of the cool procedures and all of the cool cases. So, overall I was pretty stoked about all of my placements.
The rotation was a great one. In just 8 weeks, I felt like I learned A TON. Family Medicine requires you to know bits and pieces of all medical specialities - from pediatrics, to geriatrics, to ob/gyn, to orthopedics, to psychiatry. Although it felt like a steep learning curve at times, every doctor I worked with was phenominal. There were also a lot of extra workshops to be a part of during the clerkship - muskuloskeletal exams, suturing/dermatology clinics, and casting workshops - which were all very fun and educational!
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| I broke both my wrists :( |
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| ...JUST KIDDING! |
When the rotation began wrapping to a close, I realized how much I did enjoy it. I never really thought about being a family doctor, but I could totally see the appeal.
PROS: GREAT hours, diverse patients, diverse disease processes, and continuity of care. Family doctors are literally the happiest people I have ever met in medicine. They get to see patients from birth until adulthood (if you are practicing long enough). You can tailor your practice to your specific interests. The need for family doctors is everywhere! There are 48 family medicine residency programs in california (yes, i looked this up!). I would be able to do Peds/OB work. Lastly, I actually really did like the out-patient setting, which was a definite surprise to me!
CONS: I really really don't like adult medicine...(is that bad to admit?). Also, anytime you get a patient that is complex (meaning...really cool), many docs that I worked with feel like they should refer. Lastly, I felt like a lot of the time docs were just acting as travel agents, coordinating patient care. In several situations, patients would come in to discuss many health conditions with their PCP, but all of these health conditions were managed by specialists around the city.
So, as you can see - the pros WAY outway the cons, but there is still something missing for me with family medicine. So, while I haven't totally decided against family med, I think OB/GYN or Pediatrics is still higher in the running for my future specialty choice...but only time will tell!
Saturday, March 15, 2014
Specialty Search: OB/GYN
My 3rd clerkship of the year: OB/GYN.
This is one that I could not WAIT for! Between my first and second year, I did an externship at St. John's Hospital in Grosse Pointe, MI (See here) where we rotated through various sub-specialties and I got my first glimpse of the beauty of OB/GYN, so I couldn't wait to start! On the flip side, Ob/gyn at our hospital doesn't have the best reputation -- its known for being quite catty and for having many residents/doctors who pick favorites. Part of our grading includes evaluations from residents/doctors and this clerkship was known for people getting low evaluations that excluded them from honors (which I know isn't the most important thing, but it was still worrisome). Lastly, I was nervous because of the horrible hours associated with this clerkship. More so than any other clerkship, the amount of night shifts/24 hour shifts during OB/GYN would pretty much take up all of my weekends available in the clerkship to study/stay sane.
On the first day of the clerkship, we were handed our schedules and walked through what would be expected of us. My schedule was as followed: 1 week of orientation/lectures, 2 weeks of Gyn Surgery, 2 weeks of Labor and Delivery, 2 weeks of out-patient clinic, 1 week of oral exam/written exam/random wrap-up things and (of course) the dreaded 24 hour weekend shifts sprinkled in between. Overall, I was very happy with this since it meant I was ending on out-patient clinic (which had super relaxed hours) and I would have plenty of time to study! Also, just talking about the clerkship made me excited - finally something that I was truly interested in!
GYN SURGERY - My two weeks on gyn surg were great! Having just come off of an 8-week surgery clerkship, I was kind of ready for a break from the OR, but it turns out gyn surg and gen surg are totally different! Yes, there are some long procedures (ex: hysterectomies) in gyn surg, but I just loved that a large proportion of the surgeries were 45 minutes long. Get in, get out - get the patient home! I also loved that Gyn Surg is specialized surgery from the start. Learning specialized surgical areas to select body parts is way more interesting to me than learning general surgery. At the end of the two weeks, I was not ready to leave Gyn Surg... I wanted more! That has to be a good sign, right?
LABOR AND DELIVERY - This was definitely a roller coaster of emotions! It was high stress and you really had to put a lot of effort in to know what was going on when. Unlike surgery, live births aren't scheduled...obviously. So, if you weren't waiting outside your patients rooms at the right time, no one would call you and you would miss the delivery. Also, I had several moments where I really thought I screwed up bad, which is such a horrible feeling. Ex: my very first cesarian section (ever) was right when I was coming on at sign-out of my first L&D shift. The resident told me to run and introduce myself to the patient so that I could go in on a Cesarian section secondary to severe pre-eclampsia. So, I did as I was told. I walked into the patient's room and proceeded to say "Hello! My name is Kailyne and I am a medical student. I would like to observe your c-section today." At that moment, the nurse gave me a death stare and stated "She hasn't been told she was having a c-section yet." Worst. Feeling. Ever. In the end, it turned out fine, but still I felt like a piece of bleep. On the other hand, the L&D can be the happiest place in the hospital. What is more beautiful than watching somebody come into this world? I think the highlight of my whole medical school career thus far is doing my first solo delivery, knowing that I just helped a baby successful gain life. So overall, I really really enjoyed these two weeks. Even though its extremely high stress, you adjust. Once I got my footing and felt comfortable in L&D, it was my absolute favorite place to be!
OUT-PATIENT CLINIC - This semester, I have had VERY little time in the outpatient setting. Going from IM to Surgery to OB/GYN, I had maybe 10 clinic days total up until now. So, I really didn't know if I would like this or not. Well, I loved it! I love that ob/gyn clinic is also semi procedural. I love that there is some continuity of care. I love that this element is also so predominant in the field, because of how diverse the field of OB/GYN is. I had a really great experience and got to perfect my ability to do a pap smear, while also being able to rotate through subspecialties. I also wasn't ready for this to end.
FINALS WEEK - After my 7 weeks of the clerkship, it was finally time to face the music and test out what I had learned. This week, we would have both our oral and written exam. Up until now, I had screwed up the written by a few points to not allow me to honor the rotations, so I was ready to finally get that H. Also, I knew if I was really serious about maybe going into OB/GYN, getting that mark would be important....and sure enough...I honored!!! Finally!
What a great rotation. I loved every (well, at least almost every) minute of it! But, like every field, there are definite pros and cons:
1) PROS: Women's health is an interesting and important field, continuity of care potential, procedural field, diversity of patients and diversity of settings to work in, and the incredible rewards of obstetrics. I was never EVER bored and went home every single day with a smile. I looked forward to going to work every day and was very sad when the clerkship ended.
2) CONS: The two most obvious are 1) the unpredictable hours and 2) malpractice insurance. The only other real con is that you really do just have to give the babies away immediately. I will never ever see a pediatric patient, which I don't know if I can handle.
So thats it! It was a great rotation and definitely a possibility for my specialty of choice! :)
This is one that I could not WAIT for! Between my first and second year, I did an externship at St. John's Hospital in Grosse Pointe, MI (See here) where we rotated through various sub-specialties and I got my first glimpse of the beauty of OB/GYN, so I couldn't wait to start! On the flip side, Ob/gyn at our hospital doesn't have the best reputation -- its known for being quite catty and for having many residents/doctors who pick favorites. Part of our grading includes evaluations from residents/doctors and this clerkship was known for people getting low evaluations that excluded them from honors (which I know isn't the most important thing, but it was still worrisome). Lastly, I was nervous because of the horrible hours associated with this clerkship. More so than any other clerkship, the amount of night shifts/24 hour shifts during OB/GYN would pretty much take up all of my weekends available in the clerkship to study/stay sane.
On the first day of the clerkship, we were handed our schedules and walked through what would be expected of us. My schedule was as followed: 1 week of orientation/lectures, 2 weeks of Gyn Surgery, 2 weeks of Labor and Delivery, 2 weeks of out-patient clinic, 1 week of oral exam/written exam/random wrap-up things and (of course) the dreaded 24 hour weekend shifts sprinkled in between. Overall, I was very happy with this since it meant I was ending on out-patient clinic (which had super relaxed hours) and I would have plenty of time to study! Also, just talking about the clerkship made me excited - finally something that I was truly interested in!
GYN SURGERY - My two weeks on gyn surg were great! Having just come off of an 8-week surgery clerkship, I was kind of ready for a break from the OR, but it turns out gyn surg and gen surg are totally different! Yes, there are some long procedures (ex: hysterectomies) in gyn surg, but I just loved that a large proportion of the surgeries were 45 minutes long. Get in, get out - get the patient home! I also loved that Gyn Surg is specialized surgery from the start. Learning specialized surgical areas to select body parts is way more interesting to me than learning general surgery. At the end of the two weeks, I was not ready to leave Gyn Surg... I wanted more! That has to be a good sign, right?
LABOR AND DELIVERY - This was definitely a roller coaster of emotions! It was high stress and you really had to put a lot of effort in to know what was going on when. Unlike surgery, live births aren't scheduled...obviously. So, if you weren't waiting outside your patients rooms at the right time, no one would call you and you would miss the delivery. Also, I had several moments where I really thought I screwed up bad, which is such a horrible feeling. Ex: my very first cesarian section (ever) was right when I was coming on at sign-out of my first L&D shift. The resident told me to run and introduce myself to the patient so that I could go in on a Cesarian section secondary to severe pre-eclampsia. So, I did as I was told. I walked into the patient's room and proceeded to say "Hello! My name is Kailyne and I am a medical student. I would like to observe your c-section today." At that moment, the nurse gave me a death stare and stated "She hasn't been told she was having a c-section yet." Worst. Feeling. Ever. In the end, it turned out fine, but still I felt like a piece of bleep. On the other hand, the L&D can be the happiest place in the hospital. What is more beautiful than watching somebody come into this world? I think the highlight of my whole medical school career thus far is doing my first solo delivery, knowing that I just helped a baby successful gain life. So overall, I really really enjoyed these two weeks. Even though its extremely high stress, you adjust. Once I got my footing and felt comfortable in L&D, it was my absolute favorite place to be!
OUT-PATIENT CLINIC - This semester, I have had VERY little time in the outpatient setting. Going from IM to Surgery to OB/GYN, I had maybe 10 clinic days total up until now. So, I really didn't know if I would like this or not. Well, I loved it! I love that ob/gyn clinic is also semi procedural. I love that there is some continuity of care. I love that this element is also so predominant in the field, because of how diverse the field of OB/GYN is. I had a really great experience and got to perfect my ability to do a pap smear, while also being able to rotate through subspecialties. I also wasn't ready for this to end.
FINALS WEEK - After my 7 weeks of the clerkship, it was finally time to face the music and test out what I had learned. This week, we would have both our oral and written exam. Up until now, I had screwed up the written by a few points to not allow me to honor the rotations, so I was ready to finally get that H. Also, I knew if I was really serious about maybe going into OB/GYN, getting that mark would be important....and sure enough...I honored!!! Finally!
What a great rotation. I loved every (well, at least almost every) minute of it! But, like every field, there are definite pros and cons:
1) PROS: Women's health is an interesting and important field, continuity of care potential, procedural field, diversity of patients and diversity of settings to work in, and the incredible rewards of obstetrics. I was never EVER bored and went home every single day with a smile. I looked forward to going to work every day and was very sad when the clerkship ended.
2) CONS: The two most obvious are 1) the unpredictable hours and 2) malpractice insurance. The only other real con is that you really do just have to give the babies away immediately. I will never ever see a pediatric patient, which I don't know if I can handle.
So thats it! It was a great rotation and definitely a possibility for my specialty of choice! :)
Sunday, January 12, 2014
Specialty Search: General Surgery
The months of September and October were definitely a challenge. With the start of my 2 month long surgery clerkship, I knew that I was in for a long period of little sleep, high expectations and little sympathy for my complaints. Although I knew it would be difficult, I had absolutely no idea how to prepare myself. Even though S is a surgeon and he gave me as many pointers as he could, there isn't much you can do to learn the etiquette of an OR without just sucking it up and living through the trial and error.
The first week of the clerkship was kind of a joke. It consisted of lectures, suture clinics and IV drawing workshops. The hours were super easy and I loved every minute of it!
Too bad the easiness didn't last...
The next two weeks, I was on Trauma surgery; one week on days and one week on nights. These weeks were pretty good. The mornings consisted of rounding, upon rounding, upon rounding. Around 1PM everyday, the other med student and I would sneak away from even more rounding to go hang out in the ER and wait for trauma activations to roll in. There were a lot of MVCs, some GSWs, and a few burns/explosions. Overall, it was pretty cool! My week of nights was really awesome; when you are on nights, your team is responsible for everything surgical that goes on in the hospital. So, we covered all the traumas, all the pre-op and post-op surgical patients and anyone coming in with emergency surgical problems that needed to be operated on over night. So, we stayed busy and had a decent amount of responsibility, which is good enough for a medical student. Overall, I enjoyed my time on trauma service, but was ready to really get into an operating room and get my sterilized and double-glove-protected hands dirty with surgeries.
For the next 5 weeks, I spent my time alternating between the general surgery service and the "specialty" services that included plastic surgery, pediatric surgery, orthopedic surgery, colorectal surgery and many more! The first few days were awesome...the surgeries were cool, the gave us a decent amount of responsibility, and the majority of people were welcoming to students, which was a happy surprise on this rotation.
The rest of the rotation can be summarized in the good v. bad.
THE GOOD:
Overall, the cases were very cool. I really really liked the OR. I liked having patients that would come in with problems that you could take into a room, cut it out, sew them back together and occassionally fix the problem. It was a big change from Internal Medicine, in which a lot of the cases I just felt like we were playing a waiting game, without actually helping the patients. So, in that sense, I really did enjoy surgery. I also liked that during surgery, medical students have a job. It might just be cutting sutures, or retracting, or occasionally closing the skin...but we were able to use our hands and be apart of the action.
THE BAD:
While I did enjoy a lot of the rotation, there were definitely a lot of negatives. First, and most obvious, were the horrible terrible ridiculous hours. On a good day, we could show up at 6 AM and would be released by 6PM. However, Wednesdays and Thursdays we would have morning didactics, so we would have to be there and start work at 5 AM. What made this even worse, is that every few days, we were on call until 9PM-ish. I was a lucky student that happened to have a lot of Wednesday night calls. So, I would wake up at 3:45 AM, start work at 5 AM, stay until 9PM, get home at 9:30ish, and would have between 9:30PM-3:45AM to get everything I needed to do taken care of, eat and sleep. Yeah. It sucked. I knew that I could survive that short term, but man oh man I could never be a surgery resident that lived that every day. The second thing I didn't really like was everyone's attitude. Even though the residents and attendings were (mostly) all nice, you could just tell they were angry. It has nothing to do with the individual people...its just the culture of surgery that makes you that way. I know that it doesn't have to be that way and that there are many surgeons that this is not true for...but compared to Internal Medicine, there sure seemed to have a larger proportion of angry surgeons than IM docs. Finally, I didn't love the lack of continuity of care. Yeah, sure...there was some. There were patients that came to the service A LOT...like, several times in the two months that we were there. Also, doctors will see clinic patients, operate on them, and see them again for follow-up...BUT, it just wasn't the same. The care, for a majority of patients, seemed fragmented...and I didn't love that.
So, overall....I did enjoy the rotation. I'm 99.9% sure General Surgery is NOT my chosen field...but it was still a good experience. I learned a decent amount..and hey, you have to go through a lot of specialities to cross things off before you can figure out what you're calling is! Right?
Thats all for now!
The first week of the clerkship was kind of a joke. It consisted of lectures, suture clinics and IV drawing workshops. The hours were super easy and I loved every minute of it!
Too bad the easiness didn't last...
The next two weeks, I was on Trauma surgery; one week on days and one week on nights. These weeks were pretty good. The mornings consisted of rounding, upon rounding, upon rounding. Around 1PM everyday, the other med student and I would sneak away from even more rounding to go hang out in the ER and wait for trauma activations to roll in. There were a lot of MVCs, some GSWs, and a few burns/explosions. Overall, it was pretty cool! My week of nights was really awesome; when you are on nights, your team is responsible for everything surgical that goes on in the hospital. So, we covered all the traumas, all the pre-op and post-op surgical patients and anyone coming in with emergency surgical problems that needed to be operated on over night. So, we stayed busy and had a decent amount of responsibility, which is good enough for a medical student. Overall, I enjoyed my time on trauma service, but was ready to really get into an operating room and get my sterilized and double-glove-protected hands dirty with surgeries.
For the next 5 weeks, I spent my time alternating between the general surgery service and the "specialty" services that included plastic surgery, pediatric surgery, orthopedic surgery, colorectal surgery and many more! The first few days were awesome...the surgeries were cool, the gave us a decent amount of responsibility, and the majority of people were welcoming to students, which was a happy surprise on this rotation.
The rest of the rotation can be summarized in the good v. bad.
THE GOOD:
Overall, the cases were very cool. I really really liked the OR. I liked having patients that would come in with problems that you could take into a room, cut it out, sew them back together and occassionally fix the problem. It was a big change from Internal Medicine, in which a lot of the cases I just felt like we were playing a waiting game, without actually helping the patients. So, in that sense, I really did enjoy surgery. I also liked that during surgery, medical students have a job. It might just be cutting sutures, or retracting, or occasionally closing the skin...but we were able to use our hands and be apart of the action.
THE BAD:
While I did enjoy a lot of the rotation, there were definitely a lot of negatives. First, and most obvious, were the horrible terrible ridiculous hours. On a good day, we could show up at 6 AM and would be released by 6PM. However, Wednesdays and Thursdays we would have morning didactics, so we would have to be there and start work at 5 AM. What made this even worse, is that every few days, we were on call until 9PM-ish. I was a lucky student that happened to have a lot of Wednesday night calls. So, I would wake up at 3:45 AM, start work at 5 AM, stay until 9PM, get home at 9:30ish, and would have between 9:30PM-3:45AM to get everything I needed to do taken care of, eat and sleep. Yeah. It sucked. I knew that I could survive that short term, but man oh man I could never be a surgery resident that lived that every day. The second thing I didn't really like was everyone's attitude. Even though the residents and attendings were (mostly) all nice, you could just tell they were angry. It has nothing to do with the individual people...its just the culture of surgery that makes you that way. I know that it doesn't have to be that way and that there are many surgeons that this is not true for...but compared to Internal Medicine, there sure seemed to have a larger proportion of angry surgeons than IM docs. Finally, I didn't love the lack of continuity of care. Yeah, sure...there was some. There were patients that came to the service A LOT...like, several times in the two months that we were there. Also, doctors will see clinic patients, operate on them, and see them again for follow-up...BUT, it just wasn't the same. The care, for a majority of patients, seemed fragmented...and I didn't love that.
So, overall....I did enjoy the rotation. I'm 99.9% sure General Surgery is NOT my chosen field...but it was still a good experience. I learned a decent amount..and hey, you have to go through a lot of specialities to cross things off before you can figure out what you're calling is! Right?
Thats all for now!
Saturday, November 9, 2013
Specialty Search: Internal Medicine
My first rotation of 3rd year: Internal Medicine.
I had requested this clerkship to be in slot #1 for a few reasons. First, I figured I would hopefully not sounds like a total idiot, having just come off of Step 1 studying; this unfortunately didn't matter and I now realize that I was going to sound like an idiot no matter what, but at least I tried. Second, I figured having this first would set me up well for all of the rest of the clerkships. Finally, I didn't think that there was any chance that I would like Internal Medicine enough to make it my lifelong profession, so why not take it first?
What I loved:
1) Amazing diversity of cases - Every patient was so different; loved seeing the rare and and interesting diseases I didn't think actually existed in my patients!
2) In patient setting - The really really really sick patients (meaning interesting/complicated cases) are all in-patient. So, the fact that the clerkship was 6 weeks in patient, 2 weeks outpatient was a BIG plus for me!
3) Knowing everything about your patients - IM doctors are the main provider for their patients. So, these doctors know their patients medical history inside and out. Unlike the other fields I have been exposed to, which only really care about the organ they specialize in, IM peeps look at the patients as a whole and know every little detail...its pretty awesome actually.
4) Flexibility on what/where you practice - IM has about 123928109 different sub-specialties and about 230432840 different settings you can work in. From a general internist that works mostly out patient to a cardiologist who does mostly in patient procedures, IM truly has so many paths. So, for someone like me who is indecisive on what they want to do, this is very appealing.
What I didn't love:
1) No pediatrics/obstetrical patients - Lets be real. I LOVE babies. I love teenagers. I love pregnant women. I love sexual health. So, the biggest thing that turns me off on IM is that this is the field that has none of these patients. Any time there is a kid, they are sent to family med or peds. Anytime there is a pregnant lady, they are sent to family med or OB/GYN. So, literally my two favorite patient populations are not included in IM. Big bummer.
2) No procedures. None. I literally did not do a single procedure on my two months of IM. I know there are some sub-specialities like cardio and GI that are more procedure-based, but getting to that means a lot of non-procedural rounding days. Don't know if I can handle that.
3) Talking, instead of doing: So.Much.Rounding. Literally all day is rounding. Sometimes it felt like we were discussing problems really thoroughly and spending a lot of time conceptualizing what was wrong with the patient, but that work didn't really translate into much improvement in the patients care. Obviously thinking about medical problems is important and the basis of medicine, but all day? It was too much.
So, overall...Internal Medicine was a great experience. I actually really did enjoy it a lot. I am unsure that this is my future profession, but I havent completely ruled it out!
I had requested this clerkship to be in slot #1 for a few reasons. First, I figured I would hopefully not sounds like a total idiot, having just come off of Step 1 studying; this unfortunately didn't matter and I now realize that I was going to sound like an idiot no matter what, but at least I tried. Second, I figured having this first would set me up well for all of the rest of the clerkships. Finally, I didn't think that there was any chance that I would like Internal Medicine enough to make it my lifelong profession, so why not take it first?
What I loved:
1) Amazing diversity of cases - Every patient was so different; loved seeing the rare and and interesting diseases I didn't think actually existed in my patients!
2) In patient setting - The really really really sick patients (meaning interesting/complicated cases) are all in-patient. So, the fact that the clerkship was 6 weeks in patient, 2 weeks outpatient was a BIG plus for me!
3) Knowing everything about your patients - IM doctors are the main provider for their patients. So, these doctors know their patients medical history inside and out. Unlike the other fields I have been exposed to, which only really care about the organ they specialize in, IM peeps look at the patients as a whole and know every little detail...its pretty awesome actually.
4) Flexibility on what/where you practice - IM has about 123928109 different sub-specialties and about 230432840 different settings you can work in. From a general internist that works mostly out patient to a cardiologist who does mostly in patient procedures, IM truly has so many paths. So, for someone like me who is indecisive on what they want to do, this is very appealing.
What I didn't love:
1) No pediatrics/obstetrical patients - Lets be real. I LOVE babies. I love teenagers. I love pregnant women. I love sexual health. So, the biggest thing that turns me off on IM is that this is the field that has none of these patients. Any time there is a kid, they are sent to family med or peds. Anytime there is a pregnant lady, they are sent to family med or OB/GYN. So, literally my two favorite patient populations are not included in IM. Big bummer.
2) No procedures. None. I literally did not do a single procedure on my two months of IM. I know there are some sub-specialities like cardio and GI that are more procedure-based, but getting to that means a lot of non-procedural rounding days. Don't know if I can handle that.
3) Talking, instead of doing: So.Much.Rounding. Literally all day is rounding. Sometimes it felt like we were discussing problems really thoroughly and spending a lot of time conceptualizing what was wrong with the patient, but that work didn't really translate into much improvement in the patients care. Obviously thinking about medical problems is important and the basis of medicine, but all day? It was too much.
So, overall...Internal Medicine was a great experience. I actually really did enjoy it a lot. I am unsure that this is my future profession, but I havent completely ruled it out!
Wednesday, July 10, 2013
First Few Days of Internal Medicine
3 days down, hundreds of day to go left of third year!
It has been quite the crazy last few days. From having my first clerkship orientation, to learning everything I would ever want to know in a 2-day 8 hour ECG work-shop, to having my first patients, to learning to navigate the EMR, and to finding out my score of just a little thing called Step 1 (but I'll get to that later).
Day 1: Monday morning, I went to Sparrow Hospital at 8 AM (which seems so late in the day now). We met with our incredibly nice clerkship coordinators in the morning to go over 1) the clerkship calendar, 2) all of the requirements, 3) how to honor, and many more important topics. It was amazingly informative. After the orientation, our little group of 5 students on the Medicine clerkship had 5:2 attention during a 5-hour ECG workshop (part 1) with two amazing Internal Medicine docs. They used the socratic method and basically put up and ECG, called us up to the overhead and made us interpret them even though we had absolutely no idea what was going on. Eventually, however, ECGs became (dare I say it) fairly easy to read and I know feel (somewhat) confident in how to interpret them! Who would have guessed? After the ECG workshop, we got a quick introduction to all of the different cases and logs we would have to complete on various websites and then got to have the rest of the afternoon to start reading and register for all of the millions of websites and research tools we needed to register for.
Day 2: Our first day with patients!!!! Gahh...I was so nervous. I went up to the 8th floor of Sparrow Hospital at about 7:10 AM. We were supposed to be there by 7:15 for morning report (where the night shift docs hand off the patients in a very systematic way to the daytime docs). I didn't really know what was going on for the first hand-off, but I think I did a good job pretending by jotting down notes in the margins of our patient list. After hand-off, the resident looked at me and told me to "go see the patient in room ***." And that was it...no shadowing, no introductory patient... I was just told to go see the patient and report back when it was time to round with the attending. I spent 1.5 hours with my first patient. I know, I know this sounds like an ABSURDLY long time to spend with one patient...but I am not efficient yet and I don't know whats important, so I pretty much got this guy's life story, which was quite fascinating. After doing a history and physical exam on my patient, I headed back to the resident room, checked some of his info on the EMR, went to meet with the attending, and gave my first real oral presentation (talk about nervous!!!). Much to my surprise, the oral presentation went really well! After all of the patients had been discussed and we had come up with plans for each of the patients, we rounded as a team to each of the patients' rooms with the attending physician to further speak with the patients. It was a really amazing first day of rounding and I learned a TON. I thought I was going to absolutely hate internal medicine, but I've loved it so far! After rounding, we headed back to a lecture room and finished our last few hours of ECG work-shop (part 2).
Day 3: Today was crazy fast-paced. I got in a little earlier (6:55ish) to look up my patients, but quickly ran out of time. By the time morning report and a quick resident-given lecture about acute COPD exacerbation was complete, it was 9 AM and I had only 30 minutes to round on 3 patients! 3! This time yesterday, I spent 1.5 hours on 1 patient! So, obviously I freaked out and didn't do well, but hey I guess its my second day and its not that big of a deal. I have learned my lesson and will show up earlier tomorrow! After a morning of rounding, we headed again to a lecture; this time it was split into a Q&A session (basically answering board-type questions in my little group of 5) and 30 min mini-lecture on anemias. Overall, it was a pretty good day, but I know that I need to get my s*#& together when it comes to rounding on my patients earlier/quicker/more efficiently, but I think that will come with time.
Oh...and something else that happened today...................I FINALLY got my Step 1 score. You know, Step 1..The exam that I spent a month intensively studying for. The exam that determines where/when I can do residency. Yeah, that exam thats kind of a big deal. We were told that the exam scores would be released to MSU early this morning. If we had failed, the school was going to page us to come in and talk about when we could retake the exam/whether or not we had to stop the current clerkship we were on. If we didn't receive a call, our exam scores would be released via email by 11 AM. So, I had to use all of my self control not to frantically check my email/text messaging every 6 seconds. Thank goodness that I had a busy morning, otherwise I think I would have gone crazy. Well, all morning I waited and waited...convinced that I would get a page. Finally, a little after 11 AM I got a text from a friend to tell me scores were up. I took that as I sign that I had passed and let out a HUGGGEEE sigh of relief. I decided a while ago that I didn't want to check my score for a while, but with EVERYONE around me telling me to check it, I finally gave in at around 4 PM. I made my friend Michelle stand with me while I opened it, because I was so terrified that I would burst into tears. So, after a few seconds of calming myself down, I pushed "view results" and closed my eyes. When I finally mustered up enough courage, I opened my eyes and *sigh* I could finally breathe! I was so so happy with my score. It wasn't the highest score I had gotten on a practice test, but it was close. Its a score that puts me significantly above average for most medical specialties, especially those that I am actually interested in. Its a score that puts me in a position that (according to the latest residency charting outcomes) "almost always grants an interview" at the majority of residency programs. So, yes. I did it! Such a relief. Good riddens, Step 1! I'm so glad that is officially over with!
It has been quite the crazy last few days. From having my first clerkship orientation, to learning everything I would ever want to know in a 2-day 8 hour ECG work-shop, to having my first patients, to learning to navigate the EMR, and to finding out my score of just a little thing called Step 1 (but I'll get to that later).
Day 1: Monday morning, I went to Sparrow Hospital at 8 AM (which seems so late in the day now). We met with our incredibly nice clerkship coordinators in the morning to go over 1) the clerkship calendar, 2) all of the requirements, 3) how to honor, and many more important topics. It was amazingly informative. After the orientation, our little group of 5 students on the Medicine clerkship had 5:2 attention during a 5-hour ECG workshop (part 1) with two amazing Internal Medicine docs. They used the socratic method and basically put up and ECG, called us up to the overhead and made us interpret them even though we had absolutely no idea what was going on. Eventually, however, ECGs became (dare I say it) fairly easy to read and I know feel (somewhat) confident in how to interpret them! Who would have guessed? After the ECG workshop, we got a quick introduction to all of the different cases and logs we would have to complete on various websites and then got to have the rest of the afternoon to start reading and register for all of the millions of websites and research tools we needed to register for.
Day 2: Our first day with patients!!!! Gahh...I was so nervous. I went up to the 8th floor of Sparrow Hospital at about 7:10 AM. We were supposed to be there by 7:15 for morning report (where the night shift docs hand off the patients in a very systematic way to the daytime docs). I didn't really know what was going on for the first hand-off, but I think I did a good job pretending by jotting down notes in the margins of our patient list. After hand-off, the resident looked at me and told me to "go see the patient in room ***." And that was it...no shadowing, no introductory patient... I was just told to go see the patient and report back when it was time to round with the attending. I spent 1.5 hours with my first patient. I know, I know this sounds like an ABSURDLY long time to spend with one patient...but I am not efficient yet and I don't know whats important, so I pretty much got this guy's life story, which was quite fascinating. After doing a history and physical exam on my patient, I headed back to the resident room, checked some of his info on the EMR, went to meet with the attending, and gave my first real oral presentation (talk about nervous!!!). Much to my surprise, the oral presentation went really well! After all of the patients had been discussed and we had come up with plans for each of the patients, we rounded as a team to each of the patients' rooms with the attending physician to further speak with the patients. It was a really amazing first day of rounding and I learned a TON. I thought I was going to absolutely hate internal medicine, but I've loved it so far! After rounding, we headed back to a lecture room and finished our last few hours of ECG work-shop (part 2).
Day 3: Today was crazy fast-paced. I got in a little earlier (6:55ish) to look up my patients, but quickly ran out of time. By the time morning report and a quick resident-given lecture about acute COPD exacerbation was complete, it was 9 AM and I had only 30 minutes to round on 3 patients! 3! This time yesterday, I spent 1.5 hours on 1 patient! So, obviously I freaked out and didn't do well, but hey I guess its my second day and its not that big of a deal. I have learned my lesson and will show up earlier tomorrow! After a morning of rounding, we headed again to a lecture; this time it was split into a Q&A session (basically answering board-type questions in my little group of 5) and 30 min mini-lecture on anemias. Overall, it was a pretty good day, but I know that I need to get my s*#& together when it comes to rounding on my patients earlier/quicker/more efficiently, but I think that will come with time.
Oh...and something else that happened today...................I FINALLY got my Step 1 score. You know, Step 1..The exam that I spent a month intensively studying for. The exam that determines where/when I can do residency. Yeah, that exam thats kind of a big deal. We were told that the exam scores would be released to MSU early this morning. If we had failed, the school was going to page us to come in and talk about when we could retake the exam/whether or not we had to stop the current clerkship we were on. If we didn't receive a call, our exam scores would be released via email by 11 AM. So, I had to use all of my self control not to frantically check my email/text messaging every 6 seconds. Thank goodness that I had a busy morning, otherwise I think I would have gone crazy. Well, all morning I waited and waited...convinced that I would get a page. Finally, a little after 11 AM I got a text from a friend to tell me scores were up. I took that as I sign that I had passed and let out a HUGGGEEE sigh of relief. I decided a while ago that I didn't want to check my score for a while, but with EVERYONE around me telling me to check it, I finally gave in at around 4 PM. I made my friend Michelle stand with me while I opened it, because I was so terrified that I would burst into tears. So, after a few seconds of calming myself down, I pushed "view results" and closed my eyes. When I finally mustered up enough courage, I opened my eyes and *sigh* I could finally breathe! I was so so happy with my score. It wasn't the highest score I had gotten on a practice test, but it was close. Its a score that puts me significantly above average for most medical specialties, especially those that I am actually interested in. Its a score that puts me in a position that (according to the latest residency charting outcomes) "almost always grants an interview" at the majority of residency programs. So, yes. I did it! Such a relief. Good riddens, Step 1! I'm so glad that is officially over with!
Sunday, July 7, 2013
Third Year Orientation
Last week, I spent my first of many long days to come at Sparrow Hospital getting oriented to what my 3rd year would be like. To be honest, about 50% of it was common sense or things we have already learned (ex: dress code, professionalism, how to give an oral presentation), but the other 50% was pretty useful information. Most important of this information was getting trained on two different EMR systems, which are ridiculously confusing. Hopefully it doesn't take me too long to really understand the EMR during clerkships.
In addition to lots of talks about what to expect during third year, we finally got our finalized schedules. We had a one-on-one meeting with our clinical coordinator months ago, so we kind of knew what our schedules would look like, but only our first rotation was guaranteed. Overall, I got almost exactly what I wanted...so I'm happy. My schedule is as follows:
1) Internal Medicine (2 months)
2) Surgery (2 months)
3) Ob/Gyn (2 months)
*Winter Break*
4) Family Medicine (2 months)
5) Pediatrics (2 months)
6) Elective (1 month) [Not entirely sure what I'm going to do...maybe a research month? maybe anesthesia?]
7) Psych (1 month)
We were also given our swipey badges to have access to all over the hospital and to get out of the parking lot for free (woo!)... AND we were given our pagers! All of us immediately whipped out our iPhones to take pictures of our new pagers, 'cuz thats pretty cool. At least, it seemed cool until our Clinical Coordinator stated that "we must have these pagers on us 24/7 from now until you graduate." Then, my whole class collectively realized that maybe we shouldn't be as excited for something that we will surely get sick of very quickly!
Now that I'm done with orientation, I have realized that this is it. Tomorrow morning, I will be marching into Sparrow Hospital to start my very first day of third year with real doctors, real residents, and (most importantly) real patients. I am so nervous, so terrified, so excited, so eager...but I feel like this is normal for an incoming M3 that has absolutely no idea what to expect for the next 12 months. Wish me luck for my first day!
In addition to lots of talks about what to expect during third year, we finally got our finalized schedules. We had a one-on-one meeting with our clinical coordinator months ago, so we kind of knew what our schedules would look like, but only our first rotation was guaranteed. Overall, I got almost exactly what I wanted...so I'm happy. My schedule is as follows:
1) Internal Medicine (2 months)
2) Surgery (2 months)
3) Ob/Gyn (2 months)
*Winter Break*
4) Family Medicine (2 months)
5) Pediatrics (2 months)
6) Elective (1 month) [Not entirely sure what I'm going to do...maybe a research month? maybe anesthesia?]
7) Psych (1 month)
We were also given our swipey badges to have access to all over the hospital and to get out of the parking lot for free (woo!)... AND we were given our pagers! All of us immediately whipped out our iPhones to take pictures of our new pagers, 'cuz thats pretty cool. At least, it seemed cool until our Clinical Coordinator stated that "we must have these pagers on us 24/7 from now until you graduate." Then, my whole class collectively realized that maybe we shouldn't be as excited for something that we will surely get sick of very quickly!
Now that I'm done with orientation, I have realized that this is it. Tomorrow morning, I will be marching into Sparrow Hospital to start my very first day of third year with real doctors, real residents, and (most importantly) real patients. I am so nervous, so terrified, so excited, so eager...but I feel like this is normal for an incoming M3 that has absolutely no idea what to expect for the next 12 months. Wish me luck for my first day!
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