Orthopod Test Videos
Great online resource for orthopedic testing of the knee, shoulder, and ankle from this professor at UC Fresno. Also available as a Podcast, so you can download the videos to your computer (or iPod, I guess!). Pretty cool.
or
Great online resource for orthopedic testing of the knee, shoulder, and ankle from this professor at UC Fresno. Also available as a Podcast, so you can download the videos to your computer (or iPod, I guess!). Pretty cool.
(’Cause everyone’s been asking, “So did you get a job?”)
I find it best to begin at the beginning.
In your final year of medical school, you have to decide in which specialty you want to train. This could be anything from “Internal Medicine,” where you would become an internist, to “Pediatrics,” where you’d become a pediatrician, to “Urology,” where you’d become a urologist. Radiology, Neurosurgery, Emergency Medicine–it’s all there. (Except some Internal Medicine specialties, like cardiology, endocrinology, which require you to do an internal medicine residency and then another training session called “Fellowship.”) Anyway. You decide your specialty, and then try to figure out where you want to train for residency*.
So while you’re figuring out where you would like to train for residency (based on a number of factors like reputation, location, research opportunities, etc.) you’re preparing an application for these residency programs. It’s a big electronic folder of things like grades (if your school has them), board scores (standardized national exams everyone has to take), letters of recommendation, evaluations from your time working in the hospital, extracurricular activities, research, and a one-page personal statement. So you submit that to a big centralized clearinghouse called ERAS, which charges you a fee based on how many places you apply to
. Depending on how competitive your specialty is (orthopedics, radiology, anesthesia are often at the top), you may end up applying to an insane number of programs. Like 40. This can be $500-$600 just to apply.
You want to get your application in ASAP, because residency programs can start downloading parts of it as soon as you pay, and can start offering you interviews whenever they want. Technically, they don’t have your full application until November 1, when your medical school releases your “Dean’s Letter,” a summary of your performance during medical school and sometimes has a ranking, grade, or keyword (”Graham is a good candidate,” vs “Graham is an outstanding candidate”) to differentiate students at the same medical school. But anywhere between late October and early November you’ve heard from most programs via email as to if or when they’re going to offer you an interview. For some of the more competitive programs, you may only get offered one or two dates (”Please come interview November 28 or 29″). It’s then a scramble to quickly email/call the programs back and confirm the date you want. You’re constantly balancing booking programs with trying to group them regionally, so you’re not flying back and forth across the country all the time. Because yes, you are paying for this yourself.
So you go around to different programs and interview. You’ll usually interview with 3 or 4 faculty or residents (at least in my experience), both for you to get a feel of the program and its faculty, as well as for the program to get to know you. You get a tour, breakfast and lunch, and often there’s a social event the night before to get to meet the residents outside of the hospital environment. They tell you the specifics about the residency program, why the program is unique or special, you get a chance to ask questions. (In fact, often the most common question you’ll hear is, “So, what questions do you have?”) And as I said before, you’re paying for all of this yourself. Airfare, hotel, meals on the road–it’s all on you**. I lucked out and had friends in every city where I interviewed (Thank you Eric, David, Sam, Deepika, Jesse, Eric, Eugene, Ed, Kenji, Dave, Allison, and Mike, I owe you all BIG TIME!) but still the process will end up being expensive for me to fly all over. People trying to match as couples often spend around $5,000 interviewing, depending. This is of course just loan money, so by the time we’ve paid it off it’s tripled in cost. But I don’t have ideas for a better system–you gain a ton by going to the institution and seeing it yourself.
Now to the Match part of it. I explain it this way. By getting an interview, you kind of have a potential job offer. How it works is this: the med student ranks all the places he or she interviews. The residency program ranks all the candidates they interview. Then a big crazy computer program (The NRMP, lovingly known as “The Match”) … matches everyone up. There’s a good explanation of how it works here. The Match favors the resident, so if two programs rank you #1, but you rank program A higher than program B, you go to program A.
Everyone finds out where they match this year on March 20, 2008.*** Technically we’re all supposed to find out at the same time–that is, students on the East Coast would find out at noon their time, and on the West Coast we’d find out at 9am, but often your friends on the East Coast are already calling and texting and emailing their results early, ahem. And then, July 1, or around there, you start your internship.* You are contractually obligated to go where you’re placed, so right now the thousands of medical students about to graduate and I are all anally pouring over our “Rank Order Lists,” to decide how we want to rank places.
And that’s the Match for you!
*Residency is the name of the training process you go through to become a doctor in a certain field. The length of residency depends on the specialty: pediatrics, internal medicine, and family practice are three years, others are four, some like plastic surgery or neurosurgery are seven. Internship is the name of your first year of residency, no matter what specialty. Most of the time you do your internship as part of your residency program, in some specialties like anesthesia, dermatology, ophthalmology, you do your internship separate from the rest of your training.
**There are some programs that will put you up in a hotel, or pay for your airfare, but these are rare. Often programs will have setups so that you can stay with a resident, however.
***There is a terrible thing called “Black Monday,” which happens the Monday before Match Day, where people who didn’t match at any program find out, and then have to enter “The Scramble,” where they quickly try to find an open residency spot somewhere, often not in their chosen field. (Knock on wood this doesn’t happen to anyone.)
You know, that’s the thing about socialized medicine. There’s no motivation for innovation. There’s no research or development. It all comes from The United States of America. Except, apparently, growing new bones for a patient using stem cells harvested from the patient’s own adipose tissue.
As I am counting down the days until I can get Step 2 over with (T-minus 10!), I’m going insane memorizing diseases I will never see in my lifetime. I need some laughs. So I’m asking everyone to please post their favorite medical joke. (And plus, it’d be a great chance to see people’s faces and comedic timing.) Oh, fine, if you’re anonymous, I guess you just can post the text, but come on, video is sooo 2008. (If you use YouTube, tag your video as “medicaljoke” so they’ll be easier to find.)
Either comment or email me the Youtube link or your blog posting, and I’ll start a running list here on this blog post. And if you don’t have a blog, just leave a comment! Please! I’m begging you! Help a guy escape from the hells of Boards reviewing. I’ll start:
Thanks, Dr. Bryce Swanson, DO, for recommending Rapid Slim SX to me on TV! I know you’re only a “Resident Physician,” but you said you read the study about Rapid Slim SX and it’s going to work, right? You’re in your last year of Anesthesia Residency, so you’re clearly an authority on weight loss. Which is why it surprised me that in your “Talk With Dr. Bryce Swanson” you glaze right over the health benefits of weight loss.
As an anesthesiologist, I would’ve thought you would’ve spoken most about how obese patients are more challenging to manage in the operating room, due to their decreased chest wall compliance and decreased functional residual capacity or talk about any of the other health benefits of weight loss (decreasing insulin resistance, decreases in cancer risks, etc). But instead, when you’re asked “In your opinion, what are the benefits to losing weight?” you say “I think that losing weight helps a woman feel better inside and out. She’s more confident, she’s more energetic, she regains that spring in her step because she likes the way she looks,” and mention that “also” there are health benefits. I’m also scratching my head, Dr. Swanson, because you say that “A major diet overhaul must be gradual so it can be sustained over time,” but then you go on to say that “I would recommend RapidSlim SX because it delivers amazing weight-loss results so quickly and because available published research reveals it to be a superior formula and brand.” [my emphasis] (Also, superior to what? And what’s the “available published research?” I can’t seem to find it, even though you flaunt the study all over the damn website.)
I’ve also been quite impressed with Chief Scientific Officer Marvin Heuer, MD’s work history. (Thanks, Angry Doctor!) I also love his resume, with most of his publications being listed as “Submitted for Publication.” I should fatten my resume that way. I’ve got TONS of things I could submit for publication!
Hey, if it really works, and you really believe in it, Dr. Swanson, that’s great. But a little more intellectual honesty might get you a lot further. (But I guess that doesn’t really sell pills, does it?)
I for one am spending it with my significant other, my boards review book.
But it’s not all bad. There’s a new Indiana Jones trailer out.
And rejected Shoebox Greeting Cards:
Oh, and by the way? Paget’s Disease? I hate you and all the damn questions about you.
This blog, like my medical school career, seems to be wrapping up. Expect a bunch of long-winded, well-thought-out, strongly-opinioned posts on broad topics like “What’s wrong with our health care system,” “What I would ideally like to see to fix it,” “What I would realistically accept to fix it,” “Why it’s great to be a medical student,” “Why it sucks to be a medical student,” “What needs to change in the pre-med and medical school curricula,” “What needs to change in Boards Exams,” “Being Out In Med School and Residency Apps,” and of course, just to cause a controversy, “What needs to change in America.”
Back to “The Somogyi Effect vs. The Dawn Phenomenon.” (Answer: hypoglycemia at 4am in the Somogyi effect!)
Edwin Leap:
I believe physicians are unhappy because they believed the great lie.
What was it? What was the lie and when did doctors learn it? The lie was this: ‘if you become a doctor, your profession of medicine will be all you need for happiness and fulfillment.’ In short, physicians learned to validate themselves by way of a profession.
I believe my generation of physicians never grew up with a great lie. We knew we wouldn’t make the most money (or at least, we should have known this); we knew that medicine was time-consuming, but we chose it anyway. And the medical schools chose us for our diversity, life-experiences, and well-roundedness. They’ve selected out for people who have taken time off before school (almost half of my graduating class), who have had other careers, who have explored other interests. Found other things besides medicine that make them happy.
Look at the fields that are incredibly popular today: they either make a lot of money, offer a good lifestyle, or both (I’m looking right at you, ophtho). We want to have free time outside of our careers. We want to have families and relationships. Sure, we’re ready to make sacrifices, but we weren’t told a lie–or maybe we just never believed it. We’ve had the opportunity to study abroad; we’ve been exposed to foreign countries and cultures; we have taken courses in religion, anthropology, linguistics, sociology–and we know there are more things to life (exciting, interesting, thrilling ones at that)–besides a job. (For Dr. Leap, that appears to be his faith.)
Now, perhaps this is to the detriment of our future patients–that their future doctors want more out of life than just being great doctors for them. Perhaps it is for the benefit of them. I guess only time will tell.
The Zetia/cholesterol bit from last month and the tight glucose control deaths stuff has made me take a skeptical look… at medicine itself.
The old adage is “trust no one” in medicine, but sometimes, I think, maybe we should apply that to medicine itself. It’s certainly humbling to realize that what we hypothesize to be true and what seems to make sense to us, even from a physiologic theory, and even with supporting data, might not necessarily be true. It’s an important reminder–to both physicians and patients–that we’re all unfortunately human. That we don’t have all the answers, that even with the best of intentions–and best of knowledge–we can be wrong. After all, what is medicine but humans trying to understand, grasp, and alter insanely complex biological systems that have been under development for hundreds of millions of years? We set limits, values, and numbers to help us decide “what’s normal” and “what’s disease,” but in reality, they’re gross, gross simplifications we accept so that we can triage, differentiate, and make sense of what’s going on inside that black box that is the patient’s body.
It doesn’t mean that there are no absolutes, or that medicine or science is flawed more than anything else is flawed, or that there are not facts. Just that the physician who thinks he is always correct and is master of the human body is doomed to fail and do harm. I tie it back to this great quote from MedRants about unintended consequences:
The law of unintended consequences is what happens when a simple system tries to regulate a complex system. The political system is simple, it operates with limited information (rational ignorance), short time horizons, low feedback, and poor and misaligned incentives. Society in contrast is a complex, evolving, high-feedback, incentive-driven system. When a simple system tries to regulate a complex system you often get unintended consequences.
I couldn’t find this anywhere online, so for the love of all medical students studying for Boards, it’s a big ol’ list of the rheumatic diseases and their associated antibodies:
| Antibody | Disease |
| Anti-Basement Membrane | Goodpasture’s Syndrome |
| Anti-Centromere, Anti-Scl 70 | Scleroderma (CREST) |
| Anti-ds DNA | Lupus/SLE |
| Anti-epithelial cell | Pemphigus Vulgaris |
| Anti-gliadin | Celiac Disease |
| Anti-histone | Drug-induced SLE |
| Anti-IgG, Anti-RF, Anti-CCP | Rheumatoid Arthritis |
| Antimitochondrial | Primary Biliary Cirrhosis |
| Anti-neutrophil | Vasculitis |
| Anti-platelet | ITP |
| Anti-cholinesterase | Myasthenia Gravis |
| Anti-endomyesial | Celiac Disease |
| Anti-Jo 1 | poly or dermatomyositis |
| Anti-SSA, Anti-SSB | Sjögren’s Syndrome |
He staged an accident so he could cut off his right hand. A close psychiatrist colleague would’ve gone with a little Geodon action.
Maria’s got a great post that is funny, true, and speaks volumes. Questions.
Hey Jon Marshall, DO, thanks for recommending Hydroxycut! I know you’re just a “Resident Physician” as the commercial says (funny, it didn’t mention you’re a radiologist in training) but you radiologists interact with patients and advise them on weight loss pretty consistently, right? Look, you’re pretty hot and all, and I’m sure that helps sell the pills, but seriously, dude. You chose medicine for “the science behind it. I also like dealing with people and helping them,” and you’re hawking a product with pretty iffy science behind it (Hydroxycut was sued for making false statements about it being “clinically proven” and paid to settle). And you have to admit, it’s kind of funny that you “like dealing with people,” so you went into radiology.
(Side note: what’s with Midwestern University DO School? They seem to be churning out the resident DO physician product marketers–it’s where both Dr. Marshall and Dr. Swanson went.)
To be fair, at least the Hydroxycut site gives references for their scientific research (in one study of 30 whole patients, another with 60) plus two studies that seem to be about caffeine and green tea.
But also to be fair, the advertised weight loss of 29 pounds in 8 weeks actually isn’t healthy, Dr. Marshall. And I think people are really looking for long-term weight loss, not just 8 weeks’ worth.
Hydroxycut isn’t limited to DOs, however. They’ve got Nick Evans, a MD and attending orthopedist/sports medicine man hawking the product, too. (At least his specialty is related to exercise and weight loss.) Dr. Evans, dude, you look huge! (My favorite is the 
Bodybuilding Anatomy book with his head photoshopped on a drawing of a bodybuilder torso.)
As promised, now that I’ve finished my Boards (cross your fingers that I passed them!), it’s time to take on some big themes of the past almost-five years.
I was one of those people that really enjoyed most of clinical med school. (I would say that pre-clinical med school wasn’t so bad, but I certainly didn’t enjoy it much of the time–my post is still the top Google hit for “i hate med school.”) Clinics were great for the most part. You’ve spent your first two years trying to figure out the basics of health and disease, memorizing countless facts, and you’re not really sure how they’re at all useful. And then you get to clinics, and–wow!–this is the stuff I went into medicine for! So let’s start with that:
Phew, that’s enough for today. Feel free to add your own. Next up: “Why it stinks to be a medical student.”
Combing through some old photos, I came across these I took when then-Senate candidate Obama stopped by our offices at PNHP back in early 2003. And for the record, as far as I can remember, he didn’t support single-payer then, either.
It’s not always hunky-dory as a medical student. In no particular order:
In medical school, we take “Step 1″ of our Nationalized, Standardized Board Exams before we start seeing patients in the hospital. Then, in order to graduate and start residency, we have to pass two parts of “Step 2.” “Step 2 Clinical Knowledge (CK)” is a 9-hour, computerized exam consisting of 8 1-hour blocks of 46 multiple choice questions. “Step 2 Clinical Skills (CS)” is a 9-hour, practical exam where you see 12 standardized patients, perform a history and physical, and write a note about the patient with a basic idea of your workup and diagnosis for the patient.
Now, there is some talk also about combining both Steps 1 and 2 into one exam taken during the final year of medical school. I’ll address this issue and then address the Boards more generally.
I would strongly oppose combining the two exams into one, for one main reason: Step 1 is what a number of residency directors use to help determine who to interview for their residency programs, especially at medical schools which lack grades (Stanford, where I am, lacks grades). I think this would quickly lead to all medical schools adopting grades, which I think is especially detrimental to learning, especially in the pre-clinical years. Medicine is now, for the most part, a team sport. I think it’s incredibly important for medical students to learn how to effectively communicate with their colleagues (classmates) and work together. And I think you don’t learn that when you have grades.
Grades encourage competition, gunner-ness, and cut-throat behavior, when what you really want is the promotion of cooperation. Especially in the pre-clinical years, when all you do is study and take exams. If you eliminate the major way that gradeless medical students are deciphered by residency directors, you give medical school deans all the more reason to put grades back in the curriculum. (I believe grades in the clinical years are a different story, so I won’t comment on them. I do believe, however, if you encourage cooperation in the first two years, you’re more likely to have collegial relations with your classmates when working in the hospital.)
On Step 1
Step 1 seems like a necessary evil in retrospect. It sucks, studying for it sucks, and it’s painful and nerve-wracking. But it forces you to put all your knowledge from the first two years in preparation for seeing patients. It forces you to review everything you’ve seen and forgotten, and integrate and optimize that little brain of yours. This ends up being a really good thing for seeing patients. My main critique is the subject material, but I’ll cover that elsewhere in my discussions of the curriculum.
On Step 2 CS
An utter waste. An utter. Total. Waste.
As I’ve said before, the administrators of this test take in $17 million each year for the exam so that a few hundred students each year don’t pass, take it again, and then most of them pass.
First, there’s only five cities in which one may take the exam. So if you’re not in Atlanta, Chicago, Philadelphia, Los Angeles, or Houston, you get to pay for airfare and hotel for the night, out of pocket (the exam is 7-8 hours long, so it’d be hard to fly in and out without staying the night). Next, most medical schools already require their students to participate and pass an exactly similar exam with standardized patients.
These Step 2 standardized patients are much worse–they have absolutely no personality, only poorly acting their roles. You’re being graded–at least partially–by your ability to show compassion. So you’re constantly pretending to have sympathy, while they’re pretending to actually require your sympathy. You ask, “Do you have any fevers or chills,” and they robotically reply, “No, Doctor, I do not have any fevers or chills.”
You’re also judged on seemingly worthless physical exam criteria like putting your stethoscope in the right place. So to the creators of Step 2 CS, it’s more important to be able to pretend to examine a patient than to actually identify a murmur or hear crackles on exam.
Next is the silliness of the exam itself: once you leave the exam room, you’re not allowed to re-enter. What? Are you kidding? How many times do I think to myself, “Gosh, I guess I need to do a neuro exam too,” and dart back in the room to do one?
Finally is the stupidity of the patient note. You have to come up with a differential diagnosis for the problem in question (this is good), but there’s no description of how wide a net to cast. The “workup” portion of the exam is incredible. It’s apparently more important to be able to come up with a list of lab tests and studies to order than to know what to do if someone is dehydrated and can’t tolerate oral liquids, or to give someone with symptoms of a heart attack oxygen and an aspirin.
Add in the fact that you receive absolutely no feedback on how you did from the standardized patients (it’s fine to just grade us, improvement is beyond the Step 2 CS) just adds icing to the cake.
Look, either make it a real, practical test, and really test to see if people know what to do with patients, or admit that it’s mostly to see if people can speak English. If it’s the former, put some life into it. If it’s the latter, make the International Medical Grads take it and please quit wasting my time and money.
If medical schools are doing their own standardized patient exams, why not allow the schools to proctor their own exams? They can certainly determine English language ability and if the students are competent to become doctors–after all, they are the ones granting the person the MD, aren’t they?
On Step 2 CK
This actually wouldn’t be all that bad of an exam from the “review everything you’ve learned” point of view if it weren’t such a crappy exam. (No, seriously.)
First, most of us fourth year students take this exam and then spend much of the rest of fourth year vacationing in anticipation of the hell that is internship. So often most of what we learn from studying for the exam is lost to nicer memories like the sights of Europe or the beaches of Thailand.
Second, the exam contains way too much pre-clinical, worthless detail. You know, honestly, I truly do not care what the pathology might reveal on a tissue biopsy of someone with myxedema. It is not important to me nor my patients. It is, however, possibly important to know how to diagnose myxedema or treat it. (Thankfully, the exam is much more clinically-oriented than Step 1, but no way near enough.)
Third, the answer choices are often ridiculous. For a suspected pneumothorax, my options are not “ultrasound,” or “chest CT,” or “X-ray.” They’re things like a) thoracotomy b) needle thoracostomy c) MRI head d) diagnostic peritoneal lavage. I kid you not. If you want me to suspend disbelief for a minute and pretend I’m trying to manage these patients, then give me some realistic answers, people.
The Bottom Line
Keep Step 1.
Drop Step 2 CS.
Fix Step 2 CK.
labnormality, n. lab•nor•MAL•it•ee. A patient’s laboratory testing value that falls outside the normal range. (plural labnormalities) Ex: “Man, this guy has a ton of labnormalities… hyponatremia, hyperkalemia, and he’s hypotensive… crap, adrenal crisis!”
At least for the computerized portions (Step 1 and Step 2 CK):
Any other tips people have used?
I guess we’ve been trying to computerize healthcare since the days of punchcard computer systems. Humbling that we’ve been trying for 50+ years and still can’t get it right!
As if anyone would forget, the Rank Order List is due tomorrow! Can’t believe we match in less than a month. I’m pumped.
I know I certainly can’t be the only one who is done with his Rank-Order List but just logged onto the NRMP website to make sure it’s certified one last time:
(You login to the website, enter your rankings, and then have to enter your password again to “Certify” the list and make it official. If you don’t have a “certified” list by 9pm Eastern tonight, you don’t participate in the Match this year and don’t get a job!)
So I’m reading this post by The Happy Hospitalist (note: he sure does complain a whole hell of a lot for being ‘happy’) and I’d like some medical ethic weigh-in.
The HH describes an 88 year-old man whose heart stopped, so his brain didn’t get any oxygen. According to him, the wife believes the patient will make it home. According to HH, that’s an unrealistic expectation. So doesn’t this qualify as futile care? That the treatments involved will not meet the goals of care? And doesn’t a physician have a right not to provide care that is seen as futile? And also, doesn’t a physician have an obligation to “first, do no harm?”
I guess I’m asking from multiple perspectives, so I’d really like to hear people’s thoughts on this, from the ethical perspective, the legal perspective, and the practical perspective.
Teams I’ve been on have certainly done just as many treatments for people in situations like HH’s patient, so I’m not trying to call him out or anything, I’m just genuinely curious how others think through all of this. Thanks!
Okay so my idea for a daily randomness of linkage didn’t really pan out. But some random health care and non-health care goodies:
I don’t think anyone has talked about this, because I don’t think it’s really ever happened before. But when I applied for residency this year, I debated whether I should put my website or my blogging on my application. I worried that people reading my application would be scared about blogging, or wouldn’t know what it was, or had only heard bad things about it. I worried they would just think it’s a great way to violate someone’s privacy, or a great way to get in trouble with a lawsuit. (One of the reasons I haven’t decided if I’m going to blog residency is because I’d like to discuss it with my future program director first.)
But I decided to go for it and include it in my application for a couple reasons:
At the brilliant suggestion of a mentor of mine (Hi Michelle!), I came up with a short list of some of my favorite posts (PDF) showing what my blogging was all about, printed it out, and brought copies to give interviewers if the blog came up.
And the blog did come up. I’d say at about one-third of the programs, I talked about it with at least one interviewer. The response was overwhelmingly positive. No one mentioned any concerns about HIPAA/privacy stuff, and as far as I could tell, everyone felt like it was a Good Thing ™. People liked the fact that I was reflecting, processing, and thinking about what it means to become a physician, and also liked the informal network medbloggers have created as a community. I think having the print-out of some of my posts was really, really helpful to reference. Very few interviewers (only ones that I knew before applying) had actually visited the site (that I know about). In hindsight it was probably silly to think that an interviewer that has to get through thousands of applications would dial-up my URL on his or her PC, but you never know.
My advice to future applicants: if you’re writing a blog, first, don’t be anonymous. While there are certainly bloggers who are anonymous to protect their identities and lawsuits and blah blah blah, there are way too many bloggers (medbloggers, especially, in my opinion) that hide behind a pseudonym so they can bitch and rant and complain about these horrible, horrible people (read: patients) who waste the blogger’s time. They would never say these same things to their mothers, friends, or in polite company. Being public and open about your blogging forces you to think about what you’re going to write–”do I really want my name to be associated with this?” I certainly try to follow something I learned in church camp as “Thumper’s Mother’s Rule”: If you don’t have anything nice to say, don’t say anything at all (my addendum is this: or at least be constructive).
If you’re proud of what you’re writing, and what your blog has done for you, put it on your application (including the URL)! It won’t even come up most of the time, but it certainly gave interviewers something to ask about, and definitely made me stand out from other applicants (which, as you know, is the key to getting into med school). It sure beats the same old, “So, tell me why you chose Emergency Medicine” question that I hope to never answer again in my life.
Finally, bring a list of some of your posts. It will help interviewers immediately see the things you write about, and will also help them to see you’re passionate about medicine, care about it greatly, and you’re also passionate and interested in the field in which you’re applying.
(That all being said, if your blog is just a bitch session about how terrible med school is, no one wants to hear that. Leave it out.)
So I’ve discussed being out as a blogger on residency apps, so now it’s time for the harder (but more important and wide-reaching) subject: Being Out, Coming Out–whatever you want to call it–as an LGBT person on residency applications.
I don’t really talk much about my personal life on this blog–I think mainly because where I go hiking on the weekends or who I go grab a drink with wouldn’t really interest anyone, and doesn’t have much to do with the theme of this blog: becoming a doctor, thoughts on health policy–that kind of thing. But this doesn’t get talked about a whole lot–hell, gay anything doesn’t get talked about much anywhere in the world of medicine–but it should, so here we go (sorry, it requires some history):
As a gay man man who happens to be gay, it hasn’t always been an easy road in medical school. Overall, I’ve been incredibly fortunate to be at a medical school in the San Francisco Bay Area that is overwhelmingly gay-friendly–with Out gay, lesbian, and even transgendered faculty even. My classmates have truly been amazing in their embracing of me (it probably helps that I’m kind of awesome, too). I wasn’t sure what to expect, but I’m incredibly excited for my generation of physicians, if they’re anything like my classmates.
I decided to just be “the gay classmate” from Day One–none of that “coming out” stuff that can be awkward and uncomfortable. I’ve always preferred to just drop the hint than have to come right out and say “Oh, I’m gay.” I’d much prefer to mention my ex, and then use the pronoun he, or one of many other such schemes I have previously concocted. Easier for me that way, and I find it to be less direct and confrontational. I don’t have something to prove, or some vendetta or anything. I yam what I yam.
The residents I worked with were, for the most part, great too. I wasn’t out to most of them–rarely did it come up or have any import–but when it did everyone was very accepting (as they should be). I’m not what people might call “gay-acting” (translation: what you see in the media as gay stereotypes), but I’m always surprised when someone assumes I’m straight (’cause it’s so darn obvious to me that I’m not), which a few residents did. The one incident that sticks out in my head was a surgery resident–otherwise good guy–who called his intern who felt bad for a patient “so fucking gay,” as a put-down. Lost a lot of respect for the guy right then and there. My esprit d’escalier reminds me that I should have spoken up or said something, but I didn’t.
So for the most part, I’ve always felt like I’ve just been able to be me during medical school, and I decided that’s how I was going to continue to be on my residency application. Being gay is certainly part of me, but it’s not the only part of me. I decided to include it in my application. I was the LGBT-Meds president for a year (2004-2005, baby!), so there it went on my app. (It ended up being pretty buried in my application, as achievements and extra-curriculars are listed reverse
chronologically, and I didn’t really have anything else to say about it, so that was the only place it was on my application.)
My perspective was and continues to be this: I am going to be a great doctor. I’m smart, I work hard, I’m positive and I play well with others. If a residency program wants to drop me in their rank list because the fact that I’m gay somehow overrides all those other things? Their loss.
So applied to 13 places. And got 13 interviews.
The fact that I’m gay barely came up on the interview trail–in fact, less than the blogging did. I’m not sure if this was because people were uncomfortable (didn’t seem like it), they didn’t want to get in trouble for a rules violation (possible), or just didn’t see it on my application (also possible). A gay residency director (I think the only out one in Emergency Medicine) did talk with me about it briefly, saying it was strong of me to put it on my application. I think one resident did mention that Chicago is gay-friendly, and he has a few gay friends, which was a really nice way to both a) let me know he read my application and b) let me know that he and the program were gay-friendly.
So how did things turn out? 8/10 programs where I interviewed contacted me saying I was a great candidate–whatever that’s worth–so I’d say being gay certainly didn’t hurt my application (not trying to brag to make people feel bad, just trying to give some data to future LGBT applicants). If anything, it certainly makes me stand out as a unique candidate as well.
It’s hard to say how things would have gone had I applied in another specialty or at other programs. There’s certainly a selection bias at work here: I only really applied to major urban areas (LA, SF, Chicago, New York, Boston) for my training, which are by default more open and gay-friendly. If I was applying to more rural schools, I’ll admit I don’t know if I would have put it on my application. It also helped that I knew I had a strong application, with good board scores, evaluations, research, teaching experience, extra-curriculars, and letters of recommendation–this made it easier for me to apply to these major urban areas and still feel like I’d have a chance of matching at one of them.
I don’t know what I’d say about other specialties, really. Emergency Medicine types in my experience are usually pretty laid back, fun people who’ve seen it all, and really care more about doing a good job and being efficient than much else–so I really didn’t anticipate it being much of an issue. I have no idea about other specialties, besides that fact that I know LGBT people in many specialties–including the surgical ones–but again, they’re all in the Bay Area, too. It seemed to me like the Psychiatrists, Internists, and Pediatricians were the most gay-friendly on my rotations overall, but I’ve talked with general surgeons who have told me about their gay general surgeon friends, too. There’s a pretty outdated survey on the AMSA website about LGBT-friendliness for specialties and residency programs, if that helps anyone… I’d love to hear other people’s opinions.
I hope this helps someone!
Google has now announced their Google Health product, now with a screenshot.
As I’ve said before, patients should not control their own medical records. If this Google Health product is an addition to the medical record for patients to use, fine. But if you think a physician is going to trust a patient’s listing of his or her weight over the scale in his or her office, you’ve got another thing coming, Google. (I’m also looking forward to a three page Google Health printout of a patient’s “allergies.”) It would, however, be nice to be able to get results of colonoscopies and stress tests, which it looks like Google may be able to do.
If you want an honest review of Google Health, feel free to contact me, Google. (I’m a trusted tester!) Until then, color me skeptical. (And Patient Sam Sample–watch your kidney function. Lisinopril plus ibuprofen is just asking to shut down your kidneys.)
Maggie Mahar has some great history on the origins of the “good cholesterol” vs “bad cholesterol” stuff, and how we got to our thinking about cholesterol to begin with. I don’t know how the woman has time to write and research all this for her blog, but she’s absolutely amazing. When residency starts, I’m going to seriously be cutting back on my blog reading, but Maggie’s won’t be leaving my Feed Reader anytime soon. If you’re not reading it, I’ll say it again: you’re missing out on some of the best of the web.
(And the medical school of your choice!) I make no promises, but it worked for me, so I hereby provide my path and advice to those pre-meds out there:
Undergrad
Undergrad is the time for you to explore your interests. Okay–to have fun, and explore your interests. Figure out what you love. And then do that. To some it might be graphic design; for others it might be math. Or volunteering. Or lab research. Or foreign languages. Or acting. Do. What. You. Love.
You’ll notice that I didn’t say “majoring in math,” or “majoring in Biology.” If what you love happens to be a major–great! If it doesn’t–don’t stop doing it! Figure out what it is that keeps you up at night, so excited with thoughts racing that you can’t fall asleep. Figure out what lights up that fire in your eyes: when you’re talking with friends, when is it that you get that thrill in your chest? Talking about religion? Sports? Cooking?
Undergrad should give you a depth of knowledge in one area (your major) and pique your interest in others. Medical schools are looking for the well-rounded applicant who has shown significant commitment and passion to a particular love of his or hers. Medical school is similar–you have to love learning medicine so much that you’re willing to put up with a bunch of crap for 4 years and delay gratification for many more. If you can show someone that you’re passionate and committed to something–you’re already ahead of the curve.
This all being said, of course, you also have to let medical schools know that you know you’ll like medicine. There’s nothing worse than a medical school spending their precious time and resources to figure out who they’d like to admit, and then have one of their students end up hating the practice of medicine. So find some clinical setting in which you can shadow, volunteer, or something where you get to see doctors working. I did a summer internship with a local hospital where half the time I did data entry and half the time I got to shadow doctors in different parts of the hospital.
I think one of the smartest things I did–and best for my application–was drop medicine completely from my potential career list for a time. Sophomore year sucked academically: organic chemistry and physics together for three straight quarters–and it really made me question everything. “Do I really want medicine that bad? Isn’t there something else I could do with my talents?” So I took lots of different courses, to see if I could find anything I liked more. But I always came back to medicine. I figured I could do graphic design as a hobby, program as a hobby, take foreign languages as a hobby–but never medicine as a hobby. How did this strengthen my application? I could honestly say to interviewers that I’d really challenged the idea of becoming a doctor, and that I still wanted it badly. I knew I would love medicine. (And if you find that you don’t love medicine, that’s okay. But you should really find something else to do. Better to find this out now than after you’ve taken out $50,000 a year in loans!)
Try new things in undergrad. While in some ways you want to fit in with other applicants (good scores, good grades, good letters), you want to stand out. What did every single interviewer ask me about during my interviews? Not my research, not the student groups I helped lead–it was the current events radio show I hosted with my two friends. Stand. Out. (More on this later.)
And, not totally related, but it gave me a great deal of perspective and truly changed my life: if your school offers it, do an Alternative Spring Break trip! And if your school doesn’t offer it, look into starting an Alternative Spring Break group at your school!
The MCAT
Sorry to say it, but it’s important. Because schools have thousands of applications to go through, they’ve got to use some method to reject people right off the bat, and it’s usually some funky formula including one’s MCAT score. Doing very well on the MCAT will certainly help your chances at getting into your top school, but just doing well is important, too. In my experience, there’s some vague hazy cut-off below which you won’t get a secondary application or interview at school X, but that cut-off is fairly low. (I wish I could talk numbers, but I don’t know any!) If you do well but not stellar, and this is just how you test, no matter what you do–an otherwise strong application may pull you through. (And a word to you brainiacs out there–if you’re scoring 40s on your MCATs but have no personality or can’t interview or talk to someone for 20 minutes, you in some ways have a tougher time. I’d much rather have a classmate with good MCAT scores who I can interact with that someone with a 42 who can’t express him or herself.)
What to use to study? I took the Kaplan course, which was hella expensive. It certainly kept me on track with my studying, ’cause I didn’t want to get to class and not have reviewed anything yet, but if I could do it over again I would have just tried to buy the study books on eBay or something. I also did craaaazy amounts of practice tests, which my school had on reserve in its library. (Go, U Northwestern!)
The Application
#1: Have your application ready by the day you’re allowed to start submitting. Have your letters in, your transcript sent, your personal statement ready. Medical schools work on a rolling admissions basis, so the earlier you submit, the faster you get the secondaries. The faster you submit the secondaries, the faster they can review your application and offer you an interview. And once your interview is over, if you’ve done it early, your application will be discussed in more rounds of deciding whether to offer you a spot. (Compare that to the person who submits in October, and your application gets two months’ more of time in committee.) For some of the faster schools (UChicago!), I had interviewed and been accepted by early September–before I’d even received secondaries from some slower schools. (And that first acceptance is the best, ’cause you know you get to be a doctor somewhere.)
The obvious: while you’re doing all this exploring and “doing what you love” stuff that I rambled on about, you’ve also got to be studying. Not just to get good MCATs, but also get good grades. This is likely something to make you learn how to find balance in your life–between your academic life and your social one (I still struggle at this, as most of us probably do).
Extracurriculars: It’s great to see someone with a ton of interests, but try to pare it down as you become an upperclassmen. Again–find what you love, and make a significant contribution to it. Take on a leadership role. Advance the field, or activity, or whatever.
Letters of Recommendation: I can’t remember the recommendations on how many science and non-science letters to get anymore, but follow them. If you fall in love with a class and a professor, and think, “Wow, I really love this topic, the professor seems great, I would really like a letter from this person,” make sure the professor gets a chance to know you. Does that mean kissing up and going to office hours for no reason? No. It means participating in class, making your voice heard, letting the professor know you’re thinking and processing the information in his or her class. When I knew I wanted to ask my Physiology professor for a letter, I made sure to start asking questions that I had during class, or going up after class to ask.
Next, ask and ye shall receive. Don’t just ask someone “for a letter of recommendation.” Ask the person, “Would you feel comfortable writing me a strong letter of recommendation?” or “Do you feel comfortable writing me an excellent letter for my medical school application?” People will tell you if they don’t know you well enough, or if they just don’t think they’d honestly be able to write you a strong one!
Finally, meet with the person if they don’t already know you extensively. A 20 minute private face-to-face, you with resume in hand, where they can get to know you and ask you some questions will make their letter much more personal, warm, and true.
The Personal Statement: The most important thing on your application. I read applications as a 2nd year at Stanford, and it was usually the Personal Statement that either impressed me or bored me the most, and weighed the heaviest on my voting. My tips:
Get the reader’s attention. In the first sentence. I do this with a lot of my non-blogging writing. Picture this scenario when you’re writing: the person reading your application is tired (true). This is either the first or last thing I’m going to do during the day. It’s late at night, I’ve just spent a long night studying, and now I’ve got 5 applications to get through. I’m in bed, with my laptop, my eyes are starting to drift as my parasympathetic (rest’n'digest) system is slowing me down. I’ve only got a reading light on, I’m so sleepy…. but I must… keep… reading… BOOM.
Hit me with your best shot by sentence one. Make me want to know more. Wake! Me! Up!
Have a theme; relate your life and your experiences back to medicine.
Next tip: Every word must matter. I went through a ton of revisions (see left) until I got it tightened up. I asked friends who are good writers to read it and give me their honest feedback until I got to something I liked.
Here’s my own personal statement for your viewing pleasure. (Update: I’ve included my final draft, as well as two other drafts if anyone cares to see how the thing changed over successive drafts.)
Next time: Secondaries (again with a few samples of my own), the interview, and acceptance! Good luck to all!
This is a medical weblog--a collection of thoughts about medicine, medical training, and health policy--written by a fifth-year medical student.
I recently stopped blogging, as I graduated from medical school and I'm now a physician in my residency training in New York City. But feel free to read and enjoy!
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