Sunday, 25 June 2017

NICU, Pediatrics, ER DONE!

I've got three more electives and Step 2 CS out of the way and it has flown by! I did my NICU elective in February. This was definitely the most intense rotation that I have had to date. I was paired up with a second year resident and worked the same schedule as he did. Everything he did I was to be doing it too, including meetings and lectures. It was an amazing experience because it really threw you into what the daily routine of working as a resident is like. The typical day went something like this:

7am: arrive, get report, examine all of the babies and decide what tests they need that day, start writing patient notes
9am: rounds with the attending doctor - see all of the babies again and discuss the plan and how they are doing
11am: Grand Rounds - a teaching seminar, journal presentation or some sort of other learning activity
12pm: Lunchtime general pediatrics lecture that all residents in the program attend

In the afternoon, it depends what is happening on the floor. You follow up with tests you ordered, update parents, perform any procedures that need to be done (line placements, circumcisions, etc). The NICU resident also carries a pager that goes off whenever there is a high risk delivery. When it goes off, you run and get ready to resuscitate that baby right after delivery. The day usually wrapped up anywhere between 5 and 6 pm. Every 4th day we had to do a 28 hour call shift. We would work our normal day, and then after that was done we were to stay in the hospital all evening and night and address anything that comes up with the babies during that time, take care of any new admissions, go and retrieve transfers from other hospitals, and run to deliveries. You would start at 7am and the shift would end at 11am the following day. It worked out to be between 70 and 90 hours a week.

I learned an incredible amount in such a short period of time. The NICU is really amazing. The babies are so fragile and so critically ill. It is really amazing to see how far they come (or don’t come) over the course of 4 weeks. Cook County was a great place to do it because I got to see and do so much. I got to care for babies that were less than a pound in weight and with diseases that they told me in lecture that I would never see in real life. That is definitely one of the perks in staying in a big city like Chicago, this was definitely a rotation that I will never forget!

After NICU I did another general pediatrics rotation which was at Presence Resurrection in the northwest suburbs of the city. It is a heavily Polish neighborhood so I got to see a different demographic of patients. It had a more manageable schedule (Monday to Friday 9-5) which was great because I had studying to catch up on after the insanity of the NICU. It was mostly outpatient office visits and newborn assessments in the hospital. The attending doctor was a real pleasure to work with and I learned a ton from her! After the rotation ended, I took 2 weeks off to study for Step 2 CS and then took it in the middle of May. I will definitely share my study tips, but those will come after I get my own results so I can make sure I am actually giving some good advise. 

The most recent rotation I finished was Emergency medicine at Mercy hospital. It was a good experience overall, even though emergency medicine is not my cup of tea. It is a large 25 bed ER that is always packed full. That hospital is very student friendly. All of the attendings and residents are accustomed to having students with them and do a great job at challenging students while providing education and support. I was encouraged to see as many patients as I possibly could and to go in and examine any patient that I found to have something interesting going on, even if I wasn’t taking care of that patient directly. As long as you ask permission and the patient agreed there was a lot to see and do. I really didn’t have many patients at that hospital have an issue with being seen by a student. If there were code blues or other bad trauma I was encouraged to get involved and participate as much as possible. I have been in other rotations where you are sort of left in the dark when things get crazy, so it was nice to be included in all that was going on in the ER. The schedule was quite busy and we had day, afternoon, and overnight shifts throughout the month I was there. There was only one other student in the rotation which was really nice because it allowed me to get just that much more exposure. I definitely felt much less comfortable in the ER than I have in other rotations, but I also think it is the rotation that has made me grow the most.

Next up is pediatric allergy/immunology and preparing for residency applications! I will keep you all posted, thanks for following!

  

Thursday, 16 March 2017

Should I Go To Medical School?

I get a lot of emails from prospective medical students who come across my blog. I always encourage students to contact me with any questions that they have about anything related to medical school. It is a tough process to navigate and I really wished that I had someone to talk to about the process when I was just starting out. I am so happy to be that person for so many different people. 

By far, the most common email I get is an email from someone who has come across my blog and is trying to decide whether or not they should go to medical school. They typically explain their situation, tell me they are considering applying, and ask my opinion. This is such a hard question to answer! Deciding to go to medical school is such an enormous personal choice that only you can make for yourself! This post is dedicated to those people who are thinking of going, but really aren’t sure.

The long and short of it is this: it’s a huge, life changing decision that you need to make all on your own. You need to know yourself well. You need to know your own personality and own skill set in order to make the decision. Medicine is a lifestyle that you will be committing to! People have a lot of different reasons for wanting to become a doctor. The people who really succeed have one big thing in common: passion. You have got to be passionate about medicine in order to thrive. You should want to practice medicine so badly that you literally can't imagine yourself doing anything else.


I am going to do this a little backward, and talk about some reasons you should NOT go to medical school. I want to preface this by saying that I am certainly not trying to discourage anyone from going to medical school. It is the best decision I've ever made. I truly feel like I have found my life's purpose and I wouldn't change my decision for anything.

You probably shouldn’t go to medical school if:

#1 - You think you should go because people have always told you you’re super smart

Yes, it takes a really smart person to successfully complete a medical school program. That being said, being really smart in no way means you’ll be a good doctor, and definitely doesn’t mean that you will enjoy it! If you are super smart, use those smarts to be the BEST at something you love to do. If medicine is your passion, great! But if not, use that brain power to do amazing things in a field you’ll love. From the first day I started working in the medical field as a health care aide, I was completely drawn to and astonished by medicine and that hasn’t changed a bit.

#2 - You want to make lots of money

Sure, physicians generally make a pretty good salary, but doctors these days work a ton of hours to make the money they do. They also don’t make as much money as they a lot of people think. There are so many other ways to make a high salary that forego the grueling process of becoming a doctor. If you are going into medicine (or anything for that matter) strictly for the money, you will be very disappointed.

#3 - The TV medical dramas make becoming a doctor look like fun

OK, I shouldn’t have to even say it…but those shows are not realistic! These shows completely glorify what it is like to be a medical student or doctor. Think of other shows you watch. Is high school really like they make it out to be in Gossip Girl? Does Criminal Minds accurately display the life of police officers? Absolutely not.

#4 - You want your parents to be proud of you

I work with students all of the time who admittedly go to medical school because it was an expectation that their parents had for them, or they just think it will make their parents proud. If you aren’t going into medicine for you and because it is your passion, you WILL be miserable. Medicine is not for everyone, and if you aren’t going into it because it’s what you truly want you will surely be dissatisfied. 

#5You don’t enjoy working closely with others

No matter what field of medicine you end up in, you’ll be working on a team. Starting day one of medical school, you’ll have projects and presentations that you’ll have to do in groups. You’ll rotate with groups of other students and be glued to a resident, fellow or attending. As a physician, you’ll be involved in interdisciplinary team meetings, grand rounds, and journal clubs. When you work in medicine, it’s people, people, people all day long. Even if you go into something with more “solitude” like radiology or pathology, you will have to communicate closely with the physicians who are taking care of your patients. There is no way around this. You’ve gotta be able to communicate with and work well alongside other people.

#5 You don’t truly (at least a little) enjoy studying

In order to be successful in medicine, you have to be a lifelong learner. You don’t simply get through medical school and stop there. If any field is constantly changing, medicine is it. As technology advances, so does medicine. There is ongoing research being done, protocols being changed, and medications being discovered. Once you are working as a physician, you need to stay on top of what is current. If you don’t enjoy this process, it will become a big burden in your everyday. For me, studying is almost a hobby. Sure, there are times I really don't want to even think about opening a book. For the most part though, I am excited and enthusiastic to continue learning the craft.

#6 You aren’t capable of temporarily putting your life on hold

A lot of people are drawn to medicine for the flexibility it brings. This is so true! Once you are a doctor, you can decide how much you want to work and where. If you want to travel and do outreach medicine, you can. If you want to work 2 days a week at an office nearby, you can do that too. While in medical school and residency though, there are a TON of sacrifices that you are going to need to make. It will be difficult to keep in close touch with your family and friends at times. You will miss out on things - weddings, birthdays, vacations…you name it. You might have to start your family later than you planned. Your hobbies will likely be pushed to the side for awhile. The truth is, the majority of your days will be spent investing in your career and this is just unavoidable, you won’t be successful otherwise.

#7 You want the prestige of being called “Doctor”

Having an MD at the end of your name does not necessarily mean you will be respected. In order to become a respected physician, you have to put the time and work into it. The prestige and respect come from doing a good job and helping others, it isn’t automatic.

#8 Routine and predictability are important to you

Medical school and residency are extremely chaotic times. Your situation is constantly changing. Semester by semester you are in different classes. You start clinical rotations and every 4-12 weeks you are working in a different area, with a different attending, and different students. A lot of the time, at many different hospitals and clinics. You rarely have a schedule that tells you what you are doing after tomorrow. Patients conditions can change at the drop of a hat. It is rare to find a routine or predictability in medicine. You get very little say about where you end up for residency training - on match day you could get an email telling you that you’re moving to the other side of the country. Personally, I would be bored stiff working a 9-5 and doing the same thing every day. I like to work hard, be very busy, and be in ever changing situations. Other people like predictability and routine, you’ve gotta be honest with yourself about what kind of lifestyle you want.

#9 You struggled a lot in undergrad


You need to be honest with yourself and evaluate what you are capable of. How was undergrad for you? Were you studying all day every day and still struggling? If you had to work a lot harder than others in your program then you will likely have a hard time in medical school and a hard time passing the required licensing exams. If you had a pretty easy time in undergrad, then it’s really not so bad. Maybe you couldn’t study for the life of you because you can’t sit down at a desk for hours on end. Everyone is different. I have really been enjoying medical school. Sure, it is stressful and some days are harder than others - but I enjoy the learning, the challenge, and the pressure.

If at the end of all of your reflecting you decide that medical school is indeed for you, give it your absolute all! It is going to be hard. It is going to be stressful. You're going to wonder how you'll ever finish or how you'll ever make it through. You're going to struggle financially. You're going to be tired. You're going to question yourself. Stay true to yourself and know that whatever obstacles come up can be overcome with hard work and perseverance. Medical school isn't easy for anyone, but it can be the most rewarding thing you do with your life if it is the right thing for you 💗

Tuesday, 7 February 2017

One Down, Seven to Go!

My first elective rotation is in the books! Electives are a wonderful thing, but choosing the right ones definitely has its' challenges. When doing your cores, you are told exactly what you have to do and then suddenly you are finished and you get to choose any electives that you want. The choices are endless it seems, and it can be difficult to know where to start with it all. 

I decided on radiology for my first elective. No, I definitely am not an aspiring radiologist. I chose it because I actually feel quite weak in reading images - I felt that throughout the core rotations I didn't have adequate exposure to X-rays, CT scans, MRIs, mammograms, and cardiac stress tests. Coming from a Caribbean medical school, most of our rotations tend to be in the clinical outpatient setting. Yes, I have had a fair amount of time in the hospital as well, but when compared to students from US medical schools we tend to get less hospital (and therefore imaging) exposure. I have the USMLE Step 2 CK exam coming up (it's actually a week from now....eeeek), and I thought that taking this elective immediately prior to taking the exam would be an excellent review. I was definitely right! We went into the hospital for 4 hours each morning and discussed scan after scan after scan. The doctor I was with was amazing, incredibly knowledgeable, and surprisingly enthusiastic! I feel so much more confident when it comes to reading images now, and I know that it is a skill I will use throughout my lifetime in my practice!

Last Day of radiology rotation - this was an awesome group of students to work with!!


Electives are shorter than the core rotations. Core rotations all run for either 6 or 12 weeks, where elective rotations are anywhere between 2 and 4 weeks in length. They are meant to allow you to try out some different specialties that you are considering, to get more experience in the specialty (or specialities) that you are going to apply to, to expand your knowledge base, and to get acquainted with different hospitals.

Here are some general tips that I came up with when it comes to deciding on and scheduling elective rotations:

1. Have a plan! By the time you are finished with your core rotations, you should definitely have a plan, or at least an idea, of where you think you are headed. I say this because you should be able to justify every elective rotation that you do. When interviews come around, you want to be able to explain why you chose the electives you did, and how they have helped you grow as a future physician. Do NOT choose electives because you have heard they are "easy" or because you thought that specialty "might" be fun. There should be a reason you choose each elective you do.

2. Smart scheduling - The year (yes, the whole year) before you apply for residency should be very strategically planned out. There are a lot of things that must be done in order to apply to programs. Several of these things are time sensitive, and students often get into sticky situations where timing doesn't work out for whatever reason, and they miss deadlines and have to push their applications back by an entire year. The match happens only once a year, so you need to ensure you are booking things and planning things effectively. Make sure to consider time you will need to study for exams, and time you might need to take off for interviews and such.

3. Choose 4 week electives - There are several electives that you can opt to spend just two weeks in rather than four. This is definitely my own personal opinion, but I would argue that two weeks is just not enough time to get a feel for and to become comfortable in a rotation. I think 4 weeks is the perfect amount of time to spend in a rotation because it will allow you to grow and obtain some skill in the area. Additionally, you will get to know the preceptor better which can result in better chances at good letters of recommendation.

4. Show commitment to your specialty - by the end of your cores, try to have a good idea of what you want to do. If you don't know for sure, you should at least try to narrow it down to a couple of options. Do lots of work in that area (or those areas) to show that you are genuinely interested in that specialty and that you are actively trying to increase your knowledge and experience in that field. This will also open doors to get letters of recommendation from doctors in the specialty as well.

5. Research which hospitals in your area has residency programs you may apply to and try to get electives at that hospital. Sometimes you might not be able to get a core rotation in those hospitals, but if you go on the hospital websites many of them allow IMGs to complete elective rotations there. Trust me, it is worth the extra work to get these rotations! Email department heads and be persistent, no one is going to find these opportunities for you! Planning ahead also comes into play here - many of these rotations must be booked several months in advance! One of the electives that I got had to be scheduled 8 MONTHS ahead of time - they had nothing sooner and if I wasn't planning ahead I wouldn't have been able to get it.

6. Make the most of it! Think of every elective (and every rotation, for that matter) as an audition rotation. You never know what connections you might be able to make and who is watching you. Always strive to be the best and to give every rotation your all, even if it doesn't seem so important at the time. People remember students who stand out and you never know when a seemingly average experience could open doors for you.

All in all, electives should be a breath of fresh air and a great experience. Having the freedom to do what you want to do is a great thing, just always make sure to choose wisely and always be looking ahead into the future.

As always, thanks for reading! I am going to be publishing a post in the near future dedicated to the most frequently asked questions I get about attending a Caribbean medical school and things to consider before making the move! If anyone has questions that they'd like to be included, please email me at drnicolefox@gmail.com

XOXOX

Sunday, 6 November 2016

Home Stretch for Cores!

So I am finally on the home stretch of my core rotations. For those of you who don’t know, every medical student has mandatory rotations that they have to do. They are 12 weeks of internal medicine, 12 weeks of surgery, and 6 weeks each of family medicine, pediatrics, psychiatry, and OB/GYN. After those are finished, we choose a variety of electives in the area(s) that we are planning to practice in. Some people choose to do some electives just for the learning experience because many specialties can be incorporated into primary care. For example, if you want to be an emergency medicine doctor, an elective in radiology might help you become more efficient at quickly interpreting X-rays and CT scans while in the ER. 

I am about halfway through my surgery rotation which is my last core. I must say, despite my reservations about being in such a large, unfamiliar city, I have had great learning experiences and have had the opportunity to see so much throughout my time in these rotations. Chicago is an amazing place to learn medicine!! I have had very eclectic experiences as each of the doctors I have worked with have been very different from one another, and they have each served different patient populations. 

 My OB rotation was in a very nice small hospital in the northwest suburbs of the city. Going into the rotation, I had a bit of a sour taste in my mouth because I didn’t have the greatest experience when I had my OB/Peds rotation in nursing school. I was also much younger then, and had seen far fewer gory situations than I have seen now and nearly hit the floor as I watched a vaginal delivery for the first time. I was pleasantly surprised to find out that it didn’t bother me at all this time around, and (although this is strange for me to admit) I actually had to keep myself from shedding an emotional tear with just about every delivery. It is so amazing what the human body goes through when giving birth and witnessing the immediate connection between a new mom, a new dad, and their new baby is absolutely amazing. During the rotation I got a really good mix of exposure to different things. Our time was divided up between office visits, labor and delivery, and surgery. In the office, we did routine check up and pap smears, DEXA scanning, prenatal care, and minor procedures like colposcopies and biopsies. I learned a lot about healthy pregnancies, and a ton about routine screening and prevention for women. I got to witness several deliveries as well, both vaginal and C-sections and also sat in for a couple of surgeries for gynecological cancers. The attending was awesome and genuinely wanted to make sure we were well versed in the field. He had high expectations of us and also made us do a presentation for the group each week.




My surgery rotation is with an orthopedic surgeon, so we are mostly dealing with musculoskeletal problems. I think it has been a great rotation that will be applicable in just about any field of practice. Hip pain, back pain, and knee pain have to be some of the most common reasons that people seek medical care. It has been great learning how to effectively assess someone and decide where the pain might be coming from. Again, the attending is really great and does lots of extra teaching for us. He has held workshops for us where we learned how to apply splints and casts, another where we worked on our suturing skills (using pigs feet) and he also has us do presentations. He really encourages us to bring him the difficult questions we stumble on as we are practicing for boards and works through the with us. He is amazing with his patients and a true joy to work with. I am learning so much “common knowledge” stuff that I think any doctor, regardless of the field they work in, should know. I would love to do some outreach medicine some day and the skills I am learning in this rotation will help me immensely with that! 



One of my favourite parts about getting to rotate with all of these different doctors is watching how each doctor approaches their patients. No doctor is perfect, but with each one I have found qualities that I admire and hope to incorporate into my own practice. Treating people is a true art form. It is not easy to connect with a stranger and quickly earn their trust and I have seen great examples of doing just that. Of course, I also see things that I would never do…but those things are just as much of a learning experience. It is like a fun journey where you pick up all of the great, positive things you see and put them in your pocket and simply leave the things that you don’t want to take with you. I am excited to start focusing in more on my big interests and to continue to work on becoming the great physician that I know I will soon be.

As always, thanks for reading and please feel free to contact me if you are a current student or hopeful soon-to-be student and you have questions!

XOXO