What We Can Learn From Nurses

As I creep further along in this medical school program and start to spot the finish line, I have been reflecting a lot on this journey. I have sure experienced a ton and have gone through a lot of personal growth since packing up my bags and moving to the island almost four years ago! Lately, I have been thinking a lot about how thankful I am to have had my experience as a nurse behind me, helping to guide me and mould me into the best physician that I can be. I can confidently say that my experience as a nurse is definitely going to positively impact my practice as a doctor, and there are many reasons for it.

This reality really struck me the other day. I am currently doing an elective rotation in allergy and immunology at Cook County and Rush Hospital in Chicago. We were rounding on our patients with the team which consists of an attending, two fellows, three residents, and three students. We had to perform a pretty uncomfortable test on an older gentleman who had a ton going on with him. He was in pain, had been through a lot, and had tubes and machines attached to just about every part of his body. In order to perform the test we were doing, we needed him to be semi-sitting up which was a pretty uncomfortable position for him to be in. After the test was finished, his wife politely asked if he could be repositioned in a way to make him more comfortable. As I looked around the room I watched eight sets of eyes open wide, and then one of the fellows quickly said “we will get his nurse right away and have her get him comfortable, I’m really not sure how he is supposed to be positioned”. We left the room, and the fellow found his nurse and relayed the request. I saw the familiar “internal eye roll” that nurses give doctors when they are approached and given a task that seemingly anyone could perform. I didn’t even need to have a conversation with this nurse to know what was going through her head. “Nine perfectly capable people in white coats, and not one could just help reposition the man? Like I don’t have enough to do”. I was so odd to see this situation play out from the other end. How many times had I thought a doctor was lazy or didn’t care, when really they were just worried they might do something wrong?

This illustrates one of the biggest reasons my experience as a nurse will help me - I am going to be able to understand and relate to the nurses I work with really well. Having seen and done things from their point of view will really help me communicate well with them and anticipate how I’ll be able to help them and even how they’ll better be able to help me. Good nursing care for your patients is so paramount. Being able to work together with the nurse caring for your patients is the best way to ensure that they receive great care.

Nurses spend their entire day with their patients. They are there for it all. They see every up, down, twist and turn that is thrown at their patients during their hospital stay. Nurses really get a feel for what their patients go through. They understand what happens during painful tests and how patients react to getting certain medications. They can anticipate what their patients are going to need and when. It’s not just about “caring”. I feel that most people in the healthcare field are there because they care, but being at a patient’s side every step of the way teaches you HOW to care for people. Until the skill of how to care for others is learned, all the caring in the world doesn’t go very far. It’s about anticipating those needs and comforts, regardless how big or small they might be. If you’ve got a nurse in your life - a loved one, a family member, a friend, or even an acquaintance, be sure to give them a big hug and say thanks! Nurses are amazing and really do deserve all the gratitude in the world. 

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!

  

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 💗

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