What's in an ERAS Application?

ERAS season is almost here already! It feels like yesterday that I was filling out my application. I remember the angst and anxiety I felt leading up to application time and a lot of it centered around making sure my application would look good and that I'd be able to add valuable information to all of the different elements of the application. As applicants we are basically on our own as far as the application goes. There is no one to hold your hand and make sure you know exactly what you're doing and that can be stressful! This post is dedicated to just helping you familiarize yourself with the application and the things that will be asked in it.

First, I want to clear one thing up. I have a lot of people ask me about the "CV" portion of the application. You don't upload a CV per se...ERAS generates one using the information that you enter into the application. So don't worry about how the CV should look or what format to use. That being said, this is a great time to update and polish your CV because you will want to send it to all of the physicians writing a letter or recommendation on your behalf. It can really help them add depth to your LOR especially if they haven't known you for a long time.

Below I will list the components of the ERAS application. It's a great idea to start compiling any information you have now so that it will be streamlined when applications open. That being said, you've got about 3 months to work on your application once it opens so there is no need to panic! For this year (2018) the applications open on June 6th. At that time you can start entering all of your information and deciding which programs to apply to. You can start actually applying on September 6th, and programs receive applications September 15th. It is a really good idea to have everything done before programs receive the applications on the 15th. You want to show that you were prepared and enthusiastic about applying so applying after that could hurt you somewhat. If at all possible, you want ALL of your USMLE scores in before the application goes in so try to consider that when planning out when to take your exams. USMLE Step 2 CS can take 3 months for results, so you want to do it by June 1st to be safe. USMLE Step 2 CK takes about 3 weeks, so try to get it done by the first or second week of August at the latest!

General Information

Name

Email

Gender

Birthdate/Place

Citizenship status

Mailing address and phone number

History of any criminal records

This section is self explanatory so I won't elaborate :)

Medical Licensure

ACLS

PALS

BLS

Any medical licenses or board certifications 

Past history of malpractice suits

I'd advise having current ACLS and BLS certification at the time of application if you can. This shows that you stay up to date and current with your certs. I would recommend PALS if you are applying for Peds, Med/Peds, Family Medicine, or any other specialty where you will see children.

It is not expected that you have any medical license or board certifications at the time of application. This is more for people who may be changing fields or who have medical licenses in other countries and are now trying to come to the USA to practice.

Medical Education

Your medical school(s), dates attended and date of degree

Date of degree can be empty if you haven't graduated, you can also put the expected date of degree and make it a future date.

Medical School Honors/Awards

Any special recognitions or awards you receive during medical school can go here. Things like making the Dean's list or awards given out at graduation are some examples. Every school has different incentives and awards so I won't go into too much detail.

Membership in Honorary Professional Societies

Alpha Omega Alpha ?

Gold Humanism Honor Society ?

Others

Many schools don't have AOA or Gold Humanism Honor society so don't worry if you haven't heard of these!! 

It is important to obtain membership in the professional societies to which you are applying. For example, for Pediatrics you would want to join the American Academy of Pediatrics (AAP). Other things that can go here are memberships in red cross, AMSA, or others. Programs like to see that you are interested in being involved and staying up to date with the issues going on in your field and this is a great way to show your commitment! 

Education

Type of Education (Undergrad/Postgrad)

Institution and Location

Dates attended

Degree

Degree Date

Field of Study

All of your undergraduate and postgraduate education (except medical school) goes here! Even if it isn't related to the medical field, I would still include it. The more education the better!

Current/Prior Training

Institution, Location and Training Type

Program Director

Program Supervisor

Dates Attended

Month(s)
Discipline

This is for applications who have other post-graduate training. An example would be that you matched into a Preliminary Spot for PGY1 and are now applying for a different PGY1 spot or a PGY2 spot. If you haven't been a resident before you don't need to worry about this section - it certainly won't fault you!

Experience

Work, Volunteer, and Research Experience.

Organization and Location

Position

Dates

Supervisor

Average Hours/Week

There is a separate section for work, volunteer, and research experience. 

Work experience should be limited to experience in the healthcare field or experience that will help you as a resident. Programs won't care that you worked at Subway in high school - keep it relevant or it might look like you're trying too hard to just fill in space.

Volunteer experience is a bit different - it doesn't necessarily have to be related to healthcare. Volunteering is a great way to show that you like to be active in your community and give back. Volunteering in areas outside of the medical field can also show that you are a well rounded person. For example, I volunteer with an organization that helps supply underprivileged children with clothing and school supplies. It isn't medical per se, but reiterates my desire to help children.

Research experience - structured research experience goes here. Publications are different. If research results in a publication you can have it in both sections.

Publications

Simply a list of your publications. This isn't research, that goes in section above. This is a list of your published work(s) if you have any.

Language Fluency

You input the languages you speak and how well you speak them in this section

Hobbies

This is a free text box that you can list your hobbies in. Programs like to see that you are well rounded and have interests outside of medicine. This section certainly won't make or break your application but it can show that you are into other things. A lot of my interviewers used my hobbies as ice breakers to get conversation going in the interviews so be prepared to take about them if you list them!

Other Awards/Accomplishments

This is a free text box where you can list anything else that you want the programs to see. Awards for community service would be an example of something you could put here. You don't HAVE to put anything - I didn't because I simply didn't have anything and didn't want to list something that would be a stretch just to have something there.

Personal Statement

Personal statements don't go under the main application, you upload them separately. You can upload as many versions of your personal statement as you want to! I uploaded a very personalized personal statement for programs I was especially interested in and then had a generic one that I sent to the rest. This is also important if you are applying to more than one specialty. You will want a personal statement for each specialty explaining why you are applying for that specialty and why you'd be a good asset.

Hope this helps to ease a LITTLE of the application anxiety I am sure you are all feeling! Best of luck in the match!

IMG Friendly Pediatric Residency Programs 2018

Matching into a US residency program is a tough thing to do these days. It is especially tough for international medical graduates. Just over 50% of the international medical graduates who apply to the match successfully obtain a position. This creates a huge amount of anxiety and stress through all four years of medical school. You sacrifice so much while in school and having such low chances of getting a position makes it feel even more daunting than it already is. That being said, thousands of international graduates do get a spot every year and there are lots of things that you can do to strengthen your application and help your case. The residency application process is lengthy and costly, so knowing which programs to apply to can be half the battle. You literally pay for every program that you apply to. Many IMGs are applying to several hundred programs which can cost thousands and thousands of dollars. You also have the expense of traveling for interviews, so anywhere you can save money helps a lot. Applying “smart” is very important. There are more than 200 pediatric residency programs in the country. Doing research to ensure you’d even have a shot at a program is the best way to make sure you aren’t spending unnecessary money. 

Before getting into my list of IMG friendly programs, I’ll caution you to be careful with programs in NYC. The state of NY has a “12 week rule” that states that any student who does more than 12 weeks outside of their home country are not eligible for medical licensure or residency in the state. There are exceptions that can be filed but it gets sticky. A simplified explanation and a list of exempt schools can be found here: http://medclerkships.com/new-york-states-12-week-clerkship-rule-explained/

This list is just meant as a guide to get you started. It is important to research the programs you are applying to in order to make sure they will be a good fit and that you meet the requirements. In your program search, you might notice that a lot of the big name hospitals (Cleveland Clinic, Harvard, etc) do have several IMGs on their roster. This might make it tempting to apply, but it's probably smarter to save your money. Most IMGs that match at these programs have connections there. That being said, if you score very competitively on boards (higher than 245 on both), I'd say go ahead and give it a shot! Another variable to consider is your location...programs often consider those who are native to the area that the program is in. If you are from the USA, be sure to apply to any programs that are near your home town!

The interview trail is fun, but exhausting! You travel a lot in a short amount of time. My biggest regret is not having enough time to truly get a feel for each of the locations I visited - it just wasn't possible. I definitely had a few favorite interviews. LSU in New Orleans definitely won for best food. They had a dinner the night before that the residents cooked homemade food for and it was to die for! They also took us out for a great lunch on interview day. Geisinger was the most friendly and hospitable. They made me feel at home right from the start. They provided a really cozy hotel room and thanked us repetitively for making the trip there. University of Buffalo had the most impressive facilities! They just opened a brand new stand alone children's hospital that is absolutely incredible. University of Arizona was definitely the prettiest place I visited...I am a sucker for those mountains!

Programs that were nice enough to grant me an interview:

William Beaumont Hospital - Royal Oak, MI
University of Buffalo - Buffalo, NY
Sinai Hospital of Baltimore - Baltimore, MD
Louisiana State University - Shreveport, LA
Louisiana State University - New Orleans, LA
University of Arizona - Tucson, AZ
Marshfield Clinic - Marshfield, WI
UConn School of Medicine - Hartford, CT
Michigan State University - Flint, MI
Geisinger Health Care - Danville, PA
Maimonides Medical Center - Brooklyn, NY
New York Medical College - Newark, NJ
Hofstra Northwell School of Medicine - Staten Island, NY
SUNY Upstate - Syracuse, NY

Programs that other IMGs were invited to interview at (I know people who had interviews at these places personally):

Lincoln Medical Center - Bronx, NY
Texas Tech - El Paso, TX
St. John Providence - Lansing, MI
Brookdale University Medical Center - Brooklyn, NY
St. Barnabas Health - Brooklyn NY
Flushing Hospital Medical Center - Flushing, NY
Bronx-Lebanon Hospital Center - Bronx, NY
St. Peter's Medical Center - New Brunswick, NJ
University of Texas Medical Branch - Galveston, TX
University of Florida - Pensacola, FL
SUNY Downstate - Brooklyn, NY
Case Western Reserve University - Cleveland, OH
NY Presbyterian Hospital - New York, NY
Richmond University - Staten Island, NY
Monmouth Medical Center - Morristown, NJ
Homer Stryker School Of Medicine - Kalamazoo, MI
Icahn School of Medicine - New York, NY
Mount Sinai Hospital of NY - Elmhurst, NY
Nassau University Medical Center - Easy Meadow - NY
Driscoll Children's Hospital - Corpus Christi, TX
Jersey Shore University Medical Center - Jersey Shore, NJ
Woodhull Medical Center - Brooklyn, NY
University of Kentucky - Lexington, KT
East Carolina Vidant School of Medicine - Greenville, NC
University of Florida - Jacksonville, FL
Tulane University School of Medicine - New Orleans, LA
Hackensack University - Hackensack, NJ

As I said before, this list is definitely not exhaustive. It is meant to be a place to start if you don't know where to. Best of luck! I will be posting more match tips soon :) 

I MATCHED!!

That’s right! My dream has come true!  All of the hard work has finally paid off. I have matched into a categorical pediatric position at Geisinger Health in Danville, PA!!! I know I have been on a bit of a hiatus from posting about my journey, but the match process is a lengthy one and I wanted to ensure that things turned out well before I shared information about process. I have lots of great posts planned such as tips for matching into a pediatrics program, components of the ERAS application, interview tips, and more!

First, a little about this wonderful program that I matched to! Geisinger is an enormous health care system in central Pennsylvania. They’ve got 27 residency programs and 21 fellowship programs making it a real hub for tertiary care. The hospital is just shy of 600 beds, has a 5 helicopter emergency trauma program, and contains my new home - the Janet Weiss Children’s Hospital! The children’s hospital has every subspecialty for pediatrics you can think of! From pediatric trauma to pediatric neurosurgery to a dedicated child abuse unit, there isn’t much that can’t be handled at the hospital. Though the hospital is in the small town of Danville, it has a catchment area of over 3 million people as it’s the only facility of it’s type in the area.

I will be spending my next three years there at minimum completing my training in pediatrics. I am super excited for the awesome education that I know I will receive there! I fell in love with Danville on my interview day. It was the first interview I went on and it was in the middle of October. I drove there from Chicago and was so enchanted by the rolling hills and beautiful colors of the changing leaves! The fresh air and small friendly feel was such a welcomed change from Chicago. It really reminded me of home, more than any place in the US I have been thus far. Patrick and I love to mountain bike and hike and there will be lots for us to do there! I am taking a trip there next week with my mom and my mother in law to look for apartments since Patrick is really busy with rotations right now and can’t get away. We’ll be moving at the end of May and I’ll be starting up shortly after that! For my colleagues, please stay tuned for lots more posts about the match process, and if you have questions or suggestions for blog topics feel free to email me as always at drnicolefox@gmail.com

Thanks for reading and congratulations to all of my friends who had a successful match season! This year was one of the best for our school and I am proud to be a part of it!

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

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

The books don't know these things!

Wooooh! It sure has been a long time since I have written a post. I have been really busy in clinical rotations and I have just had trouble finding time to sit down and get it done. I have been having such a great time and learning so much.

I recently finished up my internal medicine rotation. I had a totally awesome attending who was extremely knowledgeable and has a real passion for teaching. He travels to many, many different facilities - nursing homes, rehab facilities, hospitals, and outpatient offices. I will admit, at first I was a little disappointed that all of my time wasn’t going to be spent in the hospital, but I quickly changed my mind. Having the opportunity to see so many patients at so many facilities really provided a great learning experience. I saw some pretty rare cases and definitely developed my physical exam skills a lot. 

I was truly astonished by some of the long term care facilities that we visited. At the nursing homes in Canada that I have worked at, the patients were quite stable. If they required more acute care, they would be transferred to the hospital. Here, it is a totally different set up. Many of these nursing homes handle patients on ventilators, patients receiving IV fluids and medications, and some even had dialysis units right in the building. Needless to say, not a day passed where there was a shortage of learning opportunities. One of my attending’s favorite sayings was “the books don’t know these things!”. He couldn’t be more right. I firmly believe that in order to be a great clinician, you really need to get out there and see as many patients in as many settings as you can. Books can give some great knowledge, but they certainly cannot make you a great clinician! 

The 12 weeks of internal medicine REALLY flew by. I find internal medicine to be so interesting. Each patient is a completely new mystery that needs to be unlocked and I really thrive on the challenge of figuring it all out. There is so much to know and I feel like it is an area that would be hard to ever truly master.

I have just finished my 2nd week of the pediatrics rotation. I must admit, this rotation has been quite refreshing. My entire medical career thus far has been (for the most part) caring for very sick, and mostly elderly people. This peds rotation is solely outpatient and the kids we see are, for the most part, not very sick. There are a lot of school physicals, sports physicals, weight management patients, and minor illnesses and injuries. The kids in the practice are delightful to work with and so well behaved! The population is almost exclusively hispanic. I’ve recently started to try to learn how to speak Spanish and there couldn’t be a better time to do it.

The attending is awesome. He expects a lot from and is quite hard on his students, but for me, that is a huge motivator. I love to be challenged and pushed to do better and this doctor is awesome at doing just that. He is really great at his job, makes a huge difference in his patient’s lives, and is incredibly thorough.

In Canada, at least where I am from, most kids don’t see a Pediatrician on a regular basis. For the most part, kids are cared for by Family Physicians and are only referred to Pediatricians if they have a serious or chronic disease. Here though, the Pediatrician assumes the role as the Primary Physician for many children. It is such a great and interesting role because you are dealing with young minds who are eager to look at you as a role model. I really think that you can make a lifelong difference in a child’s life by getting them starting out right with healthy lifestyle habits. Prevention is the main goal if you are a Pediatrician, and if you get through to kids while they are young they are more likely to hold onto those values as they grow older.

I suppose that is all there is to report for now, thanks so much for reading!
XOXO