Residency Subspecialty Shortlist – PGY2

Choices

One of the biggest appeals of internal medicine is that it is such a broad specialty. Even within adult medicine, you can choose to sub-specialize or remain a generalist. In Canada, internal medicine residents go through a second CaRMS process called the Medicine Subspecialty Match during PGY3. In Canada, there are 15 specialty fellowships to choose from.

Lately, I have been thinking a lot about what specialty I would like to do. To help with that decision, I have decided to make another shortlist of subspecialties I am considering. For those who are not familiar, I made similar shortlists during medical school – Year 1, Year 2 and Year 3 – which I found extremely helpful. Last year, I wrote a guide on how to choose a medical subspecialty. I found putting down my thoughts into words helped clarify what I liked and didn’t like about each specialty. It’s my hope that this shortlist will again help guide my career decisions. Since there are only 15 specialties, I will list them all with my current thoughts about each one.

Top 5

  1. Respirology
    I really enjoyed my PGY1 respirology rotation and it was a subject I liked a lot during med school. It appeals to my undergrad physics background with its pressure and volume equations. I also find there’s a good balance of diagnosis and medical treatment. I have always had an interest in airway management even when I was on my anesthesia and thoracic surgery rotations. In resp, there’s a good combination of inpatient and outpatient servuce, young and old patients, and a mix of procedures such as bronchoscopy and thoracocentesis. I would say I’m 70% set on applying to this specialty and have arranged a few more respirology rotations for this year to re-affirm my choice.
  2. Critical Care
    I was first exposed to critical care as a third year medical student and at the time I loved it. It was a key factor that made me apply to internal medicine. Caring for critical care patients was applying physiology concepts in real-time. I loved the comprehensive systems approach to patient care and the  team environment was amazing. ICU nurses are amongst the best to work with! The patients were complex and each required deep thinking to manage properly. There were lots of procedures to do and I found discussing goals of care with family members meaningful. However after doing ICU as a resident, it has come downon my rank list. I found that there were things I missed doing  – talking to patients, evidence-based physical exams, long term follow up. I’ll probably still apply to critical care for CaRMS but I will see what my subsequent ICU rotations are like.
  3. Infectious Diseases (ID)
    What I like about ID is you get to see some really cool presentations of diseases. When you’re on consult service, you see patients on every service in the hospital. In the outpatient setting, you get to see a great breadth of cases from HIV patients to fevers in returning travelers. I worked several summers in a microbiology lab, so infectious diseases has always been something that interested me. However, what I don’t like so far is the I am smarter than you attitude of “why would you prescribe that antibiotic for that bug!” that gets perpetuated. Overall, ID is a really fascinating specialty that requires a broad base of general and specialist knowledge.
  4. Gastroenterology
    I have put GI high on my list without having done a rotation in yet. I’m not sure if it will remain high on my list. What I do like about GI is there’s a variety of organ systems within GI itself. From esophagus to colorectal, there are a plethora of areas to focus on. However, when I’m on team medicine it seems the only reason I call the gastroenterologists are for bleeds and scopes. Maybe my thoughts will change once I finish my GI rotation. Of note, I think hepatology is a really neat subspecialty that is coming out with a lot of big breakthroughs will change things up.
  5. General Medicine
    I enjoyed doing team medicine a lot as a PGY1 resident. You get to be the primary care team for patients, you get to coordinate their care with subspecialists, you take responsibility and I liked that. You also see a large variety of patients, whatever walks through the emergency room was fair game. This year I’ll be the senior resident on team medicine and I will have a different perspective on running a GIM team. One pitfall I do see with GIM is that in the foreseeable future GIM will equate to hospitalist medicine. Finding referrals for an outpatient practice may be challenging. Furthermore, I do think I would prefer to be an expert in one area than a generalist.

Middle 5

  1. Cardiology
    I think cardiology is really cool. From managing STEMIs, arrhythmias, coding patients to outpatient secondary prevention, I think every internist needs to know cardiology well. And although I like the day-to-day activities of a cardiologist – taking good histories, listening to heart murmurs, interpreting ECGs and echos and implementing solid evidence based treatments – I don’t think I will be pursuing it too seriously. After three months of cardiology as a medical student and resident, I don’t think I love cardiology enough. Becoming a cardiologist requires an extra long training and an adjustment in lifestyle compared to other specialties. Regardless, I’m still excited for my CCU rotation this year because I feel as if you can never have enough cardiology knowledge.
  2. Geriatrics
    I genuinely like looking after elderly patients, it’s one of the big reasons I went into internal medicine. What I like about geriatrics is its holistic care. It’s medicine practiced the right way. Instead of looking after just medical disease, you look after psychological health, emotional well being and social supports. It’s a combination of internal medicine, family medicine and psychiatry. The downside is geriatrics can be draining for the same reasons that it can be rewarding. The lack of acuity is also something that I don’t find that appealing. And I feel like I will see geriatrics patients in any specialty I choose, so I don’t feel like I would be missing too much if I didn’t choose it.
  3. Hematology
    This was a hidden gem for me and I didn’t expect to like hematology as much as I did when I rotated through it. The patient population is diverse and the diseases are quite interesting. From simple anemia workups to treating heme-malignancies, I found hematology a cool specialty. It’s also one of the few specialties that can practice bench to bedside care. Diagnoses made under the microscope can translate to clinical decision making and it was something I never really appreciated.
  4. Nephrology
    Kidney doctors are true internists. They are detail oriented, comprehensive and care for some of the sickest patients. I learned a lot of key concepts during my nephrology rotation that I will use throughout my career. Unfortunately, I wasn’t too fond of dialysis and chronic kidney disease and unfortunately that is the bulk of a nephrologist’s work.
  5. Rheumatology
    I don’t really know much about rheumatology other than (1) it’s an area of knowledge I need to work on and (2) it’s got a good lifestyle. I’m looking forward to my rheum rotation. I think I’ll learn a lot but I don’t expect it to move too much on my list.

Bottom 5

  1. Endocrinology
    Sugars, sugars, sugars, hormones and more sugar. Endocrinology is synonymous with diabetes management. Occasionally there are other hormones affected. I’m ok with treating diabetic patients but I don’t think I could spend so much time on just one disease.
  2. Medical Oncology
    Cancer treatment is one of the fastest evolving fields right. New treatments continue to come out and outcomes are getting better and better. Despite that, I still feel awful every time I break bad news about cancer. It’s heartbreaking. I think I would be really sad if everyone I looked after had cancer. Overall, I think it’s a really promising specialty with a good balance of new therapies, comfortable lifestyle and deep relationships with patients, but it’s not the specialty for me.
  3. Immunology and Allergy
    Unclear about this one… I don’t know much about it… but I can’t see why I would choose it.
  4. Clinical Pharmacology
    I was never really that interested in pharmacology. This might be a neat specialty to do an elective rotation in but I can’t imagine doing it as a career.
  5. Occupational Medicine
    I often wonder why this specialty is under internal medicine. I question whether someone had to rotate through the cardiac care unit, intensive care unit and every other subspecialty to end up doing occupational health. I understand workplace ergonomics and hygiene are important but I wonder what it has to do with internal medicine. I feel as if public health or physiatry would be better entry programs.

Wrap Up

I’ll try to make a shortlist next year around this time just before I apply. I found writing this shortlist was useful not only for identifying specialties to consider but it helped me understand what I liked about each specialty. I hope it will give me some guidance during my subsequent rotations this year.

If you are having trouble deciding on what specialty you would like to do, I encourage you to make your own shortlist and write down your thoughts about each specialty.

(Photo credit -  Flickr Caese)

Updates on Secondary Applications

paperwork

Hello? Yeah, no, I’m back here. Behind the figurative pile of application forms. Yeah, under the stack of credit card receipts. There you go. Hi! How are you? Oh, that’s great, so glad to hear it. No, no, things haven’t been too bad. Oh, this? Just a wrist brace. Yeah, doctor says if I keep writing like this, he’s gonna have to fit me for a hook.

It’s my own fault. I knew what I was getting into when I applied to almost 40 schools. But it still blows me away to think that I have written more in the last few weeks than I have in the rest of the year combined. Fortunately, getting so many applications out the door in a timely fashion has been a task made much easier by my taking a systematic approach to pre-writing.

Do Your Research

Once I had my list of schools drawn up, I created a Google Drive spreadsheet to help me keep track of my progress. I trawled through last year’s School-Specific Discussions threads on The Student Doctor Network forums, collecting information about each medical school. People helpfully post the secondary essay prompts in these threads, and though the essays may change from year-to-year, in many cases, they stayed exactly the same. After recording the essay prompts, I’d start looking for two noteworthy dates:

Determine the date they released the secondary. In many cases, this is within the first week of the AMCAS applicant data being made available to the schools. In others, the secondary goes out much later in the summer. Use this information to prioritize the essays you want to write first.

Determine the date they released the first interview invite. This is arguably the more important date. Early interview invites mean early interviews, which mean a greater chance at an early acceptance. Plus, applying to medical school is a little crazy-making, so it’s nice to have encouraging feedback about your application earlier rather than later. If a school is known for sending out interview invitations in the first week of application season, you definitely want to make sure you’ve got that school’s essays polished and ready to go.

(Note: Some schools have pseudo-non-rolling admissions, where no acceptances are doled out until March. Early interview invites may be less important at these schools, but since they also tend to be some of the top dogs, you still might want to pre-write their essays. If nothing else, it will give you more time for editing.)

Going into this game, I knew I would not be able to realistically pre-write every school’s secondary essays, but using the above strategy allowed me to have the first ten schools’ applications ready for roll-out on day one. From that point, it was mostly a matter of being green.

Reduce, Reuse, Recycle

Underneath some flowery language, many of the essay prompts are quite similar:

“Describe your activities for the upcoming year.”
“What was your greatest challenge, and what resources did you call upon to address it?”
“Describe your exposure to the field of medicine.”
“What are your career goals, and how will attending Clara Oswald University School of Medicine help you achieve them?”

And, my personal favorite, “How will you contribute to the diversity of our class?”

Once I had these five essays written in one form or another, altering the language to fit the school or to fit a certain number of words was simple enough. I felt a bit guilty at first, but why should I? As long as I’m answering the question and presenting truthful information about myself, I doubt admissions committees would be offended by my self-plagiarism.

For the school-specific questions, you have to do some digging and ferret out the programs that fit with your interests and your learning style. Not only is this an opportunity for you to demonstrate that you’ve done your homework, but it’s also your chance to convince the admissions committee that your interests match their mission.

Other Secondary Tips

  • Start saving yesterday - My secondary applications have ranged in cost from $65 to $130. When you’re picking schools, be realistic about the strength of your application as well as your budget.
  • Try not to get arrested - Almost every secondary I’ve completed has asked me to divulge my (thankfully clean) judiciary record.
  • If you don’t have a pre-medical committee letter or packet, be prepared to explain.
  • Keep your transcripts handy. Yep, even though you just went through the trouble of painstakingly entering your coursework into your AMCAS application, many secondary
  • applications require that you enter it in again.
  • Write your essays in Google Drive. Okay, sure, this is just my personal preference, but between the continuous autosave and the relatively clutter-free interface, I pick Google Drive over MS Word every time.

So far, I’ve kept up pretty well, submitting twenty-three secondary applications in two weeks. And I’m happy to report that at least a couple of my applications hit the mark, as I’ve gotten three interview invites! The timing was perfect, actually – The first invitation landed in my inbox 45 minutes after I received my first rejection, just in time to crash the absolutely killer pity party I was winding up. Hopefully there are more to come, and I’ll be back with a progress report soon. Just have to figure out how to type with these hooks.

Photo credit: kozumel on Flickr

An Introduction to Medaholic’s New Coblogger: Lizz

axolotlembryosAs many of you know, I have recently been looking for a coblogger for medaholic. Over the last year, I found most of my reaers were premed or medical students and that a lot of the new content on my blog wasn’t catering to them. In an effort to help medaholic continue to grow I’ve decided to bring on a fellow co-blogger Lizz to help me grow this blog! Here’s a brief interview so people can get to know her a bit better!

Hello. My name is Lizz, and I’m a medaholic.

Or, at least, I’m the new co-blogger at medaholic.

Who are you?

A: I’m 25. I majored in a computer science-y subject, and I work in the IT field. I hail from the alternatingly humid and frigid New England area. I love movies, Anki flashcards, Lifehacker, Reddit, Metafilter… Okay, let’s just say I love the internet. I used to have pink hair and three facial piercings, which oddly didn’t stop me from being successful in my corporate job. I think credit unions are excellent and I hate exercise.

Oh, and I want to be a doctor.

What stage are you at in your education?

A: Two and a half years ago, I was wrapping up a degree in a non-medical, non-science subject. Because I was working full-time, I was about a semester’s worth of credit short of graduating. Specifically, I still had to fulfill the free elective requirement – Three classes from a discipline outside of my major. Three more classes would mean another four thousand dollars in tuition, plus another semester’s worth of work, all spent on material that had nothing to do with my field. Naturally, I was less than thrilled.

The whole reason schools require you to branch out and take these classes is to ensure that you’re a well-rounded individual. Nobody really expects you to buckle down and take hardcore science or math classes, but they hope that you’ll at least hit up their foreign language or sociology departments. So while I haven’t actually checked this out or anything, I like to think that I’m the only graduate from my university to have volunteered to take Calculus I as a free elective.

The thing is, I had given some thought to pursuing a career in medicine, but I had almost no science background. I was one of those kids in high school who picked Earth Science over Chemistry, opting to cover the water cycle rather than water’s intermolecular interactions. My choice of Biology classes came down to picking the ones with the fewest dissections. With this in mind, I had no expectation that I was capable of doing the work and pulling off the grades necessary for a successful medical school application, so I needed a nice litmus test class. With Calculus, I figured I’d crash and burn and that would be the end of my premed aspirations.

Except, that spectacular flame-out never came. I got an A.

That A set me up with the confidence to run full-tilt at the science classes I had avoided, starting with General Chemistry I and II. They were a cakewalk compared to Calculus – In fact, to this day, Calculus I and II remain head-and-shoulders above the rest of the courses I took in terms of difficulty. Turns out my inner premed was more than capable of pummeling the hard sciences. More than that, Chemistry is almost certainly my favorite subject, and dissections are a blast. Without those three free electives, I might have gone my whole life without discovering this about myself.

Fast-forward through a few years’ worth of courses, extracurriculars, and MCAT prep. As of two weeks ago, my AMCAS application has been submitted and verified. The bulk of what medical schools are going to evaluate me on is set in stone. All I can do now is write a novel’s worth of absolutely killer secondary application essays and hope the interview invites start rolling in.

What will you be focusing on as a co-blogger?

A: Since I’m waist-deep in the medical school application process, I’m going to be talking about the advice I wish I’d been given on the way to this point. I devoured blogs like medaholic when I was making the transition from computer science graduate to pre-med post-baccalaureate student. Hopefully my advice helps guide and motivate y’all, but this blog will also give me the chance to chronicle my progress through this application cycle and beyond.

I’m also going to talk about my progress on a variety of goals. I decided to pursue medicine because I’m motivated and dedicated, and gosh darn it, I like being busy, which predisposes me to being the type of person with a hearty list of goals. Not only do they motivate me to improve myself as a person, but they also keep me from zoning out in front of Netflix for hours a day. Hopefully they’ll also help me stave off premed neurosis during this potentially 13-month application cycle.

What goals are we talking about here?

Get into medical school. Operation Get Accepted is in full-swing. Secondary applications come out next week, and interview invitations will hopefully be quick to follow. On the other hand, the earliest acceptances won’t come out until mid-October. It’s going to be a long year.

Learn more Spanish. Hablo un poco de español, as in I can say no sabemos quien es humano and other phrases of dubious utility. After I get my secondaries out the door, improving my spoken Spanish is going to be my next big project.

Lose more weight. Food is my favorite thing ever, and exercise is practically a four-letter word, so this one has been hard. But as of this writing, I’m down 34 pounds from where I was this time last year, so it can be done.

Save more money. It should surprise no one that a medical education is painfully expensive. In addition to building myself up as an applicant, I’ve been building my savings up to help defray some of this exorbitant cost. I’d like to keep a running tally of how much this cycle has cost me, as part of a financial reality check for you folks. If you’re planning on applying in a year or two and you’re not fortunate enough to have family who can foot the bill, I have one piece of advice: Start saving for your applications yesterday.

Anything else you want your readers to know?

A: I am so not perfect. In fact, I’m sort of a self-saboteur. I undermine my diet on the regular, binging on popcorn at the movies while thinking “This isn’t even that good!” When I procrastinate on Netflix, I’m mostly watching marathons of shows that I don’t even really like. I haven’t so much as uttered an “hola, como estas?” in weeks. Worst of all, I have about a hundred secondary essays I should be pre-writing! Oh lard. I’m going to go do that now.

Medaholic’s Take

I’m super excited to welcome Lizz aboard and know that she’ll be a great coblogger who will write about issues that you care about. I’m excited to see her posts about MCAT study strategies and applying for medical school in the United States. You can identify blog posts from her by looking for the author Lizz. I look forward to a new chapter at medaholic.com!

Studying In Medical School – A Timely Analysis

Today’s guest post comes from Ryan Nguyen, an osteopathic medical student who blogs at WhiteCoatDO. You can also connect with him on twitter via @RNguyenMed.

 “So how much do you really study?”

My non-medical friends often wonder where I’ve disappeared to for the past year, they’re fascinated by the idea that I spend just so much time studying. Sure, I had to put in a decent amount of work during college to even make it to this point, but my course load at UC Santa Barbara seems like a brisk walk in the park compared to the tidal wave of information that needs to be conquered for each exam now.

In an effort to quantify really just how much time I was studying, I tracked every single minute I spent preparing for one of my exams during the school year. What exactly did this mean? Every hour spent in-class, watching lecture playbacks, outlines powerpoints, or reviewing in group was written down. The exam, from my “Introduction to Disease, Immunity, and Therapies” block encompassed 2 weeks of material and roughly 37 hours of lecture material. To put that in comparison, a typical 4.0 unit class at UC Santa Barbara would cover about 30 hours of lecture material over a 10 week span. Medical school sure has a way of jam-packing information into a very brief amount of time.

In order to keep the data as accurate as possible I ONLY logged time that was spent studying. This meant I “clocked-out” any time I spent surfing the web or even going to the bathroom. For example, if I was at a coffee shop for 3 hours, I probably spent ~2.5 hours actually studying and 30 minutes for other things. After doing the actual studying and test-taking, the results were tabulated as follows.

What does this all mean?

I spent a lot of time studying

In total, I spent 76.8 hours studying for this one exam. That translates to roughly two hours spent dedicated to each hour of lecture material. On average, I would study for 4.8 hours/day, but there was a definite disparity between how much time I spent per day during the first week (3.5 hours/day) and the last five days before the exam (7.2 hours/day). Unfortunately, there’s no data on how many hours I spent studying as a premed, but I’m confident in saying my “light” 3.5 hour study days now would put some of my more “intense college study sessions” to shame. The only comparable experience is finals week in college, except the first year of medical school is finals week stretched out over a 9-month period.

I skip a lot of lectures.

One of the great things about WesternU COMP is the flexibility to learn at your own pace and style. Even with 37 hours of lecture material, I spent only 6.5 hours actually watching any lecture (in-class or via recordings). Professors provided powerpoints that encompassed testable material and I would fill in knowledge-gaps with resources from the internet (Wiki, Harrison’s, etc.). Even though I skipped the majority of my classes, I still spent a large amount of time (51.8 hours) studying by myself. This is one of the BIGGEST changes from college where skipping class was almost always detrimental to my grade. Now, I found more success tackling the material on my own.

One major note I’ll make about this study strategy is that as the year progressed and more of our lectures became clinically-based, I gradually watched more lectures. Not watching any lectures worked out in the basic sciences. However, at this point in our systems curriculum, I do watch every lecture (although rarely in person and almost always on 2x speed) in order to help learn more of the clinical applications of the material.

I use group review to break the monotony.

All those long hours of studying in front of a computer screen can get awfully lonely. Thankfully, I’ve found a study group of 3-5 classmates who I can group-review with before the exam. The amount of time spent reviewing the material was evenly split between group-study (16.5 hours) and self-review (16 hours). There were at least a few questions I got right just because of a connection one of my study partners brought up during our review sessions. Study groups can be very hit or miss, but can be worth their weight in gold if all the members get along properly.

Not Pictured: The Revolving Glass Door of Study Styles

After a year of medical school, I’ve found my study habits changing on a class-to-class basis. As I alluded to in the data analysis, one such example is the transition from watching barely any lectures to watching almost all of them. Some other strategies I’ve toyed with during the year include drawing things out for anatomy, making concept-based tables for biochemistry, self-quizzing with flashcards for pharmacology, making up patient presentations for neurology, and making absurd mnemonics for everything in between. Over the next few months, I’ll be going over a few of these study strategies on WhiteCoatDO.