1 year to go ... was it supposed to be this tough?

[mdphd2010]

i'm an md/phd student applying to pathology in september with 3 first-author papers, including one cell/nature/science-level, and 4 middle-author papers. they said coming back to year 3 was tough, but i never imagined it would be this bad. back in years 1 and 2 i was about a standard deviation above the mean, but after coming back i've been barely scraping by. a few of the other md/phds don't seem to have this problem. is it like that for a lot of us, or is it just me? how much does it affect residency?

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[Vader]

i'm an md/phd student applying to pathology in september with 3 first-author papers, including one cell/nature/science-level, and 4 middle-author papers. they said coming back to year 3 was tough, but i never imagined it would be this bad. back in years 1 and 2 i was about a standard deviation above the mean, but after coming back i've been barely scraping by. a few of the other md/phds don't seem to have this problem. is it like that for a lot of us, or is it just me? how much does it affect residency?

How far into 3rd year are you? What about it are you finding particularly tough (i.e. the hrs, H&Ps, forgotten knowledge, presentations, knowing your role/expectations, etc)?

There are some MD/PhD students that do really well when they return to 3rd year of medical school. Others struggle a bit for a while and then pick up steam. A few have trouble throughout.

Obviously, the clinical world is quite a bit different from lab. It would be helpful for us to know more specifically what the problems are, so that we can address them and help you out.

 

[xanthines]

The MSTP students at my school seem to be well-liked by clinicians as far as I can tell. I only just recently found out we have a special clinical primer course for returning MSTP's to help out with H&P's, etc. This is in addition to the regular med school course (1-2 weeks) to help second years into the 3rd year.

Did you go through anything like what I described?

-X

 

[Doctor&Geek]

Pathology? You have almost nothing to worry about - they care little about your clinical performance.

 

[FSAP]

Pathology? You have almost nothing to worry about - they care little about your clinical performance.

Agreed. It seems pathology is full of MD/PhD's.

 

[mdphd2010]

i'm in 4th year now; it just felt like in 3rd year i was always a year behind in knowledge, constantly trying to catch everyone else, who were having a great time getting honors and aoa. every shelf was hard -- i was learning all these diagnoses/presentations like new again, then trying to learn management details. i got comfortable with the structure of cc, hpi, pmh, etc. by family medicine, but i score low with standardized patients though i got the diagnoses right. our school offered some clinical shadowing and independent study time. on paper i look pretty average since my clinical grades offset my shelves, and going into pathology no great harm done. i guess i'm just curious how everyone else's experiences were, since looking back it's been really discouraging feeling sub-average, and i am a bit worried about ck and cs.

 

[dl2dp2]

i'm in the exact same boat as you.

are you sure you aren't just having too high of an expectation for yourself? are the written evaluations pretty good? the exam scores don't really matter anyway.

it's often REALLY hard to get honors in 3rd year, and I don't think you should beat yourself up for it. HP and above should be ok for most specialties, and since pathology is non-competitive, i can almost guarantee you that you'll get into the program of your choice.

what I found most painful about 3rd year is the utter irrelevance of everything i've learned, and the shocking realization of how little medicine is medicine. pathology is a great specialty in that everything you do is medicine/science. no social work non-sense, no excessive paperwork, minimal "scut". if you are certain you want to go into path, then don't worry too much about your clinical performance, especially since it sounds like you are doing about average anyway.

sigh...the bigger problem for me is to choose what i should do with my life.

 

[mdphd2010]

i think most md/phds go in with high expectations; i don't think wanting to be back to pre-phd status is unreasonable ... then, testing like crap is just soul-crushing. it's like being in the olympics pre-phd and struggling in the special olympics post-phd. to some extent i felt burned out even before starting year 3; at this point i'm stuck in the cycle of futility and lack of motivation. i try to tackle one topic at a time, but it's like a grain of sand at the beach.

 

[Sulfinator]

I hear you, my friend. I just started 4th year and am soooo glad 3rd year is over. All that 3rd year stuff is just simply draining. Now I'm doing a pathology elective and loving it . I plan on applying to path myself. I don't think you (or I) have very much to worry about. Path may be getting more a little more competitive, but it isn't so competitive that getting into a program of your choice ought to be a problem. Maybe I'll see you on the residency interview trails.

 

[QofQuimica]

OP, your situation is not unique to MD/PhD students. A big part of the problem is that doing well on rotations requires a very different skill set compared to doing well in the preclinical years or in the lab, as Vader said and sluox is hinting at. The technical requirements of the job (writing H & Ps, doing scut, etc.) aren't very difficult for most med students, let alone those of us going into this with a PhD and half of an MD. What *is* difficult is that on the majority of rotations, you are being in large part evaluated on how well you fit in.

When you're on the wards, no one cares about your PhD or your great preclinical grades. I don't know how much emphasis MD/PhD programs put on molding you folks into people who are outgoing and assertive while being personable and a team player, but those are the kinds of qualities that win you friends and influence your clinical grades positively. Sure, you need to do some basic reading too, because some attendings and residents will pimp you and you need to pass your shelfs. But the secret to doing well on the wards isn't amassing as much medical knowledge as possible. It's all about integrating yourself into the team. Look for ways you can do that more effectively, and your clinical evals will improve.

 

[mdphd2010]

thanks for the comments, q, but i guess i wasn't clear; my clinical evaluations are generally good, enough to offset lower shelf scores. it's more that i can't seem to get those scores up to my pre-clinical years ...

 

[malchik]

I can relate. I recently posted on this in a prior thread, but I had a struggle coming back to medicine to say the least. I am normally a good test taker, but I bombed those shelf exams. I chalked it up to having not taken a test like that in 4 years, combined with a scientist's mindset of paying way too much attention to the details in, and thinking too much about, the question stem. Did poorly on step 2 as well, but the results came out after the match, and I encourage you to engineer it that way if possible. Several of my mstp classmates had a similar experience, so you have plenty of company.

 

[Neuronix]

Meanwhile... when I go back I'm told I need to get as many honors as possible, take Step II CK early, and get a very high score if I want to match outside of lower tier

I'm boned.

 

[QofQuimica]

thanks for the comments, q, but i guess i wasn't clear; my clinical evaluations are generally good, enough to offset lower shelf scores. it's more that i can't seem to get those scores up to my pre-clinical years ...

Gotcha; I thought you meant the other way around based on what you said about the standardized patients. And now I see you're done with third year anyway....this is what I get for only skimming the discussion.

Sorry third year was so tough for you, but I agree with the other posters who were saying you're being kind of hard on yourself. Logically, you know your classmates didn't all get honors in every rotation and induction into AOA, because that's impossible. You're probably also overestimating how much your classmates know about medicine. Some people are just stellar at gaming the system. There was a resident's post a while back that exemplifies what I mean. All year long, this guy told each of his rotation directors that he was going to some kind of family event during the last few days of the rotation. So, he basically took off most of the last week of every single rotation to study for the shelf, which counted for a lot at his school. Sure, his secret for getting mostly honors on all his rotations was extreme, but it was creative to the point of being ingenious. And it had nothing whatsoever to do with how good of a student he was, or even how much he had learned while on his rotations.

 

[echod]

Gotcha; I thought you meant the other way around based on what you said about the standardized patients. And now I see you're done with third year anyway....this is what I get for only skimming the discussion.

Sorry third year was so tough for you, but I agree with the other posters who were saying you're being kind of hard on yourself. Logically, you know your classmates didn't all get honors in every rotation and induction into AOA, because that's impossible. You're probably also overestimating how much your classmates know about medicine. Some people are just stellar at gaming the system. There was a resident's post a while back that exemplifies what I mean. All year long, this guy told each of his rotation directors that he was going to some kind of family event during the last few days of the rotation. So, he basically took off most of the last week of every single rotation to study for the shelf, which counted for a lot at his school. Sure, his secret for getting mostly honors on all his rotations was extreme, but it was creative to the point of being ingenious. And it had nothing whatsoever to do with how good of a student he was, or even how much he had learned while on his rotations.

He's not an honest person. Was he discovered and discredited?

 

[QofQuimica]

He's not an honest person. Was he discovered and discredited?

Well, if he's to be believed, he was a resident in an ultracompetitive specialty when he posted that. So I'm going with no.

I'm not sure he would have been "discredited" anyway even if he had been discovered, as long as he didn't violate his school's conduct code and didn't take more absence days than allowed. Most of his superiors probably wouldn't have cared. You've already done rotations, right? So I don't have to tell you that third year med students are the most insignificant human beings in the entire hospital, with the possible exception of premed candystripers, of course.

 

[Vader]

thanks for the comments, q, but i guess i wasn't clear; my clinical evaluations are generally good, enough to offset lower shelf scores. it's more that i can't seem to get those scores up to my pre-clinical years ...

This was my frustration as well--generally great clinical evals, but then not doing as well on the shelfs. My take on it is that MD/PhD students tend to be more detail oriented and geared toward the basic sciences which are emphasized much more heavily on Step I. By contrast, the shelf exams and Step II are peculiar concoctions, made up of so-called "clinical knowledge" which is generally less familiar to students starting their clerkships, more amorphous, and not as easily garnered from reading textbooks. Also, there is very little time dedicated for studying for the shelf exams during rotations (as others have alluded to), so one has to plan out extra outside study time throughout the rotation.

I wish I had known how difficult the shelf exams were. Also the fact that no matter how hard you try you may still not get honors in a particular rotation. 3rd year was my worst year of medical school, but it does get better. 4th year was much better and now starting internship, although the hours are long, I feel like I am learning more than I ever did as a med student and mattering much more to patient care.

That all being said, you have nothing to worry about if you are going into path, which loves MD/PhDs!

 

[BozoSparky]

Meanwhile... when I go back I'm told I need to get as many honors as possible, take Step II CK early, and get a very high score if I want to match outside of lower tier

I'm boned.

hey neuronix...i was told something very similar last year. some mentors/advisors are not optimistic. don't be rattled, you will probably do just fine.

waiting (for interviews, then for match day) is the worst part...

don't get psyched out.

 

[Neuronix]

hey neuronix...i was told something very similar last year. some mentors/advisors are not optimistic. don't be rattled, you will probably do just fine.

I've been told pretty much the same advice from multiple advisors at multiple schools and MD/PhDs who have gone through the match.

To summarize:
If I don't get honors, I'll probably match lower-tier academic. Mid-tier if I'm lucky.
If I do get a few honors (the more the better, though an H in surg would be very helpful), I'll probably match mid-tier academic. Upper tier if I'm lucky.

Either way I should take Step II CK early and do well. This will increase my chances of those "lucky" possibilities I alluded to.

Thanks for the encouragement, in any case. It's not just one guy who threw me for a loop. I wish it was that easy to just discredit what he had to tell me.

 

[Neuronix]

Update:

I'm now finished two days of inpatient peds. I've been asked "Aren't you a finishing third year?" at least five times, because for every other third year this is their last rotation. The first day, one of the attendings commented to the assistant clerkship director that I didn't seem to have the knowledge I needed to be on the team I was assigned to. The second day the actual clerkship director came to offer assistance because the team thought my presentation was too lousy. Again, they are trying to convince me to go to an easier team. This morning I'm going in extra early as the clerkship director wants to tutor me 1on1.

The reality is I'd already given a full presentation on my patients to my attendings, and I thought I was giving a summary 5 liner for sign out. That's what the signout attending wanted. Nobody made it clear that I was supposed to be giving a full presentation, but one of the other attendings I only see at signout was very unhappy I didn't give a full presentation.

I admit numerous patients every single day. They all have the exact same diagnosis I mostly worked with in outpatient, so I feel like I'm learning little. But I have no time to read. A typical day is >12 hours and there's no downtime--when I'm done with my patients the attendings expect me to shadow them. They seem to think it's great for me to watch them struggle with difficult kids and talk to family about unrelated issues where I have no idea what's going on. Last night I was on call (What for? I admit every day?), so I just hung out a couple more hours doing what I usually do. Except I went to get coffee and missed watching the night attending admit ANOTHER of the same diagnosis I see every single day. So now she's unhappy with me. It turns out the team I'm on is the least desirable team in the hospital. That's why I'm the only med student on the team, as usually there are two students. I didn't get the memo on this one, since I'm not privy to the usual third year word of mouth.

In the middle of all this, the clerkship director wants me to present a patient from my floor to the Thursday morning med student conference. The patient and her family don't speak English and I have no familiarity with her history, other than an impressive CXR. I'm expected to know everything. I can't fudge anything, because the clerkship director admitted this patient the last time she was on service! I was forbidden from presenting the most interesting case on the floor because there's no clear diagnosis... Of course that patient speaks fine English and dad is always around and happy to explain what's going on.

All this and I'm supposed to be getting Honors I'm about to get thrown off my team, but here I am working my tail off trying to get Honors. I'd do anything to please them, but it just doesn't seem possible. Meanwhile, I need to be reading my shelf exam prep books so I can get a good score. The shelf accounts for a small percentage of my overall grade, except there's a cutoff for how high I must score to get honors. I barely passed the medicine shelf because I didn't read enough about all the zebras I never saw on inpatient. The students who are going to be AOA have already read several books and were on inpatient! I was on outpatient and I couldn't even read that much! How am I supposed to deal with this level of stress and still put on a fake plastic smile like I'm happy?!

As an aside, I feel completely useless. I do a full H&P and the attending repeats it verbatim. I pre-round and make notes that nobody reads. Nothing a med student does is allowed in the patient's chart/official records. So all this hard work is purely academic and if anything I'm just an annoyance to the children and parents as it's an extra interview and an extra exam.

 

[QofQuimica]

As an aside, I feel completely useless. I do a full H&P and the attending repeats it verbatim. I pre-round and make notes that nobody reads. Nothing a med student does is allowed in the patient's chart/official records. So all this hard work is purely academic and if anything I'm just an annoyance to the children and parents as it's an extra interview and an extra exam.

Sorry, Neuro.

I have to say that of all my third year rotations, inpatient peds was probably the worst for letting you do the least. I don't know if they're worried about a med student mishandling a child or what, but this seems to be the general experience for most med students. I did get to place a PPD once, but that's only because the other student and I told the resident we knew how to do it, and she (the resident) was too preoccupied with other things to come watch us. (I suppose it also helped that the patient in question had recently been released from prison, and therefore was not someone the resident was thrilled about caring for.) We had the same thing with the notes in the chart, too. They didn't read them, or if we were really lucky, they'd just copy and paste them into their own note before deleting ours. I had a much better time on call and outpatient, but that's because the call senior was absolutely awesome, and my outpatient preceptor was great too.

What I suggest you do is talk to some of the fourth year MD/PhD students and ask them how they managed. I mean, I could give you advice for how I got through peds, but since rotations are set up differently at every school, my advice might not be terribly applicable in your case.

Regardless, hang in there. All you can do is your best, and if you don't get honors at the end of this rotation, forget about it and focus on whatever you have coming next. In a couple of months, *you* will be the most experienced person rotating with a bunch of second years instead of the other way around, and then your grading situation will probably improve significantly.

 

[dl2dp2]

Update:

I'm now finished two days of inpatient peds. I've been asked "Aren't you a finishing third year?" at least five times, because for every other third year this is their last rotation. The first day, one of the attendings commented to the assistant clerkship director that I didn't seem to have the knowledge I needed to be on the team I was assigned to. The second day the actual clerkship director came to offer assistance because the team thought my presentation was too lousy. Again, they are trying to convince me to go to an easier team. This morning I'm going in extra early as the clerkship director wants to tutor me 1on1.

This is exactly the hazard of your system, where you have to do the entire 3rd year after PhD. For me, the current rotation feels like a vacation (even though hour wise it's one of the worst) because I don't give a rat's ass about it--it won't go into my dean's letter, residency program directors will never see it.

Although I don't see why they'd think your presentation is too lousy. How can ANYONE present poorly if you just read off a boiler plate? Also, on medicine-ish services, residents help you before you present to the attending. So none of these things should be a big problem. Unless, that is, they want you present from memory and pimp you constantly?

BTW, don't stress THAT much about your grades. You'll still match into rads if you get all HPs or even with a P here and there. You can just do research during fellowship (if you want) at that point. And if you don't, then it's $$$$. And I mean, you hated PhD anyway, so who cares.

 

[mercaptovizadeh]

Update:

I'm now finished two days of inpatient peds. I've been asked "Aren't you a finishing third year?" at least five times, because for every other third year this is their last rotation. The first day, one of the attendings commented to the assistant clerkship director that I didn't seem to have the knowledge I needed to be on the team I was assigned to. The second day the actual clerkship director came to offer assistance because the team thought my presentation was too lousy. Again, they are trying to convince me to go to an easier team. This morning I'm going in extra early as the clerkship director wants to tutor me 1on1.

The reality is I'd already given a full presentation on my patients to my attendings, and I thought I was giving a summary 5 liner for sign out. That's what the signout attending wanted. Nobody made it clear that I was supposed to be giving a full presentation, but one of the other attendings I only see at signout was very unhappy I didn't give a full presentation.

I admit numerous patients every single day. They all have the exact same diagnosis I mostly worked with in outpatient, so I feel like I'm learning little. But I have no time to read. A typical day is >12 hours and there's no downtime--when I'm done with my patients the attendings expect me to shadow them. They seem to think it’s great for me to watch them struggle with difficult kids and talk to family about unrelated issues where I have no idea what’s going on. Last night I was on call (What for? I admit every day?), so I just hung out a couple more hours doing what I usually do. Except I went to get coffee and missed watching the night attending admit ANOTHER of the same diagnosis I see every single day. So now she’s unhappy with me. It turns out the team I’m on is the least desirable team in the hospital. That’s why I’m the only med student on the team, as usually there are two students. I didn’t get the memo on this one, since I’m not privy to the usual third year word of mouth.

In the middle of all this, the clerkship director wants me to present a patient from my floor to the Thursday morning med student conference. The patient and her family don't speak English and I have no familiarity with her history, other than an impressive CXR. I'm expected to know everything. I can’t fudge anything, because the clerkship director admitted this patient the last time she was on service! I was forbidden from presenting the most interesting case on the floor because there's no clear diagnosis... Of course that patient speaks fine English and dad is always around and happy to explain what's going on.

All this and I'm supposed to be getting Honors I'm about to get thrown off my team, but here I am working my tail off trying to get Honors. I'd do anything to please them, but it just doesn't seem possible. Meanwhile, I need to be reading my shelf exam prep books so I can get a good score. The shelf accounts for a small percentage of my overall grade, except there’s a cutoff for how high I must score to get honors. I barely passed the medicine shelf because I didn’t read enough about all the zebras I never saw on inpatient. The students who are going to be AOA have already read several books and were on inpatient! I was on outpatient and I couldn’t even read that much! How am I supposed to deal with this level of stress and still put on a fake plastic smile like I'm happy?!

As an aside, I feel completely useless. I do a full H&P and the attending repeats it verbatim. I pre-round and make notes that nobody reads. Nothing a med student does is allowed in the patient’s chart/official records. So all this hard work is purely academic and if anything I’m just an annoyance to the children and parents as it’s an extra interview and an extra exam.

Sorry to hear this, Neuro. I know how bad it feels when people expect things of you but do not make their expectations known until after you've done the assignment and then they berate you and it affects your grades.

But as sluox points out, I think you've realized from your experiences in the PhD, Thailand, Utah, etc. that there's a lot more (fun) to life than plodding along in research/academia. It's a shame about the high-power residencies being so shortsighted about the value of a PhD, but you will get a good rads (or whatever it ends up being) residency, and if you end up practicing clinical medicine, especially in private practice, no one will care about where you did it.

 

[Neuronix]

Things went better today. Now that the clerkship director is involved, she's being very helpful. The attendings are pushing me, but it's a good kind of pushing.

I just thought, as always, that some of the more junior students would appreciate some of my rants about how hard it is to make the transition back. It is by far the hardest part of the program for me.

PS: Dad is in the hospital again--pneumonia on top of his baseline emphysema. My first question: What antibiotic are you on?

 

[Gyric]

Update:

I'm now finished two days of inpatient peds. I've been asked "Aren't you a finishing third year?" at least five times, because for every other third year this is their last rotation. The first day, one of the attendings commented to the assistant clerkship director that I didn't seem to have the knowledge I needed to be on the team I was assigned to. The second day the actual clerkship director came to offer assistance because the team thought my presentation was too lousy. Again, they are trying to convince me to go to an easier team. This morning I'm going in extra early as the clerkship director wants to tutor me 1on1.

The reality is I'd already given a full presentation on my patients to my attendings, and I thought I was giving a summary 5 liner for sign out. That's what the signout attending wanted. Nobody made it clear that I was supposed to be giving a full presentation, but one of the other attendings I only see at signout was very unhappy I didn't give a full presentation.

I admit numerous patients every single day. They all have the exact same diagnosis I mostly worked with in outpatient, so I feel like I'm learning little. But I have no time to read. A typical day is >12 hours and there's no downtime--when I'm done with my patients the attendings expect me to shadow them. They seem to think it’s great for me to watch them struggle with difficult kids and talk to family about unrelated issues where I have no idea what’s going on. Last night I was on call (What for? I admit every day?), so I just hung out a couple more hours doing what I usually do. Except I went to get coffee and missed watching the night attending admit ANOTHER of the same diagnosis I see every single day. So now she’s unhappy with me. It turns out the team I’m on is the least desirable team in the hospital. That’s why I’m the only med student on the team, as usually there are two students. I didn’t get the memo on this one, since I’m not privy to the usual third year word of mouth.

In the middle of all this, the clerkship director wants me to present a patient from my floor to the Thursday morning med student conference. The patient and her family don't speak English and I have no familiarity with her history, other than an impressive CXR. I'm expected to know everything. I can’t fudge anything, because the clerkship director admitted this patient the last time she was on service! I was forbidden from presenting the most interesting case on the floor because there's no clear diagnosis... Of course that patient speaks fine English and dad is always around and happy to explain what's going on.

All this and I'm supposed to be getting Honors I'm about to get thrown off my team, but here I am working my tail off trying to get Honors. I'd do anything to please them, but it just doesn't seem possible. Meanwhile, I need to be reading my shelf exam prep books so I can get a good score. The shelf accounts for a small percentage of my overall grade, except there’s a cutoff for how high I must score to get honors. I barely passed the medicine shelf because I didn’t read enough about all the zebras I never saw on inpatient. The students who are going to be AOA have already read several books and were on inpatient! I was on outpatient and I couldn’t even read that much! How am I supposed to deal with this level of stress and still put on a fake plastic smile like I'm happy?!

As an aside, I feel completely useless. I do a full H&P and the attending repeats it verbatim. I pre-round and make notes that nobody reads. Nothing a med student does is allowed in the patient’s chart/official records. So all this hard work is purely academic and if anything I’m just an annoyance to the children and parents as it’s an extra interview and an extra exam.

Neuronix, listen to your attendings, it sounds like you have a long way to go before you can even withstand the first week of PGY1, much less demonstrate that you are one of the top medical students in the country. Take pride in your work and never forget that you are taking care of patients first, your residents and attendings will notice and honors will follow.

Especially in fields like radiology and pathology, when you will work 80 hours/week and be expected to read bookshelves full of textbooks and primary literature, you need to get used to this pace.

 

[BozoSparky]

It's a hard transition, no doubt...and often very condescending, even on these forums.

 

[antoniosvidne]

Especially in fields like radiology and pathology, when you will work 80 hours/week and be expected to read bookshelves full of textbooks and primary literature, you need to get used to this pace.

Hmm...just for younger students out there, this is incorrect info.

radiology and pathology are two of the LEAST time-consuming specialties for residents. Average work week for a radiologist in residency is ~ 60 hrs, and for pathologist is ~ 50. And this is during RESIDENCY. After residency, radiologists and pathologists usually work 40-50 hrs a week. Though radiologists can work 50-60 hrs a week if they want to make more $$, and esp. if they are interventional. For more accurate info, please consult FRIEDA. These specialties are called "lifestyle" specialty not without reason.

Of course, if you want to get REALLY good at it, or devote another 10-20 hrs a week to RESEARCH on top of residency, then that's a whole other issue.

 

[Gyric]

Hmm...just for younger students out there, this is incorrect info.

radiology and pathology are two of the LEAST time-consuming specialties for residents. Average work week for a radiologist in residency is ~ 60 hrs, and for pathologist is ~ 50. And this is during RESIDENCY. After residency, radiologists and pathologists usually work 40-50 hrs a week. Though radiologists can work 50-60 hrs a week if they want to make more $$, and esp. if they are interventional. For more accurate info, please consult FRIEDA. These specialties are called "lifestyle" specialty not without reason.

Of course, if you want to get REALLY good at it, or devote another 10-20 hrs a week to RESEARCH on top of residency, then that's a whole other issue.

Hmm ... just for clarification, the above poster, despite their familiarity with FRIEDA data, has no clue what they are talking about.

I assure you (from personal experience as a resident and fellow) that in a pathology program an MSTP will be considering, you will work harder than you can imagine as a medical student ... averaging 50 hours?, as a first year with 5-6 surg path months, that is absurd. Admittedly, you get a break on the non-surg path months, but are still very busy at top places. My colleagues in radiology also put in many more than 60 hours/week, at my institution. For the "younger students," I stand by my previous post.

You do have more lifestyle options at the end of training, but those data are also a bit misleading.

 

[malchik]

Another path resident here, agree with Gyric. The hours in any (good) residency are long. That said, it feels quite different when it is a field you enjoy vs. enduring med school.

 

[Gyric]

Pathology? You have almost nothing to worry about - they care little about your clinical performance.

I appreciate your JAMA paper DG, but this statement is not true in my experience. I have been involved in ranking decisions at a top pathology residency and MD/PhD applicants are routinely ranked lower if they demonstrate weak clinical performance as medical students. The fact is that there are plenty of top applicants (MD and MD/PhD) with excellent scientific and clinical performance and usually the MD/PhDs are stellar all the way around. Do you have any data to support your claim?

 

[antoniosvidne]

I find it interesting that pathologists are so touchy about their specialty. pathology is potentially the least competitive specialty to go into right now. Sure, the numbers might be a bit higher, but the specialty is smaller, and they can pick and choose their FMG candidates to boost their scores. And if you work 80 hrs a week as a pathology resident, something's wrong. Maybe you are really inefficient. maybe your program loads you with scut like grossing and/or gallbladders. CP rotations here (top program) average 45 hrs a week, AP averages MAYBE 55. Surge path is NO more than 60, even counting frozen calls and previewing--and you can do that at home... I know because I'm married to one. sure, you do need to be good clinically, but that's cause an "average" pathologist is having a really hard time getting a decent private practice job right now. My significant other, who's not going into research, is stressing over THIS (rather than the # of hours she works).

And how absurd is it that people have to do 2 fellowships in pathology?

And oh, btw, you can get plenty of Ps and still match into a top pathology program. I know that because my signficant other has friends who are precisely like that. They all hated 3rd year.

Of course nobody's going to convince anyone one way or the other on this anonymous forum. I'm merely saying that if you want the real low-down on residency work hours, consult FRIEDA.

 

[malchik]

I find it interesting that pathologists are so touchy about their specialty. pathology is potentially the least competitive specialty to go into right now. Sure, the numbers might be a bit higher, but the specialty is smaller, and they can pick and choose their FMG candidates to boost their scores. And if you work 80 hrs a week as a pathology resident, something's wrong. Maybe you are really inefficient. maybe your program loads you with scut like grossing and/or gallbladders. CP rotations here (top program) average 45 hrs a week, AP averages MAYBE 55. Surge path is NO more than 60, even counting frozen calls and previewing--and you can do that at home... I know because I'm married to one. sure, you do need to be good clinically, but that's cause an "average" pathologist is having a really hard time getting a decent private practice job right now. My significant other, who's not going into research, is stressing over THIS (rather than the # of hours she works).

And how absurd is it that people have to do 2 fellowships in pathology?

And oh, btw, you can get plenty of Ps and still match into a top pathology program. I know that because my signficant other has friends who are precisely like that. They all hated 3rd year.

Of course nobody's going to convince anyone one way or the other on this anonymous forum. I'm merely saying that if you want the real low-down on residency work hours, consult FRIEDA.

I am touchy because of the significant discrepancy between what is on FRIEDA and the truth. Where does FRIEDA data come from? Probably from residency directors. Does anybody think numbers from residency directors actually reflect reality?

I agree that pathology is not all that competitive. How is that relevant to the above point that initiated your "correction" about residency work hours?

I highly doubt your s/o is allowed to take cases home to preview. Perhaps she is more concerned about future employment than her current hours because she is not really at a top program.

 

[Doctor&Geek]

I have been involved in ranking decisions at a top pathology residency and MD/PhD applicants are routinely ranked lower if they demonstrate weak clinical performance as medical students. The fact is that there are plenty of top applicants (MD and MD/PhD) with excellent scientific and clinical performance and usually the MD/PhDs are stellar all the way around. Do you have any data to support your claim?

The statement I made is unrelated to any of our data - only anecdotal information from graduates and faculty from my school. I think I made a very strong statement without evidence - instead, a softer statement that "they do care, but probably don't care as much as other specialties" might be accurate.

Data to support:

http://www.ncbi.nlm.nih.gov/pubmed/19240447

Residency directors in pathology ranked grades and number of honors in required clerkships lowest amongst all specialties. Ranking factors that were in the top 3 were rec letters, step 1 score, and performance in senior pathology elective.

That said, would it kosher to suggest that top programs can afford to use as many selectivity factors as necessary? Anyone who can afford to pick and choose can place more and more cutoffs to limit the number of applicants one interviews. Clearly the top graduates should be good overall, but I've seen our graduates do really well in the match without having any honors in clinicals, AOA status, or high Step I board scores.

 

[Neuronix]

Take pride in your work and never forget that you are writing fake notes on patients that nobody will ever read

Fixed that for you. I'm not taking care of anyone. I'd rather be taking care of someone. I'd say right now my goal should be learning so that one of these days I'll be competent to take care of someone.

I remember when my goal was learning. Then two advisors told me my PhD in the field I'm going into doesn't mean anything and I need to get top grades in med school if I'm going to match to an academic residency program in that field.

you need to get used to this pace.

Did you read my post? The pace isn't what bothers me. It's the fact that I have a shelf exam at the end of the rotation I have to score highly on. I didn't read shelf exam prep books for IM. I read all kinds of interesting articles on Uptodate and elsewhere about the diseases my patients had and read all the articles and did all the presentations my attendings assigned me. In the end I had great evals on medicine, but I barely passed the medicine shelf. That is an automatic HP at my school in any rotation.

That was when I was a student at the same level as my peers. Now my peers are finishing third years, and I haven't been in clinics for four years. You could be right--since I have such a long way to go, maybe I don't deserve honors. When the chips fall maybe I should be given Ps and then I'll be forced into Pathology myself.

Now it's time to go wake up some sick children to write SOAP notes nobody will ever read.

 

[dl2dp2]

Now it's time to go wake up some sick children to write SOAP notes nobody will ever read.

This is not entirely fair. In my rotations, we could write a note and have the resident co-sign it, which would save some time for them. Although this practice is discouraged, it nevertheless is used, esp. for outpatient clinic. On psych, you can write longer notes, and the attending does read it, then complements it with a shorter note.

But i do feel for you. I think a lot of 3r yr is time wasted on just getting through the formula. But if you think about it, a lot of medicine is about that, and if you aren't patient enough to do that, residency programs will be hesitant to think that they can rely on you to do the scutwork that is oh so necessary for the functioning of the hospital. Sometimes I find doing paperwork kind of relaxing...you kind of have to be very Zen about it. If you are all about OMGOMGOMG need to get 300k/tenure/nobel prize as fast as i can, then you'll be exasperated by the amount of time not directly contributed to these "goals".

 

[happyresearcher]

i' m now a 4th yr. here's what helped me:
1) care deeply about the patient rather than how you're doing/being evaluated (these don't necessarily contrast, but if the patient is your first priority you'll always be doing the right thing with your time).
2) i spent all of my free time reading about everything i forgot. i got books i would enjoy reading, with enough detail. i did not like practicing test questions like everyone else, and i didn't change my style...i did not underestimate the size of the knowledge base i lost, and how unpleasant it would be to redevelop it. on the floors i was very comfortable with not knowing answers, which is a plus of the PhD because it teaches you to admit what you don't know. People respect that honesty (within a context of a person who wants to know and will later look up the answer).
3) whenever i focused on helping the team rather than doing what i wanted to do (i.e. my preference-spending a long time prerounding on my own 2 patients vs. getting vitals on all the patients and saving time for everyone) , it always helped
4) being nice towards others always makes a big difference. no one wants to be in the hospital at 4 in the morning.
anyways, that's what worked for me. the cultures of lab vs. clinic are very different and it takes a while to get used to. i tended to have good teams.

 

[Gyric]

When the chips fall maybe I should be given Ps and then I'll be forced into Pathology myself.

I assure you that no one was forced into pathology at my program and I suspect most of us could have matched into radiology at this same institution.

If you continue to do poorly on shelf exams, regardless of your specialty interest, PDs will consider you a risk (you may have trouble getting your license, you may fail boards, etc ...). As much as you may enjoy reading the latest journals and uptodate, that is no excuse for being ill prepared for your shelf exam.

 

[Gyric]

The statement I made is unrelated to any of our data - only anecdotal information from graduates and faculty from my school. I think I made a very strong statement without evidence - instead, a softer statement that "they do care, but probably don't care as much as other specialties" might be accurate.

Data to support:

http://www.ncbi.nlm.nih.gov/pubmed/19240447

Residency directors in pathology ranked grades and number of honors in required clerkships lowest amongst all specialties. Ranking factors that were in the top 3 were rec letters, step 1 score, and performance in senior pathology elective.

That said, would it kosher to suggest that top programs can afford to use as many selectivity factors as necessary? Anyone who can afford to pick and choose can place more and more cutoffs to limit the number of applicants one interviews. Clearly the top graduates should be good overall, but I've seen our graduates do really well in the match without having any honors in clinicals, AOA status, or high Step I board scores.

Thanks DG, I would not have put it past you to pull out a PD survey and prove me wrong.

 

[Gyric]

I find it interesting that pathologists are so touchy about their specialty. pathology is potentially the least competitive specialty to go into right now. Sure, the numbers might be a bit higher, but the specialty is smaller, and they can pick and choose their FMG candidates to boost their scores.

Let me make sure I understand you ... so all pathology PDs, and only pathology, are selecting FMGs to boost their aggregate scores, thereby invalidating the summary statistics provided by the match; all to cover up the fact that pathology is the least competitive specialty? Gosh, you would think those family practice PDs would catch on. I could care less what you think about my specialty, but I am curious why you are so interested in portraying it as less competitive?

And if you work 80 hrs a week as a pathology resident, something's wrong. Maybe you are really inefficient. maybe your program loads you with scut like grossing and/or gallbladders. CP rotations here (top program) average 45 hrs a week, AP averages MAYBE 55. Surge path is NO more than 60, even counting frozen calls and previewing--and you can do that at home... I know because I'm married to one. sure, you do need to be good clinically, but that's cause an "average" pathologist is having a really hard time getting a decent private practice job right now.

Well we can argue about what the criteria are for a "top program," and unfortunately, it sounds like your significant other did not get the memo on the importance of choosing a good program. If you are only putting in at most 60 hours a week on surg path, in your first year, then either 1) you are at a lower tier layed back program 2) you are not taking good care of your patients and someone else is pulling your weight, or 3) you are not reading nearly enough to become competent. With experience the hours back off a bit, but by then boards are looming.

My significant other, who's not going into research, is stressing over THIS (rather than the # of hours she works).

And how absurd is it that people have to do 2 fellowships in pathology?

Sorry, all is not working out well for you guys. There is significant debate on overtraining and the job market on the path forum (and I think we should leave it there), but I will just add that this is not a universal experience.

 

[QofQuimica]

I assure you that no one was forced into pathology at my program and I suspect most of us could have matched into radiology at this same institution.

If you continue to do poorly on shelf exams, regardless of your specialty interest, PDs will consider you a risk (you may have trouble getting your license, you may fail boards, etc ...). As much as you may enjoy reading the latest journals and uptodate, that is no excuse for being ill prepared for your shelf exam.

Come on, Gyric, stop kicking the guy while he's down. Do you think he doesn't know that he has to do well on these tests, or that he doesn't feel the pressure to do well on them? He's here to vent and get some support because he's struggling with his rotation, not to have yet another person pile on him. If you have some great advice on how to do well on rotations and as a PGY-1, by all means, please enlighten us. I think we'd all benefit from any constructive suggestions you can give. So for example, he has a hard time finding enough time to study. When I did my rotations, I'd get up half an hour early to read every day. That worked well for me. What did/do you do?

 

[Neuronix]

This is not entirely fair. In my rotations, we could write a note and have the resident co-sign it

You can not do that on this rotation. Nothing a med student writes is allowed in the chart.

Thanks to those of you who are being supportive. Things are getting easier for me. I just like to post my very typical experiences and thoughts about MD/PhD training. Whenever I'm not super positive, I expect to get flamed. That's SDN life.

 

[smq123]

Neuronix, listen to your attendings, it sounds like you have a long way to go before you can even withstand the first week of PGY1, much less demonstrate that you are one of the top medical students in the country. Take pride in your work and never forget that you are taking care of patients first, your residents and attendings will notice and honors will follow.

I think it's interesting that whenever a med student complains on SDN about a frustrating rotation, many residents have the knee-jerk response of, "Well, you must be doing something wrong."

It's not always the med student's fault. Some rotations are not designed for maximal student participation. And some residents are very very very bad at integrating med students into the rotation.

For instance, you advise Neuronix to "take pride in [his] work." Well, what if that's just not possible because he's not allowed to even write his own notes on the patients? Then what? Is it still HIS fault that it's a frustrating rotation, or is it the attending's/resident's fault that they're not giving him more freedom to get involved?

I understand what you're saying - even as a PGY-1, I've had a few genuinely bad med students. But, in talking to him and reading his post, it sounds more like his rotation is just not designed with students in mind.

How many med students do you have rotate with you? It's hard because, as a resident, I think it's easier to blame the med student for "not trying" or "not being enthusiastic." Then, when I look back, I realize that there were a few things that I could have done to get the med student more engaged. Maybe I should have let the med student call the radiology resident to discuss the X-ray, instead of watching me do it. Maybe I should have had the med student present the patient instead of having me do it. Maybe I'm not explaining what she needs to do very well. Maybe I'm not outlining expectations enough. I think that, as residents, it's partly our responsibility to make sure that med students have a good rotation, with the rest being up to them.

This is not entirely fair. In my rotations, we could write a note and have the resident co-sign it, which would save some time for them. Although this practice is discouraged, it nevertheless is used, esp. for outpatient clinic. On psych, you can write longer notes, and the attending does read it, then complements it with a shorter note.

To be fair, I have talked to a few of Neuronix's classmates. Their school is almost shockingly resistant to allowing med students to participate in patient care. For instance, med students aren't allowed to even TOUCH central lines, much less manipulate them. This was a huge surprise to me, and a big contrast to my experience as a med student - I was pulling them, helping insert them, and helping to change them when I was in the ICU. But their school really doesn't do much to encourage med student participation in clinical rotations, which is a shame.

 

[antoniosvidne]

Let me make sure I understand you ... so all pathology PDs, and only pathology, are selecting FMGs to boost their aggregate scores, thereby invalidating the summary statistics provided by the match; all to cover up the fact that pathology is the least competitive specialty? Gosh, you would think those family practice PDs would catch on. I could care less what you think about my specialty, but I am curious why you are so interested in portraying it as less competitive?

i don't really care enough to elaborate over this. suffice it is to say, pathology is much less competitive than radiology, and if your pathology residents can all get into you radiology program, then something's wrong. I don't really care to argue with you on this, and you can take it or leave it.

Well we can argue about what the criteria are for a "top program," and unfortunately, it sounds like your significant other did not get the memo on the importance of choosing a good program. If you are only putting in at most 60 hours a week on surg path, in your first year, then either 1) you are at a lower tier layed back program 2) you are not taking good care of your patients and someone else is pulling your weight, or 3) you are not reading nearly enough to become competent. With experience the hours back off a bit, but by then boards are looming.

Again, time does not equal excellence. In fact the best residents are the fastest. You don't know where I am, and you don't know what program she's at. I'm just sharing my experience which I know about. Pathology residency is NOT 80 hrs a week in general, and certainly not uniformly 80hrs a week at a "top program". This is a moot argument.

Sorry, all is not working out well for you guys. There is significant debate on overtraining and the job market on the path forum (and I think we should leave it there), but I will just add that this is not a universal experience.

Well, people do get jobs eventually coming out this program, esp. since a majority goes into academia. She's stressed because it's hard to get a startup no matter where you are. However, even here people routinely do 2 fellowships. Again, this has nothing to do with how good the program is. pathology is really more like a 6 year residency. So whatever. If you are working 80 hrs a week, have fun!

 

[drdr2010]

You can not do that on this rotation. Nothing a med student writes is allowed in the chart.

Oh, I hear this. At a hospital we rotate in, medical students are not allowed to document anything in the EMS because it cannot be billed for. So we write notes in the EMS but then "pend" them. Supposedly, the resident, attending, etc can then look at this fake note and give us feedback. In reality no one ever looks at them and then a few months after your rotation ends, you get notifications of "chart deficiencies" due to 100s of pended notes that are just in limbo forever, never to be read or signed or used.

 

[ears]

Come on, Gyric, stop kicking the guy while he's down.

I'm on Gyric's side here. Though I certainly can appreciate Neuronix's frustration (the learned helplessness of 3rd year can be really damaging), being that kind of disrespectful to a whole specialty isn't cool. Regardless of the match statistics, pathologists are some of the smartest doctors in any hospital, and they have to make some of the toughest calls. The idea that they're in it because they weren't good enough to get into something "better" is pretty insulting.

If you have some great advice on how to do well on rotations and as a PGY-1, by all means, please enlighten us. I think we'd all benefit from any constructive suggestions you can give. So for example, he has a hard time finding enough time to study. When I did my rotations, I'd get up half an hour early to read every day. That worked well for me. What did/do you do?

OK, in that spirit, here's my advice for doing well in 3rd year: pretend what you're doing matters. I know it doesn't, I know they won't let you touch the patient or have your note matter or whatever. Try and make yourself forget it. Try and trick yourself into believing that what you're doing is vitally important, and that the patient's well-being depends on your doing your job well. I know it sounds stupid, but it'll make you feel better, it'll probably make you do what you're doing better, it'll make you learn better, and it'll make residents and attendings view you better. The rotations I did the worst on were the ones where I wasn't able to do this (or didn't try).

FWIW, my observation is that returning MD/PhDs have some disadvantages coming back, most notably feeling out of sync and not remembering stuff from four (five, six...) years earlier. But we tend to have a big advantage: maturity. Both in terms of age, because we're older, but also because climbing that PhD mountain gives you a sense of the strength of your own will. The best way (IMHO) to manifest this maturity advantage is to be absolutely as professional, gracious, and adult as possible. A key part of that is the fake-it-'til-you-make-it thing above.

 

[Neuronix]

The idea that they're in it because they weren't good enough to get into something "better" is pretty insulting.

That wasn't the point of that statement. I think I'll review the rest of the thread that led me to say that. First, my advisors in my chosen field scolded me about lack of honors in third year. This was the point of another thread (http://forums.studentdoctor.net/showthread.php?t=636747) and was alluded to in this thread as follows.

Meanwhile... when I go back I'm told I need to get as many honors as possible, take Step II CK early, and get a very high score if I want to match outside of lower tier

To summarize:
If I don't get honors, I'll probably match lower-tier academic. Mid-tier if I'm lucky.

I'm of course not alone in my difficulties getting high grades as a returning MD/PhD.

I am normally a good test taker, but I bombed those shelf exams. I chalked it up to having not taken a test like that in 4 years, combined with a scientist's mindset of paying way too much attention to the details in, and thinking too much about, the question stem. Did poorly on step 2 as well, but the results came out after the match, and I encourage you to engineer it that way if possible. Several of my mstp classmates had a similar experience, so you have plenty of company.

There are several other similar posts about the difficulties of returning. As a reminder, I didn't even start this thread about how hard it is to return to third year.

it sounds like you have a long way to go before you can even withstand the first week of PGY1, much less demonstrate that you are one of the top medical students in the country.

So it sounds like I don't deserve honors right? So if a lot of MD/PhDs struggle to get honors grades when they come back, and my advisors within my desired specialty are telling me not having honors in third year is a big red flag, what can I do? Perhaps I should consider a less competitive specialty.

And oh, btw, you can get plenty of Ps and still match into a top pathology program. I know that because my signficant other has friends who are precisely like that. They all hated 3rd year.

Pathology? You have almost nothing to worry about - they care little about your clinical performance.

Residency directors in pathology ranked grades and number of honors in required clerkships lowest amongst all specialties.

As a personal note, several advisors within my MD/PhD program have suggested I apply in Pathology because I'd have an easier time matching, a better chance of matching to a strong program, and less overall stress due to worrying about grades. The returning MD/PhD schedule at my school for someone applying in Pathology is easier too. I would have been able to take more vacation by coming back to clinic later in the year.

 

[Neuronix]

So we write notes in the EMS but then "pend" them.

That's similar. Except we don't even have EMS. My note doesn't even go anywhere it can be seen. It stays on me until the patient leaves, then it goes in the HIPAA bin.

 

[QofQuimica]

I'm on Gyric's side here. Though I certainly can appreciate Neuronix's frustration (the learned helplessness of 3rd year can be really damaging), being that kind of disrespectful to a whole specialty isn't cool. Regardless of the match statistics, pathologists are some of the smartest doctors in any hospital, and they have to make some of the toughest calls. The idea that they're in it because they weren't good enough to get into something "better" is pretty insulting.

Ah, so that's what this is all about: clearly, he dissed every member of the whole specialty of pathology (and their mothers too), went on national television to proclaim that pathologists are the dumbest and laziest docs in the whole hospital, and advocated deathmarching every pathologist out of the hospital to be summarily shot. So the guy doesn't want to be a pathologist; not everyone does. Are pathologists that sensitive about everything?

OK, in that spirit, here's my advice for doing well in 3rd year: pretend what you're doing matters. I know it doesn't, I know they won't let you touch the patient or have your note matter or whatever. Try and make yourself forget it. Try and trick yourself into believing that what you're doing is vitally important, and that the patient's well-being depends on your doing your job well. I know it sounds stupid, but it'll make you feel better, it'll probably make you do what you're doing better, it'll make you learn better, and it'll make residents and attendings view you better. The rotations I did the worst on were the ones where I wasn't able to do this (or didn't try).

This is very good advice, and I think you're absolutely right.

 

[ears]

Ah, so that's what this is all about: clearly, he dissed every member of the whole specialty of pathology (and their mothers too), went on national television to proclaim that pathologists are the dumbest and laziest docs in the whole hospital, and advocated deathmarching every pathologist out of the hospital to be summarily shot. So the guy doesn't want to be a pathologist; not everyone does. Are pathologists that sensitive about everything?

Ha. I was a little touchy, but not that bad. (And FWIW, I'm a radiologist, not a pathologist, so don't blame them for my sins.)

I guess what I'm getting at is this: it would be a shame for anyone to take a specialty (any specialty!) as a consolation prize. It seems to me to be a recipe for both dissatisfaction and under-achieving.

And in Neuronix's case, there'd be no reason for it! He's stressed about honors right now, but from what I can tell, his applciation will be pretty decent. I'd bet he'll find his way into a decent university radiology program, and have a perfectly reasonable chance to make the career he wants from there.

 

[Neuronix]

I'd bet he'll find his way into a decent university radiology program, and have a perfectly reasonable chance to make the career he wants from there.

Thanks Love your avatar btw. If only the Siemens development/production environments didn't run on a Windows XP based platform...