Ask a 3rd year IM resident anything

[am9451]

Hi everyone,
I'm procrastinating finishing fellowship applications right now so thought I would make myself available for questions. This website was really helpful during medical school and I thought I would give back.

Little about me.
I'm currently a third year IM resident in a "top 10" program applying to GI.
I went to a "top 10" medical school where I cracked my way into AOA.
Step scores in the 260s+.

I don't say this to brag (humble brag?), but I found that it was always helpful to have an idea of where users were coming from.

Q away!

Edit: Forgot to mention that I am also about 1/2 way through the most lovely bottle of chilled Sauv blanc. It'll be interesting to see how flappy my gums (fingers?) get as this progresses

---

Members don't see this ad.

 

[cbrons]

R u happy

 

[jw3600]

What exactly is the IM fellowship process? Timeline, criteria, competitiveness, etc.

 

[YoungestBrother]

Do you moonlight?

 

[am9451]

cbrons (sorry, it's been a while, I forget how to quote prior questions)

Yes, I'm quite happy! Do I have days when I feel overwhelmed, tired, and under-appreciated? Absolutely. But those days are much fewer, particularly compared to intern year and particularly compared to medical school.
I've now reached a point where I feel fairly comfortable with my day-to-day existence in a hospital, which is AMAZING and SUCH a welcome change from medical school. I think that the feeling of being the person with the littlest knowledge but who is scrutinized the most in a medical team is the primary source of unhappiness for medical students.

Sort of a vague answer, but I'm happy to provide additional details if desired.

 

[am9451]

What exactly is the IM fellowship process? Timeline, criteria, competitiveness, etc.

OMG, did I just figure out how to quote??

It's actually not too dissimilar from the residency application process. You fill out ERAS, i.e. fill in all the boxes for your volunteer experiences, research, publications. You get your letters and personal statement ready.

For competitive specialties (i.e. GI and Cards), I've heard that step scores still matter somewhat; however, the focus is definitely more on who you know (i.e. any big names who wrote you recs), where you trained, and what you've published.

Timeline is a bit accelerated compared to residency apps. Apply in July. Interview October-November. Match day is December.

 

[am9451]

Do you moonlight?

No, but if I got all my credentialing in order, I could! I will probably try to get everything in line for the Spring of 3rd year, since that's when the bulk of my elective time is anyway. It's pretty amazing how much you can supplement your income with moonlighting. I've had friends almost double their income (which is a little over 50 grand yearly).

 

[seminoma]

Hi everyone,
I'm procrastinating finishing fellowship applications right now so thought I would make myself available for questions. This website was really helpful during medical school and I thought I would give back.

Little about me.
I'm currently a third year IM resident in a "top 10" program applying to GI.
I went to a "top 10" medical school where I cracked my way into AOA.
Step scores in the 260s+.

I don't say this to brag (humble brag?), but I found that it was always helpful to have an idea of where users were coming from.

Q away!

How much do step 3 scores matter for GI?

What part of the country are you in? Does your home program keep its residents for fellowships? If so, did that go into your decision when ranking it 3 years ago?

 

[am9451]

How much do step 3 scores matter for GI?

Less than Steps 1 and 2. But it would be a red flag if your Step 3 dropped significantly lower (i.e. 20-30+ points).
It is not like other less competitive subspecialties, for which Step 3 matters zero as long as you pass.

 

[am9451]

How much do step 3 scores matter for GI?

What part of the country are you in? Does your home program keep its residents for fellowships? If so, did that go into your decision when ranking it 3 years ago?

Sorry, I didn't see the second part of your question.
I'm on the east coast. My program does indeed keep usually 1 or 2 residents per year for fellowship.
Honestly, it did not factor into my decision for residency, even though I already knew I wanted to do GI (and the GI program is quite strong!).
For me, I didn't apply to too many residency programs for location/personal reasons. This program was one of the top that fit my geographic preference AND I happened to like it a lot during interviews.

That being said, it wouldn't be a BAD decision to base residency on where you ultimately want to be for fellowship OR for other career paths.

 

[Carbocation1]

Why did you pick IM/GI?

 

[username456789]

Have you ever seen bilateral lower extremity cellulitis?

(Hint: you haven't)

Thanks!

 

[seminoma]

Less than Steps 1 and 2. But it would be a red flag if your Step 3 dropped significantly lower (i.e. 20-30+ points).
It is not like other less competitive subspecialties, for which Step 3 matters zero as long as you pass.

Did you have to study a lot for step 3 to get 260+ or was it fairly straight forward at your level?

 

[Meridian32]

New IM intern here - when in residency did you get started with research? Thanks!

 

[am9451]

Why did you pick IM/GI?

Like a lot of people in GI, I chose IM in order to do GI. Also like a lot of GI folks, I was considering a surgical field versus GI.

There are quite a lot of things I like about gastroenterology:
1) It's a nice mix of medicine and procedures - i.e. EGD, colos, ERCP/EUS, liver biopsies. For people who enjoy the OR but either miss the cerebral aspects of medicine or who don't relish the idea of spending an ENTIRE day in the OR, IM fields that might be a good fit include GI, Cards, and Crit Care.
2) You get a large amount of real estate in the body, and as a result, get to treat a lot of different pathologies. You have both gut (which also includes biliary) and liver. And a **** ton (pardon the pun!) of wrong can happen in those organ systems - you see cancer, autoimmune, structural, congenital, functional, the whole gamut. There's also both acute/sick-as-**** patients in the ICU (acute liver failure, massive GI bleeders) and chronic stable patients (IBD), which creates a nice variety as well.
3) This is more of a general plug for sub specializing, but there is something to be said for consultation medicine. I don't have to deal with someone's psych issues, poorly controlled diabetes, and dispo crap if I don't want to. OR if I want to be the patient's primary doc, which some hepatologists or even luminal docs do, I can.

There are other things I'm sure, but those are the first things that come to mind.

 

[am9451]

Have you ever seen bilateral lower extremity cellulitis?

(Hint: you haven't)

Thanks!

Ha!! Funnily enough, I recently had a case of what folks had been calling sequential BLE cellulitis. Turns out he just had awful cancer

 

[am9451]

Did you have to study a lot for step 3 to get 260+ or was it fairly straight forward at your level?

Oh man, studying for Step 3 does not even approach the level of Step 1 studying.
There's a saying - I think it's like 2 months for Step 1, 2 weeks for Step 2, a number 2 pencil for Step 3. I did a LITTLE more than that. I mostly just did a thorough run through of Qbank for Step 3 and it was sufficient.

Honestly, having some clinical training under your belt almost makes the steps MORE difficult, since you start to think in a more nuanced, "medicine is an art" kind of way, while the Steps are more of a plug and chug type of knowledge.

 

[am9451]

New IM intern here - when in residency did you get started with research? Thanks!

I got started at the beginning of 2nd year. Some ambitious folks started intern year, and I probably could have given that I knew I wanted to do GI. I just couldn't bring myself to do it.

I will say, had I started intern year, it probably could have been done at a more leisurely pace. Instead, I spent some dedicated time 2nd year in order to have a project on the books (i.e. accepted at a national meeting and manuscript done) by the time fellowship applications rolled around.

 

[olivarynucleus]

Hi everyone,
I'm procrastinating finishing fellowship applications right now so thought I would make myself available for questions. This website was really helpful during medical school and I thought I would give back.

Little about me.
I'm currently a third year IM resident in a "top 10" program applying to GI.
I went to a "top 10" medical school where I cracked my way into AOA.
Step scores in the 260s+.

I don't say this to brag (humble brag?), but I found that it was always helpful to have an idea of where users were coming from.

Q away!

Edit: Forgot to mention that I am also about 1/2 way through the most lovely bottle of chilled Sauv blanc. It'll be interesting to see how flappy my gums (fingers?) get as this progresses

Are the work hour restrictions from posted on FREIDA accurate? How many hrs a week did you work each year on average, and did you have time for moonlighting.

 

[am9451]

Are the work hour restrictions from posted on FREIDA accurate? How many hrs a week did you work each year on average, and did you have time for moonlighting.

Ahhhh, my friend, you may or may not have heard of a little thing called iCOMPARE.
Our program was randomized to the less restricted arm - i.e. the old (though still relatively new) work hour rules of 16 hour shifts for interns etc. etc. do not apply to us anymore. I believe the only stipulations we have now are 80 hour work weeks and 1 day off in 7 - I haven't reviewed iCOMPARE to know if there are additional rules.
That being said, my intern year was under the more strict work hour rules. I VERY RARELY broke them, but I did sometimes - maybe once or twice in the beginning of the year when I couldn't tell my head from my ass as a brand new intern and definitely once or twice in the MICU. However, other than those instances, the work week is actually pretty tolerable.

I probably average 60-70 hours per week on an inpatient service. I push 80 in the units. On ambulatory / elective, they're lucky if they get 20-30 from me.

 

[smarts1]

Thanks for doing this!

Did you ever consider anything other field in med school and how did you end up deciding on IM/GI?

Also, any tips for doing well on the wards/shelves?

And... How do you get good at differential diagnoses? I saw this patient once with SOB, and I literally came up with a differential of 2 diseases and the resident came up with like 10...

 

[jdh71]

Why didn't you pick the best and most awesome specialty out of IM?

 

[masaraksh]

Thanks for doing this!

Did you ever consider anything other field in med school and how did you end up deciding on IM/GI?

Also, any tips for doing well on the wards/shelves?

And... How do you get good at differential diagnoses? I saw this patient once with SOB, and I literally came up with a differential of 2 diseases and the resident came up with like 10...

Curious about your differential for a patient who comes in complaining of "pain"

 

[am9451]

Thanks for doing this!

Did you ever consider anything other field in med school and how did you end up deciding on IM/GI?

Also, any tips for doing well on the wards/shelves?

And... How do you get good at differential diagnoses? I saw this patient once with SOB, and I literally came up with a differential of 2 diseases and the resident came up with like 10...

No problem at all!
I think I answered your first question above already - take a look and let me know what you think.

In terms of doing well on the wards, I've worked with quite a few medical students during residency. The ones who get meh evals from me are the ones who don't seem to take much initiative and don't have much intellectual curiosity. I dislike when medical students need to be force-fed both clinical knowledge and tasks to do. Yes, I am here to guide you. I will be happy to hold teaching sessions (I actually really enjoy teaching) and I am happy to show you cool stuff. I am NOT happy when you ask me questions every 5 seconds that you could easily look up on your own.
The medical students who really stand out in a positive light (maybe 10-15% of students I've worked with) are the ones who really take their medical education in their own hands. They look **** up and try to answer their own questions and come to me with some knowledge under their belt. They spend extra time with their patients instead of sitting around waiting for me to come up with something for them to do. I don't expect you to come up with something groundbreaking because you don't have the medical knowledge to do so, but you can benefit your patient's care in other ways.

For shelves, I just did a **** ton of practice questions. There was a book set - Case Series I think? I used the same study strategy as I did that worked for me with Step 1, which was practicing applying the knowledge.

In terms of coming up with a good differential, this will come with time. We come up with 10 when you've come up with 2 because we've SEEN 10.
That being said, I did find it helpful to come up with a basic system of categories for most things - whether it be anatomically based or pathophys based. For example for chest pain, I think of big boxes first - cardiac, vascular, pulmonary, musculoskeletal, etc. then think about the diagnoses within each box. The truth is, the big scary things you want to know about sooner rather than later (i.e. ACS, pneumothorax, dissection, etc.) will come to your mind fairly quickly with some experience. Once you rule those out, you will then be able to gather some additional information to figure out the rarer stuff.

 

[am9451]

Why didn't you pick the best and most awesome specialty out of IM?

Ha! I actually was momentarily swayed by Pulm/Crit Care. But the thought of having to figure out all the differences between COP/BOOP/IPF/RBILD made me want to slit my wrists.

 

[jdh71]

Ha! I actually was momentarily swayed by Pulm/Crit Care. But the thought of having to figure out all the differences between COP/BOOP/IPF/RBILD made me want to slit my wrists.

Ha!

 

[ChrisMack390]

What is AOA? You don't appear to be osteopathic or an opthamologist?

 

[am9451]

What is AOA? You don't appear to be osteopathic or an optometrist?

AOA = Alpha Omega Alpha
It's the national honor society for medical students. Every school has its own criteria for how you make the cut, but it is recognized as a very favorable attribute for residency (and fellowship) applications.

 

[ChrisMack390]

Thank you!

 

[Say]

Where do you see yourself in 10 years?

 

[am9451]

Where do you see yourself in 10 years?

Love the classic interview question lol.
I see myself working as a hepatologist - maybe transplant - in an academic center. I like the idea of being a clinical educator - i.e. spending time on service with medical students and residents while setting aside some time for clinical research (mostly to keep myself attractive for academic centers to employ). Early in my career, I'd like to spend several months doing inpatient medicine - I can't help it, I love it. And then as I get older, start to transition more time to clinic.

 

[Say]

Love the classic interview question lol.
I see myself working as a hepatologist - maybe transplant - in an academic center. I like the idea of being a clinical educator - i.e. spending time on service with medical students and residents while setting aside some time for clinical research (mostly to keep myself attractive for academic centers to employ). Early in my career, I'd like to spend several months doing inpatient medicine - I can't help it, I love it. And then as I get older, start to transition more time to clinic.

Great answer, 10/10 would hire. But seriously, it is good to see someone so enthusiastic about medicine on the forum. So many people come here in their residency and are down and out about their life. Good luck to you in the future

 

[PhillyMed777]

Agreed. love the positive attitude.

 

[royalmedicus]

thanks for the time you took out for this.
you said you were set on GI before starting your residency.
so my question is, is it possible to match into a competitive specialty IF you are not sure about which fellowship you want to go into before residency? but you want to do something competitive for prestige, money or any other reason.
can one afford to 'waste' time in finding out what they really want to for a fellowship in the residency?

 

[Meridian32]

Did you consider taking a hospitalist gap year and if so, how did you decide to go straight through instead? Thanks again!

 

[kenjixshadow]

x

 

[am9451]

thanks for the time you took out for this.
you said you were set on GI before starting your residency.
so my question is, is it possible to match into a competitive specialty IF you are not sure about which fellowship you want to go into before residency? but you want to do something competitive for prestige, money or any other reason.
can one afford to 'waste' time in finding out what they really want to for a fellowship in the residency?

Absolutely! Taking the time during intern year to try out a couple different things is perfectly reasonable, and I would not call it a waste of time. As I said, I didn't start research in earnest until 2nd year. I also have friends who are taking an additional hospitalist year since they aren't totally sure what they ultimately want to do OR they just want a break from training.

 

[am9451]

Did you consider taking a hospitalist gap year and if so, how did you decide to go straight through instead? Thanks again!

I briefly toyed with the idea. A couple of my friends have done or are planning to do this.
For GI, I had thought that taking a year off would hurt my application, but I've seen numerous applicants from my program take time off and still match at incredible places - granted, that may speak more towards the strength of their resumes.
Personally, I've gone straight through so far and it's worked out well. I think I function well on momentum and didn't want to lose that.

 

[am9451]

1) Do you still drink?

2) Can I buy you a drink?

3) Which is better - Penn State or Hopkins IM?

4) How often do you lift?

5) Dogs or cats?

For serious Q, what would you do outside of medicine?

1) Yes
2) As the one making money and not paying to be in the hospital, I tend to be the buyer for my students
3) To each his or her own
4) Not applicable
5) Why not both?
6) I'm not sure what I would be doing instead of medicine. I initially fell into it because I had a Bio major and had no desire to get a PhD. Realistically I probably would have started at an entry level position job in some science-related field and worked my way up. In my fantasy, I would have become a successful travel blogger who got paid to see and write about different locations around the world.

 

[alpinism]

Is that you fat man?

Going from gomers to doing scopes all day huh...

 

[am9451]

Is that you fat man?

Going from gomers to doing scopes all day huh...

I'm sorry, what?
Not fat (though I suppose this is subjective). Not a man.

 

[mik30102]

I'm sorry, what?
Not fat (though I suppose this is subjective). Not a man.

Lol, its a reference to a book called House of God .

 

[am9451]

Lol, its a reference to a book called House of God .

Ha, got it. I think I'm one of maybe 5 residents in the entire US who haven't read it.

 

[AlteredScale]

Did you do a lot of GI research in med school? What veered you towards wanting to become a hepatologist?

 

[am9451]

Did you do a lot of GI research in med school? What veered you towards wanting to become a hepatologist?

Zero in med school.
I'm still open to other things within GI, but the liver is just the coolest organ ever. Once you've seen acute liver failure or even a cirrhotic with a MELD of 40, you will be hard-pressed to find a sicker patient on the medicine services. Some people dislike working with cirrhotics because, honestly, any treatments you're rendering are just buying time until they die anyway or get a transplant. But I think that the pathophysiology of liver disease is super interesting, and I like treating sick-as-stink patients.

 

[AlteredScale]

Zero in med school.
I'm still open to other things within GI, but the liver is just the coolest organ ever. Once you've seen acute liver failure or even a cirrhotic with a MELD of 40, you will be hard-pressed to find a sicker patient on the medicine services. Some people dislike working with cirrhotics because, honestly, any treatments you're rendering are just buying time until they die anyway or get a transplant. But I think that the pathophysiology of liver disease is super interesting, and I like treating sick-as-stink patients.

Thanks! I'm starting year one of school, did a year of GI research in undergrad so I've been quite interested in IBD, its still a litttttle early for me to decide on that though right?

 

[am9451]

Thanks! I'm starting year one of school, did a year of GI research in undergrad so I've been quite interested in IBD, its still a litttttle early for me to decide on that though right?

Eh. Some people decide earlier and follow through. Some people "decide" earlier and then switch later. Different strokes for different folks.

 

[Omppu27]

I saw you said fellows "match" in December. I thought for fellowship it was more like picking a job and not matching like residency?...

Also:

Any tips for an incoming MS1 for adjusting to the life of a medical student? I'm particularly worried about forgetting "how to study" since I'm coming off a gap year. To be honest I am low key freaking out that I'm starting this chapter of my life.

Breakfast food or dinner food?

If you could visit any country in the world, where would you go?

Thanks!!!

 

[am9451]

I saw you said fellows "match" in December. I thought for fellowship it was more like picking a job and not matching like residency?...

Also:

Any tips for an incoming MS1 for adjusting to the life of a medical student? I'm particularly worried about forgetting "how to study" since I'm coming off a gap year. To be honest I am low key freaking out that I'm starting this chapter of my life.

Breakfast food or dinner food?

If you could visit any country in the world, where would you go?

Thanks!!!

Nope, it's a match process just like residency.

As far as preparation for M1 year, you should be doing… NOTHING! Enjoy your summer! No amount of pre-reading or pre-studying or pre-whatever will have measurable benefit. Once M1 year starts, I would advise you to just try and figure out as quickly as possible what YOUR most effective way of studying is. It took me a while - TOO long - to realize that making insane outlines like everyone else in the class was doing wasn't actually helping me; that I really just needed to read the material and do practice questions. You will feel pressured to go with any of a number of "foolproof" methods to learn the material. But in the end, realize that everyone learns differently.

Breakfast food, for sure!

Oh man, I've got a travel bug. I'm dying to go to Greece, Germany, Iceland, you name it. You'll come to find that you never seem to have both the money and the time to travel, so you kinda need to bite the bullet when you've at least got 1 of the 2 and force the second.

 

[mybubbles627]

My good friend is interested in IM. What 10-20 or so programs would you recommend with no regional preference but interest in hematolgy/oncology for a strong applicant (great boards/grades, lots of research)?