Is the rest of med school like first year?

[IntheClouds4ever]

You want to spend your entire life thinking inside the box? What a boring existence. Creative thought is what separates us from computers. I want a job that can't be made obsolete by silicon and metal.

That has a hint of patchouli and dirty feet aroma..

---

Members don't see this ad.

 

[SurgDoc95]

You want to spend your entire life thinking inside the box? What a boring existence. Creative thought is what separates us from computers. I want a job that can't be made obsolete by silicon and metal.



Computer science here, but that's still pretty close to engineering.

You’re exhausting. Trying to justify your bad first year grades by essentially saying it’s not intellectually stimulating enough does lend itself to a good chuckle though.

Also, hate to be this guy, but you are at a DO program. Unless something genuinely screwy happened to you in undergrad you aren’t some 200 level IQ genius. More than likely you’re in the same boat as most of us when it comes to intelligence. Get off that big ole high horse, realize that you have a hell of an opportunity for rewarding career or quit.


Sent from my iPhone using SDN mobile

 

[Goro]

Maybe someone farther along the path can correct me on this, but I tell friends/family that this is like a really weird way to train a chef.

Preclinicals: memorizing ingredients, chef tools, cooking techniques, and flavor profiles.

3rd year: you have chefs and apprentice chefs from different culinary backgrounds show you how to use those ingredients to cook some different types of dishes. Mexican one month, Indian the next, etc. Maybe you’ll get some elective time to try out something really interesting and niche like African food.

4th year: most of it is spent going around to different restaurants and showing them you can make at least the basics with an acceptable level of quality. Maybe you’ll make a really good creme brûlée and the head chef at that restaurant will write a glowing review of it so you can show other chefs at other restaurants. Hopefully one of these chefs will take you on as an apprentice chef and you’ll train to cook the type of food you’d like to cook.

Of course, success largely depends on how well you can memorize ingredients the first two years bc if you don’t do well on the big ingredients test at the end of second year you’ll have to settle for making meat and potatoes in rural North Dakota.

If your school is like ours, 1st year is about basic science, anatomy, biochem, physio - I get it, it's dry as f***
Second year does get more interesting, as you will soon learn about the fun part of medicine, where excrement hit an air distribution device - but honestly it sucks, a lot, because you gotta study for board
Third year get A LOT better, you will see that there is a reason you learned all that stuff, and you'll actually make a difference (sometime, maybe small)
Forth year is about getting STEP 2 out of the way and apply, after that we all enter brain dead mode for a few months until the real nightmare come

Here's my way of looking at the old Flexner style curricula:
M1: learn the normal
M2: learn the abnormal
M3: learn how to recognize the abnormal
M4: learn how to treat the abnormal.
And then add in residency: learning your craft.

 

[DOFOSHO]

It all gets better intern year!

 

[pstrick]

Not really looking to argue, but I in no way mean to imply that I'm 'too smart for medical school'.
Granted, my first post does make me sound like an ass. I could have worded it better, but telling me that I'm not only stupid, but too stupid to realize that I'm stupid, doesn't really address my concern.

In my previous studies, it has been possible to work through problems on the test to get to a correct answer. (Maybe you don't know the meaning of the verb rechazar, but you can figure it out from context clues.)
In medical school, you can learn 99 facts, but that doesn't get you any closer to being able to being able to infer the 100th. (You can learn the origin of 99 muscles, but that doesn't mean you can reason through the 100th)
It goes back to what I said in my first post about this being a job better suited for a computer.

Maybe I'm too dumb to breathe and have no business at Hamburger College, let alone medical school, but it's still possible that my concerns have merit, right?

 

[Drrrrrr. Celty]

Not really looking to argue, but I in no way mean to imply that I'm 'too smart for medical school'.
Granted, my first post does make me sound like an ass. I could have worded it better, but telling me that I'm not only stupid, but too stupid to realize that I'm stupid, doesn't really address my concern.

In my previous studies, it has been possible to work through problems on the test to get to a correct answer. (Maybe you don't know the meaning of the verb rechazar, but you can figure it out from context clues.)
In medical school, you can learn 99 facts, but that doesn't get you any closer to being able to being able to infer the 100th. (You can learn the origin of 99 muscles, but that doesn't mean you can reason through the 100th)
It goes back to what I said in my first post about this being a job better suited for a computer.

Maybe I'm too dumb to breathe and have no business at Hamburger College, let alone medical school, but it's still possible that medical school doesn't require problem solving or the ability to think abstractly, right?

You know, there's really a point where this whole, there needs to be an immediate point to what I am learning right now thing just becomes childish and frankly disingenuous. I mean, did you spend all of your foundational classes in college ex. calculus and statistics bitching about how you don't actually need to think abstractly but rather just memorize a bunch of rules and facts to answer questions?

But what's worse is that this has already been stated in this thread. You've got some sort of block about all of this. I recommend working out the block, i.e figuring out whether your heart is really into medicine, not trying to explain away your feelings through transposed analogies that even you must realize are entirely contrived.

 

[UnoMas]

Not really looking to argue, but I in no way mean to imply that I'm 'too smart for medical school'.
Granted, my first post does make me sound like an ass. I could have worded it better, but telling me that I'm not only stupid, but too stupid to realize that I'm stupid, doesn't really address my concern.

In my previous studies, it has been possible to work through problems on the test to get to a correct answer. (Maybe you don't know the meaning of the verb rechazar, but you can figure it out from context clues.)
In medical school, you can learn 99 facts, but that doesn't get you any closer to being able to being able to infer the 100th. (You can learn the origin of 99 muscles, but that doesn't mean you can reason through the 100th)
It goes back to what I said in my first post about this being a job better suited for a computer.

Maybe I'm too dumb to breathe and have no business at Hamburger College, let alone medical school, but it's still possible that my concerns have merit, right?

Well in order to figure out the meaning of the verb rachazar in a sentence, you need to know all the other words within and beyond that sentence to use them as context clues. The first 2 years is just that, learning the individual words of medicine.

Maybe I am reading way too much into this or too quick to judge but from everything you posted it seems like you didn't put in the time to study/memorize first year materials because maybe, just maybe you were hoping that you can "logicize" your way to the correct answer on the exams, failed to do so hence didn't do so hot on classes, and now you are rationalizing to make sense of your shortcomings. I had classes like that in college, where I put in minimal effort, showed up to exams and could work my way to the correct answers. Maybe you are inherently smart and a good test taker and that worked for you in undergrad but this is medical school man, memorization is the name of the game.

If not, I apologize. As someone else has suggested you need to figure this out on your own. The materials get better as you move forward but still a whole lot of memorization.

 

[pstrick]

You know, there's really a point where this whole, there needs to be an immediate point to what I am learning right now thing just becomes childish and frankly disingenuous. I mean, did you spend all of your foundational classes in college ex. calculus and statistics bitching about how you don't actually need to think abstractly but rather just memorize a bunch of rules and facts to answer questions?

But what's worse is that this has already been stated in this thread. You've got some sort of block about all of this. I recommend working out the block, i.e figuring out whether your heart is really into medicine, not trying to explain away your feelings through transposed analogies that even you must realize are entirely contrived.

I don't feel like it's accurate to say that I'm trying to cover for not being exceptional. My test scores and GPA leading up to med school imply that I'm pretty average for a medical student. I'm trying to rationalize why I absolutely hate every minute of medical school, not why I'm doing poorly.

The examples may be contrived, but they reflect what I feel has been my experience in medical school.
Medical school isn't what I had hoped and I'm pretty unhappy here. I was kind of hoping somebody would tell me that it gets better.

Maybe I am reading way too much into this or too quick to judge but from everything you posted it seems like you didn't put in the time to study/memorize first year materials because maybe, just maybe you were hoping that you can "logicize" your way to the correct answer on the exams, failed to do so hence didn't do so hot on classes, and now you are rationalizing to make sense of your shortcomings.

If not, I apologize. As someone else has suggested you need to figure this out on your own. The materials get better as you move forward but still a whole lot of memorization.

This isn't too far off. It's frustrating that all of first year is flashcard-sized tidibits that you either know or don't. I was hoping for more problem solving, but there isn't much of that at my school.
I hate bulk memorization and I worry that all of medicine is just flashcards and alcohol.

 

[Drrrrrr. Celty]

I don't feel like it's accurate to say that I'm trying to cover for not being exceptional. My test scores and GPA leading up to med school imply that I'm pretty average for a medical student. I'm trying to rationalize why I absolutely hate every minute of medical school, not why I'm doing poorly.

The examples may be contrived, but they reflect what I feel has been my experience in medical school.
Medical school isn't what I had hoped and I'm pretty unhappy here. I was kind of hoping somebody would tell me that it gets better.



This isn't too far off. It's frustrating that all of first year is flashcard-sized tidibits that you either know or don't. I was hoping for more problem solving, but there isn't much of that at my school.
I hate bulk memorization and I worry that all of medicine is just flashcards and alcohol.

Right, I'm not saying you're not exceptional. I'm saying you disliked first year a lot and now you're worried that you're going to hate second year and the rest of it all and hate medicine in general. Which are all reasonable thought processes. It's not to do with the fact that medicine itself is a dull profession lacking thought. It's the fact that medicine is a soul crushing experience for most normal people. I found first year boring and uninteresting. Physiology is an extremely uninteresting subject, anatomy was even more so painful. But the time first year finished I was worn down and I needed a break from it all.

My advice to you is rework what you're doing to relax and rebound. And then learn how to find a sincere motivator to validate this all. There were days when I literally had to think about the end of the tunnel to get out of bed to study more.

But in the same breathe, I'll tell you that the heat is only going to go up next year. I personally found second year learning pathology and pathophysiology to be extremely interesting. It made up for the general boredom of first year. But I can say that I was stressed almost the whole of second year. It was literal stretches between tests to free weekends where I chilled and did fun stuff and then more tests.

 

[pstrick]

Right, I'm not saying you're not exceptional. I'm saying you disliked first year a lot and now you're worried that you're going to hate second year and the rest of it all and hate medicine in general. Which are all reasonable thought processes. It's not to do with the fact that medicine itself is a dull profession lacking thought. It's the fact that medicine is a soul crushing experience for most normal people. I found first year boring and uninteresting. Physiology is an extremely uninteresting subject, anatomy was even more so painful. But the time first year finished I was worn down and I needed a break from it all.

My advice to you is rework what you're doing to relax and rebound. And then learn how to find a sincere motivator to validate this all. There were days when I literally had to think about the end of the tunnel to get out of bed to study more.

But in the same breathe, I'll tell you that the heat is only going to go up next year. I personally found second year learning pathology and pathophysiology to be extremely interesting. It made up for the general boredom of first year. But I can say that I was stressed almost the whole of second year. It was literal stretches between tests to free weekends where I chilled and did fun stuff and then more tests.

That's actually pretty helpful.
Thanks.

 

[Drrrrrr. Celty]

That's actually pretty helpful.
Thanks.

Feel free to message me if you want more specific direction or advice. It's alright to be worried and apprehensive about all this, really.

 

[Medic741]

Wow. Thanks for the help guys.
Half these posts are helpful, half the posts are stupid zingers. I went ahead and liked all the whiny posts. You guys seem to need the validation.



These responses aren't brutal. They're barely even relevant. Maybe I'm not smart enough to do well in medical school. That still doesn't answer my question.

What is the difference between a doctor and a monkey with a subscription to visualdx? Legit question. Is medical school still a thing because the AMA has a powerful lobby, or is there actually value here?

Hey man, if you’re feeling this burned out *before* you set your career on fire please at least consider making use of your schools counseling center. Sounds like venting to someone who could reflect these ideas and support healthy mindsets/resilience may be a really smart move. Med schools a furnace...

Fellow MS1, but in my experience knowing a bunch of random facts actually does matter. Someone goes into stable VTACH but has a hx of LBBB and a-fib, do you go for the amio or Cardizem? That random fact about v1-6concordance & axis matters all of a sudden.

In all seriousness, please consider finding someone to talk to along this crappy journey in medicine.

 

[wkabenga]

Sounds like you found out you weren't smart enough to excel in medical school and it hurt your ego

Sounds to me like you're a close-minded prick who doesn't have empathy towards others' experiences with the challenges of med school....

 

[AnatomyGrey12]

Sounds to me like you're a close-minded prick who doesn't have empathy towards others' experiences with the challenges of med school....

 

[wkabenga]

Just finished first year and I'm not sure I want to return.

I hated first year.
I found the material boring and nothing here seems to require abstract thought. It's just taking in information and vomiting it back. Sometimes questions require knowing 2 or 3 facts, but reasoning skills aren't required to do well on tests. I was excited for medical school because I thought it would tax my reasoning and problem solving skills, but neither of these have yet come into play.

I feel like this is a job better suited for a computer. Studying is just populating a database. Tests are just random queries of that database to ensure you have a sufficient number of facts.
I never did well in my classes because there were no big ideas or concepts. Just facts. What is the virtue of learning the origin and insertion of the brachioradialis? Is knowing the Brodmann area for Broca's area really that important? Does knowing whether an organ is intraperitoneal or retroperitoneal ever mean the difference between life and death?

Is this all of medicine? Storage and recall? What skills does a human have that make them better suited for medicine than a computer?


If this is medicine, I will quit tomorrow. I have no interest in devoting my life to this nonsense.

Wow tough crowd here, OP is trying to seek advice yet a lot of people here attacking him for it.... SMH you guys need to chill

OP I would advise based on what you're saying here that you should look at another career, maybe biomedical engineering? It might be worth taking time off from med school to evaluate your options and future goals. Similar to you, my background is also in engineering (mechanical) and recently I decided to leave med school about three months ago at the end of my third year. I struggled with a lot of the same stuff you're talking about, I went into medical school thinking it would involve a lot of modeling and design of the human body and medical devices but you're right in that medical school does not involve a lot of creative design and requires A LOT of fact memorization. I kept assuming "in 'x' year things will improve (x being 2nd, 3rd year, residency)" but personally for me things never did and I realized this wasn't a good career fit for me.

I would caution you though, that THERE IS a lot of problem solving in medicine, and you'll definitely notice in second year that it will integrate more problem solving than you've been getting in first year and it'll be more applicable to patients. However, the kind of problem solving you'll be doing involves a lot of thinking about "gray-area" type problems where there is not a clear cut solution and you solve every problem differently based on the facts you memorize and accumulate throughout all of medical school. It is not a "black and white" form of problem solving at all, which I'm sure is the kind of problem solving skills you're used to in computer engineering. Personally for me, I felt that the type of problem solving that physicians do did not match what I personally wanted to do in my life, so I decided to get out and now I'm working to get into the biomedical engineering field.

It's a very difficult decision to make, and I definitely understand where you're coming from. Feel free to PM me if you want any advice or just want to chat. Best of luck man

 

[TheaterOfTheme]

Sounds like you found out you weren't smart enough to excel in medical school and it hurt your ego

Come on--the OP is being civil and intelligent in his/her statements. Let's not make this thread malignant.

I very much sympathize with your experience, OP. I honestly thought it would be less random memory recall as well. I hated anatomy, micro (except sketchy was fun), and pharm. But my school's curriculum introduces pathology in second semester of first year and I honestly enjoyed that. If I could read Robbins all day for fun I would. I hate memorizing pointless things as well, so I always try to see the big picture and theoretical parts as a scaffold of a building. Then I constantly remind myself of what the 'walls' or 'decorations' of that house may look like.

And for the record, memory is a component of intelligence. So let's not create straw-man arguments about who is smarter and has a bigger **** and what not. This is nonsense that we talk to each other like this on anonymous forums--OP has a very serious decision to make.

 

[TheaterOfTheme]

Also, I am slightly jealous of your curriculum being all pathology in second year as @Goro mentioned. You got all the BS over with first year as I see it.

 

[NITRAS]

Practicing medicine is nothing like medical school (thank God!).

I think my old neighbor (who practiced pathology for years) said it best when he told me that most of medical school is learning a language with three times the vocabulary of the average American. I've been an Internist and hospitalist for three years. There isn't any one thing that is complicated about medicine, but rather lots of simple things that build together. This last week, I got to make some good calls. I don't do anything special, but I do get to (or try to some days) use critical thinking.

I don't remember every detailed I learned in medical school, but practicing medicine isn't learned in medical school, its learned in residency. The language, how to talk to each other, how to talk to patients, the basic tests, medications, how to navigate healthcare systems. . . . its a lot. Physicians are the default leaders to it.

The OP should answer the questions, do you want to be a physician, and do you want to spend the next 6-8 years of pain to get there?

I didn't like medical school (but I didn't hate it). I often struggled with it. I did well in residency, and I like what I do now. I had great undergrad GPA and MCAT scores. I'm not going to rag on you, but it sounds like you went to medical school without knowing what being a physician is. The bottom line is that medical school is a lot of memorizing, and a lot of being the bottom nobody.

Now, make your choice, and be comfortable with it, cause you will have to live with it.

 

[Deecee2DO]

Sounds like you should've gone PBL.

100%

 

[Deecee2DO]

Don't back out now. First year is all the foundational basics. You NEED the basics to problem solve. People on this thread have reiterated this a million times probably. Second year will be harder than first year I heard and 3rd year is a different beast, but a different type of hard. However, think about it this way-the more you learn and memorize first year the better you will be able to learn the path etc second and third year. The more path you know and use your critical thinking skills the better position you will be in during rotations and residency when you are the guy who figures out what was wrong with a patient before anyone else did. This can put you in a position to impress your attendings. The feeling of bringing relief to a patient or saving a patient's life is is a high that is difficult to find in other professions. You think I like memorizing a crap top of interleukins? Heck no. But you have to look at the big picture. Use that as your motivation. That is what I think about and it keeps me plugging away at studying. You can really make an impact on peoples lives if you think about the end goal

 

[Cell Nucleus]

Here's my way of looking at the old Flexner style curricula:
M1: learn the normal
M2: learn the abnormal
M3: learn how to recognize the abnormal
M4: learn how to treat the abnormal.
And then add in residency: learning your craft.

This sounds like a great analogy but I am not sure if it applies to systems-based curriculum.

 

[dostudent545]

I know people have said this, but maybe to make it more understandable and compare it your computer science degree: you probably didn't get to do any coding to solve problems until you learned the proper languages first. Unfortunately, medicine has a lot of languages that don't necessarily build on themselves like coding rules/languages do. You can't figure out anatomy just by knowing physiology or vice versa.

First year is learning the language. You can use anatomy and physiology to reason out the pathology you'll learn second year. You can use physiology (assuming you covered autonomics and cellular receptors) to reason out pharmacology drugs and how their mechanism works. But yeah, there's still going to be a **** ton of memorization because medicine is a lot of naming. You might be able to recognize and understand how something works, but unfortunately, you still have to name it, unlike math where the name of your solution is what you get through your calculations. Micro is all memorization, but pharm and path are a lot more conceptualizing and understanding.

It's still not "out of the box thinking" though and that's because practicing is based what works from evidence already provided. If you want to think out of the box to develop new treatments and procedures, you should probably go the PhD route.

 

[Goro]

This sounds like a great analogy but I am not sure if it applies to systems-based curriculum.

It doesn't. But the OP is in a Flexner curriculum. In newer curricula, 1 and 2 are combined.

 

[dostudent545]

OP, I'm in a similar curriculum where all we had first year was the basics. I especially hated first semester since it was biochem, anatomy, and cell bio which are literally straight up regurgitation. Second semester was a bit better since physiology does involve more conceptualization. Second year is much better and much worse, since the material is a lot more interesting, but the stress levels are non stop.

I'll be honest though. I wasn't a fan of this curriculum. A lot of my first year knowledge was just lost since there was nothing for me to relate it to while learning it. I memorized, washed, and repeated. Systems gives you a basis to connect the anatomy and cell bio to more context and actually compartmentalize while learning it. So if your second year is similar to mine, it's going to be a lot of revisiting old topics on your own time to integrate things together to prep for boards. I don't think I properly understood anatomy until I was able to connect it to the pathophysiology I learned my second year. I personally don't understand why every single school hasn't moved away from this curriculum yet.

 

[jd2019]

Just finished first year and I'm not sure I want to return.

I hated first year.
I found the material boring and nothing here seems to require abstract thought. It's just taking in information and vomiting it back. Sometimes questions require knowing 2 or 3 facts, but reasoning skills aren't required to do well on tests. I was excited for medical school because I thought it would tax my reasoning and problem solving skills, but neither of these have yet come into play.

I feel like this is a job better suited for a computer. Studying is just populating a database. Tests are just random queries of that database to ensure you have a sufficient number of facts.
I never did well in my classes because there were no big ideas or concepts. Just facts. What is the virtue of learning the origin and insertion of the brachioradialis? Is knowing the Brodmann area for Broca's area really that important? Does knowing whether an organ is intraperitoneal or retroperitoneal ever mean the difference between life and death?

Is this all of medicine? Storage and recall? What skills does a human have that make them better suited for medicine than a computer?


If this is medicine, I will quit tomorrow. I have no interest in devoting my life to this nonsense.

Basically. Second year is worse, more difficult and less time although it is clinical memorization and regurgitation as opposed to biomedical sciences of 1st year. 3rd year is where you'll have the opportunity to think things through and apply it. But you have to do your 2 years of misery to build up a knowledge base

 

[QueenJames]

Can confirm that 2nd year is the worst.

On surgery rotation currently doing 14+ hour days and then studying after...

AND that IS STILL BETTER than dedicated time for step 1/COMLEX 1 lolol

Plus... a majority of my classmates suck huggeeeee dongs.

The more time away... the better.

It gets better homie...


kinda.

 

[Black Coffee 24/7]

1st year = manageable but sucks major balls
2nd year = Sucks a lot more balls and I start to hate almost everyone in school

Board prep = glad to be away from the school admin for once and just study for 10-12 hrs everyday for 6-7 weeks
COMLEX day = nothing prepares me for this crap
USMLE day = pissed and angry that I'm so stupid when it comes to disease and management recognition bc I have been taught by a bunch of PhDs w/o a clue. Also disappointed at myself for forgetting a ton of crap that show up on the exam. Please note that these tested materials weren't covered in depth in any Bros or Zanki resources. They are actually Step 2 materials that I'm about to learn right now.

Surgical rotation starts next week, and I have been hitting OME hard. The light is starting to turn on and it's so refreshing. I look forward to being in a real hospital and learning real medicine in a week.

 

[QueenJames]

1st year = manageable but sucks major balls
2nd year = Sucks a lot more balls and I start to hate almost everyone in school

Board prep = glad to be away from the school admin for once and just study for 10-12 hrs everyday for 6-7 weeks
COMLEX day = nothing prepares me for this crap
USMLE day = pissed and angry that I'm so stupid when it comes to disease and management recognition bc I have been taught by a bunch of PhDs w/o a clue. Also disappointed at myself for forgetting a ton of crap that show up on the exam. Please note that these tested materials weren't covered in depth in any Bros or Zanki resources. They are actually Step 2 materials that I'm about to learn right now.

Surgical rotation starts next week, and I have been hitting OME hard. The light is starting to turn on and it's so refreshing. I look forward to being in a real hospital and learning real medicine in a week.

FACTS.

It is the ****TIEST feeling when you read step 2 material and are like "OH... THAT WAS ON MY STEP 1?! WTF! I WONDER WHERE I HAD LEARNED THAT????"

Oh well.

LOL

 

[Goro]

1st year = manageable but sucks major balls
2nd year = Sucks a lot more balls and I start to hate almost everyone in school

Board prep = glad to be away from the school admin for once and just study for 10-12 hrs everyday for 6-7 weeks
COMLEX day = nothing prepares me for this crap
USMLE day = pissed and angry that I'm so stupid when it comes to disease and management recognition bc I have been taught by a bunch of PhDs w/o a clue. Also disappointed at myself for forgetting a ton of crap that show up on the exam. Please note that these tested materials weren't covered in depth in any Bros or Zanki resources. They are actually Step 2 materials that I'm about to learn right now.

Surgical rotation starts next week, and I have been hitting OME hard. The light is starting to turn on and it's so refreshing. I look forward to being in a real hospital and learning real medicine in a week.

Your clinical faculty didn't cover this?? What on earth were they doing???

 

[Black Coffee 24/7]

Your clinical faculty didn't cover this?? What on earth were they doing???

Having one sentence about this = that w/o spending much time considering the differentials isn't covering it

I got a few Neuro quests that weren't covered in any FA, Zanki, Bros, or UW materials. However, I got them right based on pure luck or just gut feeling based on the pt presentation.

On my real exam, I literally got hit with Step 2 materials where the vignette is vague as hell, and then ask me to make a decision on the diagnosis. I literally got a few of the Step 2 questions right bc I or one of my loved ones have the disease itself. Then, there are questions in which I know the classic symptoms covered in class, but I was hit with imaging findings in either words or X-rays that mean the same thing. However, I have never been exposed to these key phrases, so I probably got them wrong.

At this point, I just pray that my outside knowledge is enough for me to get a decent Step 1 score tomorrow, putting me in play for a decent Anesthesia or Neuro residency.