The Final Leg: Any questions to a 3rd year resident once in your shoes?

[LabMonster]

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I'm a 3rd year EM resident, chief, who once was in your shoes. In 2004-2005 I was reading SDN MADLY trying to figure this whole process out.

I posted on SDN (before the "what are my chances" threads) and asked "What are my chances?" Then I checked them incessantly when working and between studying for pre-reqs and the MCAT.

Reading the threads in SDN, I thought,"Man, I'm hosed." There were people (Q you know who you are) boasting 40+ MCAT scores, research, 4.0 GPAs, extensive EC activities and here I was: 28/29, getting married for the second time, having worked in a bunch of different jobs but now, applying for medical school.

I got my first choice of medical school and residency, and have made it to my third and chief year.

So here we are. This is an open thread, not for asking "what are my chances" - there is a thread for that 😉 but for any questions you may have as a pre-med fighting through the lines for an acceptance into medical college and beyond.

My intention is not to offer concrete advice, there are medical advisors for that at your undergrad, but reassurance that non-perfect numbers don't equate to stupidity and certainly don't relate to your training and development of clinical skills in medicine.

Post, flame, PM away...

 

[xoxx]

Study habits?

Tips for doing well on MCAT/Step 1?

Tips for making connections (Who to brown nose)?

Life advice?

 

[tn4596]

how many hour a day do you sleep as EM?

 

[Arbor Vitae]

Is it true what they say about EM? And where are the least pretentious people in medicine in terms residency.

 

[jsmith1]

I'm a 3rd year EM resident, chief, who once was in your shoes. In 2004-2005 I was reading SDN MADLY trying to figure this whole process out.

I posted on SDN (before the "what are my chances" threads) and asked "What are my chances?" Then I checked them incessantly when working and between studying for pre-reqs and the MCAT.

Reading the threads in SDN, I thought,"Man, I'm hosed." There were people (Q you know who you are) boasting 40+ MCAT scores, research, 4.0 GPAs, extensive EC activities and here I was: 28/29, getting married for the second time, having worked in a bunch of different jobs but now, applying for medical school.

I got my first choice of medical school and residency, and have made it to my third and chief year.

So here we are. This is an open thread, not for asking "what are my chances" - there is a thread for that 😉 but for any questions you may have as a pre-med fighting through the lines for an acceptance into medical college and beyond.

My intention is not to offer concrete advice, there are medical advisors for that at your undergrad, but reassurance that non-perfect numbers don't equate to stupidity and certainly don't relate to your training and development of clinical skills in medicine.

Post, flame, PM away...

Is medicine the right path for someone who wants to also play a major role in the lives of their children and spouse? Do only really smart med-students get into the residencies that afford this type of lifestyle? If you are not among those "really smart med-students" do you have to settle for salaries that force you to carry your school debt into retirement in order to have time for family?... Looking back that last sentence sounds kinda harsh lol.. but its already typed and backspace is broken 🙂

 

[asecondtolife]

Why did you choose EM?

I have decent numbers but connections are not my forte any advice in that department? I'm a big introvert and it's hard for me to reach out and ask for rec letters and whatnot.

 

[TheWeeIceMan]

Are there any aspects of choosing a medical school that you wish you had taken into account?

Any general tips for someone with "non-perfect number" just starting the application cycle?

 

[tima]

Is there an advantage from graduating from a 4 yr rather than a 3 yr EM residency program?

 

[DrStraggler]

Is it worth it? The time, effort, money, and sacrificed personal life?

 

[ccfman1991]

what are some things you thought would be important when choosing a medical school; then realized that these weren't that important and that you realized some other things about med schools that you wished you had considered.

i know that isn't very articulate

basically, is there anything you wish you had known as an applicant that you now know as a graduate/resident in terms of what factors are important in which medical school you attend?

 

[sunflower18]

I don't think I have any questions that haven't been asked already, but I just wanted to say -- thanks so much for doing this 🙂 I really appreciate that you are giving back some time, expertise, and reassurance to SDN. It is inspiring and means a lot.

I look forward to reading your responses!! 🙂

 

[OREdwardsJR]

In your pre-med stages, when did you become confident that you were good enough to make it to medical school?

After that, when did you become confident that you will become an adequate doctor?

 

[LabMonster]

Many questions to answer there are. Yoda, give me strength.

Study habits?
Mine sucked. As many medical students figure out along the way, the process is a marathon of memorizing partitioned packets of anatomical or physiologic information over 4 years time. What do I wish I had done differently? Use your Study books - First Aid etc. But choose ONE reference and know every page. I had many references, many books, and I got lost in detail. The details are great! (And more interesting) - But make sure you get everything else first! In other words, as an MS1/2 find one resource to study for Step 1, and really pound it. If you can recite First aid step1 you're ok 😉

Tips for doing well on MCAT/Step 1? Study. Don't put your nose in a book either. Have your significant other or (person of interest in your med-school class 😉 quiz you. The quizzes shouldn't be easy either: "Please describe how folic acid is important in human health." What does that mean? It means you should know what the molecule looks like, what diseases it's implicated in, when therapy will change it's metabolism, and when you should consider deficiency.

As a nation, we've become kinder and gentler... As medical students you should be kind and gentle to your patients, and then grill each other on biochemistry, pharmacology and pathology.

Tips for making connections (Who to brown nose)? Don't brown nose anyone. EM folk in particular don't like it... We'd rather you be really enthusiastic about your rotation than try and suck butt.

How many hours do I sleep per day - usually regulation: 8-9. On off service rotations we sometime don't sleep much but we're always within RRC regs. On EM months we're locked into 60hour/week regulations

Off service, we fall into the black hole of surgery 😉 Our surgery colleagues work very hard and we appreciate them - they're limited to 80 hours weekly.

 

[LabMonster]

And next section.

MuAgonist: Is it true what they say about EM? And where are the least pretentious people in medicine in terms residency.

Mu - dude, not sure what the original question is. EM people tend to roll with the punches and are typically "chill" folk. The least pretentious folks in medicine? well - We are 😉 I'll vote for EM and twice on Sunday.

Honestly I don't know. I think EM docs don't take themselves too seriously as a rule - just us...

We see the worst of the worst **** roll in to the ED. Before the trauma surgeons, before medicine, before family, we see it. We decide what is bad - and we need to be REALLY good at that because our consultants depend on our expertise - and THAT is our skill. We resuscitate and separate the sick from the not sick.

 

[LabMonster]

Is it worth it? The time, effort, money, and sacrificed personal life?

Yes. It is. For me, the process has been very gracious, uplifting and overall very satisfying.

 

[LabMonster]

what are some things you thought would be important when choosing a medical school; then realized that these weren't that important and that you realized some other things about med schools that you wished you had considered.

i know that isn't very articulate

basically, is there anything you wish you had known as an applicant that you now know as a graduate/resident in terms of what factors are important in which medical school you attend?

I didn't know what was important in a medical school! Wake provided everything, every student grew as a result of that curriculum.

Wake was my number one choice, they selected me and I matriculated there. When I interviewed there, I thought I bombed it - the last interviewer I had just shredded me. I walked up to the Wachovia Building and told my Dad, "I don't think it went so well."

Wake had everything I was looking for, and they delivered too - great clinical teaching and the staff was great.

 

[LabMonster]

Is it worth it? The time, effort, money, and sacrificed personal life?

Yes. It's hard on your family - but they understand. My 5 year old understands when I go to work I may save a life - and he thinks that is pretty cool. 🙂 I do too. Call is hard on my family - but that's why I chose EM - because that stops...

 

[LabMonster]

Why did you choose EM?

I have decent numbers but connections are not my forte any advice in that department? I'm a big introvert and it's hard for me to reach out and ask for rec letters and whatnot.

I am also introverted. I was called "intense" and "in-personable" in medical school.

My personality changes when I'm with an EM patient - I become more open and assume the role of an extrovert. For me, it becomes an issue of ownership - if I "own" a patient, I become very extroverted. For my patients I am open and extroverted - but that stops at the ER door. You're OK if you introverted and want to do EM as long as you can act and assume the role of EM physician. I know plenty of EM introverts - but we all break the wall and assume that the patient in front of us is the most important thing.

 

[45408]

Where did the barbarian hoard go?

Mu - dude, not sure what the original question is. EM people tend to roll with the punches and are typically "chill" folk. The least pretentious folks in medicine? well - We are 😉 I'll vote for EM and twice on Sunday.

I can agree with that. They are definitely the most chill group of guys in the hospital as a whole.

We see the worst of the worst **** roll in to the ED. Before the trauma surgeons, before medicine, before family, we see it. We decide what is bad - and we need to be REALLY good at that because our consultants depend on our expertise - and THAT is our skill. We resuscitate and separate the sick from the not sick.

I just want to add that this is institution-variable. Where I went to med school, the ER docs/residents were actively participating in the traumas. Almost everything that qualifies as "trauma" at my current institution completely bypasses the ER docs. Sounds like a trauma by radio report? Page the trauma team. ER doc isn't even present at the trauma.

Also, if a patient is going to be admitted, they really don't do much resuscitation. They just call us right away to take it from there, aside from starting an antibiotic and giving fluid. Now, I really like our ER docs, and they do a pretty darn good job of calling us only when needed but definitely if needed. Many of the ED horror stories I hear on SDN don't apply to my hospital at all.

 

[Oo Cipher oO]

What was the appeal of EM? Did you ever have one moment that made you choose it as a specialty?

 

[LabMonster]

Also, if a patient is going to be admitted, they really don't do much resuscitation. They just call us right away to take it from there, aside from starting an antibiotic and giving fluid. Now, I really like our ER docs, and they do a pretty darn good job of calling us only when needed but definitely if needed. Many of the ED horror stories I hear on SDN don't apply to my hospital at all.

I know... I'm off service right now. I was called this morning down to see a patient who the ER docs were concerned enough to call us about. But... This was a potentially surgical case and there was no fluid running. Sure, this patient was NPO, had been taken care of appropriately EXCEPT! Resuscitation. This patient was in the ED for 8 hours all said and done and I started fluids after my consult - even though the patient had a "diet."

When you're a resident, if you have a patient that is going to be NPO, give them a fluid - on a rate (even if they don't need a bolus) because they're still going to lose fluids. Preferably LR or another fluid that is as close to physiologic as possible... It's not homage to the surgeons, it just makes sense.

Thanks Prowler - I often forget I need to address this with interns!

 

[LabMonster]

What was the appeal of EM? Did you ever have one moment that made you choose it as a specialty?

Here was my decision making process starting in 3rd year: Loved surgery, loved EM, liked FP, kinda liked IM - really liked some sub-specialties of IM, loved peds, loved geriatrics.

Next echelon of decisions: Day(s) in FP clinic with a patient with multiple chronic illness and finding she wasn't compliant with 1. meds 2. diet and excercise. I started veering away from primary care at this point. Day(s) in Peds clinic where the diagnosis was simple, and parents simply didn't want THAT diagnosis, they wanted a pill and thought their parenting was just fine - again, forsaking personal responsibility and good parenting.

By this point in third year, and after being in the ED and on surgery, I knew I didn't like the really long term relationships.

Surgery got things done. OB/Gyn got things done - but there was still clinic... I found I couldn't stand clinic after a time because there was no difference between primary care vs. seeing patients in surgical clinic.

Then came further surgical experience. I was concerned about dedication at this point.

I don't mean I was concerned about my dedication to a patient vs my own life - what I do mean is that I know myself. I know that when I need to be devoted to something, I am. I took this to mean that I would definitely put many of my patients in the future BEFORE my family. I also knew, this would not end well for my marriage or my children.

By that time, I was down to ER vs Surgery - doing a trauma fellowship because I absolutely loved it. I did another away rotation in EM. That rotation pretty much locked it. I loved everything I was doing. I didn't mind asking consultants what their opinions were. I didn't care that I wasn't always involved in (at least short-term) with definitive care.

The turning point was talking with many, many surgical residents and fellows about their personal lives. To me, the price they were paying in their family (not personal) lives was too much. I really liked these residents and fellows and honestly valued their opinions - so when I was told, "Why are you worried about your wife, there's always another wife out there." I completely changed. The comment was in jest. We had a great rapport but the fact is: that thought was valid in some corner of his mind.

After doing the away and realizing I really enjoyed what I was doing (being a medical student aside 😉 and then thinking - hey, I won't have clinic and I won't have that really, really hard 7 year track into trauma surgery... It became an easy decision.

My family comes first. I won't budge on that. If it were medicine or something else and my family - I would leave medicine.

This is not to say that EM is easy. It's not. FP/IM/Surgeons have call, but do not typically work over weekends and holidays. Depending on the practice and subsequent call schedules these other specialties may work a ton of call (especially when young surgeons/IM/FP attendings) or it may be a great schedule. However, call was also not something I was fond of. I liked my ED months as a 4th year. When I was there, I was there. Sometimes, I needed to prepard for a night shift by sleeping ahead of time - but to me, that was far superior to having to leave my wife and kids because I was on call.

To summarize: I think the concept of "lifestyle" is BS. I do love the fact that I KNOW when I work and when I do - if I practice as I've been trained, I shouldn't worry much when I go home to sleep. I also love working really hard for a certain amount of time, helping many people - some I don't, but most of these are either beyond help on a chronic or acute basis. I have closure, I can follow up, and my professional life erodes only minimally on my family.

Plus, if there were an emergency in public, who would you want? On an airplane? Is there any more WIDELY useful specialty than EM? (I know, I know, FP/IM/Peds/and surgeons are also extremely useful in those situations 😉