What should I tell Adcoms??

[SSSMDt]

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I recently spent 3 months living in South Africa and working in a trauma unit in one of the hospitals in the townships. While there, I was able to stitch people up, insert chest drains, give injections, and the like... When I get asked during interviews about the sort of work I was doing down in South Africa what should I tell them? Should I just say that I volunteered in the ER doing remedial stuff? Just assisting the physicians with whatever they need? How should I word something like that? I obviously imagine mentioning the stuff above would be seen as irresponsible and wreckless and be highly frowned upon...

 

[The Milkman]

were you certified to do any of that stuff? were there MD's telling you to do it and supervising you?

 

[SSSMDt]

No. Yes.

 

[SSSMDt]

Well South African physicians don't go by "MD"s, but yes the equivalent

 

[The Milkman]

Hmmm... in my opinion if it were American earned MDs that were there supervising you, then it would be fine (essentially like a physician letting you do something in your clerkships). Not sure anymore though.

 

[drdoom12]

I wouldn't bring up the things that you aren't trained to do. I had an interviewer ask me what I did during a trip abroad and questioned if I was trained to do those things. I was. I wouldn't lie about it if asked, though, either.

 

[SSSMDt]

Goro and company.. Would you frown upon hearing experiences like that? For which I dont necessarily have formal training besides what I received while there, but was still able to do there..

 

[baxt1412]

You acted out of your scope IMO. I would be unimpressed as, IMO, it shows a lack of maturity and responsibility. I'm no ADCOM, obviously, but that's how it strikes me.

I'm guessing even there, you still were *officially* out of scope. This isn't something like traveling to Europe and drinking when you're 19 since the age is 18 there. If I had to guess, you were still carrying out techniques that you were not officially trained/certified/etc to do in that country.

 

[mimelim]

I recently spent 3 months living in South Africa and working in a trauma unit in one of the hospitals in the townships. While there, I was able to stitch people up, insert chest drains, give injections, and the like... When I get asked during interviews about the sort of work I was doing down in South Africa what should I tell them? Should I just say that I volunteered in the ER doing remedial stuff? Just assisting the physicians with whatever they need? How should I word something like that? I obviously imagine mentioning the stuff above would be seen as irresponsible and wreckless and be highly frowned upon...

I am a surgical resident, so take what I say with a grain of salt.

#1 Do not talk about things that you did that were illegal or if there are rules against them. If in South Africa or at the hospital you were at, there is a policy against pre-meds doing things, then do not talk about it.
#2 There is nothing inherently wrong with a student doing any of those things. My medical students do all of those things, with supervision of course.
#3 None of those things are particularly difficult to do. There are nuances like most things in medicine, but they have very basic technical consequences.
#4 Far more difficult than doing any of those things is knowing WHEN and WHY to do those things, which is true in a lot of surgery/procedures.
#5 You do not need formal 'training' before doing any of those things, except chest tubes. Someone can walk you through suturing or giving injections. And, even chest tubes... A couple of quick sessions and a review is usually all most people get before they have to do it for real.
#6 None of this is really all that important. You aren't impressing anyone by doing these things as a pre-med. We aren't selecting for a technically competent people for our medical school class. We are looking for people that a) want to go into medicine, b) are likely to stay in medicine and c) have the academic prowess to survive the training. Do procedures in the trauma setting doesn't really help for any of that.

 

[breakintheroof]

Relevant tweets from Michigan's admissions office, in 2013:

It is a negative (and unethical) when untrained applicants tell us about performing clinical procedures as part of a global experience!!

And 2011:

I'm (deeply) troubled when I read apps that recount clinical work done abroad that one isn't trained to do=unethical=rejection.

Be cautious, OP. (I hope you and your supervisors were cautious in South Africa, too.)

 

[DokterMom]

Personally, I would be horrified and offended. I'd be willing to bet that the patients you treated yourself were not affluent whites; and allowing a completely untrained and unqualified person (as you necessarily would be at this stage, so nothing wrong with that) to perform procedures on patients who were undoubtedly not informed of your lack of qualifications -- that offends me deeply. That's not the kind of medicine any US MD schools want to promote, and is the worst kind of 'medical tourism' imaginable.

If asked, say that you were privileged to have lots of patient contact and do not mention performing procedures.

 

[Goro]

Based upon the reactions I see to stuff like this, the most horrified people tend to be pre-meds, and I would more likley be impressed that you were able to do all that.

But I do wonder what my clinical colleagues would say. I'll have to ask a few.

Stay tuned!

Goro and company.. Would you frown upon hearing experiences like that? For which I dont necessarily have formal training besides what I received while there, but was still able to do there..

 

[armoman92]

I just watched Blood Diamond.

In my opinion, I would embellish the truth, and make up a story that somehow follows the guidelines mimelim was so kind to provide. Who is going to know? Don't make it sound remedial, spice it up. Use colorful metaphors (i.e. "bloody hands", "hearth rate accelerated" , "moral dilema" , "my need to help save a life overrode..." , etc.) Make up emergency situations where you were forced or inclined to help do something (you are not trained to do), under a direct order. Then you can reflect on it, and express how you felt bad doing it, but you had no choice. That will make the adcoms happy according to breakintheroof's post.

I am a surgical resident, so take what I say with a grain of salt.
#1 Do not talk about things that you did that were illegal or if there are rules against them. If in South Africa or at the hospital you were at, there is a policy against pre-meds doing things, then do not talk about it.
#2 There is nothing inherently wrong with a student doing any of those things. My medical students do all of those things, with supervision of course.
#3 None of those things are particularly difficult to do. There are nuances like most things in medicine, but they have very basic technical consequences.
#4 Far more difficult than doing any of those things is knowing WHEN and WHY to do those things, which is true in a lot of surgery/procedures.
#5 You do not need formal 'training' before doing any of those things, except chest tubes. Someone can walk you through suturing or giving injections. And, even chest tubes... A couple of quick sessions and a review is usually all most people get before they have to do it for real.
#6 None of this is really all that important. You aren't impressing anyone by doing these things as a pre-med. We aren't selecting for a technically competent people for our medical school class. We are looking for people that a) want to go into medicine, b) are likely to stay in medicine and c) have the academic prowess to survive the training. Do procedures in the trauma setting doesn't really help for any of that.

 

[brootas14]

I was asked a hypothetical like this at an interview this year (not having had such an experience myself). I think that the best answer to your question is, as you have been advised, not to explicitly mention the out-of-scope parts of your global experience. However, if pressed, there is value in saying that you understood that, given the very limited resources at that time, it was better for you to act than to leave the patient untreated, or to refuse to act.

Some perspectives that people give about untrained staff are routed in our understanding of our medical system, where there are sufficient (or near sufficient) numbers of providers. You're not saying that you acted in lieu of a provider who was qualified, but that you were required to, lest the patient not be treated (or pulling a higher-qualified provider away from a needy patient). There are no ideal situations here, but I think that, given how common the issue of students participating in treatment seems to be, there's an understanding that it goes deeper than you acting against better judgment.

 

[armoman92]

I was asked a hypothetical like this at an interview this year (not having had such an experience myself). I think that the best answer to your question is, as you have been advised, not to explicitly mention the out-of-scope parts of your global experience. However, if pressed, there is value in saying that you understood that, given the very limited resources at that time, it was better for you to act than to leave the patient untreated, or to refuse to act.

Some perspectives that people give about untrained staff are routed in our understanding of our medical system, where there are sufficient (or near sufficient) numbers of providers. You're not saying that you acted in lieu of a provider who was qualified, but that you were required to, lest the patient not be treated (or pulling a higher-qualified provider away from a needy patient). There are no ideal situations here, but I think that, given how common the issue of students participating in treatment seems to be, there's an understanding that it goes deeper than you acting against better judgment.

Agreed. Whatever route you take, or story you make up, rehearse it profusely, until it becomes true in your head.

 

[brootas14]

I appreciate that you agree with me, but unfortunately, its not mutual. Please don't embellish your story, no one is looking for a guts and glory kind of applicant. It comes across as immature and... bloodthirsty?

You have to be very purposeful and thoughtful in your answer, ideally that you were conflicted in that moment, but that the urgency and need precluded you from making an unbiased assessment. I'd compare it to when, as an EMT, you start CPR on a patient until you find their DNR, and don't just take the family members word for it when they say they have one. That's sort of what happened for you, right?

 

[armoman92]

I appreciate that you agree with me, but unfortunately, its not mutual. Please don't embellish your story, no one is looking for a guts and glory kind of applicant. It comes across as immature and... bloodthirsty?

You have to be very purposeful and thoughtful in your answer, ideally that you were conflicted in that moment, but that the urgency and need precluded you from making an unbiased assessment. I'd compare it to when, as an EMT, you start CPR on a patient until you find their DNR, and don't just take the family members word for it when they say they have one. That's sort of what happened for you, right?

That's what I said. Writing has it's own powers. Using descriptive details, and imagery makes your story stick out in the mind of the reader. The Adcom is reading a ton of personal statements. It's like being forced to watch a series of boring documentaries, and suddenly an Arnold Schwarzenegger movies comes into the queue. I'm not saying your statement should be silly, but colorful.

 

[g gnome]

There were two experiences I had this cycle that would lead me to believe that telling them the full scope of what you did would be detrimental.

1) At school A the applicants were asked as a group an ethical question regarding this exact situation: an applicant that has treated a patient, similar to you, and had included this in their personal statement. Long story short, the adcom said that she would not give an interview to this applicant because of a "proven lack of maturity, judgement and ethics"

2) At school B I was asked about my own experiences abroad, and the interviewer was relieved to learn that I did not treat patients. Apparently an applicant before myself had helped deliver a baby, and seemed to think that this was totally OK. Adcom was astonished.

Basically, you have nothing to gain from telling them that you treated patients and everything to lose. You absolutely saw a lot of cool stuff down there though and learned a lot from the physicians you worked with. I would focus solely on this.

 

[armoman92]

Basically, you have nothing to gain from telling them that you treated patients and everything to lose. You absolutely saw a lot of cool stuff down there though and learned a lot from the physicians you worked with. I would focus solely on this.

You also have a strong point. Like how talking to the police can only hurt you.
Most of life is crapshoot in the end.


OP, at the end of day, it comes down with how much balls you have, your temperament, and how well you act. I have a bit of a grifter personality, so take my advice with a grain of salt. Still, its the confident ones that get ahead in life.

 

[mimelim]

There were two experiences I had this cycle that would lead me to believe that telling them the full scope of what you did would be detrimental.

1) At school A the applicants were asked as a group an ethical question regarding this exact situation: an applicant that has treated a patient, similar to you, and had included this in their personal statement. Long story short, the adcom said that she would not give an interview to this applicant because of a "proven lack of maturity, judgement and ethics"

2) At school B I was asked about my own experiences abroad, and the interviewer was relieved to learn that I did not treat patients. Apparently an applicant before myself had helped deliver a baby, and seemed to think that this was totally OK. Adcom was astonished.

Basically, you have nothing to gain from telling them that you treated patients and everything to lose. You absolutely saw a lot of cool stuff down there though and learned a lot from the physicians you worked with. I would focus solely on this.

As a complete aside, it was probably safer to deliver the baby with pre-med assistance in that foreign hospital than in a US hospital with an MD.

But, yes, you have nothing to gain by telling people that you helped treat patients.

 

[candbgirl]

OP everyone seems to be assuming your activities were done because either you did them or they didn't get done. Is this actually the case ? How much supervision did you actually have. You seem to be saying you did it by yourself. Is this the case? I'm just interested in how and why you decided to do these procedures.

 

[Goro]

Yup, nothing like lying in an interview to bone up your chances.

I just watched Blood Diamond.

In my opinion, I would embellish the truth, and make up a story that somehow follows the guidelines mimelim was so kind to provide. Who is going to know? Don't make it sound remedial, spice it up. Use colorful metaphors (i.e. "bloody hands", "hearth rate accelerated" , "moral dilema" , "my need to help save a life overrode..." , etc.) Make up emergency situations where you were forced or inclined to help do something (you are not trained to do), under a direct order. Then you can reflect on it, and express how you felt bad doing it, but you had no choice. That will make the adcoms happy according to breakintheroof's post.

 

[brootas14]

OP everyone seems to be assuming your activities were done because either you did them or they didn't get done. Is this actually the case ? How much supervision did you actually have. You seem to be saying you did it by yourself. Is this the case? I'm just interested in how and why you decided to do these procedures.

I don't think its a case of not having supervision. My impression is that in many cases, they want to see as many patients simultaneously as they can, limiting the size of each team to just who is necessary. Very often this means you're missing nurses, MA's and other support staff. Pulling a physician (and thus limiting the amount of patients that can be seen) to do something below their best capability is a limitation. What I took from OP's statement is that he was acting in lieu of a member of a care team.

 

[baxt1412]

I don't think its a case of not having supervision. My impression is that in many cases, they want to see as many patients simultaneously as they can, limiting the size of each team to just who is necessary. Very often this means you're missing nurses, MA's and other support staff. Pulling a physician (and thus limiting the amount of patients that can be seen) to do something below their best capability is a limitation. What I took from OP's statement is that he was acting in lieu of a member of a care team.

I don't like the way you worded that bolded part..... Sure there are things that can be more life-saving/time-sensitive that require the training of a physician, but I don't think that anything should ever be considered "below" a physician. That may not be the way you intended it, so if it's not, then feel free to ignore this.

As far as the underlined part... I see that as the problem. OP is not a trained medical care professional, and thus I do not believe he/she should have been doing any of these things... Just my $0.02

 

[brootas14]

I don't like the way you worded that bolded part..... Sure there are things that can be more life-saving/time-sensitive that require the training of a physician, but I don't think that anything should ever be considered "below" a physician. That may not be the way you intended it, so if it's not, then feel free to ignore this.

As far as the underlined part... I see that as the problem. OP is not a trained medical care professional, and thus I do not believe he/she should have been doing any of these things... Just my $0.02

I can see what you mean to point out... point taken. I was speaking strictly from a liability/decision making point of view, and I didn't mean anything derogatory but you're right to call it out.

I also agree that he shouldn't have done or assisted on any of the procedures. The question is what to say in an interview if you are pressed on it, which is the truth. The alternative in these situations to not acting is for nothing to be done, or to cause a provider to leave caring for another patient to do what you were going to do. There isn't a right answer, but the issue at hand is reasoning out why you did it, not if/if not.

 

[SSSMDt]

OP everyone seems to be assuming your activities were done because either you did them or they didn't get done. Is this actually the case ? How much supervision did you actually have. You seem to be saying you did it by yourself. Is this the case? I'm just interested in how and why you decided to do these procedures.

Yeah I was working in an ER that was in a really awful area where violence (stabbing, gunshots, etc.) was 85% of the reason for hospitalization and was grossly under supplied, let alone understaffed. So for example I remember one overnight shift where, among many many other bloodied and beaten patients, there were 5 patients laying in beds needing chest drains and a trauma surgeon telling me to go put a drain in one of them.. I don't know it was kind of hard for me to say no given what I was watching. But anyways, most of the things I did the docs would show me once and then let me do it under his supervision (a few times if it was something like a chest drain) then let me do it alone, and things like stitching and the like I learned to do while doing research on mice in undergrad so I felt comfortable with respect to those sorts of things. And since there was nothing that was particularly hard that I was doing and I always felt comfortable, plus having docs telling me to go do something like that while they're busy it was hard for me personally to justify telling them "no." If there was something that I felt uncomfortable doing then I had no problem letting them know and they respected that.. but yeah..

Thanks for the advice though everyone.. sounds like maybe just lay off the specifics as much as I can, and if they push for things that I specifically did it sounds like I'll have to find a way to make it sounds like I wasn't being irresponsible/justify it/just not tell them.. I'll have to figure that one out.

And interesting tweets @breakintheroof thanks for bringing that to my attention.

 

[bunnyg]

..

 

[DokterMom]

Spoken like someone who hasn't been out of the U.S...

Things work differently in RSA especially in the townships... The people he was helping likely have no other option, and he was doing it under supervision!

I've lived overseas.

What I smell is one standard of care for one class and another, lesser, standard of care for the 'underclass'.

 

[SSSMDt]

I've lived overseas.

What I smell is one standard of care for one class and another, lesser, standard of care for the 'underclass'.

For the record, I did spend a week and a half working in a very modern hospital and was able to assist on surgeries on mostly fluent white patients. But you're right, most of my 3 months were spent working with those underserved. I mean, the hospital I spent most of my time at in the townships was more of a intermediary where we would stabilize the patient and then send them to the larger, more modern hospital (one of which was in our township) because the initial hospital just doesn't have the supplies to treat the patient in a complete manner. So I might not necessarily say the standard of care is less, but rather medicine as a whole is viewed in a different light.

 

[DokterMom]

For the record, I did spend a week and a half working in a very modern hospital and was able to assist on surgeries on mostly fluent white patients. But you're right, most of my 3 months were spent working with those underserved. I mean, the hospital I spent most of my time at in the townships was more of a intermediary where we would stabilize the patient and then send them to the larger, more modern hospital (one of which was in our township) because the initial hospital just doesn't have the supplies to treat the patient in a complete manner. So I might not necessarily say the standard of care is less, but rather medicine as a whole is viewed in a different light.

Part of the problem is that an investment was made in training you -- and now you're gone, taking that investment with you. I've no doubt that you'll repay that investment many times, provided you become a physician. But how much better off would the township have been had that training and supervision investment been made in a local person who would still be there providing care to a population in need?

 

[SSSMDt]

Part of the problem is that an investment was made in training you -- and now you're gone, taking that investment with you. I've no doubt that you'll repay that investment many times, provided you become a physician. But how much better off would the township have been had that training and supervision investment been made in a local person who would still be there providing care to a population in need?

I do appreciate that point you made. Thats certainly one thing I learned while working there, is that more incentives should be made to have more physicians/residents spend their time working in the townships because right now their compensation and benefits are incredibly (embarrassingly) less; or do something like make it a requirement for med students to spend some time working there or something.

I suppose the only good thing for them for me going through that is that right now I have a strong motivation to go back and work in that sort of environment again. No doubt it would be better to find a way to get local physicians and residents to spend their time working there and your points well taken.

 

[DokterMom]

I do appreciate that point you made. Thats certainly one thing I learned while working there, is that more incentives should be made to have more physicians/residents spend their time working in the townships because right now their compensation and benefits are incredibly (embarrassingly) less; or do something like make it a requirement for med students to spend some time working there or something.

I suppose the only good thing for them for me going through that is that right now I have a strong motivation to go back and work in that sort of environment again. No doubt it would be better to find a way to get local physicians and residents to spend their time working there and your points well taken.

And that insight is worth mentioning --