How Are You Choosing a Specialty?

Joshua Batt, Medical Student, Emergency Medicine

The cut was made, some dissection performed and the baby was pulled out. I was holding our patient's uterus in one hand and assisting my attending with the other during a scheduled cesarean section. All I could think was how this doctor's job is simply amazing. How many people can say that they get to open a person's body, pull out a living organism and twelve inches away, you can stare the patient in the face and have a discussion with them?

Between the work of the anesthesiologist and the obstetrician, I was enthralled by the situation. Their team effort and training made the operation a success. Baby was beautiful, mom and dad were happy and the medical crew had performed well. It was not a long procedure, but one that left me wondering if I could be doing this as a career. Yet another moment of reflection needed if I am ever going to decide what to be "when I grow up."

That question, "What are you going to be when you grow up?" continues to haunt me as time rushes past. At least I have the doctor part down; now to narrow things down a little. It certainly doesn't help going into residency applications and interviews with multiple fields of interest and no geographical preference. There are simply too many places, professions, and programs to choose from.

Some aids I have found include the specialty flowchart, the University of Virginia's Medical Specialty Aptitude Test (MSAT), and The Ultimate Guide to Choosing a Medical Specialty. There are days when I agree with their advice and other days I think they are in left field. What have you found useful in making your decision?

Residency Interview Tips

kendracampbell, MD, Psychiatry/Mental Health

Residency interview season is in full swing. I've already been to a few interviews, and I have picked up one some common do's and don'ts. Here is a list of residency interview tips that I've compiled based on my own experience and advice from others:

1) Stay Organized! I am completely organized to the max, and it has been super helpful. Here are some things I've done and recommend doing:
a) Create email folders and sub-folders, if necessary. You will send and receive many emails. Keep them organized.
b) Create a binder for program info. I have a color coded, chronological system set up.
c) Keep all your interview dates on a calendar! I have mine both on paper and electronically, which has worked super for me.
d) Keep all the papers and info they give you. I have mine in an expandable file folder system.

2) Research the programs. The more you know about the program, the better decisions you can make, and the better you look on interview day. Almost every interviewer has asked me, "why are you interested in this program, in particular?" If you can't answer this question, you will look unprepared!

3) Dress professionally. Wear a suit. Use common sense here. No chest hair showing, no huge gold dollar sign necklaces, and no hooker make-up.

4) Be on time. (Yes, I am obsessed with this one.) Leave WAY early, expect traffic delays and build in time for them.

5) Be prepared for questions. There are many great resources on the web with lists of common residency interview questions (you can check out some from the AAMC here). You should try and go though most of them and come up with an idea of an answer. You don't need to memorize every single question, but you should be prepared to answer the commonly asked ones.

6) Ask questions! It's not a bad idea to make a list of questions about the program in advance. Trust me, you will hear "do you have any questions?" one hundred million times on interview day. If you don't have any questions at all, you look like you're not really interested in the program.

7) Write thank you notes to your interviewers. Either electronic or paper, or both.

8 ) Know your strengths and weaknesses. Be able to give examples of both. Know how to sell yourself. Be confident about yourself as a candidate!

9) Have water accessible during the interview. Maybe this is just me, but I tend to get super dry mouth when I'm interviewing. I always make sure to have a cup or bottle of water nearby. I learned this lesson the hard way.

10) If you are really interested in a program, go back for a second look. This helps you remember the program, and shows that you are truly interested!

Good luck to everyone on their interviews!

AMA Interim Meeting recap

House takes action on ACOs, private contracting Here's a recap of the actions taken by the AMA House of Delegates at its Interim Meeting Nov. 6-9 in San Diego. Physicians from every state and specialty set policy that will shape the actions of the AMA on issues of most importance to the nation's doctors and their patients. The House of Delegates adopted a series of principles regarding the establishment and operation of accountable care organizations (ACO), one of the new payment and delivery models established under the Affordable Care Act. The guidelines state that the goals of an ACO are to increase access to care, improve the quality of care and ensure the efficient delivery of care. Steve Lee, AMA Medical Student Section delegate, testifies before the House of Delegates. The House asked the AMA Board to provide further clarity regarding non-physicians who may be performing invasive procedures, including the use of fluoroscopy, interventional pain management procedures and other treatments. Delegates also adopted new policy that, in academic environments, the AMA only support payment models for non-physician practitioners that do not interfere with graduate medical training. The House directed the AMA to give priority to a legislative and grassroots campaign to adopt the Medicare Patient Empowerment Act. It would let Medicare patients keep their benefits when they privately contract with any physician of their choice. Read more in American Medical News. Among ethical issues considered, the House adopted new policy that outlines a number of considerations physicians should weigh in using social media. These include using privacy settings to safeguard personal information, considering separating personal and professional content online, and recognizing that actions online and content posted can negatively affect their reputations. Special Links Poll shows great concern about pending Medicare cuts A staggering 94 percent of Americans are concerned about a looming Medicare cut to doctors, according to a new AMA poll released during the meeting. Read more On the Road with Dr. Wilson In his blog, the AMA president reflects on the Interim Meeting and points to it as an example of democracy in action. Read more. American Medical News coverage Read full coverage of all news from the Interim Meeting at amednews.com. See video highlights from the meeting View a video recap of the Interim Meeting by The Doctor's Channel. More highlights Read daily highlights from the meeting. Jeremy Lazarus, MD, Speaker of the House of Delegates, presided over the meeting. The House weighed in on public health issues by extending support for universal influenza vaccination of health care workers to include seasonal and H1N1 influenza. It also urged that marijuana's status as a federal Schedule I controlled substance be reviewed to facilitate clinical research and development of cannabinoid-based medicines. In addition, the House voted to support a requirement that athletes participating in school or youth sports who are suspected of having a concussion should not return to play or practice without a physician's written approval. They also asked the AMA to support legislation requiring the use of helmets by youths 17 and younger while skiing or snowboarding. After some cities tried to levy taxes on college tuition, including medical school tuition, the House adopted new policy opposing such taxes. On AMA governance issues, the House voted to require that endorsements of nominations of officials for public office be considered and approved by the entire Boardof Trustees. The House referred two business items to the Board for review: the future of the Interim Meeting, particularly whether it should be combined with the National Advocacy Conference and held in Washington, D.C each year, and whether to study if the AMA should be transformed into an "organization of organizations." Education Sessions Richard Deem, the AMA's senior vice president of advocacy, discussed AMA priorities to improve the health system reform law. Improving the Affordable Care Act During "The evolving Affordable Care Act: what it means to you and your patients," physicians learned about the AMA's goals to improve the health system reform law. Replacing Medicare's sustainable growth rate formula with positive updates is at the top of the list.   Retraining is an important step for physicians looking to re-enter clinical practice, said Claudette Dalton, MD. Retraining a big part of re-entry Whether physicians have taken time off because of an illness, served in a government position or started a family, they need retraining to maintain their skill set. That was a key takeaway from "Physician re-entry into clinical practice: What you need to know," which highlighted important steps physicians should take before they begin a leave of absence. Betsy Thompson, MD, reminded physicians how to qualify for incentives through the Centers for Medicare & Medicaid Services EHR program. Physicians share EHR success stories Presenters during an overview of the electronic health records (EHR) incentive program shared practical examples of setting up systems in their practices. One physician said his practice eventually realized total savings of $283,000.   Thomas Luetzow, MD, of the Wisconsin Medical Society updates physicians on a lawsuit filed over the state's attempt to confiscate medical liability funds. Legal briefing looks at current lawsuits The Litigation Center of the AMA and the State Medical Societies' open meeting updated physicians on litigation regarding the Federal Trade Commission's "red flags" rule as well as various other cases affecting physicians and patients. Special Events Nicole Lee, MD, an obstetrician/gynecologist from Pearl, Miss., talks with students during Friday's event. Doctors connect with San Diego high-schoolers About 100 high school students from San Diego's School of Science and Technology learned what it means to be a physician as part of an AMA Doctors Back to School™ event on Nov. 5.   AMA-MSS at-large officer Busayo Obayan, a fourth-year medical student at Boston University School of Medicine, does a stretching exercise during Saturday's event. Students hit the gym to highlight healthy living About 20 medical students from the AMA Medical Student Section spent part of Nov. 6 exercising with visitors of Mid-City Gymnasium in San Diego as part of a service event promoting healthy lifestyles. Rashi Aggarwal, MD, spoke about the need for leaders to match their image of themselves with others' perception of them.   IMGs share perspectives on leadership Attendees of the Busharat Ahmad, MD, Leadership Development program heard advice about leadership from a panel of international medical graduate physician leaders, including Rashi Aggarwal, MD; Nestor Ramirez-Lopez, MD; and Eileen Zhivago, MD. Later, Daniel Johnson Jr., MD, a former AMA president and former speaker of the House, discussed parliamentary procedures and how to chair a meeting more effectively. The AMA International Medical Graduates Section sponsored the program.   Join Us The AMA's strength comes from its numbers, and that strength grows when the AMA's membership increases. If you're not an AMA member, please join today by calling (800) 262-3211 or by visiting the AMA website. And please urge your colleagues to do the same.      To unsubscribe, click here to bring up a new e-mail message and click "send." No subject line is necessary. Update your e-mail address. Your personal information will not be shared with any third parties. For further information, read our Privacy Policy and Terms of Use. Also, please add the domain name "@enews.ama-assn.org" to your address book or e-mail filter "whitelist" or tell your organization's IT group to allow this address to pass through any filtering software it may have set up. Copyright 1995-2010 American Medical Association. All rights reserved. American Medical Association - 515 N. State St., Chicago, IL 60654 - (800) 621-8335

 

 

ACP Medical Student Health Policy Internship

http://www.acponline.org/medical_students/impact/archives/2010/10/perspect/

Are American Med Students Better than International Med Students?

Kendra Campbell, MD, Psychiatry/Mental Health, 07:56PM Oct 20, 2010
A medical student recently asked me the above question during their rotation with me. He specifically wanted to know if I noticed a difference in the quality of medical students, based on the school they attended. This is a question, which I considered when deciding to attend an international medical school, and is one, which I also pondered during my medical education. As a medical student, I interacted with both "American" medical students and foreign/international ones.

As a resident, I have now interacted with a variety of medical students. I've worked with students who are from U.S. medical schools, and ones who are from international medical schools. While my anecdotal evidence might not hold that much water, I can now say, with complete confidence, that the medical school which a student attends has little correlational value with their performance on clinical rotations. I obviously cannot speak to their board scores, or any other parameters. But when it comes to general knowledge, patient rapport, clinical skills, and overall performance, I've determined that it's more about the student and less about the school.

While this post started out as a discussion about AMGs (American Medical Graduates) versus IMGs (International Medical Graduates), I would like to change gears and give some general tips to medical students from the perspective of a resident. And for the record, while the resident might not be the one to ultimately grade the student (although we do have input), in my experience we are in the unique position of interacting with the students more than the attending. Sometimes we even do more of the teaching. Anyway, here are some tips, which I can provide based on my experience:

1. Be motivated to learn. Even if you are not planning on going into the specialty in which you are rotating, your motivation level speaks volumes about you as a student, and you as a future doctor.

2. Ask many questions. Asking questions shows that you are interested in learning, and will ultimately make you a better physician. (See #1.)

3. Know your patient. Since medical students generally have a lighter patient load, you have the potential to know each patient that you cover even better than the attending or resident might. I promise that nothing impresses the attendings and residents more than a med student who offers a piece of information about the patient, which was unknown to them.

4. Listen, read, and read. If you want to impress your attending and resident (and ultimately be a better prepared doctor), listen to what they teach you. Try to pay attention to what they emphasize as being important, and read up on pertinent subjects in your "free" time. You are in the hospital/clinic/etc. to learn. Take advantage of this opportunity in every way you can, and follow-up on all discussions with researching/reading in your time away from the hospital.

5. Anticipate what needs to be done and do it. Nothing will make your resident (and attending) happier than to find out that you completed the discharge paperwork for them because you knew the patient was going to be discharged that day. Have the consults sheets, CT requests, doctor's orders forms, etc. ready when you anticipate that they are required. Seriously, this is key! And I can't emphasize enough how happy this makes the residents!

So, that's my two cents on how to be an effective medical student, who will ultimately grow into an effective resident, and physician, no matter which med school you attended. But are these strategies and competencies specific to the med school one attends? I'd love to hear what you think.

Top 10 Residency Interview Questions

It’s been one month since ERAS (Electronic Residency Application Service) opened its floodgates and released thousands of potential residents’ applications for residency in the US. There are lots of great resources online for advice and tips with regards to the dreaded residency interviews. But I’ve received emails asking to provide the most common interview questions that I encountered last year, while on the interview trail. So, here is a list that I’ve created, in relative order of frequency:

1. Tell me about yourself.

2. Do you have any questions?

3. Why are you interested in (fill in the blank) as a specialty?

4. What do you like to do for fun?

5. What is your specific interest in this program?

6. What are your future goals, aspirations, beyond residency?

7. What are your weaknesses?

8. Can you see yourself living in this area?

9. Where else have you applied?

10. What area in this speciality interests you most, and do you plan on completing a fellowship?

The above questions are fairly standard. However, for fun, here are some random questions that I was also asked during interviews:

1. If you were a car, what type of car would you be, and why?

2. How do you feel about the philosophical underpinnings of psychiatry?

3. Can a doctor have a pink mohawk?

4. Have you ever had a pink mohawk?

5. If you could paint a mural on the blank wall in front of you, what would you paint, and why?

6. What is the one thing, which is not on your application, which you think would cause us not to accept you into our program?

7. What kind of dogs do you have?

8. If you were a fruit, what kind of fruit would you be, and why?

9. Tell me about the worst patient you’ve encountered.

10. How is your relationship with your family?

I hope this is helpful to a few folks out there. For all of you who have been through the residency interview process, or are currently going through it, please do add either a common question, which I’ve missed, or an “off the wall” one, which you've encountered!

Clerkship Order Linked to Outcomes on Clerkship Exams

September 14, 2010 — Third-year medical student performance is associated with the first clinical clerkship, with students who start with internal medicine showing the highest subject examination performance and overall grades.

However, clerkship order is not associated with clerkship clinical performance or US Medical Licensing Examination Step 2 scores.

The findings, from a retrospective review of medical students attending a single US medical school, are published in the September 15 issue of the Journal of the American Medical Association.

"Studies have demonstrated the importance of clerkship sequence on aspects of performance in select clerkships, and their findings support that students perform better on subject examinations as they progress through the academic year," write Susan M. Kies, EdD, from the University of Illinois College of Medicine, Urbana, and colleagues. "Although research supports that students perform better in clerkship examinations later in the year, we are not aware of any studies that have addressed whether knowledge is gained as a result of a certain clerkship specialty,"

Accordingly, in this study, the authors sought to assess whether the order in which third-year core clerkships are completed affects student performance.

They analyzed the clerkship performance records of 2216 medical students at all 4 campuses of the University of Illinois College of Medicine who completed their third-year core clerkships in internal medicine, family medicine, surgery, pediatrics, psychiatry, and obstetrics/gynecology from July 2000 through June 2008.

They found that first clerkship was significantly associated with mean subject examination scores. For family medicine, it was 71.96 (95% confidence interval [CI], 70.90 - 72.98); internal medicine, 73.86 (95% CI, 73.33 - 74.39); obstetrics/gynecology, 72.36 (95% CI, 71.64 - 73.04); pediatrics, 73.11 (95% CI, 72.38 - 73.84); psychiatry, 72.17 (95% CI, 71.52 - 72.81); and surgery, 72.37 (95% CI, 71.73 - 73.02; P < .001).

Similarly, first clerkship was significantly associated with mean overall clerkship grades. For family medicine, it was 24.20 (95% CI, 23.90 - 24.90); internal medicine, 25.33 (95% CI, 25.07 - 25.60); obstetrics/gynecology, 24.68 (95% CI, 24.32 - 25.05); pediatrics, 24.92 (95% CI, 24.59 - 25.27); psychiatry, 24.61 (95% CI, 24.33 - 25.01); and surgery, 24.97 (95% CI, 24.64 - 25.30; P = .01).

The study also found a significant difference in mean total overall clerkship grades for students taking internal medicine first compared with obstetrics/gynecology (mean difference, 0.65; 95% CI, 0.18 - 1.12), psychiatry (mean difference, 0.66; 95% CI, 0.20-1.12) and family medicine (mean difference, 0.93; 95% CI, 0.37 - 1.50).

The positive association between starting a clerkship with internal medicine and subsequent examination performance throughout the clerkship sequence may be a reflection of a general understanding of internal medicine concepts that provide a basis of medical knowledge that extends to all clinical disciplines, the authors note.

"Having taken the internal medicine clerkship, students may have the basic understanding of these concepts and an advantage in standardized examination performance thereafter," they write.

The University of Illinois may not be representative of a typical medical school because of the diversity of its 4 campuses, the authors note. Other study limitations include the retrospective and observational study design, incomplete randomization to first clerkship, and variation in clerkship experience among the different campuses.

"The success of student clinical performance may be related to factors other than those included within the scope of this study," the authors write in their conclusion. "Additional analyses of student performance in the clinical setting and in other institutions may help provide optimal experiences for students."

The study authors have disclosed no relevant financial relationships.

JAMA. 2010;304:1220-1226.