the “expert intern”: time management

Probably the two most contradictory words you will hear throughout your experience in your first year in any speciality. My personal opinion is that no matter how hard you try, you will still find yourself struggling to manage your patient load, medical and social, in addition to making it home on time, barring emergent situations with your patients.

A few things I have come to learn in my short stint as an internal medicine resident. The first thing is getting to know whether you are a morning or a night person. If you are a night person, the first thing you will need to learn is…how to become a morning person. It goes without saying because you will need to pre-round on your patients before meeting with your senior resident, and then with your attending. Hospitals vary how they round, and you will also find your niche. For me, I would print off my patient list, write their vitals, review their labs, and then off to the races to interrogate my patients for a few minutes before preparing their progress notes. I went from writing down nearly all of my patient’s review of systems to jotting down their pertinent findings in short form. All the while you will be fielding pages from your nursing teams and other ancillary staff to answer questions and concerns. As the time proven saying goes, “time flies”, and it truly does. So time management is key to understand each of your patient’s history of presenting illness, their medications, allergies, and other relevant history, and how it may or may not contribute to how you treat them during their admission.

We also all took some version of Step 2 CS. We are only allowed 15 minutes in each patient encounter to introduce yourself, perform a full physical examination, and offer your thoughts on their diagnoses and what the next steps are. Knowing you have so many patients to see in the morning, you can also time yourself to ask only the pertinent questions for now. After rounds, I would return to the patient room to update them of the plan, especially discharge planning because that would be a terrible surprise to patients. Prior to our noon conference, I would update each of the nurses about the plans for the day, from medication changes to discharge planning. Unless your program has a nursing rounds, you will need to do this too to ensure everyone is on the same page. No matter the size of your program, floor staff talk, and you do not want to be on anyone’s bad side because they can make or break your experience during rotations. I felt that by doing this, I had a sense of completion that even if I left the floor or did not touch base with the nursing staff from then on, they would know the plan or changes to management. It also sets up a line of communication between you and floor staff so they continue to communicate and advocate on your behalf.

You then should set aside a portion of time to prepare discharge summaries for your patients that likely will be discharged that day or even a day after. You will learn to insert various tasks during brief moments of free time to get ahead of the curve. It is an art that no matter what stage of training you are in, should be an area we consciously focus on. Thats it for now folks, talk to you later. Save a life!

Advertisements

Step 3

Studying and taking step 3 before my intern year was probably the best decision I could have made. I under estimated the learning curve and how tired I would be at the end of the day. I couldn’t imagine sitting down for more hours and studying textbooks/videos. Especially when there is so much to do in a new area! I will say though, being an intern may have helped me a bit for CCS cases, but I don’t think the training I have received so far in my residency would have necessarily increased or decreased my score. I think the majority of preparation should be placed on the CCS cases, if you are taking it before starting any formal training. Otherwise, you’ll get the hang of what labs and tests to order off the bat. Having completed a week of outpatient care, I believe that was beneficial for certain cases too. I can recall several of my family medicine rotation experiences helping me out, more often than out. Step 3 is a great time to recall all those wonderful patient encounters you had as a medical student. For the multiple choice portions though, UWorld was key. It gave me a decent preparation for the types of questions and the length too. Other texts I decided to use were my Step 2 CK notes, and master the boards step 3. I used the latter towards the end of my studying because it was mainly a review book at that point. I did not want to be bogged down in too much detail and wanted just the “what to do” because that is how the exam is going to test you.

There are a few practice exams too that I would highly recommend to any student to take advantage of. My score was the average of the practice exams. It’s seemed to work out for me, so I think the same would apply to other students too. So, don’t be too excited that you got a 250, but get a 200 on another. Use all of these items as study tools for improvement! (but yes, getting a passing score on a practice test is great for morale, lol). Best of luck to anyone taking the exam. Please send questions for new blog posts! Take care.

What are my chances?

A very common question that students and graduates ask across the world. When it comes to selecting applications for interviews, you never really know how the process goes. It could be as simple as picking a file that has a familiar name or undergraduate program or a personal statement that really shined. Then there might be instances where it was entirely luck of the draw and you just so happened to be one of the lucky ones. Each year, programs across the country review thousands of applications for those coveted interview slots. Us applicants are all vying for the same positions, so it’s funny that during interviews we are all so pleasant with one another. Even myself, I recall bonding with other applicants over not having received interviews from several programs and how our experiences had aligned over the interview trail.

Each year, the NRMP publishes their data about the applicant pool for that year. You can also find other nifty little charts and such that companies have published too (see below). However, it is all an average. While many programs do have cut-offs for various board scores, others may be willing to read applications that don’t meet their criteria. At least that was my experience for several programs that apparently explicitly stated they would not interview anyone with less than a 250.

https://www.doctorsintraining.com/blog/usmle-step-1-average-match-scores-by-specialty/

https://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

In my opinion, the best way to increase your chances is to have a stellar application. It should be tidy and well thought out. It shouldn’t be a hodge podge mix of activities that you threw together just because you wanted to fill up the space. Your writing should be thoughtful and really try to express your interest in everything that you have done and accomplished up until now. That is my best advice to increase your chances. Sometimes it is as simple as your grammar and saying the right choice of words. Please keep in touch and happy to help students along the way! Take care.

Residency personal statement editing services

For anyone that is applying for residency in the upcoming cycle, it is not too early to start thinking about your personal statement. You want to be entirely prepared to click “submit” the first day the application opens. The personal statement is so critical these days for more than one reason. Obviously to know that you can express yourself. The other reasons though, are that you are able to discuss the ways you reached your decision to pursue your field. You have to do it concisely because programs will read hundreds of statements! I am offering my services for applicants at a student friendly rate. Feel free to contact me to further discuss. I received 40 interviews for internal medicine, and have a strong history of writing success with students, residents, and fellows. Thanks!

I matched to my #1 ranked program

And you can do it too! I think there is a lot of stigma that comes with being an international medical graduate. It is a sad truth that we are not prioritized by many programs because of paperwork and probably a better selection of students such as those coming from US medical programs with stronger reputations. Even accepting students that have done elective away rotations at those sites that international medical graduates cannot readily get their hands on. The only thing you have to control is the application that you submit to programs. How you present yourself through your personal statement, activities, awards, research, and letters of recommendation. It all matters, and should come together to represent you as a student and clinician. What makes you unique as an applicant? It is a difficult question, but everyone brings something new to the table, and requires a good amount of thought to truly comprehend. On a number of instances, I have been asked what I felt I could bring to a program. So practice, practice, practice!

I ranked to my #1 program, and it is a university program. I was excited to have the opportunity to rotate with a strong intern class and be able to consider any fellowship I would be interested in. This program allows me to do just that. I spent match week so anxious and apprehensive about the location. Although I had several interviews, I was most excited about this program because of location, curriculum, and post-graduate opportunities. I kept thinking about how that day went and the conversations that we had. I would encourage any applicant to return for a second look if the program allows it. Again, it may not really add anything to your application, but it gives you a better sense for what goes on beyond the initial interview day.

when I went back for a second look, I shadowed the inpatient team and interacted with the attending. I was able to ask more questions to different residents that I didn’t meet the first time, and got a sense for the true nature of the program. I think it’s important because, keep in mind, the interview day is set up for so many people to get a taste of what’s offered. Even the lunch was catered, so don’t expect to have that everyday either! It was a worthwhile experience, that really helped to solidify my decision.

Anyway, I’m happy to offer my services to anyone that might be interested. I have plenty of experience editing residency personal statements and applications. It is a lot of work, and never too early to get started. Feel free to contact me. Best of luck everyone!