Hello, again!

June 17, 2015

Hi, Long Lost Readers!

My apologies for the extended break.  I had some busy rotations and then was studying for step 3.  So…7 months later, here I am!  I am beyond thrilled that I will be a PGY-2 in 13 days.  And too, found out just today that I passed Step 3!

When last we spoke, it was November.  I was just finishing-up outpatient peds and starting outpatient neuro.  Absolutely loved peds–was probably the happiest I’ve been all year.  Reaffirmed my decision to do child/adolescent psych.  (Interestingly enough, peds was my best age-group in terms of performance on Step 3).  Outpatient neuro was…jarring.  Everyone says it’s supposed to be so chill–don’t get me wrong, it’s great having holidays and weekends off, working 8:00-5:00ish, but you literally work with a different attending every day.  There are 7 or 8 attendings, so you never quite get used to any of them.  I felt constantly on my toes.  At least in most of the other rotations, you get to a point where you feel comfortable.  Oh–and there’s the same old accompaniment of off-service rotations–losing a weekend.  It’s where you have to go in and do dayfloat (cover ED and consults from 7:30-7:30).  For me, it was 4 days in a row Thanksgiving weekend.  Ugh.  Never. Again.

I had been wondering, for a while, how December worked.  I asked early-on, for December vacation time (we get 3 weeks of vacation per year but there are lots of rules about when we can take it) and was informed that I was not allowed to take additional time off in December (independent of what rotation I was on).  Everyone either gets Christmas week or New Years week off, outside of your 3 weeks of vacation time.  It’s nice unless, like me, you have to work the flanking weekends of that week.  Then it makes travel difficult (though not impossible).  Things on the unit slow down and you decide amongst your teammates who will be on short call and cover the unit each day.  It’s a pretty good month.

January started my month in the ED.  I heard it could be pretty hectic.  The first week was.  I would come in to several people waiting to be seen, then would see 10-15 throughout the day.  You start to learn what the upper years refer to as “b-s consults.”  There are many times we are called to consult on someone who does not have a psychiatric issue but because they are a liability, the ED docs decide they need “psych clearance” before they are discharged.  The only problem with this is, as I’m sure the ED doesn’t take time to notice, our consults are 6 pages long!  It’s not just a quick thing to walk in and make sure a patient isn’t suicidal.  You have to go through what happened leading up to the this event, determine if they have a substance abuse issue, argue with the ED over drug screening (no idea why they don’t do this BEFORE calling a consult), get a whole social history on this person [who just came in drunk], and do a cognitive eval on them [when they’re still sobering-up].  Then the ED wants a decision as soon as you walk out of the room…um no?  Often times, your attending that day will disagree with you or have additional recommendations–if you tell the ED that someone is clear, they will discharge that person before you have a chance to discuss them with your attending.  And then get mad at you for not giving them an answer quickly!  If you think they’re so stable, then why did you call the consult in the first place?!

After the whirlwind of ED, I was back on the inpatient unit.  Starting to get an idea of how things work and felt like I knew what I was doing, so this was a good month.  And it was my birthday.

The next two blocks were inpatient family medicine.  After my experience on inpatient internal medicine, I was nervous, but the family medicine folks were great.  They’re more laid-back than the IM folks and I felt like I had more autonomy on that service.  It was EXCELLENT review and learning in preparation for Step 3.  I decided that I would need to take Step 3 in close proximity of my family medicine blocks, while I was still in that medicine mindset.  2 weeks of the first block was night float–again, little nervous about that after my experience with IM–but it actually wasn’t bad.  We were steadily busy most nights, and I got to experience a code during one of the nights, which was a good learning experience.

I felt the pressure once family medicine ended.  I had 3 weeks before my Step 3, but also was starting a new rotation–outpatient addictions.  It involved learning the policies and practices of another facility, who just happen to do everything on paper.  Lots of new experiences for me–while I was a secretary in a paper-charting facility, having to find the chart to write orders or notes is a completely different experience.  Somehow, I still found time to study and prepare.  I was able to take some time off immediately before my exam, to clear my mind and review last-minute subjects–mainly Step 1 pearls and bio-stats.

Before I knew it, Step 3 was over.  Addictions rotation was over, and I was back on the inpatient unit for my last block of the year!  It’s second-nature being on the unit now, don’t really have to think about doing things before you find yourself doing them.  You figure out how to stay a few steps ahead of the patients and anticipate what they might need.  Because one of our attendings is leaving and in the process of moving to a different state, I have had the opportunity to work with some of the other attendings who are filling-in on the unit and have enjoyed my experiences with them.  It’s different than rounding with them on the weekends, different in a good way.

Now off to reply to everyone’s comments and requests.  Ta-ta.

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7 Responses to “Hello, again!”

  1. Priya said

    Hi!! I love your blog and have been reading it religiously! I just finished up med 5 on nevis at MUA and was hoping you could give me some tips! I’m struggling a little so I could use all the help I could get! Thanks so much for making this blog!

    • jenningers said

      Hi, Priya,

      Wow, thanks for reading the blog, glad you like it. Congrats on finishing-up Med 5, you’re through the hardest part! Please feel free to post questions and I will do my best to answer and provide tips. Good luck!

      Jenn

      • Priya said

        Thanks so much! SO upon having to retake comp I passed! Now its on to the dreaded step 1 study period. I have about 1 month and some left and I’ve basically been doing the same thing I’ve been doing for comp studying second time around (Pathoma, First Aid, Uworld timed random blocks and reviewing them which takes me SO SO long but I’m doing these for the second time, with a little goljan audio, Kaplan Q bank, and web path questions on the side) with the added joy of about 4 NBMEs. Am I doing the right thing? Should I be doing more? I honestly feel like I’m not working as hard as I should because its the same routine as I did for comp but maybe this is because I have been studying for so long. Is the hype really real? Any tips, or suggestions. Am I supposed to take a day off? Any kind of help would be greatly appreciated! Thanks so much!!

  2. Nina said

    Hi, hope you are doing well. I’m sorry to bother you but I was wondering if you have any PDF copies of MED1 required books for MUA? I start in January 2016, thank you very much for your time.

    • jenningers said

      Hello, Nina,

      You’re not bothering me at all! Thanks for reading the blog and congratulations on your acceptance to the January 2016 class! That’s HUGE! Unfortunately the PDFs for Med 1 are a couple laptops ago for me, though I think many of these pdf’s are googlable. 🙂

      Best of luck to you!

      Jenn

  3. Tri Le said

    Hello Dr. Ingersoll. After reading your blogs and doing much research online, I am now seriously considering applying to MUA. The cheaper tuition and small, quiet island intrigues me because I just want to study with no distractions. My goal is family medicine.

    You, along with some people who have graduated from MUA took the risk of going to this school before they even qualified for federal loans or California recognized…and MATCHED! That’s impressive. From what I’ve read online, it seems like the board scores, clerkship evaluations, and recommendations are the only important factors to get into a residency?

    How did MUA prepare you for the USMLE? Did they teach thoroughly all topics tested on the USMLE? Were there questions on the test you felt like you didn’t know because you were not taught the topic asked?

    Like some posters have asked, if you could share your MCAT and board scores so I could see how realistic it is for me to go to the island and obtain a residency in family medicine. Thanks for any advices. Have a wonderful Sunday!

    • jenningers said

      Hello, Tri Le,

      Thanks for reading and I’m glad the blog has been helpful so far. We need more family medicine folks in the world! I hope you are successful!

      You’ve read correctly–board scores, evals and recommendations are the heaviest-weighted factors that residency programs consider when issuing interviews. But much of what decides who is ranked (and matched) and who is not is personality! The residents already in a program have a lot of involvement in deciding which applicants seem like they’d be a good fit for the program (i.e. who do we think we would most like to work with!). So if you can get an interview, that’s the hard part. Then you just have to get a feel for the program and show that you would be a positive addition to the program.

      Preparation for the USMLE is a touchy subject. I had a chip on my shoulder for a long time regarding preparation for the USMLE and what MUA did and didn’t do. Looking back on it from my experience now, working with residents who went to US schools and teaching medical students in a US school, I think both Caribbean and US students have to be very self-motivated to do well on the USMLE. Despite what I thought, US Medical students are not spoon-fed information and babied into doing well on the USMLE. In fact, many of them had shockingly low scores given their privilege of being in a US program. In both settings, you have to be motivated to truly learn the material. There are no good short-cuts. In every program, there are bad apples who have copies of exams or get previews of the NBME shelf exams from other schools who have taken shelf exams earlier. These people win in the short-run because they do well on these exams that they have literally already seen, but then they are incapable of passing the USMLE, which it is impossible to cheat on. (You are wanded, patted-down, fingerprinted, not allowed to wear a watch, video-taped, etc.) The USMLE tests how much you’ve learned in basic sciences and how much of that you can remember and apply. MUA makes all of that information available to you in one form or another. There are some classes who have better professors than others, some classes which use better textbooks than others, some classes which have better powerpoint slides than others, and some classes which have better hands-on activities than others, but I think all of that taken into consideration, MUA gives you what you need to do well-on and pass the USMLE just as well as US schools do. The difference between the two (MUA and US schools) is the motivation to have students complete the program. MUA doesn’t seem to mind too much if you go through 5 semesters of basic sciences and then it takes you 6 months to be ready to take the Step 1, whereas US students are not held back–they take the exam when second year is over. If you don’t pass the comp shelf or don’t submit an adequate study plan with passing mock exam scores, MUA will not approve you to sign up for the USMLE until they believe you are at a point where you will pass. This is a source of frustration for many students, but ultimately is a good thing for them. It’s difficult to match when you’ve failed USMLEs and had to retake them (US or international grads).

      My MCAT of 25Q is public knowledge, I will email board scores.

      Best of luck to you,

      Jenn

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