Just Checking In!

September 27, 2015

Hello, Readers!

Happy end-of-September to you all!  For those of you currently in school, hope things are going well for you, and for those of you contemplating school, I hope the blog is helpful towards reaching a decision.

Lets see, what’s gone on since June?  Well, June was my last rotation of my intern year and also my last rotation on the inpatient psychiatric service.  I liked working on the inpatient unit and am sad that I will not be going back, except when I am on the dual-diagnosis unit rotations later this year.

July and August I was on our Geriatrics rotation.  That was fun.  It was fascinating to focus on that specific population.  Lots of folks (myself included) have the preconceived notion that there is nothing except depression and dementia in that population.  SO WRONG.  They have their own fascinating dilemmas and a variety of diagnoses just like the adult and pediatric populations which draw my attention and make me love psychiatry.  Oh, and also during this rotation, we get to run the ECT service.  That was my favorite part.  I loved learning how to do ECT and seeing the rapid, significant results it brought many of the patients.  It’s definitely something I want to do when I finish residency.

September I got to go our forensics rotation at one of the state hospitals (we have 3).  I enjoyed that as well.  I did not think I would like forensics as much as I do.  I have even found myself logging onto freida (http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page?), looking at forensics fellowships.  Don’t worry, my heart is still set on child and adolescent, but this would be a fun thing to consider after that.

Now I am on to night float.  There are two residents who share the responsibility, so I am off this week but will be on next week.  It seems intimidating because I will be the only house staff in the 950-bed hospital for the psychiatry service from 9:00pm-7:30am, but I am excited to take-on the challenge.  I have an on-call attending physician at my beck and call, I just have to pick up the phone, so I’m really not alone.  I will cover the patients who present to the emergency department with psychiatric complaints (I have done this before on the emergency psychiatry rotation), any emergent consults which are placed within the hospital (I have done this before on day float and on geriatric consults), and any issues which come-up on the inpatient psychiatric unit (I have done this before while on short-call during the many blocks of inpatient psychiatry).  So it’s really not anything new I haven’t done before, it’s just at a different time of day.

During our off-weeks on night float, we are scheduled for the outpatient psychiatric clinic (almost the whole third year of psychiatry residency is dedicated to outpatient psychiatry) which is our first exposure to outpatient psychiatry.  It’s cool to feel like you’re a third year, sitting in clinic.  I was unfamiliar with the flow of clinic, but the third years were very helpful orienting me to the correct templates, where to collect vital signs, where the after visit summary prints out, where the prescription printer is, what billing codes to use, etc.  Interviewing the patients is the same as in the hospital, it’s just in a different setting and you are under more strict time constraints.  I think I like it.  The in-office cameras take some getting used-to, but are admittedly better than having another person sit in the room and throw-off the interview.

Well, that’s really all that’s been going on.  You all have submitted some great questions in the comments section, which I’ve finally gotten caught-up on.  Please keep them coming.

Thanks for reading!


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.

The Move

June 19, 2014

Hello, Readers,

Greetings from “down East.” I’ve officially completed the move 4.5 hours to the East where I will be doing my residency for the next 4-5 years. I’m so happy to finally have finished unpacking the last box. You take small things for granted when you live in one spot for more than a few weeks. It’s nice to be able to go shopping for real housewares knowing that you’ll be in a permanent spot for at least a year.

Originally I had looked into buying a house here, but then saw that the housing market here has been really stagnant (houses on the market for 200+ days) so I thought it would be less complicated to rent for the first year. Being a college town, there are tons of apartments available, many of which are relatively new and competitively priced. I was able to find a brand new one within a mile of the medical center at which I will be practicing. I’ve had fun over the past couple days enjoying the amenities like the pool, fitness center, and club house while I have no serious obligations.

Orientation has technically begun this week. Monday there were 2 benefits sessions which were optional to attend, though we had been sent the links to sign up for benefits online, in advance. Signed up online, skipped the sessions and instead went to get my parking sticker and ID badge made. I had one of those epiphany moments when I got my badge and it had my name and in big letters at the bottom, MD. Sure I signed all of my graduation thank-you’s with an MD after my name, mostly to be cute, but it really sank in that I’m finally an MD when I saw the badge. In all of my excitement and anxiety about the Match and residency, it didn’t seem like I’d passed any significant milestones since I still have years of obligatory training ahead of me before I’ll be out there on my own.

Tuesday I wandered over to the [giant] hospital campus again, this time to get something called a One Card which is, from what I’m told, a door pass. Not sure why that can’t be tied into my badge and why it has to have my photo on it, but whatevs.

Yesterday was Occupational Health day. Thankfully they had the brilliant idea to send most of the paperwork ahead to us in one of those waves of online check-lists we have to complete (which I was complaining about a couple of entries ago), so when I made it back to my appointment, they had all the paperwork and shot records in order. There was just the annual health screen (height, weight, (bmi calculation) BP, vision screening, fingerstick for cholesterol check/blood sugar, waist circumference [eek]), yet another TB skin test (I just had one done in Feb but the hospital requires all new employees to have 2, so they counted the Feb one as #1 and gave me another ::sigh::), MRSA nares screening, a urine drug screen, and fit-testing for N-95 masks. I was happy to discover that my cholesterol had dropped from 144 at my pre-first-year-of-med-school-physical down to 129 (I attribute this to giving up red meat and taking a fish oil supplement), and my HDL had increased from 39 to 41. It’s still not where I’d like it to be, but I’ll keep exercising, pushing fiber and add oatmeal to my diet. Nephrology elective Doc was urging me to get tested for Diabetes back in April (he had just been diagnosed, himself, so I think he was projecting) but happily my fasting blood sugar was just fine at 84. Not all fat people have diabetes and bad cholesterol! ::Crosses arms::

Today’s orientation obligation was to go to the local Uniform shop and pick out resident-length white coats–yippee! The hospital gives us a $100 credit at the store so we’re allowed to pick out 2-3 lab coats and then the store will send them off to be monogrammed for us. That was fun. I like these coats much better–they’re a much more flattering length. After trying on about 50 coats, I finally chose 2. At the register, they asked me my name and department which yielded a piece of paper with how my monogramming was to look! Another epiphany moment (OMG I’m really a physician now)! After proofreading to make sure that everything was spelled correctly, we signed and were told they would be back from monogramming within 7-10 days, that they would call. With no other obligations, we went for a road trip to the neighboring coastal towns along the inlets–Washington, Bath, and New Bern. Lots of fun, very pretty. We ended up having lunch in New Bern at a famous BBQ place called Moore’s which is in the Guinness Book of World Records for having created the world’s largest open-faced BBQ sandwich back in 2010. Their chicken wasn’t bad but their hushpuppies were fantastic!

Tomorrow I have to go back to get the TB test read but then I’m free [to enjoy the pool some more!]. The parts of orientation that everyone dreads start next week–where you’re sat in a giant conference hall for 8-hours while the hospital higher-ups talk to you about avoiding needlesticks and PASS/RACE and customer service and all of that stuff we’ve all heard about 3000 times. Maybe they’ll make it fun. During the later part of the week, we have orientation within our individual departments, which means I’ll finally get to meet the other psych residents! That, I’m REALLY excited about!

Oh–the 2014 MUA Match list went up today: http://www.mua.edu/images/downloads/MUA%20Residency%202014-LR-1.pdf

More on the Match

April 10, 2014

Hey ya’ll,

Made it back to NC from LA to spend a quick weekend doing laundry and swapping out wardrobe choices before I headed off to Virginia for my last elective. I’ve gotten a lot of questions about Match stuff, so now that all is said and done I reckon it’s safe to discuss some of the details and things I learned.

So if you’re planning on Matching in 2015, you should already be working. The school wants all prospective Matchees to submit their Personal Statement by April 1. That was actually really helpful. The summer before Match got so busy for me [finalizing Step 2 stuff] that it would have been difficult to sit down and put into clear words why I want to be a psychiatrist. Ah, yes–the great mystery is revealed–I applied for Categorical Psychiatry programs, Internal Medicine-Psychiatry programs, and Triple Board (Pediatrics/Adult Psych/Child & Adolescent Psych) programs. But back to personal statements, they should state why you find the particular field interesting (usually in the form of a memorable anecdote), why you’d be good at that field, where you want to go once you’re in the field, and lastly, why you’d be an awesome asset to their program. It should grab their attention but at the same time, not be kitschy. DO NOT LIE. You will be asked about your personal statement and its contents, so be genuine and review your PS before each interview so that it’s fresh in your mind and you don’t glaze over if your nerves get the best of you.

Second thing is timing. You need to make sure that you have your CK scores back and available for your ERAS application by late August. It’s best to submit your applications to the various programs on September 15, the first day that application submission is available. In most cases, folks’ scores increase between their USMLE Step 1 and USMLE Step 2 CK so you’ll want both scores to show your improvement. Most folks have a bit of PTSD about the Step 1 and how difficult it was to remember all those details. I think many of us think if we’d just given ourselves another couple of weeks to study we’d have done better, but that’s a fallacy. Don’t let those feelings make you keep pushing your Step 2 CK back. It’s definitely not as difficult (to me, at least) as the Step 1 and I found that on some of the questions I was unsure about, logical reasoning carried me a long way unlike on Step 1 where you either knew the fact or you had to guess. The Step 2 CS is not a big rush–after all, it’s pass/fail, but you always want to leave yourself enough contingency time so that, worst case scenario, if you have a bad day and don’t pass, you have time to reschedule the CS and take it again. My dean’s advice on the CS is that you should have at least taken it by the end of the year you’ve applied for the match. I was cautious and took it early enough last fall that I was able to get my scores back by the end of the year, so that I was able to tell folks during interviews that I had received news that I had passed.

Last thing for today is interviews. It might just be my inner Southern belle, or our meticulous obsession with manners down here in the South, but I was surprised by what I saw during interviews–which I thought should be easy for most folks who had made it through medical school and the CS exam! There are some major faux pas which I saw some of my co-interviewees commit that I thought I’d pass along:

1. Wear a suit. A clean, wrinkle-free professional suit. Everyone wears suits, mostly suits with pants rather than skirts (ladies). And wear nice, bland accessories. No loud ties, bright red pumps, deep-cut blouses. I know there’s a lot of avant garde advice floating around that you need to wear something which will make you stand out or grab their attention–which could be true for dates or regular job interviews–but remember that the folks who are interviewing you are RESIDENCY PROGRAM DIRECTORS! They want to see if you’re trained and civil enough to see patients during some of the most physically and emotionally challenging times of their lives. Program directors don’t care about your flashy scarf or how high of stilettos you can endure for 8 hours, and if they do, this is not the program for you. They are conservative folks who want to see that you clean up nice and can be appropriate with patients and get your work done. High neck lines, comfortable shoes, no wrinkles, and muted ties.

2. Easy on the perfume/cologne. Don’t wear it, it grosses everyone else out and makes it seem like you’re trying to cover up a body odor problem that couldn’t be or wasn’t solved by soap and water. Most hospitals have rules which stipulate you don’t wear it as it nauseates some patients, so don’t. If you insist on wearing it, spray it on your body ONCE, then cover that area up with your clothes so the scent isn’t so strong.

3. Dinner manners. Pretend like you’re on a first date. Most programs send you to dinner with the residents the night before an interview. This is theoretically a time for the residents to get to know you and figure out if you would fit in with them for the next 3-5 years. This is not the time for you to assault them with every cut-throat question about the program’s dirty little secrets you can muster. 90% of the time, I found that the residents were just there for a free meal. Now that doesn’t mean that they weren’t paying attention to the applicants, but they’ll ask you if you have questions and aside from a couple of easy questions about how they see the program or elements of the training from their personal perspective, let it go. Let them eat, enjoy what they have to say, use the time to make observations about their relationships with the other residents–if they get along well, if they have a good sense of humor, if their morale is alright. It’ll tell you a lot about how the program treats its residents.

Ok, must go get ready for rounds. There are many, many more tips which could follow on Match processes, which I will try to share later. 12 more work days of rotations left! YAY!!!



February 5, 2014

Hi, Readers!

Checking in from my break-month, back at home in NC. Finished up in OK and have once again, relocated the bulk of my possessions back to my folks’ house for a temporary break. Interview season is over! It’s rank order list time! Tough decisions to be made, taking time to sit back and think “would I be happy there, with those people, doing that for the next few years?”

Got my last tuition left-over check back from my loan. It dwindles further. I got $600 to live on for the semester back after the school took out tuition from my $15k loan [minus the loan origination fee]. Ridiculous, no? I don’t know how other students from the US are doing it, other than perhaps utilizing the MBA program. Though I couldn’t imagine taking business classes when you need to be focusing on interviews, match stuff, and 4th year rotations. More power to those kids. I’ve accepted the fact I’m forever indebted to my parents and couldn’t have made it this far without their support.

Meanwhile, I’m working out on a daily basis trying to get back down to my pre-Chicago weight. (I’m close) And now, researching my March rotation in Louisiana–where to fly in, where to stay, etc. I have a place lined up to stay at in VA in April but I’m not getting a lot of details about LA. Oh well, patience.

Will be in touch before the match. Best of luck to everyone!

Interview Season Has Begun!

November 17, 2013

Greetings, Readers!

Brrr winter’s started creeping in! I hope you all are able to stay warm. I’m getting ready to finish my last week of rotations in NC (I will miss the mild winter weather), though even more exciting than that–I’ve started interviewing!

What a unique challenge that I did not foresee! So a bit of background information first–because most programs interview 10x the applicants for the number of spots they have (ex. 70 interviews for 7 spots), the “golden number” of interviews one needs to book to “guarantee” a match somewhere is 10. Now, that said, many places may rank you (albeit not high), but in order to statisically “beat the odds” and not have to scramble10 is what 4th years should be aiming for. Now you’d think it’d be pretty straightforward–you just say “yes” to the first 10 interview requests that come in and then say “no” from that point onwards, but it’s more complicated than that.

One factor is the cost involved in getting to an interview. I made the mistake of applying mainly to programs in the SouthEastern US (while this is where I WANT to be) but I have scheduled myself to be in Oklahoma during the busiest months of interview season. So there are places who have invited me for an interview which I would ordinarily be able to drive to, which I now MUST fly to [from Oklahoma] which is getting quite pricey. The programs are good about putting you up in a hotel room and covering the cost of your meals, but some of these flights are $500-600 RT, and you think to yourself there’s just a 10% chance that I will end up at this place. But then again, you could fall in love with this program and it could be the one who ranks you highly, so you don’t want to skip an opportunity with them unless the cost of getting there is just outrageous or you can’t fit it into your schedule.

Scheduling interviews is also tricky. The books I have read recommend scheduling yourself later in the season so that you’re more memorable, compared to interviewing first-thing when other, stellar applicants can interview after you. But then again, the more interviews you schedule during rotations, the harder it is to do well in your last few elective rotations because you’re missing so much time. This is an advantage for the kids who wait and match during their 5th year–they can schedule interviews outside of rotations at their leisure. Some folks at US schools have the privilege of taking time off during their 4th year so that they can have unhampered time to go interviewing.

The interviews themselves have been great. In general, the programs I’ve been to so far have been very excited to have applicants there and have gone out of their way to make us feel welcomed and wanted. They’re quite aware that we will be attending many interviews, so they make an effort to stand out and make a good impression. The interviews have been less formal than I feared they would be, and have lasted anywhere from 30 minutes to 1:15 depending on the interviewer’s agenda and how many questions they have for you.

In preparation, you’ll need at least 2 suits. Some folks say “I’m going to be an individual and not conform to the suit mentality” but then when I go to these interviews, everyone there is either wearing navy, black or gray suits. I have yet to interview with anyone NOT wearing a suit, so I wouldn’t deviate from this stereotype. For girls, I’ve seen about 50-50 skirts vs dress pants. I’d say whatever is most comfortable for you, though if you’re going the skirt route, bring a back-up pair of panty hose in your purse in case you get a run. During dinner with the residents the night before, it’s “casual” which I take to mean wear what you would normally wear to clinic–dress slacks and a nice shirt/blouse–UNLESS the invitation blatantly tells you to wear jeans/khakis. You’ll need comfortable shoes as most of the interviews involve a tour of the facilities. For girls, modest jewelry and a hairstyle typical of what you wear on a daily basis. Light make-up is more professional than showing off your Chanel make-up counter cat-eye skills.

Also you’ll need a portfolio–everyone has them though I don’t think we use them for much other than a professional schedule holder or to read off pre-written questions–as well as an attaché/brief case/matching purse. This last object is not a must-have, but it looks strange walking into an interview wearing a suit, carrying a bookbag. Most places, you walk in carrying your attaché case, but then leave it in the main conference area, taking only your portfolio on interviews. Because most of the time you’re flying to an interview, there is the problem of what to do with your luggage during the day of the interview when you must check out of the hotel before you leave for the morning interviews. I would recommend leaving your luggage at the hotel, locked up with the valet if possible, unless the program tells you to bring it with you. Its been my experience that the folks who voluntarily bring their carry-on/garment bag with them have clunky luggage which clutters up the program coordinator’s office/must be left somewhere less-than-opportune such as in another applicant’s car. But then I would keep your travel documents/ID/wallet with you at all times, just incase something bad happens you can at least get back home.

Hope these interview tips help–please comment with questions if they arise!

Happy Halloween, Readers!

October 31, 2013

Hey, ya’ll!

Checking in now that I have moved away from Chicago. I finished up my last core in peds, then went to a different hospital for an elective in adolescent medicine. I really enjoyed it! You get a lot of aspects of both peds and adult medicine because you cover such a diverse age group…plus it being Chicago, you get a lot of pathology. 🙂

Now I’m back in North Carolina, not close to where I live, but happy to be back in an area where my accent blends in again. I’m doing an elective in Child & Adolescent Psych which has been fabulous. I am their only medical student, so it’s interesting being intellectually by myself, surrounded by all these experts. I am in student housing, so I’m sharing a 2-bdr apartment with 2 OB students and we will be joined by another student in a couple of weeks. I’d forgotten what it was like to have roommates.

I took the Step 2 CS this past week in Atlanta. Lots of anxiety and nerves about it–not a big fan of being watched and critiqued–but then the actual exam wasn’t bad at all. The proctors were very nice. Now is the REAL hard part, waiting 3 months for the results. You’ll be doing something in clinic and you’ll think of a question you should have asked one of your SP’s and have a “Doh!” moment. But then other times, you’ll think about that triumphant feeling you had when you were leaving one of the rooms with 3 diagnoses and tons of evidence in mind and think, “yeah, I aced that thing, why am I worried–it’s pass/fail!”

So now it’s Halloween night, I don’t have studying for the CS hovering over my head, preventing me from having any fun. Wonder what Halloween festivities they have out here in the boonies?