Otolaryngology!

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I never thought I’d say this… but guys, I matched into my top specialty and at my top institution. Starting in July 2016, I will be studying to become an otolaryngologist – head and neck surgeon (do we have the longest specialty name?)!

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I was literally in tears on Monday of Match Week when I got my email. My best friend CT and I wanted to open our emails together… but my phone wasn’t ping-ing emails to me, so I tried to refresh… and lo and behold, the first words I saw were “Congratulations!” before I started bawling uncontrollably. Now that I’ve matched I feel a little more cavalier about discussing my application process, but basically, if otomatch means anything, I was severely below average for just about everything (my Step scores, my grades/AOA status, my research, my # of interviews). Going into Monday, I had already met with my faculty advisors several times to discuss what to do next year if I didn’t match, and I had mentally prepared myself to participate in the SOAP (scramble). Thankfully, I didn’t need to! And honestly, that news on Monday was enough for me. :)

The days leading up to Friday, I was in a state of anxious calm. Mostly calm but occasionally irrationally thinking that maybe the email was a fluke. My school randomly calls up students, and when I finally held the envelope in my hands, I felt like I really knew that Everything was going to be okay. Match Day was emotional overall; I ended up getting not only my top choice but also the same institution that CT will be going to, as well as a couple of my other classmates. I can’t believe my luck.

Since Match, I have been on a surgery “bootcamp” class that my school offers to help prepare us for intern year. I’ve learned so much from how to respond to a page, how to do pre-op and post-op orders, “palming” a needle driver, and more. The last week of the class, we were gifted the opportunity to be primary surgeon on a simple operation for three days related to our specialty. I got to perform a rhomboid flap reconstruction for a cheek defect with the plastic surgery team, a tracheostomy with the OHNS team, and a neck dissection with a thyroid surgeon. I honestly cannot wait for intern year to begin. I know it will be busy, but I feel so blessed to be where I am, getting to do a specialty I love and finally having the power to take care of others and hopefully make their lives better.

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Interviewing for Residency

Ah, shoot, I disappeared again. Well, I have finally finished up my interviews for residency this year. I can’t say that I am an expert by any means, but hopefully this will help answer at least some questions.

What to Wear

I’m not going to lie- this was somehow one of the biggest anxieties I had going into the season. Skirt vs. pant suit? What color blouse? It’s rough for a women, let me tell you! There are just so many options. After having interviewed, I can tell you that basically as long as you look professional, it seems anything goes. I’ve seen both pant and skirt options (just make sure the skirt is knee length and practice sitting down too). Make sure to cut the back seams on your skirt/blazer if they are new; one of my friends saw someone who hadn’t done that and we all mentally cringed. Any dark color seems fine. I would definitely wear pantyhose if you are wearing a skirt suit, and most girls I saw wore a nude pair. Shoes: heels shouldn’t be too high, flats are okay, make sure you’re comfortable walking around. Blouse: I tried to be really conservative but I saw just about everything on the trail, including ruffles, patterns, and bright colors. I really think as long as you aren’t distasteful (e.g. a plunging neckline), it’s okay. As everyone says, you’re not interviewing to show off your fashion sense, but you shouldn’t also feel like you have to suddenly rush out and buy a new closet (which… I did).

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What I wore: simple black pumps with a thick heel around 2 inches tall, nude hose, a new Halogen skirt suit, and a new LOFT blouse. I justified my purchases because the suit was on sale, and I can definitely rewear all of them.

How to Prep

I created an Evernote document of common interview questions, and I BRIEFLY answered all of them with clinical examples. I also had a separate section of just clinical stories that stood out to me so that I could remember them and apply them to certain questions. Interestingly, I got very few of the “common” interview questions, but I would still know how to answer them — why this specialty, why this residency, what makes you special.

Definitely know your application inside out. I reread my app before the first couple of interviews and then eventually got so used to answering the same questions that I stopped. I got asked most about my research but got different questions even then- some just wanted me to explain what I was doing, others asked me to predict what my results would be, one person hardcore challenged the whole necessity of the project.

Day of Interview/Dinner

If you can, I definitely recommend making the interview social dinner, which is usually the night before. It’s a great time to meet your other applicants (and remember, these are your future colleagues!) and the residents in a casual setting. I greatly enjoyed all of mine. I wore a sweater dress, tights, and boots.

The interview day: make sure you arrive early and are abreast of your surroundings if you are unfamiliar with them. I would try to ask the residents the night before about specific directions to get to the interview location. Again, put your best face forward but be yourself. Try to put yourself into the mindset that you too are interviewing the residency; this should help with the ever confusing “do you have any questions for me?” part of the interview. Some of the questions I asked about include the culture of the residency, how evaluations are performed, what are the weaknesses of the program/what would one change about the program, how call is handled. Otherwise, just have fun! Most interviews are very conversational.

Afterward, you can choose to send thank you letters. Some places tell you not to at all. In general, most people sent letters to the program director and chair of department, and maybe someone you clicked with. I don’t think it matters much whether you do.

Well, that’s all I can think of! Feel free to drop questions in the comments, and good luck!

scribbles in scrubs

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Mini-stories, all under 150 words, from the wards. Always true but some details may be left out to protect patient privacy.

tongue.

My hand is in her mouth pressing gauze against her tongue. She’s been coughing up blood for hours since her surgical wound opened up. The man who accompanied her leaves to go to the bathroom once she’s stabilized. “Who’s he?” I ask because I’m standing so close to her she can see down my scrub top, and her blood is on my neck. She says he’s a guy she just started dating. This is their second date, actually. “I’m going to have to marry him after thus, huh?” she jokes. I smile. A hospital date doesn’t sound so bad to me.

no longer with us.

“Where’s Mr. [x]?” I ask the night team resident.

“He’s no longer with us,” he calmly replies.

My team startles as I burst out “What?! How?!”

“By the time I got here, he had full-on ST elevation. We barely got him to the cath lab on time…”

“But then what happened?”

A pause. “Oh, he got transferred to another hospital.”

We breathe a sigh of relief. He snickers, “This is what happens when you don’t trend trops before transferring to another team.”

you’re not on my team.

She walks into our rooms for rounds with a poster that’s been scribbled all over. “This is my team, and this is my sister’s team. Which team are YOU on?” she asks, her blue eyes flashing wildly at me as she takes a seat at the table, flipping the poster to demonstrate the names written on each side or “team”.

We ask her typical morning rounds questions — how much did she manage to sleep last night? Were the meds helping? Did she still think she needed to escape from her burning house? She answers with the pressured speech and disjointed thoughts characteristic of mania. We try to steer her back but she storms up, grabs her poster, and glares at us. “You’re not on my team. KA CHING, KA CHING, KA CHING!” She points a trigger finger at each of us for each “ka ching” before slamming the door.

Things I Love Thursdays TILT 01

New series?! Let’s see if I can even semi-attempt to maintain this! But hey, more gratitude is always a positive thing. I’m going to try to always pick five things that I am happy/thankful for and loving!

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  1. Coach.me — Discovered this from my favorite Tim Ferriss. Basically, this is a way to track habits that you want to start. I have quite a few goals, some more ambitious than others, and you can set it to send you reminders via email or on your phone app whenever you want. Then you can “check in” when you succeed for that day. For the uber disciplined, I get that you don’t need something like this, but for me, I love the feeling of getting to check off something, and this app totally appeals to that side of me. Some examples of goals I have (ideas to get you started) include: not biting nails (ugh my worst habit), meditating, cooking dinner, cleaning for ~15min, calling my parents.
  2. Anatomy — I’m taking my anatomy elective right now, and guys, I love it. There’s just something so therapeutic about spending time with a cadaver and discovering the mysteries of the human body. I’m currently taking the head and neck course (hmm, can you figure out what I’m specializing in?). My dissection partner is also hilarious.
  3. Cleaning maintenance — A hint of this above in #1, but basically, I’ve been obsessed with trying to clean my apartment (and also looking forward to eventually living on my own because I am about at my wit’s end with messy roommates). I am trying to spend at least some time every day to tidy up SOME area. Usually I clean by DIVING in, but that always takes so long, so I’m working on doing a little bit at a time. So far, I’m loving my results because my room has probably managed to stay the cleanest it’s been for the longest period (same for my kitchen).
  4. Full Metal Alchemist — I finished “House of Cards” last week, so I’ve had a relative “void” in my TV show life as my fall shows are slowly starting back up. Several of my friends have recommended FMA to me for a number of reasons (the mythology, its messages about humanity, and my old roommate LN thinks I look like Lust). Thankfully, this is on Netflix so it’s pretty easy to marathon. I am a closet anime lover, and while I’ve seen less than 10 episodes, this is totally something I am enjoying.
  5. Sunny days — As someone on the east coast, we were “hit” by Hurricane Joaquin last week-ish, and just as I was resigning myself to the cold, the sun came out again! The past few days have been in the 70s, and I am so happy. In the end I am totally a west coast girl, I think! I’m trying to enjoy these last few warm days as much as I can.

That’s it for this week, folks! Over and onward. Quick fourth year update- my specialty has not started sending out interview invites yet, which is frustrating because literally everyone else I know has scheduled at least one interview. It helps that I’ve received a few emails from programs at least TELLING us that we should not expect to hear from them until November.

Goals for M4

This is my last year of med school. Probably the last year of official schooling I will ever do. And from here on out, as I was telling my mom, I will likely have at most one month of vacation every year and work long hours. Thankfully, I will also go into the most rewarding profession.

Still, I can’t help but feel like I will be “missing out” a bit. To that end, here are some of my goals for my last year!

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Read. A lot. — This one was pretty obvious… my biggest hobby is without a doubt reading! I set a goal of 10 books for 2015, and I’ve already more than doubled that. So who knows how many books I can attempt to conquer in the upcoming months. All I can say is I hope to finish at least one, maybe even two, per month until I graduate, which would put me at ~15 books. It seems daunting right now, but I have confidence in myself.

Travel. — My other big hobby, which is unfortunately more expensive (both in money and time). Still, there’s nothing I love more than immersing myself in some place new. Some goals- my friend ES who went with me to Europe before we started med school and I are already planning a two week trip to Japan prior to graduation. I also peripherally discussed exploring Maine with one of my friends here AG. And my family is working on a trip to Nicaragua this winter. That takes up all of my actual vacation days, but maybe I can squeeze in some smaller trips. I already plan on visiting some friends in NYC and Durham in the upcoming month. Here’s to delicious food, amazing views, learning about people and cultures, and some work for my poor camera that has been sitting in the dust.

Purge. — At the end of this school year, I’ll have to probably make another move. It was easy to move across coasts because I knew I could not bring much. This time, I’ve actually bought more things and thus accrued more. Well, I’m not sure where I’ll end up in a year, but I want to start downsizing a bit.

Become a tourist in my town. — Well, I think I’ve done most of the things that my current city offers, but just in case, I’m going to make a bucket list again like I did when I left my college town, and make sure I hit everything before I go!

Establish and maintain good relationships. — A little more nebulous of a goal but just as important as the others. Who knows where we will all end up in a few months, but I know that the friends I’ve made in medical school are friends I want to keep for life, more than just professional colleagues.

Develop good habits. — Follow this: listening to Tim Ferriss’s podcast –> coach.me –> wanting to make myself better one habit at a time. Well, if he can start flossing daily and get off of alcohol with this app, maybe I can pick up some good habits too. Right now, I have largely unambitious goals like meditating, not biting my nails, calling my parents. If this works out, I might add some larger goals.

Wrap-up everything at my medical school. — Even though my residency application is in and up in the air now, I have a few other commitments I need to honor before I leave. These include things like crafting the yearbook for my graduating class and getting a very cool research project started. I can’t get TOO checked out before I finish these other promises!

Here’s to making the last year of medical school the best! :)

Away Rotations Part 2

Continuation of Part 1… now you’ve finally arrived at your designated away institution! Hopefully by now you have heard from your institution about what to expect for the first day, but if not, I would email the chief resident of service or the secretary about one week prior to your start day to at least figure out where and when to meet the team on day 1. You can get all of the other logistics after that. For my first away, I also spent my first day there (I arrived a day early) to get the lay of the land around where I was staying and where the hospital was. Make sure to set your alarm and get everything ready for your first day.

General Tips

  1. First one in, last one out — this one is probably the most commonly given advice for away students. This is highly variable on what you are doing but you should aim to be the first one on your team who shows up and the last one to leave. Sometimes, that might not happen (some residents will really insist that you leave), but try your best. The point of this is that you should never be late, you should never leave early, and you should never miss anything (AKA try to be present, always). At the start of the day, I would always get there first to print the list for the team and start collecting overnight events/vitals/labs for everyone. If you are fast at prerounding, you won’t really even be showing up THAT much earlier… for me, usually 15min before the intern showed up was what I set myself to. At the end of the day, make sure that everything has been tied up and ready to go — all notes are done, all consults have been seen, nothing pending. This brings me to the next point…
  2. Know everyone on your list, even if you’re not assigned to — I’ve found that starting off, most teams won’t let you do too much because they need to gauge where you are, which is why if you show that you can handle the entire service, you’re already off at a great start. I spent any free moment I had during the day reading about my patients, learning their latest labs/imaging/etc., so that I was the most up-to-date on everyone. You’ll never know when you can throw out a nugget that no one was expecting, and then you’ll just look extra prepared. And before I left everyday, I would do another run through the list just to make sure I knew the latest on everyone and generally what I could expect overnight.
  3. Take call — I’m not sure if every service will assign call, but if you have the chance to, you should offer to take call. With my specialty, call tended to be home call, which meant I usually gave the residents my phone number and they would call me if anything was worth coming in for. Even if you are never actually called, at least you showed effort by volunteering. This includes showing up on the weekend.
  4. Ask “how can I help”, not “is there anything to do?” — Residents always want to say “no” to the last one, so don’t let them! Also, the more you find out how you can help, the better you will get at figuring out yourself what needs to be done, which brings me to the next point…
  5. Anticipate needs and be prepared — This, I think, was what really makes you stand out. You should always be thinking several steps ahead of what’s happening. If you don’t know how to do that, ask first to learn. Have everything you need on hand for rounds. Since I was on a surgical rotation, my pockets were literally full of staple removers, suture removers, gauze, tape of all kinds, baci, steristrips, etc. In the OR, you should at least know the procedure well enough that you can figure out what comes next. Do you need skin hooks or a certain kind of retractor? Do you need scissors? If you can figure out these things before it’s asked of you, it just makes you look extra good.
  6. Make your residents look good AKA be a good team player — It’s not always about making yourself look good, it’s about being in a team. When your resident is operating in front of the attending, do whatever you can to make it stupidly easy for them. Grab things for your resident so they don’t need to waste time getting it. If you know an answer and the resident doesn’t, absolutely DO NOT show off in front of an attending unless asked. Say good things about your residents (if they are honest) if an attending asks.
  7. There is no “free time” — If you find that you have free time on your rotation, you’re doing it wrong. I’m not saying you need to be a machine, except that’s what I’m saying. Even if there’s no work to be done, you should be reading about something – your patients, conditions, surgeries, recent literature, etc. You never know when you’ll be asked about something.
  8. Be professional/polite but also be yourself and try to feel the program — Because away rotations are sometimes considered month-long interviews, you need to be polite to everyone you meet (you never know when something might get back to someone). But at the same time, you should also be yourself and see where you belong in that program. For example, on my second away I was really cautious at first, but I found that by letting myself go a bit, I could still be polite and at the same time made friends with a bunch of the scrub nurses and anesthesiologists so that by the end, they were telling my attendings how much they loved working with me, and honestly, I missed them! It made me feel like I really belonged in that program, and that’s the kind of feeling you want to leave with.

Mid-rotation — At about halfway through your rotation, you should try to get at least an informal evaluation by a resident and an attending (multiples if possible). Ask them to be honest, and most importantly, ask them how you can improve. It never feels good to be told that one is “bad” in any way, but you want to be the best you can be so let them give you pointers NOW while you still have time to show them you can change. For example, on my first rotation I was told that I seemed a little unprepared for surgeries. While that upset me a little bit because I thought I wasn’t, clearly I wasn’t studying enough, so I took the next few weeks to really read up as much as I could for surgeries. By the end of the rotation, that same resident told me I ended with the same knowledge as at least a PGY2 level.

End of rotation

  1. If you have to give a presentation — make sure you pick a topic that at least some of the senior residents, who likely have seen other medical students rotate through, approve of. Usually, I try to pick a topic related to a patient that I’ve seen at some point so that you can have some clinical context. I did not repeat a single talk I gave, which meant I had to research for three; in the end, I’m not too upset about that because it meant that I learned A TON about three areas in my field, score! Pick sources that are in the literature, ideally from big-name journals if you can. Make sure you thoroughly read the articles and understand the experiments. Don’t make your powerpoint all words. Have summary slides. Run your presentation by a resident if possible before presenting to attendings.
  2. Ask for more feedback — When you’re done, you want to gauge how you did. Try to schedule meetings with attendings a week before your last week so you’re not just chasing them down to ask for feedback. This is the time to…
  3. Consider asking for a LOR — If you think you made a good impression, and it should not be hard to figure that out because hopefully you’ve been getting feedback along the way, you can consider asking for a letter. There’s a bunch of stuff out there about who to ask; in the end, I think you should ask whoever knew you the best and would write you the best letter, be that a chairman or not. Make sure that if you do ask for a letter, you have everything ready (personal statement draft at the very least and a CV).
  4. If you have an interview while you are there — Treat this like any other interview. Dress nice and look good. Make sure you’ve prepped before about the basic questions (“tell me about yourself”, “why this specialty”, “why this program”). Practice your answers. Be confident but be yourself. Be polite and professional to everyone you meet.

Whew, that was long and hopefully comprehensive. If you have any questions, leave them down below!

Away Rotations Part 1

These days, it seems like a bunch of medical students are doing away rotations. They offer a bunch of benefits (and harms) — exploring a new city, a new hospital, moving closer to a loved one for at least a little while, and sometimes, they can help you match at a residency program. Now I say sometimes, because if you’re planning on going there, you need to be on your A+ game. Having just finished two away rotations fairly successfully (I think), I’m writing this post to offer some advice to those who are interested in doing away rotations.

I’ll be breaking this post up into two parts — first, what to do before you get to your away institution, and then part two will be what to do once you are there.

Should I do an away rotation? This is something for you (and your adviser) to discuss. For most of the uber competitive specialties, it’s almost “required” for you to do an away rotation. For the less competitive fields, many argue that away rotations end up hurting more than helping. If you are dead set on going to a certain program for whatever reasons (e.g. your fiancee has a job in that city), you probably should do an away rotation. Otherwise, I think most people do not need to do an away rotation.

How do I apply? VSAS, affiliated with AAMC, is the site that most institutions use for away rotations. I say most because there are some institutions that have their own application for away rotators (off the top of my head, I know that University of Alabama and Thomas Jefferson University do). You log in with your same ID and password for you AMCAS if you happen to remember that. You can find a variety of different rotations from your typical 4 week sub-internship to more “fun” rotations like medical disaster management. Most institutions open up their applications in May; however, you can look at what they require earlier than that. Almost every school requires its own immunization form (some require titers, others just documentation that you have had a vaccine), and some require combinations of background checks, urine drug screens, LORs, etc. Make sure you have everything prepared as soon as possible since away rotation applications are reviewed on a rolling basis.

I’m not sure what the “right” answer is for how many to apply to. I was planning on doing two, and maybe three, so I applied to five institutions. I got accepted at all of them (to my knowledge, it’s not usually “hard” to get accepted at away rotations) and then picked the ones that worked best with my schedule (some institutions overlap their rotations with others, so you need to plan accordingly). Make sure that if you accept an offer or reject an offer that you do so in a timely fashion to be professional (at least 2-3 weeks in advance of start date). It appears that most places get back to you within one month of applying.

I’ve been accepted; now what? My biggest stress prior to going away was finding housing. Oy, what a nightmare. Here are some of my tips:

  1. Rotating room — this website was designed for away rotators. You can trust that most of these places are fairly reliable since you cannot list unless you have a university-affiliated email address. You can search by institution and then by hospital. I used this service to both find a place for me to sublet and to list my own apartment. I had no issues with either of them. I did not think many people would want to stay in my apartment, but I actually got four inquiries, so I can only guess that lots of students use this site!
  2. Craigslist — everyone knows craigslist, right? Unfortunately, one of the places I went to rotate at did not offer much on rotating room, so I was forced to resort to craigslist. You have to be smart on this website is all I have to say. To weed out sketchy people, I look for good grammar/spelling in the post, lots of pictures of the actual room you will be renting, and at least some information about the people who live there (roommates or whoever you’re subletting from).
  3. Use your connections — I ended up not being successful with this but one of my classmates was able to find both of his places through his church network. If you know friends (or friends of friends), ask around and see if anything is available. Residents are also good resources since they come from all over. If your school has an alumni network that you can get in touch with, that is another place you can look for someone to stay with.

Once I found my housing, I tried to figure out logistics. The way I ended up doing payment was I paid half of my rent (through paypal) upfront to “save” my room, and then I paid the remainder once I arrived at the location. I also asked for additional information like laundry, parking, where to buy groceries, etc. We also discussed rules of subletting, how to pick up keys, etc. The last thing you want to worry about on an away rotation is housing, believe me, so try to get this all sorted out before you go up there.

Transportation — at one of my rotations, I was going to be located within walking distance to the hospital, so I opted to fly there. At the other rotation, I would spend time at several institutions, all separated by at least 10 minutes, so I knew I would have to bring a car down. I don’t have much advice on this except plan, plan, plan.

Packing — I have such a love-hate relationship with packing. On the one hand, the planner geek in me goes crazy. On the other… well, the planner geek in me goes crazy. I always start out with looking up the weather for where I’m going to go, and then I try to think of what I expect my rotation to be like. Since I am applying for a surgical specialty, I had a feeling I would spend a majority of my time in scrubs, so I packed less “nice” clothes and packed my trusty Dansko shoes and two clean scrubs (I wasn’t sure if I would be able to wear their hospital scrubs or what so I wanted to be prepared). I packed a couple of what I call “normal people clothes” to wear if I ever had time off, and more on that later but I do not recommend wasting luggage space with this if you can. Do not forget your white coat, obviously, and try to get it as clean as possible. My white coat picked up some nasty stains over third year, so I actually went and bought a new one online to bring to my away rotations. Bring medical supplies as needed — I left my reflex hammer at home since I doubted I would require it (and I did not). And then otherwise, make sure to pack you usual toiletries, medicines, etc. Some places will interview you while you are there — if you can, ask your rotation coordinator about this sneakily, although most tell you upfront. If you are going to interview, make sure you pack interview attire!

Since I rotated over the summer, I knew I wanted to pick warmer weather clothing. I tried to pick colors that would complement, so the palette I ended up going for was roughly black, camel, pink, cobalt blue, yellow, and kelly green. For shoes, I brought flip flops for casual wear, clogs for the OR, and then two pairs of comfortable shoes that I could wear both for the clinic and outside the hospital (I went with brown loafer flats and black flats).

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Feel free to ask any other questions below about aways! Part 2 will go into the meat of rotating away, so stay tuned.