Wednesday, February 18, 2009

Planning for my 4th year

"When are you going to be a doctor?" is a question I get asked by patients quite often.

I like to think they are asking because they are interested in my progress and eager to see me fulfilling my dreams.

More likely, however, the question is based on a thought process along the lines of:

"Is THIS GUY going to be a doctor soon!? He started out by asking me all these irrelevant questions - what's he thinking when he asks how many pillows I sleep with at night?* What's he going to ask next, what colour my blankets are?

Then... he moved on to a fumbling, shoddy excuse for a 'physical exam,' making sure he touched me in every part of my body. Why on earth is he "feeling for the pulses in my groin?" Is he making this stuff up? And now he is using his stethoscope 'down there,'** is he crazy?!...ohhhh dear, when is the real doctor going to show up??

Good heavens, how long until he is unleashed to practice his incompetence on me and my friends and family? I'd better ask so I can move out of town by then."

In my defense:

* This is how I ask about orthopnea, or increased difficulty breathing when you are laying down flat, a symptom suggestive of impending heart failure.

** I'm listening for bruits in the femoral artery, which could indicate arterial blockage or disease... and I always ask if its OK for me to proceed.

The answer to the question is, just under 1.5 years, and trust me, I'm even more frightened by the thought than you are.

More on fourth year...

As I get closer to graduating, however, a few more decisions need to be made. My classmates and I are at the point in our education where we are choosing what we want to do for our fourth year.

While our first two years were mostly lectures, and the third and fourth year are mostly clinical, the third and fourth years are quite different.

Our schedule is quite firmly set in third year - we rotate through a number of "core" specialties (internal medicine, pediatrics, surgery, obstetrics, etc), and the only thing we can have any input on is the order in which we do these (and even still, need to enter a lottery to decide which students get to pick first).

However, in fourth year, we have a huge amount of flexibility in that we choose a number of electives. These can take place anywhere in Canada, the USA, or in some cases, elsewhere in the world, as long as I meet the requirements for the individual programs (some American schools, for example, want you to take the US Medical Licensing Exam after my 2nd year of medical school, which is not required in Canada).

The dirty details (for those who care...or can offer me some help!)

Based on how I understand it, what a medical student chooses for their senior electives is prompted by a number of factors, such as -

  • the requirements of their school - I have to do at least 1 elective in each of the following: medical, surgical, primary care

  • the career and residency programs they are interested in - someone interested in Plastic Surgery will obviously want to do many electives in the same, and check out the cities and hospitals where they might do their training

  • geographic preference - a specific city might be chosen for an elective because they have a good residency program the student wants to check out, or because the student can easily arrange accomodation there with family / friends (it helps to avoid paying double the rent for the months you're away!), or simply because the student wants to visit a city they've never been to (my friend did a 3rd year elective in Pittsburgh so he could go watch a Penguins NHL game)

  • interest - a student applying to a generalist (i.e. Family Practice) or less competitive specialty will probably spend more of their electives experiencing a variety of specialties they find enjoyable and interesting, rather than ones they think they "need" in order for their application to be impressive

As well, I also need to consider some other things regarding when I do an elective, based on applying to residencies:

  • whether or not the elective has a lot of call - if so, it might be tough to work on an application for residency at the same time!

  • whether or not it's likely to yield a good reference letter for residency - this only applies to the first few electives until the reference letter due date - you're more likely to earn a good reference letter from a specialty in which you work with 1 preceptor quite often, rather than something like emergency medicine, where you are supervised by someone else every shift.

Here's what I'm thinking so far, given that I am mostly interested in emergency medicine but may apply for a family medicine residency so that I can have a variety of options when I finish (ie. spend my time delivering babies, working as a hospitalist, or doing surgical assisting):

  • Places - I'm thinking of doing my electives mostly in Alberta, BC and Ontario, because that's where I'm thinking of doing my residency, they're most familiar to me, and I know more students who have done electives in these places and therefore can get the scoop on them

  • Basics - I'm interested in spending time in ER and obstetrics, so I'll likely do at least 1 elective in each of those

  • Helpful add-ons - For someone interested in ER, I would probably benefit from spending some time in pediatric emergency, trauma surgery, and/or anaesthesia

  • Just for fun / interest - If I have time, I might as well do some shorter electives in things I don't know much about, that intimidate me, or that I have simply never seen - such as rheumatology, or neurology

There are a few deadlines for choosing coming up, so now, the question is to decide where I want to do each of these electives, and if there's anything I'm missing. If you can think of anything, by all means, let me know!


Bea said...

You mentioned geographic location and that you could save by staying with friends and family in the area. This definitely was a consideration for my husband when he chose electives. Just keep in mind that even shacking up with a friend will cost you more than staying at home. You'll likely want to take them out to dinner and you'll probably be eating out more than you normally do. You may have to use a local laundromat. Transportation to and from the hospital if you can't drive there is also a cost, and of course, there's a plane ticket if it's far enough away. If you can afford it, go for it. But I'd just say take more into account than just rent.

Anonymous said...

I had no idea what I wanted to do at the beginning of 4th year (and let me tell you, it sucks not knowing!) I had an inkling that it might be ER, but wasn't sure.

So, I started with Radiology, then ER, then Anesthesia, then Ortho, then Derm. Luckily once I realized I loved ER I cancelled the next three electives, spent the next month studying for boards, scheduled an away ER rotation in Seattle (which was amazing, by the way). I ended up doing the derm month anyway because it was very easy to interview at the same time (not exactly a "high octane" specialty, as it were).

I highly suggest not doing rotations December and January, which is when you will do the bulk of your interviewing. And if you do, try to do something where you aren't expected to do much. Rads, derm, anesthesia would be great choices.

In terms of away rotations, do 'em wherever you think you might want to be. There isn't even an ER residency in Seattle, but I've always wanted to visit, so I did. Best month of my life. Turned into fantastic material for me to talk about on the interview trail. If you're thinking ER, Denver, Cincinatti, Carolinas would all be good places to do rotations at. Feel free to email me for more, I just went through all of this and I'm turning in my rank list tomorrow.

Lastly (and this is just my personal opinion) do some clinical work in March or so of your 4th year. You'll hate yourself for it while all your friends are off gallavanting around the world, but if you get to intern year and you haven't seen a real patient for 7 months you'll regret it. I'm doing ICU next month. And it's going to suck. But it's going to help in the long run.

Anonymous said...

Oh, and I think that one away rotation in your specialty is a must. I feel interviewers would have been less impressed with me had I not done a second month of ER, somewhere away from my home institution.

If you REALLY know that you want to do ER, you may want to schedule 2 aways. It can't hurt, you'll see different styles of practice, and plus, it's fun! Certainly more fun than slogging through nights of trauma call *shudder*. You'll do that in residency. Don't feel obliged to do it in med school; you likely won't get as much from it as you think.

Anonymous said...

Walkerton is a popular elective in Ontario (via UWO and the SWOMEN area). You get a comprehensive look at what a family doc can do and the accommodations are included. The preceptor does anesthesia and surg assist, obs and regular clinic stuff including procedures. The clinic is attached to the hospital so the docs often move between the clinic and hospital.

Good Luck!

Ladyk73 said...

If you want to be in the may want to do a small psych rotation.

custom web design said...

ER is a good choice.

I'm just wondering why psych rotation is needed for ER?

Anne Marie Cunningham said...

Just found your blog. I was thinking about the first part where you were describing that patients might not understand the basis for your examination and questions. It might be a good idea to explain this as you are asking/examining. Just a thought.
best of luck with the course.