<p>I will discuss applying to residencies and the rest of the NRMP in more detail as I go through the process.</p>
<p>Finalized Schedule received today. Follows pretty much as described in post #1 except that I didn't get my medicine sub-i at the University hospital, instead doing it at the community hospital which is attached to my medical center (the two hospitals merged to form one massive hospital system about 10 years ago). Not sure what the implications will be, like if I have a resident to work with or not, as I don't think the physicians are considered academic staff docs. But we'll see. This might actually work out to be more beneficial in some ways as I may get more responsibility.</p>
<p>Still waiting to hear back from the school I'm hoping to do my away rotation at. Would definitely like to know sooner rather than later, so I can finalize plans either way. I have a sinking feeling that the cost of my airline ticket out there is going up by the day...If I don't get it, I'd like to know so that I can find something else to do that month.</p>
<p>How exactly does a sub-internship work? And what kind of responsibilities might you get as a rotating med student, especially if there might not be a resident for you to work with?</p>
<p>Hopefully your away rotation works out, but if it doesn't, what else could you do during that month? Would you have to search for another peds rotation somewhere else, or do something else altogether?</p>
<p>So normally (at least what's normal at my school) on an academic service medicine service as a third year the hierarchy looks like this:</p>
<p>Attending Physician
Supervising Resident (at most places, you can't supervise until the second half of your second year)
Intern #1 (taking half the patients) Intern #2 (taking the other half)
3rd year medical student x2 each taking 2-4 patients (depending on the expectations of the residents and attending)</p>
<p>At my school, third years basically are playing doctor, there are no real consequences, and the expectations vary throughout the year - early on it's enough to just get a thorough history and physical, but as the year progresses, you need to develop your ability to create a reasonable differential, then come up with appropriate labs/tests to run, and finally appropriate, but general, treatment plans, followed by more specific plans. Certainly the development of these skills are concurrent, but happen at various rates. Any first year student can order shotgun lab tests, the key is limiting it to appropriate ones. And there are certain drugs that I picked up on dosing regiments very early on, while others, I'm still whipping out my pda and looking up on epocrates. But with so many levels in between the third year, and actual treatment decisions, I really felt like I was simply playing a game.</p>
<p>A sub-intern falls on the "intern level" - functions the same, but takes fewer patients than the interns will. So if there is 15 patients on a service, the sub might get 3, and the interns will each take 6. The sub-i is a chance to work like an intern, but with the expectation that you won't be as efficient, and that you'll need a little bit more help from the supervising resident (ie, like in having all your orders signed. There's a little less oversight, the expectations are higher, but the oversight is there to make sure nothing slips through the cracks. </p>
<p>What I'm unsure of is how this service I've been assigned to is organized. I'm 90% sure the docs on it are community based, volunteer faculty. I have no idea if they have residents. I think it's a real possibility that it might just be me on service, with 2 or 3 attendings. There are definitely some benefits that could exist - a lot more responsibility, a chance for more one on one teaching, taking on a bigger patient load, fewer zebras/more bread and butter work. But on the other hand, it could also mean a lot more work, varying levels of expectations, the lack of that extra layer of insulation in the safety net, less really interesting cases, and so on. </p>
<p>Of course on the other hand, it could be just like a normal service on the University side and I'm making too big of deal about it being on the community side.</p>
<p>As for August...I won't be looking to go elsewhere. It was a pain enough as it was to get just the one application out, and the only reason I was going there was because my buddy is starting his residency program out there and it made for a great situation - one of my best friends, a cheap place to stay, a chance to go someplace else. If I had to try to figure out housing on top of everything else...uggh...no thank you. If it falls through, I'll see what other peds openings are available at my home school, and go from there.</p>
<p>good luck. im jealous</p>
<p>Blue
Critical Care is a surgical (and medical and anesth and ped) fellowship. It is really intense medicine if you want.</p>
<p>Update with only 9 days of third year remaining...</p>
<p>If you can believe it, I'm still waiting to hear from my away rotation. I imagine they're probably trying to finalize their own student's schedules, but I'm not sure why they can't say 'we'll let you know at the absolute latest on this day' and then I can stop being so anxious about it...</p>
<p>In preparation for the possibility that I won't get the spot, I've penciled myself in to two peds rotations - in August, I'll do peds cardiology and September I will drop radiology in favor of a peds sub-i. I'd really like to take the rads month, but there's really no where to put it. I could change my adult pulm month (December) but the Department of Radiology doesn't offer anything during December (the rotation has a reputation for being easy to skip out of, so it's possible they've been burned by people leaving for residency interviews). </p>
<p>Earlier this week we had a meeting about the Electronic Residency Application Service (ERAS) and the NRMP. Two separate entities (which is a little annoying) and you have to pay for both. Overall, the process seems a bit more overwhelming than the AMCAS...not sure if that's the unfamiliarity or the actual amount of work to be done. </p>
<p>Starting to think about LOR's...lots of meetings to set up. I have one letter lined up from my attending on in-patient medicine, he's the former Dean of Students at my school, so I figure even though I'm not that buddy-buddy with him, he worked with me for a month and knows how to write the letter. I have to set up meetings with the current Dean of Students to get my Dean's Letter ready, as well as the Department Chairmen for both Peds and Medicine. So there are a lot of things to handle and get scheduled. I'll see how my July goes and I may try to get a letter from one of my attendings that month, and the same goes for whoever I work with in Arizona or one of the Peds Cardio staff if that's where I end up. I'll also likely aim for getting one with one of the hospitalists on my peds sub-i in September if that's what I end up doing. From our meeting they said you can only send 4 LOR's to a single program, but if you have more, you choose which letters are sent where through the ERAS. This is helpful for me, since I can tailor those appropriately to either the peds or med/peds programs. Apparently you can also upload as many personal statements as you'd like, and then send specific ones to specific schools. Supposedly someone a couple years ago at my school had 47 different personal statements. I think I'll probably have just two, one specific for peds, one for med/peds...</p>
<p>Costs are already starting to add up, looks like $200 just as a base - $60 to sign up, $60 to actually have your applications sent (up to 10 programs) then an additional $8 for each program 11-20. After twenty, the costs increase. I think after 30, it becomes something like $25 for each additional school. This doesn't include the cost for signing up for the NRMP...</p>
<p>So that's where it stands right now. I'll probably be putting together my CV this weekend (I'm on-call Sunday, so I'll have some free time probably), and I'll be thinking about my personal statement, which is probably going to take some elements of my medical school personal statement.</p>
<p>Been enjoying my one week of vacation between third and fourth year immensely. Broke up with the girl I was dating last week (it was fairly mutual...she was a fun-hater), and totally had a weekend she would have been less than pleased with, but I thought was awesome.</p>
<p>Best news came today. Finally heard back from my away rotation and they accepted me for a peds critical care month in August. Took forever, but at least it worked out. I was visiting the student run clinic one of my friends at another med school helps out with to see how they do things when I got the call. Will buy airline tickets thursday and look into rental cars and such. Just glad to have that wrapped up. I get to keep my rads month and keep everything just the same. Still might try to squeeze a peds cardio month in though if I can.</p>
<p>Bigred.
I assume from above that you are going into peds?</p>
<p>If so, why do your 4th year electives in peds? You should do them in unrelated fields such as rad or surgery or ER</p>
<p>You will get enough peds in your residency. As an advisor, that is one mistake I see all the time.</p>
<p>Do do one rotation at the place you want to do your residency in, but do the rest in different areas</p>
<p>I'm looking very hard at med/peds, but will apply to peds programs at places I'm interested in that lack med/peds programs. </p>
<p>My current month is a medicine sub-i, because my med/peds advisor wants me to make sure that I like the medicine part enough to make it worthwhile. It's going okay, but the experience is pushing me in different directions - in part because I'm not on an academic inpatient service, but with a private clinician/volunteer faculty, and the rotation is very heavy on clinic time (an extremely, extremely busy clinic at that, which hampers any sort of teaching time). </p>
<p>My away rotation next month is exactly that, an audition month. </p>
<p>I do understand your point, and I am taking a rads month, a month with our student-run clinic (I was an executive board member for the clinic as an M2), and a month abroad in Australia. December is currently an Adult Pulmonary Service, but I might change it. January is blocked for interviews, February is Australia, March is Peds Pulm (which I again might change) and April is essentially a vacation month, but as an M4 TA, I will have commitments throughout the year including weekly meetings with my M1's, grading of assignments and being present to grade the OSCE's for the M1's and M2's on multiple Saturdays throughout the year. It was either do that, or complete a basic anatomy dissection over the course of three days and have the rest of the month off anyways.</p>
<p>Brief update:</p>
<p>July - not quite what I was expecting. It ended up being a good month, and I will be getting a LOR from my preceptor for the month, which is what I really wanted. I learned a lot too, but I didn't get to do as much as I would have liked. </p>
<p>August - I'm out on my away rotation in the Western US. I'm in the PICU and I'm LOVING IT. This week has shot Critical Care to the top of my fellowship choices. I'm trying to keep my enthusiasm on an even keel in part because my attending is really awesome this week, and I know that can impact a lot of my feelings toward the specialty. Good attendings can really make all the difference in the world. That said, I think this is really what I want - to work with kids, deal with complex problems, and do some procedures. I've come to realize that while I would enjoy some long-term continuity of care stuff, it's not as important to me as the other things. Critical Care also has the advantage of a little more consistent lifestyle, and I'm also finding myself thinking of some possible research questions that I could pursue. I think this is pretty important since most fellowships require some research - in some cases up to half of the time in fellowship (18 months) is spent on research.</p>
<p>So yeah, things are really good. I need to work on my residency apps and stuff this month, but I might be able to get away with waiting until the middle of September. I'll have a lot more time when I get back home.</p>
<p>Bigred.
Critical Care: be it NICU or PCIU or ICU is one of the most challenging and rewarding rotations. You have the sickest and can make a differance - but you also have the most deaths which may affect you. </p>
<p>It sounds like you like kids. Make sure you do a NICU rotation at some point. If you like physiology too, they are pure "black boxes" that don't have other things affecting what they are supposed to do. Plus in your "follow-up" comments, unlike the other icus, PICUs usually have alumni days where you can follow up on your kids many years later.</p>
<p>On my way home, on a layover at DIA.</p>
<p>The rest of my month was equally as awesome. One of the weeks was kind of a cluster due to an attending being stuck abroad when he was supposed to be in the unit. But I weathered that well and my interest in critical care is confirmed. The attendings that followed that first week were REALLY good, though perhaps not quite as amazing as the one I had the first week, so I'm confident that it wasn't just her effect. I got really good comments from the residents I worked with, and ended up with a really good med student partner for the last three weeks who I worked with extremely well. I can certainly imagine her being a gunner in the right circumstances, but we had a good system that pushed us both to work hard, and I know we both benefited from it. </p>
<p>I will be getting a letter of rec from the attending I had the last week (she was on thursday to Friday, including a full weekend on call...so I got to see her alot. </p>
<p>ERAS, the residency equivalent of AMCAS opens tomorrow to actually submit applications - but not all programs begin accepting applications right away - some wait until the 15th and others until the first of October. I've spent a moderate amount of time getting information into the system, but have yet to upload my personal statements, as it's still in that final tweaking stage. I have a couple versions I'm toying with, and the process just takes some time.</p>
<p>I have a meeting with our Peds Chairman next week, and he will be writing one of my letters as well. Most of the Chairmen at my school do this, operating with the mindset that they should do all they can to help students reach their goals, but it seems that's not always the case elsewhere. The med student I worked with in the PICU wants to do OB/GYN and said her chairman doesn't do letters unless she's actually worked with the student. It was interesting see the differences between the two hospitals.</p>
<p>I'd say I'm about 90/10 at this point critical care vs cardiology/pulm, but that might be generous in terms of cards or pulm. We got a lot of consults from those specialties in the PICU, and I have to say that I just wasn't as enthused about them as I thought I might have been. They're still interesting, but my reflex excitement to them wasn't as strong or intense as critical care was.</p>
<p>It may be a bit of of editorializing on my part, self selecting the aspects I like most about Critical Care as evidence of my desire to do it in the future, but I'm really excited about it. Most of the residents (Anesthesia, ED, and Ortho) I was hanging with socially smirked when I said I wanted to do PICU (most smirked when I said I was doing peds to begin with) and then brought up any number of reasons why it was a poor choice, and on most occasions, when I thought of their criticism, it was actually something that I either liked, could see myself doing, or even if not enjoyable (like talking with families about withdrawing care) were things that I'd much prefer to have be my responsibility. (In regards to the withdrawing care discussions...I've been in several, and to be honest, I wished the attending or resident would have let me do it, because I honestly believe I would have done a better job...)</p>
<p>Anyways, that's where we stand. I start Diagnostic Radiology on Tuesday...going in at 8:30 is going to be akin to sleeping in for me at this point. </p>
<p>As an administrative note, when I do start talking about specific programs, I'll only refer to them as Program A, B, C etc. They may get a few other identifiers but I won't be naming programs by name. I think that saves my anonymity and will allow me to be a little bit less restrained in my comments. Obviously I've tried to keep my current location masked to a certain extent (though I think you could probably figure it out), and if you are extremely interested in a certain location, PM me and I'll decide on a case by case basis who gets to be privileged to that information.</p>
<p>Oh, and PrincessDad - I wasn't particularly fond of physiology during M1 year, but I have to say...that when it had a direct clinical implication in the PICU, it was much more interesting.</p>
<p>Bigred,
Chairmen's letters are helpful -- but see if one of the people you worked with is FCCM. Have them call buddy at program you are interested in. The old boy network is still the main selection help.</p>
<p>Update:</p>
<p>Currently on Diagnostic radiology, which has it's pluses and minuses to be sure:</p>
<p>Pluses:
+ we spend two days each in ultrasound, GI, Nuclear med, Interventional, Mammogram, bone, CT, Neuro, and Chest, so we get to see the whole gamut of what radiologists do.
+ I'm pretty much done at noon everyday
+ they have a decent lecture course everyday
+ the principles of radiology book is excellent</p>
<p>minuses
- with only two days in each section, every resident starts off by saying "you're not going to learn how to read ______ in two days", so you sit around and watch them read films...
- ...which is insanely boring
- the attendings and residents want to get done with all their work, so they dont' really take time to teach during the day except for small points that will make their lives easier when you're a physician.
- they don't really care if you show up or when you leave (which is also not a bad thing).
- most of the radiologists shut down when you tell them that you're not going into radiology. Only the resident who was previously a neurosurg resident continued to talk to me after I told her I was headed towards peds critical care.</p>
<p>All in all, so long as I pass, I'm okay with the month. I've gotten a little better with films, I have a better idea on what to order in the future, and the book and lecture series have been helpful. And who doesn't like getting every afternoon off. And even though I want to bang my head against the wall when I'm there, at least I don't have to worry about ever wondering "what if I had done radiology?".</p>
<p>In other news, I submitted my ERAS application on Monday. I sent 21 apps on this first round, and am debating on whether to send about 4 more. I'm going to continue to look at possible places, but 21 should be plenty for me to at least get matched. I already have 3 invitations to interview, and an interview at my home school already set up for November. There's little to no chance that I'd stay here (I won't say never...extenuating circumstances could always pop up I suppose), but it'll be good to have that as my first interview so that I can practice. </p>
<p>Other than that...I signed up for USMLEWorld yesterday and have done a couple blocks of questions cold, with mediocre results. I just have to review things is all. I had one friend who scored 33 points better on Step 2 than she did on step 1, so I'm hopeful I can have a significant increase.</p>
<p>Radiology sounds interesting, done by noon!</p>
<p>All I know about ERAS is that it's the residency matching service. How exactly does the process of applying work? Just looking for some general information/overview I guess.</p>
<p>When do you take Step 2? And how long do med students generally have to study for it?</p>
<p>Yes, I get to leave by noon...the radiology residents of course don't....</p>
<p>ERAS is somewhat similar to AMCAS - lots of demographic information, you basically fill out a CV. Some of the more annoying aspects of the medical school application process have been removed, although I only know how it works for US Med Students, there could be variations for independent applicants as well as IMG's. There are unlimited spots for experiences which is is appropriate (considering some applicants using it are well established physicians or MD/PhD, etc). You don't have to fill in your transcript course by course, the personal statement has more available characters but everyone keeps it to less than a page usually, LOR's are sent to your medical school, then you get to pick and choose which ones go to which programs. You can upload multiple personal statements if you want, then select which ones go to which programs (which I would have found necessary had I ended up applying to med/peds as well as peds). </p>
<p>The one key difference is that of the Dean's Letter or Medical Student Performance Evaluation (MSPE) as it is now called...everyone still call's it the dean's letter. Your Dean of Students will write out an evaluation of you, include comments made during your third year clerkships and your rotations early on in the fourth year, along with any comments about problems with your medical school journey or exceedingly high accomplishments. Dean's Letter's aren't released to programs until November 1st for regular match. Not sure how those work for people doing early match programs though. </p>
<p>But the thing is, at least for peds, is that a lot of programs offer interviews even without your complete application in, and certainly without the dean's letter. That likely plays a role in their final ranking on you on their match lists, but they need to fill spots and if you're interested, then they want to get to see you and how you'd fit in. Certainly for the more competitive programs and definitely the more competitive specialties, there are more applicants than spots, and so they're pickier. Some of my friends looking to do things like ENT and radiology and such have no interview invites yet, and wont' for at least a couple more weeks while programs wait for their numbers to rise so they can get a good handle on where people relate to one another.</p>
<p>I take step 2 in November, both CK and CS. I'm starting on doing a little bit of studying now, but October will be my big month. I'm taking a class that's kind of unique to my school which is an extension of our small group sessions we have while on outpatient medicine. Those cases were PBL on steroids, and at a much quicker pace. They were also much more focused on interpretation of data and making the next management decision. The fourth year cases are a little bit more complex, a lot more "disease X in the presence of condition A" sort of stuff, as well as a lot of review on EKG's and some other things. My friends who took the class and then took boards said it was an immense help, though they didn't necessarily get the amount of time to study on their own that they wanted to. </p>
<p>The axiom I heard while studying for Step 1 was - 5 weeks for step 1, 5 days for Step 2, and a BAC below 0.5 for Step 3 (or at least don't take it while post-call). I had a very average score on Step 1, which I was happy with, but it would be nice to score better. Historically, my school tends to do about 12-18 points better on Step 2. I had one friend who scored 33 points higher from Step 1 to Step 2, so I should have some gains. Whether that will really make a difference in my residency selection/choices, I don't know but it couldn't hurt. In the end, because I'm taking it a little bit later, whatever impact it could have had (good or bad) is attenuated. The thing is that people with super good scores on Step 1 will take Step 2 after match lists are in (don't want to risk getting a lower score), while those with lower scores, or at least less competitive scores for what they want to do, will take it earlier. Me, I'm pretty average, going into a field that has pretty average scores, so I'm okay, and it just comes down to whether or not I can get interviews at some of my "reach" programs.</p>
<p>I passed Step 3 post-call (then, NBME, part III). While it's not recommended, taking Step 3 post-call does simulate decision making under sleep deprivation. </p>
<p>(After taking part III, I wondered if people who failed part III should be driving automobiles.)</p>
<p>i cant wait till i get into med school..i know its ALOT of work..but i mean its worth it.</p>