Doctor and Patient: Reinventing the 3rd Year of Medical School
For nearly a century, the third year of medical school has been a pivotal point in training, a crucial step in the development of professional skills and attitudes toward patients. Recently, however, the tradition of monthlong “rotations” – a speed-dating introduction to the major disciplines of medicine and the issues patients face – has come under fire. During their third year, medical students are under constant pressure to perform for an ever-changing group of senior physicians, who in turn must evaluate the students based on brief interactions. Sailing through as many as six disciplines in just under a year, students have opportunities for only transient relationships, garnering mere snapshots of their patients’ illnesses and lives. Not surprisingly, studies have shown that these experiences result in “ethical erosion.” Students’ sense of empathy and bedside manner deteriorate, and many begin to refer to their patients not as people but as diseases, that dehumanizing shorthand of the wards.
This is an important issue. During my third year, at times it felt like I was speed-dating through some of my core rotations. Some rotations like Ob/Gyn, Pediatrics and Psych were only 6 weeks long, Family Medicine was only 4 weeks and Surgery and internal medicine were each 12 weeks. These short-lived experiences can really determine what field you end up choosing. Among my friends, it varied greatly with each hospital. For example, Ob/Gyn at one hospital really deterred most of my friends, including myself, from considering a career in the field. Whereas in a more “friendly,” positively involving program, more people chose that field. With USMLE Step 2 CS and CK hanging over you and preparing your ERAS application at the end of third year, these rotations can make or break what you apply in if you haven’t quite found your niche yet.
Harvard Medical School-Cambridge Integrated Clerkship, which assigns every third-year medical student to a “panel” of up to 100 patients to care for over the course of the year, seems like an interesting concept. I would imagine that following a patient for the course of an entire pregnancy or throughout the course of their disease, would be humanizing and inspiring. But I would worry about what you might miss out on. Part of balancing many patients with multiple diseases, is learning the tenuous balancing act that you will have to practice in your future career. Plus, for me, the more exposure to different illnesses, the better and more confident I became at handling the work-up. Part of this involved learning more about their specific disease or conditionn,which ultimately helps in reviewing for boards as well. I feel very lucky that in my internal medicine rotation and sub-I, I was empowered to manage my patient’s care from admission to discharge (overseen by my resident and attending, of course). While the patient turnover was pretty quick, it was challenging to learn the balancing act. However, I felt that I was able to have more than adequate interaction with my patients. But it certainly wasn’t like this in every rotation. In general, my advice would be to make it a goal to really get to know your patient well, beyond just their disease. Third year is the time to really discover where you might see yourself in the grand scheme of medicine, and help you decide how you want to spend your fourth year electives. It’s a time to learn, connect with patients, get a sense of responsibilities of being a doctor, and hopefully, a time to continue to be inspired along the way.
IMG Performance in the Match 2012
For the tenth consecutive year, the number of first-year (PGY-1) residency positions offered through the National Resident Matching Program (NRMP) Main Residency Match increased. A total of 24,034 first-year positions were offered in the 2012 Match. This represents an increase of 613 positions compared to last year and an increase of more than 3,400 positions since 2002.
The number of IMGs, including Fifth Pathway participants, who matched to first-year positions increased by 260 compared to 2011. Of the 11,134 IMGs who participated in the 2012 Match, 4,886 (43.9%) matched. In the 2011 Match, 4,626 (44.2%) IMGs were matched to first-year positions.
Of the 6,828 IMG participants who were not U.S. citizens, 2,775 (40.6%) obtained first-year positions. The number of non-U.S. citizen IMGs who obtained positions in 2012 increased by 54, after declining for the two previous years.
Of the 4,279 U.S. citizen IMG participants, 2,102 (49.1%) were matched to first-year positions, an increase of 218 over last year. This is the ninth consecutive year that there has been an increase in the number of U.S. citizen IMGs matching to first-year positions.
Of the 27 Fifth Pathway participants in the Match, 9 (33.3%) were matched to first-year positions.
It is important to note that the total number of IMGs who will fill PGY-1 positions for the 2012-2013 academic year will be higher than the number obtaining positions through the 2012 Match. Although the majority of PGY-1 positions in the United States are filled through the Match, a significant number of IMG applicants obtain positions outside of the Match. For example, while 4,686 IMGs obtained PGY-1 positions through the 2010 Match, 7,023 IMGs entered PGY-1 for the 2010-2011 academic year.
The 7,023 IMGs entering PGY-1 for the 2010-2011 academic year is a decrease of 312 from the prior year but an increase of 950 since the 2002-2003 academic year.
On Match Week 2012
To say that this whole thing started just a few months ago with the start of my ERAS application, interviewing, rank lists and whatnot, would be severely short-sighted of me. For me and for most people, this whole thing began as a child, having some idea of what I wanted to be when I grew up. Match week is a culmination of innocent childhood dreams, struggles and let-downs along the way as “non-traditional” students, late nights of studying, long zombie-like mornings after a rough 24-hour surgery call, and post-exam/end of rotation celebrations with amazing friends. For me, it was week where I spontaneously cried tears of complete happiness, relief and gratitude.
My path to medicine has been a long, winding road with rough terrain, detours and it seems that at times, my GPS was busted. From humble beginnings as a child surgeon, medicine meant saving lives by repairing detached limbs and performing (Sharpie marker) “cataract” surgery on Monkey-Key, my most beloved stuffed animal (made of love just like the Velveteen Rabbit). My first grade autobiography clearly predicts that not only would I become a doctor, but I would also find the cure to AIDS and subsequently become BFFs with Magic Johnson, drive a red Mazda Miata and only wear red dresses under my white coat. In fact, this highly predictive autobiography states that I was triple-boarded in pediatrics, neurosurgery and cardiology, while also being the premier hairstylist to the stars. No joke, I was living the dream.
Both fortunately and unfortunately, it wasn’t as easy as my 6 year-old mind imagined. In high school I started working in hospice care, providing comfort and happiness at the end of life. It gave me a completely different perspective on medicine and what saving lives really means. In college and graduate school, I worked part-time as an emergency room technician in Chicago. At first, it was exciting to be in the footsteps of Noah Wyle and George Clooney, but I also learned that medicine can be quick, dirty and often, devastating. I found myself questioning whether this was the right path for me and at that time, it surely wasn’t. After completing a master’s degree in public health, I set off on a journey to improve people’s lives through health education on prevention. Yet, I still felt this strong desire, perhaps calling, that I could make a greater impact with a combined background in medicine.
In hindsight, medical school itself seems to have flown by. Going through the first two years was not without pain and suffering (and seriously, it was emotionally and physically draining at times), yet looking back it wasn’t as bad as it seems. I can say that now since the end is within reach! To say that living on an island thousands of miles from my family and close friends in the most stressful time of my life was rough, cannot even begin to encapsulate this experience as a whole. But throughout the rough patches, I found friends that became surrogate family, whether it was celebrating Thanksgiving dinner, caring for my frequently injured friends, or cutting up oranges as a basketball mom. I found extraordinary future physicians along the way and developed friendships for a lifetime. Without St. George’s University, perhaps our paths would not have crossed and for this, I am ever grateful.
I am thankful for having such a supportive and incredibly patient family that were and are always there for me, even when I was stressed out of my mind and clearly, a huge pain in the ass. My family kept me going with their relentless support, as my mother’s words to “keep going” seemed to play on repeat in my head. They never gave up on me and never let me give up on myself. A worn-out birthday card from my grandfather, continued to remind me of family who have passed before me whose dreams I also carried with me.
It is a strange feeling to think that in just a few months, I will be a doctor. I am thrilled to have matched into a wonderful program where I know I will be happy. While I may not become a pediatrician-neurosurgeon-cardiologist-hairstylist, I know that I am steps closer to fulfilling my childhood dreams. And who knows, Magic Johnson and I may still become BFFs someday!
Support The Student Loan Forgiveness Act of 2012
Total outstanding student loan debt in America is expected to exceed $1 TRILLION this year. Millions of hardworking, taxpaying, educated Americans are being crushed under the weight of the educational debts, while the economy continues to sputter. Support a REAL Economic Stimulus and Jobs Plan. Support The Student Loan Forgiveness Act of 2012
That’s why I signed a petition to Rep. John Kline (MN-2), The United States House of Representatives, The United States Senate, and President Barack Obama, which says:
“Since 1980, average tuition for a 4-year college education has increased an astounding 827%.
Since 1999, average student loan debt has increased by a shameful 511%.
In 2010, total outstanding student loan debt exceeded total outstanding credit card debt in America for the first time ever.
In 2012, total outstanding student loan debt is expected to exceed $1 Trillion.
In short, student loan debt has become the latest financial crisis in America and, if we do absolutely nothing, the entire economy will eventually come crashing down again, just as it did when the housing bubble popped. Reasonable minds can disagree as to the solutions, they cannot, however, disagree on the existence of this ever-growing crisis, as well as the unsustainable course we’re on towards financial oblivion.
As a result of more than 30 years of treating higher education as an individual commodity, rather than a public good and an investment in our collective future, those buried under the weight of their student loan debt are not buying homes or cars, not starting businesses or families, and they’re not investing, inventing, innovating or otherwise engaged in any of the economically stimulative activities that we need all Americans to be engaged in if we’re ever to dig ourselves out of the giant hole created by the greed of those at the very top.
Now for the good news: there’s finally hope on the horizon!
Representative Hansen Clarke of Michigan has just introduced H.R. 4170, The Student Loan Forgiveness Act of 2012, in the House of Representatives - legislation designed to lend a helping hand to those struggling under massive amounts of student loan debt.
BMJ article: Increasing numbers of "cash-strapped" medical students raising funds through... prostitution?
I’m really not sure about the reliability of the survey method… but at least those students are getting some early experience at getting screwed over by the sad financial state of healthcare reimbursement. :(
New MCAT format approved
A few of you have asked about undergraduate coursework and majors as a pre-med. The new MCAT format has some major changes that may guide your choices.
1. The total time for the test will grow from 5.5 to 6.5 hours.
2. No more writing sample.
3. Added focus on health behavior, sociology and psychology.
Recommendations for pre-meds taking the new MCAT:
1. Take courses in psychology or sociology or health behaviors or all kinds of interdisciplinary classes. Besides helping you on the new MCAT, this makes sense. Much of working with patients is trying to gain an understand of their beliefs and how to influence/motivate health behavior chaange.
2. Kirch said, “One of the best ways pre-meds can prepare for medical school and for being a physician is “to read broadly” and “to be knowledgeable about the world at large.”
3. You don’t necessarily have to be a bio major or a physics major. Kirch said, “I think someone who is a psychology major or even a major in cross-cultural studies should have as much chance of medical school [admission] as a physics major.”
Rank list submitted!
Woo hoo! Now just the long, long wait til match day…..
From another friend. I am excited to be finally finished this year, especially since I just certified my rank list and now have to wait impatiently for my life (for the next 3 years) to be decided for me. But man, that pic really reminds of long nights of studying of the past, present and future.
Got this from a friend. Actually very true especially the unnecessary highlighting by medical students!
Thank goodness for electronic medical records.
My first case report is finally published!
And I have four + more to go! Kinda exciting.
Top 10 Reasons to Become a Doctor
On Medscape’s Differential, one of the medical student bloggers posted a great story responding to a former pre-medical student advisor and trained physician’s article, “The Top 10 Reasons Why You Should Not Go To Medical School…and the Single Reason You Should,” who has chosen not to practice medicine.
I think he really has some great points. There were and are times in medical school where I seriously thought, why am I doing this to myself? I definitely lost touch with some old friends and family. I see my friends continue on with their lives and grow up whereas I sometimes feel l like a perpetual student. I felt out of shape, I was really sick sometimes and just straight up exhausted. But, with the end in sight (May 11, 2012!!!!!!) honestly, it’s worth it. Time flies by in hindsight.
Last year, I made pretty extensive new year’s resolutions to be in better contact with my friends and family, make time to read books, cook, volunteer, knit, workout, write, and go out with friends, etc. And it’s been one of the most gratifying years for me. I really got to do all of these things during one of the busiest years of medical school, and write several journal articles (Four of which, will published in 2012, so far!). Better time management really allows you to whatever you want PLUS really feel like you are learning and helping people in a meaningful way. So many of these reasons not to become a doctor really disappear…but you have to really want it, remind yourself why you got into it in the first place and try.
Interesting article in NEJM last week.
77% survival rate among alcoholic hepatitis patients who got early liver transplants compared to 22% among those not receiving an early liver transplant. The NNT is 2… So we would need to treat 2 alcoholic hepatitis patients with early liver transplantation to save one life.
Obviously, there’s controversy in giving alcoholics liver transplants. Alcoholics usually have to be sober for 6 months to be considered for a liver transplant. Most alcoholics with severe hepatitis not responsive to therapy won’t survive the 6 months without a transplant. There isn’t any wait time for acetominophen-overdose liver transplants or from fatty liver. Should we be placing such a stigma on alcoholics that need a liver transplants vs. a person trying to commit suicide vs. an overweight person who continues to eat an unhealthy diet?
Medscape’s Physician Compensation report 2011. Not much new that most of us didn’t know already. I did find the survey question on satisfaction to be interesting.
“If you could do it all over again, would you….”
1. Choose medicine? 12% said no, 19% weren’t sure.
2. Choose the same specialty: 21% said no.
"Take the world apart and figure out how it works." - Built to Spill, 1994.
