sanguinemare

June 30, 2017

Week 1 of clerkships, and a little bit about the dissertation submission process

Today marks the end of my 1st week back to medical school, as a 3rd year student on the wards.  (Is it more grammatically correct to say “in the wards” or “on the wards”?  Hmm…) It’s been a pretty crazy ride so far, and I have to say, post-call day was pretty brutal.

So just to walk you through my week, I’ve basically been waking up around 6am this week to make it in on time at 7am (and I’m fortunate that my commute is about a <10 min walk) to be able to look up what happened to my patient overnight, check in with them, and get my thoughts organized before we round at 9am.  Generally I’ve been staying until around 4:30-5pm, sometimes just to go over my notes for the day.  On call day (Wednesday this week – it happens every 5 days), I got in at around the same time, but stayed until ~9pm, and post-call day, I had to wake up at ~4am to get in at 5am to prep for rounding at 7am to go over the patients the night shift team needed to pass over to us.  I still got out around 4:30pm that day.  So as you can imagine, that’s been pretty rough.

After I get back, I’ve been working on revising and sending out our manuscript the first couple nights to a new journal, and then yesterday I got an e-mail about minor edits for my dissertation, so I spent a couple hours fixing that on post-call night (after first taking a nap for a couple of hours), and finally got the final acceptance for that this morning.  Whoo hoo!  That also means I haven’t had any time to study/catch-up yet though, so I’ve been doing pretty poorly in terms of answering questions from the attending/residents.  It’s to the point where our attending didn’t even bother asking me questions when he went over antibiotics with us this afternoon, which is pretty much when you know you’re in bad shape. Sigh.

Anyway, also just wanted to give a brief overview of the dissertation submission process, (at least at our school) since I haven’t had a chance to yet, and did just happen to finish that today.  Basically, ~2 weeks before the PhD defense, you’re supposed to submit your dissertation to all of your committee members.  They review the file, and depending on the department, they’ll either give you feedback before your defense, or after.  My department does that after for some reason, so I didn’t see any edits until after my defense.  Then, you have 10 business days (aka 2 weeks) to make all the edits your committee requires, which can be either minor or extensive, depending.  Mine were pretty minor for the most part, luckily, but since I’m somewhat of a perfectionist, I also went back and fixed wording, added citations, fixed figures, etc.  That last one took an extremely long time to figure out because Microsoft Word for some reason was not converting pictures right, so I tried asking for help, and that person didn’t get back to me until the day before it was due (and actually they made one thing worse and didn’t fix any of the issues at all), so it was quite a bit of a panic there at the end.  Extremely fortunately for me, I was supposed to meet up with a computer engineer friend for lunch that last day, and he finally figured out the rather crude, but effective, method of print-screening the figures really large on a big monitor and copy-pasting into Word.  So there’s a tip for you, if you ever have issues with importing images into Word!

Anyway, after finally submitting it, then we wait until the graduate school looks over it and sends an e-mail with any formatting or other issues that need to be fixed.  I got that e-mail yesterday, made my revisions (and went through everything again with a fine-toothed comb to check for (many) spacing errors and typos), sent it in, and got the e-mail back this morning saying it was officially accepted.  Apparently sometimes that last step can go back and forth for a bit – another MSTP who went back a rotation before me and is now on the same rotation as me said it took him a couple weeks of going back and forth with the graduate school before it got accepted, but I think he also didn’t realize that some of his changes threw off other formatting, so maybe that’s why it took longer.  But anyway, there you have it!  That’s the dissertation submission process in a nutshell.   And it’s past my bedtime nowadays, so goodnight!

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June 26, 2017

First Day Back to Clinics

Filed under: Med School and the MSTP,MS-3 — sanguinemare @ 7:07 pm
Tags: , , , ,

Thoughts and impressions about my first day starting back as an MS-3 student on the wards (on Internal Medicine):

Orientation:

Orientation was pretty chill, but unfortunately less informative than I would have liked, in regards to say… what my actual schedule was going to be like (which, if nothing else, I was hoping we’d at least get some sort of understandable schedule.  Someone even had to ask what call/post-call meant, because there was no explanation of the hours or caps or anything in the actual orientation.  FYI, I’m still not actually sure what it entails, but from what my MSTP friend told me yesterday at retreat and somewhat from orientation today, I gather that there’s something called a “short call”, which goes from ~7am-12pm, with a cap of 4 new patients.  “Long call”, means 12pm – 8pm or so (which is when night shift gets there), with a cap of 8 new patients (and takes over if the short call team caps).  Except here’s where I get a little confused, since my interns mentioned that on our call day, we also start rounding at 7am, which also means we need to get there around 5am.  So, not really sure on that… and then “post-call” is apparently the day after long call, where we also have to be in to present by 7am.  So basically post-call days are probably going to be the worst in terms of sleep deprivation and such (but even then, as med students, we don’t have it nearly as bad as the interns).

The other 3rd years on this rotation seem pretty chill though, which is nice.  Also got to see an old acquaintance who used to be a year above me, went to Harvard for his PhD, then came back to 3rd year here, so that was nostalgic.  Apparently he’s been back since January.

The team:

We have a pretty full team – 1 PGY-3 (3rd year resident), 2 PGY-1’s (interns), 1 4th year, and 2 3rd years.  It’s good I guess so the work is split more, but it also means so that we are down 1 computer in our team room, which worked out ok today because I still didn’t have computer access yet, but will be kind of a problem later.  I ended up having to grab a “COW” (computer on wheels) after I was finally able to get access to the online system this afternoon, and that was a bit tricky to use because it was kind of cumbersome/blocked a large part of the room, happened to have a broken lever so wasn’t height-adjustable, and just wasn’t great to have to use overall.  Actually now that I think about it, I’m probably going to have to use another one tomorrow, since it sounds like everyone else is planning to get there super early, and I’m only planning to get in around 7am (one of the interns said we just needed to be ready by 8am, but it sounds like the 4th year wants to be in IM so is going to get there really early, and the other 3rd year also seems like he’s going to wake up early), so the computers will likely be all taken up by the time I get there. Ah well.

In terms of the people, our group seems pretty nice and friendly.  It’s apparently almost everyone’s first time though, which makes for an interesting dynamic.  This is the interns’ first rotation, the first AI for the 4th year, obviously the first rotation for me, and the upper level resident’s first time on this service.  The only one whose first time it isn’t is my co-3rd year, and it’s only his 2nd rotation.  So far though, other than the interns and 4th year all looking extremely tired (which is actually rather concerning…) everyone seems pretty friendly.  It’s also kind of interesting because our upper level is actually someone from my class haha.  So that was fun.  (And thankfully he’s super nice and really wants to teach people, so I’m glad it was him).  Our attending seems pretty laid back as well, but we’ll see.  He actually invited us to his place for a party on Saturday this morning haha!

My mental status after today:

Wow.  I am so lost, and know absolutely nothing.  We saw a patient with bullae and the only thing I could think of was “epidermolysis bullosa,” but when the attending asked us the most likely cause, I had no idea.  The other med student didn’t skip a beat, and said “antibodies”, and I had no idea what he even meant.  (And now that I’ve looked up EB, which is apparently usually genetically based, I’m pretty sure that wasn’t even correct…)  And what with all my access being limited and everything else, I was essentially completely useless on the team today.  I have a LOT to learn.  Which is why I need to buy the UWorld Qbank tonight and start doing some questions right away haha.  It’s going to be tough to get back up to speed in such a short time, but I’m going to do my best.  I also need to submit our manuscript which got rejected over the weekend to another journal, and still need to re-draft another manuscript and edit some other files, as well as read up on my patient tonight.  Yikes.  Now I know why everyone says 3rd year is really tough (aside from intern year).  There’s really no time to waste on any unnecessary things.  Well, I guess it just means it’s time for me to finally learn to be efficient with my time!  Wish me luck!

March 20, 2013

Last day of preclinicals… and the general overview of medical school

It’s kind of surreal, but it’s here.  Today was the last day of our pre-clinical years – the last day we will be sitting together in the same classroom, listening to lecturers and seeing the same faces every day.  Technically yesterday was our last day of real lecture – today was just a couple of review sessions before our very last test in this building.  It’s hard to believe that this is it… the culmination of 2 years in medical school.

For those who don’t know, medical school is divided into 2 “sections”, if you will.  The first two years are called “preclinical” years because, as the name implies, it is what you learn before entering the 2nd half, which are your “clinical” years.  Preclinical years are where you spend every day in lectures or small group discussions on medical cases, and you do all your basic science and medical learning.  It includes courses on things like anatomy, physiology, biochemistry, microbiology, etc, as well as organ systems like our school uses, so going through cardio (the heart), respiratory (lungs), GI (bowel stuff and all organs in the abdominal area), renal (kidneys), musculoskeletal (muscles and bones), neurology (brain), hematology/oncology (blood and blood-related cancers/diseases), endocrine (hormones), and the last one we are just finishing up, reproduction (gonads and related diseases).

After this and before entering the clinics, we all have to pass what is called the Step 1 of the USMLE Board Exams (or Step 1 for short).  This is what is going to take up my life for the next two months or so.  The Step 1 is like the MCAT, but probably 100x harder.  It’s made up mainly of clinical vignettes, or short clinical scenarios, that you have to decipher to get at the right answer.  It’s also usually formatted in a “2-step” manner – meaning, they could give you a long story about a patient, but instead of just asking you what the patient has (which would be a 1-step thought process), they would ask something like “what is the genetic mutation most likely associated with this?” or “What other conditions are commonly associated with this?”  So you not only need to be able to recognize what the problem is, but you also need to know all the other random facts associated with it.  On top of just the difficulty of the exam is the fact that for many specialties, especially competitive ones, this is a key determinant to whether or not you will get interviewed, or even if the rest of your application will be looked at.  So in a sense, your Step 1 score will determine what specialties you can feasibly apply for.  Just passing isn’t nearly good enough, especially with the fact that the numbers of medical students are currently increasing, but the residency cap is still in place and thus residency spots are getting relatively more and more limited.  Pretty intimidating huh?

Assuming you pass Step 1, you then move into the clinics for 3rd and 4th year.  The clinical years are basically when medical students really get their feet wet on working in the hospital and being part of the medical team.   3rd and 4th year medical students are the ones who get spend the most time with patients and writing up reports and presenting them to the residents (post-med school trainees) and attendings (who I think of as the “real” doctors).  I think there are core clerkships you need to take, like medicine, surgery, OB/GYN, etc, after which you now need to take national standardized exams called  and then there are electives that you can choose from if you’re interested in them, which include more of the specialized topics, such as anesthesiology, dermatology, orthopaedics, etc.  There’s a lot more specialties than there are rotations for electives, so you need to be thinking about which to choose early.  At the end of 4th year, you take Step 2 of the Boards (which has 2 parts – a knowledge portion (CK) which is like a regular test, and a skills portion (CS) which tests your clinical skills with simulated patients.  You also apply for residencies that year.  After getting into residency, in the first year, you are called an intern, and the following years, you become a resident.  That’s as far as I understand it anyway 😛

As MSTP, it’s a little different for us.  Most schools follow the same schedule we do, which is first two years as preclinical years, then take Step 1, then enter our labs/PhD programs, defend our thesis and earn a PhD, and then go back to medical school to finish our last 2 years in the clinics.  We’ve recently changed it so that 2nd years have the option to do a family medicine elective rotation first before entering the labs, which I think is a good idea because we’ll be coming fresh off of Step 1 and will be able to apply some of our clinical knowledge before going off to a different world for 4 years or so.  The last two years of MSTP’s here have said they it was a good experience as well, so I’m looking forward to it.  Part of the reason for this change was apparently because some residencies, like those in California, require a family medicine rotation before applying, so that’s something to note.  We also only have 1.5 years to finish our 3rd/4th years for some reason, which is another reason why it’s good to get that rotation in early.

Anyway, hopefully that was informative, or at least wasn’t too boring or redundant (I vaguely remember posting something briefly about how the MSTP schedule works out sometime last year or so…)  Sorry if I did end up repeating myself, although I think I understand clinical stuff a bit better now.

Ah, I’m going to miss the people in my class.  As an MSTP, we’re already going to be pretty disconnected with our classmates to begin with, but now also around 1/3 of our class are going off to branch campuses, so it’ll be even harder for me to see them around.  :\  I have heard that the hardest for MSTP’s  is when Match Day comes in 4th year for our respective classes, where everyone finds out where they’re going to go, and everyone we knew in med school will really be gone and scattered around the nation.  I’m slightly depressed already thinking about it, haha.  Ah well, it’s been a good two years.  Best of luck on Step 1 everyone!

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