Rotation Schedule

This week, I assumed my place in the national online call reqistry known as amion.com. (That's pronounced, "Am I on?") Like every other resident, my call schedule is available to anyone with the proper login. Since I'm not sure how protected said logins are, I'll relay for all those who are interested which rotations I've been assigned.

6/21 - 7/20 Yale ED & Orientation
7/21 - 8/17 Bridgeport Hospital ED
8/18 - 9/14 Bridgeport Hospital ED & EMS
9/15 - 10/12 Bridgeport Hospital ED
10/13 - 11/9 Pediatrics at Bridgeport Hospital
11/10 - 12/7 Medical ICU at Yale
12/8 - 1/4 Ultrasound & Anesthesia
1/5 - 2/1 Ob-Gyn at Bridgeport Hospital
2/2 - 3/1 Yale ED
3/2 - 3/29 Cardiac Care Unit at Yale
3/30 - 4/26 Orthopedics
4/27 - 5/24 Medicine at Yale
5/25 - 6/21 Yale ED

This is just one more step in my transition to residency!

No Sour Grapes Here!

It's clear from earlier posts I've made that I'm not the biggest fan of the residency match process. One thing that I can get excited about is the move across country. A small part of that is that if I don't get excited about it, I don't think I'd be able to finish all the tasks associated with the relocation. We're headed to New Haven on a red-eye tonight. Which is the beginning of the end of my career as a medical student. It's also the beginning of the end of my contributions to The Differential. Which is just more reason why you should head over there an read my latest column.

Match Day

We have 3 months to finish medical school and move to New Haven. Ready, get set, GO!!!

Is Match Day Overrated?

I think it is. We're waiting the extra hour to check my results from the comfort of home. So be patient, family! Since I believe in both free speech and the possibility of reform, I went ahead and listed a few reasons why the emphasis on the Match (even I use a capital letter) could be misplaced. You'll have to go over to The Differential to read it. And yes, you will still need your free login.

One of my blog friends recently asked me if the same computer that compares my rank list with 30,000 other lists and the lists from thousands of programs was the same that made Bowl Championship Series calculations. I am inclined to think that this present figuring very well could be an off-season task for the BCS brain. Like the bowl placements, there will be folks happy with the outcome and folks that are not.

By the way, which are the other professions than medicine that use similar systems for job placement as that for medical residents?

• The Military
• Professional Sports
• Anything else?

Match, Smatch... They should just call it what it is. Today is Draft Day!

The Nitty-Gritty of Interviewing

I've been blogging over at The Differential for a year, and have a few more stories/rants/ideas to broadcast in that venue before I finish medical school. This week, I've reflected a bit on the logistics of interviews and the parts that I'm not so keen on.


But this isn't my standard refer you to The Differential post. I must also alert you that the whole blog has migrated from the Typepad interface to the Medscape platform. That's good for me because I can post entries myself and not have to email them to my editor first. But it COULD be bad for you because you'll have to sign up for a free Medscape account. If you want to bask in the old, all of my articles are available here.

Interviews Continue

In the process of making some of my last reservations for airfare and hotel, I cannot help but think about how fortunate in these ever-worsening economic times we senior medical students are to have a say in where we will work next year. It seems more of a pain than a privilege to have to jet across the US in search of the best-fit residency. But as each interview unfolds and as I'm toured the guts of America's hospitals, and as I observe how emergency departments operate on this coast or that, I feel tinges of conflict. Here I am with great opportunities - only one of which I will pursue - while the patients I'm chomping at the bit to meet, treat and advocate for face the converse: evaporating opportunity, escalating suffering and vanishing resources.

When framed this way, I ponder canceling the rest of my interviews. My pro&con lists from each program pick out relatively small differences between places. In the end, I know I must continue on for another few weeks. While the next month may consist of greenhouse gas guilt, travel fatigue and missed loved ones, the four years of residency will consist of lost sleep, steep learning curves, stresses of responsibility and the anguish of bearing witness to great pain and suffering. It will be important to live in a context of a supportive environment. Academic, social and even political and geographic context will play a part in my decision to rank programs. After then, it is up to the big computer in the sky to decide where is best.

Delta Work Hours?

Last week the National Academies' Institute of Medicine released a report recommending that medical resident work hours be curtailed even more than they were five years ago. This is based on some pretty solid research, mostly from a sleep study group at Harvard. The report is the subject of my latest post at The Differential, which if you're in academic medicine, you should definitely read (if not my post, the report). Unfortunately for me, if the accreditation group makes any changes it will likely be AFTER my intern year when I'm expected to work 30 hour shifts...

Update 12/9/08: My post is getting a lot of comment activity, particularly from resident surgeons who are proudly defending the fact that they violate their 80 hour limits and love it! Check it out! By the way, Pauline Chen at the NYTimes wrote a biased "I didn't have work hours limits when I was a resident and I turned out just fine, thank you!" article about this issue. And there is lively discussion of the topic at the Times' Well Blog as well.

4th in 5 Days

I'm in NYC ready to interview at the NYU/Bellevue emergency medicine residency. It's my 3rd city in 4 days, and tomorrow will be my 4th interview in 5 days. On my day off, I observed for a few hours in the New Haven hospital before going by Amtrak to NYC. I'm not particularly tired, but I do miss being home. Some things that have made this trip easier include:

• Traveling by train in the northeast is easy: show up at the station, get on the train, work in peace and quiet for a few hours, get off the train & you're there.
• Staying with friends from med school is great. Since I took 4 years to do my PhD, my classmates are all 4th year residents and therefore very knowledgeable hosts. It saves lots of ca$h, too.
• Traveling light is a must. For me, that's a bike messenger bag and a shoulder garment bag.

Negatives include:

• Not seeing or talking to my wife much - The three hour time zone difference further complicates the fact that she is working a night shift and sleeping days, and "everything's in a fog" for her.
• Gum on transit seats. Bad form folks... If only we were in Singapore! My impromptu road extraction kit lacks a key solvent. Hopefully the friendly neighborhood dry cleaners will be able to help me next week. My evaluators will have to look REALLY CLOSE at my backside to notice the gum remnant!
• Answering the SAME QUESTION over and again. At least my response stays the same each time.

Well then! Enough from me...

Dr. Goatee

In searching the internet for possible residency interview questions, I stumbled upon some other 'tips' about interviewing. Most notably, one site from Rush University offers the following prescription for a successful personal presentation:

Dress should always be conservative, tasteful, neat—and comfortable.

Have the appearance of a successful, mature physician, not a medical student.

MEN should wear a suit, not sport coat or khakis.

• Navy or gray, solid or pinstripe.
• White or pale-blue shirt.
• Conservative tie: solid, stripes, or small pattern (red or navy).
• Keep jewelry to a minimum.
• Short hair, preferably no goatees.

It's not just the Chicagoans at Rush that offer this advice. I found websites penned by schools from LA to Boston arguing for a clean shaven face. But there are other things I noticed about these suggestions:

Dress should always be conservative, tasteful, neat—and comfortable.
Okay, I buy this. Comfortable helps when you're running to catch your next flight, too.

Have the appearance of a successful, mature physician, not a medical student.
I think I have this down, what with being older than most of the residents at some programs; in five interviews (three schools, so far), I've received the follow-up question, "How old are you?"

Men should wear a suit, not sport coat or khakis.
Okay, I'll give here. Although when I interviewed at UW for the MD/PhD program, I wore khakis and a tie - no jacket. Look where that got me!

Navy or gray, solid or pinstripe.
Evidently black is out?

White or pale-blue shirt.
Whoops again. I don't own white or pale blue.

Conservative tie: solid, stripes, or small pattern (red or navy).
My real goal here is: not ugly.

Keep jewelry to a minimum.
Nickle allergy keeps this in check for me.

Short hair, preferably no goatees.
Does a shaved head count for short hair? Maybe shaving up there will cancel out the apparent transgression I make with this:



I did end up shaving, but it was the top of my head...

EM Interview Questions

There are a number of standard residency interview questions that candidates are asked in the interview circuit. A Google search will provide you with some stock questions you should be prepared to answer. For various reasons, I tend to take advice from those sites with a grain of salt. So here are some actual questions I've been asked on my emergency medicine residency interviews.

• How did you decide to apply to our program?
• Where will you be in 10 years?
• You've a different background than many applicants. Describe your trajectory in deciding on emergency medicine.
• What have you been reading?
• What is Wunderkammern? (A hobby I listed on my application.)
• So! What do I need to know about you?
• Which of your letter writers do you admire the most?
• What questions about our program can I answer for you?
• How would you respond to (insert complicated ethical dilemma here)?
• What are you doing the rest of the year?
• What are your plans for the holidays?
• What courses are you enrolled in this year?
• Why emergency medicine?
  
• Where else are you interviewing?
• Why (insert city here)?
• What will your first book be about?
• How have you responded to a situation of personal conflict?
• What areas of emergency medicine need the most work?
• Do you want to go back to Seattle to practice EM?
• What do you do to relax?
  

I'll give periodic updates to this list. I've only interviewed in three places. Do any of you co-applicants have any additions?

Inner Viewing

You can expect my posts over at The Differential to focus on interviewing for the next few weeks. After I finished my interview at the UCSF residency last week, I jotted down a few tips for future interviews. The article is now up over at the MedScape blog.


Stay tuned for more tips. Both here and there!

Today is the Day

Today I interview at UC San Francisco for a spot in their emergency medicine residency. It is the first interview of many for me, but is one of my very top choices. I've spent the last month working in San Francisco General Hospital, and really like the place. Granted, it's the only academic ED I've worked in thus far...

Well then... Here goes!

This is What I'm Signing Up For...

Several of my friends have suggested I respond to Pauline Chen's recent article in the New York Times about the treatment of medical interns during the first year of residency. Her article is provocative, and I am planning to offer a response (from a soon-to-be intern), but am still digesting it. Stay tuned.

Interviews!

Wow!

The stress of the interview season is still crescendoing for me. I've a couple of rejections, a fair number of invites (see column at right) and a couple of programs I still haven't heard from in cities where my wife is very interested in training. Now that she is heading off for her first trip (New York, Baltimore, St. Louis, Boston, Chicago in two weeks), I'm of course antsy. Trying to fit in a couple interviews in each of the cities she likes is maddening! Especially when there are optional but strongly recommended social activities the night before or after the interview, making logistics quite painful. And I haven't even started to purchase airfare!

So it goes. I am glad to be in San Fransisco learning more emergency medicine and seeing how a residency works. Being from a city without a residency program is a real handicap in terms of knowing what to look for and assessing for fit. I'm having a great time here in spite of the stress of organizing a travel agenda. Any readers out there having the same struggles?

My First Rejection

The University of Pittsburgh declined to interview me for their residency program, but there are a couple of others who have extended an invitation (see running panel at right). I'm still playing the waiting game for the other 20 programs...

And I'll still root for Pitt basketball and football...

Interviews

I've another article up at The Differential today. This one's about the anxiety associated with interviews. Not interviewing patients - interviewing at residency programs. Except that right now, my anxiety is centered on waiting for interview offers. For those playing along at home, I'll be updating a list (on the panel at right) of which cities you may be able to find me over the next few months. I'm linking the programs' websites, too (as much for my own utility as for your curiosity). Next week, I'll fly to the Bay Area for a month-long emergency medicine clerkship at San Francisco General Hospital.

500 Coyotes

Earlier this week around 6 AM, we caught a glimpse of a bushy black-tipped tail. And this evening, there was the familiar refrain of yip yaweeee. What a great way to celebrate my 500th post! The introspective coyote, searching for his reflection in pavement puddles is not a bad representation of the recent self examination I've been doing in the residency application process.

I'm guessing this season will have more rain and introspection. Hopefully, more coyotes too!

Happy 500 to me!

Workshopping a Personal Statment

So you're trying to write your medical school or residency application personal statement? Are you stumped? Do you feel like your missing something? Do you have writer's block? Here's a little exercise modified from my school's residency application handbook to help you get your ideas out. I've been pondering drafts of my personal statement for a while, but the exercise of sitting down and answering these questions helped me fill in some of the gaps.

* What are the skills valued by specialty? How have you demonstrated them?


* Has coursework shaped your specialty decision? How?


* Have you had any experiences outside of school that were significant to you personally and professionally?


* Do you have any other interests and experiences that demonstrate your values and individuality and may be a resource to a residency program? List them!


* What is the reason for applying to your specialty of choice?


* What are the characteristics of an attractive residency program?


* What are your personal and professional goals? Including practice location, style, and emphasis...


* Does your family status impact your vision?


I left some space so that you can imagine your answers. Or print this out and write them down. Or type between the gaps. It's not enough to think about them. Put your ideas in writing and your statement will come together more fully!

The Liability of Academic Blogging

It's been almost 8 years since I've had to sell myself. I'm again at that stage in life. It's coming time for me to shape up my curriculum vitae and personal statement for residency applications. And here's the dilemma: do I talk about blogging in my essay?

First, a step back for context: I'm fortunate in that I have some friends at hospitals where I hope to match. Some of them are even in the programs I'm applying for. One friend, in particular, has volunteered to be my insider agent at that school. I'm quite happy about this, because she is a very good student and will be an excellent ER doc - probably a professor - someday. It's nice to have folks who believe in you, but sometimes I worry about favoritism. Where is the line between the good-old-boy cronyism and networking? Anyway, she's already connected me with folks who will be helpful in my application process. My interest and dedication to the ethics and policy of science and medicine is one thing that makes me unique compared to other applicants, so this is part of her description of me. A description which often includes 'blogger.'

Ethics and policy is the way my commitment and passion for improving 'the system' takes form. In graduate school, the main way that I did this was by organizing events and bringing people together under the umbrella of the Forum on Science Ethics and Policy. Now that I'm busy with medical school, I work in ways that allow me to contribute to and learn about the contextual issues of science and medicine on my own time. Reading and writing, mostly. And this is where blogging comes in. I write other things - like the review article about urgent care clinics' impact on the ER safety net I've been working on for a couple of months, or the syllabus for a med student clinical ethics course, or those pesky responses to reviewers for my work in graduate school, but blogging is where I transcribe a majority of my ideas.

My blog does not have a lot of readers. At first, my main goal was to increase readership. Readership does grow slowly with quality content, but it grows much more quickly via self-promotion, links from big bloggers and writing on oft-searched topics. I even wanted to be assimilated by the ScienceBorg at one point. Getting this attention is no longer my priority. When I started blogging, it was primarily to find a voice. These days, I use my blog as a laboratory where I experiment with writing. I had no idea how cathartic the activity would be, and my interest in writing has since spilled over into two other (much more widely read) blogs and a (sorry, no public access) personal diary. Dare I say that 'blogger' is now a key part of my identity?

So how does this all fare in the world of residency applications? Despite efforts on the part of a philosophy professor in the bay area, the notion of blogging is still taboo in academia. (Note to said philosophy professor: is there any way you could seed this trend of legitimate academic blogging in some of the institutions just to the north of you? :-) --> j/k) I believe that in the right format, blogging is a legitimate academic activity. Even so, I still tend to de-emphasize blogging and use words like columnist and writer to describe what I do. Blogging is just a means to ends activity anyway: the end could be as broad as 'increased understanding' or 'better writer,' or as specific as 'a book' or 'drafts of opinion pieces in journals and newspapers.' And all of these ends should help me be a better academic, right? So why am I afraid to present the means in my personal statement?