April and May 2016…and Commencement

Apologies again for such a delayed post.  The months since my last update have been pretty full, as you might have guessed.

After finishing classes, I had grand plans for the month-and-some leading up to graduation.  Among these, I wanted to finish a book I’d been slowly reading and perhaps start a new one, learn to play some songs (mine and others) on my guitar, and experiment with Garageband.  Very little of this got done (it is now June and I am still waist-deep in Adam Bede), but I’m still pleased with what did happen in that time.

The month of April had several highlights.  My mom visited a couple of times and helped me search for a new apartment; after several under- and overwhelming appointments, phone calls, and building tours, I finally found a place that fit most of my needs and wants.  I volunteered for (and performed at, with the Radial Grooves a cappella group) VMS’ Second Look Weekend for what is likely the last time.  I celebrated my 25th birthday with several friends–and finally convinced myself to try Hattie B’s hottest flavor of hot chicken, Shut the Cluck Up (never again!).  A few friends from church and I saw Amanda Cook in concert, which was incredible from both a musical and a spiritual standpoint.  And I once again got to sing with my church’s worship team at mile 8 of the St. Jude Rock & Roll Marathon.

The first two weeks in May were also pretty eventful.  Radial Grooves performed a few songs for Parent Weekend, during which the families of third year medical students get a taste of life at VMS.  I sang another one of my original songs at VMS’ Cultural Series–this time with guitar accompaniment; figuring out chords to go along with the melody of the song and having a jam session with a friend so he could learn the song were both completely new and exciting experiences for me.  The days leading up to graduation on Friday, May 13, involved celebratory lunches and dinners, a beautiful commissioning service by the Medical Christian Fellowship, Class Day, time with friends, and last-minute logistics.

Graduation day itself was a wonderful celebration of all we’d accomplished individually and collectively.  Vanderbilt has two sets of ceremonies: a huge one in the morning during which all students from their respective schools process onto Alumni Lawn and officially get their degrees conferred, and smaller ones for recipients of graduate degrees at respective locations around campus.  I felt like there were so many pieces to the puzzle that was my graduation day, but it all went by surprisingly quickly.  It was only a month ago, but I barely remember walking onstage in Langford Auditorium to receive my diploma and have the Dean of Students place the doctorate hood over my head.  The strawberries and champagne (although I didn’t drink any) reception, long-overdue first trip to Monell’s, and further celebration with family that followed all sort of feel like they happened in a different lifetime.  It’s funny how such significant moments become fairly distant memories in so little time.

I’ve gotten a few questions about what will happen now.  I am officially a doctor (you might say that Eni, MD is more than just a blog title now), but I still need more training to be able to practice independently as a psychiatrist.  That’s where my 4-year residency program (aka my very first job) comes in.  July 1 is when I will officially start; in the meantime, I’ve been settling in to my new apartment, getting accustomed to driving in Nashville (yes, I have a car now!) and making other preparations, such as becoming certified in Pediatric Advanced Life Support (PALS) and gathering everything I need for orientation, which will start later this week.  I’m really nervous about this next chapter, but I’m also excited to meet my co-interns, start seeing patients again, and see how everything will come together.

You might also be wondering about my plans for this blog.  As fun as it’s been to keep everyone updated on my life for the past 4 years (it’s been this long!  I can barely believe it myself!), I think this might be my last post.  I’m thankful to everyone who’s read my blog, and I hope that they’ve been helpful, whether you’re a medical student trying to figure out how to study (or how NOT to study) for a shelf exam or someone who’s always wondered how one becomes a doctor (or something like that).

Here’s to the next chapter,
Eni, MD

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Immersion Phase Update: Preparation for Internship (2/29 – 3/22)

This post is embarrassingly overdue.  Especially given the fact that I’ve been done with classes since the end of March.  Don’t judge me.

Anyway, my last ever class of medical school was called “Preparation for Internship.”  It was mostly lecture-based, reminiscent of my first 18 months as a medical student.  Faculty and residents taught us practical things about topics such as writing orders, approaching chest pain, and transitioning from full-time learners to part-time teachers.  Standardized patients helped us learn about ways to deal with drug-seeking patients or to gain informed consent for procedures.  We also had review sessions to practice components of the physical exam that are often deemed tricky by medical students.  Much of these 4 weeks offered a great review, but I was honestly a bit shocked about how much I had forgotten over 4 years and how much I would still need to learn and retain as a resident physician.

On the first Friday of March, the fourth years got together for our final class retreat.  Many of us hadn’t seen each other in several months or even longer, so it was good to be able to reconvene as a unit.  During the day, we reflected on our experiences as students.  We were even shown the personal statements we had written when we initially applied to medical school.  After having served on the admissions committee during this past cycle and seen some very masterfully written essays, I was a bit embarrassed; I felt that I could have done a better job writing about myself back then!  In any case, it was quite interesting to see how my perceptions of the medical field and my role in it have evolved since then.  After looking back on where we’d all come, we looked ahead, spending some time talking about logistics for graduation and also crafting the class oath that will be recited during the ceremony.  At the end of the day, we had a small pre-Match Day celebration during which classmates swapped both embarrassing and triumphant stories about the interview trail for gift cards.

And then came Match Day.  On Monday, March 14, I got the news that I’d matched into one of the 5 psychiatry residency programs I’d ranked back in February.  On Friday, March 18, toward the end of the Match Day Ceremony, after sitting through several speeches, celebrations, songs, and baby pictures, I opened my envelope and learned that I had matched at Vanderbilt–my top choice.  I kept it together while I was on stage (people said that I seemed really happy when I read the name), but as soon as I sat back down, I cried tears of joy and relief.  And the photographer got a picture of me crying and posted it online with the rest of the pictures.  But she’s awesome, so I forgive her.  I was especially happy because my grandmother got to see me match for her birthday.

The next day was Cadaver Ball at Marathon Music Works–what may have been my last (residents usually don’t go).  This year’s theme and many of the videos were based on Saturday Night Live.  The a cappella group performed on the big stage for the first time, and I also got to do a dance routine with some of the other 4th years.

About a week later, I went with several other Vanderbilt students to Austin, TX, for the Student National Medical Association’s national conference.  The focus for this year was on mental health disparities, so they had several workshops and talks geared toward that topic.  Additionally, they had practical advice for pre-meds, medical students, and residents about various points of interest (how to suture, how to study for the MCAT, what to consider when opening a private practice, etc).  There were also recruitment fairs for current medical students to learn about residency programs, as well as fairs for pre-med students to learn about medical schools.  Of course, I spent quite a bit of time getting to know some of the other students from Vanderbilt and other schools, and we explored the city some while we were there.  One of my favorite moments was during the banquet on the final night, when the graduating students were awarded with SNMA stoles and pins and invited to join the National Medical Association.  Hearing the names of so many other underrepresented minorities on the cusp of becoming physicians, and standing with them to take a picture was both refreshing and overwhelming in the best way possible.

So that’s my long-overdue update for March.  I’m graduating 2 days from now, at which point I will update you on the time in between.  If you’d like to watch the ceremony on or after May 13, click here.  Get excited!  I am!!

AWESOME NEWS!!!!

Hey everyone,

I just wanted to give a quick update and say that I matched into a psychiatry residency program! The NRMP (National Resident Matching Program) sent out “Did I Match?” emails to applicants yesterday morning. So now I’m preparing for Match Day (where I find out which program I matched into), which is this Friday at 11am Central Time. If you’d like to watch the ceremony online, here’s a link: https://medschool.vanderbilt.edu/programs/match-day

Thank you all for your support, interest, and encouragement! This has been such an incredible journey and I can’t believe I’ve gotten this far.

Immersion Phase Update: 2/1 – 2/26

I took a true “flex month” in February–no tests to study for, no interviews to travel for. I spent most of my time back at home; all told, I kept pretty busy with a number of tasks, errands, and events.

I spent my first week and a half in Memphis with my family, then headed back to Nashville for about 5 days.  I had been invited to participate in the Second Look Weekend that Vanderbilt Medical School’s Office for Diversity organizes for underrepresented minorities applying to residency programs.  Each participating department had its own set of activities for the day, and there were also a few social dinners and activities that all participants went to.  I enjoyed my time getting to know four other people who were applying for psychiatry, as well as others considering Vanderbilt for training in other specialties.

The day after Second Look Weekend ended, Radial Grooves (the a cappella group I sing with) performed at the third annual Dr. Vanderbilt Pageant, a humorous competition between physicians that also functions as a fundraiser.  Physicians showed off their “evening wear,” lip-syncing/dancing skills, and trivia prowess.  This year, proceeds from ticket sales went to Primeros Pasos, a primary care clinic in Guatemala.

On Valentines Day, I got a last-minute ticket (literally) to see Brené Brown give a talk at Vanderbilt about shame, perfectionism, and vulnerability.  Then I headed to Marathon Music Works for a fantastic concert headlined by Madeon.  Unlike the last time I went to that venue for an EDM concert, I didn’t have to worry with a day or so of tinnitus afterward.

When I got back to Memphis, I joined a dear friend from high school for dinner and a Hillsong concert at the FedEx Forum.  It was such a great experience from both a musical, social, and spiritual standpoint.  My friend and I are both talking about how much we wish we could go again, especially since Hillsong is heading to Boston and we both know people I went to college with there.

Another highlight of my month was the amount of time that I had to practice driving.  When I first got behind the wheel again, my parents and I noticed that I had taken several steps backward in confidence and ability.  After a few days, though, I started to feel more comfortable driving.  I ran several days’ worth of errands around Memphis with one of my parents supervising from the passenger seat.  This past week, I drove myself to a nearby church on two separate occasions; it was my first time completely alone in the car, and I think I managed pretty well!

I did complete one or two big tasks related to medical school.  I finally sat down and really thought through all of my experiences on the interview trail in order to construct my residency rank order list.  I submitted and certified the list on the official website well before the February 24th deadline.  Now I and my classmates–and fourth-year medical students from institutions all over–are waiting to hear about the results of The Match.  Here’s an interesting article about the algorithm that handles applicant and program rank order lists.

So that’s what I’ve been up to on this month off!  In March, I will be completing my last medical school course and hopefully participating in Match Day.  Stay tuned…

Immersion Phase Update: Integrative Medicine (1/5 – 1/29)

January was a super rewarding month.  Working with one of the attending physicians I’d met on my PM&R elective in July, I landed a month-long elective at the Osher Center for Integrative Medicine at Vanderbilt.  Integrative medicine, also known as complementary or alternative medicine, focuses on holistic care of the individual–bringing together physical symptoms, behaviors, emotional health, relationships, and other aspects of a person’s life to promote overall wellness.  To do this, integrative medicine combines conventional medical care with interventions such as counseling, physical therapy, yoga, and acupuncture.  The chief complaint for most patients is some form of chronic pain–from migraine headaches to fibromyalgia–but they might also struggle with things like insomnia, anxiety, weight management, GI issues, or some combination of the same.

The philosophy of holistic care that clinics such as Vanderbilt’s Osher Center are founded upon is such an important one, but one of the unfortunate and sometimes frustrating observations that I had is that patients often arrive at this clinic as a “last resort” after seeing countless specialists in the community and considering myriad medications and procedures with no relief of symptoms.  Ideally, an integrative care model would offer a first look at the conventional and non-traditional options available to patients in order to deliver the best care possible for an issue, or perhaps it would facilitate preventive care before issues arise.  However, in the current health system, this is not the case.

Over the course of the month, I spent weekdays at the Osher Center and saw patients with physicians, nurse practitioners with medical or psychiatric focus, physical therapists (in exam rooms at Osher and in the heated pool at the Dayani Center on the main campus),  an acupuncturist, and a massage therapist.  I also participated in a few positive psychology/mindfulness meditation classes, tai chi classes, and yoga classes for patients.  There was even a workshop on sleep that I sat in on for a few afternoons.  I gained a lot from my experiences; I not only learned about how some of the recommended practices fit into patient care, but I also was able to take note of different styles of interviewing, educating, and motivating patients, which will no doubt serve me well later on in my own practice as a physician.  In addition to all of this, I discovered a few things–sleep hygiene tips, breathing and mindfulness techniques, and other little suggestions made to patients–that I want to actively incorporate into my own personal life.

Aside from observing and absorbing information from clinical experiences and the database of articles I’d been sent on day 1, I was asked to give a presentation on an integrative medicine topic of my choice.  So, during the last week of my rotation, I presented a short talk on how music can fit into the philosophy of integrative medicine.  It was well received and greatly appreciated by those who could attend, much to my relief (I guess oral presentations will always make me nervous).

As if this elective wasn’t enjoyable enough on its own…I had a pretty active life outside of clinic as well.  I got to sing with the worship team at church again, singing vocals with just two other people instead of being one voice in a full ensemble.  I was super nervous, as I’d never done this before, but now I’m hoping for the chance to do it again sometime if they’ll have me.  I also put a few new covers on my YouTube channel; one of them was even shared on Twitter by the original artist, which was super exciting!  In addition, I started to think about my rank order list for residency programs, meeting with people and getting advice from faculty both inside and outside of psychiatry.  I still have about 3 weeks before the deadline, but it’s quite a daunting thought just the same.

Now I am off for the entire month of February, taking one of my remaining “flex months.”  I’m spending most of that time in Memphis, keeping busy in a number of different ways.  Check back here at the end of the month for an update (hopefully)!

As always, thanks for reading.

Post-Residency Interview Update

This is the first of a few long-overdue updates.  Apologies for neglecting to keep you guys up to speed on what’s been happening with me; life has been rather hectic.

Hello, friends!

I am happy to report that I am now done with interviews for psych residency!  I took the months of November and December completely off to travel for my interviews. I’m not sure how much detail I can or should go into about how each interview went, but I thought I’d talk about the overall process in this update, in addition to some fun things I did when I wasn’t in business formal attire.

Most programs host a pre- or post-interview event, such as an informal reception or dinner at a restaurant (all but one of my interviews had such events).  This is a great chance to meet other applicants and ask current residents about the program and the city; most of the time you can ask questions that wouldn’t go over well during an actual interview with a faculty member (such as “What’s the call schedule like here?”).  And you can get a good sense of how the residents interact around each other.

Interview days were organized in various ways.  Most started around 8am with an introductory session with the program director and/or the program coordinator.  During the day, there was typically a tour of some/most/all of the facilities which psych residents might frequent, a presentation of some sort about the highlights of the program’s city, and more time to meet residents and ask them questions.  Some programs scheduled group meetings with applicants to discuss particular aspects of the program, such as dedicated curricular tracks that they might offer to interested residents (e.g. a research-focused track or an administrative/clinician educator track).  And of course, there were the interviews.

Several people–current residents, faculty–had told me that interviewing for residency is a bit different than interviewing for medical school.  While in the latter situation, the applicant is trying to prove hirself and convince the school to accept hir, the former situation places the applicant and the program on more equal footing.  “You’re interviewing the program just as much as they’re interviewing you,” I was told. And regardless of differences in interview style and interview day format, this pretty much rang true.

All of my interviews were one on one with faculty, psych department chairs, program directors, or current residents, and they were each about 30 minutes long.  Most programs I went to had 4-5 interviews scheduled for each applicant, although at one place I only had 2, and at another place I had 7!  Sometimes all of my interviews were in the morning, other times all of them were after lunch.  But for the most part, they were all fairly relaxed; the interviewer would invite me to elaborate on  aspects of my application (one attending admitted that he almost asked me to beat-box because I mentioned that on my resume, and another asked if he could hear one of my mashups because I’d talked about them in my personal statement), ask me a few more general questions about my interests within psychiatry or about my personal thoughts about where I see myself career-wise, and then answer any of my questions.

After each interview day came the whirlwind of travel back home, flurries of thank you emails, and collections of personal thoughts about each program.  Now that I’m completely done with the interview process, I have to reflect upon what I now know about each program in order to navigate the next step of the process: matching.

No, this isn’t exactly like a string of job interviews.  I’ve gotten that question quite a bit–“so when do you hear back from programs about how you did?”  The short answer is, “I don’t.”  The long answer goes something like this.

Medical students who have interviewed at residency programs now have to construct what’s called a rank order list, organizing the programs from highest to lowest preference based on their individual values.  At the same time, each residency program constructs its own rank list of their interviewees that season, taking into consideration the fact that there is a limited number of spots for incoming residents at each place.  Both of these lists are submitted through a service called the National Resident Matching Program.  There is a special, top-secret algorithm by which applicants’ rank lists are compared with programs’ rank lists.  Then, one day in March, every applicant finds out whether they “matched” at a program, and a few days later, each school holds something called “Match Day,” during which everyone finds out which program they’ll be going to after they graduate.  There’s also another process that applicants can go through if they find out they don’t match–which, understandably, is a possibility most people don’t talk about on this side of things.  If you’re interested, Match Day this year is on March 18 (I believe it’s at 11am CST), and if you search online you should be able to find Vanderbilt’s live stream (in the meantime, click here for information about past Match Day proceedings at Vanderbilt).

Before I wrap this up, here’s a quick rundown of the fun things that happened during the past couple of months:

  • At the end of October, I bought a guitar!  This is something I’ve wanted to do for years, and thanks to a sweet Groupon deal that I couldn’t pass up, I finally made it happen.  The original plan was to practice for 10 minutes every day–I found a free app called Yousician with lessons to help with this process–but I’ve been a little bit more lax about that than I intended.  At the time of this writing, I can play 5 chords and am working on my strumming technique.  Eventually, I want to be able to write songs and accompany myself.
  • In November, members of the Vanderbilt SNMA went to the Debusk College of Osteopathic Medicine (DCOM) at Lincoln Memorial University in Harrogate, TN, for the Region X conference.  Region X of SNMA is composed of allopathic and osteopathic schools from TN and KY.  We Vanderbilt students networked, toured DCOM, sat in on lectures and interactive workshops, and bonded with each other and with students from some of the other schools.  All in all, a great time.
  • Also, I FINALLY got my driver’s license!  I took the road test in November.  Only had to take it one time.  My mom commented that I seemed much more comfortable behind the wheel after taking the test than I had before the test, as if overcoming this challenge was the source of most of my fear.  The next step will be increasing my confidence on the interstate, with the goal of driving my (loaner) car up to Nashville.
  • In December, the Radial Grooves had a few performances.  We sang at the Best Buddies Holiday Party again this year, and we also offered music–almost 2 hour’s worth!–for the Hematology and Oncology department’s end of the year celebration.  We have a lot of exciting things coming up in 2016, as well…which I will of course tell you all about.
  • I’ve been pretty active with my church as well–going to Sunday services and Wednesday night Bible study, spending time with people outside of church at potlucks and events like the Christmas lights at Cheekwood Botanical Gardens.  I also participated in a few music-related things in December.  The Sunday before Christmas, I sang with a gospel ensemble that one of the worship leaders organized; as you all know, I’ve wanted to do something worship-related at my church ever since I started attending back in 2013, so this was a treat.  The same weekend, a church friend invited me to sing background vocals with her and a couple of other women for a Christmas concert that Sunday night; this was an opportunity I couldn’t possibly pass up–well worth the hustle and bustle!
  • In addition to all of this, I spent the holidays with my family.  I went back to Memphis for Thanksgiving, reunited with my extended family in Nashville over Christmas, and went back home again to ring in the New Year.

Whew.  This was a lot longer than I expected it to be.

As always, feel free to hit me up with any questions about literally anything I talk about here.  I’m happy to answer them.  Stay tuned for the next update! 🙂

2015 in review

Hi friends!

Yes, it’s been a while since I’ve updated this blog.  I took November and December off for residency interviews.  I’m planning to post an update of sorts once I go to my last interview (!!!) in a few days.  For now, check out my year in review!  And I hope everyone has a safe and enjoyable New Year’s Eve.  2016 is going to be awesome.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 1,300 times in 2015. If it were a cable car, it would take about 22 trips to carry that many people.

Click here to see the complete report.

Immersion Phase Update: Obesity Integrated Science Course (9/28 – 10/23)

During Immersion Phase, we’re required to take at least one Integrated Science Course (ISC), which combines clinical work with aspects of our preclinical years.  The ISC I chose focused on obesity and its impact on adults, children, healthcare, and society.  We rotated through several clinical sites throughout the month and also had lectures and completed assignments on the pathophysiology of obesity, medical and surgical management, public health and cultural considerations, and other aspects of the topic.

This course was probably the most important one that I could have taken this year.  Given the fact that over a third of adults in the U.S. are classified as obese (by BMI), any medical professional will encounter patients who are dealing with obesity or some of the medical conditions related to it–diabetes, heart disease, sleep apnea, and arthritis, to name a few.  However, as I learned over the past month, many healthcare providers are more comfortable with treating the effects of the underlying problem than they are with approaching the problem itself.  To many, counseling a patient about weight loss consists of reciting some form of the “eat less, exercise more” mantra at the end of the clinic visit, or running through a list of reasons why being obese is bad for the health.  However, these tactics are rarely effective, as they largely don’t consider the patient’s opinions and goals.  A patient may know all of the oft-quoted facts but not be motivated to lose weight for any number of other reasons; by contrast, he or she may have tried and failed to lose weight alone countless times and need some guidance or accountability.  It is important for physicians to talk with patients instead of at them in order to get a better idea of their thoughts and their needs where their weight (really, any number of issues involving behavior change) is concerned; these are the underlying goals of a technique called motivational interviewing.

The Obesity ISC was also one of the most rewarding courses I’ve taken in a while, for a number of reasons.  For one, I appreciated the breadth of the experience.  I worked with internal medicine physicians, pediatricians, surgeons, nurse practitioners, dietitians, psychologists, and exercise physiologists at clinic sites specializing in bariatric surgery, hypertension, sleep, and more; I was also able to see how patients are served by the interdisciplinary teams at certain locations.  Another rewarding aspect of the  rotation was the level of continuity that I witnessed over several mornings at the adult weight loss clinic.  By being present several types of patient visit–initial consultation, nutrition and exercise evaluation, follow ups for medical weight management, education sessions and required psychological evaluations before bariatric surgery, post-operative visits–I got a good understanding of the longitudinal care that a patient might receive.  And, of course, it was a treat to meet patients for whom bariatric surgery had been a life-changing success.  I talked with a man who had lost almost 200 pounds over the year following his surgery–he legitimately did not look like the same person compared to “before” pictures in his chart; he also reported more energy and no need to use his CPAP machine at night.

For this rotation, we also worked on several projects in order to synthesize what we’d been learning over the month.  One project that someone chose to do required him to modify a recipe to make it healthier; he brought in a version of chicken Parmesan that he made in a slow cooker, which was very tasty.  We also created individual concept maps to capture the complexity of obesity and its various causes and effects.  Another project that we all had to do involved choosing a question that interested us regarding management of obesity and creating a presentation, handout, or other modality to educate our chosen audience.  For mine, I chose to look at mindfulness apps that physicians might recommend to patients who struggle with emotional eating.

Of course, that’s only a snapshot of what I experienced this past month.  Despite the relative ease of fourth year compared to everything before it, medical school has been keeping me on my toes.

Now I’m out of class for roughly two months in order to travel for residency interviews.  The process and progress of the interview season can be a bit of a sensitive topic, so I won’t openly talk about it here.  But if anyone has questions, I’m open to answering them!

Post USMLE Step 2 CS Recap

This post is long overdue.

I took the Clinical Skills portion of Step 2 of the United States Medical Licensing Exam (USMLE Step 2 CS) at the end of September; I meant to write about the experience soon afterward, but life got in the way.

In its current state, Step 2 CS is an exam unlike any of the other “steps” that medical students take.  Instead of spending countless, wordless hours in front of a computer screen at a local testing center, groups of students conduct mock clinic visits with standardized patients at one of five testing sites across the country (including Atlanta, where mine was held).  Depending on the case, students may be expected to take a brief history, perform a focused physical exam, relay a brief assessment and diagnostic plan based on the patient’s presenting complaint and physical findings, and write up a patient note.  Repeat this 12 times and add a few breaks (one of which includes lunch).  It’s a long day, but somehow it actually goes by quickly; probably because you get to talk and walk around.

Another difference between this test and preceeding parts of the USMLE is the scoring.  There is a scoring system, which is divided into Communication and Interpersonal Skills, Spoken English Proficiency, and Integrated Clinical Encounter (read: the part where you’re graded on your actual ability to function as a doctor). However, the test is reported as pass or fail.  I feel like one of the pieces of reassurance that’s offfered to U.S. medical students who are nervous about this test is that you’re evaluated in part on how well you speak English.  I liked another point that was made by one of the Vanderbilt faculty earlier this year: “It’s not about being perfect, it’s about being barely competent.”  I can certainly relate to that…

Scheduling the test is almost as nerve-wracking as taking it.  Spots fill up quite quickly on the registration site; in fact, we were advised to schedule the test 6 months in advance just in case.  And of course there’s the issue of where to take it.  With it only being available in 5 cities (Atlanta, Chicago, Houston, Philadelphia, and Los Angeles), it may take some extra planning even after the test date is secured.  Plus, it’s expensive.  Like, over $1000 expensive.  One of my classmates was convinced that she’d accidentally paid for the test three times.  But the amount makes sense once you consider that you’re paying for the facilities, standardized patients, and enough lunch for all of the examinees.

The nature of Step 2 CS makes it somewhat difficult to study for, at least when compared to the other Steps.  There is a First Aid for Step 2 CS which, although somewhat dated, is good to read through once or twice.  This book allows one to get an idea of the types of chief complaints that a standardized patient may present with, in addition to tips about passing in Communication and Interpersonal Skills (e.g. offering water to a patient who starts coughing in the room, or responding empathically to a patient’s distress).  There’s also a section with longer cases, including “scripts” that a standardized patient might use based on what questions s/he is asked; these can be useful to go over with a buddy to simulate the experience somewhat and help with thinking through the situations.  Working in a clinic site–especially on a primary care rotation–can also be useful preparation.

Hope this helps demystify the test a bit!  Good luck!

Immersion Phase Update: Primary Care (8/31 – 9/25)

This post is coming a lot later than I intended it to.  If the month of August was a whirlwind, the month of September certainly was too.  I really can’t believe it’s October now; this year has gone by entirely too quickly.

For most of the month, I was on the primary care rotation.  At Vanderbilt, each student is assigned to one clinic, which can be pediatric or adult and on-campus or off-campus.  I was placed in the Pediatric Acute Care Clinic (affectionately known as PAC), which I was familiar with from having spent two weeks there during my outpatient time on the Pediatrics core clerkship last June.  This time, I expected to have a bit more responsibility as far as which patients I could see and how I was expected to assess them, and that was certainly the case.

For this rotation, we had to make personal learning goals; one of mine was to become more comfortable with using interpreter services.  As a late second year student in PAC, I had not independently seen many (if any) patients and families who did not speak English, although several such families come through each day (I’ve heard PAC referred to as “United Nations Clinic” for this reason).  This time, when a patient whose caregivers spoke Spanish, Burmese, or Arabic presented to PAC, I signed up to see them myself first.  For Spanish and Arabic, there were sometimes in-person interpreters who would meet providers at the exam room, but for all other languages I had to learn to use Language Line, a phone service that is extremely helpful in clinic but that also comes with its own challenges.  Imagine trying to converse with a parent and an interpreter via speakerphone while the young patient and her siblings are crying or running around the room.  Or having the automated phone system misunderstand the lannguage you were trying to request.  One memorable moment using Language Line came when I tried to request an Uzbek interpreter for the mother of a patient.  I couldn’t get the system to understand what I wanted, so I took a nurse’s advice and asked for an Arabic interpreter, whom I then asked to transfer me to an Uzbek interpreter.  After several minutes, I was told that there was no one available who spoke Uzbek; I ended up going back into the room and asking the mother if she spoke any other languages.  We ended up conducting the visit primarily in Russian via phone interpreter.  Needless to say, I met my original goal and am now much more comfortable with requesting and working with an interpreter; now I want to learn a ton of languages (although I will say that using the Duolingo app on my phone has enhanced my ability to understand–but not speak–Spanish).

The variety of cases that I saw in PAC once again caught me by surprise.  I certainly diagnosed a number of “viral URIs,” but I also saw a few healthy children coming for annual checkups or ED followup visits, common childhood diseases, some rarities and a few cases where even the attending physician was unsure of what was causing the patient’s illness.  I kept a list within the electronic medical record of every patient I saw last month, and I plan to check on some of them every now and then to see what’s happened since I saw them.

For the primary care rotation, I also had to choose a patient that I saw in clinic, conduct a home visit, and write a reflection about it.  Despite some scheduling troubles initially, I found the experience quite rewarding.  We as physicians and trainees tend to forget that outside of the hospital, patients and families have their own lives, schedules, and priorities; it’s important for us to partner with the patients we see in order to deliver the care that they need, and not to simply make assumptions about their motivations or their concerns.

In addition to the busyness of the rotation itself, the 4th year class submitted their residency applications during this month!  At about 8am CST, countless medical students were refreshing the page of the application website, waiting to upload the information that would help launch them on the pathway to life after medical school.  As usually happens, the website crashed almost immediately and stayed down or “slow due to high traffic” for quite some time.  I’m sure many people across the nation panicked when they couldn’t submit their applications, but somehow I felt oddly joyful as I sat and waited for the chance to try uploading again.  I could physically feel a weight lift off my shoulders as I finally clicked submit, after the months of work and emails and meetings to get the separate pieces of the application together.  Now it’s on to interview season!

The week after I submitted my application, I took the USMLE Step 2 Clinical Skills exam (Step 2 CS) in Atlanta.  I’ll probably talk about that experience in another post, so stay tuned!

Another important event: College Cup 2015, potentially my last College Cup.  Last weekend, the four colleges of Vanderbilt Medical School competed for glory in basketball, water polo, Iron Chef, Twister, and more.  My beloved Chapman College won the tournament again this year, by only 10 points.  It was such a fun time, and I’m really going to miss this iconic part of my medical school experience.

Phew!  As you can see, a lot happened in September.  But no matter how challenging my schedule gets sometimes, I wouldn’t trade this for anything.