Category Archives: recaps

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!!

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! 🙂

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.

Immersion Phase Update: Emergency Medicine (8/3 – 8/28)

The month of August was a whirlwind.

I completed my required Emergency Medicine rotation this month, which was an experience unlike anything I’d had before.  At Vanderbilt, this rotation consists of daily morning lectures, case conferences with residents, several shifts in affiliated emergency departments, and a couple of exams.  In essence, it’s a miniature version of a third year clerkship with a dash of first year didactic learning–lots to know, lots to do, lots to be evaluated on.  There were less than 20 of us on the rotation, including several visiting students hoping to match into emergency medicine.

To be honest, I was interested to see what sitting in class for roughly 4 hours each morning would be like after so long.  I wondered if I’d take better notes, if I would feel more confident about speaking up in class…whether my attention span had gotten better or worse since December 2013.  I took slightly better notes (having an iPad with a dedicated note-taking app helps), but neither my shyness nor my attention span had improved much.  Our lecturers expected class participation, and the class was small, so often I was called on directly to read an example EKG or to answer a question; otherwise, I kept pretty quiet.

For the most part, the lectures themselves were excellent.  Most were 50-minute overviews of various topics that we would encounter on emergency medicine–everything from pediatric emergencies to toxicology to environmental exposures (frostbite, snake bites, and everything in between).  The majority of the lecturers had their own quirks or teaching styles that made them quite engaging.  One of our main lecturers frequently quizzed us on buzz words for particular conditions–ventricular fibrillation = “shock,” hyperkalemia = “EKG,” hyponatremia = “be careful [when correcting the abnormality],” and so on.  He also made countless Seinfeld and “classic” movie references and expressed his disappointment when we didn’t know where they came from (coincidentally, I had just started binge-watching Seinfeld at the beginning of the rotation, so I was pretty happy about some of the quotes he pulled out).

In addition to traditional lectures, we also had a few simulation and procedure labs.  The first lab was an overview of how to suture, how to do a spinal tap, and how to intubate (I was pretty terrible at all of these).  We also had a lab on how to apply splints to fractured limbs, during which we covered each others’ arms and legs in plaster and ACE bandages.  The most rewarding labs were done in the simulation center, where we interacted with simulation robots that can be made to blink, talk, and even sweat.  We were divided into groups, given a patient’s age and chief complaint, and asked to manage each case, asking for vitals, ordering labs, starting medications, and calling for consults based on what we were told and what we saw on the monitors.  Afterward, we had debriefing sessions during which we learned what the key teaching points and optimal management strategies were.  I wish we were able to use the simulation center more throughout medical school; it’s a great way to learn how to diagnose and treat in real time.

Of course, in addition to lectures and labs, there was also “on the job” training in the form of our shifts.  Each of us had a total of ten shifts scattered throughout the month and at different times of day: five at the Vanderbilt Hospital adult ED (one in the triage area, two in the high acuity “A Pod,” and two in the lower acuity “B Pod”), two at the Children’s Hospital ED, two at the VA’s ED, and one at the Sumner Regional Medical Center in Gallatin, Tennessee.  Each type of shift required a different level of responsibility from medical students.

  • The triage shift was a time for us to work with EMTs, going to Rapid Response calls in the hospital and learning to start IVs on patients who came in from the waiting room.  Unfortunately, my shift was pretty quiet, so I didn’t get much practice, although one of the EMTs offered to let me stick a needle in his arm (I declined, although I’m not sure whether he was joking).
  • On the A Pod, where trauma cases as well as seriously ill patients are seen, our role was mainly to see patients with the residents, go to the trauma bay when patients were brought in, and assist where we could with procedures, updates, and other tasks.
  • On the B Pod, we served as the main “resident” seeing some of the patients, presenting to the attending physicians, writing notes, and signing out to other providers at the end of our shifts, provided that it wasn’t too busy in that part of the ED; otherwise, we functioned much like we did on A Pod.  One of my shifts–my first–was a typical B Pod shift, which was so fast-paced that I could barely get used to it.  On my second B Pod shift, both the waiting room and the ED were full, so residents and attendings saw all of the patients themselves while I acted as a “sponge” and learned as much from them as I could.
  • Peds was similar to B Pod–seeing patients solo, presenting to attendings, writing notes, keeping family and staff informed–with the added opportunity to see pediatric trauma cases.  One of my Peds shifts happened to be my one “overnight” shift (10pm – 4am).  Surprisingly, I was pretty functional during those 6 hours.
  • At the VA, medical students did not have computer access.  Instead, when a patient came in, the attending or resident might tell us about them, hand us a short information sheet about why they’d come in, and have us see the patient first.  For other patients, I simply shadowed the resident.
  • The Sumner Regional Medical Center shift gave us a chance to see what care is like outside of the Vanderbilt system.  It’s a smaller ED that is a bit slower-paced than Vanderbilt even though it is still fairly busy.  Patients are sometimes “transferred out” to different facilities for a higher level of care, a process that we do not encounter at Vanderbilt since it is typically on the receiving end of such transfers.  On my Sumner shift, I did not see any patients who needed to be transferred, so it was reminiscent of a VA shift.

It was often difficult for me to figure out how I best could function on my shifts, but once I got the hang of things, I enjoyed the clinical experience and was able to learn more about the medical knowledge and thought process required of an ED physician.  In the ED, a huge part of the work is determining the patient’s disposition, deciding whether the patient should be admitted to the hospital or whether s/he can go home.  This decision often requires the provider to rely on an understanding of the patient’s past history, lab and imaging results, and sometimes his/her instincts about “how sick” the patient was upon arriving to the ED.

Surprisingly (to me at least), my experience also dispelled a quiet myth that there isn’t any continuity in emergency medicine.  While it is true that ED physicians usually don’t see the same patients over and over again, I worked with several attendings who followed up on patients after their shifts were over, seeking to learn about their working diagnoses or their hospital course.  One attending I worked with on my second Peds shift made sure to tell me about the results of one patient’s lab work the next day after class.

As I mentioned, this rotation had a few exams.  One was for Advanced Cardiac Life Support certification.  We spent a considerable number of our lectures learning how to manage various situations, such as encountering a patient in cardiac arrest or someone who has an abnormal heart rhythm on a monitor.  They stressed how much we would need to study to pass the certification test, telling us to make flashcards and quiz each other.  I came into the ACLS certification extremely nervous, but it ended up not being too bad.  So I’m officially ACLS certified to do CPR and run codes…although I hope I never actually have to use that knowledge.

Yesterday, I took the exam for emergency medicine.  This was my first computerized NBME shelf exam; I’m on the fence about whether I prefer that method to Scantrons.  In any case, the exam was pretty difficult, and I wasn’t the only person who thought so.  It felt like a combination of all of my other shelf exams, with the addition of weird things that an ED physician would be the first person to see, like animal bites, acute wound care, and fractures.  I came into it thinking that I hadn’t studied nearly enough, and I left feeling like studying more wouldn’t have helped.   Speaking of studying, for anyone who’s wondering, I only used PreTest.  I don’t even think I got halfway through the book, but I’m still proud of the amount that I was able to do in about a week and a half at the end of the rotation.  I’d planned to also read through First Aid for Emergency Medicine, but that didn’t happen either.  In any case, the test is over, and hopefully I passed.

Somehow I still managed to do “other stuff” this month.  I was able to arrange my schedule such that I only missed church on one Sunday morning and one Wednesday night.  I attended a gathering for members involved in the worship ministry and am still hoping to get more involved myself.  The Psychiatry Interest Group had their first event, a barbecue hosted by one of the current psychiatry residents, and SNMA had their introductory meeting as well.

All told, this month was exhausting.  I’m not going to say everything went well or that I didn’t feel overwhelmed some (read: most) of the time.  If I could do this month all over again, I’d definitely do things differently.  But now that the rotation is behind me, I can’t deny the fact that this was one of the most educational months that I’ve had since starting the Immersion Phase back in January.

Immersion Phase Update: Physical Medicine & Rehabilitation Elective (7/5/15 – 7/31/15)

As I alluded to in my last post, this past month I took an elective that offered an introduction to physical medicine and rehabilitation (PM&R).  This specialty looks at restoring or maintaining activities of daily living, mobility, functional capabilities, etc, in patients with permanent or temporary disabilities.   It’s a broad field, dealing with everything from chronic musculoskeletal pain to cerebral palsy to traumatic brain injuries.  Physicians in the field–known as physiatrists–work closely with physical, occupational, and speech therapists in both inpatient and outpatient settings.  The department and the residency program are quite new to Vanderbilt, but they welcomed me with open arms for the month and taught me so much about the specialty.  I initially chose this elective because I’d had absolutely no exposure to PM&R, and I was pleasantly surprised by how much I enjoyed it–in fact, I’ve been recommending it to just about every medical student I’ve talked to.

Throughout the month, I rotated through a number of outpatient settings that gave me a better idea of the breadth of PM&R.  I saw more typical clinics that served pediatric and adult patients presenting with mainly orthopedic or neurologic chief complaints.  I got to observe several procedures, such as botox injections (for limb spasticity, not for cosmetic reasons), spinal injections, and joint injections.  I even helped out with a few of these; for the most part, I simply helped the physician draw up medications into syringes or held the ultrasound probe, but one morning the attending let me inject steroid into a patient’s hip.  I was so excited to do this, even though the attending was holding my hands the whole time.

I was also placed at fairly unique clinical sites that medical students usually do not get the chance to experience.  In “wheelchair clinic” at the pediatric rehabilitation suite at 100 Oaks, I observed a physical therapist and equipment vendors as they fit children for colorful wheelchairs and car seats.  When I shadowed the physical and occupational therapists at the VA, I learned about everything from paraffin baths for arthritis to dry needling techniques for painful trigger points; I even got to go inside a balance assessment machine, which uses various tests to determine the level of function of certain neurologic components of balance.  I also observed a physical therapist in what is called lymphedema clinic; this site typically serves patients who have swelling due to lymphatic issues or muscle tightness after surgery, and the therapists there recommend equipment and perform maneuvers to help decrease patient discomfort.  On two mornings of the elective, I went to the Dayani Wellness Center, a fitness center geared toward patients with heart diseases, lung diseases, and other similar diagnoses; nurses, exercise physiologists, and other personnel create workouts, hold fitness classes, and use health coaching strategies in order to help patients meet their exercise and nutrition goals.

Additionally, I spent a week with an inpatient attending at Stallworth Rehabilitation Hospital.  Before that particular week, Stallworth was simply the place where patients often got sent when someone felt they needed “inpatient rehab” after a stroke or some other debilitating injury.  I didn’t really know anything else about it, but I learned quickly.  Typically, patients spend about 2 weeks at Stallworth, receiving some combination of physical/occupational/speech therapy daily depending on their needs and goals.  If the patient was admitted for a spinal cord injury, they usually stay a few weeks longer and receive the same services during that time.  Physicians make rounds every weekday, talking to and examining their patients, assessing for new medical concerns, writing prescriptions, and other typical tasks.  Meanwhile, case managers work on discharge planning, figuring out where the patients will go–home or to a skilled nursing facility, to name a few options–and what type of follow up they will need with therapists or physicians after they leave Stallworth.  In addition, the patient’s team of nurses, therapists, physicians, and case managers meet together during the week to discuss medical, social, and other barriers that might lengthen his or her stay.  I found that Stallworth is an environment built upon interprofessional care, with the idea that many medical professionals can and should work as a team to effectively meet their patient’s needs.  This came in handy, because I was taking a concurrent class on interprofessional education that required me to shadow two care providers who were not physicians (I chose to observe a case manager and a speech and language pathologist).  In addition to learning about the system and general routine of Stallworth, I talked at length with the PM&R attending on various topics; it turns out that he is quite interested in the intersection between his field and neuropsychiatry, so we ended up having lots to discuss!

When I wasn’t doing work for the rotation, I spent quite a bit of time working on my residency application.  This past month, I met with the Dean for Student Affairs to discuss the medical student performance evaluation (MSPE) that will accompany the application.  At this point, I am up to my neck in editing my personal statement and curriculum vitae.  At the time of my last writing, I hadn’t started writing either of them; however, I was able to put together working first drafts of both while I was away in Detroit a couple of weeks before starting the PM&R rotation.  I’ve since sent them to several friends and faculty members and have received great feedback on both.  I am also working on finalizing the list of programs I’ll apply to, as well as collecting letters of recommendation.  In the midst of all this, I found out that I passed Step 2 CK, so I’m almost done with the exams whose scores I’ll need to include with my application.

Despite having my hands full with all of the above, I still had time for some extracurriculars.  A week after I got back from Memphis, two of my dear friends from church got married; it was wonderful to be able to celebrate with them.  A week or so later, I entered a vocalist search that EDM genius Zedd opened up to his fans; I wrote and recorded lyrics for a new instrumental track that he’d made, and although I haven’t heard back from the artist himself, I’ve gotten great feedback from friends since posting my vocal demo on SoundCloud and YouTube.  In addition to all this, I joined some of my classmates in welcoming the Class of 2019 during their orientation week; aside from making me feel really old, they seem like a pretty cool bunch of people overall.  Several of them signed up to join the a cappella group, and they eagerly showed up for our first rehearsal; despite some of them saying that they had never sung before, we were able to sight-read and sing through a song that the group had performed previously.  I was also able to go back home for a children’s and youth conference at my church there, during which I met Travis Greene, a gospel artist who sings one of my current favorites (it’s such a favorite that I did a cover of it on my YouTube channel).  And this past week, I went with a friend to Bridgestone Arena for the Nashville leg of Outcry 2015, a brand-new tour featuring Christian music greats such as Passion, Trip Lee, and Hillsong.  I was exhausted the next day, but it was totally worth it.

Thanks for reading!  Stay tuned for my next update.  On Monday, I start my month of Emergency Medicine, which will include lectures and ED shifts occurring at various times of day (and night).  Wish me well!