Posts Tagged ‘residency’

Time Table for Ophthalmology Match (SF Match)

October 19th, 2010 No comments

Applying for Ophthalmology residency can often be very frustrating, because you need to start applying at the beginning of 4th year, but many schools preclude doing an ophthalmology rotation prior to the beginning of 4th year.  As a result, getting letters of recommendation can be rushed/tedious process, but don’t worry most candidates are in the same boat.  Since only a few of your classmates embark on this path each year, often there is little help from the facility and admin office, but fear not, the application process is no different than medical school/college and is easy with a bit of planning.

For an in-depth look at the match please see my sleep-deprived post-call rant and my mildly more coherent post on the interview process.

Time Line: Based on 2010 application
1st, 2nd, 3rd year: If you are fortunate enough to know you want to ophthalmology early, during your first or second year contact the ophtho program director and ask if there is a research project you can assist with.  You will likely be tacked onto a second year resident’s project.  Most projects are very easy, and allows you to get to know the attending and residents, and more importantly they get to know you.  This will put you in a very good position to get good letters of recommendation and a publication is great.
April – May of 3rd year: If you medical school permits, do your 1 month sub-internship (or elective) in ophtho.  This will give you good exposure to ophthalmology.  Let you get to know the staff when few people are doing aways.  The residents are well-seasoned, so the attendings will teach the medical students more.  Do a grandrounds (it actually easy).  Ask for at least 2 letters of recommendation.   And this will allow you to start applying to away rotations in July  (This is key because it will allow you to get letters of recommendation from 2 institutions)
April – June of 3rd year: Get your letter of recommendation from your non-ophthalmology person.  Remember for SF match you need to send the letter (not the admissions office).
May of 3rd Year: Start applying for your aways.  Please see my rant about where to apply.
June of 3rd year: SF Match application opens.  Download the application and start working on it.
July of 4th Year: If you have not already done so, do your Sub-I at your home school.  If you have already done one or cannot get a sub-I at home, do an away.  It is critical that at the end of this month you have at least two ophthalmology letters of recommendation in your possession by the end of the month.  Some programs (notably Tulane, require a 4th chairman’s letter, now is a good time to ask)
Last week of July, 4th Year: Have attendings (letter writers) review your application/personal statement.
August 1st, 4th Year: Target date for sending in application.  Yes, I know SF match’s target is Sept 1st.  But you want your application to go out on the first CD that SF sends.  This gives you time to guilt trip attendings to finish their letter of recommendation.  Early is always good.
August 14st, 4th Year: If SF Match has not sent an automated confirmation letter, call them to confirm they have the complete application.
September 10-14th, 4th Year:  The SF match is infamous for messing up distribution lists.  If a program is important to you, contact the program coordinator to ensure your application made it.  Now is opportune time to express your interest in the program and say that something extra that is not on your application.  Ignore this step at great peril.
October 26: Release date for Dean’s Letters is Nov 1st.  BUT they can be send it early, so the delivery date will be on Nov 1st.
October-December, 4th Year: Interview season
December, 4th Year: Rank List
January 6th, 4th Year: Rank list due – do not change at last minute, SF Match is infamous for being unable to confirm a new list at the last minute
January 14th, 4th Year: Match Day

See not so bad 😉

Road to Residency: On Interviewing

May 20th, 2010 No comments

I hope that my first installment has been helpful and here is my second installment.  Now that you have interviews, congratulations, the hardest part is done.  The interviews are by far the most important factor in good a favorable ranking.  Each interviewer is looking for someone they want to work with, so if you remember nothing else: you need to present yourself as someone fun to work with.

Should I Go?
At first, the thrill of getting invites is simply overwhelming, and you will inevitably schedule every interview.  While the is nothing wrong with going on every interview, it does become very grueling very quickly.  I advise people that 7 interviews is ideal.  It never hurts to have more, but having less is worrisome.  Once you have your seven,  you should have a vague idea what programs you are interested in and which ones you are not.  The programs which you have minimal interest, I would recommend declining the interview.  This saves you time and opens up an interview for someone who wants to go there.

There is nothing wrong with trying to schedule all your interviews and declining them at a latter date, but bare in mind you are taking an interview spot from a fellow applicant, so don’t cancel at the last minute.  That reflects poorly on you and your med school.

Just use common sense when it comes to scheduling.  Try to group interviews to make traveling easier.  You should never have to travel twice for prelim and categorical spots.  Prelim programs are usually very accommodating when informed about interviews for a categorical spot.  It is always okay to reschedule (with fair warning).  I would advise interviewing at your top programs first.  Scheduling early demonstrates interest and programs rank applicants on a rolling basis; it is easier to make an impression at the beginning of interview season.

Cheating: Get The Interview You Want
When interviewing for competitive programs, there are very limited interview spots and often more people are invited than can interview.  As a result, scheduling ASAP is of the essence.  Therefore Gmail is a must.  In Gmail, go to settings/filters and create a rule to push any emails from ERAS (or keyword “ophthalmology” for SF match) to your cell phone (see this topic for further help).  That way when you get an interview you get an email and a text message.  Immediately, check your Gcalendar and call the program to set up your interview.  For most of the interviews, I was the first person to call, got my top choice of dates, and the program coordinator remarked on my promptness.

My only tip here are be honest with programs if you have any problems.  If your plane losses a wing, if your radiator over heats, or your boat sinks from underneath your feet, do not hesitate to call the program.  They would rather know why your late, then to be left wondering.  In every applicant pool, there will be people who are late for reasons out of their control.  Take a deep breath… or 10 and call them.  If you are even remotely close, they will likely send help and if you communicated they will not hold it against you.  Do not leave home without the number for the program director.

The “Dinner”
If you do not go to the dinner, do not bother showing up the interview.   This is true of multiple reasons.  Firstly, most programs have the chief residents lead the dinners and they take notice of good candidates during the dinner, and the chiefs play a vital role in selecting the next group of residents.  The second would be the very few programs lucky enough to have Dr Wiese or similar program director who invites everyone to his house, talks with every candidate, observes how they fit in with the residents in a social situation.  And lastly, this is one of the few opportunities you have to talk with the residents on a frank basis.  Not all residents are happy with their program and the interview dinner is the opportunity they will use to bash it.   Find a prelim, someone with nothing to lose by talking honestly about the program to relate to them.I  f I recall, I did not stay for the interviews after the dinner for Baylor.

Closely observe the interactions of the residents.  Do they know each other?  Do they know each other’s families? Do they like each other?  or is this all socially engineered.  The truly observant will be lamentably surprised by the residents interactions during the dinner.

How Not To Dress
I think it is a bit sad that I need to mention this, but you’ll be surprised.  Pink hair, pink lycra micro mini with black lace bra showing, and 6 inch pink heels is not okay.  It makes a shunning impression, but not for a working relationship.  Dress to impress.  Guys suites or sport jacket.  Polo shirts are not okay.  Gals, anything classy.  If you think a Hooter waitress might currently be wearing it, put it back.

The Interview
We finally get to the main event.  Each interviewer is looking for someone they want to work with, so if you remember nothing else: you need to present yourself as someone fun to work with.  Start the interview by answering all of their questions.  However, many interviewers would rather react to what you have to say, so be prepared with ‘canned’ questions.  Interviewing is the ultimate in social engineering.  You are going to sit down with someone for 5 minutes who will be tremendously influential on your future. When you walk into their office look them in the eye and shake their hand. firmly Do not be in a hurry to retreat to the nearest chair, take an extra 2 seconds survey the office and commit to memory everything behind you, take note of their hobbies/research/awards, look for pictures of family and what activity is going on in the picture.   Quickly, reference this with your hobbies,  strengths, and just anything you know about to know more about.  In an average office, this will easily give you 30 minutes of conversation.  But be wary, it is not uncommon for staff to switch offices for interviews (to use 1 block, rather than have you trollop around the hospital), so unless you see the interviewee in pictures or name on a plaque do not assume it is their office.  The quicker you successfully steer the conversation away from canned/boring questions and onto personal topics the better impression you will make.  You will also notice, that interviewers want to talk with you and your always the person that the sectaries are knocking on the door asking you to move along,

I know it gets hard, but show interest in responses and when possible ask follow up questions.  The best interviews are the ones where you keep interviewers speaking.
What to ask: People like to brag about their program and in particular their specialty; keep this in mind.
– How does your program rank in <insert interest here>
– How do your fellows match
– What is the break down of fellow matches
– I see you like <insert hobby here>,  I love here <blank>,  where can you <blank> here?!?
Stock Questions:  You should have ‘canned’ answers to these questions
–  Tell me about yourself
–  Why do you want to come here
– Why should we choice you (be graceful,…..)
– What do you think of the state of medicine? Obamacare? (No matter what you argue you better be able to back it up, and no one likes a flip-flopper.. ask Al Gore and Bob Dole)

If the tour is at the end of the day, it is optional.  Don’t worry about not going.  All hospitals are exactly the same.  🙄

Evaluating the Program
This may be the single most important piece of information I am conveying in this rambling dissertation.  Lets face it, you will learn next to nothing  from the tour, interviews, slide shows, and staff.  Every program does their job at putting on a good face and tell you why they are the best.  The problem is figuring out where the masquerade ends and the truth begins.  In my experience there are four ways.  1) The “Dinner” and talking to disgruntled prelims 2) Anything that people are repeating is either really awesome or a problem they are trying to fix.   Ask different people and look for consistent answers.  Most interviewers  are not instructed on propaganda and answer relatively truthfully.  3) Go into the interview expecting lies, they are not hard to find by reading people.  4) How the program acts. Programs in similar classes, act similar.  The best programs do not provide airfare, they do not provide hotels.  These offerings are very expensive and are to compensate.  When interviewing you cannot tell a difference form a program that provides a hotel from one that does not.  So you need to ask yourself why does program 30 minutes away not pay, but this one does.  Incentives from the program need to thought of as disincentives for you.

I highly recommend you record your gut reaction to the program.  The exact feeling you have when you get in the car after the interview.  If it does not feel like a good match, the chances are the program is thinking the same thing.  It is so easy to over analyze later, but your gut reaction is usually right.  I cannot tell you the criteria that need to make you happy.  But your rank list needs to maximize happiness.  So think about location, work hours, happiness of residents, type of people int he program, etc

The Letter Game
There is no correct answer to this, but many programs keep track and thank you letters are noted and can count for you, but not against you.  Remember matching is a courtship.  You need to express your interest and maintain communication.  I highly advise writing timely hand written thank you notes to everyone you interviewed with at your top programs.  And thank you cards or at the very least emails to everyone you interviewed with at programs at the bottom of your list.  If you interviewed with >6 people, I think it is okay to write a single very well written letter to the program director and ask to extend your thanks to everyone else.

Stay in Touch
The interview dance is not done yet.  Around match time, you should be writing love letters.  You should write letters to your top programs.  You should tel your number one school that they are #1.  This should be honest and you should only send one letter proclaiming this.  Candidate and programs are allowed to volunteer how they will rank the other, but it is a violation to ask.

To your #2 and 3 programs, you should tell them they are ‘topping your list.’  Everyone else that you are interested in should get a letter stating you will rank them ‘highly.’  By doing this, you are conveying your interest honestly, and without match violation.

Programs may send you you love letters.  Getting a letter always is a good thing, but not getting it does not preclude you matching at the program.  Not all programs send them, some programs send them to almost everyone.  Alot of letters are frank lies, unless they give you a notarized contract, do not let love letters have too much influence over your rank list

Your Goals
– 7 interviews
– Fit in with the suites
– Weed out misdirection
– Stay in touch

The interview trial is long and exhausting.  At first you have a constant feeling of  jamais vu, your interviews are full of presque vu, and by the end it is ceaseless déjà vu.  Just remember all of these are signs of simple temporal lobe seizures and probably need to be checked out by a neurologist.  Anyways, I’m a bit exhausted, so sorry for any type-Os.  Check back in a couple weeks for Part III: Creating your match list.

Road to residency

May 17th, 2010 No comments

Getting into residency is just like applying to medical school.  When your doing it, it seems overwhelming, complex, and full of pointless essays.  But after matching, you gain perspective and it seems simple.  So here are few tips that I have gained from my match experience.  I would say I was a rather average applicant, but I matched to both my #1 choices in ophtho (SF match) and prelim Internal Medicine in regular match.

Getting Started:
The first step is picking your path.  It is important to settle on one career choice.  Each program wants to think your only interested in that program and will go into that specialty.  If you’re applying to several specialties, they will lose interest fast.  This is not an issue for most, but if you are the fence, cancel your next rotation and start doing Sub-Is until you find what you love.

Getting Your Stuff Done:
You can NEVER have your application done soon enough and never count on anything done.  I would recommend asking for letters of recommendation at the end of each rotation; especially if you think you did well.  It is always better to have too many letters, and when your application is due you do not want to waiting on that last letter.  Even if you asked for a letter of recommendation 6 months ago, do not count on it being done.  I recommend two months before the opening of that match you contact each person you have asked, and politely inquire if they have written the letter.  If they haven’t, do not lose touch with.  Contact them weekly until it is done.  The same is true for every other aspect of the application.  Never assume something will be done because someone has reassured you; this is your future not theirs.

You will be surprised in the delays that you will face.  I had 100% of my applications done prior to SF Match (early match) opening, and because of clerical delays I missed deadlines for schools for ERAS programs, despite having 100% of my letters, pictures, essays, etc done.  You need to check your application status constantly and contact your Dean’s office daily.  Be a bother!!!  I checked every other day and as a result, I missed deadlines, and by the time I complained to the Dean it was too late.  Don’t let this happen to you.

In addition to getting it done, programs see early applications as interest.  They will only pick a limited amount of applicants to interview.  So have your application on top.

Doing Aways:

Think of your aways as interviews.  Towards the end of third year, you should make a list of programs that you will appear at the top of your match list.  These are the schools were you should do aways.   Aways are a great way to get to know a program and the best way from residencies to get to know you.  Programs care more about how you fit in than your grades, your step 1, or anything else in writing.  The program has to work with you for years, so “Fit” is extremely important to residency.  As a result the residencies where you are most likely to match are 1) Your home program 2) programs in the same region 3) programs where you have done aways.

When you do aways, it is needless to say you need to know interest above and beyond the typical student and be nice to everyone.  The sectary that keeps losing your paper work, is already part of the department and her musings mean more than your application, so be graceful!

If you did not do an away, all hope is not lost, keep reading.

Communicate Early and Often:
Most of the programs that you are applying to have no idea who you are or why you are applying.  This leads to predictable results.  When you make the list of programs you are applying for, you should write a letter/email to every program director and tell them briefly why you want to interview at their program, list your personal ties to the area, and another information that you think is remotely relevant.  This will open doors to programs that you would not haven been asked to interview at.

When invites begin rolling out, do not wait for invites, contact programs you have not heard from.  Reiterate your interest.  This will get your application looked at again and will demonstrate your sustained interest, this can move your application up in the ‘pile.’  If you did an away, this is a great time to contact professors, which you developed a relationship with.

Finally, ‘no’ does not mean ‘no.’ If a program you really want to go to turns you down.  Do not take it lying down!  Decisions can be over turned.  Call the sectaries, relate to them (let’s face it, nurses run the hospital and assistant directors run the admissions office).  Talk with the program director; ask why your application fell short.  Your interest is something that < 1.0% of applicants show.  Hopefully you did an away, this is a good time to contact professors to talk with the chair and program director on your behalf.

Types of Letters:

There are 3 types of letters of recommendation
1)    Personal Letters:  These are typically written by young enthusiastic attendings.  These demonstrate your character and you should have at least one
2)    Famous Letters: These are written by the famous/well-known attendings.  The more well known the letter-writer the less personal these letters are.  These letters are often standard forms fill out by secretaries.  These letters, while not glowing, carry a lot of weight.  The letter states that Dr. X endorses you.  You should have 2 of these letters.

  1. There are various degrees of fame.  Any program director’s letter will carry weight and will be well received by other program directors.
  2. A legend in the field, Dr Wiese, Dr Sabiston, or Dr Kaniski, their letters are worth more than their weight in gold.

3)    The Elusive Famous + Personal Letter:  The best of both worlds, there are a few of these floating around each match.  They are golden tickets for interviews.  Don’t hold your breath for one, but use it if you got it!

How to Get into the Program You Want:
1) Aways away away
2) Communicate
3) Letters of recommendation
4) Never let anyone tell you what you cannot do.  Your grades, your step 3

Remember, that there is nothing magical to the match.  You pick programs that appeal to you and programs pick applicants that appeal to them.  Programs want people that want to go to the program and will fit in.  Their best bet is picking from regional programs.  They have so many suitors that they don’t need to pursue every applicant.  Most pick the people they will interview based off of med school, did they do an away, letters of recommendation, and a few facts from their cover sheet.  Most do not read essays until the day-of-interview and only to tease out a few talking points.  This means that the majority of responsibility for getting an interview lies with the applicant and how they court the program.

I can unequivocally say that my prospective works and feel free to contact me for any help 😆

The joys of clinic, . . .

December 18th, 2009 No comments

Last night was my first trip to the local Equal Opportunity Clinic, aka student run clinic.  The clinic went well, not too many pain seekers, and I must commend the students; they were second years who triage patients much better than many of the third years I have seen on the wards.  Someone told the attending erroneously that we were done with patients, so almost everyone in clinic went home.

So when I finished up on my last patient, there was only 2 students and myself left in the clinic.  I asked the students to give the patient his scripts and I left.  Naturally, the front door is quite literally chained shut with a novelty sized padlock, there is no security, and the parking lot is not lit.  I head to the side door and walk around to the dark parking lot.  There are only two cars left, my car and a truck that is parked, so that the cab door is next to the only entrance to the ramp to the clinic.  I’m not sure what caught my attention, but I stopped and watched the truck and noticed someone was moving around in the truck.  I got a very bad feeling and jumped over the railing of the walkway and ran towards my car.  At the same time, the door to the truck opened a large/thin man got out, never said a word, and started running towards me.  I got to my car, started the ignition, backed up (almost hitting him), and peeled out.  He continued to run after me for several hundred feet.  I called 911, but it sounded like he was long gone.  I just hope the students made it out safely.

I cannot imagine if I had not taken notice and continued down the ramp.  The path  has a railing on either side and ended next to his cab door.  All he would have had to do is wait until I walked to the end, open the door, pull a gun, and would have been completely trapped.

The thing that really pisses me off is, this is a free clinic.  Sure it is slow, the wait sucks, and we don’t prescribe narcotics, but we give out good care, we give out tons of free medications, we see everyone who comes in our door, and at least we are trying.  Everyone is a volunteer and could easily stop doing the clinic.  I did not see him in clinic, but that does not mean he was not seen by someone else.  I mean what type of piss poor protoplasm camps outside of a free clinic and waits to jump a doctor.  I mean really? Fuck you.

Hell on Earth: The Medical Intensive Care Unit

December 12th, 2009 No comments

I have recently finished up my 6th week in the MICU and I am safely say that it has been among the hardest things I have ever done.  The MICU is a simply soul-sucking place where become come to die. This is  due to the fact that the clientele of a medical intensive care unit are people who can no longer breath on their own or their heart can no longer pump without aggressive intervention.  In the MICU death is omnipresent and simply part of your daily life.

No physician welcomes death; we spent a disproportionate amount of our time trying to stave of death another day, hour,  even minutes.  However, it is recognized that death is part of the profession and often a blessing for the patient and family.   However in the MICU, death is a part of your life,… just like brushing your teeth.   When you go in the morning, the first thing that you see is families crying in a waiting room that is tastelessly furnished with glass walls.  If you are lucky, you do not recognize the people and can assume your patients made it through the night.  You then check the board and see who has died, and follow up by talking with on of the few nurses you trust to find out who your sickest patient is.  The majority of the day is then devoted to trying your best to prolong the life of a patient.

However, when all of your patients are this sick it is usually just a matter of time before they pass.  Often the hardest part if telling families that their loved one has already passed, but we are mechanically keeping them “alive” with ventilators, constant dialysis, and pressors.  They see us doing so much that they cannot understand it is futile and the horrifying reality is that anything that can feel has to be agony.  It is gut wrenching to see a rare moment of lucidly in a patient’s face and the expression of pure pain, sorrow, and longing to die.  And yet I am there only to keep them a live hours longer.  And it is only 7 am and knowing if I am lucky I will leave in only 12 hours.  The worst is when your on call and knowing it will be a minimum of 30 hours before leaving these harrowing wards.

On a long call after everyone else has left, three things inevitably happen. 1) A patient codes/seizes/becomes hypotensive or maybe all three 2) The ED calls you with a patient they have intubated (and therefore cannot talk) for a reason you cannot quiet discern, no one has a history/contact info 3) Some other service calls you wanting to transfer a patient that they have has for 4 months and no longer want to talk care of.  Usually all the above happen at once.  You spend your night talking with families on patients you barely know, making life and decisions on these patients, nursing calling you every 15-20 minutes with a critical lab, admitting new patients, training patients on other services, and after 24 hours you cannot think, physically drained, emotionally drained/liable, the opportunity to sleep has never crossed your mind, and yet you still have 6-10 hours before hoping to go home.

Now rinse and repeat for weeks on end.  Night/day cycles completely erratic, never rested, no time to visit family/go out.  And this is only the pressures of work, what about a home life, the economy, etc?  By the end of the third week you notice that no one has shaved in a week.  What quality of physician do you think is taking care of you?  I have no qualms admitting that I failed to live up to my own expectations.

Excluding the patients that you know will die the moment you lay eyes on them there are three other types
– The first are patients that should have never come to the ICU.  Patients who had to come due to some silly hospital rule about administering a medication, a patient forced into the unit by an important physician wanting good care for a special patient, or a similar circumstance.
– The persistent patient: The person who the ED did that “one extra round of CPR” and brought back someone how has been without a pulse for >30 minutes.  I’m not saying they shouldn’t try, but there is a 90% mortality rate for CPR >10 minutes and horrible long-term morbidity for those very few who leave.  More often then not these patients only have cranial reflex, meaning they can gag/blink, but nothing else.  These patients can live on the ventalotor for years (like Terri Schiavo).  An MRI can confirm that their brain matter was atrophied away and they are not locked-in.  These patients often have been in the same room for 6 months or even a year.  Most of these patients do not have health insurance, so they stay in the MICU and we watch them gradually die over the years.  They persistently occupy a room that should be used to save another,  . . .
-The final type of patients are the few rays of hope.  These are people how by all accounts should have died, but recover.  There are  a few every month.  Diffuse alveolar hemorrhage, drug ODs, hypothermia.  Sadly, these saving graces, often mean more to the physicians than the families and the patients themselves.  These very few patients do not make life any easier, but they make the struggle worthwhile.