With clinical electives done, my entire class is back in the school and catching up after a long period more or less off on our own. We're also all now finalized into our specialty choices. Some people are applying to multiple specialties with some degree of uncertainty, some are backing up, but there's no longer any room for being coy about specialty preferences - everyone's had to make a commitment one way or another.
So, we're finding out a lot about each other's final choices. After over 3 years with my classmates, it is interesting to see what people are ending up with. Most weren't huge surprises, with people either applying to what they had already expressed interest in or committing to one of the two or three options they were considering. There were a few last-minute surprises though, where a classmate did a hard switch to a completely unrelated specialty either near the end of 3rd year or even after doing some/all of their electives.
So, this post is mostly just a reminder for those still early on in medical school that while it's worth exploring specialties early as well as having a game plan for your clerkship and elective rotations, last-minute changes do happen, regularly.
Showing posts with label electives. Show all posts
Showing posts with label electives. Show all posts
Tuesday, 10 January 2017
Tuesday, 18 October 2016
Familiar Faces
Unlike most elective students, I'm doing a good number of my electives at my home school.
Part of this was by design - as a student applying primarily to Family Medicine, I don't need to do nearly as many electives in one field, so I've got some extra elective time to spend on learning opportunities, on rotations I haven't experienced yet first-hand. Those can be done anywhere, so might as well do them in a familiar setting where I don't have to pay for travel or accommodations. Plus, I can spend more time with my partner and dog at home!
Part of this was definitely not by design - I had some electives at other schools fall through last-minute after months of waiting. Just a reminder that despite the new electives portal in Canada that is supposed make electives more accessible and to eliminate the need for elective-hoarding, there's still a major incentive to gather up as many electives as possible, dropping any excess ones as you go.
One unexpected advantage of this arrangement, however, is getting to see some patients I saw previously on my third year rotations. Seeing a familiar name, or stumbling across a prior dictation with your own name on it is pretty exciting! (Side note - dictation services do a pretty good job. Recently read a note I dictating very early in clerkship and superficially, it looks amazing! When I actually read the content, it's fairly disorganized and rambling. It does its job, but I feel I can do so much better at this stage and it only looks half-decent because the dictating service my hospital uses made it look that good).
This is not necessarily a common experience in medical school. We get shifted from service to service regularly enough that any continuity within these services is pretty short-term. Seeing a patient after 2 months isn't quite the same as checking in on them over a year later, but this longitudinal care is a core part of being a physician. Even as just a reminder of the growth we go through as medical students, I'm appreciating the experience. I know some schools, particularly satellite campuses, have been working with clerkship models that build these sorts of longitudinal experiences into their structure, and US schools having been piloting studies on longitudinal clerkship for years. From speaking to some people in longitudinal medical education programs, I've been given the sense that these set-ups are better in theory than in action, but there is some interesting research on the subject. Given my recent experiences, I would love to see effective longitudinal care fit more cleanly and reliably into undergraduate medical education.
Part of this was by design - as a student applying primarily to Family Medicine, I don't need to do nearly as many electives in one field, so I've got some extra elective time to spend on learning opportunities, on rotations I haven't experienced yet first-hand. Those can be done anywhere, so might as well do them in a familiar setting where I don't have to pay for travel or accommodations. Plus, I can spend more time with my partner and dog at home!
Part of this was definitely not by design - I had some electives at other schools fall through last-minute after months of waiting. Just a reminder that despite the new electives portal in Canada that is supposed make electives more accessible and to eliminate the need for elective-hoarding, there's still a major incentive to gather up as many electives as possible, dropping any excess ones as you go.
One unexpected advantage of this arrangement, however, is getting to see some patients I saw previously on my third year rotations. Seeing a familiar name, or stumbling across a prior dictation with your own name on it is pretty exciting! (Side note - dictation services do a pretty good job. Recently read a note I dictating very early in clerkship and superficially, it looks amazing! When I actually read the content, it's fairly disorganized and rambling. It does its job, but I feel I can do so much better at this stage and it only looks half-decent because the dictating service my hospital uses made it look that good).
This is not necessarily a common experience in medical school. We get shifted from service to service regularly enough that any continuity within these services is pretty short-term. Seeing a patient after 2 months isn't quite the same as checking in on them over a year later, but this longitudinal care is a core part of being a physician. Even as just a reminder of the growth we go through as medical students, I'm appreciating the experience. I know some schools, particularly satellite campuses, have been working with clerkship models that build these sorts of longitudinal experiences into their structure, and US schools having been piloting studies on longitudinal clerkship for years. From speaking to some people in longitudinal medical education programs, I've been given the sense that these set-ups are better in theory than in action, but there is some interesting research on the subject. Given my recent experiences, I would love to see effective longitudinal care fit more cleanly and reliably into undergraduate medical education.
Saturday, 15 October 2016
Moving Up the Totem Pole
I'm now on my 4th elective, but it's my first one in a hospital setting after several rural or exclusively clinic-based electives. That means, in addition to triggering some lingering anxiety about hospital work, that I'm working with some 3rd year students. For the first time in my medical career, in a clinical setting, I'm not the low man on the totem pole.
As I'm a still a medical student, my role has not appreciably changed and the expectations have only increased marginally. However, it is a very different feeling, having that extra year of experience in medicine and, because I'm doing an elective at my home hospital, familiarity for the system I'm working in. It is a far less stressful set-up than 3rd year.
I'm also being given some authority and responsibility over my slightly-more-junior colleagues. I get a very small amount of control of the daily schedule as a result, which provides an amazing sense of liberty after a year of having zero control. I get to do a little bit of teaching, which I love - wherever my medical career takes me, I would like to be teaching for at least part of it.
Despite my supposed seniority, what has struck me is the capabilities of the 3rd year students I've worked with. Maybe I'm just meeting the best and brightest, maybe I didn't give myself enough credit back when I was a 3rd year, but they seem a lot more able than I felt back when I was in their position. In short, I'm impressed. I still have some information to pass along - I didn't get through that whole year without learning something - but it's not as wide of a gap as I thought it would be by this point!
Tuesday, 11 October 2016
Bureaucracy
The fourth year of medicine is pretty good. You get a fair bit of choice over what you do and where. You get less call. There's no block exams and evaluations are considerably less stressful.
Where fourth year (and the process leading up to fourth year) is terrible is in its bureaucracy. Medicine, as a rule, is organizationally complex, which leads to a number of rather problematic inefficiencies. Today's fun bureaucratic hurdle is registering for the MCCQE Part 1. It's an important exam, without a doubt, the only standardized test we take in medical school. It's also part of our licencing.
As part of the registration process, the Medical Council of Canada (MCC) requires identification. Completely reasonable, this is a non-trivial test that is one of the few milestones we insist on to ensure potential physicians are sufficiently knowledgeable. Any cheating in the form of impersonation would be a serious concern. So, they have a fairly stringent requirement - a notarized copy of a current passport. It's a bit specific since not everyone has a passport, and many other valid forms of ID exist, so I wish they would be a bit more flexible in what documents that would take. However, in my case, I already had my passport notarized for CaRMS, so I can reuse it for the MCCQE Part 1.
But wait! Apparently a notarized copy of the document that gets me into other countries isn't good enough for the MCC on its own! They also insist on a separate, MCC-specific form, with two passport quality photos attached and to have that notarized as well. Why? No clue!
So, now I need to get more passport-quality photos, fill out this needless form, and get it notarized. My school is kind enough to have notaries available, but of course, they're only available during regular working hours in my school's city. Not terribly convenient for fourth year students on elective across the country who, even with the nicer fourth year schedules, are still never going to be available during regular office hours without taking time out of electives. I could have had this completed at the same point I had the passport notarized, but of course, had no idea this was a requirement and was never informed of the requirement by my school despite this happening every single year.
Sadly, situations like this occur frequently in medicine and cause numerous headaches for providers, patients, and families. This is just a taste, but it follows a familiar framework. We've got multiple organizations who are not co-ordinating well on a task that is a joint responsibility, with one organization putting up needless hurdles and the other failing to anticipate challenges in overcoming those hurdles. As a medical student with my future career on the line, it's extremely annoying. I can only imagine how patients feel facing similar circumstances with their health in the balance.
Monday, 26 September 2016
Communication Skills
When it comes to being a clerk, I consider myself pretty average. I keep up with my readings, know my patients pretty well, and generally put in a good effort into my clinical duties. However, I'm far from exceptional in any of these domains. Where I do consider myself a bit stronger is when it comes to communicating with patients and their families. I have plenty to learn and perfect on that front, but I'll put myself a bit ahead of the pack on that front.
A major component of this is learning how to say "no" without it seeming like an exercise in power. The phrase I hear some doctors rely on which irks me so much because of the problems it causes patients (and other providers) is "I won't". A patient makes a request and the physician says "I won't do that". There is typically a good reason for the refusal and the physician either can't or shouldn't fulfill the request in the first place. Even with an explanation of the refusal, "I won't" sticks in patients minds, because they see the physician as being capable of helping, but actively choosing not to. It hurts a lot of patient-physician relationships. I like using "I can't" as much as possible, provided it's appropriate. Fortunately, most "I won't"s can be framed as "I can't"s. Patients are still disappointed by refusals presented this way, but I find they're less disappointed in me as a care provider, and that helps to maintain the therapeutic relationship a bit better. Physicians and patients have a natural imbalance, which patients certainly feel. By emphasizing your own lack of ability to change things with phrases like "I can't", it can help to lessen the feeling of that imbalance, and to make it clear that even if you aren't able to solve all their problems, you're still trying to do what you can.
4) Ensure you're on the same page
Even when a physician is an amazing communicator, patients don't always understand the full plan. Medicine is vast and confusing, even to the initiated. Human memory is flawed in healthy people and gets worse when we're sick or stressed. Letting patients know what's coming is only effective if they absorb what was said and remember it.
Some easy strategies can help retention. I frequently try to repeat whatever plan we agree on in a concise way at the end of an interview. I then provide an opportunity for questions, in case there are any points of confusion.
Even that leaves plenty of room for things to slip through the cracks. Two approaches I'd like to use more often - but have difficulty implementing as a learner - is having patients repeat back the plan and/or writing down the plan. At this stage, all my plans are tentative, subject to approval by my supervisors and, in many cases, subject to change without my knowledge. I can't pin down anything I say at the risk of having the patient remember my suggestions ahead of the attending physician's actual recommendations. I've already had at least one instance where this has caused trouble. So, for now, I've held off these strategies, but would like to implement them once I gain some more ability and independence.
None of the above elements are overly difficult to implement and with practice become second nature. However, they are not always intuitive, rarely taught, and virtually never reinforced in medical training. We could be doing a lot better to develop a culture of effective physician-patient communication.
I though I'd take a post to go through some of the basics of my approach to patient communication, as it's not something I feel is well taught or reinforced in medical education. I often see clerks, residents and staff committing some very basic errors when speaking with patients.
1) Establish rapport first, don't forget to maintain it
That having a good rapport with patients is critical to achieving optimal care with patients is no surprise to most medical students. It's an art - no two people will have the same method for achieving a good rapport yet drastically different approaches can be equally effective depending on the circumstance and the physician's personality. However, there are some basics to establishing and maintaining rapport which I've seen get forgotten, neglected, or perhaps never learned.
To start, taking 10-15 seconds at the beginning of an interaction for some simple pleasantries can go a long way. It's fine to get down to business quickly, but don't forget that your trust hasn't been earned just because you're a physician, and that first minute or two can make a world of difference. I try to work in a quick joke within that time if an appropriate opportunity arises - I find it puts people at ease far more easily than anything else. Most physicians understand this critical introductory period and do make an effort to come across as an actual human being for the first few minutes, though some are more effective than others, some use blatantly scripted approaches, and some forgo this entirely.
Where I see more stumbles is that once that initial phase passes, the physician's attempt to connect with patients disappears entirely. Once those pleasantries are completed, it's on to business, no time for things like emotions or empathy! This kills a lot of physician-patient relationships. Trust not only has to be earned, it has to be maintained. A few empathetic statements, jokes, or check-backs with the patient to establish understanding throughout the interaction are practically essential. They show that the patient is heard and that their presence is appreciated rather than simply tolerated.
To start, taking 10-15 seconds at the beginning of an interaction for some simple pleasantries can go a long way. It's fine to get down to business quickly, but don't forget that your trust hasn't been earned just because you're a physician, and that first minute or two can make a world of difference. I try to work in a quick joke within that time if an appropriate opportunity arises - I find it puts people at ease far more easily than anything else. Most physicians understand this critical introductory period and do make an effort to come across as an actual human being for the first few minutes, though some are more effective than others, some use blatantly scripted approaches, and some forgo this entirely.
Where I see more stumbles is that once that initial phase passes, the physician's attempt to connect with patients disappears entirely. Once those pleasantries are completed, it's on to business, no time for things like emotions or empathy! This kills a lot of physician-patient relationships. Trust not only has to be earned, it has to be maintained. A few empathetic statements, jokes, or check-backs with the patient to establish understanding throughout the interaction are practically essential. They show that the patient is heard and that their presence is appreciated rather than simply tolerated.
2) Manage expectations
People will accept almost anything if they can prepare themselves for it. I've seen patients take news of a death sentence in stride because they knew it was coming before any words were spoken. The opposite is also true. People react very badly to surprises, even rather benign ones. Sick patients and their families, who may be emotionally and physically exhausted, are that much more prone to dealing with the unexpected poorly.
Medicine is inherently unpredictable. Doctors make educated guesses and can be pretty good at it, but very little is known with certainty. Good communication requires imparting some of that uncertainty to patients and their families. It's also vital to communicate exactly where that uncertainty lies. Are you uncertain because you don't know, or because you can't know? If you don't know, is it because you need input from a colleague, results from a test, or simply the time to let things play out?
Ultimately, the goal is to have their expectations be your expectations. You want your patients to hope for the best but plan for the worst, just as you will in your practice.
Being proactive is the key. Physicians frequently assume their patients are on the same page as them without confirming that this is the case. Taking 30 seconds to explain the plan, with considerations for how the plan might change and why, is an extremely important yet often neglected point of any patient interaction.
3) You're not all-powerful - don't pretend to be
Similar to the previous, be very clear about what is in your power and what isn't. Patients think doctors have a lot more authority and ability than we actually do. Physicians, sadly, tend to play into this myth. Fortunately, it's an easy trap to avoid.
Being clear about your role from the beginning is important, particularly for trainees. Never assume a patient knows what you can and can't do.
A major component of this is learning how to say "no" without it seeming like an exercise in power. The phrase I hear some doctors rely on which irks me so much because of the problems it causes patients (and other providers) is "I won't". A patient makes a request and the physician says "I won't do that". There is typically a good reason for the refusal and the physician either can't or shouldn't fulfill the request in the first place. Even with an explanation of the refusal, "I won't" sticks in patients minds, because they see the physician as being capable of helping, but actively choosing not to. It hurts a lot of patient-physician relationships. I like using "I can't" as much as possible, provided it's appropriate. Fortunately, most "I won't"s can be framed as "I can't"s. Patients are still disappointed by refusals presented this way, but I find they're less disappointed in me as a care provider, and that helps to maintain the therapeutic relationship a bit better. Physicians and patients have a natural imbalance, which patients certainly feel. By emphasizing your own lack of ability to change things with phrases like "I can't", it can help to lessen the feeling of that imbalance, and to make it clear that even if you aren't able to solve all their problems, you're still trying to do what you can.
4) Ensure you're on the same page
Even when a physician is an amazing communicator, patients don't always understand the full plan. Medicine is vast and confusing, even to the initiated. Human memory is flawed in healthy people and gets worse when we're sick or stressed. Letting patients know what's coming is only effective if they absorb what was said and remember it.
Some easy strategies can help retention. I frequently try to repeat whatever plan we agree on in a concise way at the end of an interview. I then provide an opportunity for questions, in case there are any points of confusion.
Even that leaves plenty of room for things to slip through the cracks. Two approaches I'd like to use more often - but have difficulty implementing as a learner - is having patients repeat back the plan and/or writing down the plan. At this stage, all my plans are tentative, subject to approval by my supervisors and, in many cases, subject to change without my knowledge. I can't pin down anything I say at the risk of having the patient remember my suggestions ahead of the attending physician's actual recommendations. I've already had at least one instance where this has caused trouble. So, for now, I've held off these strategies, but would like to implement them once I gain some more ability and independence.
None of the above elements are overly difficult to implement and with practice become second nature. However, they are not always intuitive, rarely taught, and virtually never reinforced in medical training. We could be doing a lot better to develop a culture of effective physician-patient communication.
Wednesday, 21 September 2016
Overconfidence
So, I got cocky. Had a run of incredibly good days on elective. I was nailing my evaluations, getting good diagnoses, and even developing reasonably complete plans for my patients. A few days felt like I could actually run the show in the near future. I still had plenty to learn, but I was spending more of my time refining my approach and decision-making than starting from the basics. I was even trying to work on speed in my assessments.
Well, that came crashing to a halt this past week. I had two days where it seemed like I couldn't get anything right. My evaluations were incomplete, my diagnoses were flawed and my plans were lacking. I was horribly slow, even for my stage of training. I wasn't close to being independent - heck, I was barely adequate for a 4th year medical student.
It's been a big wake-up call. On reflection, I stopped doing the things that got me to this point successfully. I wasn't keep up with my readings. I wasn't thinking through my approach when I stepped in the room, acting more on instinct than deliberately considering the possibilities. I rushed through my presentations, leading to slower reviews with my supervisors and costing more time overall.
So, I'm trying to do more regular reading, every night if I can, on 1-2 topics. I attempted to be more deliberative in my assessments and more organized in my presentations. Most importantly, I've tried not to be so hard on myself. I won't get every evaluation perfect at this stage, not even close. I needed to recognize that while I have made large strides in my abilities, I'm still in the learning phase of my training. I'm going to get things wrong, miss things I should pick up on, and that's ok for now.
Good reminder that it's alright to have a bad day or two - as long as you learn from them.
Well, that came crashing to a halt this past week. I had two days where it seemed like I couldn't get anything right. My evaluations were incomplete, my diagnoses were flawed and my plans were lacking. I was horribly slow, even for my stage of training. I wasn't close to being independent - heck, I was barely adequate for a 4th year medical student.
It's been a big wake-up call. On reflection, I stopped doing the things that got me to this point successfully. I wasn't keep up with my readings. I wasn't thinking through my approach when I stepped in the room, acting more on instinct than deliberately considering the possibilities. I rushed through my presentations, leading to slower reviews with my supervisors and costing more time overall.
So, I'm trying to do more regular reading, every night if I can, on 1-2 topics. I attempted to be more deliberative in my assessments and more organized in my presentations. Most importantly, I've tried not to be so hard on myself. I won't get every evaluation perfect at this stage, not even close. I needed to recognize that while I have made large strides in my abilities, I'm still in the learning phase of my training. I'm going to get things wrong, miss things I should pick up on, and that's ok for now.
Good reminder that it's alright to have a bad day or two - as long as you learn from them.
Saturday, 17 September 2016
Electives - Initial Thoughts
Got to start my electives over the past few weeks. They say the 4th year of medicine is the best year, and based on my experiences so far, it's hard to disagree. I don't have to worry about evaluations, I'm getting sleep and a bit of actual exercise, and I'm learning a ton. Getting to choose my rotations, or at least have significant input on them, is a major bonus. Learning comes so much easier when you want to learn and are motivated to do so.
It is a bit disorienting though. Perhaps not quite as much as clerkship, because I at least know the medicine well enough. Yet, being in a different environment every 2 weeks, particularly when that often involves being in a different city, it does take a fair bit of mental energy just to keep up.
There's a trade-off between variety and consistency when it comes to absorbing new information. Too much variety and there's so much rattling around in your brain that little if anything sticks. Too much consistency and you only pick up what's right in front of you, missing experiences you may have to encounter on your own later down the line. Right now I'm on the "variety" side of things and I am definitely missing my time where I could count on doing roughly the same thing for weeks on end - I'm getting a lot of experience I otherwise wouldn't, but less is sticking than I'd like.
The other wrinkle here is that this is my main chance to explore different settings for residency considerations. As someone leaning heavily into FM, the main question I'm wrestling with right now is how rural do I want to go? I knew I didn't want to do the extremes on either end - I don't want to be in the GTA, nor do I want to do overly remote medicine. However, that still leaves open anything from mid-sized cities to small towns with only a few thousand inhabitants. I don't have any major preferences when it comes to living in these locations, so it's coming down to practice types. In larger centres, FM is much more restricted to clinic work, home visits, and nursing home care, possibly with some OB thrown in. Smaller centres, you could be running clinic, covering the ER, taking care of inpatients, then doing trips to people's houses or to nursing homes, potentially all in the same day.
I'll have more to say on that soon - right now, I'm trying to keep an open mind to fully explore each of these settings and which ones might be a better fit for my residency, and my eventual practice.
It is a bit disorienting though. Perhaps not quite as much as clerkship, because I at least know the medicine well enough. Yet, being in a different environment every 2 weeks, particularly when that often involves being in a different city, it does take a fair bit of mental energy just to keep up.
There's a trade-off between variety and consistency when it comes to absorbing new information. Too much variety and there's so much rattling around in your brain that little if anything sticks. Too much consistency and you only pick up what's right in front of you, missing experiences you may have to encounter on your own later down the line. Right now I'm on the "variety" side of things and I am definitely missing my time where I could count on doing roughly the same thing for weeks on end - I'm getting a lot of experience I otherwise wouldn't, but less is sticking than I'd like.
The other wrinkle here is that this is my main chance to explore different settings for residency considerations. As someone leaning heavily into FM, the main question I'm wrestling with right now is how rural do I want to go? I knew I didn't want to do the extremes on either end - I don't want to be in the GTA, nor do I want to do overly remote medicine. However, that still leaves open anything from mid-sized cities to small towns with only a few thousand inhabitants. I don't have any major preferences when it comes to living in these locations, so it's coming down to practice types. In larger centres, FM is much more restricted to clinic work, home visits, and nursing home care, possibly with some OB thrown in. Smaller centres, you could be running clinic, covering the ER, taking care of inpatients, then doing trips to people's houses or to nursing homes, potentially all in the same day.
I'll have more to say on that soon - right now, I'm trying to keep an open mind to fully explore each of these settings and which ones might be a better fit for my residency, and my eventual practice.
Wednesday, 13 January 2016
Electives - Classmates Edition
We're rounding towards the half-way point of third year, which means it's crunch time for specialty choice. At my school, our first real "deadline" for setting us on our paths is on Friday, when some of our home-school elective choices are due.
While I've been wrapped up a bit in my own approach to electives and specialty choice, it's been interesting to hear from my classmates, who are all going through the same thing. There are a lot of different strategies to choosing electives, as well as a number of thought processes to picking a desired specialty. If history is any guide, most (though not all) of these strategies will work. It's a helpful reminder that there's no one "right" approach to electives.
I'm also just interested in seeing where all my classmates end up. There's a pretty wide variety of personalities in the class, plus wildly divergent interests, but it's still a guessing game as to where any particular person will ultimately fit. It's definitely true that people change their minds in clerkship - while some people have been consistent, many more have switched their goals, some dramatically so. Even as we settle into the home stretch of choosing specialties, there's still room for change, and I'm finding the rationale behind those changes quite intriguing. Really wish I had a crystal ball to see how it all ends up for my class!
While I've been wrapped up a bit in my own approach to electives and specialty choice, it's been interesting to hear from my classmates, who are all going through the same thing. There are a lot of different strategies to choosing electives, as well as a number of thought processes to picking a desired specialty. If history is any guide, most (though not all) of these strategies will work. It's a helpful reminder that there's no one "right" approach to electives.
I'm also just interested in seeing where all my classmates end up. There's a pretty wide variety of personalities in the class, plus wildly divergent interests, but it's still a guessing game as to where any particular person will ultimately fit. It's definitely true that people change their minds in clerkship - while some people have been consistent, many more have switched their goals, some dramatically so. Even as we settle into the home stretch of choosing specialties, there's still room for change, and I'm finding the rationale behind those changes quite intriguing. Really wish I had a crystal ball to see how it all ends up for my class!
Monday, 21 December 2015
Documentation
I requested a rotation away from my home school for my FM block, one that I'm really excited about. Unfortunately, I've just been informed that I have to submit a giant heaping pile of documentation about my immunization status. Now, I've had to submit all this stuff to my home school already. I've had to submit it to the hospital three times. I had to submit it to my undergrad school too, plus at least two volunteer groups. At some point along the line, can't it be assumed that either I'm immune to the things they want me to be immune to, or at least I'm so good at faking it that I'll fool them too?
They don't just want the documentation either - they want a physician or nurse to sign off on it. Exactly what a physician or nurse can do to look at my documentation that anyone with eyes can't, I have no idea, but it's required, so I have to do it.
Worst, I don't know where my N95 mask certification went. I think it got automatically submitted to my home school and I have to go through them to get it, but I may have just lost it, which means I'll have to repeat the testing since my previous was slightly over 2 years old. Nevermind that I've been tested at least 4 times, each time getting fitted with the 1870 mask. Nevermind that I've never had to use an N95 mask and am starting on a rotation where the likelihood of me needing one or even being in a facility with a variety of N95 masks on hand is slim-to-none. Nevermind that if I do need to wear one, since I don't shave every day - and am not required to - the small amount of stubble I'm likely to have would break the seal. Nope, if I can't find that piece of paper that confirms what another piece of paper from 2 years ago said, I'll have to go through the testing process all over again.
Just a great use of my time, the doctor or nurse's time I'll have to take up, and healthcare/medical education dollars in general.
Anyway, it'll get done. I had to get a lot of this stuff together anyway for electives in the fall, but it was a bit shocking to be rushed into it on my first day on vacation...
Saturday, 24 October 2015
Stressing Out About Electives Choices
I mentioned previously that my electives choices are coming up in a few months, faster than I expected. I am stressing out about them, way more than I probably should be. I can't even start to make my choices for electives yet, but I've reached a near-obsession state about planning them.
Here's my basic conundrum: do I choose electives to maximize my chances of getting my preferred spot in the CaRMS match, or do I choose electives to maximize my learning? In the end, it will be a balance of both, but how far to go down each path is giving me pause. All of this is complicated by the fact that I haven't yet chosen what my target specialty will be, though I'm getting closer.
Nothing has yet to really grab me as a must-do specialty though this isn't too surprising as I've always been leaning towards a generalist role in one way or another. There are bits of each specialty I've seen so far that I enjoy, but nothing that hits me overall as uniquely interesting. What has become clear is that I value having a degree of control over my career - location, practice type, hours, that sort of thing. (This makes Family Medicine a rather attractive choice, given its excellent job market, flexible practice option, wide scope of practice, and shorter residency. I'm not set on it quite yet, and I still have some reservations about the field, but the pros of Family Med are definitely starting to outweigh the cons)
Anyway, back to electives. I have 16 weeks to work with, essentially eight 2-week stints (or perhaps one 4-week and six 2-week rotations). I'd like to do at least 8 weeks in whatever specialty I'd think of ranking first, if only to get a sense of what programs are like across the country and to maximize my chances at a good reference letter. Ideally these would come earlier in the rotation, before I have to submit my CaRMS documents. That leaves 8 weeks or less for learning, mostly on the back-end of my electives time.
But, then I think, maybe more time in the main specialty is necessary to maximize chances of matching to a place I'll like. After all, in every program I'm thinking about, I have more than 4 programs that I think would be good fits. Doing some "learning" electives within that specialty could be useful too, particularly in areas I'm not too keen on matching into (like Nunavut! Sorry Nunavut, you're really interesting, but my dog would probably freeze up there...).
And then I go back again, thinking more learning time might be best, considering most specialties I'm looking at aren't that competitive. Some rotations I may never get a chance to see again, such as Dermatology, even though I have zero interest in becoming a Dermatologist (I've quickly learned skin stuff pops up all the freaking time and most physicians aren't that good with these issues). I could take a bit of a gamble on myself - most people do match to their top 3 programs anyway - and hope that I have enough exposure between my clerkship experiences and my electives to find a good fit. Whatever specialty I decide on, if there's a choice between improving my capability as a physician and advancing my career, I'd rather pick the former than the latter - if I can still land a career I'm reasonably happy with.
Anyway, you see my indecision, before I even have a decision to make. Fingers crossed the next few months provide some clarity here!
Here's my basic conundrum: do I choose electives to maximize my chances of getting my preferred spot in the CaRMS match, or do I choose electives to maximize my learning? In the end, it will be a balance of both, but how far to go down each path is giving me pause. All of this is complicated by the fact that I haven't yet chosen what my target specialty will be, though I'm getting closer.
Nothing has yet to really grab me as a must-do specialty though this isn't too surprising as I've always been leaning towards a generalist role in one way or another. There are bits of each specialty I've seen so far that I enjoy, but nothing that hits me overall as uniquely interesting. What has become clear is that I value having a degree of control over my career - location, practice type, hours, that sort of thing. (This makes Family Medicine a rather attractive choice, given its excellent job market, flexible practice option, wide scope of practice, and shorter residency. I'm not set on it quite yet, and I still have some reservations about the field, but the pros of Family Med are definitely starting to outweigh the cons)
Anyway, back to electives. I have 16 weeks to work with, essentially eight 2-week stints (or perhaps one 4-week and six 2-week rotations). I'd like to do at least 8 weeks in whatever specialty I'd think of ranking first, if only to get a sense of what programs are like across the country and to maximize my chances at a good reference letter. Ideally these would come earlier in the rotation, before I have to submit my CaRMS documents. That leaves 8 weeks or less for learning, mostly on the back-end of my electives time.
But, then I think, maybe more time in the main specialty is necessary to maximize chances of matching to a place I'll like. After all, in every program I'm thinking about, I have more than 4 programs that I think would be good fits. Doing some "learning" electives within that specialty could be useful too, particularly in areas I'm not too keen on matching into (like Nunavut! Sorry Nunavut, you're really interesting, but my dog would probably freeze up there...).
And then I go back again, thinking more learning time might be best, considering most specialties I'm looking at aren't that competitive. Some rotations I may never get a chance to see again, such as Dermatology, even though I have zero interest in becoming a Dermatologist (I've quickly learned skin stuff pops up all the freaking time and most physicians aren't that good with these issues). I could take a bit of a gamble on myself - most people do match to their top 3 programs anyway - and hope that I have enough exposure between my clerkship experiences and my electives to find a good fit. Whatever specialty I decide on, if there's a choice between improving my capability as a physician and advancing my career, I'd rather pick the former than the latter - if I can still land a career I'm reasonably happy with.
Anyway, you see my indecision, before I even have a decision to make. Fingers crossed the next few months provide some clarity here!
Sunday, 18 October 2015
Location, Location, Location
Faster than I expected, I'm starting to look at my 4th year electives. It's tough - there's not much time to work with, a lot of uncertainty about what kind of elective I can get, or even what electives I want to get. Not knowing exactly what specialty I want yet makes it that much more challenging...
Anyway, the reason I bring this up is that I've increasingly become aware of how difficult it is to control where you live when doing your training. I've always been told that one of the best ways to ensure the career you want is to be flexible about location. Be willing to move anywhere in the country and your chances of getting your first choice specialty are very high. Be willing to move anywhere in the country and you'll get the fellowship you want, or the job you want after that.
I'm willing to move. And I'm not particularly interested in the major city centers (Toronto, Montreal, Vancouver) that tend to be uber-competitive, so my chances of ending up where I want to are at least reasonable. However, while I'm willing to move if necessary, I'd rather not move around too much over the next few years. In some career pathways, moving 4 times within a decade, potentially halfway across the country, is very plausible. For example, both Internal Medicine and Pediatrics go for three years before their subspecialty matches, each of which are typically followed by a 1-year fellowship before finding employment. That's potentially one move for residency, one move for subspecialty, one move for fellowship, and one move for work. Four potential moves total, assuming no second fellowship or locum work, both of which are entirely possible.
Granted, staying at one institution between med school and residency, residency and subspecialties, subspecialties and fellowship, and/or fellowship and employment is often an option. Most students do their residency at their home schools, after all. However, staying put isn't always a possibility. Not every residency, subspecialty, or fellowship exists at every school. Jobs aren't always easy to come by in locations with residency programs. The programs that exist where I want to stay may not be high-quality or tailored to my needs. They may not want me as a resident/fellow/employee either.
That's giving me a lot of pause when it comes to considering a long-term career pathway. If I'm going to move for residency, I'd rather not set myself up to have to move for a subspecialty or for fellowships. That's easier said than done, especially outside the competitive large cities.
This realization is also exposing a fairly fundamental conflict in my career/life planning. I'm ambitious, but I also work to live, not live to work. Optimizing my career goals means moving, a lot. Optimizing my life outside of my career means moving as little as possible. I'm not sure how easily I'll be able to find that balance.
Yet, finding that balance is now the goal. As a plan my electives, I also start to set my career path in motion. I've only got 16 elective weeks to find locations/programs that fit me well, fit my family well, and have some desirable career options moving forward. These weeks are also my best opportunities to show those programs that they should want me in their programs. Choosing electives may be the first "career" decision I've truly had to make so far since starting medical school, and I'm just now recognizing what kind of an impact these choices might have. Fingers crossed I make some good decisions!
Anyway, the reason I bring this up is that I've increasingly become aware of how difficult it is to control where you live when doing your training. I've always been told that one of the best ways to ensure the career you want is to be flexible about location. Be willing to move anywhere in the country and your chances of getting your first choice specialty are very high. Be willing to move anywhere in the country and you'll get the fellowship you want, or the job you want after that.
I'm willing to move. And I'm not particularly interested in the major city centers (Toronto, Montreal, Vancouver) that tend to be uber-competitive, so my chances of ending up where I want to are at least reasonable. However, while I'm willing to move if necessary, I'd rather not move around too much over the next few years. In some career pathways, moving 4 times within a decade, potentially halfway across the country, is very plausible. For example, both Internal Medicine and Pediatrics go for three years before their subspecialty matches, each of which are typically followed by a 1-year fellowship before finding employment. That's potentially one move for residency, one move for subspecialty, one move for fellowship, and one move for work. Four potential moves total, assuming no second fellowship or locum work, both of which are entirely possible.
Granted, staying at one institution between med school and residency, residency and subspecialties, subspecialties and fellowship, and/or fellowship and employment is often an option. Most students do their residency at their home schools, after all. However, staying put isn't always a possibility. Not every residency, subspecialty, or fellowship exists at every school. Jobs aren't always easy to come by in locations with residency programs. The programs that exist where I want to stay may not be high-quality or tailored to my needs. They may not want me as a resident/fellow/employee either.
That's giving me a lot of pause when it comes to considering a long-term career pathway. If I'm going to move for residency, I'd rather not set myself up to have to move for a subspecialty or for fellowships. That's easier said than done, especially outside the competitive large cities.
This realization is also exposing a fairly fundamental conflict in my career/life planning. I'm ambitious, but I also work to live, not live to work. Optimizing my career goals means moving, a lot. Optimizing my life outside of my career means moving as little as possible. I'm not sure how easily I'll be able to find that balance.
Yet, finding that balance is now the goal. As a plan my electives, I also start to set my career path in motion. I've only got 16 elective weeks to find locations/programs that fit me well, fit my family well, and have some desirable career options moving forward. These weeks are also my best opportunities to show those programs that they should want me in their programs. Choosing electives may be the first "career" decision I've truly had to make so far since starting medical school, and I'm just now recognizing what kind of an impact these choices might have. Fingers crossed I make some good decisions!
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