The Med Student’s Guide to Emergency Medicine (Part 2)

Zesty Mortdon is a recent medical school graduate who will start his emergency medicine training in July. In part two of this series, he addresses the competitiveness of EM, gives insight into the application process, touches on SLOEs, and gives advice on how to stand out on audition rotations. If you haven’t checked out part one yet, click here: The Med Student’s Guide to Emergency Medicine (Part 1)


 

Competitiveness

This is a hard question to gage. I would recommend looking at the NRMP match data. Specifically, look at average board scores and contiguous ranks (how many interviews you need to aim for to have a certain percentage of matching). Those will generally give you the best idea of how competitive EM is and how competitive you are within the applicant pool.

Historically, EM is mid-tier in terms of competitiveness. In very broad strokes, it’s less competitive than derm or ENT, on par with anesthesia and general surgery, and more competitive than FM and IM.

Competitiveness is also largely dependent, as mentioned above, on your away rotations and SLOEs. Killer rotations with solid SLOEs can definitely make up for a lack-luster Step 1 score.

 

Audition rotations

Unlike other specialties, auditions (also known as acting internships [AI], sub-internships [sub-I], whatever you want to call them) are extremely important for EM. This is mainly because of the need for SLOEs, which are discussed below. But auditions are also important as you get to know if a program is a good fit for you in terms of resident support, faculty set-up, and ED structure (nursing staff, scribes, EMR, dictation help, equipment, etc.)

At a minimum, you need two auditions. This typically includes one rotation at your home institution and another at an outside program. This is assuming your home institution has an EM residency and you can rotate with them before September 1st. If your home institution does not have an EM residency, or you cannot rotate with them before September 1st, you need to rotate at another outside hospital for an audition. This is because you need at least two SLOEs before applications open, and these should come from programs with an EM residency (further discussed below).

I encouraged third years to go on as many auditions as they could afford and mentally handle. These are fantastic opportunities to get to know programs and for them to get to know you. However, they can get expensive as you’re paying double rent and are in a city that may be more expensive. Even more, you have to be on you’re “A game” for all of these rotations. Think of them as month long interviews. One bad shift with a resident or attending can be detrimental. However, expectations are typically geared toward personality and teachability traits more than gross medical knowledge. Be a hard worker, personable, likeable, and willing to learn.

Where you choose to do auditions is a debated topic. Some people will argue you should do them at institutions in which you are extremely interested. Some argue you should do them at programs that write solid SLOEs. Some argue you should do them at a wide variety of hospitals to cover your bases (i.e. one at a big academic level I trauma center, one at a community hospital, one at a DO program if you’re an osteopath, etc.). I was a fan of covering your bases, though I wonder in hindsight if my application would have been stronger had I done rotations only at big centers. I ended up doing a rotation at my home institution (small, non-levelled community center), another at a big level I academic center, one at a medium sized level II community hospital, and my final at a big county/academic, level I program (ended up matching here). I got great exposure to all of the different program types and was well informed for the type of program in which I wanted to train. But I can’t help but wonder if the top tier programs missed my intentions compared to kids who only rotated at huge tertiary centers. While I advocate for my method, I can’t definitively say this is the best way to guarantee you match.

 

SLOEs

https://www.cordem.org/esloe/

The main utility of audition rotations is to obtain standard letters of evaluation, or SLOEs (pronounced “slow” or “slow-e” depending on who you ask). These letters are standardized letters of recommendation that assess you in comparison to other medical students who rotate through a given hospital. They have general questions, but also have a section that asks how you rank in comparison to other students. The options are top 10%, top 1/3, middle 1/3, and bottom 1/3. It’s important to note that while a top 10% SLOE looks best, a bottom 1/3 SLOE does not necessarily kill your chances. Some programs may even write a glowing review, including how even though you received a bottom percentile SLOE, you would make an excellent physician.

You need at least two SLOEs from programs with a residency. Three SLOEs are ideal, with a fourth letter of recommendation either being a fourth SLOE or an independent letter that is high quality and personal (I prefer the latter here). You need at least one SLOE to be written and submitted by time your application is submitted (mid-September). If you do not have one by this point, most programs will consider your application incomplete and won’t review it (though some will if you contact them and tell them SLOEs are incoming). Most programs are okay with you only having one SLOE in by time applications open and will view your application accordingly. However, it is still technically incomplete as most programs require two SLOEs. Ideally, you should have two SLOEs uploaded by time applications open. I strongly advocate for this plan. I spoke with a EM program director at a big academic center, and he said when he is faced with the task of sorting hundreds and hundreds of applications, he sorts them into three initial categories: complete, incomplete, and definite no. He said it greatly benefits you to be in the complete category, as they will be considered first. And with the pile being so big, he often finds so many quality interview choices that he does not make it all the way through the incomplete pile. This is only one PD’s opinion and style, and plenty of my colleagues matched with only one SLOE in by September. But his program was solid and he had great residents, so this bit of advice has stuck with me.

Make sure to allot enough time for the programs you rotate at to actually write the letter. If you finish your second audition September 10th, this may not be enough time for your SLOE author to submit. As a rule of thumb, I would recommend finishing your auditions by the end of August at the absolute latest. This will give your last SLOE author about two weeks to submit a SLOE.

In that same vein, who should you ask for a SLOE? This will change based on the program but is usually easy. All of these programs realize you need SLOEs in order to apply. The vast majority have a clinic clerkship director or other designated attendings that assume you will need a SLOE, and have a procedure in place to assess you (i.e. you may have to have an attending or resident fill out an evaluation after every shift you work, with all of the evaluations being conglomerated by the SLOE author to compose your letter). Regardless, this should be one of the first questions you ask when you are setting up auditions! In the off chance there is no designated process, you should ask the attending you’ve spent the most high-quality time with for a SLOE. Ideally, this will also be the attending you liked best. These are important, so make this choice carefully if you’re at a rare program that doesn’t have a SLOE-writing process in place.

Switching gears, you can get a SLOE from a hospital without an EM residency program. They have special SLOEs for this situation (see link above). I personally used this as my third SLOE since my home program did not have a residency program. However, the jury is out regarding how these SLOEs are weighted compared to residency SLOEs, and if you are better off asking EM physicians in this situation to write you a traditional letter of recommendation. I got positive feedback in multiple interviews for having three SLOEs (even though one was non-residency) and having a fourth letter from a general surgeon that I really got along with and respected immensely.

 

How to impress and succeed on EM rotations

The biggest thing to remember when on your AI is that most residents and attendings don’t expect you to know everything. I would argue the main thing they’re looking for is someone they can get along with. You’re going to be working with these folks at 3AM on Christmas Eve. They want someone they like, or at least can tolerate, during these tough days. You can teach medicine. It’s much harder to teach personality.

So to impress and succeed, it’s important to be personable. Be easy to get along with, be teachable, and show willingness to learn. You don’t have to know the differential and work-up for myoclonus. But you have to show the motivation to learn it and be able to work it up when the next patient with myoclonus shows up in a room.

Now there are ways to get some brownie points on these rotations. Anything you can do to free up time for residents will be huge. Know how to suture and how to I&D an abscess without supervision. Follow up with patients after treatment. Someone came in with nausea and was given Zofran? Follow up in a half hour and tell the resident how they’re responding. In that same vein, keep an eye on labs/imaging for each patient and let the resident know of any abnormalities. To do this, try to have access to a computer and EMR. Always ask for feedback after a shift.

One last thing: try and work at least one shift with the program director (PD). Most rotations will work this in for you, but in the event they don’t, it can be extremely useful to work directly with the PD. Putting a face to a name is beneficial. It’s also important to see how the PD manages the residents and how his or her personality mingles with yours. Finally, SLOEs from PDs are phenomenal. For one of my auditions, I asked the PD for a SLOE instead of the designated attendings. This was a gamble. I risked coming off as a student that doesn’t follow protocol or who was bothering a PD to do something another attending was delegated to do. So, I can’t recommend you do this. But if you got along well with the PD and built a solid rapport, it might be worth asking. Just assess your relationship with the PD across the rotation and go from there.

 

 

Can I match into family medicine and then pursue EM after that?

Yes.

This is a great question and one many of my classmates considered. American Council of Emergency Physicians (ACEP) puts out an annual compensation report, which includes how many EM jobs are available to FM physicians. As of 2018-2019, jobs open to primary care board certified docs was at 43%.

The catch here is that these jobs will likely be at small, non-levelled, community hospitals. It will be very difficult to find get a job in a big level I trauma center or at a university. It will also be hard to get jobs, no matter the type, in popular cities (i.e. LA, NYC, etc.).

I’m not entirely up to speed on the process of entering EM through primary care. From what I understand, some programs will offer a fellowship-like training period after residency for you to train more in the ED. It’s probably worth checking with someone who pursued EM this route.

 

Closing thoughts and advice?

My biggest advice is to make judgments from your own experience and not from what you read or hear. I’d rather trust my own experience than that of others, no matter how ubiquitous the thought. Not to say you shouldn’t listen to other’s advice or opinions, but try not to take their experience as definitive truth.

The first step in choosing a specialty does not have to be surgery or non-surgery. Think of other factors that drove you in to medicine. Do you want sick patients? Do you want your own patients? Do you want procedures? Do you want to take call? The list goes on. But again, do not default to the commonly used techniques or opinions. Take a step back and think what works best for you.

Get auditions set up early! You should aim for two SLOEs by time applications open in September. This is vital to your chances of matching. Some may argue you only need one, but I strongly suggest getting two.

When you’re on auditions, its not necessarily about how much you know. It’s more about how you mesh with faculty/residents, how teachable you are, and how much you’re willing to work.

Try to work at least one shift with the program director.

Check NRMP match data to gauge your competitiveness in this field. But remember, a killer audition can immensely improve your chances even if you’re numbers are a bit weak.

While you may have a preference for academic, community, or county residency programs, try to judge where you want to go by how well you fit in with the residents/faculty. Co-residents and faculty that are supportive and good teachers will lead for a better experience than program type.

You can practice in the ED as a family medicine boarded doc. However, your job opportunities may be limited as an attending.

There are plenty of negatives to EM. It’s important to think about what you like the best about a specialty and what you hate the least.

Thank you for reading! I would be happy to answer any additional questions. Also, any feedback would be greatly appreciated.

 

Resources for medical students

  • reddit.com/r/medicalschool
  • NRMP match data
  • Student Doctor Network – emergency medicine thread
  • Cordem.org/esloe
  • ACEP’s annual compensation report

 


 

Again, if you haven’t checked out part one, click here: The Med Student’s Guide to Emergency Medicine (Part 1)

For all updates, follow me on Twitter: @JordanSoze

The Med Student’s Guide to Emergency Medicine (Part 1)

Jordan Soze here. Today we’re featuring a guest post from a good friend of mine who will be contributing more in the future. Zesty Mordton is a fourth year medical student who recently matched into a top emergency medicine program (congrats again my dude). Furthermore, I’ve known him since high school where we bonded over music (and even saw Radiohead together). Dude is brilliant and one of the nicest guys you’d ever meet. By some struck of luck, he happened to be in the class above me in my medical school where he’s been an invaluable mentor during my journey. Naturally, in the twilight of his medical school career, I asked him if he’d like to contribute some of that sage wisdom to Soze Media and he delivered this absolute gem of a post.

If you’re considering applying to emergency medicine or simply want to know what it’s all about, read this post. Bookmark it. Save it. And read it again. It’s an in depth exploration into choosing emergency medicine as a career and the application process, so I’ve split the post into two parts. In part one, he discusses why he chose emergency medicine, what type of students should consider EM, and gives insight into the specialty. In part two, he gives priceless advice on applying to emergency medicine, including competitiveness, audition rotations, SLOEs, how to impress, and so on. Enjoy! 


Hey, everyone! I’m Zesty Mordton and I’m honored to be the first guest contributor to Soze Media. I went to high school and medical school with Soze, and after talking recently, he asked if I’d write a bit about emergency medicine (EM) for those interested in the field. I recently matched into EM and am excited to share some info about the field. Big thanks to Soze for letting me contribute to this great blog.

Let’s dive in!

Why EM?

The quick of it? I wanted a high-acuity field, no personal patients (clinic, continuity of care, etc.), short residency length (I have a boat load of student loan debt), shift-work with no call, and a specialty that I felt meshed with my personality.

For more detail, I think it’d be best to walk through my decision process.

Most students are told that the first decision they need to make is surgery vs. non-surgery. This is reasonable, but the first step I made is whether I wanted acute or non-acute patients. Now all fields of medicine tend to deal with acutely ill patients at some point. But some deal with sick patients more than others.

After my rotations, I considered the most acute fields to be the following:

EM, general surgery, neurological surgery, OB/GYN, orthopedic surgery, anesthesia, critical care fellowship (via multiple residency routes)

After choosing high-acuity, I next decided if I wanted “my own” patients (i.e. clinic and/or patient follow up) or not. Deciding I did not want continuity of care or “my own” patients, I was left with EM, anesthesia, and some critical care options.

Knowing critical care could be achieved through EM and anesthesia, I narrowed it to those two options. You can grab a critical care fellowships a bunch of different ways. I won’t go into all of the options here, but basically EM and anesthesia were the shortest tracts and I enjoyed their “bread and butter” practice more than any other residency. A critical care attending once told me to choose a field based on the residency, not the fellowship options. I think there is some truth to that, just in case you don’t end up getting that fellowship position.

Okay, so why EM? EM residency is three years, it’s shift work with no call, I’m not constantly working with surgeon and their schedules, there’s great variety in practice, and I was apprehensive about CRNAs and the shift of “bread and butter” anesthesia to a more managerial role. 

Lastly, throughout my rotations, I seemed to mesh well with EM physicians and residents more than any other field (anesthesia was a mighty close second though). More on this in a bit.

On a side note, I want to stress that it was my personal experience that drove all of these decisions. Some students might have completely different rotations and think EM is just exaggerated primary care or that CRNA involvement has been overblown for years now (though I do think it is safe to say general anesthesia is shifting to more of a managerial role). You may also disagree with the specialties I consider high-acuity. Either way, I strongly encourage each student to judge specialties based off their own experience, not the generalized experience of others. Don’t exclude surgery because you hear the lifestyle is bad. Don’t include dermatology because you hear the lifestyle is great. Find out for yourself.

EM negatives

The two biggest negatives I hear from residents and attendings are the lack of respect and the high amount of expectation management.

Being an EM physician, you are the second best at everything in the hospital. Intubation? Not as good as anesthesia. Suturing? Not as good as plastics/surgery. EKG interpretation? Not as good as cardiology. The only acception is probably resuscitation.

This second best status doesn’t give you a whole lot of pull in the hospital. Related to this is the fact that you’re going to be calling consults left and right. Ortho, medicine, surgery, cardiology, OB, etc. They’re all going to be woken up at 2AM by your phone call. Even more, you aren’t going to work up their consults exactly how they want. I don’t say this to try and point out how consult services are picky. I say this because EM physicians might forget things and might not work up patients as well as a cardiologist or OB would. This is because while the pre-eclamptic patient is in room 3, a dilated cardiomyopathy is in room 16, and two motorcycle collisions are in the trauma bays. You have so much going on that you will rule out the serious stuff, consult for the details, and try to keep your head above water. It’s just a lack of understanding for what other specialties deal with, just as EM has for other fields themselves (why did that family medicine doc tell the patient to come to the ED?).

This lack of respect may turn some people off. There’s a very good chance your clinical acumen and decision making will be called into question by others on a daily basis. This doesn’t bother me, but does bother a considerable amount of people (for better or worse).

The other aspect of this field that might be a turn off is the amount of expectation management. Some patients think the ED is a place to get an antibiotic for their URI, or to be admitted for their sprained ankle, or get opioids for their low back pain. A big part of your job is to listen to the expectation, and then explain how this will differ from your plan. This can lead to a lot of unpleasantness and difficult patient interaction. I think this is common in plenty of other fields, but not quite in the same quantity as EM.

There are plenty of other reported EM cons. High burn-out, shift work with alterations of day and night shifts, working weekends and holidays, mid-level encroachment, no continuity of care, EM doesn’t make money for the hospital, wide misuse of the ED for primary care, etc. But again, I wanted to talk about some of the most common cons I hear from other students and residents.

In the end, none of these cons bothered me too much. I think there is some merit in not only considering what you like the best, but what you hate the least.

What type of students should consider EM?

EM typically attracts students who are calm under pressure, love procedures, and who prefer shift work.

The ED is a hectic place. You are managing multiple patients at any given time and the variety of pathology spans across every medical field. Even more, some of the patients are actively dying.  There is definitely truth in the adage of EM being the most exciting fifteen minutes of every medical specialty. This results in a high-stress environment on a daily basis. EM docs have to be calm and collected under pressure. Some argue you have to love this frantic aspect of EM, want the adrenaline, etc. While it would help, I don’t think that is true. You simply have to be able to handle it.

The two other aspects that interest students are the high volume of procedures and shift work. You’ll see suturing, intubations, central lines, chest tubes, I&Ds, fairly regularly. You will probably even see a thoracotomy or canthotomy. You will also work either eight, ten, or twelve hour shifts. This is appealing to a lot of students as you don’t take call and your schedule is very predicable. When you’re on, you’re on. When you’re off, you’re off.

Besides these three main characteristics, students may like EM for the reasons I mentioned above in ‘Why EM?’. They also might be attracted to the “chill” factor. For some reason, emergency medicine seems to interest laid back, easy-going physicians. No yelling, no malicious pimping, and relaxed conversation. While I’m sure this isn’t true for all hospitals, it seems to be the general consensus with every hospital I’ve been and with other medical students. 

What qualities to look for in programs?

I don’t think this differs from any other residency.

With the strict regulations imposed by ACGME, you will get a solid education in pretty much any residency program. The biggest thing to assess is how well you fit with faculty and residents in a given program.

With that being said, there are three general types of EM programs out there that may pique your interest. They are academic, county, and community.

Academic programs are affiliated with a university and have great research exposure, fellowship opportunities, and teaching opportunities. They are affiliated with huge tertiary referral centers and arguably see the rarest pathology out there. Think Johns Hopkins, Ohio State, etc.

County programs tend to deal with low-income, underserved patient populations. And, from my experience, these programs deal with the sickest patients in EM. They are usually no-frill, efficient facilities that see over 100,000 patients a year and are pros at trauma, psych, and patients who haven’t seen a doctor in decades. Think LAC/USC, Cook County, etc.

Community programs are typically non-leveled or lower-leveled trauma centers that take care of a middle or high-class patient population. They tend to get some sick patients, but not as much as county programs. And they tend to get some research/teaching opportunity, but not as much as academic programs. There are definitely exceptions, but as a rule of thumb, I would put them in the middle of the spectrum between academic and county. The big draw here is that the vast majority of EM physicians will work at community hospitals. So this arguably prepares you best for the type of practice you’ll find yourself in after you complete residency.

Not all programs fit nicely into one of these three categories. Some places are level I trauma, big centers that are community-based. Some programs may be a combination of university and county. But this is still a useful way to generally categorize programs and things you might like about them.

The thing with these three main program types is that the ACGME has stipulations in place so you get exposed to everything. For instance, you have to do a research project in order to graduate. You have to complete so many procedures to graduate (most community hospitals have an agreement with big level I trauma centers, which are typically academic or county, so residents can do a trauma or ICU rotation with them for exposure to high-acuity procedures). Lastly, big academic and county centers have rotations at small community hospitals so you are exposed to that patient population and pace of medicine.

All in all, while the type of program does matter, you will get exposed to most everything no matter what kind of residency you end up attending. Therefore, the support and fit of the program’s personnel is most important to your choice.

Stay tuned for part 2!

Med School Memoirs: Smell the Roses

Another entry into the Med School Memoirs series. Wrote this yesterday. Haven’t edited it and don’t know if it’ll make the book I’m feeling good right now so I’m posting it. Enjoy.


 

Smell the Roses.

I skimmed my book with a blue sharpie pen in hand while he muttered notes from the morning’s final operation into the Dragon speech recognition microphone. Occasionally he’d pause and say something and I’d perk up and look at him as if he were speaking to me only to realize he’d just resumed dictating his post-op notes. After multiple rounds of this “is he speaking to me or the computer” game, his head turned towards me. I closed my book and looked up at him. This was the real deal. He asked, haven’t you finished that book yet?

Yes, I said. I’m just going through it again. I want to make sure I learn as much as possible before my audition rotations.

Put it away, he said. Let’s get some lunch. He stood up from his computer and I followed him down the hospital corridor. He pulled his surgical mask from his neck and threw it in the trash. I did the same. You’re smart and you work hard, he continued. You’re going to make it.

Thanks doc, I replied. I just… it’s stressful, you know? I feel like time’s flying.

He nodded and continued walking without a reply. His lack of response made me wonder if what I said had sounded stupid to him. I cared what he thought about me, which led me to overthink many of the things I said to him. He was an intelligent and accomplished surgeon, which is what I hope to be. Some day.

We walked side by side; I was on the left and he was on the right. He turned left into me towards the stairwell door and we did that awkward thing where you’re in someone’s way and you have a western gun draw about which way you should move to actually get out of the way. That’s the thing about being a med student; you’re either in the way or invisible. Today I was in the way.

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Med School Memoirs: Str8 Outta Mumbai

If you’ve ever read my site and used my advice, laughed, or, simply related to one of my posts, please read this one.

This is a short story I have written for my upcoming book, tentatively titled Med School Memoirs. I don’t think this one will make the final cut for the book, but I like it and think it’s pretty good so I’ve decided to share it.

I have written dozens of similar stories, but haven’t had the courage to post any of them, until today. Therefore, if you enjoy this story, I encourage you to leave a comment, tweet at me, send me an email, share it on your preferred social media – anything.

It would mean the world to me. Enjoy.

(more…)

Announcement: Med School Memoirs.

Welcome. Let’s get to it.

I have been trying to write this post for months but I never seem to find the right words.  Several times per week, I’ll write this post and delete it.  I can’t write anything on this site anymore.  But I need to just finish this and post it so that I can jump over that mental hurdle.  So, I’ll skip the flowery introduction and get the purpose of this post immediately.

While I haven’t been posting much on Soze Media lately, I have been writing. In fact, have been writing more than ever. But I’m not writing end of rotation reviews, or how-to lists, or anything of that nature. Rather, I’m writing a book.  For now, the working title is “Med School Memoirs”.

It is a collection of short stories. Many are real, others are fiction, and some blur the line between the two. I was going to try to explain the stories but I can’t seem to do it. Some stories are directly about being a medical student, while others simply take place in the setting of medical school.

When I started writing them, I had no intention to share them, meaning I could write without worrying what readers may think – which is the best way to write and stay true to your voice. My site grows in popularity and page views every month, but I haven’t posted any of these stories due to the fear that no one will care. The whole “putting yourself out there” thing, you know? It gives me anxiety.

But since I’m finally posting this announcement, I know that it must come with a teaser. I’ve written over 50 stories, and I’ll write 50 more, but the book will be a selection for 30 or so of the best stories. Therefore, once in a while until I release the book (likely early 2020), I’ll post a story that won’t make the final product and will be left on the cutting room floor. Here’s one such story, a tale of loneliness, isolation, and love.  It’s the story of my old friend and neighbor, Raj.

Med School Memoirs: Str8 Outta Mumbai

 

Twitter: @JordanSoze
Email: collegesoze@gmail.com

More to come.

The 2018 Soze Media Music Awards (Part I)

Yeah, I know most of these lists are released before 2018 actually ends, but cut me some slack, I’m a busy med student.

All the major music journalism publications have released their lists of the best songs and albums of the year. But mainstream music journalism is pretentious garbage and in my opinion, my thoughts on music are all that matter and everyone else is wrong (I’m JOKING).

I’m going to go on the record and say that 2018 was a down year for music. While the year did deliver on some unforgettable hits, I felt that there was a major lack of top-to-bottom impressive albums. Even worse, the best albums of the year were largely ignored. All the big dogs in music journalism were trying so hard to be cool and hip by anointing average records as classics.  In fact, you won’t find the best album of the year (which I’ll get to) topping any of big name lists.

While the media latched on to lame corporate pop hits and the flannel-clad hipsters tried to act like every run of the mill indie artist was the next big thing, some truly incredible music was released this year if you knew where to look.

(Disclaimer: Please don’t take me too seriously)

Without further adieu, let’s say peace to 2018 and review the year’s music.

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Miscellaneous Step 1 Tips

I’m halfway through my third year of med school. I’ve already completed family medicine, general surgery, pediatrics and internal medicine rotations (along with the shelf exams for each). Somehow, I’ve reached a realization that I never saw coming: I miss studying for Step 1. Yep, I said it.

While I have enjoyed third year (for the most part), I really dislike studying for shelf exams. Aside from UWorld, everyone recommends different resources. Online Med Ed is nice, but it makes me miss Boards and Beyond. You have to muster the energy to study after coming home from a long day at the hospital or clinic. And suddenly, residency applications and the match, which once seemed so distant, are now closing in faster than Troy Polamalu chasing down a ball carrier in his prime. The beast of Step 1 has been conquered, but a million other anxieties rear their ugly heads: away rotations, evaluations, letters of recommendation, and so on. In short, you no longer have one “big thing” to focus on, but rather a myriad of small things that you need to attend to.

I miss having that one big thing to focus on. I miss the process. I miss having complete control over my day-to-day routine. So, since I’ve been reminiscing on that journey, I’ve decided to finally publish this post (which I wrote like 5 months ago). Here you’ll find a collection of Step 1 advice that didn’t seem important enough for an entire post. I’ve sorted the advice through the following phases: first year, second year (pre-dedicated), dedicated, test day, and post-test.

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How to Honor Your Surgery Rotation: 9 Rules

Jordan is one of the best students to ever rotate through this facility

This is what my attending wrote on my evaluation at the end of my surgery rotation. I mention this not to brag (while I’ve done well, I have not replicated the same success on other rotations), but to demonstrate that I truly feel like I understand the approach to  thriving, honoring, and having some fun on your surgery rotation.

If you read my End Of Rotation Review of General Surgery (aka a synopsis of my experience), you know that I not only had an excellent educational experience, but I also made some friends along the way. Here are my 9 rules to honoring your general surgery rotation.


 

1. Be Kind and Respectful to Everyone

The most basic advice on this list, yet often overlooked. On your rotations, you’re not going to be remembered by the number of pimping questions you got right; you’ll be remembered by how you treated others and how you assimilated with the team. No one is below you. Not the nurses. Not the scrub techs. Not the orderlies. They’re all people the same as you.

So use those manners momma taught you. Smile and say good morning, even if you’re tired and don’t want to be there. Show up on Mondays and ask, “how was your weekend?” Simple stuff like that. When they realize you’re a genuine and kind person, they’ll look out for you. The scrub techs will make sure you get a good spot at the table. The nurses will help you in any way they can. The CRNAs/Anesthesiologists might even let you intubate. As a rule going forward, the better you treat others, the better your experience will be.

 

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End of Rotation Review: General Surgery

So as I wrote in my previous, and first, entry to my “End of Rotation Review” series, family medicine was super chill (click here to read it). My attending was very empathetic to the med student experience and ensured that I had a good time during my month with him.

During my last week, he said to me, “are you ready to get your ass kicked by surgery next?” Most med students dread surgery as it’s notoriously known as an arduous, soul-crushing experience. Despite being pretty sure I wanted to go into a surgical field, I was a little bit intimidated. It’s natural. I had shadowed a handful of surgeons in the past few years but only scrubbed once before. As a first year med student fumbling my way through the foreign land of the operating room, I was kicked out of the procedure for breaking sterile field twice. Not my finest hour.

After showing up on my first day dark and early, I waited to meet the educational coordinator person (idk what her title is) who didn’t arrive until forty-five minutes after we had planned. After a brief tour of the O.R.’s, pre-op, PACU, endoscopy suites and all that jazz, I eventually arrived at my attending’s office, sat down and discussed the expectations for the rotation. “Do you know what you want to do yet?”, he asked.

As always, I like to keep my answer to this question relatively vague (i.e. if you’re on pediatrics, hate pediatrics, and would rather quit med school than pursue it as a career, you keep that to yourself and say you’re undecided but interested in what every specialty has to offer). However, it was surgery, and I want to do a surgical subspecialty. I am still remotely considering anesthesia as well. So I conveyed this to him.

He outlined the plan:

“So recently we’ve decided to start doing something different. You’re going to do whatever you want. You are not going to be tied to me or any other attending. You have the freedom to make this rotation yours. If you see something on the schedule that interests you, ask if you can scrub in. You pay so much money for every day you’re here and you have so little time to explore and figure out what you want to do for the rest of your life.”

These were his terms. My grade would be determined by comments from surgeons, residents and other staff. As long as I logged enough bread & butter general surgery cases (lap choles, appy, hernias, etc) and worked hard, I was given full freedom to spend my time with whatever specialty, surgeon, and procedures caught my interest.

Again, I struck gold.

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