Couples match advice, please! :) Super nervous about going through it next year.
Sure! We were pretty nervous about it too, thereās really not that much info online. Iād recommend GooglingĀ ācouples match redditā, there are some really useful threads on there!Ā
I think the most important thing is to be realistic. Your chances of matching are still the same when you couples match vs individually match, but if you guys are not the most competitive applicants for your fields, you will most likely fall down on your rank list. For me, that was okay because Iād rather be with my SO in some average program than be alone in an above-average program. I had friends who werenāt okay with that so they didnāt couples match. Iād recommend overapplying so you can maximize your chances of getting invites in the same cities (like 80+ minimum if youāre competitive). Itās really hard to line up invites at the same time, so if one person gets an invite, schedule immediately and then hope the other person gets one too. Every time one of us got an invite, weād send emails to our respective program coordinators to declare our intent to couples match and ask for an invite for the other person. This got us an extra 2-3 interviews. Our priorities were to match together in the same city > match in any way > no match, so we ranked our combos as in the same city -> all combinations of our programs, including ones on opposite sides of the country -> combos where one of us matched and one of us didnāt. We ended up with 227 combos haha. Some of my friends only ranked matches where they were in the same city, and they were ok with soaping, so itās your preference. Couples matching is overall way more expensive -- more apps, more interviews, more fees for NRMP, etc, so plan for that too.Ā
Hope that helps! Itās a rough process but Iām grateful to be in the same city as my SO, and itās so nice knowing I have my biggest supporter with me!Ā
I started a new rotation in critical care, and itās kind of bumming me out, but not for the reasons you might think. First, off they never told me how to dress where to show up etc. despite multiple attempts to contact them. I thought thatās okay things happen people get busy, so I wore scrubs and showed up at seven in the morning Monday, spoke to security and located the Unit, The residents were- well not very friendly. They said hello but gave me no expectations, nothing.Ā Eventually, after repeatedly asking if I could pick up a patient and talking with RT and the nurse, I got to start doing some presentations, notes, and patient care. But man these residents are either really unhappy or just really apathetic. They donāt teach and seem annoyed when I ask questions, even when theyāre slammed and I offer to help they refuse. I donāt feel like part of the team at all. They donāt invite me or tell me where theyāre going when they leave (even when they are going to see my patient) so I have to ask (and get annoyed looks) or follow them like a shadow. Also, nobody dismisses me, so even after all my notes are done and my patients are taken care of- I have to drop hints or sit around and study till eight after sign out. Itās unfortunate because the medicine is really interesting and Iām motivated to work hard and learn, but I just feel so uncomfortable and unwelcome. Iām hoping things get better as they learn to trust me and get to know me, but man, do I feel like an outcast. Itās going to be a long month.
Iād talk to the clerkship coordinator. No one should have to deal with that for an entire rotation, and LCME is SUPPOSED to be getting on peopleās butts about these kind of rotation experiences. Med school is hard enough man.
Sorry this is happening to you! ): Def bring it up with your clerkship coordinator.Ā
I'm a 4th year student on my SICU-trauma sub-I right now, and while I do not condone your residents' behavior at all, I have a few thoughts on why they didnāt let you help when they're slammed or didnāt grab you when they go see someone. I feel for you, and I would feel the same way as you if my residents werenāt friendly and didnāt recognize my sincere attempts to help. Iām just trying to maybe provide another perspective.
This is my service: picture 14 critically ill patients with two interns covering 5 each and the senior covering the 4 left over and supervising the two interns on their 5 pts each. Everyone needs labs, imaging, coordination with multiple surgery services, mechanical ventilator changes, procedures like bronchoscopies, a drain pulled, a drain inserted, OR prep for those going to the OR that day, notes written, orders placed, medications adjusted, diet/exercise/prophylaxis, and constant monitoring because everyoneās vital signs are all over the place, and youāre constantly putting out fires -- that person had an acute change in mental status so gotta work them up with labs and imaging, another person got super hypotensive and now you gotta check what fluids theyāre on and which medications and oh wait theyāre NPO so you have to figure out the IV dosing, or oh no neurosurgery wants their systolics under 130 for a procedure but the pt keeps hitting 140s so you gotta titrate their nicardipine drips and IV metop pushes, etc, and oh shit all three of those happened at once, and your pager is forever beeping and you have to spend half your life on the phone, etc. And thatās only the tip of the iceberg.Ā
Ā āeven when theyāre slammed and I offer to help they refuseā:Ā To be honest, us medical students usually get in their way. Every time we interrupt them to ask them something or update them, they often lose track of what they were doing right before, which slows them down. Every time we write them a note (unless they are straight copying our notes), they have to scan it and look for inaccuracies and then give us feedback.Ā
āthey donāt invite me or tell me where theyāre going when they leave (even when they are going to see my patient)ā: They probably forgot that you were following that patient, honestly... I donāt know where my residents are 90% of the time, but I make sure to see my own patients at least 4x a day and chat with the nurses to make sure I am up to date. When we round, I write down EVERY task that we have to do for them, and then I offer to help pull drains or follow up with the nurse or remind my residents later about the task. In the meantime, after Iām done with my notes, I study. Itās ok to be independent. The way to impress is not to tail your resident, but to be proactive and show that you are constantly checking on your patients on your own (or the whole teamās, if youāre bored).Ā
Pro-tip: Do any patients on the floor have JP drains or chest tubes? (the answer is always yes.) Read about how to take one out, memorize the steps (itās literally like 3 steps for each of those), and the next time a tube needs to be pulled, ask to do it and say you havenāt done one but have memorized the steps (and then recite the steps to them). Show that you are interested and self-motivated -- people are much more likely to teach you, even the angry unfriendly ones. :)Ā
Also, itās July, and in the US, itās my internsā first ever rotation as an intern, and theyāre suddenly drowning in super sick people and donāt know how the hospital EHR works or anything.Ā
No one discussed my responsibilities with me prior to my first day, so I just told them I was going to pick up 1 patient and then escalate from there. They said sure, and the reason they didnāt discuss my responsibilities with me was because they were brand new and had no idea what their own responsibilities were lmao. Mine are good about dismissing me, but on the few times they were swamped and didnāt get my hints, I straight up asked if I could leave for the day because I had finished x, y, and z, but I said I would stay if I could help them with anything else.Ā Ā
Your residents definitely could be better about involving you, and it sucks that youāre genuinely trying to help and theyāre not being receptive. :/ It sucks that residents are so hit or miss, and how youāre treated colors your entire view of that rotation/field. I really hope this gets better for you, because the ICU is nuts and thereās so much going on that itās fascinating. I hope this didnāt come across as offensive or as though Iām invalidating your feelings -- I just wanted to share the other side of the coin from what I see, and offer a few tips. :)Ā
Let me know if I can help you out with any more protips, or if youād like some guidance on shining in the ICU. :)Ā
āyou canāt diagnose it if you donāt think of itā
what if I donāt think of it
what if Iām too dumb
what if Iām not good enough?? my patients deserve the best and Iām sure as hell not the best, if my test scores mean anything
no oneās gonna be double checking my work out of residency
what if my hand slips and I nick the aorta
Iām trying to use this terror as motivation but honestly itās just freezing me in my steps
should I really do medicine or quit now?? or finish residency and then switch to admin?Ā
Iād rather take a $70,000 job and not have to deal with this kind of stress than a $250,000 and have these burdens
this self doubt has been creeping up since first year of medical school but now that Iām applying for residencies this year itās hitting me like a truck
Iād rather not be a doctor at all than be a bad doctorĀ
1 letter of rec from program director...secured, technically, but I donāt have any rotations on her service :/ not enough spots for all the 4th years going into surgery
5 drafts of personal statement written, gotten it reviewed by my very intense surgery program director, and will probably have less intense surgeons look it over as wellĀ
resume updated
ERAS opens sometime in June, which is when I start my sub-internships, so Iām trying to front-load as much ERAS prep as I can right now.Ā
My 4th year schedule:
May: step 2 dedicated studying
June: outpatient internal medicine (mandatory rotation that is given out on a lottery system...unlucky me)
July: thoracic surgery
August: trauma sub-internship
September: UC Davis trauma away rotation
October: some chill surgery elective
I had some really nice 4th years send me their personal statements and ERAS app, and Iām grateful for the advice. I hope to pass the good will along in my blog for the rest of med-blr. Hopefully future surgeons-to-be will find these posts useful.
Iām currently on the second half of my pediatrics rotation, and my first day ever on outpatient clinics was nephrology...for both morning and afternoon. Which was literally my last preference for outpatient clinics.
Have I ever mentioned that I actually failed one of my renal exams back in 2nd year of medical school?
So I walk in, introduce myself to the nephrology clinic attending, and promptly go with them to shadow. Which is fine. Until we come back out and attending goesĀ āso, whatās on your differential?ā And I shit you not, I threw out names of random renal diseases that werenāt even related to my patient because I literally know like 3 renal pathologies. (I did say things likeĀ āwell, it COULD be [definitely not correct diagnosis but itās renal-related], but itās less likely because _____ā, which hopefully made it seem like I had at least two brain cells to rub together.) My patient definitely had nephritis but for the sake of having a differential I mentioned some nephrotic syndromes...sigh.Ā
And this was after I read half the chapter on nephrology from BRS Pediatrics the night before, LITERALLY 12 HOURS AGO.
Then in the afternoon, I had another attending who literally did not speak in sentences but rather spoke in questions. I donāt think Iāve been asked so many questions in my life. (But I actually really appreciated it, because she did it in a way to focus my assessment/plan/critical thinking. And she was cool AF and clearly loved teaching. ) And I didnāt know at least 95% of it. She also told me to go see her patients to get the history so I could present to her, which is fine usually, but absolutely NOT FINE when you literally have no idea (or time) what your patient has, even if their diagnoses are written on the chart...so your follow up questions are crap and you donāt even ask half of the right stuff.Ā
But then my last patient was pretty similar to the patient we had right before, and so I just asked the same set of questions, and when we got into the room the attending was likeĀ āhuh, I actually donāt have any more questions to ask you because our med student got it allā! Thatās right, me, the girl who failed a renal exam and had been shitting her pants all day from anxiety, had asked all the questions she wanted to know. HELL FUCKING YEA.Ā
And then I didnāt have to stay for the actual last patient because the 4th year decided to read up on the chart and wanted to see her instead, so HELL YEA (I had worked 9.5 hrs at this point) I got to go home earlier than expected.
AND THEN RIGHT BEFORE I LEFT, the attending was likeĀ āhey, youāre good. can I have your evaluation form?ā and thatās the story of how I got my ass kicked ALL DAY but maybe, just maybe, Iāll get a decent eval from an attending in my least least least favorite specialty.Ā
(To be clear, I enjoyed my time on nephro a lot more than I had thought. The morning attending took me down to the lab so I could look at the urine of my actual patient, which was cool. And then my afternoon attending was just SO cool.)
havenāt been sick EVER in medical school, but two weeks of my inpatient pediatrics rotation apparently was too much for my immune system
but my boyfriend was super cute and cuddled me, took me to my now favorite brunch place, took me shopping, made me dinner, and kept me company all day even though we both have to be at the hospital tomorrow at 6amĀ
Thanks for your honest answer! I'm asking because I was terrified of dating a friend who is a Lesbian and open about it but honestly it felt like I was going out with my best friend! Nothing happened ofc but I did feel attracted to her although I wouldn't recognize it at first, plus my family is very conservative so I was also terrified if I ended up becoming her gf or sth. You should try it, there's nothing to lose : )
I randomly had the chillest day on surgery and just had to share:Ā
4:30a: woke up
5a: print out list of patients and write down lab values for only 6 patients
6a: round with the resident
7-9a: M&M conference and Grand Rounds (i.e. two hours for me to finish all my Anki flashcards)
9-11a: study in the library because we had no OR cases this morning
11-12:00p: my resident walks up to us (thereās 2 of us on general surgery service right now) and asks us if we want tacos, so we left the hospital (!!!) and got tacos (!!!!!!!)
12-1p: had 1 hour to kill before afternoon clinic, so I study in the library some more
1p-1:30p: how long we spent in afternoon clinc before being told it was actually cancelled
and that, everybody, is how I finished 300 flashcards, 10 pages of my textbook, and made it home, all before 2pm, on a random ass Wednesday while on my general surgery rotationĀ
in response to my email asking if I could come back for two weeks in Feb 2018 since I haveĀ ācareer explorationā time
I'd love to have you back. Ā I would check with the student coordinator (can you tell me who that is?) to make sure there is room. Ā You were a super star and did a great job and we'd love to have you back. Ā Up to 3 students is no problem, so if there is only one or two scheduled I'd love to have you back. Ā Please let me know so we can plan accordingly.
He saidĀ āIād love to have you backā not once but three times!! And when I ran into him earlier today at the clinic because Iām on pediatric plastic surgery right now, he told me I should come back and that I did a great job.Ā
just got my shelf score back and the equated percent correct was 81
and the shelf cut off for honors is 80Ā
like holy shit I just barely made it by the skin of my teeth
fingers crossed I did well on my OSCE and clinical evals and holy crap guys I COULD HAVE A CHANCE OF HONORING
I studied literally every single day for the last 8 weeks (i.e. the entire rotation) for this shelf and I walked out of the rotation feeling like 1) definitely failed my shelf (did I mention I scored a 64% on a practice NBME two days before my real shelf and cried because I was so disappointed in my brain) and 2) probably subpar clinical evals but now Iām just a tiny bit hopefulĀ
Iāll never be the kind of person who can cram a week before the shelf and get 95%+ but I know I just gotta work extra hard to catch up and it WORKED GUYS IT WORKEDĀ
and oh man Iām SO PUMPED Iām giving myself the next hour to celebrate and then Iāll be cautiously optimistic for the next 4 weeks until I get my clerkship grades backĀ
just got my shelf score back and the equated percent correct was 81
and the shelf cut off for honors is 80Ā
like holy shit I just barely made it by the skin of my teeth
fingers crossed I did well on my OSCE and clinical evals and holy crap guys I COULD HAVE A CHANCE OF HONORING
I studied literally every single day for the last 8 weeks (i.e. the entire rotation) for this shelf and I walked out of the rotation feeling like 1) definitely failed my shelf (did I mention I scored a 64% on a practice NBME two days before my real shelf and cried because I was so disappointed in my brain) and 2) probably subpar clinical evals but now Iām just a tiny bit hopefulĀ
Iāll never be the kind of person who can cram a week before the shelf and get 95%+ but I know I just gotta work extra hard to catch up and it WORKED GUYS IT WORKEDĀ
and oh man Iām SO PUMPED Iām giving myself the next hour to celebrate and then Iāll be cautiously optimistic for the next 4 weeks until I get my clerkship grades backĀ
Finished my 2 week career elective in Emergency Medicine on Friday and currently sitting on the L&D floor with a lot of downtime, so figured Iād write a little something. :)Ā
Background: The ED I rotated in did not accept trauma...or kids. So it felt more like an internal medicine triage/urgent care unit. Also, since it was a small clerkship of 4 med students, we were each assigned an attending to follow around. That being said, I hope these tips are still useful!Ā
1) Know the algorithms for abdominal pain, chest pain, and shortness of breath. Know them cold. We had at least one of each every single day, and to be honest, your differential and work up will be pretty similar on each of them. Your job as an EM physician is to rule out all the lethal things, so be sure you understand theĀ āoh shitā diagnoses and how to rule them out. For example, a patient with chest pain - gotta rule out aortic dissection (chest x-ray!), acute pericarditis (chest x-ray!), and pulmonary embolism (helical CT!). You donāt have to know a list of 20 differentials, but know at least two of the important ones. For bonus points, know how to work up syncope, flank pain, leg swelling, and dizziness.Ā
2) Where should you start reading? My attending recommended Tintinalliās, and I think that and 5-min Emergency Medicine Consult were my go-toās. I started with the 5-min consult (great for getting differentials and things to rule out), like right before I went to see a patient with a complaint of ___, and then Iād read Tintinalliās after I saw the patient to form my assessment and plan. In my case, my friend lent me his iPad, so I had both (either PDF or online), and would pull it up accordingly.Ā
3) ER docs donāt take lunch. If you get lucky, your doc will let you take lunch, but itās good to over-prepare and assume you wonāt get a lunch break.
4) Ask ask ask!! I did 13 H&Ps (didnāt have to write them up because thank goodness for scribes) on my second day there, and it wasnāt because he handed them to me or asked me to do them. He was super chill and let me do whatever I was comfortable with, and so I built up my courage over the first few days -- first day I did 7 histories, second day I did 13 histories and physicals, and then the third day and afterwards I started to come up with assessments and plans and/or asked him to walk me through them. I also got to do a bunch of pelvic exams, which super prepared me for my second rotation of OB/GYN. I know two other people on my same rotation didnāt get as many chances to practice as I did because they were more shy and didnāt ask.Ā
5) Download MedCalc! And before your present your patient, look up your patientās complaint and see if there are risk stratifications or prognosis estimates. For example, use ROSE or SF Syncope (I liked the latter better) for syncope, use Wellās for PE or DVT, use HEART or TIMI for chest pain, etc. They wonāt expect you to know this, so youāll look ~super~ good.Ā
In stark contrast to my last post and how crappy I felt on Wednesday, Iām currently sitting at a 12/10 on the happiness scale, 10 being the happiest. :D Let me tell you allllllll about my first two days in my 2 week emergency medicine clerkship!Ā
Day 1 (yesterday):
IN BRIEF: first day ever on clerkships and first day ever in the emergency department, but I took histories on 7 (SEVEN!!) patients, was introduced to patient families asĀ āDr. [my last name]ā by the attending (I didnāt even know he knew my last name), learned how to take focused histories (e.g. what specifically to ask person coming in with eye pain), was complimented by one patient (āyouāll make a wonderful doctorā :āDDDD), was complimented by attending on my presentation and history taking skills (I think he was just being nice and encouraging...because I made myself cringe for being so scattered), and I caused the attending to reconsider giving the patient a prescription (he had sent the order but then he agreed with me and cancelled it)!!
Day 2 (today):Ā
attempted 2 pelvic exams (1 successful, the other exam involved a lady with an STD and a super sensitive vagina/cervix so she screamed the entire time and I lost confidence and had to defer to my attending and she also screamed the entire time he was doing the exam...), stuck my finger in someoneās butt, took 6 histories, started to do a mini physical exam -- just heart, lungs, and abdominal (mostly just copied what I remembered from what the attending did), started to learn how to come up with differentials, learned how to read an EKG (this is like, my 3rd time learning it, lmao), learned to interpret a chest x-ray (or the quick and dirty version, a la emergency medicine), realized that females with abdominal pain need to be asked about lady parts (Iām not sure why it just didnāt occur to me to ask...)
(and since I was only there from 6a to 2pm today, I had time to climb at the gym for 1.5 hrs, run for 30 min, and my roommate gave me a super delicious mango to eat!)
So overall, super successful two days so far! I like that my attending doesnāt pressure me into doing things -- I think Iām good at challenging myself, but I freak out when someone else shoves me out of my comfort zone. He basically lets me do whatever I want -- I asked to take a history, I asked to try mini physical exams, I asked to do the pelvic and rectal exams, and I think as a result, I feel more in charge of my learning and feel more comfortable being proactive about it all.Ā
Also, he doesnāt keep me after my shift ends! I have a super cushy time schedule where I work either 6a to 2p or 7a to 3p with him, and heās been great at letting me go when itās time. (Some of my friends are pulling 5a to 5p shifts...thatās going to be me in a week, so Iām gonna enjoy my time off while I can hehe).Ā
The only slight bummer is that my EM clerkship doesnāt get any trauma...like at all. Sooo itās really like a mini internal medicine triage unit. Which is good, because itās probably the easiest intro to clerkships ever, but also a bummer, because Iām missing out on the high adrenaline parts of it...Ā
But Iām pretty convinced that my EM clerkship is as good as it gets, especially as a welcome-to-3rd-year-of-medical-school-where-you-now-have-responsibilities gateway. :D
