Finally Got That MD, Now what?

I started residency a couple months ago, and it’s been crazy! It’s still strange to think that after over 20 years of school, this is my first real job. It’s definitely not like the movies. On the first day of residency, you basically revert to a first year med student. No idea how the EMR system works, and definitely no idea how to prescribe anything since we never learned doses in school! My first month of residency was on the family medicine wards. Most programs don’t do this, but since the majority of FM intern year is spent off service, it’s a nice way to get to know my co-interns before we all disperse throughout the hospital. Our first month, all 10 of us are on FM wards with 2 upper years. This gives us time to learn the EMR and understand what is expected of us day to day. You will learn to have PTSD from that pager sound.  In Family Medicine wards, we see our own patients in the ED,  admit them if needed and also see patients on the floors. If any of the patients need procedures, then they’re yours to perform. If there’s a lot of patients, this can get very tiring running around from floor to floor. Of course, there were 10 of us dividing all this work, so it was much easier than a real FM ward month where there’s probably only 3 residents. After a slow start in FM wards, I moved onto OB. OB was the complete opposite of FM Wards.

Tip: if you’re even considering doing any OB from FM make sure you ask the program or residents directly during interviews.

I personally, never had much interest in OB. My ideal OB rotation would be doing some pap smears, pelvic exams and perhaps some low-risk vaginal deliveries. Our OB rotation at LSU is more of an observer rotation. Especially in the beginning months, the OB interns are also new and have to be trained so there’s very little room for the “off-service” interns to learn. I spent most of my days installing nexplanons and most of my nights studying. Overall, not my favorite rotation, but as I said, OB was never a huge interest of mine. My next rotation for the month of September was NICU/nursery. This month went by pretty fast. Since NICU is pretty intense level care, there was no expectation for me to actually be able to manage a truly ill newborn. Most of my time was spent putting in orders that the nurses told me or calling the NP for help. Overall, a good rotation to learn about congenital abnormalities, but definitely not really in the scope of Family Practice. After 2 weeks of NICU, I moved onto Nursery. This was the first rotation I felt was truly useful. Newborn nursery houses pretty much all healthy infants. This was a great rotation for learning how to do a newborn exam and understanding the risks and benefits of breastfeeding. There’s a high turn-over rate in Nursery so there’s constantly notes to write and babies to exam. I thought this would’ve been a great rotation to do for the whole month!

I am now doing my Pediatric Clinic rotation. Clinic is always fun and frustrating. Patients are not assigned to a doctor, but instead all the charts are placed on a stand and each residents grabs the next chart available.  It’s constantly busy with some residents seeing anywhere from 12-18 patients a day. Most of the kids in peds clinic are healthy and just require check-ups. There’s the occasional weird rash and many birth defects, but you just hope you don’t pick up those charts. So far my experience in peds has been very positive. In peds clinic you learn how to write notes fast and manage common pediatric conditions such as eczema, allergies, jaundice etc. As a family medicine resident on pediatrics, I can definitely see the benefit of being able to see some children in the future since some families have so many kids and it would be easier if they could all see 1 doctor.

Overall, my first couple months in residency at LSU has been very positive. Since LSU is a safety net hospital, one of the benefits is having strong case management and social work departments as well as having the ability to learn and do everything yourself.  I did all my rotations in NY and I find that some of the differences between working in NY and Louisiana is that in NY everything is at your disposal. Every consult you can imagine will be called on every patient. At LSU, the resources are limited so we never consult unless absolutely needed. I find this beneficial so that later on I will have all the skills to practice truly as a generalist. Lastly, I feel that my experience at SGU has opened me up to a wider range of medical knowledge. Coming from a Caribbean school, I was always told that there were barriers to matching and that scores are all that matter. Throughout my interview season, I constantly met SGU alumni that were so excited to see other SGU interviewees. SGU was a great opportunity to pursue medicine at an amazing school.

 

Here’s another great article by an SGU almuni!

https://www.medschooltutors.com/blog/on-being-a-caribbean-medical-student-an-evolution-from-embarrassment-to-pride

 

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SGU is doing some amazing things

https://www.forbes.com/sites/richardvedder/2018/10/08/tuition-innovations-money-back-guarantees-and-free-tuition-for-heavy-class-loads/#44ee5ee56a64

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Life as a 4th year medical student

I’m about to finish medical school! It’s been a long road. 2.5 years in Grenada (including Foundations) and 2 years in New York doing clinicals. Unfortunately SGU is no longer affiliated with Methodist Hospital, so I wasn’t allowed to do my 4th year rotations there. By the end of 3rd year, most the student realized that Methodist Hospital would no longer be an option for 4th year so we all ran to Brooklyn Hospital to finish our clinicals.

A lot has happened since my last post. I took Step 2 CS and Step 2 CK and fortunately I passed both! The Step 2 CS is a clinical skills exam that only takes place in certain locations throughout the US. I took mine in Chicago, but many New Yorkers easily take their’s in Philadelphia. The Step 2 CS was very similar to the OSCE’s in Grenada. I definitely think that SGU prepared us well for this exam (if only I had paid more attention during CPD). One of the most helpful things I did before Step 2 CS was find a study partner to go through all the cases in the First Aid Step 2 CS book, and practice writing notes on the official Step 2 CS site. Other than that, I felt like no other preparation was needed.

Step 2 CK was a miserable experience. Just like Step 1, I found myself double guessing all my answers and wondering if I had learned anything in the past year. After my rotations, I had about 2 weeks to study before the big day. Overall, the exam went by fast, and a lot of the material were things I learned at some point during my clinical training or in UWorld. With that being said, it was still a difficult exam that takes a lot of preparation. It’s was a huge relief to be done with exams for awhile. I found out in mid-September that I had passed Step 2 CK, and I could now prepare for THE MATCH!

I began my 4th year of med school with a Family Medicine rotation at Brooklyn Hospital. I didn’t have the opportunity to do Family Medicine during my 3rd year, and I realized if I wanted to apply to a Family Medicine residency, then I better get a letter. I started my Family Medicine rotation in the middle of September hoping that I could get a letter of recommendation ASAP. Since residency applications were due on September 15th, I knew that gave me little time before programs started reading my application. In addition, I found that many Family Medicine Programs wouldn’t even let you apply if you didn’t have a letter of recommendation from a Family Medicine physician. It seemed that my chances of getting a good letter quick were grim, so I also decided to apply to some Internal Medicine programs as a backup.

4th year is a compelete blur. All your time from October-February is spent travelling and preparing for residency. A couple weeks after applying to residency, I started getting emails for interviews. I thought about how I was going to schedule west coast interviews all at the same time, but all my planning went out the window as I found that spots get filled up fast. Overall, I decided to go to 19 interviews which in retrospect probably was way to many. I was travelling 2-3 times a week to all different places all over the US. It’s a lot of time and money (thanks parents!) My rotations during these months were easier ones as I chose rotations that would be more relaxed so I could travel to my interviews.

The interviews went by so fast. All the programs kinda mixed together after awhile. I decided to rank many places on the strength of the program (university affiliated), location, look and feel of the hospital and residents. I figured out pretty fast that I probably wouldn’t hold up very well in the snow. Some of the places I interviewed at were FREEZING. After interviews, it’s time to turn in the rank list and wait 3 weeks to see if you match. Those 3 weeks were torture. Every second I found myself thinking about whether I made a mistake somehow submitting or if I ranked the programs I liked correctly. Up until the very last minute, I didn’t know where to rank most programs since I liked so many! After 3 stressful weeks I got an email on Monday from NRMP stating I matched!

NRMP

There’s so much joy until you realize you have no idea where you matched until Friday. It’s not over yet… You spend the whole week questioning your rank list and thinking what if I get the very last program on my list! So finally Friday rolls around and I found out I matched at LSU-Shreveport Family Medicine! So I guess this California girl is moving to the South!

After all this commotion, you then realize you’re not done with medical school yet. There’s still rotations to go to and graduation to prepare for. I just finished my Radiology-Oncology rotation at Brooklyn Hospital. I learned a ton about treating cancers with RT.  It was a quick month that taught me the important of knowing the different stages of cancer and potential ways to treat each. Next, I’m finishing my time in NY in a Radiology rotation! Soon it will be time to say thank you SGU for giving me this opportunity to study medicine and make it my life! Can’t wait to move to the South and see what residency holds!

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5th term and beyond!

A LOT has happened since my last post. I successfully finished basic sciences in Grenada, took my Step 1 in August and started clinical rotations! It’s been a long ride to get to this point. I never thought I would see my last day in Grenada after 2.5 years!  5th term was a lot to handle. Not only are there rigorous courses, but there isn’t a lot of time afterwards to prepare for the USMLE Step 1. Remember to fill out all the paper work early to apply for Step 1. I didn’t realize I needed a passport sized photo for my application and ended up getting them done on the island. Another thing is there are a lot of health requirements to start clinicals such as titers and what not that needed to be done. I wish I had started those before my 5th term, because they took over a week to finish and get results.   5th term is comprised of 3 main courses: pathophys, pharmacology and introduction to clinical medicine (ICM). Of the 3, I found that pathophys was the toughest since it’s basically a course to review all the material on Step 1. This course involved a lot of reading First Aid as well as old lecture notes. It’s also worth almost the same amount of credits as path 4th term so you definitely should not slack off. Pharmacology wasn’t as tough, only because our class was curved. If not for the curve, I probably would’ve had to spend a lot more time studying. I definitely think Pharmacology was one of the most organized courses at SGU. I wish I could’ve put more effort into the course. Last but not least, ICM. This course involves weekly visits to Grenada’s  hospital. This course taught us how to interact with real patients, and taught us real examination skills. Some weeks going to the hospital was a great learning experience and then others it was a drag taking the hot bus all the way to the city. Overall, I found this class interesting, but no where compared to US hospitals. At the end of 5th term, there are 2 comprehensive exams required to graduate. The BSCE and NBME. These exams were basically easier versions of Step 1. The exams are easily passable with a bit of studying and keeping up in your courses for 5th term.

After 5th term, I decided to stay on the island for a couple more weeks to study for my Step 1. This exam is a requirement for all US residencies and to begin clinical rotations. It was probably one of the most important exams I’ve ever taken! It was a stressful 6 weeks on the island of self studying before I took my Step 1! This was probably the best decision I’ve ever made since I didn’t have to spend time flying home and looking for a place to study. It however, does get extremely lonely seeing everyone leave. Everyone has a diffemt method of studying for this exam. I found that studying First Aid was not enough for me so I used a combination of lecture notes, Kaplan videos, first aid and UWorld. Looking back, if I had to do it again, I would’ve probably spent about 80% of my time doing questions and 20% actually studying material. SGU actually does a really good job preparing students for the Step 1. I think that if I had actually retained the information I learned in the last 2.5 years it would probably have been enough to at least pass the Step 1. After 3 long weeks of waiting, I finally got my score! PASS! I could not have been more excited.

In August I started my clinical rotations in NY. SGU has a lot of different sites for clinical rotations. They let you chose your top 3 preferred states and then after that it’s based in luck. Luckily, I got my first choice hospital. Clinical rotations are so much different than basic sciences. First off, everything you learned from book goes out the window when you see a real patient. I started with a Psych rotation and was thrown into the ED on my first day. I had no idea what to do. Eventually I figured out my way around the hospital. I wasn’t expecting to like Psychiatry, but it was actually a great first rotation. I learned a lot about taking a good history, but nothing about physical exams. Each core rotation is 6 weeks unless it’s Internal Med or Surgery which are 12 weeks. At the end of each rotation, there’s a shelf exam which is basically written by the creators of Step 1. Therefore, the questions are tough, but they are curved extensively. Besides Psych, I’ve now done rotations in both Geriatrics and Internal Medicine. Geriatrics is not a core rotation, but my hospital did not have any family medicine rotations. I had a great time doing my Geriatrics rotation. It was an amazing introduction to Internal Medicine. The patients were kind and didn’t mind being questioned by a student. If not for my Geriatrics rotation, I would’ve definitely not have even considered doing Internal Med in the future. I found Internal Med to be a lot of paperwork and much less actual medicine. Most days I was requesting records from other hospitals or writing notes on the computer. The rotation varies from hospital to hospital, but I did find that it was a lot less hands on than I was expecting. Nonetheless, it was a relaxing rotation that left a lot of time for studying. I learned a lot from the attendings and residents. I’m now onto my Peds rotation, so updates to come soon!

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Term 4

It’s been awhile since I’ve written. This semester has been extremely busy with Pathology, Micro and CPD. Everyone always told me that term 4 was the hardest, but  with 3 more weeks until the end of the semester, it’s not true at all. The most difficult part of term 4 is the course load. Path is worth so many credits that no one wants to screw up. I think it’s fair to say that the Path department is pretty understanding with the amount of work they expect. A typical week consists of about 20 path slides to split among your group of 8. Everyday each student presents the slides they completed during path lab to the rest of the group. This course is pretty structured so there’s no way to screw up the general busy work. As for the other courses….. Micro is a whole different story. The class is interesting, but the Professors each have their own way of teaching the material. I’m the type of person that likes to learn everything at once so you can imagine my frustration when they constantly bring up random organisms everywhere.  There’s no real method to study for micro except to try to describe the organism and make charts. The other class I’ve been taking is CPD. This class is supposed to teach us communication techniques and proper ways to do a physical exam. I know that in the next couple of months this class will be extremely useful, but it’s 3 weeks until the end of the semester, and I’m still confused what to do every time I go to lab. In class the professors teach us how to apply our skills in lab. In lab, they expect us to remember diagnoses since term 1. It’s very confusing. I find a better way to teach this course would probably be teaching how to diagnose symptoms in patients and making differentials during class. During lab, they should be teaching us how to do clinical skills instead of just expecting us to watch YouTube videos. Also throw away all the clinical skills you do in term 1 anatomy because apparently all those skills were taught incorrectly. Besides all the conflicts with 4th term classes, I’ve learned to adapt to the pace we’re learning at. If anything, the rumors about 4th term definitely aren’t true. There’s ample time to study the material if you use lab time wisely. Other than that, there’s a lot less Bananas trips this term.

On a side note, there’s a couple things SGU decided to implement this semester to all terms. We now have MCQ clicker sessions for every class. I found these questions useful for Path and sometimes Micro, but I have no idea why we have them for CPD. We don’t even have any multiple choice exams for that class. I would appreciate if the administration would relax and do clicker sessions every other week so that the Professors can come up with questions that are more like what we’d see on the exam. All in all, the clicker sessions if anything have put so much more work on our 4th term schedule. Hopefully they change the policy by the time I get to 5th term. Another thing is, they decided to implement an 80% attendance policy for every class. That’s all I’ll say about that.

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Term 3!

Glad term 2 is over. As I learned first hand, don’t take term 2 for granted. All the classes are actually quite challenging, but I found Neuro to be quite fun. It actually seemed like we were learning something useful. Plus we got to take out the PD kit and try out all the tools. I found Physio to be the most challenging out of all the classes, but that was mainly because I had no idea what was going on. Basically everyone has like 1000s of ‘MOTO questions” that we would just do over and over until we memorized the questions and hoped they appeared in the same format on the exam….they didn’t for the final haaha. Immuno was pure memorization. I felt like by the end of it, I was saying cytokines in my sleep! Nothing to be worried about for that class as long as you watch Cells Acting Badly on Youtube before the lecture.

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Term 2!

Haven’t posted in a while because it’s been so busy around here. First term is over and I passed! To start things off, there’s a brand new building on campus! Finally SGU has built a new study hall to account for the increasing number of students. At first I was upset because it basically covers the best view on campus, but since it’s not enclosed, the view hasn’t been disturbed.

Not gonna lie, I thought this semesters was gonna be a walk in the park. I have now comes to see that all the upper termers were lying to me. After a 3 week break, I returned to the rock ready to continue relaxing. 2nd term starts with 2 simple classes, Bioethics and Community, Preventative Medicine (CPM). With these classes, basically all you need to do is attend class and you’re basically guaranteed to pass. We all took advantage of this extra free time by heading to the Concord Falls all the way on the other side of the island. I’ve never been past this city, so this was really exciting. On the way, we stopped and tried some fresh sugar cane and cocoa! Then finals came and it was time for the real classes to begin. Term 2 classes consist of Physiology, Neuroscience and Genetics/ Immunology. The good thing is, classes run early in the morning so there’s a lot more time to study ( or the class recordings are posted when you wake up) We also have a lot shorter labs! This just makes me more grateful that I’m done taking Anatomy forever!!!!!!!

So this past week, we had our first round of exams, and boy were they disappointing for most people. Each class has a set of Unifieds which basically means there’s 20 questions per subject and you get 30 minutes for that set. I think we all underestimated how fast the time goes. From what I hear, most people either ran out of time on Genetics or Physiology. Of all the exams, genetics was our class’ lowest average at 65%, but Unifieds generally aren’t representative of midterms scores. Another thing is, attendance this semester is mandatory because a lot of students struggled last semester. By now, our class is still about 650 because of all the repeaters. At 3 weeks in, classes are really picking up. There’s 4 lectures every day and less and less overlap from what I learned in foundations. On the bright side, there’s a lot more time to study all this material and explore this beautiful island!

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Concord Falls

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Modica Hall

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