Missionary Orthopod in the Making

So I am almost at the end of my first 2 weeks here at Hopkins and it has really been amazing. This program is leaps and bounds above anything that I thought it would be. First off the hospital is just massive; I get enough exercise just getting from the Peds ward to the Adult ward. The residents here are definitely of a higher pedigree in terms of the schools they came from but they are not at all stuck up or hard to get along with. And any rumors that I had heard about them being malignant was been dispelled from my experience. I hate to say it, but I am pretty sure right now that I would want to end up here. But unfortunately a lot of other students do too.

There are a crap load of students currently rotating during this cycle. On the peds team alone there are 3 students including me. That really makes for a crowded environment and makes it harder for the attending to get to know you. I praise God though that almost all of the students are finishing their 4 week rotation tomorrow, which leaves me as the only student on the Peds service for 2 weeks. I really plan to work my tail off for the next 2 weeks to hopefully impress him enough to rank me highly come interview time. Despite all of that, I know that nothing I can truly do will be as good as God’s hand just working and opening up doors like it usually does.

I had to be reminded of God’s hand today when I seemingly had a conflict between my future interview at Hopkins and the one I got at Wayne State. Initially I had called Wayne State asking them if they could possibly switch me to another date since I had a conflict. They said all their spots were filled and that there was nothing they could do. Well, I prayed about it, and a couple days later someone posted on Orthogate that they had an interview for January 14, 2011 that they needed to be switched to Dec. 3 at Wayne State! So I contacted him, and we decided to both email the secretary at Wayne State to confirm the switch. When I emailed her, she sent me back an email saying that she already gave away my spot!!!!!!! I couldn’t believe what I was reading. Somehow she had assumed that since I told her I had a scheduling conflict that I wanted my interview cancelled. She didn’t even notify me that my interview had been cancelled. Well I prayed again, called her, and she told me that she had misunderstood me. Either way, someone else had my spot, so she had to call the Chairman to see if it was alright to interview an additional person. In the end, it all worked out and I got my interview “back”, and was able to schedule it for Jan. 14! God truly answered my prayers and reassured me that despite the obstacles that me be in my way, He will continue to lead me, even come Match Day.

It is becoming increasingly hard for me to not feel inferior to everyone else here at hopkins. Whether it is true or not, I “feel” like the residents here are much smarter than will ever be. Its also intimidating to be rotating with like 8 other students who come from big names schools including Hopkins, Harvard, Georgetown, UCLA, etc. Why would they even look at me over those guys? Whats the purpose of me even rotating here? I mean I really like the environment, but I just feel like I’m at the extreme bottom of any rank list that Hopkins could possibly form. Sigh….

Today is just my 3rd day here as a sub-i here at Hopkins and I feel like I’ve been here for a week. I arrived on Monday and basically for the past 2 days I’ve been trying to navigate this behemoth of a hospital. This place is so massive that you really could get lost in it for days. I am on the peds ortho service here, with Dr. S and its been pretty cool. I really didn’t know it at the time but Dr. S is like a freaking world authority on a variety of peds ortho conditions, and many patients get flown in just to be operated on by him. Today, I was in the OR with him, and two surprising things happened: 1) he acknowledged my existence in the OR 2) he told me to take the bone saw and make an osteotomy of the calcaneus and the cuboid bone. That just really made my day; after that we were in a crazy 5 hour posterior spinal fusion case on a kid who had a cobb angle of almost 90 degrees! All in all we saw some great cases and I have been learning a lot.

Its only been 3 days but already I am liking what I see here at Hopkins. From talking with the residents here, Hopkins’ program gets a ton of trauma, a mega-ton of peds, and great exposure in the other fields. The great part is that peds and spine are really the only services with fellows and the fellow almost never takes cases from residents. So far I really like the fact that they operate a good bit here, and early too. I was also surprised at how cool the residents were; I mean they were certainly pretty academic, and they knew their literature, but they didn’t seem stuffy like I assumed they would. There really is just so much to do here and I really need to read, so I’ll go ahead and do that. Bye!

So today was my last day of my away elective at Atlanta Medical Center, and as I look back over this month I can truly say that I enjoyed myself. The guys here are pretty fun to be around, super funny, and very laid back. I like the fact that you not only get the inner city patients at the main AMC hospital, but you also get the rich, insured patients when you rotate at various hospitals in Buckhead during your 3rd and 4th years.

I feel like if I matched here I would have a thorough surgical education, but I think I would have to work harder as an individual to pursue an academic career if I came here. I liked that this program did have a black resident, who could honestly tell me that he hasn’t faced any racism while being here as a resident. I really could go on and on about this program and how much I liked it, but I’m tired, and I need to drive up to Maryland in the morning to get ready for my next rotation at Hopkins. So good night.

p.s.- I have no idea where I would rank this program if I had to submit my ERAS rank list tomorrow. I’m pretty sure I would rank it over Loma Linda, simply due to location, but otherwise I have no idea.

September 30, 2010

Dear Applicant:

The Orthopaedic Residency Selection Committee has received and reviewed your
application for the Orthopaedic Surgery Residency training program at Atlanta
Medical Center. We are pleased to inform you that you have been selected for
an interview on either Wednesday, December 2, 2010 or Wednesday, December 9,
2010. Please respond to marianna.watson@tenethealth.com by October 29, 2010,
indicating whether or not you will be available on one of these dates and we
will make every effort to accommodate you.

We look forward to meeting you and learning more about your interests in
orthopaedic surgery. Additional information regarding the Orthopaedic Surgery
Residency training program is available on the internet at
www.atlantamedcenter.com. Pending your response to this invitation, additional
information regarding the interview will be forthcoming including information
regarding the reception the night prior to the interview.

If we can be of any assistance in this regard, please do not hesitate to
contact our office.

Steven M. Kane
Chair/Program Director
Atlanta Medical Center Orthopaedic Residency Program

——————————————–

Okay, so technically I shouldn’t be as excited about this one since I am currently here rotating at this program. But at least its nice to know that I haven’t performed so badly that they didn’t even want to invite me back for an interview. So I have received 2 official interview invites so far and I’m looking forward to more in October, although realistically I shouldn’t expect anymore until the Dean’s Letter comes out on Nov. 1st.

Someone on orthogate posted an organized list of last years interview invitation schedule: http://www.orthogate.org/forums/viewtopic.php?t=6751. This is a pretty good list because it helps me to be patient and wait for the certain month that I should hopefully expect to hear from a program. If I go off of this list, and if I am lucky to get 10% of the invitations from places I applied to I should have 1 interview in October, 2 in the Nov 1st – Nov 15 segment, 2 in the Nov 16-30 segment, 1 in the Dec 1-15 segment, and 1 in the Dec 16-31 segment. That is a total of 7 interviews, not taking into account the 5 programs I am guaranteed interviews at which are LLU, Hopkins, AMC, Howard, and now Wayne State. So in the end I will hopefully end up with 13 interviews, 5 of which are guaranteed and 7 of which is based on my arbitrary estimate that I will receive 10% of my interviews. From the Charting Outcomes 2009 document, I have a 95% chance of matching if I am able to interview at 13 programs, so I’m liking those odds.

I could throw numbers around all day, but in the end my future is in God’s hands. And as hard as it is to let go and let Him take over, I definitely find comfort in the knowledge that my entrance into orthopaedics is not dependent solely on my abilities and work, but God’s divine planning also.

Wow, God is really good! I was in clinic today, and I felt my phone vibrate. I checked it and there was an email in my inbox from Wayne State offering me an interview!!! Historically, Wayne State is the earliest program to offer interviews; most other interviews are offered by other programs in nov. and dec. So right now that brings me to at least 5 guaranteed interviews, 4 at places I rotated at and 1 at Wayne State! God is good!!! Below is the invitation email:

Dear DoctaJay:

Thank you for your interest in the Orthopaedic Surgery residency program at Wayne State University. We would like to extend an offer for you to interview on Friday, December 3, 2010 at 8am.    Please respond back as soon as possible to this e-mail or to the number listed below. Upon acceptance,  a more detailed e-mail will follow regarding the interview day. Thank you.

Colleen Sturr
PM&R and Orthopaedic Surgery Residency Program Manager
Wayne State University Physician Group
Oakwood Heritage Hospital

It’s hard to fully describe what it is like being a young black male in a quasi-doctor role. At my home program in LLU it means that I am one of the few black people in white coats. This means that I am often mistaken for a radiology tech or a janitor, regardless of what I am wearing because in the minds if many I am not supposed to be a doctor.  Here in the inner city at AMC the patient population is much poorer and blacker. Because of that fact I have been able to interact with a lot of black teens and young adults. Personally I have always struggled with when the appropriate time was to witness to patients in the hospital. I have so much to say, but often I feel constrained, not wanting to give them too much at one time. Its so funny I have no problem asking a patient if they pooped that morning but its somehow “more awkward”  when I attempt to tell them about God.

Just yesterday I had an opportunity to witness/be a role model to a 17 yo black male that showed up on our orthopaedics floor. I guess on Saturday he got into a fist fight with some dude somewhere on the streets. The friend of the person he was fighting realized that it wasn’t going well for his friend so he shot my patient in the thigh, shattering his femur. When I came into his room to see him that morning I asked the general questions needed to fill out a progress note, but I also felt compelled to ask him about the incident and ask how he could have avoided it. The next morning when I walked into the room there was a lady sleeping in the hospital bed with him. I was there to redress his wounds and clean out the entrance and exit holes from the bullet. While there I learned that the girl sleeping beside him was his girlfriend who was pregnant with their first kid. That opened up a door for me to talk to them about my soon to come kid. I went  on to tell her about how my wife was born to a 14 yo mom who didn’t want her daughter to follow in her footsteps. So she put my wife in a church school which required her mom to work very hard to pay for it, meaning that she wasn’t able to enjoy her teens and 20s like her other friends. But that sacrifice resulted in my wife getting baptized, meeting her future husband, being the first in her family to go to college, and to go to medical school. I encouraged my patient and his girlfriend that if they take their God given responsibility in raising their kid seriously then the sky is the limit. I also used the convo to encourage my patient to not seek revenge when he gets out, lest he gets shot again, possibly in such a way that he wouldn’t see his son grow up.

Overall I think that my words hit home because I’m a young black guy too and unfortunately for a lot of black patients that matters. Either way  we should all use whatever skills or advantages God has given us to further his gospel.

The residents here at AMC are really fun to hang around with. In clinic they have me laughing constantly at their jokes; in our ortho basic science meetings the jokes are non-stop and overall they love to tease each other in good fun. Today, one of the residents kept asking me if I wanted to join them for some basketball later this afternoon. I guess a bunch of the ortho residents and ortho reps get together to play ball each Friday. It was fun playing against them, and it didn’t hurt that I was on today too…most of my shots went in. This isn’t normal for me so I’m pretty proud of that. After a couple of games, the chief resident asked me if I wanted to join them later tonight at a bar. I told him I couldn’t because I was going to be with family. I suppose I could have explained the whole sabbath to him (my real reason for not going), but he was still kind of playing ball so I didn’t want to make him stop all that to listen to my explanation. In general however, its advised that whenever the residents ask you to hang out with them outside of the hospital, you should go. Because it allows them to see if you are cool in the hospital but awkward outside of it. They told me that AMC really cares about the “cool outside the hospital” part, so hopefully I can continue to make better friends with all of the residents.

I am currently sitting in Emory University’s library typing this post and all I can say is wow. Their library is more like a corporate building…I’m not even sure how many floors it has.

Anyway, this week I have been on Sports at AMC and so far I have seen the what makes AMC such a well-kept secret. The attendings they work with are basically private orthopaedic surgeons who want to teach, so they let AMC residents work with them one-on-one. What makes this even more amazing is the caliber of these attendings; one attending whose name escapes me trained directly under Dr. Neer, as in the Neer Sign. Another attending who I worked with today in clinic trained directly under Dr. Anderson at UAB. As a resident at AMC, you get to work one-one-one with these guys. And the best thing about it is that if they like you, all they have to do is place a call back to their fellowships or other fellowship programs. So even though AMC doesn’t really have a big name, they work with big name attendings, and when it comes to applying for fellowships, thats all you really need.

Today as I was working with Dr. Gillogly (guy who trained under Anderson) in clinic I was amazed at how huge his Sports Clinic was. He is the official doctor for the Atlanta Falcons and the Atlanta Thrashers and I could see why. His office was a well oiled machine, with signed jerseys from multiple players up on the walls, a glass encased roomed filled with physical therapists, family medicine trained sports docs, etc. I didn’t see any professional players, but I did see some football players from the surrounding Georgia universities. During lunch time Dr. Gillogly went to see injured players at the Falcon’s stadium, but students weren’t allowed to come. Either way, it was pretty awesome working with him.

After interacting with the residents during these past 2 weeks I am more confident that I would love working with these guys. They seem down to earth and seem like people that I would probably want to hang out with.

Yesterday was an awesome day of operating, but it ended with a big scare…A NEEDLE STICK. To be honest, I was more annoyed and embarrassed than anything, but technically a needle stick is a pretty big incident. I’m not even sure exactly how it happened; I was closing up a patient’s skin with 2-0 Vicryl, and perhaps I didn’t stay cognizant of where the suture was when I had grabbed the thread to tie a knot, but I felt the prick and immediately checked my gloves. At first I thought it didn’t go through my second glove, but when I peeled back all the layers to look at my finger, there was a very superficial prick with a drop of blood. I had to scrub out, and they called the nurse manager for the hospital. She came down with a load of papers that literally looked like I was signing up for a mortgage. Once I finished that, I had to get my blood drawn and the patient had to get his blood drawn. Of course, it was just my luck that the patient was a minor, so her parents had to sign a consent for a blood draw. Once that was done, then they sent it off to the lab to test for HIV, Hepatitis B, and Hepatitis C. To be honest, I wasn’t scared because the patient didn’t look like she was one to get much action, but these days you never know, so I did want to hear the results back. The HIV came back in 10 minutes as negative, but the Hep B and Hep C take 1 week to come back. The fact that this happened on my away rotation was my biggest concern since I was supposed to be impressing these guys, not making a fool of myself. But the attending told me not to worry about it…that everyone gets stuck by a needle at some point, and that its no big deal. I did make sure that I sutured up the next patient to reassure myself that I could suture without jamming the needle in my finger, but overall I am pretty hypervigilant now when I suture.

Otherwise, I am really enjoying my rotation here. I feel like I am getting to know everyone pretty well, and the attendings are starting to know my name. I am on Sports right now, so schedule isn’t q2 call anymore, but I still plan to go in each morning at 5 am to round on patients. By doing this I would be doing more than is required of me, which is exactly what residents tend to notice. Hopefully my body can keep up with this type of schedule.

So this first week that I have spent at Atlanta Medical Center has felt like 1 month already. On my first day, I arrived to the hospital, got lost trying to find the GME office and was sent to clinic because they couldn’t reach a resident to figure out where I was supposed to be. It just so happened that the clinic I was sent to was the one run by the program director, Dr. Kane. At first I got a little scared, but I had to remind myself that clinic is just that…clinic, and I have done clinic before. So I introduced myself to all the folks there, grabbed a chart and started seeing patients.

To be honest, it would be way too much to go through everything that has happened this week, because I have basically lived at the hospital for the most part. However, I can voice my initial impression of the program, from these 6 days of work. The AMC program I believe is highly underestimated. They get the same orthopaedic volume (adjusted for size) as Grady, but they have the benefit in that the majority of their patients are blunt orthopaedic traumas while the majority of Grady Hospital’s orthopaedic trauma is penetrating. And once you get burned out with the trauma at the main AMC hospital, they send you out to work one on one with private attendings that have huge clout in Atlanta and nationally, so you get a great mix.

Something else I have noticed is that this program is really really favored towards southern applicants. When they found out that I was from LLU, a med school in SoCal, I was asked at least 15 times by various attendings and residents:

• How in the world did you find out about us?
• Did you get lost, why are you here?
• Why the hell are you here?
• What made you come all the way to Atlanta?

In a way it was actually pretty annoying at first because I was starting to feel that even if I worked hard for the month, they would think that I didn’t want to come there. I mean, if spending 1 month at a program is not a big enough hint that I am interested in the program, then I don’t know what is. But I think that they are just so used to med students from the south ONLY, rotating and matching that a dude from a Cali medschool is somewhat of an anomaly. Even looking at the other 3 rotators that are on with me now, 2 of them are from the Medical College of Georgia, and the other is from University of Flordia. As the week went on though, I felt as if that bias was starting to recede. I hope that as they get to know me and hopefully like me that they will have no doubt in their mind as to my intentions.

As I am still working hard here at AMC, its impossible for me to not get excited about my upcoming rotation at Hopkins. Unfortunately, the recent news of the shooting of an orthopaedic surgeon there, brought the rotation back into my mind. AMC is definitely a community/academic hybrid program, and I look forward to seeing what the full academic like atmosphere of Hopkins is like.

So today marks my last day of my orthopaedics rotation at LLU, and I really had a blast. As I look back on my 2 weeks I feel somewhat that I didn’t work as hard as I expected. There were 3 students on the rotation, and in order for us not to overlap in the OR or for overnight calls I was only able to work about 88 hours per week. That may seem like a lot, but it was no where near to the 120 hours/week that other students said they were doing when they rotated. Either way, I feel like I really hit it off well with the chair of our ortho department. Our chair is already a super nice and likable guy, but the great thing is that he isn’t averse to positive compliments of students. At the end of 2 weeks he told me that I did a very good job on the rotation, which was reassuring. Although as crazy as this application and interview process is, that could just be a generic comment that he gives to all rotating students. But yeah, it still felt good.

At the end of the rotation, every rotating student is supposed to give a PPT presentation on a patient they saw in the ED, including a analysis of the X-ray (displayed on the big screen) and the pertinent information about the patient’s condition. I had the opportunity to observe 2 other student’s presentations and I thought they were quite good. I was a little worried about my presentation because I didn’t have time to work on it until the night before…while I was ON CALL!  But God is truly good because that night was the lightest call I have ever had, and I had the whole night to work on the presentation. I did it on a patient who presented with a nasty Schatzker type VI tibial plateau fracture that he sustained during a motorcycle accident. Since I was giving the last presentation after a long morning of grand rounds presentations, I had to really fly through my presentation. Our program director is notorius for asking very hard questions during student presentations, but I praise God that I knew the answers, and when I finished the presentation, no one had any questions…which is pretty unheard of. So I’m not sure whether they didn’t have questions because they were just ready to leave or whether they just felt that the presentation was thorough, but afterward a couple of attendings and residents said that I gave an excellent presentation. So yeah, it was good to end my rotation with a strong oral presentation.

Overall I really am impressed with LLU’s program. The residents get a ton of OR experience and the didactics are on point too, allowing them to do well on the OITE. Its just so hard however to know exactly where you stand with a program. For the most part a program will say positive things to you when you rotate in order to get all the students to rank their program highly, giving them the power to pick and choose which applicants they want. When the NRMP Match was created, it was designed to be in the applicants favor. The only way that a program can get the match to be in their favor is if a lot of students rank them #1 so that when they submit their rank list, they are more likely to get exactly who they want. So regardless of what LLU, AMC, Hopkins, or Howard says to me, I need to still make my rank list according to how I liked the programs, not how much I THINK each program liked me.

Tonight I board the plane for MD, and then on Sunday morning I will drive down to Atlanta to start my next rotation at AMC!

So my first week of ortho at LLU is over and I really had a lot of fun. My 2 week rotation is with the Department chair who specializes in hips and knees so that has been my main focus when studying at night. My day normally starts out at 5 a.m. for rounds. The students (me included) print out all the notes, see the patients, write the notes, and bring them to the residents in time for rounds at 6 a.m. At that time, the on call attending comes in to see the X-rays for the new patients that were admitted overnight. Once this happens, then the attending rounds on all of the new patients. This usually ends around 6:45 a.m. After that, the students split up to go to their assigned attendings. Since my attending does outpatient surgeries on the hips and knees, I drive over to the outpatient surgery center to prep his patients for surgery. This involves listening to their heart and lungs (yes orthopods do use a stethoscope, lol), and writing any prescriptions that the patient needs. After that , we hit the OR, get done with our operations, and then I either go home, or go to the main hospital to help out the resident that is running the floor.

I only took about 2 calls this past week, so I only worked about 88 hours. I could probably do more, but since there are other students its a little harder to be at the hospital all the time because you don’t want to dilute the experience. The call that I took on Friday was the craziest call I have ever been on. I was in the OR from 3 p.m. to 7 p.m. helping with a finger replant after some guys got his hand stuck in the gears of a wood cutter. That operation was cool because we got to suture the digital arteries back together using the microscope. During the middle of the case, the attending got up, and let me assist the resident while he was tying the arteries together. It was my first time using the micro-scissors and micro-forceps, and I have to admitt that it was a little rough at first coordinating myself. I even cut off the knot one time. When that happened the resident looked at me and said, “DoctaJay, don’t ever do that again okay?” I shook my head, and we kept on with the operation. By the end I got the hang of it, and I think that with a little more practice I could really get to like that microsurgery aspect of ortho.

After the finger replant was done, I went to the floor to help consults and we absolutely got destroyed that night. I literally did not sit down or stop seeing consults in the ER until 5 a.m. the next morning. We had a lot of interesting cases: 1) an FBI agent with a Schatzer 6 tibial plateau fracture, a kid who’s car rolled over 6 times, who only had some glass in his elbow (praise God), a 16 yo football player whose knee completely separated at his growth plate during a bad tackle, a tri-malleolar fracture 1 week out from the initial injury, 2 both bone fractures of the forearm, etc etc. By 6 a.m., I was literally falling asleep while standing, but I had a great and exciting night.

Its hard to really determine whether I am doing well, but I seem to be getting along fine with everyone, so I am crossing my fingers!

So on Monday I start the first week of my 3 months of orthopaedics rotations. During the past 2 weeks that I have been on Musculoskeletal Radiology, I have had a lot of time to brush up on my anatomy. I will be rotating with the chair of orthopaedics who I hear is extremely chill in the OR, barely pimping at all. I actually kind of wish it was the opposite, because I want to get used to be pimped everyday. Either way, I have received loads of information on how to excel on these rotations at the overall advice I have received is:

1. Never ever ever complain, or present any body language that looks tired
2. Be nice to everyone, includes nurses, janitors, residency secretaries (especially them), scrub techs, etc.
3. Know your anatomy
4. Make Life easier for the residents so that when you leave they will miss you (i.e.- writing notes, anticipating the residents needs, showing constant initiative)
5. Take as many calls as you can, while not burning yourself out
6. Never ask to go home, ever

I actually have about 30 pages of advice that I copied from orthogate to read up on, but generally what I have above is what I need to do. In addition to that I truly need to call on the help of God to give me strength during these next 3 months. I will be pretty grueling, especially because I will be away from my wife and unborn child for that time. But this is a sacrifice that I need to make, and the effort I put in now will hopefully pay off come March 17, 2011 (Match Day).

It has taken a lot of painstaking work, but my ERAS application finally completed. I should have my Step 2 CK scores back by September 1st which is the first day possible to submit our application. I want to wait until I get word on whether my research paper has  been accepted for publication, but I don’t want to wait too long. I may submit on Sept. 2nd or 3rd just to see if the research confirmation comes around then. The process of writing my personal statement was the most painful experience of it all. To write the first one was actually pretty easy, but then when I emailed it to some residents to ask their opinion, it got chewed up, lol. So I had to revamp some things, but I think now it truly shows the type type of person I am and how unique my experiences in life have been. My goal for writing the PS is to target special ones to certain regions, but changing the last paragraph. I was told that its not necessary, but a nice touch. Once, my match list is submitted, I will post my personal statement.

So today I took step 2 cs. As you know they only offered a test in a couple sites around United states. I took the exam in Los Angeles. Some of my classmates rented a hotel to stay there the night before but I decided to drive down the morning of. So I woke up at about 4:30 in the morning and I left around 5:00 am to drive down to Los Angeles. The traffic was pretty reasonable and I was driving about 90 mph so I got there at 6 am.

At 8 am I walked upstairs to the testing  site. When I walked into the main room I was somewhat unnerved to see 30 + other people in white coats  sitting in chairs  lining the wall. Everybody was super quiet, you could hear a pin drop. After we were all registered they led us into  another room to watch a 15 minute orientation video. After that we lined up and walked into the room where the test would begin.

Overall I wasn’t really surprised by anything that I saw. There wasn’t a patient that I saw that wasn’t adequately described in the first aid step 2 book. I did have one patient that just didn’t seem to like me no matter how hard I tried but I figured that I would get at least one patient like that.

To be honest after completing/ examining all the patients that day I can’t really see how you could fail it but I guess some people do. After it was all over I went home and watched tv until my head hurt and I forgot all the stress of studying for step 2 cs and ck.  With those two tests out of the way I have nothing preventing me from graduating lest I follow in the steps of the craigslist killer. I plan to hit my ortho studying pretty hard to get ready for my rotations but at least that is enjoyable. 

So today I took the USMLE Step 2 CK exam. This exam basically tests everything you should have learned from first year to the end of your 3rd year, with emphasis of course on your 3rd year clinical rotations. I woke up this morning at around 5 a.m. out of habit in order to have devotion, clear my mind, and pound a couple more high yield facts into my brain. I heard from classmates who had taken it before me that if you get there at 7 a.m. you can start taking your exam by 7:30 a.m. instead of the normal 8 a.m. My brain works much better in the morning anyway, so that was ideal for me. So I prayed with my wife, put on some comfortable clothes (remembering that it had been cold for my Step 1 exam) and drove to the testing center.

When I arrived I was the first student there. I checked in but decided to study a little bit before beginning. When I was ready to start I sat down in front of my computer, skipped over the orientation section and got right to the questions. Doing all of the Usmle World questions really made me quite comfortable with the format and it almost felt like I was taking another Usmle World exam. I finished the first block with about 8 minutes to spare, and went back over the questions that I had marked. With about 30 seconds left in the first test block I realized that I HAD ONLY ANSWERED 42 OUT OF 44 QUESTIONS IN THE BLOCK!!!!!!!!!!!!!!!!!!!!!!!!!!! I silently cursed and tried to complete the last 2 questions in the block. I ended up answering only 1 of the 2 questions before the time ran out. I couldn’t believe it! I asked God why He would allow this to happen, but then calmed down realizing that I can’t blame Him for every bad thing that occurs. The mistake was mine; I had been practicing for the past 4 weeks on my huge 24″ monitor which allowed me to see all 44 questions at once. However, today I was taking the test on a little 14″ monitor which required you to scroll down on the left to get to questions 43 and 44. I finished the first block with some despair, hoping that that mistake didn’t seal my fate. I prayed and moved on.

I did two 44 questions blocks back to back, took a 10 minute break, then did two more 44 questions blocks. Then I took a lunch break and went to Panera bread…I think I spent like 20 minutes total for lunch. When I came back I finished the last 4 sections like I did the first 4 sections. Overall, I felt that the test was fair, I just had a serious problem with time. I needed more time and was much more pressed for it on the real exam today than I was for my Usmle World tests. Either way, I left the Step 2 CK exam feeling like I had felt after Step 1 exam…not very sure of how I did. God blessed me tremendously with Step 1, despite my feelings, so I continue to have faith that He will come through again for this test.

Being done with the test takes such a huge weight off of my shoulders. This was truly the hardest test that I had left and I am so happy to be done with it. I take Step 2 CS on Monday, so let’s see how that goes.

So this past Tuesday I went to LLU’s Ortho Basic Science Conference which is pretty standard for most med students here that are interested in ortho. You get the opportunity to talk with the residents, hopefully talk with the PD and chair, learn something about ortho, and get a free meal. Normally our participation as medical students at this conference is minimal besides breaking down the tables after the meeting. But at this meeting the PD was doing a lecture on the basic science of the bone and he was pimping BIG TIME. He was asking questions about bone histology that I vaguely remembered from Histology class freshman year but couldn’t just pull up at the drop of a dime. Stuff like the RANKL receptor and its role in bone destruction/formation or the physiologic effects of bisphosphonates or (the one I was asked), what is Wolff’s Law. Thank God for the kind residents we have here because they were whispering the answers into our ears helping us to not look like idiots. I had actually read about Wolf’s Law a couple months back when I was doing my junior elective in Ortho, but after rotating on Peds, Family Medicine, and my current studying for Step 2, that concept was far from my mind. Either way that experience encouraged me that once I take Step 2 on Monday, I am going to start reading ortho material again so I can at least be in the right mindset when I start my rotations.

Speaking of Step 2 CK, I take it on Monday and honestly I just can’t study anymore than what I have. And I praise God for that fact because usually when I have reached the max that my brain can retain I know enough to do marginally well. The biggest thing that I will be fighting on Monday is fatigue. This test is longer than Step 1, so if I don’t pace myself well and get ample rest the night before I could miss questions that I would have otherwise answered correctly. So my plan is that once the sun sets tonight, I am going to start reviewing the 43 typed pages of notes I made from UsmleWorld. I am also going to go over some high yield charts in the Boards and Wards book. After that, the rest is truly up to God, and I have faith that He will be as faithful to me as He has in the past. If I don’t rely on what He has done in the past then I will continually be in the crazy cycle of God delivering me and then me doubting him, and then Him delivering me again, and then doubt sets in. At some point He expects us to truly trust in Him…and this time I promise that I will trust in Him.

Next week my wife and I go to the OBGYN for our 2nd trimester visit. Hopefully we will be able to see what the gender of the baby is. Personally we both want a boy, but I (more so than my wife, lol) am open to whatever God gives us.

I have completed the beast called UsmleWorld!

So I praise God that I only have like 34% of the questions left in USMLE World. At the rate I am going I should hopefully be done with everything by tuesday. After that my plan is to read over all the notes I have made from UWorld (mostly stuff I never learned or questions I got wrong) in order to be ready for the big day. I refuse to not have faith in God this go around. Even though I was a doubting Thomas for step 1 god stepped in and revealed his power so this time I will do my part and truly just give the anxiety and fear all to Him.

Next week i start my neurology class which is required here at LLU. The cool thing though is that this year is only a 2 week online course so it will be absolutely perfect for studying for Step 2. Once I finish Neurology then I do 2 weeks of Musculoskeletal Radiology which should hopefully prepare me for my ortho rotations and be pretty chill at the same time.

I submitted my first first author paper for publication in the Journal of Pediatric Transplantation so I will truly be praying every day that God blesses me with publication,especially before I submit my ERAS application on September 1st. I will probably come up for air again when i have taken step 2, but today is the Sabbath and i definitely plan to enjoy my day of rest.

As I have really gotten deep into my study regimen for these last 2 weeks leading up to Step 2 CK I have noticed a serious aversion on my part to studying in any of the areas on campus that I used to study in during my first and second years of medical school. The trauma of studying for test after test during those first two years (especially Step 1) has literally caused me to be anxious every time I walk back into those areas. Sure there may be some PTSD symptoms here, but I’ve noticed the problem, which is the first step to recovery. Either way, I have relegated myself to simply studying outside or in buildings on campus that I rarely frequent.

Each year all of the California medical students take the MACY exam which is basically our state’s version of the Step 2 Clinical Skills exam. This test basically is supposed to be a measure of how well you can see a patient’s chief complaint, form a differential diagnosis, talk to the patient, ask the pertinent questions according to your differential, do a focus physical exam, and explain your findings to the patient after and your overall plan. I took this test last Tuesday, and truly the days leading up to it for filled with terror. I hadn’t exactly been given super high scores during my sophomore and junior physical exam tests, so my confidence was shaken as how I would get through this MACY exam. But as I have often realized in my medical school journey, when I feel my weakest, God steps in. I praise God for a certain classmate who I saw at church who invited me to study with him. In the 6 hours of studying I did with him, I felt more prepared than ever, and when I finished that MACY exam I felt as if I aced it (which is not normal for me). So once again I give God all to the honor and praise for hearing my prayers and sending me a classmate who could help me. The great thing about this MACY exam is that it really gives you a glimpse of what Step 2 CS is going to be like, so now I feel a lot less apprehensive about that test too, which I am scheduled to take on August 17. Speaking of Step 2 CS, for any 3rd years reading this blog, MAKE SURE YOU SCHEDULE STEP 2 CS EARLY IN ORDER TO GET YOUR DATE. The test is only offered in like 5 places in the U.S. and Los Angelos is one of the hardest places to get a spot. I was on the waiting list for a spot for like 1 month before a spot opened up. You can wait a little longer to schedule Step 2 CK, but don’t procrastinate on Step 2 CS.

In other news I am basically on a 2 week research elective which really means that I get to study more for Step 2 CK, while finishing up some of the reasearch projects I was working on. I have been using the Usmle World question bank and the Boards and Wards book to prepare for the test. In my previous post I mentioned that I wasn’t pleased with my last practice test but things are going a lot better now, praise God. I think my issue was that I hadn’t done internal medicine since the begginning of the year and I was really weak on a lot of concepts that I had previously learned but forgotten. I am still doing my best to study hard in order to do better on Step 2 than I did on Step 1, so keep me in your prayers.

So I got back my Comprehensive Clinical Science Examination (CCSE) score and I sucked balls big time on it. It predicted that I would get like a 215 on Step 2, which is not good. Now, I must admit that I really haven’t studied much for Step 2 this year, but it is clear that I really need to work hard over the next 4 weeks to be ready for my test. So here is my plan:

-I will do all the USMLE World questions in 4 weeks which equals out to 88 questions per day AT LEAST. If I can do more, then I will.
– I will read through the remaining chapters of Boards and Wards in 1 week which is about 28 pages a day for 6 days (I am leaving Saturday night open since I never know how I am going to feel that night).
– Reread the whole Boards and Wards book in 2 weeks which is 41 pages a day for 12 days.
– The Sunday before I take the test I plan to go through world questions I got wrong.

I am still contemplating whether its better to do 130 questions of UWorld a day in order to be done in 3 weeks so that I could go over missed questions for a whole week. That might be smarter actually. Either way, the CCSE spooked me and now its time to study hard.

So I am doing my first orthopaedic away rotation at Atlanta Medical Center in…yeah you guessed it, Atlanta, GA. I chose this place in order to 1) see what  community orthopaedic program was like 2) open up the southern programs to my application 3) apply to a program that hopefully isn’t as terribly hard to match at as Hopkins 4) get a lot of hands on experience since they operate a ton there 5) rotate at a place that is in a city I would (and my wife of course) consider living in besides Loma Linda and Maryland. This is actually the first away rotation that I will do after I do my orthopaedic rotation here at LLU. One of the chief residents at the program just sent out this email, telling all the rotators what the rotation will be like:

Hello everyone.  i am XXXX XXXX, one of the chief residents at AMC this year.  i know you are all going to be here at different times this year, but i wanted to send out an email in advance to prepare and welcome you.  i understand that the number of places you can rotate is limited and we are glad that you’ve chosen to spend one of your months at Atlanta Medical Center.  We look forward to having you.

So this past Friday marked my last required day of my 3rd year of medschool. As I look back on this year it has been quite eventful, and honestly it all seems like a blur. Yesterday, I had a practical examination for my Family Medicine rotation, where they basically wanted me to do different sports medicine-like physical exams. Once that was over, the Family Medcine clerkship director met with me for my exit examination. When he found out that I was interested in specializing in orthopaedics he warned me to not fall into the same trap as so many orthopods in regards to medical knowledge. He recounted a patient that he just saw this past week who had seen an orthopaedic surgeon to evaluate her chronic right hip pain. They checked her out, and sent her back to him, saying that they found nothing wrong with her and could do nothing for her. The family medicine doc examined the patient more thoroughly and discovered that the patient had a limb-length discrepancy. The leg opposite the one that was evaluated by the orthopods was slightly shorter, causing her to compensate with the right leg, which led to her right hip pain. He told me this story to remind me to not just focus on one part of the elephant, but the whole (as much as possible) because it will make you a better doctor. While I must admit that I was looking forward to forgeting a lot of the general medicine that I learned in medical school, this story has really encouraged me to try as hard as I can to not be that stereotypical orthopod who can’t even manage hypertension, because my patient will probably suffer in the end.

As I look back over the year and reflect on my rotations, I can’t help but form general impressions for each rotation:

• Internal Medicine: In hindsight I am quite impressed with the vast amount of knowledge that IM guys possess. With a careful history and pertinent labs they are able to diagnose most diseases without even doing a physical exam. I think this rotation was a perfect one to start out my year with. I was fresh from taking Step 1, so I had a baseline knowledge and now I had to see if I could apply it. I must admit that it took me some time to warm up. But once I did I started to make connections and get diagnoses correct. Starting your year off with this rotation truly allows you to learn information that is the basis for just about all other rotations, and it allows you to get comfortable with the hospital setting, in preparation for future rotations. No matter how much I learned on this rotation, I just couldn’t get over the fact that there wasn’t enough “doing”. Your job for the day, was to wake up, see your patients, round on your patients with the team, write orders, then keep on checking in on your patients throughout the day, until you round again with your team in the afternoon. Maybe here and there you might be able to do a lumbar puncture, but honestly there just weren’t many procedures. Some of the residents would get excited talking about observing a bronchoscopy, or an EGD, but that stuff isn’t really a cool enough procedure for me to get excited about. This rotation truly made me realize that I wouldn’t be able to wake up everyday to do internal medicine alone. I needed more.
• OBGYN: Now that I have finished all of my 3rd year rotations, I can honestly say that besides ortho, I would definitely consider doing obstetrics. Now you notice that I didn’t mention gyneocology, because I truly hated that side of the field. I always felt like the patients were uncomfortable around me, which made me unconfortable around them. But when it came to the expectant mothers, I never had those issues. It was always a happy time, and I truly enjoyed every aspect of it, from the prenatal visits to the birth. I loved delivering babies, and the C-sections were pretty interesting too. With that said, I think that OB gave me the perfect mix between the OR and the clinic, although it was a little weak on the OR side. But alas, there is no way I could avoid doing gyn during residency, which was enough of a deal breaker for me. I have seriously thought about what I would do as a back-up specialty if for some reason God said no to me matching into ortho, and I honestly think I would go and do OBGYN. I think this was a great specialty to do before my surgery rotation because it got me somewhat used to the OR (gowning up, scrubing, etc), and helped me to be more comfortable with dealing with crazy scrub techs.
• Psychiatry: Overall, psychiatry is a good field to help patients that often would never be helped and make a good salary doing it. With that said;, if I didn’t like internal medicine because they didn’t do procedures, psychiatry was even worse. It was just non-stop talking to patients, which I enjoy doing, but I need something to break up the trend. As a student it was pretty painful to deal with these something crazy patients, but even worse was dealing with the patients who just used the system to get a place to sleep for the night. Overall, this is a field that I would never have considered going into.
• General Surgery: Since my first year of college, during my shadowing experiences I was absolutely sure that I was born to be a general surgeon. That’s why I was quite shocked to realize how much I hated it when I actually went through this rotation. The fact that many of the attendings were malignant didn’t really bother me because I have a pretty thick skin, but I just could not get over the offensive smell of poop or the sight of bowel. Whenever I would see a colostomy I was utterly disgusted. I loved the fact that as a general surgeon you seemed to have a firm understanding of how to manage a surgical patient, including many of their medical conditions, but that also meant that they ended up being the dumping ground for many of the other surgical specialties’ patients. The only thing I was drawn to, even back in college, was the trauma (gunshots, stab wounds, car accidents), but many of these were non-operative, and many actually required orthopaedic surgery, not general surgery (at least at my hospital). But I think the bowel and poop issue was my biggest, and about 2 weeks into the rotation, I knew it wasn’t for me. Which was crazy talk because it was all I had wanted to do since I started medical school. But medical students often change their desired specialty multiple times before they submit their residency application. I guess I was no different.
• Orthopaedic Surgery: This specialty kind of came out of left field for me. I got interested in it because a couple of my classmates really liked it, so I thought I would check it out. At first I was totally turned off by it because it seems so far away from general surgery. And to be honest, the musculoskeletal system wasn’t my favorite system to study in anatomy class first year. What changed everything for me was clinic and seeing patients. I really really really really enjoyed seeing patient’s with orthopaedic type conditions. While during most other rotations, I would be looking at my watch constantly, during my 1 week of ortho the time just flew by. And once I started to participate in cases in the OR, and I got a chance to drill screws and pins into a patient’s bone for myself, or use wire cutters, hammers, screw drivers, or any other gadget I was hooked. Its hard to describe the feeling when you find your specialty, but I guess I could describe it as a true elation to wake up every morning to see patients. No other specialty, probably besides obstetrics gave me this feeling, and to all other medical students who will be starting 3rd year, make sure you have that feeling before you decide to spend the next 50 years of your life practicing your trade in it.
• Urology, Neurosurgery, Ophthalmology: I knew I wanted to be a surgeon and after I realized that I didn’t want to do general a surgery I was looking at all of these specialties, however none of them really caught my eye. The neurosurgeons really worked a lot harder than I see myself working. And for the most part their patients are very very sick, meaning that their outcomes are not all that good a lot of times. I needed to do a specialty a little less morbid than that in order to be happy. As for urology, I like that they knew a lot of medicine like general surgery, and they had a good mix of surgery and clinic like OBGYN, however I just couldn’t get over putting a scalpel to a scrotum or a penis. Of course they do a lot of bladder and kidney work, but the scrotum and penis surgery kind of crossed it out for me. Ophthalmology was hands down the most boring thing I have ever seen…hands down. I would rather lick toilet bowls clean for a living than do ophtho. Just my .02.
• Pediatrics: My mom was trained as a pediatrician, but it wasn’t until I went through this rotation that I gained a tremendous amount of respect for them. I believe that pediatricians are hands down the best clinicians in medicine. Like veterinarians, they have to diagnose without necessarily being able to communicate with their patients, and because of that they are very observant and very vigilant. As part of that, I think peds tends to draw medical students that are somewhat OCD, and I just couldn’t deal with the residents. If they were girls they were passive aggressive, and if they were dudes that acted worse than the girls. Maybe it was just my particular rotation, but most of my fellow classmates hated peds the most, not because of the patients but because of the residents and some attendings. More so than internal medicine, I could not wait to be done with this rotation.
• Family Medicine: I really enjoyed my 1 month of family medicine. In one day I could diagnose a UTI, do 2 well child visits, manage a diabetic, do a prenatal visit, freeze off a wart a patient was concerned about, and deliver a baby. No other field offers that type of variety, and its a shame they get paid so little. Now would I do it for a specialty?…probably not because they don’t go to the OR, but I actually really enjoyed my time.

As you probably saw from my Twitter posts, ERAS has finally opened up and I have already started to populate my residency application. ERAS is by far the most detailed application I have ever seen, and I would caution any medical student to not procrastinate on filling it out because it could definitely delay you as deadlines approach. Anyway, since most of my time will be spent filling out ERAS and studying for Step 2 (which I take on Aug. 9), I won’t be posting much, except for ortho related stuff, which will of course be password protected until/if I match.

Praise god in whom all blessings flow. I can finally say that this past Friday marks the last post call day that I’ll have until August 30, 2010. While I never did hide the fact that I didn’t like pediatrics, I was blessed in that I  actually had a bunch of patient’s with orthopedic problems. Like the one patient I admitted last night on call was a 3 year old girl with cellulitis of her right arm. That was honestly a very manageable patient. But once again today on my post call day rounds just seemed to last forever. I just don’t understand how it can take that long to take about a patient…its just inefficient. But yeah, I take my pediatrics self exam next friday and then I start 1 month of family medicine. And since I don’t start my orthopedic away rotation until august 30th, I won’t be on call again for 3 WHOLE months!!!!!!!!!!!!!!!! And believe me I really needed that break because I was kinda burned out. I think these 3 months will give me time to recharge and not only that it will give me time to actually learn as much ortho as I can in preparation for my away rotations. The thing that scares me the most about my upcoming away rotations is my lack if ortho knowledge. I feel like I learned no orthopedics during the first two years of medical school. But that is really no excuse…other medstudents on their ortho away rotations learn enough to impress the residents, so that mean that I can too. I just don’t think I will be able to do it until I am done with these 3rd year shelf exams.

In other news, this weekend was the School of Medicine’s graduation so a lot of people that mentored me throughout my time will be leaving. Witnessing the graduation really gave me goosebumps; I just couldn’t believe that I would be in my graduation regalia in just 1 year. But first I have to match…once that is done then everything else will come.

I think that I am slowly realizing why pediatrics is so painful for me. I honestly don’t like internal medicine at all, and believe it or not pediatrics is more slow than internal medicine is. I really don’t like rounding all day and I hate the monotony of day to day inpatient pediatrics. I want to be in the OR or in clinic.

The thing I hate the most about my personality is that its really hard for me to act interested when I really hate what I am doing. I think that faking it is an important skill to have as a medical student and I feel lacking in that department. I cant wait for these last two weeks to be over. Family medicine had to be better than this.

I decided to check out how much it would cost to apply to the 73 orthopaedic programs that I have on my list. The ERAS site has a breakdown of their pricing structure and it will not be cheap. For the first 10 programs I pay $65 total; for programs 11-20 I pay $8 per program; for programs 21-30 I pay $15 each; and for every program after 30 I pay $25 per program. So just to send out my initial application it adds up to:

Programs 1-10 = $65
Programs 11-20:  10 x $8 = $80
Programs 21-30:  10 x $15 = $150
Programs 31-73:  43 x $25 = $1, 075.

TOTAL = $1, 370

Also, from reading the site I saw that they charge me $60 to transfer my USMLE Step I and Step II scores to my ERAS application, so that will bring the total $1, 430. Its definitely not cheap at all, but I have heard enough horror stories of people balking at the cost, applying to like 40 programs, and then not matching. While $1,430 seems like a lot, it pales in comparison to how much money you will lose by not being about to start residency after you graduate. And all of these figures don’t factor at all how much it will cost to spend 2.5 months on away rotations in terms of living and food expenses. And it doesn’t factor in how much it will cost during interview season for plane tickets, hotel rooms, rental cars, etc. I could easily see me pushing $6,000 total for the app process. But yeah…. this upcoming year I am not really going to worry about money, because I would rather go broke this year, then scramble.

So every year after the 4th year medical students match, the various interest groups hold meetings where the 4th years give us advice on how to match into their field. I happened to be on call the night they had the Surgery Match Group at the hospital, so I got a chance to grab some free pizza and hear what was said. They gave a lot of great advice, but the ones that particularly stuck out to me was:

• This was actually said by the Surgery PD….he said that many programs have found that their good residents tended to be the same 4th year medical students who turned in their application early. They aren’t quite sure why there is a correlation between the two, but he believes that by turning your application in early its showing that you are responsible and on top of what you “need to do”, which is basically what residency is about.
  • So of course when I heard this, I truly set in my heart that I was going to submit my application the first day possible. I really didn’t have the highest scores for medical school, but I did submit my AMCAS like 15 days after it opened and I believe that it helped me to get more interviews. The advice was also backed up by the PD of our Ortho department and some other 4th years who matched into ortho this year. They said that they submitted on the first day possible (which is Sept. 1) and that some schools gave them an interview invitation like 10 days later (this is basically before they even turned in all of their LORs). So it really does seem like a nice amount of programs offer interviews on a rolling basis. With my pretty average stats for ortho I hope that submitting on the first day possible might score me enough interviews to really be somewhat comfortable.
• Besides doing well on Step I, being AOA, and having 3rd year honors, the only other thing that they really advised was that we kill our away rotations. The basic advice here was the of course never be late to anything while on your away. Also they said that you need to always be energetic, but not annoying. Never make excuses for things that you didn’t do…just acknowledge your mistakes and do better next time. Always prepare for your cases, and definitely you need to be the first person at the hospital and the last person to leave. They also said  that you should definitely try to take call, but not so much call that you can barely answer questions the next day. They also said to always hang out with the guys when they invite you, as they really want to know if they chill with you for the next 5 years.
• Something else that they said that kind of stuck out (which the surgery PD confirmed) was that you shouldn’t be too stressed about how much surgical knowledge that you possess, because to be honest many of these attendings have been practicing for years, so your knowledge really can’t impress them. With that being said, you of course need to know your anatomy very well, and always have a research paper ready to present on any interesting cases, but besides that anything more is extra.
  • I am still a little scared about the anatomy part since I barely use it right now, and its hard to study it when I have all this pediatrics to study, but I hope I will be comfortable enough with my anatomy to answer most questions thrown my way.
• Be ready to talk about absolutely everything that you put on your CV. If they ask you about your research that you did your freshman year of college and you don’t know anything about it, then you might as well cross that program off because you probably won’t match there.

Overall it was pretty informative and I came away more excited about the whole application process. I think that if I can be on top of getting my application out early and interviewing well, then I should be able to match. Hopefully.