The Fourth Year begins

I just completed the  first week of my fourth year of medical school.  I can honestly say that this past week has been one of my favorites since starting medical school!  This month, I am doing  a Sub-Internship at a Family Medicine residency program.   I think it is important for every fourth year student to spend some time away from your home institution. The theory is that this will help you to make a more informed decision later.  My biggest advice is to start the process early.  I began working on setting up this Sub-I last February. I did not get absolute confirmation until June.  I don’t think this reflects the average experience, but it’s better to be safe than sorry.

Meeting the residents that you will be spending the greater part of your life with for the next three years is helpful.  It gives you a pretty good look into how a residency program works. You get insight into resident satisfaction, the patients that they care for, and their procedural experience.     For this rotation, I applied online directly with the program.   Some programs require you to use VSAS which I’m not as familiar with. 

The Fourth year is fantastic! You get more responsibility in patient care.  It’s your time to start sticking your neck out--they actually want you to write down your plans and recommendations.  I have been having a great time. In four days (just off the top of my head) I’ve delivered six babies, scrubbed in on five cesarean sections, and performed three circumcisions.  I even repaired a second degree perineal laceration under  the close supervision of the attending.  This program seems to put its 4^th year Sub-I students near the front of the line when it comes to procedures.  I was worried that scheduling this in July could be a mistake since all of the new interns are just starting and just as eager for experience, but I haven’t had any trouble getting procedures. 

It is important to try to identify early on what you would like to incorporate in your future practice.  Family medicine is wonderful in its flexibility.  I plan to practice in a rural town and I would like to do OB and procedures, which makes it very important for me to find a program that can provide adequate experiences  for these things.   Every program has a different emphasis, so if you can narrow down your likes and dislikes it helps. 

When Matt and I first started looking at residency programs, I really didn’t have a good idea of what I wanted to do in the future.  We began by narrowing it down by places we would actually want to live….that got us down to 80 programs!  Since I started this Sub-Internship,  I have been able to talk to a lot of residents and feel I’m getting a much clearer picture of what I want my practice to look like.  I now have my choices narrowed down even further.  I will be attending the AAFP National Conference for Family Medicine Residents and Students from July 28 to 30th. This will give me an opportunity to talk to residents from lots of different programs and hopefully get a better idea of the ones would be a good fit for me.  Matt is coming  along so he can get a feel for each of the programs.  It is important to me that he likes the location just as much as I do. And we have to have job opportunities there for him too. 

I will continue to blog about this process as I go along.

The Great Disappointment

Up front, I should say that it is very difficult for a medical student to discuss their short comings.  Most of us are Type A by nature, and not eager to show weakness.  With that being said, I will share my most recent disappointment with the hope you will not judge too harshly.  For the past eight weeks,  I have been enjoying my Family Medicine rotation.  It was the one rotation that I've looked forward to nearly all year.  I had a wonderful time working with my community preceptors and KU attendings in clinic.  The first seven weeks of the rotation reinforced my opinion on how wonderful seeing patients in the clinic can be.  I enjoyed the patients I met and loved the ambulatory setting.  You can solve problems for 25 patients and it is all in a day’s work. 

I worked hard and tried to learn as much as possible in preparation for my upcoming sub-internship in Family Medicine.  I took notes, read up on new topics, and did everything I could to show initiative.  Unfortunately, I hit a speed bump during week eight.  During the final week we had several tests that would be used to help determine my grade. We had a clinical skills assessment which I thought went fairly well.  I did a presentation from my underserved clinic experience which also went fine. But when I took the NBME shelf exam, I quickly realized I had not adequately prepared. My study plan was not adequate.  I assumed that since I had done well on the Pediatric and Internal Medicine exams, I would do fine on Family Medicine.  I used a case study book, but the content didn’t have enough depth.  I was not prepared for the test.

After the test I went home nearly in tears, telling my husband Matt that I bombed the shelf and my future career was in jeopardy.  He doesn’t put much stock in this complaint any more since I have a habit of feeling this way after every shelf and they inevitably work out fine.  But I told him that “No really. This time I really, really mean it!” Adding insult to injury, on the last day of the clerkship, we took a departmental exam on which I did absolutely, positively horribly.

On the last day of the clerkship I had to meet with three of my KU attendings, all of which I respect and one I consider my mentor.  I was embarrassed to sit down with them after they had sung my praises for seven weeks.  I didn't feel like I was able to finish strong and now they knew.  I learned at the meeting that even the clinical skills exam didn't go nearly as well as I had thought.  My department exam score was above the average, but still embarrassing to me.  My shelf score won't be released for another few weeks. Despite my performance on the exams, my attendings gave me kind words of encouragement.  I felt a little better afterward, but I am still kicking myself over potentially blowing a superior grade on the most important rotation of my third year.  We will see what the shelf score does for my grade.  I’m trying to stay hopeful.  For now I have learned my lesson.  I will never again assume I know enough.  The enticing thing about medicine is that there is always something more to be learned. 

I began medical school with the idea of going into anesthesiology. My sister, Jennifer, is an Anesthesiologist in Colorado Springs. She successfully juggles 3 year old twins, a husband, and her career. She has tremendous job satisfaction and has always been eager talk about the wonders of her trade. Jennifer was the first person in my family to go to medical school. She paved the way for me, and after seeing how happy she is with her career I had every intention of following in her footsteps.

The first rotation of the 3rd year was my Geriatrics clerkship. I spent most of my time stressing about proper roundsmanship and learning medications by their brand names, but mixed in with all of that I realized I really enjoy working with this patient population. As the year went on there were several rotations that stood out for me. I was fascinated with OB/GYN, couldn’t stop smiling during Pediatrics, and felt like everything was finally starting to make sense during Internal Medicine. While each rotation was great, all of them were lacking one thing or another. For example, Internal Medicine was rewarding but I missed taking care of kids and pregnant women. The hospital was OK, but I really enjoyed my time in the clinic. I decided during that rotation that Family Medicine is the best fit for all my interests.

By that time, I also realized a few things about myself that I hadn’t really taken into account. For instance, I like working in the clinic and I loathe the OR. I love talking to my patients, I enjoy patient continuity, and my attention span is short. Just short enough, that I would benefit from a smorgasbord of diagnoses walking through the door rather than focusing on one organ system. After throwing Anesthesiology out of the running, I called my brother-in-law. He is a family doctor in practice out in rural western Kansas. Like my sister, he is a success story of juggling kids, a spouse, and a career. Unlike my sister, however, his daily schedule seems much more flexible. He is able to tailor his work week around his kids’ activities. This flexibility is important to me, since Matt and I want to have kids in the not too distant future. (Mom if you are reading this--no, I am not pregnant!) I value family time which makes Family Medicine appealing to me.

This year I realized that the secret to job satisfaction (and my search for a specialty) is honestly zeroing in on my personal preferences. You can’t run someone else’s race. My sister would be miserable in Family Medicine and I would be miserable in Anesthesiology. I’ve come to realize that the 3rd year of medical school is an enlightening year. We discover our likes and dislikes, our strengths and weaknesses, and at the end we make one of the most important life decisions when we choose our career. I feel much more at peace now that I have chosen my own path to Family Medicine. Now the adventure begins!

Hi. My name is Brooke

Hi. My name is Brooke. I am a third year medical student. Dr. Delzell asked me to write about my life and what is like to be a medical student--going through the process of applying for residency. So, to start out, a little about me...

I grew up in a middle class family in a small town in Kansas. My Dad worked on the family farm when I was very little, and owned a company that serviced heavy equipment servicing company. He was a quiet man in public, but he doted over his daughters at every opportunity. Growing up as the youngest of 3 three girls definitely had its perks. There was always someone to shop with, someone to argue with, and someone to borrow clothes from. My oldest sister, Jenifer was former Miss Garden City. She taught me the finer points of tight rolling my jeans and eyebrow tweezing. My middle sister, Heather was an all-star athlete and taught me the importance of hard work and a sense of humor. Our house was always busy with work, school and sports. While in high school, I worked at the local golf course and played on the Varsity golf team.

During my junior year of high school, my Dad injured his back while working in the yard. We thought it was just a muscle strain but the pain became progressively worse. He collapsed at work two months later, having lost all the feeling in his legs. It was obviously not just a muscle strain. We soon learned he had multiple myeloma at the age of 47. He spent the next several months at the KU medical center receiving a stem cell transplant and other treatments. He went into remission for a short time, but the cancer came back. I accompanied him to his appointments at KU whenever possible and paid close attention to the physicians and their recommendations. I realized at that point that I wanted to be a doctor. I saw, firsthand, the impact that a physician can have on an entire family. I thought to myself, “what an honor that would be.” The doctors gave my Dad ten quality years and gave my family peace. They stood by us from the moment of the initial diagnosis, through the various treatments, and in the end with palliative care. When Dad passed away in 2007, we received a letter from one of his oncologists at KU. The words were kind and gave us comfort in our time of mourning.

In September of 2007, Matt and I were married. We got married in Colorado Springs, among friends and family. The day after the wedding, we were heading up into the mountains for our honeymoon. There would be no internet access and cell phone service would be nonexistent. Before we left, I received the long awaited email announcing my medical school interview time and date. After relaxing in the mountains for a week I returned to the KU School of Medicine for my interview day. I thought it went OK. Maybe I will blog about medical school interviews another day.

Five months later I got a letter from the School of Medicine. It was the letter that announced my acceptance. Matt had just left the house to go on a long run when the mail came that day. I couldn’t wait to tell him my wonderful news. I jumped in my car and drove around Newton, Kansas until I found him jogging along the side of the road. I parked my car in the middle of the street in my excitement and ran to him crying and holding the precious letter above my head. Later on, Matt would tell me he thought to himself “this could go either way…”. It wasn’t long before we found ourselves in a U-Haul truck, moving our dog and rabbit and all of our stuff to Kansas City to begin my medical school adventure. That letter is now framed and hangs proudly in my home office.