Week 2 of my Sub Internship

I spent the second week of my Sub-Internship on the inpatient pediatrics service, which I enjoyed.  The service was not terribly busy, given the time of year, so the residents had time to teach me about various topics.  That’s something I really appreciated. 

I also spent some time this week working on my CV and writing my personal statement.  I had a rough draft of my personal statement down on paper, but I didn’t feel like it represented me and my goals very well.  Luckily, I got to sit down with one of the second year residents one afternoon and talk to her about why she went into family medicine.  She is from a small town like me. We had very similar views on what a rural family doctor should be able to offer a community.  We would both like to practice in a rural area and we both believe that people should have access to acute, chronic, and preventative healthcare no matter where they live.  I don’t want to tell my patients that they need a colonoscopy but they will have to take an unpleasant prep and drive four hours to get it.  How many patients do you know that would actually take you up on that offer?  The more we talked, the more I realized how important it was to get these ideas into my personal statement.  After our conversation I went home and rewrote my personal statement from start to finish.  Now I feel it speaks to my values and goals.  I sent it off for editing because it is always good to have a second or third look. Once that is finished one of the faculty at this residency program has offered to give me feedback about it. He also offered to write a letter of recommendation for me.

At the beginning of the 4^th year it seemed as though everyone had an opinion on how rotations should be scheduled and carried out.  Don’t do your sub-I too early or they won’t remember you when they vote on applicants, but don’t do it too late or you won’t have time to get a letter.  Some said you should definitely have a letter of recommendation from the program you would like to get into, and others said that was frowned upon because basically it boils down to the program writing a letter to itself.  I stressed over all of this, but now I am starting to understand that it doesn't matter that much. My advice is to plan your sub-I for whenever it fits into your schedule and then work hard while you are there.  I think that if you are eager to learn and a hard worker you will be memorable.  At least I’m hoping that’s the case! 

As far as letters of recommendation go, this faculty member offered to write one for the sub-I’s on the first day of the rotation, so I am taking him up on it.  If I discover the magic recipe for the 4^th year I will pass it along.

Just a side note for those of you following this blog from the start: my family medicine shelf score came back and all is well! 

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.