Residency Interview

First off all, it's just exciting to be in the position to have one interview, especially with the uncertainty of whether there were even any interview spots available by the time I applied.   I was fortunate enough to get 5 interviews, all in California, after I ended up applying to 36 family medicine programs.

This past week, I had two interviews, two days apart.  Both places seemed like programs that prepared their residents well. They both seemed great and similar on paper, but they both had a different "feel." Throughout my short interview trail, I've been hearing "gut feeling" as a term used to describe where a resident choose to work at. I've been starting to understand what they mean by gut feeling, as one program just seemed like a better fit for me despite both programs appealing in similar ways.

During my first interview, I made the mistake of leaving to the destination to arrive 10 minutes early.  The night before, I was sure to iron and lay out my clothes, but I still left a little later than planned.  I ended up making a wrong turn, despite directions from my GPS, and had issues finding the main lobby.  This accumulated in me arriving just in time for interview.  I was further delayed by these sweet elderly women volunteers who took a while to print my nametag.  My poker face was not up to par, as one of them stated, I know you guys think we're inefficient old women.  (She must have saw a look of concern on my face, because of my late arrival.)  I assured her that was not the case and was preoccupied about being late to the interview.  In retrospect I should have left at least 30 minutes before.

The actual interview went well. I had a great time discussing the program with the residents and program directors. The interviews were much more laid back than I was expecting.  Not many difficult questions, just a question about a time I had overcome a failure.  Mainly, it was just us two having a discussion and getting to know each other better.  After interviews, we had lunch with the resident, this is usually a way to get more informatoin about lifestyle, the city, and how well you would fit in with the group. We were then taken on a tour of the city and to the local clinic.  The interview was really fun, but also tiring, probably from the anxiety and anticipation of what the interview is going to be like and how well they will like you.

Applying for residency late

I should know better by now than to think things will go as planned.  Once I realized I wouldn't be taking STEP 2 CK until August 23rd, I figured I should postpone my match date to 2019.  I wasn't sure to have CK by the time residency applications opened, and all the upcoming CS dates were already taken up. I was told that it is best to apply only once I have a "complete" application in, including CK and CS.  Since this wasn't my case, I figured I wouldn't match until 2019, but that has since changed.

I was speaking to a program residency director who said it is not too late to apply, and this was in late October.  I began to contemplate if I could still get everything in, including LOR's, personal statement, and push up my CS date so that I could get results in by February.  She said I should apply, so I did despite the opposing advice from my school advisor.

As a caribbean student, you already have a baseline tolerance for risk, so I decided to take the much riskier route.  The risks are being labeled as a "second time applicant" if I don't match, which Ross statistics indicate will decreased my chances of matching next time by around 50%! Also, by the time I got my LOR's in, it was already Nov. 14th. By this time most programs have already filled all their interview slots.  As of now, I only have one interview and am waitlisted for another program.  We'll see how it all turns out.  Praying for a family medicine residency.

There was a opening for Step 2 CS in Los Angeles, so I managed to take it on Tuesday, Nov 14th. I think it went well, but we'll see.

Activities

If all went according to "my plan" I would have already have applied for the match, but as has been the general case for my medical journey, thsi train is running behind schedule. It's nice now having a few gaps in between rotations. I've been really doubling down on my Spanish having weekly lessons and chatting with amigos on WeSpeke. I still have  along way to go but I'm progressing slowly. I'm making good progress and learning.

Now it finally feels like I have a little more Time to pursue interests outside of medicine. More time to work on my Spanish and also more time to practice piano, which I've been putting off for a while. I've also been wanting to get into boxing or MMA to stay in shape and get more involved in church.

Step 2 CK

Well, I’m making my way up the ladder, slowly. Finally finished Step 2CK after a couple of postponements. Overall, it was a more enjoyable test than Step 1, because everything was more clinically relevant with not as much route memorization.

I began studying for the test in May during a radiology rotation but was only scoring in 40-60 percentile on the exam.  I then went home in June and was studying about 5 hours a day, thinking that I would be ready to take the test by the end of the month. However, I was quickly reminded of my knowledge gaps after failing COMP in late June, so I postponed the exam.  I took the exam again in July and passed with a score correlating to approximately 200. In July, I was doing a busy family medicine rotation, so I did not devote as much time to studying as I had planned.  I finalized a date of August 23^rd.

Due to my subpar performance on Step 1, I was paired up with a mentor provided by Ross who had performed well on Step 2 CK. I met with him weekly leading up to the exam on August 23, and he helped my stick to and create a study plan for myself.  Having someone hold me accountable was a tremendous help.  It is not a good feeling to meet in consecutive weeks after not accomplishing the goals you have set for yourself, so it pushed me to study more. I bumped up the studying to 8-12 hours/day in August, when I did not have any rotations.  I set goals for the week such as going through internal medicine questions that week on going through a certain number of online med ed videos by splitting up the videos each day.

Overall I met my goals of going through UWorld questions 2x and subsequently going through incorrect questions until there were none left.  I must have done some of the same questions at least 4 times before I finally got them right. I’m so stuck in my ways.  I watched all the online med ed videos, which were immensely helpful for general understanding despite how well or poorly I may have done on the exam, I am glad I watched these videos.  I also looked through the notes, which were well worth the $90, without watching the videos.  I read through Master the Boards, some seconds twice, but this did not stick with me nearly as well as the Online Med Ed notes. I took 3 NBME exams and did the free 150 question exam.  This helped to get my timing down and build stamina for the actual exam.  My scores on NBME were 183, 200, and 230.  I also took Uworld self assessments 1 and 2 with scores of 183 and 215 respectively. 2 days before the test I rushed through USMLE secrets, which got me a few points on the actual exam, and I also rummaged through forums for high yield images, including ophthalmology, which also got me a few points. I did a much better job this time around of limiting my resources as opposed to step 1 when I used multiple question banks and multiple review books.

The actual test didn’t feel as long as even the 4-6 hour practice tests I did.  Probably because I took a quick break after each section, I didn’t feel as fatigued after the test was over. My snacks were 2 pb &j sandwiches, a trader joe kale, broccoli, chicken prepackaged salad, and trail mix. This gave me good energy throughout the test.

I recognized a good amount of questions from uworld, and I didn’t run out of time on any of the sections. And just did my best to not second guess myself and trust that I know the material.

I was so happy for the test to be over, and return to a somewhat normal life. Then I took a trip to Vegas with some friends and put the test in the back of my mind until my score comes back in a few weeks.

Family medicine ineficiencies

I will be entering my last week of family medicine rotation this week. I'e been able to see a wide range of patients and gather a plethora of new knowledge about medicine and the politics that go with operating a clinic that is primarily for low-income populations.

One of the things that plagues these types of clinic is the forced inefficiency.  With every patient with medicare, especially with children, there are a certain amount of boxes that you must check in order to "complete" the visit.  In theory, this would be beneficial to make sure that nothing gets looked over, however, it takes away from focusing on a chief complaint if there is one. The same concept can be applied to review of systems in general.  If every system was reviewed in detail for every patient then it would be nearly impossible to have a visit and note completed under thirty minutes, especially if the patient has complaints.  This takes away time from the other patients being seen on time or at all, as patients are having to wait longer and longer to get an appointment.  Furthermore, going through a review of systems, especially in an elderly patient, would lead to a wide range of problems to then be addressed.  So for most patients, the technique I've seen utilized the most for doctors, and seemingly the most effective, is to address one problem then speak quickly about the treatment plan and leave before the patient has a chance to ask follow up questions.  This unfortunately, seems to be the best way of having a quick visit without leaving too many patients in the waiting room when you have a busy clinic.

The various inefficiencies I have noticed include patients coming back for lab results, having patients come in for prescription refills. prescription writing, filling out check boxes on CDHP (well child visits).  Sometimes, it seems like medicine is always lagging in innovation when it comes to the medical/medicare patients.  In an ideal setting, I imagine their being more telemedcine follow-ups for situations such as common medication refills or discussing lab results.  Or simply emailing all prescriptions to a given pharmacy (Faxing seems so outdated).  Or even finally having a central database for all patients where all visits, prescriptions, and previous notes from all providers can be seen.  Eliminating the whole going back and forth from one clinic to another with this paper and that paper and needing certain documents signed.

Maybe I can implement some of this if I start a clinic.  Or maybe I'll find that I was just a naive medical student and conform to the notion that these inefficiencies will always just be a part of medicine.

Postpone

Looks like I may have to postpone my residency match date a year.  I didn't do nearly as well on a Uworld self-assessment practice test as I had hoped for so there's no way I'm going to take a chance of scoring poorly on Step 2.  My original date was in three weeks but i only got a measly 198 on my practice exam. My new tentative date is August 3rd.

Step 2 studying

I have began studying for step 2, my last big test before residency begins. For step 1 I felt like I used too many materials so I decided to limit the resources I use to three.  UWorld, Master the Boards, and MedEd videos.  I'm going to set small weekly goals for myself in concordance with the plan my mentor has set up for me.  Ross provided a mentor for students who they felt would benefit based on low Step 1 scores, so I decided to utilize the resource.

My study plan for this week is to compete at least 2 Uworld blocks/day on tutor mode, read 40 pages of MTB per day, and complete at least 2 hours of medeq videos/day.  I tried to keep it simple and manageable.