Sunday, December 25, 2011

Residency Interview – The Thirteenth

The anticipation for this day was growing throughout the interview season as many students spoke highly of the hospital and potential opportunities well before I had a chance to see it for myself. Lehigh Valley Health Network incorporates a number of hospitals in the Lehigh Valley region of Pennsylvania. If the size of the lettering has anything to do with the caliber of the program, they are off to a good start.

Lehigh Valley Hospital

Our day started with a short presentation of the program and the large group of interviewees was divided to spread the masses. The interviewing half had four stations with two interviewers each. As there were so many stations and interviewing students, these sessions were not excessively long which left plenty of opportunity to ask questions and provide answers. With couches in every room, the tension was definitely less than most and certainly more comfortable than other programs offered. Between program director, assistants, clinical faculty and ancillary staff many of the common interview questions were exhausted rather quickly. I definitely appreciated meeting the majority of the teaching staff and being able to ask specific questions of those holding particular responsibilities.

At lunch we all sat in our formal-wear lining the tables of the cafeteria learning everything we could from current residents. It was a moment to relax and really determine if we felt as though the program would be a good fit for us personally. Satiated, we made our way to the shuttles for a tour of the medical facilities. State-of-the-art simulation labs that modeled patient rooms, healing decorations and quarantine-prepared spaces were among some of the unique features we observed. Much of the remodeling benefits both the patients and staff. Fellowship, research and altruistic opportunities were in abundance. The emergency medicine program monopolizes one facility and shares responsibility for another. Being accredited trauma centers, they see a number of pediatric and adult cases that smaller facilities may not.

Being this late in the interview season, it was somewhat difficult to maintain a sense of enthusiasm that was obvious at the onset. Nonetheless, this program definitely elicited a sense of excitement as it has so much education to offer including well-trained emergency physicians. I can only imagine that the upcoming residency match will bring them some of the strongest applicants from around the world.

Question of the Week
What do you like to do when you are not working?

Suggested Considerations

Sunday, December 18, 2011

Residency Interview - The Twelfth

After a rejuvenating weekend in Philadelphia, my morning commute took me across the beautifully blue Benjamin Franklin Memorial Bridge into New Jersey where I found the UMDNJ School of Osteopathic Medicine. Interviews would be ongoing throughout the day and I was fortunate to have mine early, leaving the remainder of the day to explore the surroundings.

University of Medicine and Dentistry of New Jersey

I joined the in-progress round table discussion between students and residents while waiting to be called for my formal interview. It was an opportunity I had become familiar with through the course of previous interviews; probing the minds of current interns and residents as to their thoughts on the program.  When used accordingly, these can usually be a solidifying factor in choosing for or against a program. Knowing how current residents feel towards faculty, facility and curriculum is a vantage point that cannot be overlooked. On this particular day, they were very positive about the program and spoke highly in this regard. 

It did not take long before I found myself across the table from my interviewers: the  program director, an assistant director and the manager of the emergency department. These men, sage in their years and thoughtful in their remarks were attentively looking for the next residents to fill their intern class. In their professional and experienced manner, they described characteristics of loyalty, integrity and honest above all else that they sought. For them, a cohesive residency would be an effective one. I was impressed by their warmness and desire to truly provide their residents with the best program possible. My questions were respectfully answered and I was told what to expect in the coming weeks approaching the Match. 

Shortly after interviewing, we joined the interns for a tour of the hospital. All facilities are community based without trauma designation. The hospital we toured was relatively clean, organized and efficiently run from what I observed. Although the interns were helpful, it would have been nice to have an upper level resident join us to answer questions interns were unequipped to field. Overall, our interview day was relatively short, yet I felt that it was a strong contender on my list of residency programs.

Question of the Week
What are you looking for in a residency program?

Suggested Considerations

Sunday, December 11, 2011

Residency Interview - The Eleventh

With my trusty rental car ready to go and a seven hour drive ahead, I braved the New York traffic. At first the stop and go nonsense was getting to me, but it made the Pennsylvania countryside drive well worth the effort. The open road, starry night and blaring music were a perfect recipe for calming the interview tension.

Conemaugh Memorial Medical Center

I arrived after midnight and found my hotel to be quite comfortable for the few hours before waking to interview. The sun was up, fog filled the rolling Allegheny mountains and a crisp winter air was obvious as my breath condensed the air before me. It was a beautiful drive into the small valley town of Johnstown, Pennsylvania where I found my way to Conemaugh Memorial Medical Center. It is an impressive Trauma I medical center that stretched over multiple blocks on the side of a mountain and was busy even for the early morning hours.

We were greeted by the emergency medicine staff and invited to join the conference sessions already in progress. I enjoyed the interested participation of residents and faculty who seemed very much like a family in discussion. This program is pioneering an approach to the curriculum by reading the current journals in place of textbooks which tend to be years behind. It is a novel approach and seems to be effective from their initial assessments.

Individual interviews started shortly thereafter with one member of the faculty in three separate interviews. The first I was surprised to be invited to ask questions, which was an obvious deviation from the normal interview process. In fact there were no questions asked by the interviewer! As I went on to meet with the program director, he again provided me answers to my questions, yet asked none. I was astonished that I had made my way through two "interviews" and no questions were asked of me. Was I missing something? Are they getting the information they need about me? My third interview started along the same lines, but I was not going to let my line of thought lead the entire discussion. After one question, I stopped to offer time to my interviewer. His questions were unique, not related to medicine and more along the lines of how I approach an answer. When those were exhausted, he promptly provided me with a case similar to an oral board. I am happy to report that I passed with an appropriate diagnosis.

The interviews were followed by lunch and a tour of the facilities. I was surprised at the business of the hospital in such a small community setting. We even made our way to the helipad which had a beautiful view of the surrounding valley. This program is located in a neat location with all the benefits of a trauma center. It is willing to find new ways to approach learning and ensure competency in its residents all while maintaining the important family ties. It is one program I will not regret visiting.

Question of the Week
If you were to go on vacation between medical school and residency for two weeks, where would you go, what would you bring, what would you do and who would you bring with you?

Sunday, December 4, 2011

Residency Interview - The Tenth

After a transcontinental flight from the West, I found myself in the Long Island rain of New York heading to a pre-interview dinner on the town with the emergency medicine residents of Good Samaritan Hospital.

Good Samaritan Hospital

The table full of appetizers surrounded by residents and students full of questions. It was beneficial learning how residents cope with work, manage their time and invest in their future careers. It was definitely preparatory for the interviews.

We started the day later than most interview days which helped those of us who traveled through multiple time zones. Morning conference was a faculty or resident presentation with ensuing discussion. We had a detailed tour of the emergency department. I was most surprised by the rooms divided into two by a curtain, effectively doubling the bed space. Aside from the tight quarters, it appeared that work was unimpeded and frantically busy. Between trauma, pediatric and adult services, Good Samaritan is one of the busiest EDs on Long Island. The EM program is notably heavy with research and presentations commonly winning the majority of competitions attended.

After a brief overview of the program and surrounding area, we had lunch with the residents and faculty. We were then off to interview. Three separate interviews, each in panel format composed of three faculty and residents. The atmosphere calm, to the point and mutually educational. The area is culturally diverse, hospital continuously active and personnel readily available making this residency a strong place to establish a professional foundation. It was not until I was back in the car headed towards metropolitan New York that I got a taste of vehicular congestion, an avoidable yet frustrating association with this part of the country.

Question of the Week
What is your favorite movie?

Suggested Considerations

Sunday, November 27, 2011

Keep On Keeping On

Just when I finish my last audition rotation and get ready for a supposed month of vacation, I realize that interviews are still in full swing. With only a couple days of down time at home, I will soon be preparing for my next adventure on the east coast. All this travel, preparation and match anxiety has me worn out.

Performance Exhaustion

Working in the spotlight for months on end with few days in between shifts and plenty of loose ends on those days off, the moments of relaxation are nice to come by. I feel like everything is just move, move, move until there is no more energy to move. The alarm goes off, back to work, hit the road and repeat. I remember well the warnings last year's seniors gave about becoming exhausted throughout the interview season. Experiencing the long hours of peak performance and never knowing who is watching, I feel the fatigue setting in just as foretold. I can only hope that my efforts thus far and in the coming weeks will pay off come match day in mid February.

The excitement of traveling and visiting new cities is great, though it's equally rivaled by feelings of inadequacy and trepidation. I have met wonderful people in all these places, learned a great deal about the world of emergency medicine and thoroughly enjoyed my time exploring potential residencies. It's been a mixed bag of vacationing and working where the lines cross from time to time blurring the extremes of either. I really enjoy not knowing what is next or how things will turn out. It keeps an element of surprise around long enough to make things exciting. But all things being told, I am starting to realize a sleep deprivation that resembles those long days in class followed by nights of endless study, something I thought would only be a memory of the first years in medical school. In reality it is a lifestyle associated with this profession as I am quickly learning.

Question of the Week
Now that there is a light at the end of the tunnel, when do you actually become a doctor?

Answer & Wishful Thinking

Sunday, November 20, 2011

Residency Interview - The Ninth

It wasn't long ago that I visited this program for the first time doing an elective month in emergency medicine. Now six months later, I find myself on the hospital campus interviewing for a potential residency position. The interview is not only one day of suit-wearing anxiety, but a month long process of showcasing myself on every shift.

Arrowhead Regional Medical Center

After an evening out with the residents, it was not hard to see that their laid-back demeanor fit their in-hospital character well. It was as though friends were gathering rather than a professional undercover interview session over dinner. At one of the earliest interviews yet, the ties, suit coats, and slacks all found their way to the department office and patiently waited for formal interviews to begin. For most, there was no travel involved as we were already working at Arrowhead for the month. Taking turns, we were shuffled through four interviews separated by a lecture session and lunch.

My pre-lunch interviews were more energetic than the food-coma-induced afternoon interviews. The first encounter was brief with a couple of the attending faculty members. They tried to glean a perspective of performance under pressure during work situations and how we destress when not on the clock. I enjoyed the brevity and direct line of questioning they presented as it kept the mood fresh. Next up was a session with the junior residents, most of whom I have worked with in the department. Again the mood was inquisitively jovial with an opportunity to express myself outside the realm of work-place medicine. The encounters felt natural and low pressure despite the expectant nervousness associated with any interview of significance.

We then joined the rest of the residents in lecture to discuss case reports and teaching points recently experienced in the department. The cohesive nature of this group was evident as senior and junior residents worked together to respectfully formulate answers and discussion topics. Lunch was served and we made our way back to the interview chairs to finish out the day.

I was called to meet with the senior residents, two of which I had worked with previously. We recalled various experiences together treating interesting patients and elaborated on my desire to pursue a career in emergency medicine. Their conversation was welcoming and decisive as they look for students to carry on the legacy of their residency program. Shortly thereafter, I sat with the program director and another resident detailing my thoughts on the program thus far and why I wanted to be a part of it in the near future. None of the relationships were blurred between professional and informal, yet there was an overwhelming sense of family familiarity. All in all, ARMC is comfortable and inviting, as I would hope every potential employer would be.

Question of the Week
What happens when you get mad?

Suggested Considerations

Sunday, November 13, 2011

Residency Interview - The Eighth

Missing the snowstorm by a week, remnant evidence of its passing was still visible when I visited the country's northeastern city of Philadelphia. A short distance on the outskirts of the metropolitan limits was one of the community based hospitals in the Aria Health network.

Aria Health

I could not be more grateful for the generosity this program demonstrated. Their original invitation to interview a day earlier had to be turned down as I was visiting another program then. They accommodated my schedule and let me interview among students vying for another specialty the following day. At first, I felt mildly out of place as the line of thought, desired characteristics and program highlights were foreign to me during discussion and presentations. In the end, we were all students looking at a program from different angles which provided interesting insight.

As the lone emergency medicine interviewee, I was whisked away early to interview with the program director who I found as calm and kind as the treatment I had already received. We discussed the usual interview topics, how they intend to expand their program and what they have to offer. Shortly thereafter, a couple of the residents had their go at my application and put me in the proverbial hot seat. It, too, was as relaxed as my initial interactions leaving me feeling welcome and at ease with the experience.

A teaching session with the residents was led by local physicians in various specialties. Apparently, the medical institutions in the Philadelphia area are very open to sharing faculty in support of advancing medical education. This attitude creates an environment of community among health care facilities, providers and students all for the better. We toured the hospital with the residents who further answered questions about the program and health network. Despite being a smaller community hospital, the personality and character carried by the employees, residents and faculty was appreciable in my decision making. I really enjoyed my time in Philadelphia and exploring what this program had to offer.

Question of the Week
What can you bring to this program?

Suggested Consideration

Sunday, November 6, 2011

Residency Interview - The Seventh

Only one day into my new rotation I found myself standing in the long line at the airport awaiting security checkpoints before the sun reached the horizon. I would be spending the rest of the day in transit from one coast to the other losing hours fast as we crossed numerous time zones.

St. Joseph's Regional Medical Center

Waking up at 5am on the east coast was a rough task when my internal clock was screaming it was still 2 in the morning. My anxiety driven agenda helped get me out of bed, dressed and to the hospital in time to follow the medical staff into the underbelly of the large hospital. Recent construction has foot traffic rerouted on the outside, but the inside looked like a contemporary museum or lounge. Welcome to St. Joseph's in the heart of Paterson, New Jersey. Our morning started among the residents in a newly constructed auditorium reviewing cases and discussing medicine. Refreshments from the in-house Au Bon Pain worked our palates into submission before a tour of the facilities.

Among other things, the renovations have brought a whole new tower to the campus with state-of-the-art ICU, floors and revamped emergency department. Everything was so clean, colorful and busy. With various fellowships available, the latest technologies and seemingly satisfied residents, this program puts up quite a fight for a leading residency. Despite being an accredited Trauma II center, they have their fair share of trauma with what sounds like a procedure intense training. There is no lack of pediatrics and they are even gearing up for a geriatric oriented emergency unit, one of the first in the country.

Interviews were conducted after a lunch with residents in a panel format that consisted of program director, assistant program director, department manager, and resident. I felt at ease throughout the process and was intrigued by the clinical case exercise. It was done in the style of an oral board exam, something I have never practiced. Despite my travel fatigue, my answers portrayed my personality and came across the way I would have answered in a no-stress situation. I left feeling this program was a shining star among programs and was honored to interview as a guest on their campus.

Question of the Week
If one were to ask a friend of yours what one weakness you have, what would it be?


Suggested Considerations

Sunday, October 30, 2011

Residency Interview – The Sixth

Only a couple states away my alarm sounded early enough to get me moving in the right direction. Sheer terror came over me, however, when I realized I would be driving across time zones putting me at risk for being an hour late to my destination. Needless to say, but I may or may not have driven a little faster than intended

Genesys Hospital & Health

Between the early morning hours and minimal traffic, lost time was quickly made up and I arrived in time for the afternoon interviews. The brisk breeze and color changing trees was a relaxing welcome to Genesys Hospital near Flint, Michigan. Walking in the hospital felt more like finding myself at a hotel lobby. The smells of a busy food court, music from a self-playing grand piano and visually pleasing flowers filled the foyer just beyond the doors. I quickly questioned if I had gone to the right place. Noticing the other suited students, it was apparent I was not lost.

After a brief meet-and-greet over lunch, the program director provided an overview of the day and residency program. We then divided accordingly to our respective interviews. One by one we met with the program director, assistant director, department manager, director of clinical education and chief residents. Each focused on various aspects of the interview including teamwork, leadership, extracurricular activities, and business aspects of medicine. This style was new to me and I tried to take advantage of the opportunity by not repeating answers. I will admit, however, that it felt as though the process was longer since these interactions were so numerous, yet the total time commitment was less than most programs. Well done Genesys.

There was plenty of time to interact with residents and have questions answered in a no-pressure setting. They took us on tours of the emergency department, hospital and associated athletic club. All were very busy, which I did not initially expect by the surrounding rural-esque environment. Genesys lived up to the great things I heard all the way across the country in Las Vegas and I’m glad I had the opportunity to visit their program in person. 

Question of the Week
What non-medical book have you read lately?

Sunday, October 23, 2011

Residency Interview - The Fifth

The sun was still sleeping when I arrived at the hospital for my early morning interview. Having only worked a handful of shifts, getting to the emergency department was not a problem. Finding the interview room in time might be.

St. James Hospital & Health

Fortunately, I found the program director as he entered the building suited and ready to interview. A couple days prior I responded to a call on the medical floor to see if I could be of help before my shift ended. The resident in charge was unable to pass an endotracheal tube through the vocal cords and as luck would have it, I found myself at the head of the bed finishing the job. It didn't take long for the program director to catch wind of the event and in the moments before the interview it became a topic of discussion. Good thing for me...the patient was still living.

Only another student and I would be interviewing that day for one of the largest emergency medicine residencies in the country. After a short presentation about the St. James program, its many hospitals spread across the Chicago community and various local highlights, we sat for our individual interviews. They were short and to the point allowing the chief residents, director and me an opportunity to learn about each other and the program. Despite having nine hospitals in the system, we only toured the Olympia Fields facility where the interview took place.

The remainder of the morning was consumed by a didactic session with the current residents, faculty and guest lecturers. Being near a city with so many hospitals and residency programs, they are privileged to have recognized physicians lecturing on a regular basis. As quickly as it had begun, the day seemed over and it was already time to start my afternoon shift. I think it would be helpful to see some of the other facilities, but the residents trickle through my rotating ED enough to get an idea of their character. I continue to be impressed by their caliber, friendliness and hard work ethic. Since my childhood stomping grounds are miles away, this program definitely has an added bonus when it comes time to make a residency decision.

Question of the Week
If you could meet and have a discussion with any person alive or dead, who would it be and what would you discuss?

Suggested Considerations

Sunday, October 16, 2011

Residency Interview - The Fourth

Despite being invited to meet with the residents for dinner before interview day, I was not be able to join them due to a drive through Ohio's more rural parts. It was probably for the better since I was still wrapping my head around an interview early in that afternoon. 

Doctors Hospital

The west side of Columbus, Ohio felt very similar to my childhood stomping grounds; the suburban unencumbered traffic patterns with residences and businesses lining the streets. Prepared to leave my hotel early, I met another interviewing student at breakfast. We are not hard to spot as anxiety is obvious, professional attire the norm and portfolios a calming distraction. Doctors Hospital seemed to be at the center of community health with a steady flow of people coming and going. Dressed in standard suit and tie form I made my way into the educational building for the weekly didactic session among residents, faculty and fellow interviewing students. It was comforting to see other students I had met on the interview trail, once again proving how small the community within a specialty truly can be. I found the discussions by teaching staff and guests to be rather enlightening. To top off the morning session, we finished with a splinting lab before heading to the conference room for interviews.

After brief introductions were made by all in attendance, half of the group toured the facility while the others interviewed. The facilities were impressive. With so many residents in house, they have their own lounge with a mini fitness center and sleep rooms. The simulation lab was extensive and appeared to be well used by those in training. The ED was super clean, but did not seem to be as busy as one would expect for the middle of the day. One nice feature is that all the gurneys are the OB/GYN type, so that finding one when you really need it would not be a problem. The rest of the hospital was either on its way to being remodeled or in the process of getting the upgrade.

One of the strengths of this particular emergency medicine program is their involvement with the local community emergency crews. It seems that they are very involved in both ground and flight transport with regular training sessions to help educate regularly. On the flip side, with so many residency programs in one facility there are the expected clashes when one service wants to get their fair share, but has to step aside to let another service take over. In this sense, the program does not have unopposed care of all their patients. Nonetheless, trauma and pediatrics were external rotations done at inner city hospitals that get high patient volumes and acuity. With the tour complete, we started the individual interviews.

The interview was conducted by the program director, his assistant and three residents. It was a very laid back session with free-flowing conversation and questions. To my surprise, amid the questions an EKG was given to me to diagnose and manage the patient. Fortunately, I had some understanding of the tracing and could formulate an educated response and treatment, thus effectively "saving" the patient's life. This interview was somewhat unique in that the questions asked were not all typical of an interview I have experienced. They definitely required some thinking on my toes and hopefully provided insight into who I am as a person even if they weren't always well formulated answers. Overall, I left the program feeling good about the experience and enthusiastic about its potential.

Question of the Week
If you were given a large sum of money and could no longer work in medicine, what type of work would you do?

Sunday, October 9, 2011

Residency Interview - The Third

The long autumnal drive from Chicago to Michigan was calmingly pleasant with beautiful weather and fall leaves changing colors all around. It was just what I needed to relieve the anxiety of another interview day on the horizon.


Sparrow Hospital

Driving through the streets, the college town feel greeted me as students busily went about their evening activities and the MSU campus seemed to remain lively even after the sun had set. I would soon be meeting some of the emergency medicine residents at Sparrow Hospital for dinner the night before my interview. The food was good and the residents friendly. Being the knowledgeable experts about their program, they answered our questions and introduced the program with great excitement. It was a perfect opportunity to get the inside scoop on a city and facility I knew little about. To make our stay that night more comfortable, reservations were made for us to stay on campus at the Kellogg Center, a business style hotel which was definitely a welcome opportunity.

After a brief meeting in the morning to highlight the program we had two personal interviews conducted by the program director and the assistant director. It was a comfortable exchange discussing program attributes and myself as a candidate. Afterwards we toured the main and secondary hospitals. I was amazed at the state-of-the-art feel as much of Sparrow was recently built. The emergency department was larger than any I had seen in my travels and seemed to have an endless supply of rooms. This undoubtedly met the demands of the community and appeared to do so in a great setting. There was ample time with current residents to have our questions answered and to really understand the underpinnings of the program. With a strong curriculum, experienced core faculty, wonderful facilities, and a supportive community this program definitely put on a great showing. The icing on the cake was a quick trip to the rooftop helipad that overlooked the city, simply beautiful.

As a final wrap-up to the day, we were invited to dine with residents and a member of the faculty. By this time, all of our questions had been answered and it was just a matter of getting "that feeling" of knowing it was the program; a decision that is too early to make. I am pleased to have experienced this program first-hand as it was rather enlightening.

Question of the Week
Where would you like to be in 10 years?

Suggested Consideration

Sunday, October 2, 2011

Residency Interview - The Second

At the beginning of the month-long rotation I was told to be ready for a spontaneous interview sometime throughout the month. Without much warning we would be pulled aside to discuss with program leaders the program and ourselves. However, I didn't think it was going to be three separate interviews on three different days.

Kent Hospital

As a courtesy gesture towards the students who rotated at the site, we were asked to not dress in formal attire. Needless to say, interviewing in jeans and a hoodie was comfortably welcome albeit a little awkward. The first sit-down session was with the chief resident, laid back and somewhat formal in questioning. It was a good way to get an idea about the program from a resident's perspective. Then the department manager pulled us aside later in the week to get to know us and our thoughts about the program. The following week the residency director met one-on-one to finish the interview process. I would imagine when formal interviews are held, it is a little more compact and rigorous, but since we had an entire month to demonstrate ourselves, there was little need doing so.

I was happily surprised with my experience at Kent Hospital. Having never really visited the Northeast and Rhode Island in particular, it was quite the adventure to be newly exposed to both in such a high-stakes way. The faculty, staff and even patients were among some of the nicest people I have met in my travels. The department itself was one of the cleanest, roomiest and most organized that I have visited. With those qualities, it made sense that a community hospital would always have a full ambulance bay unloading new patients. Although the visiting students did not get to see the ancillary rotation sites for this program, we were informed that the following hospitals are among the list: Tuft Medical Center, Massachusetts General Hospital, St. Barnabas Hospital Bronx, St. Anne's Hospital, Children's Hospital Boston, Women's and Infants, and Butler Hospital.

I left the program feeling invigorated about emergency medicine and the upcoming match experience. On the interview trail, it seems that faculty know other faculty at various programs and the rotating students will show up time and time again. As we rotate around the country and interview for residency positions, students run into each other at various sites proving how small the world within a specialty can be. All in all, despite having three individual interviews for one program, I enjoyed the opportunity of experiencing first hand what this program had to offer.

Question of the Week
Why do you want to do _____ (insert your specialty of choice)? Why do you want to come to _____ (insert the interviewing program)?

The above are guaranteed questions in just about every residency interview.

Sunday, September 25, 2011

Residency Interview - The First

Just coming off of night shifts, I had a difficult time falling asleep and the anxiety of an interview the next day didn't make things any better. In total I think I may have slept four hours before my alarm sounded at 3am.

St. Barnabas Hospital

I shuffled about my morning activities while the world around me still slept and the crickets chirped. It had been a while since I knotted a tie, but this morning it went on with no problem. I was out the door by 4am and on the road for an early morning cruise to New York. My destination, St. Barnabas Hospital in the Bronx, roughly three hours away. Traffic was nonexistent and the morning fog was the worst obstacle. The hurried feel of New York was obvious as I approached the hospital with people mulling about and a full ambulance bay. I had arrived for my first residency interview.

I was fascinated by the inherent antiquity of the buildings, it gave a sense of being well established in the community. The only person in a suit, I stood out like a sore thumb among those in scrubs and street clothes as I walked the campus. It was apparent that I was there on official business. Shortly after finding the morning meeting place, the faculty lectures and student case reports consumed the early hours of this program introduction. These were followed by a tour of the emergency department and hospital before grabbing lunch that was provided for Employee Appreciation Day.

While it was difficult to digest lunch due to the building anxiety, we conversed with residents and other interviewees about the program. One by one we made our way into the "hot seat" for our personal interviews in front of a panel made up of two residents and two faculty members. The questions were focused around the program and my submitted application, both of which I felt comfortable discussing. I was then given time to ask about the program and before I knew it, we were shaking hands and parting ways. It was a breath of fresh air to have my first interview behind me. I definitely enjoyed the experience and look forward to more like it as I explore the world of emergency medicine residencies.

Question of the Week
You have diagnosed a patient with a terminal illness or must give grave news. How would you share this new information with your patient?

Suggested Consideration

Sunday, September 18, 2011

Night Shift

As I drove home in the early hours of the morning, I was greeted by rays of sunshine peeking through the clouds and flittering on the surface of the harbor waters. Where many people cringe at the thought of staying awake all night to fulfill a work related responsibility, this was my reward for making it through another evening at the hospital.

Call of Duty

The night shift happens when most of the community should be sleeping, yet somehow the hospital emergency department seems to stay lively at all hours. It amazes me sometimes what people will present with at three in the morning; a nagging cough, an ankle injury from the day before or chronic pains that could have been treated during the day at a clinicians office. On the other hand there are those that tend to celebrate the evening hours with brawls, imbibing their favorite alcoholic beverages or driving who knows where at that sleepy hour. So without fail, the emergency room staff assemble to assuage their complaints and injuries. In all honesty, it is not always easy to remain stoic about their complaints as a good laugh helps us stay awake and it just seems uncanny that someone would rather be at the hospital than in their own bed sleeping. Nonetheless, there will be someone there to meet the responsibility of caring for the night owls of the world in that time of need.

Of course there are true emergencies that present to the ED on occasion. The hum-drum feeling can quickly become pell-mell as resources are combined to make a difference for the people that need them most. In a coordinated effort treatment is rendered to expedite the care of the individual in question while the ankle sprains and hang nails take a back seat to the action. The night shift seems to be a different breed of caffeine guzzlers and adrenaline junkies, but when the night has come to an end, everyone scatters to catch up on their sleep and enjoy the serenity of the quiet morning hours before the rest of the world makes their morning commute.

Question of the Week
A 17 year old female is brought to the emergency department by her sister because of pruritic symptoms around her fingers and toes that is worse at night. On exam there are visible excoriations from repetitive scratching. The patient has been living in a women's shelter for several months. She has no past medical history, is not on medication and has no known allergies. A biopsy is taken from the intertriginous space between her fingers. What is the name of the organism responsible for causing her problem?

A. Herpes simplex type I
B. Staphylococcus aureus
C. Sarcoptes scabiei
D. Candida albicans
E. Streptococcus

Answer & Explanation

Sunday, September 11, 2011

A Time for Celebration

Last week may have marked the last exam of my official educational career...assuming I passed. While I can think of no more depressing way of spending my 30th birthday than sitting for a medical school board exam on a rainy day in a foreign city, the celebration of being done was thoroughly enjoyable even if it was only a modest party for one.

Moving Right Along

All I could think was, "finally this exam is done." It has plagued me for so long trying to concentrate on rotations and applying to residency programs. With any luck I will have passed and can move on to worrying about interviews and the upcoming match. It seems like just yesterday one of the upperclassmen was telling me how fast medical school would go by. Of course at the time I couldn't believe the semester would ever come to an end. And now, looking back, we have been so busy that I barely noticed the elapsed time. Although we have not quite reached the summit of this experience, it is definitely in site and attainable at this point.

Reflecting on 30 years seems rather farcical and I wonder if the 20 some years of education has really paid its dividends. Does that mean that medicine can be considered my second career? At this point, I think I am ready to move on to career mode and at least realize a little of the benefits from all of this training even if that means more responsibility. But I am getting ahead of myself. I have yet to be officially told the examination was a success and I still have interviews to attend. Now, more than ever, is the time to sprint to the finish and focus on keeping my game face. There will be more time to celebrate later, but it was nice to pit-stop for a moment and feel human again.

Question of the Week
A 25 year old medical student who was PPD-negative when starting medical school tests PPD-positive after her first ward rotation. As her physician, what is your first step in managing this patient?

A. Repeat the PPD
B. Check her liver function
C. Obtain a sputum sample for culture
D. Order a chest roentgenogram
E. Order a urine culture

Answer & Explanation

Sunday, September 4, 2011

Special Occasions

Some 2,500 miles away, my grandparents will be getting up in a few hours to go about their daily activities including opening their email and finding this delivered to their inbox. They just celebrated a wedding anniversary and today is Grandma's birthday. I want to dedicate this post to them as they have been so supportive throughout the years and especially during medical school.

Grandparents

The first chapter of my career in medicine started on their basement stairs when I was just a child. As the story goes, I am almost done with another chapter in this never ending book. In days, I will be taking another board exam and in weeks I will be starting interviews for residency. Like their significant milestone anniversaries, I am trudging past a few of my own, making small advancements that bring me steps closer to a goal I've had for so long. My grandparents have been there every step of the way, cheering me on, following my progress and feeding the cereal craved fiend inside. If I ever needed something, they were the first to offer a helping hand and always graciously generous when meeting those needs. It's too bad they are already taken, because I think everybody could benefit from the best grandparents in the world.

Through retrospective analysis, I have come to realize one of my weaknesses over the years. In short I have become a "yes" man. When a person requests my services, I have the hardest time turning them away and do what I can to provide for their need. Now I think I know where that comes from. So, Grandma and Grandpa, I want to thank you for all your support, for giving selflessly to see me succeed and for having the best cereal and treat stash I could ever imagine. You two are fantastic and I love you for who you have been in my life and the lives of others. Thank you for your examples of what genuinely caring people can do in this world. I hope you had a wonderful wedding anniversary and Grandma, HAPPY BIRTHDAY! I love you both and thank you for being such an integral part of who and where I am.

Question of the Week
A medical student writes a blog about his fantastic grandparents who are celebrating some incredible moments in life. Which of the following is true about this dedicated, hard working couple?

A. They are celebrating their 62nd wedding anniversary
B. Crossword puzzles are no match for them
C. They are the best grandparents ever
D. They still know how to have a good time
E. All of the above

Answer & Explanation

Sunday, August 28, 2011

Education Beyond the Classroom

Learning the tricks of the medical trade comes from lots of exposure to lectures, books and hands-on experience. Initially we are expected to be attentive to professors who create a basic foundation and then pick up the rest on our own time through personal study and discussion with colleagues. When it comes to the clinical setting, the direct form of teaching dissipates and we carry more of the responsibility to be self taught. Yet there remains plenty of room for a student-teacher relationship. [Classroom at the Washington University School of Medicine 1943]

Learning Through Respect

In speaking with one of the residents at the program I am visiting, he reminded me that not all physicians remember what it is like to be a student. They have forgotten the basics and want to be identified as one who no longer has to be "at that level" of training. In doing so they often seem to have a chip on their shoulder, teach very little to students and ignore even the existence of students trying to be friendly. So doctor, my morning greeting was not an attempt to waste a breath of air, it was intended to be pleasant and acknowledge your existence in hopes that perhaps you would acknowledge mine. Little things like that are what really set a tone in my opinion. It standardizes a sense of mutual respect and understanding allowing for potential growth beyond that point. Maybe it is perceived as a "brown-nosing" tactic wherein I am gunning for a response. Whatever the case, I thought it was a simple common gesture in human interaction. What do I know, I am just a medical student.

Medical students just learn to grow thick skin. Patients give you grief because you are the first person willing to listen to their complaints and desires. After hearing out the patient, the student finally presents to the residents who are the first to think you have set them back because "you must have been delivering a baby in there." If you are not thinking what they are thinking, they will let you know without hesitation that you are wrong. But this mode of action comes from their superiors too. The attendings are looking at them in a similar light but may not always say so out loud. So it only makes sense that the residents become calloused and project their troubles onto the medical student who will smile, be pleasant and always take a verbal lashing for the ever coveted passing grade. All the while the student is thinking, "why do I pay good money to be demoralized in front of patients and coworkers?" We know our end goal and will walk through the gauntlet to get there, even if that means we will be red in the face a few times.

Once in a while, however, there are those who will remember the emotional strain medical students experience. In their wisdom, the residents will slow down and teach or maybe even learn something because we are all in this together. What one person may have recently studied, the other has not heard in a while. This resident remembers the efforts students are making to impress and succeed even if they fall short once in a while. The effects of the classroom extend beyond those four walls into the community and clinics. It has the potential to reside within each relationship we have for better or for worse. I refuse to let my education be compromised by those who have forgotten how a patient teacher can influence an eager student.

Question of the Week
A 24 year old medical student admires and begins to pattern her life after her surgical mentor. Which one of the following defense mechanisms does she exhibit?

A. Introjection
B. Projection
C. Rationalization
D. Identification
E. Conscious Control

Answer & Explanation

Sunday, August 21, 2011

Peanut Butter and Jelly


The gourmet classic of any medical student is obvious; one slice of bread slathered in fruity preserves married to another slice plastered with smashed peanuts. It’s the “go-to” of meals when the cereal box has poured its last bits or the milk carton has gone dry.

The (Un-Starving) Nourished Student

Available on my shelf of kitchen space I have a small variety of cold cereals, half a loaf of bread, half a container of peanut butter and a can of beans. The half shelf in the refrigerator is barely enough room for a half gallon of milk, a handful of bananas, celery and a few remaining hot dogs. The granola bars are used to stock my work bag in case of a snack attack and I have some Tootsie Rolls to complement my meals as a small dessert. There is no question that my in-house meals are lack-luster and definitively not the most nutritious. The occasional meal is had at the hospital or a fast food joint on the way there which is surely not helping my case. I am just now realizing that I don’t even have said jelly on hand…how pathetic is that?!

Just when you thought medicine was about teaching healthy habits, you notice that those who teach it are having a hard time following the rules. Certainly, this does not go for every student as the outliers exist, but if you ask, there is commonly a stock of supplies to make the most basic of meals. Whether short on time to prepare meals, no desire to eat healthier, or an attempt at saving money we are probably not properly filling our fuel reserves. One student I work with is staying in a local hostile making the effort to find the nearest free meal even if it means walking into a nearby hotel for their continental breakfast! The best counsel I heard a while back: “somewhere there is a free lunch, and it is my job to find it.” It holds true, but when the advice proves futile I return to my meals of simplicity with minimal ingredients and little variety. So Mom, no need to worry, I am being fed and there is something from every food group.

Question of the Week

A known alcoholic man presents to the emergency department showing signs of confusion, unsteady gait and horizontal nystagmus. Upon questioning he tells you he does not remember much about the day but just finished eating a meal fit for a king. What is the first step in treatment and what structures are likely being affected?
A. IV glucose, mamillary bodies
B. IV thiamine, hippocampus
C. Oral glucose, hippocampus
D. IV thiamine, mamillary bodies
E. Disulfiram, amygdala

Answer & Explanation

Sunday, August 14, 2011

Digital Medical Instruments for Your Phone

The effect of the smartphone on technological advances is undeniable. With apps for everything these days people are expanding to a peripheral market to expand the functionality of smartphone products. If you are in medicine, there are some fun gadgets you might consider adding to your black bag arsenal of portable instruments.

Smartphone Adjuncts

Of course you could use your phone as a reflex hammer, but that is just not as exciting as having a few gadgets and gizmos on hand. So if you are looking for a medical gift or something to put on your wish list you might consider some of these ideas that are sure to draw some attention from your coworkers. Many of these have either received FDA approval or are in the process of doing so and will be available for purchase soon. The majority of these devices are expanding use beyond the Apple operating system so keep an eye out for developments if you do not already use the iPhone.

Stethoscope
  • Price - $90
  • Designed for iPhone/iPod but it looks like it would function in any headphone jack
  • App not needed
  • Other - iStethoscope Pro app ($0.99), Does not require attachment
Pulse Oximeter
  • Price - Unknown
  • Designed for iPhone and works with Android, Windows etc
  • App required
 Blood Pressure Monitor
  • Price - $130
  • Designed for iPhone, iPad and iPod
  • App required
Electrocardiogram (ECG)
  • Price - Less than $100
  • Designed for iPhone and iPod Touch, plans to be available for other operating systems
  • App required
Blood Glucose Monitor
Dermatoscope
  • Price - $1,200
  • Designed for iPhone 4
  • App required ($5.00) Compatible on iPhone, iPad and iPod Touch. Can be used without the attachment.
Ultrasound
  • Price - $7,500
  • Not currently available on a smartphone but expected to integrate that function eventually
  • Available only to medical professionals and comes with visualization device
The practicality of some of these devices is obvious. When traveling or doing house calls to friends and family they could definitely be useful to have on hand. If you are aware of any similar products, I would love to add them to the list. Please take a minute to comment on them below with any information you have found.

Question of the Week
A mother brings in her 3 year old child for a well-baby office visit. She is concerned her child is not progressing normally because he has not memorized his own name, address and phone number? You explain that children are expected to obtain these skills at which of the following ages?

A. 12 months
B. 3 years
C. 5 years
D. 7 years
E. 9 years

Answer & Explanation

    Sunday, August 7, 2011

    Anti-Medical Meanderings

    All this humid weather has kept me under a fan, in the air conditioning and rarely outside. The times when I am exposed to the elements are usually reserved for travel to my clinical site, exercise and exploration. Here in Miami Beach there is plenty to explore especially since I am coming from a desert.

    Beautiful Exploration

    Taking time out of an already busy schedule to investigate a new location is not always easy, especially when time is limited. When traveling to rotation sites out of my home city, I like to get an idea of what the community has to offer and what attractions may be in the area. On a day off, I drove to the Florida keys. I've always been curious about the tropical environment there with its long stretches of road linking numerous islands. Beautiful skies were complemented by the temperate waters and lush greenery. It was a short lived getaway that I needed. Upon my return to the mainland I pit-stopped on one part of the seemingly never ending beach. The entire coast is Atlantic Ocean beach front covered with tourists, towering resorts and one of the nicest boardwalks I've experienced. City life is bustling and the art deco facades a glimpse of times past. This is definitely a colorful place to experience medicine as the hospital caters to those who live and play here.

    Traveling to places unknown is a challenge when adjusting to the newness of lifestyle and environment. If the residency match places me here, it's nice to know what I am getting myself into. To me that makes the exploratory day trip worth the effort. Getting a sense for the people and their mentality in and outside of the medical setting is key to making what will be a life influencing decision. On the flip side, this is Miami and summer, I don't know how I could have come here and not experienced what this place has to offer! Living among the locals definitely helps get an idea for what there is to do and see. In exchange for all of this I have to learn to live with the humidity which has been tougher than I imagined.

    Question of the Week
    An 8 year old boy with rapidly deteriorating cognitive function is not oriented to time, person, or place. On exam he has nuchal rigidity and a high fever. His mother tells you that he has been swimming in a lake at a campground in Florida. You diagnose the boy with meningoencephalitis. Which of the following represents the most likely infectious agent?

    A. Neisseria meningitidis
    B. Haemophilus influenzae
    C. Streptococcus pneumoniae
    D. Naegleria fowleri
    E. Mycobacterium tuberculosis


    Answer & Explanation

    Sunday, July 31, 2011

    The Start of Audition Rotations

    Let the audition rotations begin. Catching the red eye flight from Las Vegas to Miami was not exactly my idea of fun. Nonetheless, I arrived safely and got a sneak peak at where I will be spending the next month. Literally feet from the water, Mt. Sinai Medical Center serves Miami Beach meeting numerous medical needs.

    Beach-side Medicine

    I was amazed at the number of memorial wings, buildings and structures. This hospital has a long history of providing health care in the community which was demonstrated by the banner at the front entrance sharing the recent news that it provides the best care in geriatrics. This comes as no surprise since the population of retirees is so saturated here. In my brief exploration of the surroundings, however, I did not see too many seniors bathing in the sun and shopping around town. Perhaps I was not on the right side of town. So now I am curious as to who the hospital patient population will be; international tourists, retired seniors or partying youth.

    Every hospital tends to have a unique population set. Some see greater numbers of indigent, immigrants, aged or affluent people. Testing the waters now as a medical student will help me when the time comes to make a residency rank list. Knowing what a program has to offer both in academics and patient presentation can have a significant impact on the education to be received. Fortunately, the programs that are weak in one part of the population often send residents to other facilities to get the exposure needed. Until I actually start my shifts, I suppose I will have to remain in suspense and get used to the humidity we rarely get in the desert. 

    Question of the Week
    A mother brings in her 10 month old child after what she thinks was a seizure. She reports that he was premature and has a history of broken ribs at 6 months of age. On exam you notice his hair to be steel colored and brittle. He appears very malnourished and small for his age. You correctly diagnose him with Menkes disease which has a deficiency of which of the following?

    A. Copper
    B. Biotin
    C. Zinc
    D. Niacin
    E. Pyridoxine

    Answer & Explanation

    Sunday, July 24, 2011

    The Doctor Behind the Curtain

    As the month comes quickly to a close, I reflect on the time I had in the operating room that was definitely an enjoyable experience. At first glance it looks overwhelming, but in time the buttons and monitors have started to make sense. It is no wonder that there is a dedicated individual at the head of any operating table managing a patient's life.

    Sweet Dreams

    There is much more to anesthesia than putting tubes here and wires there. As the photo demonstrates, there is one tower for monitoring the patient while providing life support and another for the medications that assist in that effort. Poles for fluid resuscitation, suctioning for secretions and gizmos for I don't know what that keep a patient happily asleep. It is amazing that so many tools, gadgets and devices can be crammed into such a small space and have such a large impact. There is barely enough room back there for the physician let alone a student to participate and learn. Despite the lack of space, the attendings continually let me interact with intubations, monitoring and interventional  procedures to get the full experience. These docs run a great one-man show and are so full of knowledge that I often could not keep up.

    This niche in medicine will apparently have a 15,000 physician shortage in the year 2020. I hear medical students clamoring to get on board and it seems that the doors may be opening for them. From the physicians who tout the profession, they share their opinion as though it is medicine's best kept secret. They manage only one patient at a time who they rarely seen again, earn a significantly comfortable salary, and between the induction/emergence phases of anesthesia have few complications. On more than one occasion I have noted the relaxed and stressless demeanor of these specialists to be common for the profession. But when patients are in distress, these doctors are collected enough to help carry a patient through more often than not. It has been a good month with plenty to learn.

    Question of the Week
    A 30 year old male presents to the emergency department with muscle rigidity and dyskinesias. You notice he is mute, incontinent, in and out of consciousness, and febrile. He is diagnosed with neuroleptic malignant syndrome. Which of the following would be least useful in the treatment of this patient's symptoms?

    A. Admission to the hospital
    B. Replenishment of IV fluids
    C. Administration of bromocriptine
    D. Administration of dantrolene sodium
    E. Administration of haloperidol

    Answer & Explanation

    Sunday, July 17, 2011

    Being Prepared

    While sitting at my desk peacefully studying for the upcoming board exam, I heard the rubber of tires sliding across pavement punctuated by an unmistakable thud. Someone hit something and it was right outside my door. I jumped into action having no idea what I would find, and relying on the limited medical training I already had. 

    Responding Empty-Handed but Full-Headed

    It didn't take long to realize that the young man driving was distraught by the apologies he was spewing at the man who lay on the ground in pain and shock. To make things worse, the man's dog was only feet away showing no signs of life. With no traffic around, I made my way to the middle of the intersection as a first responder to assess the situation. Two patients: both alive, one clearly injured and the other in a state of hysteria. The police arrived shortly thereafter to control traffic, call for medics and calm the driver. My training took over and after a quick introduction to the injured man I began a rapid trauma assessment looking for injuries from head to toe. Once it was determined that there were no obvious life threats, I focused on those things that he could identify as bothersome. With no equipment to dress his wounds, I started taking a medical history to keep his mind off of the loss of his dog and to provide the medical crew when they arrived. It was sad to see the aftermath of an unintended event and I can only imagine how it will change their lives forever.

    Moments such as this benefit from the "what if" game I have played so often. Never knowing when I will have to use my training keeps me in a constant state of preparedness. It's an awful thing when people become injured or ill, but knowing how to help in that time of need is a comforting feeling. A feeling that I would rather have than that of helplessness when it matters most. I will likely never hear from the individuals involved in this particular incident, but the satisfaction of being prepared was fulfilling enough to know that I am slowly learning that which I need to and understanding how to apply it in practical situations. It was another affirmation that my pursuit of emergency medicine is not in vain.

    Question of the Week
    All of the following are surgical emergencies EXCEPT:

    A. A tense swollen foot that was run over by a car. There are no fractures but the patient is in severe pain and has pain with passive toe extension.
    B. A tibia fracture with a small pinhole in the skin over the fracture site that drains blood containing fat droplets.
    C. A knee dislocation with no fractures, but a cold pulseless foot.
    D. A supracondylar humerus fracture in a ten-year-old with decreased sensation in the median nerve distribution.
    E. A distal radius fracture in a five-year-old with obvious visual deformity and intra-articular displacement.

    Answer & Explanation

    Sunday, July 10, 2011

    The Art of an Operating Room

    For whatever reason, I missed out on a general surgery rotation in my third year of medical school. It was replaced by random surgical specialties which were educational, but did not cover the basics of surgery. Now that I am rotating with anesthesia, I am seeing a larger variety of surgery than I could have imagined.

    Effects of Cold Steel

    In only a week's time I have observed surgeries from head to toe and everything in between. Some abbreviated and others extensive. All bring their own sense of fascination as they are usually a definitive treatment for the patient's particular condition. On numerous occasions I was able to witness cases that I thought were simply for the textbooks; in other words, those that rarely make their way into the operating room. Skin grafting, thyroglossal duct cyst removal, gangrenous cholecystectomy, thoracotomy, colectomy, craniotomy to name some that have stood out. After meeting up with the anesthesiologist and putting the patient to sleep, I stick around if the case has some educational appeal. Since I never had the traditional general surgery rotation, I am doubling up this month to get the most possible from this experience.

    Life in the O.R. is an array of medical art. Everyone has a role and moves to fill it with precision. The colors of contrasting sterile blue against blood red seem to glow under the lights while everyone mysteriously peers over their masks. Instruments shimmer in cleanliness as they move to and from the operating field. The sounds of monitors keeping pace, instruments doing their job and personnel collaborating fills the silence creating an ambient effect. In concert everyone works together to see that the patient has a positive outcome. It's a beautiful place to observe and learn, it's a place where things get done. 

    Question of the Week
    A febrile 12-year-old child presents with severe right lower quadrant
    pain that is interpreted by the attending physician as acute appendicitis.
    The patient has also been complaining of joint pain. At laparotomy, the
    surgeon notes that the appendix is normal; however, the mesenteric lymph
    nodes are markedly enlarged and contain focal areas of microabscess
    formation on cut section. This patient is most likely

    A. An asthmatic
    B. Deficient in C1 esterase inhibitor activity
    C. HLA-B27 positive
    D. Leukopenic
    E. Serologically positive for toxoplasmosis

    Answer & Explanation

    Sunday, July 3, 2011

    Anesthesia 101

    After introducing myself to the anesthesiologist I would be working with for the day he quipped, "I'm not an intubation monkey, you are going to learn something this month." With many years under his belt and all the students he has seen, I had a feeling he was speaking from experience. He taught and I learned from the best writing space available, his knee.

    Moving Forward

    Some have said that fourth year is the apology for the first three years of medical school. We get more freedom to explore our interests and roam about the country finding residency programs worth our time. At last we get a little autonomy and it was for this reason I chose to do anesthesia early in my fourth year. Since I plan to go into emergency medicine, it will help me with sedations, analgesia, medications and airway management via intubations. (Apparently, Dr. Anesthesiologist saw right through that one.) Fortunately, I had no problem with the first tube of the day and we were rather productive as far as teacher and student are concerned.

    It seems that for the most part, anesthesia is a calm environment at the head of the table hidden behind the sterile drapes. It consists of mostly monitors, charting and pharmacologic management of the surgical patient. On rare occasions things get a little hairy and I was fortunate enough to experience one such event on the first day. Fortunate because it brings a new understanding to the profession. The patient was dying and the anxious surgeon was eager to start the case. But before anything could happen the patient needed to be resuscitated or the surgery would be futile. Tensions ran high for a short time, but through focused efforts the patient responded to treatment and the surgery was performed as planned with no complications.

    Every rotation seems to have significant learning potential and I doubt this one will be any different. I look forward to a busy and productive fourth year. It also happens to be my last year as a tuition paying student which is quite a happy thought.

    Question of the Week
    A patient becomes cyanotic, has profuse sweating, an unstable blood pressure, and a temperature of 106°F two to three minutes after induction of general anesthesia with halothane. Appropriate intervention would consist of respiratory support and the administration of which of the following?

    A. Succinylcholine
    B. Dantrolene
    C. Acetominophen
    D. Hydrocortisone
    E. Epinephrine

    Answer & Explanation

    Sunday, June 26, 2011

    Things I Wish I Knew - Third Year

    And now for one of my favorite posts of the year; taking a look back at everything I have experienced and attempting to come up with a few things that helped me succeed. I would like to invite you to share your input as I may have overlooked a number of useful ideas. As in years past, I am including my weekly intensity chart.

    The Year Reviewed

    I will be the first to admit that this year's intensity chart has little benefit to anyone but myself. Everyone experiences rotations in different orders and each has a varied feel depending on site, preceptor and specialty. For the most part it was on a steady continuum. The occasional peaks and troughs were likely tests or vacations respectively. The large dip representing my vacation month when I was recovering from surgery and the recent peaks reflecting weeks that I left nothing to chance on elective rotations in emergency medicine. These later markings also show stress that has been mounting in anticipation for board examinations. Without further delay, below are those things which I wish I knew coming into third year.
    1. Maintain an open mind - Every specialty has something to offer, even if you are not enthusiastically interested in the field. You never know when a lesson learned from a particular patient will come in handy on another rotation or even later in your career. There is always something to be learned, even if you are not fascinated by the work before you.
    2. Participate actively - It is easy to observe and nod your head when preceptors carry about their normal activities. Encourage them to teach by asking thoughtful questions or volunteering to participate in procedures. One night during my studies I watched how to place a central line only to be asked the following day if I knew the steps. Because I was familiar with the procedure I was given the opportunity to place the line and have been entrusted numerous times since then. Always be ready to step in to answer questions or use your hands and actively learn.
    3. Avoid easy rotations - Every now and then it is nice to have a rotation that demands less, but too many of these can be detrimental. This is the best time to interact with patients, perform procedures and learn from attendings. We pay good money to be in clinics and hospitals, why read about the diseases when they are in the room next door ready to be seen first hand. Even if you are on an "easy" rotation, push yourself to take advantage of the little time you are there, you can read later when you get home.
    4. Pace yourself - There is more information than you can possibly consume in a few short weeks about any one subject. Start studying the specialty early on in the rotation and regularly review the "bread and butter" topics. By the end of your time there you may become exhausted when shelf exams are just around the corner. Cramming for the end of rotation exams is not going to help you in your career as much as regular study.
    5. Enjoy your time off - It is really easy to get swamped by the books, board exams and stress of preparing for residency. There is a little more time in third year to break away from school and it can be a perfect therapy for all the stress that will inevitably mount. Be sure to have regular time set aside for exercise and breaks. Work hard, play hard.
    Question of the Week
    A 67 year old male patient presents with mild confusion, diarrhea, and a new skin rash. These symptoms have been present for 1 week according to the patient's wife. What is the most likely nutritional deficiency that this patient is experiencing?

    A. Vitamin B1
    B. Vitamin B2
    C. Vitamin B3
    D. Vitamin B5
    E. Vitamin B6


    Answer & Explanation

    Sunday, June 19, 2011

    Good News Test Results

    Despite the normal challenges of being on rotation, this week had at least one positive outcome. Like the good ol' days when report cards made their way to the refrigerator door, so did the test results of my most recent exam. It was partly for nostalgic effect and partly because this was by far the most expensive exam I had ever taken. Tabulated expenses were a total of $1,500!

    COMLEX Level 2 PE

    Being that this test was among the medical school series of board exams, it comes as no surprise that the results were a relief. The examination itself was not horrific, but the cost was ghastly. I was more worried about having to fork out another payment than studying all over again should I have to retake it. I now feel one step closer to graduation and have only one more exam remaining to make it out of medical school as a doctor. That is a really good feeling that is going to be much better when the next board examination is behind me.

    Preparing for the exam was not as difficult as I expected. Classmates and I would get together a couple times each week for a month and perform timed practice scenarios from the book First Aid for the USMLE Step 2 CS. Taking turns as patient and doctor, we slowly got into a rhythm that would set the pace for exam day. The video orientation on the NBOME website provided test site details that helped to plan resources and expectations on test day. The rest was a matter of showing up for the exam on time and keeping calm. Faster than I expected, the day was over and weeks later I have my passing grade. Two board exams down, one more to go.

    Question of the Week
    A 19 year old male comes to your clinic complaining of a sore throat with no cough for the last three days. Vital signs are normal except an elevated temperature. On exam you note the patient has "kissing tonsils" with exudate and cervical lymphadenopathy. If this patient did not receive treatment at this time, he would be at risk for which of the following conditions?

    A. Subacute Sclerosing Panencephalitis
    B. Wegner's Granulomatosis
    C. Membranoproliferative Glomerulonephritis
    D. Rheumatic Heart Disease
    E. Ch├ędiak–Higashi Syndrome

    Answer & Explanation

    Monday, June 13, 2011

    Providing Fresh Air

    I have yet another first to add to my list of many as I trudge along the med student life. Like many, this one is procedural. In emergency medicine the procedures continue to accumulate the longer you are there. I think it falls into the "see one, do one, teach one" mantra.

    Rapid Sequence Intubation

    With little success at my previous attempts, intubations were starting to concern me when I could only see the epiglottis and no vocal cords. That was the closest I came before patients would start to lose oxygen and the attending moved in to finish the job. After wondering why I was going to an extra shift last week, I was glad it fit into my schedule. We had a patient with respiratory distress needing rapid intubation. Despite their predetermined status as a "difficult" airway, my attending gave me the opportunity to perform the skill. Focused and determined to finally have a successful intubation, I meticulously placed the endotracheal tube on my first attempt...in the right place! In a specialty where airway management is critical and a career of it ahead of me, it is nice to see where my first success actually occurred.

    The physician with whom I was working mentioned the day before, "you have to respect the difficult airway." Although I may not completely understand that statement at this point in my career, I know that the skill is important enough to appreciate pitfalls and workarounds. My extra shift turned out to be rewarding on this particular occasion. A simple procedure to some happened to be another milestone in my book.

    Question of the Week
    A dialysis patient has missed their routine treatment and is now currently in respiratory distress as a result. You choose to intubate the patient. In preparation for this procedure, the use of which of the following paralytic medications would be discouraged?

    A. Succinylcholine
    B. Rocuronium
    C. Vecuronium
    D. Pancuronium
    E. Rapacuronium

    Answer & Explanation

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