How to turn down an interview invite

December 21, 2007 at 8:07 pm (Applying to med school)

As December winds down, the interview season for medical schools is in full swing. Although your semester is over, the admissions committees are working furiously to try to build next year’s class. Since you are a reader of this blog I expect that you’re smart enough to have gotten multiple interview invites. I also don’t doubt that you have several acceptances at this point, too. Many of the invitations for Spring interviews will come from schools that are part of your backup plan.

Instead of spending another $500 on airfare and hotel accommodations, you’ve realized at this point where you’re willing to go to and where you’re not willing to attend. Therefore, you need to let schools down gently when you alert them that you won’t be interviewing there during the next semester. Your goal is to be cordial to these medical schools so that you keep an open relationship with them. Since you’ll have to decline their invitation in writing, I suggest you use the following template:

Dear Admissions Committee,

After a thorough consideration of your university, I have decided not to attend your institute. With over 120 medical schools, the competition was fierce this year. In the end, I had to select the school that would most closely match my goals for residency. This letter is not meant to say that you can’t turn out great physicians. It’s just to say that I got accepted to a better school. And by “better” I mean higher ranked school.

Good luck in your admissions process. I’m sure that with your stats, you’ll find someone willing to go there.

Soon-to-be M.D.

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All this work, only to be outdone by a bag of Oreos

December 18, 2007 at 10:04 pm (Clinical rotations)

When Claire got admitted to the hospital for pneumonia, I knew we were in for quite a long hospital stay. Claire was morbidly obese (her BMI was 51) and although 31-years-old, she had more damage done to her body in the previous three months than most members of the AARP had experienced over their lifetimes.

At my hospital we have a diagnosis known as the “trifecta” in which a patient has hypertension, high cholesterol, and diabetes. Claire had the trifecta. Everyday we tried delicately to manage her sugars; unfortunately, we were losing the battle. Each morning I read off her chart as her blood sugar measurements from the day before were 262, 280, 230, 305. We tried desperately to get her sugars down and threw insulin at her as if it were I.V. saline. Her body was impervious. It was as if the cells in her body were made of Teflon and no insulin could ever penetrate them.

We scratched our heads over her predicament and wonder just how someone can build up a tolerance to insulin. We had her on a no-carb diabetic diet throughout the day and gave her only water and coffee to drink. Finally, on the fourth day of admission, I asked her why her sugars were so high and if she’d been sneaking food. She confided in me that her friends and family visit her at night and bring in cake, cookies, brownies, and anything else they can get their hands on. As she said, “I like to eat.”

We were all greatly annoyed. Here we’ve spent all this effort on trying to manage her diabetes, only to be outdone by a bag of Oreos. Likewise, many patients throughout the hospital are grappling with similar issues of neglect. A lifelong smoker comes in to the clinic to be told that he has lung cancer and then cries out, “How could this be? Was it something that I did? I feel like it’s all my fault.” Naturally, physicians have to put on a professional air around their patients and passionately explained to them that there are many factors which go into causing cancer. In reality, I just want to scream out, “Did you ever bothered to read the side of the box? It says right there it causes cancer.”

I’m constantly amazed by politicians who claim that we need free, universal health care available to everyone in the United States. And somehow, all Americans will instantly become healthy, will give up high fructose corn syrup, and will take up jogging three times a week. Presidential candidates from all political spectrums tout preventative medicine as if it’s some kind of cure to all of the country’s woes. As Claire demonstrated, if people want to eat, they’re going to eat.

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How to make money off of the HPSP program

December 17, 2007 at 11:03 pm (Military medicine)

The military’s HPSP scholarship program pays for all expenses related to medical school training including tuition, books, and necessary supplies such as a stethoscope. The scholarship fund also provides money for room and board in the form of an annual salary. Currently, the military pays us just over $21,000 a year. While this amount sounds like a lot for a student, it is hardly enough to get by when attending a school in a major urban area. A few weeks ago I had a realization that military students can use the HPSP program to their benefit and generate additional income through investing.

The Department of Education currently allows graduate and professional students to take out federally subsidized loans up to $8,500 each academic year. That’s a free loan. And for students who can invest the money, all of the profits made off of the interest is theirs to keep.

Let’s say I withdraw $8,500 annually and invest the money, for a grand total of $34,000 borrowed over the course of four years. For this scenario, I will pay back all of my student loans the day I graduate medical school. I started running some numbers and here’s what I found:

If I invest in a relatively safe mutual fund that has a 7% gain each year, I’ll graduate with just over $40,000. That’s $6,000 for free. Now that may not sound like a lot, but six grand can pay for quite a few toys leading up to residency.

If I invest in a high yield mutual fund and it brings in 20% a year (and there are quite a few of those), I’ll finish with $54,000-a total profit of $20,000! Now that’s a new car.

I wish I had thought of this scheme when I first started medical school. I’ve already filed my FAFSA and am waiting to hear back on withdrawing a lone starting in the spring semester. If my calculations are correct, I might be able to pull in between $1,000-$5,000.

I wonder if anyone else has thought up this idea. I haven’t seen it online anywhere, but I’m sure that other students have tried it before.

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The military match results are in. No one cares.

December 17, 2007 at 12:54 am (Military medicine)

Every year medical students in the HPSP program as well as students from the Uniformed Services University (USUHS) must participate in the military’s residency match program. The military’s match program is loosely based upon its civilian counterpart. For example, program directors take into consideration grades, board scores, research publications, interviews, etc… However, just like everything else in the military, the armed forces has found away to formalize the process to such a high degree of micromanagement that the entire system is no longer meaningful. For medical students entering in the military match program, they have to wade through a confusing point system that churns out an score for all applicants based on factors such as class rank, prior military service, and “ability to become an officer.” Further, residency program directors have no control over who actually gets selected to attend their particular institute. Instead, a group of the three services’ top leaders convene one week during the fall and decide the fate of all military medical students. The whole process is rather nerve-racking for those of us in the HPSP program. This past week, the military once again held its annual match and crushed the dreams of many people seeking to enter their desired specialties.

The Air Force released its results on a public website in the form of an Excel spreadsheet. Out of privacy concerns for others, I will not reproduce that website here. However, I’m sure that he do some searching around you can find it yourself. Looking over that chart I noticed that over 25% of medical students are matching into flight surgery. For those of you who don’t know, flight surgery involves a one-year internship, six weeks of flying lessons and aerospace medicine, and then it’s off to the clinic to work as an attending. Certainly, anyone reading this blog will instantly realize that flight surgeons are missing out on a lot of valuable training in residency. By granting only one year of training, the military is creating an entire generation of physicians who aren’t fully prepared to become doctors.

For the Air Force, flight surgery is a wastebasket to force all non-matching students into a particular field of medicine. The title “flight surgery” is a misnomer. It has little to do with flying, and nothing to do with surgery. While I will grant that some people are willing to enter this field, surely 1/4 of applicants do not want to have an internship serve as their terminal training.

For the rare student who did match to his chosen field, he can breathe a sigh of relief as his senior year in school is over. But for those students who did not match into their chosen field or location, the next 5+ years are going to be very difficult. Each year that passes I grow more and more nervous about not getting the field that I want, and getting forced into flight surgery. While the prospect of learning how to fly is appealing, more than anything I just want to be a practicing physician. I’ve mentioned earlier on this website about the problems of taking the HPSP scholarship. However, money is not the only issue. Upon learning that I have no control over my future training, I feel as if the military has led us all into one great big lie.

I’m bound to get hate mail from the “patriots.” I signed up with every intention to serve. However I didn’t think that the military would deceive me over the amount of education that I would receive. Further, my role in the military is to be the best doctor I can be. And without that extra training, I’m doing a real disservice to the nation’s soldiers.

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1-800-IDEA-MAN: Requiring work experience before entering medical school

December 14, 2007 at 11:32 pm (1-800-IDEA-MAN)

Before entering graduate business school, applicants must spend a minimum of two years in the corporate world gaining experience and applying the knowledge earned from the undergraduate career. I’ve been thinking more and more recently that medical schools should take the same approach. For starters, we have too many immature people that enter medical school. For example, in my class, the vast majority of the students were accepted directly out of college and were only 22-years-old. Their lack of leadership and work experience showed from the very first day of classes. However, that ignorance and inexperience is now more apparent during the third year than ever before. Now I’ve come to the realization that medical schools should require several years of postbaccalaureate experience before even considering applicants. My take on it is that the whole dynamic of the medical profession would change simply by requiring work experience as an entry to the field.

In my case, I used to be an engineer before coming to medical school. I can use my engineering mindset as a problem solver to get around many issues that I come across on the wards. I can anticipate problems based on prior incidents and adapt to become more efficient in the future. One of my classmates was an investment banker. His knowledge of finance is astounding, and I would gladly trust him with the school’s budget so that he could deliver to us better health fairs and an outstanding graduation party.

Unfortunately, the vast majority of medical students have no touch with the outside world. For them the half study/half party life of college gets translated into the half study/half party life of medical school, which then leads to disastrous results. In addition to the disenchantment that so many medical students experience, there are a small minority that leave the field altogether before completing the four years. Many students feel as if they are being abused-and rightfully so. This dissatisfaction with the American medical schools is at an all-time high. However, requiring work experience would change several things:

Students would no longer accept inefficiencies. The current method of training involves long class hours, Physicianship Training sessions, and endless rounding on the wards, that only leads to scutwork and a secretary-like lifestyle. A new breed of medical students with real-world experience in hand would never tolerate this bullshit. They would demand that class be run more efficiently. They would realize that courses in ethics and professionalism are unnecessary because either students are ethical and professional before school starts, or they are not ethical and professional, and no amount of lecturing will ever change that. They would not accept scutwork as a method of “training.” They would demand that techs be hired to take the place of holding retractors, calling consults, and fetching old medical records.

This new breed of students would lead to a new breed of residents which in turn, would lead to a new breed of attendings. Those would be the type of attendings I would want working on me.

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How to behave on an interview 2: rankings

December 12, 2007 at 11:59 pm (Applying to med school)

I’ve begun working with the admissions committee again this year. I meet with applicant’s steering their lunch break and discuss with them the merits of our program. While most students are very nervous about the prospects of interviewing at a medical school, a few people are able to give us questions about life at our university. While subjects such as housing, scholarships, and even dating are to be expected, there is a few things that you should never ask during an interview—even if the medical students that are providing lunch promise they won’t go back to the admissions committee. This past week I had a one student who’s very first question of the afternoon was, “Why isn’t your school ranked higher in the rankings?”

Upon hearing his question, I wanted to jump across the table and beat them over the head with his orientation folder. Naturally my first response is to scream out, “Does it matter what our ranking is? You would come here regardless of what we were ranked if we were your only acceptance!”

For the education of my readers, let me explain to you why using the results of a ranking system such as U.S. News & World Report is bad for applying to medical school. While university administrators and even students and alumni look to the ranking systems is boasting the quality of their education, using a pop culture magazine to dictate your future educational endeavors is like asking a used car salesman if you need to purchase a new vehicle. These ranking systems are bad for several reasons.

First, let’s take a look at what the U.S. News & World Report uses in its algorithm.

1. Peer assessment by deans and residency program directors.

2. Money received in the form of research grants from the National Institutes of Health.

3. Mean MCAT, GPA, and acceptance rate.

4. Student:faculty ratio.

The peer assessment is largely based upon the title of the university and fame, rather than direct contact between the deans and the faculty and students at other universities. An administrator at a Northeastern university would be hard-pressed to discuss the merits and pitfalls of the program in the Midwest. Therefore, it’s a wonder why so much weight is put upon a popularity contest.

Looking at the money issue, we can immediately see problems with using NIH grants as the sole indicator of a university’s ability to perform research. There are numerous organizations besides NIH that provide grant money for medical research, including the Environmental Protection Agency, the National Science Foundation, the military, and others. In addition, private donations are not included as part of research funding according to the U.S. News & World Report rankings. A university could receive a donation of well over $100 million from a philanthropist, yet that money will never play a role in the school’s ranking.

Further, the amount of money that a particular university pulls in for funding does not tell the applicant if the research that is conducted at that program is even interesting or in-line with one’s professional goals. For example, a school can pull in over $30 million in funding for genetics research, but if the student isn’t interested in genetics that funding is meaningless.

While the MCAT and GPA are useful for applicants to determine where their scores are a fit, these numbers are the only part of the ranking system which is controlled by the students who attend the university. The acceptance rate is problematic for two reasons: out-of-state students rarely apply to expensive private schools, and popular universities such as the Ivy League will receive more applications than state schools, perpetuating the very numbers that push them higher in the rankings.

Finally, the student:faculty ratio is by far the most worthless piece of data in the U.S. News & World Report ranking system because it sets up a false sense of what the class size will be in medical school. For the first two years, most students will sit in a large auditorium with 100 other people—and only one lecturer. So whether this student:faculty ratio is 8 or 16 is meaningless because you will always sit in an auditorium with only one faculty member and 100 classmates.

You’ll notice immediately that the rankings do not include any information such as student evaluations of teachers, clinical experience, or even the average USMLE scores. I would argue that these three factors are the most important determinants of where an applicant should go to medical school.

So the next time you’re on an interview, remember that rankings are of little importance for applying to medical school. And if you should ever ask, “Why isn’t your school ranked higher in the rankings,” don’t be surprised if you get hit in the head with an orientation folder.

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The type of people you meet in medical school, part 3

December 9, 2007 at 9:45 am (1st and 2nd year)

In the past I’ve written about characters you’ll come across in medical school such as Patient Killer and Surgio. This week I want to address the God Squad, a group of fundamentalist Christians who are so hard-core in their beliefs that they make Billy Graham seem like a Pagan.

This is the group who schedules Spring Break trips to Latin American countries in an effort to convert the Spanish-speaking savages to their way of thinking. Awkwardness abounds when they finally realize that 99% of the residents are already Catholic. As witnessed, “You must turn from your god Haysus and believe in Jesus!”

In class, these people are the groaners whenever a lecturer mentions evolution, abortion, or women’s equality. First, women started wearing pants. It’s straight to devil worship from there.

Anatomy lab becomes problematic when they see a naked person for the first time. (I actually know a girl in my class who sincerely wished that she had been married before beginning medical school so that the first penis she would have to see would have belonged to her husband.) If paired with one of the prudes, expect a conversation like this:

Her: Is that the penis?

Me: Yes.

Her: Do they all leak like that?

Me: Yes, all penises leak embalming fluid. But it usually occurs only during ejaculation. That’s why women are so stiff after sex.

Luckily, schools are able to put a dampening on prostletyzing patients so things don’t get too out of hand. But watch out when Dan Brown’s Angels and Demons comes out in theaters…

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The puppets of medicine

December 6, 2007 at 6:05 pm (Clinical rotations)

I got my evaluations back today for internal medicine. On the whole I did well… except for the eval from my resident. She’s a fresh-off-the-boat foreign medical graduate who doesn’t understand how grade inflation works in the United States. She pulled me aside and said, “You did very well. I gave you a C.” Her comments section was loaded with praise, saying, “Very knowledgeable, works well with the team.” Under the needs to improve section, she had only one word: “unenthusiastic.” She told me, “I know you don’t want to do medicine, but you need to smile more on rounds.”

What!?! Rounds take four hours. I’m not some cheerleader who can come in and say, “Hooray medicine! Goooooo team!” Faking a smile is difficult when my job of pre-rounding is done by 7:00am and the rest of the morning is spent standing in the back of a crowd while my attending opines on starting another anti-hypertensive medication on our patient with the blood pressure of 140/80. Most of my time on rounds is spent fantasizing about having a threesome with my resident—who, might I add, is only minimally attractive at best, yet holds a lot of power over my evaluation.

In medical training we use the Socratic method to teach students. While the method is to find knowledge gaps and fill the holes in a young doctor’s education, the whole ordeal gets to be rather intimidating when the attending is interrupting the student and saying, “What are the components of Ranson’s criteria for pancreatitis?” or “What’s the half-life of labetolol?” Students call this method “pimping” because it’s such a humbling experience to have your ignorance broadcast to the entire team.

In a classic example of pimping this week, my attending wanted to see the differential diagnosis of pancreatitis. I admitted a woman to the hospital with severe upper abdominal pain. My attending asked, “Why don’t you think she’s having pericarditis?”

Me: Because the EKG is not consistent with pericarditis, she has not had any recent illnesses, she has no chest pain, and there isn’t a friction rub heard on physical exam.

Her: That’s right, she doesn’t have pericarditis. I just wanted to make sure that you knew that.

Well she’s not having a stroke, either. Would you like me to tell you why?

The good news is that I put together a patient tracking form to simplify my life on the wards. You’ll notice that I used the medfools card as an inspiration. Their card isn’t very useful for me because (1) it’s two pages and I can’t print double-sided, (2) the cards are too busy and loaded with too many forms I wouldn’t find useful, and (3) the checkboxes take up too much space for a medical student. Only an intern would need to accomplish that many tasks.

In the future, I’m going to make the boxes editable so that users can print out a nicely printed tracking sheet.

Patient tracking form

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