PGY1: It’s Tired in Here.

I’m feeling blurbish today, so I’m just going to write a series of poignant pointers, except instead of being poignant, they’ll just be fine.

Moving.  As with med school, get all the stuff taken care of that you can before residency starts – register your car, get your SSRI’s and methylphenidate transferred to a local pharmacy, join a local rec center team but tell them you’ll never be there.  Expect to spend a lot of money moving and getting settled into your new place.

Responsibility.  Programs differ in their philosophy of how much responsibility they give to new residents, but regardless of how much or how little they give, it feels weird to be at the helm of it.  It’s uncomfortable and frustrating and you can feel somewhat abandoned, at times.  The best advice I can offer is to find the senior residents that are willing to answer questions and ask A LOT of questions.  I think there’s a tendency to want to be uninvasive, but also to say “sure, I can handle that” but not realize what questions you need to ask until you’re by yourself and it’s “after hours.”  So you have to learn to anticipate things and ask about the “what ifs” beforehand.  And know that sometimes it just sucks, but it sucks for everyone at times, not just you.

"Do you have any advance directives? Would you like some?"

“Do you have any advance directives? Would you like some?”

Surgical Pathology. We have a cutting manual at our program, but I think Susan Lester’s Manual of Surgical Pathology is a pretty tremendous book for people starting in Surg Path.  The only advice I can offer is to look at the OR schedule the day before your gross day and read up on how to gross/sample the big stuff that’s coming. As for previewing for sign-out, Diane Molavi’s The Practice of Surgical Pathology is a fantastic primer on the majority of big and small stuff, without going into the details you may want to delve into after you get your feet wet.

Step 3.  I was told, “pick a light rotation month (even better if you have two in a row) like autopsy or blood bank fairly early in first year, to study for and take Step 3, because the farther out you get from med school, the less you’ll remember the clinical stuff that’s tested on the exam.”  Of course autopsy (and probably all rotations) can be quite variable in terms of workload, just don’t plan on getting your studying done on Surg Path, if avoidable.  As a reference point for other pathology residents who won’t have the clinical background of the majority of our intern peers, here’s my performance.  I got a 246 and 249 on Steps 1 and 2.  To prepare for Step 3, I did about 60% of the Qbank on UWorld and averaged about 60%.  I got a 214 on the real thing with 222 being average with a 16 SD.  Obviously not a score to brag about, but my goal was to pass and I had 3 weeks’ worth of evenings to study, so I’m fine with that.  There may be some fellowships out there that put stock into Step 3, but I’ve been told by several reliable people that no one cares about your Step 3 score (in Pathology).

"Standardized exams have led me to believe that you have a pituitary tumor of some kind. All of you."

“Standardized exams have led me to believe that you have a pituitary tumor of some kind. All of you.  And so do I.”

Futility: Step 3, Part 2: First Blood.  As an aside, what a complete racket the Step exams are.  They are proffered under the guise of standardization, but the LCME is already setting standards for US Med schools.  MOST students/graduates pass the exams.  A scenario where a student passes 4 years of medical training but can’t pass a multiple choice exam in one day should not exist – either the med school has a problem (and should be caught by the LCME) or the test is not a true measure of physicianship, WHICH IT ISN’T.  Having a standardized exam for students/graduates of non-US med schools who want to practice in the US makes sense, as they may have very different standards for passing, but adding more and more expensive means of double, triple, and quadruple checking that a physician can pass a MCQ (regardless of the fact that they are succeeding in a standardized medical school curriculum) makes one’s eyebrow raise up so high that it departs from your face and takes a night shift at McDonald’s to help pay for these computer-based spinal injuries.  Or maybe I’m just bitter that I have actual job-specific skills to learn, but had to spend a month preparing for an exam that will never have significant relevance to my career.

Anyways.  I’m about 6 months into residency and those are the points I’ll offer to next years’ first-years when they inevitably ask, “what the hell?”  Except that I’ll probably gripe longer and even more futilely about standardized exams.

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Commencement Address 2015

Good afternoon, I’m Anonymous McGillicutty, graduate from the Salina campus, and I’m going into pathology.  I’d like to start off by addressing a stereotype of pathologists: because they interact with patients far less than most other specialties, people work backwards from that and conclude that they must be poor communicators, bad at public speaking, and that something unsettling happens when one is behind a podium.  As an aspiring young pathologist, I am here to confirm those stereotypes.

Four years ago, KUMed started two 4-year branch campuses, with Salina being one of those.  We have 8 students per class and receive live lectures from KC via interactive TV, with microphones to ask questions on both ends.  It was new for KU Med and certainly new to us: we were told “you are not guinea pigs” which, early on, felt like being a rat in a science lab and the lead scientist tells the rats “you are NOT guinea pigs,” and they think, “well, technically, ‘no,’ but…”

We also heard that two different TV producers approached our director about basing a reality show on us in our tiny, new med school.  We joked about how awful and boring the show would’ve been, but as time went on, we realized, it would’ve been even more awful and boring than we ever could’ve imagined.  But two of us came to med school with children, one of us swore off all things children and is now going into pediatrics, one was married just before med school, one is marrying a Wichita student, two of us married each other, one of us got her groove back, and all of us had to deal with our collective ADD, OCD, IBS, hirsutism, sleep disorders, and many other “not otherwise specified” maladies, so it may have been more entertaining than I initially let on.

And now I will transition the way a stereotypical pathologist would transition, and just tell you that I’m changing the subject: the philosophy of the medical student changes over time.  When you start med school, you’re an idealist, attributing the loftiest ideals to your new vocation with almost no foundation in reality, and when a seasoned MD leads your first small group session, they look at you and with a knowing smile, ask “what is wrong with you?”

In the first two years of med school, you become an empiricist, or scientist: frantically learning the objective facts behind medicine through basic sciences and anatomy.  After two solid years of studying, your reward is even more studying for your first board exam, and you reach an epistemological crisis: you don’t even know what knowledge is anymore.  You’re studying for the fifth 12-hour day in a row and you realize that you don’t know how to read, and you never did, and you don’t know how you faked it for this long, but you definitely did.

After taking the first board exam, you start to turn back into a human, ready to bring your brazen altruism to third year, the clerkship year.  You have new responsibilities, what you’re doing finally resembles the medicine you dreamed of, you get to see patients, and it’s amazing.  And then the fatigue and the constant ignorance catch up to you and as a defense mechanism you start dabbling in one of those weird philosophies where you think you’re the only person that really exists and everything else is just a figment of your exhausted imagination.  You become enemies with the clock on the wall and frequently find yourself asking, “where did this blood come from?”

Before you know it, you’re a 4th year student.  You’re much smarter than you were a year ago, but in only a day’s time you can forget everything you once knew so well.  One month, you’re all over the United States doing residency interviews; the next you’re in one spot in western Kansas.  You’re everywhere and you’re nowhere, you know everything and you don’t know anything.  Now an existentialist, you look to the sky and ask “Who am I, and why am I here?”

And now we’re ready to take on a whole new set of challenges and we have to ask for our loved ones support, once again, as we embark on this new journey.

Thank you to all of the KU Med faculty and staff who helped us so much along the way and thank you for supporting the Salina campus and making yourselves available to us over the years.  Thanks to those of you that traveled to Salina to deliver lectures or meet our clerkship directors.  And a very profound thank you to the faculty and staff in Salina.  From day one, you have all clearly been invested in our professional and personal success and I simply cannot express how thankful we are for each of you, but please know how much we value and appreciate you.

Finally, thank you to our loved ones.  Thank you for supporting us, encouraging us, and forgiving us when we couldn’t make it to an event or we made it but worried about the upcoming exam or rotation.  And thank you for continuing to support as we move forward in our careers.  I hope you feel as celebrated today as we do, because we simply couldn’t have done it without you.  Thank you.

 

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Filed under 4th Year, Med School

Match Day and then some

The lead up.  I feel like I second guessed myself quite a bit over my rank list.  It’s hard to “go with your gut” when your gut can’t scream in English…it just throws up when something is wrong…emotionally wrong OR poison wrong, so it’s still not that discerning.  Do you rank because of convenience to your family or reputation of the program or for the sake of adventure and seeing a new place or prestige or safety or blee bloo blah.  Obviously it’s different for each person.  I opted for adventure for the sake of my wife and reputation for the sake of my marketability, because the job market in pathology is bad, has been bad, and may continue to be bad for some time, or so I’ve heard.   And, of course, because I really liked the program, but hopefully you’ll have a lot of those on your rank list, so that alone doesn’t seem to make the decision.

I've never steered you wrong before.

I’ve never steered you wrong before.

Match Day.  It’s exciting and nerve-racking to find out where you’ve matched, but it’s great to finally know where you’ll be headed.  I matched at my top choice and was delighted and terrified.  I loved the program and told many people before submitting my rank list that if I could move my top ranking program to the Midwest (where I’m from), I’d absolutely rank it first.  But I just didn’t know if I was ready to move my family across the country and away from our extended family. Ultimately, we decided to go for it, because it’s an amazing program, the city we’re in is excellent, and I’ve been get “the vapors” so often recently, I just knew it was a sign that I was destined for the South.

Graduation. Awkward shuffling across a stage, shaking hands and posing for rapid fire pictures in completely unnatural poses, and trying to “party” when you’re exhausted.  I was honored to give one of the commencement speeches, which I will post elsewhere.

"Ahem...the barf is all part of the presentation."

“Ahem…the barf is all part of the presentation.”

The move.  It did NOT go off without a hitch.  The rental truck was supposed to be ready at 9am; it arrived at 3pm and I was handed the keys at 4pm.  I loaded our stuff (with my 62 year old father and 70 year old uncle) until 1am.  We left 10am the next day.  My son cried and my daughter watched Big Hero 6.  The terrain starting looking differently in Kentucky and by the time we hit West Virginia, my fatigue and nerves were catching up to me.  We stopped in WV to eat and I felt like everyone was staring at us, and then several people commented on how cute our baby was and that we should have a nice day and I was pretty sure we were about to be murdered.  Then we arrived, the audio on my phone quit working, my wife lost the charger for her phone and it was dying, we were running out of money, and I was informed that the ~$3000 loan I applied for just before graduating had accidentally been deleted by the financial aid office and I would have to reapply.  Everything in it’s place.

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Filed under 4th Year, Med School