This time 3 years ago, I was interviewing for residency positions in Internal Medicine. As a foreign graduate with no US clinical experience, I knew I wasn't going to be cherry-picking at available programs. To make it worse, I had limited my search to the East coast for family reasons. I still remember the frightening experience of refreshing my email 300,000 times for emails from programs. I remember the disappointment of rejection emails, the joy of interview invitations, the what-if-I-don't-match thoughts, the overdrawn credit cards. I remember my excitement when the email read "Congratulations, you matched".
Fast forward to today. I think about my years at Howard and ask myself: what if I had matched elsewhere? How would my life have panned out without the amazing mentors I met? Hard to tell.
Maybe if I knew a few things prior to submitting my rank order list, I would have landed at a different place. Or maybe not.
This piece is directed at those that plan on making a decision soon, or those that still question the decision they made.
1. Are there people like me in the program? This is an important question for minorities. You should talk to people of your culture, color or beliefs in the program after your interview. Remember that every resident you meet will tell you their program is the best. Try to sift through the BS and get a real feel. You want to be at a place where you'd be totally comfortable. You may be more productive at a smaller name program where you're comfortable than at a bigger name where you feel out of place. Point is, understand the situation before you sign up for it.
2. A Yoruba adage says "ona kan o w'oja". This literally means there are many roads to the market. If you are considering a fellowship, you will be better off matching at a University program that has that specialty, so you can work with mentors in the field. If this option is not available to you, an extra year as a Chief resident or research fellow will improve your chances. Additional training in clinical or translational research will improve your chances. A legal permanent residency status will improve your chances. You end up realizing that everyone's profile is different. You should explore the options available to you. This leads to the next point.
3. There are always resources to tap. Some residency programs are highly structured, with specific learning goals and milestones, while others are not. Your goal is to understand what resources are available around you, including renowned mentors, research activities, local and online certificate courses, travel awards, community activities etc. Find out what's unique about your residency program and take advantage of it.
4. Before you start to hate where you match, know this: where you do residency does not matter. Becoming a good doctor depends mostly on you. All residency programs with a good volume of patients are equipped to train you to become a competent internist. Programs with too little volume will not provide the patients you can learn from. Too high volume would not give you time to study and understand the cases you see. The predominant key to success is self motivation, creating learning goals and following through.
5. The fun does not start after you become a board-certified gastroenterologist. It starts now. Enjoy the programs you interview at, the people you meet at interviews, the cities you get to visit. Most importantly, enjoy the person you are. The interviews help you understand your uniqueness and often give you a clearer idea of what your interests are.
Finally, treat your residency interviews like a first date and you're more likely going to match at the best one for you.
Good luck.
Tuesday, October 21, 2014
Tuesday, October 8, 2013
The Electrician
The patient laid unconscious in the intensive care unit bed. The cardiac monitor beeped extra loud. I was here with the Cardiology team to shock this patient. Yes, I mean electrocute. He was in atrial flutter, which meant his heart was beating at an abnormally fast rate and we planned to revert that. Applying a shock to the heart is similar to pressing the reset button on your phone. I had never done one before, and I was eager to earn my stripes on this one. The patient's daughter walked up to me, and asked for the thirty seventh time, "Doc, is his heart rate going to be normal after?". And for the thirty seventh time, I answered "We cannot tell if we would be successful, but we will try. I'll let you know soon as we're done". Since I was the one pressing the button, she assumed I was more important than the intern that I really was.
My Attending directed me to set the defibrillator energy at 200 joules, and the mode to sync. We again checked that the patient was deeply sedated. I pressed the charge button. "All clear on three, two, one" Bzzzzzzzzz. The power surge forced him to twitch once. The monitor went flat line for 2 seconds. Then, "Beep, Beep, Beep, Beep, Beep". Yes, we did it!!! He was back in sinus rhythm (normal heart beat). That was the coolest thing I ever did. I have done two more since then, and they both felt as good as the first time.
I have only shocked unconscious patients, so I don't know how they felt getting electrocuted. One day, I asked a patient who received a live shock. Live shocks can happen in patients who have defibrillators implanted in their chest because of a weak heart. Anytime the device senses a ventricular fibrillation (a fatal abnormal heart rhythm), it delivers a shock. Sometimes, the defibrillator senses wrongly and shocks the patient inappropriately. So, I met this patient who had received 3 inappropriate shocks in 2 weeks. "How does a shock feel, Mr. J", I asked. "Doc, each time, it feels like a horse kicking me in the chest, and it knocks me down flat. I feel the pain for one week". Okay, lesson learned. Now I'm a believer. My Attending had told me that patients that get shocked alive can get post traumatic stress disorder. Maybe he was making it up. Or maybe it's true.
I have made up my mind, I want to be an electrophysiologist. I would have the license to shock people. We had a patient the other day who had abnormal heart rhythm. The EKG recorded a wide complex tachycardia (fast heart rate). To find out the source, the electrophysiologist took him to the lab. He paced the heart and induced the same tachycardia. He then shocked the patient back to sinus rhythm. Coolest human experiment ever.
The heart pumps because it is supplied by electricity. The electricity is produced by a generator called the sinus node. It then travels to the rest of the heart via cables, called the conduction system. Abnormalities can occur in either of generation or conduction of electricity in the heart. The problems are fixed by an electrophysiologist. So, an electrophysiologist is basically an electrician. He works with electrodes, fuses, pliers, and screwdrivers. Okay I'm joking about the last three.
For now, I am a second year resident. At least five or six years separate me from my dream. But I eagerly wait for that day when I will fill out a form. And in the occupation section, I will write "Electrician".
Hakeem Ayinde, MD
My Attending directed me to set the defibrillator energy at 200 joules, and the mode to sync. We again checked that the patient was deeply sedated. I pressed the charge button. "All clear on three, two, one" Bzzzzzzzzz. The power surge forced him to twitch once. The monitor went flat line for 2 seconds. Then, "Beep, Beep, Beep, Beep, Beep". Yes, we did it!!! He was back in sinus rhythm (normal heart beat). That was the coolest thing I ever did. I have done two more since then, and they both felt as good as the first time.
I have only shocked unconscious patients, so I don't know how they felt getting electrocuted. One day, I asked a patient who received a live shock. Live shocks can happen in patients who have defibrillators implanted in their chest because of a weak heart. Anytime the device senses a ventricular fibrillation (a fatal abnormal heart rhythm), it delivers a shock. Sometimes, the defibrillator senses wrongly and shocks the patient inappropriately. So, I met this patient who had received 3 inappropriate shocks in 2 weeks. "How does a shock feel, Mr. J", I asked. "Doc, each time, it feels like a horse kicking me in the chest, and it knocks me down flat. I feel the pain for one week". Okay, lesson learned. Now I'm a believer. My Attending had told me that patients that get shocked alive can get post traumatic stress disorder. Maybe he was making it up. Or maybe it's true.
I have made up my mind, I want to be an electrophysiologist. I would have the license to shock people. We had a patient the other day who had abnormal heart rhythm. The EKG recorded a wide complex tachycardia (fast heart rate). To find out the source, the electrophysiologist took him to the lab. He paced the heart and induced the same tachycardia. He then shocked the patient back to sinus rhythm. Coolest human experiment ever.
The heart pumps because it is supplied by electricity. The electricity is produced by a generator called the sinus node. It then travels to the rest of the heart via cables, called the conduction system. Abnormalities can occur in either of generation or conduction of electricity in the heart. The problems are fixed by an electrophysiologist. So, an electrophysiologist is basically an electrician. He works with electrodes, fuses, pliers, and screwdrivers. Okay I'm joking about the last three.
For now, I am a second year resident. At least five or six years separate me from my dream. But I eagerly wait for that day when I will fill out a form. And in the occupation section, I will write "Electrician".
Hakeem Ayinde, MD
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