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Hanson
02-26-2003, 07:05 PM
So you're starting medical school next fall? Congratulations! You're going to be a doctor. If you are reading this, you probably have some interest in becoming a surgeon, too. Here's a word of warning right at the start: don't make your mind up too early. Despite the persistent rumor that all surgeons choose their career path sometime in grade school (or earlier), you will best serve your interests if you get a broad-based education in medical school, from basic sciences on up.

Once you've been accepted to medical school, there are a few things you should do to put your affairs in order. First, visit the city where you will be attending medical school and find a place to live. Contact friends or relatives in the area (if you have them) and spend a few days finding a place where you can live, study, and sleep both affordably and comfortably. Second, get in touch with students from the classes ahead of you and ask for some advice. Some early reassurance and advice from someone who's been through what you're about to go through will help a lot. Finally, RELAX. Don't change your summer schedule just because of medical school. You don't need to start studying until you get there.

First-Year Survival Guide
Welcome to the medical equivalent of "The Paper Chase." Although curricula vary from school to school, one thing remains constant: you must study a lot during the first year of medical school. Your first year courses will build the foundation for everything that comes after them, so try to pay attention. You should set several goals for your first year of medical school:

Excel! That's right, kick ***. Choose the subjects that you want to excel in and crush them. Certain classses are more worthwhile in our opinion: anatomy, physiology and microbiology. Find out the best ways to study these at your school from the second years. But check out the available resources yourself. You may find that unusual techniques work better for you.

Learn the language of medicine. Although you will memorize innumerable facts during the course of this year, you will also forget all but the most important details. Keep trying to see the big picture, and the little facts will fall into place.

Develop your support network. Central to this network is your spouse or significant other. You MUST set aside time to spend with them, or else everything will fall apart. Make friends of your classmates, and try to meet people outside the medical center as well. Find a sympathetic listener in the faculty or administration. Visit relatives who live near your medical school.

Start developing good health habits. During the first two years of medical school, you will be busy, but you will have much more control over your life than you will later on. Now is the time to start eating right, exercising regularly, and generally curbing the excess consumption of stimulants (alcohol, caffeine, etc.). Good health will make your work time more productive and your free time more enjoyable. Future physician, heal thyself.

Specific course recommendations are difficult, because every medical school teaches its courses in a slightly different fashion. Use whatever methods got you through college, and you will pass. To excel, however, you must follow Janis Joplin's dictum and try just a little bit harder. If your school permits it, get some old examinations from your courses. Look at both the depth and range of topics covered on the exams, and pay attention to the format. Certain review books (eg the Pre-Test series) consist of Board-type questions which are often good for checking your level of comprehension. Ask second-year students which textbooks or study guides they used the year before. Get together with your friends periodically and review new material. Sometimes, the best way to learn a subject is by attempting to explain it to someone else. The bottom line is this: the higher your grades in the basic sciences, the more favorable your applications will look when you apply for a residency position. However, clinical grades tend to be more important than basic science grades, so don't think your future as a surgeon is over just because you didn't get "Honors" in Gross Anatomy.

Remember to have some fun during your first year. Extracurricular activities (including community service, intramural sports, and performing arts groups) can be a great outlet for your frustrations. If your medical school is located at or near a large university, find out what's happening there. Explore the city which has become your new home. Go out as often as you can get away with it. You'll be surprised how much easier it is to face a week of classes when you had a good date the previous Saturday, or spent Sunday afternoon watching a football game with your friends.

You don't have to start planning for your future career during the first year, but it never hurts. Find a specialty that you might like and try to meet some of the residents (or better yet, one of the faculty) in that department. If you have plans to pursue an additional degree during medical school, start scouting for mentors or research advisers. Join the AMA Medical Student Section or AMSA (or both) to stay on top of developments in organized medicine.

One final decision to make during first year is what to do during the summer. Your options are limitless, but they depend on what matters to you most at that time. This can be a great opportunity to get a head start if you think you're going to go in to a surgical subspecialty. For example, if you're going to be an orthopod, start a research project that you can continue through med school. You'll be very happy you did. If you are in a money crunch and could use some cash, you can look for a summer job. It doesn't have to be medically-related, but that would be a plus. If you are starved for clinical experience, look into opportunities to shadow physicians at your school, volunteer at health clinics, or assist a physician in clinical research. If you are interested in academic medicine, you can probably find lab work for the summer which you might be able to continue during the remainder of medical school. No matter what you do, take at least two weeks over the summer as a vacation. After first year, you deserve it!

Basic Science Basics: Caveat Emptor: These are our opinions. There are many guides to this material such as the First Aid series. Anatomy: Texts: Snell - Quick and Dirty. Moore - Hit or Miss but on the whole better than Grant. Grant - Good but more Miss than Hit. Atlases: Netter is Better - There is nothing like it. Rohan and Yakochi - Do those colors in Netter freak you out? Look no further. Grant's - Rumored to be good. Clemente - Very detailed. If your memory is photographic... Physiology: Texts: West - Good but patchy. Has some huge holes. Guyton - Readable. Histology: Texts: Wheater - Excellent photos and concise explanations, with atlas. Biochemistry: Texts: Stryer - Comprehensive, times ten. Perhaps too much. Harpers - Succinct.

Second-Year Survival Guide
Well, you passed the first hurdle. The marathon begins here. Second year resembles first year, but the differences will become apparent as the year goes on. During second year, you will take your knowledge of normal structure and function and use it to learn abnormal structure and function (i.e. disease states). Your lectures will become more clinically relevant, as your lecturers will be M.D.'s more often than PhD's. Now is the time to start building your personal database of bugs, drugs, and other medical arcana that will carry you through your career.

Unfortunately, most second-year curricula use the "drinking from a firehose" paradigm and try to cover every disease process from the common (horses) to the very rare (zebras). For most people, second-year is the most intellectually grueling year of medical school. How can you master this material most effectively?

First, the former rules still apply. Although medical school will have to be your number-one priority this year, it will be easier if you try to maintain as much equilibrium as possible in your life. Likewise, the former recommendations about talking with upper-level students and looking at old tests hold true.

One way to optimize your learning during the year is to purchase one (or more) Board-review books for the subjects you are studying. Ultimately, your second-year studies will prepare you for USMLE Step I, and most medical schools structure their courses to do so. Hence, Board-review books can give you a sense of what you need to know.

Second year is also the time when most medical school emphasize the history and physical exam, through lectures, practice sessions, and trips to the hospital. Many medical schools start as early as first year. Make the most of this experience, but don't worry if you can't hear a murmur or elicit a biceps reflex before you start the clincial rotations. It will come with time. Microbiology: Texts: Levinson and Jawetz - It rocks. Know this and you're golden. Jawetz et al - (light blue) not as concise, somewhat more info. Pathology: Texts: Robbins - Good, comprehensive, the path bible. Pharmacology: Texts: Goodman and Gilman - Can you say overkill? Riculously Simple - Know this and you rock. Lippincott's - Good but not as much organization as Ridiculous

At many schools, USMLE Step 1 is the climax of second year. Hopefully, you will be able to take some time off to review for the Boards. If this is the case, set aside three to five weeks where you can review for six to ten hours per day. We could create another entire Web site detailing how to prepare for the Boards, but there are already several good sources of information. In addition to your friends, Romans, and classmates who have already taken the Boards, the First Aid for the USMLE series gives an excellent overview of the whole process, with suggestions for Boards books.

We cannot overemphasize the importance of doing well on the Boards. When you apply for residency positions, USMLE Step I scores will be the only measure available to compare you to candidates from other schools. The importance of Board scores varies tremendously from specialty to specialty, but they are very important in Orthopedics and Otorhinolaryngology and somewhat important in the other surgical fields. If you do well (i.e. one standard deviation above the national mean or more), you will be surprised at how many doors will open for you, no matter where you go to medical school. If you score within one standard deviation of the national mean (in either direction), your scores will not have much of an impact on your residency applications. If you score more than one standard deviation below the national mean, you face an uphill battle for competitive residency slots, no doubt about it.

Third Year
At last, after years of lectures and lab sessions, you get to take care of real patients. Your third-year will be exhilarating at times, excruciating at others, but rarely boring. If you have some inkling that you want to be a surgeon, your third-year clerkships will probably confirm it. Again, try to be open-minded about all of your rotations. If you make your mind up too early, you might be disappointed with the way things turn out in the end.

Schedule! Get the rotations you want. Find out what the good one are and who are the good residents and attendings. This can be the difference between getting a great education and spanking the chimp for month. Seriously, this is critical. Do the rotations that are important for your probable career choice later, but not last, so you're primed and have time to change your mind.

Medical school clerkships vary from school to school, but a few general principles apply. First, be enthusiastic. You are the most junior member of your team, and you have the least responsibility, so use whatever extra energy you have to keep the team's spirits up. Carry out the tasks assigned to you without complaining, and volunteer for extra duties whenever possible. Second, be informed. Try to know everything about your patients. Review their old charts, talk to them and examine them daily, and read about their disorders in your spare time. Third, be when and where you should be, always. If your resident has to page you, don't say we didn't warn you when your grades come back.

Carry a quick reference to whatever you're doing. If you can answer those few pimp questions about the new patient at rounds you'll be a star. Never, never, never complain. While you're on a service, think as if you wanted to do that as your specialty. If you know your stuff make sure the people on the team know it without being intrusive. If a question arises that can't be answered, research it and come back with the answer the next day.

This guide is for surgeons, so guess what. Learn those knots. Know two-handed both left and right and one handed both left and right. Don't forget those instrument ties. Practice 10 minutes a day and you'll be better than the first year residents. Try sewing things together with a needle driver.

Quick References: Medicine: Washington Manual - Relatively comprehensive, not well organized. Little Black Book of Primary Care - Comprehensive, slightly large. Ferri's - Good but patchy. Clinician's Pocket Reference - Has everything, fits in your pocket. Surgery: Surgical Recall Surgical Secrets Mont Reid - Good numbers, facts may be old. Orthopedics: Ortho Secrets Pediatrics: Harriet Lane OB Gyn: OB Secrets Primary Care: As per medicine. Psychiatry: If you need a pocket reference, ????

Fourth year is here. You've made it. Unfortunately, the pain is not over. Get ready for the residency application process.

Fourth Year
Fourth year is the home stretch. You should have an idea of the specialty in which you're most interested. Take your specialty subinternship as soon as possible, if you haven't already done so. Fourth year is the time to network and establish good relationships with the people who will support your application for residency. Find out what kinds of letters you need for residency, then find out who writes good letters and try to do a rotation with them. If you are in a competitive specialty do an away rotation at a place you think you might want to do your residency.

There are several basic principles to securing a good residency position:

(1) Get good letters of recommendation. Arguably, this is the most important thing you can do to support your application. The ideal letter writer is (1) a nationally-known figure (2) who knows you well and (3) attended the program to which you are applying. Obviously, the third criterion is the hardest to satisfy, but you can choose people based on the first one, and if you work hard, you will earn the second one.

(2) Polish your CV and Personal Statement. Put together a concise Curriculum Vitae (CV) that emphasizes your strengths and provides interviewers with material to ask you about. Write a one-page personal statement that summarizes why you want to be a surgeon. Be original in your writing, but don't be too daring, as surgeons are a conservative lot and a bold or innovative personal statement can hurt your chances more than help them.

(3) If you decide to take USMLE Step 2 in August, be prepared to do well. On the other hand, if you got a good score on USMLE Step 1, you can put off Step 2 until after interviews are complete. The importance of Boards varies greatly from program to program. It's up to you to find out where the scores really count.

(4) Apply early and often. It only costs a stamp to request an application, so request a bunch of them. 50 is not an unreasonable number, and some people will send away for as many as 100. Once you have the applications, compile and list and show it to your faculty adviser, your chairman, and any residents you know. They will all help you narrow down the list, and they can give you an idea how many applications you should send out to maximize your chances of matching well.

(5) Once the applications are out, FOLLOW-UP is crucial! Until you receive a rejection or an interview offer in the mail, assume that your application is incomplete. Call programs 2-3 weeks before the final deadline and ask the secretary/residency coordinator to confirm that each piece of your application has been received (application, CV, personal statement, photograph, transcript, Dean's Letter, other letters, and Board scores).

(6) Interviews will consume a major chunk of your time. Schedule light rotations or take time off during the peak season (December and January). Go to as many interviews as you can afford, both in time in money. Start out with the places in which you have less interest, then schedule your top choices for later in the season. You will be better prepared for them, and they will remember you better at the end.

Residency Specifics

Posted on Sep 30, 1999, 6:20 AM
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