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10 Tips on Choosing a Specialty

Posted on 14 December 2016 by Pei Jun Zhao

In undergrad, you’ve spent countless hours studying for exams, perfecting your immaculate GPA, and preparing for the MCAT – to become the ideal candidate for medical school. Now that you are medical students – congratulations! – you are studying to become the best doctors. But what type of doctor do you want to be?

Some of you already know the answer before entering medical school. You may have heard your friends say “I’ve always wanted to be a cardiologist”, or “I was born to do neurosurgery”, or “I came to medical school to become a family physician to serve my community”. But no matter if you are set on a career path, or are undecided, keeping an open mind is perhaps the most important. Through personal experience in medical school, I’ve compiled the following 10 tips on choosing a specialty:

1. Keep an open mind, as discussed above. This is a point worth emphasizing. About half of my friends changed their specialty of interest through the course of medical school. A few announced a new interest at the end of each inspirational block.

2. Explore each specialty that interests you. For example, do an observership, take a summer non-credit elective, or participate in research (SRTP, SROP, SWORP)… But if you do not find an opportunity to do so, there is still Year 3 Clerkship where you will rotate through the major areas of medicine.

3. Ask yourself, what do you like about this specialty? You might have seen an exciting procedure such as stent-deployment in the cardiac cath lab, or enjoy talking to people about their struggle with depression and mania, or gain satisfaction by identifying features of nuclear atypia on a pathology slide that lead to the diagnosis.

4. On the other hand, what are the undesirable aspects of the specialty? For example, will you still be happy, at the age of 50, to be paged at 3 am for an emergency appendectomy? Will you be bored of titrating furosemide in the heart failure clinic? On the contrary, some people find these aspects of their job the most rewarding.

5. Will you enjoy the “bread and butter” work of this specialty, and not just the rare and exciting cases? After all, you will be doing this job every day for rest of your medical career. While it’s theoretically possible to “see the light” and change your specialty mid-career; it is generally not advised.

6. If you are unsure, use the process of categorization and elimination. Some common contrasting themes are: Generalist vs. specialist. Primary care vs. consultant. Doctor’s office vs. hospital care. Medicine vs. Surgery. Procedural vs. non-procedural. Adult medicine vs. Pediatrics. etc. Here is an algorithm from the BMJ.

7. If you are still undecided, like many students, then reflect on what fits your personality. Some people prefer working with their hands such as in orthopedic surgery, while others enjoy contemplating complex concepts such as hormonal pathways in endocrinology. Each year, the Learner Equity and Wellness (LEW) Office offers the Myers-Briggs personality test that may help you determine a suitable specialty.

8. Sometimes there are more than 1 path to becoming the doctor you want to be. For example, the family medicine 2 + 1 residency program is an attractive but competitive career path. For example, you can do 2 years of family medicine + 1 year emergency medicine, obstetrics, or anesthesia, to name a few.

9. If you are torn between 2 (or more) specialties and it’s almost 4th year, some students split their elective time in both subjects. Others choose multidisciplinary electives, such as ICU which involves internal medicine, anesthesia, and surgical critical care. But it’s riskier to match into a competitive specialty, that may sense your ambivalence.

10. Although it’s never too late to decide on a specialty, ideally you want to make a decision before applying for 4th year electives, and at the latest before the CaRMS residency match. Never be afraid to seek help. Talk to your peers, upper year students and residents, or make an appointment at the LEW Office, if you would like more guidance.

Choosing a specialty is a career-defining decision. You came to medical school from diverse backgrounds, for a variety of reasons, to become a doctor. I hope that you will soon find the specialty that suits your calling! This blog post covers the main points, but is by no means an exhaustive list. To the upper year students, if you have other considerations that helped you choose a specialty, please feel free to comment below! To the junior students, you will be surprised at how quickly medical school passes, despite the lengthy lectures, mountain of notes, and seemingly endless exams. So may the wind be behind your sails as you set off on a voyage of discovery in the vast ocean of medicine!

Pei Jun Zhao

Meds 2017

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Aboot Medical School

Posted on 21 August 2016 by Kevin Dueck (Meds 2016)

With the move to residency I thought I would try and share some practical tips from my time in medical school. I already shared a few clerkship tips over at the OMSA Blog (http://omsa.squarespace.com/blog/2014/11/9/aboot-clerkship), so I won’t cover previous items such as stocking up on pens or picking up compression stocking.

25 Med School Tips

  1. Access support services early.
  2. Share in each other’s struggles and accomplishments. Look out for each other.
  3. Early on medical school is much like high school. Cliques, rumors, and all that goes with it. Be careful how much you share or of sarcasm/humor that may be taken as offensive out of context.
  4. Don’t be afraid to spend a little extra to have a comfortable and convenient place to live.
  5. Exercise
  6. Study for the care of patients, not to pass the test. For dry material try to picture someone coming in with the condition. What questions would you ask? What would you see? Feel? Hear? Etc. Also, try think few steps beyond the multiple choice answer, not simply the name of the top diagnosis or first line treatment. Find a way of studying that works for you.
  7. Get a mentor, preferably mentors.
  8. Mentor others.
  9. Get involved. There are many clubs, interest groups, academic opportunities, research options, chances to travel, innovate, collaborate and more. Take advantage of them, but know your limit and how to say no. There are only so many hours in the day.
  10. Calls for interest and elections close very quickly. Often there is a single opening to fill and it is given to the first interested student. Related, have a decent smartphone so you can see and respond quickly.
  11. If you want to do a larger project, one that requires substantial funding, try to secure it by the end of first year. Team projects with classmates become more difficult when everyone is on clinical rotations. Similarly, with research projects, get on them early to get a lot of the legwork done during pre-clerkship if possible. Also, as a med student people/organizations will give you an ear; you can do big things.
  12. Alcohol is used as a primary means of social bonding and coping with stress. Try to develop healthier means of coping. Ex. Exercise/athletics/yoga, mindfulness, art, journaling, weekend road trips, etc.
  13. Med school interviews don’t filter out a-holes.
  14. The top reason you get kicked out is for professionalism, not for grades. The belief seems to be that knowledge gaps can be rectified, but character gaps can’t be salvaged. Be careful on social media.
  15. You will meet many interesting, accomplished people in medical school along with impressive faculty. Enjoy it; try not to feel intimidated.
  16. Attend talks on finance; it is important. Your line of credit isn’t a blank cheque.
  17. Don’t lose yourself.
  18. Explore topics outside of medicine. Read books that aren’t medical, listen to fun podcasts, have friends outside of medicine, etc. It keeps you grounded. Most of your patients aren’t doctors; varied interests help you connect.
  19. When working in the hospital choose your attitude. You can choose to be annoyed by calls from the floor, the demands, lack of respect, etc. or you can know that there will be ridiculous calls, frustrating experiences and more and choose to maintain a positive and professional attitude. Try not to become cynical.
  20. Medical school makes your hair go gray, and in some cases fall out.
  21. Try not to lose your motivation for becoming a physician. Focus on the patient and helping them. This can be difficult with looming exams, expectations of productivity, paperwork, dictations and other responsibilities.
  22. If you choose to be a part of student government or academic committees, please keep up with your portfolio and contribute. The person before you likely put in a lot of work, don’t let it fall away.
  23. Keep on top of the required police records checks, serology, first aid/CPR, N95 testing, etc.
  24. Organizational skills are important. Being involved in multiple clubs, doing research projects, exams, deadlines, and more—you need a system. If this is the calendar on your phone, a to-do list app, a Hobonichi Techno (I’m a fan), folder system, a paper calendar, whatever. Find what works for you and stay on top of things. When things get hectic, it is key.
  25. If your school offers podcasting of lectures, it is a great resource and can save time watching them at 1.5-2x speed. At least for the first few months, I believe it is best to attend class to make social connections. Also, if a professor is lecturing in a topic of interest, it is much friendlier to walk down and introduce yourself than sending an email to connect with them.

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Insights off the run:

Posted on 22 November 2014 by Jimmy Yan (Meds 2015)

Ah yes, 4th year. The time when suddenly it becomes real: I’m going to be a doctor. That MD is so close I can pretty much touch the serifs. But before we can bust out singing to Vitamin C (yes, you know the song), there’s still a long trial before us. The long 16 weeks of electives.

Now electives are the shot for us to show off what we have to the various programs and locations across Canada (or even the world if you are so ambitious) that we have the stuff that it takes to be chosen for their program.

Through all the bedlam and rush of these electives, we get the added bonus party time fun of having to write personal statements, update the CV, scrounge together letters of reference, and fill out all the extra redundant paperwork that is required for a CaRMS application. 

Yes Natasha, I agree.

However, if we let ourselves take a step back from the daily double grind of working while being on show, move past the exhaustion from the long days, and separate ourselves from the stress of the applications, these elective times are great opportunities. They’re a time to really show off to yourself how far you’ve come. They’re an amazing opportunity to adventure through and live in (albiet VERY temporarily) different places. And you’re likely going to meet a bunch of new people who may become future co-residents, colleagues, or friends.

As the three quarter mark is approaching for the current elective tour, I thought it would be a great time to sit back and reflect on some of the subtler lessons I learned from the long haul.

1) Pack light, travel quickly (alternate title, scrubs are the best)

In one of my favorite movies, Up in the Air, George Clooney poses this question at the beginning of his seminars “What’s in your backpack?“. While his speech is focused on the metaphorical baggage that bogs a person down in everyday life, it’s a good prompt to examine the actual physical baggage that can encumber your peripatetic lifestyle during this year.

From one standpoint, it’s more economical: the airlines have recently implemented more fees for check-in luggage and driving around with heavier loads will also hike up your vehicle’s fuel costs. From another, it’s also easier to move around, you need less time to pack, and it frees up some of the clutter.

Which is why scrubs are awesome because I’ve pretty much cut down two-thirds of my clothing needs as a result. Plus you can look like a ninja at work, which is awesome.

For those without the luxury of having the scrubs option at work, there are still other ways to lighten the load. Simplifying outfits, or finding multifunctional pieces are one way. Eliminating excessive electronics, books, or other accessories are all options as well. Personally I thought that I was traveling pretty efficiently already but after my first couple electives I realized I still did not use a good chunk of what I packed. With my next stopover at home, I hope to be able to make like a bro in summer and cut down the excess bulk.

2) When in a new city, make friends with a local and do what they do

So you’re in a new city and like any good medical student you’ve done your research. You’ve never been to Toronto, Calgary, Halifax, or Vancouver (etc etc) before and want to see all the attractions (and more importantly eat all the food) before you fly out 2 weeks later (come to think about it, visiting medical students are kind of like a pack of cicada – we swarm in, drum up a bunch of cacophony, eat a whole bunch, and in a couple weeks of annoyance to the locals we’re gone).

Yeah, that’s a lot of fun and be sure to take part in it, there’s a reason why those places become the hotspot.

But at the risk of sounding a bit too hipster, it’s better to make friends with some locals or inquire a classmate who is a local and get tips from them.

Why? Well, A) they may have better knowledge on which places are worth the hype and which aren’t. This leads to much better use of your limited time. Secondly, they probably know some other up and coming trendy places that may not be listed on Fodor’s. Finally, locals can probably offer tips that make your day-to-day life on elective easier. You know, stuff like helping figure out transit routes, good places for groceries, and what you might need to bring before heading to the city.

In essence, utilize those interviewing skills you picked up in clinical sessions and strike up a conversation with a local.

 3) There are a million “absolute right way” to do a simple procedure

From suturing, approaches to presenting a case, to even taping people’s eyes, you’re never doing it right. On day one you might get a nice lesson on how to approach intubating a patient. Great, you think, I’ll just do it like this with the next few docs here and I’m set. Day two, your doc looks thoroughly unimpressed with your “technique”, even though you did the exact same thing as the other attending.

Great, don’t tell me this is your first time intubating. You’re doing it all wrong! and you get another lesson, which will only be corrected by the next guy.

Repeat ad nauseum to every elective and every physician you encounter along the way. It’s like facing Tyson for the first time on Punch-Out: you cannot win. I feel like you simply got to go with it, and take solace in the fact that you’ll likely do it yourself once you got medical students of your own to “teach”.

4) Find a good coffee shop

Quick quiz, what’s some of the signs that you’re a #BasicMedStudent?

a) You need caffeine to operate.

b) You need wifi to either work on applications or go on social media (or blogs) to procrastinate from working on applications.

c) You consume a large amount of sugar/carb dense snacks to compensate for the lack of sleep you get.

d) All of the above.

The coffee shop provides all of these amenities, making it the natural stronghold of the traveling medical student. The trick is finding a good one to bunker down in when you’re in a new city. A good coffee shop will cover the basic necessities of survival: protection from the elements whether it’s rain, snow, or the cold; a means of communicating with others via a strong wifi connection, hydration in terms of coffee/tea/beverages; and food in terms of an assortment of baked goods.These are the basics, and everyone has their own personal preference on what they value more. For me, it’s the wifi. Sometimes I can’t count on the connection at the accommodations I’m staying at and I need to get online to work on CaRMS. But that’s just me. 

And, when in doubt, find a Starbucks: they’re everywhere (especially in Vancouver)

5) Wade, don’t jump, in.

Every hospital will run slightly differently. There’s a lot of desire, especially at first to try to jump right in and look like a star off the bat. I would recommend against that. Seriously.

There’s no rush and it’s better to be a fly on the wall and watch what happens, ask the right question, and ease into it. People like to welcome the rookie and it’s pretty favorable to appear as the person who fits in well seemlessly and remembers all the veterans’ advice.

Don’t worry if you don’t try to jump in. It’s just too confusing and stressful trying to figure out a hospital’s way of doing things before you really even have been there. Each are it’s own beast. And it doesn’t matter if you might look bad in front of someone stumbling around lost the first few days. Sorry to burst that bubble but you’re pretty forgettable.

6) When it comes to accommodations – location, location, location!

Electives can be pretty expensive, from application fees, gas fees, air fare, and costs of living. And even though you’re expected to be in the hospital and clinic for most of the day, you actually won’t be allowed to live in one while you’re visiting.

Bottom line: you need to find a place to live.

Now generally the options are: rent/sublet from someone (usually another medical student or resident), find a friend, or stay with family. A lot of people go with the options of staying with friends and family to save cost or to have a good time. But I feel the most important aspect of choosing your lodging is location.

The key number is 15 – that is minutes or less from your main hospital/clinic/centre. The main reason for that is it’s close enough you can escape the clutches of the hospital quickly, but that also means you can get to the hospital quickly when you need to. This is beneficial when you want to come in early in the morning, if you want to get a few more minutes of rest or have a long morning routine, or (if you’re close enough) even having a place to retreat to on a night of call that isn’t a stuffy room with a molded plast mattress.

Having paid for a place right next to the hospital and having saved money by staying at home and commuting, I still say the location is worth missing out on the free meals and cheaper save. Over time, the earlier mornings due to the commute and having to still spend up to an hour getting home after work is done just adds up and cuts into your productivity.

7) Never turn down offers from physicians

While they may be strangers to you, you shouldn’t turn down offers from any of the physicians you meet while on electives, especially if it’s candy.  Often these offers come up innocuously, and have a very short time period to respond.  So are you in? And while that answer yes might not always be crazy, memorable, the hospital turning into a bumping club, adventures, there is often some benefit awaiting, even if there might seem to be some work involved in it.

Help out with a report? Sure that’s a bit of work, but you can get published and it makes a good impression with the residents.

Why not stay later for a case, who knows what you might learn.

Volunteer a weekend to go on an organ retrieval? Always answer yes. It’s a magical, humbling experience.

In the end the electives are not only a chance for you to demonstrate that you’re a great potential resident to each program, but it’s an amazing opportunity for you do tailor your education independently. While it can be a lot of fun to play tourist, go out and eat fun meals, and travel, it ultimately comes back to have the freedom of 16 weeks for you to pick up additional skills for your future as a ______this spot left intentionally blank________ physician.

Happy trails.

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Better than you think

Posted on 09 June 2014 by Jimmy Yan (Meds 2015)

Exhaustion from call; PTSD from getting barked at; loss of a social life. For many medical students, the surgical rotation during clerkship is supposedly the “doom and gloom” block. While it is a challenging block with a lot to learn, that is not a phenomenom unique from the other specialty rotations either. In fact, there are a lot of misconceptions on how “brutal” the rotation will be. As someone who is just finishing their 12 weeks in it, my personal testimony* (note: am interested in doing a surgical residency) is that it is not as frightful as many make it. There are in fact quite a few hidden gems about the surgical block that I am really going to miss.

1) Wearing Greens to work. – Sure you might miss out on being able to choose your outfit for the day, but think of all the time that saves as well! Over the past 3 months, I’ve greatly cut down the cost of my laundry (both time and money for supplies) and also get to the enjoy what is essentially pajamas to work. There aren’t many fields of work that let you do that, aside from maybe mattress testers and these guys.

2) Premium Parking – Okay, okay, okay. I can’t really personally attest to this because I’m still cycling my commute to the hospitals, but word on the street from other clerks and my roommate who just finished a few months on general surgery as part of his residency electives is that when you come in at 6am or earlier, you get the best parking in the house. Guaranteed. This makes getting out when you do get to leave all the easier. Also in the winter days this shortens the walk from your car to being inside with the warmth. That definitely makes a big difference.

3) Less road rage, aka less traffic – I don’t think I’ve been in a city with more infuriating traffic lights and less efficient roads than London. Even in some cities in China which have populations the size of Ontario on the road at least there is movement and is programmed to accommodate the flow of traffic. London’s traffic doesn’t make any sense, which is baffling considering how short distances one has to cover to span the city. Particularly in the normal peak “rush hours” the pace crawls by – I am definitely able to move quicker on my bike during these jams. Yet if you arrive early and leave late, you never have to deal with the extra strength Advil requiring headache that is London traffic. Picture it: leisurely arriving to work, air is still clean because you aren’t breathing in idling exhaust fumes, able to actually hear the birds sing in the morning as you go about your way, and smoothly getting to the hospital from home. No fuss, no muss. It’s almost kind of nice, right?

4) Getting to enjoy the sunrise each morning – Lost in the frenzy of the hospital and the pace of clerkship are those moments to just step back and be in the moment. Yes, we’re up at an hour the night owls are just going to bed at. Yes, we have to round on patients so quickly sometimes I get my cardio for the day just through that. But even if it’s just for a few seconds through a window in a patient’s room each morning, getting to see those first rays of a new day break over the horizon is just so moving. Getting to see the sunrise helps charge up my batteries in preparation for the long day ahead.

5) A lot of complimentary coffee – And this has nothing to do with the fact that I was on surgery during Tim Horton’s Roll Up the Rim contest. But the residents/attendings seemed always willing to buy the clerks a coffee when there was a moment’s of downtime between cases. As a person who enjoys a good cup of the black stuff, this was a very nice touch. Stick taps to that. Yes, some would say that if we had longer hours to sleep we wouldn’t need the coffee during the day, but I just like to drink coffee.  Even if it’s Timmies. 

6) No trouble sleeping at night – My brain is a troll at night. Previously, if I’d try to sleep my mind would keep me up overthinking about things that happened during the previous day, trying to figure out stuff I should be prepared for the next, or just generally screwing around with random streams of consciousness. While on surgery, when I want to sleep I just do the flop. I might have gone to bed earlier before, but I’m actually getting more sleep now.

Detractors might argue that this is simply Stockholme Syndrome reasoning but I feel that there are many overlooked moments to enjoy in the surgery rotation. There’s great teaching, a lot to do, and the feeling of being included in the team while on the rotation, but those are the obvious ones. The above list tries to address some of the hidden, little things that generally go by everyday without appreciation. But really, it’s often these little things that add up and make a difference in the end.

 

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Family Medicine and Keeping in Contact

Posted on 18 July 2012 by Robyn Sambrook (Meds 2014)

Since the time I was about halfway through elementary school, my family doctor’s practice has never been based in the city in which I’ve lived. It speaks to his skills as a physician, and the close doctor-patient relationship my family and I have with him, that he continued to be our doctor even after we moved to a different, more distant city. The distance obviously made it more difficult to see him with frequency, but annual check-ups were always attended, and we took more urgent matters to a local walk-in clinic. The arrangement worked for a number of years.  Continue Reading

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My Summer Elective experience

Posted on 23 March 2012 by Dan Myran (Meds 2014)

This summer I spent one month in Northern Ontario on a medical elective. Over the month I was given considerable autonomy to practice my clinical skills and interviewing, and was granted a unique view of complexly foreign part of the country. The following patient encounter was one of the most shocking and influential events of my elective.

My preceptor for the day had assigned me one examining room and given me a third of the patients. After seeing each patient I would give her a summary, discuss a management plan, and we would then go in to see the patient together. I grabbed my first chart of the afternoon, a 16 year old female patient was presenting to the clinic with what she suspected was a Chlamydia infection.

I knocked on the door, walked in and introduced myself to a nervous looking girl who seemed far to young to be worrying about STIs. We started talking, she had a previous episode of Chlamydia 6 months ago (the reason why she was so certain it was Chlamydia again) which another doctor at the clinic had treated. She had been sexually active since 13, used the birth control pill for two months when she was 14 (she stopped because she could never remember to take the pill) and had since used no forms of contraceptives. At this point alarm bells were ringing in my head and I asked her when her last period was. The answer was informative to say the least: over 7 weeks, and it had not occurred to her that she could be pregnant. To complicate matters, the patient normally drank several drinks a day, and I was seeing her the Monday after Canada Day Weekend, where she had been drunk for most of the weekend. At this point I obtained her consent to test her for STIs and pregnancy, and then made a beeline for the doctor’s office.

I summarized the patient for my preceptor and to my surprise didn’t bat an eye – it was a fairly standard story I guess. One urine dip later and my preceptor turned to me and said, “Ever told someone that they are pregnant?” I replied with a shaky no and then injected slightly more confidence into my voice and said that I would like to be the one to tell her. So tasked with relaying this all-important news, I went next door, with my parting instructions to break the news and find out if she wanted to have the baby.

I entered the room, and said, “I have some big new. You’re pregnant.” I gave her a moment, and then asked her how she was feeling. She said she was shocked. Now the tricky part – the key would definitely be in the phrasing. I cleared my throat, collected my thoughts and blurted out something wonderfully awkward along the lines of “Do you want to carry this baby to term?” She beamed back at me – the answer was a definite yes. The rationale was certainly not to my liking: Dad was in jail, not speaking to the young girl, and she wanted the baby to remember him. But it was her choice. The clinical encounter wrapped up quickly: my preceptor came into the room, we treated her Chlamydia infection (a single dose of 1 gram of Azithroymycin given orally, for those who are curious), gave her some general prenatal recommendations, and set up a follow up appointment.

The patient left the office happy, but I was left with some serious doubts. Aside from being concerned about her prospects for the future, two nagging issues stood out to me. First, this young girl was a high risk pregnancy with significant risk to both mother and fetus (mainly Fetal Alcohol Syndrome). I was aware of it as was my preceptor, but it is unclear how adequately we relayed that message to the patient. It is possible that the patient was unaware of her risk. Should we have directly laid out the risks for the patient before asking about having an abortion? Would it still have been appropriate to discuss risks and offer alternatives after her expressed desire to have the baby? Does pregnancy count as a “medical procedure” for which complications, and alternatives must always be discussed and then offered to the patient?

I was also struck both by how preventable the situation had been and the clear signs that this patient needed help before she showed up at the clinic pregnant. After this “routine” event, there was no discussion of how to adapt or alter the practice, and I am quite positive that similar outcomes will continue to occur. I learned considerably from this encounter, and even more from my time up north, but left my elective cognizant of enormous gaps in our health care system, which unfortunately have no easy solution.

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