Tag Archive | "clerkship"

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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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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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The cyclist’s survival guide to clerkship commuting

Posted on 26 January 2014 by Jimmy Yan (Meds 2015)

So congratulations, you decided to forego the car for clerkship and adopt the lean, green, quad strengthening machine that is the bicycle as your main mode of transportation for the 3rd year rotations. Take a moment and let that all sink in for a moment.

First of all, you got a bike. So get ready for a lot of questions of whether you are either a) stupid, b) insane, or c) Hipster. At least, that’s what the “regular” people will say about you. Get used to that. A lot.

But never mind that, because getting a bike to get around during clerkship is a GREAT idea. There are a ton of reasons that make it quite a sensible thing to do.

First of all, London isn’t that big. The distance between Victoria Hospital and University Hospital is around 10km along the bike trails, which translates to about 30mins at a moderate cycling pace. That’s about the same time it takes buses to get between the two, and that is WITHOUT traffic.

Secondly, it’s guaranteed exercise. Clerkship gets stressful, and that can through a real monkey wrench into one’s workout routine. However, by biking, you’re getting a section of dedicated cardio everyday (and it forces you  to do a leg day). That’s going to come in big when you feel guilty about indulging in those on-call and post-call meals.

Third, London is flat. While it’s not Prairie flat, it’s still horizontally-inclined enough that it’s not super daunting to a newbie cyclist. This was definitely one of the reasons I kept cycling up. The routes never seemed too arduous that they weren’t worth the effort.

That said, there is a huge valid reason against trying to cycle the whole year in London. That reason is Winter. Yes, winter sucks. It’s cold, makes the roads slippery and bumpy, and snow in the eyes sucks. Not only is this uncomfortable to bike though, it’s getting pretty unsafe. However, for the craziest (aka the honeybadger-ist) clerkship cyclists, there are ways to handle for winter.  What follows is a list of tips lifehacks on how to  make winter cycling much more enjoyable (and you don’t even need to get one of these to do it). 

1) Be prepared

Whenever I’m faced with solving any problem, I like to start with simple approach – ask myself “what would Batman do“. Usually this comes down to a two word statement: prep time. While you don’t need to go extreme as creating an alternate personality as the Cyclist of Zur-En-Arrh to be psychologically ready to handle winter cycling, be ready ahead of time to deal with the cold commute. This can be done simply through checking out weather reports, knowing which routes you plan to use ahead of time, and getting the right equipment ready.

2) Earlier the better

While most cycling commuters will already be used to leaving a bit earlier than drivers to make the trip, when the snow and ice hits, one has to be ready to take a bit more extra time on the journey. Riding through the snow is harder and slower than any other time of the year, as you can’t just power up hills, rip around corners, or zip down slopes. Plan in some extra time so you aren’t late and won’t feel rushed along the ride. The more time the better, as the worst thing that could happen is that you arrive early and can do some pre-rounding before morning report.

3) Suit Up! 

As both Barney Stinson and Japanese Macaques living in Russia know, being out in the snow requires a whole different set of gear. An important part of winter riding is keeping the core warm, yet managing sweat during the excursion. And like any good superbowl dip, the key is layering.  A base, moisture wicking layer, then an insulating mid-layer, topped by windstopping and waterproof outer shell is a classic trio (another classic trio: salt, pepper, and cumin). Protecting your feet and legs from soak and cold is equally important, because unlike Magikarp, the splash of slush from your wheels and cars is supereffective at getting you cold. Thermal long johns, insulating socks, snow pants, and waterproof boot covers are all good options.

Finally, pay special attention to your hands and your head, as they are both very vulnerable to the freezing temperature. Insulated leather gloves, mittens, or lobster claw styled gloves are all good options for keeping the hands warm and dry. As for your head, ear covers, neckwarmers, and toques make up the essentials of my winter kit. The key is to keep exposed skin to a minimum.

Oh, and if this sounds like a lot of extra gear to be bringing, a spare change of clothes (including dress shoes) can easily fit into a medium-sized pannier.

4) Eat breakfast

Breakfast is the most important meal of the day, especially so if you’re going to be pedalling hard through the powder. You’ll be burning off more calories in these trips, after all. Being hungry while making the commute will just lead to an unenjoyable bike ride, and an irritated mood before you even before your shift begins. So start the day right by being properly fueled for the road.

 

5) Get your tires snow ready. 

Like cars, bikes have winter tires.They are pretty much like a normal tire, only bigger and awesomer. Oh, and they often have embedded studs to help grip into snow and ice. This can prevent you slipping on a patch of black ice, which can be really dangerous. If you want to forgo winter tires, getting chains for your normal tires is the next piece of advice. Additionally, letting out some of the air pressure in the tires helps increase the gripping surface area. Cycling without studs or chains is a risky move, even riskier than hitting on a hard 17.

6) Cars will try to kill you

Okay, so this might be a bit of a broad overstatement. While there are dangerous drivers who wish nothing but malice towards cyclists, the danger posed from an average motorist is that they simply aren’t expecting cyclists to be on the roads when the weather gets snowy. Adding to the problem is that cars won’t be able to stop as quickly in the snow and slush either, they can slip and spin out too, and drivers also will have worse visibility in the snow. On top of all that, the road shoulders are often more clogged than an artherosclerotic artery with packs of plowed ice/snow, forcing you to cycle closer to the middle of the lane, which is a real zone of danger for cyclists in busy traffic. In the winter you need to ride defensively (make eye contact with drivers), assert lane control (which are part of a biker’s rights), be on the look out for cars, and do whatever they can to improve being visible (adding reflective gear and using high lumen lights).

7) Clean and cold

As the snow and ice pile on, so does the salt. This salt, along with a bunch of debris, gets tracked into your gears and chains with all the slush. Without proper care, these can damage and wear down your ride. Make sure to wash off the salt daily by running some hot water along the chain and gears when you get back home. Additionally, storing your bicycle in a cold and dry location is advisable as a warm bike in snow can lead to ice forming on the gears and brakes. Finally, frequent lubing of your chain and gear will help keep the ride operating smoothly.

8) Know when to call it in

Somedays you’re James “Bucky” Barnes, aka the Winter Soldier, and some days you’re Napoleon after Russia, aka Winter’s Bitch. Because that’s what being in the middle of the “Snow Belt” means, and there’s nothing you can do except this. So when it’s like Jötunheimr  outside and the mercury’s lower than Kramer’s sperm count, it’s advisable to look for other options, such as carpooling or taking public transit. To prepare for the scenario where you’re already on the road and a polar vortex hits, it’s advisable to plan for “bail out” zones, such as bus stops. LTC buses come equipped with racks that can accommodate bikes should the commute prove too long/laborious/treacherous.

Well there you have it. Winter cycling is a bit of a challenge, but nothing that should dissaude an adventurous heart. Keep at it and soon you’ll be reaching cycling in the snow like Calvin’s dad.

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Those Post Call Days

Posted on 14 October 2013 by Jimmy Yan (Meds 2015)

So for those keeping track at home, right about now marks just past the 1 month point since the actual beginning of clinical rotations. By now we’ve probably have had a decent exposure to a range of clerk responsibilities, including…(dramatic drum roll)…call.

Yes, call, that one word that make your average preclerk pull off a near perfect Macualay Culkin impersonation.

But no, we’re clerks now, and just like Freddie serenades, we must go on.

And besides, inevitably, we all got to do call. It’s just a fact of life (of a clerk).

But it turns out, the whole process of being up in the night, isn’t that bad. Note: this is the personal opinion of a self inflicted insomniac. Like Hooch, I’m craaaaaazyAs long as you’re up and about and doing something, the body’s seems to shunt enough fresh blood to the brain to keep it perfused enough to maintain lucidity and sanity. And if something active or acute is happening, then at least the adrenaline is better than coffee!

What does suck though, is when that buzz comes crashing down. Dawn breaks, morning rounds or handover occurs and you finally exit to sweet, sweet, fresh air.

And then what? You got a post-call day, which is some much coveted free time; yet you’re not exactly at the peak condition to enjoy it. So what to do?

Fortunately our handy research crew (ie: me) has searched high and low, even with the government shutdown. From that, we present to you the list of the top 5 to do, and also, top 5 things not to do, during that post call daze (oh hey wordplay!) if you DON’T want to simply sleep.

Don’t:

5) Go on a shopping spree.  – Seriously, you’re judgement is impaired, you’re blood sugar is a little off, and you’re vision is a bit blurry. You’re going to be after any little sparkly doodad or supposed “good deal” out there. Even worse, the Masonville Apple store is just a short bus ride away.

4) Fall asleep in a frat house. – While sleep is key. Make sure you’re vigilante of your surroundings when you do snooze. Make sure you don’t nap in any area where people could assume you’ve simply passed out from intoxication (because, let’s admit it, by this point you could pass off as a drunk), and you end up on this site (NSFW).

3) Try to pick up. – You simply aren’t as sauve as you think right now. Period.

2) Go for a long, extended drive. – Yes, you need that car to get back home to that ever alluring bed, but you don’t need it to just hit the open road (even if Bryan Adams compells you). Seriously, there are a number of articles telling you this is a bad, bad, idea.

1) Do another call shift. No. Just. No. 

Do. 

5) Attempt to do some course reading : Yes, nerd alert , but just hear me out. This is a win-win. Either the act of reading puts you out to a peaceful sleep completely…OR you learn something and get to impress and WOW your residents and attending on your next shift (only you won’t but it’s nice to think that).

4) Eat, and lots of it: Typically you finish call at around noon the next day. This calls for five words: All. You. Can. Eat. Sushi. ‘Nuff said.

3) Have a light work out: Emphasis on the light, as you probably aren’t at your peak self. Despite this, take the opportunity to stretch the muscles a bit, get that cardio going, and burn off some of the crappy calories you consumed during the middle of the call shift.

2) Sit/Lay down on the grass: When was the last time you got to see the sun afterall? If you have the opportunity, take it, you never know when you’ll hit that dreaded streak of “go in when dark, leave when dark” phase known as the Canadian winter, so make like Superman and recharge off the rays of our yellow sun.

1) Catch up on some shows: From Netflix to YouTube, the web is brimming with series to start, catch up on, or rewatch. I’m recommending some Archer, or if you can’t get enough of medicine: Scrubs.

So there you go, what do you think of this list? Have more ideas or suggestions? Why don’t you put them in the comments below.

Didn’t like the post? Well don’t blame me, I’m writing this post-call!

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At the brink

Posted on 23 September 2013 by Jimmy Yan (Meds 2015)

In a few short hours, clerkship will have started for me. I realize that this past week was the official start of 3rd year, but as it was largely an instructional week about some of the “how-tos” regarding clerk duties (“how to access powerchart”, “how to do a sign off”, “how to dictate”…) – a clerkship bootcamp – it really did not register with me.

Now, I cannot stop pondering over what tomorrow, the next week, and the upcoming year is going to bring. What will call be like? How different is this going to be from the past two years? How long will I be able to keep biking to my shifts? How difficult are the end of rotation exams going to be?

Ultimately my mind circles back to one question: “am I ready?”

Honestly, I want to tell myself yes. Reason it out – that hundreds, if not thousands, of students have been on this path before me and have been just fine. Normalize the process in order to soothe it over, get a hold on the anxiety, and move forward.

Yet the question returns, like a demented boomerang. It ceases to just go away. Each time it reappears it brings a friend: another question, a hypothetical situation, a hidden doubt.

Somtimes, I welcome these thoughts, as in the past, I’ve relied on the fear and worry to motivate me onward. But the stakes seem higher now, and especially with the fact that I’ll be working with real people who are sick, I don’t want to be the one needing to make mistakes in order to do it right.

If getting through medical school is a journey, I liken it to one across a mountain path. The first two years are along hilly trails: winding around, rising steady, rough at times, but generally you can see the route and it’s something you’ve been on before. Clerkship then rises out of that like a sudden and steep peak, and I now stand at its brink. Personally I haven’t experienced this yet, but I’m assured that my skills and knowledge should be adequate for the ascent. With it looming over me, I cannot be sure.

It doesn’t help that I’ve always had a fear of heights as well.

I guess in the end, I’ve made it this far, there’s nothing else to do but climb.

See you all at the next plateau.

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