Rotation: Psychiatry


Psych wasn’t a bad rotation… I got out early a few times, including the day of the daycare Family Fun Night where we were the first to play in the bubbles! 

Name/Location of Clinical Rotation

Child Psych inpatient with Child Psych clinic, Addiction Clinic and Bipolar Clinic, with two Emergency Psych Services shifts

What did I like most about this specialty?

I learned a lot on this specialty about all of the services that we could offer that didn’t necessarily restrict the patient to the inpatient setting. We had a large variety of clinic settings, inpatient, outpatient, and emergency psych services. For child psych, we had an inpatient unit that included school sessions for elementary students and junior high/high school students. There were also group activities and art and music therapies. It was pretty interesting to see those sorts of things in the hospital setting. We even had federal services available for girls who we thought might be trafficked.

What did I like least about this specialty?

I came across a lot of patients that were violent. I knew it was a possibility with this service, but I didn’t expect it to be so frequent. This was the first time I’ve ever been threatened, so that was fun. 

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I believe so. We got a very broad view of the different types of psychological illnesses and a variety of practice subspecialties and clinic settings.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

I really like finding community services that benefit patients, and I honestly think this specialty had the most available services out in the community. That being said, I really don’t think this type of practice suits me very much. Psychological issues are usually fraught with social issues as well, and it is so hard to treat not only the illness per se, but also the home environment and lots of other issues. If the home environment is the root cause, and then you send them back to the same environment, what are the odds of them getting better? 

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

Inpatient, outpatient, and a mix of both. It was pretty interesting to see so many different practice types, including the Emergency Psych service at our adult university hospital.

What info do I still need?

None–this was a very enlightening rotation.

Has my perception of this specialty changed? If yes, how?

I learned so much about this specialty that I didn’t know beforehand. I didn’t really think that psych would be a good fit for me, and even with being selected for the pediatric version of psych, it wasn’t a good fit. I really admire the people that go into psych and especially child psych. In the child psych unit, I heard some of the most disturbing, horrifying, unbelievable stories I’ve ever heard in my life. 

Did my clinical rotation experience influence the likelihood of choosing this specialty?

It cemented for me that this is not my future specialty although I do find the resources to be very valuable for pediatric patients that I will definitely use in the future.

Right now, how interested am I in this specialty?

Pretty far down the list.

What information do I still need to evaluate this specialty? Any other comments or reflections?

There are a bunch of patients that I met on this rotation that have shaped how I practice with other patients. That has been very valuable and formative for me.

Kindness is Free

At the end of every interview day, I leave with a gift. Programs are happy to make sure we leave with a token from them, and so far I’ve been gifted with many things, such as tumblers, badge holders, a mountain of pens, and even a blanket. At one such interview awhile back, part of the part my gift included a beverage and snacks. I didn’t think I’d get much use out of that goody bag.

It wasn’t long until I was proven wrong. A few blocks from the hospital, at a stoplight, was an elderly gentleman with a cane holding a sign. I’m glad my goody bag helped someone who needed it far more than I did.

You may think you have nothing to give. But everyone can give, with what they have right now, where they are right now. 

Rotation: OB/GYN

Now that I am done with my rotations until the New Year, I am catching up on posts about my third year rotations. Expect more frequent posts from me now that things are –somewhat– slower for me.

Name/Location of Clinical Rotation

2 weeks of GynOnc, 2 weeks of private practice (urogyn/reconstructive) and 2 weeks of L&D

What did I like most about this specialty?

The number of immigrants and refugees that we saw on a regular basis; finding fetal heart tones, deliveries! I got to catch a lot of babies, there were even several cases of twins, I got to use the Ultrasound machine and help run triage in L&D, and I felt like a part of the team.

We used the DaVinci robotic unit in GynOnc surgery, which was cool… but the first time I scrubbed in on a robotic surgery, I’m sure the resident thought I was the dumbest med student ever because I asked if scrubbing in was the same as for non-robotic surgeries…. because you just stand in the corner while the surgeons have their backs to the patient, working with the robot, and at the end of the surgery you might get to place a few sutures on the laparoscopic sites.

When I was on Labor & Delivery I was the only unpaired student, so instead of seeing half of the triages, births, and doing half of the morning rounds and prescriptions, I did ALL of them. I was exhausted all the time but I got some of my best evaluations of the year on that service. The one bonus was that my chief let me go home a couple hours early on the Sunday of Mother’s Day because I rocked my job, so I got time to spend with my own baby instead of catching someone else’s.

What did I like least about this specialty?

It basically meant another 4 weeks of surgery…. ug.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I think we got a very well-rounded view of what OBGYN entails, with having two-week sub-rotations in the clerkship, with time in the outpatient clinic as well.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

There are a lot of ethical issues in OBGYN, which can be draining if you get lots of them back to back. There were cases that I was in on that made me question a lot of my beliefs, which I found to be a good — if not essential, really — experience for me as I develop into a physician.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

Inpatient and outpatient, community-based with hospital privileges; lots of options.

What info do I still need?

None–I feel like I got enough experience to understand their work and their thought process in regards to the services they offer to know that it is not a specialty for me.

Has my perception of this specialty changed? If yes, how?

So, parts of it I really liked, like L&D. Other parts, like GynOnc that were mostly surgical, I didn’t like so much. Overall though, it was a great experience.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

I know that OBGYN is not the specialty for me because I am not surgically-motivated or enthused, and there is a TON of surgery involved in OBGYN.

Right now, how interested am I in this specialty?

It’s actually higher up on my list than I anticipated, but still below Pediatrics and Internal. One of my attendings even told me that she hoped that I went into OBGYN because I would be great at it (and it was my second highest shelf score).

What information do I still need to evaluate this specialty? Any other comments or reflections?

There were times that babies died. We had several pregnant ladies that came in with vaginal bleeding and absent heart tones. That part is heartbreaking. There is a scream that only expectant mothers can emit, and it is the most heart-wrenching sound I have ever heard. There is nothing like it.

Life These Days

Here is just a glimpse of what 4th year has looked like for me since late August/early September:

Please pardon the language on this picture, but I laughed at it because I recently completed a two-week EKG interpretation course and my ACLS training! Lets just hope that I don’t forget everything I learned in that elective because it was fun and useful but now I won’t see it again for a while.

There has been much more free time in fourth year, and you can bet that I am taking full advantage of it. The Ladybug and I hit the local parks for fun as often as I can muster with rotations, studying, ERAS-app production, etc.

I had my ACLS training early in the year, around the time that our ERAS applications were due. I wanted to get it out of the way before interview season started. This was a fun 2 day course with hands-on training (And I passed! Always a relief!); even though the EM residents running it told me they were sorry that I’d have to take it again–Pediatrics has a separate ACLS-style training course that I’ll take in the spring summer, either on my own or in coordination with my residency program.

Downsizing. Since we’re moving next year (either away to a new city/state or even just into a house if I match into our home program), I do NOT want to move all of this stuff, yet again. So we are downsizing and minimizing, which included our movie collection. I took a ton of books and movies to Half Price Books, and the movies that we did keep we transferred to a DVD case and threw away all of these cases. SO MUCH MORE SPACE!! I am so, so pleased with getting rid of all of that.

On the first day of Step 2 studying way back in July, I found the back of my earring caught in my hair but the actual earring itself was nowhere to be found. I panicked. These earring were a wedding anniversary gift from my grandma’s late husband, given to me on my wedding day. I not only wore them the day I got married, but also for every medical school interview, the day I got my first med school acceptance, every day of gross anatomy, the day I learned I was expecting, the day we learned she was the Ladybug, the day we met her and brought her home, the day I took Step 1… So they were beyond special to me. I love you Jed everywhere and retraced every step I had taken that morning. I had been to daycare, the gym, and all over campus. It was nowhere to be found. I have ugly-cried so many times since then, and I couldn’t bear to tell my grandma. I even had the thought of someday taking the remaining earring to a jeweler and having a replica pair made. It has been over 11 weeks since this happened, and I had given up all hope of finding it, took Step 2 without them, and put the remaining one safely in a jewelry box. One night this past week, the Ladybug was fighting sleep and crystal nf for a certain bedtime toy. I looked under her bed and GUESS WHAT I FOUND! How many times have I walked right by it without noticing it?! How many times have I swept that carpet and yet, there it was! I am so relieved! (And I never had to tell grandma that I lost it!)

I also passed Step 2 CK (total relief, I can never tell how I performed on those things) and updated my ERAS application before the September 15th deadline/release date. Now I only have Step 2 CS (the in-person part where we take care of a dozen standardized patients in the course of a day) and then I am totally done with exams (minus the AI, acting internship, elective shelf exam that I take in late October) until after I graduate and get my MD!

The Nightmares

Since we returned home from our vacation, I’ve been having nightmares. Not every night, but most nights. They reflect my current fears– failing Step 2, not getting any interviews, not Matching…

I’m not sure what to do about them. I thought that once I started filling out my ERAS application for residency that I’d gain some confidence looking back over all I have accomplished in the past 3 years. Instead, I wonder if there is anything about me that will stand out enough to land my first job as a physician (-in-training).

This week is the big week: my ERAS application will be officially submitted and many programs will start downloading applications. I may even get some interviews to schedule this week. My Step 2 scores should also come back this week. I’m excited and terrified at the same time. I seriously think I have looked over every single pediatrics program in the country. My list has been whittled down to the places where I think that I (and my family) will be happy, with lots of things for all three of us to do and enjoy. I had a meeting with my home program’s residency director, and she helped me to go through the list to make sure it was realistic. She said I had a good group of programs and she thinks I will do well–which helped my confidence a bit and since then, no new nightmares! She also told me that she loved my personal statement, which was unexpected but also boosted my confidence a bit.

Here’s to having a good week, a great start to the application and Match process, and finding the right place for my family and I as I transition to being an actual doctor next year.

Rotation: Family Medicine


Name/Location of Clinical Rotation

2 weeks in a local FM clinic, 4 weeks at a rural AHEC site. My local clinic was also the home of the HIV/AIDS clinic.

What did I like most about this specialty?

All of the people and the variety that we saw. Family Medicine also sees kids, but very few, so I was always quick to jump on those cases.

What did I like least about this specialty?

Not enough kids. But that’s what I say about everything that isn’t Pediatrics.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I got a very good perspective on the type of work a Family Medicine physician encounters every day. I liked that on my rural rotation, my preceptor asked for my opinion more often than on any other rotation so far, which kept me on my toes and always thinking.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

I really enjoyed how I meshed with this patient population. At the local clinic, my favorite patient was a young girl that came in for an STD screen. She was worried that she might have seen something in the shower and was a crying, hysterical mess. I was the first to see her, and I spent a good long time talking to her about what happened and why she was worried, and tried to comfort her. After explaining the situation to my preceptor and we examined the patient, we found…… Nothing! All that worry for nothing, but we gave her lots of options for birth control and for protecting herself from contracting an STD. She cried and gave me a hug before she left. That was the best experience, and totally exemplifies why I wanted to go into medicine to begin with.

My rural preceptor was actually pretty close to my home (with having a kid in daycare that had to be picked up in late afternoon, this was ideal), but on Mondays our last appointment was at 7pm. These were some of the longest and hardest days I have worked as a third year. My preceptor was also a pretty inspiring guy. He started the clinic on his own from a grant, taught himself Spanish so he could easily converse with a large portion of his patients, and the clinic was so successful that there was a brand-new school clinic opening that he was helping to run, along with another school clinic in the beginning phases. I even got to help out with the opening of the school clinic as my community service project while I was on service. We were constantly busy; we’d have 50 scheduled patients/day and we took walk-ins. I would volunteer to go see patients as soon as they came in the door to keep the flow going.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

The clinic setting is pretty common, but I know that the residents often train in our local hospitals as well, especially our pediatric hospital.

What info do I still need?

None–I really enjoyed my time in Family Medicine, a lot more than I thought I would. However, I still think I’m going into Pediatrics.

Has my perception of this specialty changed? If yes, how?

Umm, yes. I was really dreading this rotation. I’d already had Pediatrics and Internal, so I figured it would just be a rehashing of some of those same topics so I wasn’t particularly excited about it. However, I learned a ton of preventative medicine and saw so many cool cases, including regular bread-and-butter cases that were great practice.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

Family Medicine is higher up on my list than I thought it would be. I was very impressed by the depth of education I got on this rotation.

Right now, how interested am I in this specialty?

Pediatrics>Internal>Family>Neurology>Surgery

What information do I still need to evaluate this specialty? Any other comments or reflections?

None! Now on to…… OBGYN.

Resources for the Shelf: Case Files, Step Up to Medicine (ambulatory section), Master the Boards (Emergency Med section), Pretest for questions.