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Top 5 Tips to Build a Valuable Network

You’re only as strong as your network, and that’s as far as success will take you. Unfortunately, this is something many people do not learn early enough in life, or do not take seriously. In America, we are made to believe that if you have confidence in yourself, you can accomplish anything…That’s not necessarily true. Yes, confidence is part of the equation, but we typically accomplish more together than alone.

I have been amazed by the feedback we’ve received from PreMed StAR students pertaining to how much this community means to them. Multiple students have reached out to us and noted that this network has added extreme benefit to their premed journey. Each time I read one of these messages, I am pleased because I know these individuals are understanding the significance of team, community, and network!

It is important that you strategically grow your network. The people closest to me all bring something of unique value to the table. No two are exactly alike. They are all serious about their life’s work (not job, but work…there’s a difference) and they are all generous. These are the type of people you want in your network if you desire to accomplish great things, and these are five tips to help you build such connections.

1) Explore: You can’t grow your network if you’re not willing to meet new people. This is the first barrier that you must overcome. If you want to grow your network, you have to want to grow your network. In order to do that, you must step out of your comfort zone to meet new people. Also, a key part of exploring is meeting different people. A network full of people just like you isn’t nearly as valuable as a diverse network with people of varied backgrounds, experiences, careers, etc. Be willing to explore, meet new people, and learn new things.

2) Give More Than You Receive: This is perhaps the most important aspect to building a valuable network. In today’s society, we are told to focused on self. We are taught that we should go out and “get ours”, don’t worry about other people. That is a mistake. At the heart of everything you do, benefiting others should be the primary driver. The byproduct of helping others is they will see that you genuinely care, and in your time of need, they will be honored to stand by your side.

3) Listen: This is the little secret that drives many people straight up the ladder of success. Have you ever been in a meeting where one person is talking and talking……and talking. I don’t mean that annoying guy or gal who everyone knows is off their rocker, but rather, the person who is able to trick people into thinking he or she has the best ideas in the room. I’ll share this little truth with you, more often than you may realize, the intelligent and devoted individuals who actively and intensely listen then speak are the real movers and shakers. You can’t know what people need if you don’t listen to them. You can’t solve a problem if you can’t describe the problem. If you master the art of listening, you can more effectively accomplish tip number two above.

4) Invite: A mistake that many people make is trying to jump on board other peoples’ train too early. When I say invite, I don’t mean invite yourself to their function; on the contrary, I mean invite them to your function. The fear of rejection too often prohibits us from inviting people to join our activities and into our lives. Yes, we do get rejected many times, but this isn’t because people don’t want to be around us; it’s just that people are busy. If you think someone is worthy enough for you to invite them somewhere, that means other people probably agree and have also invited them somewhere. Don’t be afraid to extend an invitation. Just make sure you pick up the tab.

5) Confirm Via Connect: In 2017 part of networking means connecting on social media. It’s a really strange thing actually. If you’re not connected with me on Facebook then we mustn’t really be friends. That’s obviously not true, but that’s how many people feel. As a premedical student, of course I would suggest you connect with other premeds on PreMed StAR. The simple action of sending a connect request to somebody when they are not present shows that you were thinking about them.

Build a valuable network. You might not think it’s worth your time to start working on this today, but tomorrow you’ll want to have it. One last piece of advice, always remember that the network is not about you. It’s about leveraging each other so you can serve others. That’s why we’re here, to help others!

Let me know which of the five is your favorite, and what other tips you have!

Congratulations to Kirsten! Premed of the Week!

1. Tell us a little bit about yourself.  My name is Kirsten, but call me Kirsti. I major in Biology with a chemistry and a studio art minor. I grew up in Idaho and I’ve been skiing since I was 2 years old. I moved to upstate New York my senior year of high school, and I began my college career at SUNY Plattsburgh. I loved my friends and many of my professors, however ultimately the school wasn’t for me. I recently transferred to Union College where I will start classes in the fall, but to be honest I’m super nervous to start all over again!

2. Who was your favorite teacher in school and how did he or she impact you?  Honestly my favorite teacher has been life itself. Okay don’t roll your eyes, I promise this isn’t just a lame and cliche cop-out of the prompt; I’ll explain: When I was 10 years old a nauseating stomachache began to plague me and I often felt like a blunt knife was stabbing my abdomen. This made being a kid and going to school extremely hard. I am now almost 21 and I still have this stomachache along with multiple new symptoms that accumulated along the way, and none of the specialists I’ve seen so far have offered an effective diagnosis. I was often accused of fabricating my pain to get out of class or when my homework was late. I sometimes wished someone could feel what I felt so they could know how much I cared and that I wasn’t lazy – I was hurting. I have always been ambitious despite my challenges and by junior year of high school I realized I needed to pick myself up in order to succeed. I didn’t need other people to understand or sympathize and I began to realize pity was not going to help me. I befriended hard work, motivation, and determination and I finally understand why the phrase “you are not your illness” is a wonderfully overused chesnut.

3. When did you first decide you wanted to become a doctor and why?  If you had asked 7 year old me what I wanted to dress up as for career day in elementary school I would have asked for a white coat and stethoscope, so in theory I actually always knew I wanted to be a doctor.

After contracting my mystery illness I found myself in many different doctor’s offices over the years and I went through a plethora of tests. I found the whole process so interesting. No amount of questions about what they were testing for, why, and how the test worked would satisfy my growing curiosity about medicine and the human body. I now see my illness as sort of a blessing as I know much of the medical system inside and out from the patient’s perspective. I have also experienced many different types of pain all over my body and I feel this will help me understand and empathize with my future patients in a way no textbook or psychology class can teach. So now I kind of have to follow my dream, right?

4. What area of medicine are you interested in?  Surgery all the way! Probably plastic surgery because it’s so artistic and I can’t think of a better career than being able to work with my hands every day.

5. What’s the coolest experience you’ve had so far on your premedical journey?  My college adviser had been so kind as to set me up with a mentor who is an anesthesiologist. He took me into as many surgeries as I requested and I was lucky enough to see a wide range of surgical specialties. Although I am not interested in anesthesiology for my future career, my mentor absolutely LOVED his job. There was not a day he wasn’t excited to be in the OR by 7 am even after working for so many years. One day while prepping for a case, eagerly drawing all sorts of drugs into syringes, he looked over at me and said, “ I love this sh*t!

6. What is your favorite book?  The Power of Now by Eckhart Tolle because Tolle is THE BEST.

7. Tell us one thing interesting about you that most people don’t know.  I was an acrobat for about 5 years and for a little while I would have been perfectly happy running away with the circus.

Top 5 Reasons Why Students Drop-out of Medical School

I write this blog in order to prepare premedical students for the road ahead. I want you to understand common obstacles facing medical students so you can be better prepared to overcome them. Medical training is akin to a rollercoaster pulling you through the highest of highs and the lowest of lows. On one hand, medical school is extremely challenging but rest assured, it is very tough to get dismissed from medical school. Plain and simple, most US medical schools are extremely supportive and want you to succeed. Students often get many chances to prove themselves before they are booted out of medical school. Despite this, the four-year graduation rate for M.D. students dropped from 96% in the 1990s to 81% in the 2009-2010 matriculating class. So, what is causing students to drop-out you ask? Here are five reasons why students drop out of medical school.

1. Unprepared or Overconfident: No matter who you are, medical school comes with a steep learning curve. You can never be fully prepared for medical school but simply being prepared is good enough. Being underprepared or overconfident can be dangerous. By unprepared, I am not referring to academic challenges. Those who have made it this far have already proven they are academically gifted enough to succeed. Some students who struggle are unprepared in their expectations of medical school. A student who is easily distracted should not reside an hour away from school next to a nightclub. Do not tempt yourself like that. Students should not expect to sleep-in daily or be regulars at happy hour. One thing that sets unprepared and overconfident students apart is their failure to gather crucial information. Often times, these were students who were overly arrogant and felt that by asking questions they would show a sign of weakness. While other students know the big exam was moved to a different lecture hall, Mr./Ms. Unprepared will show up to the wrong hall and miss the exam.

As soon as that “acceptance” letter arrives in the mail, students should begin searching for housing, planning finances, understanding the curriculum, and networking with other students. You don’t want to be dealing with these while med school has already started.

2. Family Stress: A close friend of mine battled with this daily in medical school. Her husband was not very happy that she was studying late into the evenings. It saddened her terribly that she missed her daughter’s first day at school and then her dance recital. These things took a toll on her and by our 3rd block she called it quits. To this day, she still looks back and wonders “what if” she had stuck through and became a doctor but in the end, she feels she made the best decision at that time. There are others who unfortunately have loved ones fall sick during their schooling. Life is very unpredictable and sometimes the decision to take a break makes sense but hopefully one will hang tough or return when they are ready.

When you get that “acceptance” letter, make sure to begin preparing your friends, significant other, and family on what they can expect from you over the next four years.

3. Burned Bridges: Be very careful with what you say and how you treat others (especially around a medical campus and on the internet). You can never judge a book by its cover. If you do, that book just may make life miserable for you. I still remember a buddy of mine who had a firecracker personality. I played basketball with this guy a few times a week. Let’s just say I witnessed a number of altercations between him and other medical students on the court. What many of the first-year students did not know was that this guy was a chief resident and in a few years, rose to a very high position in the medical school. When students make mistakes, or perform poorly in medical school, a committee typically presides over their case. It would be very unfortunate if one of those committee members is someone that student has burned bridges with. In today’s global age, the medical community is tighter than ever. Therefore, there are only a few degrees of separation between everyone.

Once you get that acceptance letter make sure you stay on your best behavior. Remember, that person you are talking to could be your upper resident, faculty, or boss one day. Here is a hint for you during your interview trail. Be friendly to everyone because you do not know who you are engaging and who is watching you. While I took premeds on their interview tours I made sure to speak to the dean about the students who I found to be friendly and especially those who were courteous with the nurses and the cleaning staff. Those to me were the team players.

4. Illness: This is one of the saddest reasons to say goodbye to a classmate. It feels as though everyone expects medical students and physicians to be supermen and superwomen. Well, it’s not so when it comes to being sick. As med students, you are exposed to many unique bugs. Med school also has a way of turning students into transient hypochondriacs as they learn about the pathophysiology behind diseases. Stressors may push susceptible individuals towards depression and substance abuse. In fact, a recent study showed that 27.2% of medical students had depression or symptoms of it and 15.7% sought psychiatric treatment. Schools are doing more these days to address this problem but students must be bold enough to seek help before it gets too late.

Once you get that acceptance letter to medical school, make sure you see your doctor and do your best to get a clean health bill of health or learn coping strategies to deal with stress and adversity. Never ever be afraid to seek help.

5. Wrong Career Choice: Believe it or not, after spending years as a premed and matriculating into medical schools some students realize medicine is just not for them. Our first day dissecting cadavers in Anatomy proved to be too much for a classmate of mine. She fainted and eventually gained consciousness only to see a room full of students and professors surrounding her. This unfortunately shook and discouraged her drive to become a doctor but I believe she eventually gained enough courage to rejoin us. A very intelligent friend of mine left med school to obtain his PhD as he thought he could touch more lives through his research. Yet another friend of mine completed her medical school, residency, and GI fellowship only to leave a very promising academic career at a well-known institution to become a beautician. She felt medicine was more a dream of her parents and not something she was truly passionate about.

When you get accepted to medical school, do a lot of soul searching and make sure this is what you really want to do.

References

1. Caulfield M, Redden G, Sondheimer H. Graduation rates and attrition factors for U.S. medical school students. Association of American Medical Colleges. Analysis in Brief 2014;14:1–2.

2. Rotensterin LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016

Written by Dr. Daniel

Image Credit Pixabay

5 Things You Should Know Before Looking for Extracurriculars 

Extracurriculars are an important part of any premedical student’s journey to medical school. Beside test scores and GPA, your extracurricular activities are one of the most important components of your medical school applications. Your involvements and activities become one of the best ways for schools to gain insight on who you are as a person and what kind of student (and future doctor) you might be.

Admittedly, you are probably juggling school, work, and other commitments that prevent you from being able to jump on any project that catches your interest. Here are five things to consider before looking for another extracurricular activity.

1) Reflect on what you’ve done before moving forward

This is arguably one of the most important things to consider before looking for new internships or volunteer opportunities. Be sure to take some time to reflect on ALL of your involvements over the past few years and write them down. (Tip: Fill out your PreMedStar profile to keep your involvements catalogued for future reference.) Once you’ve taken the time to get everything noted down, take a step back and look at your CV as if your were an admissions officer. Pay close attention to the types of activities and dates of duration. Types of activities can be anything ranging from clinical experience, research experience, community service, campus involvement, leadership positions, etc. Medical school admissions is becoming much more of a holistic screening process. Ideally, you want to demonstrate that you are a well-rounded and broadly interested/experienced person. Do you notice that all of your activities fall within one category of involvement? Are any of your categories filled with outdated activities? Do your hours of engagements fall much lower in one category compared to others? These types of questions may help point out any gaps or critical components missing from your extracurricular involvements.

I want to point out that there is no formula for doing all of the right pre-med activities. If any of your activities are unorthodox or unique, highlight them. Pursuing a career in medicine is a huge commitment. Be sure to support your candidacy as a medical student through your involvements. You want to make sure you have sufficient exposure (total hours/duration committed) to research, direct patient care, and leadership experience while also not limiting yourself to just those involvements.

2) Figure out what you’re passionate about

Ideally, everything you list as an involvement will also be something you’re interested in. The idea is that over the course of your time in university, or the years leading up to your application, you will have explored different interests and dedicated significant amounts of time to the activities you’re most passionate about. Signing up for an activity that you are passionate about will feel much less like a requirement and be more enjoyable and beneficial to you in the long run. Never sign up for something just because you feel like you need to. It’s normal and expected that somewhere along the line you will find a volunteer opportunity that doesn’t align with your interests. Get everything you can out of the opportunity and move forward knowing that you’ve put in a genuine effort and explored the opportunity.

3) Be realistic about the time you can commit

Your premedical years can be one of the most taxing and stressful times of your life.Your amount of free time each week is most likely limited by school, work, and other outstanding commitments. Before jumping into a bunch of new activities, be realistic in reflecting on the amount of time you can actually commit. You can’t rush your way into gaining experience. I’ve had multiple pre-med advisers and medical admissions officers tell me that the journey to medical school isn’t a sprint- they’re looking for the marathoners. For example, it’s not enough to say you have significant research experience when you’ve only committed one quarter to working in a research lab. Realistically, every internships/volunteer experience is different. Some of them may be designed to fit within the timespan of a summer or winter break. Besides these exceptions, here is the general rule I was told. You typically want at least one year of commitment. Two years shows significant commitment, and three plus years even more. As mentioned before, you can’t rush experience. If you know you can’t commit to a weekly activity, look for something that is every other week or once a month and plan on staying with them longer to gain that hands on experience over time.

4) Get creative in your hunt

There are tons of people looking for the same opportunities as you. Don’t get discouraged if you aren’t able to find what you’re looking for right away. I’ve had a few friends on PreMedStar ask for tips on how to find clinical/research experience. I will probably make another blog exploring this topic in further detail, but for now here is my shortlist of ways to find what you want. After graduating from university I found it extremely difficult to find new clinical volunteer opportunities as most of the positions I found were prioritized for undergraduates. I had to get creative. I began to search for opportunities that were not affiliated my university or those near by. Never underestimate the power of networking- reach out to people you already know who are in the field you are interested in gaining experience in. If that doesn’t work, look elsewhere. I found a surprising amount of opportunities on LinkedIn, volunteermatch.com, craigslist, and random google searches for positions. If you are persistent and put yourself out there someone is bound to respond.

5) Don’t be afraid to try new things

My last piece of advice is don’t be afraid to try new things. Jumping into a new field may be daunting at first, but there is no way you can come out of an opportunity knowing less than you did before. Explore all of your interests. Look for new things that get you excited and spark your creativity and curiosity. Take advantage of this time to really figure out who you are and what interests you. Most importantly, enjoy your journey and make it a good one. 


How to Sleep Better to Perform Better

How much sleep do you get each night? Is that enough? I’m willing to bet that most of you could use a little more. Thinking back to my premedical days, I could have used a lot more. Those of us with Type ‘A’ personalities often believe that we accomplish more when we sleep less.   That’s not necessarily true for a few reasons: (1) Sleep helps consolidate and solidify our memories (2) Sleep helps us reduce stress levels, and (3) Sleep helps decrease inflammation.

Certainly, there are many more benefits of proper sleep hygiene, however these should remind us not to fall into the trap of believing sleep is a waste of time (something which I often think to myself). Knowing these truths, how can you improve your sleep hygiene and in turn, improve your performance as a premedical student?

1) Daily Exercise: As little as 15 minutes of exercise a day can improve the quality of your sleep. There’s just something special about a decent workout that relaxes your body and makes it easier to sleep well. Perhaps it’s the physical fatigue or just a placebo effect of sorts, but regardless, it works!

2) Adhere to a Sleep Schedule: Among the more important things you can do is stick to a schedule. Having a set bedtime isn’t only for children. Many of the most successful businessmen and women adhere to a strict sleep schedule. It is often said that it takes 3 weeks for something to become habit, so force yourself to go to bed at a specific time for 3 weeks, and expect your internal clock to take it from there. Note, this includes weekends.

3) Bed Time Routine: Having a consistent bed time routine will help you adhere to your sleep schedule. It will also allow you to relax before going to bed. Make sure your bedtime activities are distinct from your other activities and strictly associated with sleep time. For example, some people have a cup o hot chocolate and read for 10 minutes prior to bed each night. It’s typically a good idea to avoid television or any other electronic device. Just dim the lights, read a little, say your prayers, and go night night.

Sleep plays an important role in your success as a premedical student. In order for you to perform at your best, you need quality sleep in adequate amounts. Don’t feel guilty to get in that bed a little earlier than usual, and don’t feel guilty if you don’t fall asleep on that chemistry book.

So, let me ask you this, do you get enough sleep each night? If not, what can you do to fix that problem?

Image credit: Pixabay

5 Things to Consider When Applying to a Caribbean Medical School

To apply or not to apply? That is the question.

There are many strong opinions held about Caribbean medical schools. Some believe these schools provide great opportunities for students who have had set-backs, or foreign status keeping them from getting into a US medical school.  Others oppose this option with no exception. There is no doubt that Caribbean medical schools can and do produce some very well-trained physicians, but in some cases, this comes at a cost. It should be noted however that International medical graduates (IMGs) contribute heavily in addressing the US doctor shortage by making up roughly 25% of the physician workforce.

I have met many IMGs who begrudgingly admit that they did not thoroughly investigate the offshore route before accepting their admission.   I also know some who took this route and wouldn’t change a thing.  After researching and discussing with a number of my colleagues, I offer advice in their own words and propose areas to research and consider prior to accepting admission to a Caribbean medical school.  The simple truth is that for some, this option is viable, and for many, it’s not.  You have to do your research and be well informed ahead of time.

1. ACCREDITATION

You need to understand that not all 60+ Caribbean medical schools prepare you to practice medicine in the United States and some will not allow you the opportunity to get federal loans. Regional programs train students to practice medicine in that particular island or nearby areas while offshore programs train students to practice medicine in the US and Canada. Offshore programs will typically mandate students to do their 3rd and 4th year clerkships in the US. Accreditation ensures that schools are providing quality training to their students. The National Committee on Foreign Medical Education and Accreditation (NCFMEA) is responsible for reviewing the different accrediting bodies to make sure their standards match those of the US and Canada. This will determine if students attending that international medical school can receive US federal loans. Furthermore, schools must have state-approval to allow clerkships and approval is also required for IMGs to legally practice in the 50 states. Be very diligent since some wording like “recognized” or “approved” may be misleading when investigating accreditation. Understand if they are referring to regional standards or US/Canada standards. Also know whether or not your program of interest is on probation or any other disciplinary condition.

2. COSTS

Larger and better recognized Caribbean medical schools are for-profit and can be quite pricey. IMG’s who have attended these schools are often left with loans in the $250,000 – $320,000 range while US medical schools tend to be on the order of $50-100K cheaper. Interest rates tend to run higher than 5 percent for medical students. As mentioned earlier, only schools that are NCFMEA-recognized will allow students to receive US federal loans. Tuition at larger Caribbean medical schools can be very expensive but you must also be aware of the many other fees. These include the cost of living expenses one would pay at a US school but one must also factor in travel as well as costs for examinations and prep courses which can be very pricey. With this type of price tag, you want to make sure you complete your training.

3. ATTRITION RATE

“We started out with 1,000+ students in my class, but at the end I felt like a quarter or more of my class was no longer with us at graduation.” -Yvonne (IMG)

The medical training journey is a tough road that only the disciplined can traverse successfully. Caribbean medical schools are no exception to this but they come with their own unique set of challenges. While US medical schools may sometimes “hold their student’s hands” through the training process, this may not be the case in some international medical schools. Many IMGs have informed me that they felt like they were “just a number” and it was difficult at times to get the proper resources. Therefore, one has to be extremely self-disciplined and resourceful. With such large class sizes, there is a diverse student body. The weeding-out process will start very early and eliminate those who probably should never have been in medical school in the first place. Some have poor or inadequate work ethics, lack of motivation, or inability to properly balance their tasks. Others are forced to withdraw due to unforeseen hardships. Different programs have their own unique requirements (such as attendance) which must be met in order not to be booted out. Scoring systems vary among programs and material learned varies. In order to sit for the Step 1 exam, schools require their students to take additional tests including the National Board of Medical Examiners (NBME) and the Comprehensive Basic Science Examination (CBSE). Failing these exams may disqualify you from taking the Step 1 exam and may lead to dismissal from the school. According to the 2016 United States Medical Licensing Exam (USMLE) performance data, 72% of non-US/Canadian schools passed the Step 1 exam compared to 94% of US/Canadian students passed.

4. RESIDENCY MATCH

“As an IMG, I felt very discriminated against during the residency matching process. It was important that I was realistic in the programs I applied to and in the end, I applied to 100 programs.” -Paul (IMG)

As an IMG, it is nearly impossible to match into a US residency program without outscoring US trained grads on their USMLE. According to the National Resident Matching Program (NRMP), 53.9% of US IMGs and 50% of all IMGs (including non-US IMGs) matched into a US residency program in 2016. Compare this to the 98% match rate for US trained seniors. This can be very painful for those who fail to match especially if they have loans to pay back. This is more reason why IMGs must outshine others on their board exams and clerkships. Furthermore, good networking skills is a must. It would be ideal if the school offers clerkships at programs that also train residents. This is a question you should definitely ask and if you are a non-US IMG you will also want to know if there is Visa sponsorship at that residency program. The Educational Commission for Foreign Medical Graduates (ECFMG) is the standard used in evaluating IMGs who intend on practicing in the US. Students must also take the same examinations that US med school students take (USMLE Step 1, Step 2 CK and Step 2 CS) but must first gain a diploma from an institution registered in the International Medical Education Directory (IMED) in order to be granted an ECFMG certificate and enter a US residency program. Despite all the hard work and effort, some residency programs still simply do not consider IMG applicants. According to the NRMP 2016 Program Director Survey, only 64% of the programs responded that they typically interview and rank US IMGs while only 49% would consider non-US IMGs.

5. LIFESTYLE & SUPPORT SYSTEM

“The international experience enables you to build cultural competence and self-confidence while adapting to a new environment.” -Tony (MS4)

“As a non-US student, I don’t believe I was as shocked living in a third world environment than many who came from the US.” -Yvonne (IMG)

The breathtaking beaches, beautiful wildlife, and exotic foods. It certainly appears to be 2-4 years of training in paradise and away from many distractions. Depending on where the school is located, you may be exposed to a new language and different culture. While this can be an amazing experience you must also realize that there certainly will be challenges. Being so far away from family and friends may make for some very lonely months. The local stores, sporting events, and foods you are accustomed to experiencing likely will not be readily available. Prices will also likely be different than what you are used to. If there are special diets, hygiene products, medications or devices you require it would be wise to see if they are available in that area. A friend of mine was flown back to the US after developing an illness and this took a huge toll on her training. Sometimes you long for a hug from that friend or a good home cooked meal from mom. Be sure to inquire about internet access and how best students communicate with loved ones (video chat, calling cards, etc.).

 

Bonus: Stereotypes

Some IMGs experience discrimination and bias during their clinical training. These individuals feel that they have to prove themselves during clerkships and during residency despite sometimes having higher scores on their exams. Rest assured, much of this dissipates as they begin to practice medicine as medical doctors. Those who are able to stay the course and make it through as IMGs have definitely earned my respect. In the end, patient’s want a well-trained physician with good bedside manners no matter the medical school they attended.

In summary, I have addressed some key areas that every premed should investigate for themselves prior to accepting an offer for an offshore medical school. The question of whether one should attend a Caribbean medical school really must be answered by one’s own self. If an offshore school is not a student’s first choice, I recommend that they always consider other options (retaking classes, post-bacc, research) which may strengthen their candidacy first but if this has been done already or other limitations exist I would make sure they are able to check these boxes prior to proceeding:

o I am 100% certain that being a medical doctor is really what I want to do

o I am financially secure and/or will be okay paying off a debt even if I don’t complete my degree

o I am a very good test taker or am certain I will be

o I am very self-motivated and disciplined

o I can adapt well to new environments

o I am willing to study harder and focus more than ever in my life

o I am willing to do my own research about the different schools

“Although you are a premed now, think ahead and really do your homework to ensure that this is right for you. I had my rough days, but would I do it all over again? Yes.” -Yvonne (IMG)

Written by Dr. Daniel

Resources and References:

NCFMEA: https://sites.ed.gov/ncfmea/

CAAMP-HP: http://www.caam-hp.org/assessedprogrammes.html

FAIMER: http://www.faimer.org/about.html

USMLE Performance Data: http://www.usmle.org/performance-data/default.aspx#2016_step-1

AMA: https://www.ama-assn.org/life-career/residency-program-requirements-international-medical-graduates

NRMP 2016 Match Results: http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

NRMP 2016 Match Program Director Survey: http://www.nrmp.org/wp-content/uploads/2016/09/NRMP-2016-Program-Director-Survey.pdf

van Zanten M, Parkins LM, Karle H, et al. Accreditation of undergraduate medical education in the Caribbean: report on the Caribbean accreditation authority for education in medicine and other health professions. Acad Med. 2009 June;84(6): 771-775.

Congratulations to Sarah! Premed of the Week!

1. Tell us a little bit about yourself. I am from Katy, Texas – born and raised! I grew up in a small town (which is not so small anymore) and am a first generation college student majoring in psychology. I enjoy cooking, watching inspiration YouTube videos and TedTalks and free-style writing, in my spare time. I try to give back to my community as much as possible in various ways!

2. Who was your favorite teacher in school and how did he or she impact you? I have 2 favorite teachers. One from high school and one from college. Mrs. Williams was my high school Health teacher. She identified my strengths and encouraged me daily to become a better person. Whether it was showing us how to properly do CPR or teaching us how to be kind to one another, I will never forget her impact on my life. When my father passed away, 1 day before my high school graduation, Mrs. Williams and her husband came to my home for condolences. When she left, I opened the card she gave me and in it was a check to help me buy my books for the first semester of college. She is truly an angel. My second favorite teacher is Dr. Kristin Anderson – professor of psychology. She impacted my life so profoundly after taking her Social Psychology course. She taught me how to stand up for myself, to see through the biases we are faced with on a daily basis and how to think for myself critically and logically. She opened my eyes to the disparities we face as a society and how to be a better individual to have a positive impact on our communities. She is a brilliant professor and her impact on my life will be longstanding.

3. When did you first decide you wanted to become a doctor and why?  It was when I saw the reality of medicine first hand that I decided to be a physician. My dad tragically passed away in 2009 and was taken to the Texas Medical Center where we were told that the doctor’s couldn’t do anything to save him. I remember sitting on the ground thinking, “I will do everything in my power to save someone else’s parent”. And I have a mission to do this. Medicine is science and science is being revolutionized every single day and new treatments and medicines are being made. I want to be a doctor to improve and maintain good health of the people. I want to be a physician to educate people on the fact that an ounce of prevention is worth a pound of cure. I am so certain that I have the capability to do this and in turn, give someone else’s dad, mom, brother, sister, aunt or uncle a longer, healthier life.

4. What area of medicine are you interested in? I am interested in Emergency Medicine and Primary Care, both. As an ER physician, you are on the front line of defense. It is such a critical responsibility and with proper training, the ability to treat carries a wide impact. I know this as I have been a scribe in the ER for 5 years. I am also interested in primary care because I have a knack to educate, promote, and inspire. As a primary care physician, I can manage my patient’s health on a long term basis and create lasting, personal relationships with them.

5. What’s the coolest experience you’ve had so far on your premedical journey?  The coolest experience I have had so far as a pre-med was being given the opportunity to be involved in a medical research paper with a team of doctor’s. It was with this research paper that I experienced first hand the pressures of medicine: working 2 jobs as a scribe and a medical assistant, being in college, studying for the MCAT and working on the paper to meet a deadline gave me a realization that my journey isn’t going to be easy – but it will be worth it. And when the paper was accepted to be published and is now on PubMed – every minute of stress was worth it!

6. What is your favorite book?   My favorite book is “The Alchemist” by Paulo Coelho. I always encourage everyone to read this book at least once as the story teaches us about the essential wisdom of listening to our hearts and following our dreams, no matter how many obstacles we may face.

7. Tell us one thing interesting about you that most people don’t know.  An interesting thing about me – I have visited 11 countries and speak 5 languages!

MY OR EXPERIENCE(Part 2)

“I am allergic to oxygen, water, air, food, and oh yes, people”, Dr. B remarked. He was hyperbolically repeating the words of one of his patients as he viewed a medical history. The paranoia that most patients feel after undergoing so many procedures is real. Some even diagnosed themselves with some deadly ailment before coming to see the doctor. It was a gloomy Tuesday morning as the summer’s simmering heat was quelled by the rain showers which does not seem to be holding back any of its potentials. I got to the general surgery office and we had about 14 patients on the schedule between 9am and 12pm. We saw patients within the age range of 17yrs to 73yrs old. The operating room is where I familiarize myself with surgical techniques, teamwork skills, and the human anatomy. On the other hand, in the exam room, it is just the doctor with critical thinking and people skills and the patient with concerns.

Patient A was in a wheelchair in the exam room. She seemed frail and her gait shuffled every other second. As Dr. B helped her to the bed for examination, she staggered and trod slowly until she made it up to the bed. The questions began to fire like action potential in neurons from Dr. B. After several questions, he then asked if she had pain above her navel or below it. He stressed that the answer is important in making the right diagnosis. She waved over her entire belly to indicate where she felt the pain. When asked to point to the pain, she initially pointed up and then later she pointed below. I could feel Dr. B getting frustrated. I think most patients don’t realize that physicians need the patients help in order to provide the highest quality care that they deserve. Being a physician is not a one-sided task; patients have to be engaged and responsible for their right diagnosis by being honest and exact in the best way possible.

After standing all morning long, I caught a break to study before returning to the room where I would be watching three consecutive colonoscopies. The coldness of that room would have taken me to my heels but I wanted to learn so I had to take it all in. Although I was just going to observe from the room corner, Dr. B showed me how to use the endoscope. The procedure felt gross to me until Dr. B started finding polyps in the colon of these patients. He clipped them off. Polyps are usually harmless but some could develop into cancer which can be deadly if not caught early. I thought to myself that maybe physicians’ bravery to withstand even the grossest things during their course of practice isn’t born out of some dauntless gene but out of the sincere desire to get positive outcomes that would lead to a patient’s overall wellbeing. After all, medical students do cringe sometimes during gross anatomy lab. Earlier in the day, we had seen patients who had intestinal diverticulitis (inflammation of the diverticula). So, during the colonoscopy, Dr. B showed me the diverticula on the monitor: they are small pouches in the colon.

colonoscopy room right after patient 1 was wheeled out

The following day at the office, I was looking at the CAT scan of patient B who had a bilateral mastectomy. She had been undergoing chemotherapy and radiation but chose to stop it because the side effects were overwhelming. While analyzing CAT scan, Dr. B saw that the cancer had metastasized to her liver. She has masses in her liver which she knew not of. The oncologist should have discussed that with her so Dr. B refrained from addressing that issue during the examination but he strongly encouraged her to talk to her oncologist about her CAT scan result. Patient B’s fatigued eyes bore the pain that she has undergone and the slightest of hope she had struggled to gather. She asked the doctor if she could go back to work not knowing that another battle awaits her. I wish I had a magic wand. Nice people don’t deserve pain.

That same day, I was supposed to watch a surgery where the entire colon would be removed(colectomy) due to a patient’s poor decision making. He had developed a colon cancer which was caught very early and was advised to get it removed. He denied undergoing any surgery even after his daughters persuaded him to do something about it. Eventually, the cancer developed to the extent that it attached itself to the abdominal wall and protruded out of his belly. Now he has to get colectomy and have a colectomy bag attached to his abdomen so that all the waste can be disposed of. What I learned from this is that it is important to help patients understand their conditions and elucidate the imminent risk without sounding too forceful. Doctors tend to want the best for their patient while respecting their autonomy. This represents a dilemma that cannot be avoided during one’s course of practice. Yet, it is one of those things I guess, with time, doctors learn to grapple with. I cannot think of not worrying about a patient that makes a bad decision that could cost his/her life or quality of life.

The last day in the OR, I watched and participated another gall bladder removal surgery. I noticed that no two people are the same. The diagrams in the book are the same, however, in reality, one has to critically assess the anatomy of different patients. The gall bladder was detached by clipping cystic duct and cystic artery. If Dr. B had gone by the available heuristic, he wouldn’t have detected that the arteries were branched which made it two. He had clipped only one previously. Then thirty minutes later, I watched the removal of a breast tissue that had been marked by a pathologist for biopsy.

Last day in the operating room

It was an incredible experience and over four days, I learned so much than I ever thought I would. My perspective towards medicine was shaped in a unique fashion. Seeing different facets of being a physician- the meritorious aspects, the dreary aspects, and the inevitable dilemma zone- made me appreciate the nobility and uniqueness of medicine. A physician could be cracking jokes with his staff to cutting a patient open to making life changing decisions for patients. Many times, I parallel my lab work on cell culture with treating patients: I had to make sure everything is sterile, make a treatment plan, execute my plan, and incubate the cells for optimal growth. This parallelism becomes faulty when I think of patients as having hearts, loved ones, dreams and aspirations, bucket list, and so on. My takeaway from this experience is that, in a broad sense, we as premeds are entering this profession to help people but, in a subtle sense, we are really interested in medicine to restore hope in people and guide them through the decision-making process regarding their health. When one stares at death straight in the eye due to an ailment, one looks out for help because one feels helpless. But, through the provision of help and compassionate care from physicians, the once staggered hope one has for living and in life is alleviated with renewed vigor.

A second chance at life…

A second chance at life…..

It’s amazing the impact that one person can have on another. As a paramedic, you work with a partner and sit inside of an ambulance waiting for your unit to be given as assignment. Once given, you turn on the lights, flip the siren and proceed into the unknown. The dispatcher give you a brief description of what may be going on, but 99% of the time, it’s totally different. It’s that 1% that makes me realize how much I love helping people and want to become a physician.

My partner and I were given the call for a cardiac arrest in the subway station. Honestly, when we see something like that, most of the time the patient isn’t in distress at all. The patient is usually sleeping or intoxicated. When we arrived, the patient was not only having CPR done to her, but she was traveling with her 3 year old son at the time. My patient was a 33 year old woman. Just looking at her, you would never assume that she would have a massive MI (Myocardial Infarction). The police and firefighters were busy with crowd control and my partner and I started our intervention.

Any time you work up a cardiac arrest its an emotional experience. What makes it even harder is when the patient is so young. This woman was dead and we are given the task of trying to bring her back to life. With CPR continuously being done, we secure her airway via intubation. Because of the fluid loss, her vasculature was poor. So we had to drill a hole into bone using an intraosseous needle. This allowed us to give her medication and replace the fluids she lost. After about 15 minutes, we noticed that her heart went into v-fib (ventricular fibrillation), so we defibrillated her. This happened about 4 times. Finally her heart stabilized to the point where we were able to safely carry her out of the subway.

We notified the hospital and the ER staff was waiting for us. Drenched in sweat and high off of adrenaline, me and my partner were hopeful that she would make. Walking back to the crew room, I saw the patient’s son and he asked me if his mom would be okay. All I could say is that your mom is a very strong woman and she would so proud of how brave you are. He smiled. 🙂

This happened a few months ago. And now, I’ve received an invitation to a “Second Chance Brunch”. This woman not only survived, but she has suffered no deficit. Aside from having a pacemaker/defibrillator placed, she 100% okay.

I am so grateful for experiences like this one. As a medic, I’m with the patient at the beginning of the story, but as a doctor, I’ll get to see the patient all the way to the end. I want to be able to complete the story. Life is so precious, and being able to help people is such a gift. Doctors are definitely servant-leaders, and that’s what we aspire too be.

 

MY OR EXPERIENCE (Part 1)

Knife? Scalpel? Scissors? As Dr. B received each equipment, my eyes darted between the nurse’s hand and the surgeon’s hand to the patient’s belly. I was in scrubs holding a bowel grasper inserted into a laparoscope with my eyes fixated on the monitor marveling at the intricacies of the digestive system. The patient was undergoing a gall bladder removal surgery. Lactic acid began to build up in my hamstring as I adjusted the grasper as instructed and held it still as soon as I hear “stop Aisha!” It felt like I have been doing this for years because everything seems strange yet routine. I watched the puncturing, the blood squirts, the incisions, the stitching, and listened to the humorous doctor’s anecdotes during surgery.

I watched the first procedure- keloid removal- behind the cloth separating the patient’s head from the rest of the body. I call it the anesthesiologist hang out spot. I was so fascinated by his experienced hand and perfectly calculated incisions before he commented,” so Aisha this is really nothing technical, it’s just a keloid removal.” My brain screamed, “no doc, this is the fanciest thing ever.” As I stepped out of the OR, I was taught how to scrub my hands from my elbow to my fingertips. After every procedure, I sat in the doctor’s lounge with several other surgeons who were waiting to be paged. I felt intimidated at first but later motivated and excited. Back to the beginning, before the next surgery, the gallbladder removal, I did my scrubbing ever so religiously, held my hand up my torso, backed the door open into the room, and waited to be ‘gloved’ by the nurses. Timeout process was done by a nurse and this includes saying the patient’s name, age, the name of the procedure, allergies, and other few important information and then every member of the team says, “I agree.” Following that procedure, I observed and participated in the loosening of the internal sphincter of the rectum and the insertion of a feeding tube into a patient’s stomach.

After lunch, we transitioned from OR to seeing patients at the general surgery office. I saw minor cases such as a nail in the foot to a pervasive case of skin cancer. The patient-doctor interaction was a fun-filled one because Dr. B has an unparalleled sense of humor. I would come out of the exam room giggling. I noted how important it is to ask specific questions to give a diagnosis. It is like collecting pieces of puzzles to form a big picture; because most patients would not divulge every bit of their history and symptoms to the doctor. Now I see why the MCAT is so convoluted; it is not only an evaluation of your success as a medical student but also a preparation for your success as a physician. One of the most intellectually stimulating parts of my experience is learning how to read a CAT scan. Many of the post-op follow-up patients had undergone an operation to treat either a hiatal hernia or an inguinal hernia. A hernia is the bulging of an organ or tissue through an abnormal opening. When I saw the CAT scan, I wondered what information could be possibly drawn from a piece of white and black image; it made no sense. Dr. B then explained that the CAT scan image is like a loaf of bread with raisins randomly embedded in it. The bread is thinly sliced throughout section by section to find the raisins. Similarly, for humans, the CAT scan generates slices of the body in a cross-section, from head to toe. The less dense parts are black such as the lungs and adipose tissue and the very dense part is white such as the bone. Between this spectrum are organs and tissues with various shades of gray. As the day went by, after seeing many patients with a hiatal hernia, I could luckily guess through the CAT scan that a patient has this condition.

I saw the frustrations and difficulties that come with being a physician. The day has its highs and lows. Without the right information, an improper diagnosis can be made. I have so much respect for the technicians and nurses as much as I do for the doctors. Things won’t simply operate smoothly without them. They play an enormous role in setting the stage for the doctor to perform. I heard the pronouncement of people as being dead and at that moment, it felt like the world had stopped. After so much effort and hours put in to save a life, the thought of not seeing that hard work manifest into reality is heart-wrenching and it definitely takes a toll on the doctors because they cared. However, I see this as a feed-forward activation: every failure should only propel us to perform better next time. “What can I do differently?” should be the question. Sometimes there are no answers and I think one has to be okay with that.

I remained mute the whole time and only asked questions when I knew I would not be interrupting Dr. B. During some office examination, I had some profound emotional moments which I also kept muted. A patient told the doctor that he had pain in his upper right abdomen. He had a burn scar on his right chin which he got from a gas explosion when he was young. He had done a skin graft on the left and forgo the right because he decided to accept his deformation as he got older. After answering series of questions and analysis of results, Dr. B diagnosed him with gall stones and suggested the removal of his gall bladder. The patient had a choice to make or so I thought. The patient began with a sad face, “ I want this pain gone. I cannot live a normal life. This pain prevents me from playing with my grandchildren. It’s alienating.” Previously, I was thinking to myself that this was just a gallstone. But after listening to the patient, I felt how much pain he felt because it is like being helpless and plunging towards decline while life is happening around one. It is not a good feeling. I know how it feels to be away from one’s loved ones and the discomfort or pain of not being able to enjoy bonding activities with one’s family would only aggravate one’s condition or cause depression. I silently wished him well and left the room with a smile which I hoped would make him feel a bit better. It is good to be alive and even better to be healthy and to live a quality life. Pheew! That was a lot to take in in one day.

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