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shikimate last won the day on December 26 2019

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  1. 1) starting your clerkship with electives puts you in a very difficult position because presumably you haven't had much exposure to the clinical side. On the flip side the sooner you do one in your specialty of choice, the sooner you can decide if it's right for you, and gain some experience in that specialty. I would advise doing perhaps 2 weeks in your specialty of choice at your home school to get a feel for it, and do more in 4th year. 2) clerkship is a big learning curve, and a lot of people struggle in the first half of it, but usually by the second half their performance is much better. I would advise against asking for LOR in the first half of clerkship unless it's your specialty of choice and you must, or you performed brilliantly, or you've worked with that person before. I would advise you to ask for LOR either near end of clerkship or during your 4th year electives. The best time is probably at end of rotation or whenever you are given your assessment. In person is probably the most effective. 3) I would consider rural family medicine, and be very keen during that time to get exposure to as much as possible in clinic, ER, hospital or whatever setting you can get your hands on. That way you get as much exposure to various patients as possible and learn general skills that can help with many rotations. I advise against starting clerkship on high octane subspecialty electives, because you don't even have the basics down yet. I remember the first day of clerkship, I didn't even know where I could find a consult form, and what they meant when they say don't forget to stamp it with the patient's card!
  2. It's vague and sometimes I think clinicians use it defensively when they don't feel like giving specific statements on someone's performance. Maybe they are busy, maybe they don't like teaching, or maybe they just want to get home that day. They should instead tell you explicitly if you are below, meet or exceed expectations. I feel a lot of clinicians aren't sure what to expect of a medical student (or a resident for that fact) unless they are very involved with teaching or curriculum development. Sometimes you have to remind them that you haven't done your core rotation, or you just began clerkship, or that you aren't an off service resident! There is no escaping of the anxiety trying to get "above expectations" for CaRMS because the residency system is screwed up. The only thing I can say is that you don't need to wow every attending to match, you just have to find 4-5 that you feel really good about that can go bat for you. If your goal is IM I would find someone that you've worked with for at least 1 week, and ask them if they feel "comfortable" giving you recommendation. It is a good sign when they say they are "comfortable" recommending you.
  3. To answer OP's original question, I think FM is a great choice. People tend to think of FM as the prototypical office based practice that mainly does mundane tasks, but there is a huge variety of things you can do as family doc, such as hospitalist, ER, anesthesia, surgical assist, minor procedure, routine delivery etc. Unless you are extremely limited in geography, you should be able to find a niche that makes you happy. Anecdotally I can assure you 5 years of residency does make you burn out, not to mention the mess with RC exam. I can't image what it feels like for my classmates that are doing 6 year residencies or PhD during the residency or 2 fellowships just to have a chance at a job. If you really like a specialty, try to shadow the MOST DIFFICULT part of that specialty that can make or break your residency/career. For example, shadow those 5am rounds or 1 in 2 calls with no post call day, and see if you can take it. I think sometimes medical students are underexposed to the "ugly" side of a residency.
  4. Anesthesia grads I know don't have problem at all finding jobs, even in large hospitals in urban areas, without fellowship. Although I have no first hand experience, they mention they really like that you can pick and choose your shift, and if you want to make more, you can pick those overnight shifts, if you want to take it easy, you can do less. Some people in FM also did a +1 year in anesthesia and now works in rural hospital OR part time, they love that they can blend FM with some OR time to add to the variety of work they do. Rural hospitals seem to employ a lot of FM to do the anesthesia on smaller cases so the demand is certainly there.
  5. - you have home field advantage for your school's IM program, so unless there's extraordinary interest in IM in your class (or this cycle overall), you should be in good position - there's infinite debate re quantity vs quality of electives etc. My view is that quality of reference letters are much more important than quantity of electives. Worst are electives whereby you get switched around with different preceptors and none gets to know you at all in the end. What is a "good" IM elective? In my view if you can work with 1 or 2 preceptors during your 2 weeks and feel there's good chance they can vouch for you, then that's a good elective.
  6. Back some years ago lecture recordings, textbook and notes would be the best way to study, but with advent of YouTube things have been flipped upside down. One thing you realize quickly is most lecturers suck, they can't explain things well, or the way they explain things is fragmented, illogical. So more and more I advocate people using online resources that actually explain things logically. Previous poster mentioned Osmosis, it's a GREAT resource that make exceptional videos, which explain concepts very clearly and concisely, highlighting high yield topics. You can even use it to study some Royal College exam topics, that's how good they are. Not to mention there are now numerous videos showing you physical exam maneuvers. Multi-media is the key to remembering key info, you should read about it, talk about it, look at it, and hear about it, or even do it with your own hands, then you'll retain it. Another dubious distinction of med school lecture is they never tell you what's high yield on the exam and in practice. For exam purposes what's high yield can be found in USMLE First Aid book. That book is very dense but all the topics they mention in there have been distilled by generations of med students. Use that book to filter out things you must know, things you should know, and things that are nice to know, they supplement with YouTube, Wikipedia, medscape or UpToDate if you want to learn more about it
  7. There are some people I've met who really, truly want academia from the bottom of their heart. Money is not a priority for them. They truly like research and/or teaching and would happily accept most arrangements universities give them. There are some people I've met who "pretend" they enjoy their academic positions, but in reality dream of doing the same job in a community setting. You can spot those "restless" attendings if they are junior, or "deflated" attendings if they are senior. There are some people I've met who is in academia because they are IMG, or have some kind of visa or license issue whereby they require institutional sponsorship. They are mixed bag, some are in academia because they like it, some are there for the expediency of visa, some are indifferent and just wanna get a job.
  8. More provinces are likely to follow the steps of ON and AB in trying to impose a "hard cap" on total physician compensation. Physicians who are fee for service, especially high billers, are likely to see more scrutiny of their billing practice. Some services will likely be deemed "non-essential" and be de-listed from provincial insurance plans. Physicians on alternative compensation arrangements could be less impacted, but one would not be surprised if their compensation stagnate, or their workload increase. New hires pose a tricky issue (as seen in AB), because with a hard cap it becomes a zero sum game. Perhaps some specialty will see waitlist increase (I remember an article quoting the era of rad onc on salary rather than FFS) when more are placed on non-FFS models. One thing is for sure, the honey and nectar from the central bank printing press isn't going to public healthcare anytime soon, I'll leave you to figure out where it is flowing.
  9. just FYI some pathology programs do require residents to do overnight call (likely home call). Although it's uncommon to get called in, it does happen for urgent cases like transplant. Also overnight you could get pages for which you have to call back, but doesn't have to physically go into the hospital. So there is a risk that your sleep will be disrupted more than once when on pathology call, hence you should clarify this with each program. Keep in mind pathology programs are small and they need residents to cover overnight issues, so it's unlikely you could go through the entire residency in pathology and expect other residents to cover for you (assuming call is required by your program).
  10. 2 weeks in pathology should get you interview at many programs (but might not at places like UBC, Toronto). Also the workload of a medical student on pathology is a fraction of the real workload of a resident so don't get fooled. In general I do not recommend 2 backups in first round. There are always pathology spots in the second round but not many IM spots in the second round.
  11. Just to add, for example if a program matches 5 residents per year but there are only 3 PGY2 or PGY3 then find out what happened to the other residents that year that are MIA. Maybe they're off on maternity leave which is legitimate but maybe they switched out because most switches happen around PGY2/3 year. If in a small program you see people switching out frequently that's big red flag, imagine you lose 2 of 5 residents then you lose 40% of workforce and whoever remains will have to take call and pick up the paperwork etc. If you see PGY5s doing heavy clinical work that's also big red flag because you need 6+ months to study for Royal College, so too much clinical work can be detrimental for PGY5s. Even better find out if any PGY5 has failed Royal College recently because that's big red flag. For example if a fellow they have is not Royal College certified find out why, sometimes people who fail exam can do a "fellowship" for 1 year, which is just a euphemism for the program bailing them out while they study so at least they have money to survive. A lot of times the program offer no support so PGY5s are on their own which is big red flag, remember the royal college is the big forest so don't lose sight of the forest for the trees.
  12. What's frustrating with residency is that your time is very precious, therefore everything you do, from seeing cases to studying after work must be high yield because you can't afford to waste time. Your attending and co-residents can make or break it. For example, as PGY2 attending tell you to read 1500+ page textbook and know the stuff in there. That is a completely useless advice, perhaps done with somewhat of a good intention. If you have a good senior resident they'll tell you what resources are most high yield, what's most commonly asked by attending vs on exam, etc. 99% of attendings does not know how to teach, or have any idea what good resources are out there for junior vs senior residents, not someone who's been practicing for 20+ years. Telling someone to just "read this textbook" is the most useless advice I've heard but it is given day in and day out. You can watch Youtube videos and get more out of them for your Royal College exam studying. Also if your co-residents slack off then good luck because as PGY2 and 3 you'll be the ones doing the cleaning up. If you're in a small program and someone switch out or they reduce your residency spot then you're screwed because the work and responsibility will always be there and most likely junior residents will bear the brunt of the new workload. Never match to a program with a high drop out rate. Also pay attention to what happens with the senior residents in that program, because if they're desperate with job search or whatever then you can sense the PD/admin people don't care about what happens to their residents and in a few years it'll be your turn. Ask if the senior residents are happy with what they are doing after residency, there are lots of fellows who are in fellowship because they can't find jobs or their training was poor and they're afraid of going into a job. Also never ask any admin or PD how their residents are doing because that's like asking a wolf if they eat tofu, always ask the residents in an informal setting outside the hospital. Also pay attention don't just ask the most keen star resident because most likely you won't be the star resident and sometimes they have moral hazards like they were promised to be hired back to the program or have some academic aspirations so now they can't speak poorly of the program or chair or PD etc, so also ask the mediocre and even poor residents what they think. Don't dwell on bad people around you, know your goal is to complete residency and find a job. Don't dwell on bad patients, bad admin, bad attending, etc. Let them putrefact and always write down your long term, 5, 10 or even 20 year goals so you don't get distracted by short term. Academic physicians are often stuck in academic because they are too specialized. I've seen those that want to transition to community practice but have forgotten what they learned in residency and don't have the skill anymore so they are basically hostage to the department. So I ask why don't they just retire or do something outside the medicine? Like they've been in practice for 15 years you think they'd save and invest enough money they're financially independent now? Or maybe they're the HENRY makes lots of money but never rich because spent it all on trillion dollar HGTV house and have to pay alimony or something. I always tell people explore the world outside your center, do lots of electives at other hospitals and see how others do their work. Academic hospital runs very differently from community hospital or outpatient clinic etc. Academic center the cases are always harder, more complex, more layers of bureaucracy etc, and your mind get stuck thinking this is how the earth rotates. Sometimes people get sucked into being academic and look up to people with encyclopedic knowledge etc because that's all academic centers teach you. But once you go in community you see people with vibrant lives outside of medical practice who is doing fine even though they don't have some title of endowed chair in useless research studies. They might even teach you a thing or two about incorporation, work less and make more money, or something else you never get taught in academic centers. Also academic center cares too much who's assistant prof, associate prof, full prof and all that, it's all useless titles like the medieval era when you have to be Marquise or Baron of some plot of land or something. If I donate $5Mil to a department I guarantee you I create my own endowed chair then name myself the endowed professor and maybe even have a hospital wing named after me.
  13. I am selling my house near UWO and moving away. Unfortunately I can't take all the textbooks I've collected over the years with me. So I am willing to give them away to medical students or incoming residents. They are suitable for all years of medical school and junior residency/FM residency, IM, surgery, anesthesia, etc, many books. PM if interested. Also I am selling my house, it's in a great location, walking distance to MSB/UH, recently renovated. Multiple BR, 2 bathroom, 2 kitchens, so you can collect rent and let the house pay for itself. You can walk to school everyday, leave the car home and reduce your carbon emission.
  14. Get your hands on the valuable books that emphasize high yield facts (aka First Aid series) and complement it with YouTube. Do a google search on high yield review books from US med schools for USMLE steps and you'll find many many great resources. Step 1 = first 2 years, step 2 = next 2 years, step 3 = PGY1, read FirstAid series for each step and afterwards read it again because it's so high yield. Problem with med school is they expect great clinicians to be great teachers, which is not true. Famed clinicians are often some of the worst at explaining basic concepts in a way that a newbie can understand, and they don't know what's high yield for your term exam because their term exam was 20 years ago! Whereas I find YouTube has some many great contributors it can basically replace the first 2 years of med school hands down. Also med school emphasize information overload and not enough skills on information finding strategies. If I tell you all the hepatotoxic medications are on the website LiverTox why would you make someone memorize all these medications? If you can find all the mutations on OMIM why are board exams still asking them when you can Google it in 5 seconds? Mind baffling to say the least, they don't ask mathematicians to memorize every square root do they?
  15. I think it's the occasional bad apple that ruins the bunch. Most patients are fine, but one bad patient encounter will foul your mood for rest of the day! It's hard to avoid as student and resident because you have no control over your schedule, and even as attending sometimes "bad apples" are dumped onto you. So I think it's very important to have something outside medicine to keep you "refreshed" so when you start the next day your mind is clear. Maybe go for jog or bike ride, play sports, play music, whatever can help you clear your mind. Don't let the bad experiences linger, move on, physicians are humans too and it's dangerous to let bad patients and experiences drag you into a hole. I've seen people whose entire life is revolves around medicine, it's so embedded, engrossed, it's like medicine phagocytosed them! I always wonder how will they cope if one day they wake up and medicine has changed for them? For example didn't match into their desired residency, or got into medico-legal trouble, or got disabled and cannot practice anymore, or become burned out and depressed they cannot practice anymore. Would their life have any meaning left? Would their minds be able to move on? Would they be willing to pack up their box and direct their energy to excel in another field?
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