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Lactic Folly

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About Lactic Folly

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  1. My opinion is that a strong letter in medicine reflects well on you - however, if the letter may cause confusion about your career interests, it would be best to explicitly clarify in your personal statement that you were once considering internal medicine, but now have decided to focus on radiology.
  2. Conversely, you could look at it as having a bit more reassurance that your partner isn't primarily interested in your perceived status or earning potential (if you didn't meet prior to medical school).
  3. Lactic Folly

    Unhappy in medicine?

    Yes, I think all fields become more interesting the more one learns about them in depth. Medicine is ever advancing, and in any practice, there are countless initiatives that could be undertaken to improve quality of care. Although there's a perception (no pun intended) of radiology being primarily pattern recognition, in practice I've found a lot of decision making - weighing various features to ultimately come down on an interpretation. Many findings are not pathognomonic and there is a spectrum of normal variation as well as overlapping pathologies (hence the dreaded "cannot exclude") - that rim-enhancing area in the psoas might look just like an abscess, until you dig deeper into the record and find that there was a primary malignancy that looked the same, and the fluid density is actually necrosis within a tumour. What to do with a spot on the lung (simple example)? Weigh the shape in multiple planes, density, size, location, multiplicity, change over time, patient demographics, PMHx, etc. (which may be discordant and favour different etiologies) to decide whether to call it benign and spare further unnecessary workup (but be sure you're not letting something worrisome go), suspicious (but be labelled an overcaller if it turns out nonmalignant), or indeterminate (but potentially delay treatment if it could have been referred on sooner). In the periphery, yes, someone working out of their area of expertise could just say something looks abnormal and refer -- but at that referral centre, specialists will expect a more precise and accurate opinion, e.g. delineating exact extent of post-treatment change versus recurrent disease. Given the range of pathology that comes in, even people who have worked in the field for decades continue to see unusual appearances they haven't seen before and need to consult the literature. Not that general radiology is in any way more straightforward - the toughest calls can be to decide if something is normal or abnormal, a task that requires experience and knowledge of pathologies in all ages/organ systems, as well as familiarity with the huge variation in normal appearances. Ultimately, it's about managing uncertainty, which is something faced by all medical specialties in minimizing diagnostic error.
  4. Lactic Folly

    Unhappy in medicine?

    Yes, I was just thinking how different MarsRover's experience seems to be from mine. Doing diagnostic imaging in a referral centre feels like almost all thinking/analyzing/problem solving, all the time. I wouldn't say job outlook is the downside at present, more so the high volumes and expectations for speed + accuracy that lead to burnout. Doing a fellowship is pretty standard for most specialties.
  5. I would tend to agree with this most. To help with burnout, I'd encourage students to hold on to the sense of purpose and meaning in your work. What led you to medicine in the first place? With the long hours you put in, was there a time that you were able to make a difference to a patient, or offer some comfort to a family? Re: delayed gratification, there's no reason to expect that one could suddenly arrive at a sense of meaning and satisfaction once a practicing physician, if it wasn't there while training to become one. As alluded to above, the increased responsibility and workload as the years advance bring their own set of challenges. Clerkship is the time when you have the most security to learn practical medicine while always having a safety net to rely on.
  6. Lactic Folly

    Unhappy in medicine?

    I'd echo the above. The variety of work in medicine is *huge*. Have you rotated through psychiatry yet?
  7. Lactic Folly

    Calgary IM Personal Statement

    Surely you must envision yourself learning and growing in some way during your residency??
  8. Lactic Folly

    This Is Insane

    Yes, a self-published magazine is not the equivalent of a peer-reviewed journal. However, was this publication disseminated in any way in print or online? If they're not selling it as original research, but rather promoting safety in sports, it's reasonable as a public service contribution.
  9. Lactic Folly

    Competitive Matching

    This topic has been covered multiple times in this forum. The consensus is that you can be competitive, but since the timeline is so compressed, it becomes even more important to know what you want to go for early on. It's not very common to add an extra year for someone in a 3rd year program, and it's not clear how this would be much more advantageous than having two full summers off in a 4-year program.
  10. I doubt test takers are allowed to publicly share the questions they received. That's probably the point freewheeler was trying to make.
  11. Lactic Folly

    Home School Advantage

    It's most likely the latter i.e. applicant preference to stay at their home school.
  12. Lactic Folly

    Residency based on University Location?

    It's hard to know how much of the supposed "home school advantage" is due to people preferring to stay in the same place for residency due to personal reasons. There are also students who attempt to match into their home school program but do not end up there. It's most important to be a strong candidate IMO; you can still target your residency program of choice through electives/summer research if you attend another medical school.
  13. Yes, it's very common. I'd also note the maximum number of months that you can miss in residency and still complete on schedule, if that works for your household. Something like 3 months (check program requirements).
  14. CTU by its very name and design is structured around medical education. If I recall correctly, during my internal medicine rotation, there were a few staff in the same hospital who did not have any trainees but carried a similar patient load; I am sure not having to teach, speed rounding, and dictating short focused notes helped greatly with efficiency. The internists here can comment better on this. We're a bit off from the topic of resident pay, but to the question of clerk pay, in my mind it would be the same as paying nursing students, tech students, etc. for their contributions to patient care during their 3rd and 4th year practicums. I'm not sure that they receive any stipend to offset their tuition, but anyone in the know can correct me.
  15. Ok, but writing "discussed with dr. X" still means that someone else is noted as responsible on the chart, and the unit clerks treat it as being from the resident/attending. I meant orders being processed when signed with the student's name alone, without the "discussed with" notation.
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