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bearded frog

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bearded frog last won the day on February 2

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    PGY3 Peds

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  1. I mean we can't answer this for you without seeing your evaluations but like knowing specific information about medical conditions is usually not a problem. Even my staff looks up treatment/diagnosis on uptodate all the time. She's probably saying you're doing great for the start of clerkship, but you learn so much just general medicine management stuff throughout clerkship, like increasingly efficient history and physicals, the basic management of common problems, writing notes, finding relevant information to come up with a differential/plan, presenting a patient, proposing plans, when to reassess, when you notify your resident/staff, logistical planning, etc. Stuff you can't study for necessarily that just comes from experience, and everyone knows it just comes from experience, so she's not judging you for it. This is also an important learned skill, combined with the even more difficult skill of discussing assessments and plans in front of patients, which you wont master until the end of residency, or even as a staff, and some staff are terrible at this. Coming up with a differential is very important and I always review this with my clerks before they present to staff. It sounds dumb sometimes because "this child obviously has bronchiolitis why am I wasting everyone's time by suggesting foreign body aspiration" but the point is that as a learner the staff has no idea what your thought process is, but if you say "based on the history and my physical assessment of a URTI followed by wheeze and respiratory distress by most likely diagnosis is bronchiolitis. Also on the differential is foreign body aspiration but the non-acute nature and viral prodrome make this less likely. There could also be a bacterial pneumonia but as the patient has no fever and has no focal findings on auscultation this is also less likely. Finally this could be first presentation of asthma but as the child is very young and there is no atopy on family history this is also less likely. I would therefore like to treat as bronciolitis" then they know you have at least done some reading and have considered these options, and if you suggest a management for your number one differential based on this then you will look very good even if they decide to do something else. In terms of discussing assessments and plans in front of patients/families, this is very difficult to do well. Theoretically when you are doing your history and physical on the patient you are describing the results of your assessment at the same time, so at least your assessment findings should not come as a surprise. In terms of a differential, if your most likely diagnosis is cancer or something sensitive you need to mention this to your resident/staff prior to bedside rounds. Even now we try to do bedside rounds but if there is something that should be discussed prior I will tell my staff and we will discuss this prior to going into the patient room. Also avoid jargon. In front of the patient you would say something like "Based on Mrs. Jones's frequent abdominal pain and new presentation of hematochezia blood in her stool, there are a number of potential causes that require further assessment. Most likely is diverticulitis based on the localization of pain to the left lower quadrant of her abdomen, but we also need to consider inflammatory bowel disease based on her family history. Although unlikely, we cannot be completely certain that these symptoms are not caused by a more serious condition such as colon cancer, and should test for this as well". The idea being you qualify everything you say instead of just listing them out. Even if you think colon cancer is high on the differential, you would still start off saying things like "The most common reason for these findings is diverticulitis, but based on her history of weight loss, myalgias, etc as well as her strong family history of colon cancer I think it's important that we consider this diagnosis and investigate appropriately."
  2. I mean, its not so simple that you can give numbers and percentage. The idea is that, other than radiology, these specialties are doing procedures that have become dramatically faster/easier/cheaper to perform over the years, and compensation hasn't changed. Talking in generalities but an optho procedure that used to take 6 hours is now 30 minutes for example, so say they got paid a fairly compensated $X for that procedure, now they can do 4 in the same amount of time, safer, etc. Obviously its not linear and for any procedure its harder doing two 30 minute ones than one 60 minute one in general, but that's the theory on why these specialties are making relatively larger amounts to their colleagues. The idea of realignment, at least in Ontario i think, (billing rates are provincial) is to change the compensation for these procedures to be more appropriate for their actual fair compensation.
  3. If it's your home program, then its fine. Get a letter from your core at your own site, and other electives. When it comes time to it, if it comes up in interview you can say you were only able to do an early pre-core elctive and Dr. X was impressed with my performance.
  4. They still looked at the scores. To practice in the states the threshold was to just pass.
  5. We got our contract a month after match day. I assume if you really needed something in writing you could reach out to the program for a letter etc.
  6. IMHO very good news for Canadians writing USMLE for fellowship, bad news in the short term for Canadian applicants to US residency, as without the absence of standardized test scoring, schools might prefer to go with graduates of medical schools they have context for, IE top 50 US schools, vs carribean or unfamiliar candian med schools.
  7. If you couples match you can still do individual rankings mixed in with dual matching. For instance, say your SO only wants to do neurosurgery in halifax, and would rather go unmatched than go anywhere else, but you want to do psych and back up with family but are ok matching broadly. Say your priority was staying close to your SO over matching to psych vs family. You and your SO would couples match and have a shared rank order that looked like this: 1. SO - halifax nsx, you - halifax psych 2. SO - halifax nsx, you - halifax family 3. SO - halifax nsx, you - memorial psych 4. SO - halifax nsx, you - memorial family [5 - X. SO - halifax nsx, you - every other psych and family program that you're interested in across the country in your order of preference] [X - Y. SO - no match, you - every other psych and family program that you're interested in across the country in your order of preference] Z. SO - halfax nsx, you - no match As you can see, you can still put down match options as if you were matching alone after your couples match options, and you would have the same odds of matching solo if none of your couples match options work so there logistically isn't a downside to couples matching as long as you can amicably come up with a rank list you both agree on. If you preferred matching psych vs being close to your SO, you would change the order of options 2 and 3 and others accordingly.
  8. You have an acceptance - that's the hard part, matching to a specific school/program can be challenging, but not as difficult as getting into school IMHO. Lots of people who go to Ontario schools match to UBC/calgary/alberta every year. Most will end up applying broadly anyway!
  9. If you want to stay at the same institution it's probably easier since you can get to know the department and they will know you well. That being said, it generally will be about the same difficulty to match to the next province over and on the other side of the country. It will depend on how competitive the program/city is (obviously Toronto is more competitive than Winnipeg, etc). I recommend doing early electives at your target school, and more than one, possibly in a related field, if possible (IE two different family sites or two different medicine subspecialities).
  10. Clearly you do know you want to be a doctor since you're going through all the effort of applying. Reflect on what is driving you to become a doctor. Also, talk to people close to you that you trust and are familiar with your journey and ask them why they think you would be a good doctor, then take their answers and fake it till you make it. Imposter syndrome never really goes away, but the goal posts move (at some point you will worry if you're really ready to be a staff physician, but at that point residency will be no sweat and med school will be long conquered).
  11. Wow. You screwed yourself out of every school that looks at casper right here. Why would you think you could do okay only answering 33% of the questions? When filling out the rest of your applications did you fill in your academic record really really well and then leave your personal statement and ECs blank? I'm stunned.
  12. Varies wildly between rotations. Generally inpatient rotations start 7-8ish and end 4-5ish with varying amounts of call. Outpatient might start a little later? Can't say since so variable. In any case it would pretty much be the same regardless of what hospital/medical school you go to. I've done electives all over Canada in my field and its pretty much the same everywhere. Your placements will generally be in around the campus you attend, so if you're Hamilton campus your rotations will be in Hamilton, although there are some that have options to do rotations in smaller cities outside Hamilton, usually within reasonable driving distance, ie Brantford. Again not terribly different from other schools.
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