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Akane200

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  1. Akane200

    Bad days during residency

    I think that a big part of residency is about learning to take feedback in an appropriate manner. Keeping things in perspective and having reasonable expectations about yourself and of others. I don't think people should just "forget" about it. But to treat these experiences, even the bad ones, as learning opportunities. You've just started. You're not a full fledged surgeon. Of course your workmanship isn't as "good". You're a resident. A trainee, and chances are, you are just 2 weeks into being an R1. And there will be bad days. You will make mistakes. You might even kill someone (unintentionally). You are human. But the key to being a good resident is that you have to learn to be able to deal with those emotions, deal with people, and learn from your mistakes for the sake of yourself and the patients. Learn to ask for help when you don't know what you are doing. Earlier, rather than later. People are willing help you, if you tell them what you want to learn. So you didn't do a good job that day (maybe your hand ties came undone, and you have to work on tying knots or suturing better, etc). Be sure to learn from it, and do better next time. Yeah, it's difficult to take criticism, but you better be prepared for a whole lot more of it - and everyday. And I think dealing with it in a positive manner is important to all residents in every level of training. Learn to ask for help. Learn to take constructive feedback positively. And then, there are unreasonable comments that you have to learn to just roll off and throw away. It isn't easy, no. You have to have reasonable expectations of yourself and others. Welcome to residency!
  2. I believe that there are currently very few Canadian graduates of American medical schools in internal medicine residency in Canada. I only know of perhaps one in Toronto, and there may be a few more at McGill. Whether this is because there is a preference for Canadian grads over American ones (despite being a Canadian), or whether Canadians who went to the USA don't ever want to come back, I'm not really sure. Canadians in American med schools are allowed into CaRMS first round. However, given that internal medicine is a competitive specialty too (not as uber competitive as some of the above ones), and that many canadian medical students are not backing up with it, but actually want to be internists, I can see how programs will still choose Canadian graduates stilll for all of the reasons described before (known schools, homogenous quality of Canadian grad, you know what you're getting, etc). There are more American grads who do do fellowships in Canada after completing 3 years of internal medicine in the USA. We had a few really good ones come through critical care in Calgary, and in former years, for subspecialties such as rheumatology, they have taken American grads. These were exceptionally good American grads with a lot of research and from top tier schools in the USA. I think landing a fellowship is harder as an American graduate in an American internal residency trying to match to a Canadian fellowship. It's also a matter of the numbers game too (need to have enough for our own residents), but it is possible for the exceptional candidates. I hope that is helpful.
  3. Akane200

    CaRMS CVs

    I have to disagree. The carms version online of CV is very difficult to read. I was disappointed that students from some schools didn't send in a separate paper CV that was scanned in just in case. I know someone who docked them marks one year just because it shows that you were too lazy and didn't even bother submitting one to make it easier for the reviewers when others did. It's just more documentation that, if the reviewer is not interested in reading, they won't. Some students did send in an extra one, and those are still much appreciated by us because it is better! We actually prefer to read your real CV as opposed to the carms one (weird fonts, clicking here and there over and over again to find out stuff about you). More difficult to read, and I did take the time to read the carms online one, but really, when I have 5-10 files to review, the real CV is much easier to read and laid out with the info and the order that we care about. So, send in your CV and have them scan it in as an extra, unless they stipulate that they don't want it. That's just my two cents.
  4. Akane200

    Not liking it afterall

    Hee hee... this reminds me of a conversation that my classmates and I had back when we were med students. There were people who left our class, but they did it in first year - mainly to pursue more research, because those were their passion. But my classmates did have this discussion - we calculated, given the astronomic rate of our tuition (we were the first class in Ontario to deregulate the fees), that the only time that one could drop out was at the end of first year. By then, you would have amassed some $15k of tuition debt (already not counting books, living expenses, that apartment in downtown, food, etc), which, anymore than that, would be nearly impossible to pay back later on should you end up in any other occupation other than medicine. I suppose that you could do dentistry or win the lottery or do M&As on Bay street - and even then, you need connections to get that kind of job to make that kind of money to pay off that kind of debt. For students, that amount is quite formidable already. We all called this the point of no return, and when we were discussing it, we were well into third year already. If you had to drop out, you had to do it half way through 1st year or something like that. Things were different when tuition used to be around 5-7k a year (or even less than that!) just 10 years ago (prior to deregulation). I suppose back then, people could do med school, drop out even during clerkship, or even change their minds and decide to be something else. That kind of choice is a luxury today given the price of a medical education today - and, nothing has changed about the quality of teaching... all that money that we pay extra didn't go to our teachers or facilities for medical students either. It was a transfer of wealth to both the university and the banks at our expense, I still think. But you do what you have to do to become what you want to be. I don't think that the price of tuition prevented anyone from entering medicine. We all borrow from the banks. But it does limit your choice to get out of medicine even just 2 years into med school. It may also affect what we choose to do for specialties too.
  5. Akane200

    Geriatrics

    I think the practice of geriatrics depends on where you are in Canada as well. With regards to remuneration, it is on the low end since there really aren't any procedures for that given subspecialty, and the fee scale doesn't reflect all the work and effort and time that goes into one geriatrics consult. So, if you live in Ontario, you won't make enough money to cover the overhead of your office, if you are practicing primarily geriatrics in the community. That's why most, are associated with hospital based practice, and have inpatient wards (for geriatrics). It gives things a bit of "variety" so to speak. In Alberta, there is an alternate funding plan (salary), and I think that helps with practicing geriatrics here. There is no rush to get through volume (there will always be lots), the preceptors are more into teaching because they have time, and I think patients get better care overall because they get the time and attention that they need. Having said that, I didn't love geriatrics because it kind of wasn't internal medicine (or a lot medicine) anymore. I'm in third year of my residency, and not going into geriatrics. I did geriatrics in my third year. Most patients were all deemed "medically" stable before we saw them. So, there was no adjusting drugs for CHF, HTN, DM and the like, because they were already optimized by internists before we got to them. Plus, I think the geriatricians also refused patients who weren't medically optimized before referral. True, a major bread and butter of geriatric medicine is cutting polypharmacy, but there were times where it was kind of overdone accidentally, and patients went back into rapid A fib and CHF because their meds were cut; and thereby, back to internal medicine to be managed. Sometimes you just have to try to find out. The fact is, patients are on 10 or more meds because they kind of need them. Geriatricians do a great job at cutting polypharmacy... as do general internists. And a lot of the time, we would be assessing patients, and agreeing that they may have worsening dementia or delirium. We would do a bit of cognitive testing, which I found to be pretty educational for residents. But the major ones were consulted to neuropsychologists to do more detailed screening. But in the end, I found that often, there was little for us to do, except recommend a few medications (anti psychotics for sun downing, or aricept if it helped at all), and the majority of inpatient and quite a few outpatient referrals ended up transitioning people into long term care... I found that part depressing, because almost nobody seemed to get better or go home for those kinds of consults. They eventually needed to go to long term care facitilities, and that, is often sad for them and their families. A lot of social issues came up, and it was often the whole family that you were treating; that's the good part. You would talk the the patient, but then, you would not always believe everything the patient tells you, and you would then spend the next 2 hours collecting collateral because that's what is very important in geriatrics. It takes time to do geriatrics, and that's just how long it takes to help these families. There isn't anyway around it, so you have to really love it. We certainly made transitions better, and that's where they're needed. I think the biggest thing that the geriatrician did was see the big picture and coordinated the plans to help families cope with deteriorating family members into long term care. It is all about the quality of life, and that is so important. I think geriatricians did that the best. Yes, part of their job is to help keep geriatric patients independent and at home in the community as long as possible. I think that they do do this, with the aid of social work, and home care and such; and many, through family physicians have done that already. But the patients and the families that get referred into geriatrics clinics are really the ones who can't manage at home alone. There was memory clinic - where you would assess for dementia, and follow up. And I suppose, try strategies to slow the deterioration. It's kind of depressing to watch people deteriorate. Falls clinic was the better one of the things that I did. It was happier in that you could minimize falls and keep people more independent and functional. Involved OT assessment of their homes and such. Again, it's all kind of not medicine, and more OT/PT/SW side of things. The other major bread and butter of geriatrics was dealing with incontinence issues. The positives: no hurry, nothing acute (ever... because, there's internal medicine for that), can take your time, work with allied health, and keep geriatric patients as healthy as they can be, because aging, is actually natural. There's actually a lot of neurology involved in geriatrics too. You can be hospital or community based. You never have to be on call or come in in the middle of the night. It's a great lifestyle specialty, but it's something that I think you really have to like a lot. The negatives: nothing acute... and you kind of spend three long and stressful and tiring years in internal medicine before you can match into geriatrics... not remunerated as well as the other specialties. If you go into geriatrics via internal medicine, you have to know that you will be doing a lot of acute inpatient care during the first 3 years... like 90% of the time. That includes CCU and ICU. It's three years before geriatrics, and can be long and work heavy too. Just keep that in mind, especially if you don't like acute care medicine. With regards to old people: personally, I don't mind dealing with them. In fact, so many patients that we see in internal medicine are old. They have med lists that are very long, and issue lists that are also very long. That's just normal for internal medicine. It's just a reality that we have to face. But they are our patients, and we're here to see them. In terms of geriatrics via internal medicine or family medicine: I only know of one girl who has always wanted to be a geriatrician from day one. She went through internal medicine, and went into geriatrics. I think that she is unique, because in recent years, via R4 match, geriatrics has not been popular at all (like, graduating 0 to 2 geriatricians a year in the country). You can't blame residents, who slave through 3 years of a work heavy residency for choosing other things because they liked it more, had better pay, or other reasons. And I think it largely has to do with selection of internal medicine residents too - their personality types: hard working, spend many hours in hospitals, care less about lifestyle in order and agree to 3 years of this stuff that we do in the first place, who love acute care medicine, or who love academics, love research, type A, etc. That's a big generalization, but it isn't always about attractiveness of the specialty. Geriatrics, is and should be a very attractive lifestyle specialty (with the alternate funding plan). Perhaps it's also the residents in internal medicine who aren't that attracted to it because of personality fit nowadays. I know that I love acute care. I get a thrill out of resuscitations that we do, and I feel like I'm fixing something. I know someone else who gets a thrill managing diabetes day in day out because she feels like there is this long term impact that she makes a difference in. Meanwhile, there are those of us, who love rheumatology despite the functional stuff that they have to deal with. Residents in internal medicine also have more other choices at the end of third year too - like 8-10 other subspecialties to choose from... or to be a general internist if they like that the most. Out of all of the subspecialties, geriatrics is least like internal medicine than the others, I think. I think that it is closer to family medicine on the spectrum today, and that one doesn't need the acute care training of general internal medicine to be a great geriatrician. In fact, a lot come out from family mediicne with that third year of training after family medicine. And are probably just as good, if not better. Although, I've only worked with FRCPC geriatricians, so I can't really say in comparison. I hope that's a little helpful.
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