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Guest McMastergirl

Residency in Medical Genetics

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Guest McMastergirl

Well there hasn't been much action on this forum, so I thought I'd update you on my residency in Medical Genetics.

 

Overall, I'm having a great time. This is sort of surprising to me, because I thought this would be the worst year, since I'm doing adult rotation for the whole year and I'm much more fond of peds. So far I've done rotations in internal medicine (wards), endocrinology (outpatients and consults), gastroenterology (a mix of wards, clinics, and consults), and I just finished a rotation in pathology (I haven't seen a live patient all month!). Tomorrow I start my fifth block (in Ottawa we do month-long rotations which are called "blocks") in medical oncology. I lucked out - I convinced them to let me do clinics instead of ward for the whole month! I just find ward medicine to be so stressful!!! Since genetics is primarily an outpatient, consultant specialty, it was pretty easy to make my case.

 

I'm learning a lot, and I'm trying to read up on the genetic diseases particular to each specialty I do. It's difficult sometimes, because there's a lot of reading to do around your cases and patient management stuff.

 

I'm looking forward to oncology because I know it will be very pertinent to my specialty.

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Guest marbledust

Hi,

I know you have answered this before, maybe even in this thread...but I am too lazy and tired to go back and check. :)

 

Out of curiosity - you mentioned you are during your whole pgy-1 year in adult internal medicine rotations. Do you do your pgy-2 year in peds, then start your genetics program in your third year?

 

Your program sounds so unique and very appealing. I only wish I had a strong background in genetics or I might be considering it as a career. I know we get it in med school, but is it enough? Maybe I can convince one of the med gen docs here in Calgary to let me shadow them.

 

Good luck and keep us posted!

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Guest McMastergirl

Marbledust, you are correct about the rotations. In more detail, (from CaRMS page for Ottawa's program)

 

The first two years of the program include training in Pediatrics, Internal Medicine and Maternal-Fetal Medicine.

 

The first six months of third year of the program is devoted to laboratory experience with rotations in cytogenetics, molecular genetics and biochemical genetics. The second six months is devoted to research and/or clinical genetics rotations.

 

The clinical component during the fourth and fifth years of training ... [consists of participating in the] active consultative service in clinical genetics for in-patients and out-patients, including adults as well as children.

 

The programs at different sites vary slightly... for example, at U of T, the first 2 years the residents do a mix of adult and pediatric rotations, instead of a year straight of each.

 

 

To address what you said about genetics in med school... you definitely do NOT get enough exposure (in my opinion) ... this is something that I want to try and correct over the course of my career.

 

So, for people without a genetics background, can you pursue this career? I think so. It will probably put you at a disadvantage for CaRMS, but right now this specialty isn't that competitive. This past year, only 2 people in Canada ranked Medical Genetics as their first choice program! Of course the competition varies from year to year, but in general, the 6 Canadian spots don't fill in the first round.

 

I would definitely encourage you to hook up with the MD geneticists at Calgary. They have an excellent program there (so I hear)...they could give you more guidance on what they require in a resident. I think that showing enthusiasm and a willingness to learn can go a long way. You can probably take genetics courses at the university during your residency if you need to.

 

Hope this helps!

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Guest MDSMelissa

Hi McMastergirl,

 

Do you have any good reccomendations for a medical genetics elective that I can do at Mac? Have you had any really great experiences? I was speaking to Ron Carter briefly about doing an elective, but I wanted to ask you for some advice as well!

 

Thanks,

Melissa

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Guest McMastergirl

I worked with Dr. Nowaczyk at Mac. She is trained as a pediatrician and geneticist (but only practices genetics). She was a fantastic mentor for me. They recently hired a new geneticist but I haven't met him. Dr. Carter is a super nice guy and can probably teach you a lot as well, (especially about cancer genetics) but he isn't an MD.

 

Let me know if you need any more info!

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Guest blinknoodle

I know there is an awesome genetic counsellor at Mac (not an MD). If you ever have a chance to hear Tim Heshka give a talk, I highly recommend it (or even just to chat with him). He gave two lectures to my genetics class and his own story was very inspiring. If biochemical genetics interests you, you may want to chat with Dr. Murray Potter (he was also a lecturer for our class).

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Guest MDSMelissa

Thanks for the information blinknoodle and McMastergirl. I think I will contact Dr. Nowaczyk to see if she would like to take on a student for a horizontal.

 

All the best!

Melissa

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Guest KJ

Hi McMastergirl,

 

I just read a bunch of your posts on medical genetics. I actually had some questions and I was wondering if you could email me. I'm not sure how to send you a private msg, so here is my email: kj_connections at hotmail.com.

 

Thanks :)

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Guest McMastergirl

So I just met with my program director the other day and we decided on my rotations for 2nd year (I can't believe it's almost 9 months into first year!). They will be:

 

2 months ward peds

1 month NICU

1 month perinatology (well newborns)

1 month family counselling (in the psychiatry dept)

2 months of maternal-fetal medicine

1 month peds cardiology

1 month peds neurology

1 month peds endocrinology

1 month peds nephrology

1 month clinical genetics

 

 

Sounds like it will be so much more fun than adults!

 

I'm getting to see some kids this year. Both my ophthalmology and dermatology rotations will include some pediatric clinics.

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Guest McMastergirl

This month I am doing a rotation in my home department. This means I am attending genetics and metabolics clinics, doing inpatient consults (mostly in the NICU), and attending the various rounds given by the department. The hours are generally 8:30 to 5. There is a LOT of reading. Each case is so unique. There is very little that is "routine" about genetics!

 

I've been given a variable amount of responsibility in this rotation. Different staff have slightly different expectations. Some of them just have me watch and some have me do the history and physical myself, as well as dictate. Of course, you learn a lot more doing it yourself!

 

Metabolics is fascinating and overwhelming. You just don't learn all this biochemistry in med school! I like it though.

 

I'm sad that this rotation is almost done! After this I have another 3 months of adult rotations before I start my peds year.

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Guest McMastergirl

Not sure if anyone is still reading this - please post if you are still interested in hearing about this residency!

 

I'm in my second month of second year now. I started my pediatrics year with a ward rotation. It was fun, and I got to see lots of syndromes, including a baby with Treacher-Collins syndrome, and another with a rare syndrome called Antley-Bixler.

 

Now I'm in the NICU. It's overwhelming because I'm so unfamiliar with neonates. In med school during our peds rotation, we did a week in the nursery but that's it. So now I'm looking after ventilated babies, babies with chest tubes, etc. Lots of exposure to babies with congenital anomalies!

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Guest marbledust

Hey McMastergirl,

 

Yes, please keep posting about your residency! If you have time, that is. I am fascinated by your program because it is such a specialized area--it's always easy to dig up a surgical or medicine resident to talk about their experiences, but medical genetics residents are quite rare. Your posts are very interesting :)

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Guest McMastergirl

Thanks! It's good to hear that people are interested. I'll keep posting.

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Guest peachy

I also enjoy reading about your residency, McMastergirl, and hope you'll continue!!

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Guest Lactic Folly

I always appreciate it when people take the time to post about their experiences - I've learned so much about different fields that way.

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Guest DancingDoc

McMastergirl,

I don't know if you continue to update this thread or not, but I really hope you do because medical genetics sounds so interesting, but what you actually do as an MD in the field is something I know nothing about. Thanks for a great thread!

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Guest McMastergirl

Gee, it's been awhile... I'm now in my NINTH month of my second year - it's gone by really fast! Probably because I like pediatrics so much better than adult medicine.

 

I am currently doing a rotation in pediatric neurology. I am fascinated with neurology. There is so much overlap with genetics and metabolics. I spend my time in clinics for the first two weeks of the rotation, then I switch to ward consults.

 

Prior to this I did a rotation in genetics (in Ottawa at least, we do one rotation in genetics in each of our first two years). It felt like home! During my time there I had to do a presentation to the department for rounds (I presented on the Genetics of Hirschsprung disease). This was during the CaRMS interview time, so I got to meet some of the candidates for next year's spot. Match day is tomorrow! I'm so excited to find out who we got!

 

I'm going to the American College of Medical Genetics conference in San Diego at the end of March... how sweet is that!

 

Any specific questions... please ask!

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Guest DancingDoc

Sorry I keep jumping between these two threads!! But I actually do have another question. In terms of your interactions with patients, what does that involve? Is it mainly diagnosis and refering patients to the necessary specialists?

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Guest McMastergirl

Thanks for asking!

 

So the referrals we get in genetics are extremely variable. So our role differs depending on what the referral is for. I think the best way to answer this is to give you some examples of some patients I've seen in my rotations and what we did.

 

1. 29 year old man found to have 47 XXY (Klinefelter) during a work up for infertility. This was mainly a counselling session, as the diagnosis was already made. We referred him on to an endocrinologist to talk about testosterone replacement.

 

2. Woman diagnosed with Osler-Weber-Rendu syndrome after it was discovered that she had a pulmonary AVM... referred for diagnostic genetic testing. We did find a known mutation in her, so we went on to test her 2 children as this is an autosomal dominant disorder with variable age of onset. The complications can be quite serious (including brain AVMs that can bleed, and pulmonary AVMs that can embolize and cause strokes), so if her children carry the mutation, they need to be closely monitored for complications throughout life.

So this case involved both diagnosis and counselling, plus appropriate referrals.

 

3. Rule out Marfan syndrome in a teenaged boy. This is a physical diagnosis so history and exam were important and we decided he did not meet criteria so no genetic testing was done.

 

4. 4 year old boy with autism/developmental delay. Differential diagnosis is broad - our main role was to decide if there were any subtle dysmorphic features that might suggest a syndrome.

 

5. 30-ish woman whose mother died of Huntington disease. Requesting genetic testing for herself - these cases require LOTS of counselling because it is presymptomatic testing. Geneticists may do it or else a genetic counsellor does.

 

6. 6 year old boy with learning disabilities and ADHD, asked to assess for fetal alcohol syndrome. There are specific clinical criteria for this, based on historical and physical exam findings.

 

That is a sampling of outpatient consultations. We also do a large volume of inpatient consults. These are more work. Usually the consultation is for a newborn with congenital anomalies or a child with metabolic derangements... we attempt to make a diagnosis and arrange for testing and of course do lots of counselling for the parents.

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Guest smurfette99

Hi!

This is such a fabulous thread, thank you so much for taking the time to do this!!!

 

I'm not sure if you are still updating this, but I am very interested in medical genetics. In fact, I turned down a genetic counseling spot to go into medicine. It's so inspiring to see (or read, I guess) someone actually doing the program!

 

I was wondering if medical geneticists would be involved with prenatal diagnoses as well? Or would that be more the realm of a genetic counselor (or on obs/gyn?)

 

Also, do people tend to specialize in a certain disorder (or type of disorder?) For example - metabolic diseases or cystic fibrosis? Or do they tend to treat all types of genetic problems?

 

Thanks so much :)

Smurfette

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Guest Kirsteen

Hi there,

 

From what I've seen of the Med Gen folks here, (Calgary) although they may have some specific interests that they might tackle in their research, they seem to be consulted for the gamut of clincial genetics issues. Also, most of the Med Gen team seem to be located at the Children's Hospital.

 

Cheers,

Kirsteen

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Guest McMastergirl

Hi Smurfette!

Glad to hear you are planning to go into medical genetics! Where are you going to medical school?

 

Definitely medical geneticists are involved in prenatal diagnosis. I did a rotation in maternal-fetal medicine last year, which I found fascinating - I was working with ob-gyns who specialize in high-risk pregnancy. But, there was a lot of crossover btw their specialty and genetics. When a fetal anomaly is detected on ultrasound, the parents are very often referred to a geneticist for counselling. Whether they are seen by a counsellor, MD, or both, depends on the diagnosis.

 

We are also, at least at my hospital, heavily involved in prenatal and newborn screening programs.

 

Whether you want or need to sub-specialize depends on your own career goals. In large cities it might be necessary to take on a sub-specialization by doing a fellowship after residency. In smaller cities this isn't an issue. Some geneticists do "everything" and others do only prenatal, only cancer, only metabolics, or a mix of different things. Sky's the limit!

 

I check this site from time to time, so please, keep the questions coming!

M.

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Guest McMastergirl

I am now doing my final rotation of my second year of residency. This means that starting July 1st, I am officially in 3rd year, and I will be doing genetics FULL TIME... wuhoo!!!

 

To summarize this past year, it has been very challenging but I have learned TONS. The entire year was spent doing various rotations in pediatrics, save for 2 months in the fall which I spent in maternal-fetal medicine doing prenatal diagnosis. The worst part of this year was the call - 1 in 4 for most of the year - which is different from my first year in internal medicine because whether or not I did call depended on the rotation I was on.

 

Despite the long hours, this year was extremely enjoyable for me. I have a fondness for pediatrics so I was expecting this year to be more interesting than first year. Plus I just felt more confident being a resident. I have learned that other genetics programs in the country do their first 2 years slightly differently. Some put you in pediatrics first, and some will mix up the rotations so that you do both adult and peds all at once. I'm sure they both have their advantages and disadvantages, but I'm very happy the way it worked out for me. One advantage of doing adult rotations first is that you are better prepared for the LMCC part 2, which you do in fall of your second year. As you can imagine, the stations are primarily adult medicine. My colleagues in pediatrics were pretty stressed about this, not having seen an adult in over a year!

 

This past March I attended a conference in San Diego - the American College of Medical Genetics "March of Dimes" annual meeting. It was great fun - and I got to meet some of the trainees from other Canadian centres. It seems that in Canada right now, the majority of trainees in medical genetics are female. Our newest addition in Ottawa, starting in July, is also a woman - which means our program has yet to have a male trainee!

 

So I have a tentative schedule for my third year. I am starting with two months of clinical - so a mix of inpatient consults and outpatient clinics. Then I am doing my "molecular" rotation (2 months), then cytogenetics (2 months), then biochemistry (2 months). From what I gather, these rotations are lab-based. I will learn about the techniques used and how the results are interpreted.

 

As for my call schedule, it will be home call, and I think I will do about 10 days per month. This is yet to be determined.

 

I am very much looking forward to this!!!

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