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GH0ST

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GH0ST last won the day on February 9

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  1. Hi there, When you say 3 topics... do you mean chapters? an entire section of the exam? some clarity would be helpful. How many hours are you putting in every day and what is your routine? Are you in study groups? Did you utilize any prep course?? A more detailed description breaking down everything you've done so far would be more helpful. Specificity is always appreciated. - G
  2. You would think that a classier answer is ... Thanks for the feedback, though I could have been more clear that my post was focused on whether an unfinished course will affect my chances. I am however aware that a higher GPA is always a better goal to aim for. I appreciate the time you took to comment." Some free tips for you... having some tact, even if you don't think you're wrong goes a long way. Why treat a conversation with vinegar instead of sugar? Maybe one day you'll appreciate the importance of tactful communication in all aspects. You'll have a better chance at passing interviews... if you even get there. Consider that a free lesson in communication skills. - G
  3. Rofl I guess NOSM doesn't count as a medical school, you know, the first one with an actually integrated and practiced mandate for social accountability. Even Ontario government can't remember their medical schools - G
  4. What kind of response is that to someone who was giving genuine and caring advice? Should check that attitude at the door. - G
  5. Hey I hope you get the opportunity to speak to someone. Sending you well wishes. I think before any switching... can you see yourself slogging it out as a gen surg staff though? It feels as though you can't really see yourself doing that after your revelation and that is ok. Have you had opportunities to speak to psych residents and staff instead? Maybe ask yourself how much you can tolerate being gen surg staff before switching. - G
  6. Hi there I hope you are doing ok. First off I still want to congratulate you on matching. It's still an important accomplishment worth respect and celebration. I can speak to my personal experience attempting to transfer once (more to see if it was possible). Now with the benefit of hindsight, I truly feel privileged to be here and have the opportunities I've had. I would be happy to explore with you my story, approach, and thought process in more detail. Now as some people know, public health and preventive medicine can be done with family medicine, so in an ideal world for me, if I wanted to make the change it would be just after finishing FM and transitioning to PHPM at a different university. It would be the cleanest break. I did hesitate initially when I matched to Northern Ontario due to my limited knowledge of the geography, being away from family, and worried about the training. I did not doubt my interest in address societal issues or working in rural/remote environments, but I wasn't sure if I made the best decision. When I went through the process, I did not initially let me PD know (and to be fair, most of my initial contact was with the FM program first) but there's a formalized transfer process between universities and between provinces. You do need to give your post-graduate medical education dean or the relevant people in post-grad generally a heads up so they can prepare you for the process. I spoke to my post-grad dean and we had an initial meeting to discuss what the steps will be and what documentation I will require. In general, the chance of provincial transfer within the same specialty is low... especially in programs with few spots (some programs only have 1 spot for example) The next step after the 2nd step match is that universities will communicate if there's any left over spots or opportunities to take on new residents into their program. Even if you wish to transfer, if the program you wish to transfer to does not have adequate funding or enough positions the process will stop right there. Assuming that you do go through the process and the other program does have capacity and they don't have anyone on their own , then there may or may not be a meeting with that program to discuss details, particularly exploring why you want to return or go to X program. Assuming things work out, then you will eventually need your home PD to sign off on the transfer and get the process formally rolling so you can start clean by the next academic year. You need to do the minimum 12 months first... don't bother thinking of transferring when you first start. Just focus on doing the best you can in your residency program. I will say that for me, not getting the chance was actually a blessing in disguise... I had amazing opportunities to do electives elsewhere throughout Ontario (office of the chief medical officer of health, office of the chief coroner, PHO, etc) and I wouldn't have had the same access if I left Ontario. I also learned a lot about myself doing remote medicine and combining that with my urban experiences. Thinking back and thinking of what I could have transferred to, I would have limited my own horizons. I really do think it was the best thing for me that I remained with NOSM and I'm grateful for the experience. I will say that personally, I maintained a long distance relationship and got married during residency. It's possible to still have a personal life and connect with those far away. For now, focus on being the best doctor you can be. You can do a great job, regardless of where you are. Hope this helps, - G
  7. NOSM actually does well in this area in my opinion. Especially since it's less academic and more focused on learning and supporting the community. - G
  8. Haha I'm not even white... I am technically a minority. Talk about assumptions. I think we're just going to have to agree to disagree since I don't see you opening your mind. My text is for the readers who truly care about not only good medicine, but good social activism. I will emphasize once again that we as a profession can ABSOLUTELY DO BOTH. EDIT: I was thinking back since I remember we had engaged previously but I couldn't put my mind on where... you were the one that gave a 2nd year med student at UofT so much shit for a long 1 hr hx from a CMAJ blog lols. I think this summarizes our fundamental differences as people: "OP: They also assumed a role of a friend instead of being professional. In my opinion, they failed the patient. The patient needed a doctor to help her with her medical problems, she did not need a fake friend. Me: Disagree... you can be friendlier with patients and still maintain objectivity. " To address the arguments... "decentring medical expertise" isn't saying medical expertise isn't important... it's acknowledging that there is a balance and not everything we do in medicine involves medical knowledge as the top priority. Just using the CanMEDS roles ... medical expert is only one of the categories, but advocate and communicator are also competencies we are expected to have. Now we can get into more nuanced arguments like what specialties and what proportions are involved (for example... a surgeon I suspect will not require as much of a knowledge base in social determinants of health... so spoiler alert they don't take nearly as many classes on that topic). That said, in my field, or those that are more forward facing like psychiatry, or FM, and EM (to some extent) really requires greater awareness, knowledge, and application of social principles like health promotion. I don't expect them to know health policy or do environmental health (I expect my PHPM physicians to do that), but it's discouraging to think of how many patients are simply lost to the system. If I had a nickel for example for every victim of substance use that gets tossed around the ED and then sent home, only to not have a stable situation to go back to.... only ending up back in the ED, well I'd earn more than my resident salary. Coincidentally there's many physicians who started their careers elsewhere who moved into the PHPM space due to their desire to address the upstream social factors surrounding health (not only health care). Using Ontario as an example, Dr. Kieran Moore was a CCFP-EM doc who practiced for over 20 years before going back to doing another residency in PHPM. He played a significant role in the medical surveillance system development where increasing respiratory diseases in the ED get flagged to neighbouring areas to be on the lookout for increased respiratory conditions and to adjust their practices accordingly (this system is still being used to this day, and I am oversimplifying this system for the purposes of this discussion). He then was the MOH for KFLAPH and now is the CMOH in Ontario. There are many CMOHs that had clinical experience prior to their roles. Many docs in IM (particularly ID) and EM incorporate PHPM into their careers over time as they recognize how important it is. The point about letting professionals in social activism handle social issues is myopic at best and ignorant at worst. If we do not do our own advocacy for our patients and share those experiences and stories, why should we lose our unique understanding of what the system is like or not speak to the stories we see from patients?. We also see how when we focus too much on the acute problem how that affects our ability to advocate in other areas. Should we let some CEO or a health policy professor take the reins without our input? In PHPM we talk about an acronym known as: A MANIC HUG (Associations, Media, Academia, Non-governmental organizations, Industry and private sector, Clients/community: persons with lived experience, caregivers, public, Healthcare (health care system, lab, EMS, first responders), Unions, Governments (leaders, cabinet, treasury, ministries, justice, finance)) and how we need to consider many stakeholders when developing an intervention or policy (we can discuss policy instruments, stakeholder evaluation and analysis, etc at a separate time). Imagine if we weren't involved in this process... the landscape of health interventions at a population level would be drastically different (and not for the better). Last point I will mention is the notion that they know more...THEY DO. That's not really the "gotcha" that you think. I'm incredibly proud that when I work with an epidemiologist, a public health nurse, a health policy analyst, a HR advisor, an infection prevention and control specialist, or public health inspector, that I know they know the specifics better than me. I am humbled every day when I learn from these people about their craft. I think you are confusing the need to be the absolute expert with having competency in the area. @who_knows point of view is very specialist centric... the concept that unless you are the expert, your opinion matters little, is a farce. Using PHPM physicians as an example, we use knowledge in all areas both in terms of medical practice (such as infectious disease) as well as subjects like health promotion, policy, environmental health, emergency management, etc and combine them to help guide and facilitate decision making. Our diversity of knowledge base is what makes us unique and by having the ability to see different perspectives in different practice areas, we can make more informed decisions and do our best to lead our respective organizations. Using something more clinically relevant... are you really going to think that just because the GP isn't a cardiologist, or psychiatrist, that they shouldn't have an input on how to manage cardiac or psychiatric issues? That's basically what the OP is saying. Leave it only to the specialists only since if you aren't an expert ... your opinion matters less. That's quite a sad way of thinking and I surmise that something happened in your life that made you have that perspective. The only weakness I think we as physicians could work on is social media literacy/utilization. Definitely have seen many inflammatory posts over the years and I can definitely see how that affects public perception of the profession. The irony of that point is that it only supports the notion of improving/enhancing social activism education. We don't exactly get better in this area by reading medical textbooks. We get better by working on communication and advocacy skills, while contextualizing social issues. Ladies and gentleman of this premed101 forum. I've learned a lot from many of you over the years. You didn't need to be experts to teach or help shape the future of medicine. You were/are just amazing people first and foremost. Let's focus on bringing each other up and supporting one another in all aspects.... the clinical medicine as well as social awareness. We can do better in all areas and I look forward for us to do it as a team. I'll leave this on a more positive note as I won't be engaging in this thread further. Take care everyone. - G
  9. The irony of a name like @slaverymustend but then saying that physicians don't have a central role to play to address prejudice. Wow - G
  10. @Jef_fries way to cherry pick very specialized examples when you aren't looking at the big picture... those are things that at most, require some review. Being a decent human being and aware of your surroundings have a lot more impact than you think when it comes to both patient care and population health. I've also seen plenty of residents state the treatment, act "manner-of-factly" with the patient not accepting due to not having their trust, regardless of efficacy of treatment. People here are really showing so many misconceptions ... 1. That you can't have medical expertise and humanistic values... you absolutely can. 2. That medical expertise trumps humanistic values... case-by-case basis. No one here is disputing that a doctor needs to have a solid knowledge base. But this pandemic has highlighted the importance of communication and trust building, health inequities, and barriers to even the most basic of medical care as well as medical understanding. Having the experience necessary to work with diverse populations and recognizing their unique needs is arguably just as critical as knowing every treatment for condition X under the sun. 3. That these values are applied every single second... in the middle of surgery I don't expect my surgeon to care about social determinants of health... but does it hurt you to care a bit a little bit more to help a patient that will struggle more with post-op care? Or connecting with a patient that requires spiritual guidance? Or maybe a patient who has had very bad experiences with health providers in the past ... give them some time just to build a solid foundation of trust? Furthermore, we aren't saying that social awareness is critical for every speciality, but I would expect at minimum that my GPs have that level of understanding since they interact with such a diverse population. News flash people... you can be a good person as well as a good doctor. I know many of you think otherwise... sad really. I'm not surprised that there are so many of you with the same mindset as @who_knows since people seem to lose perspective when they gain the privilege of being a doctor. We serve the people at the end of the day, not just their condition. - G
  11. Disagree completely with this thread Albeit I practice FM, but my skills didn't wane because I care about population health and the social determinants. I am much better at connecting with my patients and understand the workings of society and its challenges, particularly with priority populations. I have become much better when working with those that are homeless, victims of substance use, immigrants, among many others. I will always support the notion of improving physician social awareness, since it's sorely lacking even this day. - G
  12. easier said than done... just "having mental strength is not enough" conviction needs to be back with action until you have a solid plan mapping out what you will do and how you will achieve a higher grade, one that is going to suddenly change you from a 2.0 student to a 4.0 student, your statement is meaningless can you work part time while going to school? most people do not have the luxury of having no income while going to school for after degrees how will you fund your program? reversing 2.0 grades requires years of effort and even then no guarantees that it will get you into medical school you need to think harder about this - G
  13. Hi there! @Confused_Resident First off always nice to connect with a fellow PHPM colleague. I think part of the perspective is how UBC structures their program ... it used to be where you do the MPH PGY 1 then go into clinical work which was very awkward... glad to see that's over I think I too have had periods of time where I feel a bit jaded, especially during this pandemic. I also can empathize with the relatively monotonous feel associated with meetings, but I think you also need to take that with a grain of salt as you're just starting on the PHPM journey. The first misconception people often have is that there's no ability to practice clinical medicine as a PHPM physician even if you don't have CCFP. Don't get me wrong... it is definitely a HUGE advantage to have your CCFP while doing PHPM (I personally did not apply to any program without PHPM+FM). That is simply not true. Although it's not the same conventional job as a medical officer of health, or a public health physician in a provincial health authority (think Public Health Ontario, BCCDC, AHS, WRHA, PHAC, CAF, etc) there's still many opportunities where you can try to tailor your practice. You DO NOT NEED TO BE A MOH FULL TIME. As an example, a PHPM physician that has a side practice in addictions medicine took a position briefly while at Algoma Public Health working as a consultant to help with COVID outbreak management. He wanted to have more flexibility than work MOH full time. There's so many opportunities for part time clinical work in addictions, inner city, STI, etc... A third option you didn't list is applying for occupational medicine as your fellowship (I'm giving it a shot personally). I love CD work but I also really enjoyed connecting with my patients and advocating for improved workplace mental health culture as well, paid sick leave, EAP supports, improving workplace policies etc... I'm thinking either working as a consultant with companies to instigate changes to workflow or at a Ministry of Labour while maintaining a clinical practice part time. If I don't get in no harm done as I can still work as a PHPM physician and do clinical medicine. The other misconception is that the meetings are just boring... which to some extent it feels dry. That said, you're not at the level yet where you are leading teams or the one setting things up. I guarantee you that it's much better when you aren't just a passive participant listening to meetings vs your preceptor giving you a task like "establish a program X for this condition... or support the stakeholder engagement work to solicit feedback from community members, or develop a policy to be utilized for the organization. Soon you will be the one that decides who to meet, how to set things up and with some remote supervision, actually take more ownership of your work. You will also have opportunities to lead outbreak management meetings with many physicians, IPAC groups, and other community stakeholders who will defer to your guidance. You will get many interesting communicable disease consultations on diseases of public health significance that we'd never see in general practice (had a challenging one involving a monkey bite in Equador and thinking of potential pathogens while collaborating with public health veterinarians at the ministry, or Avian Chalmydiosis, or blastomycosis in a rural community). There's work on developing Ebola guidance and emergency preparedness. The point is there's so many other opportunities and most importantly, you will get opportunities to take more ownership and facilitate the process rather than just sit back and not know what's going on. It feels different when people ask you to provide guidance on what to do in a respiratory outbreak in a retirement home, or when you have to do media interviews or radio shows... the responsibility and the engagement is completely on a different level. Please take the time to speak to many preceptors and physicians experienced in PHPM first before you make a decision. I think part of the issue is that you're still so new to PHPM but not clinical medicine and so your perspective will be different. I would be happy to speak to you via PM. NOTE: I would not say the salary is the same... FM may be higher if you're a grinder and do lucrative side hustles, but PHPM has a different level of stability especially if you're a government employee with full benefits, retirement packages, etc. Many physicians have to find their own health insurance, think about how to invest in their own retirement... when you have an employer that you know won't be defunct that's a huge boon to security in my opinion... that said you have to decide what you value. - G
  14. I feel as though you didn't think about what "International Medical Graduate" means. - G
  15. Honestly before I started at NOSM I might have had that same belief... but honestly Sudbury at least is one of the better places I've gone to personally. Training site with the CCFP-EM docs there are really focused on tailoring the experience to the resident's needs and Sudbury is at most 4hrs away from GTA. NOSM residents in CCFP EM also get opportunities to rotate in other high volume places to get more exposure. Thunder Bay can be isolating however and I can see that being an issue. - G
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