Fin

"Oh my dear treats, how I dream of you always."

The third year of medical school has finally come to an end. First, a little bit about the most recent rotation: neurology/neurosurgery. You may recall from my belated blog about geriatrics that life did, in fact, get worse after geriatrics. As if it wasn't bad enough, neurology was so much worse. Why, you ask? I had an attending who, while nice and with a good sense of humor, hardly acknowledged us for the whole two weeks. Nearly everyone in the department is from the Middle East and speak amongst themselves in tongues in the presence of others as if others didn't even exist. I'm not sure why, but I find that kind of rude. I know that in most other countries there are people from several different backgrounds all speaking different languages at the same time. The thing is, if you don't want the lame American sitting nearby to know what you're talking about, just go have the conversation elsewhere. For two weeks, I did practically nothing, and yet I had to stay in sights of the residents (who had a hundred better things to do than watch us) until four, five, or even close to six in the afternoon sometimes. The last two weeks were spent in neurosurgery. Again, we did next to nothing and were only rarely acknowledged, but at least we could go home early. At least then the resident recognized that we really didn't care to see yet another ventriculoperitoneal shunt placement or revision in a kid with a big head, and would instead let us go for the day. He was a cool resident. Overall, it was probably the worst rotation I've done all year. Thank the Lord it was a pass/fail rotation and I didn't have to study hard after going home.

Now, on to more exciting stuff. Third year is over, and after my one week of vacation, the fourth year kicks off. Not to mention it kicks off after what is likely to be an awesome weekend of camping near the White River. My new schedule will be off to the side here soon. I start in July with a month of ophthalmology - FINALLY! I have waited years (literally) to get at least to this point. In August, it's off to do the same in Lexington, KY. What's special about Lexington? Nothing, really - it's just that their program at least sounds really good and it's in beautiful Kentucky. I was about to give up on doing the rotation there after I found out that the graduate housing options were all filled up. I called the visiting student coordinator and she gave me a list of locals who rented out space in their homes or had attached apartments for short-term living. I called all the folks and one of them has offered me an excellent lodging deal. She has a house where her and her husband live upstairs, and the basement has three bedrooms, each rented out to separate people, with a shared kitchen and living room. It's only a mile or two from the university hospital.

Things with residency are shaping up nicely. The application is well under way. I have a rough personal statement written. I have finished selecting the 30 programs to which I will apply. I have already requested one letter of recommendation, but need to request two more. I have submitted my paper for publication which should be happening before too long. I'm also about to start studying for the USMLE Step 2 exams. That's right, plural - two exams. One is a written test much like the one I complained about when I started this blog. The other is a huge waste of money clinic on-your-feet exam that must be taken in one of five cities, and serves little more than to be sure you can speak English correctly. This part was originally designed for foreign medical graduates wishing to pursue an American residency, which is all fine and dandy. When the board decided to add American students to the test, it was for nothing more than to make money. 25,000 students per year x $1,000 per test / 5 testing centers = 5 million dollars per center per year. Do they really need that much money?

Well, I best be off for now. I have a lot to do and a lot to look forward to in the next year or so.

Residency

I love my wife; but, I saw this comic in the AMA newsletter and couldn't help but think of her fretting turning 27 years old - HAPPY BIRTHDAY!!





As you can see, Rachel's birthday is upon us; so, happy birthday to her. My birthday was excellent, as already stated. It was made more excellent with more birthday gifts from my own parents consisting of more camping supplies. I believe we are all set to visit the woods on 4th of July weekend.

So, I said previously that I would explain the matching process. Here it goes. Let's take the disposition of ten applicants applying for eight positions between four programs. For illustration purposes, the applicants are numbered 1 to 10, and the programs are A, B, C, and D. Program A will have four positions, B will have one, C will have two, and D will have one position. The process works according to how each applicant ranks the programs to which they applied, and also how each program ranks the applicants they interviewed. Each of the ten applicants ranks the four programs as follows:

1. A C D B
2. A B D C
3. B D A C
4. B A C D
5. C D A B
6. C B D A
7. D A C B
8. D C B A
9. A D B C
10. A C D B

Notice applicants 1 and 10 had the same rank list. Now, the programs submitted the following rank lists:

A. 5 2 3 1 10 6 9 8

B. 10 2 7 6 5

C. 8 1 10 4

D. 9 2 7 10 4

Since applicants 1, 2, 9, and 10 all ranked program A as their top choice, this is where they are initially placed in the first round. Applicants 3 and 4 ranked program B as their top choice, but B didn't want 3 or 4, so B matches no one in this round. Program C was ranked first by applicants 5 and 6, so neither is placed here as C didn't rank applicants 5 or 6 at all. Program D gets 7 as he ranked it first; as did 8, but D didn't want 8. So, thus far, applicants 3, 4, 5, 6, and 8 are unmatched after the first round. But, they have second choices to consider.

In the second round, applicant 3 chose D as its second choice, but D doesn't want 3 either. Too bad for 3. Applicant 4 chose A second, but A didn't want this applicant. Applicant 5 ranked D second, but didn't want 5 either. Applicant 6 ranked B second, so B acquires 6. Applicant 8 chose C as its second choice. Program C now acquires 8. Now, applicants 3 4, and 5 remain unmatched.

In the third round, applicant 3 has A as its third choice, which A considers better than 1, 9 , or 10. So now program A has 2, 3, 1, and 10 knocking 9 into an unmatched position for now. Applicant 4 has C as its third choice, so C no acquires 4. Applicant 5 has A as its third choice, which A considers better than 10. Program A gets 5 and loses 10. As this is the third round, one must consider the second and third picks for applicant 9 which are D and B, respectively. Program D just loves 9, so 7 gets ousted. Applicant 10 has C and D as second and third choices. Program C considers 10 better than 4, so it acquires 10 and loses 4. Applicant 7 has programs A and C as choices two and three, but neither A nor C want applicant 7. So, applicants 4 and 7 are now unmatched.

In the final round, applicants 4 and 7 hope to gain a spot. Applicant 4 ranked D fourth, but D didn't like 4 compared to its recent gain of applicant 9. Applicant 4 thus remains unmatched. Applicant 7 ranked B fourth, and B considers its 7 better than 6. B acquires 7 and loses 6. The third and fourth choices of applicant six are now considered, which are D and A. Program D likes its 9 better than 6, and 6 just missed program A since applicants 1, 2, 3, and 5 are ranked above 6.

Alas, the final result is here:

Program A got applicants 1, 2, 3, and 5; Program B got applicant 7; Program C go applicants 8 and 10; and Program D got applicant 9. Applicants 1 and 2 got their first choice, while everyone else got their second, third, or fourth choice. Two applicants, 4 and 6, finished unmatched, which is to be expected when 10 people apply for 8 positions. Although it didn't happen in this example, it is possible that a program will have a position to which no one matches. Suppose of all the people program C ranked highly, none of them ranked C quite so high and matched elsewhere; additionally, those who didn't match higher up on their rank lists didn't rank program C. This scenario would lead to no one matching in one or both of C's positions. These open spots are then vied for by unmatched applicants in what is known as the scramble - where unmatched applicants contact via phone program directors whose programs have open spots. This is a very stressful time as these applicants already failed to match, and now must be more aggressive than ever.

I don't know if any of this blog helps people to understand how the residency match works - but I felt the need to explain it to people. It me the longest time to figure out it worked until I found something that diagrammed it out for me. Only time will tell what shall happen.

The Misery That is Neurology

No, Daddy, I don't think I can quite reach the pedals.



First, let me tell you about geriatrics. A couple folks out there were hoping I would turn around and decide that I like geriatrics. Well, sorry to disappoint, but no, it didn't happen. Now, it wasn't the older patients that bothered me. It was the sitting around for two weeks with little to do, then sitting around in a clinic room boring myself to death with a whole two to four patients a day, and getting very little to nothing from it all. On the wards, we saw three or four patients in the morning, rounded, and then sat around the rest of the day since we weren't allowed to leave until after 4:30 every day. The clinic was everything but educational. See the hospice patient and nursing home patients weekly was a near waste of time. Worst of all, it's a graded rotation. It ought to be a pass/fail rotation considering no other medical school in the entire country dedicates (read: wastes) a month of their students' time on seeing patients who are no different from any other patient. What if I end up with a B, ultimately screwing up my GPA over a rotation incomparable to any rotation taken by another student at another school The things they harp on being extra careful about in the elderly are true all right, but these same things are just as important in nearly every patient on the medicine service at the VA, which I worked for two months.

As the rotation neared its end, I saw a light at the end of the tunnel. But that light quickly went out when neurology started. My discussion about this will be at some other time.

I have my paper undergoing its last revision by a transplant surgeon. After this, I will submit if for publication. I have registered for the ophthalmology matching site, and I am almost finished coming up with a list of the programs to which I will apply. It's an exciting time, so exciting in fact that I totally lost site of the fact that yesterday was my birthday. It came up on me so fast that the only reminder of the day was the wonderful pie my wonderful wife made for me. Oh, and a few b-day cards, text messages, and a million phone calls.

I don't have much else to say tonight. Guess I just have a lot else on my mind. Goodnight.