Episode 4 - Dr. Amy Faith Ho

We're lucky to have Dr. Amy Faith Ho on our podcast. She is a jack of all trades who has been successful in entrepreneurship, medicine, and policy. She also appears on Untold Stories of the ER on TLC which details the strange and wonderful happenings of the portal into our health system. 

Some of the topics we talk about:

  • Her daily routines
  • Policy work - Washington DC, AMA
  • Chicago Tribune writing - Chi-Raq controversy
  • Brand building
  • Favorite Podcasts - FOAMed, ER, EMRap, EMCrit, HippoEM, NPR, This American Life
  • Books - Art of Seduction, 48 Laws of Power - Robert Greene

TZBM The Podcast - Episode 3 - David Rivedal

This episode we focus on Plastic Surgery, not only one of the most competitive residency programs to match to, but also one with such a wide breadth of techniques and procedures. It is not an anatomical specialty like urology or ophthalmology. Rather you're applying principles of the human body to solve problems. 

So before we get started here are the numbers from 2016 match:

69 programs offering 152 positions. 216 applied with 151 positions filled through the primary match. That means 65 people, or a whopping 30% of people did not match. 

In this episode we talk about Step 1 study techniques, Plastic Surgery application tips, and Productivity hacks you can use to excel on your rotations. Featuring plastics resident David Rivedal from the Medical College of Wisconsin.

  • ·      Step Studying method

    • Study schedule

    • Iterative

    • Non crazy schedule

    • Check out these helpful study planning tools:

  • ·      Plastic Surgery application tips

    • Pareto’s 

    • Research

  • Running

  • Daily routines

    • et to work early!

  • Podcasts

    • Bill Burr comedy - Monday Morning Podcast

    • Louis CK

    • Kyle Kinane

    • Dave Chapelle

    • Nate Bargatz

    • Tom Segura

    • TJ Miller

  • Shows

    • Westworld, South Park, Parks and Rec. Peaky Blinders

  • What advice do you wish you had received when you were younger?

    • ry a lot of things!

To Zanzibar By Motor Car - The Podcast Episode 2

Welcome to the second episode of the To Zanzibar By Motor Car Podcast. The goal of this podcast is to deconstruct the abstract concept of medicine by interviewing the people who shape how medicine is practiced and healthcare is delivered. Every week we'll chat with the heroes (and heroines) of medicine, both unsung and sung, to discover the tools, hacks, and daily routines that make them so effective. 

This week we talk to Dr. Reza Afrasiabi, an MIT trained quant turned surgeon. He worked for some of the world's largest banks and hedge funds before pursuing his true passion in medicine.  In this episode we learn about finding your true passions, why money does not equal happiness, how to beat heart failure, and the disturbing truth about gun violence in Chicago's South Side.

Show Notes

  • MIT
    • Rule of 3 - sleep, social life, grades (pick 2)
  • Nature - Human Behavior Article
    • aspi et al. "Childhood Forecasting of a Small Segment of the Population with Large Economic Burden" Nature Human Behavior. 2016: 0005- Web.
  • Favorite Podcasts
    • Revisionist History, Serial
  • Recommended Books
    • Ham On Rye, The Physics of the Impossible, The Future of the Mind

To Zanzibar By Motor Car - The Podcast - Episode 1

Welcome to the first episode of the To Zanzibar By Motor Car Podcast. The goal of this podcast is to deconstruct the abstract concept of medicine by interviewing the people who shape how medicine is practiced and healthcare is delivered. Every week we'll chat with the heroes (and heroines) of medicine, both unsung and sung, to discover the tools, hacks, and daily routines that make them so effective. 

This week we talk to Dr. Jackie Gong, an OBGYN Resident at Southern Illinois University. She completed her bachelor's and master's degree at Johns Hopkins University and went on to get her MD at the University of Wisconsin School of Medicine and Public Health. In this episode we learn about residency, interviewing tips, and productivity hacks.

Show Notes

Productivity Hacks

  • Productivity Hacks
    • Plan out your day using iCal or google calendar
    • Step 3 or Creog questions on phone during coffee
  • Podcasts
    • Modern Love, This American Life, TED Radio Hour, Harry Potter and the Sacred Text, The Land of Desire: French History and Culture
  • Advice received when younger
    • Importance of documenting things

 

Interview Season

Finally able to catch my breath after a two month hiatus. I'm wrapping up my surgery rotation next week and thought I'd take some time to blog about what's really on everyone's minds now.

It's the middle of interview season for our intrepid M4s and hopefully everyone has gotten a good mix of safety, good fit and reach interviews. As I've blogged about before, the interview is the single most important component in matching into the program of your choice. Once you've been selected for an interview your scores / resume are much less important than your interactions with the program.

Your interview starts when you begin corresponding with the program

Every single interaction on email / text / phone can and will be scrutinized. Program coordinators they've told me that applicants who take too long to respond, are late / lazy with their applications, or brisk / rude with their replies are immediately viewed with suspicion. There are also online forums for program directors and coordinators to chat about residents. A rude interaction with a program such as not showing up for an interview will have later repercussions. Treat every single person you meet during the interview as if they are on the admissions committee because they probably are - directly or indirectly.  And if you can't keep it together for a few hours, you probably can't cut it for 3-7 years.  So in essence have good manners.

Branding, branding, branding

Programs, especially academic powerhouses or those in desirable locations, have their pick of applicants. Everyone has high scores, good grades, published research, prominent mentors, etc. but you need to create a cohesive story.

  • What do you care about?
  • Why do you care about it?
  • How is it reflected in your application?

I care about technology and innovation in medicine because I feel that I can help a greater number of people that way. I worked in healthcare IT before med school and then did research on a new imaging technology - 4D DSA. It's short, pithy, and you can tie a lot of your extracurriculars to it. 

Creating a brand also helps exclude programs from your list. Programs that don't support resident research may not be my best fit and that's ok. As long as you have that strong position you'll attract programs that are looking for what you have and not waste your time with those that don't.

NBA player Lou Williams makes an astute observation on Klay Thompson's Anta brand shoes. The same shoe - but different branding can change the appearance / status / and appeal of the shoe. #powerofbranding

NBA player Lou Williams makes an astute observation on Klay Thompson's Anta brand shoes. The same shoe - but different branding can change the appearance / status / and appeal of the shoe. #powerofbranding

 

Tell stories

Humans tell stories, that's what we do. When you are asked a question - what is your greatest strength / weakness etc. - always tell a story. Do this for a few reasons:

  • Show, don't tell.  No one will believe you if you say your greatest strength is hard work. But if you tell a story about how you juggled a part time job in high school along with school and taking care of your siblings, then that'll speak for itself.
  • It's more memorable. At Wisconsin we had this legendary attending - Dr. Maki - who reached mythical status among those who worked with him. Stories about his correcting the CDC, diagnosing his own hairy cell leukemia, and working 100+ hours a week as a professor emeritus and grandpa stand out. 
  • Decreases the distance between you and the interviewer. When you're with your friends you tell stories. It makes you more likeable and friendly.
ask this guy, he knows. #misterrogers #skeletonsincloset

ask this guy, he knows. #misterrogers #skeletonsincloset

Dress for Success

I majored in business as an undergrad and we actually had a whole semester long class dedicated teaching how to dress, interview, and other business etiquette. I interviewed at institutions all over this country with some very very intelligent candidates, but without fail, there would always be a person who never got the message.

For men's business dress you should wear a blue or gray suit. Black shoes preferable, but brown is ok. Matching leather - shoes, belt, watch strap. White button down shirt, and a solid colored or simple patterned tie. I added in a white pocket square as a touch. Your interview is not the time to make a fashion statement - it is a uniform. Use it effectively to show that you are a professional, thoughtful, and personable candidate. 

Life Pro Tip: Either dress like Idris Elba or become Idris Elba. If you did you'll probably match the residency of your choice.

those steely eyes, chin, and grizzly smile #swoon

those steely eyes, chin, and grizzly smile #swoon

 

At interviews I'd see people wearing suits that were way too big, like early 2000s NBA draft size. One guy even wore a tie with a polo shirt. Appearances matter and that's just the way things are. Here's flashback to Drew Gooden with David Stern.

look at that break in the pants

look at that break in the pants

 

Have normal human hygiene

Do the basic stuff that normal human beings do. Shower. Shave. Cut your nails. Put on deodorant. Go easy on the cologne. Comb your hair. Make sure you don't have any boogers. Iron your shirt. Dry clean your suit. Polish your shoes. Trust me, it sounds so basic but on every interview there's going to be that guy or gal who didn't do this.

Don't only eat cookies for lunch / dinner

I went to an institution in the midwest for an interview and one of the candidates only ate cookies during the interview lunch. When I asked him what was his favorite cookie he said Au Bon Pain. Don't only eat cookies for lunch.

Drink alcohol at dinner, but not too much unless applying for neurosurgery

I've heard these urban legends that the neurosurgery residents would take the candidates out drinking and get them plastered. Later in the evening they would meet for dinner and all the attendings would be there and they'd see how well the candidates could hold their liquor. If you're applying to normal residency programs 1-2 drinks is probably appropriate #YOLO.

 

In the end, the interview season is a ton of fun. You get to travel to cool places, meet your future colleagues and eat a ton of good food. I would say that there's this strange oujia magic with the match in that people tend to end up where they ought to be, even if it first doesn't seem that way. Remember, have fun and don't stress too much about the interviews. In the end just be yourself and you'll find the right program.

My Thoughts on Step Score for the Match

The higher the better...duh

Ok that was facetious. Like anything in your application there is the law of diminishing returns. You have to understand that most program directors use step scores as a screening tool. It is a surrogate marker for "Can this applicant pass the CORE exam / specialty board exam on their first try?" There are a couple of programs (like MGH) that have high step 1 score cutoffs like 240, but the majority of programs do not (including heavy hitters such as UCSF, Penn, WashU, JHU, etc). That means that if you get 230-240 (or whatever is equivalent for 2016 score accounting for inflation) you probably are not ruled out of any program. Scores of 240+, 250, 260, yada yada are neither necessary nor sufficient to get an interview much less a high position on the rank list - but they help. The gist is - higher is better, but there are diminishing returns.

My step 1 score was completely pedestrian for radiology (average according to 2015 NRMP data) and if you read the online peanut galleries at student doctor there was absolutely no way that I could get in to a top tier program. But the commenters at student doctor are probably not program directors at top tier programs so take everything you read there with a grain of salt! Since you can only take step 1 once and that ship had sailed, I resolved to do well on step 2. The standard thinking is that step 2 scores do not matter very much and that if you have a decent score, wait until after interview season starts and choose not to send your score. However, I figured that a good step 2 score probably wouldn't hurt, and as long as the rest of my application was strong then my step 1 score would be seen as an aberrancy and not the status quo. I ended up scoring ~2 stdev above average on step 2. I did this by allocating more time, analyzing the weaknesses in my step 1 study process, and developing a new study plan. I'll write about this in a later post.

Not everyone is a natural born test taker like some of the freaks (used as a term of endearment!) in my medical school class. One aspect of your application will not break you. Work hard, believe in your self, and never give up. 

My Thoughts on the Radiology Match

So this was the first year that interventional radiology became its own integrated residency program! Before you would have to finish a radiology residency program and then apply for a fellowship program (1 intern year + 4 radiology + 1 IR = 6 years total). Things don't really change for an integrated program (1 intern year + 3 radiology + 2 IR = 6 years total), but it's definitely a big deal. While it's absolutely necessary for IR physicians to maintain their diagnostic radiology roots, IR training brings in more experience in critical care, vascular surgery which is crucial as IR sections start running their own services. As IR fellowships are slated to phase out by 2020, the integrated IR residency will become the main path (although current radiology residents will have an early specialization option). 

If this year is representative at all, then IR is shaping up to become one of if not the most competitive specialties in medicine. According to this year's NRMP's advance data tables there were 14 positions available for first time applicants from 7 different programs (some heavy hitters including Penn, Michigan, WashU, Brigham, MGH, Kansas, Vanderbilt). There were a total of 183 applicants. This is a 7.7% match rate. For comparison, dermatology offered 420 positions for 801 applicants = 52% match rate. Now granted, there have now been another 20 programs who will have positions next year, NRMP match statistics aren't out so we don't know how competitive applicants were, and we don't know if all 183 applicants ranked IR first, it's likely that even if there are 50 spots next year the match rate will still be quite low.

The Non-Gunners Guide to Gunning on the Wards

Third year a peculiar phenomenon occurs. Some of your normally reliable and friendly classmates become transmogrified into unrecognizable people. Previously quick to lend a hand and share notes, they now read up on your patients, pimp you in front of the attending, and don't pass along messages from the intern. Unable to cope, some of you may question if you need to descend to those depths to compete, or stay the high road. Rest assured, any and all gunning that you do should be directed at optimizing patient care and studying for the shelf exam as much as possible.

Clinical evaluations are arbitrary

If you are a normal, well-adjusted human being with a modicum of work experience your clinical evaluations will be completely fine. Adhere to basic professional standards like showing up on time, wearing clean clothes, and showering, and your residents and attendings will sing your praises. Although once in a while you may be stuck with someone who is a stickler and gives you straight competents (my institution’s equivalent of “average”), it’s more than likely you will also have other evaluators who are more loosey goosey with their advanced scores (my institution’s equivalent of “honors”). In the end, unless you are someone who is severely skewed to one end of the autistic spectrum or actively trying to sabotage your medical career you’ll end up with a blend between competent and advanced. This is a good thing that at least someone thinks your competent at something because I sure felt grossly incompetent for 85% of the time in each rotation.

Subjective evaluations are not necessarily bad

Many will decry that such subjectivity is “unfair’. Schools seem to agree somewhat and attempt to objectify these evaluations by using discrete numbers because numbers are supposedly less subjective because they are numbers. We all see the folly in this as superlatives and mediocrities are just replaced by numbers. Standardized criteria across evaluators is an unachievable ideal.

However - this is not a bad thing. As much as fragile gentle-hearted M3s may complain the thing to realize is that the world is not fair. Additionally you will be evaluated forever in your professional career based on some quantitative data (i.e. how many surgeries you performed, what your patient’s A1c scores are, what percentage of your hypertensive patients are adhering to their medications etc) but also largely on how your supervisors, peers, team members and patients perceive you. It’s not inherently bad or unfair...it just is. Experiencing this earlier in your professional training should help you realize how you need to behave to create and strengthen those relationships.

Focus on the patient and being a good team member and not what your gunner med student colleague is doing

Your time on wards is about learning the language and culture of medicine. When on wards take notice of the follow ups for each patient. Outstanding labs, consult notes, missing charts, etc. are all things you can help your team with by keeping an eye on. Actively look for ways to contribute. If there's a clinical question, offer to look up the answer and give a short 1-2 min explanation. Even little things help. On surgery rotations if you are holding the dressing supply bucket that will help your team round more efficiently so they can see all their patients on time before going to cases. 

If your goal is to provide the best care possible for your patients, your residents and attendings will notice that and your clinical evaluations will be excellent.

Practice makes Perfect Presentations

The most significant interactions you have with your attendings and residents will be the 3-5 minutes you spend each morning presenting and discussing your patients. This gives an opportunity for your attending to assess how well you can reconnoiter data, interpret said data, and create a plan. With that said, how you present this information is as important as what you say. There's a certain amount of theater involved in promoting, arguing, and defending your point.

Speak with confidence and fluidity

The only way to achieve that is to practice. Figure out if your attending likes full presentations or more focused ones. Round on your patients half an hour earlier and spend some time rehearsing the important points and how you will say those points. If you can master giving good presentations, I guarantee you will see more advances / honors in your clinical evaluations.

Exam grades are important

When the resident / attending tells you to go home...you go home. Repeat, go home when your resident tells you to go home. Don't stay especially if it is not busy. Instead, go home and study. Since most students will receive decent clinical evaluations, the main differentiator will be your exam scores. Every rotation that I did not get an A in was because of my exam grade. 

Use UWorld as a staple. Pretest questions also help. Stick with one or two review books. Try to read and do some questions every day.  1 chapter + 20 questions every day. Over 4 weeks that's almost 600 questions. 

Conclusion

Third year is the most challenging and rewarding time in medical school. You'll be pushed beyond what you thought you were capable of, but also find that you'll rise to the challenge. Work your butt off but also enjoy yourself. You'll look back and be astonished by your transformation over that year. As always, believe in yourself and keep on hustling.