Hello dear readers! I know I've been quiet lately, but what with hurting my ribs and grad school applications, I've been swamped. Couple that with a job hunt and school starting, and I do hope you can forgive me my silence.
BUT! I'm coming back with a vengeance, after I rant slightly about the application process.
So this is my own damned fault, frankly, but I forgot about deadlines for a program that I REALLY want to get into. It's close to home, I already know a ton of the faculty, and I'm already attending school there, albeit informally. So I scrambled and scrambled, and I'm getting everything together.
Here is what I hate about applications: they make you list your classes and grades ad nauseum for each program that you apply to. I don't think I realized how lucky I was with the AMCAS, because I had one application, one set of credentials to list, and one essay to write. Instead I have to write a statement that conforms to each programs' specifications, fill out two applications per program, and list my classes and grades according to each program's idiosyncratic application criteria. Exceptionally time consuming.
It was pointed out to me that they make students spend the time so that people who process applications don't have to; otherwise app fees would be astronomical and it would take forever to reach a decision because they'd have to pay people to do all of the busy work that I'm currently doing. It made me a little less bitchy, but only just. ;)
So grad school. I'm applying for master's programs or alternatively a series of classes that will hopefully make my med school applications look more competitive. I only have 4 of 16 med school applications still outstanding; the rest have declined to interview me. It is looking a bit grim, so I need backup plans. I have been told that I shouldn't take it personally, and I don't. I realize it is part of the process and that while I have lots of qualifications and experiences, my grades could be better and my MCAT scores stronger. Because of the economy, cutbacks in faculty hours and facilities, a lot of med schools are tightening their criteria. Makes a process that is really tough that much more difficult to get through successfully.
Plus my cellular neurophysiology class last semester was taught by two post docs, and both actively do research. One is a neurochemist who studies neurotransmitters, and the other looks into how the brain changes with drug dependency and did her thesis on how alcohol addiction changes the brain. Her model organism? Rats. Yes, she got rats drunk and looked to see how their brains changed over time. It's pretty frickin' awesome.
And they really got me excited and enthused about doing some research. I've been doing my research internship at SFGH, and I really have been enjoying that. I have read anecdotes about a couple of students who were accepted to medical school and decided not to because research was much more appealing to them. I realized that I don't know much about research, and that given where I am in my life, perhaps I should give it a fair try. Who knows, I may end up as a PhD and studying plasticity in drunk rats. It sounds like a great career to me.
So I'm applying to two MS programs and an MA program. I also applied to two programs that are not degree programs but would give me a stronger med school application next time around. I'm not sure how much I want to actually spend two years and not get a degree of some sort, but we'll see how this goes. One program is in New York, which is slightly scary. I don't know if I want to leave my husband for a year while I go do this program and then possibly go to another state that is not home to get my medical degree.
Perhaps you are getting a sense of what I'm up against. There are a number of variables in my life. Nothing is certain and everything seems convoluted. It is a bit scary because I don't know where my life is going, but it is also exciting. I have a number of opportunities available to me.
So I have all of my letters of recommendation lined up (easy! my advisors are the best and are so nice, even though I didn't give them as much time as I wanted to) the transcripts and exam scores are all ordered and sent, and my goal these next two days are to finish ALL of the applications and statements.
I also have a tentative offer to join a neurodevelopment lab at one school. I'm holding out for my first choice, but nothing will be decided or agreed upon until after applications are in anyway. Thankfully MS applications are NOT on a rolling basis like med school apps, so no movement is done on processing until after the deadline is passed. This is more of a benefit than it seems, because it gives me time to sort out things like which lab I can work in and thoughts about a project.
I am taking a pharmacology class and a systemic neurophysiology class this semester, so I will have lots of fun material to talk about. I really wanted to post a bit about action potentials and graded potentials, because they are the basis for everything that our brains do.
Till then, ciao!
Showing posts with label Medical School. Show all posts
Showing posts with label Medical School. Show all posts
Friday, January 28, 2011
Sunday, January 2, 2011
Residencies
I promised you content... and here is the first of many, I hope.
Recently there was a kerfuffle over allowing medical residents to work shorter hours. In the end, the law remained the same such that residents are only permitted to work 80 hours a week; the major change was that the shifts went from 30+ hours to about 16, though senior residents can do 28 hour shifts with "strategic napping".
This would seem to be painfully obvious to anyone halfway paying attention: tired doctors don't necessarily make the best calls for a patient that needs and deserves excellent care. Especially if the tired doctor in question is, in fact, in training.
With good reason, there has been public outrage about the number of hospital-associated mistakes. Unfortunately, the bandwagon has been made available to sensationalist media coverage of the number of times that people at hospitals screw up. It seems as if the culture that loves to find fault with an educated elite absolutely adored punching holes in the godlike facade of doctors. People like Faux news seemed to take childlike glee in exposing the idea that yes, doctors are people too. Yes, doctors are not infallible. Mistakes are made, and it is a shame, but the best that humans can do is to try an minimize the potential for such mistakes.
Now mind you, there are all kinds of systems in place to minimize mistakes. Nurses ask for I.D. and papers before drawing blood or doing any kind of procedure, due to a mishap at Mt. Sinai in New York with a woman going in for the wrong surgery. It is awful and deeply regrettable, and so we learn from these mistakes. We ask for I.D., discuss the patient's understanding of the upcoming procedure, answer questions, and try to have redundancy programs where if one nurse or doctor misses something, then someone else might be able to catch it. Much of the wait and drag of a hospital can involve running these types of checks. Yes it can get bogged down in bureaucracy, but I would rather have accuracy than speed when it comes to my health.
Which is why I simply did not understand the hue and cry raised about lowering the number of hours that residents can work. Exhausted students that work 30+ hour shifts, go home to study more, and then must return to the hospital for more work simply makes no sense to me whatsoever if a patient's life is on the line.
Put simply, safety is put into jeopardy. I don't really see that as being an option, really.
Arguments against cutting back hours and shifts are kind of ridiculous, in my opinion. The one good argument against cutting hours was made by Orac a few weeks back, and it is somewhat compelling. We'll visit it by and by.
A residency is a paid apprenticeship. A resident gets paid very low wages for a lot of work, but it is expected because the resident is learning their profession and their craft. An attending doctor oversees their work and makes sure that they are learning what they need to learn, but in a lot of ways they are basically practicing medicine.
Because the resident is working for very low pay, certainly less than she can command as a full doctor, she pumps a lot of free work into the hospital. More patients can be seen quicker because there is a larger staff of doctors that can cover the demand, and thus the hospital brings in more revenue. The hospital benefits from this, much like when you volunteer somewhere. You are performing a service for free because it helps the organization you are working for, and you personally are possibly learning or devoted to a cause. The teaching hospitals objected to the proposed changes because it would cost them revenue.
My question to them is this: if it meant fewer mistakes, fewer lawsuits, and lower malpractice insurance, wouldn't you do it? I'd love to see numbers where the cost/benefit analysis was done, with an estimation of how much the hospital can save in lawsuits and/or eating the costs associated with mistakes, vs. how much revenue is lost from either requiring more residents to cover the lost shifts or not having that many residents.
The next objection was safety. I worked veterinary emergency for years, and I know what happens when shifts change. You hand patients off to the next oncoming shift. In many cases, to promote safety and make sure that things go well, you have the shifts overlap significantly (by perhaps 2 hours) to make sure that nothing comes up. The oncoming shift reads the chart thoroughly to make sure that they understand the case and ask questions to make sure that they get it.
The process takes perhaps 20 minutes TOPS. WHY is this so difficult for human doctors to do? What, precisely, is wrong with handing patients off to another doctor?
There was all of this noise made about "continuity of care" nonsense that really irked me. I've sen it done. It isn't that hard. Why is this kind of continuity so flippin' important that it was raised as a major safety objection? If there is something here that I've missed, please let me know, because I frankly don't get it.
Dr. Wachter's article above made some good points, which kind of coincide with Orac's argument. One is the idea that even though a shift is technically over and the resident is free to go, that the resident might need to stay for whatever reason. I do get this. I've done it myself, because I had a project or issue in the back of my mind that I had to handle before I left, and explaining it might be too complicated or take too long. This I do understand.
The other is the "swinging door" mentality, that the resident might be too eager to leave or know that the shift is over and that things might get dropped just because the resident knows they have to go. Appropriate care to detail and discussions with the attending or oncoming attending physician, in conjunction with staying to make certain that cases are being handled adequately or to handle the case yourself, can probably settle this issue. Knowing the kind of sacrifice, hard work, and discipline involved in getting into and graduating from medical school, I think that this concern really doesn't give residents enough credit for being mature adults. Communication is the key when it comes to patient care, and not being communicative enough with your team will raise all kinds of problems, not just this one.
And we come, finally, to Orac's objection, the one that I think carries the most water. There is a massive amount of information necessary to becoming a doctor, and a good one at that. Book learning can only take you so far, which is why there are residencies and internships. Residencies can be anywhere from 2-5 years long, because there is so much to learn. Orac's problem with decreasing shifts is that there is less actual time to learn what you must in order to pass the boards and be a fully accredited and independent doctor.
I understand and agree with this point of view: there is a huge amount of material to learn, and less and less time in which to learn it. There will be a critical point, with short shifts and a very long residency, past which students will be unwilling to devote their education to a particular discipline simply because of the time involved. I also think, however, that there are ways to increase the efficiency of a program so that you can indeed learn more effectively. Due to the shift restrictions, this conversation about restructuring the residency programs offered at teaching hospitals is already happening. I think that that is a great idea, because learning medicine is like trying to hit a moving target: it is constantly changing and updating itself.
There are good objections to changing the shift requirements and allowances for residents, but I honestly think that the most important ones are being lost in the shuffle. In addition, creative solutions to solving the aforementioned objections are also being lost because of a seemingly stubborn adherence to a fixed curriculum.
Recently there was a kerfuffle over allowing medical residents to work shorter hours. In the end, the law remained the same such that residents are only permitted to work 80 hours a week; the major change was that the shifts went from 30+ hours to about 16, though senior residents can do 28 hour shifts with "strategic napping".
This would seem to be painfully obvious to anyone halfway paying attention: tired doctors don't necessarily make the best calls for a patient that needs and deserves excellent care. Especially if the tired doctor in question is, in fact, in training.
With good reason, there has been public outrage about the number of hospital-associated mistakes. Unfortunately, the bandwagon has been made available to sensationalist media coverage of the number of times that people at hospitals screw up. It seems as if the culture that loves to find fault with an educated elite absolutely adored punching holes in the godlike facade of doctors. People like Faux news seemed to take childlike glee in exposing the idea that yes, doctors are people too. Yes, doctors are not infallible. Mistakes are made, and it is a shame, but the best that humans can do is to try an minimize the potential for such mistakes.
Now mind you, there are all kinds of systems in place to minimize mistakes. Nurses ask for I.D. and papers before drawing blood or doing any kind of procedure, due to a mishap at Mt. Sinai in New York with a woman going in for the wrong surgery. It is awful and deeply regrettable, and so we learn from these mistakes. We ask for I.D., discuss the patient's understanding of the upcoming procedure, answer questions, and try to have redundancy programs where if one nurse or doctor misses something, then someone else might be able to catch it. Much of the wait and drag of a hospital can involve running these types of checks. Yes it can get bogged down in bureaucracy, but I would rather have accuracy than speed when it comes to my health.
Which is why I simply did not understand the hue and cry raised about lowering the number of hours that residents can work. Exhausted students that work 30+ hour shifts, go home to study more, and then must return to the hospital for more work simply makes no sense to me whatsoever if a patient's life is on the line.
Put simply, safety is put into jeopardy. I don't really see that as being an option, really.
Arguments against cutting back hours and shifts are kind of ridiculous, in my opinion. The one good argument against cutting hours was made by Orac a few weeks back, and it is somewhat compelling. We'll visit it by and by.
A residency is a paid apprenticeship. A resident gets paid very low wages for a lot of work, but it is expected because the resident is learning their profession and their craft. An attending doctor oversees their work and makes sure that they are learning what they need to learn, but in a lot of ways they are basically practicing medicine.
Because the resident is working for very low pay, certainly less than she can command as a full doctor, she pumps a lot of free work into the hospital. More patients can be seen quicker because there is a larger staff of doctors that can cover the demand, and thus the hospital brings in more revenue. The hospital benefits from this, much like when you volunteer somewhere. You are performing a service for free because it helps the organization you are working for, and you personally are possibly learning or devoted to a cause. The teaching hospitals objected to the proposed changes because it would cost them revenue.
My question to them is this: if it meant fewer mistakes, fewer lawsuits, and lower malpractice insurance, wouldn't you do it? I'd love to see numbers where the cost/benefit analysis was done, with an estimation of how much the hospital can save in lawsuits and/or eating the costs associated with mistakes, vs. how much revenue is lost from either requiring more residents to cover the lost shifts or not having that many residents.
The next objection was safety. I worked veterinary emergency for years, and I know what happens when shifts change. You hand patients off to the next oncoming shift. In many cases, to promote safety and make sure that things go well, you have the shifts overlap significantly (by perhaps 2 hours) to make sure that nothing comes up. The oncoming shift reads the chart thoroughly to make sure that they understand the case and ask questions to make sure that they get it.
The process takes perhaps 20 minutes TOPS. WHY is this so difficult for human doctors to do? What, precisely, is wrong with handing patients off to another doctor?
There was all of this noise made about "continuity of care" nonsense that really irked me. I've sen it done. It isn't that hard. Why is this kind of continuity so flippin' important that it was raised as a major safety objection? If there is something here that I've missed, please let me know, because I frankly don't get it.
Dr. Wachter's article above made some good points, which kind of coincide with Orac's argument. One is the idea that even though a shift is technically over and the resident is free to go, that the resident might need to stay for whatever reason. I do get this. I've done it myself, because I had a project or issue in the back of my mind that I had to handle before I left, and explaining it might be too complicated or take too long. This I do understand.
The other is the "swinging door" mentality, that the resident might be too eager to leave or know that the shift is over and that things might get dropped just because the resident knows they have to go. Appropriate care to detail and discussions with the attending or oncoming attending physician, in conjunction with staying to make certain that cases are being handled adequately or to handle the case yourself, can probably settle this issue. Knowing the kind of sacrifice, hard work, and discipline involved in getting into and graduating from medical school, I think that this concern really doesn't give residents enough credit for being mature adults. Communication is the key when it comes to patient care, and not being communicative enough with your team will raise all kinds of problems, not just this one.
And we come, finally, to Orac's objection, the one that I think carries the most water. There is a massive amount of information necessary to becoming a doctor, and a good one at that. Book learning can only take you so far, which is why there are residencies and internships. Residencies can be anywhere from 2-5 years long, because there is so much to learn. Orac's problem with decreasing shifts is that there is less actual time to learn what you must in order to pass the boards and be a fully accredited and independent doctor.
I understand and agree with this point of view: there is a huge amount of material to learn, and less and less time in which to learn it. There will be a critical point, with short shifts and a very long residency, past which students will be unwilling to devote their education to a particular discipline simply because of the time involved. I also think, however, that there are ways to increase the efficiency of a program so that you can indeed learn more effectively. Due to the shift restrictions, this conversation about restructuring the residency programs offered at teaching hospitals is already happening. I think that that is a great idea, because learning medicine is like trying to hit a moving target: it is constantly changing and updating itself.
There are good objections to changing the shift requirements and allowances for residents, but I honestly think that the most important ones are being lost in the shuffle. In addition, creative solutions to solving the aforementioned objections are also being lost because of a seemingly stubborn adherence to a fixed curriculum.
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