You give me premature ventricular contractions – Emma, No Strings Attached (film)
I was never really confident reading EKGs. But after one week and 300+ EKGs later, I can finally say, without a doubt, that I can read an EKG on my own! One small step as med student in training, one big step for future Dr. Jenny!
Most of you are probably much better at reading EKGs than I am, but I just wanted to make this video as a short refresher. Plus I might need to look back on it some time in the future … I regret not making a radiology video when the material was still fresh. So I always have to go back and read Priya’s blog post. Hope you all enjoy!
Short overview incase you couldn’t catch it in the video:
1. Is the patient in Sinus Rhythm? – Check for positive P waves in leads II, III, aVF
2. Heart Rate
3. Axis deviation – Check leads I & aVF
4. Left Anterior Fascicular Block? – Check lead II
5. P wave + PR intervals – are they long? are they short?
6. QRS complex – are they wide? more than 3 small boxes?
7. ST/T wave changes
I hope that helps. I wanted to read more samples of EKGs but then this video would be a bajillion hours long.
We are so close to being finished with medical school – I am finally feeling the weight of that thought and getting excited about graduation. 🙂
My final surgical elective was in the Burn Unit at a local hospital. It was a very busy rotation; from pre-rounding at 5am, rounding at 6am, a very full panel of patients, and surgery MWF, there was a lot going on. Overall, I really enjoyed this rotation. I am fairly non-surgical, but having the opportunity to observe application of various skin grafts to 50% total body surface areas (TBSA) burns was pretty cool. I will not miss the 90 deg temps in the OR though. Burn surgery ORs are kept at least 85 deg F for patients with large burns because of the tremendous loss of heat from the absence of skin. It gets gross under surgical gowns quite quickly.
Some highlights of this rotation:
- Working with a large team of residents: 4 Interns (1 ortho, 2 gen surg, 1 EM), 1 gen surg pgy-3, and 2 fellows. Plus me, tagging along. We were a big group and everyone’s roles changed weekly.
- Surgery on Monday, Wednesday, Friday: burn cases would take up to 4 hours depending on the extent of the burn injury
- Clinical rehab psychologist on site. Many burn injuries result in PTSD from the injury or may be the consequence of behavioral issues (drug use, violence/abuse). Rehab psychologists are quite rare in hospital settings, but essential – especially in the burn unit. The majority of the cases were tragic and having a resource for patients coping with serious life changes was instrumental for their treatment and long-term prognosis. Patients that believe that life can get better, after severe tragedy, are ones that will do better with their burn/wound care and have the best outcomes.
- Patient cases were complex and a many of them were the result of homes catching fire. When your home is destroyed… what do you do after? These are really unfortunate cases and many times patients live in transitional housing or if they’re lucky will live with friends/family until they can obtain stable housing.
- Patients were very sick, and not necessarily because of their burns. So much of how well someone does is based on their health status prior to hospital admission. If someone has chronic peripheral vascular disease, poorly controlled diabetes or regular diabetes, meth use (this one’s huge), poor nutritional status (alcoholism, Crohn’s disease), or any autoimmune process then the ability for wounds to heal is significantly impaired.
I am really glad to have had the opportunity to participate on this service as I think this is a really unique surgical specialty and one in which more attention should be paid. But I’m biased now. 🙂
Until Match Day,
There are currently 2 different MATCHes you can participate in: the DO match and the MD match. The DO match is about 1 month before the MD match (and if you match into a DO program, you are locked in and cannot participate in the MD match).
Soon, none of this will matter as all programs will become ACGME (MD) accredited. However, there are a few things to be aware of:
DO programs: Do audition rotations! I didn’t get interviews at places I didn’t rotate at! Much of this process is based on how well programs know you/networking. Get letters of rec from former residents at the programs you want to go to or from known physicians in the osteopathic community. Also, go to osteopathic conferences (like the ACOOG conference held twice a year) to meet program directors. Make a portfolio and pass it out at said conferences. DO programs look at your holistically and try to get a good fit for their program. To be honest, my DO audition rotations (I had 2) were very challenging. At one rotation, there were 5 other students on service with me. At the other, there were 2 others. And because DO students tend to be super nice, helpful, smart people, it’s hard to compete with them. Everyone has a great personality. Everyone is a hard worker. Everyone is knowledgeable. Everyone knows everyone (especially on the East coast were a lot of DO residency programs are). I found that it helped if you knew one of the residents at the program (and had someone to vouch for you). Some programs really take the residents’ opinion into account when finalizing their rank list, others don’t. Also, some programs will require you to do a presentation – so be ready!
MD programs: Very much merit based – you’ll get an interview invite with high scores and grades. Many programs will not keep in touch with you after your interview so that all applicants have an equal playing field. My MD audition rotations were tricky because some programs don’t offer you an interview, even if you rotated there. Regardless, I think it’s really important to try for auditions. In the MD world, many people don’t do audition rotations, so when you show up with your DO, can-do, friendly, hard-working attitude, it makes a huge difference in the eyes of the program. One of the DO programs I interviewed at had an MD program director (who is awesome!) and she used to work for an MD program as the assistant program director. She actually stated that at her MD program (and as an MD), she preferred all the DO applicants! She said that they brought something more to the table and that they wanted to be there. I’ll also say this-one interview I got was because I sent an email to an MD program expressing my interest in it- so that (can) DO attitude really does go a long way.
I hope this helps you as make your decision on which programs to apply to and which programs to do auditions at!
As interview season comes to an end, I thought now would be a good time to reflect on them!
- WHAT TO WEAR: Remember to dress your best – this means a suit. Most folks wear conservative colors/styles (dark blues/grays/blacks). I know of a few people who had olive green and purple – I think that shows your personality as well – it all depends on how much of a risk taker you are! Try to wear good walking shoes (I know someone who had a pair of flats in her purse and just switched out her heels for the tour) as many of your interviews will include a tour.
- WHAT TO BRING: You can take a nice purse with you (I constantly ran into the issue of where to put my keys/phone without one), a portfolio pad, and a pen. Take a lint remover if your suit needs it (hotels might be able to help you with this in case you forget it, they did for me)! I’d also recommend to have in your car: pins, sewing kit (my blouse ripped during one of my interviews), hair tie, comb, pads/tampons, wet wipes, protein bars, and anything else in case of emergency.
- INTERVIEW STRUCTURE: Interviews vary, but the ones I went on were mostly structured as full or half day interviews with tours, lunch or breakfast (or both) provided, and a residency program presentation by program director and/or a resident. Some have you sit in on sign out as well.
- Individual interviews were often done one-on-one or 2-3 faculty/PD/residents with you. Only one interview I went on had the applicant in front of 30+ people for a 15 minute interview.
- DINNERS WITH THE RESIDENTS: You are often invited to a dinner hosted by residents. This can be out at a restaurant or at one of the residents’ homes. Highly recommend that you attend! You can ask questions, get a feel for how the residents interact with each other, and have some friendly faces you’ll recognize at the interview! I was told to dress up (business casual, no jeans), but I’ve been to events were applicants wore jeans and were super casual. Remember, if you have the option of scheduling the dinner, go to one BEFORE your interview – this way, you’ll have a good feel for things and have some familiar faces before your big day (which is way more formal!).
- PREP: Make sure you know where to go, when, and whom to contact if you are late (get a phone number!). Go to the location the night before if you can so that things go smoothly the morning of. Get there AT LEAST 15-30 min early! Check the weather, pack appropriately. You can Uber/Lyft places, but remember that sometimes this can backfire as you don’t know if your ride will be on time. I almost always rented a car (yes, more expensive, but I liked the security of knowing I was independent and had transportation at my fingertips).
- BUDGET: Interviews are ridiculously expensive-think about plane fare, renting a car for anywhere from 1-3 or more days, hotel rooms, food, and other unexpected miscellaneous costs. Being the gullible person I am, I would often listen to the rental car people and pay the insurance or extra fees they talked me into – look into these things and see if they are really necessary beforehand. Check the weather – do you need a bigger car? Or can you take the smallest (cheapest) model and still be safe to drive it? Use websites like Skyscanner, Kayak, etc. Also, use miles! I had to fly to Virginia on super short notice and the tickets would have been over $1,000 round trip! I was able to use my miles and (even though I had to take three flights there and three flights back), my total flight cost was brought down to $250.
- SCHEDULING: I know a few people who took time off just for interviews. If you are staying primarily at your base hospital and it’s easy to schedule your rotations, I think you can safely take some time off here and there for interviews. Honestly, if you are doing a ton of auditions and scheduling rotations on your own, this is challenging. I scheduled all my rotations close to home (not at my base hospital) and really didn’t have much leeway in scheduling them, so I’d ask for time off for my interviews. Most places were super gracious about this. They understand you need to take time off, but it always helps to say that you’re willing to come in on weekends to make it up!
- Also try to schedule your interviews wisely – schedule the programs you are most interested in in the middle of your interview trail – I didn’t do this and had my top program interviews at the very beginning and it was super stressful. You get better and less nervous with time, but don’t put your top interviews at the very end either, people (including the interviewers!) tend to get more tired!
- PRACTICE QUESTIONS! Know what you’re going to say! Do research on the program, specialty, and on typical questions. I was asked things like:
- Why are you interested in our specialty?
- Why our program?
- Why should we pick you?
- Define ‘hard work’? ‘team work’?
- Behavioral / Scenario questions
- What draws you to this location?
- TELL STORIES: for each question, I had a story to tell. I think people remember you much better when they can associate you with an awesome story (they’ll remember a thrilling tale much better than an applicant giving a generic answer). I’ve noticed that programs are trending towards behavioral questions – where all you have to do is give an example of time when you did ____ and the consequences of your actions. Be prepared for this!
- DON’T LOSE YOUR HEAD: If a question throws you for a loop. Take a moment, you can even ask for a second to think, collect your thoughts and start talking. There were times I didn’t know where I was going with what I was saying, but I just tried to appear collected! Hopefully that’s what the interviewers thought too!
- GETTING INTERVIEWS: Sometimes you may not hear back from a program (after you submit your ERAS) you really wanted. You can send an email to the program coordinator or call them and tell them you’re super interested in their program. This may not help, but I got one interview this way – by expressing interest!
- DOING AUDITIONS: In the DO/ osteopathic world, this is CRUCIAL. You NEED to do auditions to get interviews. It actually works quite differently – DO programs are looking for candidates they know well. Also, DO programs tend to schedule multiple student auditioners at the same time (which can make things really difficult in terms of standing out). MD programs don’t tend to do this – you’re often the only SUB-I there, so you can really shine – but this also means that there are fewer spots to audition! So make a great impression during your rotation there! Some MD programs take this into account as well and will give you an interview simply because you did an audition. Others won’t give you a courtesy interview even if you’ve spent a month with them.
Well, this is what I could come up with! Please feel free to add!
Traveling – it leaves us speechless, then turns you into a storyteller. – Ibn Battuta
So every med student I know has been stacking their vacation time for the end of the school year so they can do one big vacation trip … except for me. A lot of people think that your life is over once you’ve entered into medical school. I do my best to find the balance between school, career, family, friends, food and FUN!! (Lots of F’s) I love medicine but it is not the only thing I love.
Enjoy the VLOG – live vicariously through me … until you get your month long vacation 🙂