MD Writes

Match day is usually in March of the 4th year of medical school.  Medical students find out where they will be spending the next 3 to 7+ years of their life training to become doctors.  Medical students get envelopes during the match day ceremony with their residency locations.  A long process has led up to this day so it is a huge relief.

It all starts with choosing your specialty which in itself is a difficult task.  As a medical students, you have relatively limited exposure to many specialties.  Also the exposure is not what it may be in the community setting since you do your rotations in large tertiary centers.  Next you must apply for internship and residency in some fields.

This will involve getting letters of reference, a deans letter which summarizes your medical school experience, and your licensing exam test scores.  You will also write a personal statement.  interviews will come next.  This usually involves traveling to distant locations in some cases.  The interview day can be an entire or even multiple day affair.

After going on multiple interviews, you then decide on your top picks for residency training.  The residency programs also decide on their top candidates.  A computer then develops a match according to an algorithm.  The wait after submitting your rank list is painful.  But the day will finally come when you find out where you will be doing your internship and residency.

Many US medical students get one of their top three choices.  In some cases, medical students do not match to their specialty of choice.  This usually happens when the medical student applies to a competitive specialty or is not competitive for the specialty they are applying for.  In these cases, there is a scramble some days later.  All unmatched medical students scramble for the unmatched residency positions.  Often these are in a different specialty for the competitive fields.  After all this work, most students are happy with their place of training and choice of field.

The ophthalmology rotation in medical school is usually taken during the fourth year as an elective.  This means that is it usually not required but the student chooses to take it.  The rotation is usually 2-4 weeks.  This is just enough time to get the students feet wet.  Unlike many rotations, this one is heavily outpatient based.  The rotation often takes place in a clinic setting since much of ophthalmology is an outpatient field.  There will also be some exposure to the operating room.

In clinic, you will most likely shadow residents seeing patients.  The residents will examine the patients and then present to the clinic attending.  As a medical student, your involvement will not be very heavy particularly if you are there for such a short time.  During the rotation you will likely be exposed to the more common problems seen like cataracts, glaucoma and the like.

Students who wish to enter ophthalmology as a field may take more rotations including an outside rotation.  Since ophthalmology is a competitive field, the student must get top grades and really shine on their rotation.  For many other students, this is more of a laid back rotation.  There is usually not a test at the end like for the core clerkship rotations taken during the third year.

During the rotation, a lot of teaching will be from the resident and less so from the attending physician.  There may be some teaching if there are inpatient consults from the attending.  You may learn how to do an exam with an ophthalmoscope.  This may be a skill you will need in the future since the ophthalmologist may not be available at all times.  This is a good rotation to take for many students interested in clinical specialties, since during residency training, exposure is often limited.

Being in the operating room is one of the more memorable experiences I have as a medical student.  While most of the surgery rotation involves taking care of inpatients, attending to emergency room patients, etc. being in the operating room is what surgery is really about.  For just a moment, when you scrub before entering the operating room, put on the gloves and surgical gown, you feel like you are a surgeon.  The operating room is very orderly with nurse and technologists attending to their duties.

When the operation begins, the attending surgeon may actually allow you to make the initial incision.  From that point on, it is more common to hold retractors and just watch.  Occasionally you may be asked questions.  The resident who is in there with you will usually get to do most of the operation under the watchful eye of the attending.  Watching the surgeon bark commands at the surgical nurse is interesting.  All those names of the instruments and when to use them.

Some of the surgeries last for hours.  I remember my back and shoulders getting really tired holding those retractors and instruments.  There are no bathroom breaks either.  I do not know how I would go for hours not having to use the bathroom but somehow you do not need to most of the time.  Your appetite also goes away.  Maybe it is the excitement and energy during the operation.

When the surgery is finished, I remember suturing the incision with the residents.  I think this is where I really learned to do this.  This skill would serve me well later when I rotated in the emergency room having to suture laceration.  Most surgeons are nice and good to work with.  There are some bad apples who will yell at you and make you feel stupid.  It is probably the stress of the job making their bad side show.   Overall, you work like a dog but learn a ton and start to feel like you are really becoming a doctor.

Although it has been many years for me, I still vividly remember the first night on call as a medical student.  I was on my first rotation during third year on internal medicine.  Internal medicine forms the basis for the practice of medicine.  This is where you develop your doctoring skills.  It was July and I was on with some fresh interns and a senior resident who was available.  I had a wealth of book knowledge, none of which was practical.  I had no idea how to actually work up a patient and admit him.  I could tell you the pathophysiology of diabetes however.

I had worked an entire day on the inpatient units.  When everyone else was going home, I would stay for an additional 12-20 hours.  It was 5 pm and it was time to help cover any inpatient admissions from the emergency room or doctors offices.  Our first call came shortly after.  An elderly man who had an exacerbation of his heart failure.  I remember spending more than an hour in his room examining him and talking to him.

I was too polite to cut him off, but he was very wordy.  I think I heard his entire life story with a few scant details about why he was in the hospital that night.  I was extremely tough to get any past history.  The exam I did was thorough but did not lead to any clear diagnosis.  I remember writing the intake note multiple times trying to get it perfect.  During this time, the interns and residents had admitted multiple other patients.

They asked me to admit another patient around 1 am or so.  This was another elderly man in his 90s with a COPD exacerbation.  He was accompanied by his son who knew exactly what was going on.  This one was easier.  I had little sleep that night because there were other issues to attend to with the intern on already hospitalized patients on the unit.

Once morning came, I has to present my patients to the well rested attending and the team of intern, residents and other medical students.  Boy was I tired and sleepy.  I presented the patients and everything seemed to go well.  I was wordy and did not get to the point.  The attending knew right away what was going on but listened to me patiently. I would be on call every 4th night for 3 months.  Doing the same thing.  Admitting patients, attending to calls form the nurses and emergency room.

Although the rotation and call is particularly difficult, this is where you learn to be a real doctor.  While many of us go on to specialize in narrow areas, every doctor in this country needs a basic foundation of internal medicine.  With time, I became more efficient and began to admit patients quicker and more confidently.  You really learn how crucial it is to be a team player and help out no matter what.  You are the lowest man on the totem pole and you need to remember this.

The gastroenterology rotation in medical school is usually taken as an elective in your 4th year.  Gastroenterology is a subspecialty of internal medicine.  Physicians in this specialty complete 3 years of internal medicine followed by 3 or more years of gastroenterology training.  Gastroenterologists treat diseases of the gastrointestinal tract and its associated organs such as the liver. pancreas, and bile ducts.  Gastroenterologists main procedure is endoscopy which can be of the upper gastrointestinal or lower gastrointestinal tract.

Medical students must know far in advance that this is a specialty that may interest them.  Since they must first complete an internal medicine residency.  The rotation in medical school will usually be in a teaching hospital.  The medical student will be on a team of physicians in various levels of training and an attending physician.  The medical student will likely get heavier exposure to the inpatient units.  Often, this will consist of consults on inpatients with gastrointestinal illnesses and issues.

The medical student may be the first to see the patient.  He will obtain a good history and do a physical examination.  He will have to review any tests that have been performed.  The medical student may then have to present the patient to the resident, fellow and attending.  This may consist of the history, physical exam, assessment and plan.  The medical student does not need to get this perfect.  But it should be well organized and researched.

The medical student will help follow up on these patients by obtaining labs and seeing them everyday with before the team sees him.  The medical students exposure may also include clinic days.  Although usually this is less emphasized.  This may include more healthy patients with gastrointestinal illnesses like inflammatory bowel disease.  Usually the rotation is for a month so the student only gets his feet wet.

The grade will be dependent on how well the student participated in the team and helped.  How well he interacted with and worked up patients.  How much knowledge he had relative to other medical students.  At the half way point, it is always fine to ask how well you are doing and if there is anything you can do to improve your performance.