I cannot believe 2019 is almost at an end! This year has just flown by! I just had an incredible rotation in Geriatrics. It consisted of 2 weeks on consults and 2 weeks managing patients on the Geriatrics wards or off-service units. There were also two 1/2 weekends on consults.
Geriatrics was challenging in many ways:
Patients often have complex medical histories
Patients often have varying degrees of neurocognitive disorder (dementia)
Patients are often frail and at risk of falls
Patients may have delirium which can be difficult to tease apart from possible underlying neurocognitive disorder
Patients are dealing with many challenges such as incontinence which can be demoralizing for them. For some patients, continence may be their last act of independent functioning.
Patients are often on multiple medications (polypharmacy) whose side effects can put patients at further risk of falls or delirium.
Patients are faced with what we often write in the charts as “disposition”. Where will they be going next after being discharged from hospital? They are often too frail or dependent to go back home therefore may be facing the reality of moving to a residence or nursing home. There can be complex family dynamics as the details of this transition is worked out.
Despite the complexity of geriatrics, I found this to be a truly rewarding rotation as I developed close bonds with my patients and got to know some of them very well. I was really touched by some of the conversations I had with my patients and how much I learned from them. I worked with a fantastic interdisciplinary team and found the geriatric physicians to be extremely compassionate. I also developed clinical skills that will be very useful in my future practice as a family doctor.
I am now on my last rotation of clerkship! It is an elective in Allergy and Immunology and has been an extremely fascinating rotation so far! More details to come!
Featured image courtesy of Emory University School of Medicine
The other day, I was on my daily commute to the hospital for one of my clinical rotations. The train chug chugged along and as it neared one of two bridges, I turned my head expectantly to view the expansive water and distant hills. But on this particular day, the view which I have come to treasure, was blanketed by an unrelenting fog. I could see absolutely nothing outside of the window. It was a disconcerting feeling. What was happening behind the fog? When would the fog lift? As the train made it to the other side of the bridge, the water and hills left behind, the fog gradually lifted, trees and buildings slowly appeared and my view of the outside world became crystal clear once again.
This two minute experience got me thinking about how similar life can be to this event. There are times in our lives when our path forward is clear. We can feel confident enough to proceed on our journey. There are other moments, when things become less clear, our confidence may become shrouded in uncertainty and we wonder where has the path disappeared to? One thing I do know. The fog eventually lifts, and we will see clearly again. It just requires patience, determination and the will to never give up.
I recently completed my second Psychiatry rotation and have just completed my first 2 weeks of Internal Medicine. Both have been great learning experiences with amazing staff physicians and residents. On some days though, I feel truly tired. I wonder if I have the strength and ability to become a good doctor. Or I struggle to balance medicine with family life. Doubts try to creep in. But I also feel so grateful to be in a position to help people so directly in their moments of crisis, illness or fear. It truly is a humbling and privileged position to be in! And even on those cloudy, unclear days…the fog eventually lifts!
View from the train in winter-time
Featured image: View from the train in summer time, late evening (potentialdoctor.com)
Clerkship Updates! I have just completed a month in Urban Family Medicine and I absolutely loved it! It definitely solidified my interest in and passion for Family Medicine. Most of my days were spent at a private Family Medicine clinic. I also spent time at a Dermatology, ENT and walk-in clinic, a senior’s residence and palliative care center.
What I learned from this rotation
This rotation was fantastic! There was frequent, useful one-on-one teaching and feedback which helped me to grow in my knowledge and clinical skills. I was constantly challenged to think more and more independently. I had the opportunity to manage complex patients and multi-complaint visits. I developed some new skills/knowledge in Dermatology, ENT and how to manage geriatric patients.
What I enjoyed most
I very much enjoyed the one-on-one teaching, the positive learning environment, the variety of cases I saw and the variety of work environments. I loved interacting with the patients and looked forward to going to work each day!
What I struggled with the most
The greatest challenge for me on this rotation was coming up with management plans for the more complex patients. However, by the end of the rotation, I felt that I had a better grasp of how to do this.
My take home message
Urban Family Medicine was a fantastic rotation and was definitely one of my favorite rotations. I loved the variety of cases I saw, interacting with patients of different ages and getting to see patients who have been followed by the same physician for years and who know their patients very well. I also enjoyed the flexibility and variety of work environments. I really look forward to a future practice in Family Medicine!
Next rotation….Out-Patient Psychiatry. Stay tuned!
After months of reflection, prayer and exposure to different medical specialties, I have finally made a decision on which specialty I would like to pursue! I have to say that I am very excited to be at this point and feel very clear-minded about the path forward!
Choosing a medical specialty is not easy. There are so many of them to choose from! Many are interesting and potentially rewarding! This blog post will not only announce my specialty choice but also give some tips to help you with the decision process.
So without further ado….
I have chosen to go into…..FAMILY MEDICINE!
Why Family Medicine?
Getting to work with patients of all ages from babies to elderly
Variety of work contexts: clinics, hospital, ER, long-term care homes
Good work-life balance
Flexibility of practice: one can build a practice based on preferences and also needs in the community
Opportunities to work in both urban and rural areas
Good job outlook: family doctors are needed everywhere
Building long-term relationships with patients
Being involved in every aspect of my patient’s care (holistic approach)
Having generalist knowledge on a variety of disciplines (I find almost everything in the field of medicine fascinating!)
Opportunities to do minor surgical procedures
Opportunities to be involved in public health
These are just some of the many reasons that Family Medicine has grasped my attention and my passion! I am thrilled to be pursuing it!
Tips for Choosing a Specialty
Keep an open mind: I started off with keeping an open mind about the variety of specialties out there.
Do your research: I read up on the various specialties and talked to staff physicians and residents in the field about their experiences.
Wait to go through your clinical rotations first:Although reading about specialties is helpful, they do not always give the full picture on the lifestyle and work environment of a particular specialty. Therefore, I feel it is important to actually go through the clinical rotations before committing fully to or dismissing a particular specialty. You may be pleasantly (or unpleasantly) surprised!
What can you live with (or not!)?Through the course of this year, I have had the opportunity to be exposed to most specialties and obtained a taste of what I liked and did not like in each specialty. There is no perfect specialty but there are aspects of each specialty that I knew I could either live with or not. Similarly, I reflected on what aspects of medicine were important for me and needed to be in that particular specialty for it to be a good fit.
What are your priorities?It is important to factor in your priorities, for example, how will going into this specialty affect other important aspects of your life, such as your family life? Hobbies? Commitments? For me, I knew my family and church life are extremely important to me so I needed a specialty that would allow me to continue to devote my time to these aspects of my life.
Say “no” to being pressured: For some people, choosing a specialty becomes clear very early on while for others, it takes more time. Avoid the temptation to feel pressured into a decision. Only you can make the decision. Try not to let someone else make it for you.
What are the community needs? Another important aspect to consider in your specialty choice is the needs in the community. What resources for our patients are lacking and where could you step in to fill in the gaps?
I hope you find these tips useful in your decision making process. If you have further questions about clerkship rotations, specialty choice or anything else you would like to discuss, feel free to comment below or reach out to me at email@example.com. It is always a pleasure hearing from you!
Suggested reading materials: The Ultimate Guide to Choosing a Medical Specialty by Brian Freeman
I just completed my 2-week rotation in Pathology and I really enjoyed it. My days consisted of a variety of activities such as grossing specimens in the lab (that is, examining and cutting them in preparation for creating microscopy slides), looking at slides under the light microscope and electron microscope, plenty of studying as well as attending autopsies, tumor boards and rounds. I also had the opportunity to observe intraoperative consultations which is when a surgeon excises a sample during a surgery and asks the pathologist to make a quick slide (better know as a “frozen” section) in order to have a preliminary diagnosis, usually in the context of cancer.
What I enjoyed most:
First of all, I think microscopes are just so cool! Secondly, I had a fantastic team to work with! I also liked the flexibility and variability of the day with a lot of autonomy and self-directed learning. For example, my main interests for this rotation were renal and gynecology pathology so I was able to tag along with the residents and staff physicians specializing in these areas. I particularly enjoyed “sign-outs” when the staff, resident and I would sit at the teaching scopes (several microscopes connected to a main one so that you are all viewing the same slide) as this is where you get a lot of useful teaching on how to identify various structures. I also really appreciated that I got to brush up on my anatomy! The schedule was fairly light and I got to see my kids more often than in other rotations which was great!
What I struggled with most:
I missed patient contact and also sometimes felt helpless in cases where we diagnosed cancer since the clinical management is not done by the pathologist.
My take home message:
I think Pathology is a great rotation for medical students to consider regardless of your interests because it exposes you to a different side of medicine and will increase your understanding of various disease processes which is very useful to know in the clinical world. For example, I now have a much better understanding of glomerulonephritis, nephrotic syndromes and gynecology-related cancers. I also have a much better idea of how to interpret pathology reports and the amount of work that goes into creating one! I would currently rank Pathology as a “medium” as a future potential specialty for me because I still have to reconcile the fact that there is not much in the way of patient contact. However, it really resonated with me in terms of the intellectual aspects and I loved the detective work behind it.
My next rotation is an elective in Medical Genetics which sounds fascinating! Stay tuned!
My assigned desk…reading up on some renal!
My little monkeys climbing trees in the backyard. Love them to bits!
It has been 3 weeks since I started clerkship and it is going very well so far. I started off with Obstetrics/Gynecology outpatient clinic where I had to give two presentations on cases I encountered during the rotation. I was also exposed to various diverse clinics:
Obstetrics: following pregnant women at various stages of their pregnancies, interpreting prenatal screening tests, measuring fundal height, finding the baby’s heart beat with doppler ultrasound (one of my favorite parts of this rotation!) and taking GBS samples
Gynecology:managing endometriosis, menorrhagia, performing pap tests and colposcopy
Gynecology-Oncology: managing patients undergoing treatment for ovarian cancer
Diabetes: managing pregnant patients with Diabetes Type 1, Type 2 or Gestational diabetes
Fertility clinic: managing patients trying to conceive via IVF or IUI.
Ultrasound: observing the routine ultrasounds for pregnant patients performed at 12 and 20 weeks of pregnancy as well as measuring nuchal translucency.
Photo credit: parentmap.com
My reflections on this rotation: I found this to be a generally fast-paced,diverse environment with plenty of opportunities to do some procedures.
What I enjoyed most:I very much enjoyed the patient contact and sharing the joy of pregnant mothers awaiting the arrival of their little ones. I also enjoyed the clinics where I had the most autonomy to interact with patients on my own. My favorite clinic of the rotation was without a doubt Obstetrics!
What I struggled with most: There was a steep learning curve as I generally only spent one day in each clinic and every clinic runs differently. I had to learn to adapt quickly.
My take home message:I learned so much from this rotation and felt that I improved in my history-taking and charting skills. I will wait until my OBGYN inpatient rotation to make a final decision about choosing this specialty but on a scale of low-medium-high, I would put Obstetrics and Gynecology as a “low” because I have much less of an interest in Gynecology than Obstetrics and there are alternative routes to practising Obstetrics (more on that later!).
My coping strategies on rotation:
I have a 2.5 hour daily train-commute which can be exhausting but I am using this time to study, read my Bible, decompress after a long day and also to read other topics/books that are of interest to me.
I make use of technology to stay in touch with my family and keep connected. For example, since I have to leave very early in the morning before anyone is awake, I Face-Time my hubby and kids every morning once I arrive at the hospital so I can see their adorable faces before I start my day. This is so energizing for me!
I have some prayer time during my 10-minute drive from my home to the train station (and on the way back as I reflect on my day). This plus reading my Bible on the train daily has kept me in a very positive state of mind despite feeling physically exhausted.
I aim to complete my reading/studying on the train so that once I am home, my focus is fully on my family.
It is challenging to find time to exercise so I wake up 15 minutes earlier every 2 days to have a short workout and then have my longer 35 to 45 minute workouts on the weekend.
Stay well hydrated and fed throughout the day. I carry granola bars in my white coat pocket or scrubs and carry around a bottle of water when feasible. This does wonders for your energy levels!
I had one particularly bad day last week where I felt extremely tired and did not feel my performance on rotation that day had been good at all. We have to remember that despite the really difficult days, there are better days to look forward to and it is all part of the learning process as we hone our skills.
I am currently on rotation in the Neonatal Intensive Care Unit and it has been both challenging and fantastic! I can’t wait to share with you my experiences on this rotation over the coming weeks!