Finding inspiration

I am pretty obsessed with mini-post-it notes… and leaving little surprises for people to start their day with [since I get to work way before anyone else]. Hence, today’s inane image of the day:

I like leaving little notes  with fun facts or quotes like the one shown above for my co-workers.
Everyone hits a wall of non-productivity every once in a while — sometimes it is just hard to find a reason to keep studying, working or doing menial tasks around the house. Admittedly, I find that this slump comes around a lot more often than I’d like — without deadlines or someone breathing down my back, I find that procrastination gets the better of me and I end up scrambling at the last minute to finish tasks.

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Another Sunday morning

Today’s inane image of the day:

This is generally how my Starbucks workspace looks like — coffee, phone and laptop [yes, I do really like the color pink…]. While I sometimes have a love-hate relationship with weekend mornings [generally because they aren’t truly mornings anymore when they start at 10 or 11am], today is slightly different because it will probably be the last time I spend a Sunday morning at the Starbucks on State and Liberty St — with moving out of my apartment next weekend, I don’t think I’ll have the opportunity to do this again. There is, of course, the possibility that I try to do my residency at the University of Michigan, but that is pretty unlikely.

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Saturday lounging and reasons to love OUWB

I am enjoying the fact that this blog is giving me an excuse to take pictures of the frivolous things of my daily life — this being said, here’s today’s inane image of the day:

This is my idea of Saturday lounging… mmm comfy chairs and a Sweetwaters iced latte [oh and that’s Mike’s super large iced coffee]. I am definitely obsessed with the coffeeshop scene… in fact, I have very fond memories of the hours upon hours of time spent “studying” at Caribou Coffee prior to starting college. I even got a job at a coffeeshop in Ann Arbor and while I have my reasons for never wanting to return to that particular establishment for coffee ever again, I have to admit that I met some interesting people while working there.

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Mornings, how I love you

If you couldn’t tell by the time that I generally post each day, I am a morning person. It took a number of years before I recognized and admitted to the fact, but now that I am in-touch with myself [or something like that], I now complete a number of tasks as the sun peeks above the horizon each day.

But hey, give me a weekend and I’ll sleep until 1PM. I just said I was a morning person, not that I could pop out of bed at 5:30AM without reservations!

If you’ve been following my Twitter, then you might have seen my tweet about breaking into a new paper planner with pretty pens… well, I wasn’t kidding about being “old fashioned”:

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Tackling secondary applications

Thanks to Axl Rose for the comment on my last entry and a couple of others who emailed me asking about secondary applications that inspired the content of this entry!


I thought I’d make this entry full of general tips first and then provide a quick word on the OUWB secondary [keep in mind, I am not affiliated with the admissions committee whatsoever and do not claim that my advice will help you gain or guarantee admission].

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More on physician shadowing

I was perusing the SDN forums as I like to sometimes do and found a gem of a post [DISCLAIMER: this was intended to primarily be a humorous post, but the checklist does really provide some good suggestions for things to try to look out for in a more well-rounded shadowing/volunteering experience]: Gnomes’ Guide to Shadowing.

Honestly, I’d suggest that if you could get a good number of these items during your shadowing or clinical volunteering experience, that you have a good basis to go into interviews with. I personally did a quick run-through of the checklist [where I actually included experiences from both shadowing physicians and while volunteering] and sadly ended up in the “Shadow more” category. Uh oh…

If you’ve already completed a successful application cycle, what category did you score in? Do you think this could be an accurate metric to gauge shadowing experience on?

Blog changes

You might notice some changes around here — I decided to take the plunge into serious blogging by purchasing the domain name that so nicely resembles my name. Make sure to pass on the whole amanda-“x”-“i”-dot-com thing along to anyone you know that may enjoy my ridiculous [square brackets] and other such things.

One of these days, I’ll have the time to actually use a non-built in Blogger template… but today, is not the day.

Alas, it is 2 in the AM and I am in need of some REM sleep.

The much needed pre-M1 vacation

Having done mostly academia and academia-related activities for the past 15 or so years of my life, it seems that a much needed vacation is in order. As I mentioned in a previous post, I am planning to road trip out to California with Mike right before orientation begins. While there isn’t much to say about the first part of the trip [we are aiming for the approach of getting out west as quickly as possible then relaxing once we get there], I am getting super excited about the last part, since we recently booked our lodging in Palm Springs at the Colony Palms Hotel.

I’ll definitely blog about the experience while I’m there [woohoo Wifi and endless hours of free time! Now I just need the iPhone to hop over to Sprint so I can blog while we’re driving through the heart of the Midwest…].

On the note of my pre-M1 summer, one thread topic that tends to appear quite often on the SDN forums is whether or not to study during the pre-M1 summer. While I cannot say I subscribe to any one school of thought on the matter, I can say that I haven’t been studying at all. Instead, my days are filled with work, working out, eating and sleeping — which in a way is actually pretty draining. Honestly, I have never worked a steady full-time job prior to this one and while there are definitely perks [set hours, consistency in scheduling, free-time, a paycheck], I find a constant reminder of why I am pursuing medicine instead of a full-time engineering position.

But more on the whole engineering intern and medicine thing at a later time.

Here’s my take on pre-studying while you’re a pre-M1 looking forward to being a pre-resident then possibly a pre-fellow and finally being able to almost touch the $ as a pre-attending: take a moment to stop looking forward and just look around. Then breathe in, breathe out, and enjoy where you’re at in life.

There are a lot of good reasons to continue looking ahead and working for something, but if your life revolves around “what’s next?!” then you will never be satisfied. That’s the reality of it. While I agree that it can be hard to put a pause on the instinct to plan your whole future [you’re reading the words of someone who has every moment of her day blocked off on Google Calendar and is already planning on getting engaged after medical school, married during residency or right after, and then hopefully popping out 2 or 4 babies before the age of 35 — yes, I have to have it all], I noticed that taking the time to actively enjoy my current place in life has slowly unloaded weight from my shoulders.

[If you didn’t get it yet, I won’t tell you what the best way to spend your pre-M1 summer is because we all need different things. Maybe pre-studying will help you clam your nerves. Maybe it won’t. But, I do believe that the rest of our lives will be heavily intertwined with medicine and this is the last opportunity to experience life without the weight of Netter’s Anatomy Atlas or patients upon our chests.]

In the end, taking time to reflect on the present has been a positive thing. Regardless of my stressing over the future, I don’t know what life has around the corner for me and accept that the perfectly laid plans of mice and women will often go awry.

Making the final decision

As some of you may have already guessed, after finally stepping out of the waitlist limbo, I had a question to answer: which medical school was I going to call home for the next four years?

After obtaining my first acceptance from Wayne, I decided that it was probably where I would end up, regardless of whether or not I got off of the other waitlists. The factors that led me to this conclusion were primarily:
  1. solid history of pumping out medical doctors [Wayne has been doing it since the 19th century…]
  2. location [I wanted to be close to home, or at least reside in the midwest to ensure I had my support network]
  3. cost [let’s be honest here, the economy sucks and we can’t say that we know if physician salaries will continue to be as “cushy” as they are now]
In the end, even though I loved MCW [and my best friend was conveniently moving to Milwaukee!], I could not justify the cost of tuition [~$44k — making it about $15k more per year] and moving expenses when Wayne’s program would most likely get me where I wanted to be for $60k less of debt. This same cost argument was applied to OUWB at the time, but with the added fact that OUWB didn’t have a reputation at all. At that point, I had already thrown NYMC out the window completely — the lure of being close to the city didn’t make up for the fact that it was kind of in the middle of nowhere [oh, and that scary cab driver that picked up another guy to make double the $$$ and didn’t have a GPS didn’t really turn me on to Valhalla… thank god I made it safely to NYMC the night before the interview!].
Come May 15th, I was sitting pretty comfortably on the idea that I was attending Wayne State University School of Medicine and would soon call the streets of Detroit my second home. I even changed my Facebook profile information to reflect the decision!
Around that time, I was still checking up on the School-Specific Threads on SDN and noticed that someone had been recently accepted off the OUWB waitlist with a generous scholarship. A mixture of emotions swept over me — I felt like I had been passed over [despite my heartfelt update letter] and the news reminded me of how much I longed to be part of OUWB’s history. At that point, a friend of mine had already been accepted to the school and I often felt pangs of jealousy — it didn’t seem fair that the school that I loved didn’t love me back.
One of the lessons I learned from this whole process is to never, ever expect anything. All of my expectations were thrown out the window by the end — the schools I thought I would definitely get an interview from, sent me rejections relatively quickly. The schools that I did receive interviews from ended up being much better fits than I had suspected when I submitted the primary and secondary applications.
A week after the May 15th [well, 16th since the 15th was on a Sunday] deadline, as I walked into my apartment after work, I received a call from a 248 number that I did not recognize. I answered to Michelle’s distinctive voice and an acceptance to OUWB’s School of Medicine. In retrospect, I wish I had been a bit more enthusiastic when I answered the phone, but after 8+ hours of work, I was ready for my nap.
As I mentioned earlier, at the time I received the OUWB acceptance, I was 99% sure I would attend Wayne.
That is, until the generous scholarship offer.
After I hung up the phone, reality settled in. My heart had been at OUWB since the interview day and Wayne had not blown me out of the water. The scholarship had leveled the playing field on cost between the two schools. My only reservation was that I had no history to compare the two schools.
When I retell this story to people, I always say that it took me a long time to decide — but my significant other insists that it took me all of 2 hours. While I believe that on some level I had always known what I wanted, it was not apparent during the week that I had to make my decision. In the end, I needed some way to compare the schools on paper and not just in my mind — here is what I came up with:
  • Class size/community/culture: Wayne is known for having one of the largest medical school class sizes in the nation — although 300 students/class does not sound like much when a lot of students come from high schools where the class size was double this, for a medical school, this is huge. Furthermore, I distinctly remember during the tour that the classroom where exams are taken was a bit overwhelming. OUWB’s inaugural class size of 50 is pretty tiny, but also gave me the piece of mind that we would all get to know one another. Moreover, the community and culture at Wayne was automatically going to be different because there were so many “streamers” — students who just stayed home and watched streamed lectures. Although the idea of mandatory attendance brought me back to high school, I realized that this was the only way that a community could really be established. Groups will inevitably form, but I would personally like to graduate knowing every single student in my class.
  • Curriculum: Traditional vs. Integrated — in importance, I’d say that this was pretty much tied with class size. After this many years of school, I have come to realize that I usually need help seeing the bigger picture. This, in addition to the fact that many “established” medical schools are also moving toward an integrated curriculum, OUWB really beat Wayne out of the water on this. Furthermore, I was relatively impressed with the TBL [team-based learning] exercise during the interview day and believe that it’ll help in the long run with learning effective teamwork.
  • Grading: Tiered, with z-scores vs. H/P/F — [keep in mind that at the time I was under the impression that Wayne would keep the tiered grading scale — I have seen rumors of a move away from tiered grading to be effective this fall] while having tiered grading didn’t bother me, the z-score part did. I do get curious as to how I’m doing relative to my peers, but in the end, this is medical school. The graduation rate is in the high-90% at most schools and it is that way for a reason. We were all accepted because a committee thought we were capable of becoming competent physicians. Yes, doing well is important, but I didn’t want a system that contributed to a competitive atmosphere. This goes back to the culture thing — I didn’t want to feel uncomfortable with my peers, knowing that some of them are trying to do whatever it takes to get the highest z-score. Thus, OUWB’s purely H/P/F system was definitely a plus.
  • Location: Having grown up in comfortable suburbia my whole life, the idea of being plopped in one of the most dangerous cities in the country was a bit irksome. In fact, it bothered me quite a bit. Not to say that I don’t know how to take care of myself, but let’s be realistic here — I’m a female, and wanted the comfort of knowing that I could study in the library until late at night and safely walk back to my car. This being said, I heard that mid-town is relatively safe, and that Wayne does a good job with ensuring that students are kept out of harm’s way, but since I was given the option not to have to worry, it became pretty apparent that this was a factor.
  • Clinical rotations: Wayne has some great sites for clinical rotations, but I always knew that Beaumont would be a top choice for rotations. Since Wayne students will no longer be able to rotate there because of OUWB… this definitely put OUWB ahead.
  • Cost: OUWB is comparable with the scholarship [I did not get a full-ride]. Enough said.
  • Other: The final factor was where I felt there was a suitable fit… and OUWB came out way ahead on this one. Something about the faculty and staff’s warmth and investment in the students [oh hey, student-centered approach!] really made the school stand out.
There you have it!
Is there anything else about the process that you’d like to hear about? Let me know by commenting!

Double header: ethics of physician shadowing & the waitlist limbo

800+ page views?! Thanks again for visiting!

Today’s blog topics: ethics of [pre-medical student] physician shadowing and the waitlist limbo.

Ethics of [Pre-Medical Student] Physician Shadowing
Somehow an SDN thread on physician satisfaction with the profession led to a MEDLINE search for physician satisfaction, which then led to an article in JAMA that then resulted in stumbling upon a commentary entitled, “Shining a Light on Shadowing” by Elizabeth A. Kitsis, MD, MBE [where MBE is a Master in Business and Engineering, apparently].

Basically, the piece cited four concerns about shadowing [italics are quoted from the commentary]:

  1. a physician’s fiduciary obligation:How is a patient’s welfare served by having a college student present during an appointment with his or her physician?”
  2. privacy, confidentiality, HIPAA:In addition to their fiduciary obligations, physicians have other duties to their patients that are breached by college student shadowing, including maintaining privacy, maintaining confidentiality…
  3. patient consent/coercion:Physician shadowing by college students also may involved subtle coercion of the patient. To maintain his or her rapport with the physician, a patient may feel compelled to allow students into the examination room if his or her physician makes the request.
  4. student misrepresentation:It is possible that manipulation or deception may be used (unconsciously or consciously) to gain entry for a college student into a patient examination room… are college students simply introduced as ‘members of the team’ or generic ‘students,’ which may incorrectly lead patients to assume they are medical students?

While I understand the validity of these concerns, I find it incredulous that this could be posted in this day and age when physician shadowing [or something similar] is just about a must for entrance into medical schools. Not to say that the author isn’t aware of this [she does mention its importance in the application process]. Happily, there were a couple of responses from other practicing physicians that did a great job countering each of these concerns [though, sadly, Kitsis. rebukes them with the same “what if” scenarios…]

My personal rebuttal:

  1. a physician’s fiduciary obligation: I agree that this obligation may be in question when asked how the patient benefits from a college student’s presence, but I’d argue that a large proportion of students who shadow physicians end up pursuing medicine, and thus, the benefit may not be apparent for that single patient, but will be in the long run. For the most part, I believe that many pre-medical students who shadow physicians do not use the experience as a way to discover career paths, but as a confirmation of their choice.
  2. privacy, confidentiality, HIPAA: This is definitely a big one, but in all my shadowing experiences, I have always signed and agreed to the rules designated by HIPAA, making my presence similar to other healthcare professionals [though, admittedly, I believe that medical schools do delve into the issues that surround HIPAA, so I may revisit the topic later to discuss if I had any revelations after learning more that would make me see this issue differently]. Furthermore, we are all patients ourselves and should understand how important patient-doctor confidentiality is.
  3. patient consent/coercion: While I agree that a physician may subconsciously have a bit more weight in convincing a patient to allow a student to shadow, in today’s day and age, many people are a lot more vocal about their concerns. Admittedly, I do not have a good rebuttal to this one.
  4. student misrepresentation: In pretty much all of my shadowing experience I have had the physician introduce me vaguely as a “student” — while I understand that there is a fine line between what can be deemed ethical in this case, I do believe that this specific case does not necessarily cross it. The term is up for further dissection if the patient wishes [I have been asked what I am studying in school, so the possibility that I am not a medical student has crossed patients’ minds] and I feel that especially because the student is doing absolutely nothing except being a fly on the wall, there is no harm done. Though, I do believe that pre-medical students should be introduced as such in all cases.

My personal experience with shadowing has been extremely positive and helped confirm my almost-lifelong dream of becoming a physician. While I had been searching for shadowing opportunities earlier on, I did not secure an opportunity until right before I submitted my application. Although I was able to include my first shadowing experience in my AMCAS, I did not formally mention my additional experience anywhere [though, one of them did work its way into one of my secondary essays].

I shadowed a cardiac interventionalist, pediatrician and internal medicine physician. Although I cannot say I am particularly enamored with primary care, the opportunity to see primary care physicians in action made the  challenges I had read online, real. It truly is one thing to nod and agree with the patient load and frustrations that primary care physicians have to face, and it’s another to watch an infant’s mother refuse vaccinations or an obese patient refusing to change her diet despite being plagued with a variety of cardiovascular-related ailments. While the cardiac catheterization procedures were interesting, I cannot say that they really sparked my interest [I was just really cold in the OR and really happy that I had a lot of lead on to keep me somewhat insulated].

This all being said, I’d like to propose some “shadowing etiquette” tips:

  • Dress and act professionally — patient impressions are important, especially if you aren’t a doctor yet
  • Make sure you’ve signed a HIPAA statement and have discussed its meaning with the physician you are shadowing — might as well address this ethical issue
  • Ask the physician beforehand if you can be introduced as a pre-medical student to reduce ambiguity
  • Stay quiet while with the patient — while you may suspect that the patient has all the classic signs of strep throat, you aren’t a doctor… yet
Let me know if I missed anything, or if you have a physician shadowing experience that one of these issues arose during.
The Waitlist Limbo
As some of you may already know, I was waitlisted at 3 schools [OUWB, NYMC, MCW]. Keep in mind that my application was late in the cycle, so one of my interviews [MCW] was for a spot on the waitlist [more details on how this works later].
Unfortunately, the only school that outright accepted me [Wayne] did so in early May, so I was in waitlist limbo from March until May. Undoubtedly, the kid on 11 waitlists on SDN who has been on those lists since October had it a lot worse than I did… but 2 months of just waiting around trying to figure out a back-up plan for the fall was pretty traumatic. Especially since most of us pre-meds are neurotic and crazy… after sprinkling in the “unknown future” factor, it really magnifies the personality.
Honestly, I was not myself after I received word about my first two waitlist decisions. As some of you may already know or will soon know, after investing that much of yourself into this process, and realizing that there is a high chance that you will be unsuccessful the first time, it tends to be hard to find the energy to keep going. I know that had I been unsuccessful, I definitely would have needed to take a serious vacation before starting from square one.
This all being said, here are some important things to keep in mind while chilling in waitlist limbo:

  • A waitlist is not a rejection. I promise you, people get off the waitlist and make it to medical school. Many times, a waitlist could just be because you were late in the cycle and there are no seats left in the class [such as MCW].
  • Be proactive. Don’t be crazy and call the admissions office 3 times a day asking if there has been waitlist movement or if your application is with the committee or if you will be accepted. Do call and check in every once in a while [if the school permits — just ask if you are unsure] so that they become familiar with your name when it comes up.
  • May 15 is a very special day — but probably not for you. While this date is the deadline for multiple acceptances [people holding more than one must rescind all of their acceptances except one, but may remain on waitlists], chances are the admissions team needs to re-evaluate [especially if we’re talking about an unranked waitlist] or prepare for making acceptance calls. Not to say that no one gets off the list on that date, but a lot of people don’t hear anything until a day or more later. I received my OUWB call a couple of days following the deadline.
  • Update letters/letters of intent. I sent in one update letter to OUWB [and look where it got me!]. I do not suggest sending in anything “fluffy” — as in, don’t make an excuse to write them a letter [two more hours in a clinical setting probably won’t boost your application significantly…]. Send in meaningful updates — I personally had an international conference presentation submission accepted as well as received an award, so I made sure to include those in my letter. My letter was not a letter of intent. It is ridiculously important not to lie in these things — if you would not rescind your application from every other school once this school accepts you, then don’t say that they are your top choice. However, I did mention that OUWB was one of my top choices [which it was]. I do not believe that letters of intent make a huge difference, but sometimes they could tip the scales in your favor. 
If you have any questions about the above, let me know! I’d love to make this blog a relatively comprehensive resource.
Finally, some schools will do a couple waitlist-only interview days such as MCW. A good rule to follow with these is that if you do not yet have an acceptance, go for it since every interview gives you a better chance of getting in eventually. Since I did not yet hear any good news, I booked myself a plane ticket and hotel room and headed to MCW for their last waitlist-only interview day. The way that MCW’s waitlist-only interviews work is that you can receive two post-interview decisions: waitlist or rejection. Since their waitlist is tiered [and probably ranked… but they’ll at least release your tier] and they generally fill a quarter of their class from the waitlist, you have a good chance of being accepted. Furthermore, you can be placed higher than someone who interviewed earlier in the cycle [non-waitlist-interview], and thus end up in a better position. 
I really loved MCW when I visited and I saw myself going to the school — I believe that this was pretty apparent during my interview and felt like both the professor and student interviews went well. Apparently, my feeling was correct because when the tiers were released, I had been placed in the top one. I received the acceptance call in early June.
I’ll talk more about my decision to attend OUWB over my 2 other acceptances later!