Interview Day Fun!

22 01 2015

Overall, I really enjoyed the interview trail. Much of that is attributable to my personality in general, and to the fact that I enjoy meeting new people and hearing their stories. Residency interviews are fun because they are as much about the program getting to know you as they are about you becoming familiar with the personality of the program.

For those of you not familiar with how the interviews work, here’s an example of one interview schedule:

Day 1
4:00 PM, check into hotel. Steam suit if needed, look over pre-interview orientation materials
6:45 PM, meet for shuttle to dinner
7:00 PM, dinner with residents and sig o’s either at a restaurant or a resident’s house
9:00 PM, back to hotel

Day 2
6:30 AM, check out of the hotel and store luggage
6:45 AM, shuttle to the hospital
7:00 AM, the day begins. Usually, in the mornings there is a continental breakfast, a presentation about the program from one of the program directors, then everyone goes to the residents’ morning education session.
9:00 AM, walking tour through the hospital and an additional presentation or chatting time with current residents.
10:30 AM, 25-min interviews with 2-3 faculty members, one of which is usually with a program director.
12:00 PM, lunchtime! Depending on the program, there is either a resident education session, a QnA, or just general socialization with the residents.
1:00 PM, anything they didn’t do in the afternoon, from Q and A sessions to looking over the contract to promoting special features of the program again.
3:00 PM, interview day ends. Time to go back to the hotel, change into traveling clothes, and start thinking about how that program compares to the others.

The dinners the evening before weren’t required, per se, but they were a really great way to judge the personality of the other residents at the program. They were also a free meal. The sit down meals at restaurants were nice, but I generally preferred the ones that were more free form, so it was easy to talk to lots of different people. My favorite dinner was one at a resident’s house where there was not only great catering and enough seating for everyone–which is key–but the residents switched up where they were sitting between the main course and the dessert. The worst was a combination interview social and Halloween party at one of the resident’s homes, which sounded like fun in theory until the residents ignored the applicants and we ended up standing in a circle and talking to each other the entire time.

In general, it was a lot of shout-talking about the same generic topics (“Where are you from?” and “What interests you about our program,” that sort of thing). During those times it took a lot of effort to keep holding my face in an expression of genuine interest while my brain was screaming “get me out!” Every once in a while you really connect with someone and have a quality conversation that makes it difficult to leave when the dinner ends. Those were the best.

I also enjoyed my actual one on one interviews with faculty members. They were in general very interesting people and it was fun to chat with them. One of my more memorable interviews was a discussion of my college football team’s season with an alumnus at a program far from there, and another was mostly about how difficult it is to make a good cannoli shell. In short, many of the conversations had nothing to do with medicine. The worst part about these was the worst part of any interview: answering the dreaded “Tell me about yourself.” Friends, no matter what the interview is for, always have the answer to this question ready. I read somewhere that it’s the most often asked interview question and the most often flubbed question at the same time. Despite the fact I always has my answer ready, it still felt strangely uncomfortable to give the same answer to multiple people and pretend like it was a novel response each time.

The tours were also enjoyable, although this was generally because it was some of the only time spent not sitting on my butt. Meandering around a hospital’s campus was also an excellent way of picturing whether I could see myself there. Least favorite part of the interview day? In general it was sitting through the educational conferences. Not as if i wasn’t interested in learning, I just didn’t love having to sit there quietly and pretend I was riveted for a solid hour.

So those are the basics, now for the more fun part of this post!

A few stories from the interview trail (interspersed with more nuggets of wisdom):

1. Witnessed a solid number of wardrobe malfunctions. During one tour, we were walking as a group between medical building, requiring everyone to traipse outside for half of a block. During tha time, one of the girls in the group managed to get her high-heeled shoe stuck in a street grate. It took a full 2 minutes to free it, which doesn’t seem like a long time, but when you’re the one who is the subject of everyone’s focus during that portion of a residency interview–which run on very tight schedules–that is a very long 2 minutes.

2. Another wardrobe malfunction: three of the candidates during my interview days ended up with lost luggage from flights, with their suits lost along with them. All took different approaches to solving this issue. The first girl arrived in town early and was able to go to a department store and purchase a new suit. The second person did what I do: travel in work attire that isn’t a suit, so he wore professional attire rather than a suit and looked presentable. The third person had neither options, ended up calling the program, and they gave him scrubs to wear rather than jeans and a hoodie. Bottom line: if you can, pack everything in a carry on; if you need a larger suitcase, get a separate garment bag and take your suit as a carry on.

3. Snafus will happen, especially when flying. On the shuttle back to a hotel following one interview, I received two automated phone messages from early in the day (I never checked my phone during an interview, it felt rude) saying that my flight out had been cancelled. Despite calling back immediately on hearing the message, it was still several hours after everyone else on the flight and so the only other flights for the night were already full. I ended up going to the airport without having any idea how long I would be there or what my destination was. It was actually kind of exciting. As with everything else in life, it worked out. I was able to get a flight back to a different city, my parents picked me up and took me to their house, I washed clothes, and the following morning we left on a previously planned road trip to a different interview. Other than a higher long term parking bill than I had anticipated, everything worked out well. Moral of this story: don’t panic, crap happens. At the same time you should always have back up plans for travel if possible.

4. Every once in a while, there are some really cool international students along the way. I befriended a man from Colombia during one of my interviews in the north. It happened to snow during the dinner and he got really excited- he had never seen snow before! By the time dinner was over there was about an inch and a half of snow on the ground. So the interviewees did the natural thing and had a brief snowball fight (which I instigated, every once in a while you need to make your own fun). It was a blast, and it was fun to be part of such a unique memory.

5. I was also fortunate enough to be able to take some time in almost every city to explore the area. Aside from time visiting with amazing family and friends, the highlight was definitely seeing the Grand Canyon for the first time. Also ranking high on the list were shopping at the Mall of America, walking on Beale Street in Memphis, and soaking up history in Washington, DC. In doing this I was able to get a small taste of what it would be like to live in each place. Some programs actually make activities like a trolley tour of the city part of the interview day. If not, try to take some time to at least sample a local beer if you can.

6. Illness happens, especially if you, like me, end up doing interviews in between pediatric rotations in the heart of cold and flu season. In my case, this meant doing one interview with raging laryngitis. My voice was totally shot, what came out of my mouth instead was a high-pitched squeaking and breaking sound that was not only painful for me, but painful to hear. It was a huge relief to realize that the program wasn’t a good fit for me anyway, so who cared what the interviewers thought.

7. Other things that can happen during interview travel: getting asked out on a date by a man you met on a plane. No joke, it happened. I said no for a couple of reasons, among them that I didn’t know the guy for more than 2 hours and his kind, army-uniformed exterior may have been masking a serial killer and that I was in a strange city with no nearby friends or family. The biggest reason? My first thought after he asked me out was “Ugh, no, not another interview.” Because that was how I saw it mid-interview season, as two interviews in one day. I don’t know if that’s what most people would do, but friends, if this happens to you, please use your own discretion.





Why scratching at insect bites is bad

8 01 2015

During my Pediatric Infectious disease rotation, I had one of those experiences you don’t forget as a budding young medical professional: the first time you watch a patient become very, very sick, tiptoeing to the brink of death, and then rebound so hard that he or she walks out of the hospital.

That patient for me was a 7-year-old girl, I’ll call her Abigail, who came in with leg and knee pain as well as fevers. She was sent to the inpatient floor at first, and the first thing I noticed about her were her screams of pain. She was crying anyway, this look of agony on her face and tears streaming down her cheeks, but she would scream whenever any of the medical team tried to touch her legs even a little. None of her mother’s hugs and words of reassurance seemed to make any difference.

One of the most critical skills that a doctor learns in training is how to quickly tell the difference between sick and not sick. This little girl looked sick, though I didn’t quite understand how sick from looking at her at the time. What I did notice was that even though her heart rate was high–which typically happens to kids when they are screaming their heads off–her blood pressure was low. Not just low for a hysterical kid, low for a normal kid her age. When the floor attending walked into the room several seconds later, he looked at her vitals, looked at her, and walked out to call the ICU.

Abigail was transferred to the ICU and ended up getting a lot of fluids for her blood pressure as well as lots of pain medication because, to that point, she hadn’t been letting anybody near her legs. The first thing I noticed was that she had a ton of bug bites on her lower legs and ankles in various stages of excoriation (scratched open-ness), though none of them really looked infected. She also had a blister over one of her ankles that her mom hadn’t noticed before.

Spoiler alert: she had MRSA toxic shock and spent 2 weeks in the ICU. She ended up needing pressors (medicine to keep the blood pressure up, which for those of you not in medicine are a big deal and can only be given in the ICU) and she spent a week on a ventilator.

After a couple of days, when she had been on big-gun antibiotics and still wasn’t getting better, we knew that the blood culture was growing MRSA. It was strange that even with a bucket of pain medication, Abigail still grimaced and withdrew when anyone touched her legs. The blister on her ankle was a little bigger, so she was taken to the OR for wound exploration. What the surgeons found was that the bacteria had chewed through the girl’s soft tissue and had tunneled so extensively that they didn’t for sure reach the end of it before calling it quits.

An MRI the next day showed that she had nasty bone infections in both of her tibias. The ID team and the surgery team had a joint conversation with the parents about how they needed surgery to remove the infection, and how there was a good chance one or both legs might need to be amputated. I knew all of those things but wasn’t there for the conversation with the family.

When I ran into Abigail’s mother in the hallway the morning of the surgery, she burst into tears right outside of the ICU family area. All I could do at that point was sit with her while she cried. I was so afraid of saying the wrong thing, just because there really isn’t a right thing to say. They don’t make a Hallmark sympathy card for that scenario.

For a few days during that first week, I remember walking into work and worrying that she might not be there. Prior to that, I hadn’t spent much time in the ICU and all of my sick patients had been critical but stable.

But like I said, she rebounded. The surgeons did not have to amputate, and once her legs were debrided she started doing better. I left the rotation before she was extubated but continued to visit every couple of days since I was still at the same hospital. Three weeks after she came in, she was out of the ICU, and two weeks after that she did indeed walk out of the hospital.

I ran into them in the hallway the day before Abigail was discharged. Her mother was absolutely giddy when she saw me and said “This is Abigail, I wanted you to actually meet her

before we leave.” As it turned out, she was a very talkative and energetic little girl who was excited to go hunting and fishing with her dad.

Aside from still needing several weeks of IV antibiotics, she got to go back to being that kid.

Though her mother was advised to make sure Abigail wore lots of bug repellant in the future.





Nuggets of Match Season Wisdom, Part 1

4 01 2015

In my last “real” post, I talked a little bit about starting the interview process and organizing interviews. Throughout the course of interview season, I was able to gather some nuggets of wisdom that should help other 4th-year medical students through the process. The ones in this post will be all about managing your ERAS and interview offers in a way that will maximize the number and quality of interviews you can get.

So without further ado—

Invaluable nugget of advice #1: It all starts with having a solid rank list. Since there is no reliable print material that helps you gauge your competitiveness for residency application, definitely talk to your school’s higher-ups about your preliminary rank list. I didn’t think of this at first and I thought it may be a little bit awkward to talk about with my mentors, but if you can find somebody who’s experienced in your field of interest and works in the program at your institution, these people are excellent resources. Who knows better than they do what residency programs want? Bonus points if you can find somebody who is not the program director, but is intimately involved in residency selection at your own program. This is particularly helpful if your goal is to stay at your home program.

So that’s just what I did. I took in my prospective list of 18 programs to three advisers and mentors. All three were in pediatrics, and all of them had contacts at several other programs. One was the assistant director of my home residency program. They were able to give me some honest feedback about programs that might be struggling, be it a financial struggle or something unattractive about the program’s attitude, negative change in leadership, or other educational deficiency.

Because different people have different opinions, I made it a point to take my list to them separately. One of my advisers even showed me this great website where you can go and actually search a program to find out whether they have any things against them as far as the accreditation goes. Unfortunately, and quite unhelpful for all of you, I can’t remember the website now. I’d be willing to bet it’s something run by the ACGME. Remember that the longer the accreditation cycle is, the more favorable the program is looked upon by the accreditation authorities.

Okay, so the list was made. Then it was just down to submitting the application, which reminds me of…

Invaluable nugget of information #2: Do not procrastinate on starting your personal statement. Seriously don’t do it. The biggest reason why is because it’s going to take you much longer than you think to write the thing in the first place. After you actually have a draft, it takes even longer to find somebody will edit it for you, send your draft along, then wait a couple of weeks for their comments. No joke, I started my personal statement in May. The application was submitted September 15. For me, that was a very comfortable amount of time to get four drafts of my personal statement polished before submitting the final essay.

Another gap in helpful knowledge of this process? There aren’t a lot of resources to indicate what the format of the personal statement should be. The following were very helpful tips from my adviser in case you need help getting started. I’m no expert, but this will help if you’re lost for a place to start.

How to write a personal statement for residency application:

Start with the classic five paragraph format. The first paragraph should be something of an introduction to your. This is generally where you put the cutesy anecdote or whatever it is to grab the reader’s attention. The second paragraph should detail why you chose your specialty, whether you performed an impromptu brain surgery while stranded in a storm on an ocean liner at the age of 10 or whether it’s because you think skin diseases are badass. In paragraph three, outline what you are looking for in a program, and make sure you are being honest because you can’t tailor this to each program that you apply to. Paragraph four is the bit where you sell your assets and describe what you will contribute to your residency program. Obviously what you want in a program and what you have to contribute should be cohesive. In the last paragraph, go ahead and tie everything together. If you left loose ends with the opening story, then tie that into the conclusion too.

There’s no real right or wrong way to write a personal statement for residency. Again, keep in mind that you cannot tailor your statement for each program that you applied to. This is one of the many reasons why it is so crucially important that you are honest with yourself and with the programs with regards to what you want. That this entire process is all about you finding your best fit in a residency program, and that is going to happen if you lie to the program and to yourself about what you really want. This can’t be emphasized enough.

Invaluable nugget of advice #3: The early bird gets the choice interview days. Make sure that you submit your application the absolute first day that ERAS opens. This is important because one of the filters that residency programs have in place to determine who gets first crack at an interview is how early the applications come across their desk. This is easy enough to do, so please don’t give yourself another hurdle to jump. Another creepy tidbit to keep in mind is that your medical school authorities can see with their software whether you have submitted the application or not. Should you wait a couple of days, you may just get a phone call from a faculty member checking up on you—this actually happened to a couple of people in my year. If you need more incentive, the next tip should help with that.

[Sidenote: there are programs out there which will NOT offer interviews until you have passed Step 2 CK and/or CS. This wasn’t a problem for me given the timeline of my master’s program, but something to keep in mind. Schedule those early to prevent them from hurting your chances.]

Invaluable nugget of information #4: Interview offers will come much sooner than you expect, so be prepared. The length of time between when I submitted the application when I got my first interview offer? Two days. No joke, I submitted the application on Sunday, and Tuesday afternoon was when my first offer came. Organization is key to keeping track of scheduled and pending interviews, so keep a calendar either on your phone or on paper.

Programs often ask for your top 3 choices for dates when you want an interview. Some of those dates feel very quickly, especially if they’re on a Friday or during the holidays. Make sure you have that calendar on you when you respond to your offers. This will ensure that you don’t give the same dates to two different programs and then actually accidentally and double booking yourself. Having your calendar also allows you to respond to the interview request faster.

This leads me to another solid bit of advice: answer as quickly as you comfortably can secure your best option for an interview day. I’ve known classmates who have missed out on a great programs altogether because they waited a couple of days before responding to an interview offer. Don’t give yourself an anxiety stroke, though, just make sure you set aside time each day to check and respond to any offers you get that day.

I was kind of person who would have been compulsively checking my email for offers and not paying attention to the rotation I was on. That is definitely not ideal for your learning or your sanity. There’s a really great little app that you can download for free on your phone called Boxcar. You can connect it to any web-based e-mail account and set up filters. Any mail you get that fits the filters will be fowarded over to your phone and alert you as soon as you receive them. This was a fantastic find. The filters that I used were filtering by subject line that included the word interview, and filtering by sender to include the ERAS e-mail address (the noreply@eraspod or whatever it is). This is key because a number of programs don’t send emails directly to you, but send them through the ERAS messaging system. Anyway, the app was gold and I highly recommend it

Invaluable nugget of information #5: If a program doesn’t reach out to you, reach out to them. If you haven’t back from a program within about a month and a half, especially if it’s a program that you are particularly interested in, go ahead and email them. The names and email addresses of the program coordinators are listed on the Freida and on the program’s website. All you’re doing in this email is inquiring about the status of your application, reaffirming your continued interest in the program, and requesting that they consider you if any interview spots open up in the future.

Friends, this sometimes works. I sent three of those e-mails in early November, and one of them—the one I was most hoping for an offer from—called me less than a week later offering me an interview. Part of the reason why this move can work in your favor is because of that graph from an earlier post, the one depicting the number of applicants and the number of available residency positions. These programs are swimming in more highly accomplished and qualified applicants than they can possibly interview, and as a result it is difficult for them to separate out to which candidates they should offer interviews. If you are one of the candidates who is on the border of being offered an interview, letting them know that you want to be there could be the push needed to clinch that interview. Of course, if an applicant isn’t strong enough to be in that “maybe” pile, this likely won’t help you, but it certainly won’t hurt.

I’ll let you know how that program worked out in a future post.

This is the best advice that I can think to pass along to you.  Hopefully it helps!





Hey, I’m a Doctor Now!

1 01 2015

Happy New Year, everyone!

Consider me to be back from my hiatus. I’ve been wanting to start back for a couple of months now, but it’s been very easy to postpone.

Just in case you were in any way concerned about my disappearance from the blogosphere, I have NOT died, been grievously injured, failed out of school, been convicted of any crimes, been in prison, or fled the country for any reason.

Quite a lot of things actually have happened since my last post. I have:
– completed an entire residency interview season
– Written my Masters thesis
– Earned my MPH
– Made a rank list (which was no small feat
– Spent six weeks doing rotations on two different continents
– Matched into a phenomenal residency program
– Graduated from medical school
– Packed up and moved to a different state
– Completed residency orientation
– Started work as an actual doctor treating patients and their families
– Taken, and passed, the USMLE step 3
– Spent my first Christmas at work
– And, most importantly, survived halfway through intern year.

So I did a couple of things in the past 1.3 years. Just a couple.

The plan at this point is to go in chronological order and write a post about each of the above, as well as catching you up on my patient care experiences. The goal is to post 2-3 times per week, and hopefully you will be mostly caught up on my life by the end of February.

Hope you all had a great New Years Eve!





The Start of Being Employed (…I Hope)

8 10 2013

This afternoon, during a particularly tedious breast reduction surgery, it struck me that I haven’t written in a very long time.  That seems to happen quite a bit; with my schedule, I have to actually make time to write, and I have been doing a poor time of that lately.

Many things have happened since I last wrote.  The biggest change is my return to full-time medical school as a “real” 4th-year student, but not far behind in magnitude was beginning the process of residency applications.

The residency application process is a lot like sorority rush.  In simple explanation, applications are sent using a common application system (like the Common App for college or AMCAS for medical school) to all of the programs you are interested in.  Then the program sorts through the applications they’ve received through a combination of electronic filters, and they offer interviews to the candidates who make it through the screening process.  Students then schedule and complete a series of interviews, usually between 5 and 15 (often more, depending on the specialty).  Each program scores its interviewees based on a unique system to that institution—each program develops its own, as I understand it—and compiles a master rank list of everyone they are interested in having as a resident.  The students rank the programs they have interviewed at as well.  Both rank-order lists are turned into the National Residency Match Program and put into a computer with the thousands of residency programs and tens of thousands of applicants.  An algorithm is run, and the computer spits out a match.

The beginning of the ERAS (Electronic Residency Application Service) was pretty underwhelming and tedious.  Every activity is catalogued, every qualification and award described, and there is even a section for personal interests.  The student uploads the personal statement, the medical school uploads photos and transcripts, boards scores are released, and each person writing a letter of recommendation uploads their letters separately into the student’s application.

No sweat.

Then comes the task of selecting the programs you want to apply to.  This was something I’d been working on more or less since I decided I wanted to go into pediatrics, a little at a time.  I thought that this approach would make things a lot less overwhelming when the time came to push that “Apply to Programs” button.  False.  I did come up with an elaborate spreadsheet detailing every program I was interested in, including everything from the cost of living in the area to the boards pass rate of the residents to the additional opportunities provided (some have really cool international medicine or advocacy programs) to whether the program provides medical insurance.

When the time came to submit, I felt confident in my choices (18 programs, which is a larger number for pediatrics).   Then that seed of doubt took hold, quickly grew into the rarely seen Kudzu vine of strangulating anxiety, and I sat with my heart racing, looking at my list of 18 reputable residency programs wondering if my best fit program was even on my list, and, if it was, would they even look at my application?  So I did what many students in that position would do.

I panic-applied to an additional 6 programs, just in case.

Friends who went through this process last year say that’s a waste of money (they charge by the program after the first 9, with the cost per program increasing as the total number increases), and in the long run it might turn out that way.  Right now, the peace of mind is priceless.  Outside of this whole crazy process, it’s really easy to downplay the stress of it all, but trust me: in the throes of this chaos, it’s really easy to be overcome with anxiety and doubt.  Especially considering the following graph:

Image

Yes, this effectively scares the crap out of me most of the time, which is why I avoid looking at it.  Avoidance is totally a healthy coping mechanism, right?

The programs I applied to are a good mix of academic and community programs in cities of varying sizes with as few residents per year as 10 and as many as 40.  I’m not totally sure yet where I will fit in—that’s what the interviews are for—but I wanted to apply to a solid mix.  One of the pediatrics directors at my home institution helped me out a lot with selecting programs to apply to, suggesting a solid mix of 1/3 “reaches,” 1/3 “maybe-but-maybe-not” programs, and 1/3 programs I have a solid shot at.  This is a pretty standard tactic for those people who are reasonably competitive with respect to their specialty.  In Derm, for example, every person applies to all of the country’s 90+ programs and hopes for maybe 10 interviews.

Another variable is how quickly after ERAS submission programs start asking for interviews.  I think this depends on how competitive the candidate is, the medical specialty, and the program itself.  One of my peers is applying in surgery, and while we submitted our applications on the same date (Sept 15), he did not start hearing about interviews until last week—he currently has 2 scheduled.

My first interview offer came only 2 days after the applications were submitted, and I was stunned both by the rapid turnaround time and by the program itself—The Rainbow Babies/UH/Case Western Reserve program out of Cleveland.  I hadn’t expected anything that quickly, but it was a very pleasant surprise nonetheless.

Now, just over 3 weeks in, the offers have slowed down, but I feel incredibly fortunate; I’ve had 15 offers from fantastic programs.  Two of these are programs that I almost didn’t apply to because they felt so far out of reach, I only applied because I didn’t want to regret not trying down the road.  I’m looking forward to the actual interviews with nervous anticipation, and my first one is in just over 2 weeks.

This is kind of a fun cartoon, again from the Cartoon Guide to Becoming a Doctor:

Image

It’s good for a few chuckles, right?

The one thing I’m not looking forward to?  The cost.  Most places I’ll be able to drive to, but the drive is still upwards of 9 hours for a number of the interviews.  Anything over that, I’ll fly or take the train or a bus.  One saving grace is that pediatrics programs often foot the bill for a hotel or B&B (10 of my interviews are providing a night of accommodations at hotels, 2 offer significantly discounted rates at their ‘partner’ hotels, and the 2 that I would have to pay for are in locations where I can stay with friends).

Overall, the process has swung pendulously from extremely gratifying and joyous to the low of paralyzing terror.  Now that I have a solid number of programs who are actually interested in meeting me—and let’s be honest, I’m not AOA or even in the first quintile of my class—my mind is overall much more at ease than it was 3 weeks ago.

I’ll be sure to keep you updated!





The Human Connection

27 08 2013

Below is a video that the Cleveland Clinic made a little while back.  I’ve been meaning to post it for some time now.

This video is one that I was introduced to by a physician and mentor who always stresses the importance of keeping humanism integrated into the practice of medicine.  It is an exercise in empathy and illustrates the breadth of conflicts and emotions experienced by the people you can run into every day at a hospital—or, really, anywhere that you go in life.

I hope you are as touched as I was.

Enjoy!





Musings on a Graduation

22 08 2013

While it was almost three months ago, I am going to share my experience with the medical school graduation with you.  As some of you remember—and most of you probably don’t—I am not taking the traditional path through medical school, having detoured during this past academic year to earn my Master of Public Health degree before diving back into medical school full-time as an “official” 4th year student this month.  Because of this, I had the opportunity to participate in the graduating ceremony for the graduating class of 2013.

As proud of, and excited for, my classmates as I was (and still am), the experience was a truly bittersweet one.  I watched each of my peers—the ones I stood next to at my white coat ceremony in July of 2009, those I studied with, partied with, swapped patient stories with, and ultimately learned to be a physician with—walk across the stage, crouch a bit as a faculty member placed a hood over their heads and across their shoulders, and sign their names for the first time with the letters M.D. at the end.  They became physicians.

The first time I felt separated from the rest of my matriculating class was on Match Day, when everyone found out after a long year of applications, tedious interviews, and hair-twisting decisions where they would be going for residency.  That was different.  Then, I still got to celebrate with them and the following day we were all still 4th year medical students (as a side note, and this might seem petty to you, but I refused to call myself a 3rd-year just because I had a full year remaining.  I finished my 3rd year requirements and that was that, no looking back).

Graduation was different.  At the beginning of the ceremony, they were 4th year students.  Leaving the stage, they were doctors.  I’m not sure why, but it seemed like the distinction was very sudden and immense.

The speaker at the ceremony was phenomenal to the point where if the speaker at my own graduation is terrible, I plan on pretending that this was my “real” graduation speech.  I wish I could just copy and paste it here, but that could undermine the anonymity of this blog (sidenote: if those of you who actually know me are interested, let me know and I can e-mail you).

The speaker talked about a number of things, but the central speaking point was this: Don’t ever forget who you are right now, a person with some idealism still living inside, who wants to make a difference one patient at a time, who went into medicine to give other people the gift of better health.  It won’t be easy, and we will forget sometimes.  We’ll forget when it’s the end of a 24-hour shift and we haven’t eaten or sat down; or when a patient is intentionally irate, demeaning, and abrasive despite the hours we’ve put into his or her care; or when we have to miss another full night’s sleep, holiday dinner, kid’s soccer game, or date because a case came in that we have to take care of.  When we forget, instead of guarding ourselves with cynicism, we should remember who we were on the day we graduated from medical school and return to that place rather than pulling on the armor of cynicism.

This is true on so many levels, and what’s interesting is the parallel between these words of the graduation speaker and the words of the physicians who speak on the day of convocation when the first-year students receive their white coats and recite the Hippocratic Oath for the first time in front of their friends, family, and colleagues.  On that day, we were told to hang onto our altruistic spirits and our enthusiasm for all of the great things that a career in medicine has to offer.  We were told to remember that, one day, we would have to look into our rearview mirrors and see what we made of our medical school experiences, because it is such a unique time.   We were told to make the most of it, but not to lose our spirits.  The repetition is important, and it is important because the truth of modern medicine is that training to be a physician, and actually practicing as one, requires a tremendous amount of sacrifice that might not always seem worth it.

Remembering who we were upon graduating from medical school may help to deter the cynicism and burnout plaguing so many American physicians today.  If that can help to make every sacrifice worth it, it’s worth a try.