Throughout medical school, you always hear about the M4 life where we are able to choose our electives and there are few hard-and-fast requirements. One of those few requirements, however, is a sub-internship (or sub-I) in an ICU setting. I chose to rotate in the Neonatal ICU here at Mott so that I could become more familiar with newborn issues, particularly in premature babies.
I’m now about halfway through the rotation and there’s definitely been a learning curve. For one thing, I had forgotten how much math is involved in pediatrics pre-rounding. The patient’s I/Os suddenly became much more complicated to determine – intake should be calculated in terms of mL/kg/day whereas output is in mL/kg/hr. And, of course, all feeding volumes are increased per protocol in terms of mL/kg/day but orders have to be calculated in mL q3h. Yep. This rotation has enabled me to discover the shortcut to my phone’s calculator, so at least now I know that for the future 🙂
A few days into the rotation, I switched to nights. Sub-Is and interns all do six nights whereas the senior residents alternate between taking 24-hour call. I enjoyed nights, especially because it allowed me to learn about each of the babies on the resident side of the NICU and see the big picture, instead of immediately getting bogged down in all the minutiae (see previous paragraph…)
In the middle of last week, I switched back to days, which was a rough transition. Mostly because I was exhausted during the day at the hospital, but then would wake up a bit more by the time I got home. Then, of course, even though I would go to bed at a decent time, my brain would automatically wake me up from midnight to 4 a.m. for several nights after I transitioned back.
Overall, I’ve been enjoying my time in the NICU. It’s definitely a different experience, and probably unique amongst the ICUs in that some of the patients are absolutely acutely sick, whereas others are here because they were born extremely premature and we’re just helping to control their environment until they’re old enough to go home. The important thing to remember about babies (and children, but especially babies) is that they can be looking great with a life-threatening illness, until all of a sudden they’re not. It’s easy to get sucked into thinking everything is humming along, but a healthy suspicion of any minute change from a baby’s baseline is paramount.
In the NICU, we see babies on their birthday a lot. Luckily, I was able to leave the hospital in the early afternoon this past Sunday in order to celebrate a different kind of birthday – the 150th birthday celebration of my hometown Brighton. There was even a cake and everything! And, by everything, we even mean a collection of farm equipment, both modern and historical, all helpfully labeled.
Well, July certainly started off with a bang – from fireworks, that is. I’m on Emergency Medicine this month at nearby hospital St. Joe’s. Thankfully, I didn’t actually have to work the Fourth of July and instead spent the sunny day with my family before returning to Ann Arbor to continue orientation. Now that Ann Arbor allows fireworks within the city, I was able to see a lot more fireworks out my window than ever before.
Emergency Medicine is essentially a third-year clerkship that takes place during our fourth year, replete with observation cards and shelf exams. However, for many of us, this will be our last exam of medical school. And I think we’re all happy about that. During the next few weeks, we will be doing day shifts, evening shifts, and night shifts in both adult and pediatric settings. I started off my rotation on night shifts, working from 11 p.m. to 7 a.m. As an avowed sleep fanatic, overnight shifts are not my favorite (I usually go to bed before 10 p.m.), but I enjoyed them nevertheless. I was even able to repair some lacerations, including a tricky one on a patient’s hand. I greatly appreciate the variety inherent in the practice of emergency medicine, but it would drive me nuts to not know what happened to any given patient after they left my care.
This past weekend, I was incredibly lucky to be able to participate in my fifth and final Dean’s cup golf tournament. The ending was definitely bittersweet, as this is a tournament that I have helped to organize for the past four years with Dean Raj and Denise Brennan. Despite predictions of rain, the weather was gorgeous and sunny and I had a blast with my teammates, even when we almost got hit by an errant golf ball. Each pairing consists of a faculty member and three students, who play together in a scramble format.
From left to right: Dr. Jim Peggs, Jasmine Harris, me, Jake Nelson
I played with Dr. Peggs, a former UMMS dean and the person who asked me if I wanted to organize the tournament within five minutes of my entering the clubhouse as an incoming M1. We also played with two students participating in the LEAD pre-matriculation program, one of whom I asked to carry on my position (however I waited until we finished the round J). It was clear that everyone had a fantastic time, as we talked outside the new clubhouse waiting for later groups to finish. The camaraderie was immediately evident and we (maybe) fooled the participating new M1s that medical school is like this all the time… I could not have asked for a more perfect day.
And now, it’s time to sleep. My body is still adjusting back from nights and tomorrow’s shift will come earlier than my brain would like. J
Each time I participate in the UMMS interview day, my own interview day seems farther and farther away (and I’m usually quite thankful not to be wearing a suit). Well, the time for dusting off the suit is coming soon. In medical schools across the country, preparation for the upcoming residency application season is beginning. Students are attempting to craft personal statements (which, like when applying for medical school, is a task that sounds much easier in theory than it is in practice), updating their CVs, and asking for letters of recommendation.
In terms of letters, the residency application has an additional kind: the Medical Student Performance Evaluation (MSPE) or, more colloquially, the Dean’s Letter. Written by one of the medical school deans, the MSPE gives a summative evaluation of your performance in medical school, including comments from third-year clerkship evaluations, as well as notable characteristics that are evidenced by extracurricular and co-curricular involvement.
In order to create these letters for each graduating student, the deans meet with students individually to discuss their content and for us to give input. For example, at my MSPE meeting last week, we decided to include my love of learning languages as a notable characteristic (I’m fluent in French, but am working to improve both my general/medical Spanish and Mandarin Chinese).
The other aspect of the application process that bears mention at this point would be narrowing down the residency programs to which I will be applying. I will be pursuing a residency in family medicine, which means there are over 500 programs to which I could apply. That number is slightly overwhelming to say the least.
I spent several weeks (at least) freaking out over how I could possibly narrow down to 20-ish programs and soliciting advice from everyone I knew who has already been through the process. The principal answer: start by defining your geographic preferences then decide what program characteristics are important to you (for family medicine, common factors are the strength of OB training and desired population characteristics, such as focus on the underserved). Several people steered me to the AAFP (American Academy of Family Physicians) website, which has a search engine of available residency programs that easily delineates these characteristics.
Prepping my application has a long way to go, but baby steps. In the meantime, I’ve enjoyed being an M4, including my vacation time last month. I was able to go to London with my family and we had an amazing time.
This sign made me laugh. I was on the upper deck of a tour bus and was going to try to get a clear shot but the bus went up on a curb and I had to abort that mission or I would have dropped my phone on the pavement (not sidewalk, our tour guide said that was too descriptive for the Brits). “Changing priorities, 50 yds ahead” indeed.
This month, I’m working as a Family Medicine sub-I (or sub-intern) on the department’s inpatient service. Essentially a sub-I is supposed to act like an intern, except for the fact that someone else (usually the senior resident) has to sign off all of the orders that I place. I’ve now finished my first week on service and am finally (sort of) getting the hang of it. At the very least, I’m starting to remember where things are in MiChart (UM’s electronic medical record). With spending good chunks of my Internal Medicine and Psych rotations at other hospitals, it’s been a little while since I routinely pre-rounded and put in orders.
I’m enjoying my time here and really enjoy working with the team. It’s a smaller group than some: the attending, the senior resident, the family medicine inter, the psych intern, and me. It’s really great to feel like these are my patients instead of the intern’s patients that I’m helping with. And, it further confirms my desire to pursue family medicine because of the broad spectrum of clinical conundrums it entails and the amazing people you meet.
Our day starts at 7 a.m. in the hospital cafeteria where we meet with the night resident for signout to learn what events transpired overnight for our patients and to hear about any new people admitted. Rounds usually begin around 9 a.m. In between we go see our patients and formulate preliminary treatment plans for the day. During rounds, we present our patients to the team and attending, and make modifications to the plan. After rounds, we return to our team room and put in the orders allowing those plans to come to fruition. Our team admits new patients every day, so the day team admits until 5:30 p.m. and signs out to the night resident at 7 p.m.
This month also marks the kickoff of certain events for the U-M bicentennial. Yes, the University of Michigan turns 200 this year. On my own birthday a couple of Saturdays ago, I was lucky to be released from clinical duties early enough to attend the True Blue concert, celebrating notable achievements over the past two years. (While 7 p.m. is the theoretical time we are off duty, you stay until your work is done, which can sometimes be a bit later.) So, I was thrilled to be released in time to attend the concert with my family. My brother, as part of the Michigan Men’s Glee Club, was honored to perform. Other notable appearances were Darren Criss, Andrea Joyce, Jim Harbaugh, and the entire Michigan Marching Band on stage at once for “Varsity and the Victors.” Go Blue!
Yesterday was a momentous day in the lives of my original* classmates, one that they anxiously awaited with anticipation. What event was this? Match Day, where soon-to-be doctors learn where a computer program has matched them to train for the next several years of their life (thankfully, most students at Michigan get one of their top choices, but nevertheless we bow down to our robot overlords). Coincidentally this year, the third Friday in March fell on St. Patrick’s Day, further confirming what we already knew – the M4s would soon be consuming a fair amount of “happiness.”
Michigan holds its annual Match Day celebration at the North Campus Research Complex, replete with maize and blue balloons (including a grid replicating our famous block M). Students and families must wait until noon, when the envelopes with their futures inside can finally be opened. The celebration begins at 11:30 with opening remarks by Dean Raj, announcement of student awards and class-elected speaker, and the class video. This year’s video was amazing and hilarious, including attempts at singing by some of the students, among other photos and videos starring our class.
And then, it was time to open the envelopes. There was a lot of screaming actually, although the vast majority of it sounded happy. M4s at the celebration already know they have matched – they received a yes/no email on Monday so they could scramble (a.k.a. use the SOAP process) to find a residency position if needed. Nearly 99% of Michigan M4s matched in the initial match this year. After the initial celebration with their families, M4s started racing around the room, finding their friends and asking “Where are you going? I’m going to ____.”
At 12:30 p.m., Dean Raj called everyone back to their seats so that a certain few brave (very, very brave) individuals could finally open their envelopes. Why hadn’t they been opened yet? These students had elected to open their envelopes on stage and announce where they are headed in front of the room. May the odds be ever in your favor. After everyone had opened their envelopes, students also had the option to come up to the stage and announce where they were going. Dean Raj and other faculty announced the students in turn, interspersing names with the score of the Michigan-Oklahoma State basketball game. Jokingly, Dean Raj promised that if Michigan basketball was playing in the NCAA tournament during Match Day again, it will be shown on the big screen.
I’m thrilled that I was allowed to witness this momentous achievement in my friends’ lives. It was certainly bittersweet, realizing that so many are moving away from here and wishing I could join in their merriment. Next year, it will be my turn. For now, I’ll just continue giving a flurry of hugs to all of my graduating friends. CONGRATULATIONS!
*I matriculated with these students in August 2013 and completed my first 2.25 years of medical school with them. I left the class to complete a master’s in bioinformatics and rejoined the class below me.