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Transgender Health Care at Michigan Medicine

A couple of months ago I was lucky enough to snag a spot to participate in the transgender health care clinical elective here at the University of Michigan Medical School. Michigan is one of a handful of (maybe three) medical schools who offer similar electives and right now it is only offered six months out of the year.

Dr. Shumer and me in the Mott Endocrinology clinic!

Transgender health care is often interdisciplinary; therefore, the elective draws from a variety of specialties. On average, I spent a day per week each in the pediatric and adult gender clinics, staffed by pediatric endocrinologists, and adolescent medicine specialists as well as reproductive endocrinologists. I worked with patients who were following up after surgery, initiating hormone therapy for the first time, receiving counseling on removing their GnRH analog implants, and anything in between. I also went to the Michigan Medicine Comprehensive Gender Services department to observe gender assessments performed by mental health providers. Finally, I spent time in the plastic surgery department, participating both in clinic and in the OR, with patients undergoing procedures like penile inversion vaginoplasty or top surgery (bilateral mastectomy).

Community outreach is also a huge component, which really appealed to me. I had the opportunity to meet with representatives from our law school’s Know Your Rights Project, UM sex therapy, and UM speech pathology. It was great to have an inside look at how trans folks might interface with these groups.

Last year as an M2, the clinical trunk year was all about learning the basics and understanding the foundation of clinical medicine, however, as a student it was often difficult to find continuity. You may be placed in a single clinic for a couple of weeks, without the opportunity to participate with a patient’s follow-up. The trans elective has been a welcome departure from this paradigm. One patient in particular stands out. I went with one of our social workers for the initial mental health gender assessment with a pediatric patient who wanted to start hormones. As he told his story, I couldn’t help but feel humbled and privileged to be even a small part of an identity journey and a medical intervention that he had wanted for so long. This patient was so brave and thoughtful and a teenager. I was in awe.

He came to the medical clinic the following week. Under supervision, I was invited to run the entire visit and the discussion surrounding initiating testosterone therapy. The patient and his family members were so excited to see and speak with a familiar face. It felt like a reunion of sorts. It was one of the more striking times in medical school that I’ve felt the ownership that comes alongside taking care of patients from the start of their medical journey. Side note, I actually wasn’t even supposed to be in clinic that day, but I invited myself in (shout out to the real MVP, Dr. Shumer!) because I loved this patient and his family so much.

As my M4 friends get closer to graduation and I move toward residency application season, I’ve been thinking a lot lately about the type of doctor I aspire to be. I’m planning to apply into Obstetrics and Gynecology this fall, and the reality is there isn’t a lot of formal training out there on how to provide trans inclusive care. I’m grateful that this elective exists and I’m grateful that I get to train at the University of Michigan. Here, we understand that it is our responsibility as future doctors and human beings to care for this population, in all senses of the word.


Alumni Profiles: Back for Seconds

Welcome to our Second Look Weekend 2019 attendees! This weekend is about learning all you can about your future medical school.

One of the things that makes the University of Michigan Medical School special is our community: the students, the faculty and the staff, and the alumni network who are invested in the community even after they leave UMMS. The final event of our Second Look Weekend provides an opportunity to have brunch with some of these alumni. This event is an amazing opportunity to hear alums’ memories of Michigan and how it helped shape their careers. Moreover, it is a chance to meet people who can help define your future. We wanted to give you a preview of some of the alumni who will be joining us this Saturday so you can get excited about who you will be speaking with and see the lasting impact UMMS has made on their lives. Read their stories and get excited about UMMS!

Dr. John Huguenard
Class of 1973 UMMS
Dr. Huguenard was a family physician who migrated from primary care to management. He worked in public health then group practice management followed by senior medical management roles in health and life insurance as well as employee health. He is now retired and spending time with family, reading, gardening, hiking and personal travel, but still follows medical issues particularly in health care delivery and in the career areas of two of his daughters: medical genetics and neurosurgery.
UMMS shaped them as a physician by… “Taught me to take charge of my own education and performance with the confidence that everyone at UMMS was there to share knowledge and enlightenment, provide great examples of good physician practice, and step in to help when I needed it … but not before. Consequently, we graduated ready to take personal responsibility, but with an understanding that good medicine is a team sport.”

Dr. Kristopher Aalderink
Class of 1999 UM undergrad, Class of 2003 UMMS
The UMMS family is… “Everything.  A network of lifelong friends, endless source of knowledge, academic & athletic excellence.”
UMMS shaped them as a physician by… “Learning from the best of the best.”

Dr. Chris Crader
Class of 1993 UMMS
Dr. Crader practices general internal medicine on Detroit’s East Side.
Favorite memory… “Participating in the Smokers: The Little Dermaid and Enema House”
Being part of the Michigan community…Provides opportunities that I never expected, that have enriched my life as a person as well as a physician.”

Dr. Nancy Dodge
Class of 1983 UMMS
Dr. Dodge is a neurodevelopment pediatrician who runs a neonatal intensive care follow up program. She is a past chair of the American Academy of Pediatrics Section on Children with Disabilities and has a research interest in cerebral palsy.
Favorite memory… “Rehearsing and performing Smokers and collating lecture notes with my fellow Phi Chi’s.”
UMMS shaped them as a physician by… “Encouraging an intellectual rigor and reinforced drive to keep learning always.”

Dr. Melissa Meldrum-Aaberg
Class of 1989 UMMS
Dr. Meldrum-Aaberg completed her residency at Bascom Palmer Eye Institute in Miami (rated the top program in the country for many years) and stayed on to do an oculoplastic fellowship.  Following fellowship, she joined the faculty at Emory University where she practiced academic medicine for four years. She then decided to move home to Michigan in 2001 and opened her own private practice where she has worked for 18 years.
Favorite memory… “I loved medical school.  It was wonderful to focus on an area where I had such intense interest.  Walking into the gross anatomy lab on the first day and realizing that the whole dream of being a doctor was coming true is probably my favorite memory.”

Dr. Gregg Pane
Class of 1981 UMMS
Dr. Gregg Pane started out as a residency director then got an MPA degree. He had a long career in diverse settings that UMMS prepared him for well: public health, Medicaid, VA, academic health systems leadership, federal government, and now as a federal health consultant.
UMMS shaped them as a physician by… “Aspirations to serve and the knowledge and resiliency to succeed. Leaders and Best says it all.”
UMMS is special because… “Top school known the world over. Great university town and wonderful college experience.”

Dr. Sujata Purohit
Class of 1996 UMMS
Dr. Sujata Purohit works in anterior segment ophthalmology and has really enjoyed the surgery and technological advancements of the field.
Favorite memory… “Dr. Abrams pathology classes and the Smoker, especially Peter Pannus, which I helped in writing the script!”
UMMS is special because… “The dedicated faculty and all the staff that helped shape our medical training.”

Dr. Michael Sarosi
Class of 1986 UMMS
Dr. Michael Sarosi matched at the University of Wisconsin for a year of internal medicine as part of his subsequent four-year diagnostic radiology residency. He then went on to an interventional radiology fellowship at the University of Virginia. He returned to Ann Arbor at St. Joseph Mercy Hospital and has been on staff since. He considered himself lucky enough to have a career that he enjoys to this day and to have started his career at the forefront of the minimally invasive revolution in medicine spearheaded by Interventional Radiology.
UMMS shaped them as a physician by… “In spite of myself, UMMS taught me to focus and think, and how to prepare for the vast amounts of information/experience I still needed to learn.  I came out with confidence in my abilities and my ability to continue to learn.”
Being part of the Michigan community…Pride and humility in being a small part of excellence!”

Dr. Robert Soderstrom
Class of 1972 UMMS
Dr. Robert Soderstrom is a dermatologist in Flint, MI.
Favorite memory… “Excellent education and the wonderful Ann Arbor community.
Being part of the Michigan community…World-renowned academic institution, not just in medicine, but law, business, etc. Recognized everywhere.”

Dr. Michael Freedland
Class of 1987 UMMS
Dr. Michael Freedland did a general surgery residency at Wayne State University, a fellowship in plastic surgery at the University of Michigan and finally a fellowship in craniofacial surgery at Eastern Virginia Medical School for a total of nine years of Residency. Once in practice, he gravitated toward a cosmetic surgical practice.
UMMS shaped them as a physician by… “I feel that the experience was second to none. I have conversations from physicians that have graduated from other institutions and there is no comparison.”
UMMS is special because… “I like the camaraderie. At my last class reunion we had over 100 returning alumni students. Clearly other graduates feel the same as I did.”

Dr. John Weber
Class of 1986 UMMS
Dr. John Weber attended the University of Minnesota for an internal medicine residency. Following residency, he did fellowship training in gastroenterology at the University of California-San Francisco. He then continued in academic medicine by joining the UCSF faculty and pursuing basic research in mechanisms of T cell signaling. Currently he is a partner in a busy GI private practice and serves on the faculty of the Oakland University William Beaumont (OUWB) Medical School.
Favorite memory… “My long-lasting friendships with classmates. Attending weekly Grand Rounds with world class speakers. Working in a collaborative environment with a strong commitment to teamwork.”
Being part of the Michigan community…It is very special to be a part of the Michigan community. The focus on the highest quality of education, excellence and tradition are hallmarks of UMMS. A medical degree from Michigan will always be one of my greatest achievements.”

Dr. Dana Zakalik
Class of 1983 UMMS
Dr. Dana Zakalik is pursuing a career in hematology/oncology, with a sub-specialty in breast cancer and cancer genetics. She did her internal medicine residency at U of M, fellowship in oncology at UCSF, and has been an engaged clinical oncologist with an academic/research focus. She is currently a Professor of Oncology at Oakland University William Beaumont Medical School, and Director of Cancer Genetics/Hereditary Risk Program at Beaumont Health.
UMMS is special because… “Rich history in being a leader and pioneer in shaping progress and advancement science and medicine. Great breadth and depth in multiple disciplines. Training of many leaders in medicine.”
Being part of the Michigan community…I am proud and honored to be a part of the Michigan community, which combines excellence, dedication, high standards, diversity and lifelong collegiality.”

Dr. Peter Lundeen
Class of 1975 UMMS

Fifteen years ago he went to work for Spectrum Health in a variety of administrative roles: VPMA, medical informatics and part-time hospitalist. He is now working towards retirement, having retired from his informatics role and continuing to do hospitalist medicine part-time.
UMMS shaped them as a physician by… “I developed a group of fellow physicians, people in my medical school class in addition to some of the professors with whom I maintained relationships throughout my professional career. This helped immensely in exploring different paths during my professional career.”
Being part of the Michigan community…I feel proud of the training I received at U of M and continue to meet and work with many other clinicians who trained at U of M. It helps to establish an immediate bond.”

A Beginner’s Guide to Medicine for Family and Friends of a Medical Student

Do you have a family member or friend in medical school that you can no longer understand? When your loved one in medical school is speaking with their classmates, do you find yourself thinking, “What in the world are they talking about?! No seriously — what language is this?!?”

Not to fear!

With the help of my medical school class, I’ve put together a glossary of 25 of the most common terms you’ll hear medical students say and what it all means. Although it is long, this list is by no means comprehensive and is reflective only of my individual experiences as a medical student here at the University of Michigan. Regardless, I hope that this glossary is helpful for family, friends, future medical students (and current medical students) alike!

Although no one asked, I’d like to share a few quick pieces of advice before I begin. It is no secret that medical school is tough. However, I had no sense of the ways in which it would be until I started three years ago. For me personally, the hardest part of medical school has not actually been school — not the 30-hour calls, not the never-ending exams, not the fatigue from early mornings or the emotional weight of taking care of sick and dying patients. For me, the hardest part of medical school has been comparing myself to the people around me. As undergraduate students, many of us were the best at everything. Because it is so competitive to get into medical school, we had to be. This quickly shifts when entering medical school, and it’s easy to lose perspective when the world seems to be fully contained within the hospital walls. This shift is challenging and often disappointing, especially when it seems as though the people around you are succeeding effortlessly (spoiler: they’re not). For parents, friends, and family reading this who are not in medicine, the best I advice I can give is to be patient with your loved ones. Be a good listener. Remind the person of their strengths and know that you may never fully understand what they are going through. It is impossible to do it all (trust me I still try), and the available free time students have with a friend or family member in medical school will change and evolve. As a medical student, what that has helped me feel balanced is keeping in mind my strengths, widening my perspective by participating in a small number of activities outside of medicine, and keeping in touch with friends both in and out of medical school. And it also helps that I’m at an institution I love with people I love, too! 

Alright, now that that’s over with — Let’s get to it!


1. Premed: Before applying to and matriculating into medical school, medical students are required to complete an undergraduate degree. During their undergraduate studies, these students are often referred to as premed or premedical students. To apply to medical school, there are a certain number of core competencies that need to be met. Students do not need to major in the sciences; they only need to fulfill the premedical competency requirements that vary by medical school. Students will also need to complete the MCAT, the medical school entrance exam. The American Medical College Application Service (AMCAS) opens in May, one year before a student would matriculate, and it’s best to apply as early as possible. After interviewing, applicants to Michigan are admitted on a rolling basis from October through February, and accepted applicants will select their medical school by April 30th, the national date. Most medical schools then begin in July or August. At this point, students are no longer premedical students but rather plain old medical students. Finally!

I would also like to note that many current medical students were not premedical students during their undergraduate years and chose to pursue other fields (engineering, business, military, education, the arts, and more) after graduating. Students who later decide that medicine is their passion will often go back to school to complete coursework, study for the MCAT, and then apply. 

2. White Coat Ceremony: The White Coat Ceremony marks the beginning of medical school. Students are presented and cloaked by the medical school administration with short white coats that they will wear throughout medical school. Did you know that you can tell how far along someone is in their training based on how long their white coat is? Medical students have short white coats that go to their waist. Residents wear longer white coats and attending physicians wear even longer white coats. Love that medical hierarchy! 

via Instagram | @umichmedschool

3. M1, M2, M3, and M4: These titles are a shorthand way of understanding what year in medical school a student is. An M1 is a first-year medical student, an M2 is a second-year medical student, and so on. Dental students use similar terminology, so a first-year dental student is called a D1. Law students switched it up a little, so a first-year law students is called a 1L instead of an L1.

4. MSTP: MSTP stands for Medical Scientist Training Program. This refers to medical students who are in school to receive both their MD and PhD. These students will often complete the first two years of medical school with their matriculated medical school class, leave to complete their PhDs, and then return to complete the last two years of medical school before continuing on to residency. These students do not pay tuition and also receive a stipend! In total, MSTP students take about seven to nine years to complete both degrees.

5. Sequences: In most medical schools, the first one to two years of school are spent building a foundation of medical knowledge in the classroom and anatomy labs. Most medical students spend about two years in this portion however Michigan, along with many other medical schools, is transitioning to a condensed medical foundation curriculum of one year. At Michigan, we build this foundation by going through each organ system one at a time (for example cardiology for a month, then pulmonary the next), learning the normal anatomy and physiology of that organ system and then learning what happens when something goes wrong. Each organ system put together is called a sequence, and this term and structure will vary across medical schools. At Michigan, we also have pass/fail quizzes and exams built into each sequence to make sure students are successfully building their foundation of medical knowledge and are ready for the next steps of medical school. Some medical schools are not pass/fail, and students are graded during this portion.

6. Core rotations: Also known as “the wards” or “core clerkships.” After spending one to two years in the classroom setting, medical students are now ready to continue their training in the hospital and clinics. This initially happens by rotating through a set number of required core rotations. These are pretty standard for all medical schools with some variation. At Michigan, our core rotations are completed during our second year (with one exception: emergency medicine, which is completed during the third or fourth year). At other medical schools, students may rotate through required clerkships during the third year. Our core rotations at Michigan are internal medicine (IM), pediatrics, surgery, family medicine, obstetrics and gynecology (OBGYN), psychiatry, neurology, and emergency medicine (EM). Rotation length varies from about one month for the shortest rotations to three months for the longer rotations, and this is school dependent. At the end of each of the core rotations, students are required to take an exam called a shelf exam that covers the clinical material of that field. You heard that right folks: not only are students required to work in the hospital or clinic during the day, they also come home and study for the shelf exam that will be at the end of each of their required clerkships. Medical students will often say that their year of core rotations is the toughest year of medical school for this reason. After completing these core rotations, students can start to pick elective rotations. Thankfully there are no shelf exams at the end of elective rotations. You may hear medical students asking each other “What are you on right now?” This is a shorthand way of asking another medical student what rotation they are currently on. Students are split up and rotate in different specialties during different months, so not all medical students are together on the same rotation at the same time.

7. Switch weekend: The weekend in which a student switches from one rotation to another is often called a switch weekend. Because many of the rotations require students to work six days a week, a two-day switch weekend is often a treat.

via Instagram | @umichmedschool

8. Rounding: Inpatient refers to the hospital setting. Outpatient refers to settings outside of the hospital, such as clinics. Most inpatient rotations (internal medicine, pediatrics, surgery) consist of rounding. Each morning, the entire team consisting of students, residents, the attending physician, and sometimes pharmacists, dietitians, or palliative care specialists will walk around together to check in on each patient. When they get to a patient room, the student or resident taking care of the patient will present information about the patient to the team (for example: What events happened to the patient in the past 24 hours since the team rounded yesterday? How is the patient feeling this morning?). The student or resident taking care of the patient will also present a plan that they think should be carried out for the day. The attending physician will then discuss the plan with the team and make changes as necessary. The team will go into the room and explain the plan to the patient and do a physical exam. The rest of the day is spent carrying out the plans that were discussed on rounds. In order to be prepared for rounds, students and residents will get to the hospital early to pre-round on patients. Different specialties round at different times in the morning. For example, surgical rounds are known for starting very early. If the surgical team is rounding at 6 AM, then a student might have to get to the hospital between 4:30 to 5 AM in order to pre-round!

9. On call and post call: These terms mean different things to different specialties. On call may mean that a person is present at the hospital for a set amount of hours. For example, in the ICU a student or resident may work a 30-hour call where they are physically present at the hospital for the entire time. If it is night time and there isn’t a whole lot going on, the medical student may be allowed to sleep for a few hours in the “call rooms.” Other times, being on call means the student or physician has to be a short distance from the hospital in case they are needed. The term post call refers to the day after someone’s call shift has ended. Let’s say that a medical student in the ICU has just finished a 30-hour call. The medical student got to the hospital Thursday at 6 AM and it is now Friday at 10 AM. For the rest of Friday, the medical student is post call, meaning they have this day off. Usually they will have the following day off as well. As I mentioned, these terms are tricky because they can mean different things depending on the specialty. It might be best to clarify what these terms mean in the context you hear them!

via Instagram | @umichmedschool

10. Evaluations: Students are evaluated on rotations by the residents and attending physicians with which they work. At Michigan, the evaluation system is a number system from 1 to 9. Evaluators can also write comments about student strengths and weaknesses. Students are able to view their evaluations, which are factored into the student’s overall grade for any given rotation.

11. Pass vs High Pass vs Honors: Students are given grades in their core rotations and elective rotations. These grades are important because they are part of the residency application. The grades for required core rotations are made up of evaluations and shelf scores. The grades for elective rotations are made up of evaluations alone because they do not have shelf exams. The grades available are Honors, High Pass, Pass, and Fail. Usually, only a certain number of students can get Honors, and students are usually graded against the other students taking the same rotation at the same time.

12. Boards: Board exams start in medical school. They are also the steps required to becoming licensed as a medical doctor! This includes Step 1 and Step 2.

Step 1 is arguably the most important exam in medical school for residency applications, and they can be a source of great anxiety. This eight-hour exam (yikes!!) covers medical knowledge that was learned in the first two years of medical school, along with clinical knowledge covered during core rotations. You will hear students talking about various study materials (such as Uworld, a bank of practice questions, or Sketchy, a fun series of animated cartoons that helps students learn and memorize) that they use to study. All of these resources, as well as signing up to take the board exams themselves, cost a lot of $$$. Medical schools will usually give students anywhere from one to two months of dedicated time to study, at the end of which students take the exam on the date they scheduled in advance. Many medical schools have their students take Step 1 between the M2 and M3 year although this varies among schools.

According to the United States Medical Licensing Examination (USMLE) website, the scoring system for Step 1 is 1-300 with a 194 required to pass and a national mean around 230. Different specialties have different average Step scores, and this often helps students understand how competitive a certain specialty is and what their chances are to match into it. For example, a “competitive” specialty like dermatology may have an average Step 1 score for matched applicants of around 250, while a “less competitive” specialty like internal medicine may have an average Step 1 score for matched applicants in the 230s. While Step 1 is important, it is certainly not an end-all-be-all for residency applications. Residency programs factor in many data points including Step 1 and Step 2, clinical grades, research, life experiences, residency interview performance, and more. Many students match into competitive specialties each year with Step 1 scores below the average of that field due to the strength of other parts of their application. If reading this paragraph gave you anxiety, imagine studying for and taking this exam. I’m glad it’s over for me!

Step 2: The confusing thing about Step 2 is that there are two of them!

The first one is called Step 2 CK, which stands for Step 2 Clinical Knowledge. While Step 1 focuses more on the academic foundation of science in medicine, Step 2 CK is a nine-hour exam that focuses more on real-world clinical questions. The questions on Step 2 CK are similar to the questions students have seen on shelf exams from their core rotations. Like Step 1, Step 2 is graded 1-300 with a minimum passing score of 209 and a national mean in the 240s. Step 2 CK can be taken at any point in medical school. At Michigan, students generally take Step 2 as M3s within the first six months after taking Step 1.

The other Step 2 is called Step 2 CS. This stands for Step 2 Clinical Skills. This is an exam that tests clinical skills (physical exam, communication, and note writing skills) by having medical students perform these skills on actors called standardized patients. The exam is about eight hours and is pass/fail with about 96% of people passing. It is a requirement for residency applications and needs to be taken before December of the year in which a student applies to residency. This exam is only available in certain cities and fills up fast, so it is important to sign up and pay for this exam in advance. You can find out more detailed information about scoring on the USMLE website by clicking here

13. Away rotations: To apply into certain specialties (for example, emergency medicine or certain surgical specialties), medical students must complete a rotation at another school other than their home institution. These rotations are a fun way to experience a new location and hospital system, and are a good way to make connections at an institution in which a student would like to match for residency. These away rotations, often referred to as aways for short, are known as “auditions” because the medical student is auditioning for a spot in that program’s residency and wants to put forth their best effort. Even if a specialty does not require an away rotation, a student may choose to do one to get to know another school better. If a student wants to do an away rotation, they are required to apply and will choose where to complete the rotation depending on where they are accepted.

14. Sub-I: The term sub-I stands for sub-intern. An intern is a first-year resident. The term sub-I refers to a month-long rotation in which a medical student (usually an M3 or M4 who has completed core rotations and taken boards) practices being an intern on a general inpatient service. These rotations are hard due to long hours and increased responsibility but help prepare medical students to become interns in the future. At Michigan, we are required to complete two Sub-Is. Most students choose to do one ICU Sub-I and one general inpatient service Sub-I. Although we are treated like interns, we have residents that double check our work and sign our orders and notes.

via personal Instagram with permission

15. ERAS: ERAS stands for Electronic Residency Application Service. This is the service M4s use to apply to residency programs. To be able to practice medicine (prescribe medication and earn money as a practicing physician), medical students need to complete a residency program. There are some students who receive their M.D. and then choose to use it in other fields such as business or public health. If they do not complete a residency program, they are not able to practice medicine but still have valuable medical knowledge and skills that could be used in other ways. Fourth year medical students apply to residency in the fall of the year before they graduate. Just like for medical school, medical students fill out applications, write essays, and send scores and grades to a number of programs through ERAS. They are then invited to interview at certain programs.

16. Match Day: After completing all interviews, medical students will rank the programs at which they interviewed and submit a rank list. For example, if a medical student interviews at 12 programs, they will rank the programs 1-12 with #1 being their favorite program and so on. Residency programs will also create a rank list of all of the candidates they interviewed that season. Students submit their rank list toward the end of February and an algorithm matches the students’ rank lists with the residency programs’ rank lists. Medical students find out if they matched via email the third Monday in March and where they matched the third Friday in March at a Match Day ceremony. Fun fact: research on the Match Day algorithm was the basis for awarding the 2012 Nobel Prize in Economic Sciences. This is the same algorithm that sororities and fraternities use as well! Match Day is the day of the ceremony during which M4s receive their match results. Students receive an envelope that they open at a designated time. After opening the envelope, the student can see where they matched! It’s an exciting and emotional ceremony in which the student is joined by family, friends, and their graduating class to find out where they will be living and training for the next few years. You can check out the video of this year’s Match Day at Michigan by clicking here.

via Instagram | @umichmedschool

17. Couples match: The process of couples matching is pretty complicated and nuanced so let’s go through just the basics: Any two applicants matching the same year can link their rank list order to increase the chance of matching in a similar location. For example, a couple may put two schools both in Michigan as their #1 choice, two schools in Boston as their #2 choice, and so on. Each number is linked so that the couple will match at the highest choice in which both applicants match. The couple does not need to come from the same medical school to participate, but they do need to be matching the same year.

18. SOAP: Medical students find out if they match via email the third Monday in March of their graduating year. The third Friday in March is the Match Day ceremony in which students find out where they matched. Rarely, some students will find out on the Monday that they did not match. If a student does not match in the normal match process, they can choose to obtain a residency spot through the SOAP, the Supplemental Offer and Acceptance Program. This program starts the Monday on which they hear they do not match. At the beginning of the week, students receive of a list of unfilled programs in any field across the country. For example, if a student was hoping to match into a certain specialty did not match, the student has the option of looking at unfilled spots for ALL specialties, not just the one into which they were hoping to match. Students can then apply to up to 45 programs on the list. Throughout the week, students interview usually over the phone or through video calls and speak with schools, hoping to obtain a spot. If a school offers a medical student a spot, they are able to accept or reject the spot within a limited amount of time. The whole process moves extremely fast and is a way for residencies to fill unfilled spots and for unmatched students to obtain a residency. Not all students who participate in SOAP will obtain a residency spot because there are more medical students than residency spots. If a student chooses not to participate in the SOAP or does not obtain a spot through SOAP, they have a number of options including participating in the application cycle to residency the following year.

19. Graduation: Graduation occurs in May of M4 year. The graduating medical student gets their M.D. on the day of graduation! There are a few months of time after medical school graduation and before the beginning of residency to enjoy that title before putting it to good work as a resident.

via Instagram | @umichmedschool

20. Intern: All residents are also known as house officers. This term is a broad term to describe someone who has completed medical school and is in training to become an attending physician. An intern is another name for a first-year resident. The first year of residency is considered the hardest due to the grueling inpatient hours, but it is also the first year that someone in medicine will finally make money! The salary for an intern usually ranges from about $50,000 to $70,000 a year, usually varying with cost of living, and increases by a few thousand dollars each year of residency. After training is over, the salary someone makes depends on a number of factors including their specialty, location and workload. Another fun thing to look forward to during intern year: Step 3. Yes there is a Step 3. Most trainees take this exam during residency in their intern year. This two-day exam covers general topics important to practicing medicine and is often used as a data point for residents applying to fellowship. For those not applying to fellowship, a passing score of 196 out of 300 is generally considered sufficient.

21. Transitional year and preliminary year: To understand what these terms mean, let’s back up a little bit. There are two types of residency programs: categorical and advanced. Categorical programs are programs in which you graduate from medical school and then go directly into a program where the intern year is related to your field of study. These programs include internal medicine, pediatrics, general surgery, obstetrics and gynecology, family medicine, emergency medicine, and more. Other programs are called advanced programs. This means that a resident doesn’t begin training in their specific field until year two. The medical specialties offering advanced programs include: radiology, ophthalmology, anesthesiology, dermatology, physical medicine & rehabilitation, and radiation oncology. This means that before year two, the resident will complete one year of training that is called a preliminary year or transitional year. Transitional year consists of a mixture of different rotations whereas a preliminary year is more concentrated in one area of study. The need to do one over the other is dependent on the residency program of choice. Medical students apply to and interview for transitional/preliminary year, as well as advanced residency programs in the same application cycle. If this whole idea is a little confusing, don’t worry about it. Just know that first-year residents are called different titles (intern, transitional year interns, preliminary year interns) based on their residency of choice.

22. PGY: PGY stands for “post graduate year.” You will see it followed by a number. If someone is a PGY-2 this means that the newly graduated doctor is in their second year of additional training after completing medical school. Let’s say a radiology resident completed her transitional year and is now a first-year radiology resident. Even though she is a first-year radiology resident (referred to as R1), she is also a PGY-2.

23. Senior resident: Just as an intern is a first-year resident, a senior resident is a resident that is in their second year or above. The responsibilities of a senior resident include patient care as well as overseeing intern residents. After completing residency, a resident may choose to stay an additional year to complete a chief year as a chief resident. Chief residents are chosen from a pool of applicants and are involved in resident education and administrative duties. In surgery, residents in their final year of residency are often called chief residents as well.

24. Fellow:  After completing residency, a person may choose to do additional training to receive an additional degree of subspecialization. This training is called a fellowship. Residency = specialty, fellowship = subspecialty. Some of the common fellowships you may have heard of are cardiology, gastroenterology, and oncology. To become a cardiologist for adults, for example, a resident must complete a three-year internal medicine specialty residency first, and then complete an additional three-year cardiology subspecialty fellowship. To become a pediatric cardiologist, a resident must complete a three-year pediatrics specialty residency first, and then complete an additional three-year pediatrics cardiology subspecialty fellowship. There are many different combinations of fellowships that can be completed after residency if a resident would like to pursue a certain subspecialty further.

25. Attending: We’ve made it to the end — both of training and this extremely long article. An attending physician is a physician who is done with their training and is working independently.  Attending physicians need to pass certification exams every seven to 10 years to remain board certified. Free at last!

I hope you enjoyed this glossary guide and have a little bit of a better insight into the world of medicine through the medical school lens. Feel free to share this with family, friends, and future medical students!

Innovation is anything except business as usual.

Ask any of my friends here at Michigan what I studied before medical school and they could easily give you the answer: biomedical engineering. Just knowing that something worked was never enough for me, I always wanted to know “how can it work better.” I spent quite a bit of time growing up just taking things apart around the house (this clock, that radio, the desktop, etc.) and eventually settled in at U of M for Biomedical Engineering. Here, I was able to learn the fundamentals of how things worked, and then eventually worked on projects of my own to see how I could make an impact with my knowledge. Like most students, I took the little bit I knew about engineering and attempted to innovate something novel in the med-tech space. Needless to say, I didn’t get quite far on my first few endeavors simply because I hadn’t accessed the right people and resources.

Three years ago, while I was arduously memorizing amino acids for the MCAT and finishing up a summer internship, I got a phone call from current M2s Abhinav Appukutty and Allison Powell, and recent U of M Medical School graduate Leo Li. That transcontinental call set the basis for founding Sling Health – Ann Arbor, a bioengineering design and entrepreneurship incubator that helps student teams address medical issues to improve health care. Sling Health is a national organization, partnered with the AMA, that started in St. Louis in 2013. Here at Michigan, we work to push the needle on student-led health innovation by empowering multidisciplinary student teams to take ideas to reality.

Present and Past UMMS Students on the Sling Health Executive Team!

One of the greatest aspects of being here at Michigan is if you have an idea, faculty from all over the University will support you. Over the past three years, I have had the honor of bringing students AND faculty from across the medical, law, business, engineering, and public health schools together to create a community for student bio-design teams.

A typical year as a Sling team consists first of Problem Day, an event where students pitch project ideas and recruit their team members. Following this, teams present their progress at three design reviews where they obtain both faculty panelist and peer feedback on their progress, as well as financial and technical guidance on how to continue with their project. We’ve been fortunate to have partners in FFMI, the Zell Lurie Institute, the Innovation and Entrepreneurship Path of Excellence, the Office of Tech Transfer, and various Michigan Engineering and Michigan Medicine departments to help guide our project teams. At the end of each academic year, our project teams showcase their work at our Demo Day exposition, an annual exposition of student-powered health innovation from across U of M. Selected Sling Health teams then go on to compete at the National Demo Day event in St. Louis, MO.

When I first started my education here at Michigan as an undergraduate student five years ago, I was extremely concerned about how I would find my “community” of people at such a large school. As I help with preparations for this year’s Demo Day (March 27th!!!), I’m reminded of the wide array of projects I’ve seen Sling teams pursue. From trying to reinvent the Bakri balloon for low-and-middle income countries to a novel mechanism for dental ultrasound, my peers continue to forge ahead with exuberance, creativity and imagination.

Three years ago when I took that phone call, I quickly realized I could help contribute to the empowerment of many more students and projects by starting Sling Health. On reflection, Sling Health has taught me about the power of a multidisciplinary environment in medical innovation, and I am able to use these experiences from multidisciplinary teams in health care as a medical student. As co-president of Sling Health this year, I am honored to have worked with our project team members, and I look forward to seeing what each group brings to the stage for Demo Day!

Únicos, Unidos, y Orgullosos

At the beginning of February, I had the pleasure of attending the Latino Medical Student Association Midwest Regional Conference at the University of Chicago Pritzker School of Medicine. At the conference, I attended different workshops on topics like food deserts/swamps, and trauma-informed care and how it applies to Latino communities. I networked with many Latino medical students from around the Midwest. I also heard a wonderful talk from Dr. Harold Fernandez on his experience as an undocumented immigrant in the United States. His talk was inspirational, and he left us with one piece of of advice (well, two if you count his shameless plug for plant-based diets): he encouraged us to create our own happiness and joy on our journeys to medicine. His message really resonated with me as it matched my own goals that I have been working on recently.

Medical school started off rocky for me. I dived in head first, putting in hours and hours of time to study hard, signing up for tons of extracurriculars, and often neglecting to take care of myself as a consequence. I quickly learned how unsustainable my habits were and how quickly they were leading to burnout. I knew I had to make a change but I couldn’t figure out what I was doing wrong. I soon realized I was neglecting to tend to my own happiness. I was blowing off friends to study, I wasn’t doing fun things outside of school, and I hadn’t yet made an effort to build a community within the medical school.

One of the hardest things about medical school is finding balance. The demands of medical school eat up the majority of my free time so much so that taking a break from studying is often a guilt-inducing decision to make. And that’s what I’ve found myself struggling with since med school started. I can’t even imagine throwing in the demands that some of my classmates have: families, marriage, relationships, commuting, etc. Sometimes prioritizing my studies makes me feel selfish; I’m always letting somebody down. But I’m also often letting myself down, sacrificing my own sense of happiness. It feels hypocritical to sacrifice my own well-being when I will be making a career out of taking care of the health and well-being of others.

But medicine IS a career of sacrifice. It’s a long road to becoming a physician and there are a lot of compromises to be made on this journey. But having seen family members make sacrifices for this career and even watching my classmates on their own early journeys, I have re-committed myself to one principle: I won’t sacrifice my own well-being for anything. Becoming a physician is part of my purpose in life, and I’m working on making the journey towards that goal as meaningful and enjoyable as possible. YES, there will be sacrifices to be made, but there are little things I can do now to ease the path for myself.

Spending the weekend in Chicago with my classmates and getting the opportunity to meet other Latino medical students, I found myself so grateful for the opportunities and the wonderful people in my life because of medical school. Coming back to Ann Arbor after the conference to immediately study and take my GI final exam was rough, and I asked myself “do you regret going to Chicago this weekend?” I missed out on CRUCIAL study time! No, I don’t regret it because it was such a fun experience! I understand GI physiology and pathology to the best of my abilities, and I don’t regret losing the time to really know the ins and outs of copper metabolism. I also don’t regret going to trivia the other week with my friends because I had a great time (I’m usually so bad at trivia but I knew the answers to THREE questions!! I carried our team honestly). I don’t regret participating in Biorhythms (the medical school dance performance) because it was some of the most fun I’ve had since starting medical school. I don’t regret taking the time to go off campus or study outside of Taubman every once in a while.

I also don’t regret my involvement in extracurriculars, including signing up to be the social chair for the Latino medical student association because it means I get to bring that very excitement and energy to my classmates and work on building a community. I’ve had the pleasure of getting to organize mixers and potlucks, and watch my classmates enjoy themselves while building the friendships that I wanted to get out of medical school. I feel so proud to be a part of the Latino community in my class and attending the Midwest regional conference only solidified this for me. It made me feel recommitted to my identity and my purpose.

Now I tell myself if I’ve gone the day without a genuine smile or laugh, it probably wasn’t a very good day (which is OK, not every day in medical school is going to be amazing or ~fun~). But I’m working on creating the spaces, the community and the experiences to bring this kind of excitement and happiness into my life. I’m learning how to balance fun and work and how to prioritize myself in order to really give my all to my work and to my community. I am excited to see what other experiences the rest of my medical school journey will bring me 🙂

Maintaining a Passion for Dance During Medical School

A few months ago, my M-Home House Counselor shared some advice. To paraphrase, he said during medical school you spend a lot of time studying, so finding well-being may mean prioritizing some activities that truly make you happy, and then scheduling studying around those activities. That morsel of advice motivated me to find ways to incorporate one of my lifelong passions, dancing ballet, into my schedule.

Luckily, I did not have to look far to find ways to dance. Most importantly, I had the opportunity to choreograph a ballet dance for Biorhythms, the biannual student-run dance performance (proceeds from the show are donated to charity). To prepare for the performance, I met with medical school peers for an hour each week to teach the choreography. It felt absolutely incredible that I was able to grow as an artist and choreographer while in medical school. Furthermore, the friendships that my classmates and I formed while dancing (and laughing) made the weekly study break priceless.

A pre-Biorhythms performance photo with my friends.

In addition to Biorhythms, I have attended a few ballet classes at a local studio. Recently while practicing a difficult ballet combination, I smiled thinking about how my movements related to the biochemistry and anatomy that I learned in lecture. I felt the burn of lactate build as my muscles used anaerobic metabolism, and I named the muscles in my back that helped me maintain correct shoulder placement. Already, I was seeing through the lens of medicine, and medicine was enriching my understanding of dance!

Finally, participating in an event that shared the joy of dancing with patients was particularly rewarding. Last year, my friends and I performed excerpts from the Nutcracker ballet during a dinner organized by the Child and Family Life team at University of Michigan’s Mott Children’s Hospital. It felt very special that our dancing could bring smiles to young patients and their families. This year, that tradition continued. After a long day of lectures, I walked over to the children’s hospital and felt my own sense of joy as I watched my friends spread the magic of dancing to patients and families.

Long before I was a medical student, I was a ballet dancer. Now, I am so thankful to have opportunities to explore intersections of my interests, and to have a support network that encourages me to continue dancing as I develop into a well-rounded future health professional. Wherever the journey of medical school takes me, I am excited to be dancing into this next phase of my life.