CaRMS wackiness

When med students in Canada are entering their final year of study, they apply through CaRMS for their residency - the Canadian Residency Matching Service.

To put it mildly, it's a terrifying time for students in the 2011 classes across Canada. Some have been padding their resumes since they got their acceptance to med school oh so many moons ago. Others have just realized that they should have done research/picked a specialty/vaccinated a small country before now and are currently scrambling to fill their CV with astounding accomplishments. It's a bit goofy.

Back in the day, Canada had a brilliant way of doing things. Rather than being forced to choose our specialty right out of clerkship, medical students went into a year of internship. This was spent in a series of departments - like the clerkship year was for me - but with more responsibilities. Following this year, the students matched to their residencies where they focused their studies. Some docs went straight from this year to practice (general practitioner), while specialists specialized.

Problem was that eventually docs wanted to specialize early and did 'straight internships' that set them up for their specialty. Clerkship was developed to give medical trainees a way to see aspects of medicine they may not otherwise have access to. Unfortunately in the short amount of time allocated to students in clerkship per rotation, it is difficult to get a good idea of what the specialty is really all about. For example, my deliver room rotation is only 2 weeks long. We had 1 woman deliver a baby during business hours this week. I couldn't possibly decide I wanted to be an Obstetrician based on that.

This was a problem when the rotating internship year was in practice too, now it's moved forward a year or two.

While I accept that the one year of rotating internship is insufficient to train a modern physician to be able to practice anything, having just one year to choose our future is also insufficient.

At my school we have four months in our last year that is just for electives, a way to pad our CaRMS resume and discover more about the specialty we have chosen to pursue or rule out. My classmates started setting up these fall electives in January to ensure their application to residency would be shiny.

This is a great system for those students who are born knowing precisely what they want to do AND are correct. Some in my class however found out half way through (or later) in their clerkship year that they were not pursuing the path they should. They fell in love with a new specialty and are scrambling at the last minute to get electives and research set up in this new specialty.

I don't have a solution to this aside from starting our residency years split into two camps, medicine and surgery. Set up a rotating year based on this, then apply after our R1 year to the specialty of choice.

first night of call on obs/gyne

First thing my resident said to me... "oh, you're the clerk? I thought you were someone important".

huh

Surprisingly it got much better after that. I helped deliver 5 babies, assisted a c section, a salpinectomy and did 3 crazy consults in the emerg. Fun!

old school

The outpatient obs/gyne clinic is cooled by fans and some in window air conditioners.

Because the patients you want feeling warm are pregnant and menopausal women.

just heading in

Obs/Gyn clinic starts at 1pm. I will not be there early. Not a fan of this rotation.

studying on the beach

yay summer!!

Losing track of the big picture

Something that happens quite frequently, especially in pediatrics is a lack of acknowledgement of the child as a person. This unfortunately also becomes a lack of acknowledgement of the parent as a person.

As a team of consultant, senior and junior residents and medical students, a herd of eye balls moves room to room in the hospital. The herd parks outside the patient's room and talks about the most recent blood work, biopsy results or imaging. They engage in an intellectual discussion about the findings and what they will mean to the patient's prognosis or treatment plan. They enter, usually without knocking and
discuss the plan for the day. Hopefully, this discussion includes the patient and family.

Families are often starved for a sense of being a part of what is happening. They can feel like animals at the zoo. They deserve better.

Medical students often feel like we are bothering the family when we want to ask more questions. There are lots of things that these families can teach us and allowing them to be medical teachers in a teaching hospital allows them to feel less out of control of the situation they are in.

Obviously not every family feels this way. The easiest way to find out is to say something like "hi, I'm the impostor, would you mind if I learn bit more about your child, her illness and what's been going on for your family?". If they have had enough, they will either say no or answer in short terse phrases. Thank them and wish them well.

If however they start to glow and want to tell you everything about the presenting signs of illness and the path taken to get them to your hospital, listen, ask questions and enjoy the experience. I've learned so much from parents.

By the time the child is worked up and on the floor, the reason their parents first brought them in can be lost in the shuffle. Leukemia can first present as sore feet. Cardiac arrhthmias may act like nausea and vomiting.

I've also learned that kids hate a 'pity party'. They want you to ask what sports they play, what video games they have, compliment them on their pajamas. They hate it when we come in, head tilted to the side and with a gentle sigh ask how they are feeling. Treat these kids, especially the cancer kids, like regular kids. They'll tell you if they need something else.

Final lesson, introduce yourself. Telling people your name seems only fair when you know everything about their child. It lets them know you see them as a person rather than just a file.

And frankly, not doing so is just plain rude.

ICU, kind of awesome

Stupid Shozu isn't working again so all my posts from this week haven't shown up.

I've been in the peds icu for my selective. I was really surprised by how few kids have actually been so acutely sick they needed the one on one nursing. It's mostly been a holding pen for the peds floors upstairs.

When acuity does happen, it's exciting. Everyone has their job which they perform well. I was told last week that it wouldn't have mattered if I'd forgotten to pass on that a blood sugar needed to be monitored because "this place runs itself". It's kind of true.

There are many protocols in place to give nurses guidance when orders haven't been written yet. The nurses pretty much run the joint. And
love their job. They have been teaching me all kinds of great stuff like physical findings on kids with congenital disease and why certain feeding protocols are in place.

We start our days by doing handover from the night before, this is done around a table with residents, consultant, nurses and RTs there. Then the residents and I pre-round on our patients. I always get the very well patients so I'm usually done quickly. Then we do xray rounds, looking at the most recent chest films before we round on the patients and potentially change their orders for the day.

Then it's lunch.

The afternoon is spent doing physicals on our patients and writing complete notes and doing teaching if we have a great (read learner
friendly) consultant.

I love ICU, but I think I need more doing and less talking in my days.

looking forward to the weekend

I'm due for some relaxing and kitty snuggling. While I'm loving paediatrics, I really need a little break.

working in scholarship essays

I hate talking about my good points. These scholarship essays expect us to go on about how fabulous we are. The only award I've won so far was nominated by someone else (though I had to give her some pointers). Even then I needed to write my own essay. It's a process that is sometimes discouraging. While I've done quite a bit at my school, I've done very little for the community at large. I simply haven't had time. My thought was I'd take care of my classmates so they could take care of everyone else. Now it seems to be coming back to haunt me.

I sincerely don't think I could spend more time outside of studies involved in activities. I really might blow up. I wonder who will be the people in my class who win all these awards. I hope it gets spread out. My class is fantastic and each deserve an award for something or other.

Please just let me win this one though!