Ceremony

Graduation day itself was a whirlwind of activity and emotion. I've always been a crier - especially when a large group of people is doing something together (dancing, singing, chanting, swaying). When we sang the national anthem as a class, I cried and couldn't sing because I kept thinking, this is the last time we're going to sing together. As a class, we are incredibly talented and always put on a great show at our annual variety show. Singing with the class has just been part of school.

We were accepted by the vice - chancellor to be graduates from the class of medicine (phew) officially making us all MDs. That was a bit freaky and still makes me nauseous when I consider what that really means.

The ceremony itself was lovely and suited our class perfectly. There were irreverent moments and times of great solemnity. It was exactly what I had hoped for.

Until the recessional tune was started by the string quartet.

My class has always gone berserk for Journey's Don't Stop Believing. It's a huge part of what I think it is to be a 2011. We all run for the dance floor and fist pump to the song whenever it's on in whichever bar we've taken over.

When the string quartet started playing Don't Stop Believing, I was treated to our class singing together again. I tried to sing along too, but frankly, that's incredibly hard to do when one is bawling at the same time. It was the most wonderful surprise I have ever experienced. I'm still a bit in shock that the perpetrators of the surprise were able to keep it from me - I thought I knew just about everything that was going on in this class. Nothing could have made me happier and sadder at the same time.

Graduation Day

In 2007 I recited the Hippocratic Oath with a huge group of strangers.

Today, I'll repeat the Oath, but this time I get to say it with the strongest, funnest and most amazing people I've ever had the opportunity to get to know.

This is a huge step for us that we get to take together again. It's heartbreaking though that every step after this will be taken separately.

My class has been my support and my burden. They've been my friends and my pains in the ass. There are members of the class I will sincerely not miss, but only a couple. Despite our best efforts, I'm sure that we will not be as close over the coming years as we wish we could be.

This is going to be a bittersweet day - celebrating our amazing accomplishments but also mourning our close friendships. There is something precious in the day to day interactions that I've had with my class over the years - getting to know everyone's quirks, their dreams, their food preferences and being able to smile and say hi to 144 people and having that reciprocated.

My partner keeps referring to my class and the medical profession in general as a cult. I get that. We use a "secret" language, we are bound to one another tightly through extraordinary circumstances. Mind altering substances (mostly tequila) are used liberally. We see each other and medicine in general as the most important things in our lives next to our families and own health. We follow the doctrine of evidence based medicine (state your source!). We were kept together in close proximity during our clerkship training, very much like the compounds used to prevent cult members from seeing anyone in the outside world.

But I digress.

Big day. Big big day.

One version of the Oath:

The practice of medicine is a privilege which carries important responsibilities. All doctors should observe the core values of the profession which centre on the duty to help sick people and to avoid harm. I promise that my medical knowledge will be used to benefit people's health. They are my first concern. I will listen to them and provide the best care I can. I will be honest, respectful and compassionate towards patients. In emergencies, I will do my best to help anyone in medical need.

I will make every effort to ensure that the rights of all patients are respected, including vulnerable groups who lack means of making their needs known, be it through immaturity, mental incapacity, imprisonment or detention or other circumstance.

My professional judgement will be exercised as independently as possible and not be influenced by political pressures nor by factors such as the social standing of the patient. I will not put personal profit or advancement above my duty to patients.

I recognise the special value of human life but I also know that the prolongation of human life is not the only aim of healthcare. Where abortion is permitted, I agree that it should take place only within an ethical and legal framework. I will not provide treatments which are pointless or harmful or which an informed and competent patient refuses.

I will ensure patients receive the information and support they want to make decisions about disease prevention and improvement of their health. I will answer as truthfully as I can and respect patients' decisions unless that puts others at risk of harm. If I cannot agree with their requests, I will explain why.

If my patients have limited mental awareness, I will still encourage them to participate in decisions as much as they feel able and willing to do so.

I will do my best to maintain confidentiality about all patients. If there are overriding reasons which prevent my keeping a patient's confidentiality I will explain them.

I will recognise the limits of my knowledge and seek advice from colleagues when necessary. I will acknowledge my mistakes. I will do my best to keep myself and colleagues informed of new developments and ensure that poor standards or bad practices are exposed to those who can improve them.

I will show respect for all those with whom I work and be ready to share my knowledge by teaching others what I know.

I will use my training and professional standing to improve the community in which I work. I will treat patients equitably and support a fair and humane distribution of health resources. I will try to influence positively authorities whose policies harm public health. I will oppose policies which breach internationally accepted standards of human rights. I will strive to change laws which are contrary to patients' interests or to my professional ethics.

Graduation Festivities

I'm going to skip over the MCCQE and what I've been up to since writing it, with a promise to come back to it later.

Tonight our convocation festivities start.

One of the guys in my class said that he thought his family was making a much bigger deal of this than he thought it was worth. He recognizes that getting to this point in our lives is huge, but from his perspective, just another step.

I definitely get that. I think that these celebrations are a way for us to share what we've been doing for the past 4 years with our family and friends.

From our perspective, not much changes from when we first got our white coat four years ago to when we get our parchment tomorrow. It's true we've grown and learned, but we have been doing this at incremental steps so that it doesn't seem like much has changed. It's true that there has been work, but there's been fun and we've been doing it as a class with whom we've become close. It's hard to think about our day to day work as difficult when you're doing it with friends. Plus, we still need to start our residency in July which means packing, moving and trying to not look like an idiot on our first day. Our focus is far ahead to what is yet to come.

Our families on the other hand, have been dreaming of this day for longer than we have, even if they don't want to admit it. They are so proud of what we have done, seen and learned. They recognize the changes in our personalities, appearance and confidence. They are excited to see the class again since not seeing us all together since year 1. There have been few opportunities for them to share our accomplishments with us. They are excited to take photos of the new doctor in the family, to shake our hands and give us hugs. And to brag to everyone who will stand still for more than a few seconds to hear that cousin impostor is graduating from med school on Friday.

Our family and friends are proud of us.

I can't blame them really. I couldn't be more proud of my class.

More Emotional than CaRMS...

This is our last week of official classes. It's been interesting seeing how we all react to this major change in our lives. There is a lot of regret. People who haven't been hanging out with each other throughout these 4 years are regretting not getting to know each other better. Some of us went out for brunch on Sunday following a clean up. This was a real mixed bag of students - different groups who don't normally hang out. We found ourselves lingering long after brunch was done. We were having fun and didn't want it to end.

We are marking the events in our lives and able to say, this is the last time I will ... with my class. This is causing some extreme emotions.

Some are crying at the drop of a hat. Others are trying to form tight friendships with their new group of residents. Some are burning bridges (a strange way to make sure that it's OK they are leaving the province since "they hate everyone"?). We are smiling more, putting up with less. Saying the things that we are thinking, going to events that we don't normally attend. Cameras are flashing almost constantly.

For myself, I know that my emotions are very mixed. I've been seeing lots of the under-years and listening to them tell me why they'll miss me and my class. There are things that I still haven't done at school here. I don't like leaving projects half done and leaving this school for residency is going to be hard.

I've been the brunt of many people's anger and inability to deal with the stresses in their life. They are experiencing a lot of changes and pressures (MCCQE, finding new home for residency, filling out the piles and piles of paperwork for residency, distancing relationships, completing assignments, writing end of course tests, rehearsing for our variety show). It's odd that they seem to feel they are the *only* ones going through these stresses and therefore deserve to act like a child. I recognise that these changes are a difficult part of becoming an adult and am trying to be patient, but it gets harder and harder every day.

I've also been targeted for gush sessions where people tell me they don't know what they'll do without me next year. But these are the same people who are inviting everyone around me, but not me, out for beer. It's a little hard to take.

My class has been a family. There are brothers and sisters that I want to smack upside the head, others that I am incredibly proud of and want to snuggle on the couch with. We have had ups and downs together and have mostly made it through - I can imagine almost anyone in my class coming to pick me up on the 401 if my car was to break down.

Someone has called this emotional roller coaster the effect of graduation goggles. Everything has an expiry date on it now.

This will be a rough week on my mascara.

Post Match

This week has been incredibly emotional so far.

The day of the match included celebrations, crying, disappointment, drinking, dancing, hugging, crying and screaming.

Did I mention the crying?

It's hard when you are a type A personality who is used to having everything that you've worked for given to you to suddenly be given your second, third or 39th choice. Or even worse, to not get any of your choices.

Your world suddenly falls apart. Things you thought were true are no longer true. The beautiful bubble of perfection you have been living in pops and everything comes crashing down.

For some of us, the crash was largely in our heads. There was little really wrong with what we have matched to, it just wasn't our first choice.

For others, it meant taking a position provinces away from their partners or not matching at all.

It's been difficult for some members of the class who matched to their number one spot. They want to jump up and down and scream and laugh and be happy all the time. But they feel constrained by their love of our class and not wanting to hurt anyone who is less happy.

It seems unfair that their joy needs to be constrained.

'Twas the night before CaRMS Match

And final year medical students all across Canada are stressed, drunk, taking sleeping pills or oblivious.

Though I know that any of the programs I ranked will be fine, I really want my number one spot most. Anything in my top five will be OK. After that though, it's not as pleasant.

I know I can make a home anywhere and I can direct my own learning wherever I am to fulfill my own goals. But, I would really like to be near friends again, and in a comfortable community. I want to feel like I'm putting down roots not getting ready to move on again. I've always been one to live in the now, not assume that "my life will start after medical school" or at some other distant point in time. Life is what I'm living now. It's just time for me to also look to be planning a future. These are big, grown up, "I'm almost 40" thoughts.

And since everyone knows what my top pick is, will I be dealing with overly sympathetic eyes tomorrow if I don't match there? What if I do end up in my 24th spot? How will I tell everyone?

And they are keeping me awake tonight.

sleepy cat says no school please

I woke up to my monster cat sleeping on top of me. All attempts to get up for class have been thwarted by purrs and sheer gravity.

Post Rank Stress

Now that our rank order lists for CaRMS are in you would expect the stress level in the class to decrease. It has not.

On the day the ROL was due, people were still flipping around their top three choices of programs. Some were even still deciding their top choice of specialty. It was a stressful afternoon. I was threatening to glue classmates' fingers to their bums so they couldn't change their choices again.

Some poor folks cried, others threw things, it just wasn't a good day for us.

Since then, we are trying to come up with as many things as we can think of to keep us busy at night to prevent us from losing our minds. It's hard to not second guess the choices we've made. How can we know that we've made the right choice?

13 days between submitting our ROL and finding out our results is cruel and unusual punishment.

Wanna Wanna Sweetie!!

I'm back to classes now in preparation for taking the MCCQE. There is an enormous amount of information we should have ready to complete the exam successfully. It's a bit terrifying to read through some of the objectives that I should have at my fingertips.

The fact that I've made it so close to the end of my medical school degree and feel this unprepared for the exam is unsettling. This is when the imposter portion of my brain kicks in and tries to keep me from focusing. One of the problems with reviewing for this exam is that you have many many options. There are books, including the Toronto Notes and the "purple book". There is a large number of US books too - USMLE Step 2 - and flash cards. I have so many books that can be useful already on my shelves too. Our class has also arranged review classes two nights a week. We have a large number of old exams that I can review.

There's a character that Terry Pratchett wrote, a little boy Wentworth who loves candies. He cries and cries for sweets during the books. Tiffany Aching is his older sister and she describes an episode at Wentworth's birthday where he is surrounded by sweets. He is so overwhelmed with the options that he is unable to begin to eat any of them. Wentworth sits, surrounded by the cakes and candies crying "wanna wanna sweeeetteeee". His mother is only able to squelch the crying by putting a bucket on his head and taking away all but 3 of the options. With the reduced number of options Wentworth is able to happily nibble away.

I need someone to put a bucket on my head.

Or even better, take away my study options.

The Unmatched

So what happens if your letter to Santa, err, CaRMS comes back unfulfilled? What if you are one of the dreaded unmatched candidates??

Last year, 3.7% of candidates went unmatched - at least one per school.

The class of 2011 will find out on March 7, 2011 where we are going or if we are re-entering the CaRMS process.

Why candidates go unmatched can be for a number of reasons. If all the programs I apply to are filled up by the time I get that far down my list, it could be me (see “Ranking”). It’s not that I’m necessarily a terrible candidate, just that at some of the crucial points in the algorithm other candidates were better.
I’ve known candidates who did not receive interviews because of something as silly as their reference letters were not in on time.
Other candidates are incredibly specific about where they are applying to residency. If you only apply to one specialty in one program, you better be a crazy rock star or incredibly lucky.
Some candidates have made it through medical school despite being a menace to society - these are rare - and are found out by the residency committees who don’t rank the students to come to their school. The committees are trying to find people they can work with.
Last year, Gen Surg had the highest number of unmatched candidates (13), followed by Anesthesia (11). Family medicine, always touted as a safe bet, had 4 spots unmatched. (these numbers are looking at the first choice of specialty candidates were applying to).
58% of the vacant spots in residency last year were in Family Medicine (176). General surgery had 3 vacancies, anesthesia had 2. In these cases it can be that the programs were picky about their applicants or applicants hadn’t ranked the schools. Or any combination … voodoo!!

If you have ranked any programs, CaRMS will automatically enter you into the 2nd iteration. In this iteration, there are fewer candidates who are Canadian Medical Graduates, more International Medical Graduates and fewer spots overall you are competing for. As a rule, CMGs do better than IMGs if only because we understand how the Canadian Health care system works.

This is the summary of vacancies to be filled in the second iteration in 2010 Every year is a little different.

The 2nd iteration goes faster than the first but is otherwise the same. After finding out on Match Day that you are unmatched, you go over your portfolio to make sure everything is in, apply to the schools and away you go. I’m not sure you interview again, it’s not explicitly said on the CaRMS website Then your new Match Day is April 13.

If the gods are not smiling on you, as sometimes happens, you end up in the scramble. Essentially, CaRMS only takes you through the second iteration and it’s up to you to take it from there. Our Student Affairs office helps students who reach this point. The students find out which programs still have vacancies and talk to them directly about taking a spot. Again, it’s not just the duds who are left unmatched at this point, it’s also the incredibly unlucky and those who have just made poor choices.

I prefer to emphasize the unlucky though - I feel it will bolster my karma.

Rather than enter the 2nd iteration though, some candidates decide to do a year of research to beef up their resume. There are pros and cons to this. Obvious pro is a beefier resume. Cons include the fact that the longer you are away from clinical experience, the harder it is to match (can’t find the stats, just remember that being emphasized at a conference CaRMS talk I was at). When you are away from med school but not in residency yet, it’s difficult to have insurance covered and so you are not permitted to work with patients. Yuck.

What must be almost as bad as not getting the program you wanted, is having to tell your classmates that you’ve gone unmatched. One of the past year’s plays was about going unmatched. It’s a very scary, very real thing. So many assume that they will get everything they want - it’s been happening for them their entire lives, hard to imagine it would just stop now.

I hope that any folks in my class who do go unmatched feel supported by the rest of the class.

Ranking

Starting during the CaRMS interview period, we are able to rank our programs but CaRMS doesn't lock in our choices until February 22nd. We can stew in our choices and make changes until then.

This is where the voodoo really starts.

CaRMS insists that the student is always the one who comes out on top and that they are able to match most students with their number one choice. Last year, 64.6% got their top choice, 2.9% got their 7th or lower.


Here’s how I see it happening for my friends applying to urban family.
Friend 1 wants to rank Mac - Hamilton, Mac - Brampton, UofT - urban, UWO - London, UWO - Regional (that’s it, he’s ballsy and only applied to 3 schools).

He is a good applicant, not stellar though, and will likely show up on each of the school’s rank lists unless he told one of his jokes in the interview, then God have mercy on his soul...
For this friend, having a pool of potential partners is more important than the program. Fair enough given that most family programs are essentially the same, it’s just the location that is remarkably different.
He will rank 1 - UofT, 2 - MH, 3. UL, 4. MB, 5. UR

When CaRMS goes to match him, they will first put him in the pool of people who picked UofT urban. There are 106 spots available for Canadian Medical Grads, so his odds are good. But if more than 106 people ranked UofT Urban first, my friend needs for UofT to have ranked him higher than a bunch of the others applying. If he is ranked 120 and UofT gets to their 150 spot of applicants, he’s in. If UofT only gets to 110, my friend goes to his second choice instead.

Here’s how it happens with me applying to my many (many) rural programs. Because the rural programs are so small, it may be easier to understand. Also because they are so small, it’s absolutely terrifying for me.

I’m ranking 24 programs all together (at 6 different schools). My top 5 programs have 22 spots total. Very different from my friend’s top 5 which has almost 300.
A - 2 spots
B - 1 spot
C - 5 spots
D - 1 spot
E - 13 spots
So my top 5 programs span 2 schools who have ranked me. At the risk of sounding conceited, I’m a strong candidate. I’ve been to the conferences, done the FM research, sat on every FM committee I could plus all my usual extracurriculars. On the whole, not a sucky candidate. I’m hoping it’s good enough to make it into their top ten.

Program A has 4 people who, like me, are gunning for it and will definitely rank A as their #1. There may be more but my sources weren’t clear. If any 2 of the 4 rank higher than me, CaRMS will look at my number 2 spot. If I’m lucky, no one else will want B as number one and it will still be in the running. Then I’m competing against all others who have B as #2. If that school ranks me above all others with it as #2, I get B. If not, I’m moved on to C. And so on.

It’s easy to see that if this continues, given how small the rural programs are, I could potentially end up at my 24th choice.

The trick with the ranking though, is to ignore what the schools are going to do and rank the programs according to what you want. Easier with the big programs than the small in my opinion... The other trick is to only rank the programs you can honestly see yourself in. Even though I have a program ranked 24, it would still be a good program for me. It’s clearly not my favourite, but if sent there by my binding CaRMS contract, I’m OK with it.

There are some programs I’m just not ranking because I don’t want to be sent to them. Worst case scenario I’m sent to the 2nd iteration and start over again.

The Interview Tour

The interviews account for a certain percentage of our overall score that the schools use to rank us. How much they make up depends on the program and usually we have no idea. Personally, I think voodoo is involved.

The goal of our interviews (and everything to this point actually) is for the schools to want to rank ME number one. ME ME ME ME. That makes it much more likely that I will get the program I rank number one. I’ll explain this in a post about ranking.

Prep for the interviews includes collating all our best stories from our clinical experiences. We want to make sure we have examples of good and bad team interactions, leadership, earth shattering awareness that THIS is the specialty for us, strengths, weaknesses, difficult ethical experiences, conflict with a “superior” and anything that shows that we’re not the babbling idiots we usually feel like we are. We practice answering questions but have to be careful not to practice too much because it tends to make it sound too rehearsed.

We buy a suit, or two, and worry about which shirt to put underneath.

Then the actual interviews begin. CaRMS interviews take place in the last week of January to February. In Canada, winter can be less than reliable. Students in my class have had their flights and trains cancelled. Roads have been slippery. I haven’t heard of any interviews that had to be cancelled for weather, just plenty of stress in getting in on time.

The kind of interview you get depends on what specialty you are applying to. Since I want family, my questions usually went something like this:
1. why family?
2. what skills do you bring to family medicine?
3. what challenges do you see family docs may have?
4. challenges the residents may have?
5. tell me about a good/bad team experience and what you learned from it
6. tell me about a particularly difficult clinical encounter and how you feel it has shaped the doctor you will be
7. why this program?
8. tell me about this thing you wrote down on your cv...
9. tell me about your strengths and weaknesses
10. tell me about yourself (very few actually asked this)

Family is a very chill interview - they try to make it more like a conversation so they can get to know us and figure out if we are the kind of person they can work with for the next few years. I was always interviewed by a doc and a resident in a clinical exam room, except one where I was in a board room of a hotel. The interviews lasted 10-30 minutes, with an average of 20.

Friends in other specialties had different kinds of questions though. My friend applying to gen surg was asked “if you were a salad, what kind would you be” - what?? Another in obs gyne was asked multiple ethics type questions and had MMIs rather than just hanging out with the one group. Safe to say that the type of interview you will get really depends on to what discipline you are applying.

With family and some of the other disciplines, there is a morning orientation when they go over the program in detail and why the residents *love* to be there. Family is split into programs on multiple sites so we always get several lecturers to talk to us about the different programs available through the school. This can take hours and is why family med orientations take so much longer than the other specialties. On the upside, we often get at least one meal out of the deal, usually two.

The orientation is followed by the actual interviews. Having such a long introduction to the day has the odd benefit of lulling us into a close to coma state so we are not as stressed about the interview itself. Or maybe it’s just me.

The interview tour has brought out the best and the worst in some people.

Some are acting like competitive children, ignoring conversations started by students from other schools. Others are actively trying to psych one another out. Still others are so insecure in their own worth, they are lashing out at those around them.

The majority are just trying to get through interviews in one piece.

The best though are sticking up for one another. Sharing hotel rooms when the weather is terrible and requires colleagues to stay in the city an extra day. They are meeting the people from other schools and getting to know them as well. Some even help up clumsy candidates when they fall all over the ground...no one I know I’m sure...

They are being the genuinely nice people they are. These are the classmates I am incredibly proud to know.

I was definitely not immune to the stress. The night before one of my interviews I had a dream that the school had decided to get rid of the usual Q&A and make it a spaghetti eating contest instead.

I decided it would be easier to not rank that school than deal with the insanity.

Interview Invitations

Invites for our residency invitations begin coming out a day or two after our CaRMS applications are submitted. Some programs that don’t fill up regularly in the first iteration will send invites before even going over the apps. These are lovely to receive - to know that you will indeed get at least one or two interviews!

Then you wait for the programs you actually want to go to.

These are scary days. One program in particular was a bit evil to me. They sent out invites to one half of the alphabet before the second. Five days before. I thought for sure that despite all my efforts to learn as much as I could about Family Medicine and all the time I’d spent on research and picking electives, not to mention the application preparations, were all in vain. People who were, in my awful opinion, less worthy than I was for an interview. I was terrified to think that those people were getting interviews and I wasn’t. Did my references fail me? Was I an undesirable candidate after all?

Interview invites came in over a month or two. Some of the people in my class didn’t get invites until the week before the CaRMS interview period had begun. That’s scary.

Once the invites are in, you need to decide how to schedule them all efficiently. You can literally be flying from Halifax to Vancouver to Montreal to Calgary. Expensive, especially if you have more than one specialty you are applying to. Some of the people I know have close to twenty interviews. Trying to coordinate all these interviews in all these cities can be confusing and really make you wish you’d paid more attention in computational mathematics.

There are emails and phone calls to make to program secretaries as you beg them to fit you into another day to maximize the number of interviews you can get to. Online purchases of flights, train tickets, bus tickets, reservations of hotel rooms and B&Bs. Deciding whether or not to room with classmates - in the program or not? Will they stress you out or make you feel more confident? How much money will you save really?

Our credit cards all had an incredibly workout in the weeks leading up to the CaRMS interview period.

I mentioned before that I decided that going across the country was not as important for me as saving the money for a trip in the future. It was a difficult decision but enough people were doing the same thing that I felt convinced that it was going to be safe for me to just apply within Ontario. Especially since that’s where I plan to stay.

But I was lucky enough to get invites to each program I applied to. Not all my classmates were as lucky and needed to do the travelling.

They are becoming very competent travellers. One friend has perfected the art of packing to be able to pack all she needs for a two night stay and an interview into one backpack. Impressive no?

The CaRMS Process; Years 1-4 prep

For the uninitiated, CaRMS is a mysterious thing. For those of us going through it, it is also mysterious, but with the extra added benefit of being terrifying.

Here’s how it works...

In first year of med school, some of us decide what we want to be when we grow up. Others don’t. Some of us have known for ever. Some are gunners for their particular specialty and start doing research in the first year and setting up appropriate observerships. We all join clubs and go to conferences and speeches and try to learn as much as we can about what we can do in the future.

In second year, many students who hadn’t previously chosen what they wanted to do begin to have an inkling. Some of these students see what the gunners have been doing and freak out, thinking they need to get to work as well. Some of the gunners decide they must have been nuts and start to change their research focus to something else. Other students remain comfortable in not really knowing what they are going to do since that is the situation of so many others.

In third year, lots changes. We experience the clinical side of medicine and rotate through different core specialties. We also need to choose our ‘electives’ for fourth year which will display our desire for one specialty over another. It’s a stressful choice to make for most of us. We need to make sure that our faces are seen at all the programs we plan to apply to during CaRMS. But most exciting is when we figure out that everything we’ve been planning is for something we don’t even want to do anymore.

So many of my classmates figured out in the last few weeks before beginning electives that they were looking at the wrong specialty. This is exhilarating and terrifying. Electives need to be rearranged at the last minute across the country but doing so means that you are showing so much passion for a field of medicine they now love. It’s something that we are told will happen in first year but we never believe them until it happens.

In our final year, it’s time to enter the CaRMS process. We find consultants who will write us reference letters, then dwell on whether or not these consultants were the right choice. Will they say something that the programs will take the wrong way? Which consultant will put us in the best light? Did I really spend enough time with this person for them to know enough about me to write a good letter? Will they resent me asking?

We need to choose which specialty (s) we are applying to. Should we back up with a less competitive specialty just in case? Should we apply to all the schools in Canada? Am I planning on couples matching? Can I stand to live in these places for years?

We write letters and essays about why we’ve chosen our specialty, what we’ve learned about ourselves and why we want to be in the program we’ve applied to. Then we fret about whether or not we have said the right things, that our examples are beefy enough or that we have accidentally left the wrong specialty or program in the letter when we copy and pasted the lines from one letter to another.

We also need to chose which comments from our third year evaluations will best communicate the type of resident we will be. Which of the ‘code words’ used by the consultants are most flattering.

All those clubs, conferences and research need to be pared down into something that will fit into the CaRMS prescribed CV template. Choosing which should be included and which discarded is something else entirely. Anything included is fair game during the interview. We want to look well rounded but not flakey, responsible but still like we’d be fun to work with.

The week that we need to finally submit our application is terrifying as we go over everything again and again to make sure it’s all there. Birth certificate, photo. letters, essays, transcripts.

Submit.

Wait for the interview invitations to come.

of course I remember cousin Imposter

She's a doctor. She fixed Ryan's broken arm. She played clay with us.

What a wonderful description of me!! I wish I'd learn this before I went on my interviews...

things you hear when talking to people who usually wear scrubs or jeans

student 1: epic wipeout on my way in for interview, sprained my finger and probably my ankle
student 2: oh no! Is your suit OK?

student 3: Gah! I can't believe they want us to eat this breakfast! All I can think is "don't spill on the suit".
student 4: Maybe they're watching us - like a test in dexterity ...
student 3: Thank goodness I don't want to be a surgeon.

student 1: how the hell can I be expected to walk in these shoes!!?!?

student 4: teeth check! any breakfast left?

conversations you wouldn't hear in a law school

Our classes run on a weird schedule compared to the rest of campus so we can be almost guaranteed to have the washrooms to ourselves during break.

student 1: are you peeing?
student 2: yes, but a little number 2 as well, just a warning
student 3: oh good! It's about time for you to finally poo!

Back to Class

It's shocking to us how tiring it is to be back in classes for hours at a time. Some folks are here for 9 hours of class per day, no breaks. Gah.

After 2 hours, I fuzz out and have a difficult time concentrating on what is going on at the front of the class room. For example, right now I am in class. Half the class is reading the newspaper (on their laptops or paper versions), the rest are sometimes paying attention to the lecturer.

The OSCE last night went well enough. One of the downsides of being involved as heavily as I am in curriculum and the medical community, is that my examiners were all people I know from outside class. It's one thing to humiliate yourself in front of strangers, but another all together to do so in front of people you have been working with as a colleague for four years.

This morning I had my first residency interview. One of the out of province schools came to us to interview which is wonderful. I get to save money on a flight out there to apply, though, I have dumped all my out of province offers. Applying in the first place was terrifying and I was sure that I would be the person in the class who didn't get to match because I let the interviewing committee know that I'm just an impostor and don't really deserve to be here. Then I got interviews everywhere I applied. Not everyone did though so I realised that I really was a competitive candidate.

I've decided to save my money from the flights and go south on a cheap vacation while the rest of the class continues their interview tour around the country. This had the dangerous effect of making me feel *too* comfortable in my interview and talking quite loosely rather than following any sort of clear plan when answering questions. I hope I'll stay competitive anyway.

I feel a strong draw to the oceans of the Maritime provinces. There's something magical about practising medicine on the coast. The hospitals in the small communities are run by family doctors with other specialities acting as consultants only. This seems like real medicine to me. Dr. Quinn Medicine Woman real medicine. I would be able to learn an enormous amount of medicine in the short two year residency.

When the rank list is due, I'm going to have a very difficult time choosing how to rank my choices.

OSCE tonight

It seems so unfair. We've gotten this far, I know how to use a stethoscope. It makes me think they want to make sure we don't really screw up.

What I should not do if I want to past my OSCE tonight:
call my female patients sir
put my stethoscope on backwards
forget to wash my hands
fart
call any patient sweet heart or dear
ask the Pt to remove their underpants to do a head and neck exam
use my reflex hammer to accentuate all points I make
sneeze in my patients' face
say "whoa, that ain't right" loudly when looking at a patient's belly
suggest pregnancy be on the differential during the geriatric station
forget to ask for the vitals
wear jeans and a t-shirt
tell the patient they're wrong
forget to FIFE

maybe I'll pass after all...

oh no, I forgot to pack my lunch

guess I better treat myself to yummy Thai while I'm here in KW

have I mentioned how much I love electives?