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Episode 95: Learn what to look for in a mentor and how they can help you accomplish your goals.

Download transcript: Choosing a Mentor

 Melinials Want Mentorship in Medicine

In today’s episode, I’m going to be talking about how Millenials want even more mentorship, at least supposedly, than their predecessors. Specifically, I’m looking at an article from the American Psychiatric Association. Their education director, Dr. Hales, put an article, and she was interviewed in a title called “Mentoring Residents: Often a Lesson in Chemistry.”

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What she’s talking about, primarily, is interpersonal chemistry between mentors. The article states that residency is often about evaluation. It doesn’t matter which activity you’re involved in with residency. It’s not so much about evaluating whether or not the resident is good or bad necessarily, but as a function of professional development, to mirror feedback to the resident to let them know what they’re doing effectively and what they need to work on. At least, that’s the most hopeful, positive spin you can put on it. As you may have heard in prior episodes, constructive criticism on clinical rotations isn’t necessarily painless. In fact, sometimes you have to look for the positive action items after someone reams you and maybe yells at you for a mistake. You have to put a positive spin on that intentionally.

So she makes a statement here that I don’t think is based on fact, and I would like to bring under closer scrutiny, as I would encourage you to do any time you hear something that doesn’t jibe with your personal experience, or your knowledge, or just doesn’t seem to be quite right. Don’t necessarily dismiss it, but investigate it, and examine it, and become a little scientists related to things about your medical career, not just medicine itself. For example, she says, “The Millenials, these are individuals coming of age in the new century, want more structure and guidance than the earlier Baby Boomers did.” I would like to see a study that asked Baby Boomers in medical education how much mentorship they wanted. Hmmm. How can you make a statement like that? I don’t know. You don’t have evidence. So I kind of dismiss that. But I do generally enjoy and agree with the topics otherwise presented in this article. For example, this idea about needing interpersonal chemistry.

Definition of Mentorship

So let me back up a step and just kind of describe in my own words what a mentorship relationship is like when you’re a resident working with some faculty. In many programs that you would get into, there are faculty that are assigned to supervise you in different capacities. Often you can choose either a formal mentor, if they have a program like that, or maybe it’s called career supervision, or something. Hopefully, your program will cut out a little bit of time, as you progress through the program, to meet one on one with a faculty member for guiding you and answering your questions about career decisions, as you do figure out along the way what kind of things you’re interested in doing in your medical career. They can give you their tips and guidance. That’s a formal relationship. It’s not necessarily going to be someone you would go have a beer with, or whatever. Also, their advice can be tainted with recruitment. Sometimes it’s a criticism of career advice, if they’re really trying to keep you at the program, they might distract or change the subject to that often, and you might not feel comfortable. I would say that this is the time and place to be assertive. If you don’t want to go to that program, or stay there, you’re going to move away,

Episode 95:

Whether it’s inadequate note taking, or if something is missing here or there or mistake, or some kind of habit, let’s face it. Not all doctors are very good, at coaching mentoring, or teaching some of them are very [abrought 00:01:07] in some cultures and specialties. They pride themselves in being mean to each other. You’re going to have criticism, the question is how do you handle it.

What I like to think of is to make the criticism constructive. It may not come across to you, in a way that’s constructive. It’s your job to find out what can I do different, what can I learn from this, what process do I need to change in order to make this improvement in this area. You’re going to put a positive spin with the tangible handle, something physically different that you’re going to do.

Make it action based, very much like the book Getting Things Done with David Allen. I highly recommend that audio book while you’re straightening at your office, and cleaning up your house. Especially if you’re going through a massive inbox, or making new files, anytime you’re organizing. The bottom line there is that instead of putting somebody on a to do list, that just says paint the house.

Break it down to the next physical, tangible step in that big project and put something like, go to Lowe’s and look at different paint colors, or something like that. Something that you can break down, in the simple action task. You’re going to do the same thing whenever it comes to criticism you received on clinical rotations. Let say for example, and I bring this up now because I just got a criticism.

I wasn’t putting enough information in my HPI, in my History of Present Illness section, okay. It happens sometimes I think it happens when you start getting a little [inaudible 00:03:12] that’s still a little bit early but regardless the straight forward, and wrote simple to me now and they want me to kind of write a little bit more. Most in this don’t. That’s a good side bar here is criticism you may get maybe just one person’s opinion and you might be getting prices in that same area from everybody else.

It could be just that one person, that’s giving you the criticism. Take it with a green assault, it doesn’t mean you’re a bad person. Remember the difference between shame and guilt, it just doesn’t mean you’re a bad person, it means you could improve in this area, your job is to turn it into a tangible handle. Look at that thing and say okay what specific task could I do different to change the process here, so that I can improve based on this criticism.

In other words how can I make this constructive. In this example, of not putting enough information in the history of present illness section. One thing that I could do different would be to before I’m done with my note, and complete my note. Go back and look and make sure that my note reflects all the substantiation and documentation require to make whatever diagnosis I’m suppose to make in the bottom, okay.

I normally do that, I made a mistake today. That happens, I can make more thoughtful effort. Let say I catch myself next week, doing the same thing again. I can realize, “Hey, just to have that memory, of I’m suppose to do this or that.” That’s not working, I need to adjust. What I need to do, maybe put a three by five card on their monitor something. I need to change something about my system or practice, make tangible handle.

Let me talk a minute about the dynamics with feedback, on the rotations. You get what they call the 360 degree feedback in a lot of places, some places have medical students billing out, reviews and performance evaluation on each other, and their attending, and their residence, and everyone else is doing it too.

Episode 94: Learn what programs are looking for in an ERAS application.

What draws people to psychiatry?

*   Interest in serving patients with chronic, severe mental illness. Enjoying psychotic patients can be a big determinant.

*   Fascination with neuroscience.

*   Strong interpersonal skills. Ability to engage and successfully navigate almost any typeof person.

*   Introspective types; ability to look within and then MODEL appropriate, mature behaviorto your patients.

*   Lifestyle. You can’t beat it. Possibility of a cash-only practice with relatively little start-up costs; anytime, anywhere. More people chose psychiatry in 2013.1

*   Longer appointment slots: 20-30 minutes vs. 10 minute follow-up visits.

*   In psychiatry, priorities and staying centered in family is respected. 

What types of programs exist in Psychiatry?

(adapted from http://www.psychiatry.org/medical-students/subspecialties-in-psychiatry)

* Child and Adolescent Psychiatry

* Geriatric Psychiatry

* Addiction Psychiatry

* Forensic Psychiatry

* Psychosomatic Medicine

* Research – 2 years

Combined Programs

*   Triple Board Residency (Psychiatry/Pediatrics/Child & Adolescent Psychiatry) – A five-year combined residency which integrates psychiatry, pediatrics and child and adolescent

psychiatry.

*   Psychiatry/Family Practice – five-year combined residency.

*   Psychiatry/Internal Medicine – five-year combined residency.

  Psychiatry/Neurology – five-to-six year combined residency.

What medical school grades do competitive applicants have for psychiatry residencies?

A solid medical school performance is important. Therefore, passing all of your medical school classes the first time is huge, but I don’t have to tell you that. That said, it’s nice if you got a High Pass or Honors in your Psychiatry rotation but that’s not required. That grade isn’t often going to be a deciding factor by itself. So, my answer here is for the student to have an absence of failed classes rather than the presence of Honors grades.

What are the Step scores of competitive applicants?

Data adapted from http://www.nrmp.org/match-data/main-residency-match-data/.

Unscientific research into this question puts the number needed for USMLE Step 1 historically around 208. Don’t let that number “psych” you out. Different programs emphasize different things and an application is viewed in its entirety.

How important is research to remain competitive?

This depends on where you’re applying. Personally, I interviewed at Duke and UT Southwestern where it is very important. I’m training at Scott & White where it’s not emphasized but I’ve done 20 scholarly activities; far more than I could have accomplished at the other, busier programs.

If you have a publication, that stands out because of the amount of dedication required to follow through on it. Otherwise, a few volunteer assignments on someone else’s project isn’t that impressive. If you have no research experience at all, it may appear that you are unmotivated or cocky.

How to research, grades and Step scores interplay?

Again, the application will stand as a whole and should reflect who you are. If family is a priority and you haven’t done much “extra”, don’t worry about it. Find a way to mention them in your personal essay. In psychiatry, priorities and staying centered in family is respected.

Other ways you can shine in your residency application are mission trips, volunteering with the underserved, recommendations for Psychiatry program directors and AWAY rotations.

How important are away rotations?

Away rotations are KEY if you really want to train at that residency. It’s a 1-month interview! Similarly,

Episode 93: Doctor Dan reveals where the finances have gone and his best-kept secret all these years…

I want to reveal my best kept secret. I say I want to. I’ve really hesitated, for the past 2 years, I’ve kept something from you. It’s been more than that, actually. Pretty much the whole time I’ve been a resident. That is, what happens to the money, that people spend to join the medical mastermind community?

Half of it goes to operate the site. The other half has been going somewhere else. It just seems like it’s the right time, the right thing to do, to tell you, though I’ve hesitated for a long time. I’ve literally had this note set in front of my desk for a couple of months.

Here we go. I support a few non-profit charities. My favorite and the largest one that we contribute to is Compassion International. It has a unique model of 1 to 1 sponsorship in empowering local churches. Has been helping children, put them on hopeful paths since 1952. I sponsor more than a dozen children, all over the world, in different places.

If you ever watch the news and you see tsunamis here and there, earthquakes, usually the medical mastermind community is sponsoring a child  that’s in that area. I mean, I get these personal letters. Sometimes they have to drop out of the program. They don’t tell me exactly why. It certainly makes global issues come to life. It makes me a lot more connected to the world. I think that is a good thing. When budgets get tight, I really fight, trying to keep this mode of sponsorship going.

Let me give you a few fun facts for Compassion International, understanding that if you help with the medical mastermind community costs, this is where your money is going. 4 to 8 hours is the average amount of time per week that a compassion assisted child spends at a child development center. Understand that the general picture of what they do, is provide clothes, food, and books, spiritual guidance. Really, a school environment for kids that are in third world countries, that don’t have anything.

Some of them live in either shanty towns, or in some cases, they live in trash or whatever. I see pictures. They dress them up for the pictures, but I know a little bit about the third world. It was in the third world, that I got interested in medicine. I think that’s helped me connect back to my roots. As a pre-med, the very first pre-med thought I had was in Africa. Here we are, I’m helping folks in Africa, Haiti, all over.

44 weeks out of the year is the typical amount of weeks that a child participates in the program. The program is comprehensive. They do give them exams. In fact, that’s one of the biggest things that the children write letters to me and comment on, is their exams. They try hard. It’s so sweet. They really write these letters.

I have a file, that is literally 2 inches thick, of letters that I’ve received from these children, over the years. Honestly, I  could help writing them back sometimes. That’s one of my motivations for unveiling what I’m doing, is I’m too busy to sponsor, or at least be a pen pal, with 13 plus children. Your first sign up for something like that, you think, oh, it’s a financial thing. It becomes quickly, a personal thing, when they’re writing you letters and notes and that sort of thing.

If you are interested, you could sponsor them. In fact, now, the monthly membership for medical mastermind community is less than the cost of what it takes to sponsor one of these children monthly. If that’s something you’ve been interested in doing, and you’re into charity and helping folks in the third world, that are less well off than you, then you could look at it that way and join as a philanthropic type of motive.

The number of hours invested weekly ranges from 5.6 million to 11.2 million.

Episode 92:  Learn the difference between carcinoma, sarcoma, mesenchymal tumors, oncogenesis, and the protooncogenes.

NEOPLASIA

I. Nomenclature: Benign vs. malignant

A. Difference between benign and malignant cancer:

Main difference – Benign usually does not metastasize, malignant has the capacity to metastasize. Exception: B9 tumor that metastasize: invasive mole (metastasize to lungs, but goes away).

B. Overview of Neoplasia

a) MC skin cancer INVADES but does not metastasize? basal cell carcinoma.

b) MC B9 tumor in woman is MC located in which organ? Uterus – it’s a leiomyoma; tumor of smooth muscle!

c) Fibroids – smooth muscle; become very hard

d) MC B9 tumor in male (yellow) = lipoma

e) B9 tumor of glands = adenomas (ie adrenal adenoma – thin adrenal cortex b/c it is functional; it could be making cortisol, therefore suppressing ACTH, and the zone fasiculata and reticularis would undergo ATROPHY…leads to Cushing’s. If tumor secreting mineralocorticoids – it is Conn’s syndrome, causing atrophy of the zone glomerulosa (GFR – salty sweet sex)

f) Tubular adenoma = MC precursor lesion for colon cancer (looks like strawberry on a stick)

C. Carcinoma vs. sarcoma

1. Carcinoma

Malignancy of epithelial tissue (3 epithelial tissues – squamous, glandular, and transitional)

a) Squamous carcinoma – how to recognize? Little swirls of increased redness (bright red) called squamous pearls;

b) Glandular carcinoma – Round glands, with something in the middle = adenocarcinoma

c) Transitional cell carcinoma – from bladder, ureter, renal pelvis (from genital urinary tract) – all with transitional epithelium. Therefore, 3 carcinomas = squamous, adenocarcinoma, and transitional cell carcinomas.

d) Example: Malignant melanoma – first step in management? Excision (b9 version = nevus), both are derived from melanocytes. This is the most rapidly increasing cancer in the USA, not MC. They are S-100 Ag “+” tumors – aput tumors

e) Aput Tumors: S-100 Ag “+” tumors – aput tumors; aput is precursor uptake decarboxylation, meaning that they are of neurosecretory or neural crest origin. Therefore, on EM, have neurosecretory granules. S-100 Ag is used to stain things of aput origin or neural crest origin (most, not all, will take up that Ag).

Examples of aput tumors: melanoma; small cell carcinoma of the lung; bronchial carcinoid; carcinoid tumor at the tip of the appendix; neuroblastoma (secretory tumor), ie 2 y/o with tumors all over skin, and on biopsy, it is S-100 “+”, tumor was from adrenal medulla, metastasize to skin.

2. Sarcomas

Sarcomas are malignancy of MESENCHYMAL tissue (not epithelial).

* Sarcoma of smooth muscle = leioymyosarcoma;

* Striated muscle = rhabdomyosarcoma;

* Fat = liposarcoma; (these are malignancies of mesenchymal tissue, while carcinoma’s are of epithelial tissue).

Examples:

a) Bone, see metaphysis, see Codman’s triangle, and sunburst appearance on x-ray b/c this tumor actually makes bone. Dx = osteogenic sarcoma (bone making sarcoma).

b) Biopsy from girl having necrotic mass coming out of her vagina, Vimentin and keratin “-“, and desmin “+”, dx? Embryonal rhabdomyosarcoma (see striation of muscle). This is the MC sarcoma of children (vagina in little girls and penis in little boys).

c) Movable mass at angle of jaw = mixed tumor (in parotid); ‘mixed’ b/c two histologically have two different types of tissue but derived from SAME cell layer (not a teratoma, which is from three cell layers),. MC overall salivary gland tumor (usually b9) = mixed tumor.

d) Teratoma = tooth, hair, derived from all three cell layers (ectoderm, mesoderm, and endoderm) Aka germ cell tumors – b/c they are totipotential, and stay midline. Ex. anterior mediastinum, or pineal gland; therefore, teratomas are germ cell, midline tumors.

Episode 91: There aren’t enough residency positions for graduating medical students? It depends on the state; the forecast is grim.

Download transcript: Stop Cutting Residency Positions

 More Medical Students Than Residency Positions

As you may know and have probably heard there is becoming an increasing discrepancy between the number of graduating medical students and the number of positions available for internships in residences.

It’s a terrible thing to be in medical school graduate and be unemployed and not be able to get a job. This is a disturbing topic. I’ve had a considerable amount of fought before doing a podcast because I wanted to make sure I got my numbers right.

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Texas’ Medical Student Projection

Now, I’ve finally found a graph. It’s not national but it will give you an idea. I want to give you a sample from Texas and if you could find a better reference nationally to give you this specific data please give it to me and I will certainly share it again with the podcasted community. The text is hospital association in Texas Higher Education coordinating board. Hosted a forum, they got a couple of million dollars to establish new first year residency positions.

In 2012, they had a report that is available online and they said it already in 2014 there were 63 less slots available for graduating medical schools compared to the number of 4th year graduating Texas doctors. Let me be real clear what I’m saying here.

A lot of people will go to a different state to apply and attend a residency. A lot of U.S. citizens or even foreign nationals, they go to medical schools outside of the United States. What we’re talking about now is a coming crisis where people graduating in medical school within their own state can’t even get a job. Even if they all stayed in the same state, they’re being forced to go elsewhere.

Florida Grows Medical Schools – Not Residencies

Florida is actually the worst. There are medical schools popping up everywhere and this goes back several years when the AAMC said, “Hey, we need to boost the number of medical school graduates by 30%.” Texas did that but the residency growth is much slower and more expensive, believe it or not, than a medical school and its rate has only been 15% growth since then. It’s outpacing it by twice as much and the number of graduating medical schools is quickly overtaking it. This is projected to happen nationally. This is alarming.

You may be experiencing this already, but this has real life implications such as the number of applications you should put in for your residency and the number of interviews you should go to. I think everything is going to start doubling. If you aren’t already just a stellar student then I think you need to double everything right off the bat.

I’ve been down that road, had to switch programs. I know what it feels like to not match. I know what it feels like to match to your number one choice. Man, you need a lock and load on this and go to a lot more residencies if you are below average in your medical school class. That is my advice.

Projections of Unemployed Doctors

By 2016, the number is projected to jump to almost 200. 180 it says here, but I’m looking at the graph that I will include in the show. It’s for this episode. I’ve researched the actual 69 page paper that this council put out and this has happened before which id surprising, a little bit in 2007. It was about 112 more graduates than there were residency slots. That’s not that long ago. It’s happened a little bit before then, but the trajectory from 2014 and 15 and what’s projected on our into the future is much worse.

A lot of this corresponds with the economic recession, that when it dovetailed. The problem is that the government is broke.

Episode 90: USMLE Step 3 is changing in 2014 and the rest will follow suit. Learn about the changes and new structure in this episode of the Medical School Podcast.

Download transcript: USMLE Changes in 2014 and Beyond

View image of changes: USMLE changes

Dr. Dan:           Welcome to the Medical School Podcast. I’m your host, Dr. Dan, and this is Episode 90.

In this episode, I will be discussing the evolution of the United States Medical Licensing Exam. There are a number of important changes which I am sure you’ve heard about, but I want to clarify and notify those that did not know about this stuff.

Let me set the background a little bit with the USMLE. In the early 1990s, the USMLE exam for the allopathic schools replaced the NBME, the National Board of Medical Examiner certification examinations and the Federation Licensing Examination program called FLEX. It’s been around for a long time as a standalone. That’s gone on 20 plus years now.

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Of course, in 1999, they began those computerized patient simulations in Step 2. Standardized patients were introduced in 2004. That’s only about 10 years now. They’re making a lot more changes which is the purpose of this episode. Also in 2004, the USMLE undertook an in-depth review of the program. Everything is moving towards evidence-based. That’s the underlying theme here with what’s going on with the USMLE. They’re doing feedback on the test to make sure that it’s valid and actually measuring what it’s supposed to measure and that what their targeting is actually relevant to clinical practice today.

There were 5 major recommendations that came back and were adopted in 2009. The first one is to make the USMLE focus on assessments to support state licensing authorities’ decisions about a physician’s readiness to practice patient care at entry into supervised practice, which means beginning a residency, and entry into unsupervised practice, potentially after internship when you get your license and begin [moonlighting 00:02:15].

They’re trying to dovetail with the licensing exam to provide them feedback. That might mean that your individual state board might look closer at the USMLE scores themselves, particularly if they are scrutinizing you for some other kind of behavioral, personality, or disciplinary problem. They might look at your USMLE scores and require some remediation. That’s all down the road. Those aren’t current changes. I’m just trying to set the five major recommendations now as a backdrop and we’ll get to the one big change that they’re doing to the Step 3 examination this year, 2014. That’s going to be their first big kickoff to implement all these changes.

The second big recommendation is to adopt the general competency schema that is consistent with national standards for the overall design, development, and scoring at the USMLE. It looks like they want a competency-based schema. They have, of course, adopted the ACGME core competencies schemas, that is, there are 6 competencies the Accreditation Council for Graduate Medical Education. That is the group that licenses or accredits the allopathic residency programs. When you become a resident, you will know about that.

Those 6 competencies include medical knowledge, patient care, communication and interpersonal skills, practice-based learning and improvement, professionalism, and systems-based practice. They’re trying to get all four of these USMLE Step scores to be ultimately organized around these 6 core competencies that fit in directly with the ACGME competencies.

On a side note,

Episode 89: Tips for saving money in health care. And, calling all 2nd year medical students! It’s your time for a USMLE score boost!

Download transcript: How to boost your USMLE Step 1 score and save health care costs

The Dark Side of Medicine

Today I’m going to be talking about the unveiling of the dark side of the medical-industrial complex and how the institutions and boards that run the hospital systems can often times have a different agenda than you the physician, the one charged with taking care of the patient.

Calling All Second Year Medical Students

Before we get into the meat of that discussion today I want to put a call out to all second year medical students.  I have an IRB proposal that I’m putting together for a research project.  This about the fifth one I’ve done now on medical students or pre-meds or residents and such.  This one is specifically looking at mood states prior to taking the USMLE Step 1 or the COMLEX Part 1 if you go to an osteopathic medical school.   Then I’ll do a mastermind intervention and re-survey students to see if their mood states change.

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If you happen to be a second year medical student you could benefit be participating in the intervention.  Of course we’ll do official informed consent and all that stuff to tell you what’s expected and what you get out of it.  The bottom line is I want to survey some students about 40 questions.  How long does that take you, a couple minutes at the most then give you a three week, twice a week teleconference style delivered mastermind meetings to boost your USMLE study plan, to decrease your anxiety and help you get better organizational skills.  I don’t need to go into all the details here, but if you will visit medicalschoolpodcast.com, sign up for the email list.

That will instantly send you some speed reading videos, but that’s beside the point, just get on the email list because very soon I act fast, I’m telling you.  I’ve written most of the IRB proposal today with some spare time.  I am going crazy with research.  I’ve got all kinds of stuff going.  I’m about to have a gig in Philadelphia at a sleep conference.  I’m going to have a paid trip to Berlin to speak on military research that we’ve been doing here.  Everything I’ve touched is turning to gold in the research department and I would like to bring you in along for the ride and I hope that you’re enjoying the podcast.

Perhaps you’ve noticed I have a different little swing in my step, a little bit more boost of energy and reinvigoration of the medical school podcast.  That’s in large part due to getting my medical license and having the horror and black smudge of pain in my life from my previous emergency medicine residency experience wiped away with my medical license and it also has to do with being finished with my current residencies, nights and weekend call.  It’s just done.  I have a day job now (laughs).

Physician Ethics

Today the idea is that you start out in medicine, you take a Hippocratic Oath, you put on the white coat, you’re here for the patient first.  Many times you hear the term medico-legal, you hear ethical, you hear law and ethics often times combined as topics for presentations.  You’ve been beaten to death with this stuff like patient autonomy, justice, beneficence, non-maleficence, first do no harm.  Of course you have law and often times laws can be unethical.  I don’t even need to get into that here.  As a healthcare professional, specifically as a physician you have one bent, to take care of the patient, that’s my point.

Today I wanted to highlight a problem.  Especially as healthcare systems are being squeezed for finances in The Affordable Care Act is crushing smaller practices and hospitals as we have a payer shift to more public ...

Episode 88: It’s a kiss because it’s something nice that you can frame and hang on your wall. It’s death because you’ll never be able to work as a doctor.

Download Transcript: Kiss of Death

Today’s episode is all about the kiss of death when it comes to a residency training.  You never heard of this before.  I can guarantee it.  Let’s get started.  I just got out of a meeting called the Residency Training Committee Meeting, and I learned about a particular action that a residency program can take toward a resident that they feel Is not doing well that is essentially the kiss of death for their medical career.

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But let me set the stage first.  Residency training hearkens back to the days of like 1904 when Nathan Hale brought his ideas from Germany about the way medicine should be taught in America, and they were tough.  They never left the hospital. Burn out, and difficulty, depression and stress is a part of our medical training heritage here.  It was done that way by design.  It’s not an accident.  We go about 80 years in history until 1980, it was either ’84 or ’86 when Libby Zion died and her intern hadn’t slept very much.  Her resident was fatigued back in the good old days up in New York where they just ground residents into the ground.

Her husband was, I believe, a New York Times writer or something big, big writer and editor, and had a lot of connection and made a big media and legal case out of it and the upshot of all that is what you now recognize as the ACGME Duty Hour Restrictions on residents.  ACGME is the Accreditation Council for Graduate Medical Education. You’ve heard of OSHA probably, the Occupational Safety Health Administration?  That group is generally responsible for safety in the workplace, but when it comes to physician training they have stayed out of the argument so all of the typical OSHA requirements like having to get a lunch break and different stuff like that don’t apply to doctors at all.

The limited scope that the ACGME has is simply what they’ve made for themselves, in other words, duty hour restrictions, time off between call shifts, etc.. That’s it.  Residency programs can do anything they want to to residents besides violate those things on any kind of consistent basis or they face losing accreditation.

That’s kind of the backdrop is that it’s a difficult place.  In the old days, residency meant residency.  You actually lived there.  At the DeBakey Center in Houston, Texas, at Baylor, those residents never left the hospital.  They literally when they did a rotation with Dr. DeBakey did not leave the hospital for 30 days.  That’s what we have come from and you already know, I’m sure, about the duty hour restrictions.  That’s kind of where we are, but understand that at its root it’s a place where they’re supposed to train you and teach you.

That brings us to today’s topic because some of us don’t take the lessons very well.  We get too comfortable.  We get cocky.  I’ve mentioned that recently on a podcast.  It goes to our head.  We get some criticism.  It can sting, but what about when you are felt by a particular faculty member to not be cutting the mustard, not be measuring up to your restrictions, or to your requirements and they want to fire you?  Or they want to remediate you?

Let me give you a few definitions of some words.  What you have to correct folks is monthly evaluations.  That’s the simple stuff.  I generally say keep it clean unless your trying to stack up documentation to keep somebody fired.  Yes, you will be filling out evaluation forms on your peers, and they will be filling them out on you.  If there is a consistent pattern, which means two or more times you mess up doing ...

Episode 87: Doctor Dan shouts the triumphant praises of one who is done with overnight call…forever.

Hi, It’s Doctor Dan. I just wanted to record this brief special episode about my last call shift ever. Call is of course variable depending on where you work whether it’s night float system or twenty-four hour call in our program. We do six months of night float and then a year and a half of calls kind of front loaded and three night ago I did my very last call of all now that the last year and a half of my residency in psychiatry. There’s no call nights or weekends. I mean I can still work in ER during the day but I just consider that a part of our regular job, just very excited. I think that as this [inaudible 00:46], you know I got my license; I got another milestone of having passed the six months; I’m done with call now; I’m getting back into pod-casting, my passion, I love this stuff.

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I got a new iMac, kind of celebrated and I had to get the new iPhone 5c you know just to kind of get updated and upgraded and it’s definitely a passion in pursuit of my … So so many good things are all happening, that’s not half of them that I sometimes can forget the importance of one of those little milestones of my last call shift. I wanted to share a little experience with you as that stress kind of rolls off my back and goes away. It encourages you, it is definitely worth waiting for, hang in there because one day you’re last call shift will come and it will be worth it for you, I guarantee it. Honestly the harder it is, kind of the more you’ll enjoy it.

I’m in the kitchen, I get home from work, not a bad day at all, of course I chose psychiatry partly because of lifestyle balance also because I love it and we’re sitting there thinking about dinner and planning meals and when we’re going to cook what. I like to grill a lot, chicken, fish, and stuff. The first thing I do In my mind automatically is sit there and start playing the rolodex. Okay, what day of the week is it, when’s my next call, what day’s this week to I need to take … wait a minute, there’s no call, I mean it was just like that. It was really kind of weird, I just had to stop and go. You know I don’t think I realized how much the work schedule and the residency schedule affects you.

Especially trying to get in shape which I did, I was able to loose over thirty pounds as a resident and work out. You have to plan so much, you have to be proactive about your shopping. You know what it takes to always have healthy food with you, at least I hope you do. By the way, let me know if you want to … If you want me to kind of get into the area on a pod-cast at all about how to loose weight in residency. I’ve thought often about the whole fitness aspect. Anyway, I just wanted to give you a brief encouragement and to say hang in there. If you have a question for me I’d be happy to put together a pod-cast or some other kind of answer for you if you need some help and you can’t find it anywhere else.

I just added a tool on the website where there’s a bar along the right side it says “Record a question for the post-cast.” You literally can … If you want to hear your own voice on this pod-cast, you can click on that, put in your name and email I think and I haven’t used it yet. I encourage you to use it, if you like it let me know, it’s right there. It’ll make a recoding for me and send me an email notification then the next time I put together a pod-cast I can have your voice actually play. Obviously in these past post-casts I’ve been reading emails, that’s not as fun to listen to so if you’re not too shy and you’ve got a question you haven’t heard anywhere else, i’d be happy to try and answer it for you.