Expert Advice for Residency Interviewing

Kendra Campbell offers 10 helpful interviewing tips

5) Be prepared for questions. There are many great resources on the web with lists of common residency interview questions (you can check out some from the AAMC here). You should try and go though most of them and come up with an idea of an answer.

7) Write thank you notes to your interviewers. Either electronic or paper, or both.

Residency Interview Tips [Medscape]

Improve Focus with SimplyNoise

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Correlate: Ambient Study Sounds – iSerenity

Pharm Friday – Antiplatelet Agents Overview

Another home run from our friends at Pharmamotion:

Classification:

• ADP Antagonists: thienopyridines act by inhibiting the ADP-dependent pathway of platelet activation. These drugs have no direct effect on prostaglandin metabolism.
  • Ticlopidine …is approved for secondary prevention of thrombotic strokes in patients intolerant of aspirin and for prevention of stent thrombosis in combination with aspirin.  adverse effects [include] neutropenia, thrombocytopenia and thrombotic thrombocytopenic purpura.
  • Clopidogrel is approved for prevention of atherosclerotic events following recent myocardial infarction, stroke or established peripheral arterial disease. It is also approved for use in acute coronary syndromes that are treated with either PCI  or coronary artery bypass grafting. It has a better safety profile than ticlopidine.

• Aspirin: aspirin inhibits platelet cyclooxygenase, a key enzyme in thromboxane A2 (TXA2) generation. Thromboxane A2 triggers reactions that lead to platelet activation and aggregation, aspirin acts as a potent antiplatelet agent by inhibiting generation of this mediator. These effects last for the life of the anucleate platelet, approximately 7 to 10 days… indicated as prophylaxis against transient ischemic attacks, myocardial infarction and thromboembolic disorders. It is also used for the treatment of acute coronary syndromes

• Phosphodiesterase inhibitors: Dipyridamole acts as vasodilator and antiplatelet agent. It inhibits adenosine uptake and cyclic GMP phosphodiesterase activity, this decreases platelet aggregability  …it is currently used in combination with aspirin or warfarin in the prophylaxis of thromboembolic disorders.  It is also used in stress testing for myocardial perfusion imaging.

• GPIIb/IIIa inhibitors: used parenterally in patients with acute coronary syndromes…  the integrin GPIIb/IIIa antagonists prevent cross-linking of platelets… current indications include unstable angina that does not respond to conventional therapy in patients that undergo percutaneous coronary intervention.

Antiplatelet agents: mechanisms of action and general overview [Pharmamotion]

Interview Pitfalls and Match Etiquette

Jessica Freedman, MD:

Interviewers often casually ask applicants during interviews, “So, where else did you apply?” or suggest, “If you are really interested in matching here, please be sure to let us know.” Other programs routinely call applicants who are within “matching range” to recruit them after they interview. Does this constitute persuasion or pressure?

[Applicants] often feel obligated to tell a program what it wants to hear by saying, “I loved your program and I will be ranking you really highly.” Or, applicants may feel pressured to tell a program that they will be ranking it #1, even if that’s a white lie. Sometimes applicants are so nervous about matching that institutions’ recruitment efforts may influence the way they rank programs.

how should applicants deal with these situations? If you receive a residency match “love letter,” take its sincerity and truthfulness with a grain of salt. You certainly will want to respond graciously, but do not say you are ranking the program first if that is not your intention. As for fielding questions or comments that may violate the MPA, I suggest being diplomatic and somewhat vague without confronting or offending your interviewer. For example, if the interviewer asks where else you are applying or interviewing, it is acceptable to answer, “I am applying to and interviewing at a variety of programs, mostly on the West Coast” or whatever situation applies to you. If pressured to express specific interest in a program, it is fair to say, “I am very interested in this program and have not yet decided on my final rank order, but I will be ranking your program highly.” As with the “love letter,” do not tell a program that you will be ranking it first if this is not true.

Residency Match: Avoid Getting Burned [Medscape]

Correlate: The Best Predictors of Match Success

Goal Setting & Productivity – Deprioritizing the Unimportant

A lot of goal-setting advice focuses on deciding what matters to you. People exclaim, “follow your passions!” or “set priorities.” This is fine, but it misses the opposite, but equally important question: what doesn’t matter to you.

Ask yourself questions like, “If I had to pick 4-5 things to fail at, what would I sacrifice?”

Pick the things that don’t matter. Or, at the very least, decide your maximum input level for those pursuits. If you stop yourself from overcommitting on the small things, you can ensure you have the opportunity to pursue the big things.

Decide What’s Unimportant to You [Scott H Young]

Case Studies – Tackling Common Sleep Problems

The worrier

• challenge:  “My sleep problems are definitely stress-related,” she says …She lies in bed thinking about work, making mental to-do lists, and even listening to random songs that play in her head.
• advice: “She seems to have a predisposition for insomnia, and for people like her, whenever there are additional pressures, like a new job, the insomnia bubbles to the surface,” says Gary Richardson, M.D., a senior research scientist and a staff physician at the Sleep Disorders Center at the Henry Ford Hospital, in Detroit, Michigan …she needs to find ways to handle her stress better so that it doesn’t wake her up at night.
  • Distract her brain by trying a relaxation technique, like focusing on her breathing.
  • Working on keeping her sleep environment quieter, such as using an air conditioner or a fan, as well as blackout shades to block street light.

The night owl

• challenge: She grows more alert late at night, then stays up until about 3 a.m., watching TV, reading, clearing out e-mail, and organizing things for her family.
• advice: To start slowing down and readying herself for an earlier bedtime, psychologist Rubin Naiman suggests blocking blue light. “The blue end of the light spectrum — emitted by ordinary lightbulbs, televisions, and computer screens — suppresses melatonin,” says Naiman. Nicole might consider …reducing the amount of light in general. “Being exposed to too much light at night is the environmental equivalent of caffeine,” says Naiman. So at least two hours before bed, dim the lights. In addition, Nicole needs to find time earlier in the day for catching up on e-mail and organizing.

The slow riser

• challenge: Elizabeth …struggles with an innate tendency is to stay up till midnight, then hit snooze so many times in the morning. “The clock has been known to give up,” she says. Even when she feels exhausted all day, she becomes more alert at night. When she does get into bed, it takes her up to an hour to fall asleep. Elizabeth has tried going to bed earlier so she’ll have less trouble getting up in the morning, but then she just lies awake. She doesn’t drink caffeine, and she reads when she gets into bed, does yoga three times a week, and uses an aromatherapy-oil diffuser in her bedroom.
• advice: While avoiding caffeine in the afternoon and the evening is a wise move, physician and sleep researcher Gary Richardson says that having some first thing in the morning can be helpful for people like Elizabeth, who have trouble waking up.
  • Modulating her exposure to light could reset her internal clock gradually, according to Richardson. “Too much light at night will push her clock even later,” he says, so the key is to keep the lights dim the closer she gets to bedtime. Elizabeth should also maximize her light exposure first thing in the morning. If she can go outside in bright sunlight for some exercise, that would provide a double whammy of wakefulness.
  • Taking a melatonin supplement (0.3 milligram before bed) might help Elizabeth if light manipulation isn’t enough, Richardson suggests. It may help pull her internal clock to an earlier hour so she can get the sleep she needs

How to solve 9 sleep problems [CNN Health]

Correlate: Making Time for Sleep
Correlate: Sleeping Smarter
Correlate: Understand the Mechanics of Sleep

How to Manage a Negative Clinical Evaluation

Sometimes personalities can clash and an attending may write an overly harsh evaluation that isn’t indicative of your performance. If you feel that this is the case, it’s usually a good idea to speak with the clerkship director and express your concerns. At some institutions, the burden of proof lies with the attending to demonstrate that he or she gave the student constructive feedback and allowed for a chance to improve. If the evaluation is determined to be unjust, it may be removed from your record.

However, if the clerkship director does a thorough investigation and strongly feels that the evaluation is accurate, it’s usually a good idea to stop there

Will a Negative Evaluation Ruin My Residency Options? [Medscape]

Basic Study Strategies for First Year Medical Students

1. Find some peace and quiet. Studies have shown that just 20 minutes of highly focused, quiet time can help you learn and remember more than hours of working with distractions and while multi-tasking. So, to get the most out of your study time retreat to a place where you won’t be bothered by loud music or talking and can just focus in on your work.

2. Get organized. If your papers and materials are all over, you’ll spend just as much time looking for what you need as actually reading through and absorbing material which doesn’t make for a very productive use of your time.

7. Write it down. For most people, writing things down helps big time when it comes time to recall things on a test or even just during study time.

8 Tips to Help You Study Better and More Effectively [Life Optimizer]

Speciality Overview – Physical Medicine & Rehabilitation

by Sara Cohen, MD

PM&R involves the diagnosis and restoration of functional ability and quality of life in patients with disorders of the nervous and musculoskeletal systems.

Residency training in PM&R includes 1 year of internship, which can be a preliminary or transitional year, followed by 3 years of specialty training in PM&R. Some residencies combine the 4 years into 1 program. Generally, the first year focuses on the inpatient rehabilitation aspects of the field, whereas senior residents practice more outpatient physical medicine with a lighter call schedule.

The rehabilitation part (the “R” in PM&R) involves the long-term care of patients with disorders of the central nervous system, such as brain injury, spinal cord injury, and stroke. We also care for patients with amputations and orthopedic injuries. Our job as the physician on the inpatient rehab unit is to oversee the care of these patients and work with a team of therapists and other staff to maximize the patient’s function. Although the interventions we use will not “cure” patients, we help them to make the most of what they’ve got.

Rehab patients remain on the unit for weeks or even months. As a result, during my residency I was able to build relationships with them and their families, as well as see the long-term outcomes of treatment. I have a shelf in my apartment filled with gifts from patients who were very grateful for the treatment they received on our unit.

What Is PM&R? [Medscape]

Common Mistakes Made by 3rd and 4th Year Medical Students

Kendra Campbell reminds us of some easy-to-avoid clinical mistakes

1. Arguing with a patient.

2. Reporting a physical finding without actually observing it.

3. Pimping your resident or attending. …Thou shalt not pimp up the chain.

6. Documenting an important positive finding without alerting your resident or attending.

9. Forgetting you are in a hospital …We spend so many hours in the hospital that it’s easy to forget that we are surrounded by very ill people.

Top 10 Mistakes Made in Clinical Rotations [Medscape]