Saturday, October 3, 2009

Dixie Cup and a Sand Truck

My first class at Harvard Medical School is over. This Friday my class took a three-hour final exam in Molecular and Cellular Basis of Medicine (MCM), results pending until next week… It was one of the best classes I’ve ever had, well-organized and well-narrated. On the first day of class I discovered a six-inch-thick stack of printed PowerPoint lecture slides in my mail box – “Welcome to MCM!” read the first page. I flipped through the slides. Double-sided, of course. Was there any possibility I would be able to learn all this in five short weeks? I had my doubts.

My biochemistry day started at 8:30am, usually with a small group study or “tutorial”. Eight of us spent 1.5hrs working on assigned problems and discussing questions, guided by a tutor. It took a little while to get used to the format, but by the end of the course our group was very efficient and collaborative. After tutorial sessions we had 3hrs of lecture, interrupted by 15 minute break. All lectures were recorded and posted online that afternoon. For twenty bucks you could purchase a nifty RealPlayer plugin to watch those lectures in 2x speed. A few times we had a “Clinic” – a special 2-hr lecture that awarded us an opportunity to get clinical insights about diseases we studied. By early afternoon I was done with biochemistry classes and had to find a way to cram everything I learned that day into my head.

My college studying strategy was immediately out of the window: no time to make color-coded study notes, too little time to read full chapters, no time for office hours. “Efficiency” became my one and only study slogan. I used any study tool I could, from book to YouTube, whichever gave me a clear picture of what was going on in the shortest amount of time. Two weeks into the course I had the weirdest biochemistry dream: I was rocking myself to sleep on a ribosome, peacefully sliding along a convoluted mRNA molecule. I woke up feeling really weird.

Three weeks went by and I started wondering if my childhood memories are being forced out of my brain by the invading squall of cell biology. The best phrase to characterize this experience was offered by one of my lecturers, Dr. Chien. He compared his experience taking biochemistry at HMS to “Standing underneath a dump truck full of sand with a Dixie cup and trying to catch it. Over the years the amount of sand has gone up, but the Dixie cup is no bigger than it was when we first started.” Over the past three weeks my appreciation for Dr. Chien’s words has grown exponentially as the pace of the course picked up towards the end. But at the end it all came together: I earned a new appreciation for the elegance of biochemistry, especially metabolism!

Metabolism was covered in the last two weeks of lectures and it was the perfect culmination for the MCM course. Our class was working together to overcome the challenges of last week: notes, schemes, summaries and helpful links circulated the class mailing list. I charted pathways over and again to remember the fates of metabolites and the names of the key enzymes. Everything I could learn about carbs, fats and proteins my memory crafted into series of lines and arrows that combined at odd angles and trajectories to produce “Metabolism”. I was as amazed to see it all work as was Jodie Foster’s character in the movie Contact when the bald guy on the plane shows her how to crack the Alien code.

And so it is done. On Monday I’m starting a new course block “The Human Body”, which combines anatomy, embryology, and histology. I’m very excited, but I will surely miss biochemistry! It left its mark on me. Maybe it was like driving through a bunch of flies with a Lincoln, trying to hit as many of them as possible.



Sunday, September 27, 2009

Four weeks later...

I just can't believe how busy it is... I haven't had a time to write at all. I'm taking a final exam in biochemistry in a week, and then I'm starting Human Anatomy. Weeks go by so quickly and the work load is intense, but I love it! Two days ago I performed my first ever injection on a person - I attended a flu vaccination training and the nurses let us practice with saline on each other.

Sunday, August 23, 2009

My First Patient

“Doctor, I can’t breathe!”

I stared at our patient: his heaving chest, cerulean eyes, and his pink plastic hair locks. I could hear his eyelids open and close with a loud “click!” His face permanently assumed an expression of astonishment. His soft plastic skin felt disturbingly real. I grabbed his arm and felt his throbbing racing pulse. I looked over to the monitor where I could read his heart rate, blood pressure, oxygen saturation, and body temperature. I leaned closer and stared at his face intensely, as if this was going to rescue him from peril. The room was electric!

“Is it okay if I put an oxygen mask over your face?” my teammate asked gingerly.

“I guess so…”

I was, of course, in a simulation lab. Our patient was a mannequin – a young male with a perfect athletic body, currently posing as a seventeen year-old female with an asthma attack. While simulators like this one can be found in many medical schools around the country, Harvard integrates simulator training into their curriculum starting as early as first year. It was my first ever interaction with a patient.

It was an amazing and novel experience for me. I really liked working with my teammates. We scrambled together to come up with possible solutions for our patient. We asked questions about our patient’s history, their medications, their allergies and whatever else we could think to ask but in no particular order. For instance, we completely forgot to ask their name! Being in a simulated Harvard Emergency room, we could request to perform any test and administer any medication.

“My chest really hurts! It’s hard to breathe!”

“Give us an albuterol inhaler, please!” we asked.

My teammate sprayed two clicks of albuterol into our patient’s wide-open mouth. We looked over at the vital signs on the screen, waiting for a change. And there it was: oxygen saturation went up, signifying to us that our actions helped the patient. We smiled at each other, but our mannequin still complained.

“My chest really hurts!”

My happy feeling was gone. “What’s wrong with her heart rate? Why is it so high?” I wondered. I was really hoping for her to be happy and relieved. We ordered a chest X-ray. It came up on a huge flat screen, looking very pretty in high-res. I was staring at it, hoping to see the solution to this poor young woman’s problem. “Why does her chest hurt? What can I do for her?” I felt so bad. It felt so amazingly real! My heart was racing.

We found nothing obvious on the X-ray, but the consensus was reached that this woman was having an asthma attack. What to do now? We brainstormed a list of medications, but none of us was certain enough of how they were supposed to be administered.

“Let’s call her primary care physician” somebody suggested.

“Yes, let’s do that.”

“What’s their name?” We all looked at each other, puzzled by this basic piece of information.

It was our good fortune that we were able to obtain the name from our patient. We got her primary care physician on the phone and asked about her asthma history. We were told that she keeps it in check pretty well with steroids.

“Ah, steroids! Yes, let’s give her some steroids!”

The steroids brought our patient the desired relief. We successfully admitted her into the hospital and the case was over. Our instructor came out from behind the curtain, smiling. She was incredibly supportive, and discussed the case with us in great detail. She reviewed our performance and made suggestions how we could improve. We were supposed to notice that our patient’s chest was overinflated on the X-ray, but none of us noticed that. The white specs in the center of the film that I thought could have been some foreign body or dust were in fact normal blood vessels and airways. Her heart rate was elevated due to albuterol which we administered early on. It all finally made sense!

I was mentally drained, but thought the whole experience was incredible. My meager performance gave me a boost of enthusiasm, actually. I wanted to go to the library immediately to learn about asthma and the treatments for it. Next time I will know what to do!

On my way home I was reflecting on the events of the day. Absentmindedly I looked around the train car. It was crowded with people returning from work; wary faces, reading newspapers, listening to iPods, swaying to the rhythm of the train. “What if all of them suddenly had an asthma attack,” I suddenly thought with penetrating terror. I turned my head and saw a pregnant woman standing by the door. “What if she had an asthma attack? What on Earth would I do if that happened?”

But the sim lab did not give me lasting nightmares. Rather I had a new awareness that emergencies do happen and that I need to learn to be ready for them. It motivated me.

Monday, August 17, 2009

My First Day As a Harvard Medical School Student

08/17/2009

Fist Day

This morning I had a number of introductions, most notably by Dr. Nancy Oriol – the Dean of Students at HMS. She has a wonderfully charming personality and generously shared her advice about what’s in store for us. “If you’re a male”, she said, “Being a Harvard Medical School student is an aphrodisiac. Showing up at the bar and informing men in there that you’re a medical student at Harvard is death for a female”.

We shared our excitement and worries with each other (just a few hours earlier a lengthy session on mental health hazards and treatment was conducted). On a large blackboard Dr. Katharine Treadway, our instructor for Introduction to Profession class, neatly listed our points of excitement. Her writings were encoded in a language that I might one day be able to read and understand comfortably. She used single letter abbreviations for “with” (looked like marriage of e and a coma) and “without” (an s with a bar?) which I have never seen in my life. Also “b” for “be?” and other symbols. Her “E” looks like a dollar sign missing one bar.

Among things people were excited about:

- Being somebody’s hero

- Becoming an agent of social change

- Being a Harvard student

- Reaching catharsis when it all begins to make sense

- Classmates

Solid, positive stuff. Upbeat. Then we started filling out another half of the board with our worries and concerns. Things like DEATH and DEBT appeared in caps and the mood changed.

- Harming people inadvertently

- Disappointing myself and my community

- Cynicism

- Workload

- Classmates

Interestingly, “Classmates” appeared as both, an excitement point and something to worry about. One student’s exhilaration “My classmates are all geniuses and very incredible people!” became another’s fear “Are they all going to be like geniuses and all, how am I ever going to make it here?” Yet another student wondered – anonymously – if adcom has made a mistake with their decision to let them in. Yes, we were all worried and anxious, but still excitement prevailed.

After getting my ID, I walked up to the main entrance to the Gordon Hall building. Its heavy doors seemed impassable. I remembered the day I came to interview. I thought these doors would never open for me (there was also a helpful sign that said “No Access Without ID” here). So now I held in my hand the magic laminated key to these doors. I swiped the card. The yellow light flickered but remained unaltered. “Hem-hem,” I thought, “Perhaps I’m not all the way a student yet? This does say a temp ID…” But that moment I looked over at my new friend and my confidence returned. This is my first day as a medical student at Harvard. I met amazing people today. I received a heartfelt welcome from so many distinguished students and faculty. I have a new mailbox and a new home, my society home. With a confident “SWOOSH!” I swiped the card again. This time the light turned green and the door clicked, and Harvard Medical School door opened and let me in.

Tuesday, August 11, 2009

Interviewing at Dartmouth Medical School

I interviewed at Dartmouth in the fall. The day was October 16th. I took the Dartmouth Coach bus from downtown Boston where I live to Hanover, NH. I got off the bus on a drizzly afternoon to find myself in the middle of a quaint rural neighborhood which was clearly NOT Dartmouth… There was not a sign to indicate where I was nor was I anywhere near my presumed hotel location. I walked into a different hotel lobby and asked how to get to Dartmouth. I was told I have to take a $60 cab ride to White River Junction, VT -- so much for cheap travel to NH -- but hey, at least I knew where I was! Finding a cab in New Hampshire is not possible. In Boston there are frequent cab stands, but in New Hampshire if you want a cab you have to call in and wait. It took another hour of plowing through rush hour traffic to get to White River Junction. My hotel was a shabby brick building in the middle of a parking lot, but there was a big Wendy’s banner in the middle of it -- so I was happy. You can never be too far from civilization if there’s Wendy’s!

Next morning I had to take a cab to the admissions building, but this time it was only $15. I was greeted by the most incredible, friendly admissions staff! Interviewees were shown into a large antique room with high ceilings and bay windows. We all had a chance to hang out and chat, and have coffee. The official part started at 9am. We met with the dean, and the financial aid director. All struck me as the friendliest people. The atmosphere was incredibly casual and relaxed. Both of my interviews were at the Dartmouth-Hitchcock Medical Center (DHMC) and both were with medical faculty. To get to DHMC I had to take a free campus shuttle. It took roughly 30 minutes to get to the complex. A student-guided tour was offered, and a lunch at the hospital cafeteria (it really was not bad). To get back to the admissions building was trickier. A number of shuttle buses run from the DHMC and only one takes you back to school. I had to wait for that one for 45 minutes in the rain. I left Dartmouth around 4pm that day on the bus back to Boston. Overall I had the most positive impression of the school!

What did I like about Dartmouth?
I was most impressed by the atmosphere inside the Dartmouth-Hitchcock Medical Center. It’s a brand new construction and is rather enormous, but inside is designed like a shopping mall. They told us the architect designed the building in a way that would feel friendly and familiar to patients, and I really think they did it right. In the middle of the main hall there was a big concert piano. Doctors would come over and play calming music on it all day long.

I read New England Journal of Medicine and I frequently see articles on public health published by MDs and MD/PhDs from Dartmouth. The school offers a variety of research opportunities to its students in both clinical and basic sciences. There are lots of funding options available to graduate students, although I could not find a similar comprehensive resource for medical students.

Dartmouth-Hitchcock Medical Center serves New Hampshire, Vermont and parts of Maine. Students have the opportunity to see cases from all three states. Dartmouth is the only medical school of this strength and size in the area, so most difficult cases go to DHMC. When I was waiting for a bus to get back to the admissions office I met a young man with a huge surgical scar on his forehead. He was injured by a bomb in Iraq and was treated at DHMC for injury-related epilepsy.

After I was accepted I received the most personal treatment from the financial aid office. They were helpful, responsive, and very efficient. It was easy to reach a person and get help with filling out forms and supporting documentation. Dartmouth offers generous financial aid and no-interest student loans.

What did I not like about Dartmouth?
The medical center is quite far from the school and even further from residential areas. While free shuttle service is available, it is not efficient enough for a fast-paced life style of a medical student. You really do need to have a car.

New Hampshire is a very rural area – it’s only two hours away from Boston, but it is much less densely populated. You have to drive everywhere to get to a supermarket, go out for dinner, movies, and get coffee in the morning. On the other hand, it’s at the heart of traditional New England recreational activities like hiking, skiing, and snowboarding. In the fall it looks gorgeous.

I was concerned about the conservativism of DMS curriculum. It is heavily lecture-based with little research focus and problem-based learning. While certain aspects of it were attractive – community-based patient interaction programs, mentoring programs – it was not the best fit for my research interests in medicine.

Fun facts about Dartmouth
Dartmouth is a historic place. It was the fourth medical school in the US – way before John’s Hopkins was built as a large medical school. William Osler, Harvey Cushing, and other huge names in medicine all came here to give lectures and seminars.

Wednesday, July 29, 2009

Interviewing at Yale Medical School

When I applied last year I had a folder where I put everything I learned about schools during the application year. By the time the interviews rolled in I had compiled a decent amount of “intelligence” on each of the schools I was interviewing at. So here it is, the notes from my book on what I learned about schools while applying in 2008.

I’ll start with Yale, one of my favorite medical schools!

YALE

What did I like about Yale?
Heavy focus on research: research thesis is not only encouraged, but required in order to graduate. It does not have to be in basic or clinical sciences. It is my understanding that an acceptable thesis has to represent an original undertaking by the student, in whichever area they chose.

Enormous graduate school right next to medical school makes it easy to collaborate with colleagues in basic sciences (you can use their equipment, attend research seminars and poster sessions, and receive peer reviews on your work). Yale university campus is rather like Rome – it’s built on several hills. They call the graduate school location “The Science Hill”, and a hill it is indeed.

Wealth of research funding opportunities for medical students (you can learn more about it here: http://www.med.yale.edu/facres/funding/index.shtml) This amount of funding options for students is rather impressive for any medical school.

I researched and found at least three labs in neurophysiology that I would be happy to join. I started researching this question here: http://medicine.yale.edu/research/ and read more about each lab that caught my fancy in more details. I learned a lot about their recent work by studying their most recent publications – PubMed PI’s names to get the list.

Yale has a special supprt system for women in sciences and medicine. Among other things, it allows you to meet with very famous, successful women in an informal setting. If you are trying to do something unusual with your career I think there is no better place to start than to ask another person how they did it. You can read about the support program here: http://www.yale.edu/opa/arc-ybc/ybc_science/story104.html as well as here: http://www.med.yale.edu/owm/ Realize that this information is not exclusively useful to the female audience – I think a male who expresses admiration for Yale’s mission for diversity in sciences can only get kudos from the interviewer.

Yale system allows students to have a lot of flexibility with their time – for me this was important because it meant I could spend serious time on research. The Yale system is meticulously described on their website, so I am not going to say much about it. It did not rank high on my list of reasons to come to Yale. I think you must be self-motivated no matter where you go in order to succeed. Yale makes it more explicit, I guess.

Yale boasts an incredible anatomy lab. It’s brand new, brightly lit with huge windows and mobile computer terminals suspended from the ceiling on swinging arms. While you’re doing a dissection, you can refer to these terminals to help you learn about the body you are working on. Each terminal is equipped with a self-assessing module that generates questions for you. You can type in your answer and immediately get feedback on it. You can also see diagrams and virtual images of the organ you are working on, as well as related histology slides. Very neat idea! I wish Harvard had that.

While I was touring the anatomy lab under the supervision of a student guide, a younger student yelled out to my group “Hey you guys wanna check out this guy’s heart?!” Our guide respectfully but firmly pointed out that this behavior was disrespectful and inappropriate. I was pleased to see this level of awareness and mutual respect among the Yale medical students, as well as thoughtful care for their profession.

Fun facts about Yale
Harvey Cushing, the nation’s first significant neurosurgeon, went to Yale for undergrad. In 1890 he was tapped for Scroll and Key. I know he also played baseball for Yale and was vehemently competitive. He received his medical degree from Harvard, but spent most of his life practicing at Johns-Hopkins. Cushing returned to Yale at the end of his life with an honorary degree to teach. After his death, Yale inherited his immense collection of rare medical editions (you can check on Ebay – his collection could have paid for all of my medical education several times!). When touring the Cushing library you will go past a circular dome with a flat metal circle on the floor. Stand on this circle and whisper to yourself. The walls of the dome are built in such a way that sound waves are reflected back to you greatly amplified. To you it sounds like your voice is BOOMING. To everyone else it sounds like you’re being spooked by your own whisper. It's fun to watch other people doing it!

In the late 1800s and early 1900s, Yale medical school used to be quite weak and poor. So was Harvard, by the way. Ironically, neither Harvard nor Yale pursued medical research as a major reputation-building factor. Everything changed in the mid-1900s, although I’m not quite sure what triggered the change in mindset. Perhaps it was the competitiveness with Hopkins, where all the brightest research minds were collected.

If you have a chance to walk around the Yale campus (it’s very pretty), you should walk through the cemetery. I was fascinated to discover the tomb of Josiah Willard Gibbs, the very Gibbs that discovered the “delta gee” (Gibb’s free energy).

Friday, July 24, 2009

How To Ace Your Medical School Interview: Smart Practice Pays Off!

Receiving the much coveted interview invitation is a little victory. You got your foot in the door with the school. Now it’s up to you to ace your interview.

Early applicants (AMCAS submitted in early June, secondaries completed by early August) typically receive interview invitations starting in late August-early September. I received all interview invitations by email.

Scheduling an Interview
Most of my interview invitations arrived in September. I scheduled my interviews for October, figuring it will give me a month to prepare. I knew that my interview performance would play an important role in the admissions decisions, since my grades and MCAT scores were average (I did have a killer essay).

I was so excited to receive an invitation from Yale, that I made a huge mistake of scheduling it for September 15th. This left me with less than two weeks to get ready. I would recommend against doing this! A number of things went awry on my interview day and I was not well-prepared to deal with them. But I will get to that later.

Try to schedule your interview on a Monday or Friday. If time and money permits you to stay an extra day (before your scheduled interview) – definitely do that. Walk around the medical school complex (it’s usually pretty enormous), figure out where the admissions office is located. Most schools are pretty bad with giving you directions to their admissions office. Once you’re there you will receive the most detailed beautiful maps and friendly explanations from the office staff. But you’re on your own getting there… Walking around is also useful for gathering strategic information. Make notes about the cool things you find. Walk through buildings and note names of authors on posters that appeal to you. Note loyalties to local sports teams.

A great thing to do is to email one or two current students in advance and ask them for a tour. You will gather a lot of otherwise inaccessible intelligence this way. The admissions office will send you a list of contacts if you wish to stay with a student. You can use this list to find a student willing to show you around. Take your student guide out to lunch and be very nice and appreciative!!! You are doing all of this so you can have some unique, interesting things to say about the school. Interviewers always ask you “What can I tell you about our school?” Ask them about something you learned while walking around (even if you already know the answer). You won’t be taken aback by an unexpected question like that.

Practicing Questions For Your Interview
I discussed this item in detail already: see this post
http://harvardmedgirl.blogspot.com/2009/06/practice-interview-questions.html

Dressing For Interview
You have to get a business suit. If you’re interviewing in December/January you will also need a long dark professional-looking jacket. Don’t wear open-toe shoes, don’t wear jewelry, and don’t smell like anything. Don’t do make-up and don’t paint your fingernails. I actually thought that men looked very professional everywhere I interviewed. Sadly, I cannot say the same about women.

Free your hands. Don’t have Gucci bags with flashy buckles. I really liked that most men showed up with a dark leather folder. I lugged around a bulkier version of that, which was silly and useless. All you really need for your interview is something so squeeze in your hands and something to hold personal cards with. That is, a pocket in your pants would suffice. Have a pen, too.

In most places you will have to do a fair amount of walking, most of it indoors. Some schools will take you on a tour around campus. Make sure you don’t wear stilettos – you’ll be clacking indoors and falling over outdoors. Pants are way more comfortable than skirts (in my opinion) for this reason.

If you’re interviewing in North Carolina in October, you are likely to encounter 90-degree weather. Your suit will kill you. I have no suggestions to improve this state of affairs, but do bring an extra shirt and go for a dark suit.

Do not change back into your normal clothes until you leave the school!!!

Your Interview Day
(This applies to most schools, but NOT HARVARD!) You will show up at the admissions office and greet the people who work there. The staff are so friendly and nice -- it makes you feel much more relaxed. Most good schools study your file in great detail. You will be surprised by how much they remember about you! At Yale, I was casually greeted “Hi, how is Schering-Plough stock doing?” – I work for SP. Be prepared for that!

You get your name tag and proceed into some conference room where you will meet with the dean and (at some point) a financial aid representative. There is typically a one-hour introduction by the dean, and an overview of events for the day. You also get your interview day packet.

Open the packet immediately and look at your interview times. Most schools conduct two interviews. Boston University, notably, has only one. Of the two interviewers one could be a student, or both could be done by faculty. If both of your interviewers are faculty members, you just landed a jackpot. I’ll say more about interviewing with a student later. I got lucky like that only twice: at Harvard and at Yale. You will never have two student interviewers.

Your first interview tends to be in the morning. Once that’s done there is usually lunch, a student tour, more information sessions, and then another interview.

Some common things that can go wrong:
  • Your interviewer does not show up (make sure your cell phone is charged and you know the admissions office telephone number)
SOLUTION: Call the office, you will get a replacement interview. Insist that you do get one!
  • Your interviewer is on the other side of town and you get lost getting there
SOLUTION: Spend money and get a cab immediately. Call the admissions office.
  • Your first interview is running late, and you realize you won’t be able to make it to your second one on time. But your interviewer is talking and talking…
SOLUTION: Before you begin your interview politely (and with a smile) mention “they” scheduled your interviews very close together

I should mention that at Harvard, interview day does not proceed according to this neat plan. The school does nothing to convince you of its grandeur. I wrote in some detail about my interview day at Harvard here: http://harvardmedgirl.blogspot.com/2009/04/re-visit.html

There is no reason to feel competitive during your interview day. That is not the nature of the interview. There is a very real chance you might be meeting some of your classmates on this important day. Cutting each other off and running in front of each other in lines does not help you get in. Be nice – it’s the smartest play by a long shot!

HOW TO INTERVIEW WELL
I suggest that during the one month before your interview you obtain a video camera and tape yourself answering questions. You will discover (hopefully) a lot of embarrassing and funny things about yourself and will promptly correct them. When you tape yourself dress up just as you would for the interview. Suits are so uncomfortable to sit in! Practice every single day until you reach a comfort zone answering questions like “Why should we accept you?”

Read, read, read. The more you read, the smarter you will become. The smarter you feel, the more comfortable you are at your interview. Nothing makes you perform worse than being nervous. It’s alright to be a little nervous – keeps you vigilant. Make sure that you have followed the news for at least one week before your interview. I suggest some good reads in one of my previous posts: http://harvardmedgirl.blogspot.com/2009/05/how-to-get-into-harvard.html

When you meet your interviewer, shake their hand and introduce yourself. Smile and be friendly. Remember your trip around the school and maybe mention something funny about it. In general your interviewer will be incredibly friendly.

Interviewing with a student is tricky. To succeed with a student interviewer, follow these general guidelines:

1. ACT VERY PROFESSIONAL - err on the side of seeming boring. We naturally relax around our young peers. An interview setting is not appropriate for that.

2. TALK ABOUT WORK AND RESEARCH - ask them about their work and their research. Prepare some questions in advance. For example, "Did you consider doing a combined degree program?" or "What do you think about the five-year medical scientist training program? Do you know anybody who is doing it?" Have at least five of those questions ready.

3. BE SOMEWHAT COOL - students will ask you what you do in your spare time. I suppose they could be evaluating how you would fit into their community. You want to sound interesting, but don't say "I party all the time until I'm blue in face". Don't say anything you would not say to your mother-in-law. Interesting activities could be collecting pho recipes, traveling to see ancient images of Caduceus, or enjoying political posters. Something edgier than gardening…

When you interview with a faculty member, look around their office. Do you see books that you’ve read? What journals do they have on their desk? Use anything you can as a conversation starter. Say you read that article last week and what do they think about this and this point in it? Take charge. Don’t wait for them to ask you questions. If you’re lucky and they have a cultural item in their office that you recognize then ask about it (if it can lead to an interesting discussion). Pay attention to what your interviewer says about themselves! It adds a wonderful personal touch to your thank you notes if you say something specific to indicate you cared about your conversation. “Good luck with your residency at such-and-such hospital” or “Congratulations on your recent submission to such-and-such journal”.

At the end of your interview ask for their card. It’s actually quite useful to have their email in case you have to update your application. If you’re interviewing at a non-rolling school you will have plenty of time before any decision is made. Lots of things could change. A contact on the admissions committee is very useful.

Interviews are stressful, but they are so much fun! I have the fondest memories of my interview season. I’m very grateful to have visited so many wonderful medical schools.

In my interview preparation I used some techniques mentioned in this article for managing stress and remembering material: "Who Wants To Be A Cognitive Scientist Millionaire". If you're curious to know more about the research Ogi does go here: http://cns.bu.edu/~ogiogas/

Wednesday, July 22, 2009

Academic Societies at Harvard Medical School: Student Communities and Society Masters

Harvard Medical School class is rather large, about 140 students including both New Pathway and HST programs. It’s not as big as Boston University’s (180 students), but sizably larger than Stanford’s (80-90 students). To foster closer relationships among students and faculty our class is divided into five academic societies: Cannon, Castle, Holmes, Peabody and London (or HST). All HST students naturally end up joining the HST society. The rest of the class are randomly assigned to one of the remaining four. I’m happy to report that in a Harry Potteresque fit the sorting hat put me in Cannon together with my newly made friends!

My society is named after Dr. Walter Bradford Cannon (image borrowed from www.harvardsquarelibrary.org), a Harvard-trained physiologist. He studied swallowing in the 1920s using early X-ray technology. It does not mean that everybody in Cannon is fascinated with esophageal mysteries. Other than HST, societies are not ordered by themes or interests. The placement really is random, although admittedly siblings usually end up in the same club. All societies are roughly the same and offer no unique benefits (although it is rumored that Peapody sometimes has free breakfast?). Each society has their own House – all five open into the main atrium in the TMEC student center. Those who interview at HMS will have their lunch at the atrium and will see the societies.

The Master of my society, Dr. Gordon J Stewler, is a professor of endocrinology and studies molecular factors affecting tumor metastasis. Dr. Katharine Treadway, one of the four Associate Masters at Cannon, teaches “Introduction To Profession” – a two-week course that starts my first year at Harvard. The role of society masters is to support and supervise the students, and to help them achieve their professional goals. They act rather similar to academic advisors. I can’t wait to learn more about them!

Saturday, July 4, 2009

Information Technology at Harvard Medical School is Amazing!

On Wednesday incoming HMS students had their first official introduction to information technology. Two years ago the president of HMS promised to invest whatever it takes to make HMS the world leader in education technology. I was genuinely impressed with the integrated system they have since built for the students. Here are just some of the features we were introduced to.

All lectures are taped and broadcasted at twice the speed. Video feed is digitally modified to correct the pitch of the speakers’ voices. Lectures are available in podcast format compatible with iPhone, Blackberry and iPod, of course. All lecture materials can be downloaded and viewed with any eBook reader, notably the Kindle. In fact, a new pilot is being developed right now that would have a wireless auto-update of class materials and other resources.

Class and exam schedules can be downloaded and combined with Google calendar. This in tern is readily synced with your iPhone or Blackberry. This is enourmously useful to me, a Blackberry user. Students get access to their academic information through a single consolidated portal – My Courses. In addition to academic information, My Courses also features live links to department updates. You can pick and choose what departments you are interested in. For example, I am interested in the latest advances in neural prosthesis. I can easily stay in touch with the latest news at HMS in this area.

My Courses offers easy access to the most popular educational resources: New England Journal of Medicine, Journal LiveWatch, Journal of American Medical Association, and many other professional publications. Amazingly, each of these also exists as a mobile version. You can read your favorite medical news on your PDA. I tested all of this out on my BlackBerry -- it works like magic! So cool!!!

You also get easy online access to Virtual Laboratory where you can view pictures of histology slides in high res. Virtual Anatomy Lab is astonishing: it features a 3-D image of a body that you can zoom in/zoom out on. You can peel off layers of tissues and see what is underneath. High res images of slides really are high res: a single slide we looked took up 16GB, you could zoom in to see individual cells in high resolution.

Harvard email is set up to work with any PDA. You can also forward your email to Gmail and check it on your PDA. Email updates sync easily with Google. I noticed that in less than a week I received three financial aid offers for small scholarships to help pay for tuition. I’m definitely going to look into some of them.

In short, HMS has the single most integrated and easy to use IT system I have ever seen. It is specifically designed to work with all of the most popular devices that make our lives easier and more productive. I really can’t wait to start my life at Harvard!

Friday, June 26, 2009

How To Gain Research Experience?

How does one obtain good research credentials? I have been given a somewhat unique opportunity by my undergraduate institution. Instead of graduating early I had a chance to complete a Master’s degree in biochemistry. Therefore I graduated with both BS and MS. I gained a lot of basic research experience by working in the lab on evenings, weekends and summers.

My Master’s degree allowed me to get a good job at a major pharmaceutical company. By the time I applied to medical schools I had a year of industrial experience behind my belt. It was enormously helpful for my interviews.

My school was unique in that it did not charge me extra for my Master’s degree. I finished it in four years along with my Bachelor’s. Considering that MS costs about $40,000/yr and takes 1-2 years to complete, it was a terrific deal. I would not be willing to pay this money to get research exposure. Neither should anyone in my opinion. Use “free” sources like get a job in the industry. It is an invaluable source of experience because unlike academia, research in the industry FLIES FAST! If you are still in college then volunteer in a research lab. Perhaps they will even pay you some money, but do not expect much unless you bring in some grants or stipends yourself.

Below are some great programs that pay stipends and give you terrific exposure to science and research:

REU: Research Experience for Undergraduates
This program is funded by the National Science Foundation. It operates on university campuses in the summer. REU recruits students from all over America. The program pays $4000 stipend plus provides room and board. It’s a 10-week intense research experience. You decide on an independent research project to complete during this time. You are supervised by a research advisor, and two REU advisors. You will learn how to make research presentations. You will also become familiar with science opportunities beyond the lab: in politics, business, and teaching. It’s a fantastic resource and looks great on your resume. I enjoyed it tremendously. My REU project evolved into my Master’s thesis.

NIH Summer Internship in Biomedical Research
This is another fantastic summer research opportunity for college students as well as medical students new to research. NIH is located in Bethesda, MD. Its research campuses surround two major hospitals. This provides participants with unique biomedical research opportunities. For example, if you are interested in retroviruses as vehicles for gene therapy, you have a unique opportunity to work with a clinical team who can test it in patients. Of course, MD degree is required to do ANY work with human subjects. Your opportunities would be somewhat limited without MD. This was one of the reasons I did basic research instead.

Your undergraduate institution probably offers small research awards to support your laboratory endeavors. Don't be shy and apply for as many as you can. Writing grant proposals is a wonderful way to learn science related to your research project. For example, my research project focused on solving an X-ray structure of a bacterial protein. To write a grant proposal I had to learn as much as I could about the latest antibiotics. This knowledge in tern came in handy at interviews. Reading broadly in science helps you build depth of professional knowledge and competence.

What direction should you pursue in your research? A lot of exciting developments happened in molecular biology in recent years. Epigenetics and embryogenesis are fascinating fields with high degree of relevance to medicine. I did research in protein structure and function. It offers a great diversity of experience. In the past six years I worked in metabolic diseases, inflammatory diseases, neural degeneration, infectious diseases and cancer. I don’t know as much about any one area as a more focused expert would, but I understand how proteins work – very useful in modern medicine!

At Harvard I will be pursuing the latest in neural prosthesis technology. MGH is home to one of only two laboratories in the world that are developing practical neural enhancement devices for patients with paralysis, speech and hearing impediments. My husband does related kind of brain research called brain modeling at Boston University: http://cns.bu.edu/~ogiogas/
I found that my background in protein engineering is very helpful to help me navigate in this research area. The broad diversity of therapeutic areas I exposed to is invaluable in getting ahead of the learning curve in a new field.

Ultimately let your interest guide you in exploring research opportunities. It is very important to stick with whatever you choose to pursue. It is entirely possible that you will spend years in the laboratory with no publications. Do not despair, and do not leave the lab. Consistent exposure to the field earns you expertise, which you cannot obtain in any other way. Schools like Harvard are looking for students with an ability to become experts. They respect in-depth knowledge of any science field.

DESCRIBING YOUR RESEARCH effectively and intelligently is very important during the interviews. It is your moment to show you know what you’re talking about. You need to have three prompts ready before you begin interviewing:

1. Your one-sentence talk
2. Your 2-minute talk
3. A page long bullet point list of interesting things about your research project

Wednesday, June 24, 2009

Selecting Medical Schools on AMCAS

I’m posting this in response to a very good question that I received from one of this year’s applicants. Selecting what schools to add to your list is a very important point! You don’t want to miss the ones you would like, but did not have enough time to research. You don’t want to spend a fortune applying either. I’ll share some of the biggest mistakes I made while going through this process. I hope this would help you make better choices.

Initially, I had 15 medical schools on my list. All of them are in the US, and all of them I really liked. I learned about them mostly through research conferences and reading their website. Harvard Medical School has been my dream for the past six years, but I would have been happy with any of the schools on the list. Below is my original list:

Yale
Brown
Duke
BU
Dartmouth
UPenn
Harvard
Johns Hopkins
Tufts
Wash U in St. Louis
UCSD
UCSF
Cornell
Stanford
Columbia

Mistake #1: do not apply to "out-of-state" schools!
I heard so many good things about UCSF and UCSD that it did not even occur to me to think that these are California state schools. I’m from Massachusetts. Unless your MCAT score is 45, and your GPA is 4.0 your chances of getting into Stanford are better than either UCSF and UCSD. If those are indeed your numbers, then you probably want to go to Stanford anyway.

Mistake #2: do not apply to schools that you rejected previously
If they rejected you - it's a different story. If your application changed significantly from previous years, then by all means you should apply. Personal example: as a senior in college I declined offer of admissions to Tufts (through early admissions program). They did not show me that love again when I applied regular action!

If you rejected their offer of admissions - they already know that you don't want to attend their school. They will not accept you.

Thus, I applied to these 15 schools and sat there nervously awaiting interview offers. September 2nd was a happy day - I received four interview offers. By early October I had seven. At the same time, some of my classmates had ten to fifteen. It scared me. I proceeded to add another 7 schools to my list in OCTOBER:

U Pittsburg
Mayo
U Washington
Vanderbuilt
U Chicago
U Michigan
Baylor

Mistake #3: do not succumb to pressure and add more schools to your list!
I interviewed at roughly half of the places on my original list. Of the schools I added in October, only ONE invited me for an interview. Later I actually ended up being accepted to it, but truth to be told it was a huge waste of money. I strongly advise against doing this :)

I learned later that a lot of my friends had laundry lists of "safety" schools. This does not make sense to me -- why add schools that you don't want to attend? What kind of "safety" is it if you end up at the place you don't like? No, add the schools that you like. You will do better research on these schools. You will write better secondaries. You will perform better on interviews. All because you will be motivated by "I really want to go here!"

Mistake #4: do not apply to schools you would never go to
I applied to Baylor and Vanderbuilt driven solely by their ranking on US News&World Report. In retrospect, I was doing this under pressure. I would never be able to live in a red state. I would not want to go to these schools. This fact alone affected the quality of the secondaries I sent to these places. If you have a significant other (I’m married) be sure to discuss your choices with him or her.

Of the 8 schools that interviewed me I was accepted into 5: BU, Dartmouth, Yale, Pittsburgh, and Harvard. 3 waitlisted me: UPenn, Brown, and Duke. I was never rejected post-interview.

You can expect that on average you will be interviewed at half the places you apply to, and that you’ll be accepted to half of those. Of my original fifteen schools, I had one dream school and one safety school. The rest were just really good schools.

mdapplicants.com is a fantastic resource to compare your school lists and numbers to other applicants. Two things to keep in mind. One: most members on MDapplicants don’t add dates to their profiles. This is annoying and makes things difficult to keep track of. Two: profiles on MDapplicants tend to represent “top” applicants. They do not represent a random population sample.

With this said, if you want to see a fantastic MDapplicants profile, please see here. I’ve never seen a better organized and helpful profile.

Here is another good resource to look at: a Blog run by Dr. Lee Ann Michelson called Harvardocs. It features a lot of helpful information and is very clear.


Tuesday, June 23, 2009

What Medical Schools Are Looking For

If you look up “What Medical Schools Are Looking For” on Google you will get 8,330,000 entries. You’d think that among some eight million entries you can find the much coveted answer. I found that most answers are too vague and unhelpful. “Be yourself” is not something that could help me build an impressive AMCAS profile!

I decided to look for answers from people who were on admissions committees at the schools I was interested in. Below I will share some information I found useful.

New England Journal of Medicine published two very interesting and helpful perspective articles on what schools were looking for in their applicants.

One was written by Dr. Jules Dienstag titled "Relevance and Rigor in Premedical Education". I cannot offer the entire article on the blog for copyright reasons, but you can get it here. Dr. Dienstag is the dean of medical education at Harvard Medical School and sits on their admissions committee. You can trust his opinion. If you find his article online look for supplementary information link – it’s a fifteen page word document which delineates Harvard admissions guidelines. A gold mine!!!

The second helpful article published in the New England Journal of Medicine is titled “From All Walks of Life – Nontraditional Medical Students and the Future of Medicine”. I highly recommend reading this article even if you are not a non-traditional applicant (I wasn’t). It’s written by Dr. Sandeep Jauhar, an MD/PhD from Albert Einstein College of Medicine. You should primarily focus on what he thinks non-traditional applicants bring to the table. Realize that you don’t need to be a non-traditional applicant to be mature, informed, curious, etc. When you write your secondaries – this is the language to use! Finally, there was one book I read that was helpful in writing secondaries. It’s titled “How Doctors Think” by Dr. Gerome Groopman from Harvard Medical School.

Friday, June 19, 2009

Atul Gawande: The Cost Conundrum

“The Cost Conundrum” is the name of the article written by Dr. Atul Gawande in the June 1st issue of The New Yorker. It tells a story of a healthcare problem that plagues the small border town of McAllen, Texas. In 2006, Medicare paid fifteen thousand dollars for each inhabitant of McAllen. Considering that on average McAlleners earn only thirteen thousand dollars per capita, Gawande says, this figure is astounding. He writes about his visit to McAllen and the describes his observations of what factors are driving up the unusually high cost of the town's health care.

You can find the article on the New Yorker website: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

It’s a great story to reference in your interview answers. The more of these you read, the more successful your interview will be.

Thursday, June 18, 2009

Less Than Ten: Surgeons With Amputated Fingers

In 1982 Dr. Paul Brown published an article in the Journal of Hand Surgery titled “Less Than 10 – Surgeons With Amputated Fingers”. Over the years Dr. Brown spoke with 140 men and women in surgical scrubs who were practicing their craft with less than ten digits. The severity of their losses ranged from a single missing phalange to an entire hand cut off in a sawmill accident. Astonishingly, only two of the 140 surgeons reported any hindrance resulting from their loss. Perhaps even more astonishing was that some surgeons having lost a finger by accident proceeded to amputate more! This, they said, made their hand smaller and more agile.

This is a picture from Dr. Brown's article showing the hand of Sir Sidney Sunderland, a neurosurgeon. Strikingly, his right hand is missing two phalanges of his index finger! With this hand, Dr. Sunderland apparently performed neurological surgery without noting much of a hindrance.

Dr. Brown’s article provides an interesting approach to questions like “What do you think is the most important factor that makes a good physician?” He describes interviewing surgeons who overwhelmingly thought missing fingers did not affect their performance. Some surgeons were missing several phalanges as a result of a congenital defect – they were born this way. Imagine you were applying to medical school with seven fingers in hopes of becoming an eye surgeon! They must have thought that “perfect ten” is not what makes a great physician. So what was it then?

The thesis of “Less Than Ten” is that surgeons did not hesitate to return to surgery after sustaining severe trauma to their operating hand. They loved their craft and were so dedicated to it that it did not occur to them to quit. Of the two surgeons who no longer practiced, one had lost all innervation to his dominant hand after it was completely amputated. The other surgeon (and I think this is very telling) had thoughts of quitting before he suffered the trauma.

I highly recommend reading this article. I finally got uploaded this article through my domain. Please take a look at it, it's rather fascinating! http://science1on1.com/LessThan10.html

Monday, June 15, 2009

Practice Interview Questions

Rehearsing Q&A is the most effective way to improve your performance on your interview day. Ask your parents, friends or spouse to pose as the interviewer and have them read questions to you out loud. Try and maintain eye contact with the person you’re talking to, but don’t give them a deadly stare. Find a video camera and tape yourself answering questions while sitting on your office chair wearing your suit. Get ready for some embarrassing surprises! I realized that I was nodding to myself like mad whenever I spoke, that sitting down the back of my suit somehow rose up, and that my hands were glued to my knees like a third-grader’s. It was the single most informative instance of feedback on my interview performance I ever received.

Finding interview questions to practice with is not easy. I started by using the Studentdoctor resource where I found lists of questions from students who already interviewed: http://more.studentdoctor.net/schoollist.php?type=2

However I found that it can be somewhat annoying to navigate. You have to click on a large number of individual student responses to come up with a list of ten non-redundant questions. But it’s a good start.

I used studentdoctor questions in order to come up with my own. I also edited the list as I went through my interview season and gathered more feedback on my performance. I arranged the questions in groups:

1. WEIRD QUESTIONS
2. STRENGTH/WEAKNESS QUESTIONS
3. SCHOOL-SPECIFIC QUESTIONS
4. HEALTHCARE QUESTIONS
5. HAPPY or PROUD MOMENT/SAD MOMENT QUESTIONS
6. ACTIVITIES/CLASSES QUESTIONS
7. LEADERSHIP QUESTIONS
8. RESEARCH QUESTIONS
9. WHY MEDICINE?

If you think of your application in terms of these categories, you can organize your interview to highlight a particular theme of about your candidacy. Write down your answers but do not memorize them – you don’t want to sound robotic. Just become comfortable and familiar with them.

Below are some example questions that I put together. Some of them are borrowed from Studentdoctor resource, some I was asked, and some I just made up.

WEIRD QUESTIONS
  • If you were a superhero, what super power would you have and why?
  • Have you ever experienced a situation where your integrity was compromised
  • What is your favorite color
  • What is your favorite type of food and why?
  • Why didn't you stay with a student host?
  • Do you lift weights?
  • Why do you think we need sleep?
  • What do you do for fun?
  • What do you do to keep yourself healthy?
  • Where does your sense of morality come from?
Don’t worry if you get an odd question. Steer the discussion back to the theme of your application. For example, “What superhero power do you want to have?” You could say “well I want to fly all over the world and see how doctors live and work in other courtiers”.

STRENGTH/WEAKNESS QUESTIONS
  • Do you think you would do well in the (school X) System?
  • Why should (school X) choose you?
  • What is the ONE important lesson you have learned from all your clinical experiences?
  • What should I tell the admissions committee about you?
  • If somebody on the admissions committee said to me “well she’s good but I’ve seen better” what would you like me to answer to that?
  • What do you want to talk about?
  • Is there anything else that we should cover about you (at the end)?
  • What qualities should a physician possess?
  • Name three qualities important to being a physician that you already possess, and another three that you don’t just yet, but that you believe you will strive to gain in medical school?
  • What do you want to talk about?
  • What is your weakness?
  • When you look in the mirror, what do you like and not like about yourself.
  • What do you think will be your biggest challenge in becoming a doctor?
  • What is your weakness?
  • What is one of your weaknesses?
  • If there were one reason for us to not accept you, what would it be?
  • If (school X) didn't accept you, why do you think that would be?
Take every opportunity to talk about your strengths. If you are given a wide opening (like “what do you want to talk about”) talk about your strengths! Say “I’d like to tell you about myself and what brought me here today”. And dive right into your strengths! You should have three major strengths worked out, look at the first few pages of “Better” by Dr. Atul Gawande to help you with ideas.

Coming up with a “good” weakness can be a huge problem. If you resort to something along the lines of “I work too hard” or “I take on too many projects” get ready for some sour responses. It’s been done too many times. Think about embarrassing but funny situations – are you clumsy at the lab bench? Do you have a fear of public speaking? If you don’t have a weakness that’s funny then you can borrow a story from Frank Vertosick’s “When The Air Hits Your Brain”. Don’t draw attention to bad grades or poor MCATs. Your weakness has to be a weakness, but a non-essential one. It helps if it’s funny.

SCHOOL-SPECIFIC QUESTIONS
  • Why school X?
  • Why do you think school X is the right place for you?
  • What other schools did you apply to?
  • Why did you apply to school X?
Read the school website to answer these questions. Scan their news feed for big grants (usually NIH) and recent award laureates and recipients. Read about two or three people you’d like to do research with. Perhaps the school has a unique educational system (like Yale) or location that appeals to you. At top schools, geographic location should not even come up. They expect that if your dream is to attend their school, you will happily pack your bags and move to Siberia if needed.

HEALTHCARE QUESTIONS
  • What are your thoughts on socialized medicine?
  • What is the greatest impact you plan on having in the medical field? How would you go about doing this?
  • Tell me how you would fix the health care system.
  • Name three current controversies in the field of medicine that you are interested in, and explain your stance and future considerations regarding the debate.
  • Why shouldn't healthcare be paid for by the government
Read NEJM or JAMA to understand the current healthcare issues. NEJM has online broadcasts of conferences and panel discussions of healthcare. Those are short (20-30 minutes) and easy to digest. You will learn interesting opinions about healthcare in US. It would be great if you learned about the healthcare system of at least one more country.

HAPPY or PROUD MOMENT/SAD MOMENT QUESTIONS
  • What were the happiest and saddest moments of your life?
  • What was your proudest moment?
  • Compare life in foreign country to experience in the U.S.
  • What is the greatest challenge you have faced?

If you're going to tell a sad story, make sure to end it with something positive. At Pittsburgh I told a sad story from my childhood. The atmosphere in the room became palpably dense and the uncomfortable silence duly followed. I smiled and said, “Well, uh, that was depressing!” and we both laughed and relaxed. However, when I interviewed at Boston University my interviewer apparently enjoyed sad stories because they kept asking me questions about it. I dropped many leads into more positive topics, but my interviewer chose to ignore them. Beware of those situations!

ACTIVITIES/CLASSES QUESTIONS
  • Tell me about this class you took (interviewers really knew my application in detail)
  • Explain (points to AMCAS activity) and what you learned from it.
  • Tell me about x and y activities listed on your AMCAS / essays?
  • Let's go through your AMCAS application...ECs and background info.
  • How did you find about your undergrad school coming from a foreign country?
  • Tell me about your university. I've never heard of it (said in a most condescending manner).
  • Tell me about your MCAT preparation and your feelings about the result
  • Where else are you applying? (named and asked about specific schools)
  • Looking at the healthcare system today, are there any problems you may have to deal with when you start practicing?
Google your awards and activities. Of course, Google yourself before you start interviewing. Most of my interviewers immediately reached over to their computer and Googled my file right in front of me. It can be intimidating! Know your application inside out and have something interesting to say about every activity.

LEADERSHIP QUESTIONS
  • Describe the leadership positions you have held.
  • What challenges did you face as a student group officer?
RESEARCH QUESTIONS
  • Tell me about your research.
  • How to go about setting up an experiment related to my research.
  • Explain your research to me like I was a molecular biologist, (it was Mol Bio research)
  • What research are you interested in
  • To discuss my interest in research and why I didn't apply to MD/PhD
  • How would you apply your current (basic science) research to medicine?
  • How does your research apply to medicine or how would you translate it?
  • What was your favorite research experience and why?
  • How does your research fit in with your medical vision?
  • Tell me-in layman's terms- about your research?
WHY MEDICINE?
  • What do you want to do in 5 years?
  • What other schools did you apply to?
  • Why is medical school right for you?
  • Take me through a perfect day in your life ten years from now.
  • If you could change one thing about our society, what would it be?
  • How do you know you want to do medicine, apart from those few clinical volunteering experiences? (tip: be assertive, and give a strong answer; don't shrug it off as a weakness)
  • Explain your experiences and how you decided on medicine
  • Tell me about your family (here try to include something about your family background that made you want to go into medicine)?
  • What are your short term and long-term goals following completion of medical school?
  • Flash forward to twenty years from now....Tell me what your day will be like?
  • Why do you want to be a doctor?
  • Where do you see yourself in 10 years?
  • How has all your activities prepared you for a career in medicine?

Wednesday, June 10, 2009

HMS Labcast

I really like this website: http://podcast.hms.harvard.edu/
It has wonderful fun material on the latest and greatest research at the medical school!

Here is a few questions that were featured in episode 9 "How To Make a Doctor". They came from regular Bostonians who were curious about what it is they teach to students at the medical school? I thought these would be good questions to think about how to connect with people (your patients and your interviewers):

Q: How do medical schools teach doctors compassion?
Q: Are you teaching doctors people skills?
Q: Are you teaching students communication and compassion skills?
Q: How do you get students to see life as a process of learning?
Q: Considering the vast amount of information out there, what should the students be learning?

To help medical students address these questions, Harvard medical school encourages students to undertake an independent project, whether in the laboratory or in global health, or community health. These is talk that in a few years becoming engaged in a project like this would become a requirement for Harvard medical school students. Yale medical school students are already required to write a research thesis in order to graduate.

Thursday, June 4, 2009

Atul Grover on Medicine in Public Policy

I enjoyed listening to this interview with Dr. Atul Grover, who teaches at Georgetown and Johns Hopkins. It was published on aspiringdocs.org on June 4th. He talks about the importance of diversity among medical professionals both in public medicine (where the role of diversity is perhaps more obvious than in other areas of healthcare) and academic medicine. I wish I heard this interview before I interviewed at medical schools.
Interview with Dr. Atul Grover is posted here:
http://www.aspiringdocs.org/site/c.luIUL9MUJtE/b.5200531/k.1426/Meet_the_Experts_Podcasts__Atul_Grover.htm

I also recommend reading "Better" by another Atul (!), Dr. Atul Gawande, which covers interesting issues of public policy and medicine. I greatly enjoyed his first book, "Complications", but "Better" definitely has more of a public policy angle. Both books are fantastically easy to read. Recommend.

Tuesday, June 2, 2009

Dean Tosteson Dies a 84

Daniel C Tosteson, Dean of Harvard Medical School from 1977 to 1997 died on May 27th. He is responsible for the emergence and the success of the New Pathways program at HMS which I am privileged to participate in. An article about him published on the HMS website is quite good: http://webweekly.hms.harvard.edu/archive/2009/052809/comm_news_tosteson.html

Incidentally, most students who come to Harvard Medical School for an interview are very likely to either have a meeting, or an interview, or otherwise walk through the Tosteson medical Education Center. Look for it when you visit, it faces the main road Ave Louis Pasteur.

Monday, June 1, 2009

Vaccinations for Medical School

Official vaccination records are due at HMS health office by June 15th. They want to know that you've had all of your required vaccinations, a recent TB test, and a blood titer to prove that you actually have antibodies to that stuff you were vaccinated for. I wish I knew this at least a year in advance because it's hard to get all of this stuff done in a month :(

But I suppose it's a good thing that the school is so strict about vaccinations (most schools would accept mere records of vaccination without requiring expensive antibody tests) since I'll be working in a hospital for a long time and will likely become exposed to lots of nasty diseases. Next week I'm marching into my doc's office, armed with twelve forms that have to be filled out and signed by him.

***
I just finished all of my vaccinations for medical school (06/11/2009). Because HMS requires that you prove you have antibodies (a record of vaccinations is not enough, this is not like college) it took me a month and a half and three visits to the health center to get everything ready. Make sure that you budget enough time to finish this part, you need to do this with your physician!

Required immunizations:
Measles/Mumps/Rubella
Hepatitis B
Chickenpox (varicella) - record of disease is not sufficient
Meningoccal vaccine
Tetanus-diphtheria booster - fresh one is required every 10 years
Fresh TB test
Polio (optional)

Plan on three visits with your primary care physician: 1) go over the paperwork, figure out what's missing 2) do the blood titer and wait for results 3) finish going over the paperwork with your primary care physician and get his signatures on every page.

Sunday, May 31, 2009

Good Reads For Your Interview

Preparing for the interview season is a stressful affair. Interview invitations begin trickling in late in August, for some schools it could be as early as August 14th (for example, Brown sends out interview invitations starting that early). In early September most applicants receive 5-10 interview invitations, and most interviews are scheduled for late September to late October. Suddenly you find yourself traveling all the time, your boss becoming frustrated with your chronic absenteeism at work. You eat pre-wrapped food from airport cafeterias and festoon your suitcase with single-serving shampoo and conditioner bottles. You wear a suit. Constantly. In North Carolina in September in 80-degree weather. In Maine in October when it's 30s. The point is, interviewing season is exciting, but it's also exhausting. It helps if you prepare for it before the fun begins.

So how to prepare? How to know what to say (and what not to say) at your interviews? There are many ways to prepare for your interview season, but the bottom line is this: READ. Read constantly. You want to know a lot before you start interviewing. You also want to chose intelligently what to read, selecting books and articles densest with relevant information. My strategy was to sort all of my reading material into three categories:

1) Current Events
2) Medical Issues
3) General Interest

CURRENT EVENTS
I am generally interested in politics so I stay in touch with current events through news sources such as CNN or Washington Post. When I interviewed the country was electrified with the election campaign, so it made sense to anticipate that my interviewers would be intellectually curious people engaged in the election process. This is how I decided to make "Current Events" a major reading category. Recommended readings in this category:
www.washingtonpost.com
www.politico.com
Politico webpage gives a rich and concise overview of what's happening in the world, I would highly recommend reading it.

A quick-and-easy way to stay in touch with current politics is a recent WBUR newletter service. They will send you a daily summary of events by email. You can quickly scan the headlines and read only the ones you’re interested in. Overall it is a great way to stay informed. You can subscribe to the service here: http://www.wbur.org/updates/wbur-today-signup

MEDICAL ISSUES
There are so many wonderful medical issues to read about, all rooted in ethics, new technologies, new policies, and demographics. It really helps to be knowledgeable in this category. I really enjoyed reading books by Dr. Atul Gawnde, "Better" and "Complications" to learn about the current issues facing medicine. Gawande will give you an idea of the kinds of issues that medical profession faces today. He is also a wonderful writer and researcher. His books are very informative. I learned about doctors in the Army, doctors in India, issues facing doctors working in prisons, doctors assisting with administration of lethal injections to prisoners, and much more.

"The Silent World of Doctor and Patient" by Jay Katz (a doctor and a lawyer from Yale) is a fantastic source of questions in medical ethics, however it is a torment to get through. I read this book in small bits. Few pages here, few pages there in between more entertaining literature. This book alone made me so much more aware and informed -- if you're going to read anything on medical ethics, read this book.

I finally paid $64 for a year's subscription to New England Journal of Medicine online. It is simply a cornucopia of most current medical knowledge written by good writers. Every week a new issue comes out, featuring two articles in the section called "Perspective". These are usually the most pressing, most recent, most burning issues in medicine - unrivaled source of conversation material!

I also read books about what it's like to be a doctor: personal accounts by medical professionals of their lives, their careers, their medical education. I read a number of books by different authors, and although the material is mostly engaging I found that the best writing was by far was Dr. Frank Vertosick, a neurosurgeon trained at Pittsburgh. I read his books "Why We Hurt" and "When The Air Hits Your Brain", the later one being my absolute favorite. It is a funny, witty, engaging read. Sadly, Dr. Vertosick was struck with Parkinson's disease and no longer practices neurosurgery.

Finally, I read the six hundred page biography of Dr. Harvey Cushing, the nation's first neurosurgeon by Michael Bliss. He also wrote the biography of Dr. William Osler -- I don't think you will have time to read both of these books in one season. I recommend reading about Cushing because he was American and more of your interviewers are likely to know him. Osler was Canadian, and I found that fewer of my interviewers knew him.

GENERAL INTEREST
Here I read anything of interest, which for me means science and politics, and superhero movies. I loved reading Dr. Carl Sagan's books about the universe, "Candle In The Dark" and "Varieties Of Scientific Experience". I also loved reading Dr. Richard Dawkins -- "The Selfish Gene" and "The Blind Watchmaker". These were excellent sources of fun knowledge to share, learning about human evolution, and the evolution of our minds, and the origin of gender struggles.

I read some fiction, although I had little time left for it. One of my favorite American authors is Cormack McCarthy, I read "The Crossing", "Blood Meridian", "The Road", and others. Although I enjoy reading fiction, it was the least helpful for my interviews. It's good to have read one interesting fiction book and be ready to say something interesting about it.

Did all this reading pay off? Absolutely. At Dartmouth my interviewer was reading the same New England Journal of Medicine Perspective article that I was - we had a great time discussing it. At Yale I toured the Harvey Cushing library and other historical places I read about. When asked "What did you like today at Yale?" I had a great response ready. They love Atul Gawande at Harvard! I talked and talked with my interviewers about him. They called him "Our Sanjay Gupta". I never hesitated to answer questions on medical ethics and felt I was able to say something about their historical origins. At Duke I was asked what super hero I would like to be. Since I watch "Heroes" I knew what to answer immediately (I would love to fly like Peter, of course!!!)

Thursday, May 28, 2009

HMS Acronyms Explained

The title is a twist on my favorite philosopher's book title "Consciousness Explained" by Daniel Dennett from Tufts University. Although Harvard Medical School acronyms are not nearly as complicated as consciousness, more often than not I was googling to find what they meant!

HMS = Harvard Medical School
NP = New Pathways
HST = Health Science and Technology
FUNC = First Year Urban Neighborhood Campaign
FEAT = First Year Adventure Trip

After almost two years of working, a year of monstrous applications, and four thousand dollars shaved from my savings account I am less than three months away from starting Harvard Medical School! The official registration begins August 17, but I should get my HMS email address some time in June... I frequently imagined what it would be like, being a medical student at Harvard, and now I'm about to find out first hand! I read the official website to keep myself in the loop about what's happening at the medical school: http://hms.harvard.edu/hms/home.asp, and then school sends us updates on first-year class schedule and other activities.

There are two pre-matriculation activities that are designed to help the new students meet their older peers and introduce us, incoming first-years, to some of their (presumably more amicable) faculty: FUNC and FEAT. FEAT is a backpacking trip into the wilderness of New Hampshirean mountains and I'm sure this would be amazing, but I'm not a fan of August mosquitoes and sleeping that close to Earth, so I'm not doing it. FUNC, on the other hand, is a community service program organized by (maybe?) current first-year student at HMS. This picture is taken from FUNC brochure that the school sent me in May - it features a student happily chopping carrots for Community Servings program around Boston. That's all I really know so far about it, but I signed up anyway -- they promised more information later on. Whoever organized both programs clearly has a soft spot for witty acronyms!

An entering class at Harvard Medical School is roughly 140 students. Of those, about 110 enter as New Pathways student (and I am lucky to be one of them!), and about 30 enter as HST students, which stands for Health, Science and Technology "track". Those students have remarkable opportunities to do research at both Harvard and MIT, the program is designed with the idea to give Harvard medical students access to the leading researchers in health technologies and engineering. I remember when I first applied to HMS I tried my best to understand the differences between New Pathways and HST, but little was available. On www.studentdoctor.net I found a spectrum of opinions ranging from "there is no difference" to "they never even see each other!" Interestingly, some students who were accepted to HST in my entering class expressed fear (!) and anxiety about it on studentdoctor blogs.

The truth is that HST is quite different from New Pathways (I finally understood the differences, but only after I was accepted and attended the revisit weekend!). New Pathways features a unique curriculum which makes use of problem-based learning, the so-called "PBL approach". HST students spend most of their time in lectures. During the revisit they allowed us to sit in on one of the tutorials - small group learning activity that substitutes for most of the lecture time in New Pathways curriculum. The one I attended started at 9am, and it was a very small group of students (5-6) discussing a case of a patient with flu-like symptoms. A new case is offered for students' consideration each week, and on Friday (which is when I happened to attend it!) is the big finale - students finally learn the true diagnosis of the patient. Each student in the group researched one of the possible diagnoses and then presented it to the group in a very casual way - among the six students it seemed that everything was covered from immunodeficiency due to alcoholism to exotic Korean viruses. The group was nominally headed by the instructor, who was a young, smiling, friendly doc (a specialist in infectious diseases), but his role was apparently to make sure the students weren't saying something wrong as opposed to leading the discussion. I was very impressed.

Unfortunately I did not get the opportunity to attend HST activities. HST students were rounded up and bused to MIT to participate in some undoubtedly cool stuff. We had very different schedules for the revisit weekend, but got back together for breakfast and dinner (Harvard treated us to some really good food, actually, nothing like the Quaker Bars they "featured" on the interview day!)

Thursday, April 30, 2009

Interview Day vs Revisit Weekend

I interviewed at HMS in January -- it became my last medical school interview. At 8:00 am sharp all twenty of us nervous applicants were escorted into a dimly lit conference room with a long table in the middle and two rows of chairs of both sides. There were several pots of coffee and a sorry bowl of Quaker bars on the table in the corner. My brains were floating in a bath of adrenaline but I did manage to absorb some of the short introduction to our interview day, namely that there will be no hospital tour, no formal lunch with current students, no anatomy lab visit, or any of the usual events that one finds on the courtship agenda of the other 150 medical schools in this country. Semiconscious I breathed out "When are we going to have the financial aid session?" only to have the coordinator burn a whole through my pinstriped suit with her Cyclops gaze - "If you are invited for a revisit", she said as if I just desecrated the Lenin Mausoleum, "you will have a session then". I asked no more questions for the rest of the day and was certain that this unacceptable frivolity will cost me any possibility of admission. Next I was handed a couple of cab vouchers to get to my first interview which was at Mass General Hospital on the other side of town, and that was all the love that HMS showed me that day... It is true that of all the schools I visited, Harvard did the least to convince you of its greatness. Nothing like the revisit!!! Almost all who received the coveted letter of admissions came to the revisit, filling the large antique hall of the Vanderbuilt medical student dormitory building (you can see the entrance to Vanderbuilt in this picture). Our chatter was amazingly synchronous, students asking each other time and again "Where did you come from?", "Where did you go for undergrad?", "Are you positive you're coming here?" My head was spinning and I was starving too, having come here right from work. I don't know what it is about HMS, but they sure keep you waiting for food, perhaps in a healthy attempt to keep our cholesterol low? It's a prominent feature on campus banners, by the way. Two hours after we arrived at Vanderbuilt, and many more hours for some students who flew in from all over the country, our starving cohort proceeded into a huge ballroom arranged with clothed restaurant-style tables, a prominently featured speaker podium, and a large bar which students flocked around. It seemed that all of HMS's grandeur was baked into their amazing artichoke dip and all sorts of dinner treats for our hungry stomachs. We shared this amazing dinner with faculty members and students who were most friendly and easy-going. Dr. Matthew Frosch gave the kindest remarks about the school and the HST curriculum -- I spoke to him on the phone before I applied to Harvard and he was every bit as intimidating as I would imagine, so nothing like he was that day! -- and current students spoke with passion about how much they loved being at Harvard. Over and over they repeated that the greatest asset they were awarded by HMS is their classmates, and this opinion was passionately shared by the faculty and the administration. It was just a great time!

I did not spend the night at Vanderbuilt as many students did because I live a short train ride away from HMS. So next morning I arrived from Downtown Boston to share breakfast with the other students. It was in the same ballroom, but there were no speakers this time. After breakfast we gathered into groups that went on various tours around the campus: we began by sitting in on a tutorial class, then proceeded to tour one of the older hospitals on campus - the Brigham and Women's Hospital (the picture below is the old Peter Bent Brigham Hospital, but it was much extended in the recent years). The tour was headed by two fourth year-students, but they somehow managed to arrange for us to be guided through the intestinal transplant unit by the surgeon who worked there. He introduced our group to two of his patients, a young man whose abdomen was an intricate network of surgical scars from numerous intestinal transplants here received, and a baby-girl who underwent similar surgery. Both were friendly and smiling, and greeted us with enthusiasm. Next we marched over to the neonatal ICU where a small group of us, myself included, was allowed to tiptoe through the unit and see the tiny babies in their clear plastic cribs, attended to by doctors and their families. A very pregnant doctor told me with a smile that I should choose to specialize in neonatal emergency care. I thought she was awesome.

Tired of walking and riding in elevators -- a time-consuming business for a group of fourty people -- our tour dropped us off at the medical school building where we were scheduled to have our financial aid session (for me it had a whiff of magical significance), a review of "opportunities", and an address by Dr. Jules Dienstag, once dean of medical education at Harvard. I've read his article in the New England Journal of Medicine in July 2008 about the need to upgrade the pre-med requirements to make them more adequate for modern medical school curriculum. It was very exciting to meet him in person!

I jolly-well napped through the talk about opportunities because it turned out to be concerned primarily with international medicine and travel. I'm not interested in travelling abroad (at least, at this point in my life), but I recognized that for somebody who was, they offered rich and exciting variety of options. Then came the financial aid. It started with a photo... featuring a gleeful bunch of people, dressed up in Halloween costumes, smiling and delighted - nothing like your undergrad financial aid, where half the staff is depressed from giving bad news to your parents and husbands that MORE of their money is going bye-bye. Harvard financial aid is mostly good news -- it really is incredibly generous!

I left soon after the financial aid session ended, having asked Dr. Dienstag about his article! I felt increbily excited, and above all - that this was the right place for me. I know I will be so happy at Harvard Medical School, and I will try and write about my expreinces there as I go along through this remarkable journey to become a Harvard-trained physician.
 
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