Page 1

VOL. 23 NO. 1 • $5.00

The Residency Match Guide

Special Report: National Heart, Lung, and Blood Institute


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IN AN ENVIRONMENT OF SUPPORT Experience beyond the ordinary. At Kaiser Permanente you’ll have expansive, integrated systems at your fingertips, putting you that much closer to the information you need. Apply all you’ve learned in an environment that supports your growth– and your future. For more information, visit our website at http://residency.kp.org.


速 F O R

M I N O R I T Y

M E D I C A L

S T U D E N T S

Charter Members 2011

Michigan State University Kalamazoo Center for Medical Studies

These special friends of the Journal for Minority Medical Students have demonstrated their commitment to reach out to minority medical students by placing their recruitment messages in each quarterly issue. We salute them and encourage our readers to consider these programs as they continue their medical education.


North Shore Long Island Jewish Health System A Major Academic Health System Dedicated to Patient Care, Teaching and Research

Allergy & Immunology Colon & Rectal Surgery Diagnostic Radiology Emergency Medicine Family Practice General Practice Dentistry General Surgery Internal Medicine Neurology

Nuclear Medicine Obstetrics & Gynecology Ophthalmology Oral & Maxillofacial Pathology Oral & Maxillofacial Surgery Orthopaedic Surgery Osteopathic Family Practice Osteopathic Neurological Surgery Neuromusculoskeletal

Pathology Pediatric Dental Medicine Pediatrics Physical Medicine & Rehabilitation Podiatric Medicine Psychiatry Thoracic Surgery Urology Vascular Surgery

The nation’s third largest, non-profit, secular healthcare system, the North Shore-Long Island Jewish Health System provides care for people at all stages of illness throughout Long Island, Queens and Staten Island – a service area encompassing more than five million people. The health system includes 15 hospitals, four long-term care facilities, a medical research institute, three trauma centers, five home health agencies and dozens of out-patient centers. North Shore-LIJ facilities house more than 5,576 beds, and are staffed by over 7,000 physicians, 7,000 nurses and a total workforce of more than 35,000 – the largest employer on Long Island and the ninth largest in New York City.

For further information: Office of Academic Affairs Telephone: 516-465-3192 Fax: 516-465-3190 www.northshorelij.com

9773-11-05

47 Journal for Minority Medical Students


THE RESIDENCY MATCH GUIDE Vol. 23, No. 1

Features 29 The Match Issue Intro 31 2011 Match Results 33 What is ERAS? 35 How to Choose a Residency Program 40 Match Timeline 42 Secrets from the Pros: How to get into the most competitive residencies

on the cover: Patricia Onuegbu

Patricia Onuegbu graduated from Mercer Medical School in Macon, Georgia. She’s celebrating her match in Pediatrics with Sacred Heart Hospital in Pensacola, FL.

46 Personal Statement Tips 48 Preparing for the Interview 51 Tips for Surviving the Intern Year 52 The Inside Scoop From current residents who have “been there, done that” 54 2012 Main Match Schedule

Perspectives 6

Publisher’s Page

9

AAMC Perspective by Sarah A. Schoolcraft

13 AMA Perspective by Jon D. Fanning 17 NMA Perspective by Leonard Weather, MD 21 AMSA Perspective 23 SNMA Perspective 25 The Surgeon General’s Report by Regina M. Benjamin, MD, MBA, VADM, USPHS 55 Introducing the Journal’s Disparities Initiative 59 A Second Opinion, Please by John Dunn, MD

Special Report The National Heart, Lung, and Blood Institute


MY

PASSION:

public health and research

MY

CALLING:

family medicine

My family medicine training gave me the skills I need to take research from the bench to the bedside for my patients.

BE THE DOCTOR

you always wanted to be.

fmignet.aafp.org


JOURNAL FOR MINORITY MEDICAL STUDENTS PUBLISHER Bill Bowers EDITOR-in-chief Laura L. Scholes laura@spectrumunlimited.com Contributing Writer John Dunn, MD SENIOR ACCOUNT EXECUTIVES Gail Davis Campus Rep Liaison Nisha Branch, Howard University College of Medicine ART Director Jeff Garrett copy editor Robert Blue PUBLISHER’S ADVISOR Michelle Perkins, MD EXECUTIVE ASSISTANT to the PUBLISHER Amy Harrison

SPECTRUM HEALTHCARE DIVERSITY & INFORMATICS PRINCIPAL INVESTIGATOR Bill Bowers VICE PRESIDENT OF OPERATIONS Tamika Goins SENIOR DEVELOPER/DBA Naresh Kumar

www.spectrumpublishers.com www.spectrumunlimited.com

MYTH: You must complete an orthopaedic rotation to apply for an orthopaedic residency. FACT: There are numerous opportunities to gain clinical exposure to orthopaedics besides a rotation. The truth is, exposure to and early success in the profession goes a long way toward influencing your chances of acceptance. But you have several options besides a traditional rotation. You can work with an orthopaedic mentor, apply for the Summer Orthopaedic Internship program, or contribute to an orthopaedic research study. So, if you’re driven to deliver exceptional patient care, don’t let the lack of a medical school orthopaedic program stop you.

Choose a career in Orthopaedics – our exceptional mentoring programs offer personalized guidance and support to help you turn your aspirations into reality. For more information, visit aaos.org/diversity or email mentor@aaos.org


PUBLISHER’S PAGE

Our New Match Issue Your Guide to A Great Future By Bill Bowers, Publisher, Journal for Minority Medical Students

Bill Bowers

Match Day 2011: Texas A&M

6 Journal for Minority Medical Students

e’ve shaken things up a bit over here at the Journal, and we think you’re going to really like what you see. This Residency Match Guide is the first in our new “era” of publishing. We’re beefing up our website (www.spectrumpublishers. com) and making our print publications bigger, bolder and more helpful than ever. In addition to the national voices you’ve come to look for in the Journal (AMA, AAMC, etc.), we’re making our feature section more “guide-like” to help you navigate the biggest challenges you face in your med school career. For example, in this issue we give you a solid timeline to help you prepare for Match 2012 with milestones, tips and other general advice. We also bring you the “secrets from the pros,” interviews with residency program directors across the country

where they share all of the inside info to help you get into the program of your dreams. We also talked to two residents—one who just finished intern year and one who just finished her family practice program—to bring you firsthand advice on how to survive—and thrive—in residency. All throughout the magazine, you’ll see the smiling faces of students from around the country who celebrated successful matches on Match Day 2011. We’re so proud of all of you, and we send a special thanks to the schools who provided such inspirational images. And just think: if you take the advice of the experts we interview here, it could be your smiling, happily matched face you see in our Residency Match Guide next year! Enjoy!

Match Day 2011: University of Cincinnati


T HE M OUNT S INAI S CHOOL OF M EDICINE ’ S C ENTER FOR M ULTICULTURAL & C OMMUNITY A FFAIRS AND THE G RADUATE M EDICAL E DUCATION C ONSORTIUM

VISITING ELECTIVES PROGRAM FOR STUDENTS UNDERREPRESENTED IN MEDICINE (VEPSUM) VEPSUM offers four-week electives at Mount Sinai School of Medicine (MSSM) and its affiliates in the Graduate Medical Education Consortium to qualified 3rd-year and 4th-year medical students who are from groups underrepresented in medicine1 and who attend U.S. accredited medical schools. In collaboration with the MSSM Center for Multicultural and Community Affairs, VEPSUM is designed to increase diversity in the house staff and subsequently the faculty of the Mount Sinai School of Medicine and its affiliated institutions.  Electives are available between July and February. Students must have completed their required core clerkships before starting the program.  Tuition is not charged.  Housing and travel expenses are subsidized for one month.  Students are provided the potential to network with residency program directors, residents, minority faculty, and students, and have access to the Office of Graduate Medical Education, Center for Multicultural and Community Affairs, medical school library, seminars, and workshops. To learn more about VEPSUM and the application process, please visit: http://www.mssm.edu/about-us/diversity/initiatives/visiting-electives-program We look forward to receiving your application and to having you visit with us! For more information please contact: Monique Sylvester, MA at monique.sylvester@mssm.edu

1 The Association of American Medical Colleges (AAMC) defines groups underrepresented in medicine “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population."


Medical Students: A Career In Pediatrics Can Open Up New Doors The American Academy of Pediatrics (AAP) has a membership opportunity for medical students. The AAP offers many benefits, both general and specific to medical students, including:  Affiliate membership in the Resident Section  Free admission to the AAP National Conference & Exhibition (NCE)  Discounts on all AAP products and services  Pediatrics 101—a resource guide from the AAP  Online Resources - An e-newsletter for medical students, - Medical Student Listserv®, - Access to the YoungPeds Network And much, much more!

For information please contact us at: pedscareer@aap.org or call Julie Raymond at (800) 433-9016 ext. 7137 or visit www.aap.org/ypn

michigan state university kalamazoo center for medical studies

Our MissiOn

At MSU/KCMS, we realize that being an exceptional physician means having a balance between the personal and professional areas of your life. Our mission is to help you achieve your clinical and academic goals in a truly supportive environment. More than 180 residents take part in our residency programs and have exposure to the broadest range of health care. Our partnership with awardwinning Level One Trauma Centers means that from newborns to the elderly, you will have patient diversity that will allow for you to develop your skills to their fullest.

Michigan State University Kalamazoo Center for Medical Studies is a university and community partnership driven by a team of dedicated professionals committed to provide excellence in graduate, undergraduate and continuing medical education, knowledgeable and caring service, and research.

At MSU/KCMS, you will have opportunities to participate in a variety of research projects. We are proud of our numerous awards and grants and our faculty that understands the correlation between great research and great patient care. At MSU/KCMS, with quality of education comes quality of life. Almost half our residents own their own homes in a region that has been ranked as one of the best places in America to live. The “Kalamazoo Promise”—which provides free college tuition for students completing K–12 in the Kalamazoo Public Schools—low cost of living, clean air and an abundance of recreation means your hours outside of MSU/KCMS will be as fulfilling as those inside.

www.kcms.msu.edu · (800) ASK-KCMS

Our VisiOn Michigan State University Kalamazoo Center for Medical Studies will excel in providing quality medical education. We will deliver expert, responsive patient care and pursue innovative research.

Our Values MSU/KCMS offers fully accredited programs in Internal Medicine, Pediatrics, General Surgery, Family Medicine, Psychiatry, Orthopaedic Surgery, Medicine-Pediatrics, Emergency Medicine, Primary Care Sports Medicine Fellowship, and Transitional Year. MSU/KCMS also offers an Osteopathic Traditional Internship and dually accredited AOA/ACGME Family Medicine and Internal Medicine residencies.

Compassionate Service Leadership Lifelong Learning Teamwork Commitment to Excellence


AAMC perspective

Tips and Tools for Success in the Residency Match Process By Sarah A. Schoolcraft, MS, Senior Research Analyst, AAMC

Sarah A. Schoolcraft, MS

Each March, medical school seniors eagerly await the results of the residency selection process. It only takes a moment to rip open the white envelope and learn where you will be spending your residency, but getting to this point can be a stressful and time-consuming process. Before you even begin to rank your preferences, you must first research which field of practice you want to work in, and whether or not you will consider an alternative field if you are unable to match in your preferred field. Then, you must research the programs to determine which ones best fit your needs and interests. You must complete your application, prepare for interviews, and do your best to ensure your preferred programs will include you in their rank list. Finally, you must wait—probably the hardest part for many! We at the Association of American Medical Colleges (AAMC) understand the work that goes into this process, and we hope to make this selection process manageable for all of our aspiring doctors. If you are struggling to determine which medical specialty best suits your personality, skills, and career objectives, we encourage you to visit AAMC’s Careers in Medicine (CiM®) program. For more information on the selection pro-

cess itself, we encourage you to visit the National Resident Matching Program (NRMP®) website. On the NRMP website, you will find research discussing factors considered by programs when granting interviews and ranking applicants. Although we encourage you to read the “Charting Outcomes of the Match” report available on the website, we will use this article as an opportunity to summarize a few things to keep in mind while preparing for the residency match process. Residency matches are made via an algorithm that uses the ranked preferences of both applicants and programs. The process attempts to place you in the program you have ranked as most preferred, but if you cannot be matched at that program, it will try again with your second preferred program, etc. Match Week is the third week of March, and Monday of Match Week is when you learn whether or not you have matched. If you did not match, you will have an opportunity on Tuesday and Wednesday of Match Week to “scramble” for available slots. If you did match, you will find out on Thursday where you will be going. More detailed information on this process can be found at the NRMP website.

Journal for Minority Medical Students 9


Medical Student Programs at Harvard Medical School Boston, Massachusetts

VISITING RESEARCH INTERNSHIP PROGRAM (VRIP)

VISITING CLERKSHIP PROGRAM (VCP)

Sponsored by the Harvard Catalyst Program for Faculty Development and Diversity, VRIP is an 8-week mentored summer research program open to 1st and 2nd year U.S. medical students, particularly underrepresented minority and/or disadvantaged individuals from accredited U.S. medical schools. VRIP is designed to enrich medical students’ interest in research and health-related careers, particularly clinical/translational research careers. VRIP offers students housing as well as a stipend and transportation reimbursement for travel to and from Boston. Applicants must be U.S. Citizens or U.S. Noncitizen Nationals or Permanent Residents of U.S.

Sponsored by the Harvard Medical School Minority Faculty Development Program, VCP is open to 4th-year and last quarter 3rd-year minority medical students in good standing at U.S. accredited medical schools who wish to participate in a clerkship in any discipline at Harvard Medical School (HMS) affiliated hospitals. Housing and financial assistance towards transportation expenses to and from Boston are available. Students are assigned a faculty advisor, provided the potential to network with HMS residency training programs and have access to the medical school library, seminars and workshops. Clerkships are offered year-round. Applications must be submitted 3-6 months in advance of the desired rotation.

For more information on Harvard Catalyst programs please contact: Vera Yanovsky, Program Coordinator Phone: 617-432-1892 E-mail: pfdd_dcp@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu/catalyst

For more information please contact: Jo Cole, Program Coordinator Phone: 617-432-4422 E-mail: jo_cole@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu

Program Director: Joan Y. Reede, MD, MPH, MBA Dean for Diversity and Community Partnership Associate Professor of Medicine Harvard Medical School


aamc AAMC perspective Results from previous matches suggest Remember, you are your own best you will have a better chance of matching by listing every program you find advocate, and it is important to list all of interesting—the numbers are on your side! your qualifications in your application. However, because of the way the match is conducted, it is important to ensure that Remember, you are your own best advocate, you would actually enjoy being matched with all and it is important to list all of your qualificaprograms listed, and that they have been ranked tions in your application. However, results of the according to your true preference. Residency can Match indicate that test scores are not a guarantee be challenging, and it is imperative to participate of Match success. Very high scores in the most in a program that ultimately makes you happy. competitive programs are not necessarily tied to Match success, and applicants with lower scores still have good chances of matching to one of their preferred programs. We at the AAMC are confident that the majority of you reading this will be placed into one of your preferred residency programs, and we hope to make this process less stressful and more enjoyable for you. Although it undoubtedly involves a good deal of research and hard work, it is worth it as you move one big step closer to your goal of becoming a physician. Good luck! Match Day 2011: University of Nevada Additionally, it is always prudent to have a back-up plan. Some specialties are more competitive than others, and if you rank only programs in your preferred specialty, you might put yourself at risk of being unsuccessful. Utilize the CiM® program to research other specialties to see which you would consider an acceptable alternate that matches your skills and personal values. It is important to rank preferred programs in this alternate specialty, as well. Likewise, some programs may be more competitive than others, so be sure to include both highly competitive and less competitive programs on your rank order list.

REFERENCES “Charting Outcomes in the Match.” National Resident Matching Program Web Site, http://www.nrmp.org/data/chartingoutcomes2009v3.pdf. Accessed 18 January 2011.

Journal for Minority Medical Students 11


With the diversity of our staff reflecting the diversity of the varied communities we serve, Continuum Health Partners can truly be seen as a microcosm of New York City. Across our four acclaimed hospitals, we provide award-winning clinical and compassionate care enhanced by cultural competency training for residents that allows patients, families and colleagues to feel most welcome. Here, you can work alongside some of the nation’s most renowned providers of healthcare, including attending physicians who hail from the prestigious Columbia University College of Physicians and the Albert Einstein School of Medicine. As part of our residency program, you’ll have the opportunity to thrive in an atmosphere that celebrates our differences, encourages your perspective and allows us to learn from — and flourish with — each other.

Continue your education with Continuum Health Partners. As distinguished as we are different.

Discover our innovation. Discover our diversity. Discover Continuum Health Partners. To learn more about our residency programs, visit • chpnyc.org/professionals/slr_gme • bethisraelgme.org/rprograms.html • nyee.edu/residency--fellowship-programs.html

Destination Diversity champions a diverse workforce and fosters an inclusive culture that delivers quality care to a diverse patient population. We support the creation of a multicultural environment that works for everyone and capitalizes on the diversity of all employees. Continuum Health Partners is committed to diversity and equal opportunity.

Make The Commitment To Medical School, And We’ll Make The Commitment To You.

The School of Medicine at the University of Alabama at Birmingham offers you more than a world-renowned medical curriculum. We also provide you with opportunities to succeed. Our Office of Minority Enhancement was created specifically to help students like you to make the most of your education and enjoy all of the advantages of medical school. Call us, and find out more about: our special programs, including combined M.D./Ph.D. and M.D./M.P.H. degrees, the Early Decision Plan, and the Summer Health Enrichment Program (UAB-SHEP), which prepare you to enter medical school. financial assistance, assistance in securing research and clinical opportunities, counseling and support for academic and personal concerns, tutorial programs, and liaison activities among the School of Medicine, minority students, and medical organizations. For more information about our minority programs, please call 1-800-707-3579, ext. 6 today. Or write: Office of Diversity and Multicultural Affairs The University of Alabama School of Medicine 1530 3rd Avenue South, VH 102K Birmingham, AL 35294-0019 Visit our web site: http://medicine.uab.edu Standing, from left: Sandrine Niyongere, MSII, Ezinne Okwandu, MSII, Alexis Mason, MSII, Whitney McNeil, MSII. Seated, Justin Jackson, MSII.

UAB is an equal education opportunity institution.


AMA perspective

“All-in?” What the new Match rules could mean in the future By Jon D. Fanning, Director, Resident & Fellow Services

T

he newly adopted “all-in” policy of the National Resident Matching Program (NRMP) may have some significant implications for medical students entering the Match each year. The new policy, which becomes effective for the 2013 Match that opens for registration on September 1, 2012, will require all residency programs participating in the Main Residency Match to place all available positions in the Match. So, what does this mean for you, a current or future medical student?

Match, are concerned that they may be disadvantaged by the new policy. Meanwhile, programs that have not offered positions outside the Match believe the new policy creates more equity by prohibiting the recruitment and acceptance of independent applicants early in the match season. IMGs and some specialties have also voiced concerns because they believe IMGs will be unable to secure visas and state medical licenses in time to begin training on July 1. Residents and fellows of the AMA have expressed several concerns about the “all-in” policy, including whether:

Why do we need “all-in” for the Match?

According to the NRMP Board of Directors, the purpose of the “all-in” policy is to help “eliminate inequities in how residency programs recruit U.S. allopathic senior students and other applicants while simultaneously reducing the risk of undue persuasion when residency programs offer positions outside the Match.” The new policy requires residency programs that participate in the Main Residency Match to offer all PGY1 and PGY2 residency positions through the Main Residency Match or another national matching program. Consequently, all U.S. medical school graduates and independent applicants, including

Jon D. Fanning prior-year graduates of U.S. medical schools and students/graduates of Canadian and international medical schools, will be offered positions only through the Match.

Divergent opinions

Both residency programs and residents (along with medical students and international medical graduates) have expressed divergent opinions about this newly adopted policy. Programs that have previously filled the majority of their positions with independent applicants, outside the

1) residency programs will have the flexibility to immediately fill additional positions as they become available throughout the year; 2) residents who change specialties will have to go back through the Match process; 3) off-cycle residents will be allowed to obtain positions outside the Match; 4) couples in separate Match processes, or others with unique geographical needs, will be given enough flexibility throughout the process; and 5) IMGs will have enough time to

Journal for Minority Medical Students 13


AMA perspective apply for a visa, if they are required to wait until Match day at the end of March, and still start their training by July 1. As for the Scramble (the period during Match Week when unmatched applicants attempt to obtain positions in unfilled programs), it will be replaced by the Supplemental Offer and Acceptance Program (SOAP) for Match Week 2012. Consequently, any unfilled positions in the Match will be rolled into SOAP. SOAP-eligible, unmatched applicants are required to initiate contact with the directors of unfilled programs only through ERAS (the Electronic Residency Application Service).

AMA sets new policy

To the extent that it eliminates flexibility within the Match process, the AMA does not support the current “all-in� policy for the Main Residency Match. To address this concern, the AMA will work with the NRMP, and other residency match programs, including the secondary match or scramble process, in revising Match policy. This will include efforts to create more standardized rules for all candidates, including application timelines and requirements. The AMA will also work with the NRMP and other external bodies to develop mechanisms that limit disparities within the residency application process and allow both flexibility and

standard rules for applicants. These efforts will help ensure both fairness and flexibility in the residency Match. To stay up to date on this and related issues in medical education, be sure to subscribe to AMA MedEd Update, a free monthly email newsletter covering medical school, residency/fellowship, and continuing medical education news and issues. To subscribe, email us at meded@ ama-assn.org or call (312) 464-4635.

Match Day 2011: University of South Florida Match Day 2011: University of Washington

14 Journal for Minority Medical Students


Major strength lies in the quality of our faculty, residents and students

OFFiCE FOR DiVERSiTy HOUSE STAFF AND FACUlTy AFFAiRS

Vanderbilt School of Medicine is seeking to bring the best residents, fellows and faculty from all ethnic, racial and gender groups into this great Medical Center. As we broaden our reach, you will enrich our environment and make Vanderbilt a leader in promoting people of diverse backgrounds. We invite you to visit Vanderbilt and learn more regarding our training programs or visit our website at www.mc.vanderbilt.edu/gmediversity.  U.S. News & World Report listed Vanderbilt Medical Center 16th on its 2009 “Honor Roll” of hospitals, a tribute reserved for a select group of institutions labeled the “best of the best.”  Vanderbilt is the third fastest growing health sciences center in the country in research funding

 The Monroe Carell Jr. Children’s Hospital at Vanderbilt has been ranked No. 15 on a listing of best children’s hospitals in the U.S. by Parents magazine, the third national accolade earned by the hospital this year.  Our office supports the Minority House Staff for Academic and Medical Advancement (MHAMA), an organization of Vanderbilt house staff and advisors www.mc.vanderbilt.edu/mhama. Contact us by e-mail at omecca.b.dale@vanderbilt.edu. or call 615-343-7958 André L. Churchwell, MD Associate Professor of Medicine (Cardiology) Associate Dean for Diversity in Graduate Medical Education and Faculty Affairs Vanderbilt University School of Medicine

www.mc.vanderbilt.edu/gmediversity


Naturopathic Medical Students Embrace Diversity - Globally and Locally The AANMC proudly recognizes the students of its member schools for honoring their commitment to multicultural diversity.

Carina Lopez, Class of 2012

Francisco Heredia, Class of 2011

UNIVERSITY OF BRIDGEPORT COLLEGE OF NATUROPATHIC MEDICINE

SOUTHWEST COLLEGE OF NATUROPATHIC MEDICINE “I saw that no one was addressing the many ailments that afflict Latino immi-

“As a Puerto Rican woman who would be the first doctor in her family, there was a lot of pressure to just be the best.” Even as a child Carina Lopez knew her future was in the medical field. With an inclination to help people and an early understanding of the importance of health, Carina found herself in the pre-med program at New York University (NYU). But when she became disillusioned with her conventional medical education, her Puerto Rican heritage and upbringing around holistic remedies led her to the career path of naturopathic medicine. During her medical studies, Carina has been fortunate enough to travel to the Dominican Republic and Belize. During her time in Belize, she predominantly worked with diabetic patients teaching them the important role a proper diet plays in managing their disease and overall health. As a naturopathic medical (ND) student, listening to instructors lecture about the success of simplistic yet effective naturopathic treatments serves as daily inspiration to Carina. With an interest in teaching, she will be well prepared to provide the same inspiration to other ND students someday.

READ MORE Carina.AANMC.org

grant communities from a naturopathic perspective. Being Latino should not be a risk factor for diabetes, or for any other health condition.” Francisco Heredia credits his mother for indirectly leading him to a career in naturopathic medicine. As a child he witnessed the combination of poor health management and polypharmacy medications nearly killing his mother, but then with a healthy diet and exercise she was able to slowly wean herself off all medications. He witnessed firsthand the natural cure that conventional medicine hadn’t provided. Francisco has always been comfortable with natural medicine, growing up in a family that drank “manzanilla” (Chamomile tea) for an upset GI, used arnica cream for bumps and bruises and visited “sobadores” (lay people trained in physical manipulation) to help mend broken bones or re-position dislocated joints. With a strong passion for community organizing, Francisco wants to give back to the Latino community by educating, motivating and empowering Latinos to take control of their own health. Following graduation he plans to settle in San Diego, Calif., and to eventually open a Latino immigrant community-based clinic with a focus on prevention and chronic degenerative conditions, where he will serve as a clinician, community organizer and public educator.

READ MORE Francisco.AANMC.org

Considering a career in naturopathic medicine? Find out more: the diverse ways of practicing naturopathic medicine.  Discover Students of AANMC schools go on to follow varied career paths

and lead extraordinarily influential lives Students.AANMC.org

information from the ND schools. Becoming a licensed  Request naturopathic physician begins with a strong education. Start by choosing the school that’s right for you Choose.AANMC.org

our PDF brochure offering a concise overview  Download of what it takes to become an ND Download.AANMC.org


nma perspective The NMA Has Advocated and Worked for Health Care Reform‌Now What? By Leonard Weather, MD, President, National Medical Association

I

would like to take this opportunity to applaud President Obama, who did what no other United States President was able to do: enact the Patient Protection and Affordable Health Care Act. As the physicians who take care of many of the patients that this Act will directly affect, it is the mandate of the NMA to assure that our voices, concerns, and needs are heard. As we all know, this is not a perfect bill and there are hurdles that we face as physicians. We must be at the table and actively involved. It is critical that our organization adheres to our core principals by honoring our past, and solidifying our present in order to protect and ensure a meaningful future. Health care reform is a living, breathing dynamic entity that takes more than a legislative act. It takes action and we must be part of that action. As a physician organization in the midst of health care reform legislation implementation, the NMA must work to fiercely protect our physician interests during this crucial time in the history of our country. By protecting and strengthening the black physician, we greatly serve the interests and concerns of our patients. We must work as diligently for the tens of thousands of our fellow physicians as we did to ensure that our patients received the benefits of the bill. Needless to say, we can ill afford for our physicians to be burdened with regulations, increased malpractice rates, obnoxious distracting insurance ratings, and decreased compensation. We must make sure that, in the interests of our beloved practices, we protect our reimbursement rates, our ability to maintain our practices in our communities, and

Leonard Weather

Journal for Minority Medical Students 17


nma perspective the ability for us to practice medicine in the way in which only we can. I invite you to be reminded of what the great physician William Osler said: “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.�

Match Day 2011: Dartmouth

18 Journal for Minority Medical Students


Match Day 2011: University of Alabama at Birmingham


amsa perspective

Ideas to Spread the Message of Health Care for All T

here are hundreds of ways for you to be active in AMSA’s campaign for Universal Health Care (UHC). Events can be as simple as inviting lunch-time speakers to your school or as elaborate as organizing a rally or weeklong action campaign in the community. Choose activities that are appropriate for your school and community, but remember that we don’t know what we are capable of until we push ourselves.

Lunch-Time Events Lunch-time events are a great way to introduce the topic to many students at one time. Speakers You can always find speakers in your area who are interested in some aspect of UHC. Some potential topics include: the uninsured, different ways of getting to UHC (e.g., single payer), what it’s like to wage a grassroots campaign for UHC (you can contact local activist groups), international health care systems, Medicare/Medicaid/S-CHIP, and more. The following is a list of potential speakers for your event: AMSA national leaders Physicians for a National Health Program (PNHP)— PNHP can provide you with a speaker on single-payer

health care. Medical school faculty and local physicians National healthcare advocacy groups (e.g., Universal Health Care Action Network) Labor groups (e.g. Service Employees International Union, Jobs with Justice) The labor movement has always been at the forefront of health care access campaigns. Labor tends to bring a fiery, passionate voice to the issue, which can really charge medical students up! Grassroots tools workshop You can conduct a workshop on how to organize a letter-writing campaign, how to lobby, how to write a letter to the editor, etc. You can organize a panel discussion by uninsured individuals on their experiences being uninsured. It can be hard to find people who are willing to share their story, but if you can find even one person, the impact can be tremendous. Debates Debates are a fun, exciting way to stimulate discussion and unveil the pros and cons of an issue related to UHC. Potential topics include: single payer vs. non-single payer; pro-UHC vs. anti-UHC; incrementalism vs. compre-

hensive reform, whether healthcare is a right or a privilege?; and government vs. free market solutions for UHC. Debates can be led by medical students, residents/physicians, policy experts, and speakers from AMSA, the AMA, or PNHP.

Local Activism Letter Writing Campaign Set up a table and have people sign letters advocating for UHC. Or, you can have a lunchtime talk on the issue and close it with a letter writing campaign. Writing a letter to preserve Medicaid is always an easy way to speak out on health care access issues. AMSA’s Legislative Action Center provides Congressional addresses and emails and sample letters to legislators. Call-in Day This is similar to the letter-writing

Journal for Minority Medical Students 21


amsa perspective campaign, but with less paper! Pick an issue, pick a date, and have people at your school flood Congress with calls all in one day. AMSA’s Legislative Action Center provides Congressional phone numbers. Local or State Lobby Day Local and state elected officials love to meet medical students and hear their opinions, as it is rare for them to hear from us. Find out how to set up a lobby day. Candlelight vigil for the uninsured AMSA has historically used Candlelight Vigils as a powerful way to raise awareness about the uninsured. Get your entire campus, local community groups, and elected officials involved. This is a great way to get exciting media coverage too! A complete Candelight Vigil Guide is available online. Letter to the editor Letters to the editor are a great way to express your viewpoint Get involved with national campaigns Check out campaigns like Covering Kids and Families (enrolling eligible children into S-CHIP) and Covering the Uninsured Week. Visit www. coveringkidsandfamilies.org and www. covertheuninsuredweek.org. Take the issue into hospitals & your community Greater awareness of the problems and

22 Journal for Minority Medical Students

solutions can be brought about by taking the issue of health care reform into the hospitals and student-clinics we go to everyday. Wear a “Health Care for All!” button on your white coat. Talk to residents and attendings about the problem and listen to their opinions. Medical students are always asked to make presentations, so make a presentation about the problem of uninsurance and relate it to your patients. You will be amazed at the in-depth discussions that can come out of a single medical student’s presentation!

Get a UHC T-shirt from AMSA’s online store and wear it proudly!

Be Creative and Have Fun! Remember, you have to have fun while you’re organizing, because otherwise you’re not going to be able to mobilize others.


snma perspective

SNMA ignites passion with year-long HEAT initiative T

he SNMA Health Equity Advocacy Tour (H.E.A.T.), a nationwide initiative to raise awareness about the social determinants of health, recently ended its year-long, seven-city tour. The H.E.A.T. initiative started in Chicago in October, 2010, and continued until March, 2011. It brought SNMA and community members together to address the needs of underserved communities and focused on several key areas: food justice, homelessness, environmental justice, childhood obesity, education, poverty,

and access. A few months after the October, 2011, kickoff, SNMA members in the Boston area worked to increase attention on the effects that homelessness has on nutrition and sexual health. Tufts and BU student members were trained to make healthy food options more “appetizing” to local food pantry visitors; Harvard and Brown students helped educate women at a Boston area shelter about sexually transmitted diseases and HIV. Down in New Orleans, Region III SNMA members helped to

clean up and rebuild Joe Brown Park so that local kids would have a safe place to play and residents of all ages would have a place to be active and promote healthy lifestyles. In Washington, DC, volunteers, SNMA members, and NMA members did a one-mile walk/run with the theme of “Combating Childhood Obesity One Step at a Time.” The proceeds benefited the children of the Calomaris branch of the YMCA. In Philadelphia, Drexel University College of Medicine hosted a town hall meeting with the provocative, “Poverty Kills!” Local experts gave testimony about the role poverty plays in health. Later that day, many of the participants contributed their time and energy to a community service project for Chosen 300 Ministries, an organization that works to unify people for the common purpose of feeding the homeless. “Education as a Social Determinant of Health” is the theme Region IX took on in New York. They hosted an Information Expo where each chapter had an interactive display to inspire dialogue about the importance of education. They also hosted a town hall meeting on the topic with Nathan

Journal for Minority Medical Students 23


snma perspective The H.E.A.T. initiative brought SNMA and community members together to address the needs of underserved communities.

Match Day 2011: University of Arizona

24 Journal for Minority Medical Students

Boucher of the Public Health Association of NYC; Frank Gray, Ed.D.; former Superintendent of NYC schools; and other leaders in education in the New York/New Jersey area. The last stop on the tour was Atlanta, and the issue of health care access was the focus. Region IV sponsored a health fair for the residents of the Nicholas House, Atlanta’s only shelter for homeless families. They provided a variety of screenings—blood pressure, glucose, eye, BMI, and mental health— and residents from Morehouse School of Medicine provided counseling for attendees about their results. There was also a town hall meeting, “Saving the Healthcare Safety Net,” that addressed the issues of access to health care through safety net hospitals and community health centers. Panelists included Dr. Harry Heiman, Director of Health Policy at the Satcher Health Leadership Institute, and Dr. Leon Haley, Jr, Medical Director of Grady Memorial Hospital Emergency Care Clinic.


The Surgeon General’s

Report

Disparities are the Problem; Prevention is the Key By Regina M. Benjamin, MD, MBA, VADM, USPHS Surgeon General Regina Benjamin

s America’s doctor, I really want to provide Americans with the best scientific information available on how to live healthier lives. I want to try to bring some clarity and understanding to the overwhelmingly confusing conversations that are going on now about health and health care. I really am especially grateful to serve at this historic time, as we make these overdue changes on how we finance and how we deliver health care, changes that will eventually give all Americans access to the high quality affordable health care that they deserve. Giving Americans health care coverage is just the first step to truly reducing the health disparities that plague our country. And we know that reducing and ultimately eliminating health disparities is going to require more than just giving patients an insurance card. We have to address the social determinants of health, such as poverty. There was a study published in the December 2009 issue of the American Journal of Public Health that showed that poverty and drop-out rates are as important a health problem as smoking is in the United States—and we definitely know how bad smoking is. In fact, on average, poverty showed the greatest impact on health, smoking was second, followed by being a high school drop-out, non-Hispanic, black, obese, a binge drinker, and uninsured. As important as these social determinants of health are, there is one other thing that is very close to my heart: prevention. Prevention is the foundation of our nation’s public health system, and prevention is the foundation of my work as Surgeon

General; my priorities focus on wellness and prevention. I’m a family doctor, so I couldn’t settle on just one area to focus on—I like everything. But there’s probably no more serious challenge to the nation’s health and well-being than that posed by obesity and being overweight. Since 1980, obesity rates have doubled in adults and more than tripled in children, and the problem is even worse among Hispanic and Native American children. You know the statistics. More than two-thirds of adults and more than one in three children are overweight or obese. We see the sobering impact of these numbers and the high rates of chronic diseases, such as diabetes, heart disease, and other chronic illnesses, that are starting to affect our children more and more. For example, recently a study from the University of North Carolina School of Medicine reported that obese children as young as age three showed signs of an inflammatory response that has been linked to heart disease later in life. And when we talk about obesity, we have to talk about breastfeeding. We know that when a child is exclusively breastfed for the first six months of life, he or she is less likely to become obese. In our country, we don’t breastfeed nearly to the rates that other countries do, and so we’ve put this at the top of our priority list, too. Smoking and tobacco are still big problems in the U.S., and the tobacco companies are targeting our children and our teens with their marketing. So we’re working on projects that are geared to encouraging kids not to smoke.

Journal for Minority Medical Students 25


HIV/AIDS is still a major problem in this country, particularly with women and girls. We tend to think that because we now have drugs to treat HIV that people aren’t dying, but still, people are. There’s a new documentary out called The Other City, which is about HIV/AIDS in Washington, D.C., where the rates of infection are higher than some sub-Saharan countries in Africa. I encourage you to watch it. Another area of interest for me is mental health and substance abuse. This summer I spent a lot of the time along the Gulf Coast addressing the behavioral health effects of the Gulf oil spill. We’re still dealing with the behavioral effects of that—depression and suicide. All of these issues—and many more—make it all the more important that we support the President’s Affordable Care Act. This historic act not only allocates funding to prevention and wellness, but makes it an integral part of our system. The new law establishes The National Prevention, Health Promotion, and Public Health Council, which I have the honor of chairing. The members of this council include Cabinet-level heads of agencies throughout government—not just HHS, but throughout government—which indicates the significance of this Council. We’re going to develop the first-ever national prevention strategy and make recommendations to the President and to Congress about the most pressing health issues affecting the nation and changes in federal policy on how to prevent those problems. With this Council, I really hope to move us from a system focused on sick care to a system focused on prevention and wellness. Because just like many of you, as a family doctor I have seen so many missed opportunities for prevention in health care settings across this nation. If we really want to truly transform and reform our health care system in this country, we need to prevent people from getting sick in the first place. We need to stop the illness and stop the disease before it even starts.

26 Journal for Minority Medical Students

I really hope to move us from a system focused on sick care to a system focused on prevention and wellness.


Why is this med student smiling?

FACULTY POSITION The Sidney Kimmel Comprehensive Cancer Center (SKCCC) at Johns Hopkins Leukemia Clinical Investigator

recruiting a clinical investigator with expertise in leukemia/myelodysplaindividual will participate in an active clinical and research program in leukemia, should be board certi-

Photo courtesy of Vanderbilt University SOM

Because she just found out she can join our community of minority med students and premeds. So can you:

www.spectrumpublishers.com

hematology, and eligible for licensure in the State of Maryland. Responsibilities will include: attending on inpatient leukemia service, attending and supervising fellows in outpatient clinic, and developing and supervising research protocols. commensurate with the individual’s University, an EEO/AA employer, is committed to increasing the representation of women and members of underrepresented groups on our faculty and encourages applications from such candidates. Applicants should provide a letter of interest, curriculum vitae/bibliography and the names of three references to:

Richard J. Jones, M.D. Co-Director, Hematological Malignancy Program The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins 1650 Orleans Street-Room 244 Baltimore, MD 21231 rjjones@jhmi.edu


Match Day 2011: Mayo Medical School


Match Day 2011!

/ / / / / / / / / / / / / / / / / / / / / / / / / / / / / / F

or most people, March Madness is about basketball. But for med students, it has

a whole other meaning. It means the jangled nerves and sleepless nights leading up to Match Day, the day that determines not only where you’ll work after medical school, but

Tufts University

what kind of doctor you’ll become. For our annual Match Guide, we’ve gone behind the curtain and gotten residency program directors from around the country to give us the secrets to matching successfully. We’ve talked to two residents—one intern, one just finished—about everything you need to know

UAB

to survive what might be the most intense and rewarding time of your career. We’ve also got all the info you need for the changes that are happening for the 2012 Match. Ready? Let’s go! Texas A&M Journal for Minority Medical Students 29


/ / NYU

Dartmouth

University of South Florida

Ohio State University University of Cincinnati 30 Journal for Minority Medical Students


/ / / / / / / / / / / / / / / / / / / / / / / /

The 2011 Match by the numbers

By Jeanette L. Calli, M.S., Program Manager, AAMC Careers in Medicine

The 2011 Match continued the encouraging momentum for primary care, as again the number of U.S. medical school seniors matching into family medicine, pediatrics, and internal medicine rose, according to the National Resident Matching Program (NRMP). Family medicine experienced an 11 percent increase in matched U.S. seniors, who filled nearly half of the 2,708 family medicine residency positions offered. U.S. seniors filled 8 percent more (2,940 of 5,121) positions in internal medicine and 3 percent more (1,768 of 2,482) positions in pediatrics. “This year’s results mark the second consecutive year of increased interest in family medicine,” said Roland Goertz, MD, MBA, president of the American Academy of Family Physicians. “Although several factors likely contribute to the increase, we believe an important element is recognition that primary care medicine is absolutely essential if we are to improve the quality of health care and help control its costs.” Overall, 2011 was a record-breaking year as the total number of positions topped 26,000 (up by 638), and the number of U.S. seniors who participated increased by 489 to 16,559 compared to the 2010 Match. Also, the match rate for U.S. seniors rose to more than 94 percent. Emergency medicine, anesthesiology, and neurology have also experienced this upward trend, each increasing the number of positions filled by U.S. seniors by more than 10 percent since 2007. And the perennially competitive specialties dermatology, orthopaedic surgery, and otolaryngology were joined by plastic surgery, radiation

oncology, thoracic surgery, and vascular surgery in U.S. seniors filling at least 90 percent of positions. For the second year, the number of non-U.S. citizen international medical graduates (IMGs) who registered for the Match declined (down 587 to 6,659), while the number of U.S. citizen IMG registrants increased (up 74 to 3,769). Their match rates were 41 and 50 percent respectively, both increasing slightly over the previous year. “We are pleased with the Match results,” says Henry Sondheimer, MD, senior director for Student Affairs and Programs at the AAMC. “It was also very gratifying there were fewer than one thousand unmatched U.S. seniors participating in the Scramble, despite the increase in their overall numbers.” Although the news was generally positive for U.S. seniors and the increase in the number of positions offered is helpful, the Match remains competitive. Nowhere is this more evident than in the Scramble, a two-day period during Match Week when applicants who have not matched can “scramble” for the residency positions that did not fill. In this year’s Scramble, 971 U.S. seniors and 7,232 other applicants competed for 1,035 positions, about 400 of which are categorical positions. So while the number of first-year positions grew since last year, class sizes continue to expand and new medical schools continue to open. The expanding applicant pool requires students make a wise specialty choice and develop a backup plan. Our advice to ensure a successful

Journal for Minority Medical Students 31


/ / / / / Match holds: Position yourself to be as competitive as possible. Not everyone can be at the top of their class, but you can work hard by maximizing the learning opportunities your school offers, asking for help when you need it, and developing as the best physician you’re capable of becoming. Be realistic about your competitiveness. Use the joint AAMC/NRMP Charting Outcomes in the Match report, other school-specific match data, and advice from a trusted faculty advisor to gauge your competitiveness in specialties and residency programs you’re considering. Avoid the mistake of overestimating your competitiveness. Apply broadly. Another common mistake is applying to or ranking too few programs. Talk to advisors in your specialty and use tools such as the American Medical Association’s FREIDA to learn about programs that may be a good fit. Rank a range of programs. The matching algorithm favors students’ rank order list (ROL) over programs’, so applicants aren’t penalized for ranking competitive programs higher on their ROL. However include a good mix of competitive, likely, and acceptable safety programs. Ranking all the programs where you interviewed—as-

suming you’re willing to attend—reduces your likelihood of not matching and is especially important in competitive specialties. If you think you may not be as competitive for a specialty, consider a back-up specialty option. Manage your anxiety. The application, interview, and match process is nerve-wracking. And because you’re legally bound to attend the program at which you match, the stakes seem high. The anxiety you’ll feel is normal, and so is second-guessing yourself. Just don’t let it overtake your rational, decision-making abilities. Remember the Match is only one milestone in your journey to become a physician. For more interviewing and application resources, sign in to www.aamc.org/careersinmedicine and click Getting into Residency. REFERENCES National Resident Matching Program (2011). Advance Data Tables: 2011 Main Residency Match. Washington, D.C.: National Resident Matching Program.

Vanderbilt

University of Washington

32 Journal for Minority Medical Students


What is Er as ?/ / / / / / / / / / / / / / / / / / / / / / / / / / / / / / W

e know. You’re just a year or two into med school and you’re already tired of all the acronyms! But ERAS, or the Electronic Residency Application system, is a biggie. It’s a tool that helps you apply to multiple residency programs at once. You’ll access it directly on the ERAS website or at your med school (contact your dean’s office), and you’ll use the electronic data entry system to enter all the pieces needed to complete your application: 1. 2. 3. 4. 5. 6. 7.

A student Profile (name, address, AOA status, etc...) A curriculum vitae Letters of recommendation Deans letter USMLE scores Medical School Transcript Personal Statement

After you enter the information, then come the big decisions: you’ll choose the residency programs you want to apply to and voila: your application gets delivered straightaway.

Specialities Not Included in the Match Some specialties do not participate in the NRMP. These include neurology, neurosurgery, ophthalmology, otolaryngology, and urology. These specialties have an early Match (usually January of the 4th year of medical school). You can obtain further information by contacting the Matching Program for the specialty, as shown below: Neurology Neurology Matching Program P.O. Box 7999 San Francisco, CA 94120 (415) 923-3907 http://www.sfmatch.org Neurosurgery Neurosurgery Matching Program P.O. Box 7999 San Francisco, CA 94120 (415) 923-3907 http://www.sfmatch.org

UTMB Ophthalmology Ophthalmology Surgery Matching Program P.O. Box 7999 San Francisco, CA 94120 (415) 923-3907 http://www.sfmatch.org Otolaryngolology Otolaryngolology Surgery Matching Program P.O. Box 7999 San Francisco, CA 94120 (415) 923-3907 http://www.sfmatch.org Urology AUA Residency Matching Program 2425 West Loop South Suite 333 Houston, TX 77027-4207 (713) 622-2700 Ext 86 Fax: (713) 622-2898 http://www.auanet.org

ERAS Tip Though ERAS has lots of information on programs, it’s not the definitive source. Make sure to do your homework and find out as much about the schools you want to apply to from websites, talking to faculty and current residents, or however you can. Also: make sure that the schools you are interested in use ERAS!

Journal for Minority Medical Students 33


////////////// / / / / ERAS IN 5 EASY STEPS

Step 1: Research residency programs

Flori

ersit y da State Univ

Choosing a particular program at this point isn’t crucial—the interview will be the deciding factor here. Choose as many programs as you’re interested in; in fact, it is to your advantage to apply to more programs now and then pare down the list later.

Step 2: Get your ERAS token from your Dean’s Office

Do this early. The dean’s office will be processing 100 to 200 student’s ERAS applications, so make sure you’re at the front of the line!

Step 3: Get to know the ERAS web site

Go to the ERAS Web site, www.aamc.org/eras, and complete your application and designation list. The on-line help will guide you through the completion of the ERAS application.

iversit y Columbia Un

Step 4: Get photographed

Take a recent photograph to your designated dean’s office for processing. Ask all letter of recommendation (LOR) writers to send LORs to your designated dean’s office.

Ensure that all segments of the application have been completed and your designated list of programs is final. No programs can be deleted once the application has been transmitted to the ERAS PostOffice.

Step 5: Keep tabs on your progress

Nebraska Universit y of

Unive East Carolina

rsit y

34 Journal for Minority Medical Students

The Applicant Documents Tracking System (ADTS) uses e-mail to acknowledge documents that are downloaded by programs. Check your e-mail frequently for requests for additional information and invitations.


Choosing a residency program: An insider’s guide to what’s really important By Jeff Wiese, MD Choosing a program is like buying a car: not every program will have every feature, and some features you will value more than others. Every residency program is a perfect match for someone. Your task is not to take responsibility for ranking the quality of all residency programs, but instead to choose the one that speaks to you. Sure, you might want to build an Excel spreadsheet in the hope that some objective score can be calculated to tell you which program is for you. But in the end, the spreadsheet will likely go in the trash. You will make your decision based upon the people you meet; everything else will serve as a justification for that decision. There will be no substitute for your gut feeling about this one. But gut feelings do not come as a vision in a dream; they evolve as you go through the process of thinking about the strengths and weaknesses of each residency program.

Must-haves There are some criteria that every program must fulfill; if it does not, you should simply walk away. The program should be in good standing with the RRC and ACGME. Probation does not mean that the program is not worth considering, but it does send an alert that you should look carefully at why the program is on probation and what they are doing to correct the problem. An additional red-flag is a program that is in denial of the problem that put them on

probation (i.e., “We got put on probation for excessive work hours. But that rule is ridiculous, residency is about working hard!”). Academic vs Non-academic If you are interested in an academic career, you need to train at an academic center. Even quasi-academic programs (i.e., hospitals not at a medical school but that have medical students rotate through the hospital) may underserve your needs. Board pass rate/ resident completion rate Everyone talks a good game about what they do to help their residents pass the boards. However, if a significant number do not pass after completing the program, something is definitely wrong. This can be dismissed if you get a sense that the program is changing to correct the problem; but if you do not, beware.

The Very Importants Are the residents happy? There is a reason for why unhappy residents are unhappy. The specific reason is unimportant; unhappy residents are a marker of something seriously wrong. Don’t waste your time trying to find the specific reason; just walk away. A close corollary to this is how the hospital, department, and program administration sees the residents. Are they workers or colleagues. Workers are referred to as numbers (“We have five residents at this

Journal for Minority Medical Students 35


hospital. We have 30 residents who do the ICU each year.”) Colleagues are referred to by name. (“I’m going to have you talk to Jim. He just finished the ICU.”) Look for the program director and chairman to refer to residents by name, and you will have your answer. What type of patients will you care for? A residency should train you as a good human as well as a good physician. Intrinsic to being a good human is appreciating and respecting the diversity of people. The program should offer you a chance to care for a diversity of patients with different socioeconomic, ethnic, and cultural backgrounds. It is also important that the program give you a spectrum of disease types. Reading about lupus never substitutes for caring for a patient with lupus. You should also have a mix of private and nonprivate patients. You cannot learn medicine by taking orders from a private physician all of the time. You have to be in the position to make decisions. You have to become comfortable with the discomfort that comes with putting yourself on the line for the decisions you make. Responsibility is a learned virtue. Patient volume There should be enough patient volume to make the training worthwhile, but not so much that it puts patients at risk or compromises your ability to think and learn. Slow call days are the dream of the intern, but not of the first year attending. Far better to have high volume now when you have the opportunity to make mistakes while you have supervisors to keep your patients from dying, then to make them during your first year out of residency (because you saw too few patients in residency) when you are all alone. House-staff Quality Don’t become enamored with impressive faculty. The really impressive faculty are so good that they have protected time that keeps them away from the wards (so that they can be with their research). Most of your education will come from patients, and after that, your other residents. Look for the following:

36 Journal for Minority Medical Students

“You will learn more in one day of internship than one year of medical school.” 1. Do they sit down at the end of the day and review the past twelve hours and plan for the next day? 2. Do the self-assess and seek for areas they could improve their abilities? 3. Do they admit mistakes? Are they honest or are they self-aggrandizing? 4. Do they teach? What do you get to do and when do you get to do it? You will learn more in one day of internship than one year of medical school. Why? Because you are actively doing something, not standing around shadowing someone. This does not apply to programs where you continue to stand around for a year. Programs that are dominated by private physician services are the worst, since private physicians are unlikely to give you the latitude of learning by doing that teaching physicians will provide. Ask if you scrub/operate as an intern? Do interns do procedures? Will you have your own panel of clinic patients?

The Importants Character of the hospitals Consider the number of hospitals in the program, their proximity to each other and the diversity of patients that are seen as a function of these different hospitals. Learning different systems of health care delivery is important because you have no idea the type of hospital in which you will ultimately practice. The best way to learn this is to be exposed to different systems of care. The schedule of rotations The specific schedule is unimportant; it will be hard for you to assess the importance of doing three VA ward months if you do not know the quality of the VA ward month. It could be either good or bad, and you will not be able to tell. It is important that you have elective and ambulatory time, however, as both of these provide


/ / / NEOUCOM

University of Arizona

Penn

NYU

Dartmouth

Journal for Minority Medical Students 37


time to catch up on sleep and reading. Look carefully, however, and make sure this “elective time” is not burdened with jeopardy and nightfloat. Both of these mercenary assignments mean work with little education. Regardless of your feelings about clinic, it is important that you learn how to work efficiently in an ambulatory setting. You should also have the opportunity to see some ICU and ER time, but not to the exclusion of the rest of the program’s rotations. Ancillary services This borders on unimportant, since having to do a few of your own blood draws is not such a bad thing. You should not have to serve as a patient transport or routinely be woken up or pulled from conferences to draw blood, however. Curriculum You need to know the science that goes behind the diagnosis and management of your patients, and the list of topics in which you should demonstrate competency before you are done with your training. You shouldn’t have to discern this list yourself; the program should provide you with a defined curriculum. Are there medical students? Medical students buoy-up a residency because students ask the questions that no one else wants to ask, but know that they need to be answered. There is no competence like that which comes from being able to teach a topic. Students will define the envelope of your competence, and this will make you acutely aware of your incompetence, which is the first step to becoming great.

How does the program treat its patients? An unintended, unsavory by-product of the work-hour rules is frequent patient hand-offs and shift work. You learn to be a physician by being a physician. However you slice it, it means assuming longitudinal care of a patient (to the end of their hospital stay or their life). If you are admitting patients just to pass them off to another shift doctor, you will miss this valuable lesson. You will also lose a few patients, since dropping the baton is proportional to the number of times it is handed off.

The Things that Seem Important, But Aren’t Pay The average intern will work 3520 hours a year. A program that pays $40,000 a year pays at $11.36 an hour; a program that pays $38,000 a year pays at $10.80 an hour. The distinction is hardly important to outweigh the criteria above. Besides, you’ll be making six figures in a few years. Moonlighting Moonlighting is discouraged at the best programs. It is education that always gets hurt when resident’s moonlight, since tired residents never stay around in the afternoon to teach students or you. Having it as an option during elective months in your third year is a plus, but not worth weighing into your decision. Parking Come on!

University of Nevada

UTMB

38 Journal for Minority Medical Students


Call rooms Just because you stayed at a Holiday Inn last night does not mean you are a good physician. Same with the call rooms. You shouldn’t have to compete with other animals and insects, but past that, the call rooms mean nothing.

Should I stay or should I go? Your home program will likely want you to stay on as a resident. Why? Because for better or worse, you are a known commodity—a bird in the hand, as they say. There are some advantages for staying at your home school, not the least of which is avoiding the expense and emotional trauma of moving, and that the program is a known commodity. The most compelling reason, however, is that after seeing all other programs on your list, you think that this program is for you. Do not be afraid of leaving the nest, however, as there are great things waiting for you elsewhere as well. The advantage to leaving is that you will learn a new set of approaches to the same problems. Dogma is the death of the scientist, and so the physician, because it stifles creative thought. Seeing that other methods to the same problems result in similar or better success strikes to the heart of destroying dogma, and will broaden your horizon to thinking creatively. It is also healthy to see a different population of patients, as this too augments your development as a person and thus as a physician. You are taking a risk by leaving your school and going elsewhere, but if you believe there is a program that is better than yours (or even roughly the same) have the courage to set out for greener pastures. Dr. Wiese is Professor of Medicine, Associate Dean for Graduate Medical Education and Director of the Tulane Internal Medicine Program. From “Choosing a Residency,” www.tulanemedicine.com.

Texas A&M

Vanderbilt

University of Cin

Universit y of N

cinnati

ebraska

Journal for Minority Medical Students 39


Match Timeline Begin asking for letters of recommendation. Continue this process as the year progresses and as you work with other faculty members (i.e., during your sub-internship), but start thinking about letters right now. Remember that most academic faculty take vacation during the summer months (when the academic load is light), and it may be hard to contact them during the summer. It will also be harder to get them to complete the letter during the summer.

Begin working on your personal statement, especially if you have decided on your career. Even if you have not, now is the time to starting putting pen to paper to elucidate what matters to you and what you are looking for in a career. Who knows? This just might solve your career crisis.

Go to your Dean’s Office and obtain an ERAS Token. You cannot log on to MyERAS (your personal page) without it. Immediately log on to ERAS and register with ERAS. (see above). You do not have to upload all of the data now, but make the site available for the Dean’s office.

ne u J May April

le hedu c h s c s i r k th Ma , bac s e y i t l r cia h spe Januahird Year c t a rly m T or ea :F

* No t e

40 Journal for Minority Medical Students

. onths m o w t up by

Finish your personal statement; have someone read it for you. Write your CV and have someone read it.

July


Flo

ni ta te U S a d ri

y versit

re b m e Nov nuary Ja

re b m e Sept tober oc er b m e t Sep t Augus

Begin uploading the CV data on the ERAS site. Finalize your letter of recommendation list in the Dean’s office.

Finish completing the ERAS form. Select the programs to which you want to apply.

You will begin to receive interviews from programs. Some programs will not extend interviews until the Dean’s letter has been released (November 1st) so do not panic early in October.

Begin Interviewing!

Journal for Minority Medical Students 41


Secrets from the Pros: Nora Osman, MD Office of Multicultural Faculty Careers Harvard Medical School

Dr. Nora Osman is uniquely qualified to give us some residency secrets: She meets every underrepresented minority (URM) candidate who comes to Harvard to interview for a residency position. What are some of the most common mistakes you see candidates make? Dr. Osman: The biggest thing I see is that people forget that the interview is actually part of the admissions process, and an important one at that. They think that board scores and transcripts are all that matter, and that the interview is just a chance to make sure they’re not psychotic. Because of this, they come unprepared for their interview. By that I don’t mean they don’t know about the program—we don’t really care how much people know about the program—but they don’t know about themselves. They don’t know what’s on their CV. They’re not able to talk about who they are and what they’ve done. Remember: anything you put on your application, anything you put on your CV is fair game, and you’ve got to not just regurgitate what you’ve already said a thousand times, but you’ve got to talk about it with passion and interest. You should also come in with some good questions (and by this I don’t mean “Is there a good shuttle service?”). Ask about things that you’re interested in: “What kinds of community service opportunities might there be for me?” “What kind of mentorship is there for me here?”

42 Journal for Minority Medical Students

How much of what makes a successful match is fit? Dr. Osman: We do joke about how we like to see if people play well in the sandbox. We’re not just looking for somebody we’d like to hang around with; we’re looking for somebody who we believe would benefit from the learning environment we have here, would contribute to program, and, most importantly, would take care of our patients well. You can be the smartest person in the world, but we need you to be a good doctor, too. What are the traits you are looking for in a candidate? Dr. Osman: Compassion. Passion. And something that’s critically important is that he or she be a curious person and intellectually stimulated by knowledge. We’re looking for career learners. We’re also looking at what he or she has done for the past four to eight years: What did he do in med school besides get straight As? Was she in a chorus? Did he go to Namibia to work in a clinic near the diamond mines? Do you have any tips especially for URM candidates? Dr. Osman: One thing I tell students is that there is some benefit to doing away clerkships like our own Visiting Clerkship Program. Ours is specifically for URM students, and it gives them the chance to come here for a month (with everything paid for) and do a rotation. You meet people, network, learn, and

at the end you’ll be able to get a letter from a Harvard faculty member. It’s definitely a good way to get your foot in the door. The other thing I’d say to URMs is to not forget you’ve earned your right to be here. I often see students who think we’re being nice to let them have an interview. We don’t have to be nice; we don’t have to do anybody any favors. So if you’re invited for an interview at one of the top programs in the country— wherever you’re invited—you’ve been invited because they want you. You deserve to be there.

Reality Check “Some people find a program that feels like ‘home,’ but not everybody does, so don’t worry if you don’t ‘fall in love’ with any of your programs. That said, if someplace speaks to you, then listen to it. That gut feeling—positive or negative—is as important as the items on your pros and cons list.”


Secrets from the Pros: Robert Gaiser, MD Residency Program Director, Anesthesiology University of Pennsylvania

What are some of the biggest and most common mistakes you see people make when applying to your program? Dr. Gaiser: The number one problem I find is people not being familiar with the program. It’s expected at the interview that you’ll at least have looked at the department’s website and have a little bit of familiarity with the program. Another big mistake I see is people customizing their essays and then sending it to the wrong program or even a different specialty. That’s when we realize we’re a true backup. What are you assessing when interviewing a candidate? Dr. Gaiser: Once you’ve been offered the interview, you clearly have what it takes to be a resident at that spot. Now it’s going to be based on the interview, and fit is the deciding factor for us. That’s because with most specialties, residents spend 90% of their time with their colleagues and 10% of their time with the attendings. In anesthesia, they spend 90% of their time with the attendings and 10% of their time with their colleagues. So I tell my faculty who are interviewing residents to ask themselves, “Could you be in a room with this individual for an extended period of time?” We have 30-minute conversations with our candidates and if after 10

minutes we find we can no longer talk to this person, that means that they’re just not clicking with our program. How important is it for a candidate to have experience in anesthesiology outside of rotations? Dr. Gaiser: They must do a senior level elective; that’s a minimum. Having research and doing additional rotations may help, but not doing those definitely won’t hurt. How important is the personal statement to your selection process? Dr. Gaiser: I’ll echo what our dean of students says: the essay never helped a person; an essay can only hurt a person. I recently read about an interesting study out of Duke that talked about something called the “I factor”: “I did this” and “I did that.” When the “I factor” was high on the personal statement, those residents tended to be more problematic than residents without a high “I factor.” What about recommendation letters? Do you only want to see letters from anesthesiology faculty? Dr. Gaiser: It’s important to get at least one letter from your specialty, and then after that, it’s the top team members who know you the best. If you can get a letter that says basically

“This was one of the best students I’ve ever worked with”—from whatever department—that carries a lot of weight.

TIPS - If you’re interested in a program, let them know. Send a heartfelt email after the interview to let them know how strongly you feel about their program. - In the interview, be consistent. Don’t tell different stories to different faculty. You have to assume they talk to each other. - Remember that the schools are not only interviewing you, you should be interviewing them. “I remind our faculty that it should be a sell on both parts.”

Journal for Minority Medical Students 43


Secrets from the Pros: Brian Streams, MD Residency Program Director, Dermatology Kaiser Permanente, Southern California (LA Medical Center)

What are some of the biggest and most common mistakes you see when people apply to your program? Dr. Streams: They have not demonstrated in their application a commitment to dermatology. Dermatology is one of the more competitive residencies, and so most program directors are looking for research, strong grades in all clinical rotations, and something about their experiences in med school that demonstrate that they are passionate about the field. Dermatology is not a strong focus in medical school; usually med students don’t get exposed to dermatology until late third year or early fourth year. By that time, sometimes they don’t have enough time or have not made enough effort to demonstrate an interest in the field. The stronger candidates have decided a little earlier that they’re interested in dermatology and have taken steps to do research or get some publications, write papers, so they show they’re committed. What kinds of people are you looking to have letters of recommendation from? Dr. Streams: It’s definitely important to have at least one extremely strong letter of recommendation from a prominent faculty member within the field of dermatology from an academic program; it’s not that critical to have multiple. All the letters need to be extremely strong and consistent in the evaluations. We look at all of the rotations, not just dermatology. They need to be strong in medicine, surgery, pediatrics because of the competitive nature of the programs.

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How important is the personal statement in your selection process? Dr. Streams: I don’t think the personal statement can hurt you that much, but I think people underestimate how much it can really help you. If you write a personal statement that really stands out, it will capture who you are as an individual, that’s really strong. Some people write personal statements that are just summaries, or CVs and we don’t get to see who that person is. Stronger personal statements tell a story about the individual and those stand out more. But a really strong personal statement definitely doesn’t trump board scores or class rank. What other traits are you looking for in a candidate assuming he’s got all the right stuff academically? Dr. Streams: We’re looking for applicants that appear to be team players. Because dermatology residencies in general are smaller, you really look for people who work well together and can adapt to different situations. And because our program is in metro Los Angeles, which draws patients from all ethnic backgrounds, we look for people who have experience working with people from all different backgrounds. Finally, because we’re not a research-focused program, we look for people who like working in the clinic and can bond with patients. Have you ever been wrong about a candidate? Dr. Streams: All the time. That’s why the interview process is so important, and

we rely heavily on it. Of course, we look for minimum criteria on paper in terms of scores and grades (and it’s a very high bar), but then once they get here, anything is possible. How many do you interview for how many open spots? Dr. Streams: We interview 40 candidates for 2 spots each year. What advice would you give to a potential candidate? Dr. Streams: If you have any interest in dermatology, explore that interest very early. Don’t be afraid to take some time off to get more experience in dermatology to make your application stronger. Don’t give up. If dermatology is what you want to pursue and you don’t match the first time, continue to apply and do what you need to do in the meantime to make your application stronger. We’ve definitely had candidates who applied twice and even three times that finally matched with us.


Secrets from the Pros: Dr. Jeffrey Nicastro Residency Program Director, Surgery North Shore Long Island Jewish Health System

What are some of the biggest and most common mistakes you see that residency candidates make? Dr. Nicastro: The biggest thing I see is that medical students spend far too much time on their personal statements. They should relax, have fun, and write a grammatically correct essay. There are a couple of exceptions: one is if there’s something really interesting or unusual that got them interested in medicine. The second is if they have a gap in their application (bad grade, poor USMLE scores) due to an extenuating circumstance; the personal statement is a good place to clearly explain it and tell how they’ve bounced back. I also think that sometimes people are a bit naïve about the selection process. I’m going to be honest with you—the fact of the matter is that there are a lot of applicants for a relatively small number of spots. Poor USMLE scores are hard to overcome, even if you’ve gotten good grades and have great letters. You have to be realistic. How important are the recommendation letters? And who do you want them to be from? Dr. Nicastro: Particularly in surgery, one of their letters should be from the surgery program director and/or the chair of the surgery program at their home institution. If I have numerous letters from nonsurgeons, I wonder whether they’re really interested in surgery or if it’s a backup and their first priority is something else. In terms of content, what I’m really looking for is a letter from any program

director who says, “If this person were interested in medicine, I would be actively trying to recruit them into my program. I wish they were.” That’s the key sentence. It’s always at the end. Likewise, if the surgery director at the candidate’s school says, “I am going to actively recruit this person to stay in my program,” that holds a lot of water. The words and phrases I look for are: “Outstanding.” “One of the best medical students I’ve seen.” “Has my highest recommendation.” What are the top traits you’re looking for? Dr. Nicastro: It’s hard to discern, but assuming the candidate is qualified, it all comes down to fit for me. I never want to attract someone to my program if I don’t think they’d be happy here. In terms of the interview, the thing that personally doesn’t sit well with me is if someone is trying too hard or seems almost too enthusiastic. I also like seriousness. If you’re really serious about a program, show me that you’ve done a bit of homework about my program and that you just didn’t apply in a shotgun fashion. I’ll also say this: it’s important to go where you want to be. If you want to go to a particular part of the country because of family, that’s great. To me, that shows strength, not weakness. It shows that you have insight into your own personality and that you know what you need.

TIPS - Always be honest and answer questions the best you can. If you don’t know an answer, be honest and say you don’t know. - If you’re not interested, don’t come. - Do well in medicine and your intended specialty (“I obviously don’t want a person who’s failed anything,” Nicastro says. “But I’m not really looking at grades for anything other than medicine and surgery.”

Reality Check “An above-average candidate from a toptier medical school ‘beats out’ an exceedingly well qualified candidate from a less prestigious school.”

Journal for Minority Medical Students 45


Tips on writing your personal statement

/ / / / / / / / / / / / / / / / / / By Jeff GonzĂĄlez, MD

W

hy is the personal statement so important? It is important because it is the only

part of your application that is not based on test scores or other people’s perceptions of you. For this reason committees place a heavy emphasis on the personal statement. It is the one part of your application over which you have complete control and that allows you to make a personal case for yourself. Because of these reasons, however, it is very difficult to write.

NEOUCOM

There are some basic questions that you need

to address in your personal statement. These are usually divided into three paragraphs that address: 1) what got you interested in the field that you have chosen; 2) what you are looking for in a residency program; and 3) what your expected goals are in the field you have chosen. You are always free to add other commentary that is relevant to the above topics. But, make sure you discuss these three topics in your essay.

Your personal statement should fit onto one

page when it is printed from the ERAS system. You can test this prior to submitting your statement to

Columbia University

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residency programs.


/ / / / / / / / / ////// Some helpful suggestions in getting started: 1. Go back to your medical school application essay. Some students find it useful to look at that as a basis for their residency statement, specifically the introductory and final paragraphs.

2. Find out if your school has a writing office that can help you with your statement. 3. Use a theme to structure your essay. This helps unite all aspects of your statement. 4. Provide concrete examples that pertain to your life, goals, and experiences. 5. Be concise. Refrain from using a lot of unnecessary words. 6. Begin your essay with an attention grabber: a quote, a story, an anecdote, or a riddle. 7. Finish your essay with a conclusion that refers back to the beginning of your statement and restates the theme. 8. Have your departmental program director evaluate/critique your statement. Remember they have probably seen thousands of essays and are most likely the best authority at your institution to evaluate your work. 9. Don’t be afraid to start from scratch if your essay is not working. 10. Write about what interests you, excites you. Your reader wants to hear a positive essay not a negative one about the profession.

Mistakes to avoid in a personal statement: 1. Underestimating the importance of the personal statement.

2. Underestimating the time and difficulty involved in developing the personal statement.

3. Lack of “flow.” When someone reads the essay, they have no idea what the applicant is trying to say. They jump from one tangent to another. When I see a statement like this I would rather not read the essay at all. To prevent this error you need not one, not two, but at least three people to read your essay and give you feedback. You need to revise your essay several times. Therefore, you cannot start working on the essay one week before it is due. I recommend starting to work on your personal statement in July. Remember that most attendings will ask for a copy of your personal statement in order to write a letter of recommendation. Therefore, you need to start early.

originality/strangeness is applauded. Keep it simple, to the point, and address the issues I have brought up before.

8. Procrastinating until the very end to begin your statement. You need to start months in advance. 9. Failing to let yourself come through. This goes back to trying to make your statement too cute. You do not want to show up to an interview and have the interviewer thinking: Am I speaking to the same person that wrote this statement? 10. Including topics in the statement that if asked to discuss you would not be able to answer, such as particular research points, volunteer activities, etc.

Dr. Jeff González is a gastroenterologist with The Palmetto Surgery Center in Hialeah, Florida. He served as Chair of the Resident and Fellow Section of the American Medical Association (AMA) which originally published this article.

4. Spelling and grammar mistakes. These can kill you. It says a lot about an applicant if they have not taken the time to carefully proofread their essay. Is this someone who pays attention to detail and will spend time taking care of patients in my hospital? No! 5. Avoid clichés. 6. Making the writing process a group effort. This does not work. 7. Being too cute. This is not an essay for college admissions where

Journal for Minority Medical Students 47


/ / / / / / / /

How to Prepare for the Residency Interview By Jeff Wiese, MD

L

ike almost anything to do with medicine (or life!), the single best piece of advice about interviewing is to be prepared. Read through this section, speak to people who have been through the process, use a resource book, and do your homework. Solid preparation will provide you with added confidence, sharpen your focus, decrease stress, and allow you to relax a little bit.

Practice Interviewing Practice will make you calmer, more organized, and help you sound better during the real thing. Ask a specialty advisor, a faculty member, or the Office of Student Affairs staff to conduct a mock interview with you. • Prepare as if it were a real interview—review your answers to specific questions. • Carry copies of your CV, personal statement and transcripts, a list of questions you wish to have answered, and a note pad, as you would for your interview (use a nice leather portfolio). • If possible, dress as if it were a real interview (see suggestions below).

Know Yourself Make a list of your top strengths, goals, values, accomplishments, and abilities to use as a general reference for all interview questions. This will provide your answers for a majority of the questions you are asked. • Go into every interview with five key things you want a program to know about you. What makes you a good candidate? What makes you unique?

48 Journal for Minority Medical Students

University of Virginia


• Review your own medical school file before the interview.

Know the Program and Specialty • Know a great deal about the individual residency programs. • Review all the information they send you. • Visit the program’s Web site. • Ask for an interview schedule ahead of time if it was not included (fax or e-mail). • Ask the program what to expect and what materials to bring for the interview day. • Find out about the faculty, particularly any interviewers (Medline search, Web search). • Speak with any graduates in the program or others you might know. • Speak with residents and M4s on interview day for the real story. • Know a great deal about the specialty’s culture: » » » » » » » » » » » »

What do practitioners in the field really do? What types of procedures do they perform? How are they perceived by other specialists? Do they have opportunities for subspecialty training? Are there specialty board exam requirements? What do they value or view as important as a specialty?

Looking the Part

UAB • Be prepared for bad weather—always have an umbrella and overcoat with you.

Create a List of Questions You Want Answered Based on the needs and wants you outlined for yourself earlier, brainstorm a list of information you wish to find out during your visit. Below is a list of possible questions. • What is the success of graduates: board scores, help finding jobs/fellowships?

• Dress should always be conservative, tasteful, neat, and comfortable.

• What are the clinical, non-clinical, and administrative responsibilities of the residents?

• Have the appearance of a successful, mature physician, not a medical student.

• Are there research opportunities?

• MEN should wear a navy or gray suit (solid or pinstripe), not a sport coat or khakis. • White or pale-blue shirt. Conservative tie: solid, stripes, or small pattern (red or navy) • Keep jewelry to a minimum. Short hair, preferably no goatees. • WOMEN should wear a suit, although skirt or pants are acceptable. Classic, solid colors: medium to dark gray, medium to dark blue, or black. Simple white or cream top. • Simple, comfortable shoes. Keep jewelry to a minimum. Make-up and perfume work best when they are not noticed.

• Status of the program and hospital: Have any house staff left the program? Accreditation? • Quality of current residents? Have any left the program recently? • How are residents evaluated? How often? By whom? How may they give feedback? • Teaching opportunities? • Do you foresee any changes in the next three years? • What makes this program so unique?

Create a list you wish to specifically ask residents, such as: • What contact will I have with clinical faculty?

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• How are the attendings to work with?

• What do you do in your spare time?

• What is the average daily work load for interns? Is it varied?

• Present an interesting case that you had, as if you were in clinic.

• How much didactic time is there? Does it have priority? • What types of clinical experiences will I have? • What is the work schedule? Call schedule? Time off? • What is the patient population I will see? • Are you happy? Was this a good match for you? • Do the residents socialize as a group?

• Tell me about a patient encounter that taught you something. • What would you do if you knew one of your more senior residents was doing something wrong? (Filling out H&P’s without doing the evaluations, tying someone’s tubes without consent, and other ethical questions.) • Which types of patients do you work with most effectively? (Least effectively?)

Questions Not to Ask

• How do you make important decisions?

These are topics you should typically not ask about during the interview. Most of this information will be in the packet they send you or covered in an introductory meeting. If not, it is better to contact the institution’s Graduate Education office. • Salary

• How do you normally handle conflict? Pressure?

• Benefits • Vacation • Competition • Maternity leave arrangements

Questions the Interviewers May Ask The following is a list of potential questions that may aid you in your preparation. • How are you today? (There are NO innocent questions) • Do you have any questions? (Yes) • Tell me about yourself. • What are your strengths and weaknesses? • Why are you interested in this specialty? (#1 question asked.) • What other specialties did you consider? • Why are you interested in our program? • What are you looking for in a program? Where else have you interviewed? • Why should we choose you? What can you contribute to our program? • How well do you feel you were trained to start as an intern? • Describe your learning style. • Tell me about....item(s) on your CV or transcript, past experience, time off, etc.? • Can you tell me about this deficiency on your record? (do not discuss if you are not asked) • What do you see yourself doing in five (ten) years? • What do you think about...the current and future state of health care, this specialty, etc.?

50 Journal for Minority Medical Students

• If you could no longer be a physician, what career would you choose? • What to do think about what is happening in...? (Non-medical current event questions.) • Teach me something nonmedical in five minutes. • Tell me a joke. (Keep it simple and tasteful.) • What if you do not match? • Can you think of anything else you would like to add? (Yes...)

“Illegal” questions might include • What are your plans for a family? Are you married? Have children? • How old are you? • If we offered you a position today would you accept?

Make sure to: • Not ramble. • Really listen to the questions and make sure you understand what is being asked. • Answer the question that was asked and do not answer a question they did not ask or add too much loosely related information. • Be comfortable with pauses, silence; stay poised and confident. • Sound fresh every time even though you’ve answer the same question 20+ times throughout the entire interview process. • Smile! Highly underrated and often forgotten when nervous and tense. • Consult someone from the specialty about common questions in their interviews. • Always send a thank you letter after an interview.


/ /

Top 11 Tips to Surviving Your Intern Year From SEIU Healthcare

Tip 11

Allow yourself time to unpack or you’ll be living out of boxes until November.

Tip 10 Brainstorm a list and then stock up on all nonperishable items you think you’ll ever need (TP, stamps, toothpaste, and delicious snacks such as cheesy puffs).

Tip 9

Take care of issues like changing driver’s license, plates, tags and registering your car if you’re moving from out of state. The DMV is often not open late.

Tip 8 Expect to be fatigued on your first day, since you’ll probably spend the whole night before worrying about it. Bring coffee – lots of coffee.

Tip 7

Grab extra scrubs during orientation and wear them whenever possible to cut back on laundry loads and trips to the cleaners.

Tip 6 Once in the hospital, get to know as many names as possible. You’ll get tests, procedures, and information faster because people work harder for people they know.

Tip 5

Ask, ask, ask. Don’t be afraid to ask questions early. You will look much less of an idiot if you ask how to get hold of ECHO reports in your first week, than your second month.

Tip 4 Go to your residents and attendings early and often for feedback. Your resident might be shy. Do not let little pet peeves build up.

Tip 3

Buy a RELIABLE easy to use and LOUD alarm clock. It’s good to buy lots of extra batteries too.

Tip 2 Stock up on easy-to-cook meals, because it’s too easy to fall asleep with the stove on.

And finally, the number one tip for surviving your internship year... Tip 1 Find an apartment near the hospital where you can sleep during the day (and sleepwalk back to when you’re post-call).

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The Inside Scoop:

Alex Hernandez, MD First-Year Resident (Intern), Family Medicine University Physicians Healthcare, Kino, AZ

What kind of patient population do you serve? Dr. Hernandez: It’s a smaller- to medium-sized, community-based hospital with an underserved mostly Hispanic and uninsured population. We also serve a fairly significant correctional population.

What’s been the most surprising thing about residency? Dr. Hernandez: Managing my time is the biggest thing. In residency, you have to be able to multitask and still care for patients appropriately. You feel more responsible about the ultimate outcome of a patient.

How has it been different from what you expected? Dr. Hernandez: My education made me as prepared as I could ever be, but the first year is always very eye-opening. You find out what your deficiencies are, learn to work with those, and better yourself.

How does it feel to actually finally be taking care of patients? Dr. Hernandez: It feels good at times and it feels frustrating at times because there are still times when I don’t know things that I wish I did. It’s a learning process. The things I do know are definitely rewarding; I can teach patients on the spot. When I came to residency, my goal was to have an ability to communicate with patients openly and say what was on my mind rather than what they wanted to hear. I’m able to do that here, and I’m glad for that.

Dr. Hernandez’s Intern-Year Tips • The most important thing is to enjoy the learning process in medical school. If you don’t enjoy learning, it makes residency that much harder. You have to learn while you’re working 80 hours a week. • Get exposed to as many diseases as possible and as many different populations as possible. Those two things will become very handy by the time you start residency. There may be things that you’ve seen that nobody else has dealt with before. • Take a leadership role rather than a backseat (“I’ll learn it when I get there”) role.

52 Journal for Minority Medical Students

• Be as well rounded as possible, not just in terms of medical knowledge, but in terms of patient populations. • Always value your sleep. Whenever you sleep— even if it’s just a couple of hours—you rejuvenate. • Develop the ability to multitask. Finish fast and be done with it; don’t half-complete something and then have to come back again to complete it. • Have fun at the hospital. Enjoy your coworkers. Enjoy your patients. If your patients see you are caring for them, they will be put at ease. That will go a long way to decreasing your stress levels.


The Inside Scoop:

Meshia Q. Waleh, MD 3rd Year, Family Medicine, Duke University Hospital

Why did you choose family medicine? Dr. Waleh: I wanted to be able to reach all types of people, and I was really interested in education, wellness, and prevention. Also, I moved out of the country for a while and I was teaching nutrition and STD education, and I just loved teaching people. I’ve been given the knowledge; it’s a gift. I want to share it with people and help them take responsibility for their own health. Family medicine trains you to be a doctor. You can be anybody’s doctor any time in his life from birth to death. It’s a great specialty.

What made you choose Duke? Dr. Waleh: I wanted to go to a good program, but honestly, Boston was freezing cold! Actually, I really wanted to be closer to my parents as they aged, and Duke had an excellent program. People had always told me, “You’ll just know when it’s right” about a program, but before I interviewed at Duke, I had interviewed at many other programs, and I hadn’t felt that yet. I was wondering if I was missing something. But when I interviewed at Duke, that moment happened for me. And it’s really true: you’ll know when it’s right. In fact, I cancelled the interview I had after Duke because my feelings were so strong.

What was the hardest thing about residency for you? Dr. Waleh: The amount of organization coupled with increased responsibility. You’re a resident, but you’re a professional; you’re not a student anymore. I had to learn how to be more organized. Keep lists with important dates and deadlines. It’s hard in intern year and then it gets harder and harder because your responsibilities increase and you’re studying for the boards. It’s a lot!

Did you know going in what to expect? Dr. Waleh: No! I thought when I was in medical school that I could relax when I got to residency! Once there, however, I realized very quickly I was wrong. It was a challenging transition, but I had an advisor who cared a lot and really helped me. I had to be open to that help, so I could accept it and do well.

What was the most exciting thing about residency? Dr. Waleh: The patients! I love my patients, I really do. They teach you a lot and the relationships you develop are priceless. Even if I’m having a bad day at work and am stressed out, I’ll have an encounter with a patient and remember why I’m doing it.

You just finished your residency. What are you doing next? Dr. Waleh: My husband and I are moving to Honduras to spend a year doing mission work (I’ll be doctoring; he’ll be working on their disease registry and technology infrastructure). We’re planning on coming back, but we’ll see—we’re so excited!

What advice would you have for students going through the Match soon? Dr. Waleh: Life takes a team. No one person can do it themselves. Don’t be afraid to ask for help. Learn from others. Journal for Minority Medical Students 53


2012 Main Match schedule September 1, 2011 Registration opens at 12:00 noon EST for applicants, institutional officials, program directors, and medical school officials.

November 30, 2011 Applicant early registration deadline. Note: Applicants may register for $50 until 11:59 p.m. EST. Applicants who register after November 30 must pay an additional $50 late registration fee ($100 total fee) until February 22, 2012, when registration closes.

January 15, 2012 Rank order list entry begins. Applicants and programs may start entering their rank order lists at 12:00 noon EST.

January 31, 2012 Quota change deadline. Programs must submit final information on quotas and withdrawals by 11:59 p.m. EST.

February 22, 2012 Deadline for registration and ROL certification. Rank order list certification deadline. Applicants and programs must certify their rank order lists before 9:00 p.m. EST. Staff will be available to answer your questions during the final deadline hours. CERTIFIED applicant and program rank order lists and any other information pertinent to the Match must be entered in the R3 System by this date and time. Withdraw deadline. Independent applicants who have accepted a position through another national matching plan or by agreement outside the Matching Program must withdraw before 9:00 p.m. EST.

March 12, 2012 Applicant matched and unmatched information posted to the Web site at 12:00 noon EST.

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Filled and unfilled results for individual programs posted to the Web site at 12:00 noon EST. Locations of all unfilled positions are released at 12:00 noon EST only to participants eligible for the Supplemental Offer and Acceptance Program (SOAP).

March 13, 2012 Programs with unfilled positions may start entering their SOAP preference lists at 11:30 a.m. EST.

March 14, 2012 Programs with unfilled positions must finalize their first-round SOAP preference lists by 11:30 a.m. EST. SOAP offer rounds beginning at 12:00 noon EST.

March 16, 2012 Match Day! Match results for applicants are posted to Web site at 1:00 p.m. EST. SOAP concludes at 5:00 p.m. EST.

March 17, 2012 Hospitals begin sending letters of appointment to matched applicants after this date. Note: SOAP-eligible unmatched applicants shall initiate contact with the directors of unfilled programs only through ERAS. Other individuals or entities shall not initiate contact on behalf of any SOAP-eligible unmatched applicant prior to contact from directors of unfilled programs. Such contact is a violation of the Match Participation Agreement. Contact between programs and matched applicants prior to the general announcement of 2012 Match results at 1:00 p.m. EST Friday, March 16, 2012 also is a violation of the Match Participation Agreement.


A Health Revolution is Here

THE JOURNAL’S NEW CAMPAIGN TO ELIMINATE HEALTH DISPARITIES It seems fitting that the Journal for Minority Medical Students chooses this fertile time to announce our new five-year effort: The Campaign to Defeat Disparities & Achieve Health Equality. The Department of Health & Human Services recently unveiled a comprehensive strategy to reduce health disparities among racial and ethnic minorities by releasing two important strategic plans: The HHS Action Plan to Reduce Health Disparities and The National Stakeholder Strategy for Achieving Health Equity. Our own campaign dovetails perfectly with the HHS efforts, and we’re excited to give our full support to their important work.

The HHS Interview The new HHS plans build on provisions in the Affordable Care Act and represent the most comprehensive effort ever at HHS to address racial and ethnic health care disparities. In addition, HHS will step up its efforts to gather and analyze data about health issues in minority communities. Here, Dr. Garth N. Graham, HHS Deputy Assistant Secretary for Minority Health (pictured above), gives some details of the new strategy.

The Campaign Manifesto • Knowledge is power: it’s time to spread the truth about the lack of health equality in the United States. • Good health is the nonnegotiable foundation for “life, liberty and the pursuit of happiness.” • We believe it’s not enough to reduce health disparities, we need to eliminate health disparities. • As tomorrow’s doctors, medical students are in a unique position to contribute to this fight. • One person can’t eliminate health disparities by him or herself, but one person can do something today to eliminate health disparities. Join us!

What are health care disparities and why should people care about this issue? Dr. Graham: Health care disparities are differences in health outcomes between various populations. We see that Hispanic

Journal for Minority Medical Students 55


Americans, African Americans, Asian Americans sometimes are affected by certain diseases disproportionately compared to the rest of the population. If diseases disproportionately affect a certain community, it makes that community less productive and less able to contribute overall. If we want to have health equity in our country, we want to make sure all populations achieve a similar life expectancy. What does the health law do to reduce health care disparities? Dr. Graham: There are specific provisions around workforce diversity, cultural competency and improving data collection so we get better data on minority populations. And, of course the fact that we are going to be expanding health insurance [will benefit] minority populations [because they] overwhelmingly make up the ranks of the uninsured. What will you do with the data you collect? Dr. Graham: It will tell us a better story. If you were to just look at the Asian American population overall, you would think there might be a lot of homogeneity and you wouldn’t be able to tell a lot about the health care disparities within the Asian American population. Once we are able to do that we can target our resources better and be able to create change. How will you know if the plan is working? Dr. Graham: We will hold ourselves accountable in general. The plan is going to be updated on a yearly basis, when we will track certain measures to see where we’ve gone [and] what we’ve done. If strategies don’t work we will have to retool and go in a different direction. We are going to be very public whether progress has been made or not. Five years from now, what will the health care disparity issue look like in America? Dr. Graham: We’re hoping in five years we will see a narrowing of the gap between minority populations and others. The short-term goal is to see an impact in health care outcomes in minority populations through these actions. When we do our annual reviews we want to have people see where we are. We are making ourselves transparent to be able to show all those organizations who worked with us just where we are.

56 Journal for Minority Medical Students


The NPA Interview The Association of State and Territorial Health Officials (ASTHO) is one of several key partners working with the Office of Minority Health to promote the National Stakeholder Strategy for Achieving Health Equity and the National Partnership for Action’s goal to reduce differences in health for racial, ethnic, and other underserved communities. ASTHO President John Auerbach, DPH, who also is Commissioner of Health for Massachusetts, has issued a health equity challenge to ASTHO members, that among other things asks them to adopt at least one strategy in 2011 that could lessen the burden of health disparities and health inequities. Dr. Auerbach talks about why ASTHO is taking on health equity now and how its work fits into the NPA. You have issued a President’s Challenge to promote health equity. What compelled you to focus on this issue and make it a priority for state and territorial health officials at this time? Dr. Auerbach: We can’t address chronic diseases like diabetes or heart disease; infectious diseases like tuberculosis; or injuries related to accidents unless we pay attention to the disproportionate burden of illness and premature deaths experienced by populations of color, as well as other populations. If we want to reduce these health problems, we’ve got to deal with disparities and health equity promotion.

Dr. Auerbach

How would you define success? Dr. Auerbach: There are many ways to consider success. In terms of the response of state health departments, I would define it as widespread action on disparities elimination and health equity promotion. While many state health departments have been focusing on these issues for some time, our response has been uneven. We need a concerted effort at this time with a variety of creative and evidence-based approaches to reduce the gaps in health outcomes. And we need to work together to elevate these issues to a different level of awareness and understanding. Why should we be focusing generally on this issue as a nation? Dr. Auerbach: This is a central and significant health issue for the nation. And fortunately, we have an opportunity to make progress as the Affordable Care Act (ACA) is implemented and insurance coverage expands. Lack of access to health care has contributed to the health disparities in the country, as people of color are disproportionately likely to be uninsured. In addition, thanks to the ACA’s Public Health and Prevention Trust, there may also be new opportunities to work on public health efforts to reduce disparities at the same time that insurance coverage options expand.

Journal for Minority Medical Students 57


The NPA comes at a time when there are many efforts underway—at the local, state, regional, federal and even foundation-supported levels—to address disparities. How will the launch of the NPA facilitate your efforts? How important is it that the federal government has also taken on this issue? Dr. Auerbach: The leadership of the HHS Secretary Sebelius and the Office of Minority Health in developing the NPA has been critical to making the promotion of health equity a priority. The NPA provides guidance and direction to state-specific efforts and it provides a framework for understanding how state-by-state actions fit into the larger national whole. A particular strength of the NPA is its involvement of diverse federal agencies. That inclusive model is one that more and more states are following. For example, in Massachusetts we have a Council to Eliminate Health Disparities that is overseen by our Secretary of Health and Human Services, but it also includes representatives of education, transportation, and other sectors. What are barriers that need to be overcome? Dr. Auerbach: The problem of disparities can seem so overwhelming that some feel illequipped to take it on. At a time of budget cuts, it seems particularly challenging to begin or to strengthen an initiative. But we’ve seen that even without a lot of money, you can make a difference. We can advance the discussion simply by using the bully pulpit. For example, when the NPA was released, a number of states held public events to highlight its content. States can also issue specialized data reports that focus on disparities and the social determinants that contribute to them. Some states have added language in their contracts that require attention to developing materials and taking action steps that are culturally or linguistically appropriate, as well as hiring staff who reflect the demographic character of the populations being served. All of these things don’t cost a lot of money, but advance the work. Would you agree that raising awareness about the problem would be an important first step? How do you then engage sectors that don’t typically link what they do to health? Dr. Auerbach: Raising awareness is key as is working outside of our comfort zone. Our experience has been that we need to spend more time working on the problem with business leaders, educators and our sister agencies in state government. In my state and many others, we are already doing just that. Our medical director now spends about a quarter of her time with the department of education. She works with them on policy issues and responses to health concerns. That has allowed us to work in partnership to address matters of health equity. For example, after the Haitian earthquake, we saw more and more newly arrived children entering schools without the proper immunization records. Some schools handled this more sensitively and effectively than others. Using our established partnership we were able to issue guidance to all schools via the school department in a very effective manner. Another recent example involves a partnership we have built with our colleagues in transportation planning. We have begun a process to conduct health impact assessments on the big transportation projects with particular attention to the effects on the most vulnerable populations. We anticipate this will consider the impact on health disparities and adapt transportation plans accordingly.

58 Journal for Minority Medical Students

“The problem of disparities can seem so overwhelming that some feel ill-equipped to take it on. At a time of budget cuts, it seems particularly challenging to begin or to strengthen an initiative. But we’ve seen that even without a lot of money, you can make a difference.”


A SECOND OPINION, PLEASE The Case of the Sinister Sinus Pain By John Dunn, MD

Maria: I’m sorry Anthony, but we don’t have anything else! Anthony: B-O-R-I-N-G! That’s all I have to say about that. Yvonne: I’ll give you “B-O-R-I-N-G” you “M-O-R-O-N!” How do you know? You don’t even know what he’s got! Anthony: Repeat after me, Yvonne, “If it looks like Aunt Tilly…” Yvonne: Give me a break… Anthony: You think I’m gonna stand up here and present a case of sinusitis? Maria: We don’t know it’s sinusitis, Anthony. He doesn’t have congestion, or a fever, or anything! Anthony: (singing) “I dream of Aunt Tilly, with the light brown”... Holmes: (entering) My goodness! I must have stumbled into Carnegie Hall… Yvonne: Carnegie Hell is more like it… Allow me to introduce “His Royal Flatness.” Anthony: Yeah? Are you calling me flat? That’s like the pot callingHolmes: Ahem! Anthony: Uh, that’s like…that’s kinda harsh, don’t you think? Yvonne: Not nearly as harsh as my fist on the side... Holmes: Please! We have work to do. Who has a case? Maria: Anthony does. It’s a case of facial pain. Anthony: Sinusitis. Maria: No, we don’t know what it is. It’s just facial... Anthony: ...sinusitis. Holmes: Remember, Anthony, “Just because it looks like Aunt Tilly…”

Anthony: Huh? Yvonne: Just give us the case, Spaghetti Head. Anthony: Hmph. (Yvonne advances menacingly towards Anthony) Well, uh, seeing as you asked so nicely…Here goes. JL is a 57 year-old salesman with a history of alcohol abuse and hypertension who presented to the walk-in clinic with five days of pain in his left cheek. He described it as a pretty severe steady ache, which radiated into his jaw area, associated with some mild nasal congestion and blurry vision. In other words, typical sinus symptoms, like I said. Holmes: Typical? Blurry vision? Anthony: Yeah, well, that’s probably because his eyes are watering. Holmes: I see. Please continue. Anthony: OK. Well, he didn’t really have a fever or sore throat, exactly. He denied cough, shortness of breath, GI or neurological symptoms, and he didn’t have any rashes. Yvonne: I guess that rules out shingles… Maria: I don’t know. Can’t the pain precede the rash? Holmes: Yes, although usually by only a day or two. But zoster is certainly a good thought, Yvonne. What else do you have for us, Anthony? Anthony: Like I said, he had a history of alcohol abuse and hypertension. He said he hadn’t been drinking in “awhile,” Journal for Minority Medical Students 59


A SECOND OPINION Anthony: His pupils were slightly unequal, but he thought that had been noticed before. Holmes: Really! Can you remember which one was larger? Anthony: Uhm, the right one, I think. Holmes: So, the pain was on the side of the smaller pupil? Anthony: Uh, yeah, I think so. Holmes: Can anyone tell me what condition might cause left facial pain with visual blurring and a dilated left pupil? but he also wasn’t taking his blood pressure medicine too often. He’s divorced, has two grown children, and smokes two packs a day. Maria: It sounds like this man doesn’t take very good care of himself. I’d think a dental infection would be pretty high on the list. Holmes: Indeed. And did your exam provide any particular clues, Anthony? Anthony: Nah, not really. Holmes: Well, could we trouble you to present it to us, just for practice? Anthony: Oh, yeah, sure. Yvonne: NOW?!? Anthony: Whoa, girl! Lighten up, will ya? On exam he appeared mildly uncomfortable and kept rubbing his jaw. His blood pressure was pretty high—180 over 100, pulse 80, respirations and temperature normal. Maria: That is a high blood pressure. I wonder if that could have anything to do with what’s going on? Holmes: Interesting thought, Maria. We should keep this in mind. What else did you find, Anthony?

60 Journal for Minority Medical Students

Maria: That would be acute glaucoma, right? Holmes: Yes, that’s correct, Maria. Opthalmologically speaking, a constricted pupil in a painful eye could indicate an inflammation of the iris, or “iritis,” but keep in mind that the autonomic nervous system also controls pupillary responses. What else did you find, Anthony? Anthony: He had some tenderness to percussion of the left cheek but he doesn’t have any teeth, so that pretty much rules out a dental infection, Maria. Yvonne: In the same way you’re protected from brain tumors, right, Ace? Anthony: I am? Great! Let’s see, what else? Maria: Ears, nose, and throat, maybe? Anthony: Right. His ears, nose, and throat were fine. Maria: And his neck? Anthony: Supple, mildly tender along the left sternocleidomastoid muscle, no adenopathy or masses, carotids two plus, no bruits.

Holmes: Good. And below his neck? Anthony: Lungs clear, heart sounds regular, belly benign. Neuro exam was also fine. Maria: Except for the unequal pupils. Anthony: Right. Holmes: Very intriguing, and certainly concerning, when we put everything together. Anthony: It is? Holmes: Yes. Allow me to frame it in a way that points out a worst-case scenario. We have a middle-aged gentleman with uncontrolled hypertension who presents with facial and neck pain. There is no source for a dental infection and it is not typical for sinusitis. The key finding, I believe, and one that would be easy to overlook, is his constricted pupil. I suspect if we examine his eye more closely, we may find further evidence to support or refute my concerns. Shall we allow our readers to ponder the possibilities, while we reexamine the patient?


A SECOND OPINION: THE ANSWER A Second Opinion: The Answer Yvonne: So do you admit it might be more than a sinus infection? Anthony: Well, it’s still in the differential… Holmes: Yes, it certainly is, but let’s review the physical clues. Anthony rightly spotted his patient’s unequal pupils... Yvonne: Hey! That’s just like us... unequal pupils! Anthony: Huh? Yvonne: There’s you, and then there’s…the rest of us! Unequal pupils! Get it? Anthony: Ha ha… Maria: But we missed the rest of the syndrome, didn’t we? Holmes: I think so. As you will all recall from your basic neurology courses, the classic triad of a Horner’s Syndrome is ptosis (drooping of an eyelid), miosis (constriction of the pupil) and anhydrosis (lack of sweating in the involved area. Horner’s Syndrome can be produced by a lesion anywhere along the sympathetic pathway that supplies the head and neck. There are three major pathways in the sympathetic nervous system that can produce a Horner’s Syndrome. The first descends from the hypothalamus to the cervical spinal cord. The second descends from the sympathetic trunk, through the brachial plexus and over the lung apex, before heading back up to the superior cervical ganglion, which is near the angle of the mandible and the bifurcation of the common carotid. This is how a lesion at the apex of a lung can cause a Horner’s Syndrome. The final pathway ascends within the adventitia of the internal carotid artery and eventually affects the fifth and sixth cranial nerves and muscles that dilate the iris as well as

retract the upper and lower eyelids.

Anthony: Some sort of occlusion.

Maria: Does the ptosis affect both of the eyelids?

Holmes: Indeed!

Holmes: Yes, Maria, it often does. Sometimes this weakness of both upper and lower eyelid muscles is known as an “upside down ptosis” and, as you saw with Anthony’s patient, it can be subtle. Yvonne: How about the anhydrosis, Doctor Holmes? Lack of sweating can be hard to appreciate, can’t it? Except in Anthony’s case, where it’s associated with a total lack of physical, or mental, activity. Maria: You go, Girl! Holmes: Indeed, Yvonne. Anhydrosis is frequently not appreciated by either clinician or patient. In children one may notice a lack of facial flushing instead of a lack of perspiration, which is sometimes known as a “Harlequin” sign. This of course is a reference to the classic Italian Commedia dell’arte character Harlequin, with the brightly colored diamond pattern costume. Yvonne: Of course… Maria: Wow, this is all pretty complicated, Doctor Holmes. How do we know what’s actually going on in Anthony’s patient? Holmes: You’re right, Maria. It is complicated. About 40 percent of the time the cause for a Horner’s Syndrome can’t be clearly determined. Local trauma to the sympathetic chain and tumors account for a significant number, but when a patient presents with acute neck or facial pain and a Horner’s Syndrome, there is one specific and potentially devastating cause we need to consider. Any thoughts?

Anthony: Like a thrombus… Holmes: Due to...? Anthony: Uhm… Maria: Spontaneous carotid dissection! Holmes: That’s it! Between 40 and 60 percent of patients with internal carotid artery dissections present with an isolated, painful Horner’s Syndrome. A number of these are related to trauma, which may be relatively minor, and a number may be spontaneous. In either case, these patients are at very high risk for cerebral infarction, which often occurs within days to weeks of the onset of symptoms. Anthony: So what do we do? MRI? Holmes: Precisely. I would recommend an emergent axial MRI of the neck with T1-weighted, fat-suppressed sequences, and magnetic resonance angiography. Anthony: Yeah! That’s just what I was going to say. Yvonne: Uh huh. Good thing we’re not doing the study on you. Anthony: Yeah, that’s for sure. (Pause) Why? Yvonne: Because we need “fat suppressed sequences.” If we did that on you, the screen would go blank. Anthony: What the...? Holmes: Let’s move along, children. There’s no time to waste!

Yvonne: Well, you said some of the fibers run along the carotid artery… Holmes: Exactly, and what types of catastrophic carotid events can happen? Journal for Minority Medical Students 61


ERAS Network

RESIDENCY TRAININg AND OPPORTuNITIES

PEDIATRICS

CINCINNATI CHILDREN’S HOSPITAL MEDICAL CENTER Cincinnati, OH

Cincinnati Children’s is a national leader in pediatrics. As a major academic pediatric medical center, we attract patients from all over the world, conduct pioneering medical research and offer outstanding teaching programs. We work closely with community-based caregivers. Our vision is to be the leader in improving child health and in preparing tomorrow’s pediatricians. We’re proud to be ranked third in National Institutes of Health funding to children’s hospital and pediatric departments nationwide. In addition, US News & World Report consistently ranks the Department of Pediatrics as one of the top four pediatric departments in the country. Running the Numbers Number of beds 413 Annual admissions, including short stays 20,574 Radiologic procedures 151,595 Outpatient visits (includes satellites) 583,785 Emergency department visits 84,486 Surgical procedures (inpatient and outpatient) 23,759 Critical care admissions (cardiac, ICU, NICU) 2,142 Interactive Team Care Each ward team is made up of four PL-1s, with primary responsibility for patients on their ward and a PL-2 or PL-3 supervisor. Each team also includes a faculty member who makes rounds and plays an integral role in teaching. These teams cover wards that admit primary pediatric and subspecialty patients of all ages. Please contact us or visit our website: Pediatric Residency Training Program Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue, ML 5018 Cincinnati, Ohio 45229 513-636-4315 • www.cincinnatichildrens.org INTERNAL MEDICINE

BRIgHAM & WOMEN’S HOSPITAL Boston, MA

The Internal Medicine program at Brigham & Women’s Hospital is a national leader in clinical training and research. As a major academic medical center, we are at the forefront of medical research and innovative curricular development. We draw patients from a large international referral base as well as our large local diverse population, and we are the second largest provider of free medical care in the state of Massachusetts. Our vision is to promote healthcare and health equality throughout the region, and we are dedicated to recruiting, training and retaining a housestaff and faculty that reflect the diversity of our patient population. We will be accepting applicants to our categorical medicine, primary care medicine, combined medicine/pediatrics and preliminary medicine programs. Key Hospital Information: Number of beds: 777 Inpatient Admissions: Over 45,600/annually Ambulatory Visits: 773,000/annually Emergency Department Visits: Approximately 58,000/annually Contact: Nora Y. Osman, MD Assistant Program Director Office of Minority Affairs bwhresinfo@partners.org 617/732-5775 www.brighamandwomens.org/residency

PHYSICAL MEDICINE AND REHABILITATION

REHABILITATION INSTITUTE OF CHICAGO/NORTHWESTERN UNIVERSITY MEDICAL SCHOOL Chicago, IL

Providing medical care to this nation’s estimated 40 million physically disabled citizens is a responsibility that often falls to the physiatrist—the physician specializing in the field of physical medicine and rehabilitation. Patients commonly seen by physia trists include children and adults who have disabilities such as hemiplegia; paraplegia; quadriplegia; amputations; arthritis; frac tures; pulmonary, vascular or neuromuscular diseases; and other less disabling conditions. The Department of Physical Medicine and Rehabilitation at Northwestern University Medical School offers a program of interdisciplinary studies centered at the Rehabilitation Institute of Chicago (RIC), with associations at Veterans Administration Westside Medical Center, Northwestern Memorial, Children’s Memorial, Evanston Hospital, Illinois Masonic Medical Center and Alexian Brothers Hospitals. With more than three decades of experience in the field, RIC is dedicated to excellence in research, education and providing com prehensive care programs to the physically disabled. A 176-bed private, nonprofit freestanding facility, RIC was named top reha bilitation hospital in the country by US News & World Report for fourteen years in a row. Information: Office of GME Northwestern University Medical School 645 N. Michigan Avenue Suite 1058-A Chicago, IL 60611 312-503-7975 kku935@northwestern.edu Contact: James Sliwa, DO Residency Program Director Rehabilitation Institute of Chicago 345 E. Superior St. Chicago, IL 60611 www.northwestern.edu/pmr rbailey@ric.org Applications: Electronic Residency Application System (ERAS) erashelp@aamc.org www.aamc.org/eras 202-828-0413 202-828-1125

Journal for Minority Medical Students 53


FAMILY MEDICINE

SCHOLARSHIP OPPORTUNITY

SPARTANBURG REGIONAL HEALTH CARE SYSTEM

PREVENTIVE MEDICINE/ PUBLIC HEALTH CLERKSHIP

Spartanburg, SC

Spartanburg Family Medicine Residency Program is situated in the foothills of upstate South Carolina, near lakes and mountains, and 3-1/2 hours from the ocean. Spartanburg is a college town with a diverse industry, a four-season climate, and new modern facilities. We have core experiences in IM, Peds, OB, Surgery and multiple others that rival any in the country. Advance OB, endoscopy and other procedural training is strong. An OB fellowship and rural site is available. Our dynamic Family Medicine Residency Program is looking for graduating students to join our “family” in June, 2011. If you are looking for a community-based program with university strengths, where the educational opportunities are matched by a quality and beautiful place to live, then Spartanburg may be the place for you.

Griffin Hospital, Derby, CT

Griffin Hospital’s Department of Preventive Medicine is offering a $500 Scholarship in Preventive Medicine & Public Health to 3rd or 4th year medical students. Selected students will participate in a four week introduction to publilc health and preventive medicine. Activities planned based on student’s interest including clinical preventive medicine, occupational medicine, hospital quality improvement, behavioral health, health and human rights, and design and conduct of clinical research. $500 towards room and board will be provided. For more information and the application process, please contact Margie Bliga at mbliga@griffinheralth.org or www.griffin health.org. Minority students are strongly urged to apply.

Contact: Otis L. Baughman, III, MD Professor of Family Medicine Director, Spartanburg Family Medicine Residency Program 853 N. Church Street, Suite 510 Spartanburg, South Carolina 29303 (864) 560-1558 Fax: (864) 560-1510 E-mail: obaughma@srhs.com www.spartfam.org

Join our new online community for exclusive online content, directory of residency programs, information on upcoming events, and much more!

www.spectrumpublishers.com


A dvertiser ’ s I nde x

American Academy of Family Physicians . . . . . . . . . . . . . . . . . 4 American Academy of Orthopaedic Surgeons . . . . . . . . . . . . . 5

T

he UCLA Intercampus postdoctoral research and clinical training programs in Medical Genetics utilize the resources of its affiliated campuses and teaching hospitals to train academically oriented applicants with M. D., Ph.D., D.D.S. or equivalent degrees in a wide variety of clinical and/ or research opportunities in molecular, biochemical, immuno-, cancer, cyto-, somatic cell, and population genetics. Five-year combined Pediatric/ Medical Genetics residencies are also available at each of the affiliated hospitals and applications are accepted through ERAS. These programs meet all the requirements of the American Board of Medical Genetics and Accreditation Council for Graduate Medical Education (RRC).

Application forms are available from: Patricia Kearney Coord. Academic Affairs Medical Genetics Institute Cedars-Sinai Med Ctr 8700 Beverly Blvd West Tower 665 Los Angeles, CA 90048 www.uclamedgeneticspostdoc.org

American Academy of Pediatrics . . . . . . . . . . . . . . . . . . . . . . 8 Cedars-Sinai Medical Center . . . . . . . . . . . . . . . . . . . . . . . . 64 Harvard Medical School . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Johns Hopkins Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Kaiser Permanente . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CV2 Michigan State University Kalamazoo . . . . . . . . . . . . . . . . . . . 8 Mount Sinai School of Medicine . . . . . . . . . . . . . . . . . . . . . . . 7 North Shore Long Island Jewish Health System . . . . . . . . . . . . . 2 U.S. Navy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CV4 UAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 University of Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Vanderbilt University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Wake Forest University School of Medicine . . . . . . . . . . . . . . CV3 R E S I D E N C Y I nde x

Pediatrics Cincinnati Children’s Hospital Medical Center . . . . . . . . . 62 PHYSICAL MEDICINE & REHABILITATION Rehabilitation Institute of Chicago . . . . . . . . . . . . . . . . . . 62 internal medicine Brigham & Women’s Hospital . . . . . . . . . . . . . . . . . . . . 62 Family medicine Spartanburg Regional Health Care System . . . . . . . . . . . .63 SCHOLARSHIP OPPORTUNITY Preventive Medicine/Public Health Clerkship, Griffin Hospital . . 63

The Journal for Minority Medical Students is published quarterly by Spectrum Unlimited. Subscription rates: $20 per year. Back issues: $5. Copyright 2011 Spectrum Unlimited. No part of this publication may be reproduced without the consent of the publisher. The opinions expressed in this publication are those of the authors and do not necessarily reflect the view of the magazine managers or owners. The appearance of advertisements in the publication does not constitute endorsement of the product or company. SPECTRUM UNLIMITED • 1194-A Buckhead Crossing • Woodstock, GA 30189 • (770) 852-2671 • fax: (770) 924-4327 • JMMSmag@aol.com • www.minoritymedicalstudents.com


A Mission to Care. A Mission to Cure.

As an academic medical center, Wake Forest University Baptist Medical Center brings together the best of patient care, research and education. With internationally recognized faculty who are pushing the frontiers of medicine and a focus on expert training, Wake Forest Baptist offers the benefit of the latest medical knowledge and subspecialty care. Wake Forest University School of Medicine provides an opportunity for a unique medical education. We offer: • MD Degree • Two five-year, joint-degree programs— MD/MBA and MD/MS, and flexibility to pursue other degrees • Seven-year, joint-degree program—MD/PhD • Physician Assistant studies—master’s degree • 57 accredited residency training programs • The Graduate School of Arts and Sciences offering master’s level and PhD degrees • Post–Baccalaureate Premedical Program— a one-year certificate program • Scholarship Clerkship Program for visiting senior medical students • Maya Angelou Center for Health Equity For more information about Wake Forest University School of Medicine, visit our website at www.wfubmc.edu/school.


Journal for Minority Medical Students  

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