First Day of My Third Year

Today was my first day of the third year.  To be fair it wasn’t a true first day, so much as an orientation day.  This post is going to be a couple random thoughts about the day.

First off, I hate orientation days.  Being the kind of person who likes to jump right in and get my hands dirty – a learn as I go kind of guy – orientation days seem to drag on and are extremely boring from my perspective.  The “need to know” things in an orientation day can usually be summed up in maybe an hour.  They could just tack this to the beginning of the first day and call it good.

Another thing I hate about orientation days are the ice breaker and get-to-know-you games.  Today we had at least four different speakers have us go around the room, introduce ourselves, tell them where we were from, and a little about ourselves.  Doing it once is more than enough.  By the fourth time you feel like strangling a puppy.

Next random thought, I have my own business cards.  The program gives them to us to distribute.  How cool does that make me?  Admittedly, probably not very cool.  But I feel a ton cooler.  Also, I have a pager now.  I guess I’m important enough to page and give out business cards.  Whoa.  Moving on up the ladder.

Yankton, SD has over 65 practicing physicians.  Yankton county only has a population of 21,000.  I was unable to find out the size of the catchment area of the hospital.  But that seems like an impressive number of physicians for a community this size.  Also, while talking to the physician recruiter, she said that they are currently looking for family practice doctors, internal medicine physicians, endocrinologists, urologists, general surgeons, and 3 invasive cardiologists.  I asked if the Yankton community even had the resources to support three interventional cardiologists, and she stated that they had all the infrastructure in place, they could hire and support all three tomorrow.  I was shocked.  Not only does Yankton have 65 practicing physicians, but also it could support many more.  Crazy.

Talking about physicians, a neurologist has just started practicing with the large multispecialty group in the last two months.  I was excited to hear this, with my interest in the neurosciences.  Also, the hospital plans on upgrading their MRI to a 3 Tesla with fMRI capability, in conjunction with research funding.  So, fMRI research will be taking place right where I’m studying.  That is exciting.

We will be getting a TON of hands on experience.  Just recently a student interested in surgery who has been going his third year in Yankton, was allowed to do the left side of a hysterectomy under close supervision of an attending surgeon.  In what other medical school could a person get that kind of hands on experience as a medical student?  No where.

We will be required to do 42 history and physicals with a problem list – over dictation (with our own dedicated transcriptionist) over the course of the 3rd year.  We will be required to assit with twenty vaginal deliveries, assist with five c-sections, do twenty new born exams, and twenty-five well child exams.  There are medical students in the United States who finish their third year having never assisted in a vaginal delivery.  And here at SSOM, 20 deliveries is just the bare minimum requirement, some students log way more.  I wonder how many babies the Ivy league medical students deliver?

While orientation day was boring, the information I received over the course of the day made me super excited to get this year started.  It has a LOT of potential.

Sanford School of Medicine – Match Statistics

One thing that I learned sometime during my Pre-Med days was to look at match statistics of schools to determine how well they do at training their students.  I thought that was good advice.  Obviously, how well a school does training their students should correlate to a better match rate.  I mean it’s exactly like looking at how well certain colleges place their students into careers.

So, I took that to heart.  Now, I’ll be the first to admit, I wasn’t exactly afforded a large choice between medical schools.  What I mean to say is, I didn’t get into a ton of medical schools.  But hey, that doesn’t matter now does it?

So, before I even started medical school, I took an interest in the matching statistics of the schools I was applying to.  And after I was accepted at the Sanford School of Medicine (SSOM), I really concentrated on their matching stats, and to be honest we do pretty well.

I have compiled the matching statistics from SSOM since the year 2000 in a spread sheet, and I have found some interesting trends.

Match Stats

Since the year 2000 (including the 2010 match) – we have graduated and matched 545 students from SSOM with 93 going into Family practice which is 17.1% .   Compared to the US match rate of 7.4% matching into Family Practice (and only a 3% behind the leader), I would say that SSOM is doing pretty well meeting it’s mission.  And out of all the students who graduated since 2000 almost 45% of them have entered a primary care specialty (which would include Family Practice, Internal Medicine, Pediatrics, and Psychiatry).

Our medical school has also done a great job matching students into very competitive specialties as well. Dermatology has long been known as one of the most difficult specialties to match into.  Yet, three students from a class of 50, matched in both the 2007 and 2008 match.  Or to put it another way, 6% of our class those two consecutive years matched into a specialty in with only 1.8% of medical students are able to match (according to the 2009 match statistics).

While most of our students match in the midwest, some have matched into some of the most well known universities in the country including Baylor, Cleveland Clinic, Dartmouth, Emory, Massachusetts General, Mayo, UCSF, Rochester, Vanderbilt, Yale, and others.

So, if you’re a Pre-Med student, don’t worry if you don’t get into the Ivy league schools.  State schools, even little South Dakota, can help their students match into competitive specialties in well known programs.

Top Ten SSOM Specialty Choices

  1. Family Practice
  2. Internal Medicine
  3. OB/GYN
  4. Anesthesia
  5. Pediatrics
  6. Psychiatry
  7. Emergency Medicine
  8. Radiology (Diagnostic)
  9. Pathology
  10. Orthopedic Surgery

Top Ten SSOM Match Locations

  1. South Dakota
  2. Minnesota
  3. Iowa
  4. Nebraska
  5. Wisconsin
  6. Kansas
  7. Michigan
  8. Missouri
  9. Texas
  10. Illinois 

Sanford School Of Medicine – Early Clinical Exposure

One reason I chose to come to the Sanford School of Medicine here in South Dakota, is because of the early exposure to real clinical medicine.  Sanford SOM is known (by those in the area) for it’s amazing clinical experience especially in the MS3 and MS4 years.  The medical students at this school work almost exclusively one-on-one with attending physicians.  Usually there is no senior student, intern, junior resident, senior resident, chief resident, or fellow blocking the third year medical student’s view of the action.

But little is known about the early clinical exposure in the MS2 year.  Here at the Sanford SOM, the second year classroom schedule ends at the end of March.  A transition to the clinical world takes place over the end of March and early April, and then the real fun begins.  Each MS2 gets paired with a rural family practice physician somewhere in the state of South Dakota, and we spend an entire month with them.

Almost all of us were exposed to serious trauma, OB/GYN, geriatrics, pediatrics, general medicine, emergency medicine, and some even were scrubbing into surgeries.  I personally was rounding on hospital patients, putting in stitches, doing history and physicals, seeing clinic patients, seeing nursing home patients, and assisting with surgery.

To give you an idea of how much exposure we had, I personally logged in over 200 patient encounters.  Some of these include:

  • Ear aches
  • Multiple Myloma (Cancer)
  • Well Child Visits
  • Physicals
  • Abdominal pain
  • Pneumonia
  • Allergies
  • Head trauma
  • Broken ankle/foot
  • Knee injury
  • Elderly falls
  • Vertigo and Dizziness
  • Constipation
  • Hypothyroid
  • Stroke
  • Heart Attack
  • Congestive Heart Failure
  • Flu
  • Breast Lump
  • Headaches
  • Low Back Pain
  • Smoking cessation
  • Pregnancy
  • Diabetes
  • Warts
  • Depression
  • Bipolar Disorder
  • Hypertension
  • Syncope
  • Hemorrhoids
  • Strep Throat
  • Hernia
  • Seizures
  • Cough
  • Acid Reflux
  • ADHD

I was also lucky enough to get to do some cool procedures too!

  • Interpret X-Rays, CT scans, and MRIs
  • Assist with ultrasound of the bladder, cartoid arteries, and pregnancy
  • Put in stitches
  • And scrub in and first assist on 8 surgeries including open appendectomies, laproscopic cholecystectomies, C-sections, and a hysterectomy.  
So, here’s a taste of the clinical exposure we get at this medical school.  If you’re interested to read more about what I have to say about the Sanford SOM, read my medical school review Part 1 and Part 2.  It was an awesome first clinical experience, and I cannot wait to get started with the 3rd year!

CT Surgeon Shadow

Over the break, I had a chance to shadow a cardiothoracic surgeon for a day.  This surgeon was one of the partners at North Central Heart, also known as the Avera Heart Hospital of South Dakota.  

The experience was pretty cool.  The cardiothoracic surgeons and handful of interventional cardiologists that I had a chance to meet were receptive to students, and I learned a lot about cardiac pathologies.  

The visit was also disheartening for those interested in CT surgery.  Out of the group of surgeons, only one (out of four) would recommend this specialty to their son/daughter.  While all of them were attracted to the field based on their interests in cardiac diseases, acute patients, and surgical treatments, they weren’t sure if that was enough reason to pursue the field in today’s environment.  

Of course declining reimbursements was one of their main reasons.  But also, the lack of jobs.  Most of them believed that the thoracic surgeon colleges were training too many CT surgeons.  If they keep it up, the job problem will only worsen.  “How would you feel if you put in 10 years of post medical school training only to find out that you can’t get a job?”  

It was eye opening.  The surgeon that I was shadowing told me that he talked his own son out of becoming a CT surgeon.  Told him to be a neurosurgeon, ENT, urologist, or orthopod.  This field is extremely interesting to me since they deal with very sick patients, interesting pathologies, and surgical treatments.  But it’s scary that even the current cardio-surgeons here in South Dakota think their specialty is losing the “turf battle” to cardiologists, vascular surgeons, and interventional radiologists.  

Sanford School of Medicine – Social Networking

Currently, the Sanford School of Medicine is in the process of getting a task force together to write a code of conduct regarding the use of internet social networking and other technologies.  

I wonder if this is in response to that JAMA article that recently came out.  If so, I wonder how many other medical schools are getting committees together to address social networking issues.  How many medical schools already have code of conducts for social networking?  – If you are in a medical school with some kind of official professionalism document which refers to social networking could you email it to me?  

I think this is a good step for the medical school, and will really help clarify things for the future.  We don’t need to have the same problem the University of Louisville had with Nana Yoder.  

Avera Clinical First Steps

The Avera healthcare system offers a nice 6-week summer course to the Sanford School of Medicine medical students between their first and second year called the “Clinical First Steps.” The program setup for two primary purposes.

The first is to give the early medical student a glimpse into what clinical medicine is really all about. To do this, the program tries to educate the medical students about what the supporting staff do in the hospital setting. The creators of this program had some stories as based on physicians who sometimes wondered, ‘why didn’t I learn that in medical school?’ They have also heard their fair share of, ‘how come that doctor didn’t learn that in medical school?’ types of comments. So six years ago they decided to create this program to give us the type of experience that generally isn’t taught to medical students.

Today during our orientation, the leaders of this program really wanted us to take home this first goal of the program. The example was one of a young 3rd year student. The ER physicians during this trainee’s time let the student ‘lead’ on a some-what critical case. The student started barking orders and requesting tests (an ABG to be exact). Getting carried away in the moment, the student demanded to see the results of the ABG ordered only 5 minutes prior. (NOTE: I have no idea how long it takes to get results from an ABG, this is just the story we were told.) Moral of the story was that medical students need to learn how long tests take to order, how long rooms take to clean, what a social worker, PT, OT, case manager, administrator, et cetera does all day. Knowing these things will makes us more effective and understanding physicians, and is the first goal of the Clinical First Steps program.

The second goal of the program has a little different spin. According to the opinion of one of our leaders, there are some doctors out there that were not meant to be doctors. Of course these doctors were smart and dedicated individuals, but they just don’t have the compassion (or whatever) to be good physicians and just work pay-check to pay-check not ever really caring about the patients. Luckily these people are a small minority. Our leader continues on to say he feels that unfortunately a larger portion of doctors end up in specialties where they are not truly happy. He feels that many physicians do not work in a specialty where they are truly engaged in what the specialty offers and the types of patients that doctor encounters. These doctors careers quickly become just jobs. When this happens these doctors also start to live from pay-check to pay-check looking forward to the day that they retire. This man’s opinion scares me, as I (and I’m sure my colleagues as well) want to work in a specialty where we are happy and fully engaged in it throughout our careers.

Finding this calling, is the second goal of the Clinical First Steps program. Throughout the next six weeks program leaders hope to expose us to as many different specialties as possible to help us get a feel for what we may someday want to do.

I am excited to go through this program and I have high hopes that it will help me narrow down my calling. I also can’t wait to start interacting with patients again, I really miss the hospital environment and it really brought back good memories being on the floors again.