Reflections on Third Year

The past year has been one of unexpected and broad personal discovery, involving aspects of heartbreaking disappointment and sheer, unsurpassable joy.

Since July of last year, when I started third year, I’ve met amazing people, learned incredible things (including learning how much I don’t know) and been afforded unique opportunities.

I can confidently say that the third year of medical school was one of the most life-changing years of my life. Not only did I (finally) figure out what I want to be when I grow up, but I experienced breathtaking highs, gut-wrenching lows, unexpected humor, and a back door glimpse into a mysterious side of life…and death…that many never see.

Overall, I feel like this year, both personally and professionally, I’ve truly experienced an overwhelming breadth of humanity…and honestly, I never saw it coming.

I just wanted to thank y’all for making this journey with me. I have received so much advice, support, encouragement, and love from Mind On Med readers and through Twitter. I am continually thankful that I choose to share my experiences here – not only to give others a glimpse into this life, but so I can look back someday and remember how pivotal these years were in helping me become the physician I will eventually be.

I’m expecting that the next year will be an adventure in itself – two new babies (!!) who will hopefully keep cooking until December (oh, did you miss that – yah we aren’t getting another dog – no my friend, we met our four-legged & furry quota long ago), residency applications and interviews, Match Day in March, and all kinds of fourth year fun (hopefully involving significantly more DIY projects than third year). Thanks for sticking with me through the craziness!

Ok, I do believe that is enough mushiness for one year.

Here’s a few of the most viewed posts on Mind On Med from the past year:

Image: FreeDigitalPhotos.net | Ambro

Medical School in Denmark

Today we have a wonderful guest blogger, Andy Skovsen, with us to talk about medical education in Denmark! Andy lives in Copenhagen, but seems to have been a bit of a nomad having lived in the US a while and just returned from working in South Africa! He has also spent some time in the Danish Military and still works part-time with them. I must say, I’m a little jealous of all the great culture and scenery he seems to have experienced. Andy graduated from medical school in 2008 and has been pursuing a career in Surgery, with a particular interest in trauma and emergency medicine. He has a great blog called Doctor’s Without Filter, which is co-authored by himself and two others in Danish (Go-Go Google Translate). Andy got married last summer (Congrats!!) to a doctor who is currently pursuing a career in Cardiology and in his free time (which sounds like it might be severely limited!) he enjoys sports like skiing, mountain biking, diving, and surfing! I have to admit, I want to be friends with Andy – he sounds like tons of fun!

 

Getting In:

How old is one when they begin medical school?

Usually around 18-20. Some gain entrance through a separate set of university specific merits and tests, and are usually a couple of years older.

What exams does one have to take to get in?

Entrance is granted through application. You take finals from “gymnasium” (roughly equivalent to last year of high school and first two years of college in the US). Entrance is based on your GPA after this. Approximately 10% gain entrance through a separate quota system, which is defined by each of the 4 universities in Denmark offering a medical education and usually involves testing as wells as merits.

Is there any required pre-requisite coursework?

Certain levels of Maths, Danish, English, Physics and Chemistry are required to apply. These can be supplemented post-gymnasium graduation.

Is it a competitive occupation?

Very competitive. The number of applications far exceed the number of places. At the moment, it’s the most sought after university degree in the country.

What are you called at this stage of training?

Medical student.

 

Being In:

How long is it?

6 years. After 3 years, you are given a Bachelors diploma, which is pretty much useless unless you want to transfer to a different Masters degree.

How are the years broken down?

This varies from university to university, but generally broken into 12 semesters with the first 6 being pre-clinical, and the last 6 being clinical.

Describe your typical day.

Varies immensely for each semester/rotation. The common denominator seems to be end-of-semester exams, which increases workload and hours hitting the books to all waking hours and eliminating partying to zero.

If you choose a specialty, when do you have to decide by?

After graduation you do one year of internship, then you apply for positions in your specialty.

What are you called at this stage of training?

Medical Student

 

Getting Out:

What exams do you have to take?

Once you take your final exams from medical school, you’re pretty much done with exams.

Do most people graduate?

Students drop out of medical school mostly to switch to other degrees. I remember starting medical school, during the first lecture, we were told to “look to your right and look to your left, those two people will not be here when you graduate.” A rough estimate tells me that about 1/4 to 1/3 of starters do not finish.

When are you finally considered a “doctor?”

After passing the final year of medical school you get your diploma, then you sign the Hippocratic Oath and become a doctor.

Do you have additional training after MS or do you start working immediately?

One year of internship is mandatory. The internship is split into two 6-month positions, the first usually being in a hospital, and the second often (80%) being in primary care/family medicine. Each year is a lottery, where all graduates are assigned a random number correlating with the amount of graduates is a number internships. The graduate that received number 1 in the lottery gets first pick and so fourth. Positions are all across the (small) country. The system is perceived as unfair by many, but is not looking to be changed any time soon.

What’s the average debt for attendance?

None! Medical school is paid by the state. When attending university, you also get a small allowance (about $750/month) to live on, but books you must pay for. Living expenses are rather high, especially in Copenhagen, so many students work and may also take loans.

What are you called at this stage of training?

Doctor, Intern or Resident.

 

Being Out:

What’s the average salary?

Salary is fixed. Currently base salary is around $4,500/month on top of this you get a small remuneration for being on call, etc. Usually comes to around $5,000/month. On top of this comes taxes (50%+). Through your career your salary increases in increments.

Is the job security good?

It’s good. 100% of graduates are employed in internships. In the long run, some specialties are very difficult to get into and others you can walk right into after internship.

Can you switch specialties?

Yes, you can switch, but you start back from the first year after internship.

What are you called at this stage of training?

Doctor or Resident

 Image By Andy Skovsen | Available on Flickr

Very interesting! Thanks so much for sharing, Andy – I really enjoyed reading about medical education in your country and I know these posts are some of the most popular on Mind On Medicine, so I’m sure others enjoyed the information as well.

Other Medical Education Monday posts can be viewed here!

Surgery Clerkship

I finished up my Surgery Clerkship a while back and thought it was about time I gave you guys a peek into the daily life of a medical student rotating through surgery! I was a little terrified going in, but the residents all mostly turned out to be very down to earth (hard-working and busy, but down to earth) and helpful.

Surgery

A specialty that encompasses a variety of sub-specialties and involves a lot of…surgeries…who’d have guessed it? The residency for general surgery is usually five years and fellowships to specialize in other things are an additional 1 or more years after that. All in all – it’s takes a lot time to become a surgeon.

The Clerkship

  • 8 Weeks – Five weeks are split between the services covered in our hospital, including (but not limited to) trauma, vascular, general, burn (and burn ICU), SICU, etc. We also spent one week on a specialty (mine was Pediatric Surgery) and one week on Urology with the final half-week reserved for shelf-studying.
  • Occasional lectures, grand rounds, tumor boards and meetings.
  • Eight overnight calls – Basically arrive at the hospital around 5:30am as per usual and leave the next day around 8am or so.

Daily Life

  • Usually arrive around 5:30am or 6:00am and round on your patients, be ready for morning checkout by 7:00am.
  • Morning Checkout: Goes through all the patients admitted overnight and ensures all surgeries for the day are scheduled and covered by residents and attendings.
  • The rest of the day is reserved for surgeries, it’s really dependent on what service you’re on.
  • Typically home between 5pm and 8pm, depending on the service & how busy they are.
  • Occasionally you’ll go to clinic in the afternoon instead of scrubbing into surgeries.

Surgery Clerkship Books

    

  • Pestana Notes for Surgery – Easily the best and most used resource for this shelf exam, you can read about it here. Our school provided copies of it, so I’m not sure where to buy them.
  • NMS Surgery Casebook– Highly rated and easy to read, tons of relevant cases.
  • NMS Surgery Textbook – I didn’t use this, but heard positive things about it from people who wanted more text than just cases.
  • Surgical Recall – MUST HAVE for pocket book on this rotation! This book is so useful, even for other rotations. I guarantee it will have 85% of the pimp questions you receive on this rotation right there inside it. I used it to review relevant chapters before surgeries.
  • Overall  – This shelf exam is very Internal Medicine heavy, don’t just study surgery books! I made the mistake of sticking solely to Surgical books and while I still did okay, I think reviewing some internal medicine would’ve served me well.

What I Like

  • Working With My Hands: This field is centered greatly around the use of tactile skills. I liked that we were always doing something and getting immediate feedback on whether our interventions were successful or not.
  • Trauma Call: I did not expect to love trauma call, but it was so fun! There’s something exciting about being able to immediately solve an awful problem with your own two hands (and by “own two hands” I mean…other people’s hands…because let’s be honest, my hands don’t solve anything other than AgenesisOfTheCoffeeCup at this point).
  • Pediatric Surgery: This field was so fascinating to me. I saw an extremely skilled surgeon operate on a teeny, tiny 2 month old baby (who was born around 24 weeks). It was amazing. The whole week I was on Pedi Surg I was in love – it was great. However, in the end I knew it was not for me…mostly because I have no interest in doing 5 years of general surgery to maybe or maybe not get into one of the most competitive fellowships out there.

What I Dislike

  • Constantly Standing In One Place: Some surgeries are LONG – particularly some of the trauma surgeries and vascular surgeries – and standing in one place for 10 hour surgeries on a regular basis makes me wanna vomit. A couple days per week operating sounds great to me, but some of these surgeons are operating 5, 6, 7 days a week for 10 or 12 hrs a day. I just don’t have the stamina for that.
  • Variety: I can’t decide if there was too much variety or too little. All we did was operate – there was nothing else! There was tons of variety in that they possess the skills to do a huge number of different surgeries, but all they do is surgery!
  • No Pregnant Women: Unless it’s a dire emergency, general surgeons do not operate on pregnant women. I missed that patient population terribly.
  • Lack of Relationships: Except in very rare circumstances, these doctors are (rightly) not focused on getting to know their patients or developing long-term relationships with them. I missed getting to know my patients and having some continuity of care.
  • Often A Sad Specialty: A lot of surgeries end up with less than optimal outcomes, especially in trauma surgery. Most of the patients are very sick and many of them don’t make it. I missed having the occasional healthy or happy patient.

Overall, I enjoyed the rotation, but it was extremely exhausting and very emotionally taxing. The hours were long (often students were exceeding the intern hour restrictions) and the work was very different than what I want in my day-to-day life. While I enjoy utilizing my tactile skills (or, developing them, rather), I don’t want surgery to be the sole focus of my career. I really enjoy being a part of a patient’s care long-term and getting to know them a bit better and I’d miss that if I were to decide to go into this specialty.

Information on Other Clerkships!

 

 

Image: FreeDigitalPhotos.net | jannoon028