Cosby High School Pre-Med

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Pre-med career presentation

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  • --Happier when taking non-science classes --NIH research and Honors project --Late pre-med contact prevented more guidance and assistance and limited my medical and volunteer experiences.
  • --Happier when taking non-science classes --NIH research and Honors project --Late pre-med contact prevented more guidance and assistance and limited my medical and volunteer experiences.

Transcript

  • 1. What was I thinking? A medical career in-progress Cosby High School March 22, 2011
  • 2. Why am I here?
    • I am here to discuss what life as a doctor is like based on my perspective. I am going to talk about my thoughts and my experiences and I hope to provide some insight along the way.
    • PLEASE ask questions.
  • 3. What is a doctor?
    • What does a doctor actually do?
    • What skills and qualities should a doctor have?
    • What kinds of doctors are there?
  • 4. What is a doctor?
    • What does a doctor actually do?
  • 5. What is a doctor?
    • What does a doctor actually do?
      • Care for patients.
      • Teach.
      • Research.
  • 6. What is a doctor?
    • What skills and qualities should a doctor have?
  • 7. What is a doctor?
    • What skills and qualities should a doctor have?
      • Intelligence
      • Patience
      • Thoughtfulness
      • People skills
      • Empathy
  • 8. What is a doctor?
    • What kinds of doctors are there?
  • 9. What is a doctor?
    • What kinds of doctors are there?
      • Surgeon vs. medical
      • Specialist vs. primary care
      • Adult vs. children vs. women ’s health
  • 10. A typical month of health care in the United States
  • 11. How did I decide to apply to medical school?
    • High school:
      • Did not really have a strong desire to enter medical school.
      • A lot of people advised me that “You should be a doctor” but I really didn’t think too much about it.
      • I took AP Biology as a senior and realized that I really understood and enjoyed it.
      • Received a summer research internship at the National Institutes of Health. The exposure that I had in this program gave me a better understanding about medicine.
  • 12. How did I decide to apply to medical school?
    • Undergrad: medical vs. grad school
      • Actually, I needed to decide between a science and non-science major.
      • Declared a Biology major, with a lot of lab classes, but I enjoyed classes more when I was taking more non-science electives
      • Lots of basic research experience--mostly at the NIH, but also undergraduate research.
      • Limited medical and volunteer experience
  • 13. How did I decide to apply to medical school?
    • As my junior year began in college, I decided that I wanted to pursue a medical career.
    • Late contact with my pre-med advisor limited my options somewhat, but I had ensured that was completing required classes.
    • Took a practice MCAT and did well enough to keep going.
  • 14. What is the best pre-medical path?
    • Early contact with pre-medical advisors
    • Academics: Biology, Chemistry, Physics and English requirements
      • High-level Bio and Chem classes are helpful
      • Challenging and wide-ranging coursework
      • You can major in anything you like (including arts and humanities)
  • 15. What is the best pre-medical path?
    • AMCAS Application
      • Tests: MCAT (biological sciences, physical sciences, verbal and written sections)
      • Recommendations: good letters from people who know you well
      • Activities: medical and community service, leadership roles are important
      • Essays: be creative (but not too much) and address issues not well addressed elsewhere
  • 16. How long does it take?
    • I submitted my application in August, but did not get any scheduled interviews until January
    • I did get rejection letters pretty quickly
    • First acceptance in April (EVMS)
    • Accepted off the wait list to VCU SOM in May--the week of graduation
    • Accepted off the UVA wait list in late June but declined
  • 17. Mistakes I made
    • Should have had earlier contact with my pre-med advisor.
    • More medical and volunteer experience would have helped.
    • I really did not have a back-up plan had I not been accepted into medical school; I was fortunate that things worked out.
  • 18. Career path decisions?
    • MD vs. PhD vs. clinical research
      • Actually, applied to most medical schools in MD/PhD programs, but was not accepted to any
      • As time passed, clinical focus was more appealing and research less so
      • I decided in my 2nd year of medical school to pursue a clinical career
      • Since returning to Richmond in 2007, clinical research is more interesting and more available.
  • 19. What is medical school like?
    • VCU SOM curriculum (for now--probably changing in the next couple of years):
      • M1: basic sciences--anatomy, biochemistry, physiology, immunology, etc
      • M2: some basic science with clinical relevance--microbiology, pharmacology--followed by systems-based teaching on illnesses, treatment, etc.
      • Foundations of Clinical Medicine--longitudinal program in M1 and M2 to teach history, physical exam and clinical decision-making skills
  • 20. What is medical school like?
    • VCU SOM curriculum:
      • M3: clinical rotations: Ob/Gyn, Psychiatry, Internal Medicine, Family Medicine, Neurology, Pediatrics, Surgery
      • M4: currently require 2 clinical rotations: an Acting Internship and a Critical Care elective. The rest of the year is completely elective
  • 21. What is medical school like?
    • USMLE National Board Exams:
      • Step 1: basic science knowledge; taken between M2 and M3
      • Step 2: clinical practice and clinical decision-making; taken beginning of M4
      • (Step 3: necessary to get license, taken after internship)
  • 22. Not exactly what I expected…
    • A lot of work, studying, stress, long nights: there were some tough days, and more long nights than I had expected.
    • And the friendships, support, teamwork: these made the days and nights better, and made for long-standing relationships.
  • 23. Financial issues
    • Took loans the first year, was able to participate in a Commonwealth of Virginia Primary Care Scholarship program all 4 years, SOM scholarships
    • Janet worked all 4 years
    • Lived cheap.
    • Graduated with minimal debt ($16k)
  • 24. Life/school balance
    • My wife and I got married 2 months after graduating William and Mary.
    • This added a challenge: I had to focus on studies and academics while also spending time at home.
    • I budgeted time every day and every weekend when Janet and I could spend time together without school getting in the way.
  • 25. What ’ s the point?
    • It can be easy to become disillusioned. Certainly, this sounds like a lot of work.
    • Remember your individual motivations:
      • PATIENTS need care
      • Desire for a SERVICE career
      • Calling to a VOCATION
  • 26. After medical school…
    • After completing medical school, almost everyone enters a residency program to learn a specialty
    • (the first year of residency is your internship)
    • A chance to learn increasingly complicated diagnostic and treatment skills, patient management, decision-making, etc
  • 27. After medical school…
    • I chose to specialize in Family Medicine because:
      • I wanted to work in a rural / underserved area, and the scope of practice would be very valuable
      • I liked the opportunity to care for patients at all stages of their lives
      • Opportunities for procedures
      • Community and preventive care oriented specialty
  • 28. How do you choose your residency?
    • There is a national residency match program: you choose your favorite programs, they choose their favorite applicants, and then a computer program matches things as best it can.
    • VCU SOM typically has a better than 95% rate of matching students to one of their top 3 programs.
  • 29. After medical school…
    • Matched to the Blackstone Family Practice residency program: a rural-based program in Southside Virginia.
    • Full-scope of training, including emergencies, preventive care, etc.
  • 30. Finally: a real doctor
    • After graduating residency, I entered a private practice in Keysville Virginia and worked there for 4 years.
    • In Keysville, we had a wide-ranging practice with a high proportion of chronic illnesses and geriatric care.
    • We did deal with numerous minor emergencies and the occasional life-threatening emergency.
  • 31. Finally: a real doctor
    • As the 4 years came to an end, I realized that I was more interested than I thought in teaching and working with medical students.
    • I am fluent in Spanish, and was realizing that this was much less common among physicians in Central Virginia than I thought.
    • Came to work at Hayes E. Willis Health Center in South Richmond in August 2007 to have more teaching opportunities, work in a community health center, and work with Spanish-speaking communities.
  • 32. Life in practice
    • Once completing residency, things have been a lot more fun.
    • I can focus my practice on things I like to do, or that I do well.
    • In group practice, sharing call allows a lot of personal flexibility.
    • I am trying to stay active in the practice, the medical school and the community.
  • 33. INTERMISSION
  • 34. What ’ s a typical week in primary care?
  • 35. What do family physicians do?
    • Family physicians provide comprehensive and continuous primary care health care to:
    • individuals and families
    • women and men regardless of age or disease
    • infants, children and adolescents regardless of disease
  • 36. Family physicians provide
    • Prevention & management of acute injuries and illnesses
    • Health promotion
    • Hospital care for acute medical illnesses
    • Chronic disease management
    • Maternity care
    • Well-child care and child development
    • Primary mental health care
    • Rehabilitation
    • Supportive and end-of-life care
  • 37. Procedures performed by family physicians
    • Arterial lines
    • Audiometry
    • Casting
    • Central lines
    • Colonoscopy
    • Colposcopy/LEEP
    • EKG
    • Excisions of moles, nevi, cysts, warts, skin tags
    • Endoscopy
    • Intubation
    • Joint Injections
    • Paracentesis
    • Pap Smears
    • Pulmonary function testing
    • Punch biopsies
    • Skin biopsies
    • Spirometry
    • Suturing lacerations
    • Thoracentesis
    • Ultrasound imaging
    • Tympanometry
    • Vasectomy
  • 38. What FP attributes are valued?
    • Deep understanding of the whole person
    • Act as a partner to patients over many years
    • Talent for humanizing health care
    • A command of complexity
  • 39. Family physicians ’ whole-person orientation and training ensures that FPs…
    • Consider all of the influences on a person ’s health
    • Know and understand peoples ’ limitations, problems and personal beliefs when deciding on a treatment
    • Are appropriate and efficient in proposing therapies and interventions
    • Develop rewarding relationships with patients
  • 40. Family physicians have a unique influence on patients ’ lives
    • Serving as partner with patients to maintain well-being over time
    • Empowering with information and guidance that are needed to maintain health over time
    • Providing care that includes long-term behavioral change interventions that lead to better health
    • Developing ongoing communication between patient and physician
  • 41. Family physicians are relationship-oriented, which ensures…
    • Good relationships with other physicians and health care providers.
    • Better patient understanding of complex medical issues and improved participation in the care process.
    • Less expensive and better healthcare experience for patient.
  • 42. Family physicians have a natural command of complexity and
    • Thrive on managing complex medical problems
    • Integrate all of the medical and personal issues facing an individual
    • Break down medical terms and complex medical issues to make it easier for patients to understand
  • 43. Lifestyle of Family Physicians?
    • 39.7 hours per week in direct patient care
    • 50 hours per week in patient related activities
    • Avg. wks worked – 46.9 weeks
      • 5 weeks for vacation/CME
    • Avg. Income for 2006: $161,000
  • 44. Where do family physicians practice?
  • 45. Life in practice
    • Currently, working 8 to 5, 5 days a week and I take call every 4th week (telephone call only)
    • 2 1/2 days Pediatrics (mostly in Spanish) and 2 days general Family Medicine
    • Hayes E. Willis is a community health center; patients who do not have medical insurance are able to apply for assistance through the VCC program
  • 46. Life in practice
    • Currently, I have been teaching VCU SOM students in their required M3 Family Medicine rotation.
    • Teaching an Foundations of Clinical Medicine students in a new evening clinic at the CrossOver Ministry medical center.
    • Helped set up an M4 elective with a focus on medical Spanish (there is an increasing need, locally and nationally, for Spanish-speaking physicians).
  • 47. Life in practice
    • Involved over time in various service activities:
      • Organizations: Rural Area Medicine clinic in Wise County, Piedmont HIV/AIDS Services and Education, Richmond Medical Reserve Corps, Dominican Aid Society of Virginia
      • Individual: immigration detainee medical review and evaluations
      • International: ongoing community development and medical relief project in the Dominican Republic; medical director of a relief trip to Nicaragua; participant in 2 separate trips to Honduras
  • 48. International medicine and global health
    • I have been involved in 10 medical service trips in 3 countries (2 Honduras, 1 Nicaragua, 7 Dominican Republic)
    • Project leader in Nicaragua and the DR
    • Ongoing trips to the DR with W&M undergrads and with VCU SOM and SOP students (via HOMBRE)--last in the DR in January , planning for June
  • 49. International medicine and global health
  • 50. International medicine and global health
  • 51. International medicine and global health
  • 52. International medicine and global health
  • 53. International medicine and global health
  • 54. International medicine and global health
  • 55. International medicine and global health
  • 56. Where I am now
    • My wife and I are still happily married 14 years into this
    • Medical school debt is fully paid off, and my service requirement for my scholarship has been satisfied
    • I am on the clinical faculty at VCU SOM, working in a community health center where I can provide medical care to patients regardless of insurance status
  • 57. Would you do it over again?
    • YES
    • There have been challenges along the way, and there are challenges still, but at the end of the day I feel like I am making a difference
    • Look for opportunities to increase your knowledge and skills, and to provide service to patients and the community--this keeps you renewed and up-to-date
  • 58. Thanks
    • Some slides were copied from the American Academy of Family Physicians Your Future is Family Medicine presentation.
  • 59. What thing has Dr. Ryan been least involved with during his career?
    • Teaching Medical Students
    • International Medical Service
    • Seeing patients at a community health center
    • Conducting research
  • 60. Dr. Ryan was chosen to attend VCU and UVA medical school
    • Immediately after he applied
    • Through a guaranteed admissions program he applied to out of high school
    • Off waitlists
    • By the AMCAS system
  • 61. The M1 and M2 years are mostly focused on
    • Basic Sciences
    • Clinical Rotations
    • Residency Training
    • Building surgical skills
  • 62. The M3 and M4 year consist of
    • Shadowing physicians
    • Clinical Rotations / Applying to Residency Programs
    • Taking more science courses
  • 63. Which of these personality traits are not needed to be a doctor:
    • Thoughtfulness
    • Impatience
    • Empathy
    • Intelligence
  • 64. When should you meet your college's pre-medical advisor:
    • Soon after you start college
    • Just before taking the MCAT test
    • As you finish your medical school application
    • At graduation
  • 65. What kinds of patients can a Family Physician care for:
    • Children
    • Adults
    • Pregnant Women
    • All of the above