Cosby High School Pre-Med


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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.
  • Cosby High School Pre-Med

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