Interviews = Done!

I am officially done with interviews!  It's a relief to be done with that phase and be able to relax a little before beginning my last three rotations!

So what's next?

As you can see from my prior post, I'm most of the way done with the residency application process!  Important dates:

• February 20: Finalize my rank list
• March 15: Match Day!  I'll finally 100% know where I'm going next year.
• April 5: Last day of rotations
• May 2: Graduation!

There may not be many updates in the near future since there won't be much more than waiting.  I'm not going to publicly post my final rank list, but I will certainly post match results!

Nationwide Children's Interview Recap

The recently opened new patient tower

Hospital: Nationwide Children's Hospital
Number of Beds: 451
Number of Peds Residents (per year): 30
Affiliated University: The Ohio State University
Location: Columbus, Ohio
Interview Date: 12/21 (rescheduled from 1/9)

The interview day schedule was the shortest of any interview I've had.  We didn't start until 8:00am and were finished by 1:00pm, which was nice!  We ate breakfast, watched some brief videos, then headed out for our tour.  After the tour, we had our interviews.  Following the interviews, we ate lunch with the residents and attended the residents' noon conference. When the conference was over, we chatted with some interns for a few minutes and were done.

The new hospital includes 6 acres of green space with an underground parking lot

I had four interviews: one with the program director (15 minutes), one with an assistant program director (15 minutes), and two with faculty (30 minutes each).  All of my interviews went very well and we had great conversations.  I had previously met with the program director to express my interest in the program, so it was a very comfortable conversation with someone who already knew me.  I really connected with one of my faculty interviewers as well.  We had a great conversation about life and discovered we had a lot in common.

The two-story "Magic Forest" in the lobby

Things I liked about the program:

• NCH is home for me.  The familiarity is an undeniable bonus.  I know the buildings, some of the faculty, some of the residents - and I like everything I've seen.  I've spent 5 months of rotations working full time at NCH and still really enjoy being there.
• NCH is ranked as the 7th best children's hospital in the country, but there is not a culture of elitism.
• The emergency department is the second busiest in the country, and is also brand new.
• The brand new patient tower just opened this year and all of the facilities are state of the art.
• The electronic medical record system is the best out there, and I already have several shortcuts and customizations set up from my time there.
• The residency class size is big enough to have many residents to share the work, but not so large that you can't know everyone.
• The board pass rate is nearly 100%.  It was 100% last year and over the last six years has averaged 95%.  
• Every sub-specialty is represented at NCH, and some of the nation's top physicians in their respective fields call NCH home.
• The hours for a typical work day at NCH (7am-6pm) are better than many other programs.
• Most of the patient teams are specific to one specialty (Infectious disease team, GI team, etc).  Focusing on one field and being taught by one physician allows for more in depth study of each topic.
• NCH has a culture of "family-first".  The patient rooms were designed with patient and family comfort in mind.  Patient rounds always include families (if they desire) in the discussion.

One of the new patient rooms overlooking the city.  Above the bed is an LED light where the patient can control the color and brightness.

Things I didn't like about the program:

• Because the hospital is so large, there are a lot of patient floors that need resident coverage.  This translates into many months of the year being spent working on inpatient wards, which equates to long hours and hard work.  I'll spend 8 months of my first year on the wards, 3-4 during second year, and 4-5 during third year.  This is considerably more than some other programs.
• The primary care exposure is not as diverse as some programs.  There aren't as many months in the schedule for outpatient rotations or as many choices for clinic locations.  I should be able to use many of my elective months for this if I choose however.

A 1400 gallon fish tank in the lobby of the Emergency Department

Things I liked about the location:

• Columbus is home for us.  We know and love the area, we have connections here, and we are settled.
• We're close to family in Columbus.  Within two hours we can be with any family.
• Columbus can offer everything you could ever want to do - and we enjoy those options frequently.  There are many sports, parks, shopping centers, and outdoor activities.

Highbanks Metro Park is our favorite park in the Columbus area

Things I didn't like about the location:

• Two hours is close, but there are certainly closer residency options for being near family.
• It could be fun to try a new city and not just stay where it's familiar.

My very favorite place in Columbus

Overall Thoughts:
Columbus and Nationwide Children's Hospital are home for me.  It's hard to imagine myself being anywhere else.  I've loved NCH since I first entered two years ago, and it certainly feels like the best fit for me.

Penn State Interview Recap

Hospital: Penn State Hershey Children’s Hospital
Number of Beds: 136
Number of Peds Residents (per year): 14
Affiliated University: Penn State University
Location: Hershey, Pennsylvania
Interview Date: 12/10

The day started with morning conference with the residents followed by a overview of the residency program.  Next, I had two twenty minute interviews with two faculty members.  Later, we went to the resident's noon conference and ate lunch during the lecture.  Attending two lectures during the day seemed excessive though they were well done.  After lunch we were able to tour the brand new children's hospital scheduled to open next month.  We were done for the day around 2:30pm.

The new lobby - which is supposed to look like a tree house

Both interviews were very relaxed and neither interviewer asked me any tough questions.  We mostly just talked about the program and the area.  Both of my interviewers were specialists, so they weren't able to talk to me much about primary care opportunities in the area.  I didn't feel as though I connected extremely well with either interviewer, but they went well.

A courtyard between the adult hospital and the new children's hospital next to the cafeteria

Things I liked about the program:

• The curriculum is extremely flexible.  I have not seen another program that is as willing to accommodate resident's desires.  They allow residents to trade ICU months for primary care months and many other switches and electives.  Because they don't have many inpatient teams that need coverage from the residents, they are able to offer the residents many other opportunities.  Because of this flexibility, I would be able to tailor my education more towards primary care experiences if I wanted.
• They have a brand new children's hospital opening next month.  The facilities are gorgeous and are very patient and family focused.
• The emergency department is a level one trauma center, which implies that they have an all-inclusive emergency department.  They also have a top level NICU.
• Despite being a relatively smaller children's hospital, they are still able to offer a full range of services and sub-specialties for patient care.
• For resident clinic hours, there are three choices that serve very different patient populations.  While they don't have a lot of options close to the hospital, they are able to offer very diverse experiences.
• There are many unique opportunities such as children's camps and a boarding school in town that allow residents to be medical providers in unique settings.

One of the new PICU rooms

Things I didn't like about the program:

• The hospital is relatively smaller than many others that I've visited.  I'm not sure if the patient load would be large enough for me to see as many patients and conditions as I would be able to elsewhere.
• Because of the smaller patient census, inpatient teams are not divided by specialties.  The mix of patients could be quite disjointed.
• There is not a pediatric emergency department.  They use one hallway of the adult ED, but even that hallway is not always exclusively pediatrics.
• As with the ED, there seems to be a tight integration with the adult hospital that is attached.  I prefer a more stand alone pediatric setting where all providers for the kids are specifically pediatric trained.
• The EMR used is Cerner.

A rooftop patio off the lobby of a patient floor

Things I liked about the location:

• The more rural setting provides some beautiful views and outdoor environments.
• The cost of living is extremely low in Hershey and there is cheap, nice housing within walking distance of the hospital - which is never an option in hospitals located in larger cities.
• Hershey is somewhat in the middle of nowhere but is within a short trip (1.5-3hrs) from multiple ski resorts, DC, NYC, Philadelphia, Pittsburgh and Baltimore.  Harrisburg (the state capital) is only 15 minutes west.

Hershey is obviously known for its chocolate

Things I didn't like about the location:

• Because Hershey is in the middle of rural PA, there isn't much to do in town.  You can only tour the chocolate factory so many times.
• Hershey can very much be a tourist town with Chocolate World and Hershey Park.  I think living in a mainly tourist town could get frustrating.
• Hershey is at least a 5 hour drive from home and it wouldn't be an easy drive if the weather was bad.
• With Hershey being a small town and Harrisburg being an economically struggling town, I don't think there would be many opportunities for jobs.

Hershey Park - an amusement park originally built for families who worked at the Hershey Chocolate Factory

Overall Thoughts:
A good hospital, but it doesn't top my list in any one area.  While I think the area is gorgeous, I do enjoy living in a city with all of the opportunities that come with that.  With the location not being what we're looking for and the hospital not being nearly as good as others I've visited, nothing about this hospital makes me think it would be the best fit for us.  It certainly is a good hospital in a nice location but nothing pushes it towards the top of my list.

Louisville Interview Recap

Hospital: Kosair Children's Hospital
Number of Beds: 263
Number of Peds Residents (per year): 21
Affiliated University: University of Louisville
Location: Louisville, Kentucky
Interview Date: 11/20

My Louisville interview was initially scheduled for 11/20, but I was ill and was able to reschedule this interview for 12/6.  The day started with breakfast and attending the resident lectures as most do.  We then had several presentations, two 30 min faculty interviews and a tour.  As with the other interviews I have done, we had a lunch with residents followed by a tour then summary and wrap up ending around 2:00pm.

One of the new private NICU rooms

My first interview was with the program director for the residency.  While having an interview with the director was a little intimidating, I really liked talking with her.  She was very nice and friendly but was also no-nonsense kind of person - which I loved.  We had a great conversation about child advocacy and issues about which we are both passionate (reducing childhood obesity and child abuse).  My second interview was with a faculty member who had just recently finished her fellowship training at Nationwide Children's Hospital in Columbus.  It was great to talk with her about how Louisville compares to Columbus.

I love how colorful children's hospitals are!

Things I liked about the program:

• The residents and faculty are among the friendliest of any program I have seen.  The culture is so welcoming and genuinely friendly.  Everyone seemed so relaxed and fun.  This is the first program I have seen where I truly felt as though I could entirely fit in with all of the residents.
• The size of the residency class seems like a good blend of having enough residents to share the work without feeling like a huge program.
• The program is expanding and growing - as much as they can within the space they have.  As the only stand-alone Children's hospital in Kentucky, the hospital is constantly very busy and patient load is adequate.
• They are getting ready to switch to EPIC for EMR in March.  While this seems a little late to just be starting with an EMR, it would be in place in time for me to start.
• I really liked a child advocacy program they do called PUSH (Pediatricians Urging Safety and Health).  PUSH is a resident-run program advocating for the children in Kentucky.  They specifically focus on childhood obesity, child abuse, and community education.  Their mission varies from advocating for legislation to creating resources for pediatricians to educating the community on safe practices.  I love what the program does and would definitely be heavily involved if I were to attend Louisville.  Even if I don't go to Louisville, I may try to start a similar program wherever I end up.

One of my favorite parts of the hospital: The "Kitten Scanner" is a pretend MRI machine where kids can put toys in the scanner and see what happens.  A tv screen then shows them how a scan looks inside the body but doesn't hurt the patient.  Using this demo has reduced the number of sedations needed for MRIs by 30%!

Things I didn't like about the program:

• The hospital has overgrown its facilities.  The hospital began as a five story relatively small building about 40 years ago.  More recently, three more stories were added, but they have reached the maximum capability to expand.  The support beams cannot support more than eight stories and the building is completely surrounded by other buildings.  Without being able to expand up or out, the desperate need for more space is difficult to accommodate.  The hospital is almost always full and usually has many patients on a wait list for beds.  They even have to use a massive inflatable tent in a parking deck to create extra rooms for the emergency department.
• There aren't many global health opportunities.  Two trips are offered to Ghana or Ecuador. However, for Ecuador you have to be fluent in Spanish to attend - which I am not.
• The team structure for inpatient teams consists of one senior resident and one intern.  About once a week at least, the senior resident will have other commitments and the intern is left alone to manage the team which can have up to 15ish patients.
• There are not many choices for longitudinal clinic work.  There are three clinics available, but they all see a fairly similar patient population.
• There is not any structured one-on-one mentorship program to connect us with a faculty mentor.

The lobby of The Brown Hotel - a gorgeous and historic hotel in downtown Louisville where the residency paid for our stay

Things I liked about the location:

• Louisville (must be pronounced "Lo'ville") is beautiful being right on the river.  There are gorgeous scenes throughout the city.
• There is a flair of southern hospitality and a relaxed feel as is stereotypical for the south.  Everyone was incredibly friendly from the hotel to the hospital to the restaurant.
• Even being just slightly more south than I'm used to, the temperature is warmer!
• There are a lot of fantastic restaurants in Louisville.  The residents said that it ranks in the top 10 cities in the US for great food.

Kentucky Derby takes place just outside downtown Louisville

Things I didn't like about the location:

• It would be a five hour drive home each way.  Similar to Indianapolis, the drive seems much longer than I would like.  Being this far away from family would make it difficult to see them as often as we would like.
• While Louisville certainly isn't a small city, it doesn't quite have the feel of a thriving metropolis the way Columbus does.  As a result, there isn't nearly as much to do or neat things to see.

Downtown Louisville is right on the Ohio River

Overall Thoughts:

• I loved the feel and culture of the program and city.  Unfortunately, with the program being so far from where family is and the buildings being quite limited in space and technology, I don't see it ranking high on my list.  I really enjoyed my visit but there are some undeniable limitations to this program for me.

Rainbow Interview Recap

Hospital: Rainbow Babies and Children's Hospital
Number of Beds: 244
Number of Peds Residents (per year): 27
Affiliated University: Case Western Reserve University
Location: Cleveland, Ohio
Interview Date: 11/30

This interview day started nice and early at 7:00am.  We began with a general presentation of the program by a residency director who should be in sales.  She was great at selling the strengths of the program and city.  Next we attended a portion of the residents' morning conference which I really enjoyed.  Following the conference I had two 30 minute interviews with two different faculty members.  After our interviews, we joined one of the teams for a quick preview of the way they round on patients followed by a tour of the hospital.  After the tour, we joined the residents for a casual lunch and ended the day around 1:30pm.
 

Part of the main lobby

I had two interviews with two very different faculty members.  My first interview was with a more intense physician who seemed mostly interested in what research I had done (which isn't much) and what research I'm planning on doing (which is as little as I'm required).  He also seemed a little elitist.  When I asked him if the hospitals in the area collaborate, he essentially answered to the effect of, "Why would we?  We have everything here that they can't offer."  He also asked me "What are you most proud of?" which I always find a challenging question to answer without sounding conceited.  Despite the interview seeming a bit rocky, he told me at the end that he was planning on ranking me highly - so I'm still not sure quite what to think of that interview.  My second interview went much better.  She was a primary care pediatrician who shares my heart for primary care, preventative medicine, and psychology.  We had a lovely conversation and I genuinely enjoyed talking with her.

A large covered atrium connecting the children's hospital to the adult hospital

Things I liked about the program:

• The program provides top-notch training.  The curriculum is outstanding, they offer great board review, and their board pass rate is consistently above 95%.
• There is a relatively new (2009) NICU (neonatal intensive care), inpatient pediatric psychiatry unit, and emergency department.  The NICU especially is quite impressive and is ranked #2 in the country.
• Many of their residents go into top fellowship programs in the best hospitals in the country.  They are well trained for any field they desire.
• A well-established global health program allows residents to go almost anywhere they would like from a Native American reservation in Montana to numerous countries around the world.  
• The program has a very unique inpatient team known as the "Silver Team".  Junior residents (second years) completely run the team independently.  They are supervised by an attending but operate as though they are fully independent. This experience would be an amazing learning experience.

One of the new NICU rooms

Things I didn't like about the program:

• There aren't many elective blocks that allow us to tailor the curriculum to what we are interested in.  New accreditation requirements are going to require them to add more elective blocks, but that may not take place soon enough for me.
• The clinic experience (office visits) is one half day per week, which is standard for programs.  However, we don't get any option for where we do our clinic.  All residents have to do their clinic in a resident clinic that serves 95% medicaid patients.  While I do enjoy working with that population of patients (and plan to as part of my career), the complete lack of choice or diversity of experience concerns me for my preparation for caring for my future patients.  Besides this clinic, there is only one built in month for community primary care.  I could use electives to increase that, but then I couldn't do any other electives.
• More of their residents do fellowships than primary care.  Only 20-30% of residents choose primary care.  While this isn't necessarily a problem, it can be indicative of the attitude of the program.
• The EMR is not EPIC, which you know is my EMR of choice.
• Each year, you only have one month where you are free from any call scheduled (nights and weekends).  It seems like they work them quite hard.
• Research is required.
• There is a very elitist attitude among many of the staff and residents as evidenced by the comment I mention above by my interviewer.

One of the hallways leading to patient rooms

Things I liked about the location:

• Cleveland is a very convenient location based on where our families are located.
• Being on the shores of Lake Erie provides beaches and many beautiful parks.
• The cost of living in Cleveland is very affordable.
• There is a lot to do in and around Cleveland.  There are several pro sports teams, the second largest theater district in the country (second only to Broadway), a ton of amazing restaurants run by top chefs, and several great museums.

Cleveland is a fun sports town - if you don't care about winning.

Things I didn't like about the location:

• Cleveland can get much colder than even Columbus.  Lake effect snow can mean feet of snow in Cleveland when Columbus may only get rain.
• While Cleveland does have a lot to offer, I still really enjoy Columbus and the things offered there.
• Cleveland is improving economically and in crime rates, but it still feels like a city that isn't thriving.
• Several of the residents and attendings unintentionally made comments along the lines of "being stuck in Cleveland".  While they did try to backpedal and talk about what they loved about the city, it's evident that Cleveland is not a city that most feel excited to live in.

Lake Erie Beaches are extremely close

Overall Thoughts:
The residency program at Rainbow is undoubtedly a great program that would give me a top-notch education - and they know it.  The culture of elitism is not somewhere that I feel as though I really fit in.  I also think that the lack of outpatient opportunities is a pretty big issue for me since that is what I want to do with my life.  I have no doubts that I would get a great education if I went to Rainbow, but it just doesn't quite feel like the right fit for me.  If I ended up at Rainbow, the small issues I have with the program would likely be insignificant- but I haven't seen anything that would lead me to rank it higher than Columbus.

Akron Interview Recap

Hospital: Akron Children's Hospital
Number of Beds: 303
Number of Peds Residents (per year): 17
Affiliated University: Northeast Ohio Medical University
Location: Akron, Ohio
Interview Date: 11/29

The day started with attending the residents' morning lecture followed by a general presentation about the program.  I then had two 20 minute interviews with a faculty member and one of the chief residents.  We were then given a quick talk on the benefits of the program.  Next we had an "open forum" where we could ask the chief residents anything we wanted to know.  We went on a tour of the hospital, ate lunch with some more residents and then were dismissed for the day around 1:00pm.
 

My interviews felt much more like real interviews than my previous sessions at Indy.  I was asked a lot of the standard questions: "Why a doctor?", "Why a pediatrician?", "Where do you see yourself in 15 years?", etc.  I didn't get any extremely challenging questions and my interviews seemed to go smoothly.

A large Rube Goldberg type machine in the lobby that moves large marbles through a complex system of ramps and contraptions

Things I liked about the program:

• ACH uses the electronic medical record system "Epic" which is the same one that is used in Columbus.  I'm quite familiar with the system and think it is the best one available.
• The program has a good class size around 17 which provides enough residents to share the work load but not so many that it is hard to get to know everyone.
• A great board review course is built into the curriculum to assist residents with the licensing boards.
• They have great elective choices for primary care, global health (trips to Haiti, Ethiopia and Kenya), and many other areas.
• There are several affiliated camps (diabetes camp, trach/vent camp, asthma camp) that residents can be involved in as a counselor.  I would love being able to be involved in a summer camp again - even if just for a week.
• ACH does offer the highest level of NICU care (level 3) which means they can provide for any needs that a premature baby may have.
• The call schedule (overnights, weekends, etc) is not very intense and it sounds as though residents get more days off than I've heard in other programs.
• Their residents have good fellowship placement rates in top programs. 
• There is a lot of time available for electives and primary care exposure.  Primary care (community offices) opportunities are also open for preferences (urban, suburban, rural, close to home, etc).

Petie the pony that comes to visit kids after he goes through an intense sterilization ritual

Things I didn't like about the program:

• The number of patients admitted at ACH seems drastically lower that what I'm used to at NCH.  for example, on Infectious Disease at ACH they tend to have about 5 patients where we usually have about 30 at NCH.  I'm concerned that being involved in so many fewer patients would mean that I wouldn't see as many things and wouldn't have as much hands on learning.
• The team structure seems jumbled.  At NCH, there is a separate team for most specialties.  At ACH, there are 4 inpatient teams.  Green (general peds), Yellow (Infectious Disease, Pulmonology, Allergy/Immunology, and Neurology), Orange (Adolescent, Cardiology, Endocrine, Renal, GI, Rheumatology, Physical Med & Rehab, and Genetics) and Red (Hematology and Oncology).  Because the yellow and orange teams cover such a strange mix of patients I feel as though I would constantly be juggling so many different concepts, attendings and styles.  A large part of a resident's job is to figure out how attendings like things done and I'm not sure how you could accomplish that when you could be working with eight attendings on one team.
• Standard work hours are 6am-6pm while I'm used to 7am-6pm at NCH.  While that one hour difference doesn't seem like a drastic change, one extra hour of sleep per day in residency doesn't take long to feel significant.
• The trauma center is a level 2 (level 1 is the highest level of care) which means that the services offered are not as comprehensive.
• Research is required as a resident.  This wouldn't be a deal-breaker, but research is not enjoyable for me and not all programs require research.
• There are certain services that just aren't offered because it is a smaller hospital: solid organ transplants, dermatology, etc.  I probably wouldn't miss them much if I did attend here, but it seems like a good indicator of the comprehensiveness of a program.

The expressive therapy room that allows kids to put on performances, dance, do art projects or any other expressive therapy they desire

Things I liked about the location:

• All of our family is in or around Akron.  The convenience and luxury of being able to see family even if I'm only free for dinner would be a huge benefit.  This is by far the biggest plus of the Akron program.
• Akron feels like home for me to a certain extent.  Growing up in the area gives me a lot of comfort with knowing and understanding the area, know the patient populations in different parts of town, and knowing people in the area.
• The cost of living is the lowest of everywhere I'm applying (as far as I know).
• There are a lot of fun things to do around Akron including some amazing parks.

The Akron Aeros stadium is across the street from the hospital (you can see the hospital in the background on the left) and you can watch fireworks when at the hospital at night.

Things I didn't like about the location:

• While Akron is familiar, Columbus is a city I've fallen in love with and it's hard to be excited about the city of Akron when I'm used to all that Columbus has to offer.
• Growing up in Akron and ending up in Akron would make me feel as though I had never branched out to some extent.  Diversifying my experiences will only add to the value of care I can provide.

Cuyahoga Valley National Park (10 miles from ACH)

Overall Thoughts:

• A smaller, older and less technologically advanced hospital than what I'm used to.  While I'm sure I could be happy in Akron, I think working in ACH would feel like settling because I know the alternative options.  I think Akron provides solid training and good patient care, but when I've started training in a place that is among the best in the country, other places seem to fall short of my expectations.  I think it would be irresponsible to choose a residency based solely on the location of my family when I wouldn't have much time off to see them anyway.  When 90% of my awake hours are going to be spent in my residency location, I need to choose where I feel I can get the best training for the sake of my future patients.

Dr. Google and Mindless Optimism

~~~~~

One night on call, I heard this overhead page: "Code Blue - In front of Cheryl's Cookies."  Typically the [seemingly] 1000 calorie cookies just aid in killing you slowly, but I guess they worked more swiftly that time.

[The patient was fine for those of you insulted by my dark humor.]

~~~~~

A term we use often in medicine is "functional" to describe something that we can't explain and by process of elimination assume that it is rooted in psychological distress. If a surgeon diagnoses a patient with "functional abdominal pain" the underlying message is often - "it's all in her head" because there is no pathology we can find associated with the symptom.

A patient with psychogenic non-epileptic seizures (aka "pseudoseizures") was being interviewed about how her life has been affected by these seizures.  PNES are thought to be psychological in origin and have no biological basis.  In an attempt to explain that she wanted to get back to her normal activities, the patient exasperatedly stated, "I just want to be FUNCTIONAL!"  If she had only known that she had just made her own diagnosis.

~~~~~

A patient who had been consulting Dr. Google came in stating, "I think I have Bell's Palsy.  I don't have the facial droop, but I have everything else!"  Apparently Dr. Google didn't tell her that the ONLY diagnostic criteria for Bell's Palsy is facial droop (unilateral facial paralysis).

~~~~~

One patient suffering through a terrible case of paralysis as a result of Guillain-Barre syndrome had a poster on his wall that said "PMA" which he explained to us stands for "Positive Mental Attitude".  As he was explaining his mantra, my German attending interrupted him saying, "It's so American - this mindless optimism.  You have a right to be grumpy if you want to be!"

~~~~~

Pt: "Hey Doc, can I get some Viagra?"
Dr: "Tell me more about what's going on."
Pt: "I don't know, but my wife really needs it!"
Dr: "Wait, so you want a prescription for your wife to take it?"
Pt: "Yes!  It works that way too, doesn't it?"

~~~~~

One attending I was working with described a patient as having "nascar-opathy".  I later found out that this was his way of describing patients with fever than 4 teeth.

~~~~~

Riley Interview Recap

A view from the outside of the newest part of the children's hospital

Hospital: Riley Hospital for Children
Number of Beds: 455
Number of Peds Residents (per year): 25
Affiliated University: Indiana University
Location: Indianapolis, Indiana
Interview Date: 11/2

Most interview days are structured similarly: they include presentations on the program, tours, observing a part of the daily life of the residents, and of course, the interviews.  Riley's day was no different.  The tour took us through a few parts of the old hospital building and through much of the new hospital building (pictured above) which they will fully move into by this time next year.  We also saw a state-of-the-art simulation center as well as rode on the "people mover" monorail that connects several medical campus buildings.
 

"The People Mover" (Yes that is the official name)

My interviews were mostly relaxed.  My first interview was with a woman who asked me some difficult questions. She asked, "Tell me about a difficult attending and how you handled them." and "If you were the dean of your medical school, what's one thing you would change?" among other challenging questions.  Mostly, the interview was conversational and I felt it went well.  My second interview was with a man who didn't ask me a single question about myself.  Not one.  He asked me if I had any questions about the program and proceeded to talk to me about how great the program was for the entire time.  While I didn't mind the pressure being off of me, I'm not sure on what basis he can evaluate me.

The lobby of the new building

Things I liked about the program:

• Riley is the only comprehensive children's hospital in the state of Indiana (Ohio has 3).  This is a positive because they pull from every corner of the state which drastically increases the diversity of patients and conditions they see.
• They offer one of the best benefits packages of any program I have seen.  All insurance is included without premiums, the salary is competitive, and the vacation policies are generous.
• The program has a unique partnership with Moi University in Kenya.  Residents have an opportunity to rotate through Kenya for two months and experience a different world and culture while practicing medicine in a completely different environment.  (The partnership is so unique that it has been nominated for a Nobel prize twice).
• Camp Riley is a summer camp for youth with physical disabilities where residents have an opportunity to be the camp physician for a week.  I would love reliving some of my camp counselor days in this type of setting.
• Riley has a unique partnership with the community that allows residents to spend two entire months working on community advocacy.  Projects can include working with a women's domestic violence shelter, working on breast feeding advocacy, working on a national pediatrics podcast, or any other project a resident wanted to develop. 

A nurses' station and hallway of one of the new patient wards

 
Things I didn't like about the program:

• Riley is the only comprehensive children's hospital in the state.  While I also mentioned this as a positive, it concerns me that they are in many ways, "the only show in town."  I know that competition within Ohio has driven many of the hospitals to improve in ways they may not have been able to do had there been a feeling of security in knowing you didn't have any direct competition.
• Their electronic medical record system is not as good as the one I am used to in Columbus.  Being a constant seeker of efficiency, cumbersome systems are a great frustration for me and I could see this system being a major source of headaches if I were to work at Riley.
• Some systems seem antiquated beyond where they should be for the capabilities of the hospital.  For example, in Columbus, if we want to page someone then we click a web page and in about 3 clicks and 10 seconds we can find the exact person we need to page who is on call for a particular specialty and send a page.  At Riley, you have to call the operator, request that they look up what you need (while trying to accurately describe exactly who you are trying to reach), write down the pager number once they've found it, hang up, then page the person on call.  While I'm sure it wouldn't be a major deal once there, it seems like a sign of other antiquated systems.

One of the new patient rooms: the small TV you can see is just for the parents and the kids have a big screen TV just for them

 Things I liked about the location:

• Indianapolis feels very similar to Columbus, which I have come to love.  The size and feel is nearly identical.  Indy is also a fun sports town (though not for teams I particularly care about) with a lot to do.
• The cost of living is incredibly affordable.  The cost of living is also nearly identical to Columbus, but combined with the incredible benefits package, the money would go further.
• Great outdoor activities abound.   Eagle Creek Park is just outside downtown and is six times the size of Central Park in NYC.  There are also miles and miles of amazing bike trails around town.
• The downtown area is really neat and newly revitalized.  Hosting the Superbowl in Feb 2012 brought in a lot of development and created a great downtown area right around the med center.

One of the many gorgeous bike trails in the city

Things I didn't like about the location:

• Indy is somewhat in the middle of nowhere.  There isn't much within a short drive of Indianapolis but cornfields.
• The location would be somewhat far from family.  While 5 hours is certainly drivable, I'd prefer to not spend a big portion of my precious time off driving to my destination.

Eagle Creek Park

 

Overall Thoughts:

•  A great hospital within a great city.  The similarities to Columbus and Nationwide Children's Hospital would assist in a seamless transition if I were to end up here, but I don't see the positives being strong enough to pull me away from where I feel at home in the Ohio area.

Step 2

I should probably mention briefly that I passed both parts of Step 2 (for US medical licensing boards).  The test wasn't nearly as frightening as Step 1, but it did have two lengthy parts:

Step 2 CK = Clinical Knowledge.  This test was a multiple choice, 9 hour long exam meant to gauge if we'd absorbed anything over the past 3 years of med school.  We get a numerical score that most residency programs want to see before they decide if they will grant us an interview.

Step 2 CS = Clinical Skills.  This test involved 8 hours of talking to standardized ("fake") patients.  This exam is strictly pass/fail and we don't receive a score for it at all.  2/3 of the score assesses if we speak English and can communicate effectively.  I was not too concerned about preparing for this exam (99% of OSU students pass on their first attempt).

The worst part of these exams was the cost (~$1700 between the two of them).  My biggest fear of failing them involved having to pay those fees again!

Residency Application Process

I apologize for the lapse in updating - the blog has slipped my mind in the seemingly rare moments when I have down time.  I'd like to claim I'll be better at updating, but I'll likely only get worse as residency starts in July.  I'll do my best.

A quick update on the process of applying for residency:

Step 1: Figure out what you want to do with your life.
- As you likely read in May of 2012 and in February of 2011 (among other places), I figured this step out a while ago.

Step 2: Research potential programs.
- As far as I know, there are 199 pediatrics residency programs - including 9 in Ohio.  Not all are possibilities as some cater only to D.O. graduates (the difference between DO and MD is explained here).

Step 3: Narrow down the application list.
- I've decided to apply to 9 programs (in alphabetical order, not preference): Akron Children's, Case Western/Rainbow Babies (Cleveland), Cincinnati Children's, Indianapolis Children's, Louisville Children's, Nationwide Children's (Columbus), Penn St (Hershey, PA), Pittsburgh Children's, and St. Louis Children's.

Step 4: Complete and submit applications.
- These were submitted on September 15 of this year.  The application involves a CV/Resume of sorts as well as a personal statement.

Step 5: Interviews!
- Interview season runs from October to January for most places.  So far, I have 6 interviews scheduled. It's late enough in the season that I don't really anticipate receiving any more invites.  In order of interview date: Indy (11/2), Louisville (11/20), Akron (11/29), Rainbow (11/30), Penn St (12/10), and Nationwide (1/9).  I don't yet have an invite from Cinci, Pitt, or St. Louis.

Step 6: Rank Order List = ROL
- My ROL will be finalized February 20, 2013.  This will be where I enter my preference for order of programs in which I am most interested.  Residency programs also submit their lists of applicants in whom they are most interested.  Some fancy computer program figures out the best combination for all of the applicants all across the country based on these ROLs.  Applicants rankings matter more than programs: If I list program A as my first choice, that matters more than if program B lists me as their first choice.

Step 7: MATCH DAY!
- On March 15, 2013, all of the graduating medical students in the US get to open an envelope that tells them where they will be spending the next few years of their lives. (For peds, residency is 3 years long.)  My entire graduating class will gather in a large auditorium and open our envelopes all at the same time.  Most of us will be happy with what's inside!


I'll try to continue updating as I work my way through the interview process and match day. Please post any questions you may have about the process.

Stereotypes Exist For a Reason...

12 Medical Specialty Stereotypes:

 

Specialty Choices

I took a quiz on which specialty would be the best fit for me.  I have already decided, but I was curious if the quiz would line up with what I was thinking.  I'm not sure if the results could have been more correct:

Interestingly, here are the results from when I took this same quiz over two years ago:

Low on the Totem Pole

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Patients are usually given hospital non-skid slipper-socks that have rubber on the bottom for safety to prevent falls.  I couldn't help but laugh when I read in a two-month-old baby's chart, "Non-skid slippers were issued to prevent falls."

~~~~~

A parent, in writing about her daughter's psychiatric history, wrote that she had been diagnosed with "psycofrenia".  I'm not sure if she meant "psychosis" or "schizophrenia" - but her daughter didn't have those.

~~~~~

One of the most amusing names I have seen a parent give their child: Ho'nasty.  Spelled exactly like that.  When asked about pronunciation, the mom was clearly irritated and said, "It's pronounced HONESTY!" in a tone that indicated she thought it was obvious.

~~~~~

One family counseling session took a turn towards the couple needing marital counseling.  The couple was not getting along and couldn't agree on what to do for their son.  At one point, the social worker asked, "Are you two ever on the same page?"  To which, the wife said "No" and the husband said "Yes".

~~~~~

A patient of mine was especially upset about receiving one of her medications at 6pm instead of 8pm.  Every time I saw this patient, she asked me repeatedly about changing the order.  I continued telling her that I would discuss it with the team, but the team never actually changed the time.  Eventually, she said in exasperation, "Can't YOU just change the order?"  I explained that we're not allowed or able to alter any orders and she smirked and said, "Oh, so you're THAT low on the totem pole."  I could only smile and say, "Yeah, pretty much."

~~~~~

Rights to a Chair

Harmless sayings that shouldn't be misheard:

The medical field certainly has its own language - which can cause problems when we think we are saying one thing but a patient or family hears an entirely different meaning.  Often, the double meanings can be entertaining, but they can also seem quite offensive. Imagine how you would feel if you overheard a physician saying these phrases without any other context:

1) "Go get the cow out of room 320."

2) "Wow, that patient is really tachy!"

3) "He is a little S.O.B.!"

Surely, you can see how these would sound offensive to someone overhearing them. But here's what they really mean:

1) COW stands for "computer on wheels" - or just a cart that we can wheel around to use the electronic medical records on the move.  For obvious reasons, the hospital is trying to eliminate the term "COW" from our vocabulary.

2) Tachy is short for tachycardic, meaning the heart is beating faster than normal.

3) S.O.B. in medicine simply means Short Of Breath, nothing more and nothing less.  Most of us don't even think about the cultural meaning of the abbreviation when we say or write SOB.

When you're in health care settings, if you hear words that don't sound quite right or don't sound familiar, just ask.  We don't always remember we speak a different language.