Love Letters for Medical Students

29 01 2011

While Valentine’s Day is coming soon, a different sort of ‘love letter’ may be sent or received by senior medical students.  As recruitment season draws to a close, residency programs and applicants may be busy exchanging notes of interest, affectionately dubbed “love letters” by scores of medical students and on StudentDoctor.net.

What do these love letters mean?  Some students have asked us whether it is a Match Violation to get or send a love letter.  Others have worried they did not send enough or what type of language they should use.  Well, here are some quick tips on how to approach this somewhat awkward situation.

  1. Is it a Match Violation? It is not a Match Violation for a program or a student to express interest in the other.  However, these statements of interest cannot be binding (i.e. we will only rank you highly if you rank us #1).  If there is any part of it that is binding, then it would escalate to the level of a Match Violation.  Read more about what constitutes a violation here.
  2. “Rank highly” vs. “Rank #1”? –  It is poor form to send more than 1 program a “I will rank you #1” note.  There are 2strategies that most students will use- The first is to select the #1 program to send a “rank #1” letter to and then to send “rank highly” to the next 2-3 programs on the list.  Since some believe that “rank highly” has become the code for “I love you but not enough,”  the alternative is to be coy and not let any program you will rank them #1, but use language like “I could see myself there” or “I would be honored to train there.”
  3. “Rank to match” statements from the program – It is possible that programs could call or email to alert you that they are ‘ranking you to match.’  While you may feel elated, this does NOT mean that you should pack up your belongings and move.  This also does NOT mean that you should cut programs from your list since are secured a spot.  What this DOES mean is that they are interested in you and have likely placed you in a position on their rank list where they THINK on an average year you could match there.  Because the Match is very tricky and the competitiveness for an individual program can change year to year, “ranked to match” in one year may mean “out of luck” in another year.  So our advice is to not put a lot of stock into these statements and still preserve the breadth and depth on your list that you will need to secure a position.  Remember the length of your Rank List is one of the best predictors of whether you will match or not.
  4. What about programs that I don’t send letters to? Will they think I hate them? –Absolutely not.  The letters can serve as a signal in the game that you are interested but just because you don’t send a letter does not mean that you can’t end up at that program.  Programs are maximizing their ability to get the best candidates regardless of this communication.   It would be extremely unusual for a program to strike someone from their list if they don’t receive a letter.  Likewise, if you are not very competitive for a program, your letter is not going to be the dealbreaker to move you in to the rankable range.  Remember, the letter is really a statement of interest that may help a little, but not a lot.
  5. Email vs. Paper – During the recruitment season, paper thank you cards can be a nice touch if sent in a timely fashion.  However, the post-recruitment love letter should probably be an e-mail given the occasional snafu in snail-mail especially in large hospitals.  The nice thing about the email is that it can be immediately forwarded to the members of the recruitment committee or others.  In terms of who to send the love letter to, it is usually sent to the program director unless someone else was clearly the lead recruitment person for the day (an associate program director or a faculty member).  As always, try to personalize the letter to highlight the things you enjoyed about the program that day.
  6. There is no ‘right’ answer – As with our other career advising posts regarding the Match, there is no right answer here.  Since everyone’s case is different, the best thing may be to consult with a faculty member from your field who has been advising you on the process.

Alas, in spite of all the love you may get or feel, the irony is that the key to a successful residency match is not to fall in love.   Remember, you are not in a relationship with any program yet.  Since anything is possible, you need to keep an open mind.  Try to group your list in tiers.  Consider that you would be happy at any of the programs in your ‘top tier’  to avoid being dead set on one place.  Visit last year’s archived post if you need more help creating a rank list or checking it twice.  Lastly, don’t forget to certify your list.

Happy Match List Making!

–Vineet Arora, MD and Shalini Reddy, MD





#SGIM2011: Tweeting the Meeting: Why and How

20 01 2011

Bob Centor over at MedRants and I have written this piece for the 2011 SGIM meeting.  We hope that you will follow the tweets &  attend the meeting.

As you read this, you likely are wondering what is this tweeting stuff.  Maybe, like some you want to avoid twitter, because you do not want people to always know where you are and what you are doing.  Twitter is a convenient useful way to gather and share information.  We both find that Twitter helps us stay aware of both medicine and other fields.  Neither of us tweets (proper verb to refer to send out a message) our location or whether we are washing our hair.

We both use twitter to become aware of data.  Since twitter messages have a 140-character limit, you really do not have to waste time reading too many long messages. 

Today, for example, Bob Centor received several tweets that looked like this:

RT @FutureDocs RT @Atul_Gawande In NYer how to control health costs. 5% of pop accounts for 60% costs http://nyr.kr/eHW5BH

 Several points here:

  1. RT stands for retweet (a rebroadcast)
  2. @FutureDocs is Vinny Arora’s Tweeting name and @Atul_Gawande is obvious. 
  3. This tweet alerted me to a new Atul Gawande post in the New Yorker.
  4. http://nyr.kr/eHW5BH represents a shortened form of the actual url of the article.  Twitter users use shortening programs to save characters.

We subscribe to other medical tweets, some business tweets, some political tweets and even sports tweets.  We both tweet frequently to give a quick “heads-up” to an article that we read.

So we encourage you to sign up for Twitter (it is free).  You need not ever tweet; feel free to just follow tweeters who provide useful information.  In particular we hope you will use Twitter to keep up with #SGIM2010 prior to and during the meeting:

Why         

  • Engage with other SGIM members – One of the main reasons to belong to a professional society is to network with like-minded colleagues, form collaborations and friendships to support your personal and professional goals.  Using Twitter, you’ll be able to identify others who are tweeting the meeting and even connect to them in person at the SGIM “TweetUp”.  (A TweetUp is a meeting organized through Twitter).
  • Spread the word about generalist topics to other stakeholders- In addition to connecting with SGIM members, it is important to educate and raise awareness about issues relevant to general internists to the broader community, especially during this polarizing and volatile debates about healthcare and medical training.  Twitter provides a platform to immediately broadcast this message to other stakeholders that could include patients, public, policymakers and others? . 
  • Stay up to date about meeting news  – Wondering about the latest news about the abstract deadline or when the Meet-the-Professor session you wanted to go is?   Using Twitter, you can follow @societygim for updates so that you are up to speed on the latest information to have a positive meeting experience.
  • Participate virtually, even if you don’t attend- While we hope to see you at the meeting, we know your professional or personal obligations may prohibit you from coming to the meeting in person.  As opposed to staying in the dark and waiting to hear from your friends and colleagues how the meeting went, why not follow the Twitter stream and engage with attendees who are there in real-time?   

How

  • Get a Twitter account – This is the first step.  If you are not sure whether you want to do this, you may find it helpful to see these Twitter tips and myths that originally appeared in SGIM Forum. 
  • Follow SGIM users – Start following SGIMers on Twitter, try @societygim @medrants @futuredocs @jgimeditor @jgimeditor1 @bradcrotty @MotherInMed @ewidera @AlexSmithMD @Bob_Wachter as a few examples.
  • Follow #SGIM2011 Hashtag – By searching under this hashtag, you can find out who is tweeting about the SGIM annual meeting to find new followers.  By indexing your tweets with this hashtag, other SGIMers will be able to locate your tweets to learn what you are up to.  (A hashtag always starts with #.  For this meeting we have chosen #SGIM2011.  You can search Twitter at anytime to just read #SGIM2011 tweets.
  • Attend SGIM Social Media sessions – This year, the annual meeting offers several offerings which aim to educate SGIM members about social media including a pre-course for medical educators to learn about wikis, a workshop on how to use social media to advance your career, and a town hall to contribute to the future of the SGIM communications strategy.
  • Come to the SGIM tweetup – The first annual SGIM TweetUp will take place on – well, we will announce the location and time on Twitter..  Come meet the Tweeters you follow and discuss the meeting and social media.

We hope to see you at #SGIM2011.  Start following the Tweets, and even join in if you want.





The “Social” Side of Hospital Rounds

17 01 2011

This weekend, I just finished another 2 weeks on service – the first 2 weeks of 2011 in fact.  This time, I had also had a shadower, but one of a different kind.  As part of our Institute for Healthcare Improvement (IHI) Open School, we are making an effort to have collaborative learning opportunities for our medicine and health administration program students.   Achieving true interprofessional learning is challenging for schools like ours without a pharmacy or nursing school.    

To jumpstart our collaboration, a team of us traveled to at the Institute of Healthcare Improvement conference.  It was there over dinner that Jeff Kunkel, one of the Social Work students, asked me if a lot of social work issues came up in hospital care rounds.  I laughed momentarily and reassured Jeff there would be lots of social issues and invited him firsthand to witness them on rounds.  Unlike the premeds that I sometimes take on the weekend, I wanted him to come during the week so that he could also attend the multidisciplinary rounds with our case managers and social workers that our attendings go to daily. 

The opportunity presented itself that first Friday – our team was on call so it was a perfect day since we did not have many patients and were able to delve into their problems.   While there are social issues every day, dealing with them becomes exponentially harder over the weekend when you only have social workers on call.  This makes Friday an especially important day to advance care or facilitate any discharges.  While some believe that doctors don’t work on weekends, the truth is that they do.  The problem is that not everyone else works on the weekend making the hospital inefficient over the weekend and nothing gets done.

 I introduced Jeff to our housestaff team as a social work student who was especially interested in the social issues.  For each of the presentations, they started with a one liner to brief our student on the patient’s problem but also described the social issues.  In doing so, the social issues that sometimes plague our rounds (and our residents) all of a sudden became the highlight of rounds.  The patient that leaves AMA, the patient who was homeless, the patient who did not want to go to rehabilitation but was too weak to go home, the patient who was uninsured and could not afford his medications…  the list goes on.

Afterwards, we had an opportunity to debrief.  It was fascinating to hear what Jeff found interesting.   He noted that I sometimes have to ‘talk patients’ into leaving the hospital.  I told him that the sad truth is that patients often expect to stay in the hospital longer than they can and should.  Not only is staying in the hospital dangerous and costly due to hospital-acquired infections and other hazards, hospitalizations are increasingly scrutinized to ensure that each hospital day is ‘medically necessary’ by auditors who are incentivized to penalize.   Given this, managing patient expectations becomes very important and something that the attending often ends up participating in. 

As we think about the increasing pressure to ensure that patients who don’t need hospital care go home, it is equally important to ensure a safe care transition to avoid a preventable readmission.  While optimizing these decisions requires clinical judgment, it cannot be done without thinking through and addressing the social issues.  This makes having a great social worker even more important for the future.  Unfortunately, like many other healthcare fields, there is an impending social work shortage as highlighted by a major capitol briefing held by the National Association of Social Workers.  While many of us tend to focus on the need to train competent physicians and nurses, we must not forget the that we need good social workers too. 

–Vineet Arora MD





Blog ‘Paper’ Anniversary: Reflections & Top Posts of 2010

3 01 2011

It’s been one year of blogging or our ‘paper’ anniversary here on FutureDocs! 

I was reminded of this milestone with the receipt of the WordPress blog ‘report card’ below.   While I was excited to learn about the clean bill of health and intrigued by metrics related to shipping containers, I’m not going to lie.   It can be very challenging to stay fresh, write creatively, and keep up with posting while holding down an academic career.          

However, one thing I have learned (and confirmed by @MotherInMed who helped me get started) was that if you are inspired, the post will write itself (like this one).  Therefore, it is critical to pay attention to those moments you are inspired.  This gives rise to a somewhat startling personal observation– blogging can acutally improve your attention span and focus.  Sounds crazy, I know… But, unlike social media sites which can be highly distracting (Twitter or Facebook addicts anyone?), I find that I often pay closer attention to my surroundings so that I don’t miss the inspirational moment around the corner that I can share.   For example, in lieu of walking around aimlessly at medical conferences (a risk at any conference especially in medicine), I found myself taking notes and immediately reflecting on sessions to distill the most salient points, such as the oppressive nature of medical education or expert failure highlighted at the recent Association of American Medical Colleges.

In examining the report card below, the top posts on this blog are both predictable and surprising.  With the explosion of interest in technology and plenty of technophiles in the blogosphere, it is no surprise that posts about Twitter myths for docs and whether the iPad lives up to it’s hype on the wards are at the top.   The other 2 posts relate to career advising, which was a welcome surprise.  They also do reaffirm the need to continue to provide solid career advice to medical trainees, no matter how mundane (like what to wear to the hospital).   In addition to technology and career advising, I’ve enjoyed the ability to highlight various advocacy issues relating to medical education like healthcare reform, resident duty hours, the Match, and women in medicine.  Lastly, I must admit that I do enjoy writing for pure fun — like the posts on movies in medicine or healthcare phobias.   

Special thanks to uber medbloggers KevinMD and medrants who occasionally cross post or reference these posts and all those who subscribe and comment.   I was especially honored to be included in KevinMD’s top 10 posts of the year for this post on shadowing (which curiously did not make the WordPress list below).  

So here’s to more inspirational and informative moments of 2011, both in life and on the blogosphere.

–Vineet Arora, MD

***Blog Report Card From WordPress:

Fortunately, the stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and sent me the following high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads Wow.

Crunchy numbers

This blog was viewed about 20,000 times in 2010. If each view were a shipping container, your blog would have filled about 4 fully loaded ships.

In 2010, there were 30 new posts, not bad for the first year!  The busiest day of the year was March 5th with 304 views. The most popular post that day was Top Twitter Myths & Tips.

Where did they come from?

The top referring sites in 2010 were twitter.com, kevinmd.com, Google Reader, medrants.com, and facebook.com.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

Top Twitter Myths & Tips February 2010
6 comments

Attending Rounds with the iPad – Hype or Hindrance? August 2010
13 comments

What Not to Wear: Hospital Edition May 2010
4 comments

Personal Statement Do’s and Don’ts July 2010
4 comments

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