The summer between first year and second year of medical school is sometimes referred to as the “last summer” since it is the last time students can travel or take off before they start the journey towards USMLE Step 1 and then their third year clerkships. With the angst building, first year medical students are actively deciding in the dead of winter what they will do over the summer. One popular decision is to do research – this is not uncommon since residency programs are increasingly competitive and look for students who have a commitment to scholarly work. However, there are a plethora of other things students could do as well. As tonight is our “Intro to our Summer Research Program” for Pritzker medical students, I thought I would share some of the most common questions I get about the “Last Summer”:
Should I do research in a competitive field? The answer here is to do substantive research that you are interested in with a “CAPE” mentor (Capable, Available, Project interests you, Easy to get along with). As my premed advisor once told me, “Mickey Mouse” research is not going to look good to anyone (no offense Mickey).The key is to find something you are passionate about – after all you have to tell this story on your interview trail of why you choose to do this and the answer “because I wanted to go into ortho” is not really that captivating to anyone (even to an orthopedic surgeon). Instead, if you do something you are passionate about, like community health work, you can always tie it back to your chosen field. Most residency program directors don’t expect you arrived in medical school with laser like focus towards their field anyway and expect to hear some type of journey or a-ha moment that drew you to their field. Because competitive specialties are often reimbursed for clinical work and tend to be smaller departments, they depth of research opportunities may be more limited. But, don’t forget that neuroscience research is relevant to neurosurgery – and oncology research on head and neck cancer is still relevant for ENT and so forth. The best research is often interdisciplinary and crosses department boundaries so you should not be afraid to either. It’s also important to remember that as a first year student, it’s hard to even know if you will be competitive for radiation oncology or associated competitive specialties. You will need killer board scores, and great clinical grades. So, while you may think securing the research with the Dept Chair will give you an extra ‘edge’, nothing and no one can make up for a poor performance on high stakes exams or clinical rotations. So, don’t forget to study!
I want to go to country X? How can I get a global health rotation there? Well, certainly the urge to travel is strong in anyone (including me). But, you need to separate your travel bug from a genuine interest in global health. Most global health rotations are not a vacation – and may not be what you think of as “tourist” destination (despite the short-lived popularity of Off the Map). Maybe your stars are aligned and your school or a nearby affiliate you know has a program near your hot spot of interest. Usually, however, it is not that easy and you should consider how strong your affinity is for a specific country or location versus your interest in getting the best global health experience possible. Global health programs that fund medical students are not easy to come by. So, if you are genuinely interested in global health, it is always better to go with an established program and mentor to get the most substantive experience even if it’s not in the exact country you are interested in. The other thing to remember is while this may be your last summer for a while; it is not your last vacation! You will have time to plan a vacation to your designated hot spot if you can’t work it in this summer.
Do I have to do anything? The answer here is easy – no, you don’t have to do anything per se with your ‘time off’. Many students find themselves on thehamster wheel of endless extracurricular activities. The real question is what is your goal? If it is to go home and see family and friends, there is nothing wrong with that! The key is to ensure that you are doing something with your time off that will make you feel ready to face the second year of medical school. It is easy to forget that there is a lot of time to participate in extracurricular activities at various other points in your medical school career. The key is that if you will regret not spending time with your friends or family this summer, then you need to make time to do that.
What if I want to do everything because I don’t want to close any doors? This is not an uncommon feeling for medical students. However, its important to remember that your summer work is not choosing a specialty! There is essentially nothing you can do over the summer that will ‘close a door’ – there may be some things that allow you to put your foot further into the doorway but that does not mean another door will close. The only doors you close are the ones in your mind. Most students decide on their specialty after their third year rotations and will often fine-tune their experiences in research in that area in the fourth year. Another thing to consider is to do research in a cross-cutting area like ethics that could apply to everything. Sometimes the angst you may be feeling is about making a choice that is wrong for you. However, the truth is that as long as you are genuinely interested in the opportunity, you cannot make a wrong choice since it will be an easy story to tell no matter what you do. Since everyone is different, it is always good to get individualized advice from a faculty advisor at your school who can comment on your specific career and research goals.
Finally, no matter what you do with your last summer, don’t forget to make sure you enjoy it!
Yesterday, a tweet caught my attention from @JasonYoungMD who stated “My Five Foundations of Felling Fine: Food, Fitness, Friends & Family, Falling Asleep, Fulfillment.” This seemed like the best advice I had heard for the newbie interns taking teaching hospitals by storm as well as the rising third year medical students who are about to be unleashed on the wards (if they haven’t already). It also is a great starting point for program directors who are wondering how to ensure that their residents are “Fit for duty” according to the new ACGME rules.
Food – While this is basic part of sustenance, finding food sometimes in the hospital can be challenging, especially at odd hours. Fortunately, this has gotten better, but the choices may not be healthier. In my own hospital, I’ve seen the front lobby transform from a small coffee kiosk (Java Coast which was celebrated when it arrived) to a full fledged Au Bon Pain (ABP as we affectionately refer to it). While ABP was a welcome addition, it is easy to consume a lot of empty calories eating muffins or breakfast sandwiches! To make matters worse, research from one of our very own sleep research gurus has shown that the more sleep deprived you are, the worse food choices you make! Therefore, the thing you will reach for after a night shift is going to be the carbohydrate loaded Danish. Residency programs must know this and usually have morning reports full of this type of food. So, consider how you will make healthy food choices – whether that be bringing your own food, or finding out where the healthy options are. Lastly, don’t forget about the empty calories that come with beverages, especially coffee-related drinks. For you Starbucks fans, there is an app for that – and I guarantee you may change your choices.
Fitness – Like food, fitness can be hard to come by. Interestingly, working in the hospital can actually be a way to get exercise. For example, some studies demonstrate that residents walk as much as 6 miles on call! However, its also just as easy to sit behind a computer and take a “mission control” approach to your call night where you are monitoring all your iPatients. So, think about this and consider wearing a pedometer and most importantly getting into a routine. When time is of the essence, find a way to work fitness into your day like taking the stairs in lieu of the elevator, or parking farther away. If you join a gym, you have to make sure you go…and one easy way of doing this is to make sure your gym is on your way home from work and that is your first stop. During residency, I actually switched to a gym that was directly on my route home that had a parking lot so I literally had no excuse and actually felt guilty while I drove by and did not stop there. Others opted for 24hour gym craze that that could work for anyone’s schedule. Lastly, exercising with a friend will likely lead to greater results than the solo work out.
Friends & Family – Speaking of friends and family, this is the support system that gets interns through residency. Fortunately, another omnipresent F can be helpful here – Facebook. Busy interns or students can at least get reminders to electronically wish your friends happy birthday or log in on that random Monday off to reconnect with friends. It’s also important to set appropriate expectations with your friends and family, for example when you are starting on a time intensive rotation that can be demanding. Because of the intense nature of working in the hospital, some of you will form fast friendships with your co-interns and residents which can be helpful to get you through. However, even your closest friends (including those at work) will ask you to choose between them and sleep- which can be very tough when you are running low on sleep.
Falling asleep –So, speaking of sleep, my first question was where do I sleep? Sounds silly I know, but I actually did not know where the call rooms were or did not have the call room key for my first call night ( I actually can’t remember which) so I ended up going to sleep for an hour in an unoccupied hospital bed. So, this may not be possible today for 2 reasons: (1) interns are not likely sleeping when working the jam packed 16h shifts; and (2) hospital beds are nearly always filled! Still the challenge for today’s interns is getting sleep when working odd hours, especially if starting night shifts on night float or ‘night medicine’ as programs are evolving to include more night rotations. If this means you have to invest in window treatments or wear an eyeshade at night, just do it. There is nothing better than sleep for a resident and the more the better. While your sleep at home may be limited regardless due to your other family obligations, its important to know your limits and set aside nights where you will recover.
Fulfillment – Last but not least, its important to figure out how to keep yourself happy and fulfilled during your residency. In some cases, that is a particular hobby or loved one that you need to stay in touch with. In other cases, fulfillment is more complex. It is not uncommon to have doubts about your future career as you stand by the fax waiting for outside hospital records, wait on the phone to schedule a follow up appointment for a discharged patient, or even transport a sick patient to get a needed test. While many are working on ways to reduce the burden of this largely administrative work, interns and medical students are still straddled with a large amount of scut which can be demoralizing. So, where do you find the fulfillment in your work? Well, you will find it when you least expect it – in the words of a patient who is eternally grateful. In other cases, you will meet a mentor or role model who shares your passion and interest in medicine, whatever that may be, and can inspire you to keep you going. Whatever it is, find it and hang on to it for dear life during your darkest hours and it will pull you through.
I do need to add one more F to this fine list – So provided that you are keeping up with the first 5 F’s, the best thing is that being in the hospital, learning medicine, and caring for patients is actually FUN! So, don’t forget to pause and enjoy it…these tips will also serve you will in the FUTURE!
–Vineet Arora, MD
Other helpful posts to conquer any FEARS of starting on the wards: