This thing I refer to as My Life

Happy New Year!!

This posting was actually intended for the official site, too. However, I have decided that since it may upset some interviewers, I would only post it here. At least initially. I don't was to incur any added stress because some interviewer happen to google my name and discovered the school blog. As such, I have even added in a little comment at the end from ML!

What you are about to read is what I have been doing for the last month and will continue to do next month. In other news, I have decided not to do a coronary care unit month, after my Jan interviewing "break," rather, I am going to do a second month of transplant surgery. I will probably spend most of my time in the ICU and clinic instead of the OR, but I may be able to sneak in some OR time and maybe get to fly in the helicopter, again.

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Would you like to dance?

From the poor grammar on my blogs, it should be apparent that there is no editing done on the part of the university. In fact, they have really made just one request of me, at least, which is to post something about the residency process. At first I was quite hesitant because all of this information is in the public domain and, if anyone searches my name this is one of the first things that shows up: a not-so-little element of danger. As such, I have not posted much. But, now that things are about half over, I am a little more confident that there will be some level of anonymity and possibly more importantly, I have nothing negative to say. It is important to note that my views will not be shared by many of my peers, especially those working towards residencies in different fields.

One of the early steps in the process is deciding what area (or areas) for which you are going to apply. Although I tried to deny it (and all of my friends thought it was obvious), I am applying for residency in Radiology. Once that decision is made, one fills out an application to the field(s). Most of the programs utilize the same online application that goes by the name of ERAS. In a lot of ways, it is similar to medical school applications. I think the most challenging part is the personal statement. Here, you are supposed to highlight your life and describe what makes you a unique candidate over all of your peers. Within the character limit, you have a great deal of latitude as to how to make this thing appear, however, the general consensus is you do not want to be to much of a character when you compose it. You want to be interesting without being strange, dishonest or annoying. You want to write creatively enough that you can draw a reader in to the story because each interviewer has just a fraction of time to go through your application. The other rule of thumb is that the personal statement will rarely elevate the status of your application; however, it can severely lower it.

Some students suffer from not having enough interesting things to write about while others have a difficult time creating a short story of their life. As you might guess, I suffered from the latter. I started rather early in the summer and went through several iterations and complete rewrites until I achieved something that was reasonably short, somewhat interesting and useful to the reviewer. I think this process was the most stressful part of the process, so far.

Once the applications go out, you start checking your e-mail very frequently for the first replies. Weeks start to seem like months until that first e-mail arrives. Since I am applying to Radiology, that means I also have to apply for a transition year program for my intern year. Because of a "little" computer SNAFU, the transition year invitations came in first, actually, while I was doing my away rotation in Texas. After an invitation is received, one schedules an interview and there is this attempt to schedule them such that, if you are traveling, it is in a coordinated fashion. This does not always work the way you would like it.

The interviews follow similar formats. Often, there is a little introduction to the department and hospital which is followed by a series of interviews. The transition year programs usually have one or two interviewers and the Radiology programs have three to six interviewers. Usually they are one-on-one interviews, however, there was one program that was two-on-one. The latter of which one would think would be intimidating, however, the way it turns out is one of the faculty members asks you a question and while they are recording your answer, the other asks you another question, so it turns out to be an efficient means to transfer information. How useful the information is, I am not certain, but they did get a lot of it.

Take a moment to step back. There is a well known book about the residency interview process. Many of my classmates found the book to produce a considerable amount of anxiety. In part due to the large section in the text about the questions and suggested answers, or at least guidelines as to how to approach the answer. Some of them are quite bizarre, but I found it more difficult not knowing what to expect. So, when I was on my rotation in Georgia, I read through the book while riding the train to work. I worked through all of the questions and it has made me much more comfortable when interviewing.

The Dance

I'm not sure why I call it this, but it seems to fit. Often, the dance starts long before you arrive at the location. I suspect the dance actually starts when you accept the invitation and the interchanges that take place in making the arrangements, but things really heat up when you get to where you're going. Many programs will have a dinner the night before and it is clear that the dance is in full swing. You want to dress nicely, but casually. These dinners are presented as an opportunity to get to know the current residents and sometimes some of the faculty. I think that is true, in part. I wonder if it is more to see how well the current residents like you, which is important; however I wonder if you can make that type of judgment based on one evening. I liken it to speed dating and I think it is difficult to truly get a sense of someone from just one evening, but that is the current paradigm.

Generally, the evening ends fairly early since you have to be bright-eyed and bushy-tailed the next morning for the big dance. This dance starts bright and early with a lot of grooming and donning of the interview uniform. The parameters for the uniform (as set forth by the residency book) are stricter for the men than for the women, which I think is actually good for us (men) since we don't have to agonize over what to wear. Gray or navy suit (a lot of people wear black now), white or light blue shirt, a conservative tie and polished shoes. If you are staying at a hotel, You pack up all of your clothes and check-out. Showing up late is considered a poor form but even more so if you do not call and let the residency coordinator know. Arriving 10 to 15 minutes early is considered arriving on time. Actually, I think some of this is residency dependent as I have not sensed any bad vibes during my Radiology interviews when someone shows up a little late.

You arrive--it helps to have a smile on your face and a pleasant attitude. After all, if you cannot put your best foot forward on this day, what are you going to be like post-call? After finding your way to the residency coordinator, you introduce yourself and there is no doubt the dance has begun. Generally, you are seated in an area while all of the other residency applicants arrive. Some times the interviews start promptly, other times there is about 30 minutes built into the schedule. Introductions usually start around the room. Often, you'll already know several of the other applicants from previous interviews. Small talk is the order of the morning and often related to distance of travel. If there was a gathering the evening before, there might be some recap of how nice the evening was and if there was any difficulty returning to the hotel. Fortunately, all of those nice things have been perfectly truthful. (In the dance it becomes a little difficult separating truth from fiction--reality from your preconceived notions of ideality. Maybe the seasoned interviewer is able to avoid this pitfall.)

Some interviews will split the applicants into groups where one group interviews first while the other group tours the facilities. I find touring first and interviewing later to be a little more relaxing, thus I am usually in the group that interviews first.

The interviewer will often greet you at the waiting room (for lack of a better term) and walk with you to some office. Sometimes it is their office, which gives you a little advantage. You can look around the room and see what kind of art, photos or other information can be gleamed from the walls in a "Usual Suspects" sort of way. They can be used for ice-breakers or as a final question…"You have some model trains, is that one of your hobbies?...You know, one of my best friends from high-school has starting getting into that, he has the strangest set of hobos, prostitutes and pan-handlers for his set! Who would have thought?" Yes, I did actually get to say that, and yes, it is actually true! (Thanks, David!) It is a great way to end an interview…I think. I suppose we'll see. But, I have jumped to the end, let's go back to the beginning.

The interviewer often has a list of standard questions, however, if they found something interesting in your application material, they will forgo the standard questions ("How would you describe yourself in one word?") and ask you something more interesting. I think this is one of the few instances where being a non-traditional student has an advantage--I don't know if that extends beyond the interview itself, but it helps in the interview. For me, the most frequent question is how I moved from my career in chemistry over to a career in medicine. I can babble about that for a long time, but I try to keep it down to a 5 minute story. (Obviously, that is a challenge for me.) Thus far, everyone has seemed to like the story and think that it makes sense. It is rare that someone asks why I am going into Radiology, but often they will ask the legitimate question of if there was anything other field that I found interesting. My favorite way of having this question asked, so far, was, if Radiology just was not an option, what other field would you pick? I think that is a very telling question in that it highlights a lot of what you like about the field to which you're applying and about you as a person.

Sometimes I will be asked if it was difficult making the decision to go to medical school, which I think is another good question mostly because it shows that they know there is a world outside of the hospital; and, because it was not an easy decision to make. At that point, they will usually start to tell you the highlights about their program. This gives you a moment to breath and relax until the last step comes: "Do you have any questions for me?" According to the book, you should always have questions for the interviewer. They can be about the program, the hospital or the area. It does not matter if you have asked the question to every other interviewer at the program and, I happen to think, that asking the same question to several people can be valuable if it is a valuable question. I think it is more likely that you are getting the real answer if everyone is in sync. However, it may just be that the question was a well anticipated one and the answer was agreed upon beforehand. (Just because two people are dancing the Tango, it does not mean they are actually lovers, does it?) Some interviewers will start by asking if I have any questions for them putting me in the hot seat first, but I believe the onus to get things started should be on the interviewer.

Once the interviews are done, many students think this is the time to relax and I am certain that the faculty and staff want this, but it is a fool who thinks the dance has ended or even taken an intermission. The dance continues.

The tour of the facilities is often the most repetitive part from program to program at least for Radiology since a CT is a CT, an MRI is an MRI and an angio suite is an angio suite. Well, the latter is not entirely true. I have noticed some differences in the modernization of some of the interventional suites and it is nice to see a large, modernized room, but I don't think it will have that large of an impact on my decision making process. Not because of disinterest, but rather because all of the suites I have seen seem usable and I don't know enough about the interventional subspecialty to make too strong of a value judgment on the modernizations. Maybe that should be another question of mine to ask the interviewers. The two things I am most interested in seeing are the reading rooms and the conference room. Many of my fellow students would add the cafeteria in that list but I am trying to make food less important in my life. The reading room is where the radiologist views all of the data and produces the reports. This is where most of the radiologist's time is spent. The conference room is probably the next most utilized space. I suppose the residents' lounge should be high on that list also but it does not seem that radiology residents have a lot of down time. You are either busy or you are home. That is one of the perks of the field. On the down side, when you are on call you are constantly busy.

Fortunately, most of the residents that are taking the applicants on the tour understand that there is little value in seeing yet another 64 slice CT or 3T MRI: Both of which are great things to have but not terribly exciting to see. Much of the tour time becomes time to ask the residents questions and hear what they have to say about the program and their experiences. I find that the more time I get to spend with the residents, the better able I am to assess the program. That does not mean I have to ask all (if any) questions, but rather pay attention to what he or she has to say, read their body language and pick up on subtle (and not so subtle) clues. At least that is what I am trying to do.

The tour is followed by lunch. This is where I have seen most of the students forget they are still in a dance and, so, as far as the program goes it is probably the most informative. Depending on the size of the group, the lunches can be catered or simply through the hospital cafeteria. With your table manners all in order, you want to pick something that is not going to be too difficult to eat. You don't want to look like you're a pig. And, you don't want to complain. I have seen all three, but I suspect the latter would be the most unhelpful in the dance.

Many programs will take you to a regularly scheduled seminar. This is where I have the most difficulty. Since bathroom breaks are few and far between (if you get them at all), you are supposed to stay away from diuretics like caffeine. (Oh! Did I mention that you are not supposed to take coffee or water into the interview with you? Something about being disrespectful or not taking the process seriously. I understand this rule of the dance the least, but this was impressed upon us in our M3 surgery oral exam.) You have been awake since early in the morning. You probably did not sleep terribly well in the hotel bed. You are coming off of the adrenalin rush of the interview. And, now you are in a lecture in a dark, warm room just after eating. Does that sound like a recipe for anything?

Sometimes the lecture is just before lunch, which is a little better. However, If there are enough applicants or interviews to fill the morning, the tour may be after lunch. There is usually some more time to interact with the residents at some point during the day or there may be presentations by the radiology faculty. For the interviews that I have had so far, those are the key songs no matter what order they are danced.

The dance requires grit, grace and gratitude. A little luck will likely to go a long way, too.

Aside from ML: (When ML edited the blog she had this to say in reference to my observation about not being allowed to take drinks into the interview with you…) "Of course this is rude! You are thinking about your own comfort over the fact that you were invited to spend time with the interviewer! You are also insinuating that they have not thought of your every need--they are being an unthoughtful host." (That last part was actually underlined three times. Can you tell we were brought up in two different environments?)

Maximum Security Psychiatric Hospital

That is the official description of Forensic Psychiatric Center. Actually, that rotation ended several days ago, but I want to share a particular story and it was important that some nondescript time pass.

On my last day, I sat in on a competency and liability examination. This person (not a patient) had being charged with two counts of open murder. Open murder, by the way, means the prosecution is not sure to what level (murder 1 down to manslaughter) this person is responsible, but it will be some degree of murder charge. The person had a history of psychosis and the defense attorney wanted to have an official assessment to determine if the mental illness played a roll in this case.

Just the day before, I had learned how to read some of the tattoos such as the teardrop tattoos next to the eye is supposed to symbolize the number if murders that person has committed. Sad thing is I have seen a person that had teardrops that ran into a puddle on the cheek. (Not the person in this story.) Now I know what that meant. This person had a symbol of the gang on the inside bicep and the area code of the location of the gang on the forearm on the same side. On the other forearm was the person’s name in the gang. Well, it was more interesting at the time than it sounds right now. Oh, well.

According to the police report, the story of the person being prosecuted went something like this: there was a report of a big argument between a couple and they separated. One member of this couple went and gathered some friends (group A) and returned to the house to pick up some personal items. The person at the house had also gathered some friends (group B) and when they were all together, group B threatened group A and damaged group A’s vehicle as group A left. Shortly there after, group A returned in a different vehicle and shot at the house in classic drive-by shooting fashion. However, the intended party members were not in the house at the time. Rather, there was an underage minor and another adult who were both killed by one of the members of group A (which included the examinee).

Walking into the facility:

The hospital is only two years old. Photography is not allowed inside so I will try to describe it. (You can see the outside at this link and go to the Center for Forensic Psychiatry in Ypsilanti, Michigan.) You emerge from two sets of non-descript double-door into an expansive hall: Very wide, two stories high with large windows down the left and a loft of office cubicles on the second story on the right. A series of open electronic gates are positioned 5 yards ahead and to the right. A large, arching, information desk is positioned to the left. In between is a metal detector followed by an X-ray baggage machine. Beyond, breaking up the hallway, are two tall, sequential, sideways-arching planters with a series of chairs curving gently on the concave edge. After swiping your card at the electronic gate, causing your face to appear at the central security station, you can hear your footsteps echoing down the hall. Light shines on your left as you approach a wall of glass—bullet proof, thick, set into heavy duty metal. To the side the glass is mirrored—nothing but your darkened reflection—surrounding the security station. Moments pass, an odd smile on your face, the wall slowly starts to slide open. Passing through, it immediately changes direction to shut. As it quietly latches closed (not like the movies) you have that sense down your spine that you are in, but getting out is not entirely your decision. In front is another long hallway. Not as tall or wide, but longer and expansive none the less. You turn left and go around the mirrored guard station to a normal sized metal door with a small bullet proof window. The motorized dead bolt slowly pulls back. In front of you is an open guard station, which faces to the right, with several guards behind it—you enter from the side. To the left is small a coffee room followed by two larges seating areas. The first is usually empty. The second contains the accused who are awaiting psychological examination. Sprinkled among the examinees are uniformed prison and jail officers.

The Forensic Center guards are cynical with a splash of friendliness. They are curious about a fresh face passing through the side door. After quizzing you as to why on Earth you would volunteer for such a rotation they welcome you and inform you of the three punch warranty: no one will be able to land more than three punches on your before help arrives. (I immediately asked them what I get if they don’t make it in time?...A fourth hit. But that hasn’t happened…yet.)

Further down the hall is a series of small examination rooms. Everything still looks new, but there is a very slight acrid smell of smoke and stale air: a desk secured to the wall and floor with a chair on either side; a video camera is placed in the upper corner of each room. The chair closest to the door has a red panic button on the wall an knee level—if you think you’re getting into trouble you can just swing your knee out. The examinee is called into the room by the therapist and asked to sit on the inside seat. (As a rule, you never let the person come between you and the door.)

The examinee is informed that everything said in the room will be shared with the court and that there is no confidentiality. They are instructed to only answer questions they want to answer. Part of the exam is to determine if the person is able to assist in their own defense and if they understand what is taking place—competency to stand trial. The second part of the exam is to assess if the person was sane at the time of the event—criminal liability. The former is much easier to assess than the latter and the latter may not be testable at all if the person refuses to discuss the events around the alleged crime.

The exam starts similarly to any psychiatric exam except a bit more detailed. Medical history, surgical history, medications, hospitalizations, psychiatric history, social history extending back several years, housing status, job status, education, abuse history, drug usage history, family history, depression screening, mental status exam, etc. Then a discussion of the alleged crime is broached. The examinee is asked to describe the days and events leading up to the alleged crime: every detail. The event itself is often skipped by the examinee, as it was this day. Then the details of the time after the alleged crime are discussed. The stories (which can last well over an hour) are not usually linear, rather they overlap and gaps which need to be "filled in." When it is clear that the examinee no longer wants to discuss such details, the exam is concluded with a discussion on the basic events and people involved in a trial. At best, the entire exam is two hours. It is usually longer, especially for new examiners. Time passes quickly, but you are mentally and emotionally drained by the time it is over. At my stage in my career it is not possible to suppress the tidal waves of emotions brought out during the examination. For that, I am happy.