Hello friends!

What’s next - nurse anesthesiologists? 😭🙏🏼

[Serious]

Faculty here. I've seen comments and concerns expressed from students that their application was overlooked when sending out invites, and therefore a program does not actually practice the "holistic review" that they preach. So, I wanted to share my perspective as a reviewer/interviewer of 5+ years to hopefully give some transparency. Obviously this is my one perspective at one program, and every program will approach things differently, so take this with a grain of salt.

What holistic review means IMO:

1. Grades: Taking into account that your med school is entirely P/F and doesn't give a rank, when other applicants have ranks or quartiles and may have honored 7 clerkships.

2. Factoring in life experience, such as working in the service industry or military or having had a prior career, which means you may have less time for extracurriculars or publications (honestly former servers tend to have great people skills).

3. Board scores: Just because you have a 280 Step score doesn't mean an automatic interview if it's clear you are dual applying (based on clubs/volunteering/research) and my program is a backup. Similarly, just because you have a 219 or 401 doesn't mean I'm putting your app at the bottom of the pile.

4. Scholarly activity: were most of the posters and papers you listed from your undergrad thesis on corn rhizomes in 2020-2021? Or were they in my field and recent? Were they presented at national conferences, or at your school's research day?

What holistic review is NOT:

1. Overlooking your misdemeanor/felony charge or your professionalism strike on your MSPE just because you had great test scores or grades. There are many perfectly great middle of the pack applicants who don't have red flags like this, so explain what happened if you can, and be prepared to talk about it in your interviews.

2. Inviting or not inviting someone based solely on the total number of publications, extracurriculars, awards, etc. For example, volunteering: someone who has one volunteering gig that they've been doing weekly for 3 years may be viewed more positively than the person that listed ten separate one-time events such as running a booth at the breast cancer or Alzheimer's walk.

The reality of the Match is that there are more applicants than spots in basically every field, so some people just won't make it, and that sucks. We are doing our best to choose our future colleagues, and personally we really agonize over our rank list each year, so these decisions aren't made lightly. Good luck to you all.

Before med school, I could ignore a headache. Now I have a whole differential diagnosis in my head.

What's the most ridiculous disease you've convinced yourself you had after learning about it in med school?

I am a nontrad MS2 recently engaged, and my fiance and I have been thinking about when we would like to have kids. Since I’m nontrad and I don’t want to wait until I’m 35+, I can’t wait until I complete residency to have kids. So to the moms out there who have had babies in med school/residency, please share all your advice!

My future hubs is currently in residency and will complete his training at the same time I complete med school. So, he will be an attending at the same time I’m a resident. So although finances won’t be an issue, we will both unfortunately be pretty absent parents for the first few years and will be relying heavily on family members/daycares/etc. Some people say M4 year is a good time, but I’m worried about seeming visibly pregnant during away rotations; as unfortunate as it is that this happens, I want to avoid any biases against me. I’m also worried about having less time off during residency than I would in my M4 year and want to give myself enough time to recover before getting back into the full swing of residency. Just thinking about all of this feels pretty overwhelming tbh.

TLDR; Seeking advice for the best time to have a baby and what recovery looks like as a woman going through med school/residency with a partner who also works full time

Gonna be starting rotations soon and just thinking about STEP 2. Is there anything you wish you would’ve done differently that would’ve made dedicated easier / better? Or maybe that would’ve helped you score higher?

I plan to use ANKING but I’m also just conflicted should I plan to do only my incorrects or all the tags for that specific rotations.

Thanks in advance.

M1: “Here’s a multivariate, credit-weighted, heteroscedasticity-adjusted Bayesian regression model incorporating the cumulative integral of examination performance, normalized z-scores, standard deviations, confidence intervals, and a Monte Carlo simulation of 10⁶ hypothetical academic trajectories, wherein your final preclinical grade is calculated as (G=\frac{\sum_{i=1}^{n}w_i x_i}{\sum_{i=1}^{n}w_i}+\int_0^T f’(t),dt-\lambda\sigma^2+\epsilon), subsequently subjected to a nonlinear logistic transformation, a two-tailed hypothesis test at (\alpha=0.05), and a 95% posterior credible interval, ultimately demonstrating with 99.7% statistical confidence your class rank”

M3: “Yo Steve, could you remind me how Alex looked? Ya, the M3 who just rotated with us…. No, that Alex was the PA student…. Sure I guess High Pass”

I'm lucky enough to have received several interviews. I was wondering about how the rank list limit works. I know you can rank 20 for free then a fee for each after that. If I applied and rank Program X for track A and B does that count as two ranks or is it by program so it would only count as one?

I feel like it’s really hard to tell after the fact. Are there any signs that you did particularly well or, on the other hand, that an interview didn’t go great?

Also, how do you know if you were just kind of average? Like the interview was fine and you didn’t do anything wrong, but you also probably didn’t stand out much.

Would be interested to hear from people and how you usually judge or grade your own interviews afterward.

Hi everyone, I’m shadowing in the OR tomorrow and was wondering how early to get there before the case starts? I don’t want to bother the surgeon asking this late on a Sunday night, so any help would be appreciated 💕

I'm sitting on 4.

Noting that the average for unaccepted is 4, average accepted is ten.

Anyone with thoughts?

Edit: guys this is not ChatGPT. This is something that actually happened to me. I wrote about it because it was such an insane experience and genuinely want to know if anyone has had something similar happen to them.

I have been having a really difficult time on my surgery rotation, and something happened this week that I haven’t been able to stop thinking about.

For context, I’ve been 100% set on surgery throughout medical school. I’ve served on a national surgical board, taught suturing classes, and taken a dissection elective so many times that my school eventually started paying me for my work. I’ve been told time and time again that I have the skill set and attitude to succeed in surgery, and until recently, I never really questioned that it was what I wanted to do. I should also mention that I’m a 4’11”, child-looking, 26-year-old woman. I’ve never really felt like my appearance affected how people perceived me or my abilities, but these past few weeks have honestly made me start questioning that.

Three weeks ago, I started my general surgery rotation, and my God, I have been absolutely MISERABLE. In my first two weeks, I scrubbed in a grand total of twice. The first time lasted maybe two minutes because the resident wouldn’t let me help close port sites. The second time, I got my ass absolutely handed to me by an attending because I didn’t know the full steps of a tracheostomy. She told me I needed to get my shit together if I ever wanted to audition for her program.

In general, I’ve been treated like some sort of inconvenience who’s constantly getting in the way of everyone’s “real work” (actual words said to me). I feel like I’m barely acknowledged unless I’m doing something wrong, and I’ve spent most of my time just trying to stay out of everyone’s way.

I keep telling myself it’s the program and not the field. I’ve talked to visiting residents who have reassured me of the same thing and encouraged me to do an elective with them. Other people, though, have told me that if I’m questioning surgery at all, then maybe it just isn’t for me. And that has really been getting to me.

I’ve spent years working toward this, and suddenly I’m questioning whether I want to spend my life around people who make me feel so small. I’ve been going back and forth in my head, wondering if I’m being too sensitive, if I just need thicker skin, or if I’m genuinely getting a glimpse of what my future could look like. More than anything, I’ve been disappointed in myself for even considering giving up something I’ve wanted for so long because of a few miserable people.

This week I finally had a day where I actually got to participate in surgery. I was able to scrub in, help with small parts of the procedures, and feel like I was contributing something. One of the cases involved an older woman undergoing abdominal surgery, and I had the opportunity to assist in ways I hadn’t been allowed to before. It wasn’t anything groundbreaking, but after spending weeks feeling completely useless, I was genuinely thrilled just to be there.

I’ve always had this little habit when I’m working with patients. I’m not religious, but whenever I get the chance to place a hand on someone, I take a moment to silently send them some sort of good intention or positive energy. I don’t really know how else to describe it. I used to do the same thing in the cadaver lab, even though those individuals had already passed. It was just my way of acknowledging that this was a person, someone who was allowing me to learn from them, and that I was grateful for it. So I did the same thing during this woman’s surgery.

The case went well, and I left the hospital that day happier than I’d been in weeks. For the first time since starting the rotation, I was reminded of why I loved surgery in the first place. Not the prestige or the idea of being a surgeon, but the actual work. Being in the OR, working with my hands, learning anatomy, and having the privilege of caring for someone in such a vulnerable state. That was what I wanted.

The next morning, we saw the same patient during rounds. After the residents finished with her, they left her lying flat in bed. Bedside manner hasn’t exactly been a priority on this service, so I stayed behind to raise her bed and make sure she was comfortable.
As I was adjusting things, she looked at me and said, “I know you.” I laughed a little and said, “Well, I was at your surgery yesterday!”

She looked at me and said, “I know. I felt your spirit with me when I was under.”

I genuinely didn’t know what to say. Of course, my immediate thought was that she was probably a little out of it from her medications. I was trying to come up with some sort of rational explanation, but I was also curious to hear what she meant.

She told me she felt like she already knew me, that she could sense I had been there with her, watching over her, and that I had a kind spirit.

Now, I know there are plenty of explanations for this sort of thing. But what got me was that there really hadn’t been much opportunity for her to recognize me. I was covered in a mask and surgical cap, and I hadn’t spoken much during the procedure. Before I left, she asked if I would come back and see her later.

When I had a free moment that afternoon, I did. She had a family member visiting, and I was honestly relieved because part of me was still wondering if she would even remember our conversation from that morning. She did!

We ended up talking for quite a while. I learned about her life, her family, and who she was outside of the hospital. I thanked her for allowing me to be part of her care and told her that she had been my teacher. Without patients like her, I wouldn’t have the opportunity to learn any of this. It was just a really lovely conversation.

Eventually, I told her a little about myself and what I’d been going through. I explained how much I had always wanted to be a surgeon, but that the past few weeks had made me question whether I was really cut out for it. I told her how discouraged I’d been feeling and how strange it was to suddenly be so unsure of something I’d spent years working toward.

At one point, I half-jokingly told her, “If you tell me to keep going, I’ll work toward matching into surgery.”

She thought about it for a moment and said, “I want you to do what you know you will be the best at.” And without even thinking about it, my mind went straight to surgery. Then she added, “And knowing you, you will be the boss.”

I don’t know why, but that absolutely broke me. Here was this woman who had known me for maybe a few hours, telling me exactly what I had been needing to hear for weeks. She didn’t know the extent of how miserable I’d been or how much I’d been questioning myself. She had no reason to know any of it.

I had spent the past three weeks feeling invisible, like I was a burden to everyone around me, and somehow this woman, who barely knew me, made me feel more seen than anyone else had. And what really gets me is that I wasn’t even supposed to have some profound interaction with her. I was just happy to finally be involved in a surgery. The following morning, I only stayed behind because I noticed she was uncomfortable and wanted to help her. It was such a small, ordinary moment, and somehow it turned into something I think I’ll carry with me for the rest of my life.

I’m not religious, and I tend to look for scientific explanations for things. I know she could have been influenced by medications, or maybe she simply picked up on something in the way I interacted with her. I don’t know. I’m not necessarily suggesting anything supernatural happened. But I also can’t explain why meeting her, at that exact point in my life, felt so significant.

I had been feeling lower than I ever expected to feel during medical school. I was starting to resent something I’d spent years loving, and I was genuinely afraid that maybe I had been wrong about myself all along. And then I met her. I cried in the hallway after.

I don’t know if I believe in angels or fate or people being put in our paths for a reason. Maybe it was all just a coincidence. But if it was, it was a pretty incredible one. I went into that OR thinking I was there to learn something from her surgery. I never expected that she would end up teaching me something about myself. I’m still not sure what to make of the whole experience, but I think it was exactly what I needed.

Has anyone else had an experience like this with a patient? Or had someone come into your life at exactly the right moment and say something that stayed with you? I’d really love to hear your thoughts, advice, or similar stories.

TLDR: I have been struggling on a hostile surgery rotation and questioning my dream of becoming a surgeon. During rounds a patient said she felt my spirit with her during surgery and encourages me to pursue what I know I’ll be the best at. The encounter made me feel seen and reminds me why I love surgery. Though I’m not sure whether it was coincidence, medication, intuition, or something spiritual, the patient gave me exactly the reassurance I needed.

I know

Just sleeping

And take a hot shower 😭

I'm just a bit worried about my grade on a particular 4th year elective because the preceptor has been very unfriendly and my grade is entirely based on his evaluation.

Im having some trouble finding a good pace to study at. For example, I’m going through sketchy pharm, watching videos and doing the anki after the videos. For some of the videos I am also doing U world questions. However, I find myself being slowed down by constantly reviewing the anki cards. I thought I could get through Sketchy pharm with anki in two weeks and now it’s taking a month.

What is a good pace to study and review?

Preceptor comments: exceptional exam, used feedback to make extremely thorough notes more concise, helpful for management of patients that were not primarily theirs, impressive. Functioning beyond training levels.

Grade: high pass

What the fuck bro

Even tho I’m not getting many interviews in IM, I’m pretty damn proud of my personal statement. I tell myself they didn’t even get to that before they screened me out. And that is their loss. Anyone else feel the same? (USMD, would appreciate if commenters could indicate USMD vs -IMG cause it’s a different experience)

Hello all! I'm curious as to how medical schools handle cadaver lab PPE. I'm currently in a cadaver lab at my university, and I was shocked yesterday when we were using bone saws with no PPE whatsoever. Formaldehyde is a carcinogen, so doesn't it pose a toxicity risk to us to breathe in bone dust from formaldehyde-preserved cadavers?

Thanks for the answers! I know it's stupid, but I am a little concerned about this. I don't want to develop health issues later down the line because of my undergraduate/medical school cadaver lab.

Just want to clear this up based on the recent discussion that wasn't making a distinction between CFS without PEM and ME/CFS with PEM.

PEM is what makes ME so bad. A type I (or maybe II) interfereon response triggered seemingly randomly, but which over time patients start to recognize tends to happen 12-48 hours after exertion. The exertion can be fairly mild exertion.This PEM is totally crippling/disabling because you have to shut down your life to try to stop the PEM reactions. If you push through, or make a mistake, even smaller things set you off the next time and you get even more intense interferon responses in a vicious cycle.

Yes, this causes deconditioning as a comorbidity, which has its own awful symptoms including fatigue, but the deconditioning does not cause PEM itself. If I could eliminate PEM I'd be in the gym every day working towards getting my life back, pushing through any amount of fatigue and agony. The #1 thing I want in life is the ability to exercise without risking becoming permanently bedbound.

Wondering how many of us here actually have enough time to work out.

I just graduated medical school, and I'm in this awkward in-between phase where I'm just waiting for residency to start along with a few side hustles (step 3 prep, work). So I kind of have more time and I'm wondering if I should just bite the bullet and start working out.

I gained a few pounds during my Step 2 prep (shoutout to Chick-fil-A). I've always been severely underweight so I know next to nothing about the gym, let alone how to fit it into a med student/physician schedule.

Does anyone here have the time to work out, and if so, what's your schedule like?

I dont have very many interviews so I want to prepare as best as I can :')

Does anyone know if this a primary care track or not? The website is very unclear and I didn’t realize it might be primary care until after already applying (?)... I’m very interested in health equity but planning to sub-specialize.