What I learned Durring My First Quarter of Medical School

This blog post is going to be more heavily focused on handling the coursework at OUWB.  Honestly, Medical school is definitely the hardest thing I have ever done; but, like everything else I definitely look at it with an attitude of learning. I'm not perfect, but I know I can learn how to be and adapt for my shortcomings.

Also I'm going to try and do this more on a weekly basis. I think its really important to document your learnings and share them with the world.

Here is what I've learned:

1. MEMORIZE & MASTER THE MATERIAL FROM DAY 1
• This may seem obvious to some, but the material can get overwhelming and may feel inclined to put off memorizing till later.
• Do like 10 slides and ask yourself what you just studied and summarize it in your head. Also test yourself on little details if you can memorize them. 
• Saturday and Sunday ask yourself what you would not feel comfortable being asked questions about and study that extra even if you don't think highly of a lecture.
2. DO 2 - 3 LECTURES PER DAY. (SCHOOL SPECIFIC)
• Here at OUWB we have 3 days in which all our lectures are crammed in (Monday, Tuesday, & Wednesday). The other days are clinical integration days in which we practice our clinical skills in preparation for 3rd and 4th year. Without this realization it is easy to get overwhelmed; it seems like a never ending barrage of lectures. however if you look at it closely you really only need to master 3 lectures per day.
• There is around 15 lectures per week to master with class from 8-5. So that leaves you the weekends to do questions and really hone your skills.
3. USE THE WEEKENDS TO DO QUESTIONS
• With this schedule you should be caught up with that weeks lecture by Friday. Allowing you to do questions on the weekend and identifying weak points in your studies. 
• Also avoid the familiarity trap. Its easy to reread your lecture notes and say "Yeah I know that." Its another thing to actively recall what you studied and use it to answer a question.
4. NEVER MISS LECTURE.
• It honestly wastes so much of your time. If you go to lecture, sit there and zone out, you then have to go home and to re-watch the lecture and take notes; doing double the work.
• GO TO LECTURE. DO IT ONCE. DO IT RIGHT THE FIRST TIME!
• Try paying attention as much as you can and note which parts of lecture you didn't understand, didn't catch, or lost focus on. 
5. GO INTO LAB SAT & SUN.
• It's really hard to drag yourself into lab after class from 8-5, so go into lab for a few hours on Saturday and Sunday.
• You go in with a fresh mind and not physically drained.
6. FOR BFCP, OVERKILL EVERY TBL.
• NEVER BE LATE TO A TBL. It is the most damning thing you can do.
• Start studying early for them.
• If you ace them it will give you a huge buffer for the final. and will allow you to study more for AFCP
7. FOR AFCP, DO QUESTIONS FROM LIPPINCOTTS AND GREYS
8. GO TO REVIEW SESSIONS FOR BOTH AFCP AND BFCP
• THEY PRESENT THE MATERIAL IN A DIFFERENT WAY.
• THEY ALLOW YOU TO ASK QUESTIONS
• SEE QUESTIONS REGARDING TOPICS YOU WILL BE TESTED ON.
9. START REVIEWING FOR THE EXAM TWO WEEKS EARLY. PLANNING 3 WEEKS AHEAD.
• We have so little time. you need to spread out your studying and reviewing so that you don't kill yourself with stress.
10. RHYTHM, STRUCTURE & PLANNING is MOST IMPORTANT. WORK ON YOUR SCHEDULE EVERYDAY
11. DRINK LOTS OF WATER.
1. you don't need caffeine. the reason you get tired and have headaches is because you have low blood pressure because your lacking H2O/FLUIDS.
12. GO TO SLEEP EARLY EVERYDAY @ 10:00 PM
• I usually wake up around 6:45 so to get near 8/9 hours of sleep.
• IF you break this rule:
• YOU WILL BE STRESSED
• YOU WILL BE TIRED
• YOU WILL BE DISTRACTED/UNFOCUSED
• YOU WILL FALL BEHIND
13. 25:5 rule
1. 25 min studying 5 min break
14. When the alarm goes off in the morning jump straight into the shower, even if your a zombie.
15. Only do one thing at  a time
1. don't watch tv while you study

Obviously this outline is a work in progress. What are some of your insights? I know we would love to hear them. Please, comment below!

9/17/2016 6:00PM M1 The Beginning

9/17/2016 6:01PM

This is the first log entry into my MDLogbook. If your trying to follow my adventure through medical school you've come to the right place.

I just finished my first month of M1 and it was the most intense thing I had ever done. I was in class from 8:00AM - 5:00 PM every day for weeks, being presented material that I had never seen before. In college I used to study for 2 hours for every one hour of class. In medical school we have 4 or 5 major classes with 8 hours of class and about 5 hours to study all the material, do research, and be active in clubs etc. I am proud to say I have made it through the crucible, that is the first month of medical school, and come out the other side with a great deal of learnings and insight.

For me success has come down to figuring out a routine. I realized it takes me 1.5 hours max to re-listen to lectures and refine my notes. For BFCP and AFCP I found that it is all about the lectures, so knowing them well comes very handy. For Anatomical Fundamentals of Clinical Practice (AFCP) there is a practical 1-hour exam in addition to the written portion. For the practical portion I have started going into lab on my own free time to review the relevant structures. So far, my strategies have proven to be very effective; however, I am anticipating a game changer when we get to organ systems. When we get to Organ systems receiving advice from M2's and professors in tandem will be very helpful in preparing for the subject.

I also found out that I’m not a natural interviewer. In APM I got stumped pretty badly. It’s something I need to work on. I need to prepare for APM as well. Its good though now that I know it’s something I need to work on, I can adapt for it and make it one of my strengths.

I just started joining clubs. It’s weird a lot of clubs start having applications for their board super early. I may have missed a few deadlines in focusing on school.

I also need to find a mentor. Luckily Facebook has helped me so much with networking. When I meet people I immediately add them on Facebook and try my best to keep in touch with them; it’s amazing and people are so open to answering my questions. Facebook is a really really powerful tool; I just wish all physicians used it and thought of it in this way. I think it’s also a powerful tool for spreading your personal brand; I think it has to do with actually doing things that are good/amazing and actually documenting it. Well that’s what I’m trying to do anyway.

Capstone/Embark- I've heard a lot of conflicting advice with regards to this subject. People tell me to do what you love and to take on a project your passionate about. I have also received advice to take on a smaller project at the school one that is manageable and can finish quickly in order to spend the remainder of my time working on other research. I think I will do the latter because I can see myself biting off more than I can chew. Unfortunately, I have done this before and been unrealistic with my ability to commit to a project. I think it’s really important to err on the side of caution, if anything.  

Why I Am So Excited to Attend OUWB

I am pumped about going to OUWB. The more I learn about the school the more I am proud to be a GOLDEN GRIZZLY. As you may already know, the quality of your medical education is really determined in large part by the quality of your clinical education. Your experience in the clinical setting determines your success in residency and after. In fact, program directors focus heavily on your grades during your clinical years. This should be a huge consideration especially when selecting the medical school you plan to attend. With this in mind, OUWB is attached to some of the best hospitals and health systems in Michigan. "Beaumont Hospital, Royal Oak is nationally ranked in the following 10 medical specialties in the 2014-15 lists released:
• Cardiology & Heart Surgery - #25 in U.S. (#1 in Michigan)
• Diabetes & Endocrinology - #16 in U.S. (#1 in Michigan)
• Gastroenterology & GI Surgery - #20 in U.S. (#1 in Michigan)
• Geriatrics - #24 in U.S. (#1 in Michigan)
• Gynecology - #44 in U.S.
• Nephrology (Kidney) - #37 in U.S. 
• Neurology & Neurosurgery - #35 in U.S.
• Orthopedics - #9 in U.S. (#1 in Michigan)
• Pulmonology - #22 in U.S.
• Urology - #42 in U.S.

Both Beaumont and Oakland have a long-standing history of teaching students. "Beaumont has been teaching and training medical students for 55 years and has three hospitals that participate in student education." "Oakland University (Oakland) and Beaumont Health (Beaumont) were founded at approximately the same time, half a century ago, in close proximity to each other and in a region of greater Detroit...Oakland and Beaumont both recognized the negative impact that a physician shortage would have on the quality of health care available to the residents of Michigan. Following exploratory discussions, including discussions with community leaders, it was concluded that the combined faculty, staff and infrastructure resources of Oakland and Beaumont provide a remarkably strong base on which to build a new medical school to help satisfy the demand for physicians in Michigan and the nation." OUWB isn't just a new school; its a medical school with a long track record of excellence in teaching students and residents all the while meeting the needs of its community.


With such a long standing history of teaching both students and residents, its no wonder why OUWB students have such impressive matches. In their most recent match, OUWB students matched at a number of competitive residencies including residencies at UCSF, Stanford, Harvard and others. A comment I read a while back really touched on this: 

"Personally, I think a competitive specialty and/or academic medicine probably isn't a problem for a top OUWB student. They had three ortho matches in their first class (out of 47 graduating.) A MGH anesthesiology match, a Harvard Longwood psych match. Lots of strong Midwestern academic institutions. Granted, if you have a precise place in mind where you want/need/must go, a more prestigious/established school might count for something. But I saw a lot to be excited about in that inaugural match list. The fact that WB has very strong ortho and optho departments (with research opportunities) probably counts for something too. Small class size presumably yields more opportunities, as well."

OUWB has smaller classes than the average medical school, providing greater opportunities and more resources to their students. The class size is around 125, allowing for smaller classrooms and a more personalized education. This also allows the administration to more effectively meet the needs of their students.With such a small class size individuals will have the chance to get to know one another well. I am looking forward to making quality relationships that will last the span of my medical education and my medical career.


Since OUWB is a new school it can bring in cutting edge approaches to medical education as well as pivot to make effective changes that enhance our medical education unencumbered by tradition or precedent. What our school has that many don't is a small and efficient administration. Our administration doesn't have many of the bells and whistles that many other schools have, allowing the administration to make changes and pivot the curriculum such that it enhances the quality of our education. Furthermore, in attending a newer medical school we have the attention of the administration. From what I understand, the school is greatly interested in optimizing its curriculum; constantly sending out surveys and things of that nature to gauge student success. It is good to know that our thoughts and opinions will be heard and that with every successive class comes greater improvements.

All in all, I am very proud of the school I am going to attend and am honored to join the OUWB community. 
I look forward to meeting all of you at the white coat ceremony!
Sincerely,
Ari Schreiber

A Program Director's Tips For ERAS

Donald Morrish, MD

Donald Morrish, MD is a former Associate Residency Program Director and a board certified practicing physician who knows how to compete for a residency training position. He provides ERAS® application and personal statement editing and review, one-on-one mock interviews and strategic planning for a post-graduate residency training position. Today he answers some questions we have regarding applying to residency!

How much does Step 2 actually matter? Can a good Step 2 score make up for a below average Step 1?

HUGE! I'll say it again...it's HUGE! Here's the play. If you have an ok USMLE I and a great, or significantly improved USMLE II there are so many ways to benefit from this accomplishment. You exhibit a growing fund of WORKING medical knowledge (that's what step II tests and PDs evaluate, your medical knowledge) it exhibits your self improvement skills, being able to analyze your performance, set a plan and execute it and produce! It exhibits professionalism, working medical knowledge, self-improvement, maturity, etc. You can use it as a strength during your interview as well. PD asks, what are some of your strengths your response..." I'm goal-oriented. I recognized the need to improve my fund of woking medical knowledge that would be translated in to better patient care activities so I did a little reflection, changed my study habits, improved my test taking skills and achieved my goal of scoring a 260 on my STEP II." That a hell of a lot better than the standard med stud response, "I'm hard working, good team player." The goal oriented response score some major points and distinguishes you as a strong candidate with solid interpersonal and communication skills too. Wow, that's a lot but that's how much a difference a professional can teach you. It's all in the details! Best of luck and do a killer prep for step II.

Did you find a good correlation between the success of your residents and their step scores?

This is a really good though difficult question to answer. On first answer, strong step scores = residents with good in-service scores. That being said in-service scores aren't everything. PDs evaluate residents on interpersonal and communication skills, professionalism. Practice-based learning and Improvement, Systems-based practice and Patient care abilities too. These remauing 5 areas can be easily evaluated through the quality of your ERAS app, supporting documents (LORS, MSPE) your interview too. Hope that answered your question. Best of luck!

Does the status or prestige of the person who writes your LORs matter?

Yes, immensely. Not all LORs are created equally. The boots on the ground preceptors who know what PDs are searching for should be your authors not residents, podiatrists, dentists. There's a ton to learn on obtaining a phenomenal LOR and it's one of the biggest mistakes candidates make in submitting the wrong number, wrong author and poor content. I wish you the best of luck, get what you deserve a phenomenal LOR whenu perform well during a rotations.

Do readers have an eye for breadth vs depth wrt activities? I know some who will list multiple single occasion volunteer experience as if they were each long-term projects.

The ERAS application requests information on the dates of the activities and let me tell you. PDs are a r pretty savy group of accomplished individuals who know the ins' and outs' of when their are being bs'ed! Candidates who pad their apps loose out because most PDs have been around the block a few times and spot padding a mile away. Solid activities that are socially redeeming and NOT a "Health Fair" such as Big Brothers' Big Sister's are great organizations where you as an candidate can exhibit your substantial volunteer work. I always tell med suds, add meaningful content to your application because it only gets reviewed once. Good luck!

How much time was spent reading each personal statement? Any point in putting in some serious effort? What made some personal statements stand out?

Pds will read your entire personal statement if your ERAS app piqued their interest. Oftentimes, PDs will ask themselves, does this candidate interest me enough to interview?...it's simply that important. Write a personal statement that distinguishes your candidacy. Let a PD want to meet you in person. Write about your interest in the specialty, give examples about why your the best cnadidate and express your true likable personality. Best of Luck!

To those of us who still have a few years before ERAS, what steps can we take now (besides scores) to make ourselves as competitive as possible?

Research, network within your intended specialty, advanced certifications, strong personalized LORs, and a commitment to setting yourself apart from those who do the basics! Good luck you're on the right track!!!

Where does continuity in your chosen specialty rank among factors for matching? For instance, if I'm interested in EM and have been continually involved in EM (research and volunteering), how does it appear to PDs in the grand scheme of things?

Big! It speaks to your professionalism. A core competency PDs evaluate residency candidates on. Consistent involvement involvement in the specialty score points and it will give you more street cred when you claim in your personal statement EM was a mature, professional choice based on first hand experience. Good luck!

When doing away rotations, I understand it's our opportunity to "audition ourselves" to the PD/institution. Is there any real way surefire to obtain a letter of rec from the chair in an away rotation? I guess I'm just really unsure if there's an appropriate way to do it (especially if you've maybe worked with the chair a few times)

Thanks!

When someone sends me a chair's letter I don't place much value in it. Multiple reasons, Chair's are very busy docs the have admin responsibilities, some do clinical work, some do consulting, (like myself) and don't get to know med studs as much as the PD, Division chiefs etc. Chairs don't write phenomenal LORs, you get a form letter and last but probably most important. PDs know Chairs don't spend much time with med studs, they're with their residents. Bottom line go for the boots on the ground docs who know how to write letters and can attest to your abilities. One last comment, don't ask for a lor on the fly be professional, make an appointment and provide them with solid information about you. The extra effort pays off tremendously. Good luck! 

Can you match into a competitive specialty without research at all?

Anything is possible but if you're looking to increase your odds research is one of the important characteristics strong candidates exhibit to garner more interviews. Research isn't all about peer reviewed journal publications, it can include abstracts, poster presentations, etc. There are great ways to exhibit Practice-based Learning and Improvement Skills (research) without formal research experience and publications! It's my secret weapon in teaching candidates! Best of Luck and try to get some experience! the higher the overall rating the better the chance for an interview and once you get your foot in the door, promote and distinguish your candidacy! Best of Luck!!! 

Among the thousands of applicants that you've considered, is there one in particular that still stands out to you to this day?

Yes, there's one application that stood out. The applicant's ERAS application was "good" not great though met our criteria then I read the individuals LORs, that had killer content and then their personal statement was so honest that I wanted to interview the applicant. What made the LORs stand out was the content of each lor was individualized as if the author knew the candidate and spoke of their specific skills, qualities and accomplishments and then added a personal note. Not a typical form LOR, the author wrote specific interesting qualities about the candidate to validate their first hand knowledge of candidate. Then the applicant's personal statement spoke to me as a PD and as a human. The candidate told me why those chose the specialty (with sincerity) backed up their claim of great skills and qualities and let me in on their personality. I wanted to interview the candidate myself and I was happy I did. Bottom line, strong LORs (can be done easilty though not the usual way) a solid, well-written personal statement that gives another dimension to your candidacy. Good luck.

How could you tell that the applicant was writing sincerely.. was it more a matter of content or writing style?

Great! It was both, let me teach you a very important lesson. The content and the style of the personal statement was solid. But what impressed me more, the writing style found on the applicant's ERAS application was consistent with their personal statement. Candidate's oftentimes have professionals write their personal statement and then the PD looks at the quality of the ERAS description section. If they appear dfferent, you didn't write your own personal statement or ERAS application. Your ERAS app will be tossed into the round file! The mistake is what I call the ERAS application/ personal statement Mismatch...no pun intended. It's great to get expert advice and editing but not legal to have a inexperienced (re:residency) write your personal statement. Good luck!

What sort of things should be included in a personal statement? Also, how badly will 1 poor grade in a clerkship hurt an otherwise strong application?

Why you chose the specialty, what specific qualities, skills and accomplishments you bring to the specialty and program. Promote your candidacy in a modest though interesting way. Clinical vignettes, talk of a dying family member (although life changing, PDs' don't want to read it again), choosing to be an MD/Do at ean early age, etc is so pedestrian and boring. Perform a self assessment of your skills, the you chose the specialty, highlight the skills PDs seek. If your aa Psychiatrist, have stellar interpersonal and communication skills, the quality of your ERAS descriptions, attention to detail, a fluid personal statement, etc. will open doors. One poor grade shows your human. If you say some died or you thought your preceptor was an idiot, I wouldn't hire you. If you claimed responsibilty for the "shortcoming" and told me what you did to rectify it and exhibited proof, cool, I'll look at your application. Submit a stellar application and personal statement then interview like a pro and one less than perfect score will not impede your success! Good luck!

Hi Dr.Morrish, I wanted to know your take on having research done in college/achievements obtained while in college on our ERAS app? Thank you!

If your ERAS application lacks some significant meaningful content such as recent pubs and advanced certifications, etc. then place the research on your app. I know I'm beating a dead horse on this comment though...highlight the research skills, qualities and accomplishments you worked so hard to learn during the project. Eg, biostatistics, epidemiology, etc. The project itself isn't too important to PDs. I wouldn't include the college achievements b/c PDs will say to themselves what have you done lately. Best of luck! be able to discuss your research during interviews and programs thinking you'll add value.

I'm not a medical student, but I am wondering for more selective specialties, how are multiple research in different fields looked upon? Let's say I wanted to go into...I dunno....say Ortho. And I have 2 posters of Anesthesio here, 1 abstract from a Plastics basic science research stint, 2 pubs from a clinical ortho lab, and 1 paper from endocrine basic science lab. If you were an ortho PD, would you care only for the 2 pubs from the Ortho lab or would you look at the entire package?Also how do you view publications/research done in undergrad/gap year if they were in a medical field?

My pleasure, you're a part of a great group! Good question, maybe u should pursue ortho! Entire package because I'm looking for the skills, qualities and accomplishments not the specific project. If you have an application that doesn't distinguish your ortho candidacy and it's so generic and not geared towards ortho that you have some "splaining" to do. You'll need to convince a PD you're a good ORTO candidate otherwise will chose another awesome candidate and there are plenty to chose from.

reddit program director

Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures

Formulating data from chart review; Drawing correlations
based on two tail tests.

Early last year, I had the opportunity to work with an orthopedic surgeon in conducting research on readmissions after open reduction-internal fixation of proximal humerus fractures. the goal was to identify potential sources of risk for this procedure. After hours reviewing charts, learning the vernacular of an orthopedic surgeon, compiling data, establishing correlations of statistical significance, and writing portions of the manuscript, I am excited to announce that our paper is finally published! Check out the link below!

Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures

Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization

Edward Yian, MD; Hui Zhou, MS, PhD; Ariyon Schreiber; Jeff Sodl, MD; Ron Navarro, MD; Anshuman Singh, MD; Nikita Bezrukov, MD

Perm J 2016 Winter;20(1):47-52

Abstract

CONTEXT:

Surgical treatment for proximal humerus fractures has increased exponentially. Recent health care policies incentivize centers to reduce hospital readmission rates. Better understanding of risk factors for readmission and early mortality in this population will assist in identifying favorable risk-benefit patient profiles.

OBJECTIVE:

To identify incidence and risk factors of 30-day hospital readmission rate and 1-year mortality rate after open surgery of proximal humerus fractures.

DESIGN:

Retrospective cohort analysis from Kaiser Permanente Southern California Region database.

METHODS:

Using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes, all operative proximal humerus fractures were validated. Hospital readmission, one-year mortality, and demographic and medical data were collected. A logistic regression test was performed to assess potential risk factors for outcomes.

RESULTS:

From 1387 surgical patients, the 30-day all-cause readmission rate was 5.6%. Forty percent of hospital read-missions were due to surgery-related reasons. Severe liver disease (odds ratio [OR], 3.48, 95% confidence interval [CI] = 1.42-8.55) and LACE (length of stay, acuity of admission, comorbidities, and number of Emergency Department visits in the previous 6 months) index score ≥ 10 (OR, 4.47, 95% CI = 2.54-7.86) were independent risk factors of readmission on multivariate analysis. The 1-year mortality rate was 4.86%. Multivariate analysis showed length of hospital stay (OR 1.11, 95% CI = 1.05-1.19), cancer (OR 3.38, 95% CI = 1.61-7.10), 30-day readmission (OR 3.31, 95% CI = 1.34-8.21), and Charlson comorbidity index greater than or equal to 4 (OR 13.94, 95% CI = 4.40-44.17) predicted higher mortality risk.

CONCLUSION:

After open treatment of proximal humerus fractures, there was a 5.6% all-cause 30-day hospital readmission rate. Surgical complications accounted for 40% of read-missions. Severe liver disease and LACE score correlated best with postoperative 30-day readmission risk. Length of hospital stay, preexisting cancer, 30-day readmission, and Charlson comorbidity index were predictive of 1-year mortality.

Applying to Competitive Residencies

Hey guys, was recently looking stuff up about applying to Orthopedic Surgery and I found this document which I posted on my google drive. Hopefully you guys can view it and download it.

Applying to Competitive Residencies

Posted by UCSD SOM, it talks about different residencies and how best to prepare for them. Let me know if it helps!