STEP 2 CS Discontinued

 Sak Pase!

I've been meaning to update you all with this announcement but I umm...forgot lol 

Basically there's no more USMLE Step 2 CS. For those that are confused we are still required to take Step 1 and Step 2 CK. CS is the clinical skills portion of the exam where we see "patients" and do an interview and a physical exam on them. Afterwards we have to basically try to figure out what's wrong with them by coming up with diagnoses. To use better English, I took the following directly from the USMLE website loll "Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues."

Unfortunately for Caribbean students like me, we have to do other things to meet graduation requirements. Just because CS is gone doesn't mean we're "off the hook." We still have to prove that we speak English basically :)  Yes, I know I'm a US Citizen but the fact that I go to a Caribbean medical school means I have to do extra ish like this. So basically there are several pathways we can choose from to meet those requirements. More information on that in a later post. But in addition to choosing one of those pathways, the ECFMG says....and I quote "Consistent with the requirements for the existing pathways, IMGs who pursue one of the six pathways for the 2022 Match will be required to pass the Occupational English Test (OET) Medicine to satisfy pathway requirements. OET Medicine is designed specifically for physicians, in consultation with physicians. The test assesses the health care-specific English language competency of physicians. It emphasizes the type of language physicians will need to communicate effectively in a clinical setting with peers and patients, including the ability to show empathy and to break down complex medical terminology and procedures into simpler language."

Sounds pretty easy right? Wrong! I've heard that a lot of people has failed the OET on their first try. 

So you see? It's bittersweet. We said goodbye to CS but there are still extra steps we as Caribbean grads need to face to graduate. Am I freaking out? Always! But it's not by my will that I've made it this far. God has brought me to where I am today and I'm trusting him to continue pushing me to where He's destined me to be. 

TTYL 💜

4 Things I Learned After IM

Sak Pase!!

Happy New Year! 🌚 

Y'all I finished twelve lonnnnnnnnggg weeks of internal medicine. I passed the shelf and now I'm in my third rotation.....Obstetrics & Gynecology. 

IM was way too long. The first 6 weeks I was at an outpatient clinic. In the clinic I was in, 98 percent of the patients were Haitian and like 80 percent ONLY spoke Creole lol. It wasn't a problem for me because of course, I'm Haitian and well I speak Creole lol. Sooo basically, it was me and 3 other students from AUC. We would go to the front to ask the sweet medical assistants for the next patients on the list. We then went into the lobby and called on our patient, brought them to the back in a room and take their weight, height,  and vital signs. We then started a note on their charts in the computer. Basically we did an H&P (history and physical). We asked them what brought them in and did a physical exam. If they're new patients, we would get a full history on them, including past medical history, family history, social history, medications they take etc. I also learned how to do EKGs and a whole lot about medication management and diabetes and hypertension. I also learned how difficult it is for patients to manage their health when they're living in poverty, especially my Haitian people. I can't wait to become an established physician to be able to give back to my community. 

The next few weeks I was in inpatient. I did half of that at Jackson Memorial Hospital and the other half at Broward Health. 2 completely different experiences!

At Jackson, I was with two different Attending Physicians. Each week you're with a different attending unless you request to stay with the same one. The first week I doing the night shift lol. It was from 10pm to like 4am if i remember correctly. It honestly wasn't all that bad until my car got towed :) It was me and 4 other students, we basically went to admit patients who came into the ER, we would get a history from them if we could (i say if we could because it's the ER the patients are not able to give histories sometimes)then examine them. Afterwards we would go back to the computers as a group and work on a patient note, the main part of that is the Assessment and Plan portion. Basically list everything that's wrong with the patient one by one and then write supporting details under each complaint and what lab tests, procedures and consults that patient might need for each complaint. The doctor would then go over the note with us, mostly the A&P like I said before.

The other weeks I was in the day shift and I worked with a wonderful Attending. Y'all I loved him!! He was enthusiastic and full of energy. He absolutely loved his patients. We walked into a patient's room who was admitted because of a stroke so he lost control of half of his body so it was difficult for him to eat. Y'all, this doctor walked in to the patient's room and fed the patient himself. Fed him his food and gave him his juice then cleaned his mouth afterwards. He wasn't afraid to touch his patients. He really cared and I loved that. He's also a great teacher. In one day, I learned tons from him. We got there in the mornings and he would give us his patient list and we would divide the patients up among ourselves. We go chart review then go see the patient, do a history and physical exam. After about 2 hours, the attending would meet us on the floor and we would round together and present our patients to him from beginning to end. Then he would spend about an hour or two teaching us on a topic or going over some questions. 

Then, I went to Broward. The experience was a lot different. I was exhausted. Exhausted was me. First of all the drive was hella long. At Jackson, the students worked directly with the attendings. At Broward however, we were working under Residents. I mostly saw the attendings when we rounded on our patients. But basically I would get there at 7am sometimes 6:30am depending on when we would round that day. Look up my patients' charts, go talk to their nurse and telemetry about any overnight events then go see the patient and examine them. Afterwards, the med students, the residents and attending would round on the patients. We would present either to the resident or to the attending depending on the day. After rounds, we stayed with the residents. They usually give us a topic to look up and do a presentation on later on. We also do other miscellaneous things like go educate this patient on smoking or alcohol cessation, go explain to this patient how she should take her home meds, go talk to case management about this etc. So unlike Jackson we didn't leave immediately after rounds. So hours would be 6:30/7am-3pm. But every 5 days are call days, meaning our team is on call and whatever patients come into the ER we have to go down and admit them. The hours for call days were 7am-7pm. Those were fun lol (insert sarcasm) but I did learn a whole lot. All in all, it was an exhausting three weeks. I was too tired to study. By the time I got home, I would take a nap and when I wake up i would only have a few hours to study then its back to sleep because I have to be up at 5:30am the next day. I did learn a lot though, I admit. AND Glory to God, I passed my shelf. I used online med ed of course, my faithful buddy Uworld and Dr. High Yield on Youtube. So now I'm done with IM and moving on to ObGyn, woot woot!

I want to end this post with 4 things I learned after my IM rotation....

1) I used to always complain about IM Physicians not spending enough time with their patients. But tbh I realize now that they do a lot of shit. I mean like I  have a new appreciation for them. Yes I agree, most of the time spent is not with the patient but that just means that the time they do spend with the patient is very crucial. Most of the time, physicians are in the background, critical thinking and using their knowledge and training to figure out what could be wrong with the patient, what labs and imaging to order  and most importantly what meds or treatment options to give the patient NOW while we figure out their mystery. I mean it's amazing. It gave me a whole different outlook on medicine. Like physicians are some smart ass people y'all lmao. I mean you have take the patient's history, their labs and their imaging results and rely on the knowledge that you've gained throughout your training to make sure that another human being doesn't die. That's a lot of pressure man and time is of the essence. The last 6 weeks of IM made me realize how important medicine is, especially hospitalists because people be coming into the ER with some crazy shit y'all lol. 

2) Another thing I learned. Imposter syndrome will creep on you now slowly but surely. The last 6 weeks of IM has definitely showed me how much I don't know. I mean it was only my second rotation but still I kept thinking how much I didn't know and how much my peers knew. I kept asking myself wth I was doing in medical school. Who do I think I am? lol. What made it worse was that I was told that I lacked medical knowledge. I mean that shit hurt and I felt like complete shit. But I had some wonderful friends speak life into me. It was only my second rotation, I have room to grow. Even doctors are still learning. I was put here for a reason and i've made it so damn far, that's definitely not by accident. God doesn't make mistakes now does He? I might not be the smartest med student out there but I am def one of the hardest working students out there and I guarantee you, I won't give up now. Gotta lot of work to do but I knew that coming in. Nothing changed. 

3) Assessment & Plan is like the most difficult part of a patient note for me. I thought the HPI was the most important so I always worked on perfecting it and i'd like to think that I did (haha right) but working in Inpatient I realize how much of an emphasis the attendings and residents put on the assessment and plan portion and tbh it's the hardest part of the note for me. It requires critical thinking, shit ton of knowledge ad some experience definitely helps. My critical thinking abilities are subpar, my knowledge is lacking I was told and well....I don't have much experience so you can imagine how much I struggle with A&Ps. I explained what it was above. basically its a list of what might be wrong with the patient and what was already wrong with the patient and under each complaint you gotta write a bunch of stuff to support the diagnosis by using labs, symptoms, etc. HARD but one day friends, one day. 

4) Finally, residents work a whole lot DAMN IT!!! Like what have I done? What have I signed up for? They only get one day off a week and its like a random day. So I'll be working 6 days a week. I have to say bye bye to weekends and bye to two days off. Y'all might be like duhhhhhh but I legit never knew this until now. 

Anyway enjoy this pic of me just existing on my last day of IM lol....

TTYL! 💜

Done With Babies, Time For Grownups

SAK PASE!

Hey youuu, guess what!? I just finished my first rotation in medical school! I know it's only one rotation but I couldn't be more excited. So last time I posted, I told y'all that I completed two weeks of inpatient pediatrics and that I was starting outpatient pediatrics that following Monday. Welp now I'm done with 4 weeks of outpatient pediatrics. I took my pediatrics shelf exam yesterday and I just found out today that I passed. So grateful!! I'll delve into more details....

So, I did my outpatient Peds at a Pediatric clinic in Aventura. I live really close so it was great for me! So there are two Pediatricians who own the clinic and they are brothers. We also worked with two Nurse Practitioners, one more than the other. 

A typical day: I get there at 8:50am and we start at 9am. Some days we see sick patients in the morning and well visits in the afternoon. Other days, it's flipped so well visits in the morning, sick patients in afternoon. The clinic is realllllyy busy so you'll definitely have lots to do. So I would go into the patient's room after the MAs finish their vitals signs. But while the MAs are doing the vital signs, I go to the patient's chart just to review their past medical history, their discharge papers from the hospital if they were recently born and any previous notes and visits at the clinic. Just to get an idea of what kind of patient I'm dealing with and what to expect in terms of medical problems and what to ask for. Next, I go to the patient's room and get an H&P (history and physical). For sick visits, I only usually ask about the chief complaint and OLD CARTS (onset, location, duration, characteristics, associated/aggravating symptoms, relieving factors, timing and severity). But for Well Visits, I ask about ERRTHANG. If the patient is a baby, I ask about feedings, dirty diapers, wet diapers, sleep, meds, and all of the above. If an adolescent, we ask about school, exercise, drugs, smoking, alcohol and we screen for depression in addition to the rest. After the history, I do a physical exam. Then I go report to the physicians or to the nurse practitioners then we go into the room together. If I have questions, I ask the doctor or the NP afterwards. Sometime the physicians sit down and give us a lecture on a case they saw at their rounds in the hospital that morning or they do a lecture on a topic that we've asked them about. Sometimes they give us uptodate articles to read then we go over it together mostly after lunch. Okay so then we get lunch...sometimes an hour, sometimes 30 minutes. Then get back to the grind in the afternoon at 1:30pm and then we go home sometimes by 5:30pm sometimes 6:45pm lol, it really depends on the day.

Like I said, it was really fast paced so there wasn't any downtime. I actually ordered some compression stockings/socks on amazon because at the end of the day my feet were swollen and IN SO MUCH PAIN that I had to elevate them when I got home. Plus I run several times a week and that's usually a task because of how much my feet hurt. Since I bought the compression stockings, my feet hurt less at the end of the day. They hurt less but they still hurt lmbo! Overall, it was a great experience, I am still very much interested in pediatrics but we'll see after I complete all of my core rotations! 

I also mentioned that I took my pediatrics shelf yesterday. It was 110 questions and 2 hours and 45 minutes long. I found out today that I passed. Y'all I was scared shitless! lmaooo I finished that exam and I was scaaaared. I ran out of time and had to guess on the last few questions and there was a lot of randoms in there I didn't know and I was legit scared but to God be the Glory. He always comes through for your girl! 

How did I study for my shelf? I did all 400 and something pediatric questions on Uworld. I also did a good amount of Amboss questions in the beginning of the rotation. I think around 80 or so. I did the Zanki Peds deck on the Anki app. I took two NBME Practice exams. I watched all of the Online med ed videos. I watched Emma Holiday's peds review on youtube. I watched Divine intervention's Peds review on youtube, and finallly I watched Dr. High Yield's peds review on youtube. I think that's about it. I learned a lesson for next time...I should have ran through the uworld peds questions TWICE but I only had time to run through them once and that's because I started studying too late. 

It was a struggle for me to study. By the time I came home I was soooo tired. I had to run, shower, eat, study then go to bed on time. There wasn't nearly enough time in the day for all of that. But I did it!! If I could make it through this first rotation, I know I can make it through the rest! 

So now I'm done with the babies, now it's time for grownups! I start the outpatient part of my INTERNAL MEDICINE rotation on Monday! I'm doing 6 weeks of outpatient at a clinic near me! Again it's only like 15 min away from me. SO SO grateful! 

Alright that's all folks. Enjoy these pics below. I had to blur out a part of the second pic because of patient information lol. That pic is one of all of the students rotating at clinic. 

Like usual, email me if you have any questions. But it seems like y'all prefer messaging me on IG instead so feel free to do that too, whatever's clever!

TTYL 💜

A Day in Inpatient Peds

 SAK PASE!!

So I started this post Friday night, it's currently 9:53pm and I just finished going over a block of questions on Amboss. In other words, I'm tired af so I'm definitely not finishing this post tonight lol.......

Okay, so I just finished my two weeks of inpatient pediatrics, I'm starting outpatient pediatrics on Monday at a clinic near where I live and I can't tell y'all how excited I am. Don't get me wrong, I enjoyed my first two weeks but the rotation was in Broward county and it was about an hour drive there and an hour and 10min drive back because of .....SOUTH FLORIDA TRAFFIC. I'll miss the rotation but I will not miss that drive and the gas money I had to spend annnnd the waking up at 6am parts lol. I'm just writing this post to give you guys a peak into a typical day I had in inpatient peds. 

6AM: Okay so I wake up at 6am, not gonna lie, sometimes 6:15am and sometimes 6:25am. The times I wake up at 6a, I usually have enough time to sit down and drink my coffee and eat my breffus. I usually have a parfait for breffus or just plain yogurt and grapes. 

I leave my house at 6:45am on a good day, 6:55am on a bad day lol (bad days being when I wake up at 6:25). I get to the hospital and I'm on the peds floor by 8am always, most of the time before 8. To be on time is to be tardy :)

8AM: My first week, I was with a Family Medicine Resident who was on his peds rotation and another AUC student, she's a 4th year doing her peds Sub-Internship. So she's there for 4 weeks while I was there for only 2. Anyway, the first week, the Resident assigned us each our patients to present to the attending during rounds. So we would log onto the system and look at how many patients are on the peds floor and we would separate accordingly. So for example I would get a new admit and two old patients. The new admits are of course more work and more tedious because you have to look at their chart on the computer then go into the room and interview the parents and sometimes the patient too if they're old enough, then I have to do a physical exam on them. That usually takes some time to get the history. So the history includes the History of Present Illness (HPI), the Emergency Department course/stay (basically what the ED did to the patient before they got admitted to the peds floor), the birth history of the patient, past medical history, meds and allergies, immunizations, family history, and social history. Then, the physical exam. Then finally the assessment and plan. That was a mouthful but I hope I made some sense. 

This is for new admits....for patients who I've seen before I usually do a SOAP presentation,...Subjective info, objective info, Assessment and plan. I do that unless we have an attending that day that hasn't seen that patient at all yet. We usually have an hour and a half to do get ourselves ready before we started rounding.

9:30/10AM -> ROUNDS: All of the Attendings are different. One of them wanted us to present in the patients' rooms (nerve-wracking to say the least), two others had us present in the nursing station area, and one other had us present by the patient's door. So yea, in the two weeks I worked there, I worked with 4 different Attendings. I loved that because I got to experience the styles and teachings of different people. You guys I learned sooooo much from each of them because they each had different experiences to share. In my opinion, the hardest part of presenting patients to the Attendings is the Assessment & Plan part. This part requires you to think like an actual physician and figure out what your plans are for the patient and I always struggle with that part. I also have trouble with the medical terminology. Here's to hoping I get better with time. 

2-3PM: After Rounds is lunch. After lunch, we each get an assigned topic to search on UpToDate, we then have to do a short presentation to the Attending whenever he or she is ready. Then sometimes we go Round on our patients again depending on the Attending. This doesn't take too long, this is just to update the parents and to see how our wittle patients are doing. By 4:45-5pm, its time to go hoooommme! 

The second week was about the same as the first week...except it was just me and the 4th year student, the Resident had to move on to the next part of his training and left us :( The 4th year student helped me soooo much though. TBH if she wasn't there, Idk what I would do. I learned a lot from her. 

THAT'S ALL FOLKS. That's a typical day in inpatient peds. Here are 2 pics just cuz.....

TTYL💜