Monday, 28 November 2016

To Visit or Not

I've been trying to get OB/Gyn electives, but it's been proving difficult to get any in Hamilton. They're popular. I'd had a number that had been declined because of no availability, and since I was getting desperate for OB electives, I applied to visiting ones.

I have 10 weeks (well 8 plus 2 vacation) elective time next year, and my next elective block isn't until January 2018, after I've applied to CaRMS.

Currently, I have these booked:

February 13th to March 26th block
1. OB/Gyn in Ottawa (2 weeks)
2. OB/Gyn (RE) in another city (2 weeks, different subspecialty)
3. Diagnostic Imaging (2 weeks, home-school)

July 17th to August 13th block:
4. Family medicine (2 weeks, home-school)
5. Emergency (2 weeks, visiting, only informally booked. Will need to apply through the portal when it comes available)

I'll be honest, I really don't want to be away from my family for a month for those first two if I can avoid it. We went through having our family broken up for months at a time when my husband worked out west and it was incredibly hard on our kids. I'm already going to be away for my paeds rotation, and could end up away for more. My kids already deal with a lot and I don't want to make things harder on them.

During the Ottawa elective, my husband and kids will be there for almost half of it. He's going to bring the kids up for Winterlude over their Family Day long weekend plus a day either side, so I'm not actually going to be away from my family for more than a few days during that one. I really wanted to ensure I do a visiting elective in Ottawa because it's #2 on my preferred locations since we like the city. My husband grew up there and I lived there for ten years, so we know it well and wouldn't mind moving back temporarily.

To my surprise, I just had two OB/Gyn electives approved locally, for the second and third elective spots above. The one in the #3 spot is with a preceptor I would REALLY like to work with, and it's primarily surgical and I'd like more surgical exposure.

I'm not sure which to take, or whether to take either. Visiting electives are the major way we demonstrate interest to prospective programs, but we also need to keep things varied. Not sure if my preclerkship electives will be considered in looking at how broad my electives were.

I do think I should probably do 3 OB/Gyn electives pre-CaRMS, but doing two at Mac might be a bad idea.

Debating whether I should take the one in the #2 spot, and then try to book another down East - again, my family will be with me - instead of that Emerg elective in August.

Honestly, I've no idea. With just a few days left to decide, though, I have to figure it out soon. 

Super happy baby!

Thursday, 24 November 2016


After I'd done what I felt was a sufficient amount of reading on my elective topic yesterday, I ended up spending some time looking at CaRMS stats.

When I was in undergrad and working on my strategy for applying to med school, I spent a lot of time looking at the statistics that I was able to find. I'm a numbers person and I often find comfort in looking at numbers while I find anecdotes tend to be more intimidating. For a time, I would go look at the posts on premed forums to see what types of people got in and obsess a bit. It was often disheartening, because I knew there were many ways I'd never measure up. I just did not have the time or means to do as much in the way of ECs as they did. I didn't have access to the same sorts of opportunities because of where I lived, and even if I did, the fact that I had issues with childcare and so on made it hard to actually do anything.

Still, I did get into med school. On my very first try, at that. So it's not like all of my stressing about being inadequate actually meant anything in the long run.

However, with just a year to go until CaRMS (my classmates hate it when I point that out) I'm finding many of those old feelings of inadequacy returning. I am a good student, sure, but so is everyone else in med school so it's not like I stand out that way. As with my med school applications, I don't get gold stars for balancing a family while attending school. As with my med school applications, actually, having a family may hurt me in that it means I'm less involved outside of my mandatory activities. Extracurricular activities are still a thing when it comes to CaRMS applications.

OB/Gyn - which I am increasingly convinced I will be making my first choice - is competitive to get into. More than several other specialties often considered competitive, actually. On average, roughly 90% of applicants overall match to their first choice specialty. For OB/Gyn applicants who rank it as their first choice discipline, the percentage who match to it is much lower, and falling. There's very little change in the number of applicants to OB/Gyn year to year, but the number of spots for CMGs has fallen by 20% since 2010.

What bugs me a bit about CaRMS applications is how much of the selection process really seems non-quantifiable. Like I said, I'm a numbers person. But with med school there's no GPA, we don't have any sort of standardized testing score like the MCAT at this level in Canada. There's no way to compare myself to the successful applicants on a numbers basis, I can only look at overall trends in matching. That's something I find challenging.

Realistically, my chances of getting into OB/Gyn are way higher than were my chances of getting into med school. I just have to try. Agonizing about it isn't going to get me anywhere. It's a bit different in that I really only have one shot to make it work (unless I go unmatched, but let's ignore that possibility for the sake of my blood pressure.)

Keep focused on the goal and do my best. That's all I can do.

Four and a half years ago, I was talking about this very same thing - about how I psych myself out by comparing myself to others - and wrote something that I think I'm going to put on my wall.

To rework it a bit: I often feel thoroughly inadequate in the face of people who do things far better than I do. It's a bit discouraging, but I don't have to be the best, most impressive applicant ever to realize my goals. "You don't have to be the fastest gazelle to get away from a hungry lion, after all. You just can't be the slowest."

That said, I still went and made a few figures with CaRMS data, because I like visual representations of trends.
What happened in 2012 and 2013?!?

Tuesday, 22 November 2016

Other Pursuits

During the transition to clerkship rotations, we had a suturing station. I like suturing. A lot. It probably should not have surprised me as much as it did given my hobbies, but it did.

I'm an artsy sort. It's not that I have any particular natural talent in artistic pursuits because I do not, but I enjoy artistic expression in a general sort of way and have a lot of enthusiasm for it. Any ability I have is entirely acquired through a lot of practice but I'm not exceptionally good at any one thing since I've never felt the need to completely dedicate myself enough to any one field to develop significant skill.

When it comes to music, I am very out of practice with my instruments but used to be pretty good. I am an enthusiastic if not particularly talented singer. I do sing Broadway musicals constantly in the car when I'm driving my kids around, to the dismay of my son. Currently I'm on a Hamilton kick. It was Les Mis until recently, so I think my kids consider this an improvement.

I took up a number of my hands-on artsy hobbies partly as ways to increase my fine motor control. I've mentioned before that my finger coordination has always been pretty terrible as evidenced by my awful handwriting unless I write very slowly. I started sewing when I was ten, then eventually I took up calligraphy in my teens to discipline the muscles in my hands. Then I took up yarn arts - knitting and crochet.

How does this at all relate to my enjoyment of suturing?

Well, think about it.

My wall of British actors.
While I will never be steady enough to do microsurgery, I can make neat, evenly-spaced sutures relatively easily (in practice scenarios.)  Crochet taught me how to make smooth rotating and hooking motions, which helps drive the needle smoothly. Knitting taught me how to coordinate my finger movement timing without tangling a thread. Sewing taught me to be comfortable working with needle and thread without stabbing myself. Calligraphy reduced the tendency of my fingers to tremble when doing fine work.

I've spent many years working on steadying my hands and being able to exert fine control over them. I have sketchbooks full of pages where I have just written words out over and over, trying to neaten my writing into legibility, then some semblance of presentability. I've spent many days with inkstained fingertips after evenings of trying to eke some amount of beauty out of pigment and pen. I've spent hundreds of hours trying to train my eyes and hands to work together well enough to put recognizable images on paper.

And it worked. It proved possible to teach my stupid fingers something useful. 

Now, this may all fall apart completely when I am actually suturing a living human, but it is still incredibly satisfying to see something I put a lot of work into have practical applications.

Obligatory baby picture (unrelated to the rest of the post)
This shirt was a gift from my ProComp group (a lovely group of individuals.) Her initials are M.E.D., so the shirt is not entirely about my career choice!

Monday, 21 November 2016

Welcome to Clerkship

With the second year OSCE behind the class (except for me) and our tutorials wrapped up, procomp finished, MF5 done, today is the first official day of clerkship.

Last week, we did our two days of transition to clerkship, which was actually pretty fun. We did rotating stations (Mac seems to love rotating stations...) on O2 management, airway management, suturing, casting, IV insertion, EKG, foley insertion, and defibrillation. Basically a crash course in the hands-on part of important procedures that we've spent over a year learning about. We learned indications for things, we've learned interpretations, but we didn't really actually work with the equipment until now. I still really like suturing and IV insertion was fun too.

Then.. that was it. Preclerkship is done. We're clerks now. (*Hyperventilate*)

At the clerkship orientation session, we were given little "clerkship survival kits" from OMSA (the Ontario Medical Students Association.) The implied message: "Welcome to living out of a bag for the rest of your training!"

Earplugs, toothbrush and paste, and a phone charger. Very useful stuff, though, so I am grateful.

I am on reading elective this week, and I'm having fun with my topic - issues in access to maternal care in low and high resource settings. My supervisor is a perinatologist who does a lot of international work. He's also super nice, so I'm glad to be working with him.

Next week I start a three week research elective. I'll be conducting a literature review and preparing a paper on the topic (it's related to my interventional elective back in the summer.) Super excited for that as well. It's an interesting topic, and I may get a publication out of it which is just a perk.

Since I'm working from home and I'm not doing clinical work like my peers, I expect I'll feel a bit more 'clerkish' in January when I start OB/Gyn. While I'm enjoying this work, I know I'm going to get a kick out of that too.

Bring it on!

Thursday, 10 November 2016

Adapting to Challenges

Baby is three and a half weeks old now. The last week has been a bit rough. There was one day where I ended up needing to be away from home all day. Miss M is in the middle of a growth spurt and it's really important that during these early weeks I nurse as much as I can instead of pumping, when possible, since babies are more efficient than pumps. I have another full day next week, 8am - 5pm, which is going to be challenging to work out logistically.

I basically am nursing constantly while at home, and then even when I'm away my husband is bringing her to me as much as possible. It's involving a lot of running around for him, but he's such a trooper.

Growth spurt means she isn't sleeping well, which means I'm not sleeping well. I'm a bit concerned because of this.

Today we had our CAE on the Mental State Examination. I was literally so tired beforehand that I had difficulty putting sentences together, but we were allowed notes for this so I think I probably did okay. Monday is the CAE for the psych subunit. Tuesday is my class' year 2 OSCE, so it's on everything we've done so far in clinical and communication skills. 

When I met with the faculty about my leave, we'd actually agreed that I would delay this OSCE and do it with the 2019s next year. But I was feeling fine last week and so when I was asked as I was leaving the office if I'd be sitting the OSCE with my class, I decided to just go ahead and do it now to get it out of the way so I don't have to prepare for an OSCE while doing CaRMS apps. However, I am very, very tired, and I don't know if I can get through the entire OSCE - which is at the time of day that M basically nurses for 4 hours straight - without pumping. It's not really possible to just run off for 20-30 minutes in the middle of a station/circuit-based examination. So I've decided to go ahead with delaying it. I'll have to request leave from my family med rotation next fall to sit the OSCE with the 2019s, but that's better than completely tanking it right now because I have had no sleep and am in pain from engorgement. 

This aside, overall I'm actually doing really well for having a three week old baby, though a large part of it is down to my husband being amazing. I actually find it rather funny how often people express surprise or amazement that I'm back to school and stuff already - this happens multiple times almost every day and I'm never quite sure how to respond. The baby is not the most demanding thing on our plates right now, to be honest, and I was completely physically recovered by 10 days anyway. The lack of sleep has been significant the past few days but this is most likely temporary, once she's through this spurt. 

I knew these few weeks would suck. I expected this. I even wrote several times on this very blog that I knew I'd be stressed the hell out for this period. Honestly, it's not half as bad as I expected, but it is challenging in ways I wasn't anticipating, so there's that. At least I'm being accommodated so that it's still possible to graduate on time with my class while not having to put myself through anything too horribly taxing right now. I'm very appreciative.

Today my MF5 group had our farewell lunch. I'm going to miss these guys; they've been great. All my groups have been, but this one was particularly fun and friendly and I'm sad to see the end of it. But I can't think of a better group to have finished off preclerkship with. 

Definitely going to keep posting lots of baby pictures...

Sunday, 6 November 2016

Last of the Last

We're on the last few cases of the last subunit of the last foundation of preclerkship. In two weeks and one day, I'll officially be a clerk. I have eighteen months and four days to go until the very last day of my program. 

It's very hard to believe that it's almost over, and I'm essentially at the halfway point of med school - well, what would be the halfway point at a traditional program. I technically have longer until graduation than I have completed - I'm 14.5 months in - but the transition to clerkship is a big mile marker and for most med students is essentially 'halfway' so I'm choosing to consider it that way. 

Plus, the next year and a half is going to go very quickly. Six weeks just flies by and with my longest blocks being 6 weeks, it's going to feel like this whole period is gone in a flash. Well, maybe not internal or surgery. I hear they're pretty killer.

Since my initial elective period will be done essentially completely at home, I don't think I'll really feel like a clerk until January, when I start my obstetrics and gynaecology core. After that, I have a series of six different two week blocks (3 elective then 3 cores, one of which is a selective) which I'm sure is going to go by incredibly quickly. 

But nervous about working for fifty weeks straight - I start January 2ed next year and go straight through until December 18th of next year without a break. It's nothing I haven't done before, but it's still a bit daunting. Clerkship is a bit of a different level of intense.

It's odd to consider that as of January, I'll be doing what I'm going to do for the rest of my career, at least a pared-down version of it. There will be more in the way of educational components, obviously, but I'll be seeing patients, writing orders, dictating notes, and doing a whole lot of paperwork. While there are a few important milestones along the way - finishing med school, finishing residency, getting my first job - at which I'll gain even more responsibility, ultimately I'll be doing the same sort of stuff in my day to day life from January onward. Some differences (I'll still have tests and such to prepare for, at least for a while) but definitely in the same ballpark. It's different than going to classes and studying for tests.

So the transition to clerkship is, I think, going to be a really big one. It'll be interesting to look back on my reflection this evening in a year's time, when I'm preparing my CaRMS applications and residency is looming. 

Obligatory baby picture. :) She's three weeks old tomorrow!

Tuesday, 1 November 2016

Practicalities - On Breastfeeding (and doing so while med student-ing)

Yup, it's a post about breastfeeding. You had to know this was coming at some point. But I'm big on normalizing breastfeeding, and it's part of new baby life for me and lots of moms, so I'm going to talk about it and how I manage it during med school.

Miss M is two weeks old now. She's growing well - as of yesterday, she was almost half a pound up from her birthweight. Babies always lose a bit of weight - up to 10% is normal, M lost about 5% - but they should regain it by two weeks of age. She's done quite a bit more than that unlike my first two, possibly because she's combo fed which means she is both breast and formula fed.

I used to be very militantly anti-formula, to the point where I would argue that formula should be available by prescription only. I believed a lot of things that I now know aren't true and I had made breastfeeding a huge part of my identity in an attempt to prove that I was a good mom even though I was really young because I'd internalized the message that "good moms" breastfeed no matter what, unless they are completely physically unable to. I no loner think this way, obviously, but I did for a long time and I was a bit of a jerk about it, to be honest. I'm firmly in the "fed is best" camp these days.

Really, I hated the early weeks of breastfeeding my other two because my kids comfort nursed and cluster fed a lot but I steadfastly refused to allow any bottles of pumped milk or formula or any use of pacifiers because I believed that they would lead to damaging my supply and lead me onto the "downward spiral of supplementation" which I had been warned about repeatedly. I remember sobbing my way through many feeds in the early weeks. It really impacted my ability to enjoy the time with my newborns and do anything but nurse 'round the clock.

Didn't want to go through that again, and I'm much more flexible with infant feeding now and realize that formula is a perfectly reasonable alternative food for my infant, so we decided to combo feed from the start to ensure that she's comfortable going back and forth from breast to bottle and is familiar and comfortable with the taste of formula.

As well, it's way, waaaay easier for my husband to have a couple of ready-to-feed formula bottles in the diaper bag to use when he's on the go with the baby. But breastmilk is cheaper (not free - my pump was $300 and a box of storage bags, which is enough for ~4 full days worth of feedings, is $15) so we want to use that as much as possible.

So far, so good. She goes between breast and bottle (formula or expressed milk) easily and has no apparent taste preference. She also takes a soother which makes me very happy because 1) my husband can more easily calm her, 2) I don't have to deal with hours of acting as a pacifier, and 3)  pacifiers reduce SIDS risk.

To maintain my supply, I pump while I'm away from the baby. Currently, I can't go longer than 2.5-3 hours since that's how often she nurses. Most of my sessions are 3 hours long, but when you add in transit time, and the fact that she may have last nursed more than an hour before I leave, then I have to pump roughly in the middle of most sessions. I've had my husband bring the baby to me at school so that I can feed her directly, but she ended up being quite a distraction to my group (yes, I actually breastfed during a small group session) because she's cute, so we didn't do that again.

When I'm in our main building, finding space for pumping is not an issue. While I have absolutely zero issue nursing in public, pumping is different mentally for me and I want to be somewhere private. The lovely admin staff have been great about letting me use an empty office.  I do have these fantastic things called Freemie collection cups (I make no money from recommending them - I just think they're awesome) which mean I don't end up needing to be partially undressed to pump like I would without them but still, I'm not whipping out my pump in a session. The baby is cute, the pump is not. It's also loud. Whirr-hiss-whirr-hiss.

Finding space when I'm not in the main MD program building is a bit of a challenge. The hospital (where I have some sessions) does have a few locking single-user bathrooms, and they're perfect. Private, lock-able, have a sink for washing up, and they usually have an outlet. But there's only a few and they are not always available. Ran into that today. I was darting around for a good ten minutes trying to find an alternate place to pump before one of the bathrooms came free.

Making pumping arrangements is also coming up in a few other ways. For one, the places I'm staying at while on visiting electives. I needed to email the property owners to ensure I'd have access to enough freezer space to store the milk I'll be pumping (up to a week's worth at a time, which is actually quite a lot of milk.) I have to contact supervisors and admin staff ahead of time to ensure I'll have access to a private space with an outlet and a fridge. It's a bit awkward to have to ask, but it's best I ask well ahead of time so that it doesn't come as a surprise when I show up.

So far actually sorting out the breastfeeding while on the run thing has been interesting, but it's going more smoothly than expected. I keep a manual pump in my bag just in case I get stuck somewhere or forget my electric one. I have a cooler pack so I can store up to 24oz for up to 24h away from a fridge.

Overall, though, it's workable. I have no supply issues (we thought this might be a problem because I'd be away a lot from the start and I didn't historically do well with a pump, but I'm pumping more than she takes while we're separated) and she has no issues with being combo fed. It's gone more smoothly than I thought it would, and that's making life easier for all of us.

We'll see how this works out when I transition to clinical work in January, though. I'll write a post about how that works out.

Pumping with Freemies means I can be way more covered!

She got her own Halloween pumpkin.