Breast Surgery Elective, Choosing a "Parallel Plan", and Tips for an Away Elective
Wow! It sure has been a while since I wrote a blog post so I figured we should catch up. Last month I did an away elective in Chicago which was a great experience. The breast surgery elective there was a good eye opener for someone who has worked all third year rotations within the same hospital system. Getting out there and seeing a different hospital system—the similarities and the differences—was awesome!
Breast Surgery Elective
This rotation was a rough start actually because orientation was on a Monday, which happened to be an administrative day for my attending so there was some confusion about where I was supposed to be after orientation. I was directed to check in with the residents on the general surgery team—and because of that my first week was hectic as I was working alongside the residents on the gen surgery team and working their schedule (which was 5 am to 5/6PM, 6 days a week). I did not mind working these hours although it had been a while since I had to wake up so early so the adjustment was definitely an experience as I was not expecting it. However, I got to see way more than just breast surgery, and do more too! It wasn’t until my attending checked in with me during week two that she addressed that I was doing way more than expected for breast surgery – and she defined my role as a student and what hours I should be attending. She also gave me two textbooks to read in my downtime that I found interesting. My attending was amazing and a compassionate doctor. I am thankful she has patience for teaching, and taught me a lot about breast pathology.
Since my attending had administrative days on Monday and Friday – those became days that I could use to explore Chicago which I definitely took advantage of the art, history, and culture the city has to offer. Tuesdays were the main surgery day for breast surgeries (and operations were also scheduled on Thursdays usually but one to two cases instead of 8-10). On Tuesdays, the day was spent between the OR and the pre-op holding areas making sure patients were comfortable, their post-op visit appointments where scheduled, and participating in the lumpectomies, mastectomies, and other procedures. It was optional for me to scrub in on non-breast cases my attending had and being someone who loves surgery I took advantage of being in as many different procedures as possible. Wednesdays were usually outpatient clinic all day where I got to help with wound dressing changes, new patient visits, follow up appointments, and other clinic-related duties. Some of the most touching moments were when patients had newly diagnosed cancers disclosed, or where informed of being cancer-free for however long had passed since original treatment. Thursdays usually started with rounds in the hospital, surgeries in the OR (breast cases were limited on this day), and helping residents with errands. I think what I took away from this elective was I have a deeper passion for oncology than I realized previously, and that surgery really would be the only “parallel plan” for me.
How I chose to NOT have a “Parallel Plan”
My school recommends a “parallel plan” which essentially seems like an alternative or a backup plan to increase your odds of matching. Some people would choose Family Medicine (FM) as an “parallel plan” to Ob-Gyn because you could still practice Ob-Gyn related care within FM; however I could not bring myself to apply to FM as I am that passionate about my choice for Ob-Gyn and would rather take a year to make myself a better candidate for Ob-Gyn if it came down to that instead of training to become an FM doctor. Being trained at an offshore medical school makes a decision to pursue a single specialty more risky, but I want this badly enough. My wife and I have decided together that pursuing a passion should supersede a backup plan. It is important to me because of how prevalent burnout has been reported in medicine and, as someone who throws himself into his work, it would be in my best interest to throw myself into something that brings me fulfillment at the end of the day—a feeling I did not get from FM rotations but definitely did from Ob-Gyn (and even this breast surgery elective to an extent).
This is a personal decision, and for some people who are still undecided after cores and a couple electives as to what to apply for match then it might make sense to have multiple specialties to apply. Had I not had my pathology elective so late, path might have had an opportunity to be a "parallel plan". Although I never experienced many specialties first hand - like radiology or anesthesiology, I have submitted my application for Ob-Gyn with no regrets—and no "parallel plan". Good luck to all of my co-applicants as our submitted ERAS applications make way to the electronic accessibility by residencies across the country today!
Tips for an away elective
Secure housing in a safe place that will make you comfortable in this place away from home – I had a friend living in a hostel which I do not recommend. Hopefully they are not taking bed bugs along with this unique experience.
Network with the people who can get your voice heard – while I was in this surgery rotation, I made sure to stop by and chat with the Ob-Gyn residency coordinator to talk about a question I had that could not be answered online. We ended up having great conversation about life, and we ended the conversation with her asking for my full name along with my Step scores. I also spoke to some of the residents, some being RUSM grads, to help me later on in the residency interview process by knowing some of the residents and allow me to feel more comfortable should I come back later for an interview.
Enjoy the city! I took advantage of many things Chicago had to offer which made being away from my wife and kids a little easier. A month is not that long in the grand scheme of things but Chicago had so much to offer that I barely made it through half of my list of things to explore while I was there. Being a student on a budget, I recommend you look for the free things to do in the city also and take advantage of doing things you couldn’t normally do back home.
Spend extra time during the first day or week getting familiar with the hospital layout. Hospitals aren’t just confusing for patients, but the faster you learn the layout the faster you’ll be able to help other lost individuals who will ask you how to get somewhere. It also allows for you to be able to volunteer to run certain errands if you know where the departments are that you’ll need to get to.
Treat every day like an interview. Keep clothes ironed/pressed, treat everyone with respect and kindness, get to know the people who keep the hospital running and be nice to them. From the person standing guard to the person making ringing up your breakfast, be nice and courteous to everyone (although don’t be disingenuous – don’t pretend to be someone you’re not to fit in because you should go to a program where you’ll be happy and people are similar to you). You never know who you might run into while in a hospital no matter how big you thing the place is.
Infectious Disease Elective
So, this month I am enjoying another rotation in Atlanta, Georgia, and I am glad to be home with my family. I am doing an Infectious Diseases rotation which has been a great review of antibiotics along with a crazy perspective of how diseases such as HIV can vary dramatically based on the person infected and their diligence in obtaining treatment. I also learned about a unique population in Atlanta living with HIV that opened up a new question that I will likely be trying to answer during residency too: How do I know when it is appropriate to offer PrEP (pre-exposure prophylaxis) therapy to a woman? Medical students and doctors have the stereotype of high-risk patients for being exposed to HIV which unfortunately is a stigma given to gay men who engage in anal-receptive sex.
However, the population of women served by my attending are mainly women in heteronormative relationships with no identifiable risk factors. These are not IV drug users. These are women who have presented previously for obstetric care, tested negative for all STDs including HIV, maintained monogamous relationships, and would have given no clinical indication that they were at risk of being exposed to someone with HIV. How, as a future Ob-Gyn, would I be able to spot that one patient where I could help provide a drug that could help prevent her from being part of the 1,500+ new cases in Atlanta each year? In 2016, there where 1,513 newly diagnosed patients and 16.7% were female. About 1 in 5 new cases were of women and identifying those at-risk is a mystery. Time will tell, and I believe my attending is currently working on a scale – similar to Centor criteria – to help providers ascertain when a woman should be offered PrEP therapy. I plan to look into this more, and would love to hear out any ideas you all may have.
I still can't believe that I will finish all degree requirements this December. Seems like time is going slowly and quickly at the same time... Next month, I am doing an audition elective in Ob-Gyn in a program that I have learned some about from my attendance at the ACOG annual conference earlier this year. I am excited to go to Ohio for this elective as I imagine it will be beautiful to be there in autumn. Lastly, shout out to my amazing wife for raising our three beautiful children while I have these away rotations. October should be the last month we will be away from each other for a while, and I am grateful to have her as part of my wonderful support system. Actually, I am grateful to everyone who has strengthened me in this life because without you all then I could not be the person I appreciate myself for being today.
