The medical school interview

In this post I want to share some experiences on what the medical school interviews are like. During my application process I attended eight (8) interviews. These ranged from small private schools to large universities.

[1] Appearance
It is important to look your best; you are applying to a professional program. Focus on having clean shoes, haircut, and a dark appropriately sized suit. Also, don't chew gum; its distracting.

[2] Interview day
Every school does pretty much the same thing -> you will see the classrooms; anatomy room; other areas. The only thing I would pay attention to is the dinning facilities (you want to have a nice place for lunch/dinner because you will be spending many hours in the building).

[3] Lunch time

Usually this is a chance to eat with medical students from the school. Here is where you can probably find out the most information. But don't expect to hear anything bad about the school; med students volunteer for this stuff and are generally people that have a positive view of the school, or are afraid of saying anything bad. Save the negative questions for Student Doctor Network.

Useful questions to ask: Where do students live? How much is rent? What is the daily schedule like? What holidays do you have off?

[4] One on One interview

This is where the differences come into play. Some of them will have two people interviewing you. It can be a faculty member or it could be a practicing physician. Out of eight interviews only one asked me an ethics question. You are guaranteed to be asked "do you have any questions for me?" So you need to have an idea as to why you are choosing the school, and come up with some generic question. I suggest asking about non-academic stuff (don't bother asking about research, quality of teaching, etc...), ask about student organizations, volunteer projects, etc.

[5] Can you predict acceptance based on interview?

No, it is pretty much a game of chance after you are done. You may have had a bad interview or a great interview and the outcome can be the same. The reason for this is that there are other things that come into play besides your interview performance. So don't dwell too much on your performance.

I follow a 6:2 rule -> for every six interviews you should expect to get two acceptances.

A strategy for applying to medical school

Now that I am a medical student, and have gone through the application process I look back at the process of getting into medical school. So I would like to offer a strategy to pre-meds out there based on my experience.

[1] Apply to 15+ schools

The idea behind this is to spread your risk, and increase your chances of getting in. I know that each primary costs ~$50 and each secondary another $50-70. You have to look into the long term results; its better to pay that extra $1000.00 and get in rather than having to incur costs of re-application.

My general rule of thumb is that for every 5-6 applications you should get at least 1 interview.

[2] Choose schools wisely

My biggest mistake was that most of my schools were in the North East (OH, PA, NY, MD). These states are just crazy competitive b/c it has the most density of medical schools, and traditionally people apply here more. So even the less competitive schools get tons of applications.

I suggest applying to 50% schools in North East & 50% in Mid West/South.

[3] Apply to Osteopathic Schools (D.O.)

Osteopathic schools have lower MCAT/GPA requirements and are easier to get into. Don't let the D.O. designation dissuade you. D.O.s and M.D.s work side by side and get the same salary.

The only part that is different if you want to apply to a D.O. school is that (1) application is done through a different service (2) You need to shadow a D.O. physician and get a letter of recommendation.

[4] Go to the cheapest school if accepted
Medical school tuition is extremely expensive these days. Some schools I got into send me a finanical package of $73,000.00 per year in tuition + living. Think about this number, you will be graduating with $292k in medical school dept alone. Also keep in mind that interest rates on Stafford & Grad PLUS are very high right now (6.8% and 8.5% respectively). So when you are in residency for 4-8 years the interest on this 292k will be unbearable.

Summer break

It's the summer between first and second medical school year. Some advise to travel, visit friends, while others work and study for the upcoming board exams. What ever it is, this summer is the last normal summer a medical student will ever have.

Stress and Dept of U.S. Medical Students

By now the application process is drawing to a close and some of the applicants are either very happy with their acceptance letters while others are gearing up to apply again for the next school year.  I was lucky to get in on the first try, yet I did not understand the many realities of medical school until I started this school year.  

For those that got in, it is important to realize that being accepted does not guarantee graduating medical school.  People will be dropping out after the first semester, second semester, and even third semesters because of academic failure or in minor cases health issues.  A 1994 article in Academic Medicine showed that graduation rate of 1988 matriculates was 81.2%.  Now that may have been not so bad in 1988, but things are very different today.  

The main problem is the cost of education.  Think about it -you probably spent about $60k+ on undergraduate education and now you will be spending at least $50k/year on medical school.  So if for some reason you are not doing well in your first year and fail out, you are now $100,000.00+ in dept.  The situation is made worse by the fact that majority of medical students have basic science education (biology, chemistry, etc...).  With these types of basic degrees it will be difficult to find work.  So you will have to go back to undergrad and get another degree.    

It is this financial stress that hangs over my head all the time.  You need to work hard and pass every test because the alternative is not pretty.  Once you start your first year there is not much opportunity to go back.  

On Acute Radiation Syndrome (radiation sickness)

The following text presents some introductory concepts of radiation and exposure.  This topic is complex and links are provided for additional reading.
In the last couple of months I have been reading about effects of radiation on the human body.  This renewed interest came after the April anniversary of the Chernobyl Disaster during which the firefighters and plant workers that responded to the accident received a lethal dose of radiation.  Those workers and firefighters developed what is called Acute Radiation Syndrome (ARS) or radiation sickness.  Furthermore, I have learned that high radiation exposure can occur not only in nuclear power plants, but in nuclear waste reprocessing plants, research institutions, hospitals, and facilities specializing in food irradiation.  

Radiation & Dose Basics
Radiation is energy released by atoms undergoing decay.  This energy can be converted to heat, as in nuclear reactors, and in biological tissues this energy can cause ionizations.  The ionizing radiation can be in the form of alpha, beta, gamma, electrons. [2]

Amount of such radiation is characterized by a dose.  The commonly used SI unit is Gray (Gy) with units J/kg [3].  Gray describes how much energy has been absorbed per unit of mass.  For example, an 80 kg person that received a dose of 10 Gy had absorbed 800 Joules of energy from particles (alpha, beta, gamma, etc.) that have hit the tissue.

Effects on Body
Radiation has a destructive effect on the body; whereas some amount is tolerable, certain amounts are lethal.  Acute Radiation Syndrome (ARS) occurs when body is exposed to large radiation doses within a short period of time.  The amount of time is critical, for example nuclear plant workers receive small doses over years, which might not be tolerable if received all at once in a matter of seconds.  The dose we are talking about is at least 0.5 Gy to produce mild symptoms and with 3.5+ Gy causing severe symptoms with LD50/30 (50 % of those exposed will die within 30 days if left untreated). 

For a detailed discussion on physiologic effects look at a June 2004 article from Annals of Internal Medicine titled Medical Management of the Acute Radiation Syndrome [4]

The following video shows soldiers on the roof of the containment building of the Chernobyl NPP.  These people are using shovels to clean up radioactive graphite following the explosion.  All of these people received lethal doses of radiation.

Sources:
[1] A technical explanation of dosimetry with equations link
[2] Radiation (wikipedia)
[3] Gray (Gy) (wikipedia)
[4] Medical Management of the Acute Radiation Syndrome link to article

Very Hard Life - Doctors in Iraq

What kind of life does a doctor experience in a war-torn country? This question has been on my mind ever since I listened to reports of casualties following suicide attacks and military operation in the current Iraqi war. I have read a number of articles describing the lives of doctors in Baghdad and the answer was worse than I expected. Living in US, I have come to expect a doctor to have some form of elevated level of security due to the basic need of people with such skills (I even heard rumors of med students/doctors feeling safer in bad neighborhoods due to the fact that their would-be attackers understand that they may rely on their help some day). The current situation in Baghdad is very different; doctors there are afraid for their lives; 2,000 doctors have been murdered since 2003 according to Mother Jones magazine [1], and around 35% left the country. One of the causes is the elevated status doctors have in the society, which leads to kidnappings for ransom. Another, most compelling one, stems from religion; for example Shiite doctors/residents fled when Sunni militia was coming around [2], and a reverse happened when the Mahdi Army took over hospitals and went after Sunnis [3] .The hospitals lack supplies, the staff is afraid to come to work, and patients are being targeted. This topic is of great significance, and should be understood by current students and doctors.

[1] Mother Jones Magazine (link)
[2]Counterpunch.org (link)
This is an eye-opening article by a university professor from Baghdad, which describes the state of medical care as well as lives of doctors in Baghdad.
[3] CBS News (link)
A journalist reporting on Mahdi Army control of hospitals in Baghdad.

An article of a personal account by a physician from a private hospital in Baghdad. (link)

Image Sources
Image-1: wounded in Iraqi hospital (Reuters)
Image-2: Iraqi doctors in Baghdad emergency room (AP Photo/Ali Abed)

Treating AF - A look at Cox Maze IV procedure

My interest is surgery, and this post will give a quick look at the Cox-Maze procedure. The goal of the procedure is to treat atrial fibrilation (AF), which is a cardiac arrhythmia. The physical contraction of heart muscle results from conduction of electrical signal over the muscle. The heart has pathways that guide the signal from SA node down to the ventricles. In AF this conduction is disrupted in the atria, resulting in abnormal heartbeat.

Surgical Procedure
In the 1980s James Cox, MD developed a procedure that involved making scars on the atria in a certain pattern such that normal electrical signal conduction would be restored (The pattern of these scars resembles a maze). The original procedure was called Cox-Maze III, and was quite challenging. The latest advancement came in 2006, when surgeons from University of Washington, St. Louis integrated bipolar radiofrequency device, in what became known as Cox-Maze IV. The procedure uses radiofrequency to create scars, instead of the manual incisions and suturing.

Read the journal article, The Cox-Maze IV procedure for lone atrial fibrillation for an in-depth discussion.

image source: Ecardio.org

Don't See Your Doctor Right Before Graduation - A Lesson in Health Insurance

This post is for those students that are going to be graduating and loosing their health insurance. Right before I graduated, I went to my physician to get a physical to make sure that everything was OK. At the time, this made sense and so I got my physical only to find out that there was something wrong and required specialized treatment. But once I graduated and started looking for alternative health coverage I realized that I made a mistake. Insurance companies have this thing called pre-condition, which is their way of saying that they won't cover any ailments you had on the previous insurance plan. So when my physician diagnosed me, I had fallen into this pre-condition trap. If I were to get an insurance plan with a pre-condition clause, I would not be covered for treatment related to that condition.

Now there are some nuances. Pre-condition is usually present in "cheap" insurance. I say this because even the cheapest, descent insurance is $300.00+/month. Good health plans, usually offered through employers, don't have pre-condition stuff. But the health plan advertisements you might get from your school or mail, are usually crap.

The lesson:
1. Don't go to your doctor right before you graduate, wait till you get health coverage through med school or job following graduation.

2. Get COBRA coverage. Its usually offered through your parents' plan an will give you the coverage you previously had under their plan but with a monthly premium ($300.00-$400.00/month).

3. DO NOT be without health insurance. Get a basic plan which you can afford. The worst thing is to be without nothing b/c a couple nights at the hospital can cost you the equivalent of a down payment for a house. The $200.00-$300.00/month will save you thousands in case something happens (and since you are young and very active it probably will)

My Interview Impressions & Experiences

I have now completed eight (8) interviews and would like to share my impressions on this process. Interviewing was at times a lot of fun and other times a big drag. The most positive experience was traveling; I got to travel to some pretty cool places such as NYC and the beaches of Florida. There were times when I was running out of money and did a red-eye interview and another time I stayed with my friends and had a great night. This brings me to a good point - if possible stay with a friend or another med student. You will learn way more about the location as well as have a less stressful stay.

There was a number of schools that impressed me due to their program and facilities. For example, Mount Sinai had the best view of any school, the Central Park. Their anatomy lab faces the Central Park and is an impressive site. The location is nice too, and the living cost is reasonable ($800.00) for a shared apartment, which is great for NYC. Ohio State impressed me with their Asian and Hispanic student run clinics. These clinics are ran by students and a lot of skills can be learned early on. LECOM Bradenton was a lot of fun because the day before I was on the beach, which is only 30 minutes away from the school. The school is on a nature preserve and has an alligator swimming in a pond that is next to the school. Their program is PBL only, and students love it; I sat in for a 2 hour session and was amazed at how the students are able to use what they learned to figure out cases.

Advice:

1. Go to every interview!
Even if you have an acceptance somewhere don't become complacent. Give yourself as many options as possible; you spent all that time studying and applying, interviewing is the fun part. Personally, there were schools that I thought I would not like at all, but was very impressed when I was actually there.
2. If you can avoid hotel stay, do so.
It is sometimes tough, but I did one red-eye and it worked out well for me.
3. Carry-on luggage only (or at least put your suit in there).
I was at Philly and was waiting for my luggage for an hour, only to find out that I was at the wrong luggage place. Thankfully I got my luggage, but I was getting ready to attend the two interviews in jeans and a smelly t-shirt.
4. The two interview questions I encountered most:
a. Why do you want to go to this school?
b. What are your three (3) strengths and three (3) weaknesses?
5. How you feel about the interview does not necessarily predict the outcome.
At the beginning I naturally felt that a positive interview would somehow result in an admission letter. But this is not the case; I was at an interview that I thought went terrible and yet I got what I wanted.

At this point I am still unsure as to where I will go next year, but I will keep you posted.

Sources:
Central Park Image: www.edsphotoblog.com
Beach Image: http://www.siestakeyassociation.com/Images/siestakeybeach.jpg

Magnetic Catheterization...it's cool and a whole lot of money

Every once in a while I run into new technology that appears to be years ahead of its time. The latest piece is a magnetic catheterization system developed by Stereotaxis. The concept is to make catheterization hands free, by replacing a person's hand with a magnetic field. Two large permanent magnets guide a probe through the vessels while the physician operates the device remotely by using a joystick and viewing 3D data on the screen. It looks quite cool, and costs a lot of money; hopefully the benefits of this device will make it a good investment.



image source: www.stereotaxis.com

Fruits Of An Engineering + MD Degree

Being a pre-med engineer can be confusing as most students do not know how they can use their degree in the medical career. It seems that almost all of the focus is given to promoting science majors as future doctors, while engineering schools have little information for its students with a medical interest. Sure, there is bioengineering, but degrees such as mechanical and electrical engineering also give skills that may be suited equaly if not better for future doctors, yet they are underrepresented.

The reality is that a great deal of technological progress is undergoing in the medical industry, and doctors with engineering backgrounds are needed more than ever to help bring technology to market. A great example of this is Dr. Anthony DiGioia who earned a bachelors in civil and masters in civil/biomedical engineering and continued on to Harvard Medical School. Doctor DiGioia used his engineering background and university contacts to link robotics and surgery by forming the Institute for Computer Assisted Orthopaedic Surgery. The work of this institute facilitates development of new surgical robotic technology. Some of the projects included the HipNav & KneeNav systems that allow for better positioning during hip/knee replacement procedures.

In technology development, the idea is everything. It is always possible to find bright minds to put things together, but it takes much more to develop the right idea. I believe that a combination of an engineering background along with a medical degree is exactly what is needed to push current medical technology in the right direction. Dr. DiGioia did it, and hopefully engineering schools will start educating their students about this new phase in technological advancement.

source: The Future of Surgery, Christopher Davis, Pittsburgh Business Times, Feb 8, 2002

Unicondylar Knee Arthroplasty (UKA)

As part of my recent work experience I had a chance to learn about a unique knee arthroplasty procedure. The word unicondylar, means that only a single condyle gets replaced. The procedure is applicable to conditions where only part of the knee surface is damaged. Whereas total knee replacement would remove both healthy and damaged bone, altering normal kinematics of the joint, UKA will preserve some of the kinematics by keeping the healthy part.

Although the procedure is not new and has been around for thirty years, it is gaining more attention because it can be performed in a minimally invasive fashion. Minimally invasive procedure allows for smaller incision site, decreased recovery period, and reduced morbidity.
image source: www.emedicine.com

Read more

Parrots Help Vets

I have been following the Journal of Military Medicine and almost every issue touches on the Post Traumatic Stress Syndrome (PTSS). The current war in Iraq has resulted in large numbers of soldiers with this problem, and has increased interest of the medical professionals. Today on the radio I heard of a parrot sanctuary that is used as a treatment center for vets. The place is called Serenity Park, and it houses abused parrots. The veterans take care of the facility and interact with the parrots. This interesting approach seems to have positive results.
image source: www.hedweb.com/animimag/parrot-hotlinks.htm

Read more

The Forgotten History of Ambulance Service

In America, the ambulance service is something that impresses me almost daily. Having lived in Russia, I can attest that we have something that is truly great and dependable. Not only will the ambulance arrive quickly, there will also be equipment to sustain the patient till the hospital. During the Black History month, our university published an article about the Freedom House Ambulance Service, the first EMS service in the nation. Formed in 1967 by Peter Safar, its goal was to provide advanced care to people on the way to the hospital. The employees were African Americans from the Hill District neighborhood of Pittsburgh, and together with the medical team at Presbyterian Hospital they developed nation's first EMS service that is common place today.
image source: www.freedomhousedoc.com

Further Reading

Plastic Surgery -Not Just for VOGUE Cover

What field of surgery is given most attention by the entertainment industry; plastics of course. This being the entertainment industry with its quest for constant appeal, a one sided view is given. Can you imagine what impression is given after watching Doctor 90210 or Dr. McSteamy? The issue is that people see very little of what plastic surgery is truly about. This week I observed a plastics case that is worth mentioning to show that work of plastic surgeons is not just for Vogue cover.
The case involved a patient who had a large portion of skull bone removed due to tumor. The open area was replaced by a graft. The procedure was complicated by the fact that some skull tissue was gone, complicating proper alignment during closure. Now this was much more satisfying to see than McSteamy yelling at his residents and sleeping around.

The mini doppler was a device I found quite interesting. As shown in the photo above, it consists of a probe connected to a small box with a speaker. The probe allows to determine the location of important vessels without the need for opening the skin. The blood running through the vessels produces a rhythmic "whoosh" sound.

photo: Koven Technology, Inc. (http://www.koven.com/products/ES100X.htm)

List of Schools

I am on spring break and used the free time to put together a list 25 schools. This list used to be much larger, but had been narrowed down primarily by a location requirement. To me it is very important to live in a major metropolitan area so that I can have a descent social life and not rely on a car. I know there are great places in California, but I am not willing to be so far away from my parents and friends that all go to East Coast schools...
The schools represent major Eastern/Midwest cities (Chicago, Philly, NYC, Atlanta, and others) and are ranked by average MCAT score. The list will be narrowed down to around 18, and I welcome suggestions...

GE Cardiovascular Ultrasound for Aortic Valve Replacement

This is my second week volunteering in the OR, and now that I come in the morning, I get a chance to see a wide variety of cases. This week I observed a part of an aortic valve replacement procedure. The surgeons were busy with their work, but the anesthesiologist showed me his ultrasound machine that, it turned out, was an integral part of the procedure.

GE Healthcare has created the Vivid Cardiovascular Ultrasound System that gives anesthesiologists unprecedented capabilities for evaluating the heart and other organs. The device used at this OR was the Vivid 4 model. It has a probe that is inserted into the esophagus to show the coronal view of the heart, and into the stomach to show a horizontal view. A large monitor shows the imaged region in real time, which allows to evaluate the mechanical function of the valves and the myocardium (heart muscle). For example, I saw that the aortic valve was opening very poorly, a condition called aortic stenosis. A very cool feature that adds to evaluation and diagnosis is doppler. This allows to monitor blood flow inside the heart. As seen in the image; the blood flow is color coded according to velocity (but it might be mass flow). The heart I saw, had a clear flow back into the left atrium as the AV valves were closing, which is termed ventricular regurgitation. Besides giving different viewing capability, this machine allows to make measurements. In this procedure it is important to determine the size of artificial valve to be inserted, and that was done by measuring the width of the aortic opening in mm.

image source: GE Healthcare (www.gehealthcare.com)

To make a final comment, I learned that contact lenses and OR environment do not mix. My eyes were getting irritated from the dry air and from smoke caused by bowie (if spelled wrong let me know) knife. Also, here are images of the three general planes used in medical imaging.

image source: National Institute of Technology and Evaluation

What $1.5 Million Will Get You

Today I got a chance to see a prostatectomy, and not just any old school prostatectomy but a robotic one. Using a da Vinci robot that costs a whopping $1.5 million plus all the costs of the retractors and cutters it uses, the urologists performed this delicate procedure in about 3 hours. As explained to me, the benefits are the greater control of laparoscopic devices that the robot provides. It makes it easier to sew the sites of incision within the abdomen, and also leaves less bleeding. In addition, the camera of the robot is 3D, which makes it easier to navigate and move the instruments around; the regular laporascopic camera is 2D.

What was interesting was the fact that the procedure wasn't entirely done by the robot, a resident was standing by the incision site and was holding a laparoscopic retractor to help out with the procedure. It was very cool to watch, but seemed a little excessive.

image: www.marketwire.com

Four Months Till Application

The official application will start in four months when AMCAS is up. In the mean time I am looking up schools. I have determined three main requirements: located in large metropolitan area (so Chicago, Boston, NYC), be affiliated with a large hospital (level 1 trauma, children's, and VA), and standard curriculum (none of that PBL and self teaching, I like old school lectures).
My main way to see the locations is through Google Earth, works great.

How I Studied for the MCAT

Things to keep in mind before you read my strategy. I took ochem1,2 and bio1,2 the year I took the MCAT. This, I think gave me a valuable advantage.

Period of study: June 1 - August 17 (~2.5 months)
MCAT test date: August 19

Materials Used
KAPLAN 2005 Science Review ($23.00)
AAMCAS official practice tests ($120.00)
Textbooks ("free")

The Breakdown

June 1 - July 15: Thoroughly reviewed each subject in the KAPLAN Science Review Book
study period: 9am-1:00pm; 5 days a week
I sat down and systematically reviewed every chapter in that book. Almost all the material is the most basic parts of the subjects covered, so its not a problem to understand if you took the courses. I used my textbooks to supplement some things, and learn material new to me.

July 17 - August 17: Reviewed each subject two more times.
study period: 9am-1:00pm; 5 days a week; Practice MCAT every Saturday for next four weeks

This I think was the most beneficial decision I made. I am now convinced that reviewing material is crucial. I went back and each week reviewed everything for two subjects. For example the first week I went over all of physics and bio, and the following week all ochem and chem.

I also started taking practice MCAT tests every Saturday. I did this under real test conditions, with correctly timed breaks and test times. This is where I learned how to pace myself and how to deal with the test. I also developed a timing scheme that I will talk about in a little bit.

My Timing Protocol