Continue reading »]]> No one will ever agree on which residency is the hardest, or which residents work the most. However, with some new data from the FREIDA website, we get a better idea than ever before.  (For more information about the FREIDA website, read my previous article) FREIDA reports diverse variables about each specialty including the average of numbers worked per week, the average number of days off per week, and the average vacation time of each specialty.  I have compiled these into one database so that for THE FIRST TIME EVER you can compare objectively which residencies work the hardest.  (Well, at least you can compare which work the longest).

The first figure demonstrates the average number of hours worked by each specialty. As expected, the surgical sub-specialties work the longest hours with neurosurgery leading the pack and general surgery following closely in second.  Of the medical specialties, suprisingly, neurology works the most hours, with pediatrics and internal medicine following close behind. And at the bottom of the list… you guessed it, Dermatology. I wish I loved skin!

The results of the average number of days off per week and the average vacation time during residency follows closely with the trend seen in the graph above. For your viewing pleasure I have the entire compiled dataset posted below.  

Continue reading »]]> This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.

This list of books was specifically created to help medical students. However, I would suggest the same books to anyone taking an undergraduate course in anatomy, to dental students, optometry students, podiatry students, physicians assistant students, advanced nursing students, etc. etc.  When you are studying anatomy there are a few things you have to focus on: 1- Learning the name and location of the structures, 2- learning to identify the important anatomic relationships in the body, and 3- learning the clinical correlations related to the important relationships. Your tests will focus on each of these areas, so you must focus on them as well.

Continue reading »]]> FREIDA Online is a fantastic resource for any medical student. I recently wrote about how students can compare individual residency programs using FREIDA's various different variables.  The database is not limited to comparing individual training programs; it also allows students to compare different specialties.  

The "Specialty Training Statistics" section provides basic statistics about training in each specialty. Variables presented for each specialty include:

1. Number of residency programs in the US
2. Length of training programs
3. Average number of interviews performed by each residency program
4. Total number of residents
5. Gender Gap for each specialty
6. Average number of faculty per resident
7. Average number of work hours per week for each specialty
8. Average number of days off per week  (THESE LAST TWO ARE VERY IMPORTANT!  COMPARE SPECIALTIES!)

LINK HERE

The "Graduate Career Plans" section of FREIDA provides information about the careers plans of each of the medical specialties.  Variables presented for each specialty include:

1. Percentage of residency graduates pursuing further training
2. Percentage of last year's graduates who are in private practice
3. Percentage of last year's graduates who are employed in academic settings
4. Percentage in the military
5. Percentage employed as basic scientists
6. Percentage who are unemployed

In each case, the statistics are taken from the most recent graduating class and the database is updated each year. 

LINK HERE

Read these data carefully.  I found that the "Hours Per Week" section was very useful and very realistic!

Continue reading »]]> Having a hefty six-figure debt hanging over my head, a family at home, and a resident salary to manage it all, I often find myself pinching pennies.  I recently discovered Ramen noodles in ready to eat cups for about $0.28 a cup!  This has changed my residency….where else can you get a lunch that  1- is hot, 2- costs $0.28, 3- is ready to go at any time, 4- is able to sit in my locker for months without spoiling, 5- does not require a Tupperware?  

There are only 1300 problems with this plan….and each one is a mg of sodium. Will one of you please invent Ramen with added beta-blocker!  You would save my life!

Continue reading »]]> My life since July 1 (the stress): Still trying to find time to read, drinking from a fire hose, late nights, early mornings, add on cases late at night, busy call, lectures all the time, research deadlines, poster printing, knowing nothing, different expectations for each attending, trying to find time to study, googling in patient exam rooms because I have never heard of their disease before, falling asleep at the microscope in the OR, trying to get home before my kids go to sleep every single day, failing to get home before my kids go to sleep many days, working my tail off to find time to get one post a month done on shortwhitecoats!

My life since July 1 (the amazing): Waking up chomping at the bit to get to work and learn more, the most incredible surgeries in the world, patients who can’t stop talking about how much you’ve changed their lives, blind to 20/20 in days, seeing the retina….all of it, working with incredible faculty who change the way I will think…forever, grand rounds that blow me away, watching individual RBCs moving through vessels at the microscope, an unexpected and awkward hug from a patient, stopping dead in my tracks once a week and thinking ‘this is so freaking cool!”, going in at 6am leaving at 9pm and not wanting to trade it for anything else.

Student doctors, take advantage of the time you have to make movies like this one. But with each hour of disappearing free time, your career will become that much more incredible.

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Applying to residency is equally exciting as it is stressful. I found myself searching for any information I could find about different programs and what made each program different.  During my hours of searching I found that the AMA’s site, FREIDA ONLINE, was one of the most useful resources.FREIDA is an online database of all ACGME regulated residency and fellowship training programs.  The FREIDA database is searchable by specialty or by state.  The amount of information available for each program is truly staggering, here is just a short list of some of the information you can find out about each training program:

• Program director name and contact information
• Length of the program
• Institution and hospital affiliations
• Size of the residency
• Number of applicants interviewed
• Number of faculty
• Average work hours
• Weeks of call per year
• Amount of didactic lecture
• Salary information
• Vacation weeks
• Benefits information

Now that I know the inner workings of my residency, I looked back at the FREIDA profile to see if the information is correct, and I can vouch for the database, it is spot on.  They provide an analysis of the averages of many of those statistics for each specialty. So, you can compare the ‘hours worked in a week’ of a program you are interested in with the national average. Click here to access the ‘training statistics’.

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A Transitional Year Resident's Perspective: An interview with a transitional year resident from the Ann Arbor, Michigan.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty. See what doctors from every specialty had to say about why they chose their specialtyand how to match in their residency.

• What is a transitional year residency?
  

Transitional Year (TY) residencies might be the least well known residency option after medical school. The TY is a one year residency with a general focus which prepares recent graduates for advanced residencies. To understand where a TY fits in, you must understand that there are a number of residency programs that do not start specialty training until the 2nd year after medical school graduation (i.e. PGY2). These specialties include anesthesia, dermatology, neurology, physical medicine and rehabilitation, radiology, radiation oncology, and ophthalmology.

Each of these residencies begin their specialty training after a resident's intern year. Many of these residency programs will combine the intern year (PGY1) with the advanced specialty training. In these cases, the resident will remain in the same residency throughout their training and there is no need to complete a transition year residency. However, there are programs in each of these specialties that do not start training their residents until the second year after medical school (PGY2). These programs require their residents to complete an approved intern year prior to beginning specialty training. Approved intern years include a year of preliminary medicine, preliminary surgery, preliminary pediatrics, or a transitional year residency.

• How is a transitional year residency different from other intern years?
  

The goals of training are basically the same among all intern years; we all learn hospital based patient care. Surgical interns take care of patients before and after surgery in the hospital, medicine interns take care of medical patients in the hospital, pediatric interns take care of kids in the hospital. A transitional year resident will take care of all of the above. The transitional year aims to be a broad hospital-based training. TY residents will spend various months working on medicine, surgical, OB, pediatric, outpatient, ED, ICU, and elective rotations. The great asset of a TY is that it provides more flexibility, allowing residents to focus on their interests. I am interested in research and was able to complete two months of intense research during my intern year: something no one from an internal medicine, surgery, or any other residency could say.

• Are Transitional Year Residencies easy?
  

Not all TYs are made equally. It is a well known fact that there are some pretty cush TY residencies out there. However, there are also some very difficult TYs. To illustrate this fact, last year I interviewed at a number of TY residencies of varying difficulties. The easiest one had 4 required inpatient months, one outpatient month, one ED month, and 6 electives. Sign out during inpatient months was 3pm. When you were in the ICU you covered 2-3 patients, and you were NEVER on call the entire year. In contrast, I interviewed at a big hospital TY where there were two MICU months where you covered 15 patients, 6 required inpatient medicine months, 2 surgery months, a busy ED month, terrible call, and three 'electives' which were all time consuming. In general, however, the answer to this question is yes. Transitional years are FAR easier than prelim surg residencies and quite a bit easier than prelim medicine residencies as well.

• Is the training as good at a Transitional Year Residency?
  

Absolutely, if you choose the right place. Many months this year I have more free time than I did in medical school. I have found that with the free time I am actually reading and studying a ton. I think that you MUST take call to learn how to be a doctor during your intern year. I am not sure how you can become a 'well trained' doctor if you never take call during your intern year. Being on call at night is when you really have to make decisions and you really learn a ton. You don't need 11 months of inpatient work to become a great radiologist or a great ophthalmologist. However, 6 solid months of medicine/surgery will certainly prepare you for your next level of training. Then you can spend the other half of the year becoming great at something else: research, pediatrics, surgery, golf, sleeping, etc etc

• Describe a typical transitional year schedule?
  

Everyone must do: 1 month in the ICU, 1 month ED, 1 month outpatient, 2 months general medicine. I believe the rest is up to the residency program. Most programs end up giving 3-5 months of electives.

• What are the potential downsides of a Transitional Year?
  

Not many! More free time, less stress, more fun…what's not to like. I guess one downside is that it closes some doors if you choose to switch specialties. For example, if you were doing a preliminary medicine year at an academic center and decided you wanted to do medicine instead of anesthesia, the switch would be easier. After completing a TY year you can only go into the specialties I listed above.

• How competitive is the Transitional Year match?
  

It is actually very competitive. There are not many spots, and they are all coveted because they represent less work, more free time, more electives, and a much easier year. Also, imagine all the applicants trying to get spots: future radiologists, ophthalmologists, radiation oncologists, dermatologists. This is not a list of ordinary applicants. Matching into a TY is about as hard as matching into radiology or ophthalmology.

• What are residencies looking for in a Transitional Year applicant?
  

I asked my TY program directer this exact question and this was his response: "We know we will only have you for one year. However, during that year the TY class will take care of about 50% of all the patients in this hospital. So, it is in the hospitals best interest to have someone who 1- will work hard without being asked, and 2- will maintain the great patient care that we have at the hospital." I think those two things are exactly what all programs want. I think item #2 may touch on competency a little bit, but is mostly referring to your interpersonal skills.

• What should students look for in a Transitional Year residency?
  

Whatever you want to look for in a TY year. That sounds cliche, but as I said above, not all TYs are made equally. Do you want a chill year at the risk of missing out on training? You can find that. Do you want to do pediatrics as well as medicine and surgery? You can find that.

• Is there anything you wish you knew before application season?
  

I interviewed at a few places that had both TY years as well as preliminary medicine years but the curriculum was exactly the same. In other words, if you match into the preliminary medicine year, you still have the flexibility that the TY residents at the same program have. All of these programs will let you apply to both the TY and the prelim med year after your single interview. These are great programs to find because even though there is no difference at all in the curriculum, the preliminary medicine years are a bit easier to get into.

• What other advice to you have for students applying to a Transitional Year?
  

Good luck, intern year is exhilarating, fantastically rewarding, difficult, and very very short. Enjoy it. Read The House of God (amazon link), there is no better time than intern year. Also, watch the first season of Scrubs where the characters are interns…it is incredibly realistic!

Editor's Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty. If you are interviewing or working on your application for orthopedics or another specialty, check out First Aid for the Match and The Successful Match: 200 Rules to Succeed in the Residency Match.

Continue reading »]]> Choosing the right anatomy atlas is a stressful decision, and one that is quite important. For many of you (students in medical, dental, optometry, and podiatry school) this will be one of the first decision you must make at your professional school. In order to help you sort through some of the most popular choices, let me highlight some of the pros and cons of each text.  I am a firm believer that education should be tailored to the student. If your school/teacher tells you to buy a certain anatomy atlas, do not listen. This is like telling a left handed student that he/she must take a test using their right hand.  You must find a text that allows you to learn best. There are many options and each has its own strengths.

One IMPORTANT HINT:

Check out each atlas on amazon.com, you can browse the pages of each book in full color by clicking the "Click To Look Inside" tab over each book. This is the best way to see what you are going to like.

1. Netter's Atlas of Human Anatomy

The Netter's Atlas of Human Anatomy is the best selling anatomy atlas in the country, and my personal favorite.  The images are bright and colorful. The detail is crisp and memorable. I am a visual learner, and the bright images helped me focus and remember better. In fact, the images were so vibrant that I could often see them in my head during tests, allowing me to remember specific details in each image.  One downside to this atlas is its relative lack of information and detail. There is no text other than anatomy labels. There are no clinical correlations. There are not as many structures labeled as some other texts.

2. Rohen's Color Atlas of Anatomy

Unfortunately for me, I did not learn about Rohen's Color Atlas of Anatomy: A Photographic Study of the Human Body until after my anatomy class. Had I known about this book, or seen it at all, I absolutely would have purchased this right off the bat.  Unlike many other atlases, the focus of Rohen's are real life photographs. There are beautifully dissected bodies, bones, and radiographs showing each structure. Where the anatomy becomes confusing, Rohen's uses color labeling to help students understand where structures are located in three dimensions. The images are high definition and very memorable.  The layout is crisp and clear.  I can not think of a downside to Rohen's. Perhaps if you do not want to look at real photos but rather artists' renderings, this would not be for you. Because the text uses photos, it is more difficult to see the fine and subtle differences in some structures. However, in my opinion, this is real life and your practice exam will not be based on artist's anatomy drawings.

3. Gilroy's Atlas of Anatomy

Gilroy's Atlas of Anatomy does not seem like anything special at first glance. However, I have never met someone who used the Gilroy atlas and did not love it. In fact, it holds the #2 AND #4 position for Best Selling Anatomy Books on Amazon! (#2= Kindle Edition, #4= standard edition).  One very useful aspect of the Gilroy text are the clinically oriented tables and boxes. In nearly every section, the text focuses on some of the most important clinical correlations related to the structures being discussed. These tables are clear and concise. While you can achieve the same information with a clinical anatomy book, some prefer to have both sets of information in the same place.  The downside in my opinion are the quite pedestrian images, but this does not bother most students.

4. Grant's Atlas of Anatomy

Grant's Atlas of Anatomy is a well known text with a great history and crisp images similar to the Gilroy text. Many students use the companion, Grant's Dissector, in the anatomy lab. The images in the dissector are similar to the full text book. Many students at my school enjoyed this text and felt like there was a perfect mix of anatomy plates to clinical correlations in the book.  This is a no-frills purchase: it is one of the cheaper atlases but provides everything a student would need.

5. Thieme Atlas of Anatomy

The THIEME Atlas of Anatomy is well liked by its users, just Google the title and you will find loads of students who love it. However, I have never actually met a student who used it. We had a couple copies in our library, but no one every looked at them.  If you are a textbook lover, you might want to look at the Thieme book. It reads more like a textbook than an anatomy atlas.

6. Clemente's Anatomy

Little known Clemente's Anatomy: A Regional Atlas of the Human Body is a sort of cult-favorite atlas. Many believe the illustrations in Clemente are the best on the market. They are clear and straight forward.  There is a good mix of clinical information. The price is low, and the satisfaction is high.  I have not used Clemente's but those who have used it say that they would use it again.

7. Gray's Atlas of Anatomy

Gray's Anatomy for Students is one of histories best-known atlases. However, I think that the atlases listed above have surpassed this historical text. There are newer versions, but I fear the TV show named after the atlas will forever be more famous than that atlas itself.  The images are nice and there are a number of photos and radiologic images which accompany the anatomy illustrates. Because of Gray's historical status, it warrants a few minutes to flip through the pages, but I would not purchase this text myself.

8. Sobotta, Atlas of Human Anatomy

Sobotta – Atlas of Human Anatomy was introduced to me through a reader of this site. I did not have any exposure to it prior to the comment below. After reviewing the atlas at length I must admit that it is very impressive. The images are clear. There is ample text to explain clinical correlations. And, most importantly, the text can be purchased in a two volume set. This will decrease the load on your back by about 15 pounds every day. This is actually a very nice feature

 Did you use a great atlas that is not on this list?  Tell me about it!