Category Archive: Specialties

Basics of Fundus Drawing

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Ophthalmology

July 7, 2015

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Few ophthalmology residents today learn the art of color fundus drawing. This used to be a fundamental skill required by all ophthalmologists. With the advent of electronic medical records, wide angle fundus photography, and the never ending push to see more patients, the art has nearly died. However, there are a number of reasons why the art should not be ignored by ophthalmology residents; allow me to try and persuade you.

Why should I still be drawing the retina?

First, you will need to be able to read old medical charts; some of which have only fundus drawings without text descriptions of the retina. No matter what form of ophthalmology you practice, you will need to read and interpret these intricate fundus photography. Second, many retina specialists suggest that taking time to produce a proper fundus drawing is the best way to coerce residents and ophthalmologists into a proper, complete retinal examination. Retina specialists in particular have been known to spend more time on a colored pencil drawing of the retina than on the retinal exam itself. Finally, if you are at all interested in a retina fellowship, there are few better ways to impress your old-school retina faculty than to produce great fundus drawings. So, with that in mind, here is a quick primer.

The Fundus Skeleton

A true retina drawing will contain three concentric circles. The first represents the equator, the second represents the ora serrata, and the third represents the pars plana. There should also be 12 tick marks indicating each clock hour of the retina. (See a great example here). 

A Work of Art

Next come the colors. A normal retina should have a red hue and most ophthalmologists will color in the entire first two circles (out to the ora serrata) with a light red color. The image on the left is representative of how to draw most common findings in the retina. Feel free to download and print this image, I have found it very useful. Let's break up the details by color.

Color Fundus Drawing

Click for full size [large] image file

Brown:

Any alteration in the choroidal pigment. Brown is usually reserved for a nevus or melanoma.

Black:

Any alterations in the retinal pigment including pigment mottling, lattice degeneration, dark retinal pigmentation (CHRPE), or laser scars.

Blue:

A sign of fluid, blue can represent veins, sub retinal fluid surrounding a retinal tear, retinal or macular edema, or a frank retinal detachment.

Red:

As previously stated, normal retina is red and most ophthalmologist paint the entire fundus with a light red color. Arteries are also red and any retinal neovascularization is red as well. A darker red is used inside of a blue outline to demonstrate retinal holes or tears. 

Green:

Anything in the pre-retinal space. This includes media opacities, vitreous hemorrhage, pre-retinal hemorrhage, pre-retinal gliosis, epi-retinal membrane.

Yellow:

Exudative processes including retinal exudation, drusen, retinal scars, emboli, choroidal neovascular membranes.

Good Luck!

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Interview: The in’s and out’s of radiation oncology

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Radiation Oncology

July 6, 2015

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radiation oncology

 

A Radiation Oncology Attending's Perspective: From an interview with a radiation oncology attending.

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 specialty and how to match in their residency.

 

  • What attracted you to radiation oncology?

I realized that a radiation oncologist has a unique opportunity to serve as a physician for patients at a very difficult time, and I appreciated the emphasis on shared decision making and communication skill by my mentors in the field. I also enjoyed the emphasis on anatomy and imaging.

 

  • Describe a radiation oncologist's typical work day?

I typically arrive at around 7am when treatment begins for the day. Most of a radiation oncologist’s work is in an outpatient clinic. The day is spent seeing new consultations, follow-up visits, and evaluating patients who are currently under treatment. When you aren’t seeing patients, your time is usually spent creating individualized radiation treatment plans for new patients, which includes doing a CT simulation, contouring, and planning with a dosimetrist and physicist.

 

  • What type of lifestyle can a radiation oncologist expect?  

Nearly all of a radiation oncologist’s work is in an outpatient setting, which means that nights, weekends, and holidays are usually free. This is one of the more attractive features of the specialty.

 

  • What is the potential salary of a radiation oncologist?

The average salary varies significantly between academic settings and private practice. There is a wide variety of compensation agreements depending on each unique situation.

 

  • What is the job market like for radiation oncology?

Radiation Oncology is a very small field. For example, in some less populous regions, an entire state might have around 16 radiation oncologists. Because of that, it can be challenging to find a job in a specific geographic region. If it is essential for you to live in a certain region, be aware that it might be difficult to make that happen, and that you might have to accept significant compromises to get a job in a given area. This is one of the drawbacks of radiation oncology. If geography and flexible location are important to you, other larger specialties might make for an easier job search (e.g. internal medicine, anesthesiology, etc).

 

  • What can you tell us about radiation oncology subspecialties?

Most radiation oncologists complete their training after the 5 year residency without doing a fellowship. A fellowship can sometimes help to bolster academic credentials if needed or be used as a segue into a job at a desirable institution. Common fellowships include pediatric radiation oncology and proton therapy.

 

  • What are the potential downsides of radiation oncology that students should be aware of?

If you have academic aspirations, it can be difficult to find protected time as a radiation oncologist. Geographic limitations are an important consideration (see above).

 

  • How competitive is the radiation oncology match?

Very. Radiation Oncology attracts students with great boards scores, strong letters of recommendation from mentors, and ample research experience.

 

  • What must a student do to match well in radiation oncology?

Students must obtain great board scores, demonstrate research productivity, and produce strong letters of support from mentors who know you well.

 

  • What are residencies looking for in a radiation oncology resident?

Strong credentials will open the door for an interview. Beyond that, programs are looking for someone who can carry on a normal conversation and has a pleasant personality.

 

  • What should students be looking for in a radiation oncology residency?

It can be interesting to look at where graduates end up after residency. There is a wide variety in the quality of didactics, with most radiation biology and physics courses being something that you just have to endure no matter where you match.

 

  • What else would you tell medical students who are considering radiation oncology?

While radiation oncology offers a desirable schedule and good compensation, it is important to go into the field for the right reasons. Keep in mind that as a radiation oncologist, you will be taking care of patients who are very ill, and are often approaching the end of life. To be successful, you will need to develop the skill of navigating these sensitive discussions with agility, and sometimes it can be emotionally exhausting. At the same time, helping patients and their families work through these scenarios is very meaningful and fulfilling work.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: How to Match in Physical Medicine and Rehabilitation

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Choosing a Specialty, How to match in....?, PM&R, The Match

May 30, 2015

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PM&R Vintage

 

A Physical Medicine and Rehabilitation (PM&R) Resident’s Perspective:  From an interview with a PM&R resident from Ohio.

 

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 specialty and how to match in their residency.

 

  • How competitive is the PM&R match?

Matching in PM&R is not as competitive as some fields, such as radiology, neurosurgery, dermatology, etc. However, it also used to be a relatively unknown specialty. Medical student exposure to PM&R has improved and the number of applicants seems to be steadily increasing, so it is becoming more competitive.

 

  •  What must a student do to match well in PM&R?

A student looking to match well in PM&R should focus on the same things students would pursuing other specialties. Like any specialty, doing well on boards is important. Most programs have now instituted board score cut-offs for applicants, which are around 200-220 for USMLE Step 1. In general, students should perform well on their clinical clerkships throughout medical school, and a rotation is PM&R is preferred. Strong supportive letters of recommendation, including one from someone in PM&R, is preferred. At least some exposure to or participation in research is also a plus.

 

  • What are residencies looking for in a PM&R applicant?
PM&R residencies look for all the usual strengths in an applicant like good board scores and academic performance, good clinical performance on your clerkships, research exposure, etc. In my experience, PM&R residencies also tend to appreciate individuals with additional interests like sports and music. There are many in PM&R who followed non-traditional paths to medicine and may have had other careers first. Personality is also very important, as it takes pretty caring and compassionate people to be providers for individuals with disabilities as well as an ability to work with a multi-disciplinary team. In addition to a student's application, their interview day with a residency program will be very important

 

  • What should students look for in a PM&R residency?

If you are pursuing PM&R but not yet sure whether you want to do a fellowship, look for a well-rounded PM&R program with opportunities for exposure to the subspecialties. I looked for a program with a good balance of inpatient and outpatient clinical duties and wanted exposure to all the major areas: Sports/MSK, stroke, TBI (traumatic brain injury), SCI (spinal cord injury), amputation and pediatric rehab. I also looked for programs that had an ultrasound curriculum, as well as plenty of exposure to procedures including electrodiagnosis (EMG), botox, interventional spine and baclofen pumps. Beyond curriculum, the deciding factor in residency programs for me was finding a good “fit.” I paid close attention to interactions with residents, students, fellows and faculty on interview days to try and get a feel for whether this was a place I would like to train or not. 

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Like any other specialty, having a well-rounded application is important. Although board scores are important and used as a screening tool, residencies want to see much more than that. Do at least one rotation in PM&R, even if you have to arrange an away rotation. Also try and have at least one Letter of Recommendation from someone in PM&R. I looked for well-rounded programs to rank, but ultimately my rank list came down to finding a good fit on my interview day. Pick a program where you can see yourself being both well trained and happy for 4 years

 

  • What do you wish you knew before application/interview season?  

Although I did a lot of practice interview questions before my interviews, one question I didn’t have a great answer for was “So what is a Physiatrist?” I struggled with this question because the scope of our field is pretty broad, but having a decent answer will help guide your personal statement and save you the embarrassment if asked on the interview trail

 
  • What other advice do you have for students applying for PM&R residency?  

People like to say “plenty of money and relaxation,” and although the lifestyle is good there are long days and hard days. We take care of very sick patients, many of which have experienced something catastrophic, and as their physiatrist we can be their greatest advocate or on some days just their cheerleader. In PM&R, you have to be willing to wear many different hats. Also, make sure you write “PM&R” NOT “PMNR,” and know how to pronounce “Physiatrist.”  

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why Did You Choose Physical Medicine and Rehabilitation (PM&R)?

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Fourth Year, Choosing a Specialty, PM&R, Why did you choose....?

May 30, 2015

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EMG2

 

 

A Physical Medicine and Rehabilitation PM&R) Resident’s Perspective: From an interview with a PM&R resident from Ohio.. 

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 specialty and how to match in their residency.

 

  • What attracted you to physical medicine and rehabilitation (PM&R)?

I initially explored PM&R because I always had an interest in neurophysiology and neuroanatomy, and I knew that physiatrists took care of patients with stroke, traumatic brain injury, spinal cord injury, and other disorders of the nervous and musculoskeletal systems. During my first rotation in PM&R was when I learned that physiatrists primary focus in helping their patients is by improving function. This focus on function is ultimately what attracted me to PM&R, because enabling patients with different abilities to function can substantially affect quality of life. Another aspect of PM&R that attracted me to the specialty was working with a multidisciplinary team to provide care. 

 

  • Describe a physiatrist's typical work day?

The workday of a typical physiatrist is quite regular, usually from about 8am to 5pm, but this can vary somewhat depending on your type of practice. There are many physiatrists who only do outpatient clinic, while others do both inpatient and outpatient. 

 

  • What type of lifestyle can a physiatrist expect?  

Lifestyle of a physiatrist can be somewhat variable depending on practice setup and location, but overall is considered to be well balanced relative to other specialties in medicine. We also have a high job satisfaction. PM&R is a very family friendly field, with plenty of free time and family time. Most physiatrists do not work nights, but there is some call coverage for those with inpatient duties. On average, call is usually about one week and one weekend per month, but can be less frequent depending on size of the department. Primary (first) call at large hospitals is most often covered by residents and fellows, and the attending is only called when needed. Call does usually include rounding on the weekend, which is usually brief.

 

  • What is the potential salary of a physiatrist?

The average salary of a physiatrist is around $180,000-190,000. 

 

  • What is the job market like for PM&R?

The job market for physiatrists is excellent both immediately following completion of residency as well as after advanced fellowship training

 

  • What can you tell us about PM&R subspecialties?

Another advantage to training in PM&R is that there are many options for subspecialty training. PM&R residents can pursue fellowship in many areas including the following: Interventional Pain/Spine, Sports Medicine, Cancer Rehabilitation, Stroke Rehabilitation, Traumatic Brain Injury, Spinal Cord Injury, Pediatric Rehabilitation Medicine, Neuromuscular Medicine/EMG, Informatics and Research. Most of the clinical fellowships are 1 year of additional training, and Pediatric Rehabilitation Medicine can be 1 year for those who completed a combined residency and 2 years for those who completed a general PM&R residency 

 

  • What are the potential downsides of PM&R that students should be aware of?

Although I did not consider salary when making my career decisions, it is an important consideration for students to think about as many of us have student loan debt and families to provide for. One potential downside of PM&R that students should be aware of is reimbursement changes for procedures, particularly electrodiagnostic testing. The salary I mentioned earlier is at or just below the average for all physicians.

 

  • What else would you tell medical students who are considering PM&R?

I highly recommend considering a career in PM&R. It is a fairly small field of medicine but it is growing and evolving, with so many exciting possibilities particularly with advances in technology. Being a physiatrist is incredibly rewarding. It is difficult to describe what it feels like when you see someone who had a stroke, spinal cord injury, or amputation walk again, but it’s pretty awesome to be a part of the team making that happen 

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: How to match in neurosurgery

Categories:

Choosing a Specialty, How to match in....?, Neurosurgery, The Match

May 30, 2015

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Recklinghausen neurosurgery

 

A Neurosurgery Resident’s Perspective:  From an interview with a neurosurgery resident from a top program in the Midwest.

 

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 specialty and how to match in their residency.

 

  • How competitive is the neurosurgery match?

Neurosurgery is among the very competitive specialties. Still though, I think that 80% of U.S. grads match somewhere.

 

 

  •  What must a student do to match well in neurosurgery?

All students should rotate at their home institution as well as at least one away rotation (almost everyone in my medical school class did at least two away rotations).  Boards are important.  Research and publications are very well looked on, as is performance on the sub-internship.  Being a good sub-intern is not about how much you know, but rather how hard you work, how willing you are to be at the hospital constantly, and how easy to get along with you are.

 

  • What are residencies looking for in a neurosurgery applicant?
The answers are the same as what I mentioned earlier. As a resident, I want someone who’s going to work their tail off on service and not let down the rest of the team.  

 

  • What should students look for in a neurosurgery residency?

Make sure the fit of your personality matches the department.  Seven years is a long time to be miserable if you don’t like the people, no matter how prestigious the place. 

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Letters of recommendation should be from neurosurgeons (it’s a very small world), or research mentors. Perhaps other types of surgeons can write your letter of recommendation if you’ve worked with them a lot.   Other letters really won’t count for anything.  You should get one from the chair at the places where you rotate.  It doesn’t matter if you didn’t really work with them at all; they will solicit feedback from the residents and staff you did work with and their letter serves as a summary of your time there.  

 

  • What do you wish you knew before application/interview season?  

It’s well worth it to interview at a lot of places and get a “tour” of neurosurgery.  It really is a small world and you’ll run into people over and over.  

 
  • What other advice do you have for students applying for neurosurgery residency?  

It’s an awesome privilege to be able to do this stuff. Good luck!  

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why did you choose neurosurgery?

Categories:

Choosing a Specialty, Neurosurgery, The Match, Why did you choose....?

May 30, 2015

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vintage neurosurgery
 

A Neurosurgery Resident’s Perspective: From an interview with a neurosurgical resident from a top program in the Midwest. 

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 specialty and how to match in their residency.

 

  • What attracted you to neurosurgery?

I knew pretty early on that I enjoyed surgery.  I liked surgery rotations, liked the satisfaction of work that was both mental and physical, liked that there is a lot of instant gratification in surgery, being able to (sometimes) fix something in a very immediate way.  Within surgery I think I could have liked a lot of rotations, but I ultimately gravitated to neurosurgery because I liked seeing people who came in pretty dramatically ill, and sometimes we were able to help, or at least mitigate the badness.  I liked the intensity of it, as well as the variety; there’s everything from tedious microsurgery for brain aneurysms to giant spine cases where you’re using big power tools.  The common denominator is that most of it is pretty high stakes.  

 

  • Describe a neurosurgeon's typical work day?

In general, days start early and end late.  As a resident I usually get in around 5:30, and the day ends when the cases are over and evening rounds are done.  Sometimes I’m out by 6, but more often substantially later.

 

  • What type of lifestyle can a neurosurgeon expect?  

Many neurosurgical problems (trauma, ruptured aneurysms, cranial or spine infections) need to be dealt with right away, whether it’s the middle of the night or the weekend.  There are some neurosurgeons that have more regular schedules than others, but most have a substantial amount of call.

 

  • What is the potential salary of a neurosurgeon?

I honestly don’t know exact numbers, but I do know it is generally high, even for surgical specialties.  I think that shouldn’t factor too much into your decision to go into it though- It’s nice to know you’re going to be well compensated, but I’ve got to think a lot of the long, off-hour, painful cases would be utter misery if your only motivation is that it pays a lot.   

 

  • What is the job market like for neurosurgery?

I don’t know- I’ll tell you when I’m closer to completing residency!  One thing to be aware of is that in general, private practice docs do more spine surgery, and more of the cranial work is done at Academic Institutions. 

 

  • What can you tell us about neurosurgery subspecialties?

Subspecialty training after residency can be in pediatrics (1 year fellowship), endovascular or open vascular (1-2 year fellowship), spine (1 year), tumor (1 year), functional (1 year), peripheral nerve (1 year).  

 

  • What are the potential downsides of neurosurgery that students should be aware of?

A large part of neurosurgery can be trying to help people with chronic pain, and they can be a challenging population.  Neurosurgeons suffer from some of the highest malpractice rates in the country.  There is much discussion in neurosurgical circles about the decreasing reimbursement for our procedures.  Much of patient volume in private practice is spine.  

 

  • What else would you tell medical students who are considering neurosurgery?

A lot of people say “only do neurosurgery if you couldn’t do anything else.”  I’m not that dogmatic, but you need to realize it’s a pretty heavy lifestyle commitment  

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: Why Did You Choose ENT?

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Otolaryngology, Why did you choose....?

May 11, 2015

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Neck Dissection
 

An Otolaryngology (ENT) Resident’s Perspective: From an interview with an ENT resident at from the Midwest.

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 specialty and how to match in their residency.

 

  • What attracted you to ENT?

I was attracted to surgery initially.  After shadowing in ENT I realize that I really enjoyed the anatomy, I enjoyed the personalities that I encountered in the specialty and I thought that the idea of treating deafness with cochlear implants and the idea of helping kids with cleft lip really exciting.

 

  • Describe a otolaryngologist’s typical work day?

Work is usually in the office or in the operating room.  Some ENTs split their day between both, but most have "clinic days" and "OR days".  A resident will round in the morning (early like surgery) and either go to the assigned OR or go to the assigned clinic.  Rarely do residents have days to just do floor work after internship.  After the day's work is done residents will finish any consults from the day, round on the patients in the evening and sign out to the covering resident.  

Attendings will typically come in to start their OR or clinic in the morning, check on their patients during the day, and head home when the work is done.

 

  • What type of lifestyle can a otolaryngologist expect?  

ENT lifestyle is good.  Most ENTs have predictable hours and flexibility to arrange their schedule to avoid working late into the night.  In private practice, ENTs finish by 5 o'clock and their family can count on them to be home.  In academic practice, there can be more evening meetings or emergent consults; and family flexibility is important.  Many ENTs are in academic medicine or practice in private groups and divide call across the group. 

 

  • What is the potential salary of a otolaryngologist?

$200-300k for someone starting academic job, 400-600k+ for private (Midwest estimates)

 

  • What is the job market like for otolaryngology?

There seems to be a shortage of ENTs currently and private groups are recruiting heavily across the country.  Academic jobs are available, but may require flexibility on location to get exactly what you are looking for.  Fellowships are generally available, although trends seem to ebb and flow & are unpredictable.  (i.e. recently facial plastics fellowships were very popular: twice as many applicants as positions, but not the case this year (2015))

  • What can you tell us about otolaryngology subspecialties?

Options for otolaryngologists include General ENT, Head and Neck Oncology, Facial Plastics and Reconstructive surgery, Advanced Pediatric Otolaryngology, Laryngology, Rhinology/Allergy, Otology/Neurotology, Skull Base, Surgery, Sleep Medicine.  All differences in salary are mainly determined by private vs. academic setting.

+General ENT- no extra training, most are in private practice with great salary and wide open job market

+Head and Neck oncology- 1-2 year fellowship required, almost all are associated with academic department, most likely type of ENT to have long hours- because surgeries are complex and urgent due to cancer treatment.  Airway and bleeding emergencies happen in the patient population, so call can include overnight emergencies requiring surgery.

+Facial plastics and reconstructive surgery: 1-year fellowship, there is variability within this subspecialty from purely cosmetic facial plastic practice to free flap reconstruction after major cancer surgery.  The lifestyle of the cosmetic surgeon in private practice can be as glamorous as it sounds.  The free flap surgeon lifestyle resembles the head and neck-oncologist.

+Advanced pediatric otolaryngology- 1-2 year fellowship, generally associated with tertiary referral hospital and/or academic center.  Lifestyle is a bit busier because they are more likely to have ICU patients than General ENT counterparts.  Kids are frequently getting things stuck in their trachea at night so call often involves surgery.  

+Laryngology- 1 year fellowship: voice surgery, again typically associated with academic center/tertiary hospital.  Some of these ENTs treat professional vocalists and their practice may resemble the cosmetic (posh) clinic.  Most laryngologists have consistent hours but airway emergencies can be quite stressful.  

+Rhinology/Allergy- 1 year fellowship. Generally specialize in sinus surgery and there is a trend to managing allergy.  May be in private or academic setting.  Lifestyle is good because emergencies are rare- consults can generally wait until office hours.  Somehow billing has been very favorable for rhinology and they are in demand because their practice is lucrative.  

+Otology/Neurotology- 2 year fellowship. Focus on treating ear disease and ear surgery including operations on the internal auditory canal (between the brainstem and the inner ear.)  They are associated with tertiary referral centers/academic centers and have a good lifestyle- consults can generally wait for business hours.  

 

  • What are the potential downsides of otolaryngology that students should be aware of?

The residency is a surgical residency and that comes with the long hours, pimping, and no service cap.  ENT does not have strong history of research and there are many aspects of treatment which are based on expert opinion as the best evidence.  If you want evidence like cardiology has- it just isn't there yet.  You will encounter snot, ear wax, tracheostomy secretions, pus from neck infections.  If this is unacceptable- stay away.  

 

  • What else would you tell medical students who are considering otolaryngology?

Many ENT's enjoy all of the gizmos.  Our academic meetings feature many companies coming up with gadgets, scopes and tools for work in the ear/nose/throat.  Robotic surgeries are becoming common in ENT practice.  Minimally invasive surgery is progressing rapidly.  Some of the first applications of 3D printing in medicine have occurred in ENT.  If  you love innovation, look into this specialty.  We have been curing deafness with cochlear implants for decades.  There are many more examples.

There is a big variety within the field and you can perform simple procedures like ear tubes or tonsillectomies- all the way to reconstructing a baby's trachea or removing the voicebox for cancer treatment.  We frequently work alongside other specialities; neurosurgery has overlaps, endocrine surgery with the thyroid and parathyroid glands, oral surgery, ophthalmology, plastic surgery, pediatric surgery, cardiothoracic surgery etc.   

Another strength of the specialty, in my opinion, is that there is no direct medical counterpart (for example neurosurgery and neurology).  Which means that we treat head and neck diseases and we decide when to treat medically and when to treat surgically.  

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: How to Match in ENT

Categories:

Choosing a Specialty, How to match in....?, Otolaryngology

May 11, 2015

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Ear Exam

 

An Otolaryngology Resident’s Perspective:  From an interview with an ENT resident from the Midwest

 

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 specialty and how to match in their residency.

 

  • How competitive is the Otolaryngology match?

The match is very competitive, recently it has been otolaryngology matched applicants with the highest average Step 1 score.   

 

  •  What must a student do to match well in Otolaryngology ?

Generally applicants need to have good test scores, and strong research and extracurricular features in their CV to be ensured an interview.  However, the programs are small- and personality conflicts are hard to avoid, so the interview becomes crucial to actually matching.  Programs have many qualified applicants and interviews are important for finding people who will be a good fit.  Also, the field is small, a well-connected chairman seems to know all the ENT's in the country, so your letters of recommendation (specifically who wrote them) is vitally important to where you match.  

 

  • What are residencies looking for in a Otolaryngology applicant?
Residencies are looking for someone who they get along with, someone they can trust to tell them the truth when staffing a consult in the middle of the night (not just what they want to hear).  Big academic centers are looking for hard-working and successful researchers with a record of being able to get a project to publication as a student.  Of course, any concerns that the resident will have professionalism or personal coping issues during training will flag them to fall way down the rank list.  (Programs are generally 2-3 people per year/ 5 year program, losing one resident means losing 10% of the residency).

 

  • What should students look for in a Otolaryngology residency?

Students should pay attention to what graduates  have been doing.  If everyone is going into fellowship and becoming chairman somewhere- you can be sure that there is some unstated expectation that matched applicants will continue that trend.  On the flip-side, if everybody goes into general practice and you want an academic job, there may not be mentors or support for you to get there.  Think honestly about what you ultimately desire- then come up with a politically correct way to convey those career goals to discuss in interviews.  

Another thing to look for is representation of all the subspecialties.  It can be hard for academic programs to retain facial plastic surgeons. If you hope to treat cleft lips, make sure there is someone to learn it from.  

Observe the general happiness of the residents.  If you match, you will join that small cohort of people and spend more time with them than your spouse.  Watch for anything that might be intolerable.

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

It is a competitive match so seek a mentor who is well-connected in the field.  They will help you with curating experiences to put on your CV and where to get letters of recommendation.  This may mean looking outside your institution.  Successful research is sought and will be discussed at all interviews.   Letters of recommendation are almost all positive, so it becomes important WHO wrote the letter.  If you have your heart set on a specific program, make sure your letter writers know the chair/program director.  Be proactive without being annoying in the process.  One of my co-residents was not offered an interview here, but she called and politely discussed her situation with the coordinator and program director.  She got an interview and ended up matching.  The corollary is that if you are rude to the secratary managing interviews, they can mention it to the committee and get you off the rank list.  Be professional!  Rank lists are deeply personal and involve many factors- but basically rank where you WANT to go. 

 

  • What do you wish you knew before application/interview season?  

I wish I knew how small the field is.  Fortunately my letter writers were well known- to my benefit.  In a competitive specialty like this one, small things matter- if you are professional and hard-working it will show. 

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Top Ten Books for Ophthalmology Residents

Categories:

Ophthalmology

May 5, 2015

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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.

No one outside of ophthalmology can truly appreciate the breadth and depth of this specialty. Most doctors assume that it must be quite simple to learn everything you need to know about one small organ. Though I had been told this many times prior to ophthalmology residency, I was still shocked but the amount of pathology that occurs in the eye. With a few years of residency under my belt, I will try to answer the most important question: what are the ten best books for ophthalmology residents.

Let me preface this list by saying two things.

  1. To do well on exams (OKAPs, ABO Board Exam) I can not rely on books, but rather I rely on questions. I have previously written a review of Ophthoquestions, which I think is a fantastic online resource and has helped me prepare very well for OKAPS. So while the following books are important, I would not recommend studying for OKAPS without a question bank, either online or in print.
  2. Your attending physicians will tell you that you can not ignore the current literature. For a while I convinced myself that I did not have time or desire to read current journals. However, the longer I am in ophthalmology, the more I realize how effective it is to read through the top ophthalmology peer-reviewed journals. As a resident you will get the "Blue" Ophthalmology Journal at your home. It takes no more than 10-15 minutes to read the abstracts. You will learn a ton and stay up-to-date on what is important in ophthalmology
  • Updated May 2015

1. The Wills Eye Manual:

A great reference manual is a must for all ophthalmology residents. The Wills Eye Manual, or as I call it, The Bible, always has everything I need to complete a workup or start a treatment regimen. Some residents also enjoy The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. Both are good, just make sure one of them is in your bag when you take your first call.

2. The Basic and Clinical Science Course (BCSC):

I know what most of you are thinking…What? The BCSC is second? Sacrilege! It is true, the BCSC is a great resource, but I must put the Wills Manual first because of its universal utility. You can carry 15 BCSC books to the hospital with you every day. Most of you will get these from your residency program; if not, you should seriously consider spending the money for them.

3. Friedman's Review of Ophthalmology:

Friedman's is like the "First Aid Series" for ophthalmology. The book is full of high yield facts and pearls. It is surprisingly thorough and is a great resource to study prior to a subspecialty rotation or OKAPs. I have found, however, that reviewing the lists of facts presented in Friedman's is not very useful until you have a grasp of the concepts…something that will come from time in clinic and the BCSC series.

4. Nerad: Techniques in Ophthalmic Plastic Surgery

I will list a number of subspecialty texts in this Top Ten list, but not have I turned to more often than the Nerad text. This is the perfect book to prepare for oculoplastic surgery patients in the clinic and the OR. The night before every oculoplastic OR day I would read through the techniques of the upcoming surgeries and I was always very well prepared to learn in the OR and to answer most pimp questions that came up. I HIGHLY recommend this book. 

5. Last Minute Optics:

I previously wrote about Dr. Hunters free optics lectures. This is the text that parallels his free lectures. If you prefer written text over video lectures, this is the best optics book available. You can read it in a few hours and you will learn a surprising amount of clinical optics. It is perfect for last minute OKAPs studying or if you actually want to learn clinical optics but don't have much free time.

6. Chern: Review Questions in Ophthalmology

There are many great resources for ophthalmology residents looking for good questions. I have already written about the online questionbank, Ophthoquestions, which I highly recommend. There are also 50 questions at the end of each BCSC book, which are very good. As far as printed question books, the Chern book takes the cake. It has hundres of great questions and great explanations.

7. Chang: Phaco Chop and Advanced Phaco Techniques:

Every ophthalmology resident wants to become a safer, faster, more efficient surgeon. Dr. Chang is world renowned in his phaco technique and his ability to teach his phaco tecnique. I found this book to be incredibly useful as I approached my third year surgical rotations. It discusses general techniques and also advice for getting out of difficult situations. You really need to read about everything that can happen in the eye, because you will not see everything as a resident. 

8. Cornea: Krachmer, Mannis, Holland:

The last three suggestions I will make are large, dense, subspecialty textbooks. The BCSC series is simply not robust enough to help with difficult cases. A good cornea text or atlas is a must for all clinics as a reference. I have been very impressed with the organization and clarity of the Mannis text, though there are a few others. For a less dense option with beautiful photos, Krachmer has also put out his Cornea Atlas, which is full of great cornea photos.

9. Ryan's Retina:

A retina reference text is another must-have for residents and clinics. Most of you will have access to these reference books in your libraries or clinics. If not, consider purchasing one early in training so you can familiarize yourself with it and bring it with you to your private clinics after training. The Ryan text is very well known, but another great option is Gass' Atlas of Macular Diseases.

10. Walsh and Hoyt's Clinical Neuro-ophthalmology:

A final must-have reference is a great neuro-ophthalmology text. Remember, these are the issues that can kill ophthalmology patients. You will not always have fellows and neuro-ophthalmologists in the room next door and you will need a great reference book. The Walsh and Hoyt text is the favorite of most ophthalmologists. 

 
 
 

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ophthoquestions.com: A Review

Categories:

Ophthalmology

May 4, 2015

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I realized early in medical school that, for me, the best way to learn is by doing questions. USMLE World and Kaplan's QBank got me through Step 1, Step 2, and Step 3. When ophthalmology residency started, I was relieved to hear about www.ophthoquestions.com. A much smaller pool of buyers (US and maybe UK ophthalmology residents) means the company can not have nearly the same profit margin as USMLE World and Kaplan. Nevertheless, I was quite surprised to see that the product was still very good. I have been VERY please with my experience, here are my thoughts…

 

ADVANTAGES

  • The online format is unique in the field of ophthalmology. There are many great review books and question books to prepare for the OKAPs and the American Board of Ophthalmology (ABO) Exam, but nothing as portable and technologically savvy as ophthoquestions.
  • The questions are well written and parallel very well the questions on the OKAPs. I am told they also parallel well the questions on the written ABO Exam. Having not taken the ABO Board, I can not verify this.
  • For the most part, the explanations are detailed enough to learn the finer points of the pathophysiology without being overbearing. If anything, ophthoquestions errors on the side of being to succinct. They can do better at having more robust explanations. In this regard, USMLE World and Kaplan's Q-Bank are superior products. 
  • The questions are obviously written by subspecialists with knowledge in the specific fields, making the answer explanations very reliable.
  • If you do all the questions in the database you will be VERY well prepared for OKAPs
  • The price may seem steep (~$150 per year) compared to question books, but with 3,500+ questions nothing has the same amount of content

DISADVANTAGES

  • In my opinion, the current (May 2015) content on the site does not properly reflect to proportions of subspecialty content on exams. For example, and huge proportion of the ophthoquestions content is devoted to refractive surgery, while very little is devoted to uveitis. This does not reflect the content on exams, and certainly does not reflect the content that ophthalmologists should know.  Of course, you can simply not do all the refractive surgery questions, and this would solve the problem. 
  • The writers occasionally become defensive and personal when defending their questions and answers. I respect their opinions but I really don't think that a question bank is the place for defensive answers. 
  • If you do NOT complete all the questions in the database, the price (~$150 per year) is certainly very high. If you are only going to do a few hundred questions, you might as well purchase a question book like Chern: Review Questions in Ophthalmology. 

CONCLUSION

I am very pleased with my ophthoquestions.com experience and recommend it to all new residents. It is the best product on the market for OKAP and ABO board preparation. It has some faults, but to be honest, not that many. I am not someone who will read the whole BCSC series, because I will never remember chapters and books. But the content in ophthoquestions is presented in a memorable and organized way that has CERTAINLY helped me do well on the OKAPs exams.

 

Some other ophthalmology review tools:

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