Saturday, June 25, 2011

Specialty Stereotypes

“ All those things you fought against as a youth: you begin to realize they're stereotypes because they're true.”
-David Cronenberg

There are a lot of jokes among medical students and physicians about what types of people typically enter a given specialty.  Orthopedic surgeons are the clean-cut jocks.  Pediatricians are the nice people.  Psychiatrists are the quirky ones.  Internal medicine physicians are the intellectuals.  And what are emergency physicians?  We're the rebels, the people who don't quite conform to the standards of doctor-dom.

Of course, these stereotypes are just that: stereotypes, and they have limited relationship to reality.  But even limited relationships to reality are somewhat linked to reality.  This became apparent during the first half of our intern orientation this week, most of which we spent doing ACLS and PALS training.  On the first day of ACLS training, which was Tuesday, my classmates and I showed up in jeans, t-shirts, tennis shoes, and in one case, a pair of toe shoes.  What about everyone else?  The orthopedic surgery intern in my group wore a button-down shirt and khakis with loafers.  The medicine interns were dressed as if for clinic, with the men wearing shirts and ties with slacks, and the women in blouses with slacks or skirts.

I asked one of the medicine interns why he and his classmates were wearing ties.  He explained that they were told to dress professionally for clinic.  I pointed out to him that the mannequins were not going to think that he was unprofessional if he didn't wear a tie while performing CPR on them.  The next day, he and most of his classmates were not wearing ties, which was all for the best.  It isn't easy giving CPR to a mannequin when your tie keeps getting stuck between your hands and the mannequin's rubber chest.

The whole experience of giving CPR to mannequins is kind of strange anyway, especially when the mannequins are just a torso with no arms or legs.  At one of the ACLS stations, the preceptor asked my group what we wanted to do.  One of the other interns replied, "This guy has no arms, no legs, and no brain.  Are we sure that his life is worth saving???"

Saturday, June 18, 2011


“The beginning is the most important part of the work.”

Hi, and welcome to my blog.  I am a new resident at at the UMass emergency medicine residency program--well, or at least I will be starting on Monday.  Residency is the next stage of medical training after graduating from medical school.  As residents (also called house staff), we already have our medical degrees.  That means we are officially doctors.  However, we're not yet ready (or licensed!) to practice medicine independently.  The information that students learn in medical school provides the background for being a physician, but it doesn't provide the practical know-how.  For my residency classmates and me, the transition from medical student to practicing emergency medicine physician will occur over the next three years.  That amount of time feels both inordinately long and frighteningly inadequate at the same time.

I'm a nontraditional student who had a previous career prior to going to medical school.  Unlike some of my classmates, I was not one of those people who planned on being an emergency physician from the get-go.  In fact, I had never even considered emergency medicine (EM) as a career until I did a month-long rotation during medical school.  I found that I enjoyed doing procedures like suturing or draining abscesses; preferred being busy rather than having long stretches of time where I didn't do very much; and liked seeing patients with a variety of problems.  I also felt like I could deal with some of the negatives of this specialty, including stress, burnout, difficult patients, healthcare disparities, and changing shift hours.  Finally, I felt like I had more in common personality-wise with EM physicians than I did with physicians in other specialties.  I will leave it up to you to decide whether that is a good thing or not.

Four months ago, I ranked UMass number one in the national residency match.  I first became interested in this program because my goal is to be a medical toxicologist.  Medical toxicology is a subspecialty of EM that takes care of patients who have been poisoned or overdosed.  When I went on my residency interviews, multiple people told me that if I want an academic toxicology career, UMass was the place to go.  But I also felt that this program was strong in the other major subspecialties of EM, including pediatric EM, ultrasound, EMS, and research.  What clinched the decision for me was that I had such a great time at my interview day.  In particular, I felt like I really clicked well with the residents and faculty that I met.  To me, fit is the most important thing when selecting a program.  There aren't any "bad" EM programs in terms of the quality of training provided, but there are definitely EM programs that are bad fits for specific candidates.

What you are currently reading is going to be a weekly blog describing my experiences in residency.  The intended audience is primarily medical students and premedical students, but I'm happy to have other interested readers as well.  The primary focus is on what it's like to be an emergency medicine resident, both in general and at UMass in particular.  It's also about the universal experience of being a resident; those of you who are considering a career in medicine, or who are already pursuing one, will still get a glimpse of resident life even if you don't choose to specialize in emergency medicine.  Hope you enjoy.