Medical Jargon Demystified II: Pecking Order

Something that I have always found incredibly confusing until I became a part of this structure myself was the hierarchy of medical education. I thought it may be useful to just clarify who is who and how far along in their educational journey in a post.

• Attending (This person is definitely a doctor, they are what we usually think of when we say doctor. Undergrad + Med School + Residency (depending on the field, fellowship))
• Resident (All of these people are technically doctors, they have an MD or DO after their name)
• PGY (INSERT #) (post graduate year) depending on how long their residency training program is this could be PGY 1 - 10)
• PGY 1 (these guys are the interns, they are the lowest of the low in the MD totem pole.  They are first years that were medical students between 2 and 10 months ago and act fairly clueless for the better portion of the year)
• Medical Student (These people are not doctors yet, they DO NOT have MD or DO after their name)
• M4 (4th year student, operates at a similar level to a PGY1)
• M3 (3rd year medical student, fairly clueless but depending on how far along in their 3rd year are closer in performance to an M4)
• M2 (2nd year medical student.  Still in the didactic learning years with minimal clinical exposure, have net to no idea what they're doing)
• M1 (1st year medical student.  In their first year of didactic learning, little to no clinical exposure, has absolutely no idea what is happening ever)

I hope that little snippet helps give a better understanding of what all these weird letters and titles really mean. 

Medical Jargon Demystified I: Wait, I'm still an Undergrad?

I thought it was high time I wrote a post clarifying some of the terminology associated with medical school and generally about the timeline.  This may be quite obvious to many of you out there but I myself was a little bit confused by all of this jargon before I was thrown into the thick of it.

First lets take a look at the timeline from high school onwards down the path of physician-hood

1. Complete high school (4 yrs)
2. Complete bachelor's degree aka undergrad (3-4 years)
3. Complete medical school (4 years) (complete, HA . . . oh don't we all wish it was that simple) there are some added nuances here of allopathic (MD) vs. osteopathic (DO) as well as foreign grads (including some MBBS) but that is a story for another day
4. Complete a residency training program (3+)
5. OPTIONAL: Complete a fellowship training Program (1+)
6. Become a practicing physician aka be an attending (FOREVA+)

Disclaimer: this is really a barebones look at how this breaks down for some people sometimes.  All of these steps do have to be completed, in this order but not necessarily in one fell swoop straight out of high school.  Many people insert alternate careers between steps 2 and 3, some choose to travel the world, others peace out for a little bit DURING STEP 3 (not to be confused with the USMLE Step 3, but again, another day another story).  Some follow the "traditional" route outlines above while others still opt for guaranteed admissions programs that couple college + medical school into a 7 (sometimes 6) year program. 

The nomenclature that I found the most confusing was that medical school which in my mind is professional school maybe loosely referred to as graduate school is called undergraduate medical education.  I thought to myself, "are they serious? I just finished undergrad, this makes zero sense to me."  This all started to make sense when I began hearing people refer to residency training programs as graduate medical education.  

Moral of the story: in med school you're the bottom of the food chain, again. 

In any case at the completion of medical school although you may have your professional title of Doctor there is still some board exam/licensing examinations and residency training that needs to be completed before you are able to practice independently.  

I hope that this post was able to clarify some of the confusion associated with this process.  Keep an eye out for more posts aimed at simplying and clarifying this journey that often feels shrouded in mystery. 

If you have any specifics or other questions feel free to comment below or e-mail at WaitingForMD15@gmail.com

"You look 18, are you sure you're in medical school?"

My very first rotation is coming to a close.  I can't believe it.  Time for another strike out M1 M2 M3. 

Its hard keeping up with the blog but the truth is I really am meaning too.  There is a list of drafted posted with little tidbits and stories I didn't want to forget.  Between moving and rotations starting its been a rollercoaster.

Thanks for sticking it out.

Sage Advice

When I was little and people asked me what I wanted to be when I grew up I said "a doctor".

It wasn't until I started medical school that I realized how non-specific of an answer I was actually giving people.  Doctor.  Internist (I didn't even totally understand what that meant until M1 year)? Pediatrician? Surgeon? Pathologist? Orthopod? Psychiatrist? Family doc? Not to mention advanced fellowship training . . . cardiologist? intensive care doc? allergist? neonatologist?

The list is literally endless.

I've always had an inkling about what I thought I wanted to do.  I wanted to be a pediatrician--or so I thought.  It then occurred to me that this was likely because for the first 18 years of my life, literally from birth to adulthood that was the only physician I had ever seen.  Naturally thats what I thought I wanted.

When I started medical school I thought it was imperative to keep an open mind, there are fields of medicine that exist out there that I have yet to even discover as potential careers.  As a medical student prior to clerkship years how can you possibly already know what you want? Granted there may be those few who since birth have known what their one true passion is, what about the rest of us?

I'm itching to start my clinical years and put the pre-clinical years and step 1 behind me and forage ahead into the world of medicine.

I had the opportunity to spend some time shadowing in the NICU (neonatal intensive care unit) and struck up conversation with one of the Neonatology fellows.  One of my favorite questions to ask of people above me in the totem pole is "When you were in my shoes, what was one thing you wish you had known?"  He gave me one of the best single lines of advice I think I have received in all of medical school thus far

"Don't look at the fellows or the residents, we are all exhausted.  Look at the attendings.  Could you see yourself doing what they do for the rest of your life? Do you like them?"

So simple and in some ways so incredibly obvious.  I hadn't really considered things from that perspective, the one that lumps medical students in with residents and fellows.  Really its just a extension of the education spectrum.  They're still in the grind, they've got their eyes on the same prize as us.  Being a real doctor.

Maybe though when I finally reach attending status I'll be able to look back and chuckle and realize its not all that different on the other side.  Until then I've got my eyes peeled.

May The Odds Be Ever In Your Favor

PAUSE: STUDY. EAT. SLEEP. RINSE. REPEAT x 30

REWIND: My alarm was blaring, it was 5:30, I needed to get up. I felt around my nightstand for my glasses and grappled to put them on my face. Todays the big day. I trudged my way to the bathroom and took a quick shower--a burst of hot water propelled me further into wakefulness.

As I got dressed my mind was racing. It was racing with all of the last minute things I forgot to look up. I quickly ran to my desk and flipped to the equation section of First Aid. Waves of panic washed over me in a rhythmic beat. Clearance. Loading Dose. Maintenance dose. Renal Plasma Flow. Glomerular filtration rate. Inulin. PAH. As I scribbled those down to look over on the ride to the testing center my mind came to a screeching halt and starting leading me down another corridor of confusion. P450 inducers? What were they? Phenytoin, Rifampin. P450 inhibitors? Grapefruit juice. There are more, where is my mnemonic? I raced to the page where I knew I had scribbled a helpful note in the corner. Glancing over the list a momentary sense of relief, I knew them.

Flipping through the pages of first aid at every turn I felt like I was sinking. Did I remember the material? I don't know. My roommate was somewhere in the background packing a lunch and calmly getting ready. I'm not that person. I can't stay calm in those last moments and hand the reigns over to fate, not just yet. I believe in cramming till the 11th hour. Some people say you know what you know. I whole heartedly disagree. How many times on an exam are you searching for just that one little tidbit? Sometimes I find that little tidbit floating in the ether of my mind because I happened to see it as I unceremoniously shoved my notes into my bag before entering the exam room.

The exam itself was quite a marathon but in all honesty I don't even know where the time went. Not to say that I was completely rushed and racing the clock, but it didn't feel quite as long as I was expecting. It was tiring and long and at certain points I felt downright bored.

I did what I could to prepare, based on what I had seen and heard. Uworld? FA? Goljan? Pathoma? Pharmcards? Microcards? CMMRS? Rapid review path? So many resources and so little time.

The step 1 was like no other exam I have ever taken, I don't even know how many questions I answered with 100% confidence. I hesitate to share my study plan until I receive my score.

I set my goals high at the start of all of this, I walked away from that exam hoping, begging and pleading the universe for a pass.  Walking out of that exam felt very much like the end of the road for some of my hopes and dreams but nobody walks out of that feeling like a million bucks.

Stepping out of my testing center and onto the busy sidewalk I was again struck by the realization that it was only my life that had been on pause for the last month.

I'm really hoping that somehow Effie Trinket's words ring true for me, but until then I'll be holding my breathe. (I apologize for the Hunger Games reference, but I had to, I can't say taking the step 1 is all that different than being thrown into the arena)

For now I'm shifting my focus to gearing up for clerkships.  Ready to hit PLAY again.

Into The Wild

Studying for the step 1 has to be the most daunting academic challenge I've ever had to overcome.

I'm finding that the stress of it has as much to do with the grueling hours spent and sheer quantity of material as it does the finality of the whole thing.

If I mess this up then I've essentially ruined any shot at being a successful doctor, a good doctor.  Thats how it feels.

Similar to any standardized test in the past I am confident that at some point in my life I will look back on it and chuckle--vaguely remembering my score +/- 20 points because thats how little it will matter.

That thing is starting to happen where I'm violently oscillating between having too much time and too little all in the matter of hours. (clearly one of the stages of studying for me, for more check out this prior post: Note To (Future) Self

Times like these are a testament to the resilience of the human body and brain or more accurately, plasticity.  A month ago--studying for finals--more than 4 hours of studying felt like too much.  Anything less than 12 hours feels sub-par right now.  Oddly there aren't enough hours in the day for what I've set out to accomplish, everyday I'm surprised by how much I intended to do that remains unchecked on my to do list.

There is something to be said for slipping outside for a few minutes and getting some fresh air and a reminder that the earth is still spinning, people are still living their everyday lives even though it feels like mine has come to a standstill.

A Lot of People Go To College for Seven Years

Don't we all wish it only took seven years?