You-Know-What

Okay, the topic of the post might sound misleading to most, but those who are aware of it, might agree.

I am taking about the San Francisco Match (or the SF Match, as we call it affectionately). There seems to be a surprising lack of resources for more information about this match and how it works. I have yet to see another website besides the official site (which is quite informative for a beginner) that has some information on the system.

First things first, this is NOT a match for match in California! In fact, it has absolutely nothing to do with location whatsoever. A lot of people ask about whether you need a SSN or PTAL for this match. And the answer is NO.

This is just the same as the NRMP/ERAS match, except for the fact that its for certain fixed sub-specialties, and takes place earlier in the year.
Now since I matched for Child Neurology, that is what I'll talk about (even though the SF match also caters to other sub-specialties like NDD, Ophthalmology, Plastic Surgery etc)

Three Years of Child Neuro include one year of Adult.

What is Child Neurology and why am I talking about  it here?
Well to answer the latter first. I MATCHED! And want to spread the love! (Especially for IMGs who don't have a med school advisor, and rely on seniors and forums for all information!)

To answer the former, read on..

When can you get into it?
WHENEVER YOU WANT! (..Well almost!) There are a couple of separate pathways to get into Pedi Neuro. To make sure I don't give a wrong message, let me quote from the website:

"Prerequisite Training: The training can be initiated following one of three options:
(1) 2 years of residency training in pediatrics in the United States or Canada;  

(2) one PG-1 year (as described in the Program Requirements for Residency Education in Neurology**) and 1 year of residency training in pediatrics; or 

(3) 1 year of pediatrics plus 1 year of basic neuroscience training.

The program director must review and determine the acceptability of these initial two years of training."

** (Excerpt from the Neurology RRC Program Requirements (ACGME): 'Those that provide 4 years of residency training, the first year of which training (accredited in the United States or Canada) must include a broad clinical experience in general internal medicine. This year must include at least one of the following: (a) 8 months in internal medicine with primary responsibility in patient care or (b) 6 months in internal medicine with primary responsibility in patient care and a period of at least 2 months total time in pediatrics or emergency medicine or both. Residents must spend no more than 2 months in neurology during this year.'  

I am taking the first pathway, by entering Child Neurology as PGY-3 in 2013. (Does that clear it up a little?)

So, wait, its a Residency after residency, or a Fellowship ..or what? Huh?

Child Neurology, while technically is a fellowship level thing since you do it after a Peds Residency; it is considered a Residency by the Board. So basically, if you do Peds  then Child Neurology-- and end up taking both Boards-- you can be 'Double Board Certified' with 'Certification in Pediatrics' and 'Certification in Neurology with Special interest in Child Neurology'.
The Neurology Certification means you can practice adult neurology too (since you do have to spend one-third of your Child Neurology Residency in the Adult Year)
Then there's the opportunity to pursue a fellowship, in one of the many fields of interest like Epileptology, Neuromuscular disorders, Sleep medicine etc.


The Timeline:
Its an early match.
How early? Well, the process of submission of documents starts in June (as opposed to September, for ERAS).
- You mostly have interviews ranging from late-October and should finish by late-December (though I met someone who was finishing in mid-Jan, so that's how far it can go!)
- Then you submit the rank list by mid-Jan.
- And Match Day is usually in the last week of Jan. (It was January 27th this year!)


How many programs? 
There are not as many programs for Child Neurology as are for Pediatrics (doh!!). There are about 70 odd programs (--they give you the comprehensive list once you register for the match) . I applied to twenty five programs, and received interviews from thirteen places.

Most of the programs via the SF Match are for the three year Child Neurology i.e. beginning as a PGY-3. But programs prefer if their residents do both- Peds as well as Peds Neuro-- from their place, so they *usually* try to co-ordinate with the Peds Department. This means while they might try to interview you for Pediatrics as well (if you apply there via ERAS), it is NOT an obligation.
Now some places like Cleveland Clinic, Rainbow Babies etc have a dedicated five year track. Which means, if you get in the Child Neurology part of the track, you mostly get in for Pediatrics as well (again, through NRMP!)


Match Data:
While people might think that the competition is less in Pedi Neuro, let me assure you-- its a MYTH! There are about 1-3 spots per year per program. So the ratio for candidates per spot boils down to the same thing. Here is a link to last year's match data from the SF Match. So last year 69% IMGs matched, which is more than the average NRMP match percent, but definitely involves more of a commitment!

I know some IMGs might be tempted to apply just for the heck of it.

If that is your plan, then DON'T!

Here's a scenario:
Assuming, you apply for about 30 Child Neuro programs and a hundred-ish Peds programs. (I did.. since I wasn't sure I would be able to make it in Pedi Neuro this year). If you end up getting interviews in Pedi Neuro, then quite possibly your credentials are good enough and therefore you will get interviews for 'just-Pediatrics' as well.
Now, if you aren't sure if you want to go for Peds Neuro, then you might be in a fix since the match date is earlier. Your rank list is divided between the programs that invited you for both Peds/CN and the ones that have only Peds!
You might end up going to a specialty you aren't sure about (Pedi/Neuro) without giving a specialty you might love (eg Peds or IM) a chance!
[Basically what I'm trying to say is, applying to Peds Neuro is not like applying to say Family Med or Peds as a back up that I've seen a lot of Internal Medicine people do! Its a different ball game altogether]

Apply to the field only if you LOVE it! Since if more than just five years of your life.

_________________________________
I tried to cover everything that sporadically kept coming up in my head. More questions are welcome. I'll try to write another post if I have some common queries, or answer questions in comments.

Good luck!
_________________________________

PS: Hugs to one absolutely fantastic CN intern I met during my away rotations. She patiently helped me out a lot through the whole process, when I didn't know squat about You-Know-What! Thanks, S. x

The Brain Doctor

Hello people!

If you're a person who doesn't know me in real life or on Twitter, then, hey thanks for checking in! A lot has happened since I last wrote.

BRAAAAAIN!

One of the biggest decisions of my professional life has been made. I know where I'll end up for the next five years, and how I'll come out of it. Yes, I now have a Residency position at one of my top choices! And that too, exactly in the specialty that I wanted to go in--- Pediatrics Neurology! :D

This blog played a HUGE part in my choice, since some of my readers here introduced me to the field of Child Neurology in the first place! Then doing an elective in the same furthered hammered the interest in!
In one of those earlier posts I had mentioned how I loved the academic part of Neurology -- the lesions and the localisations *swoon*; but wanted to become a kiddie doctor-- well, safe to say Peds Neuro fulfills both wishes! A dream come true. Yes.

Magical!

Dream, reminds me, I also managed to catch a trip to Disneyworld after the interviews! Had a FANTASTIC time!! All thanks to the family I have here!! :D

Also, I just finished with the USMLE Step3 exam today. And can only hope to pass. (Please pray for me. Thanks.)

As you can see I have loose associations and am in almost a hypomanic state today, I'll end this post here.

Bye bye USMLE! (hopefully!)

But I need to write a couple of pending posts. Those shall happen soon. Just, not right now.
x




PS: Oh, I just realised.. one of my best friends is getting married in a couple of hours! Too bad I can't be there! But I wish K and A the very best for their new life together!! Love you, K! (even though I'm sure neither of them will read the blog in a million years! )


Image Credit for IMG1: Gray's Anatomy for Students: One of the best anatomy books. Ever!

Hiatus

I have been neglecting the blog for quite some while now (umm.. over three months!). While I apologize for it, I would also like to tell y'all the couple of excuses that I have lined up for the neglect :P

1. Microblogging: Twitter has taken over my blogging (for now). Now days, anything remotely interesting that happens in life is reported instantly on Twitter, rather than waiting to write on the blog later. Even things that I am wondering about, missing, enjoying or need to decide on are posted on Twitter for instant decisions.
Must say, I've met quite a few fantastic (and some not-so-fantastic-yet-interesting) people via the microblogging site. :)
I tweet as @drarps by the way.

2. Laziness: Yes, I've admitted to this before and I'll say it again-- I am a lazy blogger. (I still have the Birthday post to finish -- which I can't actually do for another couple of months since I don't have the clues with me as I travel)

Which brings us to point three:
3. Travel: I have been traveling quite a bit in the past two months. If you think it would provide quite some fodder for the blog, you are correct!
I've had my share of mishaps and incidents, (been lost in a strange city, seen some amazing places, spent more than the average person's share at the airport, traveled in a bus where a physical fight broke out at 3 in the night! etc.) but I've seriously been pretty busy planning out the routes and flights, to keep up with the blog.
Again, all these incidents were taken out of my system by ranting on twitter.

4. Exam-lessness: As is natural, the quantity of blogging ideas (and will to publish them), is inversely proportional to the amount of time on hand. Therefore, I blog most often when I am preparing for an exam and am constantly stuck with books.
Technically, I have an exam to prepare for even now, but I haven't been studying for it (why: see point #3). So, I guess for me, no exam= no blogging.


Well, my excuse list ends here. I agree these are pretty lame, but this is all I have for now. Maybe one day I'll become more responsible towards the blog and write more often. Till then I leave you with these pictures that show how I've been the past three months--

(Keep praying for me. Okay?)

And where have I been? Here mostly.

Also, while I end the excuse post, I'll leave you to read the pick of posts on the blog-
Making of a Doctor - First post after the first day of clinical posting.
Best-est teacher in the world - (Clearly it wasn't one of my English teachers! :P)
Test-imony- One of the most hilarious stories I heard in med school! (<--MUST READ!!) Also in line, mono-phonic thinking!

Happy Holidays! :)

Just dropping in a line to wish y'all a Merry Christmas! :)

Happy Holidays!

Brutal Assault

A black day was written in the history of Dr. S.N. Medical College last night when scores of students and doctors were brutally assaulted by the police/jawans. These residents of the UG boys hostel were victimized in their own home, as police barged inside the hostel and beat them up.

_________________________________________________________
Penned by Telly, here is a summary of what happened:

Scheme of Events, (4th-5th Sept. 2010)

• Trauma Centre – Two injured brought in, Resident Doctor attends. Lots of attendants with the injured, who end up in a verbal tussle with the Doctor. Doctor stops treatment. Returns to treat the injured after talks.

Room broken in

• Trauma Centre – The gang which assaulted the injured rushes in. Start violence. Doctor informs the colleagues to swarm in. Policemen come, and start hitting anyone, and everyone with Lathis. Resident Doctors beaten up.

• Trauma Centre – In the meanwhile, Interns come for rescue. Police kick start their jeeps, and drive at break-neck speeds at Interns. Interns forced to run to their hostels.

Blood on the Terrace

• Boys Hostel – Policemen run and lathi-charge the few students there. Students start pelting stones on them.

• Boys Hostel – Huge number of policemen called in. 200 policemen, including RAC jawans stationed outside the Hostel. Students are called for. They are asked to come outside.

• Boys Hostel – Policemen and RAC jawans rush in the hostels, indeterminate hitting by Lathis. Innocent students studying quietly in rooms, Sleeping, are hit with lathis. Doors are broken open. Coolers dismantled. Even students cooperating to come out are beaten like criminals.

• Each step you take on the staircase, you receive one hit. Hit on head. Run behind a student till the terrace, loses balance, and falls down.

• Mass looting by the policemen, money, mobiles. Laptops thrashed on the floor, on purpose. 

Meeting for calling a strike

• Post-massacre – Immense political pressure to not let the senior doctors go on strike. Threatened in different ways.
  

The road less taken.. and how much it'll cost

I’m going to make a list of the moolah spent by an IMG (Indian in this case) if they want to do a Residency in the US of A.

The journey from USMLE to MD ( Yeah! Borrowing term from Digital Doc :D) is a long, and, of course, expensive one. A lot of juniors at college have asked me this question time and again - "How much will it cost me if I decide to work for a Residency in the USA?"

Having been through almost 3/4^th of the process, I’m just listing the basic $s that I have spent on the process till now. By the end of this post you should have a gross idea of how much it’ll cost, and thus you can make a realistic decision of what you want to do next – AIPGEE or USMLE.

(I assume that you have basic idea of what the USMLE and the whole process is like on the whole, and are familiar with the terminology.)

-A lot of costs vary by individual choices. So I’m going to list what I spent as an example where this difference arises.

Exams:

There are a lot of exams that you need to take to be fully ECFMG certified.

TOEFL: An optional exam that is steadily converting into almost a mandatory one if you want to have a competitive CV for electives- Fee $130  Its $165 now.

USMLE Step 1, 2 (CK & CS): A little over $1400 ($700*2) for USMLE Step 1 and 2CK, and $1200 for CS. EDIT: Exam now costs much more than that. USMLE Step1 $880, Step 2CK $895, CS $1295. Check official website for regular increments!

USMLE World: QBank plus the Self Assessments- They’re worth every penny. For Step 1, a two month UW subscription plus UWSA will cost you $195 ($135 + $30*2). And Step 2, will be $165 ($135+$30)

NBME Self Assessment: To assess your prep, you’ll end up taking online NBME practice tests. Since each test costs $45 to take (and $60 for one “special test’ for each exam), the number of tests you take depends on your preparation. There are some who take none while others end up taking all tests. I spent a total of $375 for NBME SAs for both exams.

Electives:

Application: Most Universities have an application fee of $100 or so. Although there are some that are free too. Umar Tariq’s website has a comprehensive list of all information for electives. (I spent about $500 on applications)

Tuition Fee: This totally varies by University where you end up doing electives. Some like Harvard and Tufts have a fee of $2000-3700, while others like Cleveland Clinic and NIH are free. (I paid about  $1400 as tuition)

Malpractice Insurance: This is another thing that is new for us and since there seems to be just one company that provides MI to students on a monthly basis, they have been increasing the premium with every passing year! I ended up spending about $600 for MI.

Travel and Housing: Of course travel to the US will cost another $1000-1500.

Housing will vary from $300 to $500 per month depending on the location. This cost multiplies depending on how long you stay in the US. (I’ll take my expenditure as $500 since I was in luck wrt housing.)

Misc: Add to it other costs like travel insurance, visa fees, immunization titers before going to the US.

Then there’s the whole other set of expenditure on FOOD (major spending if you don’t know how to cook daily meals!), travel within the country and, of course, SHOPPING in the United States. ;-)

Fed Ex:

Giving this a special slot since there is a LOT of paperwork to be sent! There are numerous applications, college documents and Godknowswhat!! Each packet costs about $50, and I’m sure I’ve sent over ten such packets. (= well over $500)

Applying for Residency:

After all this preparation, we come to the main application! It costs a bundle, especially for an IMG!

Registrations: $50 for NRMP and $90 for ERAS token

Application: Come September 1, and a major hole in your pocket is just one click away.

In ERAS, applying to 30 programs in each specialty adds up to $305, and then for each additional program its $25 per program. So, if you are a regular IMG who needs a visa, and is not a big hot shot already in the medical world, you’ll apply to over a hundred programs.

You do the math.

(I ended up spending over $2500, plus another $70 for a USMLE transcript release)

Then there’s more:

Although till now this is the stage I’ve reached in the process, there’s a lot more to come.

Travelling again to the US, expenditure of travel within the US for interviews, USMLE Step 3, living there for about six months… and it goes on.

Bottomline:

Going by this list, USMLEtoMD -till now- has cost about a total of *drumroll* $11,350 *faints*

For those who are planning to start on this journey, this was just a preview for you to have an idea of what the costs are going to be like. Just a thought to keep it realistic.

(And now I won’t have to explain the details individually to anyone who inquires- I can just direct them here! :D)

Note: I’ve tried to keep all figures correct and comprehensive according to my memory. If there is something that you’d like to add or remove, let me know. Hope this post was useful! 

:)


Image credit: Google Images

Medic Music- 3

Here's the next bit in Medic Music.
Sung to the tune of the classic 'The Reason' by Hoobastank, listed some side effects of anti-cancer drugs.
(Apologies in advance for killing the awesome song that The Reason is.)

Here goes:


Lyrics:

Vincristine’s neurotoxic

It causes SIADH too.

Vinblastine blasts the marrow

Hematopoetic cells remain a few.

Cyclo-P is an alkylating agent

That causes cystitis

--Hemorrhagic cystitis—

That needs to be prevented

Acrolein is the culprit.    

Mesna prevents it.

Cisplatin harms the kidneys

It causes 8^th nerve toxicity too

Lung fibrosis is bleo--

And doxo is cardiotoxicity

With 5 fluoro uracil is seen

Photosensitivity-- yyy

(That’s *not* reversible with

A dose of leucovorin)

It needs thymidine for rescue

Thymidine rescues (4)

Mtx -- fatty liver

Myelosuppression’s also a taboo

Mucositis is prominent too

All s/e of Mtx

Coz folate is what he lacks

Leucovorin reverses

(It makes the patient the patient all better

And that’s all that matters!)

Original Song:

The Reason

Image from here.

Another thing, if anyone is interested, there's this cool Chemo-man to remember s/e of anti cancer meds:

Chemoman's image from here.

World's Simplest Cake

I’m not much of a cook.

Doesn't look very tempting in this picture.
But its totally Yummy! ;-)

There are only a couple of things that I can work up in the kitchen- Chai, instant popcorn, Maggi and this surprisingly delicious cake brownie thing which I like to call the “World’s Simplest Cake”

Now this cake is one of the simplest desserts that you can make! Plus most of the ingredients are easily available.

One of my best friends taught me the trick, and since then I’ve taught this cake to lots of people, and believe me they all loved it. Try it out:

[Writing down exactly from the recipe that my friend wrote for me:] 

Ingredients:

1 cup Maida (Refined flour)

½ cup cooking oil

1 cup curd (preferably thick in consistency)

1 cup grated sugar

2 teaspoons baking powder

½ teaspoon Baking soda/Eno

½ cup Cocoa powder (the unsweetened Cadbury kind)

¼ teaspoon Coffee ( *very very little*)

Process:

1. Mix all ingredients. It will become a semi solid paste. Add a little milk to make it slightly liquid.

2. Pour into microwave safe container.

3. Microwave for 7 minutes.

4. Remove and let it stay in a cool dark place for about 15-20 minutes.

5. Remove from container. Serve warm, with vanilla ice-cream.

(This post was written basically to keep an online record of the ingredients needed, since I always mess up the proportions. But if you do happen to try it out, leave experience in comments!)

PS: This post reminds me of OB Cookie’s blog. It makes a pretty interesting plus useful read. With every post she manages to write a post, *and* throw in a delicious recipe.

PPS: My third bit for Medic Music is done (..actually, it has been done for a while now) but my microphone’s busted now. So unless everyone likes a drone with their music- it’ll have to wait till I have enough money to get a new mic.

Medic Music -2

I'm back with the second song for Medic Music.
This time its in a much more listener friendly setting- you don't have to navigate away or download it. :D

The song is sung to the tune of Lollipop by Mika. Of course, even after all my efforts, I could not get a karaoke generator, but Pranab's advice was useful- made the clip with Audacity (unlike the generic Windows sound recorder used last time). Thanks Pranab! :)

The song isn't all that good ( I like DJS more) but had to get it out of my system before I could move on to something better. Made it up somewhere during the exam prep, when I was trying to remember various drugs for Parkinson's disease and what each of the drug's role is in treatment.

Here goes- for *both* of my listeners! ;)

Lyrics:
So you dx'ed Parkinson, eh?
What you gonna do about
x2

For young- with mild
Anti cholinergics do the trick
x2

For oldies with mild disease
No anti cholinergics please.
For mild ones, give 'em amantadine
No side effects in seeing or peeing.
x2

Severe severe
Rx'ing it now m'dear
x2

Young get agonists of dopamine
Much less side effects are they seen.
Levodopa is for older men,
Add carbidopa then!
x2


Original song:


Image from here.
Shobit: Still waiting for some tricks.

Aazaadiyaan!

This song from the movie Udaan (2010) has some of the best lyrics I have heard in a long time.

Pairon Ki Bediaan Khwabon Ko Baandhe Nahi Re, Kabhi Nahi Re
Mitti Ki Parton Ko Nanhe Se Ankur Bhi Cheere, Dheere Dheere
Iraade Hare, Bhare, Jinke Seeno Mei Ghar Karein
Woh Dil Ki Sune, Kare, Na Dare Naa Dare

Subah Ki Kirnon Ko Roke Jo, Salhake Hain Kahan
Jo Khayalon Pe Pehre Daale, Woh Aankhein Hai Kahan
Par Khulne Ki Deri Hai Parinde Udke Chumenge
Aasma Aasma Aasmaaaa
(x2)

Aazaadiyan Aazaadiyan
Maange Na Kabhi,
Mile Mile Mile
Aazadiyan Aazadiyan
Jo Jeele Wahi Jeele Jeele Jeele

Subah Ki Kirnon Ko Roke Jo, Salhake Hain Kahan
Jo Khayalon Pe Pehre Daale, Woh Aankhein Hai Kahan
Par Khulne Ki Deri Hai Parinde Udke Chumenge
Aasma Aasma Aasmaaaa
(x2)

Chorus:
Kahani Khatam Hai, Ya Shuruwat Hone Ko Hai
Subah Nayi Hai Yeh, Ya Phir Raat Hone Ko Hai
(x2)

Aane Wala Waqt Dega Panahein
Ya Phir Se Milenge Do Raahein
Khabar Kyaa.. Kya Pata..

(Lyrics from here )

:)