Wednesday, August 9, 2017

Rotation 2: Less Is More In Critical Care

Posted by Jessica Gerges at Wednesday, August 09, 2017

Less is more. That was the recurring theme of this rotation. Less is more, especially in the ICU. I just finished up critical care in Detroit and “less is more” is the phrase I kept hearing from my preceptor, my attendings, and even some of the medical residents. During my first week, my preceptor and I were sitting down talking about possible interventions for a specific patient and he said, “Less is more in critical care. If you walk into a patient’s room and you don’t know what to do, the patient has a greater chance of survival if you just close the door and do nothing.” I always kept that in the back of my mind when working up patients. The exciting part was that during my second week, the new medical residents were starting their residencies. I learned that they had a tendency to take a more conservative approach with their interventions because they wanted to be safe. Because of that approach, I have had many situations where I had to try to convince a resident to discontinue a drug or decrease the dose, depending on the situation.

Because I was in Detroit, I dealt with a much sicker patient population than what we see in Ann Arbor. I would say that’s what made me most nervous when starting this rotation. It was my first inpatient rotation, it was my first rotation overall, and I was doing a specialty. Because it was critical care, I was trying to prepare myself for the worst of the worst. As I’m writing this, I can tell you that I have seen almost every type of patient out there on this rotation. From gunshot wounds and stabbings to drug overdose to cardiac arrests and COPD exacerbations; I’ve seen it all and I was learning so much.

Here is an insight to what a normal day looked like for me:
6:30 AM-7:45 AM—Arrive to hospital and work up patients
7:45 AM-8 AM—Pre-rounds discussion with preceptor
8 AM-11 AM—Rounds with MICU team
11 AM-Lunch—Post-rounds discussion with preceptor
1:30 PM-4 PM—Topic discussion, clinical questions, updates on patients

Throughout my rotation, I had 4 different attendings. Each attending had a different starting time and different pace during rounds. I had to learn how to manage my time for each attending. Towards the end of my rotation, I had to show up at the hospital at 6 AM because my attending started rounds at 7:30 AM. I needed time to work up old patients and new patients (and sometimes that still wouldn’t be enough time to prep).

I was extremely lucky with my preceptor for this rotation. He was very knowledgeable and he always challenged me. On my first day, he said, “I’m going to ask a lot of pathophysiology questions. You’re going to hear ‘why?’ from me a lot. You’ll be tired of it by the end of this rotation.” And boy, was he right! I had to explain the rationale for anything and everything that had to with a patient. Whether it was my dosing recommendations, the side effects the patient may be experiencing, why the patient is improving, why the patient is not improving—I had to explain it all. Most of the time, I didn’t know the answer. Sometimes he would explain it to me, sometimes he would make me look it up and explain it to him after lunch, and sometimes he would make a topic discussion out of it. Looking back at those moments, I’m glad he challenged me that way! Pathophysiology was never my forte but understanding the “why” behind everything allowed me to be innovative with my recommendations.

One of the things that stood out to me the most during this rotation was how the nurses and physicians appreciated pharmacists. I admired the respect they had for my preceptor and his recommendations. I enjoyed watching some of the residents and attendings lean on my preceptor for his input and really depend on him. If he disagrees with something, they will listen to him. If he has a warning, everyone on the team will make note of it when monitoring the patient. It was refreshing to see. I have been told by multiple attendings that I was lucky to placed with my preceptor because I was going to learn so much from him and they were right!

I learned so much on this rotation and by the end of the 5 weeks, I felt like there was still so much more I needed to learn. I feel like this rotation has prepared me well for my upcoming inpatient rotations. If all my rotations are going to be like this one, then I’m in for a ride this year!

Saturday, August 5, 2017

Rotation 2: The Crazy World of Detroit ID

Posted by Josephine at Saturday, August 05, 2017

My Rotation 1 was community pharmacy so this ID consult service rotation was my first inpatient/hospital rotation. I will preface this entire blog post by saying it was one of the most character-building and mind-changing experiences I have had thus far in pharmacy school.

The Typical Day
6:30 AM: Arrive at the hospital
6:30 – 9:00 AM: Work up patients, check labs, solidify assessment/plan, etc.
9:00 – 10:30 AM: Meet with preceptor to discuss patients and go through topic discussions, would sometimes meet for longer depending on when rounds started.
10:30 AM – 6:30 PM: Various, schedule built around attending and the ID consult team (ID medical fellow + 2nd/3rd year medical resident + medical student + ID clinical pharmacist + me! the pharmacy student). For the pharmacy student, priority was given to rounds, which could sometimes go as late as 6-7 PM. Other things would fit in such as attending grand rounds/different lectures, working up patients for the next day, preparing topic discussions, answering any questions from the preceptor or consult team, etc.

I would typically arrive at 6:30 AM in the morning and leave the hospital around 6:30 PM… and do more work at home. Saturdays were for completing the additional work of this rotation – writing a paper, doing a journal club, etc. Sundays were for working up patients for Monday.

*Fair warning, this was not an easy rotation. It might have been easier for someone that has already had an inpatient rotation, but even as a baseline, it was very challenging.

The Main Responsibilities
1.     Patients: I would work up 2 new patients each day in an accumulating fashion (Day 1 = 2 new patients, Day 2 = 2 more new patients + 2 patients from Day 1, and so on). For each new patient, I would be required to prepare a topic discussion on the primary reason for ID consult (so, 2 topic discussions daily), in addition to an assessment and plan. The consult service itself followed perhaps 15-25 patients, but the most I had to follow at one time was perhaps ~10 (which was already a lot for me..) In total I think I did about 30 topic discussions. 
2.     Dosing: For each of the patients I was following, I was required to do dosing calculations by hand for vancomycin and aminoglycosides (no shortcuts with PK calculators).
3.     Review paper: a minimum 4-page well-cited review paper was required. The topic could be an ID topic of the student’s choice. In my case I wrote about Carbapanem-Resistant Enterobacteriaciae with a focus on new agents in development. Very exciting stuff.
4.     Journal club: As is typical in the other rotations, I was required to give 1 journal club on an ID topic, preferably comparing 2 drugs.

Why was this rotation so exciting?
ID in Detroit is definitely NOT like it would be at a small community hospital. For one thing, the consult service sees patients with more difficult to treat or unusual/uncommon infections. The Detroit patient population is also interesting (lot of HIV/AIDS and IV drug abuse.) The types of infections we encountered were also skimmed over or not really covered during P3 therapeutics. For example – in addition to a lot of MRSA, I saw multidrug-resistant pathogens (like carbapenem-resistant acinetobacters/Enterobacteriaciae), strange but problematic pathogens we never even hear about in school (like stenotrophomonas), and even uncommon disease states (like neurosyphilis).  And of course, we also got the whole slew of infections caused by opportunistic pathogens in the uncontrolled HIV population – so cryptococcal meningitis, PCP PNA, etc. I definitely learned a lot in preparing my topic discussions, that is for sure.

Because of all this, I was able to see how we might use unconventional and creative methods to treat patients. Remember those “big-gun” typically non-formulary agents we barely learned about in P3 therapeutics? (linezolid, daptomycin, carbapenems) Yeah, we used those a lot. Also used other interesting combinations like polymyxin B + meropenem, vancomycin + cefazolin, daptomycin + ceftaroline. All of this leads me to see that ID practice in Detroit is quite progressive.

I should also mention that my preceptor is very involved in gram-positive research. Therefore, part of what made this rotation so exciting is that I got to learn about how the anti-infective research being done at this institution is creative and quite literally practice-changing – no joke, I only spent a month here, but I was quickly able to see that the data coming out of this lab (and others like it) actually affects the ID treatment decisions and pathways in place at the hospital. And that’s kind of incredible.

This rotation also gave me a great opportunity to practice my vanco dosing. I say that especially because this institution doses vanco by AUC instead of by troughs. I was really lucky because through doing all of those calculations by hand, and through discussions with my preceptor and his fellows, I gained a more full understanding of vanco PK/PD. Yes, it was tedious… but it sounds like more institutions might be adopting this in the future, so it was a good thing for me to learn.

The People: A huge factor in making this rotation so enjoyable.

My preceptor is super knowledgeable about ID and clearly very passionate about the field. I will say that he’s very high in demand and also very busy, but he always made time for me; in addition to the morning discussions (sometimes going on for hours), he was constantly available through email or text or phone call. He was instrumental in getting me to think with an evidence-based mindset (see below) and helped me learn to question things like the patient's condition, how certain infections occur, the team's recommendations, why guidelines recommend certain therapies, etc. He also spent considerable time coaching me on developing my “voice” on the team – how to make recommendations and give information in a respectful way. As a student doing my first inpatient rotation, I was very grateful for that. From what I’ve heard, not every preceptor will invest quite so much in a student, so this was definitely something to appreciate.

The ID fellows that co-precepted me are part of my preceptor’s anti-infective research lab. I think it was a huge benefit for me to have context with them because since they are pharmacists too (completed PGY1 and/or PGY2), they were able to teach me about a variety of things – PK/PD (this was huge), therapeutics, pharmacology, navigating interdisciplinary team dynamics, practical advice on rounding, midyear, residencies, LIFE in general etc. Not to mention they were really fun and down to earth.

And… the ID consult team! I really loved being at this hospital. The attending physicians are very good at precepting, not just the medical students/residents/fellows but they would ask me questions too! The residents and fellows are also really receptive to pharmacy input. There is a clinical pharmacist (ID specialist) who generally rounds with the team and became a sort of informal preceptor for me. He helped me learn to consider the whole patient and how to ask the right questions, and was also also available during the actual rounding time on the floors in case I didn't understand something from the pharmacy perspective. Something that I didn't expect was that I got pretty close with the medical student that rounded with me. She taught me quite a few things from the medical perspective – not to mention it was also easier to ask her questions when everyone else was busy doing other stuff.

What were the challenges?
This rotation was a HUGE test of my time management and emotional resilience. First off, my preceptor challenged me to only take information from the primary literature for my topic discussions and drug info questions. It was so difficult for me at first because if you think about it, that kind of rules out resources like textbooks, class notes (didn’t really use these anyway...), and UptoDate. But I got faster and more efficient at doing those lit searches (feel like a pro now). Looking back, I’m grateful that I was pushed to consume the literature in that way because I feel like I have a good method now for answering any questions I might have in the future.

As expected, making ID-related interventions on the ID consult team is a challenge. It’s humbling to know that I was among experts and I most likely knew the least out of everyone there. However, I quickly learned that there are ways to still catch the things that others didn’t think about – for example, a couple of the interventions I made had to do with renal dose adjustments of antibiotics. So this is encouragement for anyone else who feels like they are struggling to make interventions – keep pressing on!

This next challenge was unexpected - I will say it took me like 2 weeks to overcome being intimidated (don’t laugh!). I mentioned above that I realized I was among experts. Additionally, some preceptors are very big and well-known people in their respective fields. My particular preceptor definitely falls into that category. And then there’s me, a tiny little pharmacy student who knows next to nothing and has never had an inpatient rotation. I definitely let that hinder my confidence a lot. But I eventually got comfortable enough to see that preceptors are real down-to-earth people too who really want to see their students grow and learn. I’m speaking to anyone reading this who feels crippling self-doubt, lack of confidence or discouragement – it’s okay and natural to feel that, but it’s also worth it to work towards loosening up and learning under a growth mindset. Definitely something I’m trying to develop as I go along.

I also want to say that I grew a ton personally. The reason I’m sharing all of this is because I want to be real here. I still remember during that first week, I drove home crying because I didn’t think I could handle the rotation (it was raining a ton and thankfully I didn’t crash into something). I was overwhelmed, sleeping like 4 hours a night, feeling like I was a disappointment to everyone including myself. Basically I felt like the biggest hot mess ever. In hindsight, I realized that I placed unreasonable expectations on myself – thinking that if I didn’t become some sort of ID expert after my month in Detroit, then something was wrong with me and I wasn’t working hard enough. But I realized the more important thing for me as a student might not necessarily be to focus on retaining and regurgitating all of that knowledge, such that I would get it right and win at life all the time. Instead, perhaps the more important thing is to learn how to ask the right kinds of probing questions. Because in the end, I’m pretty sure that the discipline of learning how to ask the right questions will set the foundation for further growth and learning.

OVERALL, this rotation shows me that some of the best things are indeed hard-won. This was an extremely challenging but exciting and rewarding experience. The reason why I say that this rotation was mind-changing is because of how unexpected it was. I went into it thinking that ID was kind of a static field, without the fast-paced changes I had come to see with something like Heme/Onc. Thankfully I was wrong. ID is one of those fields where you have to be very up to date all of the time. Resistance is a very real concern. And any recommendation you might make regarding an antibiotic now, has the potential to affect other patients in the future. To me, that’s kind of exciting and it makes me hungry to learn more…I'm a week out from this rotation but I already miss it so much. I would definitely recommend ranking an ID rotation in Detroit for any student that might be interested. 

If there are any questions, just shoot me an email (! And for a different take on this same rotation, please see a previous student’s post (Jared Borlagden).

For now, it’s off to rotation 3 – health systems!

Sunday, March 19, 2017

Rotation 7: Accreditation Standards & Rotation 8: Coumadin Clinic

Posted by Millie at Sunday, March 19, 2017

Hi everyone,

Ever since the New Year it has been a whirlwind of a schedule! Balancing rotation and residency program interviews was definitely challenging, but I was lucky to have understanding preceptors and a great support system throughout this whole process (thank you family and friends!). Now that I have a little breather, I will catch you up on what’s been happening over these last few months.

My 7th rotation was at the U-M College of Pharmacy. It was a unique rotation in that it was a hybrid of both teaching and pharmacy administration. Throughout the rotation I was able to work with another P4 student on various projects pertaining to our College’s admissions process, course and curriculum evaluations, and accreditation standards. It was really eye-opening to fully understand all of the different people and responsibilities necessary to successfully run a pharmacy program. We were also given the chance to develop materials for one of the team-based learning sessions, as well as the opportunity to lead the class in the activities.

One of my favorite projects of the rotation was to help develop a new course for the University that will be housed under our College. It was awesome to see this process from square one and have my ideas really shape this new course! Overall, this rotation experience gave me a nice glimpse into the always-changing responsibilities of pharmacy academia/administration.

After spending 6 weeks at the College in this administrative role, I then switched gears to work at an anticoagulation clinic. When I first heard I would be at an anticoagulation clinic that had purely telephonic encounters, I wasn’t entirely sure what to expect. However, anticoagulation was a topic I hadn’t gotten too much exposure to yet, so I was looking forward to learning and building my skills in this area.

By the end of rotation 8, I can definitely say it was one of my favorite rotations. Our clinic enrolls patients on warfarin or on a direct oral anticoagulant (DOAC). My typical day included making phone calls to our clinic patients who had recently been discharged from the hospital, counseling patients who were either starting an anticoagulant agent for the first time or switching therapy, adjusting and monitoring warfarin therapy based in INR results, making follow up calls, and working on a handful of projects for the clinic. During my last week, I gave a presentation on transcatheter aortic valve replacement (TAVR) during an interdisciplinary teleconference – a topic that was really fascinating to learn about and present on!

I also actually really enjoyed the telephone encounters because I felt like it allowed for good conversations with the patients and a more efficient way for us to manage their health. My preceptor was a terrific mentor and I could tell everyone at the clinic really admires his experience and values his input. I discovered there is so much to learn in anticoagulation, and gained an appreciation for the differences and data behind the DOACs. Plus, everyone at the clinic was so nice and cared so much about all of their patients, which makes for a really great environment to work in.

Starting tomorrow, I’ll be on rotation with the Surgery Transplant team. I’m excited for everything I am about to learn over this next month and I can’t wait for graduation in just 5 weeks now! 

Friday, March 17, 2017

Rotation 8: Acronym World

Posted by Jared at Friday, March 17, 2017

Hello everyone!

As implied in my earlier post, I had the opportunity to do a rotation at the FDA during this block. Specifically, I was in ORP, or the Office of Regulatory Policy within CDER, or the Center for Drug Use and Evaluation. Starting at the FDA, you quickly realize everyone talks in acronyms (OGD, OCC, OND, OSE, etc). It can be very easy to get confused and lost, and I usually had to look up acronyms throughout the rotation just to figure out what someone was referring to.

Interestingly, the division I worked under was made up almost entirely of lawyers, alongside one pharmacist (my preceptor) who acts as their project manager. Some of the office's main responsibilities included participating in the development of rules and regulations, along with responding to citizen petitions. Citizen petitions allow individuals, groups, and companies to write to FDA to try to persuade them to change something, such as remove a drug from the market, issue a guidance or rule, or make labeling changes. At meetings, it was very interesting to see some of these issues brought up and observe how different disciplines would interact and collaborate in order to accomplish their goals or address the issue at hand. 

In terms of what I did, I helped with various projects that were in line with whatever issues my division was working on at the time. However, besides this, one of the big things about the FDA rotation is the Pharmacy Student Lectures. These typically occur every day, and are scattered throughout the department. They allow students to see how the FDA works within different divisions and departments, and also allow us as students to see the types of non-traditional roles pharmacists can take at the FDA. Furthermore, we were also able to take field trips to different organizations in the DC/MD/NOVA area. During my rotation, we visited APhA, ASHP, the Coast Guard, NIH, and the Pentagon as well! Through these activities and lectures, I was able to also meet other pharmacy students who were also on rotation at the FDA. Interestingly, many of us were going through the residency interview process during this block, and some had already acquired fellowships. Regardless, it was great to have peers to interact with and talk/de-stress about residency interviews, which leads me to the following:

I found out today I matched at one of my top choices for residency programs! I'm really excited for what the future holds, and it's great to finally have an idea of where I'm going post-graduation. Extremely thankful to all my friends and family that have supported me to this point, my preceptors that have helped me develop over this last year, and the College for the number of opportunities they've provided us. Only five weeks until graduation!

Thursday, February 16, 2017

Rotation 7 - General Medicine and Residency Interview Season

Posted by Jared at Thursday, February 16, 2017

Hello everyone! January and the first part of February have been a pretty busy time, but I'll update you with my latest rotation, along with my insights on residency interviews after going through the process!

Rotation 7: General Medicine

Like Millie, I was assigned to cover an adult internal medicine service for my general medicine rotation. During this rotation, you have the option of ranking between adult internal medicine, cardiology, surgery, pediatrics, or the NICU. Note that the NICU is typically an afternoon rotation, while the rest run from a normal 7-3:30 schedule. There are some blocks where the ED is an option for this rotation, but it wasn't during this block. Millie describes the rotation pretty well, but I'll quickly go over my time frame during the day.

6:00 - 7:00 AM: I would arrive at the hospital to work up patients for my service. On average, it would be about 10-12 patients a day.

7:00 - 8:15 AM: Talk over the patients with the resident I was on rotation with first, make
recommendations, then go over those recommendations with our main preceptor prior to rounds

8:15 - 11:00 AM: Round with the medical team

11:00 - 12:00 PM: Go over patients, discuss status/interventions, topic discussion

12:00 - 2:00 PM: Lunch, attend educational lectures (i.e. CE, resident on-call report), look up drug information questions, write warfarin/vancomycin notes, follow up on other medical issues for the team.
2:00 - 2:30 PM: Follow up with preceptor on issues, mini-topic discussion

2:30 - 3:30 PM: Student topic discussion. These consisted of either general topic discussions from preceptors, or student-led discussions that included new drug presentations, a topic discussion, journal club, and case presentation.

I enjoyed having internal medicine as my past rotations (ID and critical care), I felt I was only looking at certain aspects of the patient (i.e. antibiotics, renal dosing, etc.). However, on internal medicine, I could no longer ignore all the comorbidities a patient had. I really needed to make sure that a patient's medication was correct for not just the main problem, but even their home meds as well. It really taught me to look at the patient as a whole, and definitely helped solidify my knowledge. Also, my preceptor was great at going over a bunch of topics that helped me revisit a lot of areas from therapeutics. This definitely helped me out for residency interviews, which I'll go into next...

Residency Interviews

The month of December after Midyear is a frenzy. You're choosing where to apply, you're getting your letter of recommendations in order, and you're stressing out waiting to see the e-mail confirmation that they've been sent to PhORCAS, and that your transcripts are in. You spend days writing a letter of intent, and then you hit submit and play the waiting game.

Programs go about offering interviews very differently. There's no standard set of rules in terms of when they respond or how they will respond. Some programs will tell you when they'll get back to you by, others will just be silent until they send an interview offer or rejection. Some of my programs responded pretty quickly after the deadline, others took a few weeks. Some programs will either only give you one date to interview, some will have you fill out a list of preferences, or some will give you dates and you simply choose the one that works for your schedule. Finally, some programs will e-mail you, and some will call.

This process honestly requires you to both be extremely flexible and to have your calendar and phone at the ready. This is particularly true when some programs will call you and ask you to interview on a date, and you have to pick on the spot. Thankfully, I was able to have an hour or so to look at my calendar before responding back to them after the phone call, but I know of some students that weren't afforded that luxury for some of their programs. Sometimes, however, you will run into scheduling conflicts with interview dates if a program only offers certain dates or if you have rotation requirements. If you're unable to re-schedule the interview and can't accommodate it into your schedule for whatever reason, it's okay to decline as long you as explain your rationale and express your gratitude for being offered the interview in the first place. Programs would prefer you cancel prior to scheduling a spot. DO NOT schedule an interview and then cancel last minute. This causes bridges to be burned and looks extremely unprofessional on your part, and since pharmacy's a small world, you never know who they might tell...

As for the interview process, I would say Michigan prepares us extremely well. Most questions weren't out of the ordinary in terms of questions you would expect (why residency, why our institution, situational questions, tell me about a time when..., etc). At this point in time, I have completed the majority of my interviews, with just one more between now and when our rank list is due for the Match. Some tips I have below based on my experience:

  • Know your CV inside and out, forwards and backwards. I studied my CV prior to interviews and took notes on all my presentations in case I got asked about any of them. The rule of "if it's on your CV, it's fair game" is extremely prevalent during residency interviews. Looking back, I've been asked about the majority of my presentations/projects, or have at least referred to them at one point during the interview process. It doesn't look good if you can't speak to at least what the project/presentation was about and what you did. For Michigan students, this is EXTREMELY true for your PDI. PDI becomes a default answer to a lot of questions (tell me about what you're most proud of, a time when you had to manage multiple deadlines, etc). Know your PDI, what you did, and what it found. I know I have been asked about it on multiple interviews.
  • Try to group interviews together that are geographically close, especially if you know their dates ahead of time. This particularly applies to applicants going out of state for interviews. For example, I had some interviews out in the Pacific Northwest that I was thankfully able to coordinate in the same week, so I didn't have to travel back and forth between Michigan and Portland/Seattle. Some programs do release their interview dates ahead of time, so you can try and be strategic about choosing dates.
  • Be nice to everyone you meet, including your fellow interviewees! The adage "you're being evaluated the whole time" honestly holds true. I had heard that programs evaluated how social you were with the other candidates you interviewed with, so this is something you want to keep in mind. While you're all interviewing for the same spot, note that these people could potentially be your co-residents! You don't want to appear stand-offish or anti-social, as program directors and preceptors will notice. 
  • Eat breakfast and drink coffee/water if you need it! Interviews are a long day, and there are a lot of people you're going to be talking to. Make sure you're fully energized for the day, so your brain is at its sharpest.
  • Be prepared for clinical cases. A number of programs have parts of the interview where you have to work through/present a clinical case. From my personal experience, I've experienced a lot of ID/anticoag, but generally a lot of these cases are types of situations you might experience on an internal medicine rotation. The main thing interviewers are assessing here is your thought process. Don't stress too much if you don't remember the exact dose of azithromycin you'd give for a patient with CAP or how long you would treat them. One thing to mention always is where you might go to look up that information (i.e. IDSA guidelines, institutional guidelines, etc.)
  • Write down your interventions/disagreements as you go through your APPEs. You'll almost always get asked about your most meaningful clinical intervention, or about a time a doctor disagreed with you. Writing these down will help you to refer to it later during interviews.
  • Remember you're interviewing them, too. Just getting to the interview is an accomplishment, especially with how competitive residencies are now. Honestly, just be yourself and try to get to know them, along with showing off your personality. You really want to know if you'll "fit" at the program, as you'll be spending the next 1-2 years there, and you don't want to hate your time there and be miserable. As always, prepare a number of questions for the different people you might meet (i.e. residency program director, preceptors, coordinators, residents). Finally, don't feel bad asking multiple people the same question. It's good to get different perspectives to help you better assess if the program is a fit for you.

I will say doing most of my interviews during the general medicine rotation was mildly hectic, but I'm glad most of them happened during this block. I felt really prepared for the clinical cases I came across and had various things I could speak to when interviewers asked me about clinical interventions/disagreements. Thankfully, I had most of my interviews during this block, as I'm currently in DC doing a rotation at the FDA. However, note that there are a lot of interview dates that occur during block 8, where you don't have an extra 5-6 days built in to go on interviews. Thankfully, my preceptors during both rotations have been really accommodating with me and have allowed me to go on interviews.

Hope that helps with a picture of residency interviews or the general medicine rotation. Feel free to e-mail me ( with any questions. Thanks!