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 (jpborlag@med.umich.edu) with any questions. Thanks!