Why I Got a MPH in Medical School

The beautiful thing about medicine is that there are so many ways to go about helping people. It takes many different careers to maneuver the healthcare infrastructure in this country. I have always been interested in learning more about the various factors that influence how people interact with their health. I believe this is what drew me to getting a Master of Public Health (MPH).

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Getting a second degree in four years of medical school was certainly a lesson in time management, but it can be done. One of the most profound lessons that I took away was that there are many barriers to accessing healthcare for a lot of people, especially minorities. There are the obvious barriers such as distance to a provider and financial obstacles. Furthermore, a lot of the minority population in this country have a (warranted) distrust of hospitals and physicians. It is important for physicians to recognize these limitations and adjust the way they interact with patients. Moreover, it is important to develop community health programs to meet patients where they are.

“Now more than ever, understanding epidemiology, implementing biostatistics, and analyzing research is vital.”

Dr. Patricia Oby Ekwueme, Contributor, Med Student Edge

Through my public health courses, I was also able to see how public health experts provide insights to shape public policy. Now more than ever, understanding epidemiology, implementing biostatistics, and analyzing research is vital. This information allows healthcare professionals to provide appropriate primary prevention of disease and address negative consequences of disease. Additionally, having a degree in public health gives more credence to a voice when discussing these issues.

My MPH degree has allowed me to learn from impressive physicians who have dedicated their lives to working in community settings. I will take these lessons into my career to provide more informed care to my patients, within the hospital and beyond.

Are you interested in getting an MPH? What interests you about public health?

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What People Think about USMLE Step 1 Becoming Pass/Fail

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The USMLE made an extremely impactful decision when it announced its decision to transition the USMLE Step 1 exam from a numeric score to a pass/fail grading system. These changes have sparked extensive national and international conversation on social media and within the academic literature. Here, I have compiled the most up to date commentaries on the topic. These span from generally applicable discussions of the pros and cons of the new pass/fail scoring system to specialty specific and applicant targeted advice.

If the new Step 1 pass/fail grading system applies to you, I would be sure to carefully read these articles. They offer perspectives from key stakeholders including program directors on the best ways to position yourself for success within the new Step 1 grading framework.

Must Reads

Moving Forward

Be on the look out for updates and more material from our team on how this transition in Step 1 score affects you. This will drastically affect the way that medical students should study and what material they should learn. We will be providing you with the most up to date information so that you can plan and prepare accordingly.

What do you think about Step 1 becoming pass/fail? Share your thoughts below.

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Personal Statement Editing

ERAS applications are due right around the corner. One of the most difficult pieces of the application is the personal statement. Your personal statement should tell a narrative that convinces programs to invite you for an interview.

Struggling getting started? Have an outline, but need some inspiration for fitting it together? Need edits on a completed draft? Have a finalized product, but want to get input from an unbiased opinion?

For all these scenarios, we provide an individualized and thorough review of the content, grammar, and flow of your personal statement. Your reviewer will have the opportunity to discuss the edits and recommendations with you so that you can maximize your benefit. Gain the advantage of an outside, unbiased perspective. Get honest feedback and advice so that you can have your best personal statement for your residency applications.

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Personal Statement Editing

This is a one-time non-refundable purchase to have your personal statement reviewed, edited, and get feedback with one of our team members. Email carterjosephboyd@gmail.com your personal statement and a screenshot of your receipt of payment.

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USMLE Step 1 to Be Pass/Fail

If you’re like me, then you’re probably wondering how pass/fail grading for Step 1 will change things for your ERAS application. On June 16, 2020 the governing body for the United States Medical Licensing Exam (USMLE) announced its continued commitment to adopt a pass/fail scoring structure for the USMLE Step 1 exam.

In order to allow programs to prepare for the change and implement the necessary updates for residency application processes, the USMLE has scheduled exclusive pass/fail scoring to begin January 2022. This means that if you are taking Step 1 late in the year in 2021, then you will likely be in the same applicant pool as others who will take Step 1 on a pass/fail basis. With that being said, there are numerous points to consider when you are preparing your academic schedule around when to take the licensing exams.

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If you are confident in your ability to do well on Step 1, then it is in your best interest to take the exam before the move to pass/fail score reporting. A strong score can help to distinguish you from your peers and will give you access to a larger number of residency programs. On the other hand, if you were to not perform at the highest level with your Step 1 score, then it may be a strategic move to wait and take the exam when it will be scored as pass/fail. For those that will be taking Step 1 sometime late 2021, or early 2022, consider these points when making your decision.  A strong Step 1 score can boost your application, but if you have other elements on your CV that are particularly strong, just receiving a passing score with the pass/fail grading system may be a safer alternative.

USMLE Step 1 Pass/Fail Scoring Will Begin January 2022

First, the Step 1 exam has long been considered the most important factor in your residency application. The score you receive from that singular exam has a tremendous impact on the type of physician that you can become, and this has been reiterated by program directors nationwide. The second and third most important aspects of your ERAS application will be your letters of recommendation and personal statement, respectively.

Although the Step 1 score has historically allowed for a “leveling of the playing field” amongst US graduates and International Medical Graduates, it is safe to say that this will no longer be the case. As pass/fail scoring is adopted for Step 1, it will certainly have a greater effect on IMGs as we will be losing our single greatest avenue for demonstrating aptitude. 

As Step 1 importance is phased out, I am hopeful that a more holistic approach will be taken when considering applicants for future residency application Match cycles. I predict that more weight will be granted to our Step 2 CK score, as well as an increased reliance on things such as publications, research, letters of recommendation, and scores from clinical year exams (shelf exams).

While programs adapt to the changes set forth by the USMLE, it is important that you remain focused on building out your CV in every aspect that you can until we know for sure what program directors will consider to be the new most important aspect of the application. Remember that a well-rounded applicant will be viewed more favorably than an applicant who only demonstrates a singular strength.

How do you feel about Step 1 becoming pass/fail? Share your thoughts below.

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OLD CARTS

If you are like me, then you probably have trouble staying organized while obtaining a problem-focused history. I have found that I must rely on frameworks and schemas to keep all the information straight. The framework I use most often is the mnemonic “OLD CARTS.” It stands for Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing, and Severity. Let’s break it down! 

Onset

Say you are in the emergency department and a patient presents with abdominal pain. Your mind races as you try to remember the anatomy, pathology, physical exam findings, lab tests, etc. Where do you even begin? The first piece of information I like to know is when was the ONSET of the pain? Has it been going on for just a day? Or is it a more chronic issue? Remember our previous discussion on problem representations and goal directed history taking? A problem representation is the patient’s demographics, chief complaint, and the time course of the chief complaint. By remembering to ask about ONSET, you already have one piece of the problem representation!

Location

This one is pretty straight forward. Simply ask the patient where the pain is located. I have found that asking them to point to the pain with one finger to be helpful. 

Duration

How long does the pain last? At first, this may seem like it is the same as onset, but can you think of a scenario when duration may be different from onset? Say a patient presents to the emergency department with substernal chest pain that started 3 months ago. It has never lasted more than a few seconds and only happened when they were carrying laundry upstairs and got better when they rested. Now, the pain has been constant for the past hour. Understanding the duration as well as the onset helps tease out acute pain vs. acute on chronic pain. 

Character

The way to obtain this information is to ask, “Can you describe the pain?” Is the pain sharp, dull, aching, throbbing? Say a patient with a history of migraines presents with a headache. It is crucial to determine if this is the same pain they experience with their migraines or if it is different. Knowing the character of the pain could be the difference between treating them for a migraine or a sub-arachnoid hemorrhage. 

Aggravating/Alleviating Factors

Ask the patient if they have found anything that makes the pain or symptoms better or worse. For example, a patient with lower back pain that is made better by leaning forward on their shopping cart may have spinal stenosis. Or a patient who breathes more comfortably while propped up in a recliner instead of lying flat may have heart failure. You can also ask about the use of any over the counter medications such as NSAIDs, decongestants, or antacids. 

Radiation

Does the pain radiate to any other locations? What if a patient has severe epigastric pain that radiates to the back? You are halfway to diagnosing acute pancreatitis according to the Atlanta Criteria. You check a lipase and it is 5 times the upper limit of normal. It’s a slam dunk. You give them aggressive fluid resuscitation, pain control, advance their diet and discharge them in two days. Asking about radiation also triggers you to remember about referred pain. For instance, cholecystitis may have referred pain to the shoulders and inferior myocardial infarctions can present as abdominal pain. 

Timing

Knowing the context of the symptoms is crucial. Ask the patient, “When do you experience the pain or symptoms?” If a patient presents with dyspnea, are they short of breath with rest or exertion? Do they have abdominal pain when they eat or is it unrelated to meals? Do they have upper extremity weakness when reaching for things in their cabinet? 

Severity

This may be the trickiest pieces of information to gather. Pain severity is incredibly subjective and pain scores are often unreliable. Some people may downplay the amount of pain they are experiencing while others may overexaggerate their symptoms. I use this part of the mnemonic to simply look at the patient. Do they appear uncomfortable or in distress? Are they tachycardic and hypertensive breathing 25 times per minute? Again, the context of the complaint is crucial. 

Conclusion

For me, OLD CARTS is tried and true. I use it for practically every patient. Early on, it may be most helpful to go in order. As you become more comfortable taking histories, you will learn to let the conversation flow naturally. 

I hope you find OLD CARTS as useful as I have! 

Do you use OLD CARTS or do you have a different framework for organizing your history of present illness? Share your thoughts below.

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How do you handle stress?

Any residency training program is undoubtedly going to have an element of stress. Unfortunately, stress can bring out some of our worst qualities, habits, and tendencies. This is only amplified when stressful situations arise in the background of fatigue and sleep deprivation common among residents.

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Programs know that every resident will be stressed or placed in stressful situations at numerous points throughout residency. Their objective is to find applicants that handle stress in a mature and healthy manner. Individuals that have positive coping mechanisms for handling stress will be more prepared to endure the daily pressures and demands of residency training.

You should have a well prepared answer that demonstrates that you handle stress in a mature and healthy way. Below is a listing of some healthy and unhealthy ways of handling stress. Include the good and avoid mention of any behaviors that may appear maladaptive in the context of a professional interview. Also, avoid listing ways of dealing with stress that don’t mesh well with being a medical resident. If every time you get stressed you require a week long beach vacation, being a resident may be logistically very challenging.

“Individuals that have positive coping mechanisms for handling stress will be more prepared to endure the daily pressures and demands of residency training.”

Dr. Carter J. Boyd, Founder, Med Student Edge

Write out your initial response, then put yourself in the interviewer’s perspective. Are the mechanisms that I use to cope with stress healthy and sustainable given the demands of being a resident? If the answer is yes, use your response. If not, you may want to consider altering your answer.

Healthy Ways of Coping with Stress

  • Exercising
  • Hobbies
  • Spending time with friends and family
  • Meditation
  • Reflection
  • Adequate sleep
  • Breaks
  • Sharing with others

Unhealthy Ways of Dealing with Stress

  • Drug or alcohol abuse
  • Denial
  • Social isolation
  • Excessive weight loss or weight gain
  • Large financial expenditures

This type of question allows you to demonstrate your personality and interests. Let that individuality shine through, but also ensure that your answer is appropriate and reassures interviewers that you possess a balanced approach towards managing stressful situations.

How do you like to handle stress? Let us know and comment below.

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Take Advantage of Virtual Research Conferences

As the COVID-19 pandemic continues to impact our daily lives, research conferences have been forced to transition to virtual formats. While it is disheartening to see a rewarding aspect of productive research disappear, virtual research conferences present a tremendous opportunity to the savvy medical student.

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There are two barriers to presenting research at conferences: having research to present and the cost of attending the conference (travel, lodging, food, etc). Research conferences transitioning to virtual formats has eliminated one of these barriers. You can present via Zoom or another medium directly from the comforts of your home.

This should be a huge incentive to finalize research projects and get them submitted. A presentation at a virtual conference will count just as much as any other presentation on your residency application. If the projects you are involved with now are long-term in nature, create your own opportunities to complete quick projects that can be easily submitted.

“A presentation at a virtual conference will count just as much as any other presentation on your residency application.”

Dr. Carter J. Boyd, Founder, Med Student Edge

One false belief that I have encountered is the idea that a project has to be finalized before it can be submitted to a conference for presentation. This is inaccurate. Projects are regularly presented at the national stage with preliminary or incomplete results. Given the time delay between abstract submission, acceptance, and presentation, I have even seen abstracts get accepted with no results…just a description of what their primary and secondary end points were. While I wouldn’t necessarily advise that, you get the point.

Attending virtual research conferences also presents a great learning opportunity. It affords you the opportunity to listen to talks from other presenters and may help give you new ideas for research or collaboration. Fees (especially for medical students) have been waved or highly discounted for most virtual research conferences.

One of the most important aspects of research conferences for medical students is the opportunity to network with fellow medical students, residents, and attendings. With virtual formatting, hopefully conferences will find creative ways to allow for these interactions to occur, even only if in larger group settings.

While it is unfortunate that research conferences will be held virtually for the considerable future, take advantage of the web-based formats to continue to build a competitive CV and bolster your residency application.

Have you submitted any of your work to a virtual research conference?

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Choosing Psychiatry

One of the first lessons I learned in medical school is that there is no right way to do things. Before medical school, I knew that I wanted to work with minority communities, but had not decided on a specialty. During my pre-clinical years, I realized that nothing particularly stood out to me. I entered third year hoping that some specialty would rise above the rest.

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I was fortunate in my third-year because I had my internal medicine rotation, and saw what I thought a “typical doctor” looked like, and my psychiatry clerkship close together. While I enjoyed the team dynamic I felt on my internal medicine rotation, I was more drawn towards the patients that had complex psychological needs. By the time I finished my eight weeks, I realized that internal medicine was not for me. However, there were aspects that I enjoyed and would love to incorporate in my future career.

“The field of psychiatry encourages its trainees to dig deeper, look harder, and heal creatively.”

Dr. Patricia Oby Ekwueme, Contributor, Med Student Edge

My psychiatry rotation was some of the best weeks of my third-year experience. I loved learning about the various psychiatric diagnoses and how they can manifest so differently in people, necessitating personalized treatment plans. I enjoyed hearing people’s stories and seeing how aspects of their personal lives were being intertwined into their pathology. Psychiatry was one of the fields that truly understood the value of learning about and caring for the whole person. The field of psychiatry encourages its trainees to dig deeper, look harder, and heal creatively. It was easy for me to decide on psychiatry and even easier for me to incorporate my original career goals into this specialty.

Now that I am in residency, I am even more affirmed in my decision to enter the field of psychiatry; especially with everything that is going on in this country and in the world. Mental health is often overlooked and under-emphasized, but it is so important in the future of an individual, a community, and a country. I am excited to see the changes that will shape the way clinicians operate in the years to come.

Are you interested in psychiatry? Leave a comment for more information about the field.

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How to Write an Abstract

As you prepare to publicize and share your research findings, it is essential to know how to write an abstract. Abstracts are typically the only element you submit to conferences for presentation. When your research is published, the abstract is often the only item that is read.

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While specifics may vary, abstracts generally follow the same format: introduction, methods, results, conclusions. There often is a word count limit with 250-300 words being fairly standard. Knowing how to write an abstract is an important skill to have in your research tool chest. We’ll go over some basics of how to compose an abstract.

Start Somewhere

The hardest part about writing an abstract is getting started. It can be difficult to succinctly yet adequately describe your months of hard work in just 250 words. The best place to start is by just writing down your thoughts. If you had two minutes to give a sales pitch, what would you say? It is much easier to cut down once you already have some thoughts written on paper. Briefly contextualize your study, then expound more into what you did, what you found, and why it is important.

Introduction

Provide a one to two sentence background of your topic and why this research is relevant. This can be extremely difficult. One helpful tip, assume that the typical reader has some basic knowledge of terms or conditions that are commonly encountered in that particular field. Finalize your introduction section by listing the objectives of the study.

Methods

You will not be able to include every detail of how you performed the study. Still, you want to give the reader a good idea of what you did. Paint broad strokes with intermittent specifics. Be sure to mention any primary endpoints and statistical tests that you used.

Results

While in the paper you should report all of your results, in the abstract simply include the results that best convey the objectives and conclusions of your study. It is helpful to include basic demographic data and summaries. However, don’t spend too much time focusing on ancillary data points. Report the data in an organized manner and be sure to include p-values and confidence intervals when applicable. It has been shown that just including a p-value in your abstract makes it more likely to be accepted.

Conclusions

When you write an abstract, the conclusion section is debatably the most important portion. Here you should contextualize your results for the reader and reveal the impact and significance of your research on the broader literature.

Follow these steps for each of the four main sections when writing an abstract. You will assuredly require editing from your co-authors and may need to trim the abstract to meet the requirements. Proofread your work several times before sending it to your residents and attendings for review. You want the copy they see to be free from grammatical errors so that their comments can be content based. If you are struggling getting started or are confused about formatting, look to examples in the literature. There are countless published abstracts instantly available to you for consultation.

Learning to write an abstract is a process and takes time. Take every opportunity you can to practice this skill. With time, you will see major improvements in both the quality of your abstracts and the speed in which you can write them.

Have you written an abstract before? What was the hardest aspect for you? Share your thoughts below.

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Book Review: Lessons from the Mouse

While we’ve learned a lot from lab mice over the years through various experiments, those aren’t the mice we will be discussing today. Let me take you back a few years and tell you how principles implemented in The Walt Disney Company and the classic cartoon character Mickey Mouse can help you excel in professional school. In his book, Lessons from the Mouse, Dennis Snow reveals the lessons he learned while working for Disney and offers how they can help guide you towards success. Snow spent 20 years working for Disney, starting at the theme park and working his way up to senior management and leadership roles. He is now a full-time speaker and consultant who helps organizations enhance their customer service and empower employees. In his book, Snow lays out 10 lessons that he learned while working for Disney which helped propel him to a more successful career. While most of the principles are customer service based, I will be highlighting my favorite 5 of his lessons, relating them to our journey through professional school. While the lessons may seem simple, implementing them in your life can have a profound effect on your professional outlook.

1. Never Let Backstage Come Onstage

We all have bad days, and sometimes we don’t want to be at school or work. However, regardless of our personal situation, it’s imperative that we step back and realize that as a medical professional there is always a job at hand that requires our full attention. We cannot always control outside circumstances, but we do have the choice to have a positive attitude. We always need to ‘be on’ when interacting with patients, faculty, and classmates on a professional level. Snow wrote this about the culture at Disney. “The expectation was for you to leave problems at the door at the beginning of your shift and pick them up again at the end.” Our patients deserve our attentiveness and focus on the problem at hand and our faculty and classmates deserve our best efforts inside the classroom and operatory. Always be mindful of your attitude, be cognizant of those around you, and be intentional and earnest in all of your professional interactions.

2. Have Fun With the Job No Matter How Miserable You Feel

Snow writes, “Making the mundane pleasurable is a real skill, and it’s all about attitude.” It is easy to get stuck in a rut while at school or work, but it is our job to see the fun in every situation. A few easy ways to make things less of a drag include creating competitions, engaging with patients, and faking it until you feel it.  Friendly competition can increase camaraderie and make any task more fun and engaging. Engaging with patients is a simple and easy way to not only get to know the patient, but also a great way to learn something new and pass the time. Finally, if these first two options aren’t working for you, just fake being happy. The latest psychology studies show that faking a smile and telling yourself you are having fun can have a profound psychological effect and actually cause you to be happier. While we definitely need to be professional, we shouldn’t take ourselves too seriously. Have fun with the job and you’ll get way more out of it.

3. Pay Attention to the Details – Everything Speaks  

Medicine is certainly a detailed oriented profession. From taking exams to diagnosing illnesses, we must pay attention to details so that we can create an accurate depiction of the bigger picture in our minds. Be meticulous and work hard to understand the complexities of your work and your patients. Those around you will notice, and you will be rewarded in the long run.

“The secret or principle here, is that you are responsible for your own career. No one is going to care more about your future than you.”

Dennis Snow, Author, Lessons from the Mouse

4. Never, Ever Say, “That’s Not My Job” – Don’t Even Think It!

I will be the first to admit this was one of my major flaws as I went through dental school. We had seemingly endless busy work, projects, and lab activities which at the time seemed rather tedious and meaningless. Like many of you, I like to be efficient, and I often thought many of the tasks at hand didn’t need to be done or could have been done by someone else in a more efficient manner. However, looking back I realized that most of the time we can’t change the tasks we are presented with, but we can change our attitudes towards them. Approach each rotation, patient encounter, problem, and activity as a new learning experience and with a positive attitude no matter how meaningless or tedious it may seem. Realizing that each job can serve a bigger purpose will help change your outlook and give you a more meaningful time in professional school.

5. Take Responsibility for Your Own Career

Snow writes, “The secret or principle here, is that you are responsible for your own career. No one is going to care more about your future than you….Those who succeed don’t see themselves as victims. They see themselves as powerful and in charge of their lives and careers.” How do we take charge of our careers?

First, gather a good support system; find a mentor and let them know your goals. Having people to push you and hold you accountable is a great step towards professional success. Next, be passionate and always continue to learn. Nowadays, we have unlimited resources to help us learn, so it is important to utilize them to broaden our understanding of topics that may confuse us. Lastly, ask for what you want; the worst you can be told is no. Ask for additional responsibilities, for research, for scholarships. Let your professors know what you want. They are there to educate and help propel you in your career, so utilize them and you might be surprised with how willing they are to help.

I hope you enjoyed learning about some of the simple principles to help steer your career path towards success. Remember that we can’t always control external circumstances, but we can control our attitude and our attitude will drive our future outlook. I will leave you with one final quote from Snow that really hit home for me. “There are three types of people: those who make things happen, those who watch things happen, and those who wonder what happened. People who make things happen will always be in demand.”

What principles have you implemented in your professional life that have helped you take charge of your career and direct you towards a path to success? Comment below or contact us directly.

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