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September/October 2005

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Practical Guidance on Managing Work-Life Issues Doctors & Dating Who Has The Time?

SURV VING RESIDENCY

Perfect Fellowship Match

STRESS RELIEVERS

GENERALIST OR SPECIALIST

SUB-SPECIALTY SPOTLIGHTS CARDIOTHORACIC SURGERY CLINICAL NEUROPHYSIOLOGY

www.survivingresidency.com Sept/Oct 2005

EVALUATE YOUR JOB PERFORMANCE

Surviving Residency

Practical Guidance on Managing Work-Life Issues

SURV VING RESIDENCY

September/October 2005 Vol. 1, No. 2

Publisher/Managing Editor Shonette Charles Editor Andrea Hill Circulation Manager Diane Hill Staff Writer Lesly Sheridan

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Personal Remedy

STRESSED OUT? hOW tO hANDLE tHE pRESSURE

Surviving Residency is published bi-monthly by HillCharles Communications LLC P.O. Box 6206 Baltimore, MD 21206. Reader correspondence is welcome. We reserve the right to edit, reject, or comment on any and all submitted material. We cannot be responsible for the return of unsolicited material. Distribution of the magazine does not constitute an endorsement of information, products, or services. The publisher reserves the right to reject any advertisement or listing which is not in keeping with the magazine's standards. Surviving Residency and scale logo are a protected trademark. Reproduction in whole or in part without written permission from HillCharles Communications LLC is expressly prohibited. Copyright 2005 by HillCharles Communications LLC. All rights reserved. CUSTOMER SERVICE AND SUBSCRIPTIONS Please use our website: www.survivingresidency.com. You can also call 443-257-7813 or write to Surviving Residency at P.O. Box 6206, Baltimore, MD 21206. ADVERTISING For advertising rates and our editorial calendar, visit www.survivingresidency.com, email us at [email protected], or call 443-257-7813.

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DOCTORS AND DATING: WHO HAS THE TIME?

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Sub-Specialty Spotlight

THORACIC SURGERY

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PIECING TOGETHER THE PERFECT FELLOWSHIP MATCH

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Post-Residency Checkup

GENERALIST OR SPECIALIST: HOW DO YOU DECIDE?

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Sub-Specialty Spotlight

CLINICAL NEUROPHYSIOLOGY

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Prescription for Success

EVALUATE yOUR jOB pERFORMANCE tODAY

Departments 1 Medicine in the News 2 Did You Know...? 16 Quickies

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MEDICINE IN THE NEWS

Aggressive Treatment = Healthier Babies

A study published in New England Journal of Medicine showed that pregnant women who develop gestational diabetes give birth to healthier babies if their condidition is managed aggressively (blood sugar monitoring, special diet, and insulin therapy).

BRACING FOR THE FLU

Officials at all levels of government have been developing extensive plans on how to handle an avian flu pandemic from Asia, which scientists generally agree is inevitable. Appearing to only spread by close contact between humans and poultry, the avian flu virus has killed 55 people in Asia this year. However, public health officials fear that the virus could mutate and trigger a global pandemic. Conservative estimates from the Centers for Disease Control and Prevention put the death toll at 207,000 and hospitalizations at 734,000 from a future pandemic in the United States. Some experts charge that the U.S. is not doing enough to prepare. The U.S. has only stockpiled enough antiviral drugs, which would be key to slowing the spread of the virus until a vaccine is developed, for 2.3 million people--significantly less than many other countries and only enough to treat one percent of the American population. Federal authorities counter that progress is being made. The U.S. plans to stockpile enough of an experimental vaccine for the H5N1 virus to treat 20 million people, and the only flu vaccine plant in the U.S. should be capable of year-round production by the end of September. Earlier this month, the U.S. announced the launch of an international partnership with world health officials to combat the threat of avian influenza and improve global readiness.

Cancer Myths Prevail

Although 85 percent of Americans consider themselves somewhat knowledgeable about cancer, belief in many cancer myths prevail said a study published in Cancer. Nearly 41 percent of those surveyed believed surgery could cause cancer to spread and 13 percent were not sure. More than 27% of participants believed that the medical industry is withholding a cure for cancer, and 14 percent did not know.

12%

AIDS Meds Out of Reach

According to the U.N. Secretary-General Report, only 12 percent of the six million HIV/AIDS patients that are ill enough to need treatment have access to needed medications.

Juice Fends Off Alzheimer's

Amy Borenstein of the University of South Florida and colleagues studied 1,800 elderly Japanese-Americans and concluded that drinking fruit or vegetable juice at least three times a week makes you four times less likely to develop Alzheimer's disease than people who do not. Researchers believe that the high levels of polyphenols found in these juices may protect the brain.

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DID YOU KNOW...?

GOING NOWHERE FAST

Travel times (in minutes) for cities with populations of 250,000 or more people. New York City 38.3 Chicago 33.2 Newark, NJ 31.5 Riverside, CA 31.2 Philadelphia 29.4 Baltimore, MD 29 Los Angeles 29 Miami 29 San Francisco 28.5 Washington, DC 28.4

Source: US Census Bureau

WINNING GOLD WITH GEOGRAPHY

HELPING KATRINA'S SURVIVORS

Some charities that are helping the survivors of Hurricane Katrina are: ·American Red Cross: www.redcross.org or 800-HELP-NOW ·America's Second Harvest: www.secondharvest.org or 800-344-8070 ·Catholic Charities: www.catholiccharitiesusa.org or 800-344-8070 ·Episcopal Relief & Development: www.er-d.org or 800-334-7626 ·Islamic Relief: www.irw.org/katrina ·Salvation Army: www.salvationarmyusa.org, 800-SAL-ARMY ·United Jewish Communities: www.ujc.org ·United Methodist Committee on Relief: 800-554-8583 In an effort to better serve the affected communities, most charities are requesting financial donations instead of clothing or goods. Can you locate Belarus on a map? What about Tonga? Well, the "Geography Olympics," an online geography competition (geographyzone.com) that has attracted more than 1.2 million people from 192 countries, is showing that most Americans could benefit from a geography refresher course. You have 200 seconds to answer the 10-question quiz and your score is automatically incorporated into your country's overall performance. Australia, Madagascar, and Germany are the top three leaders, respectively, and the U.S. is in 61st place.

OIL SPILLOVER EFFECT

Does today's high gas prices have you singing the blues? Well, the pump is not the only place where your wallet is taking a hit because of high energy prices. Since oil and natural gas are used to make countless everyday items--like plastics, computers, crayons, shaving cream, and surgical equipment--their price increase impacts the manufacturing costs of these other items. Other industries feeling the heat: Roofing - Materials are made from crude oil Tires - Manufacturers' prices have steadily increased Farming - Diesel fuel for equipment and nitrogen fertilizers for crops are made from crude oil Plastic bags - Approximately 35 percent more expensive now than last year

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DID YOU KNOW...?

MR. AND MRS. SMITH

Fewer women are keeping their maiden names or hyphenating after marriage. Claudia Goldin, a Harvard economics professor who has studied the issue, found that the percentage of women who kept their family names declined from 23 percent in 1990 to 17 percent in 2000. Similarly, 83 percent women in a 2001 survey by Bride's magazine adopted their husbands' surnames.

Sun Belt Mania

According to recent Census Bureau projections, nearly two-thirds of Americans will live in the Sun Belt-- the South and West--by 2030.

YOUR BACK-TO-SCHOOL CHECKLIST

(NC)-With September upon us, parents and children are getting acclimated to the return to school. Focused on ensuring parents and kids have everything they need for school, Canadian Tire has put together the following checklist to prepare parents and kids for the upcoming year. 1. Check with the school to ensure all registration requirements have been taken care of and ensure that the school has emergency contact numbers. 2. Walking or riding to school is an excellent way to fit physical activity into your child's day. If your child is riding his/her bike, ensure the bike is in good working condition, that their helmet fits properly, and the bike has a bell. 3. To help ensure your little ones have everything they need, contact the school to see if it has a supply checklist. Some of the basic items most students need include: notebooks or paper, pens, pencils, pencil crayons, ruler, eraser, glue stick, pencil case and backpack. 4. A healthy lunch and snacks will help ensure kids have the energy they need to get through the day. By choosing a cooler lunch bag and using plastic storage containers, you can help ensure food stays fresh. 5. Don't forget homework. Check with your child everyday to see if any work was sent home. Buying a ready-to-assemble desk, desk lamp and desk organizer is a simple and affordable way to create a student's very own workspace away from the distraction of television and video games.

- News Canada

While on a one-year deployment in Iraq, soldiers from Fort Hood, Texas wrote, recorded, and produced a cd called Live From Iraq. The soldiers recorded the 15-track cd, which talks about everything from worn out equipment to perceived lack of support from Americans back home, using a makeshift recording booth they setup in their camp. Copies of the cd can be purchased through the group's website (4th25.com).

RAPPING IN IRAQ

A Clean Fight

In hopes of cleaning up the sport of cockfighting, an Oklahoma state senator proposed a bill to outfit fighting roosters with tiny boxing gloves.

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PERSONAL REMEDY

S E R ST ? T U O

How To Handle THE PRESSURE

D SE

As you already know, practicing medicine is one of the most stressful occupations in the world. Take the everyday challenges found in any work environment, add the responsibility of caring for patients, and you have a very high stressload. Then, throw in demands at home and you have a potential pressure cooker. Although some stress in your life can be beneficial, too much stress is simply unhealthy. Since you cannot avoid stress completely, you must develop ways to successfully manage it.

Effects of Stress

Sandra Lee, professor of psychology at Seton Hall University and an authority on stress, said that stress is an essential aspect of life. "There is an optimal level [of stress] for each person. We have to balance the good stress that motivates us and helps us to be productive." While there is such a thing as good stress, everyone has a personal threshold of stress that can be encountered before it has a negative effect on your body and mind. When you are

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PERSONAL REMEDY

D

under significant amounts of stress, the body produces stress hormones, like cortisol. These hormones can produce symptoms--reduced appetite, increased blood pressure, and sleep disturbances--that are recognized as the early warning signs of stress. Not managing stress over an extended period of time can also lead to more serious health problems.

5 Ways To Cope With Stress Experts say that your attitude plays a large part in whether events create a feeling of stress. Consequently, the key to handling stress is realizing that some things are out of your control and then managing your expectations. 1. Be realistic about what you expect from yourself and others. 2. Be more assertive, not passive or aggressive. 3. Be flexible. 4. Be mindful of where you are. Don't take work problems home or visa versa. 5. Be able to find the humor (or absurdity) in stressful situations.

Source: HelpGuide.org

Stress and Work

According to Lee, the most stressful occupations (physician, fire fighter, police officers, etc.) are those that couple the possibility of saving the lives of others with unpredictable outcomes. Knowing that the inherent nature of your profession can produce extreme levels of stress, you should work hard to minimize stress wherever you can. Unfortunately, interpersonal dynamics in the work environment can be like a mine field, thus, increasing your stressload considerably. To better manage stress, you first must identify what situations are stressful for you, and then develop a strategy for neutralizing it. If you know that a particular co-worker stresses you out, find ways to limit contact with that person, while still maintaining your professionalism. Similarly, if you find a particular task stressful, figure out the best way to approach it. For example, if you are anxious when you have to present in front of an audience, then make sure that you are well prepared, and practice giving your presentation beforehand.

Stress Relief Tactics

When finding ways to relieve stress, remember that every person is different and must find his or her own ways to cope. Lee suggested, as a preventive measure, first finding ways to prevent unnecessary stress, like getting enough sleep and nutritious foods. A properly cared for body tends to deal with stress more effectively than one that is lacking in basic physical needs. Another way to relieve stress is to find hobbies or interests that help you relax. Exercising, which releases endorphins into the brain leading to an overall sense of calmness and tranquility, is an excellent way to rid your mind of the day's worries. Blocking off a period of your day as "quiet time" is yet another way to decompress. Sometimes your schedule is so busy that you may think it impossible to have some time to yourself. However, scheduling even just a few minutes to rejuvenate can be highly beneficial. Lee said, "Find five minutes to relax. Turn off your phone and computer and do some deep breathing."

5 Stress Relievers Yoga Meditation Tai Chi Dancing Exercising

Source: HolisticMed.com

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Doctors & Dating

Who Has The Time?

by Andrea Hill

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After a hard day at work, is your cat the only one greeting you at the door? Is your board review book the only thing you cuddle at night? Although you probably want to find that special someone, you may feel that you do not have the time to make yourself available. While it may be tempting to completely engross yourself in your career, it is important to remember that the happiest people lead a well-balanced life with time for both professional and personal endeavors. Being short on time is a good reason to be a creative dater not an extinct one.

Traditional Dating Alternatives

Due to time constraints, personality traits, or plain boredom, many people have moved beyond the notion of the traditional dinner and a movie as the only way to date. For many people, the biggest hurdle is finding a person to achieve this basic step so millions are using technology and services to find potential mates. One of the most popular methods to meet people is to use an online dating service, such as match.com or eHarmony.com. Consequently, online dating is now a $500 million dollar industry, and at last count, there were approximately 13.8 million websites dedicated to online

phones and then send text messages to prospects using Match.com Mobile. Similarly, customers of Comcast Digital Cable can view video profiles of Hurrydate.com members. With the proliferation of cyber-romances, there are now companies that will help you make sure that your cyber-partner is really not married or a felon. Sites like Lemondate.com and Truedater.com allow people, who have met the online daters, to post reviews. Likewise, there are many companies that you can pay to run a background check on your online date.

Dating at the Work Place

However, for some, cyberspace seems a little far, so many singles look (or at least consider) in their own backyard--the hospital--for that special someone. While dating a co-worker in theory sounds like a good idea (i.e. availability of bonding time, ample opportunity to meet those with similar career goals), you have to ponder many things before deciding to take the plunge and ask a coworker on a date or accept an invitation.

Hospital Policy

Before dating anyone, you should always assess the possible positive and negative consequences of the relationship. This is especially true when deciding to date a co-worker. Many hospitals have rules against employees dating each other. From the employers standpoint, coworkers who are dating can present a tricky situation either way: preferential treatment and office canoodling when the romance is going well and the opposite end of the spectrum when things are not. To prevent any awkwardness, more employers are forbidding employees to become romantically involved with each other. Consequently, before pursuing any romantic relationship with a co-worker investigate your employer's policies on employee dating.

dating--with about 3.6 million of them geared towards physicians. Robin Gorman Newman, reputed dating expert and author of How to Meet a Mensch in New York, praised the power of online dating services. "When crunched for time... Internet dating can be a great [alternative]. You can do it 24-7, rain or shine. You don't have to get dressed up, and you don't have to recruit a friend to go with you. But, you have to make sure you are using a reputable website." However, your computer is not the only technology that you can use to facilitate your dating connections. Online daters can transfer their profiles to their cell

When Things are Good

If you are one of the fortunate people whose hospital does not restrict employees from dating each other, and you are looking to date someone from within, work to maintain boundaries when you are at work in order to make all involved (even outside parties) comfortable. Newman suggested considering people from other departments or floors. Of course, you should steer away from dating or pursuing those in a supervisory or subordinate role with you. (This can be misconstrued as sexual harassment!)

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Also, both parties should be realistic about the dynamics of a workplace romance. Along with the normal stress of getting to know someone, a person's "work" personality is often different from his or her "offwork" personality. Thus, you might have problems differentiating between the two. In addition, consider the role that other co-workers could possibly play in the relationship. Let's face it. Dating co-workers tends to be big news at work and will travel fast! You might find that your two-person relationship has turned into a 10-person relationship, including nurses, attendings, and other residents. F i n a l l y, while getting to know someone for a few hours of the day is great, do you really want to see that person at work and afterwards as well? Spending too much time together can also be a source of stress on a relationship.

is not a lot of free time in your schedule, so always remember to prioritize. Dr. Rotonya McCants, an internist in Missouri, is currently involved in a long distance relationship where prioritizing time is essential, "Another difficult part of having a long distance relationship is learning how or where to prioritize quality time, usually via phone, when sometimes all you want to do is sleep or prepare for the next day's presentation." Also, try to find ways that will balance your time spent on with your significant other and your career. Dr. McCants figured a system that is beneficial to her career and r e l at i o n s h i p, which is the ultimate goal, "During the week, I had time to focus on residency. On my free weekend, I spent it with him."

Dating Strategy = Love Doctor

In order to be successful in dating and relationships, you must have a strategy. Newman said, "Singles need to socialize strategically so they can maximize their chances of meeting Mr. or Ms. Right. A plan of action is the key, along with the three rights -- right time, right place and right attitude." Always look for opportunities to meet people and make dating a priority. Newman also suggested mixing with others on a regular basis. Make yourself available for a connection whenever possible. "If you go to a gym, instead of exercising on independent machines, take an aerobics or dance class.... You can get in shape and meet someone at the same time." As with any endeavor, remember dating requires time and creativity. Before you know it, you will be "The Love Doctor."

The Flip Side

Unfortunately, most relationships do not end in marriage. Will you be able to maintain your professionalism if the relationship bites the dust? Again, imagine having to see an ex-boyfriend or ex-girlfriend everyday at work. Failed relationships have the capability to create a tense environment for not only the exes but for co-workers also. No matter how mature the involved parties are, there is always room for turmoil. Ian McNiece, a dating expert and columnist for TipsOnDating.com, warns about dating at work because even the most professional people might become illogical. "The problem with dating at work is that you are bringing powerful emotions to bear in a place that is your safe haven."

Making Time for Relationships

Wherever you find the perfect partner, you must make time for that relationship. We all know that there

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SUB-SPECIALTY SPOTLIGHT

CARDIOTHORACIC SURGERY

Cardiothoracic surgeons have surgical expertise in the treatment of disorders or illnesses in the organs found in the chest cavity (i.e. heart, esophagus, and lungs). Dr. Vaughn Starms, a thoracic surgeon at University of Southern California, believes this subspecialty is so important to the field of medicine because of its effect on so many of the major organs. According to American Medical Group Association, the average salary for a thoracic surgeon is $416,896, which places these specialists in the top three percent of all medical doctors and the top one percent of all U.S. professions. Possibly the most exciting thing about practicing thoracic surgery is the constant change and evolution of technology in the field. Minimally invasive and robotic procedures are no longer where the subspecialty is going but where it is. Similarly, once thought of as cutting-edge, coronary bypass grafting is now a time-proven operation that now seems commonplace. To provide more insight on the sub-specialty, Dr. Anthony Periconi, an associate professor of thoracic surgery at University of California at San Diego, spoke with Surviving Residency. Surviving Residency: Why did you choose to practice thoracic surgery? Dr. Anthony Periconi: I was always interested in the complexity of cardiopulmonary physiology. The way the organs work together to ensure the human body is receiving the two most fundamental elements, air and blood, is amazing. SR: On your average workday, what makes you look forward to coming to work? DAP: The complexity of the surgical problems I encounter. My job is to be a problem solver. Each day, I begin work knowing that I could possibly face the tremendous task of saving someone's life. Inevitably, all physicians are here for our patients. SR: What type of person is best suited to practice thoracic surgery? DAP: All types! Still, you must have a love of problem solving, and the ability to be flexible. Many things may change in the course of a few seconds, and you have to be flexible and think on your feet. SR: What advice do you have for residents considering a fellowship in thoracic surgery? DAP: Do not be disturbed by the amount of time and sacrifice it will take to be a thoracic surgeon. It will all pay off. Consider the opportunities that thoracic surgery presents for you and also, the opportunities that you can hold for thoracic surgery. Before entering any field debate whether you will be able to evoke some sort of change. Be excited about all of that thoracic surgery has accomplished and what it can accomplish in the future. Also, remember that your professors and advisors are here for a reason. Take the time to talk to them for guidance on career choices.

THE NUMBERS 6 out of 10 Approximate number of people with lung cancer who will die within 1 year of finding out they have it 14,250 Number of new cases of esophageal cancer the American Cancer Society estimates in 2005 13,570 Number of new cases in which people will die of the disease 1.2 million Number of new and recurrent cases of coronary attack per year 1 in 7 Number of deaths that are due to lung disease 70 Average age of people found to have lung cancer 3 to 4 Number of times esophageal cancer is more common in men than women 3 Rank of lung disease as a killer of Americans 1 in 5 Number of deaths (494,382) in the United States in 2002 due to heart attack 41% Percentage of people who experience a coronary attack in a given year that die from it 172,570 Number of new cases of lung cancer American Cancer Society estimates in 2005 163,510 Approximate number of new cases in which people will die of the disease

Sources: American Cancer Society, American Lung Association, American Heart Association

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After years of training, you have resolved to specialize. Determining your area of specialty is only part of the puzzle, figuring out where you should train is the other part. Although the fellowship application process is similar to that for residency, some things are different on both sides of the table. The competition for many subspecialty fellowships, regardless of location, is extremely intense so you definitely need to bring your "A game." Likewise, you are probably more specific about what you are looking for in a fellowship program and also may have to take a different family situation into account. With all the variables that are in play, can there ever be the "perfect fellowship match"? To help answer the question, Surviving Residency went behind the curtain of the fellowship application process in Department of Vascular Surgery at University of Maryland Medical System.

What They Are Looking For?

Bright, self-motivated, enthusiastic, communicative, intelligent, hard working, technically capable, and a team player...that is the candidate every program wants. While it seems like a difficult task, a candidate's application and interview help program directors find out how close (or far) you come to this ideal fellow. Dr. William Flinn, program director of Vascular Surgery at University of Maryland Medical System, said that when evaluating applications, "The primary focus is on the institution where the applicant has done their general surgery training." Like Dr. Flinn, many program directors consider an applicant's training program and clinical experience the foundation of the application. Training programs with high volume and large variety of cases know that applicants, from residency programs with similar environments, can generally handle the caseload. Where your residency program provides general information about the clinical experience you have, your cur-

riculum vitae gives program directors specific information about your achievements. Make sure that your curriculum vitae is comprehensive and includes all of your accomplishments, yet presented in a clear and succinct manner. Two things that many programs look for on an applicant's curriculum vitae are published articles and research experience. If your curriculum vitae is on the "light side," then sending off an early application is probably not the best approach. Letters of recommendations can carry significant weight in how your application is assessed or very little at all--depending on the program. Some program directors feel that letters of recommendation offer excellent insight into how others perceive the candidate, and place even greater weight on recommendations from colleagues that they know. However, other directors think that the inherent subjectivity of letters of recommendation makes it difficult to make objective comparisons between applicants. Like recommendations, personal statements are inherently subjective in nature. Yet, the personal statement may provide the most unique insight by revealing how the candidate views himself/herself.

Determining Where to Apply

Clinical experience, program size, research opportunity, work setting, resources, reputation of attendings, geography...the list of things you can consider when deciding where to apply is endless. The first step is to really be honest with yourself about the features that you desire (and do not). Not crazy about research and looking to go into private practice? A program that stresses research probably is not for you. Intrigued about a particular procedure? Then you should make sure that the programs that you are looking at handle those types of cases. Since there are so many variables to contemplate, another important step

is to prioritize those things that are most important to you. While some programs will have all the features that you desire, other programs might only have some of those aspects for which you are looking. Dr. Rao Gutta, a second-year vascular surgery fellow at University of Maryland Medical System, considered operative experience, location, and call schedule when looking at programs. Determining what things are most important to you will help you figure out what variables are must-haves and which ones you are willing to compromise. Once you decide what characteristics you are looking for in a program, Fellowship and Residency Electronic Interactive Database (FREIDA) (http:/ /www.ama-assn.org/ama/pub/category/2997.html) is the first place to look for which training programs to map to your criteria. Once you have identified specific programs, you should view their websites to get more information on their focus and training experience. Dr. Kirk Charles, another second-year vascular surgery fellow at University of Maryland Medical System, said, "I searched on PubMed to see what papers program faculty members had published. This information gave me additional insight into the cases to which I would be exposed."

Meeting of the Minds

You've submitted your application, now what? How do programs determine which candidates they invite for interviews? For fields, like cardiology and gastroenterology, where the competition is fierce, program directors can be extremely selective and invite only those candidates that most closely match their ideal fellow criteria. However, in vascular surgery where the applicant pool roughly equals the number of training slots, Dr. Flinn said, "We offer an interview to anyone from a RRC-approved general surgery residency program." Then again, they do look at the applicant's geographic location. Dr. Flinn continued, "We

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PIECING TOGETHER

T H E P E R F E C T FELLOWSHIP MATCH

www.survivingresidency.com Sept/Oct 2005

by Lesly Sheridan

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wouldn't want to have someone come all the way from California unless we really thought they were a competitive candidate." For both Drs. Charles and Gutta, timing of the interviews and program location were the determining factors in accepting invitations. In many ways, the interview is like two information highways side-byside. The program is receiving information but also sending it. The same is true for the applicant. Dr. Flinn explained, "From the staff standpoint, the interview is just to allow us to connect a real person to an application. From the program standpoint, it allows us to show the applicant the strengths of the programs." Similarly, while putting your best foot forward in speaking to the faculty, residents should also use the interview to ask detailed questions that give you more insight into the prog ram's strengths, as well as its weaknesses. Given that many programs have applicants meet with faculty and current fellows, you get a variety of perspectives. Dr. Charles said, "I used my time with the attendings to find out what the program was like, more information on the people that I would be working with, and the program's expectations. From the fellows, I tried to find out their perspectives on the program--how demanding it was and what they liked and disliked." Dr. Gutta echoed these sentiments and said that he used his time with the fellows to get more detailed information on how the program fared in his selection criteria--clinical experience and call schedule.

gery, conduct matches for fellowship positions through the National Resident Match Program's Specialty Matching Services. Whether they participate in The Match or not, most programs must go through a process where faculty must rate candidates, then rank them. Dr. Flinn explained that in his program, each candidate's final rank is a composite of each faculty member's individual evaluation. On the other side of the table, armed with your selection criteria and interview data, you should also have the information you need to rank your program choices. However, for married or seriously involved residents, this oftentimes is not a solo decision. Dr. Gutta said, "If [residents] are married, they should take their spouses to programs that they are seriously considering." Consequently, for Dr. Gutta where his wife was interested in going was the other major factor, along with clinical experience, that determined how he ranked programs. While ranking your programs can be a challenging task, the next step is straightforward if all the programs that you are interested in participate in The Match. However, if some of your preferred programs are outside The Match your process is a little more complicated, especially if you get an offer before The Match occurs.

ever, the perfect fellowship match is really the one where you can receive the training that will keep you on the path to a successful medical career in a location that you can enjoy, if not in the long-term, at least in the shortterm. Dr. Flinn concluded, "The match only truly becomes a `good match' if at the end of their fellowship training [fellows] have achieved the perfect balance of intellectual, academic, surgical and endovascular experience that prepares them both to become boardcertified vascular surgeons and have a successful career in the practice environment of their choice." So, can the perfect fellowship match exist? Yes, if you keep an open mind and commit to having the best possible training experience you possibly can, the perfect fellowship match is possible-- regardless of the program's rank on you list. Who knows? Your last choice may be the best place for you after all.

The Perfect Fellowship Match

Does it really exist? Most people think that the perfect fellowship match is when the applicant and the program ranked each other number one. How-

Ranking Your Choices

Now many subspecialties, like abdominal radiology and pediatric sur-

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POST-RESIDENCY CHECKUP

Generalist or Specialist...which path is right for you? For some people, the answer is simple because their minds were made up when they entered residency. Dr. Rotonya McCants, an internist, knew general internal medicine was the right path for her after considering all of her previous rotations. "I thought about quite a few specialties, including surgery, after doing each rotation. In the end, it was my Internal Medicine rotation that fit perfectly." Similarly, about half of the cardiothoracic surgery fellows that started in 2002 decided on that career path before or in medical school.1 However, for those of you who are still undecided, here are some issues to consider before making a choice. dealing with a wide variety of patients. Consequently, in one study, the majority of residents who chose to specialize admitted that their attitudes toward difficult patients discouraged them from taking the generalist path.2 Likewise, you should also think about how your personality meshes within the different work environments.

How Do You Decide?

G NE E

Lifestyle

IST AL

SPEC

Nature of the Job

Does being an expert in one field appeal to you or would you like to handle a broad array of cases? Dr. Mark Nuer, a clinical neurophysiologist, decided to pursue a subspecialty fellowship because he wanted to learn more about the electric composition of the nervous system, " I did not want to just stop at neurology." In order to make a sound decision, try to make arrangements within your program to do a rotation in subspecialty areas in which you have an interest. Use the rotation as an opportunity to investigate whether you can visualize yourself practicing in that particular area. Similarly, talk to your program directors, discuss your interests, and seek advice about the best way to explore opportunities.

Which path fits your life goals better? Will you be able to have the work-life balance you are seeking? While some subspecialties are appealing because they seem to be more prestigious or have a higher earning potential, you should also consider the pressures and demands that will be placed upon you. General pediatricians worked fewer hours, and despite lower incomes, reported higher levels of satisfaction than their pediatric specialist colleagues in one study.3 Similarly, length of training is something that should be considered. Another study showed that the limited training time was an important factor for residents, especially among women, choosing to become internists.2 However, Dr. Anthony Periconi, a thoracic surgeon, believes that the amount of time and sacrifice that it takes to become a specialist pays off in the end.

IALIS

T

Future of the Field

Is the field evolving and growing? Is it currently saturated with practitioners or is the demand larger than the supply? Whichever way you are leaning, you should definitely investigate the job market and future prospects for the field. In addition, consider the direction in which the industry is going and determine if it is one in which you can thrive and be successful.

Orringer M. "Unity and Participation: Embracing Counterintuitive Survival Skills." Annals of Thoracic Surgery, 2002. Nelson HD, Eckstrom E, Patrixio GR, Matthews AM, and Cooney TG. "Study of General versu Subspecialty Career Paths in Internal Medicine." Portland, OR: Oregon Health Sciences University, 1995. 3 Shugarman R, Linzer M, Nelson K, Douglas J, Williams R, and Konrad R. "Pediatric Generalissts and Subspecialists: Determinants of Career Satisfaction." Career Satisfaction Study Group, Pediatrics 2001.

2 1

Your Personality

Another area to examine is your personality and determine if you are better suited for one type of patient interaction over another. An internist must be able to maintain a positive and professional attitude and outlook, while

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SUB-SPECIALTY SPOTLIGHT

CLINICAL NEUROPHYSIOLOGY

Clinical neurophysiologists diagnose and facilitate treatment of afflictions of the brain by measuring the amount of electric activity throughout the brain, spinal cord, nerves, and muscles. Clinical neurophysiology was first explored in 1935 when the first reports of measurable brain wave activity spread across the U.S. The founding of the field as a subspecialty began in the 1960's with the initial design of field training coursework and continued well into the 1980's with the creation of the first clinical neurophysiology post-doctoral fellowship. Sometimes referred to as electrophysiology, clinical neurophysiology uses three methods to measure brain activity. 1. Electroencephalography (eeg)- the actual recording of the electric activity of the brain; 2. Evoke potentials (ep)- recordings of electric activity and any changes thereof when the brain is exposed to stimuli; and 3. Electromyography (emg)- the recording of electric activity in the body's muscle While clinical neurophysiologists need to know some basic electronics, don't be alarmed if you are not a technology wizard. Mark Nuwer, M.D., program director of clinical neurophysiology at University of California, Los Angeles Medical Center, entered the field out of awe of the "elegant technology used to learn the uses and functions of the brain." Like Dr. Nuwer, many consider the use of advanced technology to discover the inner recesses of the brain the most exciting aspect of clinical neurophysiology. Dr. Kevin Boylan, director of neurology at Mayo Clinic College of Medicine, believes clinical neurophysiology is just beginning to reach its full potential and can progress even farther with more notoriety. Likewise, Dr. Arup Mallik, a clinical neurophysiologist in Glagow, Scotland, believes one of the downsides of the subspecialty is its small size and low profile. However, the positives--including the large number of other specialties (i.e., neurology, neurosurgery, psychiatry, pediatrics, ophthalmology, etc.) with which clinical neurophysiologists work and the wide range of medical conditions they help diagnose and manage--more than make up for it. When comparing fellowship programs in clinical neurophysiology, Dr. Nuwer suggests first deciding on your ultimate career goal. If you strive for a career in academia, look for programs that allow you to concentrate on one specific learning path (epilepsy, muscle and peripheral nerve diseases, sleep disorder, or intraoperative monitoring of nerve function) in the field. For those interested in becoming a community practitioner, Nuwer advises you to pursue programs that allow you to learn in depth every aspect of clinical neurophysiology in order to easily translate your studies to your practice. Whichever path you take, Dr. Millik believes that if you have an interest in the neurosciences and want the added bonus of little on-call commitment and a reasonably good quality of life, then clinical neurophysiology may be for you!

THE NUMBERS 2.5 million Number of Americans affected by epilepsy and seizures 18 million Number of people in the U.S. that have obstructive sleep apnea 40,000 Approximate number of people in the U.S. who experience Bell's palsy each year 10% Percentage of the American population that will experience a seizure in their lifetime 2 Number of times sleep apnea is more common in men than women 181,000 Number of new cases of epilepsy are diagnosed each year. Between 20 and 40 Age of most people when they experience their first symptoms of multiple sclerosis 3% Percentage of Americans who will develop epilepsy by age 75

Sources: Epilepsy Foundation, MayoClinic.com, National Institute of Neurological Disorders and Strokes

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PRESCRIPTION FOR SUCCESS

Don't Wait for Your Annual Review Evaluate Your Job Performance Today!

or fW yo lit or W k b Ha k

Qu

a

its

t ion en ct i ty ili at era P t ab In nd e ep D

Question One...Does the resident demonstrate a knowledge-base appropriate for his/her year group? Question Two...Does the resident exhibit the surgical skill appropriate for his/her year group? Whether you are a seasoned senior resident or an inexperienced intern, the thought of performance evaluations at the end of the year can cause a little anxiety. Why feel anxious? Taking the time to assess your own job performance not only reduces the chance that you will be surprised by feedback you receive, but, if you do it early enough, also gives you the opportunity to improve your weaknesses and refine your strengths before evaluation day. The first step, in a self-review, is to understand the criteria in which you will be evaluated. While most evaluations ask assessors to judge a resident's knowledge-base, skill set, interaction with patients (when applicable), and professionalism, it is best to know the specific criteria and questions that will be asked. If you did not receive a copy of the evaluation form at orientation, ask your program coordinator for a copy. Also, keep in mind, that programs often change the evaluation process from time-to-time so you want to make sure that you know of changes to the process for the current year. John Putzier, author of "Get Weird! 101 Ways to Make Your Company a Great Place to Work" suggests starting your assessment by mapping out your strengths and weak-

nesses. Simply draw a line down the center of the page, put a plus sign and a minus sign in each column and get to work. This birds-eye view of how you stack-up is helpful in identifying the areas where you need more development. When you have these weaknesses identified, outline a strategy and action plan with timelines on how to improve in these areas. Putzier then advises that you think outside of yourself. Put yourself in the shoes of the attendings, other residents, hospital staff, and especially, your patients. What type of "customer service" are you providing these groups and is it meeting their needs and expectations? In your assessment, it is important to understand not only the needs but also the priorities of those whom you work with and patients that you treat to ensure that you are focusing your efforts in the areas where they are meeting the greatest need. Another important aspect of your self-evaluation is to assess how you are managing your long-range career plans. Are you devoting time to efforts that will help your post-residency career goals? Are you building and nurturing your network? Start working on the knowledge, skills, and contacts that will assist you in reaching your long-term goals, as well as those needed for your current level of training. Dr. Beverly Kaye, CEO of Career Systems International and co-author of "Love It, Don't Leave It: 26 Ways to Get What You Want for Work" recommends that you regularly conduct a self-evaluation. Not only do these assessments act as a bridge to better self-understanding, but they also give you insight into how you can be a better doctor for both your patients and coworkers--without being "on the record."

Job Performance Factors to Evaluate Quality and Quantity of Work Work Habits Patient Interaction Communication Skills Co-worker Relationships Dependability (Reliability/Consistency) Conduct and Disposition (Attitude) Adaptability/Flexibility Initiative

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QUICKIES QUICK FIX

Computer Performance Tips by David Mahler

Here are the most effective steps you can take in order to increase the performance of your computer and enhance your computing experience.

More Memory (RAM)

QUICK TRIP

For many, the thought of autumn conjures up images of football, tailgates, school, and homework. Another fall ritual is the leaves of trees changing from green to earth-toned hues of yellow, orange, red, and brown. Taking a scenic drive or hike to observe this autumn spectacle is a great quick trip. On a budget? Just take a day to explore the surrounding area. However, if you have a little money to spend, many New England b&bs and inns offer weekend packages for leaf watchers.

If your computer has less then 256 MB of memory you may want to consider adding more. If you don't know how much memory you have: right click my computer, go to properties and look towards the bottom of the dialog box. Memory is where the computer stores open files or programs in order to give the processor quick access. To put it simply, more memory means more speed and stability. You can buy memory online or visit your local Best Buy where they can install it for you if you don't feel comfortable doing it yourself.

Defrag your computer

Imagine a filing cabinet that is out of order, you would have to look harder for your files just as a computer would when it is fragmented. Over time your computer will become fragmented. When your computer is fragmented it has to work harder to do just about anything a computer can do. Defragging your computer is essential for computer performance and stability. Diskeeper is by far the most effective and efficient defrag program I have ever used. With Diskeeper you can defrag your computer without having to close other programs. You also have a "set it and forget it" feature that enables you to set your computer to defrag any time without having to think about defragging ever again. Most notably this defrag program gives your computer a clear performance boost.

QUICK EATS

Delicious Pumpkin Pie

1 flaky pie crust mix or single-crust pie 2 eggs 1 can (14 oz/398 mL) pumpkin purée 1 cup packed brown sugar (250 mL) 1 tsp ground cinnamon (5 mL) 1/2 tsp salt (2 mL) 1/2 tsp ground ginger (2 mL) 1 cup light (10%) cream or evaporated milk (250 mL) Whipped cream to garnish Crust: 1. PREHEAT oven to 450°F (230°C). 2. PREPARE pastry according to package directions for unbaked 9-inch (23cm) pie shell using half the dough. Save remaining half of pastry for another pie. Filling: 3. In large bowl, whisk eggs well. Add remaining ingredients, stirring with a whisk until well blended. Pour into prepared pie shell. 4. BAKE on lower oven rack (one rack below centre) at 450°F (230°C) for 15 minutes, then reduce temperature to 350°F (180°C) and bake for 30 to 35 minutes longer or just until knife inserted in centre comes out clean. Cool completely before slicing. Serve with whipped cream. -News Canada

Remove adware & spyware

If you frequently receive popups while not surfing the Web you may have excessive amounts of adware or spyware on your computer. By removing the adware and spyware you will not only receive a performance boost but you will enhance your computing experience by removing bothersome ads. Ad-Aware and Spybot Search and Destroy are both free programs that will scan your computer for adware and spyware and allow you to remove it with ease.

Surf the Web faster

Firefox (getfirefox.com) is a new browser that is faster and more secure then Internet Explorer. With Firefox you can download and install extensions which "plug in" and give the browser more functions. For example I currently have extensions that tell me the weather and block online advertisements. Download and install this program today and replace your current browser which most likely is Internet Explorer.

About The Author David Mahler started his business (http://www.capehostpro.com) designing websites in 2002 and has since extended his business to include such services as Intranet design, database design and website copywriting. Copyright 2005 Capehostpro.com.

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ENJOY... · Rocky Mountain Beauty · Southwestern Culture · World-Class Golf, Skiing & Trout Fishing

Explore New Mexico

The Land of Enchantment

Join a well-established medical community in Farmington, New Mexico, a rapidly growing city in the Four Corners area. A great place to raise a family!

Anesthesia · Emergency Medicine ENT · Family Practice Gastroenterology · Internal Medicine Medical Oncology · Neurology Orthopedics · Pulmonary Medicine Radiology · Urology

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CONTACT TERRI SMITH

Tel: 888-282-6591 Fax: 505-324-3370 Email: [email protected] www.sanjuanregional.com

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Practical Guidance on Managing Work-Life Issues

SURV VING RESIDENCY

FINDING YOUR FIRST JOB STUDY TIPS FOR IN-SERVICE EXAM MANAGING YOUR CREDIT GREAT CITIES FOR DOCTORS BEING A TEAM PLAYER

Next ISSUE

SUB-SPECIALTY SPOTLIGHTS GASTROENTEROLOGY NEONATAL AND PERINATAL MEDICINE

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