Guide to 4Guide to 4thth Year Year

ElectivesElectives

Hosted by ASGHosted by ASG

21 February 200721 February 2007

Why “Away” Electives?Why “Away” Electives?

Witness medicine, U.S-style.Witness medicine, U.S-style.

PRACTICE medicine as it is in the U.SPRACTICE medicine as it is in the U.S

Understand WHAT will be expected of you during Understand WHAT will be expected of you during residency.residency.

Understand WHERE you want to complete your Understand WHERE you want to complete your residency training.residency training.

Solidify your choice of specialty.Solidify your choice of specialty.

Get LOR’s from U.S. physiciansGet LOR’s from U.S. physicians

Getting startedGetting started

Setting up electives can be an easy 3 step Setting up electives can be an easy 3 step process. process.

If…you put in the effort early:If…you put in the effort early: 1 – Research 1 – Research 2 – Doing the paperwork2 – Doing the paperwork 3 – Sending out the material3 – Sending out the material

Why are you doing this??Why are you doing this??Or how to chooseOr how to choose

where/what electives. where/what electives.

1.1. By the summer between 3By the summer between 3rdrd and 4 and 4thth years years you should be decided upon your choice you should be decided upon your choice of specialty.of specialty.

2.2. Further, you should have a geographic Further, you should have a geographic area chosen for your residency. area chosen for your residency.

This will inform your choice of electives.This will inform your choice of electives.

STEP 1 – ResearchSTEP 1 – Research

Visit a medical school near your home Visit a medical school near your home

Visit FREIDA at www.ama-assn.org.Visit FREIDA at www.ama-assn.org. This is probably the best way of This is probably the best way of

choosing. choosing.

Consult the ASG provided list of past Consult the ASG provided list of past electiveselectives

STEP 1 STEP 1

Things to consider:Things to consider:1. DO THEY TAKE FOREIGN STUDENTS?1. DO THEY TAKE FOREIGN STUDENTS?

2. Location 2. Location - where you are going to live?where you are going to live?

- Cost of housing. Can be substantial.Cost of housing. Can be substantial.- how will you get there?how will you get there?

3. Cost 3. Cost - how much does the elective costhow much does the elective cost- Expenses : transportation, housing, food, gas, Expenses : transportation, housing, food, gas,

utilities, etc.utilities, etc.4. Time/Schedule4. Time/Schedule

- What is the limit of time spent at institutionWhat is the limit of time spent at institution- will you have enough time to get from one rotation to will you have enough time to get from one rotation to

the next (if schedule available)the next (if schedule available)

STEP 1STEP 1

Don’t do ALL your electives at Big Name Don’t do ALL your electives at Big Name SchoolsSchools

Look for programs that have taken IMG’s Look for programs that have taken IMG’s in the past and that you are planning to in the past and that you are planning to apply to that particular programapply to that particular program Make a good impression, will most likely get Make a good impression, will most likely get

an interview offer an interview offer

STEP 1STEP 1

Narrow down your possibilities to 4 or 5 Narrow down your possibilities to 4 or 5 different institutionsdifferent institutions

Last part …EMAIL and ASK for the Last part …EMAIL and ASK for the materialmaterial You might have to have it sent to your You might have to have it sent to your

house…US/Canadian address.house…US/Canadian address. Some schools offer all the applications onlineSome schools offer all the applications online

STEP 2 - PaperworkSTEP 2 - Paperwork

It will involve:It will involve: getting material from Dean’s officegetting material from Dean’s office getting your medical recordsgetting your medical records getting medical testsgetting medical tests asking for a number of letters asking for a number of letters

Watch out for application deadlines!Watch out for application deadlines!(Some places have them, others do not)(Some places have them, others do not)

STEP 2STEP 2

What you will need:What you will need:1.1. Transcript from Dean’s OfficeTranscript from Dean’s Office2.2. Letter of “Good Standing” from Dean or Vice Letter of “Good Standing” from Dean or Vice

DeanDean3.3. Vaccination proof and/or TitersVaccination proof and/or Titers4.4. Malpractice Proof Malpractice Proof 5.5. Proof of Personal Health Insurance in the USProof of Personal Health Insurance in the US6.6. USMLE Step 1USMLE Step 17.7. Letter of Recommendation (s)Letter of Recommendation (s)

STEP 2 - TranscriptsSTEP 2 - TranscriptsOfficial transcripts with all completed Basic Official transcripts with all completed Basic Sciences and Core Clinical Rotations.Sciences and Core Clinical Rotations.

PROBLEM !PROBLEM ! You are in the middle of your rotations You are in the middle of your rotations Solution – make sure Dean’s office puts down “pending” Solution – make sure Dean’s office puts down “pending”

for clinics which you are in or still have to do.for clinics which you are in or still have to do.Internal MedicineInternal MedicineSurgerySurgeryPsychiatryPsychiatryFamily MedicineFamily Medicine

Might have resubmit to the Elective institution a full Might have resubmit to the Elective institution a full completed transcript before startingcompleted transcript before starting

Make sure that you have all grades and credits Make sure that you have all grades and credits from Basic Sciences!from Basic Sciences!

STEP 2 – LetterSTEP 2 – Letter

Obtain letter of “Good Standing”Obtain letter of “Good Standing” What is it?What is it?

Nothing more than a letter that you have not killed anyone Nothing more than a letter that you have not killed anyone here, that you are up to date with all your work, and you are here, that you are up to date with all your work, and you are mentally stablementally stable

Who writes it?Who writes it?Dean or Vice Dean should write itDean or Vice Dean should write it

What if they don’t have it?What if they don’t have it?You write one, have them read it, and they will sign it.You write one, have them read it, and they will sign it.

How many?How many?Get enough copies with original signatures as you have Get enough copies with original signatures as you have applicationsapplications

STEP 2 – Medical ProofSTEP 2 – Medical Proof

You will be asked to provide proof of the following You will be asked to provide proof of the following vaccination or exposures to:vaccination or exposures to:

PolioPolio MMRMMR DPT and last Tetanus boosterDPT and last Tetanus booster Hepatitis BHepatitis B Hepatitis CHepatitis C VaricellaVaricella TBTB Pneumococcal VaccinationPneumococcal Vaccination

You might have to provide Titers for someYou might have to provide Titers for some

STEP 2 – Medical RecordsSTEP 2 – Medical Records

Do I need titers:Do I need titers: YES…it is a definitive way of showing proof that you YES…it is a definitive way of showing proof that you

have been immunized and that you are not infectious have been immunized and that you are not infectious nownow

Where to get it?Where to get it? ASG website has the map posted with directions how ASG website has the map posted with directions how

to get thereto get there

How much is it?How much is it? It will cost you about 300 zloty to get the following:It will cost you about 300 zloty to get the following:

Rubella Ig, Varicella Ig, HBV Ig, HBV Ag, HCV IgRubella Ig, Varicella Ig, HBV Ig, HBV Ag, HCV Ig

STEP 2 – Medical RecordsSTEP 2 – Medical Records

TB – you will have to be testedTB – you will have to be tested

Where?Where? You can do it at Pulmonology and the cost is 25 zlotyYou can do it at Pulmonology and the cost is 25 zloty

When?When?

What about BCG?What about BCG? They do not care…you still need to be tested. They do not care…you still need to be tested. You will also need to have CXR and if you are lucky they will You will also need to have CXR and if you are lucky they will

even write the results in Englisheven write the results in English

PPD givenPPD given Result readResult read

MondayMonday ThursdayThursday

TuesdayTuesday FridayFriday

FridayFriday MondayMonday

STEP 2 - MalpracticeSTEP 2 - Malpractice

Available at the Dean’s office at your Available at the Dean’s office at your request.request.

If not there, email the New York Office and If not there, email the New York Office and have them Fax over a copy with your have them Fax over a copy with your name on it either toname on it either to Dean’s officeDean’s office ASG officeASG office

STEP 2 – other materialSTEP 2 – other materialOther things they can request:Other things they can request: STEP 1 resultsSTEP 1 results – if you haven’t taken it, – if you haven’t taken it,

but you are planning on it, then hold off but you are planning on it, then hold off with application until you can deliver the with application until you can deliver the scores, but scores, but REMEMBER ABOUT DATESREMEMBER ABOUT DATES

Letters of RecommendationLetters of Recommendation You should be also collecting them for You should be also collecting them for your ERAS/MATCHyour ERAS/MATCHConsider getting them from Department Consider getting them from Department Heads – some Residency programs also Heads – some Residency programs also require themrequire them

STEP 3 – Sending applicationSTEP 3 – Sending application

Check and recheck your applicationCheck and recheck your applicationAttach application fee Attach application fee US currency (check/money order) or US currency (check/money order) or

Canadian currency depending where you are Canadian currency depending where you are doing your electivedoing your elective

Money orders can be obtained on Fredry near Money orders can be obtained on Fredry near the Okronglak (round building) at Western the Okronglak (round building) at Western UnionUnion

Send applications home and have your Send applications home and have your parents attach checksparents attach checks

STEP 3 – Sending applicationSTEP 3 – Sending application

Before sending applicationBefore sending application Inquire if rotation is still open Inquire if rotation is still open Get in touch with institution and ask if they Get in touch with institution and ask if they

can reserve the particular rotation that you are can reserve the particular rotation that you are interested ininterested in

Check deadlines to see when you can send it Check deadlines to see when you can send it in. in.

If everything is OK…SEND IT!If everything is OK…SEND IT!FedEx an expensive but reliable option FedEx an expensive but reliable option – tracking option– tracking option

After sending ApplicationAfter sending Application

Remember it takes a good week for mail Remember it takes a good week for mail to arrive to the US/Canadato arrive to the US/Canada

Ideally, you should get a written response Ideally, you should get a written response within a month… if you don’t, email or call! within a month… if you don’t, email or call!

If they did not receive your application, ask If they did not receive your application, ask if you can fax it to them and deliver official if you can fax it to them and deliver official version at a later date.version at a later date.

Arrival of LetterArrival of LetterIF you are approvedIF you are approved…You are done. …You are done. You now only have to worry about You now only have to worry about getting there.getting there.

IF you are IF you are NOTNOT approved approved…Call them…Call them Ask whyAsk why If rotation booked…your alternatives are:If rotation booked…your alternatives are:

Change date (if possible)Change date (if possible)Change to a different rotationChange to a different rotationTry to pick up a rotation at the other Try to pick up a rotation at the other institution that you have applied toinstitution that you have applied to

Time Line Time Line

JanuaryJanuary

FebruaryFebruary

March March

AprilApril

MayMay

JuneJune

JulyJuly

AugustAugust

SeptemberSeptember

STEP 1STEP 1

STEP 2STEP 2

STEP 3STEP 3

You should be in You should be in electives !electives !

What electives should you do?What electives should you do?Start out with an “easier” rotation:Start out with an “easier” rotation: Outpatient clinicOutpatient clinic Consult ServiceConsult Service

If you are feeling ambitious:If you are feeling ambitious:Sub-InternshipSub-Internship

All MS4’s are required to do oneAll MS4’s are required to do one Extremely demanding, huge responsibilityExtremely demanding, huge responsibility Sub-I’s in Internal Med difficult to get, as MS4’s are all required to do Sub-I’s in Internal Med difficult to get, as MS4’s are all required to do

one by their medical schools, spots usually fullone by their medical schools, spots usually full Save it for the end: Save it for the end:

Familiar with the hospitalFamiliar with the hospitalComfort with writing notes/physical examinationComfort with writing notes/physical examination

Get specialty-specific letter of rec.Get specialty-specific letter of rec.

ConclusionConclusion

Start early and you should have no problems!Start early and you should have no problems!

If you are planning on doing electives in the If you are planning on doing electives in the Spring the same deadlines may apply to you Spring the same deadlines may apply to you (check with the medical school)(check with the medical school)

If you are the ‘If you are the ‘last minute’ last minute’ type, you too can get type, you too can get an elective.an elective.

Essentials:Essentials:

Essentials:Essentials:

Pocket Medicine: The Massachusetts Pocket Medicine: The Massachusetts General Hospital Handbook of Internal General Hospital Handbook of Internal Medicine – by Marc S. SabatineMedicine – by Marc S. Sabatine

Prep for your ElectivesPrep for your Electives

Practice presenting patients like you would during rounds Practice presenting patients like you would during rounds and writing SOAP notesand writing SOAP notes

Pre-read!!!!Pre-read!!!!

Learn Lab Values shorthand:Learn Lab Values shorthand:

Familiarize yourself with medical shorthand terminology:Familiarize yourself with medical shorthand terminology: rrr, mmm, ntnd, ttp, no m/r/g…..rrr, mmm, ntnd, ttp, no m/r/g…..

WBCHbHtc

Plt NaK

ClHCO3

BUNCr

Gluc

Most Importantly:Most Importantly:

Practice presenting patients like you would during rounds Practice presenting patients like you would during rounds and writing SOAP notesand writing SOAP notes

Familiarize yourself with medical shorthand terminology:Familiarize yourself with medical shorthand terminology: rrr, mmm, ntnd, ttp, no m/r/g…..rrr, mmm, ntnd, ttp, no m/r/g…..

Know EVERYTHING about your ptsKnow EVERYTHING about your pts

Follow up on all lab results, imaging studies, line Follow up on all lab results, imaging studies, line placements, etcplacements, etc

Communicate with the nurses – don’t assume that they Communicate with the nurses – don’t assume that they check their orders regularlycheck their orders regularly

If something’s changed, let the nurse know If something’s changed, let the nurse know

TipsTips

Geriatric pt?Geriatric pt?

- GDS/MSSE- GDS/MSSE

-Make sure that they’re seen by PT-Make sure that they’re seen by PT Inquire about pt’s activity level, who do they live with, Inquire about pt’s activity level, who do they live with,

etcetc

Lines? PICC, central line - note placement and Lines? PICC, central line - note placement and datedate- ie PICC line in left arm (9/06/06 -)- ie PICC line in left arm (9/06/06 -)

Pt on antibiotics? – Note start of txPt on antibiotics? – Note start of tx ie Zosyn (11/17/06 -)ie Zosyn (11/17/06 -)