Medical Training Advice: Starting Internship!

Dun Dun Dun!

With the first day of internship just around the corner, many are pooping in their pants just thinking about the start of the end of their normal existence for the next three plus years. Don’t worry, you are in good company. Patients are probably also shifting uncomfortably in the beds of teaching hospitals across the US. Here are some helpful (hopefully) tips to keep in mind:

1. Make sure you know the location of all the bathrooms, this is very important. Don’t hold your pee; go if you have to.

2. Don’t go to the gym in your scrubs. You just look like you are showing off.

3. Don’t lie. If your senior resident or attending asks if you did something but you forgot, say you forgot. Don’t say that you did it, and certainly don’t make up anything because eventually you will get burned.

4. Remember you are an intern. You job is to learn and people are even expecting you to make mistakes. Don’t avoid things you aren’t good at or don’t know how to do because you might feel embarrassed. It’ll be much worse when you still don’t know when you are a senior.

5. Be nice to the nurses. They know much more than you how things work.

Just a few excerpts from the practical tips section of my book. My prayers go out to all who are starting this journey. It may not feel like it, but the next years will go by so fast so make the most of the experience!

The most reassuring thing someone said to me before I started? “Don’t worry. The human body is resilient. It’s actually pretty hard to kill someone accidentally.” I guess that’s true. You shouldn’t push your luck though.

Medical Training Advice: International Rotations

For those of you who are in medical sch0ol, an international rotation is a great idea if you can work it in your schedule (and if you can afford it). It’s an opportunity to see how healthcare is delivered elsewhere and just good in general to travel and see more of the world. The best time to do that is the summer between your first and second year (your last real summer) or during your 4th year. Even if you are just a first year, now is a good time to start thinking about this because it does take some planning.

Start exploring different options in your administrative office. Some schools already have partnerships in place with different hospitals/clinics, which make things like getting credit and scheduling much easier. The staff can usually get you in contact with other students who have gone before. Each school has their own policy and paperwork that is required.

Of course there are also many resources online. The international elective section here provides some good info if you are interested in family medicine. If you are planning to practice in California, I would highly recommend a medical Spanish immersion program that is part of the rotation. During my fourth year, some of us went through CACHAMSI, which is a program based out of Riobamba, Ecuador, which was an amazing experience.

It was a one month rotation and was structured for medical experiences in the morning (there were different sites like primary care in the rural setting and the ER in the local hospital) and Spanish didactics in the afternoon. We were each set up with a host family so it was a total immersion experience. The weekends were free for travel and exploration.

4th year of medical school is a great year, especially after your sub-internships and residency interviews. Plan ahead to make the most of it!

P.S. Don’t forget about vaccines and prophylaxis depending on where you go! International health insurance is not a bad idea either.

Here’ some pics! Fellow Travel buddies: Farshid, Charles, Regina

Medical Training Advice: Find a Mentor

Everyone needs a hero. If you read the free preview of my book, you know that one of the biggest influences on my medical career has been Dr. Nick Yphantides. If you don’t want to read the whole thing, here’s an excerpt:

After I accepted Christ… I went happily on my way to college at UCLA, majored in physiological science like a good little pre-med, and researched and volunteered my way into medical school. In medical school, I just looked for Christian things that I should do. So, I started volunteering at the free clinics, as well as going down to Mexico on weekend mission trips. I was a medical student who happened to be a Christian.

Then I met Dr. Nick Yphantides, a mentor who would change the trajectory of my medical career. Growing up, my heroes were Jackie Chan and my dad, and I quickly added Dr. Nick to that list. He was one of those superstar students who made medical school look like child’s play. He graduated high school and college early, and rumor has it he got top marks in every class and rotation in medical school.

This was a guy who could have done anything he wanted. But he was also a devoted Christian who loved the Lord, and was convicted by God to serve the indigent poor of San Diego. Because of that, he chose to go into primary care and spent the first decade of his career on the front lines serving exclusively patients without insurance.

In Dr. Nick I found a Christian who happened to be a doctor. He understood that God’s heart beats for the poor, oppressed, and marginalized. For Dr. Nick, medicine was simply a means in which to carry out that heart. As I spent time with him and saw that passion lived out, God began to put a similar conviction on my heart as well.

Worth the Cost, Introduction: My Story

If you are pursuing any career, not just medicine, an important thing you need to do is to find someone who has gone before that can mentor you. And especially if you want to do it for the Lord, you need to find someone who is living that out. Things can get really hard, and we need the experience of those who have gone before to follow after and a glimpse of faith lived out.

If you want to be inspired, here’s a cool video that shows a snapshot of Dr. Nick’s life.

Who in your life can you ask to mentor you in what you would like to do? Who in your life can you be a mentor for?

How to Cope

In my last post I talked about how difficult it is for those in medicine to repeatedly come face to face with human suffering. Whether it was the consequences of personal choices or due to unfortunate circumstances, the burden of caring for the sick can weigh heavily on the soul. It’s sad that even though medical training strives to raise up compassionate healers, people often come out jaded and cynical instead. Here are just a few things that have helped (and continue to help) me on the way.

1. Take a time-out

Medical training is such a hectic process, especially during your intern year. There is just so much to do you’ll be running around like a chicken with its head chopped off, rushing from floor to floor, patient room to patient room. Sometimes you just need to mentally check out for a moment. There was this place outside the hospital I would go to from time to time just to re-group. Even if you can’t escape the clinic or hospital, pausing for a minute before seeing the next patient can help to let your emotions catch up to your body so that you can be fully present.

2. Learn your patients’ names

It’s amazing how there are days I can’t remember a single name of the patients I saw that day. This might seem counter-intuitive, that the more you get to know a patient, the harder it will be emotionally if things take a turn for the worse. But I think it is the dehumanizing of our patients that makes our jobs seem pointless and futile. Our patients become just another thing to fix, another obstacle asking of us our energy and time that is already so limited. But connecting with patients as people can help us celebrate with them the small victories even if there’s no ultimate cure.

3. Journal

Our experiences are meant to be processed, not buried away. I started my book project wanting to be helpful to others. After I finished writing, I found that there was something hugely therapeutic in revisiting my training experience and working through the lessons that I learned. If no one buys or reads the book, it would have played an important role in helping me articulate one of the hardest seasons of my life. You don’t need to write a book, but who knows, maybe one day your ramblings can turn into one.

4. Connect with others

This is along the lines of number 3. Medical school and residency were my loneliest times, even though their were plenty of people around. It’s hard to talk to others about our experiences because either we don’t want to be a burden, or we don’t think others will understand. The problem is that we are created as relational beings, so we do need others to help us process. Don’t forget your relationships, particularly your spouse. And sometimes professional help might be necessary. There’s no shame in this; some of the situations you’ll face will be intensely traumatic. There are resources available through your program so don’t be afraid to seek those out.

5. Keep the eternal perspective.

As high a calling it is to care for people’s physical body, we have to be reminded that there is a higher, spiritual reality. In the words of Dr. Cox from Scrubs, “Sooner or later, you’re going to realize that everything we do around here, everything is a stall. We’re just trying to keep the game going, that’s all. But, ultimately, it always ends up the same way.” The decay of our bodies and eventual death is inevitable, and while our job is to hold back the tide, our job as Christian physicians is, through our care of the physical, to point people to a deeper spiritual healing that we all need. This is where we need to remember God’s promises that He will one day make all things new.

This is just a short list of things I found helpful that I am still learning to do as I continue in my career as a physician. The road is a difficult one. My prayers go out to those who have embarked on this journey.

What has helped you from developing cynicism and becoming jaded?

Medical Training Advice: How to Prepare for Residency

Congratulations to all who matched into residency! For those who don’t know, last Friday was Match Day where everyone who got accepted into a residency program found out where. During your fourth year of medical school, you apply to residency programs in your field of interest. After your interviews (hopefully you get some), you then submit a list of the programs in order of preference. The residency programs also rank all the students they would like to accept and by some magical (and complicated) formula, you are “matched” with a residency program based on the respective rankings.

Where you match is where you have to go, unless you decide to take the year off and try again the next year. It’s a bit of a lottery so it’s quite nerve wrecking. During match day there’s usually some sort of ceremony where all the envelopes with the match results are laid out with your name on it and it’s a royal rumble affair to get your envelope. Some schools have students individually come up to get their results (extra torture). Usually there’s a lot of rejoicing, but there’s also disappointment for those who don’t get their top choices. But regardless of where you match, it’s a huge achievement so my congratulations again.

People ask what they should study or if they should do really hard rotations near the end of medical school in order to prepare for residency. To that, I reply with a resounding NO. There definitely is preparation to do, but not in medical knowledge. That’s what the 1st three and a half years of medical school was for. Medical school is hard, no doubt about it. Residency, though, is on a whole other level. You need to establish and re-establish some life-lines.

What are life-lines? These are the things most important to you that renew you, encourage you, and support you. These are things that will give you the strength to get up again after being beat-down, sleep deprived, and emotionally trashed, and do it again and again. These are probably things you have neglected because of all the studying and rotations during 3rd year. First and foremost are your relationships.

The most important is your relationship with God, and it really is time to reconnect with Him and build into your routine the basic spiritual disciplines. If you didn’t have time during medical school to read your Bible and pray, then anticipate not having much of a relationship with God in residency. You have to be very intentional about carving time out for God, and if you are in the habit of doing that when you do have time, you’ll build up the discipline to do that when life gets busy.

Now is a good time to start scoping out churches where you will be training. Hopefully you took into consideration the church community in your ranking process. If you don’t have a church home, it might be a good idea to find a church with different services so that you can go if you are on call on Sundays or post-call. Fellowship with God and other believers is going to be key in reviving your soul and reminding you of why God called you into medicine.

Next is your relationship with your significant other, especially your spouse. They will be your number one fan, but they also will be affected by the difficulties of residency. The long hours and the emotional drain will cause big strains so it’d be wise to strengthen your marriage prior and continue to tend to your relationships during the process. This is a huge topic just by itself, you can read this article for more on the subject. Of course your relationship with your family and friends are important so make an effort to build up your encouragement base before the craziness starts. You’ll need all the support you can get.

Lastly, I’ll just mention you need to connect again with the activities that give you joy, whether it’s a sport, hobby, or special routines. Medicine isn’t just about caring for others, you have to care for yourself first. Again, residency will be hard. There will be times when you can’t do all that you want to do (or know you should do). Hopefully by building up the support and habits now, you can not just survive residency, but thrive.

What are your life-lines?

Medical Training Advice: How Do I Decide What Specialty to Go Into?

Here’s the first of the posts I want to do to address commonly asked questions I get about the medical process. If I collect enough of these, I’ll make a separate FAQ section. Enjoy and thanks for reading!

How Do I Decide What Specialty to Go Into?

After your decision about Christ and your spouse, this is probably the next most important decision you will make. Well, maybe the decision to have a kid is somewhere up there too. This is a question I get pretty often, but unfortunately there’s not a one-size-fits-all answer.

Besides going through rotations with an open mind and heart to get the most out of each experience, the best advice that I received is to talk to as many physicians as you can about their daily practice. You might love certain things about a specialty, but you might come across those diseases or procedures once in a blue moon. It might seem cool to be a surgeon, but are you ok with taking out gallstones and appendices the majority of the time? Find out what the bread and butter is in each field and ask if you can see yourself doing that day in and day out.

Having said that, you can do a lot with medicine with a little creativity, flexibility, and perhaps a willingness to sacrifice some monetary compensation. I didn’t want to do patient care everyday so I split my time up between my clinic in Long Beach seeing patients and Harbor-UCLA doing some teaching. If salary is a big deal, here’s a general idea of how much physicians can make in different fields.

If you are wondering what field would be best to serve the Lord with, that one is easy: any field. The question is what do you want to do to serve the Lord. Do you want to serve the Lord overseas or in a rural area? Then a surgical field, obstetrics (or family medicine with emphasis on high risk OB) would be super helpful. Realize, though, that certain specialties are more volume dependent so you might not be as free to do ministry work in order to keep your skills up (even more of a concern with residency work-hour restrictions).

But you can really do anything and be used by God to impact his kingdom. There’s a tremendous need for medical education to train up native physicians so even if you are a super sub-specialty, you can meet needs overseas. Of course, specialty services are much needed for those without insurance or access to care. And not to mention the day-to-day ministry opportunities that you have with your patients, whatever field you re in. The moment they step into the office and particularly the hospital, they become more aware of their mortality and more open to thinking of things of eternal consequences.

If you are interested in how I chose to go into family medicine, check out the free preview.

If there are particular questions you would like to see addressed, please leave me a message or email me at jacktsai@unfailingspring.com.

Unfailing Spring

"You will be like a well-watered garden, like a spring whose waters never fail." Isaiah 58:11

Category Archives: Medical Training Advice