Tag: pre-med

The Med School Interview

Oh why, hello again.

I’ve been reflecting on my time in medical school and what a tremendously weird road it was to get here. And your specific path may just as weird as mine! Or it may be easy breezy pumpkin squeezy. And if that’s the case, I somewhat envy you; but at the same time I’m proud of how I got here. But overall, reflecting is something I’ve found myself increasingly doing lately… I’m going to blame turning 30 on that.

Anywho, in less than a year I will be undergoing residency interviews, so I figured it was about time I wrote this post. What are some important aspects to review for a medical school interview?

I may or may not also have some inside information… but like with every post, please take this with a grain of salt. Everyone’s experience is different. Things that can change how your performance goes. Some major things that can help you:

  1. Confidence. Oh my how this is a big one. You should be confident, but not arrogant. They know you are going to be nervous. Can you work through this?
  2. Prior interview experience. You are more likely to be comfortable on an interview if you’ve had one before.
  3. Prior experience at that campus. If you happen to have gone to school there for a previous degree I can promise you will automatically feel more comfortable at your interview.

Don’t worry if you don’t have #2 or #3; those are things that may help you but aren’t required. But you definitely need to have #1. And only you can work on that!

Oh.

And this is going to be very list heavy. Sorry not sorry.

Researching before you go!

First off, are you interested in MD or DO? Because that will change how you answer some questions…unfortunately.

I have interviewed at both, but in total of my 3 years of trying to get into medical school I only received 3 interviews. One each year. My first year was at an MD school, and my second two years were at KCU where I eventually ended up. My significant other had a good range of interviews between MD and DO, so I will add in some of his experience as well.

  1. You need to research what is important to the school. Look at their values. Now, repeating them verbatim won’t help you, but understanding what they are looking for is important.
  2. If you are interested in DO, you should already know we do a lot more with our hands. Our hands are one of our major tools! So research what DO actually is please! Don’t be the student that walks in and tries to wing it because your CV got you an interview but really you are just interviewing at a DO school for your backup. Don’t be that kid.
  3. Also on the DO route… learn the 4 tenants of osteopathic medicine. That will win you bonus points. And try to be able to describe how you would use them in the specialty or field of medicine you are currently interested in. You will likely change what field you want to go into by the time you graduate, so don’t worry about being sold on that specialty when you interview. But if you are interested in it, work that into your conversation. If you aren’t sure, no big deal! You can still explain how the 4 tenants can help you as a physician.
  4. What type of environment is the school in? City? Suburban? Rural? These will all play a big part in your interview day. Ultimately, if you can’t see yourself being in that area, then you won’t thrive there. If you are a city person at heart and go to ATSU (Kirksville is the birthplace of DO, but there’s nothing there) which is very rural, will you be able to thrive as a student and a person? All things you need to consider.
  5. Talk to students who have been there. Ask them how student life is? Is it student friendly or is it very much top down administration? Are there great resources that your school can help you with? Curriculum is big, but what exactly do you want to know about the curriculum? Make sure you are getting a good understanding of what you want to know, so you can really develop good questions on interview day. (P.s., interviewer’s hate curriculum questions. It’s the scapegoat for all students to ask about when they don’t have anything else to ask).
  6. Are you interested in research? Does this school have that opportunity for you?
  7. What is available in the community?
  8. What types of clubs are on campus? Are you interested in any? Can you see yourself being a part of that? Same goes for SGA, student ambassadors, tutors, etc. If this is something you are interested in doing, know what that school has to offer. A lot of this can be found on their website.
  9. Go to the campus. Try to go to one of the days they have tours. This is where you can get more time with the guides to ask more specific questions. Ask about GPA requirements, MCAT scores, maybe sneak off and talk to a few of those students like I mentioned earlier. Being on campus and actually feeling the vibe will tell you if you fit in there or not. Trust your gut. If you walk onto that campus and immediately it doesn’t feel good or it feels strange, not for you. Versus if you walk on the campus and feel welcome, good choice for you!
  10. Know if the school is big on keeping students in the area or not. Some schools make you sign clauses that you will practice for x amount of years in the area. If this isn’t something you are willing to do or compromise on if you get in there, then don’t waste your money applying.
  11. Are there big-little programs to help you orient your first year? Or groups of students who are willing to help? Do they offer tutoring for first year students? What resources are given to you first year? All of these things won’t make or break a school, but are helpful in knowing if they are available or not.

Questions to prep for

Yo, this will be difficult. But the main thinking goes along this:

  1. Can you answer it coherently? Is it a well rounded answer that you aren’t stuttering through and that answers the question? This is honestly one of the biggest things in interviewing. Answer the question, and do so in complete sentences and coherently.
  2. Confidence when answering. Don’t fidget. Good eye contact. If you need a minute to think of a scenario then tell them you need a second to rack your brain before answering.
  3. If you are passionate about something in your life, make sure you use that in your examples of answering questions. They like well-rounded candidates. Obviously they want to see you have a passion for medicine, but your entire life shouldn’t be revolved around that. Do you have hobbies? Do you play sports? Are you an avid traveler? Or crafter? Whatever it is, make sure you work it into your examples somehow.
  4. Know the basic interview questions. Strengths/weaknesses. Have several scenarios where you’ve had to overcome an obstacle or issue or working with someone that was difficult and how did you work through it. They can seriously ask that question in 10 million different ways. Why MD vs DO? Why do you make a good candidate? What would professors at your undergrad or previous institution say about you as a student? If you could invite any 3 people in the world to dinner or on vacation, who would it be and why? If you were stuck on an island, what x amount of things would you bring? You know, those types of questions. There are 8 million websites that have examples of this and can probably give these better than I can.
  5. Know why you want to go to that school. Seriously. You should be thinking about this. If you are interviewing there, why did you spend all this time and money if you aren’t sure why you want to be there? Think about it and make sure you can answer that question.
  6. If you answer too curtly or you drone on during answering your questions it won’t look good. Treat it like you are having a conversation in a coffee shop with a business colleague. Good length, long enough to answer appropriately and hold attention. If you answer too short, they will run out of questions with you. Too long and they won’t get to ask you what they need to get through. And obviously be professional. No swearing people!
  7. Ethics questions. Ah, so many students are nervous about this. There is no right answer to an ethics question regardless of what someone might tell you. They simply want to know if you’ve given the answer some thought, why you would choose that answer, and can you give a coherent and confident answer. They aren’t expecting you to understand medicine… because you aren’t in medical school yet. That is their job to teach you. Use your common sense and be able explain why you chose that answer. But no, there isn’t a right answer to those questions.
  8. It’s really hard to prep for any odd ball questions honestly.

Dress

This is a very controversial topic. Some schools are hella sticklers for what you wear. Some are more relaxed. Rules are as follows:

  1. Dress professionally.
  2. Cover yourself.
  3. Shower; groom yourself well.
  4. Wear comfortable shoes.

For men, this means a suit and tie. For women, this can be a pantsuit, a skirt suit, or a work dress with or without a jacket.

Bold colors and wild patterns are honestly bit no-no’s. But just know a lot of people will be in black. It’s a power color, and it works in every situation. HOWEVER YOU WILL NOT STAND OUT IN BLACK. Go with a gray or navy suit. Girls if you wear a dress, it’s okay to have a tiny pop of color, or you can do a navy, dark green, tan, gray, or white dress. For shirts, a lot of people like I said will be in black suits and white tops. Women most commonly wear black suits and a pale pink top. I’ve seen girls wear light red and green tops. I’ve worn jewel tones before and it was just fine. Just make sure it isn’t too in your face, but enough to set you apart.

Day of:

So, most of the interviews will be split into two blocks on the same day in order to maximize the amount of people being interviewed.

  1. You interview in the morning, and then go through all the information midday
  2. You go through all the information midday and interview in the afternoon

For most of my interviews, I fell into the second category. So the information includes the following in an interview:

  1. Curriculum set up/type. They won’t give you too much information. You will get that at orientation.
  2. Vaccinations
  3. Other expectations if you accept and deadlines to get it in.
  4. Tour of the place.
  5. Usually they feed you. Which can be hella difficult. KCU offered me barbecue BOTH TIMES. Try not to get that all over your nice clothes. But it was very delicious, I’ll give them that.
  6. Then the interview.

Some tidbits:

  1. Don’t be the obnoxious person talking over everyone. You won’t make friends, and if the people leading the tours are students they will give that information back to the committee.
  2. Don’t be on your cell phone. I’ve seen too many kids do this. THIS IS NOT PROFESSIONAL. You can text/call whomever after the day is over. Put it down. Or better, turn it the fuck off.
  3. If the tour is student lead, now is your time to ask the good stuff. What don’t you like about the school? What are some of the biggest issues you’ve run into as a student? You can always ask them the positive side of those questions to, but I personally want to know the nitty gritty. Is there a department to look out for? How do they handle mental health? What are some fun things that you’ve gotten to experience since being there? etc.
  4. Do take notes. Take notes of the people talking. Take notes of the people’s names who interviewed you. If you interview at KCU, you can actually look up the faculty by first/last name or department. Most of them have photos (not all). That way you can get their names to write them a thank you note!
  5. Do pay attention. I know it is long, and exhausting. Try to be as attentive as possible.
  6. And for christ’s sake. Be friendly. Mingle. Chit chat. Show you are a communicative person. Everyone is nervous, but they look to see if you are by yourself or mingling or entirely hogging the spotlight.

Let’s see, what else is important… Oh, ask your interviewers questions!

Ask those questions back when you are being interviewed! It is okay to have a list of previously made questions. This is why you brought that bad of paper/portfolio. Well, along with other things. But this is where it will also be of use to you.

Again, don’t ask those damn curriculum or grading questions. It’s a cop-out, and they hate it. Interviewers can tell you don’t actually know anything about the school or you didn’t put any thought into your interview. 

Ask what you want to know about the school. So think about this while you are writing your questions. Some examples:

  • Why did the professors choose to teach there?
  • Why did the professors choose teaching in general?
  • What are they passionate about? And how did they become passionate about that topic?
  • How do the students feel relative to x, y, z?
  • Are the students/professors/staff happy with their choice of school?
  • Is there something they absolutely love about their school/campus?
  • Is there something they dislike about the school/campus?
  • If there is one thing you could change about this school or campus, what is it?
  • What is a hidden gem in the area/community that you love to go to?
  • Since I’m in town, what are some great places to explore before I leave to really get to experience the area?

Post-interview:

Don’t bombard them with an answer after you interview. If they tell you how long it will take to hear back, expect it to take that long. It will just be a pleasant surprise if they give you an answer before then! I think KCU typically takes 6 weeks to decide. They do several interviews and then make a decision on that chunk of interviews for everyone. Know that any thing around holidays or breaks will take longer or be closer to that 6 weeks.

But if they don’t tell you during the information session, it is okay to ask how long you can expect to hear back. If they don’t get back to you in the time they told you they would, then reach out.

Thank you notes

Honestly, doesn’t really matter if you do these. I usually do just as a nice gesture, but you do not have to. Again, make sure you are writing down who you spoke to and interacted with on the day of the interview.

  • You can write a general thank you to the admissions team
  • You can write a thank you for all of your interviewers, or you can send them one specifically.

It is fine to be generic or have a template, but it won’t be as touching. If you choose to thank the admissions team, it can be more general. But for your interviewers, make sure to add in what you spoke about (i.e. what topics you discussed outside of their set interview questions).

I’m pretty sure most schools don’t factor in if you sent a thank you letter into their decision. It is just a nice touch and helps keep things professional.

If you do write them, write them immediately and send them off within a few days to a week of your interview. It is bad etiquette to send it in later than that. Plus, you are likely to forget details of your interview as time passes.

What about non-interview scenarios? Like MMI’s or skit scenarios?

Well, I’ve had a few and so has my significant other like this. What are the types of interviews you can walk into:

  1. A panel. It is you and several people all starting at you. It could be 3+ people. Very intimidating. Expect at least one to try to be a bitch or hardass.
  2. One-on-one interviews. You will usually have many if you do one-on-one. That way, each interviewer can ask the same questions to everyone and a range of people get to meet them. However, I’ve had one interview where only one person interviewed me for 45 minutes. It depends.
  3. MMI or multiple mini interviews. This can consist of a mini scenario on the door and then you go in with your answer and answer questions. This is the only non-traditional type of interview I did. Sometimes this will include a small group project.
  4. Acted scenarios. These just suck. They usually include actors.

The whole point of these is to see how you act under pressure and under a possible chaotic scenario. Can you keep your cool? Can you calm the situation and answer in a well-thought out manner?

For my MMI, I had several mini scenarios (ethics, non-ethical, questions for me) that I had x amount of time to read and think of an answer, and then x amount of time to present that and answer additional questions with the interviewer.

For the scenarios, thankfully I didn’t have this. But my significant other did. He said most of the time the scenarios were absolutely outrageous, could include politically charged or controversial topics just to see how you would react, and if you could calm the scenario down and answer appropriately. I think this is ridiculous and not a good judge of character. And personally, I wouldn’t want to go to a school like that. But I digress.

Also know that you will likely have to do a group activity. How do you work well with others? Medicine is a team sport after-all!

The other big thing is schools are now asking you to do a writing prompt on interview day. This is to see if your interview paper materials are similar to how you wrote on the day of your interview. They want to know if someone else did your personal statement, answered your secondary questions or if you did it.

One last major thing…

I know. This post is long.

SET YOUR SOCIAL MEDIA ACCOUNTS TO PRIVATE DURING INTERVIEW SEASON.

I’m not joking. There are people at the university or interviewers who will look you up online and see what you’ve posted. And since the type of information they gather from an online search is very subjective (based on the interviewer), a drinking photo, a smoking photo, doing weed, partaking in questionable activities, etc can all come back and bite you in the ass.

Set it to private. Keep it private. Once you have been accepted (or denied) and interview season is over you can set it back to public. Once you are in they don’t care. But it could be JUST the extra thing they needed to kick you out and give you a denial or waitlist. Don’t do that to yourself. Give yourself every chance.

And uh, I think that’s it. It’s a long one, and hopefully a helpful one. I recommend you look at many different sources for this to prep, but always take each person’s experience with a grain of salt. Just because it was easy for one person doesn’t mean it will be for you or that it was actually that easy (they could be lying). Good luck with interviewing!

Scribe Series: Assessment & Plan

Just like with everything else in medical writing, your Medical Decision Making (MDM) and assessment and plan will be different depending on your specialty and your provider’s preferences. I will try to walk you through how to go about writing this as a scribe. Ideally, your provider should be dictating this to you OR you should be taking the information that the provider relayed to the patient in the room and using it as your plan. As you improve as a scribe and understand your specialty more, your provider may have you write you own or at least start it on your own. Ultimately, the information should be coming from your provider!

What is an MDM/Assessment & Plan?

Well, by now you should be familiar with the SOAP note format. It is the easiest way to chart; and by easy I mean it makes the most sense to the most people. MDM and assessment and plan fit into the A&P section of the SOAP format.

Assessment (A) are the diagnoses or differential diagnoses that you are trying to rule out. In general, students are encouraged to list their differentials. Attendings with enough experience usually list what they are billing them for as the diagnosis in their assessment. If they are unsure of the diagnosis yet, they will put symptoms with a differential to work through.

The plan (P) is what you intend to do to narrow down the differential, treatment, and any counseling/education you give to your patient. This is a snapshot of what you are doing/intend to do so when you look back at the chart you can see what you’ve done and why. Most providers also give some sort of medical reasoning in with their plan to remind them what they were thinking of when they see the patient again; but not always.

MDM or Medical Decision Making is a combination of both. I saw this the most within the ER notes I was writing. They would write the MDM and discuss why they ruled a diagnosis in or out (reasoning behind their differential), important things they found on labs, and a brief recap of their pertinent HPI and PE. It was an explanation as to how they arrived at their diagnosis. It can also touch upon how the patient’s course was during the ER stay, so they have some reasoning to show why they discharged them, admitted them for observation, or had them admitted to the floor. Usually in my ER charts I would have a course section above the MDM, where many timestamped events were noted. It served as a snapshot to show what was done/why something was ordered/consults that were placed/advice given on consults/etc. That way, your MDM would just be about medical reasoning.

Then usually under the MDM in those cases you would have a diagnosis/assessment line. Here you would place your definitive diagnoses; since you had a paragraph or more above it going through your differentials and medical decision making.

Examples:

There are literally so many ways I have written these. It’s almost going to be difficult to provide a good way to break it down for you! But I will try my best.

The way I learned in medical school is as follows:

Assessment should be a one line containing the restatement of the patient’s name, age, and chief complaint. It should be followed by the differential diagnoses (which can usually be in bullet or number format) of what the patient’s symptoms may most likely be. Additionally, you would add any chronic diseases or pertinent history that you can count as a diagnosis.

The plan includes what you intend to obtain/do/counseling for the patient. For example:

Assessment: Patient is a 39 y/o M presenting with SOB. DDX include:
- asthma exacerbation
- pneumonia
- bronchitis
- H/o uncontrolled asthma 
- current smoker

Plan:
- albuterol nebulizer treatments q4 hours for 24 hours at home
- oral steroids
- CXR
- CBC, CMP, ABG

Now, this is a great way to teach students. It is also useful in settings such as internal medicine, family medicine, peds, etc where you are taking care of the patient’s chronic conditions. It can also be helpful in an inpatient setting where you are following the patient over several days. HOWEVER, it is not always used this way.

In the ER setting, as noted above, I would typically use the MDM method. It would look like the following:

MDM: Patient is a 39 y/o M with a h/o uncontrolled asthma and is a current smoker, presenting with SOB, wheezing, and a pulse ox of 88% upon presentation. On exam, he was noted to have inspiratory and expiratory wheezing bilaterally and decreased breath sounds on the L base, tripoding, and was in acute respiratory distress. His VS revealed tachycardia at a HR of 110 and hypoxia with a pulse ox around 88% on RA. He was immediately placed on a nasal cannula with slight improvement to 90%, and was later placed on a non-rebreather with his highest oxygenation at 92%. CXR revealed a patchy infiltrate to his L base. He was given a course of IV steroids, started on IV antibiotics, and given several nebulized albuterol treatments. Patient had some improvement in his symptoms post nebulizer treatments. He was admitted to pulmonology, Dr. Star, for further management. 

Diagnosis: 1. Pneumonia 2. Hypoxia 3. Uncontrolled asthma, likely exacerbation 4. Current smoker

Disposition: Admitted

Here, you can see the thinking behind why we did what we did. In more complicated cases, you would have several differential diagnoses that you would show you ruled in or out. For this one, the treatment/evaluation was more forward.

Now, a lot of times an MDM will show up in a different format. It will appear like a separate A&P, but essentially be a full MDM. I have seen this in internal medicine look something like this:

1. Diagnosis. talk about it. Why you are ordering labs, why you are concerned, and what you talked about with the patient and any at home things they need to do.
2. Next diagnosis. Same thing
3. Next diagnosis. You get the idea

Again, I used this a lot in my internal medicine and family medicine clinics as a scribe. That way, the A&P were together in one place and anyone reading the chart (but more likely the original physician who read it back before seeing them again) could see their diagnosis, their differential in why they were concerned, what they ordered or next steps in ordering, and what they told the patient. That way, they knew exactly what they were thinking and what was relayed to the patient.

See in medical school, they like things nice and neat. They want you to be complete, but don’t want things to be a mess. The way they taught us all the way up above at the start of this post makes things uniform. Especially since people in the first two years have varying degrees of previous exposure to writing notes.

HOWEVER, the internal medicine version I just mentioned is much more inclusive of everything. And as a scribe, it helped me lump in why we were doing things for which diagnosis. It also helped me learn some at home/plan things that were typically involved with each diagnosis. You start learning what labs, imaging, and at home changes the patient needs to do for what types of diagnoses. One, you learn which will always help you. Two, when you start hearing the spiel for the next patient or for patients down the line, you know where you are going to put that information in the chart and what diagnosis it should go with!

Now, this example probably wouldn’t be as well suited for an outpatient visit. So I’ll try another one in this format. 

 1. Elevated blood pressure. Patient has had two office recordings of elevated blood pressures. This was discussed today in office. At this time, he does not meet criteria for HTN, however we have discussed obtaining a BP cuff for home, or going to a local CVS/Walgreens/Walmart to regularly check his pressures. If he obtains one for home, discussed having a nurse visit to make sure it is properly calibrated. If he is using a store, discussed the importance of using the same cuff from the same store to obtain accurate readings. We will review his readings upon his follow up visit. Behavioral modifications such as walking more, or starting more exercise/activity, increasing his water intake over sodas/teas/sugary drinks, and lowering his salt intake discussed and patient given high blood pressure handout. All questions/concerns addressed. 

2. Pre-diabetes. Patients Hemoglobin A1c in office today is 6. Diet versus medication discussed at length. Patient would like to trial behavioral and diet modifications first. Will see how this is going when he returns for his BP checkup, otherwise will obtain another A1c in 3 months. Side effects of metformin, dosing, and regimen discussed at length. Offered a referral to our in house nutritionist, which he would like to schedule a visit with. 

3. BMI of 31. Discussed importance of weight loss, which would help improve both his elevated BP and pre-diabetes. Healthy food choices and exercise/activity discussed. 

4. Smoking. Cessation discussed. Patient is not willing to quit at this time as he reports it "helps with stress". However he is willing to trial cutting back. Cessation assistance offered, he declined today.

As you can see, I set this one up for a really great future heart disease patient. But you will see a lot of people like this in clinic. The first bullet point is longer than I would have put; this is for your benefit so you can see what something may be talked about in clinic. In general, you would probably put less than that. As a new scribe though, there is nothing wrong with writing that down. Just don’t be sad when your provider erases a chunk of it, as it is implied in the notes that all those things were discussed.

What do you put in the plan versus the patient’s handout?

Great question! So glad you asked.

In general, a lot of what you will put in your plan versus the patient handout will be the same. The only differences are you will put more information of what was explicitly discussed in the patient’s handout and you will write it in layman’s terms. You will need to put all those details in there of making a nurse visit, suggesting for activity, suggestions for small changes discussed as there is usually a lot talked about in a doctors visit. Having all that written down will help the patient remember. This will get printed either by the physician or the front desk staff before they checkout and handed to them to take home.

PLUS, a lot of EMR’s now have pre-made handouts for different diseases. So you can search for the disease and what type of information you want to give the patient to have that printed out as well. For example, for pre-diabetes nutritional guide, you could find that instead of just a handout explaining what pre-diabetes is and why it’s concerning.

The plan will be a shorter, more concisely worded, and with more medical jargon put in place. The plan will be part of your SOAP note. The printout will be in the chart, but not part of the actual note itself that your doctor and other physicians will read. That is why they look at the plan!

I hope this was helpful in differentiating and how to write an A&P versus an MDM. Again, just like with your HPI’s, practice makes perfect. Thankfully though, a lot of this will either be directly dictated to you or discussed with the patient in the room, and you just have to jot down the information.

Good luck! Cheers.