Saturday, August 29, 2009

The Boards...

Years ago, a physician told me "If you're going to be a doctor, I hope you love studying..."

Well, residency is over. The reading, of course, never ends... and neither should it. There are always new things to learn: new guidelines, new studies, new vaccines and new diseases. What many didn't count on though, was exams! Besides the inservice exams we do every year in residency (and in Med-Peds, because we are doing 2 specialties, we get to do two of these each year), there are the Boards.

After residency in Internal Medicine, graduating residents get to take the internal medicine board exams, held by the American Board of Internal Medicine. It is an all-day computer exam, going from 8:00 to 6:00 with 240 questions set in blocks of 2 hours each (60 questions to a block, so 2 minutes per question). If you pass this (pass rates have been of the order of 91 - 92% with roughly 7,100 taking it every year), you are certified as a diplomate of the Board of Internal Medicine -- a "board-certified" internist. This is the initial certification. One has to re-certify every 10 years. Sounds like fun, doesn't it?

It's amazing how there's a little cottage-industry that is spawned by the many exams in medicine. There are review courses, study guides, books, DVDs, CDs, MP3s... you name it.Every exam (the USMLEs, the Boards in each specialty) has its own little industry. While no-one can legally tell you what'll be on the boards, you hear a lot of "they're bound to ask you this, or that.

Well, I've been through yet another exam trauma -- the whole ritual of preparation angst, pre-exam anxiety, exhaustion and finally relief. I took the exam on Thursday this past week, so I 'blew off' this weekend (didn't do anything meaningful).

Results come in 3 months.

Oh, did I mention, that because I'm Med-Peds, I have the Pediatrics Board exam to look forward to. I plan to do that next year, but I'll start studying now. Fun, fun, fun!

Sunday, August 16, 2009

The first first 2 weeks

I had meant to write about my first day in the job as a Med-Peds physician. That was July 27th. It is August 16th as I sit down to write this entry. The first day is a bit of blur, so I'll write about the first 2 weeks instead.

I remember that my first day had one no-show -- a bit anti-climactic. However, there were enough patients to keep me busy, mostly new patients who came to establish care. In these past 2 weeks, I have had a lot of adults coming into establish care and get an annual physical. Similarly, there have been a lot of kids who came for well-child visits and sports physicals. After the first 20 or so, I wanted to see a sick person! I enjoyed the freedom of seeing patients on my own. In the first couple of three visits, I would come out of the room, look for my staff, remember I was it and go back in to finish the visit. Even at the end of the second week, I still had to catch myself dictating "this is resident physician Vijay Aswani dictating..."

The first Peds clinic call was exciting. I was nervous about whether I would be able to keep up with the flow of patients. It was fun! I did end up admitting one 12 year old. My last case of the call morning was a little 2 year old with nursemaids elbow. I was able to click it back into place in seconds.The mother was suitably impressed. This is one of the few things in pediatric medicine where the fix is instantaneous. I was grateful for that case in my first day.

I staffed residents for the first time day before yesterday (the last day of my first 2 weeks). I supervized a resident tapping a left knee effusion that I had seen the day before and saved for this clinic. Everything went flawlessly. The patient felt no pain and we took off more fluid that I can remember taking off a knee.

All in all, I am feeling more at ease in my new job: building new patient relationships, taking care of patients and doing a variety of things with both adults and kids -- what a Med-Peds practice should be. Some highlights were: diagnosing my first case of diabetes mellitus type 2, tapping a knee effusion, setting a nursemaid's elbow, parotiditis, atrial fibrillation, managing blood med side-effectsd (hyperkalemia), performing a pelvic exam on a first time patient... the list goes on.

I have the internal Medicine board exams in about 11 days. Scary. Trying to study while practicing in these early days is hard: almost every patient is a new one that I need to get to know before I can go faster in my visits. Right now, each office visit is 30 minutes and each physical is an hour. I hear that that will change to 20 and 40 minutes respectively, within a month or so. Got to get faster.

My only beef is that I wish I had more time to think about some of the cases. If I could think, read and consider before having to 'move on to the next case', I would probably order fewer tests and maybe get to the answer faster in some cases and get to answer in some cases. Perhaps this will improve with time as I become faster.

Onward and forward to another week...