September 2006 E-Newsletter

Medical Student Perspectives: Crafting a Great Personal Statement

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Personal Statement (PS): the words alone can strike fear in the hearts of medical students applying to residency. Throughout our many combined years of advising students, we have observed that writing a PS is often the most dreaded aspect of the application process. As program directors, we have read thousands of personal statements and we have seen it all: the good, the bad and the ugly. We would like to share some tips to help make the process as painless as possible and some do's and don'ts to make the product the best it can be.

First, let's review the purpose of the PS. It is true that the PS is a very important part of your residency application. The importance is not because it is critical in determining your position on a rank list, but because it is a window into who you are. A good PS is much more than a narrative rendition of your CV (curriculum vitae or resume) that simply enumerates your accomplishments in sentences and paragraphs. Ideally, it should reflect your qualities and values, as well as your interest and passion for the art, humanity and science of medicine. It should be personal. A great PS will make the program director eager to meet you and potentially work with you. It will provide the interviewer with valuable discussion points for your conversation. It should give a sense of who you are, rather than simply list what you have done. A poorly written PS can cast doubt on your dedication and focus for a demanding profession like medicine. The program director may wonder if your communication skills are up to the challenge of caring for complex patients, conveying complicated information and educating patients, families and colleagues. The PS that falls between these two extremes may be neutral in its overall effect, but represents a missed opportunity to add luster to your candidacy. The tips contained in this article are based on our combined experience as student advisors and program directors who have each read thousands of personal statements over the course of our careers.

Tips for Getting Started

  • Think of the PS as an exercise in self-reflection and an opportunity to convey something unique about yourself. Do not approach it as merely a task or check box to be completed in the application process. Why do you want to go into medicine? What kinds of programs are you looking for? What characteristics do you seek in those programs? What are your values? Who has helped to shape them? Have you had to overcome adversity? How did this experience shape who you are?

  • Think about what you would like a residency program director to know as they consider inviting you for an interview and ranking you for their program. What is unique, distinctive and/or impressive about you?

  • Make a list of the things that you would like a program director to know about you. Does this information exist elsewhere in your application? If so, can it be amplified or developed further? If you get stuck or have trouble with your list, sit with a friend and brainstorm a list of your attributes that are important to share with residency directors.

  • Decide how you can best convey this information. How can you pique the program director’s interest? Try to use interesting experiences to illustrate your points.

  • Find a hook. A good hook is something that makes people want to read your PS.

Format

  • The length of your PS should not exceed one page. Program directors have limited time to form an impression of you from your PS, so keep it concise.

  • Formatting your PS into paragraphs with individual themes makes it much more readable than a single large block of text. Be sure to use good transitions between ideas represented in paragraphs.

  • Sentences should be crisp and understandable—avoid long, run-on sentences.

Content

  • The PS should reflect your passion and interest in internal medicine. It should not be used to explain your pet peeves about your school or education.

  • Be prepared to be asked about the content of your PS. If you do not wish to be asked about an aspect of your background or record, do not include it in your PS.

  • Use examples. In medicine we all love a good story so try to illustrate your points with concrete examples from your experiences and observations whenever possible. This will help make you and your PS memorable.

  • Avoid highly controversial topics. You never know who will be reading your PS, how they might interpret your position and how it might later affect your work as a resident in their program.

  • If you have a non-medical background, this could have important implications in your medical career. For example, someone who previously had experience as a software engineer will certainly have experience with basic problem-solving techniques. This would be a helpful perspective to include in a PS.

  • Remember to stress your positive traits. There is nothing dishonest about telling someone about your good points!

  • A valid and important role for a PS is to reflect what the student author is searching for in a residency program. Keep in mind however that a program director could come to the conclusion that their program might not be a good fit for you. This may not be a bad thing. If your goal is to train in a community hospital, it is probably appropriate for a university hospital residency director to feel that their program might not be right for you. If you apply to a program that may not seem an ideal fit for your goals, you should be prepared to tell them why you chose to apply there. You cannot say, "This is my last choice, safety net program."

Tone/Style

  • Be confident. Do not be arrogant.

  • Even though this is called a PS, do not get so personal that you embarrass yourself. Imagine your PS being read aloud to the entire admissions committee. This will not happen, but it is a good test to determine if the content is too personal.

  • Be creative, but not to the point where your creativity distracts from the message of the PS and its main focus: you.

  • Keep your PS constructive. This document is not the place to complain or share pet peeves, but rather to show what you will bring to the program. It is more desirable to present how your input may have led to an improvement in your medical school curriculum rather than complain about what was lacking in the first place.

  • Humor is a wonderful tool to help the reader enjoy your PS; however silly humor may reflect negatively on your ability to be serious about your patients or your education.

Process

  • Circulate your first draft to a trusted friend or two, as well as a couple of faculty members, for review well in advance of application deadlines. Do not wait until the last minute to ask a faculty member or friend for a critique.

  • Do not copy someone else's PS. Over the last few years, program directors have noted more PS homology as a result of applicants purchasing personal statements from websites. Be yourself and write it yourself.

  • Be meticulous about spelling and grammar. Program directors will wonder if a sloppy PS reflects a sloppy approach to work. Some program directors have majored in English, so be sure to consult a dictionary and check your grammar.

Crafting your PS should be fun! It gives you a great opportunity to share something about yourself that goes beyond your transcript and list of accomplishments. A great PS makes program directors and interviewers want to meet you and ultimately work with you. While no PS can substitute for an excellent academic record throughout medical school, it may help you and your application stand out from the pack and win you an invitation to interview or gain a few points on a program’s rank list. We are confident the advice presented in this article will help you on your way to crafting a truly great PS. Good luck!

Kelly A. McGarry, MD, Assistant Professor
Dominick Tammaro, MD, FACP, Associate Professor
Michele G. Cyr, MD, FACP, Associate Professor and Director
Division of General Internal Medicine
Rhode Island Hospital
Brown Medical School
http://www.brownmedicine.org/gim

My Kind of Medicine: Jacqueline W. Fincher, MD, FACP

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Memorable Patients

Dr. Fincher became fast friends with "Mrs. Eva" when she first started practicing in 1988. An “older very dear lady,” Mrs. Eva’s appearance reminded Dr. Fincher of her grandmother. Suffering from congestive heart failure, atrial fibrillation, diabetes, and hypertension, Mrs. Eva also had a seizure disorder and a leg amputation from childhood. She was a strong, independent woman who lived in her own house well into her 80s.

Mrs. Eva was thrilled when Dr. Fincher became pregnant, offering to baby sit for her when needed. But just eleven months after giving birth, Dr. Fincher was diagnosed with a very aggressive form of breast cancer with a poor prognosis. Mrs. Eva was one of the very first people to call Dr. Fincher and became a source of strength, comfort, and support.

“She called me frequently to check on me during my illness,” Dr. Fincher said. “When she would come in for her doctor visits with me, frequently the conversation would begin with her asking about my health."

As Mrs. Eva grew older, Dr. Fincher and her young daughter would make "house calls" at her home, but they were more social visits than medical calls. As Mrs. Eva’s health deteriorated, Dr. Fincher took care of her at an assisted living home and a nursing home until she died a couple of years ago.

“Mrs. Eva was very much a blessing in my life.”

Dr. Fincher’s favorite patient, however, was her grandmother, who lived in Atlanta but would not see a doctor for maintenance care. She preferred that her granddaughter treat her over the phone and call in prescriptions.

Dr. Fincher convinced her grandmother to move to her town four years before her death at age 97. Caring for her grandmother as both physician and a family caretaker, Dr. Fincher learned firsthand about all sides of caring for the elderly: dealing with Medicare, keeping up with multiple medications, and the loss of independence, which is particularly difficult for patients with sharp minds but failing bodies.

“I honestly did not think she would last six months. What a blessing she was to my family and me. Just like Mrs. Eva, she taught me so much as a person and a doctor about having faith to carry you through the joys and sorrows of life.”

Professional and personal flexibility. Interpersonal relationships. A holistic approach to medicine. These are a few of the benefits of a career in internal medicine cited by Jacqueline W. Fincher, MD, FACP.

All in the Family

The daughter of a physician, Dr. Fincher decided she wanted to go into medicine at the age of seven. As a young girl in the late 1960s, Dr. Fincher perceived her three career options as teacher, flight attendant, or nurse. The thought of assisting her father some day in the exciting white-cap-and-skirt uniform of a nurse served as the initial inspiration.

When Dr. Fincher’s mother explained that doctors give orders that nurses have to follow, it was enough for the oldest and most strong-willed child in the family to change her mind.

Deciding on a Career Path

A degree in biology from Oral Roberts University in 1981 led Dr. Fincher to the Medical College of Georgia, where she earned her medical degree in 1985. She completed her internship and residency at the Medical College of Georgia in 1988.

“I always wanted to practice internal medicine,” Dr. Fincher explained from her four-physician practice in rural east Georgia, about 30 miles west of Augusta. “I liked the idea of being able to see patients and treat whatever their problems are. I wanted to be a doctor for adults.”

In medical school, Dr. Fincher became interested in neurology. But by the end of her senior year she started to question that career path. During her internship she asked her residency director for two months of internal medicine and two months of neurology.

“While diagnosing headaches, stroke, and seizure is fascinating, I really liked the idea of being able to treat the whole patient,” Dr. Fincher said about her final decision to become an internist. “Plus, internal medicine involves psychiatry and neurology.”

Options and Flexibility

Dr. Fincher, who practices with her husband James Lemley, MD, FAAFP (a family practitioner and medical school classmate), credits internal medicine with allowing her greater freedom to decide where she wanted to practice medicine.

“If I had become a neurologist, I’d have had to practice in Augusta instead of in the small town where my husband was raised,” said Dr. Fincher. “Internists are needed everywhere – cities, suburbs, and rural areas.”

With the age of the four physicians in her practice ranging from 35 to 47 and their children ranging from four to 15 years old, the family-run practice benefits everyone involved.

“Our families value the practice and the practice values our families,” Dr. Fincher said.

Private practice allows Dr. Fincher to make time for her family and political involvement in health care issues.

“If I want to take off early to see my daughter’s school program or attend a legislative session in Atlanta, I don’t have to ask permission from anybody. I just have to let my partners know.”

Like Mother, Like Daughter

Dr. Fincher and her husband have one daughter, Laura. The 15-year-old has always said she would never become a physician (“too much dinner table conversation about medicine!”). But recently, she changed her tune.

“Just this year Laura told us she's thinking about possibly becoming a physician,” said Dr. Fincher, “because, in her words, ‘of the respect that people still have for physicians, the ability to really help people, and the important role physicians have in a community.’”

Georgia on Her Mind

As a practicing internist in a rural setting, Dr. Fincher enjoys the daily medical challenges.

“You have to be a jack-of-all trades. You never know who’s going to walk through your door. We see patients ranging from young children to nursing home patients more than 100 hundred years old. It makes it interesting. I’m never bored.”

Dr. Fincher and husband Dr. James Lemley.


Another benefit of internal medicine training, according to Dr. Fincher, is that she can help those close to her. “It’s comforting to know that I can take care of my own family and friends. I know how to help them and advise them.”

A Personal Battle

The personal relationships Dr. Fincher has developed with her patients have helped with her own battle with an aggressive form of breast cancer that began 14 years ago. The entire community rallied around Dr. Fincher. Her name appeared on billboards with encouraging words such as “Dr. Jacqueline, we’re praying for you.”

“I received more cards, flowers, and food delivered to my house than you can imagine,” Dr. Fincher recalled. “I have a deep connection with this community. We’ve both been there for each other.”

The cancer support group that Dr. Fincher started 12 years ago is still going strong.

The Future

Like many physicians, Dr. Fincher sees reimbursement and business issues as the biggest challenges facing health care. Yet internists are uniquely positioned to make career choices.

“Internists don’t have to lock themselves into private practice for 50 years,” Dr. Fincher said. “The broad knowledge gained through internal medicine training is transferable to other industries related to medicine. Internists will have flexibility 10, 20, 30, even 40 years from now.”

Internal Medicine Interest Group of the Month: Kirksville College of Osteopathic Medicine

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The beginning of the academic year at Kirksville College of Osteopathic Medicine has given the Student Osteopathic Internal Medicine Association (SOIMA) some great opportunities to enhance students’ understanding of internal medicine as well as increase membership in the club. With a little vision and creativity we were able to triple our club membership at the recent freshman orientation club fair!

One of the goals for SOIMA this year is to enhance the preparation of students as they transition into rotations. In addition to holding lunch meetings on topics intended to educate the members of the club about pertinent issues in medicine, we have created an interactive website for the organization. Using this website, we will be holding live online chats with current third and fourth year students in medicine rotations, internal medicine residents, and residency program directors. Since our students do their rotations at sites across the country, this tool will enable us to gain insight before we head into our clinical years. We hope that students who have interest in internal medicine will use the website to help prepare for what is to come their way. This opportunity will not only enable students to gain a greater understanding of what internal medicine and its subspecialties are about, but will also help students network with potential residency programs.

We hope these tools help educate students about the wide variety of opportunities available to them as they begin to plan their careers in medicine. With the support of organizations like the ACP and the American College of Osteopathic Internists, we look forward to an exciting and productive year.

Seth Gunderson
President, Student Osteopathic Internal Medicine Association
Kirksville College of Osteopathic Medicine, 2009
E-mail: sgunderson@atsu.edu
www.internalmedclub.org

Winning Abstracts from the 2006 Medical Student Abstract Competition: Improving Senior Medical Students’ Knowledge of Appropriate Screening Strategies for Older Patients Using a Probabalistic Approach to Decision-Making

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Author: Veronica Sikka, Virginia Commonwealth University, 2007

Introduction:
Medical students are taught epidemiology early in medical school with inconsistent reinforcement in later years. As part of our Donald W. Reynolds educational initiative, we sought to assess senior medical students’ knowledge one month before graduation regarding cancer screening in the elderly and evaluate an educational intervention.

Methods:
In April 2004, prior to a new 40-minute lecture on cancer screening in the elderly, 80 senior medical students were shown 6 case scenarios that reflected increasing age and co-morbidity. In each scenario, students indicated whether they would screen for cancer of the colon, breast, cervix, lung, ovary, and prostate. Their responses were collected. The lecturer presented population-level data on life expectancy stratified by age and health status, plus data on operating characteristics, benefits and burdens of common screening tests. He did not discuss the cases. After the lecture, students again scored the same 6 cases.

Results:
Before the lecture, students tended to screen aggressively even when the patient’s age, diagnosis, or general condition suggested a high burden-benefit ratio. After the lecture, screening declined significantly in many low-yield or high-burden scenarios, while aggressive screening persisted in cases with greatest chance of benefit. Several informative patterns evident in pre and post lecture choices will be discussed.

Table of results

Conclusion:
In 2004, graduating students at Virginia Commonwealth University School of Medicine were insufficiently prepared for cancer screening decisions in elderly patients. Decision-making improved after the intervention for most but not all situations. The evaluation method provided interesting insights.

Subspecialty Careers: Cardiology

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The Discipline

From the Greek kardia, meaning heart, as used in the Hippocratic treatises.

Cardiology is the prevention, diagnosis, and management of disorders of the cardiovascular system, including ischemic heart disease, cardiac dysrhythmias, cardiomyopathies, valvular heart disease, pericarditis and myocarditis, endocarditis, congenital heart disease in adults, hypertension, and disorders of the veins, arteries, and pulmonary circulation. Management of risk factors for disease and early diagnosis and intervention for established disease are important elements of cardiology.

Procedures

Important procedural skills in cardiology include: cardioversion; arterial catheter insertion; balloon-tipped pulmonary artery catheter insertion; temporary and permanent pacemaker insertion; implantable cardiac defibrillator insertion; ambulatory electrocardiographic monitoring; echocardiography; left ventricular catheterization, coronary angiography and percutaneous vascular interventions; nuclear scan wall motion studies; stress electrocardiography; thallium perfusion scanning; and tilt-table physiology studies.

Training

Cardiovascular fellowship training requires three years of accredited training beyond general internal medicine residency. Of the three years, a minimum of 24 months must include clinical training in the diagnosis and management of a broad spectrum of cardiovascular disease.

Training Positions

As of 2005, there were 173 ACGME-accredited training programs in Cardiovascular Disease and 2,142 active trainees. Eighteen percent of the trainees were female and 65% were US medical graduates.

Certification

The American Board of Internal Medicine offers certification in cardiovascular disease.

Practice

Approximately 82% of the graduates enter clinical practice in cardiology in the United States, and 16% enter academic medicine.

Major Professional Societies

The American College of Cardiology
American Heart Association

Major Publications

American Journal of Cardiology
Heart & Lung
Journal of the American College of Cardiology

Advocacy Briefs: Your Action Needed: Give the Medical Student Perspective on the Impending Medicare Reimbursement Cuts

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During these final days of the congressional session, we need your help to ensure that the voice of the new generation of physicians – today’s medical students – is heard on Capitol Hill. Unless Congress takes action, Medicare reimbursements for physician services will be reduced by 5.1% on January 1, 2007. These cuts will destabilize the Medicare program and put Medicare beneficiaries’ access to health care at risk.

Contact your members of Congress today and urge them to halt the impending cut and stabilize future payments before Congress recesses for the elections – expected September 29. Send an e-mail from our Legislative Action Center. You do not need to be an ACP Key Contact to send a letter.

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Did You Know You Can Enter the ACP’s National Medical Student Abstract Competition?

Did you know the ACP offers Medical Student Members the opportunity to present their research and interesting cases at the national annual meeting? If you are involved in a research or community service project through your medical school, or have come across an interesting case during your internal medicine rotation or preceptorship program, you should take advantage of the ACP’s National Medical Student Abstract Competition. For the past thirteen years, hundreds of Medical Student Members have presented their work to thousands of College members at the premier internal medicine meeting, formerly known as Annual Session.

To find out more about the competition and win a chance to present at Internal Medicine 2007 in San Diego, please check out www.acponline.org/abstracts. All of the details and the instructions for submitting an abstract are located on this site.

MKSAP for Students 3 Question 1

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A 56-year-old man with a 25-pack-year smoking history, distant cerebrovascular accident, and a 10-year history of hypertension treated with hydrochlorothiazide is evaluated because of generalized fatigue. Blood pressure is 110/70 mm Hg.

Laboratory Studies
Serum sodium: 128 meq/L
Serum potassium: 3.3 meq/L
Serum chloride: 79 meq/L
Serum bicarbonate: 38 meq/L
Arterial blood gases on room air pH, 7.50; Pco2, 50 mm Hg; Po2, 74 mm Hg

Which of the following best explains the patient's acid-base disturbance?

( A ) Metabolic alkalosis
( B ) Respiratory acidosis
( C ) Respiratory alkalosis
( D ) Metabolic acidosis

MKSAP for Students 3 Question 2

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An otherwise healthy 28-year-old man has a 4-month history of epigastric discomfort and heartburn. Symptoms are usually exacerbated postprandially, especially after eating spicy foods. The patient denies dysphagia, weight loss, and decreased appetite. He has an active lifestyle and takes no medications. Physical examination is normal, except for mild epigastric tenderness. Routine laboratory studies are normal.

Which of the following is most appropriate at this time?

( A ) Ambulatory 24-hour esophageal pH monitoring
( B ) Barium swallow
( C ) Esophageal manometry
( D ) Upper endoscopy
( E ) Trial of acid-suppressive therapy

MKSAP Answer 1

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Answer: A

Educational Objective: Recognize the presence and etiology of a metabolic alkalosis.

The low blood pressure and hypochloremia suggest volume-sensitive metabolic alkalosis due to diuretic therapy. Metabolic alkalosis is indicated by the high serum bicarbonate level and pH greater than 7.4. Respiratory compensation for the metabolic alkalosis is appropriate. The Pco2 is 50 mm Hg, showing the expected 10-mm Hg increase that compensates for the 14-meq/L increase in serum bicarbonate level. Metabolic acidosis is not a possible diagnosis since the bicarbonate level and pH are elevated. The normal arterial-to-alveolar oxygen gradient makes underlying chronic obstructive pulmonary disease unlikely, and blood gas values do not indicate concurrent respiratory acidosis.

References

Khanna A, Kurtzman NA. Metabolic alkalosis. Respir Care. 2001;46:354-65. PMID: 11262555[PubMed]

MKSAP Answer 2

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Answer: E

Educational Objective: Recall how to manage a patient with uncomplicated gastroesophageal reflux disease.

This patient has the classic symptoms and findings of uncomplicated gastroesophageal reflux disease (GERD). A response to acid-suppressive therapy is the best way to confirm the diagnosis, since additional testing is not indicated if the patient's symptoms resolve with therapy.

Upper endoscopy is usually indicated only for patients with complications of GERD. Patients with such complications usually present with warning symptoms (dysphagia, odynophagia, weight loss, or anemia), none of which the patient has. Esophageal manometry is used to diagnose esophageal motility disorders or evaluate patients prior to antireflux surgery. Ambulatory 24-hour esophageal pH monitoring is indicated for patients who do not respond to initial acid-suppressive therapy or who may have a diagnosis other than GERD.

Barium swallow is used in the evaluation of esophageal function and in assessing structural abnormalities of the esophagus.

References

DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1999;94:1434-42. PMID: 10364004[PubMed]

Internal Medicine Residency Program Fast Facts

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Program Name: Albert Einstein Medical Center
Location: Philadelphia, Pennsylvania
Hospital Type: University Affiliated Community Hospital
Program Size: 82 positions
First Year Salary: $42,000
Web Site Address: www.einstein.edu

Program Name: Exempla Saint Joseph Hospital
Location: Denver, Colorado
Hospital Type: University Affiliated Community Hospital
Program Size: 27 positions
First Year Salary: $43,000
Web Site Address: www.exempla.org

Program Name: Greenwich Hospital
Location: Greenwich, Connecticut
Hospital Type: University Affiliated Community Hospital
Program Size: 22 positions
First Year Salary: $49,000
Web Site Address: www.greenhosp.org

Program Name: Lankenau Hospital
Location: Wynnewood, Pennsylvania
Hospital Type: University Affiliated Community Hospital
Program Size: 39 positions
First Year Salary: $45,000
Web Site Address: www.mainlinehealth.org

Program Name: UMDNJ – New Jersey Medical Center
Location: Newark, New Jersey
Hospital Type: University Hospital
Program Size: 115 positions
First Year Salary: $45,000
Web Site Address: www.umdnj.edu/mresnweb

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