Guide to 4 th Year Electives

1. Guide to 4th Year Electives Hosted by ASG 21 February 2007

2. Why “Away” Electives? • Witness medicine, U.S-style. • PRACTICE medicine as it is in the U.S • Understand WHAT will be expected of you during residency. • Understand WHERE you want to complete your residency training. • Solidify your choice of specialty. • Get LOR’s from U.S. physicians

3. Getting started • Setting up electives can be an easy 3 step process. • If…you put in the effort early: • 1 – Research • 2 – Doing the paperwork • 3 – Sending out the material

4. Why are you doing this??Or how to choose where/what electives. • By the summer between 3rd and 4th years you should be decided upon your choice of specialty. • Further, you should have a geographic area chosen for your residency. This will inform your choice of electives.

5. STEP 1 – Research • Visit a medical school near your home • Visit FREIDA at www.ama-assn.org. • This is probably the best way of choosing. • Consult the ASG provided list of past electives

6. STEP 1 Things to consider: 1. DO THEY TAKE FOREIGN STUDENTS? 2. Location • where you are going to live? • Cost of housing. Can be substantial. • how will you get there? 3. Cost • how much does the elective cost • Expenses : transportation, housing, food, gas, utilities, etc. 4. Time/Schedule • What is the limit of time spent at institution • will you have enough time to get from one rotation to the next (if schedule available)

7. STEP 1 • Don’t do ALL your electives at Big Name Schools • Look for programs that have taken IMG’s in the past and that you are planning to apply to that particular program • Make a good impression, will most likely get an interview offer

8. STEP 1 • Narrow down your possibilities to 4 or 5 different institutions • Last part …EMAIL and ASK for the material • You might have to have it sent to your house…US/Canadian address. • Some schools offer all the applications online

9. STEP 2 - Paperwork • It will involve: • getting material from Dean’s office • getting your medical records • getting medical tests • asking for a number of letters • Watch out for application deadlines! (Some places have them, others do not)

10. STEP 2 What you will need: • Transcript from Dean’s Office • Letter of “Good Standing” from Dean or Vice Dean • Vaccination proof and/or Titers • Malpractice Proof • Proof of Personal Health Insurance in the US • USMLE Step 1 • Letter of Recommendation (s)

11. STEP 2 - Transcripts • Official transcripts with all completed Basic Sciences and Core Clinical Rotations. • PROBLEM ! You are in the middle of your rotations • Solution – make sure Dean’s office puts down “pending” for clinics which you are in or still have to do. • Internal Medicine • Surgery • Psychiatry • Family Medicine Might have resubmit to the Elective institution a full completed transcript before starting • Make sure that you have all grades and credits from Basic Sciences!

12. STEP 2 – Letter • Obtain letter of “Good Standing” • What is it? • 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 mentally stable • Who writes it? • Dean or Vice Dean should write it • What if they don’t have it? • You write one, have them read it, and they will sign it. • How many? • Get enough copies with original signatures as you have applications

13. STEP 2 – Medical Proof • You will be asked to provide proof of the following vaccination or exposures to: • Polio • MMR • DPT and last Tetanus booster • Hepatitis B • Hepatitis C • Varicella • TB • Pneumococcal Vaccination • You might have to provide Titers for some

14. STEP 2 – Medical Records • Do I need titers: • YES…it is a definitive way of showing proof that you have been immunized and that you are not infectious now • Where to get it? • ASG website has the map posted with directions how to get there • How much is it? • It will cost you about 300 zloty to get the following: • Rubella Ig, Varicella Ig, HBV Ig, HBV Ag, HCV Ig

15. STEP 2 – Medical Records TB – you will have to be tested • Where? • You can do it at Pulmonology and the cost is 25 zloty • When? • What about BCG? • They do not care…you still need to be tested. • You will also need to have CXR and if you are lucky they will even write the results in English

16. STEP 2 - Malpractice • Available at the Dean’s office at your request. • If not there, email the New York Office and have them Fax over a copy with your name on it either to • Dean’s office • ASG office

17. STEP 2 – other material • Other things they can request: • STEP 1 results – if you haven’t taken it, but you are planning on it, then hold off with application until you can deliver the scores, but REMEMBER ABOUT DATES • Letters of Recommendation • You should be also collecting them for your ERAS/MATCH • Consider getting them from Department Heads – some Residency programs also require them

18. STEP 3 – Sending application • Check and recheck your application • Attach application fee • US currency (check/money order) or Canadian currency depending where you are doing your elective • Money orders can be obtained on Fredry near the Okronglak (round building) at Western Union • Send applications home and have your parents attach checks

19. STEP 3 – Sending application • Before sending application • Inquire if rotation is still open • Get in touch with institution and ask if they can reserve the particular rotation that you are interested in • Check deadlines to see when you can send it in. • If everything is OK…SEND IT! • FedEx an expensive but reliable option – tracking option

20. After sending Application • Remember it takes a good week for mail to arrive to the US/Canada • Ideally, you should get a written response within a month… if you don’t, email or call! • If they did not receive your application, ask if you can fax it to them and deliver official version at a later date.

21. Arrival of Letter • IF you are approved…You are done. You now only have to worry about getting there. • IF you are NOT approved…Call them • Ask why • If rotation booked…your alternatives are: • Change date (if possible) • Change to a different rotation • Try to pick up a rotation at the other institution that you have applied to

22. January February March April May June July August September STEP 1 STEP 2 STEP 3 You should be in electives ! Time Line

23. What electives should you do? • Start out with an “easier” rotation: • Outpatient clinic • Consult Service • If you are feeling ambitious: • Sub-Internship • All MS4’s are required to do one • Extremely demanding, huge responsibility • Sub-I’s in Internal Med difficult to get, as MS4’s are all required to do one by their medical schools, spots usually full • Save it for the end: • Familiar with the hospital • Comfort with writing notes/physical examination • Get specialty-specific letter of rec.

24. Conclusion • Start early and you should have no problems! • If you are planning on doing electives in the Spring the same deadlines may apply to you (check with the medical school) • If you are the ‘last minute’ type, you too can get an elective.

25. Essentials:

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

27. Prep for your Electives • Practice presenting patients like you would during rounds and writing SOAP notes • Pre-read!!!! • Learn Lab Values shorthand: • Familiarize yourself with medical shorthand terminology: • rrr, mmm, ntnd, ttp, no m/r/g….. Hb Na Cl BUN Gluc WBC Plt Htc K HCO3 Cr

28. Most Importantly: • Practice presenting patients like you would during rounds and writing SOAP notes • Familiarize yourself with medical shorthand terminology: • rrr, mmm, ntnd, ttp, no m/r/g….. • Know EVERYTHING about your pts • Follow up on all lab results, imaging studies, line placements, etc • Communicate with the nurses – don’t assume that they check their orders regularly • If something’s changed, let the nurse know

29. Tips • Geriatric pt? - GDS/MSSE -Make sure that they’re seen by PT • Inquire about pt’s activity level, who do they live with, etc • Lines? PICC, central line - note placement and date - ie PICC line in left arm (9/06/06 -) • Pt on antibiotics? – Note start of tx • ie Zosyn (11/17/06 -)