Fourth Year, Here We Come!

Now that I'm feeling a bit of that second trimester energy burst, and have some free-er time (with the didactic block and research time that will take me through mid-May), I'm trying to get a bunch of things squared away.

One of the big things is my fourth year schedule. The fourth year of med school comes with a bunch of requirements. We need to do 3 weeks in any field of medicine (this basically means not-surgery and not-pediatrics). I have chosen endocrinology, so as to focus on treating diabetes, something I will do a lot of in family practice, and then picking up another three weeks in outpatient psychiatry as well. Then there's 3 weeks required in surgery. This one is up in the air right now, as I was planning on an obstetrics elective that has just been disqualified as counting as surgery. Another requirement is 3 weeks in pediatrics, which I will do in the general community clinic. We have to do a month in the emergency room, which I'm really looking forward to. The most time-consuming requirement is a sub-internship: a month on a hospital inpatient service where we are supposed to function like interns (first-year residents). Most of my classmates will do this in internal medicine, but I am actually going to do mine in pediatrics, since peds is equally applicable to family med. I had such a great rotation in pediatrics this year, and I also think that they will be a bit more accepting when the crumpet shows up to breastfeed during lunchtime teaching conferences or at dinnertime when I'm on call. Then there are a few more week-long classes/rotations that have to fit in as well.

I've got a tentative schedule all entered into the computer. The beginning of the year is the most important part: I end 3rd year surgery in Scottsdale on June 20 (yup, I will be almost 34 weeks pregnant at that point), then return to Rochester and try to cram two rotations into those last 6 weeks, ending the Friday before the crumpet is due. I'm also trying to figure out whether, if I have not gone into labor yet, I can start another rotation and then pick it back up after my maternity leave. I've got 6 weeks blocked out at home with the crumpet, and I want it all to actually be with the crumpet, rather than hanging around at home waiting to deliver!

The rest of the year is highly dependent on whether this early admission to the Dartmouth family med/MPH program works out. If it doesn't, I'll have to shuffle a lot of things around to take time in the fall to go on residency interviews. If it does, all I need to figure out is that goofy surgery elective.

Finally, I also have to take both parts of the US Medical Licensing Exam Step 2. This is not as stressful as Step 1, which my class took at the end of second year. It is kind of a pain, though! There's a multiple choice component (Clinical Knowledge, or CK) that is computer-based like Step 1. We're allowed to build 2 free weeks into our 4th year schedules to study, but I've mustered all possible free time for maternity leave, so the current plan is to study for Step 2 over the two weeks I'm taking off anyway to visit family at Christmastime. Then there is something called Clinical Skills (or CS for short), which is a fairly new addition to the testing regimen. It's a whole day of observed scenarios with standardized patients (actors). It's basically to make sure that you can speak English and not be a total jerk to a patient. For the privilege of taking this exam, medical students from all over the country have to get themselves to one of five places: Philadelphia, Atlanta, Chicago, Houston, or LA. So that can cost a pretty penny. Then there's the actual test fee, which is over $1000. Nice racket they've got going there!

After talking to a couple of residents, I was advised that it would be much better to go and take this test before the baby arrived, even if I was waddling-ly pregnant. Though it is possible to get special approval to bring in a breast pump, there might not be enough time to do that, and I probably wouldn't be allowed out of the test site to see the crumpet either. So, in the last week, I've done the registration and paid my enormous fee and then started looking at the schedule. Chicago is really the only site that makes sense for me, especially approaching the crumpet's due date. I really don't want to (and, realistically speaking, cannot) travel at all after 36 weeks, leaving me a whole 2 week block after returning from surgery in Arizona to find a time to take this test.

Well, Chicago was a total shut-out. Philly? I have friends in Philly! Shut out there, too. Atlanta? Then I could visit my cousin! Nope.

Yours truly is currently scheduled to take this test in Houston. Five days after flying back to Rochester from Arizona. Niiiice. I'm also on an email alert list for openings in Chicago and Philly, so please keep your fingers crossed that something better opens up for me!