|Early Career Johnite Initiative (ECJI)|
4. My uncle has a private practice in the US and has offered to allow me to do an observership with him. Should I take him up on his offer?
It is always better to do an observership in a hospital setting. That way, you could learn much more by virtue of being exposed to the educational program of that hospital. In addition, you get to network more, understand the system better, and make yourself a better candidate for the residency match. However, if you find yourself in the US without a hospital-based observership in hand, by all means, do join private practitioners in their clinic. If nothing else, you would be able to learn the style of how to communicate with patients (which is extremely different from the way we do things in India) as well as with ancillary staff in the ‘American way’(which is also a very, very important skill to learn). It would be a good opportunity to get to know and imbibe some aspects of the culture here, which would help you communicate better – all of which will shine through during your interview, and even while you do your residency in future.
5. Macha! I have secured an observership/ externship at St. Janardhanan’s Hospital in Springfield (…). How do I best go about making good use of it?
Congratulations! You have managed to get your toe (not even foot) in the door. You must first of all be clear about what you should get out of this opportunity. First off, you should be able to get a Letter of Recommendation from a US based physician at the hospital where you have got in. This Letter of Recommendation would be used at the time you apply for interviews. All those who apply for the interviews have ‘good’ letters of recommendations. You need to get a SUPER-DUPER one that really stands out. In order to get this, you need to exceed the expectations of the supervising attending. This gets harder year after year, because each year these attending come across candidates who are equally driven to perform…
BUT, I’m just an observer, what can I do??
Number one: Be keen to learn, and participate in rounds. If you are asked to present a case, make sure that you know each and everything about your patient. You should even have his lab values down pat. Your presentation should be clear, coherent and concise. Most importantly: your THOUGHT PROCESS and REASONING should be logical, sound, and should make sense. You SHOULD have differential diagnosis, and you should also know the reasons why you would favor one diagnosis over your differentials. You should read up about the management of these cases (No relying on textbooks here – many textbooks are outdated by the time they are printed.) You should pull out the latest review articles and guidelines about the management of the particular condition, and be able to briefly talk to the treating team about these guidelines (Guidelines? Review Articles? Journals? – How do I do this? Well, if you think that PubMed is a popular Bar where Doctors go to booze, you have a long way to go, and could even think of reconsidering the path you have chosen). Even if you are not asked to take a case and present it, you should read up about every single case that you come across, and have the management and discussion at hand (or in head), so that if the attending/ resident asks you for ‘your thoughts’, you would have something concrete to talk about, and thus ADD TO THE KNOWLEDGE POOL of the treating team. Of course, it goes without saying that you should not make yourself look like an obnoxious know-it-all; you are there to discuss, not to dictate. In addition, you are allowed to disagree (pick your battles), but NEVER make the resident/ intern look bad in front of the attending – you will earn their wrath, and negative feedback from them to the attending, would torpedo your chances of a good letter of recommendation from the attending.
If you come across interesting cases, volunteer to help write them up as case reports. Of course, you would have to include the names of your attending and resident in your case report. This way, you would learn a lot about the particular disease condition, you would have proof of your productivity, you would increase your standing with the attending, and also have something more on your CV that you can brag about during interviews. In recent history, a particular Johnite managed to write up and publish three case reports during the course of an observership – needless to say, this helped considerably during the interview season.
ALWAYS BE PUNCTUAL, well-dressed, diplomatic, amiable and do not get involved in the politics that you might have around you. The importance of punctuality cannot be over-emphasized. The ‘chalta hai’ attitude must be left behind. Attend all the teaching sessions that you can, even if they might be a little boring. You will learn something new, and you never know when that would come in handy.
6. Should I pay for an observership/ externship?
This differs from place to place. Some training hospital do require a fee for the processing of your papers; some don’t. However, a rule of thumb is to stay as far away as possible from companies who offer paid observerships/ clerkships/ externships (‘Americlerkships’ is one such company). This is because program directors often do know that the letters of recommendation that you procure from such ‘corporate’ paid-observerships would not be an accurate representation of your performance. Physicians enrolled in these programs would go out of business if they were to ever provide any candidate with a ‘bad’ Letter of Recommendation, and so would provide only good ones. The credibility of their letters is therefore dubious.