Med/Peds advice

[Cytarabine]

I'm hoping someone here can provide me with their input on how appropriate med/peds is for me / what direction I should go and answer a couple of questions. I'm currently stuck in deciding between IM vs peds vs med/peds.

I'm a 3rd year that's thus far done both IM and peds and enjoyed them both. I really value continuity of care, the development of a strong doctor-patient relationship, and patients who are coping / adapting to serious illness, day-to-day variety, and I really like the hospital more than clinic, though a mix of both would be ideal. Regardless of which route I go, I am not particularly interested in research, but I'm extremely interested in an academic career with a focus on student/resident/fellow education. With those things in mind, there are 4 paths I could see myself going down (in order of decreasing likelihood):

1) Adult or peds heme/onc
3) Split time between adult and peds hospitalist/intensivist
4) Combined med/peds heme/onc

Anyway, questions:

(1) Is med/peds a reasonable route to go if I'm unsure on which of these directions I'd like to pursue? I could see direct use for med/peds training if I went route 3 or 4 or if I was involved in transitional care or survivorship care as part of ped heme/onc, but part of my interest in pursuing it is because I simply am not sure which route I'll ultimately go.

(2) If med/peds IS a reasonable route for me to go, any recommendations for programs to consider? I'm a reasonably strong applicant (>250 step 1, mostly preclinical honors, IM honors but otherwise no grades back, strong evals) with an MPH, but reasonably weak on research, extracurricular stuff, and school name. As far as looking for a program that fits me, I've had difficulty because so many med/peds programs seem to have a niche, be it global health, research, underserved populations, primary care, etc. My "niche" would be clinical medicine and clinician education. I looked a while back and either BWH or MGH (don't remember which) had a clinician educator track for IM residents, but I'm not going to bank on matching a program that competitive.

(3) How do you handle acting internships for med/peds? In other words, between medicine and peds, is it important to do 2 of one and 2 of the other? If you're stronger on one side than the other, can you do more/all of that side, particularly for aways?

I think that's about it. Sorry for the long post, but a sincere thank you to anyone who takes the time to read and provide advice. Getting a bit stressed with applying for aways coming up and not knowing what to do. If more information is needed about anything, I'd be happy to answer whatever.

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[GirlyDoc36]

So I was slightly creeped out when I was reading this because you sound EXACTLY like me. I was having a very similar existential crisis at this time last year. I'm away on an interview right now but I really want to answer this. So I will respond once I get back and have a full keyboard to work with. In short, yes med peds is very appropriate for you. More tomorrow, sit tight.

 

[zany_brainy]

Uh are you guys me? This is really scary lol. I've decided I'm going to go the med-peds route and I'm considering either hospitalist, combined heme-onc or combined endocrine with an emphasis on education. I'm going to add in a couple of my questions (maybe they'll help you @Cytarabine ).

1. I'm trying to figure out what to do 4th year. I will definitely be doing an IM SubI, but do I have to do a peds SubI? Or can I do a peds subspecialty and get a letter from that?

2. With regards to LOR, do letter writers specifically have to mention why we'd be good candidates for med-peds? I asked a couple of people for letters and told them that I will be applying med-peds, but I'm not sure if I had to ask them to tell the programs why I'd be a good med-peds candidate.

3. Again with regards to LOR, I know we need at least one from IM (possibly chairman) and one from Peds (possibly chairman). Can I send in a letter from another specialty, like psychiatry for example? I recently had my psych rotation and I really got along with my attending, and he said he'd write me a letter, but I'm not sure how useful that letter will be for my application vs a letter from another attending in IM or Peds.

Maybe @group_theory can help us out!

I hope to catch you on the interview trail later this year @Cytarabine , if you decide on the med-peds route!

 

[L72521]

I'm an MS4 currently interviewing for med-peds, so I can give you my $0.02.

1) With respect to the question of whether med-peds is a viable option if you're unsure of career path, I think that depends. You don't have to know for sure that you'll ultimately be practicing simultaneously both medicine and pediatrics to go into med-peds. People have more diverse reasons for going into it than that. Even if you decide you want to do adult heme/onc eventually, you could decide that, for you, med-peds training is the best training for that. Moreover, you could go into residency committed to doing combined med-peds heme/onc and then change your mind (this happens all the time with med-peds residents--just take a glance at the "where our graduates are now" lists that many of the programs post on their web sites). I think that you have to be sure that med-peds is the right residency training for you, regardless of whether you've nailed down specifically what you want to do in the future. In your case, your paths are all things which med-peds could get you to, so it's understandable that med-peds would be especially attractive as it's the one residency that would leave all your options open. One caveat to this--I wouldn't approach your personal statement and interviews, etc. with the "I'm not sure whether I want to do med or peds so I'm just going to do med-peds" sales-pitch. While it my factor into your decision making, you should tentatively pick one of the combined med-peds options as the plan around which you organize your application. No one in your future residency is going to lock you in to the career path you stated in your application--but you need to have a single stated career path during applications, otherwise you will come across as wishy-washy with your message.

2)On programs to consider, I don't think that you should focus so much on each program's niche (unless it's a fully exclusionary one e.g., Hopkins only wanting purely primary care people). Even if a program has a global health niche, not everyone at those programs does global health (it's usually a "track" that people can do) and most programs would be very interested in a strong candidate like you if you declared yourself as being on a path to become a master medical educator. This is definitely an accepted path for people to take, and I think you would benefit from the fact that it's one of the less common ones (you'll look more unique). Though many programs don't have dedicated educator tracks, that doesn't mean you won't find good support and resources for your goals. If this is your goal, I would place emphasis on programs that are strongly affiliated with and located near to a medical school, as opposed to community programs.

3) 4th Year AI/Sub-I - I did an IM sub-internship and a pediatrics sub-internship and this came recommended to me by a med-peds program director and several med-peds residents who I reached out to when I was planning my 4th year. You don't have to do 4 sub-I's unless your medical school requires that. I only did 2 (1 of each) and I have done very well in terms of getting interviews. I'm not sure whether you can substitute a sub-specialty for a sub-I, and I would tentatively suggest that you do both sub-Is unless another poster shows up who only did 1 sub-I and still got a lot of interviews. Away rotations or "audition rotations" are absolutely not necessary for med-peds and they can hurt you if you're strong enough on paper that you likely would get an interview just on the basis of your application. It can be difficult to shine when compared to an institution's home rotators because they already know the hospital, the EMR system, etc. Also, even if you have an awesome personality, there's always a chance that you could rub someone wrong and have that stick. These are risks to consider before scheduling an away. On the other hand, there can be upsides to aways. Reasons to do aways-- (1) there's a particular program you are absolutely in love with but feel you may not quite measure up for an interview, (2) there's a program you are not quite sure about and want to explore more thoroughly. I want to re-iterate though that med-peds isn't like some fields like EM, ortho, etc. where aways are expected. I didn't do any aways and I'm very happy with that decision.

4)LORs - The program web sites often get pretty specific about letter requirements. Most of the programs require 2 chairman letters (one medicine chairman and one pediatrics chairman). Some of them specifically state that they want the remaining 2 letters to be a clinical medicine letter and a clinical pediatrics letter. However, in the ERAS system, you can send different letters to different programs. I recommend that you ask for at least 1 clinical medicine letter and at least 1 clinical pediatrics letter in addition to your chairman letters. If you have someone offering a letter from another specialty, you can certainly accept the letter and then decide later whether to assign it to any programs. Some programs don't require chairman letters or only require 1 chairman letter, in which case you would have room for another letter at your discretion. As far as your letter writers saying why you would be a good candidate for med-peds, I don't think this is strictly necessary but if the person can speak well to that, then it would be a plus. Just make sure you've discussed your career plans with your letter writer when you ask for the letter. I recommend asking for a brief meeting at which you can discuss your plans, your applications strengths/weaknesses, etc. when you ask for the letter--ultimately the letter writer will decide what they write. You can definitely get a letter from a sub-specialty--just make sure the letter writer knows you well enough to write a strong letter.

 

[Cytarabine]

So I was slightly creeped out when I was reading this because you sound EXACTLY like me. I was having a very similar existential crisis at this time last year. I'm away on an interview right now but I really want to answer this. So I will respond once I get back and have a full keyboard to work with. In short, yes med peds is very appropriate for you. More tomorrow, sit tight.

You lied to me girlydoc. I'll remember this. I'll remember.

I hope to catch you on the interview trail later this year @Cytarabine , if you decide on the med-peds route!

You too! Interesting to see a few people with the same specific interest

I'm an MS4 currently interviewing for med-peds, so I can give you my $0.02.

1) With respect to the question of whether med-peds is a viable option if you're unsure of career path, I think that depends. You don't have to know for sure that you'll ultimately be practicing simultaneously both medicine and pediatrics to go into med-peds. People have more diverse reasons for going into it than that. Even if you decide you want to do adult heme/onc eventually, you could decide that, for you, med-peds training is the best training for that. Moreover, you could go into residency committed to doing combined med-peds heme/onc and then change your mind (this happens all the time with med-peds residents--just take a glance at the "where our graduates are now" lists that many of the programs post on their web sites). I think that you have to be sure that med-peds is the right residency training for you, regardless of whether you've nailed down specifically what you want to do in the future. In your case, your paths are all things which med-peds could get you to, so it's understandable that med-peds would be especially attractive as it's the one residency that would leave all your options open. One caveat to this--I wouldn't approach your personal statement and interviews, etc. with the "I'm not sure whether I want to do med or peds so I'm just going to do med-peds" sales-pitch. While it my factor into your decision making, you should tentatively pick one of the combined med-peds options as the plan around which you organize your application. No one in your future residency is going to lock you in to the career path you stated in your application--but you need to have a single stated career path during applications, otherwise you will come across as wishy-washy with your message.

2)On programs to consider, I don't think that you should focus so much on each program's niche (unless it's a fully exclusionary one e.g., Hopkins only wanting purely primary care people). Even if a program has a global health niche, not everyone at those programs does global health (it's usually a "track" that people can do) and most programs would be very interested in a strong candidate like you if you declared yourself as being on a path to become a master medical educator. This is definitely an accepted path for people to take, and I think you would benefit from the fact that it's one of the less common ones (you'll look more unique). Though many programs don't have dedicated educator tracks, that doesn't mean you won't find good support and resources for your goals. If this is your goal, I would place emphasis on programs that are strongly affiliated with and located near to a medical school, as opposed to community programs.

3) 4th Year AI/Sub-I - I did an IM sub-internship and a pediatrics sub-internship and this came recommended to me by a med-peds program director and several med-peds residents who I reached out to when I was planning my 4th year. You don't have to do 4 sub-I's unless your medical school requires that. I only did 2 (1 of each) and I have done very well in terms of getting interviews. I'm not sure whether you can substitute a sub-specialty for a sub-I, and I would tentatively suggest that you do both sub-Is unless another poster shows up who only did 1 sub-I and still got a lot of interviews. Away rotations or "audition rotations" are absolutely not necessary for med-peds and they can hurt you if you're strong enough on paper that you likely would get an interview just on the basis of your application. It can be difficult to shine when compared to an institution's home rotators because they already know the hospital, the EMR system, etc. Also, even if you have an awesome personality, there's always a chance that you could rub someone wrong and have that stick. These are risks to consider before scheduling an away. On the other hand, there can be upsides to aways. Reasons to do aways-- (1) there's a particular program you are absolutely in love with but feel you may not quite measure up for an interview, (2) there's a program you are not quite sure about and want to explore more thoroughly. I want to re-iterate though that med-peds isn't like some fields like EM, ortho, etc. where aways are expected. I didn't do any aways and I'm very happy with that decision.

4)LORs - The program web sites often get pretty specific about letter requirements. Most of the programs require 2 chairman letters (one medicine chairman and one pediatrics chairman). Some of them specifically state that they want the remaining 2 letters to be a clinical medicine letter and a clinical pediatrics letter. However, in the ERAS system, you can send different letters to different programs. I recommend that you ask for at least 1 clinical medicine letter and at least 1 clinical pediatrics letter in addition to your chairman letters. If you have someone offering a letter from another specialty, you can certainly accept the letter and then decide later whether to assign it to any programs. Some programs don't require chairman letters or only require 1 chairman letter, in which case you would have room for another letter at your discretion. As far as your letter writers saying why you would be a good candidate for med-peds, I don't think this is strictly necessary but if the person can speak well to that, then it would be a plus. Just make sure you've discussed your career plans with your letter writer when you ask for the letter. I recommend asking for a brief meeting at which you can discuss your plans, your applications strengths/weaknesses, etc. when you ask for the letter--ultimately the letter writer will decide what they write. You can definitely get a letter from a sub-specialty--just make sure the letter writer knows you well enough to write a strong letter.

Thank you for the post - there was tons of helpful information in there

 

[URHere]

I'm another MS3 with an interest in Med/Peds. This thread has been very helpful and I hope no one minds if I just tack on a few of my own specific questions.

1) Would there be any benefit to doing a specific med/peds selective? I have been considering doing one as an away rotation. Med/peds doesn't really exist in the NW, and I thought a dedicated rotation may be a good opportunity to network with people in the med/peds field and get a feel for what combined practice is really like. That being said, many of these selectives clash with my school's MS4 schedule, so it wouldn't be trivial.

2) Does anyone have thoughts on how a PICU or NICU rotation would stack up against a dedicated Peds sub-I? I'll be completing a medicine sub-I over the summer, but I've been told by my advisor that I should also plan to have my ICU rotation and subspecialty rotation complete before ERAS goes out. Not much time for a second sub-I, especially if I choose to do an away (as above). I know it's not common to do a subspecialty so early, but my PhD is in ID and I have good relationships with many physicians in that field…hence good letters if I do an official rotation with them pre-ERAS. I am also very interested in a global health career.

 

[GirlyDoc36]

You lied to me girlydoc. I'll remember this. I'll remember.

Ahhh I'm sorry! This week proved busier than I expected. The poster above gave a lot of great info that correlates with what I was going to say. I'll add in some of my stuff as well. Mini background on me, I'm going into med/peds with the future plans of either combined critical care, hospitalist, or adult congenital heart. My niche is also medical education so throughout my interviews I've been asking about the opportunities for getting training in being a clinical educator so I can expand on that aspect.

I'm a midwesterner and applied mostly in that region with some in the northeast as well. The programs that I came across that had specific "tracks" for clinical educator were Rochester University, University of Minnesota. Other programs such as University of Chicago and University of Pittsburgh Medical Center (UPMC) have post residency fellowships in clinical education. The program directors of each of these programs went through these respective fellowships. But, as the previous poster implied, you don't necessary need a dedicated track to get this education. Every single program I went to had an answer for me regarding training in this area, even if there wasn't a specific track. There have "residents as teachers" seminars, go through a Stanford clinical educator series, have opportunities to interact with medical students both in the hospitals and in classes within the medical school for first and second year students. Basically I've felt that wherever I end up, I'll be able to formulate my training to get what I want out of it in medical education.

In response to the sub-I issue, to give another perspective, I actually only did one formal sub-I in the PICU at my own institution and got a ton of interviews. We have a required MICU rotation in our fourth year at my med school which is supposedly considered a sub-I as well but it was not as intense as my PICU one so I don't really count it.

I agree with everything else the previous poster said. Again, I apologize for my false promises! I hope this was semi-helpful.

 

[GirlyDoc36]

I'm another MS3 with an interest in Med/Peds. This thread has been very helpful and I hope no one minds if I just tack on a few of my own specific questions.

1) Would there be any benefit to doing a specific med/peds selective? I have been considering doing one as an away rotation. Med/peds doesn't really exist in the NW, and I thought a dedicated rotation may be a good opportunity to network with people in the med/peds field and get a feel for what combined practice is really like. That being said, many of these selectives clash with my school's MS4 schedule, so it wouldn't be trivial.

2) Does anyone have thoughts on how a PICU or NICU rotation would stack up against a dedicated Peds sub-I? I'll be completing a medicine sub-I over the summer, but I've been told by my advisor that I should also plan to have my ICU rotation and subspecialty rotation complete before ERAS goes out. Not much time for a second sub-I, especially if I choose to do an away (as above). I know it's not common to do a subspecialty so early, but my PhD is in ID and I have good relationships with many physicians in that field…hence good letters if I do an official rotation with them pre-ERAS. I am also very interested in a global health career.

1) So I sort of did one of these. Like I said in my previous post, I'm from the Midwest so med-peds is very prevalent but my school doesn't have a program. So I did a med-peds rotation at our sister campus to make sure I wasn't crazy in wanting to do it. It was originally supposed to be 4 weeks of outpatient in a community med-peds clinic. Since I wanted to also look at the residency when I was there, I worked with the coordinator to make it two weeks of outpatient and one week each in internal and peds. This was a little unorthodox but I was able to see much more of the program and meet the residents where I would just have been with two community docs if I had stayed in outpatient the whole time. But it's ultimately up to you. If you want to do it to decide that you want to do med/peds and you think it will help you, then great, it will give you a feel for med peds. But you definitely don't NEED it to apply.

2) I did PICU as my sub-I in August. This was my first rotation back from break after third year. I got invited to interview at most of the places I applied to so this in no way affected that. I did have my letters already done before this so I didn't need anymore. However, PICU is still general peds just with sicker patients so a letter from a doc in that respect would still be very worthwhile. I personally loved my PICU rotation so I may be biased but it gave a nice added challenge to doing a sub-I that I think really helped me. I've personally never heard the ICU/subspecialty before applying thing. These two rotations I mentioned above were what I did before applying and I was successful with interview invites.

I don't think I answered your questions explicitly, but that's just what I did for my 4th year schedule. I haven't really had anyone in my interviews ask me about my specific fourth year rotations, so I've gotten the vibe that there isn't a formula they're looking for. But this is just my opinion so do with it what you will.

 

[Cytarabine]

Ahhh I'm sorry! This week proved busier than I expected. The poster above gave a lot of great info that correlates with what I was going to say. I'll add in some of my stuff as well. Mini background on me, I'm going into med/peds with the future plans of either combined critical care, hospitalist, or adult congenital heart. My niche is also medical education so throughout my interviews I've been asking about the opportunities for getting training in being a clinical educator so I can expand on that aspect.

I'm a midwesterner and applied mostly in that region with some in the northeast as well. The programs that I came across that had specific "tracks" for clinical educator were Rochester University, University of Minnesota. Other programs such as University of Chicago and University of Pittsburgh Medical Center (UPMC) have post residency fellowships in clinical education. The program directors of each of these programs went through these respective fellowships. But, as the previous poster implied, you don't necessary need a dedicated track to get this education. Every single program I went to had an answer for me regarding training in this area, even if there wasn't a specific track. There have "residents as teachers" seminars, go through a Stanford clinical educator series, have opportunities to interact with medical students both in the hospitals and in classes within the medical school for first and second year students. Basically I've felt that wherever I end up, I'll be able to formulate my training to get what I want out of it in medical education.

In response to the sub-I issue, to give another perspective, I actually only did one formal sub-I in the PICU at my own institution and got a ton of interviews. We have a required MICU rotation in our fourth year at my med school which is supposedly considered a sub-I as well but it was not as intense as my PICU one so I don't really count it.

I agree with everything else the previous poster said. Again, I apologize for my false promises! I hope this was semi-helpful.

I was just giving you a hard time, thank you for all the information! Happy to hear about the accommodation for medical education. The Stanford clinical educator series in particular has been hyped up a lot to me and is something I'd love to do

I think I just have one more question right now. It sounds like med peds is big on getting applications in as soon as possible. Looking at the schedule for 2015, it looks like applications open September 15th and MSPE's are released October 1st. I was going to plan on getting the 2 chair letters for peds and IM, then 2 additional letters - one from a peds faculty and one from a medicine faculty. I was originally planning on getting the latter two from my SubI's. 4th year starts for me July 6th, so if my 1st 2 rotations were SubI's, I'd finish my second SubI on August 28th. If I were to get letters from these two SubI's, should I request that they be in by September 15th or by October 1st? Does waiting on my SubI's to get letters sound like a reasonable plan? If I were to ask for letters from those I've rotated with thus far, I could get a good letter from both medicine and peds faculty and an exceptional one from a non-medicine/peds faculty. Based on that, I'd really like to try to wait and get my letters from my SubI's and see if I can't get what I think would be exceptional letters from medicine and peds faculty (worst case hopefully coming out with good letters).

Thank you all again for the information, it's been very helpful

 

[chargersfan]

I was just giving you a hard time, thank you for all the information! Happy to hear about the accommodation for medical education. The Stanford clinical educator series in particular has been hyped up a lot to me and is something I'd love to do

I think I just have one more question right now. It sounds like med peds is big on getting applications in as soon as possible. Looking at the schedule for 2015, it looks like applications open September 15th and MSPE's are released October 1st. I was going to plan on getting the 2 chair letters for peds and IM, then 2 additional letters - one from a peds faculty and one from a medicine faculty. I was originally planning on getting the latter two from my SubI's. 4th year starts for me July 6th, so if my 1st 2 rotations were SubI's, I'd finish my second SubI on August 28th. If I were to get letters from these two SubI's, should I request that they be in by September 15th or by October 1st? Does waiting on my SubI's to get letters sound like a reasonable plan? If I were to ask for letters from those I've rotated with thus far, I could get a good letter from both medicine and peds faculty and an exceptional one from a non-medicine/peds faculty. Based on that, I'd really like to try to wait and get my letters from my SubI's and see if I can't get what I think would be exceptional letters from medicine and peds faculty (worst case hopefully coming out with good letters).

Thank you all again for the information, it's been very helpful

You should aim to have all your letters in by Sept 15th or whenever ERAS opens. Most if not all of med/peds interview invites come out BEFORE October 1st. If you wait until the 1st you will be at a severe disadvantage.

 

[GirlyDoc36]

^agreed.

 

[Cytarabine]

Sorry, I lied, one more. For most programs, would I need step 2 done for Sept 15 as well?

 

[chargersfan]

Sorry, I lied, one more. For most programs, would I need step 2 done for Sept 15 as well?

It really depends on how you did on step 1. If you didn't do so well you should have step 2 done to show an improvement. If you did well on step 1 then no. Programs only need a step 2 score to rank you.

 

[chargersfan]

I'm another MS3 with an interest in Med/Peds. This thread has been very helpful and I hope no one minds if I just tack on a few of my own specific questions.

1) Would there be any benefit to doing a specific med/peds selective? I have been considering doing one as an away rotation. Med/peds doesn't really exist in the NW, and I thought a dedicated rotation may be a good opportunity to network with people in the med/peds field and get a feel for what combined practice is really like. That being said, many of these selectives clash with my school's MS4 schedule, so it wouldn't be trivial.

2) Does anyone have thoughts on how a PICU or NICU rotation would stack up against a dedicated Peds sub-I? I'll be completing a medicine sub-I over the summer, but I've been told by my advisor that I should also plan to have my ICU rotation and subspecialty rotation complete before ERAS goes out. Not much time for a second sub-I, especially if I choose to do an away (as above). I know it's not common to do a subspecialty so early, but my PhD is in ID and I have good relationships with many physicians in that field…hence good letters if I do an official rotation with them pre-ERAS. I am also very interested in a global health career.

I would do a specific med/peds elective if there was a particular program that you are very interested in. If you do well it can enhance your chances of matching there.

In my opinion a PICU rotation is more valuable than a NICU rotation. For some odd reason the med/peds national requirement is 3 months of NICU and 1 month of PICU. So the more PICU rotations you do the better. If you've already done a medicine sub-I, I would forgo the peds sub-I and do PICU instead. The ICU experience is much more valuable than a regular ward experience especially since you've already done a medicine sub-I

 

[Cytarabine]

It really depends on how you did on step 1. If you didn't do so well you should have step 2 done to show an improvement. If you did well on step 1 then no. Programs only need a step 2 score to rank you.

Thanks, that makes my life / scheduling 4th yr a lot easier if I can take step 2 at the end of september.