Beauty In The Unforeseen

Author: Yanet Camarena, MD

            My arrival on the island of St. Maarten as a first semester student was filled with the anticipation of what medical school would be like on this beautiful oasis, excitement in knowing that this was a major step toward becoming a physician, and fear of the unknown. I spent two wonderful semesters on the Island where I was overwhelmed by the novelty of St. Maarten, my new colleagues who had come from all over the world, and the challenge of medical coursework! I recall the feeling of relief and anxiety as I prepared for and completed my first set of block exams. I came home the next afternoon after classes, opened my email, and to my dismay saw a big bold letter F staring back at me and allowing the thoughts of insufficiency to rise. “How could this be? I had prepared for so many hours. Maybe I was wrong, and I am not meant to be a doctor. I could quit now before I’m in mountains of debt.” We have all been there believe me! I could have quit and gone a different route but my passion for anything else wouldn’t have come close to a career as a medical doctor. Later that night after a couple of hours of sobbing, meetings with the professor of the subject I failed, and speaking to a trusted friend I leaned into that moment of “failure”. I reminded myself that “failure”, while hurtful should be seen as an opportunity to reevaluate and make changes. So that is exactly what I did. I began to study in shorter increments of time, made flashcards, and began to learn the material in a way that could be applied and not just memorize it like I had done up until then. I soon saw improvement in all of my coursework. In addition to those study changes I made it a point to focus on myself. I chose to workout daily, prioritized speaking to family or loved ones even if for 10 minutes a day, prayed and meditated in the evenings before bed, and lastly went out on the weekends with friends without feeling guilty. 

            At the end of my second semester in May of 2017 I packed up my carry on and went home for a short 10-day break that soon turned into a 2-month hiatus full of anxiety, fear, mourning, and unexpected change. A category 5 hurricane named Irma ripped across St Maarten leaving the island in shambles along with many of my colleagues stuck on the island until help could be sent over in the form of cruise ships, cargo planes, and small boats. Safety was ensured and all students soon returned home or to a safe place back in the US until further notice.

            My third semester began three weeks later in Preston, England. The sense of displacement hung over us like a dark cloud on a rainy day. The curriculum was drastically changed for everyone due to time lost and availability of computer labs on the new campus. The friendships and trust built on the island amongst everyone is what maintained me in high spirits throughout the remainder of my time in basic sciences. My friends and I soon began making plans to travel across Europe in order to make the best of the current situation that had forced us to be on that side of the globe. The last semester of basic sciences ended with a small 5th semester party as most underclassmen had to be moved back to the Island as it was quickly being rebuilt leaving us with a feeling of “survivors’ guilt” as classmates who decided to decelerate or failed a course would have to also move back to St Maarten. At the completion of basic sciences, I moved back to Texas with my then fiancé, now husband to begin my dedicated study time for Step 1 and finalize everything for my wedding. This dedicated time once again brought about negative thoughts and feelings of being enough. The demoralizing process of realizing how little you actually know in conjunction with a score determining what type of specialty you would even be “able” to pursue competitively ate away at my already low self-confidence. I found myself in tears at mundane things and with little motivation, realizing that it was not healthy to place my worth on a single exam score I took a step back. I recalled that pouring myself into studying for 10-12 hours with little to no breaks was not how I had succeeded in basic sciences and that knowing myself I functioned at a higher capacity when breaking everything up into 2–3-hour increments with breaks to talk to people, eat without reading about medicine, and release stress through working out. I even made it a point to not study past 10pm. The biggest mistake I made was NOT postponing my exam like I should have. Had I postponed I would have gone into the exam with more confidence, knowledge, and lastly practice due to getting more exposure to questions. I received my Step 1 score the day before my wedding. I passed, but not by much, devastated at the score but knowing that this was a true reflection of the self-doubt and lack of knowledge I had during the time of the exam. Knowing I couldn’t change the past I was bound and determined that for my Step 2 exams I would be kinder and more patient with myself allowing self-confidence to be cultivated. 

            The clinical science portion of medical school was my absolute favorite as I had the opportunity to truly apply what I had learned outside of standardized testing. I completed all core rotations at Danbury Hospital in Danbury, Connecticut with the exception of Pediatrics which I completed in Miami, Florida. Soon after completing my third year, I took Step 2 CS a couple of weeks later in Philadelphia and passed! I went into my clinicals with an open mind and found that I fell in love with every single rotation. With this in mind and after completion of my 6-week core Family Medicine rotation I knew that this was the specialty for me! It was so well rounded, yet challenging, and most importantly varied allowing me to treat everyone from newborns, pregnant mothers, teenagers, and even geriatrics.

            I won’t waste your time by giving you more boring details of my third and fourth year with the infamous pandemic and instead will give you the main take away from these two years. First study each and every day on the wards and at home; an hour a day of specific material goes a long way when preparing for Step 2 CK. Hate reading, watch some OnlineMedEd videos! This is how I increased my Step score 40 points from Step 1 to Step 2 CK! We are not above any task, be humble, but don’t let anyone take advantage of you by forcing you into scut work the entire shift. Be confident in what you know and what you don’t know. Ask questions often.  Be honest with yourself and those you work with and ask for help when needed. Do NOT take constructive criticism too personally it is there to help you become a better doctor for your future patients. Understandably it is easier said than done but just take a couple of breaths and remind yourself it’s not personal. Take advantage of every opportunity when in the hospital or clinic this is your time to shine and figure out what your passionate about! Make connections with other students; they are not your competition we are all in this together and you’ll be surprised at what you can learn from each other! Lastly, work hard each and every day this is your opportunity to show residents and attendings who you are and allow for them to write more comprehensive letters of recommendation for residency. 

            When preparing for The Match I first had to become familiar with the following terms: The Match, NRMP, ECFMG certificate, and ERAS. What is The Match? The National Resident Matching Program (AKA The Match also called NRMP) is a U.S. based private non-profit non-governmental organization created in order to place medical students into residency training programs located in US teaching hospitals via a fancy Nobel prize winning mathematical algorithm that is applicant driven. Great!! Now next term, ERAS. ERAS stands for Electronic Residency Application Service that all 4th year medical students who want to apply that year for the Match are eligible to purchase a “token” AKA a 14-digit numeric code needed to register for ERAS and its services. This is where the actual residency application in its full glory consisting of your legal name, permanent residence, accomplishments, professional photo, personal statement, work experience, research, and extracurriculars, that are considered significant for your future employer, can be uploaded and where I submitted the application to my list of programs. ERAS also allows you to search for programs based on specialty and location within the website and ultimately where most programs send you interview invitations and communicate with you, if not the email you listed on the application. Last, and probably the most important, term that I had to familiarize myself with as an IMG was ECFMG. ECFMG stands for Educational Commission for Foreign Medical Graduates is a program that assesses the readiness of International Medical Graduates (IMGs) via a certification process known as ECFMG certification that is received after completing medical school and are eligible only AFTER verification that you have received your medical degree.

            Now that you know the terms you are probably thinking when does this all happen? This entire process of purchasing a token, completing your application, applying to programs, interviewing, and matching occurs started in the beginning of my 4th year and went on throughout the year. After interviews were completed, there was a specified due date where every applicant and program submitted their rank order list into the NRMP website. As an applicant I ranked ONLY programs with whom I interviewed with and was willing to train at. This is because once you match with a program you are in a binding contract that cannot be broken. Two to three short weeks later after finalizing my list I received an email on the Monday of Match week (March 15) letting me know that I had matched into a program, but I did not know until that Friday where I had matched. For those that do NOT match on Monday they have the opportunity to enter the SOAP (Supplemental Offer and Acceptance Program) through which you apply for and offered positions that were not filled via the Main Match. Whether you match via the main Match or SOAP you should be incredibly proud of yourself as this is a huge accomplishment having got that far.

I am grateful to have matched with my #1 program with UAMS Regional Centers-West in Fort Smith, Arkansas to train as a Family Medicine resident for the next 3 years. My plans are to practice full spectrum family medicine with obstetrics, serve people of all ages, use my native Spanish language to better serve the Hispanic population, and one day become part of a teaching hospital Family Medicine staff. 

TIPS:

1. Comparison breeds self-doubt

2. Be patient and kind with yourself

3. You are your own worst critic

4. See failure as an opportunity to reevaluate and change something 

5. Lean into the support from your friends and family. Don’t expect them to read your mind express how you feel

6. Prioritize self-care

7. Be 10-15 minutes early 

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