On Call With RK.md

Cardiovascular pharmacology in acute care settings involves a variety of medications ranging from vasopressors and inotropes to inodilators and inhaled pulmonary vasodilators. Listen in on this podcast as I discuss how I use agents like epinephrine, norepinephrine, vasopressin, milrinone, phenylephrine, calcium, methylene blue, and more in my practice. […]

Surgical scrub technicians (“scrub techs”) are incredibly important individuals in the course of an operation. They facilitate surgical workflow by providing instruments, positioning the patient, ensuring sterility, assisting with tissue retraction, etc. […]

After taking a hiatus for over a year from podcasting as a critical care fellow, I’m finished with my formal training and ready to hit the ground running as an attending physician with the rebirth of my podcast. […]

As I scroll through my recent blog posts, I realize I haven’t blogged about my critical care fellowship directly in quite some time. Many of my “lesson” posts are a direct result of things I encountered during my training, but today is a day of reflection as I have now completed my ICU fellowship! Above all else, my patients continue to inspire me with their stories of resilience, love, and optimism amidst even the most dire circumstances. Ever since I became a physician five years ago, I have always gravitated towards the “difficult conversations” regarding ethical issues, leading multidisciplinary meetings, and discussing goals of care. Why? Because it’s in these moments where a patient and his/her family and caretakers are at their most vulnerable. Where I am reminded about the sanctity of the patient-physician relationship. Where I try to combine humanism, humility, and the entirety of my training to answer: “Doctor Kumar, what should we do?” I have seen life taken from those who should have survived, and second chances given to those who should have perished despite overwhelming comorbidities and critical illness. Critical care has allowed me to employ knowledge, procedural skills, bedside manner, and teaching in a manner which I never imagined. And a special shout out to the ICU nurses I have worked with over the last year. You all have shown me true patient advocacy despite whatever “tunnel vision” treatment teams and consultants often possess. I’m so grateful for each one of you, and I hope you all enjoyed my quirkiness! ;-) Here's hoping I have a great start to my cardiothoracic anesthesiology fellowship tomorrow! :-)

Interview season is over, acceptances are rolling in, and you've already started the countdown till orientation. Amidst this excitement, it's easy to make some pretty bad decisions with the intention of being prepared. I had almost eight months off after receiving my acceptance from Baylor Med to "prepare" for medical school. Caught up in the emotions of having been accepted by my dream school made me all the more determined to be ready. I distinctly remember grabbing my mom's old nursing textbooks to look through some high yield clinical vignettes even before I understood what the terms meant. As idiotic as this was, I feel others are inclined to behave similarly. With the guidance of upperclassmen and my own first-hand experience after starting school, I quickly learned that there are some things you should do before beginning medical school. Living This is perhaps the most difficult task for any incoming MS-1, especially if you're an out-of-state (OOS) student, but it's absolutely imperative that you act as soon as possible to find a place to live. Some schools and apartment complexes provide programs to help you find roommates and/or a suitable place to live. If you have a family or plan on staying at the same school for residency, a condo may be a worthy investment. In the case of OOS students at Texas medical schools, you can claim in state tuition after one year of owning property (ie, a condo). Textbooks/Equipment You'll probably receive a list of materials to purchase sometime during the summer. Depending on the school, the items may be labeled as "optional" or "required." Regardless, it's always a great idea to ask upperclassmen how many of those materials really are required. Furthermore, you're likely to come across students who have digital copies of the textbooks and manuals once you start class, so there's no rush. This also applies to medical equipment like stethoscopes - make sure you ask an upperclassmen!! By not jumping the gun, you'll save yourself hundreds of dollars and the headache of having to return books/equipment. Studying I've told this to interviewees before - from my perspective, the individual concepts we cover in medical school are rather easy. It's just the volume that can be cumbersome. You'll have plenty of time to learn the material once you start school, so there's no point in getting a head start. Pre-matriculation is an option at some schools, but for those who choose not to, don't feel like you're behind. Travel As a general rule of thumb before starting school, you want to pursue things which take more than a weekend. This is a perfect time for international travel, getting married, etc. Once you start the curriculum, it's nearly impossible to take an extended leave of absence (except maybe in your 4th year, depending on the school). Paperwork/Second Look One of the most dreadful tasks in undergrad is filing for financial aid, and depending on your situation, it may still be at the top of your "to-do" list for medical school. Make sure that you fill out your FAFSA, submit any final transcripts, and verify that your paperwork has been completed appropriately and received by all parties. In addition, I recommend attending the second-look (if offered). Now that you've been accepted, you'll be far more receptive to information about the school, meet with the dean(s), and pose questions to current students from the perspective of a matriculant. It's amazing how much better a tour is when you don't have to worry about interviews afterwards. ;-) As always, drop me a comment below with questions or other suggestions for things to do before starting medical school! :-)

Letters of intent (LOIs) and thank you notes are often submitted by applicants to improve their chances for an acceptance, but do LOIs even get considered? Realistically, it depends on the school and how late in the application cycle they receive supplemental materials. Some schools may brush them aside entirely. Other schools may think an applicant is going "the extra mile" to impress the admissions committee. Either way, I suppose from a pre-med's point of view, it can't hurt; however, there are some ways you can make sure the LOI is effective. First and foremost, don't write a LOI before your interview! What's the point?! Aside from looking desperate to an admissions committee, you really don't have anything to write about until you visit the program. Next, the content of the LOI should focus primarily on how you connect with the school. What can you bring to the table which will strengthen the upcoming class? Which opportunities (clinical, research, elective, etc.) did you learn about that you foresee yourself pursuing? Why - should - they - accept - you?! These things will become apparent to you after the interview, tour of the school, and interacting with current students. Also, just as with everything else in the application process, you want to be timely about submitting your LOI. Call the admissions office a day or two after your interview and ask if an e-mail will suffice or if a hard copy needs to be faxed or mailed. Remember, this document will be added to your official application file, so be sure it's free of any errors. While there's no guarantee that LOIs are taken into consideration, applicants who don't get into their top school choices are left wondering - "well maybe if I had sent a letter of intent, they would've accepted me!" Just fire up your word processor and go for it! :-)

Why did I select anesthesiology as a career? Find out on this podcast! Also check out the factors that led me towards anesthesiology from when I was a medical student (link to post). Many of these considerations held true throughout my training. I have no regrets! :-)

We've all heard the horror stories of studying 10+ hours per day, having no social life, and having to sacrifice one's sanity just to keep up with the growing volume of medical knowledge and research. Here are some of my general tips for studying! Learning is a highly individualized process, and as a result, study habits vary from person-to-person, the material at hand, and even around one's work schedule. The last of these is important because in undergrad and even med school, students have so much more time dedicated to learning their trade and coursework. As a resident, balancing a full work load (60-80 hours per week) while ALSO attempting to study for in-training exams and boards can be a daunting task. Here are some study tips which have served me well over the course of my training. Quality Over Quantity "How many hours do you study?" I never understood the point of this question. With all the distractions we have in the modern era, the sheer volume of "hours spent studying" probably has little to do with actual comprehension and retention. I study in very short bursts (no greater than 30 minutes) with distractions between sessions, but I'm extremely focused when I read. It's also why I have to take my exams very quickly, because I can't sustain that degree of concentration for very long. Naturally, the overall time commitment ramps up just before exams and falls off immediately after an exam. And that's okay. Just focus on how much material you were able to get through (and retain) rather than the number of hours. :-) Sacrifice "Burnout" is an incredibly important concept in healthcare training, but individuals have different thresholds where they cross the proverbial line. Know yourself and the circumstances surrounding your work schedule and personal life. Don't feel guilty if you find yourself choosing sleep or recreation over studying from time to time. That being said, sacrifices must be made to truly commit oneself to healthcare. I can't tell you how many times I chose studying over celebrating special occasions, hanging with colleagues, vacation, etc. Fortunately I've found studying with the goal of teaching to be a very zen-like experience which brings me a great deal of happiness. Find your motivation and resilience to stay afloat amidst a life of sacrifice. Learning will become a natural extension of your daily pursuits, and you'll feel like studying is less of a chore and more of a hobby. :cool: Standardized Exams - Practice Questions Programs are always looking for "well rounded" individuals, but standardized exams (USMLE, SAT, MCAT, etc.) are still way more important than applicants want to acknowledge. Think about it - they're objective exams. For example, it doesn't matter where you want to college, everyone takes more or less the same MCAT. In this sense, these exams are an (imperfect) assessment of one's fund of knowledge and critical thinking which can be compared directly to other applicants. That's just how our system works. With that in mind, for each of these exams, find a single text to use as your primary book (i.e., First Aid for USMLE Step 1). Minimize the number of additional resources you use, annotate material from those sources into your primary book, and focus on doing thousands of practice questions. Active Engagement In a world of podcasts and PowerPoint lectures, it's very easy to rely on our auditory and visual senses to learn difficult concepts or volumes of information. I used to do this too. Sitting in the back of the lecture hall just flipping through slides as I half heartedly retained the information... it was frustrating, ungratifying, and very routine.

A pivotal part of any application process is composing a personal statement (PS). This can be stressful as we're not usually accustomed to writing about ourselves, but here are some tips which might help you plan and revise your PS draft. * Use a cloud document service like Google Docs, Office 365, Pages, etc. This will keep your PS saved and easily accessible from anywhere to update on the fly. * Sit down, concentrate, be honest and do some self reflection - why did you choose this career (medicine, PA, nursing, pharmacy, etc.)? Find out which milestones in your education and personal life led you to this decision, and decide on which one or two to make cornerstones of your PS. * Don't worry about starting your PS from start to finish. Just start writing phrases you think of, topics you want to include, brainstorming ideas... anything! Word processing makes it so easy to shift things around and omit others all together. :-) Besides revising the grammar, spelling, and syntax of a personal statement, ask yourself the following questions: * Have I mentioned this material elsewhere in my application? Try to avoid reiterating facets of your primary application unless you plan to elaborate. * Can any part of your PS be interpreted as presumptuous? Is the writer making claims he or she has no way of knowing. Appealing to your humility by acknowledging your ignorance will serve you well early on. * Flowery language is overrated and doesn’t show your command of language. Focus on masterfully unraveling your story rather than big words. * Does this contribute to the the overall theme? I’ve read personal statements reiterating disjointed/confusing activities which somehow magically lead the writer towards their career choice. Have a theme in mind and focus on how each sentence relates to said theme. * Let personal friends, colleagues, professors, and family members read your PS. Aside from their opinion, ask them if the PS sounds like you or like a scripted composition. It's your personal statement. Your voice better shine through! I’ve found that shorter personal statements which focus on avoiding redundancy and are rooted in showing one’s path to their career choice (rather than merely telling) are more effective, and consequently, more memorable. In adhering to just the important details, applicants don’t have to worry about going beyond the allotted word limits either.

A curriculum vitae (CV) catalogs your working career (including accolades, presentations, publications, education, extracurriculars, etc.) in a chronological order with detail. I think about a résumé as a snapshot of the CV. Typically it's less than a page and only contains highly relevant points which differentiate you from other applicants. In either case, it's important to have easy access to an updated copy of both for volunteering positions, job applications, and especially higher level education applications. I'll provide some tips about keeping an updated CV knowing that the same tips apply in generating a résumé based on the position you're seeking. In general, I have a copy of a CV and a résumé on a cloud storage with word processing capabilities (ie, Google Drive or Office 365), so you can update these documents on-the-go. I focus on updating the CV and will regenerate a résumé based on the position I'm seeking.

This inaugural episode of "On Call" describes how this podcast came to be and a little about me! :-)