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Albany Med EM Fellowship Blog, Part Deux

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Hi Everyone...

About 2 years ago, Matt and Jordan, 2 of the EM fellows at Albany Med, started a blog detailing their time in the Albany Med EM Fellowship. It got me interested in learning more about residencies, and was a major reason why I eventually decided to take the plunge myself. I ended up applying to a couple of different programs, but after interviewing at Albany Med, I knew I had found the right place. I was fortunate enough to be offered a spot and took it without a second thought. I wanted to do something similar to what they did, and try to share some of my experiences along the way. Whether or not to do a residency/fellowship is a big decision, and it really helped me to hear peoples' personal experiences. I'll try to post every few weeks, but I can't make any promises. Feel free to post any questions and I'll do my best to answer them... I'm still new to all of this, so maybe some of the more seasoned resident graduates could also chime in.

My wife and I moved up to Albany last week, and have really enjoyed it so far. This year there are 4 fellows, an increase from previous years when there were only 2 spots. The two other fellows started in mid-August so that we could be staggered going through rotations. It also allowed us to each receive some one on one mentoring from the outgoing fellows. Our first few shifts in the ED are scheduled such that one of the outgoing fellows will be there, basically shadowing us and helping us learn the ins and outs of the department. She won't be picking up any patients, and will basically just function as a guide as we get used to being "real PAs." I think it will be a great way to get our feet wet. The first week of October, we are scheduled to have a 2 week ultrasound rotation. This will include some classroom time for a few hours each day, and some hands-on time, just walking around the department doing as many scans as possible. The guys who started in August said they got close to 200 scans each last time I talked to them. Should be a great experience!

Well that's all for now. Feel free to post questions, and I'll also try to check in every few weeks with a quick update.

-Andy

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Time for a quick update...

 

The last 2 months have been a whirlwind of learning a new hospital, a new EMR system, and trying to become a better EM provider  not to kill any patients. The first few weeks of the fellowship we spent just getting used to the department. Our first 7 or 8 shifts were scheduled with one of the outgoing fellows, and she was there just to help us learn the ins and outs of the how things work at Albany Med. It was SO helpful having her there and having her show us the ropes for the first 2 weeks. We would have been lost without her. After 2 weeks, the training wheels start to come off, and we began working shifts on our own. There is usually one of the other fellows in the department, and there are is always plenty of backup from the attendings. I've never felt like I was in over my head, because I know that there are lots of people around who are willing to help and answer questions.

 

In October, we completed a 2 week ultrasound rotation. It consisted of 1 week of classes and hands-on training and 1 week roaming around the ED practicing ultrasounds on any willing patients. During that time, we racked up around 250 ultrasound scans each. We mostly focused on FAST, renal, gallbladder, and cardiac, but we also did some OB and ultrasound guided IV too. It was a great experience. Dr. Cadigan, who teaches the classes, is fantastic and really knows her stuff.

 

The rest of October consisted of just working our regular 4-5 10 hour ED shifts per week. We mostly work evenings, because that's when the action tends to happen. The schedule varies, but we're never really scheduled to stay any later than 2am, which is nice. That said, I'm usually there about 30-45 minutes extra finishing up charting and tying up loose ends.

 

Last week, 3 of us went to Syracuse to get ATLS certified. It was a fun trip, we all passed, and the classes were actually pretty useful. Unlike some of the other certifications, they really like to make sure you are competent before they pass you... That test is no joke.

 

For 2 weeks in November, I have been doing my ophthalmology rotation. The first week is spent upstairs in the clinic. At first it was mainly just shadowing, but by the end of the week, I was starting to see some patients on my own and getting a lot more comfortable with eye exams. The second week, which I'm just now starting, consists of taking call with the ophtho resident. I'm scheduled for fewer ED shifts, and instead will just be going in for eye emergencies several days this week. It's a nice change of pace, and it is really a great way to learn how to manage eye patients. It's a real luxury to be able to sit and pick the brain of the ophthalmologists, finding out what things we should be consulting them for and what we shouldn't. I still have a lot to learn about ophtho, but this was a great start. I can at least feel fairly competent with a slit limp exam, and I have a pretty good idea of when I need to call in the specialists. I think I may go back at the end and try to do another ophtho rotation... we'll see.

 

Well, that's all I've got for now. They keep us busy, but it's totally manageable. It's been a fantastic experience so far. I'll try to keep the updates coming and get some of the other fellows on here to share their thoughts, too

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Do you mind elaborating a little bit on what your daily schedule has been ? And how many days a week are you working?

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We're scheduled to work 4 days one week and 5 the next. Plus there are things like Wednesday morning conference we attend. Our shifts are 10 hours long. The usual shifts are 11-9p, 12-10p, 2-midnight, 4-2am, and the occasional 9-6pm or something like that. On conference day we usually work 6 or 8 hour shifts. So it comes to probably 50-55 hours a week on average I would say. When you're doing off-service rotations, the scheduling just depends on how busy that service is. For example SICU is more hours than ophtho.

I'll just say that going into it, hours and being worked to death were one of my biggest concerns. I knew that it would be more hours than a regular job, but that's how you get experience. I haven't felt overworked. Adam and Sara, the directors, are very flexible with scheduling understand that we have lives outside of emergency medicine.

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Hey Andy,

 

If you don't mind, could you discuss some your stats when you applied? (GPA, experience...).

 

Thanks.

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As far as GPA and experience goes... I don't think either is a major factor in admission. A GPA below 3 might be a dealbreaker, but I think what they really look at is potential and desire to work in EM. I would guess that all of us had GPAs in the neighborhood of 3.5 or maybe a little higher, but don't put too much stock in that.

 

I was an EMT for a couple of years before PA school, and that may have helped some. But I know that there have been several fellows in the past and present classes who went straight through from undergrad to PA to fellowship. So the short answer is, there really isn't a formula that they're looking for. The biggest thing is just to have some good EM rotations and demonstrate that you are passionate about this specialty.

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Do you recommend to apply to many of the EM residences in hopes of landing one? Sounds like steep competition being only 4 slots available. 

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If you are absolutely set on doing a residency, then, yes, I would suggest applying to several. They are pretty competitive, but if you're a good candidate you won't need to apply to 12 programs to get in. The Arrowhead program, for example, takes I think 12-14 people each year. Residencies are definitely getting more competitive, but there are also more and more programs being added each year.

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For 2 weeks in November, I have been doing my ophthalmology rotation. The first week is spent upstairs in the clinic. At first it was mainly just shadowing, but by the end of the week, I was starting to see some patients on my own and getting a lot more comfortable with eye exams. The second week, which I'm just now starting, consists of taking call with the ophtho resident. I'm scheduled for fewer ED shifts, and instead will just be going in for eye emergencies several days this week. It's a nice change of pace, and it is really a great way to learn how to manage eye patients. It's a real luxury to be able to sit and pick the brain of the ophthalmologists, finding out what things we should be consulting them for and what we shouldn't. I still have a lot to learn about ophtho, but this was a great start. I can at least feel fairly competent with a slit limp exam, and I have a pretty good idea of when I need to call in the specialists. I think I may go back at the end and try to do another ophtho rotation... we'll see.

 

 

This is gold.

Something that I am still uncomfortable with is the eye, even with working closely with ophthalmologists and having them walk through slit lamp exams.

As an AMC PA grad, I wish that this residency was available way back when. What a great opportunity. Make the best of it and thanks for the updates.

G Brothers PA-C

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Hi everyone,

 

My name is Matt, I'm one of the other fellows, along with Andy, doing the fellowship at Albany Med. I was fortunate enough to start back in August and wow has time flown by. It is unbelievable to think that I am almost half way done with this 12 month fellowship. I know I have come a long way as a PA over these past 6 months and I can't wait to see where I am when its all over. A little update, so far I have completed a 2 week ultrasound course and am continually honing my skills during my everyday practice. Toxicology - time on call seeing patients in the ED/hospital for consults along with formal lectures, and we have been fortunate to go to two toxicology conferences one in NYC and one in Syracuse. This time was nice as well because we had less shifts in the ED during these weeks because we are on call. Further the Toxicology Attendings we have here at AMC are all wonderful and great teachers. Currently I am doing my airway rotation with anesthesia down in the OR for the week. It's so beneficial getting comfortable with airways in a nice controlled environment before putting these skills to use in the hectic ED. Further, its nice because we can practice using lots of alternative devices like LMAs, ILMAs, Glidescope, Bougies, etc. Other rotations I have completed to this point include time in the pediatrics ED, ophthalmology (Excellent!), radiology - reading mostly cxr and other plain films, and all four of us passed ATLS, on the first time!! Looking at the schedule, next month (February) I'll be spending some time in the CCU (Cardiac Care Unit), which is all cardiac ICU patients often following MI's etc. One other nice feature to Albany Med is our visinity to great skiing. A bunch of us are heading up to Mt. Snow for a weekend in February. Should be a nice time for some R&R.

 

For anyone out there thinking about fellowships/residencies, I highly recommend it. I think the opportunities afforded during these programs are invaluable. For those of you considering EM fellowships/residencies I highly recommend considering the fellowship here at Albany Med. The most important things I was looking for in programs was the demands of the program and the opportunities afforded. I knew a fellowship was going to be demanding however, I did not want to be part of a program simply pushing you to see more and more patients. There is absolutely none of that here. The program directors Sara and Adam are absolutely wonderful and are constantly looking for ways to improve the program and extend opportunities to us. Further, they completely understand we have lives outside of the ED. There is not doubt, in my mind, the fellowship experience here at AMC is one of the best out there.

 

Anyways enough for this rant...for anyone out there with any questions regarding fellowships/AMC etc please feel free to post or send a message to myself or Andy. I'll be back once I have some more updates...hopefully it will be a little warmer!

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Hi Andy and Matt, 

 

Thank you both so much for taking to time to write these updates! It's been so valuable getting this kind of insight and definitely furthered my decision to apply here! Just sent in my application yesterday! :)

 

If you don't mind... what advice do you have for those of us hoping to start an ED fellowship? Are there certain things you wish you'd learned or focused on prior to starting? Thanks!

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Good luck! Maybe we'll get to meet you when you come up for an interview.

I kind of wish I had focused more on my internal medicine and pharmacology skills. As PAs, it's our bread and butter, but it's easy to lose sight of just how important all that "family medicine" stuff is in the ED. We all know the line between EM and family medicine is blurring, but I think I was still a little naive coming in. Other than that, just get a nice broad foundation. Learn as much as you can in each specialty rotation, because it will ALL come in handy eventually in the ED. 

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For anyone out there thinking about fellowships/residencies, I highly recommend it. I think the opportunities afforded during these programs are invaluable. For those of you considering EM fellowships/residencies I highly recommend considering the fellowship here at Albany Med. The most important things I was looking for in programs was the demands of the program and the opportunities afforded. I knew a fellowship was going to be demanding however, I did not want to be part of a program simply pushing you to see more and more patients. There is absolutely none of that here. The program directors Sara and Adam are absolutely wonderful and are constantly looking for ways to improve the program and extend opportunities to us. Further, they completely understand we have lives outside of the ED. There is not doubt, in my mind, the fellowship experience here at AMC is one of the best out there.

 

 

 

 

well said

and why they should be mandatory

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Hey there! My name is Jenelle and I am another one of the four current PA fellows here at AMC doing the ED fellowship. I know Matt and Andy have already talked extensively about their experience but I just wanted to add to that. I am currently doing my airway/anesthesia rotation where we spend 1 week in the OR doing just intubations…it has been awesome so far! So far I’ve been able to get 26 airways, mostly ET tubes but also a few LMAs and 2 glidescopes, in 4 days. Tomorrow is my last day on this rotation so I’m hoping for at least 5 more or maybe 7 more so I can beat Eric’s record! ;) As Matt said, I really can’t believe I’m almost finished with my 5th month…it’s been a crazy awesome experience. Yes, we put a lot of hours in (approximately 50-60 per week), however, I head into work every day so thankful for this amazing opportunity, never dreading a day.

 

So far the rotations that I’ve completed are ultrasound, toxicology, ophthalmology, radiology, pediatric ED, and airway, with a bunch of ED time mixed in there. I still have CCU, EMS, SICU, trauma, and 2 electives coming up. Ultrasound was SO beneficial. Dr Cadigan, our ED ultrasound specialist is amazing to work with. I was able to get over 220 scans within 2 weeks, which Jenna (fellow from last year’s class) tells us was SUPER marketable during job interviews. Also, I can’t say how impressed I am with our toxicology specialists here; they are all amazingly brilliant and I have learned so much from working with them during our tox rotation and in the ED. This rotation was really great because I personally didn’t get much, if any, toxicology background in PA school, which is pretty common and very important stuff to know in the ED. Another rotation that has been immensely beneficial to me was ophthalmology. Again, I definitely did not get much clinical experience with eyes in PA school, which again is critical for ED practice. I certainly did not feel comfortable seeing patients with eye complaints prior to doing this rotation; I didn’t feel confident at all in my eye exam skills (had never even used a slit lamp before) or my assessment of eye complaints. However, after the experience gained from the ophtho rotation, I now feel much more comfortable and confident with these patients. I feel like some of the other residents and mid-levels in the department tend to come to us fellows with ophtho and ultrasound questions given the great experience we’ve gained from these rotations, which I think says a lot.

 

As far as ED time goes, we pretty much function the same as the ED physician residents, which I think is pretty cool. We do all of the same things they do, except some of them are assigned to traumas and we aren’t, except for during our trauma rotation or overnight shifts. However, many of the residents will let you pick up and manage their trauma patients if you ask them to. We attend the same weekly conference as them, the same monthly journal club, and most of the same rotations.

 

Again, as Matt already said, I really can’t say enough about how great this program has been so far and how fantastic our directors are. They truly care about getting us the best learning experiences and are always looking for feedback from us on how to better the program and to ensure that we’re getting the best fellowship experience we possibly can. I personally was most impressed and still am highly impressed with the quantity and the quality of off service rotations offered by this program. I looked into a lot of other Fellowships/Residencies and couldn’t find a program that I was more impressed with in that regard, and my opinion hasn’t changed!

 

I apologize for the length of this post, but there’s just so much to say! I will try to post another update after a few more rotations. My next rotations coming up soon are CCU (cardiac critical care) and EMS, where we get to ride along in the LifeNet helicopter and in ambulances, which should be pretty neat. Oh yeah, and all of us fellows and Adam are also going to the ACEP/SEMPA EM Academy conference in Las Vegas for a week in April which should be a ton of fun!! Please feel free to ask me any questions you might have; I am more than happy to answer! Feel free to email me at romigj@mail.amc.edu if you have any questions that you don’t feel comfortable posting on the blog. 

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Hey everyone! My name is Eric and I am one of the 4 fellows at Albany Medical Center ER currently. I felt now was a great time to comment on my experience so far because I am about half way through the fellowship. So far in addition to all my ER shifts I have completeted rotations in: ultrasound, toxicology, ophthalmology, pediatrics, anesthesia, radiology. I still have yet to do a rotation in CCU, SICU, EMS, trauma. and my elective month.

 

I started my fellowship with 2 weeks of ultrasound training which was beyond amazing to learn. When we were not doing class or hands on with our attending, myself and another one of the fellows were out in the ER ultrasounding every person we could find which was amazing because patient's were very receptive to letting us practice and learn and just by explaining to the patient what we were looking at and for, helped educate the patient and us reinforce the skills and knowledge exponentially. Matt and I even took it a little further and started learning how to apply ultrasound to many other things (i.e. Ophthalmology, peritonsillar abscesses, etc.). After hearing from previous fellows how marketable ultrasound training was when applying to jobs, I made it a point to keep up with my ultrasound skills and get as much exerperience as I possibly could. So far I have about 560 ultrasounds logged of various kinds. Dr. Cadigan who is our ultrasound ER guru is exceptionally amazing to work with and will take free time to go out of her way and explain something to you if you have any questions.

 

As Jenelle has previously mentioned, I too feel that I did not have the confidence I should with seeing patients with eye complaints. We unfortunately did not have a great deal of Ophthalmology training in school. I will even admit that when I saw patient's initially in the ER at the beginning of my fellowship I was intimidated by doing a good and thorough slit-lamp examination or even knowing who needs to be consulted and who can be sent home with follow-up. Well after my Ophthalmology rotation with various amazing Ophtho residents and attendings at AMC, I was a rockstar! I learned so much and just learning how to perform a good and thorough slit-lamp examination alone is a huge help. I now see patient's and do things without even needing to consult Ophto residents to do. I remove foreign bodies from people's corneas. I even performed a laceration repair of a lid margin using 7-0 chromic gut sutures, which impressed the Ophthalmology resident that is something that normally requires a skilled Ophthalmologist to handle. So needless to say, I have now have a huge passion for Ophthalmology and find that other PAs, residents, and sometimes attendings have asked me questions about using the slit-lamp or with handling certain Ophtho complaints, which is a huge confidence booster.

 

Toxicology was beyond amazing. I never how much existed regarding tox until doing this rotation. Albany Medical Center ER is extremely fortunate that we have 3 amazing board certified Toxicologists! Between the lectures and tox cases that I had, I gained a huge amount of knowledge that I would have never learned otherwise. We learned not just drugs/medications, but how to recognize and treat certain exposures to chemicals (i.e. from patient's place of employment), plants, etc. Now when we get overdoses or exposure to random chemicals, I jump right on it and feel confident seeing those patient's and knowing how to treat them accordingly.

 

Anesthesia was an amazing experience. I don't know how many intubations some people may have done while in school, but after talking to some of my friends who have completed a year of ER as a PA, they have done ZERO. With that said, I did 32 intubations in 1 week alone! Talk about a great experience, after that week I felt like I could walk into any situation and intubate without any hesitation.

 

Pediatrics was a great rotation because let's face it, kids can be very intimidating to treat. Unless you have that background in Pediatrics, there are a lot of differences in working up a kid or newborn baby. We have some absolutely amazing Pediatric ER certified attendings and they just made the experience amazing. I loved every minute of it, and within 1 week alone I was picking up ICU level peds patient's.

 

All in all, my experience over the past 6 months has been beyond amazing and far exceeded my expectations prior to starting the program. It is also great because I have 3 other amazing PA fellows that I work with, and we enjoy sharing our experiences with one another because we all want to learn and help each other come out of this program with the most knowledge that we can possibly gain over this year. Everyone else in the ER has been great from nurses to the other PAs, residents, and attending physicians. I find that no matter how busy it may be sometimes, there is always someone is willing to help if I have a question or feel like I need to bounce some ideas off of them. If anyone has any questions at all about my experience or the program itself feel free to contact me williae1@mail.amc.edu.

 

I will definitely keep updating this blog with any latest experiences or news.

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Hey Everyone,

 

Its about that time of year...interview season! Looking forward to meeting all the great candidates for next years class. Interviews are right around the corner! Feel free to message me or the other fellows with any questions about the AMC ED fellowship, interviews at AMC or in general, or Albany itself.

 

As far as updates...I'm currently in the Surgical/Neurosciences ICU at AMC for the month of March. I'm loving every minute of it! Lots of acuity, lots of procedures, and lots of learning. The hours can be demanding during the month but it is an opportunity I would not pass up and I know its going to be make me a stronger provider when I return to the ED. After this month, I'll be 8 months done with the fellowship, and it's flying by. I still have a lot to learn and work on when I get back to the ED next month which I'm looking forward to.

 

Last month, I had my 6 month evaluation. It was much more formal then I was expecting but extremely beneficial. I had an  meeting with the directors Sara/Adam and had the opportunity to provide feedback to them on my experience and rotations so far. This is important because I know they take the fellowship very seriously and are constantly looking to improve the experience and make changes. Furthermore, the 6 month eval i received was extremely beneficial in talking about how I've been doing, what to work on, and future plans. It was great to see the constructive feedback I received from the ED and our off service rotations. It gives me great insight into how I'm doing and things I want to try and work on/improve over the next 6 months. Overall, I was really amazed at the constructive feedback the ED attendings provided during my review. It shows they really care and have my professional growth as a provider in mind.

 

With regards to the never-ending winter, in April we are heading out to Las Vegas!!! cant come soon enough. We will all be attending EM Academy sponsored by SEMPA/ACEP. Should be a great conference! Anyone else going to be out there? Let me know.

 

To those that have interviews coming up good luck and Trust me..you're making the right decision!!

Matt

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Well it has been a while since any of us have posted, so I thought I'd give everyone an update.... We're closing in on the last couple months of the program. Matt and Eric actually finish up next week. Jenelle and I have until the end of September.

 

Since the last update, we've all had the chance to spend a month in the Surgical ICU. I think I speak for all of us when I say that was a pretty great experience. Definitely a change of pace from the ED. Days start around 6am but usually end around 5 or 6pm, so that's kinda nice. For the most part it was 5 days a week. Very manageable. The morning was spent pre-rounding and then rounding with attendings and the rest of the clinical team. Each day you'd have 3-4 patients you were responsible for. Do a daily note, update medications, maybe a procedure or two... In the afternoon, admissions would start to roll in, which usually meant lots of procedures (mostly intubations, chest tubes, and central lines). All in all, it was cool to see what happens to our critically ill patients after they leave the ED.

 

We've also had the chance to get into the simulation lab a few times in the last couple months. Basically, we pair off into teams of 2 and each of us takes turns running some kind of critical care scenario. I got lucky enough to have the seizing infant/respiratory distress case... Aside from using the wrong end of the Braslow tape and probably overdosing the child with ativan, I think it went fairly well...! Our program directors, 2 ED attendings, several ED nurses, and one of the former PA fellows volunteer their time to help put the simulations together. It can be nerve wracking, but everyone is always so supportive and patient. We're lucky to have such a cool facility. I know that they're hoping to incorporate it into the the curriculum more heavily next year, too.

 

For the last 6 weeks, I've been working nights. We each do a stint of overnights in the A Zone (mostly trauma and critically ill patients with a sprinkling of psych patients). I was nervous about it. I wasn't sure if I was ready to handle the patient loads or the acuity level. I've got to say, though, that it has really been one of my favorite rotations. There have been some rough nights, no doubt. There have been times where I was counting the minutes until the AM team arrived... But my ability to carry lots of patients, sort out the sick from the not sick, and get people where they need to be has increased exponentially these last few weeks. When it's just you and one other resident carrying half of the department, you realize that getting stressed out doesn't change a thing. All you can do is keep seeing patients. We've had a fair amount of a stabbings, shootings, MVCs, etc... Working nights feels like much more of a "team sport" than days. It's been a lot of fun. Tomorrow is my last night. I'll miss it, but I'm also ready to have a normal sleep schedule again!

 

I got to fly with the LifeNet helicopter crew a few weeks ago, too. We only transported one patient during my two days, but we did get several calls and would hover around the scene of the MVC before being told to stand down. It was a cool experience. I have a new found respect for the medics and flight nurses who do that for a living. They are some of the sharpest medical providers I've come across and they all seemed to love their jobs. I can see why... I want to look into what kind of opportunities exist for PAs...

 

Other than that, it's been just a lot of regular ED shifts for the 4 of us. We've finished all of our off-service rotations. Jenelle and I are doing "electives" for the last month. For me, that means a few days seeing nothing but ortho cases, a few days of lacerations and plastics cases, a few days of bedside ultrasound, and a few days of fast track. Ironically, "fast track" patients are still one of the areas that I feel like I need more experience in. Learning to see lots of patients efficiently but safely is a skill that comes with time, and it's one that I want to start working on. I know in the "real world" there will definitely be a lot more pressure to move the meat.

 

Well that's all I've got for now. I'll check in one more time a few weeks from now. That will be right as I'm finishing up the fellowship program. Please feel free to PM or post any questions in the mean time....

 

-Andy

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sound like great experiences! Prob more excited to pursue a residency after graduation now.. I'm a few months away from my program rotations, so I have about a year left of school.

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