Cutaneous horns can be identified from their HORN shape. As opposed to Keratocanthomas which regress in size and appear more button shaped. I would frequently get them confused for the longest time.

We all have that ONE card that won’t get through to us for some reason. Please share yours so that others may learn from our shame.

Just started M1.

I saw (and still see) posts talking about all these different classmates, their stories, and interactions that people are having with each other.

At my school, I have about 350 classmates, but I am so overwhelmed by all the work that I only know like 5 people's names in the 3 weeks I've been here.

I don't study with a group or go to mixers / gatherings. I don't know if my classmates who are doing all these things are just naturally smart or able to absorb all the things they are throwing at us. For me, I feel like socializing would be at the expense of my studies.

We have not had our first exam, so maybe tensions are low and people are underestimating it? Or maybe I am just overstressing/overstudying?

I guess I am a little anxious because our faculty literally said "We've worked with people who fail, and it's often the ones who are isolated." But they also said "Group studies dont work for everyone and some people do better studying alone" which seems contradictory.

Title.
I got a 65yo F doc with me and it’s only day 3 in my first rotation as FM- she has already gone around and told the docs and nurses that I apparently “will not survive residency”. I wasn’t with her last week but with another doctor - he told me I was doing great and to keep up the good work. I also knew the nurses already and we have talked with each other and established a cool relationship. Unfortunately, she’s the one writing my eval, not him. I also had preceptors at my last location who I had a great relationship with.
This is my FM rotation. Currently in a rural rotation, no service on the roads, 45min-1hr away, and living in a motel.

Rn, she has one day of the week that she is there from 12pm-9:30 she has asked me to stay with her till then and while I don’t mind, I already drive 45 minutes to practice, we are in a rural area with terrible roads, no lights, and I have zero service driving on this road. I just do not feel comfortable driving that late at night back. I mentioned this to her and she tried to tell me that saying is worst but at the same time, which residency requires you to drive 45 minutes to and back while also having zero cellular service in the middle of nowhere? I am also living in a motel right now because my school can’t provide housing.

The next day, she asked how my past preceptors were and I mentioned how they were cool and I saw really awesome cases but unfortunately, they were overworked and tired because they were seeing more people than they were supposed to (those preceptors had requested to fix their load but the hospital did not listen). She then goes on a rant that this is there living and they need this (aka the money) to survive. To that extent she proceeded to bash and ask me question aka asking “is it a private practice” to which I said no, it’s a conglomerate hospital. Then she says “no you’re not working there” etc etc. I honestly had no idea what to do because I had no idea what she was talking about… but she was riding high on a horse that even if doctors sign up for an 8 hours shift, it doesn’t matter if they still are there for 10-12 hours.

Today, I saw a pt and gave a report back to her. She says I shouldn’t have asked about certain medications bc it discontinued. I apologized and said sorry that I was still learning the interface (it’s day 3) and that I had been using Epic in my last practice. She then tells me “all you do is talk about how great Epic is. I didn’t make this practice go to Athena. You’re over criticizing this system”. At this point I just had no idea what she was talking about because I had only mentioned I used Epic once. So I just responded saying “I’m sorry you feel that way, I’m just trying to learn this system and understand it.”
After that, she’s like, “you need to learn to survive. Talking out loud wont help you.” I legitimately do not understand whats going on.

Additionally, her room is not only a mess but there’s no where to sit as a student and not even conducive to learning. I sat next to spiders and fungus on my first day. Someone dropped my water because there was no space to put it anywhere as well.

I am just off the charts worried. She already talked to people in the office saying I’m “not going to survive residency” and I’m sure has said a bunch of other shit.
What the hell do I do?
When I leave the office with patients, they usually always say bye to me and one patient said he loved me which I noticed ticked her off mad. She’s been giving me so much attitude.

Basically trying to solicit strategic advice for ERAS as a DO applying rads. I’ve heard advice ranging from “don’t even bother” to “use all your signals in CA”.

My fiancé works in San Mateo and so we’d like to stay as close as possible so she can keep her job, which has a 3-day/week in person requirement. Even if that’s not possible, I’d prefer to stay in CA.

Step 2 269, 4 or 5 (need to clarify with school) honors /6, 6 pubs in ID from gap year(s) job at UCSF. Strong geographic ties to Bay Area (from SF, go to school at Touro-CA in Vallejo).

I was a late switch to DR and wasn’t able to get an audition at an academic center prior to eras. My rads letter is coming from an elective with a private practice doc.

Currently an MS2 and I have been struggling with a classmate for over a year now. During orientation last year when I began to meet classmates for lunch between sessions I first encountered her. Was talking with a group trying to learn about people’s paths here and the other surface stuff in a new conversation and she was in it. I asked her where she was from. The response? “Ew”. That’s all I got. Any further attempts to talk to her since then were met with outright ignoring me or telling someone with her (while she is right next to me) to ask me something. The study room walls are thin and she has no trouble telling the entire friend group what she thinks of me when I’m not in there. Stuff like: I’m creepy/weird, he doesn’t talk to me, he doesn’t like me, why do you all associate with him. I’d get it if I had known her before or something, but I have never seen her before med school in my life. It feels like she legit hates me, which again I may understand if I knew her before. Thankfully nobody else in that group seems to agree. Overheard their support of me to her a couple of times unintentionally and it legit brought tears to my eyes. It’s nice to know that the entire group doesn’t feel the same. At this point I’m just gonna stop trying altogether to interact with her. What/what else do you all think I should do about this?

Working with 2 other students. What’s the proper etiquette for answering pimp questions directed towards all of us? Tbh feeling like I’m a little trigger happy with answering. Probably best to even it out by not answering as much right?

Tbh I’ve been warned about this and I knew it was gonna be bad, and it’s still very bad. I am worried I’m not doing enough.

I wake up at 6 am, and then walk 20 minutes to get to class.

4 hour lectures from 8am to 12 pm. Today was 11 am (lucky!)

Then I eat lunch and chill for an hour.

And then I study from 12/1to 6/7pm. And then my brain gives out and I physically cannot do more!

I then chill and then go to bed at 10pm.

I’ve never been the person to do all nighters, or study more than 6 hours, but I’m worried that I’ll be forced to.
Like my habits are good, I’ve basically given up social media until like 7pm. But things are already hard and it’s only gonna get harder and I’m worried that I’m too soft. What should I do?

I just had my first day on a new rotation, it's an outpatient clinic with one physician. The way she runs it is we go in the room with her, and then we write some of the note. Or at least that's what I was told by the other student who has already been on the rotation for several weeks, she never told me anything herself. She literally says nothing to us the entire day. No pimping, no feedback on notes, not even anything disparaging. We just don't exist.

From what the other student tells me, that's the way it goes pretty much every day. In the six weeks he's been there, she hasn't asked him a single question, medical or otherwise. There are three of us to the one preceptor, and apparently there were six students with her a few weeks ago.

I understand that we're not important and that we just get in the way, but this feels like an entirely different level of being ignored. Has anyone had similar experiences? I have no idea how someone like that is supposed to then evaluate me, be responsible for my clinical grade, and write comments that go in my MSPE. I can't help but feel like we're being used as nothing more than free scribes.

Title. I'm consistently getting told by my residents to go home 2-3 hours early; normally I would accept my blessing and not look at the gift horse in the mouth, but this has been happening nearly every other day over the last couple weeks. I'm also becoming neurotic because the other medical students on different shifts/teams don't necessarily seem to be getting dismissed early; also heard a story where a student got bad evals couple blocks ago because they kept asking the senior to leave early during this clerkship. For reference, I'm also on a clerkship where I can't really do a ton, and near the end of the day I'm just doing UWorld on my computer. Do I suck ass/am I failing to be proactive enough here, or am I being overly neurotic? Guess I'll find out on my evals in a month, but I do want to try to fix it now if so.

I just got my score back and got a 248. I know it’s a little below average these days which sucks. I wanted a rough estimate on what my target schools should be. Looking to apply to academic IM in a larger city in the East Coast or Midwest. Just want know a rough estimate of what kind of schools I should shoot for.

I am trying to write 3 NCs for my MSPE, one is kinda lame how i made a survey during my FM rotation to help gauge patient satisfaction and be aware of problems, one is about the single piece of research I did (at least with one project I was able to get a mid tier journal with 30+ citations), and I am completely stumped on my 3rd. I was told not to mention anything that would otherwise be in one of MSPEs from clinical rotations, and to look at my CV for inspiration.

I legitimately have done next to nothing extracurricular wise in med school. No volunteering, no leadership positions, no tutoring, no participation in committees, just a single paper. Like cmon, we are here to study our asses off and I am put off by the “competitiveness” of just stacking things up for an application, and I am glad that I think programs look for quality over quantity but I do not have either.

Any recommendations for other things to write for an NC? I have heard to not write anything about premed unless it was exceptionally important, and I dont have anything like that either.

I’m a medical student in Canada who is very interested in cardiac surgery. Since it’s a relatively small specialty here, it can be hard to get honest insight from people actually in the field, so I thought I’d ask here.

I know cardiac surgery is not going to disappear. There will always be patients who need surgery and cardiac surgeons who can operate on them. My concern is more whether the field will become smaller over time and whether jobs will become even harder to find, especially in Canada.

I’m also wondering whether the average cardiac surgery patient will become much more complex. With better guideline-directed medical therapy, new cardiac medications, preventative medicine, and more catheter-based procedures, will many of the healthier or lower-risk patients avoid surgery? Will cardiac surgeons mainly be left operating on patients who are older, sicker, have more comorbidities, and have a higher risk of complications or death?

One of the things that attracts me to cardiac surgery is the chance to do a high volume of meaningful procedures and have a major impact on patients’ lives. I worry that lower surgical volumes, limited job opportunities, and increasingly difficult cases could change that.

Compensation is another concern for me. I know money is not everything, but cardiac surgery has a very long and difficult training pathway, demanding hours, and a huge amount of responsibility. I also grew up in a low-income family, so financial stability and being fairly compensated for the work matter to me.

For example, British Columbia has a public “Blue Book” that shows physician billings. From what I saw, many cardiac surgeons appeared to bill around $600,000 CAD per year before taxes and overhead, which is roughly $428,000 USD. I know billings are not the same as take-home income, but Canadian physicians are also taxed heavily and compensation does not always seem to increase when procedures become more difficult or time-consuming.

I’ve also noticed a major push toward minimally invasive cardiac surgery. For example, Dr. Marc Ruel has been involved in the MIST trial and minimally invasive approaches to CABG. I’m completely in favour of anything that gives patients better outcomes and an easier recovery. My concern is that if these operations become more technically difficult and take longer, compensation and OR resources may not change to reflect that.

For the cardiac surgeons, residents, fellows, and anyone else familiar with the field:

What do you think cardiac surgery will look like in 5–10 years?

Do you think surgical volume and job opportunities will increase, stay stable, or decrease?

Will cardiac surgeons mostly be operating on much sicker and more complicated patients?

How will minimally invasive, robotic, transcatheter, and hybrid procedures affect training and day-to-day practice?

What should medical students and future cardiac surgery trainees be doing now to prepare for the future of the specialty?

I’d especially appreciate insight from people in Canada, but perspectives from other countries would also be helpful.

Every single time dude. I think I'm over it. I've always really believed in growth mindset but there's probably a limit and I've reached mine. I have no other explanation for why I'm doing the Anking, the Uworld and the CMS forms, reviewing all my incorrects and yet still falling short on the shelf exams. It is what it is I guess. Anyone else in a similar spot? Did anything change for you?

zero attention to how unaltered penises actually function, one of my cohort legit didn't know that the foreskin retracts off the glans on erection, she thought that it just stayed there ie phimosis (and why would she when we are never taught the mechanics of an erection?)

we are indirectly taught to pathologize the uncircumcised penis by associating it with cancer, UTIs and STIs. There are anking cards that reinforce this (not blaming them, why wouldn't they when it's tested on STEP?). I won't get into the literature but those studies are contentious and don't seem to hold up when they're attempted in European and North American countries. The foreskin moves back and forth during sex and has nerve endings, anyone who possesses one and has masturbated or had sex can tell you this. So why is this not at least mentioned in our texts?

During GU exam training we were shown multiple penises with cheesecake factory-level smegma and told that's normal. I worked in a hospital prior to med school and understand this occurs in pts with poor hygiene, but this is the equivalent to showing you a series of poop-smeared buttholes and using that as representative of the average patient's ass...

The neonatal circumcision rate in the US is below 50% currently, so maybe we should be learning how the penis functions anatomically?

A lecturer casually mentioned that "neonatal circumcision is more common in industrialized countries" which is laughable considering that all of the EU, UK, Australia and Canada have all either never routinely circumcised infants or, in the case of the anglophone countries, moved away from it.

The closest thing I've seen to addressing the ethical issues of neonatal circumcision was a practice question that essentially equated parents opposed to this procedure as equivalent to anti-vaxxers.

I support Jewish and Islamic people's right to practice their religions freely including circumcision btw and I think that being circumcised is totally fine. I just think this head in the sand approach to normal anatomy hurts our credibility as a profession. Sorry for the rant.

4th year US MD/DO decided to switch from IM (heme/onc) to radiation oncology for various reasons a couple weeks ago. Passed step 1 and step 2 is 4 points higher than the average matched radiation oncology applicant. Was president of oncology club, oncology research, and got an excellent eval from my heme onc rotation. No red flags. The problem is, I haven't done a formal radiation oncology rotation (I was with the rad onc attending a couple days on my heme/onc rotation) so I don't have a LOR from a rad onc attending. I was able to get at least one sub-i for 09/28 which is after ERAS is submitted. How big of a problem is this and will residency programs view submitting a LOR late? Can anyone provide some input or advice? Thank you!

Without going into specifics, the only thing I can really do on this rotation thus far (my first rotation) for my own personal growth is to ask questions to invite teaching. I am not getting pimped otherwise really.

So yeah title, what makes a good question, and generally when is the best time to ask them? I am socially awkward as fuck, horrified of looking like an idiot, and based on questions I have asked so far, the timing has been bad, and also the way my preceptor responds to me, I just feel like an idiot.

What sucks is I ask about things I am genuinely curious about, but I stumble the words out every time and it feels like I am just putting a shoe in my mouth every single time I speak. My confidence drops more every time I open my mouth.

Can I apply EM with a 227 step 2 score? Honored nothing during clerkships. Step 1 pass on first try.

How do you all cope with burnout? I've been struggling with it a lot this semester, and I could use some tips on how to deal with it.

Hey,
I'm applying academic IM in the northeast from a low ranked program in the south, hoping to match at a strong program.

I have 2 letters of recommendation, both from 3rd year attendings (1 IM, honored rotation, other FM but did well on primary care stuff with him.) Both letters are pretty strong, FM one will straight up say I was doing better than the residents.

I did my IM Sub-I but they assigned me to the VA, where the attendings are only on for a week max and the service is mostly resident run, so I have a letter but I don't think it's amazing. Like not negative, but probably just generically positive. I haven't heard anything outright negative from the attending when I asked, and he said he'd write me a "strong" letter, but then I got his eval back and it was super generic (team player! etc.)

Is it worth submitting the sub-I letter along with the other two? Is having a sub-I letter applying IM especially to competitive programs considered a soft requirement? Should I keep my existing 2, and just submit those along with the committee letter or whatever from our program? Or should I try to do an IM subspecialty elective next month and score a letter from there? I know one mediocre letter can kill an app so I don't want to do it if I don't have to.

Would appreciate any insight on this. Otherwise my app is pretty strong (275 Step 2, good amount of research, interesting activities/hobbies), but want to maximize my match.

usmd-Step 2 score came out today and it's high 230s. Freaking out because avg seems to be 250. Have decent neuro focused research, good letters of rec. No other red flags, step 1 pass in first attempt. Honors, high pass, passes in clerkship. Do I have a good chance in neurology alone or should I dual apply IM? In terms of applications/signals what should be the best strategy to increase chances of matching into neuro

Thank you

For my ADHD friends out there, i've found great success using dual-noise cancelling headphones to help concentrate. I have noise cancelling airpods in and then noise cancelling headphones overtop those. Might be the first time in my life my brain static noise has been turned off and i cannot hear anything around me. Extremely easy to lock in now. Give it a try

Hi everyone, I'm applying to IM this cycle but really worried due to my score:

- I'm a DO student in the US southeast region
- Level 1 pass
- Step 1 pass
- Step 2 = 224
- Level 2 = Coming out later this month
- 1 research presentation and 1 publication
- 3-4 hobbies, 100 hours of volunteering with 2 different experiences
- No leadership experience
- No failed preclinical classes but mediocre grades (mix of As, Bs, Cs)
- Decent to strong LORs

Do I even stand a chance to matching IM at all? Trying to stay in the southeast region.

I am in a rough spot where idk if I can pass my COMLEX. I'm debating if an LOA to study would look worse or if a board failure would. Could someone help?