Blog Archives

Sleep As a Vital Sign

“Without enough sleep, we all become tall two-year-olds.” — JoJo Jensen, Dirt Farmer Wisdom

As a resident, I spent one horrible week on my surgical rotation clocking 138 hours in the hospital…and I slept only 6 1/2 of those. By the end of the week, I had decided to quit residency. Fortunately, a good night’s sleep helped me turn that decision around.

I recently heard an interesting AMA Journal of Ethics podcast called “Sleep as a Vital Sign” with Dr. Lauren Hale from Stony Brook University. In her interview, she clarifies the distinction between sleep medicine and the study of sleep as a public health issue, the latter of which is her academic interest. She offers policy recommendations to decrease morbidity and mortality from sleep deprivation, like eliminating daylight savings time and making school start times later. She also touches on how the lack of sleep adversely affects medical professionals. 

The podcast episode is brief and interesting. Plus, you can get CME credit for listening :-).

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NRMP® Data Indicates Matched Residency Applicants had Longer Rank Order Lists than Unmatched Ones

Over the years, the NRMP has published data regarding the impact of length of rank order list (ROL) on success in the Match. I first noticed information on this topic in a document called the Impact of Length of Rank Order List on Main Residency Match Outcomes: 2002-2016. There, the NRMP reported that matched applicants consistently had longer ROLs than unmatched applicants. More recently, this information has been validated in the NRMP’s Impact of Length of Rank Order List on Match Results: 2004-2023 Main Residency Match

Since the latter document assesses two decades of Matches, we can take it seriously. Those approaching the application process should consider a reasonably wide net in choosing residency programs at which to apply and then should include all programs on their ROLs that they would consider “acceptable,” meaning an applicant would rather train there than not Match. Of course, there is a financial cost to applying broadly, and that expense needs to be balanced. However, according to this data, matched applicants and filled programs consistently have longer ROLs than unmatched applicants and unfilled programs. The NRMP reminds candidates that a longer ROL does not adversely affect the chances of matching to choices higher on the ROL. Here’s a video that reinforces that fact. 

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Medical Student and Resident Mistreatment is Pervasive

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn’t something we were truly being targeted for: He likened the situation to Boston traffic – how drivers lean on their horns for little cause because they are simply frustrated about their days.

It’s not personal, he said.

When I got to my clerkships, I was dismayed to find that I had underestimated how often I would experience the mistreatment the well-meaning third-year had warned us about. As a medical student, I was berated on numerous occasions for absolutely no logical reason. Residency was worse. The sexism and cruelty was hard to manage, and yet, I had little recourse. 

In a recent piece, AAMC staff writer Stacy Weiner highlighted that, in 2023, at least 38% of US medical students reported having suffered mistreatment and that residents described similar rates. According to the piece, 75% of students and residents don’t report their mistreatment, at least in part because of concerns about retribution. 

The good news is that there are some institutions that are implementing systems to decrease mistreatment, including the University of Colorado School of Medicine and Penn State College of Medicine in Hershey. To its credit, Icahn School of Medicine at Mount Sinai created an online form to report mistreatment with access from every hospital computer.

Here is the AAMC article with more details about this ubiquitous, critical issue.

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If You’re an IMG, Make Sure to Review this Page

If you’re an international medical graduate (IMG) applying for residency this year, I’d recommend you take a look at the Educational Commission for Foreign Medical Graduates® (ECFMG) ERAS Support for Residency main page. There, you can find eligibility requirements, an overview of the IMG application process, a timeline, and details regarding which documents ECFMG ERAS Support Services will upload for candidates and what your obligation is regarding those documents.

There’s also technical guidance for your letter of recommendation writers, so you can direct them to online instructions through the Support for Residency main page.

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Applying to Residency this Cycle? Don’t Forget the New AAMC Fee Assistance Program for Residency Applicants 

Here’s a quick reminder that the Association of American Medical Colleges (AAMC) is expanding its Fee Assistance Program (FAP) to residency applicants this year.

The good news is that if you were previously approved for the AAMC FAP, you will automatically get a 60% discount on your residency application for this ERAS season.

The bad news is that current medical students are not eligible to apply for the FAP even if they now have financial challenges that they did not have prior to medical school or if they qualified before medical school but declined to apply for the FAP benefits.

The AAMC says they are going to survey “the student affairs community” to understand “if and how” they can further expand the FAP for residency applicants.

Here is more information with some frequently asked questions.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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