This post is out of a request from one of the readers. I probably wrote several topics in different angles. You finished AICM 5th semester so, now what do you do? Most of the students may feel that they were not fully prepared to take the USMLE Step 1 by the end of AICM 5th semester and they need to go over their weak areas and improve their basic science foundation. 

After you finished AICM this is what you need to do:

1. Take NBME and see where you are at in terms of your knowledge.
2. From the NBME, evaluate which topics you are weak in.
3. Plan out how you are going to cover the weak areas, such as using videos, First Aid book, and question banks (Kaplan, USMLE World).
4. Take NBME again, a different version, to see where you are weak at.

Keep one thing in mind, if you hear that a fellow student studied for several months after AICM and passed the USMLE Step 1, that doesn't mean that you can study for the same amount of time and pass. Everyone is different and everyone from the island studied differently. You are not ready to take the USMLE Step 1 until the NBME test tells you that you are above the passing range.

Check out, the steps on studying for the USMLE Step 1.

The following is a video of Jackson Park Hospital. This is good introduction for the students in Bonaire and Anguilla. This is where you will do AICM 5th semester and possibly your core rotations if not at Mercy Hospital. In the video you will see some of the residents of the hospital whom you will meet when you do AICM or do your clinical clerkship; that is if you start by this year or next year.

If you didn’t get the memo, then here it is, in order to start AICM or further clinical clerkships SJSM students are now required to be certified in not only CPR, but also in OSHA and HIPAA. Anyways the entire cost for OSHA and HIPAA cost be about $55.  Better to know this now then later because it takes a while to complete the two courses.  And if you haven't done so, then also get CPR certified.

OSHA Blood Borne Pathogens basically deals with how to handle hazardous materials in the medical area. It basically is about what to do and what not to do in the wards. OSHA training costs me about $30 and I was certified at compliancetrainingonline.com. The OSHA training typically takes an hour with a test at the end. However, since it is painfully boring it could take up to an entire day.

Basic HIPAA certification was the more boring one out of the two because unlike OSHA training, HIPAA training didn’t have an audio reading off the page. HIPAA deals with the privacy and security of medical information of patients. HIPAA laws were created because apparently criminals can steal medical information and make fraudulent transactions since the medical information is very sensitive. The HIPAA certification costs about $25 and it can be completed at myhipaatraining.com. HIPAA certification is supposedly done in 30 minutes, but it’s also so boring so it can take up to a day with a test at the end.

Also, note that you need to be CPR level C certified to also conduct clinical clerkships. I believe the certification lasts around two years and then you have to retake the course. Jackson Park Hospital offers it for $40 per student.

If you go on craigslist and you may see postings and think to yourself it’s too good to be true. For example, I saw a posting of a one bedroom apartment on 71st street for $550 with no security deposit. And it’s couple of minutes drive to Jackson Park Hospital. First of all, it’s not a scam, you really could get a place that cheap near the hospital; however, you are compromising your safety and the safety of your car. Any place near the hospital is dangerous. Unless your car is in a garage, you are most likely going to have your car broken into.

If you are going to stay near the hospital, then stay above 60th street, around Hyde Park, or around the suburbs like around 85th street. If you are driving and if you have a non-Illinois license plate just make sure you don’t bring any attention to your car such as sparkling things or evidence of you having a GPS system anywhere in your car, or a phone charger, etc.

If you are taking public transportation, then it’s very important to go to the bus stop in groups; a group of 4 or 5 students is a good safe number. Muggers, even with a weapon, would not have the guts to mug anyone if they were in a group especially at night when you have on-call duty.

With this bad economy, plus Chicago being a very corrupt city, thieves are everywhere because they can’t get a job and they will hurt others to gain money. So for those who are settling in Chicago, be wise and choose a safe area even if you are far from the hospital.

I got this question via email from someone who looking to settle in Chicago.  I gave a detailed and important answer and it might be helpful to those who have never been to Chicago before.  Don't mind if there are any grammatical errors because I typed it up very quickly. 

so I'm starting to look for a place to live in Chicago. Any good neighborhoods with nice apartments or condominiums that you know of near the Jackson park hospital? 

Thanks

And this is what I replied to him:

Live in apartments near Hyde Park (near President Obama's House) or around the University of Chicago, that's where most students from University of Chicago and medical students live. Also, a warning, avoid living near the hospital, that's dangerous area. Live north of 60th street; do not live south of 60th street.

Another warning is about parking of you're going to bring your car, come around 7:30 AM to get a parking space in the parking lot in front of the hospital. The parking lot is right in front the hospital on the same side facing Stony Island Ave. Do not park in the back parking lot behind the hospital; one secured parking lot is for doctors, where medical students cannot park, and the other parking lot, across the street, is insecure but whoever parks there gets their car window broken into. In the insecured parking lot, people who have cars with an out-of-state (not Illinois) license plate are targeted.

Also, if you're going to take public transportation, do not carry a laptop bag. I suggest a book back that has a laptop pouch inside. I recommend a Targus book bag with a laptop pouch from Amazon; it's the same type that I got and it's cheap. Carrying a laptop bag in front of the bus stop is asking to get mugged at knife point. I'm telling you this because one student got mugged at knife point last year at broad daylight; however this didn't happen in front of the hospital because there are police around the hospital. The bus stop closest to the hospital is 10 minute walk away.

First of all, Happy New Year people.  It's been a crazy past year for me as the Bonaire to USA transition; on top of that with only three week break after finishing Bonaire I started AICM right away in January 2011 and finished it in April 2011.

I know AICM is on the minds of MD3 and MD4 and so I'm trying to gather a lot of information about it and luckily I stumbled on information about it.  As you scrolled down you will see the topics in detail on what to expect when you attend the USMLE Step 1 lectures in AICM in Chicago.  Also, the following may seem overwhelming, but once you go through it once it's not that bad.

Biochemistry and Molecular Biology

• Gene expression: DNA structure, replication, and exchange, transcription, translation, including defects.
• Structure and function of proteins
• Metabolic pathways of small molecules and associated diseases
• Biosynthesis and degradation of other macromolecules and associated abnormalities, complex
• Carbohydrates glycoproteins, and proteoglycans

Human development and Genetics

• Embryogenesis: programmed gene expression, tissue differentiation and morphogenesis, homeotic genes, and developmental regulation of gene expression
• Congenital abnormalities: principles, patterns of anomalies, dysmorphogenesis
• Principles of pedigree analysis, including inheritance patterns, occurrence and recurrence risk determination
• Population genetics: hardy-Weinberg law, founder effects, mutation-selection equilibrium genetic mechanisms: chromosomal abnormalities, mendelian inheritance, multifactorial diseases clinical genetics, including genetic testing, prenatal diagnosis, newborn screening, genetic counseling/ethics, gene therapy

 

Behavioral Sciences, Ethics, Statistics

• Progression through the life cycle, including birth through senescence
• Psychologic and social factors influencing patient behavior
• Patient interviewing, consultation, and interactions with the family
• Medical ethics, jurisprudence, and professional behavior
• Quantitative methods
  
  • Fundamental concepts of measurement
  • Fundamental concepts of study design
  • Fundamental concepts of hypothesis testing and statistical inference

Pharmacology

• General principles of pharmacodynamic and pharmacokinetic
• General properties of autacoids, including peptides and analogs, biogenic amines, prostanoids and their inhibitors, and smooth muscle/endothelial autacoids
• General principles of autonomic pharmacology
• General properties of antimicrobials, including mechanisms of action and resistance
• General properties of antineoplastic agents and immunosuppressants, including drug effects on rapidly dividing mammalian cells

Microbiology

• Microbial classification and its basis
• Bacteria and bacterial diseases
• Viruses and viral diseases
• Fungi and fungal infections
• Parasites and parasitic diseases

Immunology

• Production and function of granulocytes, natural killer cells, and macrophages
• Production and function of t lymphocytes, t-lymphocyte receptors
• Production and function of b lymphocytes and plasma cells; immunoglobulin and antibodies.
• Antigenicity and immunogenicity; antigen presentation; cell activation and regulation; tolerance and clonal deletion
• Immunologic mediators: chemistry, function, molecular biology, classic and alternative complement pathways, cytokines, chemokines
• Immunogenetics; mhc structure and function, class i, ii molecules; erythrocyte antigens
• Immunizations: vaccines, protective immunity
• Alterations in immunologic function
• Immunologically mediated disorders
• Immunologic principles underlying diagnostic laboratory tests (e.g., ELISA, complement fixation, RIA, agglutination)

Hematopoietic and Lymphoid Systems

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes
  • Organ structure and function
  • Cell/tissue structure and function
  • Repair, regeneration, and changes associated with stage of life
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical injury
  • Neoplastic disorders
  • Metabolic and regulatory disorders
  •  vascular and endothelial disorders
  • Systemic disorders affecting the hematopoietic and lymphoreticular system (e.g., nutritional deficiencies, systemic lupus erythematosus)
  • Idiopathic disorders
• Principles of therapeutics
  
  • Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the hematopoietic system
  • Other therapeutic modalities

Central and Peripheral Nervous Systems

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, neural crest derivatives
  • Organ structure and function
  • Cell/tissue structure and function
  • Repair, regeneration, and changes associated with stage of life
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical disorders
  • Neoplastic disorders, including primary and metastatic
  • Acquired metabolic and regulatory disorders
  • Vascular disorders
  • Systemic disorders affecting the nervous system
  • Idiopathic disorders affecting the nervous system
  • Congenital disorders, including metabolic
  • Degenerative disorders
  • Paroxysmal disorders
  • Disorders of special senses
  • Psychopathologic disorders, processes and their evaluation
• Principles of therapeutics
  
  • Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the nervous system
  • Other therapeutic modalities (e.g., radiation, CSF shunting, surgery)

Skin and Related Connective Tissue

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes
  • Organ structure and function
  • Cell/tissue structure and function, including barrier functions, thermal regulation, eccrine function
  • Repair, regeneration, and changes associated with stage of life or ethnicity
  • Skin defense mechanisms and normal flora
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical disorders
  • Neoplastic disorders
  • Metabolic, regulatory, and structural disorders
  • Vascular disorders
  • Systemic disorders affecting the skin

• Principles of therapeutics
  
  • Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the skin and connective tissue, including anti-inflammatory agents emollients, sunscreen, retinoids, antimicrobial agents, cytotoxic and immunologic therapy
  • Other therapeutic modalities

Musculoskeletal System

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes
  • Organ structure and function
  • Cell/tissue structure and function
  • Repair, regeneration, and changes associated with stage of life
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical disorders
  • Neoplastic disorders
  • Metabolic, regulatory, and structural disorders
  • Vascular disorders
  • Systemic disorders affecting the musculoskeletal system (e.g., diabetes mellitus)
  • Idiopathic disorders
  • Degenerative disorders
• Principles of therapeutics
  
  • Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the musculoskeletal system
  • Other therapeutic modalities (e.g., radiation, surgery, casts, rehabilitation)

Respiratory System

• Normal processes
  
  • embryonic development, fetal maturation, and perinatal changes
  • organ structure and function
  • cell/tissue structure and function, including surfactant formation, alveolar structure
  • repair, regeneration, and changes associated with stage of life
  • pulmonary defense mechanisms and normal flora
• Abnormal processes
  
  • infectious, inflammatory, and immunologic disorders
  • traumatic and mechanical disorders
  • neoplastic disorders
  • metabolic, regulatory, and structural disorders
  • vascular and circulatory disorders
  • systemic disorders affecting the respiratory system
• Principles of therapeutics
  
  • mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the respiratory system
  • other therapeutic modalities

Cardiovascular System

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes
  • Organ structure and function
  • ell/tissue structure and function
  • Repair, regeneration, and changes associated with stage of life
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical disorders
  • Neoplastic disorders
  • Metabolic and regulatory disorders
  • vascular disorders
  • Systemic diseases affecting the cardiovascular system
  • Congenital disorders of the heart and central vessels
• Principles of therapeutics
  
  • Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the cardiovascular system
  • Other therapeutic modalities

Gastrointestinal System

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes
  • Organ structure and function, including alimentary canal, liver and biliary system, salivary glands and exocrine pancreas, motility, and digestion and absorption
  • Cell/tissue structure and function
  • Repair, regeneration, and changes associated with stage of life
  • Gastrointestinal defense mechanisms and normal flora
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical disorders
  • Neoplastic disorders, including benign and malignant
  • Metabolic and regulatory disorders
  • Vascular disorders
  • Systemic disorders affecting the gastrointestinal system

• Principles of therapeutics
  
  • Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the gastrointestinal system
  • Other therapeutic modalities (e.g., surgical procedures, stents, feeding tubes)

Renal/Urinary System

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes
  • Organ structure and function
  • Cell/tissue structure and function, including renal metabolism and oxygen consumption, hormones produced by or acting on the kidney
  • Repair, regeneration, and changes associated with stage of life
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical disorders
  • Neoplastic disorders, including primary  and metastases
  • Metabolic and regulatory disorders
  • Vascular disorders
  • Systemic diseases affecting the renal system
• Principles of therapeutics
  
  • Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the renal and urinary system
  •  other therapeutic modalities (e.g., dialysis, renal transplantation)

Reproductive System

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes
  • Organ structure and function
  • Cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroid and gestational hormones
  • Reproductive system defense mechanisms and normal flora
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical disorders
  • Neoplastic disorders
  • Metabolic and regulatory processes
  • Systemic disorders affecting reproductive function
  • Disorders relating to pregnancy, the puerperium, and the postpartum period
• Principles of therapeutics
  
  • Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the reproductive system
  • Other therapeutic modalities affecting the reproductive system (e.g., tampons)

Endocrine System

• Normal processes
  
  • Embryonic development, fetal maturation, and perinatal changes
  • Organ structure and function
  • Cell/tissue structure and function, including hormone synthesis, secretion, action, and metabolism
  • Repair, regeneration, and changes associated with stage of life
• Abnormal processes
  
  • Infectious, inflammatory, and immunologic disorders
  • Traumatic and mechanical disorders
  • Neoplastic disorders
  • Metabolic and regulatory processes
  • Vascular disorders
  • Systemic disorders affecting the endocrine system
  • Idiopathic disorders
• Principles of therapeutics
• Mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the endocrine system

Source: Advancedpreclinical.com

In AICM, you will be required to sign up for a QBank, USMLE World particularly; and you are required to complete at least 50% of the Qbank before finishing the semester. They require you to start the Qbank after the USMLE Step 1 prep review and at the beginning of the rotations of AICM. There are around 2100 questions from USMLE World QBank and completing 50% of it in 2 months is possible but with full concentration. However, in AICM you are required to complete around 1050 questions, which is 50% of the Qbank, with clinical rotations. In clinical rotations you will have to do presentations for each rotations, you will be at the hospital majority of the day, plus you are required to do overnight on calls for Internal Medicine rotation, and USMLE World is a very difficult Qbank. USMLE World requires a person full concentration and commitment to successfully get the most out of the Qbank. One of my friends, who was on dean’s list in Bonaire, took an entire day to do one block of the QBank because of the extreme difficulty of the questions.

AICM Schedule includes the first 2 months of USMLE Step 1 review in a classroom, then the next 2 months the students do orientation and clinical rotations in the clinical floor. With rotations one cannot complete 1050 questions and fully get through the explanations. The only way to get through the questions is to blindly and randomly click answers so the AICM instructor sees that you are doing the questions. By blindly clicking on the questions you are just satisfying the teacher and you’re wasting your money because you are required to pay for USMLE World questions which goes from $99 for 30 days to $400 for one year.

My advice to the upcoming MD4 students is to do USMLE World questions starting from MD4. You will have a lot of time in MD4 semester because MD4 classes not as difficult as MD3 classes. Most MD4 students in SJSM make the mistake of relaxing in the last semester because the hardest semester is over. However, MD4 semester is a perfect opportunity to get started in being better prepared than the previous students. If you are consistent with USMLE World questions then you can finish all of it before MD4 semester is over. If you just do 20 questions a day from USMLE World, and thoroughly go over the answers and explanations then you will have time to study for MD4 classes plus enjoy having fun in the last four months in Bonaire/Anguilla.

For upcoming AICM students, if you have at least 2 months before AICM semester begins, then finish on round of USMLE World questions for Step 1, and trust me you won’t regret it. By doing so you will be able to go over the questions faster in AICM and you will satisfy the requirement for a grade and you will get the most out of it.

If you finish USMLE World questions in Bonaire or Anguilla, then the USMLE Step 1 review in AICM will be very effective in helping you because it will be a very good review. However, if you don’t do the questions then the USMLE review will be a waste of your time, and you have no choice about it because you have to attend it for a grade.

If I knew then what I know now I would not have wasted so much time on the island twiddling my thumbs; therefore, take my advice and start early. I write these blog posts to help my fellow students in SJSM because no one else does; that’s why I take the time to write them because valuable information can make or break a student. The information is presented to you so, it’s up to you to use it, good luck.

Here’s the news people, SJSM raised their tuition $300 for basic science and $350 for clinical science. Here is the news letter with the updated info. SJSM was known to be the cheapest medical school in the Caribbean that had descent accreditation but I guess that change. I hope loans come out soon and stay permanently otherwise students will have trouble paying so much for clinicals. In my opinion if you want to go to SJSM but you don’t have money then take 2 years and save up the money, of course by then the tuition can go up even more. SJSM is gaining good accreditation and it’s developing very fast if you look into it. People in Bonaire told me the new MD1 class has 90+ students plus more students from the pre-med group. I don’t know how they could fit so many people in those two campuses. My class had 50+ students and we felt crowded.

As I progress through the months, I realized that AICM could’ve been well optimized if and only if I was better prepared in Bonaire. AICM can be a good program if taught by certain teachers but it can be a waste if it was taught by other teachers; however, the same can be said with Kaplan and Falcon review courses as well. My biggest mistake was that I started to prepare late. I cannot emphasize enough on that enough. When you’re an MD4 use every second of your free time to prepare for the USMLE Step 1. Of course you have to keep up with the MD4 courses, and that should come first, because without passing those you’re not getting off the island. Preparation early is the best option, but the living conditions in Bonaire was horrible for me so I was tired and I was not motivated to study. In MD4 semester all I could think of is how much longer till I get off the island and get back to the beautiful United States of America. But anyways that’s my two cents for now.

I know budgeting is a big factor for the MD3s, MD4s, and the upcoming MD5s. By now MD5s are probably settled, but I hope any advise I give will be helpful. Now the reason students from SJSM needs to settle in Chicago is because they need to complete 8-weeks of USMLE review and 8-weeks of introduction to clinical medicine. So those 16 weeks will be subtracted from the 96-weeks of rotations SJSM requires students to complete in order to finish the MD program.

Keep in mind, living in Chicago is expensive but if you spend smart then you will save a lot of money. The following is an idea of how much you should spend per month if you live in Chicago.

Rent, Utilities -> $600 (You will get that price if you live near Hyde Park)
Public Transportation -> $86 for Unlimited Rides for 30 days
Food -> $150

Now if you drive in Chicago then transportation will be a bit more expensive because Chicago is one of the cities with the highest gas prices in America. By this summer gas prices will reach $5.00/gallon for regular gas in Chicago. Also, most SJSM students live near Hyde Park, which is where President Obama’s house is located. Hyde Park is where a lot of students from University of Chicago stay. There is also the medical library which is free to access for SJSM students as long as they show their hospital ID. Most SJSM students study in the library because it’s clean, resourceful, quiet, and it’s free to all medical students.

Also, please include the AICM requirements of paying $180 for 3 months of a Qbank. Most students signed up for 6 months to a year because they refused to do the Qbank questions during rotations because they don’t get enough time to rest and study. Also include the $50 per NBME exam which must be taken at the beginning of AICM and at the end of AICM to measure your improvement. The NBME exams will not count for the certification to take USMLE Step 1 that SJSM requires which a score of 650 or above. A third NBME exam with a 650 or above is required by SJSM along with 75% or above in ExamMaster final. Keep in mind the ExamMaster exam is included in the tuition but not the NBME exam. So basically you will be spending $150 for the NBME exams.

So for food, living, and traveling with public transportation, a monthly expense will come out to $836; now multiply that by 4, the total comes out to be $3,344. In the 4 months of AICM also add $330 on top of the total; it comes out to be $3,674.

I know it’s a lot but if you gain a lot of connections in Chicago, your spending could be lower; good luck.

As you know for the AICM 5th semester, we have 8 weeks of introductory rotations to complete. And within these 8 weeks every student is required to complete 4 on-call shifts: 2 for Internal Medicine, 1 Family Medicine, 1 Surgery, and 1 OB/GYN. For me AICM is completed and as I prepare to head to my home state I found a little time to write this post to give prospective students a heads up on what to expect.

Internal Medicine

For IM, we have to do one shift in a weekday and another in the weekend. In a weekday we have to complete a shift from 8 PM to 8 AM the next day. On a Saturday or Sunday we have to complete a shift from 8 AM to 8 PM. During the weekday shift, it’s was tough for me, since I have to stay up all night. On my shift I had to take history and physical for a new patient and present the case to the on-call resident who’s on the floor. He doesn’t go to the patient, instead he listens to what I got from the patients and he looks over the patient’s charts. Most of the times the nurses on the floor will take care of the patients who are admitted while the medical students and the residents joke around and goof off in the residents room. During the night, each medical student will take turns to sleep for couple hours or more while the other students admits new patients or check up on other patients who are already admitted. I can’t sleep in the hospital so in order for me to drive home safely I consume as much caffeine as possible so I can drive home awake. After my shift was done at 8 AM, I had to attend the morning report which lasted till 9 AM.

Family Medicine

In this rotation, we have to come in during the day to complete our duties in the Family Medicine clinic. After the clinic closes, which is around 4:30 or 5 depending on the day, we have 3 hours to do whatever we want. At 8 PM we have to join the Internal Medicine students and basically do Internal Medicine on-call shift. And just like Internal Medicine, we have to show up for the morning report.

OB/GYN

This is one of the most boring shifts I have ever had. It’s not that the OB/GYN rotation is boring, it’s just that there isn’t many patients admitted to OB/GYN for us students to see anything. OB/GYN and Pediatric students are side by side because the nursery is in the OB/GYN area. The on-call shift for this rotation is from 8 AM to 8 PM.  I went to the OB floor and put my cell phone number and name so the nurses can call me whenever they need me; it's mandatory. After attending the morning report, I had to go to the Family Medicine clinic and sit with the attending while a senior student reads his/her presentation. After his/her presentation the attending explains the topic presented form his/her experiences.  Afterwards, I went to the floor of the clinic and helped out the residents till the clinic closed.  For the rest of the day I go to the Internal Medicine floor and the OB floor back and forth.  During my on-call shift there were two ladies who were in labor but there were a lot of students around so I didn't stick around much, I went to the Internal Medicine floor.

Surgery

The surgery rotation is another boring rotation since you don’t do anything. You basically stand back and watch patients in surgery. Most of the appointments are not even surgeries, they are nothing but colonoscopies.

What is a morning report?

The morning report is a routine seminar everyday in which a resident presents a case in front of medical students and an attending and describes how he/she diagnoses the patient. After the resident completes his/her presentation, the attending takes over. The attending, which can be any doctor, goes further in the subject and explains the case and the cause of illness of the patient. This seminar takes roughly an hour or so to complete. Within that hour you will see other residents and medical students eating their breakfast or checking their FaceBook on their iPhones, or whispering about what to do in the weekends.

Is there any attendance rule?

All students scheduled for the on-call rotations have to have an attendance sheet signed by a resident or an attending after the on-call shift is completed. The education office of the hospital will also give out three meal tickets per on-call shift which accumulates to $15 in lunch/dinner or $9 in breakfast. At the end of the semester the sheet must be turned in along with all the other paperwork and assignments to the education office. The medical office will give each student a grade and submit that grade to Saint James Medical School which will count for rotations.

Dress Code

Medical students on their on-call shift will have to wear scrubs. These scrubs are given by the hospital. And no, you don’t have to pay anything extra for them.

As you know AICM is mandatory for our class. I want to go over what to expect so you’ll get an overview of what’s going on. The pre-clinical program is divided in 8 weeks. The first 2 weeks has to do with preparations for the clinicals. The first week has to do with labs, which includes practicing injections in dummies, nasogastral tube insertion, catheter insertion, etc. The second week deals with EKG and orientation for the clinical. In this week there is no fixed schedule, you have to show up when the doctor shows up and the worst part is if you come to the hospital after an hour and a code yellow occurs then you have to leave and the orientation is cancelled, fun huh? It’s very frustrating and time consuming.

For the rest of the 6 weeks you will be split in groups for your rotations. The rotations include:

1. OB/GYN
2. Internal Medicine
3. Family Medicine
4. Surgery
5. Pediatrics
6. Psychiatry

Our On-Call schedule are as follows:
Internal Medicine – 2 Shifts
8 PM – 8 AM Weekdays
8 AM – 8 PM Weekends

Family Medicine
8 PM – 8 AM Weekdays

OB/GYN
8 AM – 8 PM Weekdays

Surgery
8 AM – 8 PM Weekdays

While doing the rotations you will also be assigned to do presentations on a topic classified within the rotation. Also during rotations you have to complete 2000+ questions from a desired QBank. It’s a lot of materials they throw at us and unfortunately they expect us to study well for USMLE Step 1 while being on this hardcore schedule. So, my advice for all those of you still in Bonaire and Anguilla, prepare yourself.

Look ma, I’m updating my blog. Yeah I know I haven’t updated anything for a while. The reason is I’m finally in the rotation part of AICM and it’s taking so much of my time. Some say it’s a waste of time but you actually see what illness people have and you learn a lot from it. I already got on-call rotation and it’s hectic.

In rotation no one will hold your hand. As in, you can do whatever you want go where ever you want and no one will keep an eye on you. However, you have to have certain papers signed by doctors and residents at the end of the week and turn it in to the administration. We also have topics to write about and present it to our preceptors. On top of rotations we have to do USMLE QBank questions and it’s just so much to do at once.

On my call I did history of a patient with few of my colleagues. We asked questions regarding their health, chief complaint, social history, family history, etc.
Right now, it really does not matter which school you went to. I’m working with students from ROSS University, American University of Antigua Medical School, International American University Medical School, and several more. The greatest part is we’re working with these students from other schools and yet we’re paying for rotations at a cheaper price than them; I guess that’s what makes Saint James School of Medicine stand out.

Also, I’m also lucky to see my old senior students from SJSM. They know me from Bonaire so they help me out; they all passed the USMLE Step 1 so they help me out of what I need to do and where I need to go.

So far, I’m enjoying the clinical setting and this is it. We are finally here minus taking the Step 1 which I will be taking soon. And when I do sit down and study for it hard core then this blog will not be updated for a long period. If you send me any email after April then don’t expect any replies until I’ve taken the Step 1, sorry but I have to do this.

Another day and another class I have to sit through in AICM. Fortunately, we have one more week to complete before we jump on to the clinical clerkships. The February batch came in earlier this month and the class seems to be packed. In a way it’s like Bonaire all over again. I have been seeing my classmates for 16 months and now more time with them; they seem like a family now.

Now we have to be in the hospital for the next 7 days straight to finish up everything for the review. The reason we’re not getting the weekends off is due to the convenience they are trying to give us. Instead of being in the hospital for 12 hours from 8 AM to 8 PM, we just have to show up for clinical clerkships from 2 PM to 8 PM excluding the on-call shifts. So, we only have to be in the hospital for 6 hours so we get the other half of the day to work on QBank questions. The AICM director in the hospital made it mandatory for us to sign up for USMLE World questions since it is the highest rated QBank out there.

Advanced Introduction to Clinical Medicine semester is broken down in two separate sections. Before the students had to do clinical rotations plus attend the lecture classes; however, lectures and clerkship gets in the way of each other. If someone is at surgery rotation then he or she cannot attend the lecture classes if the surgery does not finish. To make things easier from now on, students are to attend the lectures for the first 8 weeks; afterward, in the 2nd 8 weeks students complete the assigned clinical clerkship.

So far I’m in the lecture portion and I haven’t experienced clinical yet so I cannot write anything regarding the clinical clerkship.

For the first two weeks it’s a pain because we’re in the hospital till 7 PM. Some days we have to come at 8 AM and other days we have to come at 2 PM but we usually leave after 5 in the evening. And whenever we come home late we’re tired and we need time to relax and by that time it’s already 9 at night so, we don’t have time to study. However, after these two weeks we will back in our normal schedule, 8 AM to 2 PM. Even in that six hours we only get 10 min break in every hour, with no lunch break so, after 2 hours most of us loose attention and wonder off. Some of students are texting or playing games on the phone, others are on the PC, and others are talking in the back.

NBME Exam
Everyone took the NBME exam this week and by no surprise majority of the students performed badly. They performed badly not because they didn’t study, it’s all because the preparation wasn’t as strong as it should be in Bonaire. However, now based on how they can study and perform academically, they will now need to review all the concepts of medicine and establish that strong foundation of medicine so they can do well in the USMLE tests.

It’s been a while since I wrote a post; the reason being is I just graduated basic science and I had to get things prepared for AICM once I arrived in America. I am in the January batch for AICM so I had less than a month to turn in everything and head to Chicago on time. It was a pain getting the paperwork done for the hospital; however, they were not BS papers the Bonaire government asked for. They were papers the hospital asked for such as insurance and immunization proof. The following is what I had to get or sign:

Personal Health Insurance

Immunization Proof

- MMR

- Hepatitis B Vaccination

- PPD Test/BCG Vaccination/Chest X-Ray for TB

- Vercella/Zoster/Chickenpox

Personal Health Insurance

Liability Insurance

Student Clinical Contract

CPR Certification

Police Report

Now, the AICM program is held in a Chicago hospital; I will not say which hospital for legal purposes. I don’t think it would be a problem to say which hospital but I rather be safe than sorry.

For AICM we have to get our drug test done at the hospital, which is $20. AICM is a prep course and an introduction to clinical clerkship. AICM seems to be an 8-weeks review course to prepare for the USMLE Step 1 and another 8-weeks clinical clerkship. The review course was created to help us; however, I don’t think it’s helpful. In the beginning we have to take NBME test and another one at the end of the 16 weeks. SJSM requires AICM students to pay for NBME test which is $45 per test. On top of that it’s mandatory for us to sign up for USMLE World and the lowest price is $180 for 3 months. So, we’re looking at $270 on top of the drug test. These charges and requirements were a surprise for me, but it looks like I have to do it.

USMLE Step 1 Restriction

SJSM also has set forth new restrictions for the students who graduated basic science. The teaching in Bonaire isn’t sufficient enough to get a good score in the USMLE Step 1; therefore, you need to do more in order to get a 90+ on the test. According to the new rule SJSM set, students need to get a 650 or above on the NBME exam and at least a 75% or above in the Exam Master test made by the SJSM office. I don’t know about you but 650 on the NBME is a 99 on the USMLE Step 1. The funny thing is this rule is not set in stone and it’s not written anywhere.

I made a mistake for signing up for the AICM so early. If I took AICM at least 4 months after basic science then it would give me enough time to study and so I would be fully prepared to get a 650+ on the NBME exam. If you get a chance to delay taking AICM I advise that you do so. Take the extra free time and study for the USMLE Step 1.

One of the students of MD4 got in contact with the SJSM students who is in AICM; so far we got an idea of how AICM is going to be. The schedule shows that we are basically in the front lines of clinical treatments in the hospital because we will be watching everything live.  The schedule is something like this:

9 AM – 1 PM
USMLE Step 1 Review – First Aid Book is the outlines

1PM – 2 PM
BREAK

2 PM – 8 PM
Rotations

And we get 2 on-call shifts during the week. That means we cannot leave the hospital and we get called anytime of the day, even at 3 AM in the morning. I heard we have to sleep in the doctor’s lounge when we want to sleep, but it’s not going to be the regular 8 hours of sleep I guarantee you that. So overall we’re getting a little taste of residency but without getting involved.

Dress Code
I don’t know about the girls but for the guys we have to wear dress shirt and tie, basically the whole formal wear. And we have to wear it 5 days a week. The only time we wear scrubs is during our on-call shifts.

The schedule looks pretty intense since it looks as if we’re in the hospital all day. Someone also said that you have rotation only 8 weeks out of the 16 weeks but I could be wrong. However, if that’s the case then I’ll have time to study for USMLE Step 1 in the 8 weeks when I don’t have rotations. I’ll be honest I cannot study in the classroom with an instructor lecturing me. I have to sit down in a silent room with a book and read the materials myself.

One thing I’m happy about is, these 16 weeks counts for the 96 weeks of rotations we have to complete in order to get our MD degree from SJSM. And when we review for USMLE Step 1, it counts for our rotation weeks, which is just great. Although, I’m not too excited about staying in Chicago, because I heard during the months of January to mid-March the weather is pretty bad. Chicago gets a lot of snow during those months. My Canadian classmates won’t have a problem though since they’re used to the snow and cold but I’m from a Southern state where snow comes one time every 3 years. And in the South if we even get one inch of snow all our schools close, but in Chicago one inch of snow is like rain drops. Go figure, it’s all good, let’s see how it goes.

I haven’t blogged in a while because MD3 studies occupy a lot of my time. Sometimes it’s overwhelming, especially microbiology.

Last week the dean came to the MD3 room and gave an announcement on a solid decision made by the Chicago office administration. He said: “I have good news, and I have bad news. The bad news is we have the so called ‘5th semester’ in Chicago right after Basic Science classes. Now the good news is, I am still the dean. ” Lol…he started off with his random jokes because apparently this 5th semester is bad news to a lot of people in class.

What’s the Scoop
So, here is what we got about the 5th semester, Advance Introduction to Clinical Medicine semester; it’s basically the clinical rotations moved up 4 months. AICM is also done by Ross Medical School in Miami, FL but SJSM will do it in Chicago, IL. The initial plan is that after basic sciences students get about 4-6 months to study, to prepare, and to take the USMLE Step 1. However, with this change in curriculum, students are now required to complete the AICM semester before they are allowed to take the USMLE. They said the new semester is supposedly created to help students pass the Step 1. The semester is a complete 16 weeks semester, with 8 weeks for just clinical clerkships, and the other 8 weeks with Kaplan-style reviews. Then we get 2 months to take the test and to get rotations set up.

The new semester is part of clinical sciences so it’s not $4,500, it’s $7,200. The $7,200 covers both the tuition and the hospital fees, but in addition to it the student has to pay a $800/year liability insurance. Apparently they have jacked up the tuition price from $6,900 originally; we have to pay $400 more per semester now. I just hope they keep the prices how it is until my class graduates.

The 16 weeks in Chicago count for the 96-weeks clinical clerkship so, now we have 80 weeks to cover for clinical clerkship. ACGME requires 72 weeks in order for students to sit for the Step 2, but I’m unclear on why SJSM requires 96 weeks.