3.09.2012

Is being an ER doctor as cool as it seems?


(OR - Quit Medicine? Part II)


As a group, doctors are not very good advocates.


Not for themselves, not for their patients, and not for their profession.


Gradually (and not so subtly) everything non-medicine has played increasingly larger roles in interfering with the doctor-patient relationship. Everyone suffers (even those greedy bean-counting executives suffer when they finally succumb to their own illnesses, or as they deal with trying to navigate American healthcare for their families). And instead of demanding a seat at the table, exercising their responsibility to weigh in on all things medicine...they sit on the sidelines and complain.

But this is beside the point.

My point today is to talk about whether or not choosing emergency medicine (or even choosing a career in medicine) is what I thought it would be.

Let’s start with what I thought it would be like.

***

I knew, as a medical student, that my role was insignificant. I knew residency was hard with long hours and physical exhaustion. I understood that college and professional school would be expensive (and accrue a large debt for a girl from a non-wealthy family) and residency would mainly serve to delay my ability to pay off these debts.


I recognized that I was socially underdeveloped, and had no practical knowledge about anything not in the lecture notes. I expected to wait to have a family, and accepted being continually absent from my own life to undergo this training program.


However, I also expected more freedom once done. I hoped for enough money (which is subjective and constantly changing) to live comfortably. I hoped to reclaim some “lost” time (and hang out with friends, read some novels, get married, have kids). I hoped to mentally *graduate* from student status, and buy a big-girl house, and big-girl clothing.


Most of all, I thought there’d be more appreciation and respect for the sacrifice doctors make in order to do what we do. I hoped for a more powerful voice as a professional. I thought doctors and patients would advocate together for the best possible health-care situation. (Vocal in a 'I am woman, hear me roar' kind of way...sorta like the nurses. I guess medicine is still too male dominated to be very vocal....)


But what I quickly realized was…

…being a physician is not quite what I expected.


But I’m a roll-with-the-punches kinda girl (or at least I try to be), and realize that physicians are *still* quite cool. Saying you’re a doctor does offer a certain degree of legitimacy in conversation…and it is easier to get a ‘seat at the table’ if you bring a medical degree with you. I do acknowledge (and appreciate) that.


Instead of complaining (further) about all the things “wrong” with being an ER doc, let me make it clear…

…it really is a fabulous job.


Not a day goes by when I don’t get some fantastic job solicitation (usually in not-quite-so-desirable places to live) begging me to consider a move to Podunk, Wherever, for crazy sums of money. And even locally, having board certification in a specialty that everyone uses makes finding decent job a small issue. There’s never a shortage of ‘business’ as an ER doctor. As the recession progresses (and the economy slowly recovers) our ‘business’ just increases as people lose their health insurance along with their jobs - which is unfortunate. But single payer would allow everyone to have access to (at least minimal) medical care...and (get this) we'd actually get paid for said care. (I honestly don't know why doctors, especially primary care and first-responders, would be against getting *some* compensation from *everybody* you serve)....


...but I digress.

What I do in the ER, matters. It is meaningful work. And the pay is not bad either.


I often get asked: would you recommend this career for your children (or some variation thereof).


The answer is (still) absolutely yes!! But with caveats.


I think it’s important to go early, go hard, and get done. Doing it this way, you could be done with all your training by age 29. Still plenty of time to “catch up” on everything else in life. After all, what better way to spend your twenties than setting yourself up professionally (and possibly financially) for the rest of your life. All before you have children, get married, or acquire additional responsibilities (such as elderly parents) or in society.


I think it’s important to focus on the practical aspects of choosing any career, medicine included. It is not “a calling” or some sort of “special” state of being. It is a career. A way to make a living and contribute to society professionally. Just like a photographer (with better pay)….or a plumber (with equal pay).


Realize that having a fantastic career (any career) will not adequately replace loving relationships, family, and personal development. Temporary sacrifice is expected of many low-rung staff in any career…but constant/permanent sacrifice is not worth it.


If you put off having a family, miss your grandmother’s funeral, miss your cousin’s wedding…and then, at 35 realize that you cannot conceive…medicine would NOT have been worth it.


Everyone has their own ‘balancing act’ to achieve. Some of us put more emphasis on family…while others lean more towards career. That balancing act is highly personal. I will say, it’s very easy to weigh career more heavily (even when you don’t intend to) because of external pressures and the societal value placed on wage-earning and 'work' – especially for the “liberated woman.”


If you’re not careful, you’ll become imbalanced, convincing yourself that you’re where you want to be…even when it’s not. And…discontent sets in.


But, if you are able to put “everything in its proper place” in the ranking of your life priorities, medicine can be an excellent career. And EM...allows a doctor to do this. To work a lot...or work a little.



There are days, nonetheless, when you think to yourself...

....what *else* might I be good at? Is there anything else I might want to do?


1.04.2012

Quit medicine? (part one)


When I was a medical student there was a girl who, after 2 years of medical school, decided…she didn’t want to be a doctor after all! I remember hearing a rumor that she decided she would rather spend her days swimming with dolphins. Then…she was gone.


That got me thinking, for the first time in my life actually, what do I WANT to do? Prior to this, my standard reply of “I want to be a doctor” achieved sufficient accolades from everyone, and the satisfied look on their faces served as confirmation that I was on the “right path.” I never really gave it a second thought. But this girl…had the audacity to decide on her own that she was going to “throw away” everything she’d worked for (and all the sacrifices her family had made to allow her to opportunity to attend medical school) and make the “irresponsible” choice to swim with dolphins in lieu of becoming a doctor. I mean, who does that?


At that time, I thought to myself: good for her for knowing what she wants to do, but why not finish medical school first, *then* go swim with dolphins? That way, if her perception of a dolphin-swimmer’s life was misaligned with the reality, she would have “being a doctor” as a back-up career option.


So I spent no further time pondering any other choice at this time. Instead of thinking about what I *wanted* to do, I focused on completing the path I was on, because that’s what made sense to me. I reminded myself that the most difficult (academic) work was complete after taking the USMLE Step I (after 2nd year). The third and fourth years were the clinical (interesting, “field-trip”) years, where you *finally* get to legitimately “play doctor” for real! Why quit now?


But *when* IS a good time to quit? Once you get on the ‘medical-training-in-America’ highway, there is no “easy” time to deviate. It makes sense to complete medical school because once you achieve your advanced degree, you can *still* go fold jeans at The Gap if you want. Nothing (but a few years) is lost by finishing the degree program. So you finish…


Then, you can’t quit before internship. You can’t even get a medical license without completion of an internship! It only makes sense to obtain licensure. Why go through all of that training (and torture) in medical school to become a doctor, and then take away your ability to actually get a medical license because you’re too “lazy” to do just one more year?


Unless you know something that I don’t (which is quite possible), there’s nothing you can practically do as a new doctor (with no other training) without residency completion. You can’t really make any money (and with the huge burden of student loans, *choosing* to NOT make money is a crazy option), aren’t respected as a doctor, and are ostracized completely from “real” specialists (and everybody’s a specialist these days). Who wants to sign up for that? When in just 2 more “short” years, you too can be a board eligible specialist! So…I made up my mind that I would complete the entire training program, and *then* I could reevaluate my decision from a position of “safety” – as a board certified physician specialist.


As a 4th year student contemplating specialty choices, I decided *then* that (despite everything I thought I knew about myself) I had no desire to spend significant time taking care of sick people – gasp! And this realization just kind of snuck up on me as a senior medical student.


Before medical school I thought I wanted to be the quintessential doctor who took care of the entire family their entire lives, family medicine. Then I realized that people are “difficult” and I do not want to be ‘responsible’ for people, sick people…and certainly not their entire lives! Whose crazy idea was that in my head all those years, thinking I could pull that off?


So I eliminated the kids and pregnant women which is essentially internal medicine. That felt better. But still, too big. Too much. Too long. But, nothing else was particularly appealing, and this late in the game many options are essentially removed from the table. So IM it was. But then, I signed up to do an anesthesiology rotation because I’d heard it was super easy…and after 3.75 years of medical school, I was so ready for easy!


True to its reputation, the rotation was a cake walk! Show up at 6am (which was the most difficult part) and intubate a patient or two, then go “read” (i.e. do whatever) until the next morning. There was the opportunity to see trauma anesthesia, which allowed the student to do a-lines, venous lines, and more! Very cool stuff! Still not completely sold on my IM choice, I switched to anesthesia, just like that. I was desperate to “find” my “place.” I was a gypsy, and even as 2nd semester 4th year (senior) student, I was uncommitted!


So I clung to anesthesiology. Sure, I was cognitively aware that I would not be able to intubate and leave. I realized that the days began very early, and were long. Call was busy, and the training stressful. But, I *also* didn’t have to take care of a bunch of people…forever. One patient at a time. Done with surgery/procedure, done with patient. Sounds perfect.


Let me say, it is about this time I began to awaken from the unconsciousness of whirlwind academic overachievement and hierarchal indentured servitude, and realize that “maybe this whole doctor bit is overrated by those *stuck* IN it.” As a coping mechanism, I think many doctors just don’t *think* about their lives, and are unable to consider alternative life paths because they subsist on the delusion that this way is the only way to “be somebody.” And it doesn’t help that doctors typically see themselves as professional corporations and not the workers that they are, so their work conditions are super shitty, but no one cares. Especially not the doctors.


But I digress.


As an internal medicine intern (required prior to starting my anesthesia training) I actually had a great time. Becoming an intern is, in many ways, the prize for years of hard work and being invisible. Years of proclaiming “I’m going to be a doctor on day” to finally *being* a doctor is a huge step forward. Because, honestly, how many of us know someone who’s “going to be a doctor one day?” Not a big deal.


Just *finally* being the DOCTOR was enough positive momentum to sustain me through the internship year. And the amount of practical knowledge I acquired was worth the “abuse” and “sleep deprivation” at that time in my life. I felt legitimate (although incompetent). Also helpful was the knowledge that I was moving on to ‘bigger and better things’ with anesthesia. I was NOT going to be “doing this” (rounds, carrying a pager, writing long H&Ps, the whole deal) much longer. I was going to do short notes, cool procedures, and sit on my ass all day as an anesthesiologist listening to uplifting music, reading trash magazines, and getting paid well. Couldn’t wait!


So you can imagine my disillusionment when I actually began the anesthesiology residency. It was early mornings and long days. It was being on-call and lack up sleep. It was lonely. And in some respects, demeaning, boring, yet stressful all at the same time. And, the worst part was (for me) – there was no one to talk to, and minimal patient interaction. Who knew that taking care of sleep people would be lonely and impersonal?


Clearly, I hadn’t thought out my specialty choice well.


What now? I don’t want long term relationships taking care of sick patients. I don’t particularly like small children (even more so before I had my own). Being all up in vaginas all day was the *last* thing I found appealing. What else is there? Maybe I would go back and finish IM, and then subspecialize? But that would tack on like 5+ years to my training, and after this whole fiasco, I had no time for such nonsense. After all, I’d been trying to find an exit off this medical highway since 2nd year medical school, but stayed on for very logical and practical reasons. But at some point, I just had to draw the line.


It is important to keep in mind that doctors have done themselves a huge disservice by subscribing to the current status quo of medical training. Unlike nurses, or PAs, we cannot just “switch” specialties and “do a new thing” when we get bored with the current thing, or otherwise we can no longer do certain procedures or function in certain capacities. Nor can you move to another part of the country on a whim and expect be granted a medical license from another state (never mind the fact that you already HAVE a medical license after passing a *national* exam, which is asinine and a post for a different day). For multiple reasons it is not practical for a mid-career physician to “go back” and do another residency to obtain different credentials to do a new thing. Overall, medical education does not easily extrapolate into meaningful work outside of medicine. So, once you choose a specialty, you’re essentially stuck! A decision you make about your career at age 25 had better serve you well when you’re 50.


Oh, the pressure!


After all of this, I decided to pursue emergency medicine, primarily because it allows doctors to be doctors when they want to be doctors – and cool doctors at that. But, when you didn’t WANT to be a doctor, you could do something else. Anything else! And still be cool. With a solid “back-up” plan that is EM. And the cherry on top of that sundae was: I didn’t have to take care of sick patients for forever. I can step in when they really NEED help, I can TALK to them, I won’t be lonely, I get to do cool stuff….and then…I get to go home! To my life. All the while, making 100% more than a pediatrician, and 50% more than FM with less stress, less work, less ‘distraction’ from my REAL (non-doctor) life. (And judge if you must, but money *does* matter, especially when the cost of medical education is in the hundreds of thousands of dollars!)


Fabulous.


Right? It’s all good now as an ER doctor….isn’t it?



11.09.2011

Medical Memoir - In Stitches One Girl's Opinion


Medical school memories came *flooding* back as I read Anthony Youn’s memoir, In Stitches.

Medical school was a time in my life where the details are sketchy because it was a blur of studying, isolation, anxiety, frustration…sprinkled with intermittent moments of fascination and joy. I can completely relate to his thoughts about pediatrics, “Little people, little dollah”, and being torn between life-style specialties and being a “real” doctor. I shared his dislike for the standardized patients and the weirdness that entire situation evokes in all of us.

My favorite aspect about this book is its honesty and authenticity. As I devoured the book chapter by chapter, I felt like I UNDERSTOOD Tony. I was able to peek into a life very similar, but very different from my own. His book was truthful, the language was clear, the humor and candidness kept me interested and I really felt like I traveled this journey with Tony. As I read the pages, I thought of my OWN similar experiences….and my reaction to them. And as I flipped the page….reading his words were like reading my own mind. It was quite amazing!

There were only two questions that stayed with me through-out the book: Why didn’t his family help him acquire better living conditions? And was he really a virgin until medical school? (implied, but not stated)

I will say that I feel like the first part of the book would appeal more to young men, with all the talk about girls, women, and overall “manning up.” Since women do not (typically) go through this, it’s all very foreign in an annoying kind of way (as a woman). I was much more interested in…all the rest. Thankfully there’s plenty of ‘all the rest’ and the book was thoroughly enjoyable.

I would LOVE to read a “part II” plastic surgery residency memoir. It really was *that* good!


9.06.2011

Attendings who don't want to teach

Q: Now that I'm *officially* well into my intern year, I realize that some of our EM attendings are not interested in teaching (or otherwise interacting) with interns. As an intern, I'm offended. Is this acceptable behavior, and how should I handle it?


A: You're right, the attendings should be willing to work with ALL of their OWN residents (interns included). Its one thing to shun rotating residents/intern/students, but *your own* should be taken care of.

There are two different ways to look at this to help explain why SOME (i.e. not me, LOL) attendings avoid students/interns. The first way is to try and see their point of view.

Imagine you’re an attending:

When you go to work, you feel exposed (legally) because the residents are a liability. They don’t always know what to look for, what to tell you about, and how to treat the problem. Even if you, yourself, get up and go see/talk to the patient, you may miss something in your short interaction. And there are LOTS of patients. Actually, you feel overwhelmed at times because you’re responsible for the actions of others, although you don’t know what they’re doing/hearing/seeing. You have to ‘trust’ them…and that’s hard to do. And, you are just one person, and to have 2-4 people ‘presenting’ cases to you for 8-12 hours is just too hard. You can’t think, you don’t know who’s sick…and you can’t physically see everyone and do everything yourself.

And it’s even *worse* when an intern is working. BECAUSE they *really* don’t know what to look for, ask about, check or test for. And when they present to you, the story is often unclear, and you’re left sorta confused. The differential is too broad when the intern presents, and you either have to go see the patient yourself, or ask lots of detailed questions to the intern to get a better story. If the intern didn’t ask the important questions, you either have to send them back to get a better history and physical, OR you order tons of tests/studies to compensate.

Example:

10 month old baby is brought in my mom with a fever to 102.9 x 1 week. Intern presents it as a viral syndrome. Great, discharge, right? BUT they didn’t notice the dehydration and lethargy. They didn’t comment on the petechial rash. So, as an attending you can either:

1) get up and see the patient yourself as if he’s your own (this isn’t very practical if you have more than a couple of residents/interns to supervise or else the flow of the department will be very slow)

2) have the intern order more tests and studies to support the ultimate dispo (which isn’t really teaching, and isn’t really proper EM)

3) you can have a senior resident see the patient, and ‘advise’ the intern. That way, the likelihood of missing meningitis is lower if the senior resident signed off on the intern’s work.

Of the 3 – it’s easier to have the senior resident involved. Also, it’s logical because it allows the senior resident to see more, do more, supervise a bit, and begin managing an entire department. And as attending, you’re there just as back-up for the senior resident. It’s easier to teach the intern if the obvious nuances of the case have been discussed with the senior (at least from July – December). And it frees the attending up to work with the senior and students as well.

The attendings look forward to working with certain residents, just as much as residents like particular attendings. Typically attendings like residents who are confident, do appropriate work-ups, then come to them with their own thoughts about what’s going on, and what to do about it. Then the attending can talk to the resident as an educational ‘coach’ and (almost) colleague about the case. This is fun for attending.

Being stressed out about missing something because an unreliable resident (whether it’s because they’re ‘new’ or just ‘suck’) is telling you half-truths and cannot think for themselves…is miserable.

***

The second way to try and understand what’s going on is to realize that this has nothing to do with you, and everything to do with their own issues:

Imagine you’re an attending…and you’re a bit bitter about your job (for whatever reason). Really, you don’t want to work shifts, you’d rather get credit for shifts worked, while NOT doing any shifts. BUT, you’re not quite *important* enough for the department to allow you to engage in other scholarly activities…and since they NEED attendings to work shifts, you get more than your “fair share” (for your rank and experience), in your opinion. But you can’t quit, because you need your benefits and paycheck too bad. So you make due.

There are two types of doctors (those who actually are comfortable with themselves, their knowledge, and love to share and can readily admit when they are unsure of something....and there are those who pretend to know *everything* and don't want to answer questions because they feel threatened by the resident who's actively reading, and who, on any given day, may be better-read on a particular topic than the attending).

So let's say I'm the second type of attending -

I don't want to 'expose' myself as interns don't know much about 'the way things work' and instead of just 'going with it' they'll ask:

"why? why? why do we use this drug instead of that drug? why can't we just do the procedure this way like Rivers said? Tintinali's new edition said that we shouldn't use this study, that the new ultrasound technique is better..."

Whereas a senior would be more apt to 'just go with it' as per current local ED culture. And if the senior asks questions, it's more appropriate for the attending to follow-up their question with a 'reading assignment' to be presented the next shift. So the residents ‘learn’ to not ask questions.


So, in short: either this is their way of hiding the fact that they don’t know something….OR they’re acting out because they don’t want to be in the position they’re in….

Either way nothing to do with you.


My advice is: YOU SAY NOTHING! Go with the flow...and do not let the Eye of Sauron fall upon you. Stay below the radar right now. Learn, learn, learn. Shine on the inservice in February.

Next year...maybe say something if you're still so inclined (maybe). It's not worth the risk right now. If you're black-listed, you will have a horrible residency experience. Lots of former residents can attest to this fact.

4.19.2011

Can I be cool with my nurses (and they cool with me)?

When I was a medical student, I was quite envious of the nurses.

It seemed like the nurses, from the RNs to the licensed practical nurses, had the best of everything. Their lounge was big. Their area well stocked with food and drinks. They were always having celebrations...for everyone...for everything. They made late-night Starbucks runs, and had food delivered to the hospital all the time. And even though they were courteous enough to offer me a latte (sometimes), it always felt weird to 'fraternize' with *them*. They, were them...and I was *us.* "You cannot trust 'them,'" I was told. "'They' will throw you under the bus first chance they get!"

So, for years, I had an awkward relationship with the nurses. If I needed them to do something...how do I ask? "Um, excuse me Nurse, did you see my order?" Or, "Ms, I mean, Nurse Smith...can you get room 1 a bedpan?" It just seemed like...I was asking them to do things...like I was in charge. But they are quick to let you know you're not in charge. But, you kinda are in charge. But you cannot 'remind' anyone that you are in charge...or else you belittle their contribution.

What gives?

Then I realized...as I advanced in my education/training...and as I spent more time as an attending...that good nurses are really there to help make your life easier. If they are not doing that...I would argue that perhaps they are not good nurses. And the thing is, I didn't realize this until I had an *awesome* nursing staff to support me!

In residency, the nurses were indeed a little cult...whose primary mission seemed to be to make your life as difficult as possible. Sorta like they were jealous of a young woman doctor...and resented having to take orders from her. They were not polite. They claimed they didn't know how to do much of anything. "Um, I couldn't start the IV on room 3...so I guess you'll have to come do a central line." Or, "we cannot get blood from Ms. Jones...so you'll have to do a femoral stick." Really?! Really, really! Either you're one sorry nurse...or you're just out to get me.

As you progress, it becomes less acceptable for the physician to perform nurse duties...while simultaneously performing doctor duties. Time becomes more valuable, whereby if the physician isn't seeing patients quickly...someone is losing lots of money (and it's usually someone "more important" in the hierarchy than the doctor). And that...is not tolerated. CEO losing money?! So support staff is hired so the physician can continuing 'bringing in the money.' And this extrapolates to nurses who enjoy (or at least don't mind) nursing.

Fast forward to now. I have a great relationship with my nursing staff in general. Some of it is because my nurses are now there to support me (rather than antagonize me). Some of it is because it is the expectation that the nurses do nursing work. But a large part of the equation is me. I am more comfortable with myself, with my skills, and being a doctor. And because I am comfortable with me, and my role as leader...I am less...awkward. I am more willing to "fraternize with nurses because I realize that being friendly with nurses doesn't undermine me or my role. I see myself as team leader...but I give each member of my team the option to critically think and act without me micromanaging their decisions. I ask their opinion...and I don't feel like "they think I'm stupid" if I don't know something.

And in exchange, they bring their kids in to see me for impromptu doctor visits. They save me a piece of baby-shower cake. They "protect" me from the patients and their families (this is a post for a different day). They sneak me a Tylenol or a Reglan out of the Pyxis when I'm not feeling well. They catch my oversights...and they have my back.




Short story:

Last week I had to reduce a patellar dislocation. SUPER easy to do...but I'd never done one before. So, I gathered my nurse and my tech, and confessed. "Hey guys, we have to reduce this...and I've never done one. So I'm going to read up a bit, then we'll do it, okay?" Amazingly, they were even more excited to learn *with* me. We checked out emedicine. We watched a short video. Gave each other encouragement. And went in the room like we knew what we were doing. Like we did this sort of thing everyday. "Don't worry Mr. Johnson, this will be quick and over in less than 10 seconds" (hopefully). We exchanged glances...smiled a little bit. And did exactly what the doctor did in the video. For about 6 seconds, it didn't seem like it was going to work. But then we heard it. The "clunk" of the patella going back into place! We all exchanged glaces again...with big grins on our faces.

We walk out of the room, and into the back, giving each other hi-fives! WE did it!

How fun is that?! This is what makes emergency medicine a team sport.

4.18.2011

Vita-Salute San Raffaele International MD Program. A New Opportunity For Your Medical Education In Milan, Italy.


In this changing world, opportunities periodically come forward in our lives that provide us with a new path to achieve our goals. For those of you that are considering becoming a doctor I want to share with you a new opportunity that you should consider for your medical education.

One of the biggest problems in becoming a physician in the United States is costs. We have watched the cost and debt load for students attending medical schools grow at rates that will make it impossible for many to achieve their dreams of becoming a doctor. This changing cost structure makes it important the perspective students consider all of their options.

We would like to suggest an option for your consideration that will provide you with a cost effective and quality medical school educational opportunity. A place where you can receive a world class medical education, have access to superb faculty and develop international relations that will help you in your future. Plus it is a chance to go to medical school in Milan, Italy. Yes we said Milan, Italy.

Vita-Salute San Raffaele University http://bit.ly/unisr01 is part of the San Raffaele Foundation which includes Hospitals, Research Centers and the Vita-Salute San Raffaele University. San Raffaele is well known worldwide for its excellence: it is a highly specialized center for molecular medicine, diabetes and metabolic diseases, as well as biotechnology and bio-imaging. The Hospital channels many of its resources into cancer treatment, cardiovascular diseases and numerous acute and chronic-degenerative diseases and a very efficient Emergency Department that serves a vast area.

The International MD Program builds on the institution’s solid presence on the international scene: San Raffaele healthcare centers can be found in many countries of the world, including Brazil, India, Uganda, Poland, Chile, Israel, Mozambique and Algeria.

This degree course provides medical-scientific education at the highest level, allowing students to improve their skills and to upgrade their knowledge. It also provides clinical and laboratory research opportunities and additional education in humanities and cultural sciences: philosophy, communication skills, cognitive neurosciences and psychology, which are the building blocks of human society, regardless of social status, race, or creed.

The International MD Program is designed to train a new kind of doctor: someone who possesses the necessary human, cultural and professional abilities to actively participate in health care and share ideas in today’s globalized world. Unlike other Medical Programs in Italy where clinical courses are held in Italian, the International MD Program is fully in English, including classes, lectures, practicals and all clinical activities.

Students enrolled in the San Raffaele International MD Program have access to all the facilities of the Vita-Salute San Raffaele Institute and the San Raffaele Scientific Institute, including skills labs for practical training, a library with more than 20,000 books and several thousand scientific e-publications and resources, as well as to the clinical and research laboratories of the San Raffaele Scientific Institute http://bit.ly/scientificinstitute, the largest private research institute in Italy, that further expanded with the inauguration of DIBIT, a scientific facility for basic, translational and clinical research.

DIBIT is part of the largest biomedical science park in Italy, which includes the San Raffaele Hospital, Science Park Raf, created to support the foundation's development, and the Vita-Salute San Raffaele University.


Applicants who wish to enroll in the International MD Program are required to take an Admission Test.

64 places are available for Academic Year 2011-2012:

32 for EU citizens
32 for Non-EU Citizens.

The Admission Test will take place on April 28th 2011 in the following locations:
Milan, (IT)
New York, (USA)
Kuala Lumpur, (Malaysia)

Candidates who wish to take the Admission Test can visit the following website for detailed information:
http://bit.ly/mdadmissions.

The deadline is April 20th, 2011.

Here are the guidelines on the admission process for A.Y. 2011-2012: http://www.medicine.unisr.it/upload/file/Guidelines%20on%20the%20Admission%20Process%281%29.pdf

For more information on the International MD Program please visit the following website http://bit.ly/mdprogram.


We hope that all perspective medical school students will consider the International MD Program at Vita Salute San Raffaele. It is a wonderful opportunity to earn your MD, learn from an outstanding faculty, develop international relationships and immerse yourself in Italian culture. Opportunities such as this don’t come along often so don’t let this one pass you by.