Student Spotlight: Dr. Himaja Singana
Dr. Himaja Singana just completed a neurology rotation with Dr. Bernad and Dr. Stein. Read what she has to say about the program and meet Dr. Singana.
Interviews with AMIQT Successful Residency Match Candidates: Dr. Bhatti and Dr. Mazo
What makes for a successful US residency match application? Here you’ll find answers from two AMIQT alumni who matched in US residency this spring, Dr. Karandeep Singh Bhatti and Dr. Victoria Mazo.
- Where did you Match?
Dr. Bhatti: Cooper University Hospital, NJ.
Dr. Mazo: University of South Florida, Tampa.
- Can you talk a little bit about your medical journey? How did you get where you are now?
Dr. Bhatti: I did my medical school at Common Medical College, Amritsar. I’m a 2018 graduate. Year of graduation is a big deal, so I say that for everyone to get an estimate of my profile. I decided to do the USMLE after I graduated. That is something I would say to all of you who are planning to do your USMLE – begin planning during your internship and not after you graduate. I wanted to go for neurology, so at that time, because rotations were not open, I heard of Dr. Bernad’s tele-rotation. Because of COVID I was not able to get an in-person rotation. That’s how I reached AMIQT. It’s one of very few clinical rotations which are willing to help out in terms of gaining US clinical experience.
Dr. Mazo: I’m originally from Moscow, Russia. I graduated medical school in 2017 and that’s the year I came to do my externship with Dr. Bernad. It was April so I was about to graduate, and I came to have my hands-on experience with Dr. Bernad. It was amazing. Then, I moved to the states later on that year because my family was here. Ever since then, I’ve been working on my USMLE’s. I had a baby, so that was also a holdup, and I finally got ready, took all of the steps, and applied for match 2021. That’s my journey.
- Which rotation did you do with AMIQT and was that impactful for your residency match process?
Dr. Bhatti: I did the neurology rotation with Dr. Bernad and it was immensely helpful for me. As I said there were not many opportunities because of COVID to get hands-on clinical experience. I had only two months of clinical experience on my application when I applied for neurology so I was a bit worried about how it would pan out, but luckily Dr. Bernad’s letter of recommendation was very helpful. It was brought up by interviewers many times. They were quite impressed by what he had written for me. Also, because this was the first time this tele-rotation concept had started (it was the first match cycle), they were all very intrigued to know how it all happened, how patient interactions went on, and how we learned about the subject in the first place. So it was a very unique experience and something that almost everyone was quite impressed with, how I was able to do this safely at distance in a tele-health module.
Dr. Mazo: I think so. That was the only neurology rotation I had. It was not only amazing because it was hands-on (I got the chance to talk to patients and take patient notes) but it was also out-patient, in multiple sites, and we got a chance to do in-patient and be a part of Grand Rounds at George Washington. It was the best experience. I can’t stress this enough. I’ve been telling all the people who have asked me about my journey that this is probably one of the best things I could have done for my future because I got a chance to know what a neurologist actually does in America. It was impactful also because I got an interview at George Washington University because of my connection to Dr. Bernad. I really loved the program; it was one of my top five choices.
- Do you have any advice for people applying to US Residency?
Dr. Bhatti: My first advice would be to start early because of challenges that may come in the year of graduation. Starting early helps in the process of USMLE.
Number two: definitely focus on doing well on your exams. Even if you don’t – because sometimes scores are the things that are not very well in our control (sometimes things don’t go how we plan them), then comes the most important part, which is US clinical experience. I’ve been very fortunate to have gained US clinical experience with the masters in their field, like Dr. Bernad in neurology. Choose wisely. Go with the mentors who are very willing to teach and recommend you to residency programs with all their heart. Also, be sincere in whatever you do. You can’t expect to be there and not participate and then expect a letter of recommendation at the end. You have to be very willing to learn and contribute. Dr. Bernad’s rotation was a huge learning point for me in all this whole process, so definitely plan out your US clinical experience well, even if it’s a tele-rotation, which we all know is going to be the future of medicine from here on. Apart from that, work well on your CV and personal statement, something that AMIQT helps with. Dr. Nakka helped me immensely with my CV and personal statement. These are things that we all need help with, so go to someone who you know will do their best to help you out. For me, that was definitely AMIQT.
Dr. Mazo: My advice would be to make a smart choice about where to apply. If you choose smartly, you don’t set your expectations too high or too low. You just have to know exactly where you want to apply so you don’t waste money and are not wasteful with your time, applying and waiting for programs which are probably not going to invite you. Especially for foreign medical graduates, if you go online and see that the program doesn’t have any foreign medical graduates, you probably shouldn’t apply there. Same thing with interest – if you are interested in doing research and the program doesn’t have research, maybe you should apply just for backup, but you have to understand what’s important for you and your career. What’s also important is to understand that a lot of programs are advanced. I didn’t know that before I started applying. You have to be mindful that it’s very hard to get a preliminary spot and if it’s only an advanced program, you have to prepare for that. Do your homework before you apply – before you pay money and wait for invitations.
My biggest advice would be to know your application well and the program application well. Be prepared. Go there knowing faculty – what they do, what their research is, so you can impress them by showing your interest in the program. It’s not only them choosing you; it’s also you choosing a place to work for four years, so it’s something where you can’t underestimate the importance of knowing the program well.
How to Conduct an Excellent Patient Interview
The patient interview is a crucial, if overlooked, part of every physician’s practice. What questions you ask – and how you ask them – will determine what information you receive, and the quality of the diagnosis to follow rests on that information.
Dr. Peter Bernad, MD, MPH, FACP writes, in his book Closed Head Injury, that while examinations “help to localize” issues, they are “only one part of a more complete evaluation of the patient. The most important information is nearly always obtained from the patient history.”
As a neurologist specifically discussing diagnosis of closed-head injury, Dr. Bernad nevertheless speaks a general truth of medicine; the patient interview is a crucial aspect of the differential diagnosis process.
So what makes for an excellent interview? For this article, I spoke with AMIQT preceptor and clinical psychiatrist, Dr. Martin Stein, to get his insight on the importance of the patient interview and the best way to properly interview patients.
AMIQT: How do you begin a patient interview?
Dr. Stein: Walk into the waiting room and call the patient’s name. Look at how they walk and their facial expressions, take them to your office, offer a seat, and say, “how can I help you?” Introduce yourself, say, I’m Dr. ____, how do you want me to call you, and how can I help you today?
What elements do you make sure to include?
You want to get the patient’s story: what’s wrong, why they came to see you. It’s very simple these days, with EMR softwares that have all the right questions loaded. More importantly, you want to find out: who is this person coming to see you? What kind of a person are they, what is their experience? Are they frightened, are they scared, what is their facial expression? How do they make you feel? This is a very important thing. Do they make you feel comfortable? Do they make you feel irritated? All these kinds of internal perceptions are very important in the patient interview. Anybody can ask the questions, but getting a sense of who the patient is and the feeling of the patient is more of the art of it.
Why are your personal reflections important?
How the patient makes you feel is just as important as what the patient says. For example, the patient may say very little, but their eyes are wide, a fearful look is on their face. You may find a patient with past abuse experience filled with horror or dread, or you may find the patient incredibly comfortable to talk with. These all give you a sense of what’s going on inside the patient’s head. How careful the patient is, are they afraid of you, are they embarrassed? All these observations are important when you’re talking to the patient.
How do you make a patient comfortable when asking personal questions about their health?
Well, I would say: this may be embarrassing but it’s important to find out. For example, “would it be okay if I asked you some personal questions?” Ask the patient directly what they want to do, using an “Is it okay if I” beginning. Is it okay if I examine you? It’s important to ask the questions in a way that the patient has the power to say no. Patients may feel very disempowered at the doctor. The more that they can feel in charge, the better the result.
You may not get everything the first time. One of the reasons it’s important to see patients on a follow-up basis is that it takes time to get a whole history. People only say what they’re comfortable saying at the time they’re meeting with you.
Often if a patient is abused, for example, and the effects of the abuse are a very deep secret, the abuse will belong to this category called unspeakable truths, which things people do not speak about but are critical. One has to tread very delicately in an interview. You never know when you’re going to touch an area where the patient is very upset or very affected, so you kind of tip-toe at times.
Why is the patient interview important in addition to clinical tests?
The first question, once you say hello to the patient, is How can I help you? or What brings you here today? And what then comes out is what we call the chief complaint. We train to try to get the chief complaint in the patient’s own words. Unfortunately, most doctors interrupt the patient within the first 20-30 seconds, but ideally, the patient should be able to spend 2-3 minutes talking about what bothers them.
Often, what brings them in the office is not really what the problem is. That is their “ticket of admission.” The person has to have some problem to come to the doctor, but underneath it there may be other problems that are of more concern. The patient may come with a headache, but it turns out that as they talk you may find they have been harassed by a boss or by family member, and the fact that they’ve been harassed or the fact that they’ve been in a physical situation may be more important than the headache itself.
What advice would you have to a doctor in a rotation about a patient interview?
Take your time. Be friendly but not too friendly. If you’re a student, don’t be afraid to say you’re a student. Most important, don’t be afraid to say “I don’t know.”
How do you assist AMIQT participants with patient skills?
AMIQT participants watch experts talk to patients. In our program, Dr. Bernad is one of the best historians I’ve ever met. He has a great way of finding some way to connect with almost every patient. He often stops, while taking full history. He wants to know first “who is the patient”: what kind of work do they do? What’s their outlook on life? Where do they live? Where do they come from? In the process, he seems to find a way to identify some small piece of his life experience and find a way to connect with the patient. When our students observe that kind of behavior, it gives them a sense of how they can use their lived experience in patient interviews.
I want to emphasize that the personhood of the doctor, who you are, is as important as the questions you ask the patient.
What goes into who you are as a doctor?
You come into medicine with a whole set of personal experiences. You’re more than a question taker, you’re a person talking to somebody in distress. Just stating the facts will not necessarily help the person in distress. You have to make a connection with them; you also want to give them some kind of reassurance that coming to you is a positive experience. Even if you have to give them negative information, you need them to feel they have made the right decision by coming to see you, that you’re making sense to them, that you’re a person they can trust, and that somehow, you give them some hope. One of the things Dr. Bernad says is, “I will try to help you.” He says, “I will do everything in my power to try and help you. I will try to make you better.” And in many studies, hope is up to 40% of the cure. It’s scary to have a concern. People don’t come to a doctor’s office for nothing. They come with a worry or concern and want to feel that it’s being taken seriously.