Managing Medical Residency Interview Expenses

Many students are in the last push of interviews before Match Day. While we have posted before on general tips for residency interview travel, the following guest post goes into more specific details:

The time has come for you to interview, and congratulations are in order. The hardest 3 years of medical school are behind you. But you will hemorrhage money during the next few months if you are not adequately prepared. In order to prepare well and travel efficiently, consider each dimension of your travel (airfare, hotels, car rentals / transportation). Let's start with the most expensive piece: airfare.

Airfare

This is where most of your travel dollars will be spent. The more competitive the specialty you’re applying to, the more locations you’ll want to visit, and the harder it will be to coordinate them by region. If possible, try to cluster a few interviews in one corner of the country at once. This will save you the time, money and energy required to fly from say, California to Virginia. Kayak has a helpful feature that lets you plan multi-point (or non-round-trip) flights to facilitate such trips.

However, be aware that the more competitive specialties with small program sizes offer fewer residency interview days, and such a cross-country journey might be unavoidable. You also may have to visit the same city twice. For example, Tulane ophthalmology’s only interview days were November 5 and 12, and LSU’s only days were December 2, 3 and 4.

When to book: The first batch of interview invitations is usually sent a month before the earliest available interview days. If you have two interviews several days apart in one part of the country, you can avoid flying back and forth by calling / emailing program coordinators to see if they have room to add you to their interview schedule. Start calling the program coordinators as soon as you receive the invitations, but it is okay to wait before finally picking a date. I waited 2-3 weeks before the date I picked, waiting for other invitations to come through, so that I could schedule something else nearby r and avoid paying for multiple round trips. Between a New York ophtho interview and a Yale ophtho interview that were a week apart, I was able to add on a New Haven transitional year interview and a D.C. preliminary medicine (round trip AMTRAK) interview during the gap. Just be careful... spots can go fast!

Who to book: Kayak will compare fares among the major airlines that are its affiliates. However, it is important to consider several budget airlines that do not participate. Southwest is easy to book online and pretty cheap, but like all airlines, expensive to reschedule. Similarly, check out JetBlue especially for interviews in the Eastern part of the country.

If you get a last minute interview invitation, Priceline and Travelocity can get you a better deal, but be specific about your arrival and departure times. I wouldn’t use these to schedule an interview far in advance because your interview schedule may change. When a large city has multiple airports, it’s also helpful to consider which airlines fly to the airport that will be closer to your interview.


Hotel

Hotels are very pricey in places like NY and DC. I tried to stay with friends whenever possible, and Facebook was very helpful for finding college friends who had moved to various cities. Just click the “Find Friends” tab in the upper left to reveal the drop down menu, then “See All Friends,” then find “Search By Current City” in the white drop down menu.

If you cannot find a friend to stay with, consider using sites like Priceline, Hotwire, Kayak or Hotels.com. Ideally, pick one site and use it all the time. For example, on Hotels.com, if you book 10 nights (3 nights here, 2 there, 5 somewhere else), you get an 11th night free in *any* hotel, subject to availability. There are other seasonal deals available, such as:  Orbitz Winter Hotel Sale: Save up to 50%! The offer is running until January 23, 2011.


Transportation

If you can’t get rides from friends or book hotels within walking distance of the interview, Hotwire (specifically Hotwire Hot-Rates) and Priceline are the cheapest for renting cars, and this can be done in short notice. Many cities and hotels have airport shuttles that are cheaper than cabs, but these might take too long if you have an early flight for an interview the very next day. Check a city’s Metropolitan Transit Authority website or even Google Maps to see if you can plan a route by subway. Program coordinators have helped interviewers with these kinds of issues every year, and they are a helpful resource for answering questions regarding what’s practical. The main point of this section is to avoid using a cab. Try your best to get a deal, but remember: at the end of the day, the goal is a successful interview, no matter the cost!

Resources:

• CarRentals.com: From $8.98 A Day
• Fodor's 1001 Smart Travel Tips
• Google Maps
• Hotels.com
• Hotwire Hot-Rates
• JetBlue
• Kayak
• Orbitz Winter Hotel Sale: Save up to 50%!
• Southwest
• The Smart Traveler's Passport: 399 Tips from Seasoned Travelers
• Travel Tips for the Sophisticated Woman: Over 1000 Tips on Museums, Shopping, Dining, Chocolate, Looking Great & More
• Travel Wisdom: Tips, Tools, and Tactics for All Travelers

Back to the Future

A recent article posits that our brain has an underlying mechanism behind all optical illusions, namely, the ability to see into the "near" future:

In the current issue of the journal Cognitive Science, researchers at the California Institute of Technology and the University of Sussex argue that the brain’s adaptive ability to see into the near future creates many common illusions.

“It takes time for the brain to process visual information, so it has to anticipate the future to perceive the present,” said Mark Changizi, the lead author of the paper, who is now at Rensselaer Polytechnic Institute. “One common functional mechanism can explain many of these seemingly unrelated illusions.” His co-authors were Andrew Hsieh, Romi Nijhawan, Ryota Kanai and Shinsuke Shimojo.

One fundamental debate in visual research is whether the brain uses a bag of ad hoc tricks to build a streaming model of the world, or a general principle, like filling in disjointed images based on inference from new evidence and past experience. The answer may be both. But perceptual illusions provide a keyhole to glimpse the system.

Makes sense to me. For more perceptual puzzles, check out Blind Spots.

Blind Spots

Check out Blind Spots, a simple little website that demonstrates to people where they blind spots are, and how our brain tricks us into believing we do not have any such areas. The notion that our brain constructs an image which we assume to be reality has always fascinated me.

Extraocular Muscle Movements - Function Explained

Usually, anatomists and clinicians share the same base of knowledge regarding how the body functions. However, as I was doing Step I practice questions today, I came across a question that referred to the functions of the extra-ocular muscles. As I flipped through First Aid for the USMLE Step 1, I noticed that the section on extra-ocular muscles had been visited by me before:

Abduction:
Inferior oblique
Superior rectus
Inferior oblique
...

Apparently, I had reviewed this topic at various times and found varying results from different sources. I decided to end this once and for all with the med student's almost authoritative resource: Wikipedia. The page that came up was helpful, but Wikipedia posed more questions than it answered. Apparently, clinicians in the past believed that the obliques adducted, while anatomists begged to differ. Luckily, a reference to a British Medical Journal article resolved the issue: the anatomists won, the obliques abduct.

It is interesting to see how someone's mistake if inculcated enough can become dogma. Simply by looking at the muscles, as was pointed out to me, the actions are apparent. As the obliques attach on the temporal aspect of the orbit, when they contract, the orbit will rotate against the force around its axis. In other words, the eye will abduct. How clinicians missed this for apparently a long time is beyond me. However, the British have a theory:

Our final conclusions, and what is now our policy for instruction on this muscle, is as follows. The superior oblique, acting in isolation, turns the eye down and out. However, if it was tested clinically by the patient being asked to look down and out, its action could be mimicked by the combined action of inferior and lateral recti. This is particularly so as the inferior rectus acts most effectively when the eye is abducted (looking laterally). Thus if the patient is asked to look down and in, these muscles are excluded and the problem is solved. Essentially we are testing the ability of the superior oblique to look downwards.
The confusion, which I hope the above clarifies, is compounded by some ophthalmologists being so used to testing the muscle by asking the patient to look down and in that they have forgotten that the isolated action is down and out.

Ah ha! So it was the ophthalmologists' fault! Well, well. Mystery solved!

Updated 2015-12-08

How To Assess Colorblindness

Quick site update: I installed Photoshop this past week and started playing around with it. Heh, probably not the best software for the colorblind. Anyway, check out the new logo up top!

When I was on Family Medicine, my preceptor was involved with clearing people medically before they could fly. Usually it was fairly routine, but the one thing that differed from the typical physical is that he had to scrutinize their eyesight much much more than usual. One of the items he had to check was their color vision and make sure they were not colorblind.

There are several ways to do this, but the most popular method involves the Ishihara Color Test. We have all seen these before. They are basically dots of different sizes and colors that form a number that is visible only to people who are not colorblind. Here is an example (do you see a number below?):


Can you see the '74' in the middle in green dots? If not, that might mean you're colorblind (or illiterate, I suppose). The reason the dots are red and green is that this is the most common form of colorblindness with up to 10% of males having this disability. I mention 'males' because the gene for the red and green receptors are on the X chromosome, which means the inheritance is X-linked. There other forms of colorblindness like blue-yellow colorblindness, but this has autosomal inheritance and is less common.

However, even after one has diagnosed a patient, it is interesting to consider how they see the world. A colorblind person went ahead and tried to demonstrate through photographs, which I found interesting. I wonder though, when making the page, didn't the images look identical to him since he couldn't actually see the full color images like most of us can? How does he know he did it right? I guess there really no way to see the world exactly as he does, but it's still an intriguing approximation.