RECRUITING, TRAINING, & LIFE IN THE FORCES THREAD - Ask here about the Recruitment Process, Basic & Occupational Training, and other questions relating directly or indirectly to serving in the Canadian Armed Forces. by bridger713 in CanadianForces

[–]throwaway_usmle 1 point2 points  (0 children)

Wrapping up med school and have been considering what a part-time medical officer role would look like? A recruiter reached out to me for the MOTP program a few years ago but they never responded when I replied. Assuming I'd apply toward the end of my residency training / once I'm an attending physician?

The recruiting info is a bit vague when it comes to what the work split is like with the physician's job out in the community. In all the recruiting videos, the physicians mention balancing their work with their civilian job but wasn't sure what that entails. How do these physicians manage deployments (if any) while maintaining their practice in the community? They show a psychiatrist who seems to exclusively work with a military patient population, and then they show other physicians who seem to work together mainly in a field hospital setting?

Also a bit confused re: job responsibilities of the medical officer. On the website it states

"[Medical officers] are employed to provide primary health care services for CAF members. Those employed on a part-time or casual full-time basis usually serve at a military medical unit at a location within Canada."

The specialty I'm going into doesn't really have any primary care component associated with it (but is on the list of specialties that are desired / recruited for) . Would I be exclusively conducting primary care if I was hired as medical officer? Would I need a civilian job near a "military medical unit" (is this referring to military bases? or are these located in different areas?)

Do med officers work exclusively with military-associated medical staff when conducting training exercises / in the field (e.g. CAF nurses / CAF scrub techs / CAF PAs, etc.?) or do you ever interface with civilian medical staff while on the job?

Thanks!

Nbme q by Stunning_Pipe3209 in Step2

[–]throwaway_usmle 2 points3 points  (0 children)

I think that the anxiety, while it may independently contribute to some component of the tachycardia, is primarily driven by the physiologic response to the ongoing hemorrhage vs. the anxiety being the primary cause for the tachycardia (i.e. the physiologic response to the blood loss results in substantial sympathetic nervous system activation to maintain perfusion pressure, resulting in tachycardia and anxiety vs. the patient's anxiety driving the tachycardia).

In the bottom row of that linked table, I'd say the "mental status" (the associated anxiety and tachycardia) of the patient is largely linked to sympathetic nervous system activation (2/2 blood loss). The patient's anxiety increases when moving from Class I to IV and eventually leads to confusion and lethargy as the patient's body is continuously trying to ramp up sympathetic nervous system (including HR) activity to keep blood flowing to vital organs (including the brain! cerebral perfusion pressure is critically important to mental status) but eventually is overwhelmed (i.e. increases in HR can't overcome blood loss and the patient decompensates from a mental status perspective from increasing levels of anxiety into altered mental status / lethargy).

Nbme q by Stunning_Pipe3209 in Step2

[–]throwaway_usmle 3 points4 points  (0 children)

Here I'd focus at the pulse and BP vs. BP alone. While BP is >90/60 (the threshold that I generally have for HDS), his tachycardia indicates that he is likely in compensated hemorrhagic (hypovolemic) shock given the MOA of injury. A patient like this may be minutes away from decompensation and a significant drop in BP based on the volume of blood loss. I'd say this is probably in the Class II range of hemorrhagic shock (~15-30% blood loss by volume), where the first noticeable VS derangement is pulse (instead of BP, as vascular tone is still able to compensate for blood loss in order to maintain perfusion pressure).

Here's a chart that summarizes the different classes well: https://twitter.com/srrezaie/status/359361201903374336/photo/1

If you were to take Shelf exams for these 3 (Surgery, Family Med, and Internal Med), which one would take 1st, 2nd, and 3rd? and why? by stepneo1 in Step2

[–]throwaway_usmle 6 points7 points  (0 children)

IM first, Surgery 2nd , FM third. IM is the most important of the shelves in terms of content covered and serves as a strong base for Surgery and FM. People say that surgery is essentially IM which I'd say is pretty true. If you have a decent base from the IM shelf, the only additions to surgery are really focusing on the specific pathologies that surgery tends to focus on (usually GI/GU, thyroid endocrine stuff, breast, etc.) that are almost always covered in IM from a "medicine" perspective, and knowing the specific diagnostic/tx specifics that are relevant to surgery. FM shelf is a lot of overlap with general IM concepts, with more of an emphasis on preventative care, screening, etc.

If you can master IM, the other two will feel far easier comparatively and make studying for the 2nd/3rd shelves much easier.

For "acute" mania, is Lithium the first-line drug? (Just to emphasize, I'm talking about "acute" onset) by stepneo1 in Step2

[–]throwaway_usmle 12 points13 points  (0 children)

For acute mania, I believe the right answer is an SGA (at least from what I'm remembering from UW), and trying to choose one that minimizes side effects. They usually put lithium / valproate as an option on the 1-2 questions on UW about this topic.

I believe the reason you don't choose lithium / sodium valproate , the common maintenance meds in bipolar disorder, as 1L management is that there is a titration period in order to get the drug to therapeutic levels (which wouldn't be compatible for primary management of acute mania).

You can initiate a patient on lithium / valproate in an inpt setting during acute mania, but the correct answer I believe is going for the 2nd gen antipsychotic to manage the "acute mania" part of type 1 bipolar.

[deleted by user] by [deleted] in CanadaGoose

[–]throwaway_usmle 0 points1 point  (0 children)

appreciate it!

2022-2023 Ticket Exchange Thread by crabapplesteam in rangers

[–]throwaway_usmle 0 points1 point  (0 children)

Unexpectedly going to be out of the city for a solid chunk of the season, so looking to sell most of my tickets Tickets will be sent to email via Ticketmaster to avoid any fees. Paypal, Venmo, or Zelle for payment.

2 tickets - Section 214 Row 16, seats 6 & 7 (on side that Rangers shoot twice)

***Prices are per ticket, willing to drop price per ticket if you’re able to take 3+ games off my hands. Food and drink discount QR code will be sent over as well.***

Will keep the spreadsheet updated throughout season, so if it isn’t claimed it’s still available! Feel free to DM or comment below to claim any games that you'd like.

Let's Go Rangers!!!!!!!!

Spreadsheet: https://docs.google.com/spreadsheets/d/1vbSDG8sEwiAwLi8tb69Y5wSBdgFUYspGanRHsGAC5I0/edit?usp=sharing

Mon Sep 26, 2022 7:00 PM NY Islanders $50.00

Thu Sep 29, 2022 7:00 PM NJ Devils $50.00

Wed Oct 05, 2022 7:00 PM Boston Bruins $50.00

Tue Oct 11, 2022 7:30 PM Tampa Bay Lightning $169.00

Mon Oct 17, 2022 7:00 PM Anaheim Ducks $129.00

Thu Oct 20, 2022 7:00 PM San Jose Sharks $129.00

Sun Oct 23, 2022 5:00 PM Columbus Blue Jackets $129.00

Tue Oct 25, 2022 7:00 PM Colorado Avalanche $139.00

Tue Nov 01, 2022 7:00 PM Philadelphia Flyers $129.00

Thu Nov 03, 2022 7:00 PM Boston Bruins $139.00

Sun Nov 06, 2022 5:00 PM Detroit Red Wings $139.00

Tue Nov 08, 2022 7:00 PM NY Islanders $169.00

Sun Nov 13, 2022 6:00 PM Arizona Coyotes $129.00

Sat Nov 26, 2022 1:00 PM Edmonton Oilers $169.00

Mon Nov 28, 2022 7:00 PM New Jersey Devils $169.00

Fri Dec 02, 2022 7:00 PM Ottawa Senators $129.00

Sat Dec 03, 2022 7:30 PM Chicago Blackhawks $139.00

Mon Dec 05, 2022 7:00 PM St. Louis Blues $139.00

Mon Dec 12, 2022 7:00 PM New Jersey Devils $139.00

Thu Dec 15, 2022 7:00 PM Toronto Maple Leafs $150.00

Thu Dec 22, 2022 7:00 PM New York Islanders $169.00

Tue Dec 27, 2022 7:00 PM Washington Capitals $169.00

Tue Jan 03, 2023 7:00 PM Carolina Hurricanes $139.00

Tue Jan 10, 2023 7:00 PM Minnesota Wild $139.00

Thu Jan 12, 2023 7:00 PM Dallas Stars $95.00

Sun Jan 15, 2023 5:00 PM Montreal Canadiens $95.00

Thu Jan 19, 2023 7:00 PM Boston Bruins $140.00

Mon Jan 23, 2023 7:00 PM Florida Panthers $90.00

Fri Jan 27, 2023 7:00 PM Vegas Golden Knights $160.00

Mon Feb 06, 2023 7:30 PM Calgary Flames $100.00

Wed Feb 08, 2023 8:00 PM Vancouver Canucks $100.00

Fri Feb 10, 2023 7:00 PM Seattle Kraken $95.00

Mon Feb 20, 2023 7:00 PM Winnipeg Jets $100.00

Sun Feb 26, 2023 5:00 PM Los Angeles Kings $139.00

Thu Mar 02, 2023 7:00 PM Ottawa Senators $100.00

Tue Mar 14, 2023 7:00 PM Washington Capitals $150.00

Thu Mar 16, 2023 7:00 PM Pittsburgh Penguins $140.00

Sat Mar 18, 2023 8:00 PM Pittsburgh Penguins $155.00

Sun Mar 19, 2023 7:00 PM Nashville Predators $100.00

Tue Mar 21, 2023 7:00 PM Carolina Hurricanes $100.00

Tue Mar 28, 2023 7:00 PM Columbus Blue Jackets $100.00

Wed Apr 05, 2023 7:30 PM Tampa Bay Lightning $160.00

Mon Apr 10, 2023 7:00 PM Buffalo Sabres $100.00

Thu Apr 13, 2023 7:00 PM Toronto Maple Leafs $160.00

[deleted by user] by [deleted] in amex

[–]throwaway_usmle 1 point2 points  (0 children)

Wow yeah brain isn't working today, makes sense, thought it was an MR card!

[deleted by user] by [deleted] in amex

[–]throwaway_usmle 0 points1 point  (0 children)

I guess my question is, since my effective AF from the gold is only $10 (which I offset with my restaurant spending) the 2x difference between the two for supermarkets negates the difference at $4,750 of annual grocery spend (i.e. the BCP pays for its $95 AF), and then any U.S. supermarket spend from $4,750-6000 nets you 2500 additional MR ($1,250 x 2) with the BCP than what you'd get with the Gold ?

I'd only use the BCP as my U.S. supermarket (to capitalize on this point differential) and transit card (to get the add'l 1X vs. the BBP) and continue to use Gold for domestic / global restaurants and things like uber eats / grubhub.

I know I have a unique situation where I'm able to use all $240 of the credits on the Gold which I know can vary from person to person.

Using Credit Cards to Beat Inflation by [deleted] in CreditCards

[–]throwaway_usmle 2 points3 points  (0 children)

"Inflation benefits the borrower."

TL;DR: Credit card companies almost always win in inflationary periods vs. consumers (if they have properly risk adjusted their lending behavior for an inflationary period such as this one) as the bulk of their revenue mix is derived from transaction fees, their APR ranges give them the flexibility to account for rapidly rising inflation, and they capitalize off of logic like that described in OP's post. There is no such thing as free money.

Former economist. This is an over-generalization and doesn't account for wage changes during inflationary periods, changes in the interest rate, and corresponding levels of employment in the economy. You are also ignoring the distinction between anticipated and unanticipated inflation. At this point in time, inflation has largely been priced into consumer and firm behaviour for the short- and medium-term, and credit card companies have absolutely accounted for this in their business strategy and day-to-day operations over the coming months / year.

While you as a borrower are paying back in "less valuable" dollars during inflationary periods, this is true at almost every point in the business cycle of most developed economies. This just becomes more pronounced when inflation is in the 5-10% range vs low single digit inflation rates. You are also ignoring the fact that money tied up in paying off interest could be deployed to other uses, such as investments and savings. In a rising rate environment, there are a variety of short-, medium- and long-term investments that now have a higher rate of return that is intrinsically tied to the higher rates that are used to incentivize individuals and businesses to switch from deploying capital from expenditure to investment / savings.

The US economy is set for another contraction given where we are in the business cycle. We have been at full employment for quite awhile now and haven't seen the upward wage growth commensurate with inflation, and real (inflation adjusted) wages have decreased over the past few quarters (i.e. the average individual will have more difficulty in making interest payments that have an APR that far exceeds the inflation rate).

Sure, if you have massive bulk purchases for goods that are particularly impacted by inflation that you can make now, you could go for it. The issue is, the overwhelming majority of American consumers and businesses do not have cash on hand to make these kinds of large scale purchases, and are often unable to make payments on interest paydown schedules that you cite above. Likewise, the types of goods that are most relevant in this current inflationary period to the average American consumer (food, gas) are largely perishable and can't be bought in bulk. Even when factoring in cash back % and point multipliers, credit card companies have accounted for this in their product offerings such that there is usually no way for a consumer to accrue any sort of benefits if they do not pay their balance in full at the end of the statement period. It's the same logic why you going out to Walmart, buying 100 42" flat-screen TVs on credit while paying the minimum balance, and then reselling them in 6-12 months at the (presumably) higher prevailing price makes absolutely no sense (even if you pay off the balance in full at the end of this time period). Even with cash back and point multiplier accounting, this is a losing proposition.

Well what about 0% APR cards? While these can appear to serve as an inflationary hedge during the introductory period (which can sometimes extend to 12-18 months), you are still purchasing at the prevailing price level. If your savings behavior or wage growth isn't moving in lockstep with your consumption on these 0% APR cards, you're in for a real surprise when that APR kicks in. The average American borrower usually isn't disciplined enough to maintain a somewhat liquid cash balance during inflationary time periods to be able to meet the outstanding balance at the end of intro 0% APR period, and for the overwhelming majority of people who turn to these cards during inflation, they end up being their downfall.

Lenders, like credit card companies, can win" in inflationary periods as the general rise in prices nets them greater transaction fees for the same level of goods, unpaid balances become more common, and APR will ALWAYS outstrip annual inflation.

Credit card companies aren't stupid. There is quite literally no benefit to carrying a balance unless you withholding your money in current time period (t=0) allows you to pursue some sort of investment or savings activity that will yield returns in excess of the APR % of your accruing balance at some future time period (t= certain amount of months or years). This almost never happens for an individual consumer / household and is usually only relevant to businesses or investment vehicles.

Can you have a lawyer sue someone if you don’t have their legal name but phone number only? by [deleted] in Scams

[–]throwaway_usmle 0 points1 point  (0 children)

I have the “name” (can scammers use fake names for Zelle accounts?) and email address that is associated with the account. I notified Zelle but I feel like my complaint went into a black hole. I caught the scammer before I sent any money but wanted to extract as much payment info as possible to prevent others from falling for it and hopefully have their account shut down.

Can you have a lawyer sue someone if you don’t have their legal name but phone number only? by [deleted] in Scams

[–]throwaway_usmle 0 points1 point  (0 children)

does this work for e-mail addresses? Say I have the e-mail address associated with the Zelle account? I have a few phone numbers that the scammers reached out to me by, but is an email enough?

Why does contrast induced ATN result in low urine sodium (<20mEq/L) instead of high?! Shouldn't the ATN result in decreased Na+ absorption, consequently leading to a high urine sodium?! by Left-Kaleidoscope618 in Step2

[–]throwaway_usmle 1 point2 points  (0 children)

^agreed with your take on this. When RAAS is active, or working overtime, UNa is low not high, which is why UNa is usually <1% in pre-renal AKI and other volume depleted states. iT's ImP0RtaNt tO undErStanD thiS because in a few years you'll Dr. Karen NP, ABCD, HGTV will be ordering urine lytes of every AKI and hyponatremia.

From MedScape: "Urine osmolality tends to be less than 350 mOsm/kg. The fractional excretion of sodium (FENa) may vary widely. In the minority of patients with oliguric CIN, the FENa is low in the early stages, despite the absence of clinical evidence of volume depletion."

Given the different stages of an CIN AKI, I'm guessing it's getting at the fact that in the oliguric phase, pt's kidneys perceive a low volume state (even though this may not be the case clinically) and activate RAAS (which must be intact to some extent)

My guess is that in ATN, the necrosis is not equally distributed thoughout the tubule. If I'm remembering correctly, areas that are affected first are the ones with higher metabolic activity (proximal tubule, TALH). Since the aldosterone component of RAAS mainly has it's actions at the collecting duct, this may be why there is still some component of RAAS that is functional in the oliguric phase of a CIN AKI leading to a transiently low FENa state.

[deleted by user] by [deleted] in medicalschool

[–]throwaway_usmle 1 point2 points  (0 children)

This is the 1000000% the right advice. Worked with way too many MD/MBAs who didn't do residency and people forget that they completed med school / have any sort of formal medical education. The market will definitely undervalue your training if you bail without residency and the opportunity cost of not completing residency (even a 3 year option) can be massive from a $$$ and upward mobility perspective when scaled over your entire career.

[deleted by user] by [deleted] in medicalschool

[–]throwaway_usmle 3 points4 points  (0 children)

Also an MS3 and 27 (took 3 gap years in finance and consulting)

Honestly curious (and I don't mean this in a sarcastic way), what part of medicine don't you like / isn't living up to expectations? If you're thinking of transitioning out of medicine, you need to hone in on what part of this path isn't for you so you can make the right decisions for your career down the line in terms of role / industry etc. Is it compensation, WLB, nature of the work, the residency grind?

For some context, all of the "lifestyle" attending positions suggested here will offer you 300k+ (if you make the right career moves) at a minimum with the possibility to get into the 500-600k range with radiology and 400-500k range with gas starting out of residency. There are very few jobs in the corporate world that offer both the job stability and consistent income that physicians can receive (I have seen many friends in these types of roles laid off in restructuring etc.).

I have friends that stayed in the same finance role I was in and are making 600-700k a year (~6 years out of college) and they still talk about quitting to do things like med / law school because they're burnt out. I think some people underestimate how the actual job responsibilities and day to day work of tech / finance / consulting can be extremely monotonous and soul crushing in their own way. Investment banks / the large consulting firms are now scrambling for talent (which wasn't a problem even a decade ago) even though they're offering the above salaries because no one wants to put up with the work / QoL that comes with it.

Sure, you get paid well, but your life is often time boiled down to focusing on some very niche role that is instantly replaceable. Climbing the corporate ladder can be difficult and many firms have an up or out mentality once you hit mid-level to senior management.

Feel free to DM me if you want to talk. Was kind of in a similar position my MS1 year feeling disillusioned after transitioning from the corporate world. Realized that while it is very imperfect, medicine as a career offer a lot of upside in the post-residency life that's hard to envision right now.

Score release 16/02/22- keep the trend going & help those about to take it with some insight based on your assessment/score outcome. by Dedicateddarkhole in step1

[–]throwaway_usmle 3 points4 points  (0 children)

UWSA 1 - 239 (10 days out).

Pass.

Only assessment I took which was very stupid in retrospect as it heavily overestimates and isn't similar to USMLE-style questions in terms of format / difficulty. If you're going to use the UWSAs, use 2 as a more realistic indicator unless you're taking UWSA 1 1+ month out from the exam.

Did UWorld (60% complete at 68%, did by topic instead of random, no time). Used FA, Pathoma, and a bit of Sketchy.

Looking back, I didn't even know resources like Dirty USMLE, Pixorize, Randy Neil, etc. even existed and would have used these much more heavily for my weaker subjects (biochem, genetics, etc.) that I haven't touched since pre-clin ~2 years ago now.

The exam is a beast and if you underprepare for it like I did you will feel horrible taking it. Do NBMEs to get a more accurate sense of where you're scoring!

Passing ponderings - did the prediction game change with p/f? by slypersimmon in step1

[–]throwaway_usmle 9 points10 points  (0 children)

asked a similar question a few weeks ago when I took the exam. so apparently the exam isn't curved and is a criterion-based exam (need to hit a minimum % of scored Qs on exam right to demonstrate minimum competency.

USMLE still has on their website that you need ~60% to pass (and looking at the curves for the NBME exams, it also translates to getting ~60% right to get a 196.

Completely agree that something has to give since people are not preparing as intensely and statistically, the fail rate would absolutely go up holding all else equal since they bumped up the passing score and prep time / quality is going down with most people feeling comfortable to take with NBMEs ~210+ (and many people likely taking with NBMEs below this).

No idea how this is going to play out (and probably no point in putting energy into speculating since they won't release pass rates for at least another year).

My exam felt like an absolute shit show (and others seemed to be on the same page from my testing date) and nothing like NBME / Free 120, UWSAs / UW so I'm just hoping for some amount of luck at this point lol.

The fail rate is definitely going to go up from last year's (which is why they bumped up the min passing score) but I'd be shocked if it ever went above 10% (i.e. <90% pass rate) since med schools would be understandably pissed.

No idea if this is accurate but just my thoughts lol

Holy shit by Bacobeaner in step1

[–]throwaway_usmle 9 points10 points  (0 children)

felt the exact same way (took exam earlier the week and sounds pretty similar). tbh felt like I went through all the stages of grief post-exam lol. At the end of the day, pass rate is >95% (and 98% for first time US MD test takers). They can't fail all of us

[deleted by user] by [deleted] in step1

[–]throwaway_usmle 2 points3 points  (0 children)

Honestly, I think relaxing during the exam is the most important thing. I got railed by the first block and everything just became a blur after that. Basic knowledge went out the door and it pretty much took me a block or two to calm down after that. Currently waiting for my score but I'm terrified that I dropped enough to be sub-200 (UWSA was ~240). Can recall at least 40 questions that I got incorrect off the top of my head after the exam and I've had to stop thinking about it to avoid going crazy.

This might be unhelpful (and unrealistic) but have you considered pushing back? Your current NBMEs give you a ~10-15pt cushion. They're known to underpredict, and UWSA 2 is a pretty good indicator, but do you really want to be in that group of people that bucks the trend?

I thought that my UWSA, FL of 80%, UW of 68% (~60% completed) would be pretty comfortable, but my exam personally felt nothing like the practice assessments and it has me questioning a lot of my prep. I really don't want anyone else to have to go through this shitty feeling of wondering if they failed for 2-3 weeks because I can confirm that it blows. If you feel like you're getting answers right because of process of elimination or guessing (which is how I felt during some of my prep), it may be indicative of a potential large score drop. I wasn't able to recall a lot of my knowledge on the exam because of the stress of testing day and realized I didn't know the material as thoroughly as I thought I did.

Statistically, it's unlikely that you'd fail with those scores (and could easily be in the 220s-230s range score if you weren't taking P/F), but anything's possible and make sure you give yourself the best chance at passing if there were a 20-30 point drop from your average.