Julianne H. Worst, SDN user name Julianne, is a 32-year-old first-year student pharmacist and pharmacy intern. She is currently a member of the class of 2011 at Auburn University’s Harrison School of Pharmacy. Worst, who spent her childhood in both Savannah, Georgia, and Montgomery, Alabama, did her undergrad work at Bevill State Community College in Alabama. She has been married for almost 15 years and has one seven-year-old son.

Choosing pharmacy as a specialty was almost a fluke for Worst. “I actually stumbled on the profession after my son, Ezekiel, was born prematurely back in April of 2000. At that time, I was working about 50 or 60 hours a week (in retail management) and while I enjoyed the work, I could no longer adhere to that type of schedule. I resigned from the management position and spent the next 12 months caring for my son. When I returned from my leave of absence, I requested to come back on a part-time basis and I was assigned to working in the pharmacy as a technician. I quickly fell in love with the profession and decided to make it my career.”

Although Worst jokes that she may not know what an iPod is, she says there are some advantages to being an “older” student.

“I’m glad to be an older, ‘non-traditional’ student, because I feel that my maturity level and real-world experience serves me well in the high pressure environment that I’m in right now,” she observes. “Since I have so many responsibilities and connections outside of the realm of pharmacy school, I can see the big picture and visualize the end result of my hard work. To a younger person, four or five more years of school may seem like a very long time. I know from experience, though, that it will pass quickly, and that is one of the main things that keeps me motivated and focused on my goal.”

But the road isn’t always easy, especially juggling work, school and family.

“Everyone around me (including my son) has made sacrifices to see this thing through,” Worst notes. “Right now, Zeke is living with my mother and father in Montgomery while I’m in Auburn and my husband is in Birmingham. My in-laws, sisters, friends, and even the neighbors have stepped up to help whenever they are needed because they want to see me succeed. It has been a community effort from the beginning, and without the love and support of everyone around me, my journey towards becoming a pharmacist would have been over long before it even began!”

Worst says she’s striving toward better balance.

“During my undergrad years, I was able to juggle all of those things with relative ease; however, I’m finding very quickly that the same strategies I used back then just aren’t working as well for me now,” she explains. “I’m in the process of adjusting to my new situation and learning alternative ways of handling the many demands that are placed upon me these days. If nothing else, pharmacy school has taught me the value of time management and the importance of flexibility — attributes that are absolutely necessary for anyone considering applying to pharmacy school.”

When Worst is not busy attending classes and seminars, studying, or conducting weekly visits to patients as part of her Pharmacy Practice Curriculum, she is a moderator in SDN’s Pre-pharmacy and PCAT areas.

Worst, who found SDN through a search engine while looking for interview tips and suggestions, recalls of her first SDN experience, “SDN was such a great resource for me when I was applying to pharmacy school that I wanted to give back in some way to show my appreciation. I hope that I can help others who are just beginning their journey towards becoming pharmacists.”

“The interview feedback section was by far the most helpful to me at first,” she explains. “Reading the entries helped to answer many of the questions I had about the process itself, clarified my understanding of what I should do to prepare, and gave me a better idea of what to expect from each school that invited me for an interview.”

“Afterwards, the pre-pharmacy forum kept me sane while waiting for a decision by the schools that had invited me to interview. On that forum, I was able to commiserate with others in the same position, while gathering valuable advice/suggestions about what to do if I was rejected.”

Worst says she found value in SDN after acceptance as well.

“Once accepted to HSOP, I began to take a greater interest in the pharmacy forum because of the wealth of information it contains,” she explains. “I have found helpful suggestions on everything from study habits and time management skills, to balancing the demands of school with a successful family life. As I continue my pharmacy education, I look forward to communicating with and learning from other student pharmacists around the nation via SDN.”

Worst has some advice for students who may have just stumbled onto SDN. “Take advantage of all of the wonderful information and services available on the site, but do not rely solely on those things to make your decisions for you. Feel free to ask questions, but please search for an answer first. You would be surprised just how much relevant information is already out there if you take the time to look for it!”

With that said, Worst does recommend cutting SDN newbies some slack as well.

“Be patient with the newcomers to the site,” she advises.

“Remember what it was like to be in their shoes (overwhelmed and anxious) and try always to be helpful. If you have ideas for making the community better, more efficient, etc., please share. It is the suggestions and collective ingenuity of the SDN members that keep the site going strong.”

Well, that, and volunteers like Worst.

SDN contributor Tim Shea (Therapist4Chnge) is currently in his fourth year of a PsyD in Clinical Psychology and his second year of a MS in Clinical Psychopharmacology at Nova Southeastern University in Ft. Lauderdale, FL. Tim received a BA in Psychology from Goucher College in Baltimore, MD and an MS in Clinical Psychology from Nova Southeastern University. When not dividing his time between his studies, providing mentoring to the SDN community or indulging in his love of piano and photography, Tim also hosts a website – Struggling With Food (www.strugglingwithfood.com) – that provides information about eating disorders.

In a recent interview, Tim spoke about his life, the challenges of clinical psychology, and the need for education about eating disorders.

Please tell us a little about your background—family, educational, professional?
I grew up in New Jersey. Whether academic, athletic, or recreational, my folks really supported me in all of my endeavors. I’m a classically trained pianist—I have been playing for the last 20 years or so. Music, along with athletics, has been a consistent outlet for me. I played football, lacrosse, and track and field during high school, and I was recruited to play lacrosse in college. As for music, I still compose for the piano, though most of my spare time is spent behind my camera’s lens (www.tsphotogallery.com). I shoot mostly nature, but I dabble in landscape and sports photography as well.

Do you feel that there is a specific experience from your past that had a major impact on who you are today?
My undergraduate experience at Goucher College certainly shaped the person I am today because it provided me an enriching environment and encouraged personal and academic exploration. They found me, and I fell in love with the academic energy when I stepped foot on campus. They encourage all students to take classes in a wide range of disciplines, so in addition to my psychology classes, I was able to take classes in the hard sciences, sociology, feminist studies, and philosophy. My undergraduate experience, coupled with my mentor, were a large influence on my career.

Did anyone inspire your career choices?
I was lucky enough to work with a great mentor in Dr. Rick Pringle, and also study under Dr. Norm Bradford and Dr. Brian Patrick. Dr. Pringle encouraged me inside of the classroom and outside in the world while providing me with sound guidance that really helped shape my current career path. He was the person who first got me involved with body image and trauma work, which eventually expanded to include eating disorders. Dr. Bradford and Dr Patrick provided a solid grounding in theory, while also providing the space and opportunity to explore psychology at a much deeper level than I expected during my undergraduate training.

What strengths do you have that have allowed you to be successful?
I think the most important think is to know what you are good at and focus on that. Flexibility and determination are definitely two qualities that have served me well. I have also been told that I am personable, and I think no matter what you do in life, it helps if you can get along with most of the people you encounter.

What led you to choose a career in clinical psychology? In what field did you obtain your M.S.?
I have always been interested in the field, though it took a detour for me to fully realize that it was a career option—not just a hobby. Previously, I ran a chapter of a non-profit organization, took a chance on two start-up firms, and then worked at a Fortune 50 company. Each experience contributed greatly to my learning, and I am thankful for the crash courses in business, consulting, and management I picked up along the way. Yet, each job fell short in being able to provide the balance and enjoyment that I require from a career. Even though I worked 70-90+ hours weeks, I still found time to read my psychology journals and research; it just took me some time to realize that is what I really wanted.

I obtained my MS in Clinical Psychology while pursuing my PsyD at Nova Southeastern University, where I am currently a 4th year student. I am also pursuing an MS in Clinical Psychopharmacology.

What specialties are you interested in pursuing and why?
My clinical interests involve both eating disorders (specifically low-weight anorexics) and trauma. The complexity and depth of both are what first piqued my interest, though the clinical work and research is what pulled me in further. I think there is an opportunity to make some significant contributions to the field in this area, and I would like to be a part of that.

You’ve put together a website called Struggling with Food—tell us about that. What motivated you to create it?
Struggling With Food was an idea I have been kicking around since 2004. I wanted to have a place for people to come together to talk, support, and learn about eating EDs. Issues with eating disorders and nutrition have been interests of mine for a number of years, and they have become a focus of my research.

My ultimate goal is to reach globally and act locally. I think eating disorders are often misunderstood, both by society and within the healthcare field. I would like to get to a point where I can go into communities and help educate them, as well as help educate professionals who want to learn more about working within the ED population.

Do you feel that work on the website has influenced your career path? How?
I think it has provided me an opportunity to connect with other organizations that are doing great work to help in this enormous area of need. Unfortunately, I have not had as much time to dedicate to my website lately, but I hope to develop it as I become established. I am always open to anyone want to contribute articles, information, resources, and/or research to the website.

For others who might be considering a career in psychology, how would you characterize your experience as a student?
It has been challenging, but incredibly rewarding. Graduate school pushes you academically, but I think the real challenge is finding balance in the work. I think the people who are most successful are the ones who can balance their academic, research, and personal goals. Overall, I have enjoyed my training, though it definitely has been a grind at times. I am especially thankful to be surrounded by others who are as passionate as I am about the field.

Where do you see yourself practicing once you have completed school? Have you found that that ambition has changed over time?
I would like to settle in or around a place like Nashville, TN or Charleston, SC. My goal has always been to open up a consulting practice and combine my clinical and business training. As for clinical work, my focus will be in eating disorders, and I would like to start with an intensive outpatient practice and eventually fund my own boutique transitional program for people in eating disorder recovery.

Can you explain what a clinical psychologist is and what they do?
A clinical psychologist is trained in research, assessment, and psychotherapy at the doctoral level. They are the highest trained professionals in their field, and they use research to inform their clinical work. Clinical psychologists can work in a range of areas: teaching, research, consultation, administration, assessment, psychotherapy, etc.

What kind of training is required for someone to pursue this discipline?
A PsyD/PhD is required to become a Clinical Psychologist. Typically, a person will graduate with a bachelors in psychology or a related field, gain additional research and/or clinical experience, and then look towards graduate school to further their training. It takes at least 4 years of full-time graduate education, a 1 year internship, and a 1-2 year post-doc before you are license eligible. It is a long road, but it allows for a great deal of professional flexibility in regard to career choices.

What trait or special skills would you describe as being important for someone considering becoming a clinical psychologist?
Whether you are primarily a researcher/academic or clinician in private practice, a clinical psychologist needs to have excellent communication skills. Clinical psychology is unique in that there are many intangibles that contribute to a personal ability to be successful. Book knowledge is merely one part. Analytical skills are also vital: being able to process large amounts of information is important, but equally important is the ability to synthesize your learning and apply it clinically.

I am curious about the kind of lifestyle one might expect from practicing as a clinical psychologist—what kind of hours do you think it will require? How busy do you expect it will keep you?
There is a wide range in salary for clinical psychologists because of the plethora of career opportunities, so it is hard to put a number on that. I think one consideration is the type of work you would like to do, and work/life balance you want to achieve. I know many professionals have hybrid careers where they may teach or conduct research and then carry a private practice on the side. Others choose to focus primarily on assessments, while some take their training to the corporate world.

Starting up a practice will definitely take more hours, but if you can get a sustainable practice, many clinicians can design a very flexible work schedule. Ultimately, it is up to each individual to define what kind of lifestyle they want to live. Clinical psychology allows for non-traditional hours, as well as working in a number of different arenas.

What’s the most important or rewarding thing that you feel you have done at this point in your career?
I decided to do what I love, even if that meant up and leaving a stable and successful career. Too many people end up in a career that is either not fulfilling or a compromise. I want to get up in the morning and love what I do, and try and make a difference in some people’s lives.

We often expect in interviews to hear only about the positives of a chosen field, but some may be curious about whether there is a flip side to that question. Are there downsides that you can see to being a clinical psychologist? If so, what might they be?
I think the biggest challenge is the increased competition from other professionals. Clinical psychologists are the highest trained professionals in their field, though with the squeeze of managed care, it has become more competitive for general private practice. Specialization has become more popular, and allows clinical psychologists to differentiate themselves from other professionals doing therapy.

What do you think perspective students ought to look for in a program when considering clinical psychology as a career?
I believe a program needs to provide an even balance between clinical and research training. Each inform each other and though a person may prefer one area to another, I believe solid training in both is necessary to be an effective professional. Whether you are looking to do primarily research, clinical practice, or some combination, it is important to have a mentor or mentors that match your interests and needs.

If you had an opportunity to speak to your younger self when first starting out, what kind of advice might you offer?
I would probably tell myself not to stress as much and to take everything as it comes. I think this field self-selects people who have always been very successful (myself included), though at various times it will challenge you, and you will feel as if you are in over your head. I think it is important to understand that part of the training is to be overwhelmed and then learn how to work through it. I look at the people coming in now and I try to pass this on, but part of the process is going through that struggle.

What issues do you see as particularly important within psychology at the moment? Where do you stand on those issues?
I think clinical psychologists are woefully under-represented at the legislative level, and we need to do more as a profession to protect our interests and the interests of our clients/patients. It seems that most clinical psychologists are not as active as they should be, and the general public, as well as legislature, really fails to understand what we do as a profession, why it is important. I wish the [American Psychological Association] did more to be pro-active in this area. The [National Alliance of Professional Psychology Providers] has recently taken a larger role, and I am hoping they can work together in support of our profession.

Do you see any changes or movements happening within your field in the near future?
The prescription privileges movement has been an ongoing hot-button topic. I believe it can be beneficial for many of the under-served areas, but I think ultimately it will be a niche area within clinical psychology. I think the most eminent change is the push towards universal healthcare, which in its current proposal is scary for everyone in the field. I believe the mental health/health/medical communities need to band together and ensure that this push is not going to further erode services to patients and reimbursements for professionals.

To discuss this article on the SDN Forums, click here.

Amy B. Fought, SDN user name Amy B, was a freelance photographer before attending medical school. Born in Chicago and raised predominantly in Rich Creek, Virginia, Fought is currently finishing her MSIII year in medical school with the goal of becoming a DO.

At the age of 41, Fought says that in her free time, she still enjoys photography, as well as spending time with her family. For now, her days are spent doing rotations at various locations from about 8 a.m. to 5 p.m., though she says it all depends on what rotation she’s on.

“For Internal Medicine, I started at 6 a.m. and sometimes didn’t get done until 7 p.m.,” Fought notes. “Just depends on where you are, what you are doing, how many patients you have and what your preceptor is like to work with.”

“For the most part on rotations, you see patients in various settings,” she continues. “Some places you work closely with your preceptor, and other places you are on your own to see your patients and then report back later to your preceptor. I am currently on my Psych rotation at a Veteran’s hospital. After this rotation I will be caught up with all my third year [rotations] and will be starting fourth year.”

Fought attended Virginia Commonwealth University in Richmond for her undergrad, and Edward Via Virginia College of Osteopathic Medicine in Blacksburg, Virginia, for medical school.

Fought, who has been active on SDN for many years, is currently a Senior Moderator in charge of the Osteopathic Medical Students’ forum.

“When I first joined [SDN], it was to figure out what I had gotten myself into,” she recalls. “I was just starting as an undergrad back in 1998. I was an older student who decided, after the death of my best friend from ovarian cancer, that perhaps I could make a difference and help people and families like my friend’s family. I had never envisioned myself as a doctor growing up. I was happy in my career as a freelance photographer, but her illness and her death shook me up and I knew I needed to change my life path.

“I remember spending hours on SDN reading through all the posts and trying to follow the correct pre-med path that would get me to medical school. It was a great help to me when I felt lost, alone, confused, angry or happy, etc…. there was always someone that could relate and help me, or who could give me support.”

Fought also found help during the complicated medical school application process.

“I remember the year I first applied to medical school,” she says. “It was the year that AMCAS first went to a computerized system. It was a nightmare trying to apply. For those of who you applied that year, I bet you remember well what I am talking about. I remember sitting at my computer for hours and hours (if I recall it took 36 hours total just to get the application submitted) trying to finish that application. It was great to post on SDN each time a problem arose and find out I wasn’t alone and others were having the same issues. I remember helping each other out by sharing what was working and what wasn’t.”

She found even more support when she was waitlisted and didn’t clear the list.

“I was so upset and felt like giving up,” Fought recalls of that time period. “It was the folks here on SDN that encouraged me not to give up and to apply again. I took a year off and away from anything relating to medicine and then applied again. I was accepted to both a DO school as well as an MD school, and ended up choosing the osteopathic medical school in Blacksburg.”

She also started a class thread after being accepted, and she and her classmates started to get to know each other through SDN.

“When we first met, people would look at my name tag and say, ’Oh I know you. You’re Amy B aren’t you?’ It was great starting school and already knowing so many of my classmates through SDN,” she adds.

Fought explains that she soon started to give back and help others as she had been helped. It started with a few private messages for advice or help with particular situations, then soon she was promoted to a Moderator and most recently to a Senior Moderator.

“I take great pride in that and enjoy giving back to SDN, for all the help I got when I was just starting out in this path to becoming a doctor,” Fought notes.

She advises those new to SDN to start with the “stickies” in areas of particular interest.

“Personally, I have gotten used to seeing the same types of questions year after year, and quite frankly it doesn’t bother me when someone asks something I have seen many times in the past,” she explains. “But it does bother others on SDN, so that is why there are FAQs listed.

“Also remember that you can’t always believe what you read. Not everyone has a 43 MCAT and a 4.0 GPA even though they say they do. Don’t get discouraged by reading other poster’s posts and think you are not smart enough to be a doctor.”

Fought also advises “seasoned” SDN users to give the newbies a break.

“Remember that we were all newbies at one point in time, and don’t be so fast to tell people to search for their answers,” Fought advises. “That may bug people, but newbies don’t know how to work the forum as well as the seasoned SDN users, so give them a break once in a while. I would encourage people who have been here awhile to make sure they start helping others who are just starting out. In other words, give back your time to help those who are following you.”

Fought is married, but her story doesn’t stop there.

“I am married and have two children, one son and one daughter,” she explains. “Or at least I did before March 2, 2007. My life was drastically changed on that date. My son had ulcerative colitis. He had his first major flare up in February and was hospitalized for colon rest … [he] was being discharged from a local hospital here in Blacksburg when things went horribly wrong. By the time I realized there was something wrong and went and got help, it was too late. He died later that morning from a massive air embolism. I carry great amounts of guilt with me.”

Fought’s final piece of advice is one that everyone would do well to heed.

“Enjoy life and live it to the fullest. Tell those you love each day just how much you love them. You never know when you will leave this earth. It can happen at any time,” she concludes.

Holzheimer grew up in the D.C. suburbs of Prince George’s County, Maryland, before attending James Madison University, where he graduated in 1999 with a bachelor’s degree in health science and a minor in biology, public health, and pre-med.

From there, he went to Nova Southeastern University’s College of Osteopathic Medicine, in Ft. Lauderdale, Florida, in 1999. Then it was on to Clearwater, Florida, for his medical school rotations before a residency at the University of South Florida in Tampa from 2003 to 2006, where in his last year he was also chief resident.

Although Holzheimer says he always knew he wanted to be a doctor, in the beginning he wasn’t so sure about emergency medicine.

“I always wanted to be a doctor ever since I can remember,” he explains. “I had very bad asthma as a child and was in and out of the hospital. I wanted to be in emergency medicine because of the TV show ‘ER,’ but I wasn’t sure I could handle it (based on what I saw on TV), so I did a summer shadowing in an emergency room in Alaska in 1998, and I realized that it’s not as sensationalized as what’s depicted on TV.”

As a faculty physician for Washington Hospital Center at Georgetown University Hospital, Holzheimer says he works about 30 hours a week but his shifts vary—sometimes mornings, nights, or weekends.

“We do 8- to 9-hour shifts. We clock in and clock out at the end of the shift and that’s it until the next shift, no pagers, no [being] on call,” he adds.

“Shift work in an emergency room department is different, because someone’s always staffing it 24 hours a day, 365 days a year, so we’re there like shift workers at McDonald’s.”

Holzheimer says he’s not on call unless there’s a national disaster or a local disaster.

“Some consider the schedule of emergency medicine to be a pro, some consider it a con, but we’re generally scheduled fairly, so no one person has to work all nights, weekends, or holidays,” he notes.

A decided pro for Holzheimer are the number of days off he gets, which he uses to spend time with his wife. A big fan of video games, Holzheimer says he’s even convinced his wife to play too.

The payback? He cooks for her.

As for what his wife thinks of his work schedule, Holzheimer says she’s able to work around it and enjoys the time he has off. Since she recently gave birth to their first child, a son, you can bet she puts her husband’s time off to good use these days.

According to Holzheimer, not everyone is cut out for emergency medicine.

“Know that this is what you want to do and that it’s truly for you,” he advises. “Most medical schools allow rotation into the emergency room, and if not, ask to hang out there on an off weekend to get a feel for it, because taking a patient to the emergency room is a lot different than being in it working. And ask people questions, because most people in emergency medicine are friendly and laid back.”

When Holzheimer isn’t working or changing diapers, he’s busy running his forums, keeping them free of trolls and inflammatory posts, as well as on topic.

Holzheimer is an SDN veteran, having been on the site since 1999. He used SDN as a place to talk to peers, and after several years he was promoted to moderator.

His advice for those new to SDN is to learn to use the search function.

“Any question you might have, chances are it’s been asked at least once before,” Holzheimer says. “Also join in on posts, but keep in mind that anyone can post here, so average the advice all together rather than just taking one poster’s advice.”

For seasoned SDN users, his advice is one word: “Stay.”

“SDN is popular in part because so many people give back to those who are new,” Holzheimer concludes.

To discuss this article on the SDN forums, please click here.
To learn more about Osteopathic Medicine, visit the American Osteopathic Association.

Roxie Twedt, SDN user name oxeye, is set to join the ranks of medical students at the University of Nevada School of Medicine come fall 2007. In the meantime, the San Francisco Bay Area native, who spent three years early on living in Tokyo, Japan, is helping the Student Doctor Network as the Assistant Mentor Coordinator, a moderator position in the Mentor Forum.

“I supervise the Promotion and Recruitment Assistants in the Mentoring Forum, and manage the mentors in the forum,” she explains of her role. “I maintain several tables of contents in the forum to make the threads easier for students to navigate and also cut down on some of the repetitive questions that mentors receive.”

“We want the forum to work well for mentors and SDN users, and a big part of my responsibility on SDN is making sure that the mentors and the SDN users are happy with the forum,” Twedt adds.

According to Twedt, there are several new projects in the mentor forum, including the medical student peer mentoring thread and the Confidential Consult subforum.

“All4MyDaughter, lilnoelle, and I are all working to get these projects going,” she says, adding, “I expect the new subforum to be very popular. It’s a discussion forum, so anyone from SDN can reply to discussion threads, but all posts will need to be approved by moderators. We hope this will encourage people with sensitive questions to ask for advice without fear of the thread getting off-topic or being personally attacked.”

SDN has the MCAT to thank for Twedt’s involvement in the forums. She found SDN via a partner site, momMD.com, when she was seeking advice about balancing medical school and children.

But something else kept her here.

“I stuck around SDN because I love how active the site is,” she explains. “I was studying for the MCAT at the time, so I spent a lot of time in the MCAT forum.”

Naturally, she was soon recruited as an SDN advisor in the MCAT forum. When the opportunity to join the staff of the Mentor Forum came up, Twedt was intrigued.

“I was excited to volunteer as an advisor in the Mentor Forum, because I think it is a wonderful resource that SDN is offering and I wanted to help out any way that I could,” she recalls. “I was promoted to Assistant Mentor Coordinator soon after joining the Mentor Forum staff.”

Twedt says in the short year and a half she’s been a member of SDN, she’s gotten a lot of use out of the site.

“I utilized the MCAT forum while I was studying for the exam and waiting for score release – and long afterwards,” she laughs. “During the medical school application process, I spent a lot of time reading the Pre-Allopathic Forum. I spend the majority of my time on SDN now in the Mentor Forum, but I’m sure I will continue to use all of the resources of SDN that are available to me as I progress in medical school, residency and beyond.”

SDN also provided assistance Twedt says she might not otherwise have had access to.

“As a non-traditional medical school applicant, SDN was a great help to me when I was applying, because I did not have access to the typical resources that pre-medical students have as undergraduates,” Twedt adds. “I have also made some very good friends on SDN and hope that we will all stay on SDN throughout our educations and beyond.”

As for those who may be new to SDN, Twedt offers some words of wisdom.

“Spend time reading the forums, particularly the stickies and Frequently Asked Questions that other SDN members have spent time putting together for your benefit,” she recommends. “Most importantly – post! Get to know other members and have fun. Regardless of where you are in your education process, it’s hard work and it’s stressful, so it’s nice to get on SDN and talk to people who can relate to what you’re going through. If you have specific questions, where you can’t find answers elsewhere on SDN, ask in the Mentor Forum. Navigate outside the forums as well. There are great articles posted regularly on the front page, and the blogs are very entertaining to read.”

She says seasoned SDN users can also help SDN continue to improve.

“Look around at that SDN is now compared to when you joined,” she says. “This growth is a result of a lot of time and effort on the part of all the volunteer staff, and we hope you like the changes. Are there any areas where you would be able to contribute to SDN’s continued growth and development? Speak up if you have ideas.”

Twedt, who’s been married nearly five years and has two daughters – one of whom will be four in September and the other who will be two at the end July – is currently enjoying her last summer as a stay-at-home mom. In addition to helping out SDN, she enjoys listening to classical music and playing the piano, and also likes to spend time with her numerous animals (dogs, a bird and perhaps soon, a kitten).

Twedt also has her eye on becoming a Child Passenger Safety Technician within the next year.

“I enjoy helping other parents,” she concludes. “My two focuses are breastfeeding and education about proper use of car seats. I’m a Certified Lactation Counselor and a Child Passenger Safety Assistant. I expect to have time to take a course to become a Child Passenger Safety Technician next summer.”

In August 2004, Q took the MCAT and scored a 43S. She began giving MCAT advice on SDN when she joined as a member in October 2004. Q joined the SDN staff in June 2005 as an advisor for the MCAT Study Questions subforum and later became MCAT forum moderator. She now oversees all of the SDN premedical forums. Recently, SDN spoke with Q to get her input on preparing for and taking the MCAT. 

1. What did you do to prepare for the MCAT?

I was still in graduate school when I started studying for the MCAT, and I was also working for Kaplan as an MCAT instructor. I used Kaplan’s online prep course, mainly because it was available to me as an instructor. I was able to teach for Kaplan while I studied for the MCAT because I had taken the MCAT once before while in college.  I received a 34P on my first attempt. I did all of the homework assignments for physics and most of the biology ones too. I didn’t do the chemistry or organic assignments since I was teaching chemistry and organic at my university. I also took the five proctored full length practice tests along with my MCAT class.

It was a pretty crazy time; I was still working full time in the lab and teaching 3-4 nights per week. During the week, I was able to get in studying time by waking up early to read for half an hour in the morning, and reading again for half an hour in the evening before I went to bed. I’d spend most of Saturday and Sunday studying, maybe eight hours per day, unless I had to teach. This was my schedule for about ten weeks, and then I started burning out.

2. What were the best and worst parts of your experience with the MCAT?

The best part was walking out of there and finally having it over with. While you’re studying, the MCAT kind of takes over your life, you know? And, of course, the day I got my scores was a great day.

The worst part was that my test date actually got delayed for two weeks because of Hurricane Charley hitting Florida on the weekend when the MCAT was scheduled. I was totally burned out and more than ready to get it over with, and here I had to wait another two weeks!

3. Were you surprised by your score, or did you expect to do that well?

I was aiming for a 40. That’s what I got on my Kaplan diagnostic, and my practice full length tests ranged from 37-41. I figured I’d probably get a 38 or so on the real thing, but I would have been happy with anything over a 35. So yes, I was pretty surprised; I expected to do well, but not that well.

4. How did other people react when they heard about your score?

My mom and I were talking on the phone when the scores came out; when I told her what I got, we both just started screaming. When I told my PI, his response was, “Gee, I knew you were smart, but I didn’t know you were THAT smart.”  Interestingly, my old PI for my M.S. had almost the same word-for-word response. My Kaplan manager said that she had never heard of anyone getting a score like that. Maybe only my MCAT students weren’t surprised.

The funniest response was by one of my Ph.D. committee members, who asked me if I was going to retake the test so that I could try to get a perfect score. No freaking way!

5. Which section of the MCAT do you think is the hardest or easiest, and do your scores reflect that?

In general, VR is definitely the hardest section. It’s the hardest section to study for, and it’s the hardest section to do well on because the curve is so much stricter than on the other sections. You have to get a much higher percentage of questions correct to get a high scaled score on VR than you do on the science sections. Plus, the subject material tends to be things that most premeds don’t read about very often, like philosophy, literary criticism, and economics. In my case,

I think I was most worried about PS because it had been so long since I had taken physics. I really studied physics like crazy. So I guess I’d have predicted that BS would be the “easiest” section for me, and in fact BS was the section that I got the 15 on. I’m not sure that you can read so much into my scores though, because I don’t think there is very much difference between a 14 and a 15. We might be talking about a difference of one or two questions.

6. You said that VR is the hardest section; how can a person raise their VR score?

VR is one of those things that you can only improve with practice, and lots of it. You might have to experiment with different techniques until you find one that works well for you. I used the Kaplan VR techniques, and they worked really well for me. I’ve had some students who swore by other techniques that they read about in other books. The important thing is to pick a technique that works well for you and really practice it like crazy.

Starting several months before you plan to take the test, try working through two passages a day and reviewing the explanations. The key though is not to just do a zillion passages and questions, but to really pay attention to the types of questions that you tend to miss. Practice doing more questions like that. Also, if certain types of passages give you trouble, start reading more articles in those subjects. A lot of students hate reading philosophy or literary criticism passages; they need to go to their school library and start reading philosophy and literary criticism on a regular basis until they get comfortable with reading them.  

The other tricky thing about VR is that you have to be pretty fast. A lot of people tend to spend too much time reading the passages and not enough time working on the questions. Again, improving timing is something that comes with practice. There isn’t any shortcut for improving on VR, unfortunately. You have to just put in the time to improve your weak areas.

7. You mentioned working to improve your weak areas—what were your weak areas?

Physics and physiology. I took intro physics and biology in 1993 as a college freshman, so I forgot a lot of stuff by the time I started studying in the summer of 2004. Actually, I never learned physiology in college at all; what little physiology I knew before I started medical school I learned from Kaplan.

8. How well do you think that a person’s MCAT score predicts their medical school performance?

Honestly, I don’t know the answer to this. Logic suggests that there must be some amount of correlation between MCAT scores and medical school performance, but it’s really hard to separate out the influence of hard work versus natural talent. I think that most people who do well in school and on the MCAT work very hard for those accomplishments. The lazy genius who aces the MCAT and is the top student in the class is something of an urban myth, in my experience.

9. Do people score really well on the MCAT more because of natural ability or hard work?

I was asked at one interview whether I thought that anyone could score in the 40s on the MCAT. I hadn’t ever thought about it before that interview, but I have to say that the answer is no, and the main reason doesn’t have anything to do with either natural ability or hard work.

The thing is that the MCAT is a curved test, and the system is set up where most people can’t score 40+. It’s very difficult to score in the teens on any one subsection, and in order to get a 40, you have to independently score that high on all three subsections. Very, very few people manage to do it.  The AAMC told me by email that for the August 2004 test administration, there were eight 42s, two 43s, and zero 44s or 45s out of nearly 35,000 people who took the test nationwide.

I do think that test-taking is a skill, and like every other skill, some people are naturally better at it than others. However, even people who are “average” at the skill of taking tests can improve to become above average with hard work. So I wouldn’t say that people score really high on the MCAT due to either natural ability OR hard work, but rather because of a combination of natural ability AND hard work.

The other thing about people who do well on tests like the MCAT is that they read quickly with comprehension. Remember that the MCAT is a timed test. If you could spend as long as you wanted to take the test, then a lot more people would get significantly higher raw scores because one of the factors limiting most people’s MCAT performance is running out of time. In contrast, people who score really high on the MCAT are people who finish early because they are fast readers, and giving them more time wouldn’t be particularly helpful.

10. How much are admissions committees impressed by seeing MCAT scores over 40?

Not as much as you might think. When I was interviewing, I had several admissions folks practically gloating to me about the high-stat applicants that they had rejected because those applicants were arrogant and acted like they were entitled to a medical school seat based upon their stats.

Sorry, but that isn’t how the medical school admissions game works. Stellar stats will only get you so far. I think for the MCAT that once you hit the mid-thirties range, say 35+, then scoring even higher on the MCAT doesn’t really do much to improve the overall strength of your application. A 35 already puts you in the top 5% of all test-takers. If you apply with a 35 MCAT, no adcom is going to doubt your academic ability based on your MCAT score.

11. How much does your MCAT score matter once you’re accepted to medical school?

It really doesn’t matter at all. Once you’re in, you and all of your classmates are more or less on equal footing; the school wouldn’t have admitted you if they didn’t think you were capable of completing the program successfully. I’m getting ready to start my second year this fall, and I can tell you that we’re all thinking a lot more about taking Step 1 next spring than we are about the MCAT!

12. What advice do you have for people who do poorly on the MCAT and need to retake it?

It’s really important to figure out why you didn’t do well so that you can take steps to correct your deficiencies. For example, if your problem is that you run out of time because you spend too long reading the passages, then you need to practice getting through the passages faster. If you weren’t prepared enough, you need to make sure that you prepare properly for your next attempt, and so on.

13. What are some of the most common mistakes that people make when preparing for the MCAT?

One common mistake that people make is taking the test before completing all four pre-req courses and/or without adequately studying. Keep in mind that the MCAT is a curved test, and you’re taking it against a lot of very smart people who have completed all four pre-reqs and taken a test prep course besides. It isn’t a good idea to skimp on the preparation; those classes are called pre-requisites for a reason.

Another mistake people make is not taking enough practice tests. You want to be very familiar with the test format before you ever set foot in that room. Most test-prep courses have students take about five or six practice tests, and I think that’s a good number. You can get practice tests from the AAMC website at www.aamc.org that are very good. These tests are old MCATs that have been released by the AAMC; one of the tests (3R) is offered for free. In addition, some test prep companies like TPR and Kaplan offer one free practice test each on their websites. It’s probably worth your while to take advantage of those resources. Make sure to take the tests under strictly timed conditions, and review all of the answer choice explanations after you’re done.

But the most common mistake I see is that people do not set aside enough time to really study for the MCAT. If you are already working full-time, taking classes full-time, or a combination of both, and now you want to study for the MCAT on top of it all, something has to give. If you’re a full-time student, take a slightly easier load the semester you take the MCAT, and make studying for the MCAT like one of your classes. If you’re working and have outside responsibilities like childcare, cut back on your work some so that you have enough time to study for the MCAT.

You can’t do everything, so give yourself the time that you need. You have to actually carve out the time in your schedule; you won’t find that time lying around somewhere waiting for you.

14. Do test prep courses make enough difference to be worth the extra cost versus self-study?

I’ll start this question with the caveat that I’m a long-time instructor for Kaplan. But my most objective opinion is that test prep courses are most helpful for people who need a kick in the derriere to study effectively. In other words, if you’re a highly motivated person who will make a study schedule and stick to it on your own, you probably don’t need a test prep course. But if you’re the kind of person who tends to start out with good intentions and then quickly gets off track, it might be worth the money to take a course because it helps to hold you accountable. One of my jobs as an instructor is to keep pushing my students to complete the assignments and keep up with the study schedule.

I also think that there can be some psychological comfort from taking a test prep course, especially for older students who have been out of school for a while and aren’t really sure where to begin. But as to whether you MUST take a test prep course in order to do well, the answer is no.

15. As a nontraditional student, what advice do you have for other nontrads who are preparing for the MCAT?

There are no special preparation methods for nontrads that are different than what the younger students need to do. Nontrads have some disadvantages in that they have often been out of school for a while, and they have to get back into study mode to prepare for the MCAT. But the process is pretty much the same for us as for the trads; first take the four pre-reqs, take 2-3 months to study, take plenty of practice tests, etc.

I think that sometimes nontrads tend to want to rush through the process; they feel like they have to make up for lost time since they are older. But I look at it this way: you aren’t going to be 22 as an M1 no matter what you do. It’s better to take an extra year to do things right the first time and not have a poor first MCAT score to overcome along with other potential deficiencies in your academic record. I was 31 when I started medical school, and I’m far from being the oldest medical student on SDN.

16. When do you think is the best time to take the MCAT?

You should take it whenever you’re prepared and feel that you can do well. Ideally, take the MCAT no later than May or June of the year when you plan to apply. If you take a very late MCAT, consider applying the following year instead.

For example, I took the MCAT in August 2004, but I didn’t apply until June 2005 for the 2006 entering class. That way, instead of being one of the late 2004 applicants, I was the very earliest 2005 applicant. I had my AMCAS submitted on June 1 and verified by June 15.

Now that the test is computerized, there are more choices of test dates, and you’ll get your scores back faster.  But, it’s still not ideal to take the test in September of the year you plan to apply, because many schools are already interviewing people by then. By the time you get your scores back in October and are ready to finally begin applying, some of the earliest applicants will already be getting their first acceptances.

17. What advice can you give about the new CBT MCAT?

Some of the test day strategies are a little bit different since the test is on a computer now instead of being done with pencil and paper. But overall, the preparation required is about the same: take the pre-reqs, study for the test, and take several timed practice tests on a computer.

It’s also a good idea to go to the AAMC website and take the computer tutorial before you go to take the real test. You don’t want to waste valuable time on test day because you aren’t familiar with the computer interface. These tips and more are available in the MCAT subforum in the General Questions sticky thread.

18. Tell me more about the SDN MCAT Study Questions subforum.

The MCAT subforum is intended for students who are studying for the MCAT and other pre-health tests like the DAT, OAT, and PCAT. There are two series of threads there. The Explanations threads are the ones that are stickied at the top of the subforum. There is a separate Explanations thread for each MCAT subject except biology, which has two of them. There is an additional General Explanations thread. These threads are for didactic posts that explain difficult concepts and offer advice. Regular members should not post in them; these threads are kept locked for this reason.

The second series of threads are the Question threads. Again, there is a separate thread for each subject, two for biology, plus a general question thread. These threads are open for students to ask questions about concepts or study problems they are having. All questions should be asked in the appropriate Question thread; the MCAT mod staff will remove all new threads that are started by users.

[Editor’s note: the MCAT subforum is located at  http://forums.studentdoctor.net/forumdisplay.php?f=134]

19. Why are you and the other staff so strict about not letting the members post MCAT questions or answers on SDN?

The AAMC is very serious about protecting the integrity of their tests, and they actively monitor SDN. We want to continue having SDN as a free community with as little outside oversight as possible, which means that we need to police ourselves. In addition, we want to protect our users. Users who violate AAMC copyrights could theoretically be prosecuted by the AAMC. Finally, although we at SDN enforce our privacy policy as diligently as possible, no public website is totally anonymous. It is good advice to never post anything on SDN that you wouldn’t want attributed to you in your offline life.

20. What role do you play on SDN, and what made you decide to join SDN and give MCAT advice?

I’m overseeing the premedical forums now, but I joined the SDN staff two years ago as one of the original two advisors. (Shrike was the other one.) Lee Burnett created the MCAT subforum, and Shrike and I set it up. Last year I became mod of the MCAT forum, and then one day last summer I was promoted to smod. I’ve continued modding MCAT, and I also advise in the Physician Scientist forum. Another staff member, gridiron, is now taking charge of the MCAT subforum, and a new MCAT mod will be promoted soon.

It’s difficult to explain the attraction and addiction that SDN has been for me. Briefly, I was a pharmaceutical chemist in my former life, and I also taught classes for the university where I was doing my PhD. One of my students told me about SDN, and the night I got my MCAT score back, I decided to join. I basically realized after I called my parents and the manager at Kaplan that I didn’t know another soul on this planet who would even understand what my test score meant, let alone care.

What I like so much about SDN is the community we have here, especially for those of us who are older students. You tend to be isolated from other premeds when you’re out of college, and it’s nice to know that you’re not the only crazy “grown-up” going through this process. I have met several friends on SDN, including some of my current medical school classmates and the other SDN staff. I have to say though that I’m glad I didn’t join SDN before I took the MCAT because it’s easy to spend too much time on SDN when I should be studying!

The discussion thread for this article may be found here: http://forums.studentdoctor.net/showthread.php?p=5342523

Although he had an interest in the biomedical field, Swafford says he was not sure whether to go into research. After working for the KUMC Department of Pharmacology, Swafford says he realized he didn’t like it quite as much as clinical work (he was also volunteering at an emergency room doing clinical work at the time).

Currently, Swafford has his eye on an emergency room specialty.

“I like the pace and the fact that it’s unpredictable,” he says. “You get to deal with all types of medical problems and all types of patients, and to me that’s the most interesting. You get to practice an ‘older’ style of medicine and be a jack of all trades.”

As for where he plans to do his residency, Swafford says he doesn’t plan to stay where he is and instead wants to go “somewhere where he will see more trauma—somewhere with an established emergency medicine program.”

“I’m also looking for a three-year program rather than a four year, because by then I’ll be ready to be done,” he laughs.

Swafford has been volunteering at the same emergency room for five years now. Before medical school, he says he was assigned “busy work,” but now that he’s in medical school (and thus covered by his school’s malpractice insurance), Swafford functions as a provider in training, which includes conducting procedures under supervision, as well as working up treatment plans.

He works a couple of shifts a month, and Swafford says that although a lot of his colleagues have emergency medical technician or paramedic training (in part because they like the adrenaline rush involved in the work), he gets his adrenaline rush from running, water skiing, wakeboarding and climbing when he has the time.

Interestingly enough, Swafford has been involved with the Student Doctor Network since he was in high school.

“One day I was Googling stuff about medical school and found SDN and signed up,” he recalls. “Now, I spend way too much time on there!” Originally Swafford says he spent time in the pre-med forum, and now he’s moved on to the residency forum.

“SDN offers good premed info,” he says. “Like what you need to do for your application to be competitive. You get a good idea of what medical schools are looking for.”

He adds that most students have weak areas (he says his was his grades—a 3.3 GPA), so he got involved in clinical volunteering to compensate.

“You also get a good feel for what you’ll need to be able to talk about in the interview process,” Swafford adds. “What you’ll be asked, and what the interviewers will counter with.”

“As I’ve gotten into med school I’ve been networking more through SDN,” Swafford concludes. “I’m learning about residency programs and where I might fit in. With SDN, you can give yourself a good advantage. Without SDN, I wouldn’t have any idea about the inside track.”

After being dissuaded (for such reasons as not having any family in medicine and not being extremely wealthy) by her high school counselor when the discussion of medical school came up, Cox instead pursued what she figured was as close as she’d ever get, a degree in psychology.

Then, while Cox was in graduate school studying psychology, she lived with residents, and everything changed.

“They basically said, ‘If I can do it, so can you’ to every excuse I had, and one by one, the barriers I had created over going to medical school fell to the wayside,” Cox recalls.

So during graduate school, she completed some premed courses in preparation for what was now on her horizon.

Then fate stepped in.

In the interim between research grants, while playing intramural volleyball, she became acquainted with an Infectious Disease fellow from Australia who was in need of researchers for a project he was working on

”I knew I didn’t want to pursue my Ph.D. in psychology, and I needed a job while I finished my medical school prerequisites, so I moved to Australia to help him with his research,” she explains. That was 1996, and Cox ended up staying there for six years.

While Cox was in Australia, she says she decided to go to medical school and pursue an internal medicine subspecialty, partly because the price was right at the time, as school was inexpensive there compared to the U.S., and partly because she was considering staying in the “Land of Oz”.

Then, during her third year, fate again intervened.

“I did my Core general surgery rotation, and I just knew I wouldn’t be interested in it, but I actually found that I really enjoyed doing work with my hands and the decisive nature of the field,” Cox remembers, adding that it (surgery) appealed to the “type A” impatient American in her, rather than the “no worries”, laid-back nature typical of the Aussies.

Cox adds, “The final nail in my Internal Medicine career coffin came when I did my Core IM rotation and hated it. I couldn’t stand the indecisive nature, the delay in diagnosis and treatment, and the endless rounds and mental ‘one-upmanship’ that I experienced during my medicine rotation.” So after working closely with the plastic surgery residents in Australia, she then decided to pursue that as her field and keep general surgery as her “backup” plan.

“But I didn’t match into Integrated plastics, and it was also becoming less interesting to me as I learned more about oncology,” she adds.

“Eventually, I realized I would have to leave Australia and complete my residency in the U.S. so I would not have to repeat one to work here,” she continues. “So I applied to several plastic and general surgery residencies in the U.S., eventually matching to General Surgery at Penn State in Hershey. This was close to family in Virginia and I already knew two people doing residency at Penn State, so I felt very comfortable there.”

And it was there, at Penn State, that fate played its final hand.

“The Chair of the Surgery Department mentioned a breast oncological fellowship, and I had never heard of it,” Cox laughs. “But it seemed to fit for me—I like to talk to patients, which a lot of surgeons don’t, and I’m interested in women’s health and oncology, including oncoplastics….All of which led to where I am now in New Jersey.”

As a Breast Surgery Fellow at The Cancer Institute of New Jersey, Cox says, “You would not be hard pressed to find recent or current breast fellows who were going to be something else and had the experience of enjoying the decisiveness of this and wanting to see their patients again after the O.R. Many had originally planned a career in Family Practice or Medicine, like I did.”

And while being the “bearer of bad news” might turn some people away from this career path, Cox says she prefers the relationships she develops with patients.

“We have a different relationship with our patients than the typical general surgery population,” she explains. “I will see them frequently, sometimes for years after surgery or for High Risk Surveillance. And they refer their friends and family members to us; it’s not unusual to spend part of the office visit asking patients how their sister with cancer is doing, or looking at pictures of new babies delivered after systemic treatment for breast cancer.”

“I hear from other MDs that the field is unappealing to those who don’t like the dealing with the possibility of death, especially in younger people, or those who don’t like to spend time talking with and educating patients, because there’s lots of both involve. There’s also an emotional aspect—for many women and their partners, the aspect of losing all or part of a breast is traumatic.”

Cox adds that unlike the stereotypical surgeon, in her career “you have to be a team player and be comfortable in a multidisciplinary environment.”

“I focus on good relationships with other team members, such as plastic surgeons, social workers, genetic counselors, radiation oncologists and medical oncologists,” she notes. “There are a lot of fingers in the pie, and as a surgeon, you can’t believe you are the only important part of the equation. There is little room for ego here. I like that…I’m used to being in an academic environment, and I like to see things from different disciplinary perspectives. If you decide this is your avenue, there doesn’t seem to be a lot of burn out.”

The Student Doctor Network has also played an important role in Cox’s career path.

Like most people, she says she found SDN by doing some sort of Internet search.

She had already been active on a friend’s website started when he was a third year medical student, and Cox had helped him moderate a forum. But, as is often the case, she says he got busy and stopped working on the site.

“I was interested in learning and sharing, and I was also figuring out how to get back to the U.S. and find a residency [while I was in med school],” recalls Cox of her impetus for stumbling across SDN.

That was about eight years ago, and Cox says she posted fairly frequently on SDN and became a regular member a year later.

“Lee asked me to become a moderator, because I suppose I was seen as active and was posting often and giving reasonable advice,” Cox says. “And as the site became more popular, Lee needed help with administrative work and I’ve been helping with that for three years now.”

“As time has passed, my role has changed. Now that I am more senior in my training career, I’m not as up to date with medical students’ needs and requirements, so I have to stay out of some stuff, such as the premed and med student forums, because I don’t want to lead anyone astray. So I stick to the residency forums for the most part,” she continues.

Cox is an example of using SDN to its fullest potential, as she says she’s now using her SDN contacts to help in finding an attending job as a Breast Oncologic Surgeon, and asking others questions such as, “What I should ask for in a contract?” or “Is It inappropriate to ask if they have any single men on faculty when I come to interview?” (It’s clear her sense of humor has remained intact through the process as well.)

“I’ve come out the other end of SDN, and I hope to still be of use to the newer or more junior members,” she adds. “I can see the forums have changed, too, because there are a lot more members in senior residency or fellowships now. Even some attendings. Sometimes I see the common post from a surgical intern that says ‘I’m going to quit!’ and I can say, ‘Hey, we’ve all been there and here’s how I made it through.’”

Cox says her forum moderating duties require about half an hour per day on the general surgery and general residency forums, which she adds are “almost self moderated and don’t require that much oversight.”

“I do catch trolls form time to time, which does engender complaints, but helps keep the conversation on-topic and civil,” she notes. “That’s the goal—you want it to be self moderated. The moderator should just be resolving conflicts and disagreements.”

She says that moderating time spent does depend on the volume of posts on threads, but that on the two she oversees there average about 10 new posts per day.

In addition to her work and SDN involvement, Cox says she enjoys reading about Middle Eastern religion and travel and has traveled to Morocco, Turkey and Israel, as well as Thailand and Southeast Asia.

One of the biggest transitions for Cox has probably been dealing with New Jersey itself. Cox, who was born in Florida, spent most of her life in California and had never even been to New Jersey before starting her fellowship.

“I’m getting used to the humidity here. We’re 40 minutes outside Manhattan, so I’m getting used to the people and their accents too,” she laughs.

Fortunately, the ability to adapt to any situation seems to come naturally to Cox.