Life's Musing

             It's the 6th day from the official start of my Pre-residency training in Obstetrics and Gynecology. Today I just got home from a post duty after my second 32 hours straight duty. I didn't know I'm this tired, in the real essence of being, until I arrived home and process all the things that had happened the past few days. In these 2 episode of straight 32 hours duty from the start of my pre-residency training, I've been receiving devastating news in the middle of the night about our close and dear relatives' sad passing into the afterlife. I get shock whenever I read the news but it seems subconsciously while I'm on active duty I was like on pause of processing very emotional moments/events of my life because of the demand and anxiety that I'm in while on my duty for if I will I might suddenly crumble. But whenever I get home, I tend to get so emotional and I just suddenly cry uncontrollably for a few minutes because it's like my brain just start playing the very emotional and sad event which occurred and it's now the time to process it. It's just really heavy in my heart too. I guess it also adds up to the toll of stress I feel due to my pre-residency training. 

              This event in my life reinforce a life lesson that I should always be kind to people because you may see them smiling or doing great in whatever they do trying to keep all things together and it seems like nothing wrong is going on but deeply that person is struggling with a lot of things. Hence, always be kind and understanding. You may not be great and smart but see to it to make yourself be the kindest and most understanding person you know you want other people to be towards you. 

            A lot of things happen in life. We have to learn to accept and move on forward. It doesn't mean to say that you shouldn't process and feel the emotions you should be feeling. You shouldn't even feel guilty about feeling them. Just experience it fully for eventually that's one of the ways you'll get through it. Always be kind and understanding. Don't be too hard on yourself. Know there are a lot of people who will be there for you. 

Things I wish I learned and applied during Medical School

I'm not an all-star kind of student. I'm not one of those who easily understand every lecture/ topics from one reading. I'm not one of those students who also remember almost everything (if not everything) that they are reading. I was an average kind of student to say the least. I do my very best to pass every exams I took, mostly yes, some I didn't. The whole time I was in medical school, it was a struggle. I was always struggling to find the best study habits or learning method that would really stick and work for me for good. Sometimes I thought I had it figured out, for a month or two, I'm doing well in studying and getting good exam scores, then suddenly I'm losing it. My years in medical school was like a trial and error thing on how to be able to maximize my time and be able to study well. I feel like I was a loser because I couldn't carry out my study goals. Those series of frustrations and disappointment created an anxiety in me. However, slowly during my Post Grad Internship year, I develop my study habit, not that polished and really consistent, but it was a start. I guess it was out of necessity that I was able to develop it because I really need to review for the board exam after internship and pass it, so I can finally be the Doctor I so long dream to become. But, it was actually after graduation from internship during our formal review for the board exam that I was able to develop well my good study habits. 

It started when I was struggling during my review, trying to read and crunch all those reviewers from all different subjects and it felt like my current study habit, though better than before was still far from being so effective in maximizing my time and learning abilities. Also, I guess because I was losing my motivation and my optimism that I can really pass the boards that it really overwhelmed me. It really gets you at some point especially during the intense review days, trust me. Or maybe you won't, lucky you :)

So I stopped reviewing for a few days. Like, really stopped. You may think I really wasted a lot of time during that time. But sometimes you really need to learn and let go of something that no longer serves you. Learn something  new and something better. This was the time I came across this quote which became my favorite: " Give me 6 hours to chop down the tree, and I will spend the first 4 sharpening the axe. " by Abraham Lincoln. And it's true, we must a lot more time preparing and sharpening our weapons and tools for us to effectively do what we need to do in a lesser amount of time and energy expenditure.

By sharpening the axe, I meant, I focused watching YouTube videos on how to study effectively. Through it, I came to know Jim Kwik, he is, I would say a master in learning or memorizing. I've learned various study and learning techniques from him. One of which is using Pomodoro Technique. It's when you study for a 25 min period straight with no distractions, not even checking your phone, eating or drinking, just simply studying and understanding what you're reading. After 25 minutes, the bell ring and you'll have a 5 minute short break for your brain to rest and let the information be processed well and consolidate it to long-term memory. There's what Jim Kwik refers to as Primacy and Recency effect. Primacy effect means that you remember well the first few topics you studied while the Recency effect means you remember well the recent topic you studied. How does Pomodoro technique becomes effective, as you can see, 25 min period is not that long, primacy and recency effect will really take effect because there's a short period where your brain is able to rest in taking information and be able to process and consolidate it. Unlike, if you are gonna be studying for 1-2 hour straight, based on the theory of Primacy and Recency Effect, maybe you'll only be able to process and consolidate the information during the first and last 10-20mins of that 1-2 hour straight of study period. The rest of the time and information you took in between was not properly consolidated hence you can't remember them very well. That's I can best describe it, because when I applied it it was that effective I remember most of what I studied even if it was already a few days or weeks ago. I was able to focused studying and not be distracted because my brain knows I just need to focus for 25 minutes at a time and get a reward after for 5 minutes. After a series of 4 cycles you'll get a long break of 25 minutes. It's not really that constrictive, you can have Pomodoro app where you can revised your focus time into 30 minutes or whatever, it's really up to you. Also that was the only way that I was able to do study marathon without getting tired. I start studying at 6:00am until 12:00am everyday since I learned and applied it. My boyfriend noticed how invigorated I was studying so he also did it. It was both effective for us.  

You may be wondering, when did we take our shower, cook food for lunch or dinner, do house chores like washing the dishes, doing laundry? Especially at a time like that where every minute count for you to be studying all those reviewers. We did those things during our short and long study breaks. We never felt guilty we are doing other things. Also we are able to break the monotony of just studying and really enjoyed it while doing so. We didn't have the same Pomodoro time stamp, since I start studying earlier than him and I also end studying before him too. During our long break he'll be cooking our food, and mind you it was really great nutritious food he prepared all the time, as if he was a chef. I'm not exaggerating lol. It really was. Hmmmm a  wonderful memory. While me, I was helping him prepare food, wash dishes, doing minor cleaning around the house. We took our time eating our food during meal time and have a good chat. It was only during our short and long breaks where we would talk to each other. It was an unspoken rule not to disturb the other while on focus time in Pomodoro app is ongoing. 

During this period in my life, I develop the discipline to study and do things at their appointed time. One great thing I learned from YouTube during that time I was immensely focused studying videos on how to be a disciplined, motivated person who can study effectively, I learned about meditation and mindfulness and  about making good daily habits. I started waking up early to start my day early as well. I woke up at 4:00am, practice meditation and mindfulness for 30-60mins. After which I'll exercise for about 20-30minutes, then I'll cook food for our breakfast. After cooking breakfast, I'll take a bath and that's when they woke up, together we ate our breakfast. At 6:00am I'll set up my study area and start studying. While studying we are listening to Baroque music, study shows it's effective to increase your focus and memory. I couldn't agree more. All of it played collectively in developing my good personal and study habits. I studied well, I ate well, exercise regularly, making me feel healthier and energetic hence pushing me to be productive even more each day. 

That time of my life, our intense review days for the board exam is something I'm truly grateful for. All those good habits and discipline I develop is still in me up until now. I still practice them and I can say it made me even a better person that I once was. It also helped me managed my anxiety because I no longer feel that I'm not in control of my time and my self. May be you can try it too. Research what's the best study technique for you. Develop your daily good habits and make the most of it. Because of it, competition with other people is dissolve and you are just focused in competing with your old self and be better. Always be the better version of yourself each day.

Blogpost: Apologetic and Grateful

    I haven't posted in a long while now, I'm truly sorry for that. Realities of being a responsible adult and now a professional Doctor got the best of me for awhile. I must say, I wasn't able to adapt to it quite fast as I was expecting myself to. 

    Funny, how during your medical school days you always feel like, every day is just a worse day and its just getting worse and worse as upcoming days of  deadlines for your requirements, projects and exams (written or OSCE) are fast approaching. To keep yourself motivated, you just keep on thinking and believing that you'll have the best moment of your life once you finally pass the Physician Licensure Examination and get your PRC license and life only gets better and better from then on. But once you're a Doctor you'll realize that the hardships, endless nights of studying, thousands of pages of transcription notes and books to study are truly necessary to prepare you in your practice as a Doctor. And it was just a start for an endless of studying and continuous learning process you'll be doing for life as a Doctor. 

    I must admit, the feeling was truly great, you can't even properly describe it when that much long awaited moment comes and you learned you passed the board exam. It's so surreal. I remember, receiving the great news around 2 o'clock in the morning. I was awoken with that great news and chatted with our batchmates about it. We were all awake, who wouldn't be? Thousand of us had been anxiously waiting for days for the results to come out. It was a great feeling mixed of sadness for we have friends who didn't make it that time. I remember talking over the phone with my very close friend about how our sacrifices and many days and nights of studying finally paid off and just how grateful we are for passing the exam for like 3 hours I think. I know 3 hours of talking was quite tiresome on a different occasion lol we just stopped when we realized the it was breaking dawn already. I kept on receiving a lot of congratulatory remarks in Facebook and Messenger and replying to each one for days. Yes, you heard that right, days. It felt good and not bothersome to be honest lol. It's a great feeling also knowing you made your Alma Mater, family, relatives, friend and hometown proud of your achievement as if it was also their own. So just hang in there dear student, just keep on studying, keep on grinding day in and day out. Study smart and hard each and everyday. Always remember, you are doing it for yourself and for your future patients. I hope no matter how hard it is, even if you've already thought of so many reasons to quit that you'll keep on going and remember that one big reason why you decided to enter medical school and wanted to become a Doctor in the first place. Whatever it may be, keep holding unto it. 

P.S. 

I started writing a blog during med school days, I created then shut down a lot of blogs since first year, this is the only blog I really had the guts to keep, which I must say I'm not actually good at doing.  I love reading and writing blogs. It's one of the things that help me get through med school. I read blogs for inspiration and learnt some tips how to survive med school. I wrote blogs to relieve my stress and frustration during med school. I shut them down because I don't think I have any readers other than my boyfriend hehe and then after re-reading them I feel embarrassed to myself. But I always have this urge to write whenever to share my experiences and thoughts about my journey. Thank you for reading my blog. I now commit to posting regularly (big word: commit, lol) I'm sorry if I wasn't able to reply to your comments (hahaha as if I have so many) I actually didn't think someone reads this until I checked it today. Ironic, how you write and post something and expect no one reads it. If you have any questions just feel free to comment. And I'll reply to them as best I could. Once again thank you for reading my blog! I truly am grateful. God bless!

BEing a Family MEdicine Resident

A lot of people I know will be stun if they knew I am a Family Medicine resident now. Some already are, upon knowing about my decision but they eventually understand. Everyone just really saw me being a Obstetrician and Gynecology specialist. Never say never they say, so I won’t say that I'll never become anything other than a Family Medicine Specialist. One thing I learned in life, is it always take you by surprise. You may be dreaming of one thing then be led to another. Before I say a lot more, I decided to write something about my experience being a resident for two weeks now. You may be wondering, "Where? In what institution?". Surprisingly, for you all out there, I'm doing my residency in FamilyDOC. You may be wondering again, "Why Family Medicine and why FamilyDOC?" So here it goes :)

I have various reasons why I decided to choose Family Medicine, first, because I want to be a specialist who is able to manage patients from all walks of life with illnesses that is commonly present is the community. I love talking to patients from all walks of life because I love continuously learning from them. I do not want my specialty to limit myself from it. Second, with the advent of the Universal Health Care Law in the Philippines it is really a great sign about our health care system and about Family Medicine practice in general.

Why FamilyDOC? Well, I've done a lot of research of course even when I was still in med school. I heard they offer a very competitive salary even before they have a residency program for their doctors employee. Then, eventually they created a Family and Community Medicine residency program which they applied for accreditation. I've talked to my seniors who are almost done in their 1st year residency about their experience and I've heard a lot of great things such as the very good working schedule where you can have 2 days off in a week, it may not be consecutive days but it's like heaven's gift, having a residency program where you can have 2 days off in a week right? And the fact you can go home each night after your clinic duty that is the best of all. Because no matter how tiring your duty went, if you can still spend the rest of your night resting and sleeping wonderfully in your own bed, again, it's heaven's gift right? Also, FamilyDOC's residents are being taught not just how to manage medical cases, but how to become an effective manager and leader in a work place and community. Most of all, it's actually FamilyDOC's vision itself that caught me, and that is providing greater affordability, accessibility and quality health care services to the community. I'm from the a province and from where I am from, we lack doctors. The doctors usually live in the capital of the province or ity. One doctor maybe for each municipality but it's not enough, way more than NOT enough. It's one of the reason I entered medical school and why I was able to get through it. I want to be of service to my community eventually. I dream to become a doctor who can manage all kinds of patients, from a pregnant mother, to her little children, to adults and the elderly people. All kinds of doctors are wonderful whatever specialty they may have. I just don't think it would serve with great purpose to many people in my community, even if I can do a complicated cesarean operation in a hospital but if I won't even know how to manage cases commonly present in my community. I leave the highly specialized skill to other doctors I can refer to :) I know. It sounds like a Miss Universe answer ^_^ But if you've been admitted for 5 days in a hospital in your province where you only saw your doctor once in the ER, it will definitely change how you see the practice of medicine. I believe all people from various places, from all walks of life, deserve equal access to quality health care. It might not sound believable yet, but there's a wonderful future for it here in our country.

And so far, in my few days of doing clinic duty in various branches of FamilyDOC, mingling with different staff, co-residents who are all kind, warm, approachable, supportive and all other great adjective you can possibly look for in a colleague, just simply make my experience even more great. It's kind of scary at first, especially for someone like me, fresh from passing the board exam who has very limited experience managing variety of cases. And boy, you'll definitely see a lot of interesting cases in the community, I'm telling you. The computer system makes it even harder to adjust too on your first few days. It might take you down for a while but eventually you'll get the hang of it, you'll become faster typing in the computer. You'll learn how to interview patient and encode the info at the same time but still being attentive to your patients.  Basically you'll develop a lot more skills you didn't know you will in your life. Kind of exaggeration I guess but something of that sort. Definitely, what I can say is I'm definitely enjoying my stay there. I look forward to more learning I'll have from my seniors, colleague and patients in the future. 

I pray for all you out there, seeking their passion and path in the field of medicine, that may you find the one that resonates with your life the most and something you see yourself enjoyably doing everyday, not dreading each day that will come to pass.  Cheers to you in advance.

Finally an MD. Now What???

I finally reached my dream of becoming a licensed physician, as someone who already has the license to heal, or so they say. A week ago, we had our Oath-Taking Ceremony held in the Philippine International Convention Center. It was a momentous event for each newly licensed doctor and their families. We were welcomed to the other world of medicine and I realized just how much a mere license ID card would mean to a person who really worked hard to get it. 

I posted this blog because I want to share some of the realizations I had since that momentous event of passing the September 2019 Physician Licensure Examination. It was a roller coaster. In just a few weeks in between the release of results and the oath-taking ceremony, a lot of things in me has changed. A lot of things I newly discovered I had in me which in turn affected my decisions for my future. Moreso, I realized that it wasn't just me. Almost all of my friends and classmates underwent and still undergoing the confusing moment of "Now that I'm Doctor, then what? What awaits me now? What field of residency program should I take? Should I really take one, is that really necessary? If not, what will I do now instead? Where will I go?". These are just some of the few mind-boggling questions I had. So why not write and share about the struggle I went through which might help future doctors as well.

It would seem that I really do not know what I really got into when I entered the field of medicine. In a whole lot of way, yes I didn't. I guess it's because I'm the first Doctor in the family, and I have no one to personally guide me. I thought it was as simple as having the utmost desire to heal people in their suffering from physical ailments and nothing more. Don't get me wrong, that desire was the most important thing that fueled me all throughout my journey in achieving my dream. But, in medicine, there's more to it than meets the eye.

While waiting for the oath-taking ceremony, I went home to celebrate with the whole family our brother's wedding. At that time, my older sister asked me to search for photos that I can print to put on a frame to be hung on our family wall. I realized that I've been missing a lot of my family's get together every time my siblings and their family went home to the Philippines for the Fiesta celebration. And our family photo taken at home, hours prior to my brother's wedding was the only photo in the last five years where I was able to join my family. I realized my nephews grew a lot, I didn't even notice. In my mind, they're still a baby or a toddler because that was the last memory I have spent with them. I realized that my parents and my siblings are getting older. Years passed by, I didn't take every opportunity I should've had to spend with them whenever they come home to the Philippines. Life is very short. It will pass you by quickly. A simple realization but it hit me really hard to my core. I value my dream a lot but I don't want to reach all of them at the expense of my family when they are one of the most important reasons why I studied really hard to graduate and pass the board exam on time. By on time, I meant base on my goal timeline.

And so, as I ponder upon the thought of what to do next, if should I continue to study and specialize in another field like how I originally planned it or if I should take some time off, go into moonlighting jobs first to save some money and so I can be with my family whenever possible since I am just working, shall we say,  as a freelance doctor. In that critical time of confusion, I don't want to simply rely on my own understanding because I know, highly likely I'll make a wrong decision. I simply put my mind to rest, I prayed day in and day out asking for God's guidance and for enlightenment amidst my confusion. Slowly, I was able to get a clear answer. I realized, we know what we really want in life, oftentimes they're just clouded by the noise and desires of other people for our lives or maybe we just don't have the courage to pursue what we want because we might disappoint some people along the way, that's why in turn, we tend to forget it as if they are just an afterthought. And I want to pursue a field of specialty in congruence with the reason why I enter medical school and at the same time, I can still spend some quality time with my family and friends. You know what they say about "always go back to your why"? Yes, it's true. It will keep you grounded and align with your vision and dreams. That is to specialize in a field where I'll be able to help people from all walks of life.

Thankfully, whatever my decision may be, my family always has my back. They even suggested me to take a vacation I deserve in Canada with my sister. I was actually on it, I renewed my passport and was ready to apply for a visa while continuously praying for guidance. God never fails. He enlightened me as to what to do next. God lead me to seek family and community medicine. That's when my journey in family and community medicine begins. Fortunately, God gave me a wonderful opportunity to be part of this wonderful institution where I believe I'll learn best to become a family physician. This I believe deserves a separate blog post :)

What I want my future readers to take home from this blog post of mine is that, pursue your dreams and your passion but not at the expense of something or someone as equally important to you as your dreams. Some time in our life, we'll be put to test, we'll be confused. It's alright, take some time off, take that time to rest and ponder upon life. Don't make a rash decision. Pray and pray a lot. Ask God specifically for what His plans for your life and pray that whatever they may be, that may you be able to submit to Him. God listens and He hears our prayer. Clarity comes with wisdom which God blesses us with when we pray. Congratulations to us all who work really hard to become the best version of ourselves and who work tirelessly to reach our dreams.

Steps of becoming a Doctor in the Philippines

Whenever we ask children what do they want to become when they grow up, and they answers,"I want to become a successful doctor someday" most often we replied "Oh that’s really nice, that's a very noble profession indeed" or this "I know you can do it, just continue believing in yourself and in your dreams"

It is indeed a noble profession a lot of people dream of becoming. But for some people, like me, who doesn't have anyone in the family who is a doctor, we don't know how long would it take us to become a successful doctor someday.  

Here I want to share something I learned from going through this same journey as yours which I honestly didn't know upon entering medical school but wish I knew, not that it would change my course but somehow you know would've totally prepare me holistically :) 

This timeline of your journey starts after graduating from senior high school since this where you and your classmates take different baby steps in achieving each of your dreams. 

Timeline of becoming a successful Doctor:

• 4-5 years of pre-med degree 
• 4 years of medicine proper
• 6-7 years straight program (UP INTARMED/La Salle Human Bio)
• 1 year post graduate internship
• 2 months of board exam preparation 
• 3-6 years of residency training
• 1-3 years fellowship training

You can take any pre-med degree, even non-medical related ones, however, some medical schools would require units of some science courses such as physics etc. Though, I can say it is more advantageous to take health-related degree if you already knew you wanted to pursue the field of medicine after graduating from high school. I took BS in Nursing which only took 4 years unlike others such as BS in Physical Therapy which takes 5 years. Of course, not only you consider the length of years studying, but more importantly your passion. If you are passionate of becoming a physical therapist or pharmacist or med tech, regardless how long it takes, you should pursue them. Your passion is what makes your journey more enjoyable.

There are few medical schools which offers straight program for medicine, such as the 7-year program of UP INTARMED, 6-year program of La Salle BS Human Bio and recently, UST released an article that they will be accepting the 1st batch of their 6-year Innovative Doctor of Medicine program for the academic year 2019-2020. You may click the links I provided, to visit their website. This is one fact I didn't know before entering medical school. I hope a lot of medical schools in the Philippines or more so, all medical schools in the Philippines will offer straight program for medicine. Since being in this field really takes a toll of our lifetime, it's one way of shortening it but still providing quality education producing best doctors. 

Every medical student should undergo 1-year post grad internship in their matched hospital. I'm not sure with med students from UPCM if they are allowed to have their internship done outside PGH. You may refer to my post about internship for more info :)

And for you, who, like me, wants to pursue residency training in your chosen field of specialty, it is important to know that not only they differ in specialization but also in their length of years of training. And another 1-3 years, depending on what sub-specialization you wish to pursue. More or less, hospitals offers the same length of training for these different programs. There are a lot of students who take into consideration the length of residency training in choosing their field of specialty, that's why I included the common field of specialty in this post. 

Below are the accredited residency program and its equivalent of years of training offered in Perpetual Help Medical Center-Las Pinas as of December 2018.

RESIDENCY PROGRAM	YEARS OF TRAINING
Internal Medicine	3
Pediatrics	3
Obstetrician & Gynecology	4
General Surgery	5
Emergency Medicine	4
Radiology	4
Radiologic Oncology	4

There are now straight program offered for various specialty as well, where you don't have to undergo the previous required residency training. For example, before you need to take residency for IM before going to Neurology but now there's a straight program for Neurology, others are Dermatology, TCVS, Orthosurgery, Neurosurgery and etc. PGH offers a lot of accredited residency and fellowship training. Don't worry my dear, along your journey to MD, you'll gain a lot of information from your mentors regarding the field of specialty you're planning to take. Don't be shy to ask and they'll willingly help and guide you :)

It's honestly exhausting just thinking about how many years still ahead should I go before I can say "I am now a successful doctor". Each of us has our own definition of being a successful doctor. Some feels it's already enough to be a general physician once they achieved getting that MD attached after their name and a license to heal. It won't make any person less of a doctor if he/she did not pursue further training in a specialized field. What matters is how he/she was able to help other people with the knowledge, skills, & attitude he/she gain from all those years of studying.

Each of our journey differs from one another, and we should not compare our success with that of others. Taking further training in these fields are not the only way to serve as a doctor and be successful. May we all discover our passion and pursue them with an earnest heart, all for the greater purpose of serving those who are in need. May we all be blessed. To God be the Glory!

Post Grad Internship Matching: Things to consider before clicking your hospital of choice

'Tis the season to be jolly, falalala lalala. LOL.

Indeed guys it's the season to be jolly because it's already Christmas season and at the same time, it's the APMC Matching season for all medical students in their clerkship year for the upcoming post graduate internship July 2019 - June 2020.

For those who are still kind of confused as to how does APMC matching works and why is it important for medical students to engage in it, I'll quickly give a brief overview and some links to help you in your application which was well written by APMC-SN

All clinical clerks who want to do their internship after right after finishing clerkship, are required to register in E-NIPS in order to be included in the scheduled online matching process to be match in their respective hospital of choice. It's not mandatory for every medical student to participate in it, such as for those who are not planning to do their internship here in the Philippines and for those who wish to delay their internship for the time being.

APMC-SN already posted the schedule of matching for the Regular National Internship program  which will be running from July 2019 - June 2020. The 1st round of matching already started last November 05, 2018. You may click this link APMC National Internship Program Primer if you wish to know more of the step-by-step process created by APMC-SN as a guide for the online matching process. Below are pictures posted by APMC-SN in their facebook page for your guidance of the  July 2019-June 2020 Internship Program.

Now let's go to the heart of this entire post, which I hope will guide you as to which hospital is best to have your internship done cuz during my time I didn't know what things should I consider in choosing the hospital. I was looking for some tips from various blogger, I'm not sure if I was able to find one but that's the reason why I wrote this blog, to help future medical students who'll be undergoing the same process in time. 

In contemplating your hospital of choice, there are a few questions to ponder on about yourself such as; What type of active learner are you?What is your priority during internship, to learn more theoretically or clinically? Where are you planning to take your residency, if there's any? Do you want to experience less or more toxic duties than your clerkship rotation? Do you want to go where there is a higher monthly allowance? These are just some of those things which I'll quickly tackle. 

Each and every student's learning ability are different from one another. Some says they learn best when they are expose to various cases rather than simply reading it from our books. So in turn they chose government hospitals where there are a lot of rare cases such as PGH, Jose Reyes, Ospital ng Maynila, DOH and etc. Some students, especially those who came from private institution, wants to learn more clinically and be able to perform a lot of various clinical procedures that they weren't able to perform frequently or not at all during clerkship such as doing thoracentesis, closed tube thoracostomy, spinal tap, intubation, epidural anesthesia, minor surgeries such as wound debridement, I & D, excision biopsy and a lot more. You can do a lot more of these in public hospitals due to a lot of cases and fewer manpower to do all these procedures. 

A lot of my senior interns, residents and consultants personally advised me stay in our school's own hospital institution because it has a balance experience in terms of being exposed to a lot of cases and having that benignity to study them since our institution only has 12 hours max during duty status. After which we have a lot more time to study & prepare for the board exam. As they said, learning to confidently perform various clinical procedures shouldn't be my priority at all as I will be able to learn them when I proceed to residency. However, some seniors and mentors also told me that having their internship in public hospital prepared them to confidently managed cases on their own which helped them during their moonlighting. So this is something you need to answer within you regarding as to what is your main objective in your internship.

You also need to consider the field you want to pursue and where you are planning to pursue it. They said it'll help you during your residency application if you had your internship in that said hospital also because you were able to form a close bond with the residents and consultants. Though at the end of the day, residency application is still a competition especially in institution where there are a lot of applicants. Another advantage is you are able to witness how the residency training is in that institution. Is it still something you want to get into? If not, then maybe you can start reconsidering other institution for your residency after internship.

Some students felt like they were too benign during their clerkship and felt as if they learn only a few than what they were expecting, so they decided to pursue internship in hospitals where they see fit they'll learn a lot more. Some however, felt like they got really burnt out from all the clerkship toxicities they had, that they considered to lay low and have their internship in private hospitals, thought not all, mostly are benign compared to public hospitals. Some highly took into consideration the monthly stipend they'll get from an institution regardless its toxicity. 

For my experience, I chose to have my internship in PHMC-Las Pinas, it is our school's owner hospital situated behind our school building, the Tamayo Tower. Originally I was matched in a different institution because PHMC was honestly not in my top 3 choices in the online matching. I was originally planning to have my internship done outside to get a different clinical experience than I once had during my clerkship. However, due to practical reasons, since it's nearby our house, about 5 minutes away from home and also because I actually plan to have my residency in this institution. So why not stay instead. I wrote a separate blog regarding the process we went through in order to be un-matched from our previously matched hospital and be rematched to another.  Since it's a private institution, we only get to perform fewer clinical procedures compared to what other interns does in other public hospital. But honestly, our residents and consultants are really kind enough to let us do the clinical procedures when we ask permission from them. If you are confident enough to do it after reading and watching how the procedure is done, take the initiative to volunteer. It's a very effective learning process. 

May be you are wondering, how did my internship went? Do I have any regrets staying in the same institution? Honestly, I thank God we made the right decision. I don't have any regrets. I am on my 3rd rotation already (Internal Medicine). Major rotations came first. We only have 12-hour duty on our duty status. On that 12 hours, I maximized my time to learn the best I can from the cases I see clinically. I'm not too tired after duty compared during clerkship when we had a minimum of 30 hours straight. I have the balance of seeing a lot of different cases and being able to study in preparation for the boards when I get home. Our institution is supportive enough as well to help us when we organized for review classes every Saturday. May be in the near future I'm gonna write on how I study and prepare for the boards during my internship period. :) Lastly, we get a small amount of stipend each month. 

My message is that, wherever you may go into for your internship, make the best out of it. It's upon us if we will take the initiative to learn. If it's toxic make the most out of that toxicity, read on all the cases you see in the wards, ER, OPD. If you are lucky enough to have a benign duty, study on your free time and read on the clinical cases you see. It's easier than done, but let's develop in ourselves the discipline to study not just for the board exam but as what most med student's favorite quote says (my personal favorite as well)

"Student, you do not study to pass the test. You study to prepare for the day when you are the only thing between a patient and the grave"

- Mark Reid

Disclaimer: This is just my personal opinion or realization that I've come up with from my experience as an intern and from the advised I got from my seniors/mentors before. Probably not everyone will agree with me as each of us has our own experiences. If you have other suggestions/comments/advise please comment down below. I'll gladly appreciate it a lot. Thank you :)