How to Manage a Negative Clinical Evaluation

Sometimes personalities can clash and an attending may write an overly harsh evaluation that isn’t indicative of your performance. If you feel that this is the case, it’s usually a good idea to speak with the clerkship director and express your concerns. At some institutions, the burden of proof lies with the attending to demonstrate that he or she gave the student constructive feedback and allowed for a chance to improve. If the evaluation is determined to be unjust, it may be removed from your record.

However, if the clerkship director does a thorough investigation and strongly feels that the evaluation is accurate, it’s usually a good idea to stop there

Will a Negative Evaluation Ruin My Residency Options? [Medscape]

Basic Study Strategies for First Year Medical Students

1. Find some peace and quiet. Studies have shown that just 20 minutes of highly focused, quiet time can help you learn and remember more than hours of working with distractions and while multi-tasking. So, to get the most out of your study time retreat to a place where you won’t be bothered by loud music or talking and can just focus in on your work.

2. Get organized. If your papers and materials are all over, you’ll spend just as much time looking for what you need as actually reading through and absorbing material which doesn’t make for a very productive use of your time.

7. Write it down. For most people, writing things down helps big time when it comes time to recall things on a test or even just during study time.

8 Tips to Help You Study Better and More Effectively [Life Optimizer]

Speciality Overview – Physical Medicine & Rehabilitation

by Sara Cohen, MD

PM&R involves the diagnosis and restoration of functional ability and quality of life in patients with disorders of the nervous and musculoskeletal systems.

Residency training in PM&R includes 1 year of internship, which can be a preliminary or transitional year, followed by 3 years of specialty training in PM&R. Some residencies combine the 4 years into 1 program. Generally, the first year focuses on the inpatient rehabilitation aspects of the field, whereas senior residents practice more outpatient physical medicine with a lighter call schedule.

The rehabilitation part (the “R” in PM&R) involves the long-term care of patients with disorders of the central nervous system, such as brain injury, spinal cord injury, and stroke. We also care for patients with amputations and orthopedic injuries. Our job as the physician on the inpatient rehab unit is to oversee the care of these patients and work with a team of therapists and other staff to maximize the patient’s function. Although the interventions we use will not “cure” patients, we help them to make the most of what they’ve got.

Rehab patients remain on the unit for weeks or even months. As a result, during my residency I was able to build relationships with them and their families, as well as see the long-term outcomes of treatment. I have a shelf in my apartment filled with gifts from patients who were very grateful for the treatment they received on our unit.

What Is PM&R? [Medscape]

Common Mistakes Made by 3rd and 4th Year Medical Students

Kendra Campbell reminds us of some easy-to-avoid clinical mistakes

1. Arguing with a patient.

2. Reporting a physical finding without actually observing it.

3. Pimping your resident or attending. …Thou shalt not pimp up the chain.

6. Documenting an important positive finding without alerting your resident or attending.

9. Forgetting you are in a hospital …We spend so many hours in the hospital that it’s easy to forget that we are surrounded by very ill people.

Top 10 Mistakes Made in Clinical Rotations [Medscape]

CORE – Clinical ORthopaedic Exam for iPhone

This reference database of ~250 clinical tests facilitates diagnosis of musculoskeletal and orthopedic disorders. It offers descriptions on how to perform each test as originally described by its author, video demonstrations (if wifi-connected), diagnostic properties (reliability and validity), and links to supporting medical references via abstracts in PUBMed.  Currently retails for $39.99

CORE – Clinical ORthopaedic Exam from clinicallyrelevant.com

Developing an Approach to Patient Handoffs

Pauline W. Chen, M.D.

I worry that I am playing some real-life medical version of the children’s game “Telephone” where the complexity of my patient’s care will be watered down, misinterpreted and possibly mangled with each re-telling.

While older patients with multiple chronic conditions will see up to 16 doctors a year, some of the healthiest younger patients I see count not only a primary care physician among their doctors but also a handful of specialists. Hospitalized patients, no longer cared for by their primary care doctors but by teams of fully trained doctors, or hospitalists, in addition to groups of doctors-in-training, are passed between doctors an average of 15 times during a single five-day hospitalization. And young doctors, with increasing time pressures from work hours reforms, will sign over as many as 300 patients in a single month during their first year of training.

researchers have begun looking for new ways to approach patient handoffs, studying other high-stakes shift-oriented industries like aviation, transportation and nuclear power, as well as other groups of clinicians.

By incorporating more efficient methods of communication, the hope is that patient care transitions will eventually become seamless and less subject to errors.

When Patient Handoffs Go Terribly Wrong [NYT Health]

Optimize Netbook Note Taking with Microsoft Word

There’s a cool feature from Word 2003 which is buried in 2007 for true fullscreen viewing. You can get the button by going to the Word Orb > Word Options > Customize > look under “All commands” and select “Toggle Full Screen View”

I realized you can save a ton of battery life by dimming the screen, and taking notes with a black background and a white/gray font color, the contrast is much better.

Click Esc on your keyboard to exit full screen mode.

Taking Notes with Netbooks [LifeHacker]

Online Surgical Primer – Surgical-tutor

English expert Mr. Stephen Parker, FRCS has built an excellent surgical resource for students with time constraints.  Surgical-tutor offers clinical tutorials in surgery, multiple choice questions, and extensive image galleries.

Surgical-Tutor

Choosing a Specialty – A Straightforward Approach for the Uncertain

from Anne Vinsel, MS, MFA (Project Administrator, Graduate Medical Education, University of Utah Medical Center)

Research those specialties in your institution. Go to the departments and make friends with the residency program coordinators. If you haven’t already done so and haven’t rotated in the program, arrange to shadow a faculty member for a day. Talk with 1 or 2 residents and check out the pros and cons of the specialty. Finally, ask the program coordinator if your board scores would be in a competitive range. Most program coordinators won’t share their board score cut-off, but they likely would tell you if your scores are within range.

Twelve Steps for Choosing a Specialty [Medscape]

Generic Versus Branded Drugs: Concerns Amidst Limited Evidence

Many physicians have found [the switch to generic drugs] particularly problematic in classes of drugs with a narrow therapeutic range, including antiepileptics, psychotropics, antiarrhythmics, and anticoagulants.

although the generic’s mean maximal concentration and area under the concentration-time curve are typically within a few percentage points of the original’s — typically about 4% — the 90% confidence interval for those means can be 20% below or 25% above the branded drug’s mean.

much of the current evidence of problems with generic antiepileptics is anecdotal, or comes from retrospective or case-control studies — not randomized controlled trials.  But all of those studies have come to similar conclusions.

Two retrospective studies published last year in Neurology found that patients who had events like break-through seizures were much more likely to have been switched from a branded product to a generic… “Brand-to-generic seems to be the biggest issue,” Meador said. “But generic-to-generic seems to confer some risk as well.”

some non-SSRI antidepressants aren’t so forgiving, said Jeffrey Lieberman, MD, a psychiatrist at Columbia University in New York City.  He mentioned the tricyclic drug nortriptyline and bupropion (Wellbutrin) as more susceptible than most antidepressants to dosage variations.

Generics versus Brands: How It Plays Out in Practice [Medpage Today]