Medliorate

Improving medical students

Archive for June, 2008

Preventative Services Resources

Posted by medliorator on June 30, 2008

Agency for Healthcare Research and Quality (AHRQ)
The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services, AHRQ supports health services research that will improve the quality of health care and promote evidence-based decisionmaking.

Partnership for Prevention
a national membership organization dedicated to building evidence of sound disease prevention and health promotion policies and practices and advocating their adoption by public and private sectors.

National Guideline Clearinghouse (NGC)
a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.  The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.

Posted in Tools | Comments Off on Preventative Services Resources

Wilderness Survival

Posted by medliorator on June 29, 2008

By Pamela F. Gallin, MD…

almost 2.5 million people called poison centers for help in 2006. In 2004, 112,000 people died of injuries from falls, drownings, and other accidents. In 2006, search-and-rescue rangers in our national parks responded to nearly 4,000 calls, more than a third of them for people who were also sick or injured. Every year, around 3,000 succumb to choking.

Before you head out on a hike, check the weather (you can find forecasts for many wilderness areas at wunderground.com), take plenty of water, and make sure someone knows where you’ll be and when you’ll be back …Avoid cotton, which traps moisture.

In general, people who try to find their own way out fare worse than those who stay put, says Richard N. Bradley, MD, of the American Red Cross. Find shelter before dark, and try to keep dry. Stay visible so anyone searching can see you. In a wide-open area, make a signal with colorful gear, make a big X out of rocks, or dig a shallow trench, says Dill. “The top layer of soil is a different color. Scrape it away and make straight lines, which are easy to spot from above.”

You can go several days without eating, so in most cases, you’re better off not foraging for food… If you’re stranded in your car, stay there: You’re more visible to rescuers, and the car provides shelter.

You’re gushing blood—and getting scared. Forget about tourniquets, says Dr. Schneider of the American College of Emergency Physicians. Use your hand or a clean cloth, paper towels, a scarf, or any fabric you can grab, and push down on the wound until the bleeding stops. Tourniquets, which every Boy Scout learned how to make back in the day, are now a first-aid no-no. “If you have a cut on your upper leg and you put pressure on it, you’re just closing that vessel. But if you put a tourniquet on, you’re going to close the vessels to the entire leg,” says Dr. Schneider. “You could lose your foot.”

Save Your Own Life [Reader’s Digest]

Posted in First Aid | Comments Off on Wilderness Survival

On Teen Pregnancy

Posted by medliorator on June 28, 2008

Kenneth F. Trofatter, Jr., MD, PhD…

We live in times when there has never in the history of humans been a greater disparity between the age of puberty and the social and economic demands that allow us to survive productively in this world. That also means that children are now reaching the age of ‘reproductive maturity’ when they are least likely to be in a position to control impulses, to understand the consequences of, and to make sensible decisions (or to resist sexual overtures of older and more experienced males) related to, sexual activity. The consequences are not only pregnancies and sexually transmitted disease but, in most cases, as has been shown repeatedly in the past, a loss of lifetime opportunities for success, a life spent in poverty, poor health, a long history of dependency on social welfare, limited access to an adequate health care system, and the high likelihood that their inheritance to their children will be a life similar to theirs.

Abstinence-alone efforts have also failed as a widespread approach and are practically meaningless anyway to children at the age at which they are now reaching puberty. There is growing data to support that teaching about contraception is “not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education (Kohler, et al., J Adolesc Health 2008;42:344-51).” But, all this needs to be presented in a program of ongoing education and practical incentivization. “The most expedient way to strengthen the impact of pregnancy prevention programs on adolescent childbearing is to shift the focus of intervention …to helping young women develop goals that make adolescent childbearing a threat to what they want in life. This means intervening actively enough to ensure that goal setting translates into an internal desire to postpone childbearing beyond adolescence (Sheeder, et al., Matern Child Health J 2008: epub May 16).”

Teen Pregnancy: We ARE Failing our Children [Healthline]

Posted in Pediatrics | Comments Off on On Teen Pregnancy

Residency: 56 Hour Work Week?

Posted by medliorator on June 27, 2008

Rumor has it that resident work hours will be shortened to 56-hours per week. How to make up the experience? Add a year to residency of course. [Kevin MD]

see Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules

Posted in News, Residency | Comments Off on Residency: 56 Hour Work Week?

How to Defer Federal Student Loans

Posted by medliorator on June 26, 2008

step-by-step manual on how to apply for economic hardship deferment for your federal student loans from No Acute Distress (Personal finance issues for loan-burdened medical students):

The following assumes that you have federal student loan debt and that you are interested in having payments and/or interest accrual deferred for at least one and perhaps two years after med school graduation. Your interest accrual will only be deferred for loans such as subsidized Stafford and Perkins loans. Interest will continue to accrue on unsubsidized Stafford loans.

  • You can only submit to any particular lender 30 days prior to the day your loan goes into repayment.
  • Economic Hardship Deferment How-To [No Acute Distress]

    Posted in Finance, How-To | Comments Off on How to Defer Federal Student Loans

    Top 10 Most Competitive Residencies (2008)

    Posted by medliorator on June 25, 2008

    (2010 Match data available here)

    (2009 Match data available here)

    • 94.2 percent of U.S. allopathic seniors were matched, the highest match rate in more than thirty years.
    • 51.9 percent of U.S. citizens trained in international medical schools were matched, a slight increase from the 2007 figure of 50.0 percent.
    • The match rate of non-U.S. citizens trained in international medical schools continued to decline, from 48.9 percent in 2006 to 45.5 percent in 2007 and 42.4 percent in 2008.

    PGY-1 Rankings:

    Rank Specialty Applicants/Position
    1. Pediatrics – Primary 15.4
    2. Medicine – Preventative Medicine 9.3
    3. Medicine – Primary 7.8
    4. Radiation Oncology 7.2
    5. Dermatology 6.3
    6. Emergency Med/Family Med 5.5
    7. Medicine – Family Medicine 5.2
    8. Radiology – Diagnostic 4.8
    9. Pediatrics – Emerg Med 4.4
    10. Physical Medicine & Rehab 4.0
    11. Medicine – Dermatology 3.8
    12. Neurology 3.5
    12. Preventative Medicine 3.5
    14. Vascular Surgery 3.4
    15. Medicine – Psychiatry 3.3
    Rank Specialty US Applicants/Position
    1. Radiation Oncology 6.7
    2. Pediatrics – Primary 5.9
    3. Dermatology 5.6
    4. Radiology-Diagnostic 4.1
    5. Medicine – Family Medicine 3.6
    5. Medicine – Dermatology 3.6
    7. Pediatrics – Emerg Med 3.3
    8. Emergency Med/Family Med 3.0
    9. Thoracic Surgery 2.7
    10. Transitional Year 2.5
    10. Medicine – Primary 2.5
    12. Vascular Surgery 2.3
    13. Physical Medicine & Rehab 2.0
    14. Medicine – Emerg Med 1.9
    14. Psychiatry – Family Medicine 1.9
    Rank Specialty US Matches / Total Applicants
    1. Preventative Medicine 0%
    2. Pediatrics – Primary 4%
    3. Medicine – Preventative Medicine 5%
    4. Medicine – Primary 8%
    5. Emergency Med/Family Med 9%
    6. Radiation Oncology 12%
    7. Dermatology 14%
    8. Physical Medicine & Rehab 16%
    8. Medicine – Psychiatry 16%
    10. Neurology 17%
    11. Radiology – Diagnostic 18%
    11. Psychiatry – Neurology 18%
    13. Medicine – Family Medicine 19%
    13. Pediatrics – Emerg Med 19%
    15. Pediatrics – Medical Genetics 20%

    PGY-2 Rankings:

    Rank Specialty Applicants/Position
    1. Emergency Medicine 5.5
    2. Psychiatry 3.8
    3. Nuclear Medicine 3.0
    4. Anesthesiology 2.2
    5. Dermatology 1.8
    6. Neurology 1.8
    7. Physical Medicine & Rehab 1.8
    8. Radiation Oncology 1.5
    9. Radiology – Diagnostic 1.5
    10. Preventative Medicine 1.0
    11. Urology 0.3
    Rank Specialty US Applicants/Position
    1. Emergency Medicine 3.7
    2. Psychiatry 3.3
    3. Anesthesiology 1.5
    4. Radiation Oncology 1.3
    5. Dermatology 1.2
    6. Radiation – Diagnostic 1.0
    6. Nuclear Medicine 1.0
    8. Neurology 0.8
    9. Physical Medicine & Rehab 0.7
    10. Preventative Medicine 0.0
    10. Urology 0.0
    Rank Specialty US Matches / Total Applicants
    1. Nuclear Medicine 0%
    2. Emergency Medicine 11%
    3. Psychiatry 13%
    4. Physical Medicine & Rehab 26%
    5. Neurology 31%
    6. Anesthesiology 36%
    7. Dermatology 42%
    8. Radiology – Diagnostic 56%
    9. Radiation Oncology 57%

    Charting Outcomes 2008 (PDF) [NRMP]

    Posted in Matching, Residency | 4 Comments »

    How to Be Impressive

    Posted by medliorator on June 25, 2008

    Let’s begin with some examples… that generate the “how did he do that!?” response

    • A college student who setup the U.N.’s first youth advisory council and led the effort to write a youth rights constitution adopted by the Arab League.
    • A high school student who was the president of two student clubs and was a member of the varsity tennis team.

    the [first]… might be called [a superstar; the latter] might be stuck with the moniker of “grind,” “hardworking,” or, pronounced, no doubt, with a note of disdain: “ambitious.”  …We know students like this. We feel that, with a high enough tolerance for pain, we too could be that busy. It’s hard work. But it’s not mysterious.

    What happens, however, when presented with the story of a student who works with the U.N. and drafted a constitution for the Arab League? Our simulation apparatus fails. We don’t know how, exactly, one becomes a player in major international organizations.  The effect of this failed simulation: a sense of novelty and wonder.

    The first [example elicits] great admiration not because they are harder working or more talented than the second… but because we cannot simulate the path they took to their achievements.

    I can identify three steps that will help you get to this impressiveness sweet spot:

    1. Enter a Closed World and Exceed Expectations. The first step is to get involved as an insider in a world that interests you …In such entry-level, non-full time situations, the people above you will be pleasantly surprised that you are getting things done. You will soon be rewarded for this.
    2. Package Insider Connections. After you’ve proved yourself in this world, you’ll begin to notice interesting opportunities that only an insider, like yourself, would know about. Look for an opportunity to lead a project that would be available only to someone on the inside. Leverage your insider knowledge to its fullest extent.
    3. Escalate. The solo project from (2) will defeat most people’s simulation apparatus as it was built upon connections available only to insiders. In this final step, leverage this effect, and the good job you did your past project, to shake loose an even more un-simulatable project. Repeat this process a few times, with each iteration ramping up to an even more insider-supported, harder to simulate project.

    The Art of Activity Innovation: How to Be Impressive Without an Impressive Amount of Work [Study Hacks]

    Posted in How-To, Tips & Advice | Comments Off on How to Be Impressive

    How to Take an MRI

    Posted by medliorator on June 24, 2008

    A recent study in the journal Surgical Neurology recommended that MRI’s be done while the patient is in the position that causes symptoms.  This is helpful advice.  MRI’s are usually done while the patient is lying down.  Lying down takes stress off the spine and changes the positions of spinal structures, sometime making things look normal when there’s really a problem.

    Get Your MRI In The Position That Causes Pain [How to Cope with Pain]

    Posted in How-To, Radiology | Comments Off on How to Take an MRI

    Powerpoint Presentation Tips

    Posted by medliorator on June 24, 2008

    2) The 10 minute rule–Your audience fades after 10 minutes. If you have to lecture for 50 minutes, conscientiously change-up every 10 minutes or so. Turn on the lights, show a blank screen and tell a story, have your audience stand up and stretch, anything to reset the 10-minute boredom clock.

    3) Pictures beat text–We remember a good image far longer than a string of text. During your talks, show images, speak words. If you need blocks of text for your talk, use handouts.

    Three brain rules to improve your presentations [Getting Things Done in Academia]

    Posted in Tips & Advice | Comments Off on Powerpoint Presentation Tips

    Coffee Drinking and Heart Disease

    Posted by medliorator on June 23, 2008

    Long-term coffee drinking does not appear to increase a person’s risk of early death and may cut a person’s chances of dying from heart disease

    Researchers led by Esther Lopez-Garcia of Universidad Autonoma de Madrid in Spain followed 84,214 U.S. women from 1980 to 2004 and 41,736 U.S. men from 1986 to 2004.  They found that regular coffee drinking — up to six cups a day — was not associated with increased deaths among the study’s middle-aged participants. In fact, the coffee drinkers, particularly the women, experienced a small decline in death rates from heart disease.

    The study found no association between coffee consumption and cancer deaths.

    Coffee habit may be good for your heart [MSNBC]

    Correlate: Neuroprotective Effects of Caffeine

    Correlate: Coffee Pros & Cons

    Correlate: Drive Home Safely – Coffee vs Sleep

    Posted in Wellness & Health | 1 Comment »