Medliorate

Improving medical students

Archive for October, 2008

Three Timeless Study Tips

Posted by medliorator on October 31, 2008

You can prepare yourself to succeed in your studies. Try to develop and appreciate the following habits:

  • Put first things first – Follow up on the priorities you have set for yourself, and don’t let others, or other interests, distract you from your goals
  • Discover your key productivity periods and places – Morning, afternoon, or evening?  Find spaces where you can be the most focused and productive.  Prioritize these for your most difficult study challenges.
  • Look for better solutions to problems – For example, if you don’t understand the course material, don’t just re-read it. Try something else! Consult with the professor, a tutor, an academic advisor, a classmate, a study group, or your school’s study skills center

Effective Habits for Effective Study [Study Guides and Strategies]

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Comparing Years in Practice & Quality of Care Provided

Posted by medliorator on October 30, 2008

Purpose: To systematically review studies relating medical knowledge and health care quality to years in practice and physician age.

Data Synthesis: Overall, 32 of the 62 (52%) evaluations reported decreasing performance with increasing years in practice for all outcomes assessed; 13 (21%) reported decreasing performance with increasing experience for some outcomes but no association for others; 2 (3%) reported that performance initially increased with increasing experience, peaked, and then decreased (concave relationship); 13 (21%) reported no association; 1 (2%) reported increasing performance with increasing years in practice for some outcomes but no association for others; and 1 (2%) reported increasing performance with increasing years in practice for all outcomes.

Conclusions: Physicians who have been in practice longer may be at risk for providing lower-quality care. Therefore, this subgroup of physicians may need quality improvement interventions.

Niteesh K. Choudhry, MD; Robert H. Fletcher, MD, MSc; and Stephen B. Soumerai, ScD.  Systematic Review: The Relationship between Clinical Experience and Quality of Health CareAnnals of Internal Medicine 15 February 2005 Volume 142 Issue 4 Pages 260-273

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Comfort Crying Patients like a Pro

Posted by medliorator on October 30, 2008

Crying can be a completely natural and expected response to information… You also don’t know what else is going on in the patient’s life; sometimes your news is actually the single straw—as unremarkable as it may be—that, according to the proverb, breaks the camel’s back.

You don’t have to do anything if your patient is crying. Sometimes, the best course of action is to just be with the patient. The gives the message that (1) it’s okay to cry, (2) I’m not going to freak out just because you’re crying, and (3) maybe the best response to the situation is to cry.

  1. Acknowledge the situation in a calm manner – Try: “This is understandably upsetting. I’m afraid that I cannot spend the time with you that I’d like to due to the clinic schedule.” Your overt recognition of the situation acknowledges the patient’s experience. Sometimes, that in itself can be healing.
  2. Communicate that you are concerned about the patient and, though there may be nothing you can do to “fix” the situation, you would like to offer what you can – you can offer to visit the patient again later on in the day… you can offer to call the patient in a day or two to check in
  3. Ask the patient what would be most helpful in that moment – This inquiry communicates that you respect the patient’s opinion, that this is a collaborative effort, and that you want to help.

What to Do When a Patient is Crying [intueri]

Posted in Clinical Rotations, How-To, Psychiatry | Comments Off on Comfort Crying Patients like a Pro

Heart Sounds & Cardiac Exam Primer

Posted by medliorator on October 29, 2008

Blaufuss Medical Multimedia Laboratories offer a free interactive tutorial worthy of a closer look.

  • Cardiac Exam Module
    • heart sounds tutorial
    • quiz
    • detailed animation of S2 splitting.
  • Electrocardiogram Module
    • Supraventricular tachycardia tutorial
    • Interactive ECG viewer
    • interpretations & detailed explanations.

http://blaufuss.org/

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False Memory Formation with Sleep Deprivation

Posted by medliorator on October 28, 2008

Sleep is known to provide optimal neurobiological conditions for consolidation of memories for long-term storage, whereas sleep deprivation acutely impairs retrieval of stored memories.

Subjects either slept or stayed awake immediately after learning, and they were either sleep deprived or not at recognition testing 9, 33, or 44 hours after learning. Sleep deprivation at retrieval, but not sleep following learning, critically enhanced false memories of theme words. This effect was abolished by caffeine administration prior to retrieval, indicating that adenosinergic mechanisms can contribute to the generation of false memories associated with sleep loss.

Sleep Loss Produces False Memories [PLoS ONE]

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Prescribing Placebos

Posted by medliorator on October 27, 2008

679 physicians (57%) responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).

Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists [BMJ]

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Record-Breaking Medical School Enrollment

Posted by medliorator on October 27, 2008

First-year enrollment at the nation’s medical schools this year increased nearly 2 percent over 2007, to more than 18,000 students—the highest enrollment in history.

The three medical schools that have just established—or are planning to establish—branch campuses were responsible for most of the enrollment increase (Mercer University School of Medicine, Texas A&M Health Science Center College of Medicine, and University of Arizona College of Medicine).

After a five-year increase in applicants to medical schools, the number of applicants leveled off this year at more than 42,200. While the overall applicant pool is one of the largest in more than a decade, the number of first-time applicants decreased by 3 percent. On average, there were more than 2 applicants for every available opening at a medical school.

Medical Schools Increase Enrollment to Meet Physician Demand [AAMC]

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The Most Important Components of your Residency Application

Posted by medliorator on October 26, 2008

METHODS: A questionnaire consisting of 20 items based on the current Electronic Residency Application Service (ERAS) guidelines was mailed to the program directors of all 118 EM residencies in existence in February 1998. The program directors were instructed to rank each item on a five-point scale (5 = most important, 1 = least important) as to its importance in the selection of residents.

RESULTS: Response rate = 79.7% of Emergency Medicine residencies

Rank Application Parameter Rank (+/- SD)
1. Personal Statement 2.75 (0.96)
2. Publications 2.87 (0.99)
3. Basic Science Grades 2.88 (0.93)
4. Extracurricular Activities 2.99 (0.87)
5. Medical School Attended 3.00 (0.85)
6. AOA Status 3.01 (1.09)
7. Awards/Achievements 3.16 (0.88 )
8. USMLE step I 3.28 (0.86)
9. Interest Expressed in Institution 3.30 (1.19)
10. USMLE Step II 3.34 (0.93)
11. Elective Done at Institution 3.75 (1.25)
12. Recommendations 4.11 (0.85)
13. Clinical Grades 4.36 (0.70)
14. Interview 4.62 (0.63)
15. EM rotation grade 4.79 (0.50)

Selection criteria for emergency medicine residency applicants [Acad Emerg Med. 2000 Jan;7(1):54-60.]

Correlate: The Most Important Components of your Residency Application – Part II

Posted in Matching, Residency | 1 Comment »

Cheap Ways to Destress

Posted by medliorator on October 25, 2008

1. Turn off the TV
2. Go for a walk
3. Call up a friend Don’t underestimate the power of human contact
6. De-clutter your home
7. Treat yourself to a hot bubble bath If you take as little as thirty minutes to soak away your worries, you’ll feel like a new person.

10 Ways to Reduce Stress Without Spending a Dime [Dumb Little Man]

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How to Utilize Criticism

Posted by medliorator on October 24, 2008

You need the critics, because criticism can help you make improvements.

You need to be able to absorb and act on sometimes unfair criticism, while staying motivated.  The people with the thickest skins aren’t insensitive jerks.  These are the people who are able to take downright abusive comments, pick apart the pieces to make themselves better, and still be able to wake up with energy in the morning.

if you disregard every piece of feedback that doesn’t come with a smile, you’re missing out on a lot of growth opportunities.

criticism tends to come in a few major forms:

  • Insults –  personal attacks based on emotions, not reasoning.  They tend to attack you or your character, not what you’re doing.  I tend to ignore these unless they run in a very specific theme, in which case it’s time to do some self-reflection to see if they have any basis.
  • Critiques – These are, sometimes harsh, suggestions for improvement… strip away all the abusive language and focus on the information it contains.
  • Anger – If you’re doing things to piss people off, don’t be surprised when they get angry.  Use this feedback to check your behavior, to see if there is anything you could change to stop it.
  • Not interested – implied criticisms… the “no” you get after asking for a favor, or the unreturned calls.  I think the best way to interpret these is to modify your approach and try again.

How to Develop a Thicker Skin [Scott H Young]

Posted in How-To, Productivity, Professionalism | 1 Comment »