medical education
denialism | February 18, 2009What to say about psychiatry that isn't already completely covered by television and movies? It's unique among the specialties for its coverage in the media. Maybe because we're such social animals, or maybe because such shows about psychiatry or therapy appeal to a voyeuristic impulse in us to peer into people's most private thoughts and feelings.
Our exposure to psychiatry in medical school, however, is primarily with inpatient psychiatry - people who for whatever reason require hospitalization to deal with their mental illnesses. Reasons may range from soul-crushing anxiety attacks, to…
denialism | February 4, 2009The process of choosing a medical specialty, and applying for residency programs is nearly complete as I have returned from my tour of the West Coast and am nearly done with interview season. This is when medical students travel the country at great (and unreimbursed) expense to find their future training program. When all is said and done, all your research into programs and time spent interviewing boils down to a simple question. Do you want to work with these people for the next 3-7 years of your life?
It's also nice to see the cities where you may live and get a feel for the type of…
terrasig | January 4, 2009In preparing for the ScienceOnline'09 session on Gender in Science - Online and Offline, one planned discussion point will be how to enlist allies representing the dominant power structure to enhance equality and diversity in the STEM disciplines. No one ally can do it all but a combination of like-minded people can make a huge difference.
Here is a terrific example of an ally, written by superb higher ed reporter, Eric Ferreri, of the Raleigh (NC) News & Observer, on Dr Henry Friedman and CAPE, the Collegiate Athletic Pre-Medical Experience:
Georgia Beasley was practicing her jump shot…
sb admin | December 18, 2008A (long) while back, I gave you a brief explanation of what an "internist" is. I later gave you a personal view of primary care medicine and some of the challenges involved in creating an infrastructure of primary care (only 2% of American medical grads are going into primary care). We also had a little chat about medical mistakes and medical training.
No matter what changes we ultimately make in the way we train internists, one of the lessons that residency teaches is to identify who is truly sick. I don't mean who is faking it, I mean being able to look at someone briefly and decide…
denialism | December 12, 2008Aside from taking 4th year medical school classes it's also the time of year that medical students who plan to graduate in 2009 (like me) are applying to residency programs across the country. This is an interesting process and one that many people outside of medicine are unfamiliar with, and quite surprised by. For one, did you know that we don't have final say on where we train in residency but that the decision is made by a computer?
It's true. The process is called "the Match" and it's a time of great excitement and anxiety for 4th year medical students. For one, there are far more…
sb admin | November 28, 2008MarkH is going through the process of deciding what to what to do when he grows up. This is a much more difficult and important decision than many may realize. In order to understand the gravity of this process, I'll have to refresh your memories a bit regarding medical education.
In the U.S., to apply for medical school, you must have completed a (usually) 4-year bachelor's degree from a university. During the final year, you take what amounts to an entrance exam (the MCAT), and send out preliminary applications (often with fees). If the schools like your preliminary applications, they…
signout | November 14, 2008I've been away from the blog for a while, working on fellowship applications and riding the wave of the ICU. Thank you for your patience, as ever.
As you might remember from my days as an intern, I used to love the ICU. That love is no longer: doing procedures to people whose fate is inevitable isn't as much fun as it used to be, and I feel powerless in the face of a culture that doesn't exactly embrace the avoidance of unnecessary intervention.
This most recent time in the ICU, I worked with an intern who seemed to me less eager than some to take on the burden of her responsibility. About…
denialism | November 7, 2008It's that time of year, 4th year medical students (like me - kind of) are choosing their future careers and starting to interview all over the country in their residency programs of choice. I've been notably quiet - subsumed in work, study and applications - but I am catching up on writing about the clerkships I've done in the meantime (Pediatrics, Psych, OB/Gyn and Family Medicine). But since I'm applying for residency now (MD/PhDs have an abbreviated 4th year) I figured now would be a good time to tell people about what this is like, and in the coming months what cities I'm going to be in…
denialism | November 6, 2008I've been busy, as you might imagine, with work, study, and applying for medical residency. However, I thought it was about time to get people up to date with some of the clerkships I've finished in the meantime before letting you guys in on some of the decision-making processes involved in choosing a residency.
So, time to talk about pediatrics. Pediatrics, despite a reputation for warmth and fuzziness, is a challenging field. Kids aren't just little adults, and the treatment and diseases of infants are different than those of toddlers, which are different from pre-adolescents, which…
sb admin | September 12, 2008One of our sciblings, Dr. Signout, is learning the ropes as she struggles (and presumably excels) through her medical residency. As her writing has picked back up, she has brought up some important questions about medical education and medical professionalism. I'm a little further along in my career than she, and I have some thoughts that may flesh out her experiences, and shed some light on the medical profession as a whole.
Her latest posts brought up two particularly important issues, one about how doctors are treated "without the white coat" and the other on what it means to put…
signout | September 12, 2008From the Department of the Maximally Self-Righteous comes this delightful little piece of scholarship, a letter to the Journal of the American Medical Association (JAMA) that describes a survey of internal medicine interns on the subject of professionalism. In it, participants were asked to rate their participation in and perception of "unprofessional behaviors" related to residency. The survey* was created based on the input of third-year medical students, residents, and faculty, and was administered in the first three months of the subjects' intern years.
Among behaviors rated as most…
sb admin | August 22, 2008I'm a little down today. I've told you before that I take care of my own patients in hospice. I've also told you about watching patients and friends lose their battles with disease.
This week I had serious talks with several people about end-of-life issues (the details of which I can't really share at the moment). I've also had to tell someone about an abnormal lab result (a very bad one). In fact, the best news I've delivered all week was telling someone they had mononucleosis (rather than something worse).
I've found, in my limited experience, that terrible illnesses don't change…
terrasig | August 16, 2008CORRECTION: The following was to be a part-sincere/part-serious sendup of my buddy Bora's penchant for monitoring the entire Internet. Bora did indeed host the first edition of Praxis, the new blog carnival of academic life.
However.
The Praxis experimental carnival of "the experience of living the scientific" was established, founded, and otherwise continues to be led by Martin, author of The Lay Scientist blog.
Mini Bio:
Well I'm Martin, I live in Cambridge, England, and this is me on the Amazon in 2007. I did a frankly weird Ph.D. looking at the relationship between models from ecology,…
choofnagle | July 25, 2008Okay, as Denialism's lawyer, let me get to the issue of the rose tattoo.
A medical procedure is a battery. Patients consent to it, thus allowing the doctor to engage in even invasive touching without liability for the battery. The scope of consent is key, however. Many individuals have a rough sense of consent; they think that if consent is given to one thing, anything goes. But, the law takes a much more nuanced approach to consent. Thus, a patient does not consent to all forms of touching, just ones that are consistent with the procedure authorized.
Was applying a rose tattoo within…
sb admin | July 25, 2008My Scibling DrugMonkey brought up a half-valid point. The half that was valid was that none of the medical bloggers spoke out about the surgeon who assaulted a patient. The half that was insane was where this is used as further evidence that doctors are arrogant pricks. Based on this comment and those of the commenters on my blog, some further clarification is needed.
I can't speak for other doctor-bloggers, but the story of the surgeon who tattooed a patient wasn't that interesting to me because of its isolated nature. When looking at antivaccine claims, altmed claims, and all manner of…
denialism | July 24, 2008Who wrote this?
As someone who spends a substantial portion of his professional time teaching medical students, I can tell you that this kind of attitude-that physicians are gods, not mere mortals, and wield power over other human beings that no one dare question-is inculcated in them from the very beginning of medical training. It is an ugly secret of our medical training system. And the more prestigious the institutions where physicians receive their training, the more overweening is this attitude.
Anything that a physician calls a "joke" or "for the patient's benefit" simply is that, and…
sb admin | July 24, 2008Our Scibling PhysioProf has launched the opening salvo in what may turn out to be a rather bloody flame war. In the interest of actually gaining something from this other than venting my own anger and frustration, I will beg your indulgence here as I explain why my colleague is so utterly misguided.
PhysioProf (hereafter referred to as "PP") is a researcher at a medical school, and teaches medical students (no secrets here...I'm not outing anyone, just re-stating facts already in evidence). According to my sources who know such things, both PP, and his/her blog partner DrugMonkey, write…
sb admin | July 14, 2008Teaching new doctors is an interesting process. Much has been done over the last ten years to improve the way we teach new doctors. Medical residents still work very hard, but there are strict rules on work hours and other "service" duties that can interfere with education and safety.
One of the issues that often comes up in running a residency program is the problem of "service" vs. "education". Per the accrediting body that does these things:
The learning objectives of the program must not be compromised by excessive reliance on residents to fulfill service obligations.
Along with…
sb admin | June 6, 2008The practice of medicine requires a careful mix of humility and confidence. Finding this balance is very tricky, as humility can become halting indecision and confidence can become reckless arrogance. Teaching these traits is a combination of drawing out a young doctor's natural strengths, tamping down their weaknesses, and tossing in some didactic knowledge. I supervise residents---they make the decisions, but it's my name and my ass on the line, so I keep a close eye on things. Some teaching physicians dictate every decision on patients, some do nothing at all. I try to keep toward the…
sb admin | June 5, 2008When a resident of student presents a patient with me and I help them formulate a plan, we call it "staffing" the case. Recently while I was staffing, I was presented with a patient who speaks little English, but speaks another language fluently. Unfortunately for us, this language wasn't Urdu, Spanish, French, Romanian, or Hindi (languages spoken by the people immediately within my reach). The medical instructions we needed to give were fairly complex---too complex for Pidgin English, so I paged one of my interns.
"Hey, S.," I said, "how well do you speak (insert little-known language…