Polish Your Online Image, AAMC Advises Medical Students and Residents

How can you make sure future program directors find only the best “you” online? Follow these suggestions when using social media services such as Facebook, Twitter and blogs:

- Consider carefully what you’re posting
- Avoid posting patient stories
- Periodically search yourself
- Check the photos in which you’re “tagged”
- Define funny - Humor can be hard to interpret
- Choose your friends carefully
- Restrict your privacy settings

References:

Careers in Medicine. AAMC, 2010 (PDF).

Image source: OpenClipArt.org, public domain.

How to Use Social Media for Medical Education

Here are a few suggested approaches for social media use in medical education:

- Peer student groups can utilize a private blog to share clinical experiences

- Course/program directors and staff can use a wiki to manage course/program materials and centralize frequently used documents

- Longitudinal preceptors can use a microblog (e.g., Twitter) to share links to journal articles, medical news, and reminders

- Admissions personnel can use social networks during the application, interview, and acceptance processes to build a community before students ever set foot on campus

- A public affairs office could generate podcasts to share graduate news, campus information, celebrations, and research success stories


The Networked Teacher - Diagram, Flickr http://goo.gl/CVddi

References:
Saarinen C, Arora V, Fergusen B, Chretien K. Incorporating social media into medical education. Academic Internal Medicine Insight. 9(1):12-13, 19. Read the full-text PDF here.

Effect of 16-Hour Duty Periods on Patient Care and Resident Education

Dr. Amy Oxentenko details a study appearing in the March 2011 issue of Mayo Clinic Proceedings (available at: http://www.mayoclinicproceedings.com) that looked at the effects of 16-hour duty periods for residents, and the impact of reduced shift length on:

- patient care metrics

- education

- transitions of care

- work hours

- resident satisfaction

iPad use by medical residents gets rave reviews, increases productivity

View more videos at: http://www.nbcchicago.com.

The Internal Medicine Residents at the University of Chicago Medical Center are now equipped with iPads as their primary device for clinical use.

In the summer of 2010, the Internal Medicine Residency (IMR) program began piloting a project to study the use of iPads on the inpatient wards. Initiated by the Chairman's Office, the project was intended to enhance efficiency of patient care activities on the wards with the goals of improved patient care and more robust conference attendance.

The pilot was overwhelmingly positive and has led to broader use of the devices for all IMR residents. The DOM Internal Medicine Residency program is the first training program in the country to utilize the device.

As an Assistant Professor at University of Chicago, I work with the residents on a daily basis and I can confirm that they love their iPads.

References:
University of Chicago Medical Center
iPads Helping Doctors. NBC.

Reduced workload and increased participation of attendings associated with higher satisfaction of doctors in training

An experimental inpatient-medicine service was designed with reduced resident workload comprising two teams, with each team consisting of two attending physicians, two residents, and three interns.

Attending physicians, selected for their "teaching prowess", supervised the teams throughout the workday and during bedside team-teaching rounds.

This experimental model was compared with a control model comprising two teams, with each consisting of one resident and two interns, plus multiple supervising attending physicians who volunteered to participate.

Over a 12-month period, 1892 patients were assigned to the experimental teams and 2096 to the control teams; the average census per intern was 3.5 and 6.6 patients, respectively.

Overall satisfaction was significantly higher among trainees on the experimental teams than among those on the control teams (78% and 55%, respectively; P=0.002).

Interns on the experimental teams spent more time in learning and teaching activities than did interns on the control teams (learning: 20% of total time vs. 10%, P=0.01; teaching: 8% of total time vs. 2%, P=0.006).

A model with two attending physicians and limited patient-staff census resulted in greater satisfaction on the part of trainees and attending physicians than the standard approach.

Reduced trainee workload and increased participation of attending physicians was associated with higher trainee satisfaction and increased time for educational activities.

References:
Evaluation of a Redesign Initiative in an Internal-Medicine Residency Program. NEJM.

Image source: OpenClipArt.org, public domain.

"With UpToDate, students and interns may be as capable of teaching the resident (or attending) as visa versa"

From Wachter's World:

"In 1984, one resident even wrote a letter to the New England Journal of Medicine called “Ripping and Filing Journal Articles,” taking the Journal to task for its habit of beginning an article on the back of the last page of the previous one (which meant the page needed to be photocopied if you wanted to tear both articles out of your personal copy of the journal). Fair point, but talk about a resident who needed to get a life.

Today, as in so many other parts of our lives, the computer, with its magical access to the universe of on-line resources, has democratized the learning of clinical medicine. At UCSF, by the time morning rolls around, the students and interns have often already read the on-line UpToDate synopsis of the topic at hand, and may be as capable of teaching the resident (or attending) about it as visa versa."

Note: UpToDate is a peer reviewed medical information resource (paid, not free access) published by a medical company called UpToDate, Inc. It is available both via the Internet and offline. An update is published every four months. The material is written by over 3600 clinicians and has over 7300 topics. The website was launched in 1992 by Dr. Burton D. Rose along with Dr. Joseph Rush. A new online subscription for 1 year costs $495, $195 for trainees (source: Wikipedia).

References:
Substituting Coffee Cake for Journal Articles: Another Unforeseen Consequence of IT. Wachter's World.

Are You Dependent on UpToDate for Your Clinical Practice?

95% of junior doctors consider electronic textbooks the most effective source of knowledge. 70% of junior doctors read the medical literature in response to a specific patient encounter. BMJ, 2011. http://goo.gl/QZyJE

Image source: UpToDate.

Medical school letters of recommendation have formally been replaced by tweets

Doctor_V's tweets in Brizzly (click to enlarge the image) - read from the bottom of the screenshot.

Doctor_V:

If you are a medical school I highly suggest you admit @beccacamp .@LeeAase I don't know if Mayo School of Medicine takes Twitter recommendations but I formally recommend @beccacamp. Medical school letters of recommendation have formally been replaced by tweets.

Indeed. And if the tweets are by Doctor_V, they should be strongly considered in the admission process... :)

500 repetitions of 4 cardiac murmurs improved auscultatory proficiency of medical students

According to a 2004 study in Chest, the ability of medical students to recognize heart murmurs is poor (20%), and does not improve with subsequent years of training.

Five hundred repetitions of four basic cardiac murmurs significantly improved auscultatory proficiency in recognizing basic cardiac murmurs by medical students. These results suggest that cardiac auscultation is, in part, a technical skill.

Related resources

The Heart Sounds Tutorial by Blaufuss.org is a fancy flash-based simulator with animations. The McGill University Virtual Stethoscope is another useful website. Click here for more web-based teaching resources for hearts sounds from UCLA and breath sounds from Loyola University.

References:

Mastering cardiac murmurs: the power of repetition. Barrett MJ, Lacey CS, Sekara AE, Linden EA, Gracely EJ. Chest. 2004 Aug;126(2):470-5.

http://www.ncbi.nlm.nih.gov/pubmed/15302733

Image source: Modern stethoscope. Wikipedia, public domain.

Physical Examination Videos

Standardized patient: Over the course of three days, I had 23 head-to-toe physicals from 23 medical students

From Slate:

"I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy.

A "standardized patient" is a trained person who is paid $15 an hour to be poked and prodded by inexperienced fingers, so that med students can learn communication and examination skills before they are sicced on actual sick people.

Now there are standardized patients trained for genital duty (they're called GUTAs, for genitourinary teaching associates).

Dr. N wasted the first eight minutes of the exam trying repeatedly to get a blood pressure reading. The panic in his eyes seemed to say, "She appears to be alive, yet she has no vital signs."

Comments:

Lakshman Swamy - Don't forget that some of them were capable! I have to say, in my experience as an MS2 at Wright State, our standardized patients are amazing teachers. It is much easier to learn physical exam skills and even interviewing when the patient can give you precise feedback. The author is right on with the characters that patients can portray... it is shocking when they break character to give feedback! Just recently I learned how to do the male exam with two standardized patients ("GUTA" -- never heard of that term before). I was definitely feeling a little ... awkward before the session began-- this was by far the most invasive thing I had ever done to another person. But the standardized patients were amazing about the whole process, even acting out the different hesitations that we might encounter in patients, emphasizing the importance of the exam, etc. Without being too graphic, I can't emphasize how much I learned about how to do those exams and what I was actually supposed to be finding. It was a totally different experience than I expected, and after it, I feel really confident about the whole process.

I can't even IMAGINE what it would be like to do that with my classmates-- and how much less I would have understood. Wow.

References:

Oh, no! I'm the first patient these 23 medical students have ever examined. Slate, 2010.

http://www.slate.com/id/2169480/pagenum/all

Image source: OpenClipArt.org, public domain.

Anesthesia 2.0: Web 2.0 in anesthesia education

Educators in all specialties of medicine are increasingly studying Web 2.0 technologies to maximize postgraduate medical education.

Web 2.0 technologies include:

- microblogging
- blogs
- really simple syndication (RSS) feeds
- podcasts
- wikis
- social bookmarking and networking

Although direct practice and observation in the operating room are essential, Web 2.0 technologies hold promise to innovate anesthesia education and clinical practice such that the resident learner need not be in a classroom for a didactic talk, or even in the operating room to see how an arterial line is properly placed.

Web 2.0 and advanced informatics resources will be part of physician lifelong learning and clinical practice.

References:
Anesthesia 2.0: Internet-based information resources and Web 2.0 applications in anesthesia education. Chu LF, Young C, Zamora A, Kurup V, Macario A. Curr Opin Anaesthesiol. 2010 Jan 19. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/20090518

Image source: Wikipedia.

Night shifts/calls may increase risk for cardiovascular disease

The cardiovascular risks associated with night shift work in medical staff have been suspected for years.

Coronary heart disease (CHD) incidence was investigated in a previous study of 79,109 women from the Nurses Health Study, and observed raised rates among night shift workers, particularly those who had worked for more than 6 years on rotating shifts (51% increased risk). Studies have also demonstrated an increased incidence of the metabolic syndrome in shift workers.

The authors of this study evaluated the effects of a 24 hour physicians on-call duty (OCD) (‘night shift’) compared with a ‘regular’ day at work on:

- 24 hr electrocardiogram (ECG)
- heart rate variability
- blood pressure (BP)
- serum and urine ‘stress markers’

Each physician completed a 24 h OCD and a 24 h control period including a regular 8 hr non-OCD, 30 healthy physicians with a median age of 33.5 years were included.

- ECG showed a higher rate of ventricular premature beats (VPB) during early morning hours during night shift.

- BP monitoring revealed a greater diastolic BP throughout 24 hr associated with a higher rate of systolic BP during sleep time.

- Tumour necrosis factor (TNF) alpha concentrations increased during night shift. Urinary noradrenaline excretion was greater during OCD.

The authors concluded that the study results highlight the association of OCD with an increased risk profile for cardiovascular disease. In addition to the acute effects observed, frequent night-calls over a longer period may lead to sustained alterations in cardiovascular homeostasis.

References:
Arrhythmias and increased neuro-endocrine stress response during physicians' night shifts: a randomized cross-over trial. Markus Rauchenzauner et al. European Heart Journal 2009 30(21):2606-2613; doi:10.1093/eurheartj/ehp268
Night shift work and the cardiovascular health of medical staff. A. Steptoe. Eur. Heart J., November 1, 2009; 30(21): 2560 - 2561.
Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

USMLE Algorithms - YouTube Channel

"Joseph, M.D." is the author of 40 video algorithms focused on the United States Medical Licensing Examination (USMLE) and uploaded on YouTube: "These video clips are algorithms that were made specifically for students preparing for the USMLE exams. They have been cross references with the most up to date medical resources, but if you have any questions, or comments, please do not hesistate."

Example:


Pulmonary Embolus Algorithm.

Joseph, M.D. recently launched a website devoted exclusively to the algorithm videos at http://www.usmlealgorithms.com

Suggested learning devices and books for USMLE and ABIM, from my personal experience:

Job-hunting in a recession: Physician jobs are out there but they may not be easy to find

From American Medical News (AMedNews.com):

53% of companies hiring physicians said ability to sell a home is a significant barrier.

Physicians traditionally work within 100 miles of where they trained.

Physician recruiter: We have seen at least a 15% decline in the number of candidates applying for our positions.

85% of employers offer physicians signing bonuses with an average $24,850 (up from 58% in 2006).

Related:
Job Search: There's a feed for that?!
Image source: OpenClipArt, public domain.

What do doctors in training carry in their white lab coats?

The study was done in Ireland in 2001 and quite a few things have changed since then but it is still an interesting one to have a look at. Nowadays, many students and residents do not carry handbooks but an iPhone or another type of smartphone. And I hope than less than 33% have cigarettes in their lab coat pockets.

The authors designed a study to ascertain the weight and type of items carried by 54 junior hospital doctors in their white coats.

- Mean weight carried was 1.63 Kg. There were no statistical difference between males and females.

- Interns and senior house officers (SHOs) carried significantly more than registrars.

- Medical specialties carried significantly more than surgical specialties.

- 33% carried cigarettes.

The conclusion was that junior hospital doctors carry the equivalent of almost two 1Kg bags of sugar with them in their white coats, this added weight may contribute to increased fatigue during long hours on duty. As doctors become more senior they carry less.

References:
Junior hospital doctors: a weighty issue. Hone S, Mackle T, Keogh I, Colreavy M, Walsh M. Ir Med J. 2001 Jul-Aug;94(7):208, 210.
Image source: Lab coat and scrubs. Wikipedia, Samir, Creative Commons Attribution-ShareAlike 3.0 License.

Related:

A Cartoon Guide to Becoming a Doctor: What's in your short white coat? http://goo.gl/aGhE

Video: Presenting to an Attending physician

The video below was created by Nova Southeastern University - College of Osteopathic Medicine (NSU-COM) to help second-year medical students prepare for communicating patient information to an attending physician.



Presenting to an Attending physician

Video: How to Interview for Medical School

The videos below were created by Nova Southeastern University - College of Osteopathic Medicine (NSU-COM) to help medical school applicants prepare for their interview at any medical school.


How to Interview for Medical School Part 1


How to Interview for Medical School Part 2

This video is not from NSU-COM:


How to Interview for Medical School: The three A's. ARRIVE on time; your APPEARANCE; your ATTITUDE. It's the biggest day of your working life; do it RIGHT. Prepare.

CNN video: A young doctor's first day