Joshua Batt, Medical Student, Emergency Medicine
The cut was made, some dissection performed and the baby was pulled out. I was holding our patient's uterus in one hand and assisting my attending with the other during a scheduled cesarean section. All I could think was how this doctor's job is simply amazing. How many people can say that they get to open a person's body, pull out a living organism and twelve inches away, you can stare the patient in the face and have a discussion with them?
Between the work of the anesthesiologist and the obstetrician, I was enthralled by the situation. Their team effort and training made the operation a success. Baby was beautiful, mom and dad were happy and the medical crew had performed well. It was not a long procedure, but one that left me wondering if I could be doing this as a career. Yet another moment of reflection needed if I am ever going to decide what to be "when I grow up."
That question, "What are you going to be when you grow up?" continues to haunt me as time rushes past. At least I have the doctor part down; now to narrow things down a little. It certainly doesn't help going into residency applications and interviews with multiple fields of interest and no geographical preference. There are simply too many places, professions, and programs to choose from.
Some aids I have found include the specialty flowchart, the University of Virginia's Medical Specialty Aptitude Test (MSAT), and The Ultimate Guide to Choosing a Medical Specialty. There are days when I agree with their advice and other days I think they are in left field. What have you found useful in making your decision?
Thursday, December 2, 2010
Monday, November 29, 2010
Residency Interview Tips
kendracampbell, MD, Psychiatry/Mental Health
Residency interview season is in full swing. I've already been to a few interviews, and I have picked up one some common do's and don'ts. Here is a list of residency interview tips that I've compiled based on my own experience and advice from others:
1) Stay Organized! I am completely organized to the max, and it has been super helpful. Here are some things I've done and recommend doing:
a) Create email folders and sub-folders, if necessary. You will send and receive many emails. Keep them organized.
b) Create a binder for program info. I have a color coded, chronological system set up.
c) Keep all your interview dates on a calendar! I have mine both on paper and electronically, which has worked super for me.
d) Keep all the papers and info they give you. I have mine in an expandable file folder system.
2) Research the programs. The more you know about the program, the better decisions you can make, and the better you look on interview day. Almost every interviewer has asked me, "why are you interested in this program, in particular?" If you can't answer this question, you will look unprepared!
3) Dress professionally. Wear a suit. Use common sense here. No chest hair showing, no huge gold dollar sign necklaces, and no hooker make-up.
4) Be on time. (Yes, I am obsessed with this one.) Leave WAY early, expect traffic delays and build in time for them.
5) Be prepared for questions. There are many great resources on the web with lists of common residency interview questions (you can check out some from the AAMC here). You should try and go though most of them and come up with an idea of an answer. You don't need to memorize every single question, but you should be prepared to answer the commonly asked ones.
6) Ask questions! It's not a bad idea to make a list of questions about the program in advance. Trust me, you will hear "do you have any questions?" one hundred million times on interview day. If you don't have any questions at all, you look like you're not really interested in the program.
7) Write thank you notes to your interviewers. Either electronic or paper, or both.
8 ) Know your strengths and weaknesses. Be able to give examples of both. Know how to sell yourself. Be confident about yourself as a candidate!
9) Have water accessible during the interview. Maybe this is just me, but I tend to get super dry mouth when I'm interviewing. I always make sure to have a cup or bottle of water nearby. I learned this lesson the hard way.
10) If you are really interested in a program, go back for a second look. This helps you remember the program, and shows that you are truly interested!
Good luck to everyone on their interviews!
Residency interview season is in full swing. I've already been to a few interviews, and I have picked up one some common do's and don'ts. Here is a list of residency interview tips that I've compiled based on my own experience and advice from others:
1) Stay Organized! I am completely organized to the max, and it has been super helpful. Here are some things I've done and recommend doing:
a) Create email folders and sub-folders, if necessary. You will send and receive many emails. Keep them organized.
b) Create a binder for program info. I have a color coded, chronological system set up.
c) Keep all your interview dates on a calendar! I have mine both on paper and electronically, which has worked super for me.
d) Keep all the papers and info they give you. I have mine in an expandable file folder system.
2) Research the programs. The more you know about the program, the better decisions you can make, and the better you look on interview day. Almost every interviewer has asked me, "why are you interested in this program, in particular?" If you can't answer this question, you will look unprepared!
3) Dress professionally. Wear a suit. Use common sense here. No chest hair showing, no huge gold dollar sign necklaces, and no hooker make-up.
4) Be on time. (Yes, I am obsessed with this one.) Leave WAY early, expect traffic delays and build in time for them.
5) Be prepared for questions. There are many great resources on the web with lists of common residency interview questions (you can check out some from the AAMC here). You should try and go though most of them and come up with an idea of an answer. You don't need to memorize every single question, but you should be prepared to answer the commonly asked ones.
6) Ask questions! It's not a bad idea to make a list of questions about the program in advance. Trust me, you will hear "do you have any questions?" one hundred million times on interview day. If you don't have any questions at all, you look like you're not really interested in the program.
7) Write thank you notes to your interviewers. Either electronic or paper, or both.
8 ) Know your strengths and weaknesses. Be able to give examples of both. Know how to sell yourself. Be confident about yourself as a candidate!
9) Have water accessible during the interview. Maybe this is just me, but I tend to get super dry mouth when I'm interviewing. I always make sure to have a cup or bottle of water nearby. I learned this lesson the hard way.
10) If you are really interested in a program, go back for a second look. This helps you remember the program, and shows that you are truly interested!
Good luck to everyone on their interviews!
Tuesday, November 16, 2010
AMA Interim Meeting recap
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http://UofLAMA.blogspot.com/
Friday, October 29, 2010
ACP Medical Student Health Policy Internship
http://www.acponline.org/medical_students/impact/archives/2010/10/perspect/
Wednesday, October 27, 2010
Are American Med Students Better than International Med Students?
Kendra Campbell, MD, Psychiatry/Mental Health, 07:56PM Oct 20, 2010
A medical student recently asked me the above question during their rotation with me. He specifically wanted to know if I noticed a difference in the quality of medical students, based on the school they attended. This is a question, which I considered when deciding to attend an international medical school, and is one, which I also pondered during my medical education. As a medical student, I interacted with both "American" medical students and foreign/international ones.
As a resident, I have now interacted with a variety of medical students. I've worked with students who are from U.S. medical schools, and ones who are from international medical schools. While my anecdotal evidence might not hold that much water, I can now say, with complete confidence, that the medical school which a student attends has little correlational value with their performance on clinical rotations. I obviously cannot speak to their board scores, or any other parameters. But when it comes to general knowledge, patient rapport, clinical skills, and overall performance, I've determined that it's more about the student and less about the school.
While this post started out as a discussion about AMGs (American Medical Graduates) versus IMGs (International Medical Graduates), I would like to change gears and give some general tips to medical students from the perspective of a resident. And for the record, while the resident might not be the one to ultimately grade the student (although we do have input), in my experience we are in the unique position of interacting with the students more than the attending. Sometimes we even do more of the teaching. Anyway, here are some tips, which I can provide based on my experience:
1. Be motivated to learn. Even if you are not planning on going into the specialty in which you are rotating, your motivation level speaks volumes about you as a student, and you as a future doctor.
2. Ask many questions. Asking questions shows that you are interested in learning, and will ultimately make you a better physician. (See #1.)
3. Know your patient. Since medical students generally have a lighter patient load, you have the potential to know each patient that you cover even better than the attending or resident might. I promise that nothing impresses the attendings and residents more than a med student who offers a piece of information about the patient, which was unknown to them.
4. Listen, read, and read. If you want to impress your attending and resident (and ultimately be a better prepared doctor), listen to what they teach you. Try to pay attention to what they emphasize as being important, and read up on pertinent subjects in your "free" time. You are in the hospital/clinic/etc. to learn. Take advantage of this opportunity in every way you can, and follow-up on all discussions with researching/reading in your time away from the hospital.
5. Anticipate what needs to be done and do it. Nothing will make your resident (and attending) happier than to find out that you completed the discharge paperwork for them because you knew the patient was going to be discharged that day. Have the consults sheets, CT requests, doctor's orders forms, etc. ready when you anticipate that they are required. Seriously, this is key! And I can't emphasize enough how happy this makes the residents!
So, that's my two cents on how to be an effective medical student, who will ultimately grow into an effective resident, and physician, no matter which med school you attended. But are these strategies and competencies specific to the med school one attends? I'd love to hear what you think.
A medical student recently asked me the above question during their rotation with me. He specifically wanted to know if I noticed a difference in the quality of medical students, based on the school they attended. This is a question, which I considered when deciding to attend an international medical school, and is one, which I also pondered during my medical education. As a medical student, I interacted with both "American" medical students and foreign/international ones.
As a resident, I have now interacted with a variety of medical students. I've worked with students who are from U.S. medical schools, and ones who are from international medical schools. While my anecdotal evidence might not hold that much water, I can now say, with complete confidence, that the medical school which a student attends has little correlational value with their performance on clinical rotations. I obviously cannot speak to their board scores, or any other parameters. But when it comes to general knowledge, patient rapport, clinical skills, and overall performance, I've determined that it's more about the student and less about the school.
While this post started out as a discussion about AMGs (American Medical Graduates) versus IMGs (International Medical Graduates), I would like to change gears and give some general tips to medical students from the perspective of a resident. And for the record, while the resident might not be the one to ultimately grade the student (although we do have input), in my experience we are in the unique position of interacting with the students more than the attending. Sometimes we even do more of the teaching. Anyway, here are some tips, which I can provide based on my experience:
1. Be motivated to learn. Even if you are not planning on going into the specialty in which you are rotating, your motivation level speaks volumes about you as a student, and you as a future doctor.
2. Ask many questions. Asking questions shows that you are interested in learning, and will ultimately make you a better physician. (See #1.)
3. Know your patient. Since medical students generally have a lighter patient load, you have the potential to know each patient that you cover even better than the attending or resident might. I promise that nothing impresses the attendings and residents more than a med student who offers a piece of information about the patient, which was unknown to them.
4. Listen, read, and read. If you want to impress your attending and resident (and ultimately be a better prepared doctor), listen to what they teach you. Try to pay attention to what they emphasize as being important, and read up on pertinent subjects in your "free" time. You are in the hospital/clinic/etc. to learn. Take advantage of this opportunity in every way you can, and follow-up on all discussions with researching/reading in your time away from the hospital.
5. Anticipate what needs to be done and do it. Nothing will make your resident (and attending) happier than to find out that you completed the discharge paperwork for them because you knew the patient was going to be discharged that day. Have the consults sheets, CT requests, doctor's orders forms, etc. ready when you anticipate that they are required. Seriously, this is key! And I can't emphasize enough how happy this makes the residents!
So, that's my two cents on how to be an effective medical student, who will ultimately grow into an effective resident, and physician, no matter which med school you attended. But are these strategies and competencies specific to the med school one attends? I'd love to hear what you think.
Monday, October 18, 2010
Top 10 Residency Interview Questions
It’s been one month since ERAS (Electronic Residency Application Service) opened its floodgates and released thousands of potential residents’ applications for residency in the US. There are lots of great resources online for advice and tips with regards to the dreaded residency interviews. But I’ve received emails asking to provide the most common interview questions that I encountered last year, while on the interview trail. So, here is a list that I’ve created, in relative order of frequency:
1. Tell me about yourself.
2. Do you have any questions?
3. Why are you interested in (fill in the blank) as a specialty?
4. What do you like to do for fun?
5. What is your specific interest in this program?
6. What are your future goals, aspirations, beyond residency?
7. What are your weaknesses?
8. Can you see yourself living in this area?
9. Where else have you applied?
10. What area in this speciality interests you most, and do you plan on completing a fellowship?
The above questions are fairly standard. However, for fun, here are some random questions that I was also asked during interviews:
1. If you were a car, what type of car would you be, and why?
2. How do you feel about the philosophical underpinnings of psychiatry?
3. Can a doctor have a pink mohawk?
4. Have you ever had a pink mohawk?
5. If you could paint a mural on the blank wall in front of you, what would you paint, and why?
6. What is the one thing, which is not on your application, which you think would cause us not to accept you into our program?
7. What kind of dogs do you have?
8. If you were a fruit, what kind of fruit would you be, and why?
9. Tell me about the worst patient you’ve encountered.
10. How is your relationship with your family?
I hope this is helpful to a few folks out there. For all of you who have been through the residency interview process, or are currently going through it, please do add either a common question, which I’ve missed, or an “off the wall” one, which you've encountered!
1. Tell me about yourself.
2. Do you have any questions?
3. Why are you interested in (fill in the blank) as a specialty?
4. What do you like to do for fun?
5. What is your specific interest in this program?
6. What are your future goals, aspirations, beyond residency?
7. What are your weaknesses?
8. Can you see yourself living in this area?
9. Where else have you applied?
10. What area in this speciality interests you most, and do you plan on completing a fellowship?
The above questions are fairly standard. However, for fun, here are some random questions that I was also asked during interviews:
1. If you were a car, what type of car would you be, and why?
2. How do you feel about the philosophical underpinnings of psychiatry?
3. Can a doctor have a pink mohawk?
4. Have you ever had a pink mohawk?
5. If you could paint a mural on the blank wall in front of you, what would you paint, and why?
6. What is the one thing, which is not on your application, which you think would cause us not to accept you into our program?
7. What kind of dogs do you have?
8. If you were a fruit, what kind of fruit would you be, and why?
9. Tell me about the worst patient you’ve encountered.
10. How is your relationship with your family?
I hope this is helpful to a few folks out there. For all of you who have been through the residency interview process, or are currently going through it, please do add either a common question, which I’ve missed, or an “off the wall” one, which you've encountered!
Thursday, October 14, 2010
Clerkship Order Linked to Outcomes on Clerkship Exams
September 14, 2010 — Third-year medical student performance is associated with the first clinical clerkship, with students who start with internal medicine showing the highest subject examination performance and overall grades.
However, clerkship order is not associated with clerkship clinical performance or US Medical Licensing Examination Step 2 scores.
The findings, from a retrospective review of medical students attending a single US medical school, are published in the September 15 issue of the Journal of the American Medical Association.
"Studies have demonstrated the importance of clerkship sequence on aspects of performance in select clerkships, and their findings support that students perform better on subject examinations as they progress through the academic year," write Susan M. Kies, EdD, from the University of Illinois College of Medicine, Urbana, and colleagues. "Although research supports that students perform better in clerkship examinations later in the year, we are not aware of any studies that have addressed whether knowledge is gained as a result of a certain clerkship specialty,"
Accordingly, in this study, the authors sought to assess whether the order in which third-year core clerkships are completed affects student performance.
They analyzed the clerkship performance records of 2216 medical students at all 4 campuses of the University of Illinois College of Medicine who completed their third-year core clerkships in internal medicine, family medicine, surgery, pediatrics, psychiatry, and obstetrics/gynecology from July 2000 through June 2008.
They found that first clerkship was significantly associated with mean subject examination scores. For family medicine, it was 71.96 (95% confidence interval [CI], 70.90 - 72.98); internal medicine, 73.86 (95% CI, 73.33 - 74.39); obstetrics/gynecology, 72.36 (95% CI, 71.64 - 73.04); pediatrics, 73.11 (95% CI, 72.38 - 73.84); psychiatry, 72.17 (95% CI, 71.52 - 72.81); and surgery, 72.37 (95% CI, 71.73 - 73.02; P < .001).
Similarly, first clerkship was significantly associated with mean overall clerkship grades. For family medicine, it was 24.20 (95% CI, 23.90 - 24.90); internal medicine, 25.33 (95% CI, 25.07 - 25.60); obstetrics/gynecology, 24.68 (95% CI, 24.32 - 25.05); pediatrics, 24.92 (95% CI, 24.59 - 25.27); psychiatry, 24.61 (95% CI, 24.33 - 25.01); and surgery, 24.97 (95% CI, 24.64 - 25.30; P = .01).
The study also found a significant difference in mean total overall clerkship grades for students taking internal medicine first compared with obstetrics/gynecology (mean difference, 0.65; 95% CI, 0.18 - 1.12), psychiatry (mean difference, 0.66; 95% CI, 0.20-1.12) and family medicine (mean difference, 0.93; 95% CI, 0.37 - 1.50).
The positive association between starting a clerkship with internal medicine and subsequent examination performance throughout the clerkship sequence may be a reflection of a general understanding of internal medicine concepts that provide a basis of medical knowledge that extends to all clinical disciplines, the authors note.
"Having taken the internal medicine clerkship, students may have the basic understanding of these concepts and an advantage in standardized examination performance thereafter," they write.
The University of Illinois may not be representative of a typical medical school because of the diversity of its 4 campuses, the authors note. Other study limitations include the retrospective and observational study design, incomplete randomization to first clerkship, and variation in clerkship experience among the different campuses.
"The success of student clinical performance may be related to factors other than those included within the scope of this study," the authors write in their conclusion. "Additional analyses of student performance in the clinical setting and in other institutions may help provide optimal experiences for students."
The study authors have disclosed no relevant financial relationships.
JAMA. 2010;304:1220-1226.
However, clerkship order is not associated with clerkship clinical performance or US Medical Licensing Examination Step 2 scores.
The findings, from a retrospective review of medical students attending a single US medical school, are published in the September 15 issue of the Journal of the American Medical Association.
"Studies have demonstrated the importance of clerkship sequence on aspects of performance in select clerkships, and their findings support that students perform better on subject examinations as they progress through the academic year," write Susan M. Kies, EdD, from the University of Illinois College of Medicine, Urbana, and colleagues. "Although research supports that students perform better in clerkship examinations later in the year, we are not aware of any studies that have addressed whether knowledge is gained as a result of a certain clerkship specialty,"
Accordingly, in this study, the authors sought to assess whether the order in which third-year core clerkships are completed affects student performance.
They analyzed the clerkship performance records of 2216 medical students at all 4 campuses of the University of Illinois College of Medicine who completed their third-year core clerkships in internal medicine, family medicine, surgery, pediatrics, psychiatry, and obstetrics/gynecology from July 2000 through June 2008.
They found that first clerkship was significantly associated with mean subject examination scores. For family medicine, it was 71.96 (95% confidence interval [CI], 70.90 - 72.98); internal medicine, 73.86 (95% CI, 73.33 - 74.39); obstetrics/gynecology, 72.36 (95% CI, 71.64 - 73.04); pediatrics, 73.11 (95% CI, 72.38 - 73.84); psychiatry, 72.17 (95% CI, 71.52 - 72.81); and surgery, 72.37 (95% CI, 71.73 - 73.02; P < .001).
Similarly, first clerkship was significantly associated with mean overall clerkship grades. For family medicine, it was 24.20 (95% CI, 23.90 - 24.90); internal medicine, 25.33 (95% CI, 25.07 - 25.60); obstetrics/gynecology, 24.68 (95% CI, 24.32 - 25.05); pediatrics, 24.92 (95% CI, 24.59 - 25.27); psychiatry, 24.61 (95% CI, 24.33 - 25.01); and surgery, 24.97 (95% CI, 24.64 - 25.30; P = .01).
The study also found a significant difference in mean total overall clerkship grades for students taking internal medicine first compared with obstetrics/gynecology (mean difference, 0.65; 95% CI, 0.18 - 1.12), psychiatry (mean difference, 0.66; 95% CI, 0.20-1.12) and family medicine (mean difference, 0.93; 95% CI, 0.37 - 1.50).
The positive association between starting a clerkship with internal medicine and subsequent examination performance throughout the clerkship sequence may be a reflection of a general understanding of internal medicine concepts that provide a basis of medical knowledge that extends to all clinical disciplines, the authors note.
"Having taken the internal medicine clerkship, students may have the basic understanding of these concepts and an advantage in standardized examination performance thereafter," they write.
The University of Illinois may not be representative of a typical medical school because of the diversity of its 4 campuses, the authors note. Other study limitations include the retrospective and observational study design, incomplete randomization to first clerkship, and variation in clerkship experience among the different campuses.
"The success of student clinical performance may be related to factors other than those included within the scope of this study," the authors write in their conclusion. "Additional analyses of student performance in the clinical setting and in other institutions may help provide optimal experiences for students."
The study authors have disclosed no relevant financial relationships.
JAMA. 2010;304:1220-1226.
Monday, October 11, 2010
Wednesday, October 6, 2010
Smoking costs U.S. economy billions each year
Expenses directly attributable to death and disease caused by smoking are estimated to be costing the U.S. economy more than $301 billion annually, according to a study released recently by the American Lung Association. In the study, researchers at Penn State University calculate that smoking results in workplace productivity losses of $67.5 billion, costs of premature death totaling $117.1 billion and direct medical expenditures of $116.4 billion (see below).
The study, titled "Smoking cessation: the economic benefits," provides a nationwide cost-benefit analysis that compares the costs to society of smoking with the economic benefits of states providing smoking cessation coverage. The AMA fully supports the report, which provides state governments with compelling economic reasons to help smokers quit.
"Smoking cessation programs have been shown to successfully help smokers quit—lowering the risk for smoking-related diseases and the high costs associated with treating them," AMA Board of Trustees member Barbara McAneny, MD, said. "No other public health measure, including breast cancer or diabetes screening, sees the economic benefits of smoking cessation."
The AMA offers various online tools that physicians can use to help their patients quit smoking, as well as educational resources about the dangers of secondhand smoke. Among them are a webinar to help physicians counsel parents about secondhand and third-hand smoke exposure, a podcast to help physicians incorporate counseling about secondhand smoke into their practices, a self-learning curriculum that explains office-based prevention and intervention strategies regarding secondhand smoke and a module about managing tobacco dependence.
In addition, the AMA’s Healthier Life Steps™ program offers tips and resources to help physicians talk with patients about the dangers of tobacco use. The program provides patient self-assessment questionnaires, action plans, tracking calendars and other resources to help physicians counsel patients who smoke or use other tobacco products.
Learn more about what the AMA is doing to help physicians help their patients quit smoking, stop using other forms of tobacco and avoid exposure to secondhand smoke.
The study, titled "Smoking cessation: the economic benefits," provides a nationwide cost-benefit analysis that compares the costs to society of smoking with the economic benefits of states providing smoking cessation coverage. The AMA fully supports the report, which provides state governments with compelling economic reasons to help smokers quit.
"Smoking cessation programs have been shown to successfully help smokers quit—lowering the risk for smoking-related diseases and the high costs associated with treating them," AMA Board of Trustees member Barbara McAneny, MD, said. "No other public health measure, including breast cancer or diabetes screening, sees the economic benefits of smoking cessation."
The AMA offers various online tools that physicians can use to help their patients quit smoking, as well as educational resources about the dangers of secondhand smoke. Among them are a webinar to help physicians counsel parents about secondhand and third-hand smoke exposure, a podcast to help physicians incorporate counseling about secondhand smoke into their practices, a self-learning curriculum that explains office-based prevention and intervention strategies regarding secondhand smoke and a module about managing tobacco dependence.
In addition, the AMA’s Healthier Life Steps™ program offers tips and resources to help physicians talk with patients about the dangers of tobacco use. The program provides patient self-assessment questionnaires, action plans, tracking calendars and other resources to help physicians counsel patients who smoke or use other tobacco products.
Learn more about what the AMA is doing to help physicians help their patients quit smoking, stop using other forms of tobacco and avoid exposure to secondhand smoke.
Friday, October 1, 2010
Burnout in Medical Students Linked to Self-Reported Unprofessional Conduct
September 14, 2010 — Burnout in medical students is highly prevalent and is associated with self-reported unprofessional conduct involving patient care, according to the results of a Mayo Clinic study reported in the September 15 issue of the Journal of the American Medical Association.
"Our findings suggest future physicians' altruism, professionalism, and commitment to serve society are eroded by burnout," lead author Liselotte Dyrbye, MD, from the Mayo Clinic in Rochester, Minnesota, said in a news release. "This is concerning since burnout is a pervasive problem among medical students, residents, and physicians in practice."
The goal of this cross-sectional survey was to examine the association between anonymously reported measures of professionalism and burnout among 4400 eligible students from 7 leading medical schools (Mayo Medical School, University of Washington, University of Minnesota, University of Alabama, University of California–San Diego, University of Chicago Pritzker School of Medicine, and the Uniformed Services University of the Health Sciences). The survey included the Maslach Burnout Inventory (MBI), the Primary Care Evaluation of Mental Disorders depression screening tool, and the SF-8 quality of life (QOL) assessment tool. Response rate was 61% (n = 2682).
More than half (52.8%) of the respondents were found to have burnout on the MBI, and those students were more likely to report some form of unprofessional conduct. Although relatively few (<10%) reported academic cheating, up to 43% percent of third- and fourth-year students admitted to some form of unprofessional conduct involving patient care. For example, they may have reported a physical examination finding as normal even though they had not examined that area.
Because the students knew that the reported behavior was inappropriate, the investigators suggest that some elements in the educational process may promote dishonesty.
Burnout was the only aspect of distress independently associated with reporting at least 1 unprofessional behavior, based on multivariable analysis with adjustment for personal and professional characteristics.
For 6 different scenarios, the opinions of only 14% of the students regarding relationships with industry were in line with the American Medical Association policy regarding appropriate interactions between physicians and pharmaceutical companies.
The study authors therefore called on medical schools to "do a better job teaching students about conflict of interest and appropriate relationships with industry."
Altruistic feelings concerning a physician's role in society, such as a desire to provide medical care to the underserved, were less often reported by medical students suffering from burnout.
"As our nation reforms its health care system, it is essential that physicians advocate for patients, promote the public health, and reduce barriers to equitable health care," Dr. Dyrbye said. "Burnout appears to be a threat to this process."
Limitations of this study include response bias, assessment of only a limited number of behaviors and attitudes representing professionalism, reliance on self-reported behavior, and inability to determine causal relationships.
"Future research should investigate whether interventions designed to reduce burnout help students cultivate professional values and behaviour," the study authors conclude.
The Mayo Clinic supported this study. The study authors have disclosed no relevant financial relationships.
JAMA. 2010;304:1173-1180.
"Our findings suggest future physicians' altruism, professionalism, and commitment to serve society are eroded by burnout," lead author Liselotte Dyrbye, MD, from the Mayo Clinic in Rochester, Minnesota, said in a news release. "This is concerning since burnout is a pervasive problem among medical students, residents, and physicians in practice."
The goal of this cross-sectional survey was to examine the association between anonymously reported measures of professionalism and burnout among 4400 eligible students from 7 leading medical schools (Mayo Medical School, University of Washington, University of Minnesota, University of Alabama, University of California–San Diego, University of Chicago Pritzker School of Medicine, and the Uniformed Services University of the Health Sciences). The survey included the Maslach Burnout Inventory (MBI), the Primary Care Evaluation of Mental Disorders depression screening tool, and the SF-8 quality of life (QOL) assessment tool. Response rate was 61% (n = 2682).
More than half (52.8%) of the respondents were found to have burnout on the MBI, and those students were more likely to report some form of unprofessional conduct. Although relatively few (<10%) reported academic cheating, up to 43% percent of third- and fourth-year students admitted to some form of unprofessional conduct involving patient care. For example, they may have reported a physical examination finding as normal even though they had not examined that area.
Because the students knew that the reported behavior was inappropriate, the investigators suggest that some elements in the educational process may promote dishonesty.
Burnout was the only aspect of distress independently associated with reporting at least 1 unprofessional behavior, based on multivariable analysis with adjustment for personal and professional characteristics.
For 6 different scenarios, the opinions of only 14% of the students regarding relationships with industry were in line with the American Medical Association policy regarding appropriate interactions between physicians and pharmaceutical companies.
The study authors therefore called on medical schools to "do a better job teaching students about conflict of interest and appropriate relationships with industry."
Altruistic feelings concerning a physician's role in society, such as a desire to provide medical care to the underserved, were less often reported by medical students suffering from burnout.
"As our nation reforms its health care system, it is essential that physicians advocate for patients, promote the public health, and reduce barriers to equitable health care," Dr. Dyrbye said. "Burnout appears to be a threat to this process."
Limitations of this study include response bias, assessment of only a limited number of behaviors and attitudes representing professionalism, reliance on self-reported behavior, and inability to determine causal relationships.
"Future research should investigate whether interventions designed to reduce burnout help students cultivate professional values and behaviour," the study authors conclude.
The Mayo Clinic supported this study. The study authors have disclosed no relevant financial relationships.
JAMA. 2010;304:1173-1180.
Monday, September 27, 2010
The Drug Pushers' Free Lunches
Joshua Batt, Medical Student, Emergency Medicine, 12:41PM Sep 25, 2010
"Big Pharma", as it is affectionately called, has medical providers in the crosshairs. Despite laws prohibiting the extent to which they "promote" their products, they continue to push the latest medications at any cost. As medical students we enjoy the "free" pens, stationary, and lunches. After all, there is a free lunch every day and it is our job to find it.
The controversy of the pharmaceutical giveaways is becoming tamer, but reps are always on the hunt for a few to jump on command. Of course I enjoy having food brought to my facility and offered for a mini lecture on the new drug or medical device. In all reality I probably would never hear about the medicine on my own and they give some education as to indications, contraindications etc. The problem is that their drug is usually "the best" on the market, so there is a little research to be done in my spare time to see what may be lurking in the shadows that I have not been told.
Many will argue that it is not right to receive the free handouts because it drives up costs for the patient. There is certainly some cost involved on that end which pays for the representatives to market the products. That's business. Without the drug reps making their rounds, some of the latest drugs would go unused, meaning patients may be missing a medicine that could have a potential benefit in their situation.
Round and round the battle goes. With little pharmacologic didactic sessions in the clinics I am willing to spend a little time pleasing my palate while learning something new and pertinent to my career. This month in particular has been unique in that representatives visit us four days each week. I just plan on it for lunch and learn a little in the process.
Perhaps I have overlooked a glaring flaw in this model of medicinal dissemination and by all means I would love to hear your opinions or stories.
"Big Pharma", as it is affectionately called, has medical providers in the crosshairs. Despite laws prohibiting the extent to which they "promote" their products, they continue to push the latest medications at any cost. As medical students we enjoy the "free" pens, stationary, and lunches. After all, there is a free lunch every day and it is our job to find it.
The controversy of the pharmaceutical giveaways is becoming tamer, but reps are always on the hunt for a few to jump on command. Of course I enjoy having food brought to my facility and offered for a mini lecture on the new drug or medical device. In all reality I probably would never hear about the medicine on my own and they give some education as to indications, contraindications etc. The problem is that their drug is usually "the best" on the market, so there is a little research to be done in my spare time to see what may be lurking in the shadows that I have not been told.
Many will argue that it is not right to receive the free handouts because it drives up costs for the patient. There is certainly some cost involved on that end which pays for the representatives to market the products. That's business. Without the drug reps making their rounds, some of the latest drugs would go unused, meaning patients may be missing a medicine that could have a potential benefit in their situation.
Round and round the battle goes. With little pharmacologic didactic sessions in the clinics I am willing to spend a little time pleasing my palate while learning something new and pertinent to my career. This month in particular has been unique in that representatives visit us four days each week. I just plan on it for lunch and learn a little in the process.
Perhaps I have overlooked a glaring flaw in this model of medicinal dissemination and by all means I would love to hear your opinions or stories.
Tuesday, September 21, 2010
What if I Don't Want to Do a Residency?
Question:
I didn't enjoy my third year of medical school and now I'm not sure if I want to do a residency anymore. What should I do?
| Response from Sara Cohen, MD Fellow, Department of Physical Medicine and Rehabilitation, Harvard University, Boston, Massachusetts; Fellow, Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts |
Near the end of my third year of medical school, I went out to dinner with a few of my classmates. Naturally, the conversation quickly turned to which residencies we wanted to get. My friend Ben, who had just finished his surgery rotation and still had circles under his eyes, said, "I don't think I want to do residency. I hate patient care."
We were all aghast. "So what are you going to do?" someone asked.
"I don't know," Ben admitted. "But there must be some options out there for an MD who doesn't want to do a residency, right?"
Since my conversation with Ben, I've heard that question posed many times by exhausted medical students. Some students thrive on the excitement of third year, but some hate waking up early, working weekends, being constantly sleep-deprived, and missing out on time with their families. Other students find that they hate procedures or dealing with difficult patients.
The first question to ask yourself is why you don't want to do a residency. Is it because of the long hours and difficult call schedule? If so, you might consider some of the specialties that have less grueling residencies. The infamous ROAD specialties (radiology, ophthalmology, anesthesiology, and dermatology) are known for combining high pay with reasonable hours, although for that same reason, these residencies are generally very competitive. Emergency medicine also has reasonable shift work, even during residency. Other specialties with reasonable hours that tend to be less competitive include psychiatry, pathology, and physical medicine and rehabilitation (PM&R). As a PM&R resident, I worked mainly 8 to 5 with rare weekends and call from home. It was nowhere near as grueling as, say, a surgery residency, and I didn't miss my family or feel sleep-deprived. (Learn more about PM&R in an article I wrote previously for Medscape.)
If your main concern is that you dislike direct patient interaction, consider one of the specialties where patient care is minimal, such as radiology, pathology, or preventive medicine. Whereas radiology and preventive medicine require a clinical transitional year, pathology does not. That means that if you enter a pathology residency, you'll never have to see another patient.
If you like patient care but hate procedures, consider psychiatry. If you love procedures but hate long-term patient care, consider anesthesiology or emergency medicine.
The field of medicine is incredibly broad, with many specialties, and it is likely that a good "fit" can be found for everyone, depending on individual likes and dislikes. Residency is probably the best option for someone who has completed medical school, and just because you complete a residency doesn't mean that 100% of your future job must involve patient care. A lot of clinicians do some research, teaching, or administrative work in addition to their clinical duties, so you can divide your time and create the lifestyle you want.
Try to remember why you went to medical school in the first place, and allow yourself some time to recover from your exhaustion. Medical students can get discouraged when they don't immediately love one of the core clerkships during third year, which is why you should try to set up interesting electives that are potential career choices. Also, you might see things differently when you've had a few good nights of sleep.
If after thinking it through thoroughly, you still decide that residency isn't for you, you can pursue several options. It's a good idea to complete at least 1 year of residency so that you can get a medical license. That way, if you ever decide to return to medicine, you will be in a better position if you already have a license.
A physician who doesn't want to do clinical work has many other options. If you have a mind for business, you may want to consider getting an MBA (Master of Business Administration) and working in the administrative end of medicine. Alternately, you can get an MPH (Master of Public Health) and find work in public health. Careers in medical writing, informatics, engineering, and consulting are also possible.
Dr. Joseph Kim hosts an extensive Website about nonclinical medical jobs, including actual job opportunities as well as general guidance about pursuing a nonclinical career. But keep in mind that each of these fields has its own set of challenges, so you should thoroughly investigate these options before making a dramatic career switch.
As for my friend Ben, after a nice long shower and a nap (and possibly some research), he decided that residency wasn't such a bad option after all. He matched with the rest of us.
Thursday, September 16, 2010
Depressed Medical Students More Likely to Link Stigma With Depression
September 16, 2010 — Depressed medical students have a higher prevalence of stigmatized attitudes than their nondepressed counterparts, a new cross-sectional study suggests.
In fact, 56% of those with moderate to severe depression said that their fellow medical students would respect them less, and more than 83% worried that faculty members would question whether they could handle their responsibilities.
The survey also found that although the depressed medical students had higher rates of suicidal ideation compared with the nondepressed students, those in their third and fourth years of school were more likely to report it than first- and second-year students.
"It was somewhat worrisome and concerning to see that students with high depression scores experienced really quite a wide range of stigma, and that it came from many directions. Perhaps most unsettling was that it came from their fellow students, faculty members, and counselors," lead author Thomas L. Schwenk, MD, professor and chair of the Department of Family Medicine at the University of Michigan, Ann Arbor, told Medscape Medical News.
"Now, we don't have any way of knowing: Is this real or is it perception?" added Dr. Schwenk. "But of course it doesn't really matter so much because for them, perception is real. Feeling that this stigma comes from so many different places makes it difficult to know where to go to safely disclose and safely seek care."
The study authors note that overall, "medical students experience depression, burnout, and mental illness at a higher rate than the general population, with mental health deteriorating over the course of medical training."
However, they are also less likely to seek appropriate treatment. "Students may worry that revealing their depression will make them less competitive for residency training positions or compromise their education, and physicians may be reluctant to disclose their diagnosis on licensure and medical staff applications," the investigators write.
"We just think that caring for oneself and for each other should be part of the attributes of an outstanding physician and being receptive to treatment of mental illness and to the needs of colleagues should become part of the construct of professionalism," added Dr. Schwenk.
The study appears in the September 15 issue of the Journal of the American Medical Association, a theme issue on medical education.
High Prevalence of Stigma
For the study, the investigators evaluated data from all 769 students enrolled at the University of Michigan Medical School. The Web-based Patient Health Questionnaire survey was completed by 505 (65.7%) of the students (58.4% women) between September and November 2009, and all identities were kept confidential.
Because of the anonymity of the participants, no follow-ups were conducted or referrals to mental health resources offered. However, existing medical school resources were described throughout the survey process.
Results showed that the overall prevalence of moderate to severe depression in the students was 14.3% (95% confidence interval [CI], 11.3% - 17.3%).
Of these, female students were found to be twice as likely as male students to have moderate to severe depression (18% vs 9%, respectively; 95% CI for difference, −14.8% to −3.1%; P = .001). There was no significant difference in depression found between the first- and second-year students (13.4%) and the third- and fourth-year students (15.4%).
Suicidal ideation at some point during medical school was reported by 4.4% of the overall students. However, it was more likely to be reported by third- and fourth-year students than by first- and second-year students (7.9% vs 1.4%; P = .001).
There was no significant difference in suicidal ideation found between the women and the men (5.1% vs 3.3%, respectively).
When looking at the stigma questions, students with moderate to severe depression agreed more frequently with the statement "If I were depressed, fellow medical students would respect my opinions less" than did those without depression (56.0% vs 23.7%; P < .001). They also agreed more frequently that fellow students and faculty members would view them as being unable to handle their school responsibilities (83.1% vs 55.1%; P < .001).
"Students with higher depression scores also felt more strongly than did those with no to minimal depression that telling a counselor would be risky (53.3% vs 16.7%) and that asking for help would mean the student's coping skills were inadequate (61.7% vs 33.5%)," report the study authors.
Men agreed more often than women that others would not want to work with a depressed medical student (49% vs 29.4%; P < .001) and that they could endanger patients (36.3% vs 20.1%; P = .002).
Finally, first- and second-year students agreed more frequently than did third- and fourth-year students that seeking help for depression would make them feel less intelligent (34.1% vs 22.9%; P < .01) and that "depressed medical students would provide inferior patient care" (79.3% vs 66.9%; P = .007).
"The male vs female and first-year vs third- and fourth-year student data are important and certainly provocative, but we did not explore them in great detail in terms of other factors," said Dr. Schwenk. "If you take the data at face value, however, it suggests that men are somewhat more critical of students who are depressed than women are. That's somewhat worrisome, given the fact that women experience depression at a higher rate."
Overall, the study's results "suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment," summarize the authors.
Dr. Schwenk reported that his team hopes to expand this study and to "reach out to other schools" with the survey. "Clearly, one school does not constitute an adequate sample." Also, "in short order," they hope to design some intervention programs to be used in a medical school environment.
Deconstruct Stigmatized Attitudes
This study "serves as a reminder of how difficult it is to be a medical student. The initial encounters with severe illness and the extremes of life are poignant and profoundly affecting," writes Laura Weiss Roberts, MD, from the Department of Psychiatry and Behavioral Sciences at Stanford University, California, in an accompanying editorial.
Dr. Roberts, who was not involved with this study, writes that the study showed some encouraging results. "Third- and fourth-year students expressed less stigmatized views of depression in peers. These data suggest that the iterative experiences of medical training may inspire more accurate and empathic understanding of the illness experience, whether in a patient or a colleague."
She notes that the findings also "issue a clear invitation to intervene" with depressed and at-risk students. "Whether the stigma perceived by depressed medical students is a sign of illness...or an accurate 'read' of the culture of medicine, it is important to deconstruct stigmatized attitudes toward mental illness.
"Such efforts will be seen as superficial unless secure, affordable, and confidential pathways to mental healthcare, preferably outside of their usual training settings, are created for physicians in training across all levels," she adds.
Dr. Roberts writes that "few funds" are currently dedicated to medical education research, although it is a critically important area to explore.
"The future of medicine rests on the shoulders of today's medical students, and the care with which medical school administrators and faculty attend to their learning and well-being may bring good to them, as well as to the patients of tomorrow," she concludes.
This study was supported by the Department of Family Medicine at the University of Michigan. The study authors have disclosed no relevant financial relationships. Dr. Roberts reported receiving research funding from the National Institutes of Health, the US Department of Energy, and the Medical College of Wisconsin, and being the owner of Terra Nova Learning Systems.
JAMA. September 2010; 304:1181-1190.
In fact, 56% of those with moderate to severe depression said that their fellow medical students would respect them less, and more than 83% worried that faculty members would question whether they could handle their responsibilities.
The survey also found that although the depressed medical students had higher rates of suicidal ideation compared with the nondepressed students, those in their third and fourth years of school were more likely to report it than first- and second-year students.
"It was somewhat worrisome and concerning to see that students with high depression scores experienced really quite a wide range of stigma, and that it came from many directions. Perhaps most unsettling was that it came from their fellow students, faculty members, and counselors," lead author Thomas L. Schwenk, MD, professor and chair of the Department of Family Medicine at the University of Michigan, Ann Arbor, told Medscape Medical News.
"Now, we don't have any way of knowing: Is this real or is it perception?" added Dr. Schwenk. "But of course it doesn't really matter so much because for them, perception is real. Feeling that this stigma comes from so many different places makes it difficult to know where to go to safely disclose and safely seek care."
The study authors note that overall, "medical students experience depression, burnout, and mental illness at a higher rate than the general population, with mental health deteriorating over the course of medical training."
However, they are also less likely to seek appropriate treatment. "Students may worry that revealing their depression will make them less competitive for residency training positions or compromise their education, and physicians may be reluctant to disclose their diagnosis on licensure and medical staff applications," the investigators write.
"We just think that caring for oneself and for each other should be part of the attributes of an outstanding physician and being receptive to treatment of mental illness and to the needs of colleagues should become part of the construct of professionalism," added Dr. Schwenk.
The study appears in the September 15 issue of the Journal of the American Medical Association, a theme issue on medical education.
High Prevalence of Stigma
For the study, the investigators evaluated data from all 769 students enrolled at the University of Michigan Medical School. The Web-based Patient Health Questionnaire survey was completed by 505 (65.7%) of the students (58.4% women) between September and November 2009, and all identities were kept confidential.
Because of the anonymity of the participants, no follow-ups were conducted or referrals to mental health resources offered. However, existing medical school resources were described throughout the survey process.
Results showed that the overall prevalence of moderate to severe depression in the students was 14.3% (95% confidence interval [CI], 11.3% - 17.3%).
Of these, female students were found to be twice as likely as male students to have moderate to severe depression (18% vs 9%, respectively; 95% CI for difference, −14.8% to −3.1%; P = .001). There was no significant difference in depression found between the first- and second-year students (13.4%) and the third- and fourth-year students (15.4%).
Suicidal ideation at some point during medical school was reported by 4.4% of the overall students. However, it was more likely to be reported by third- and fourth-year students than by first- and second-year students (7.9% vs 1.4%; P = .001).
There was no significant difference in suicidal ideation found between the women and the men (5.1% vs 3.3%, respectively).
When looking at the stigma questions, students with moderate to severe depression agreed more frequently with the statement "If I were depressed, fellow medical students would respect my opinions less" than did those without depression (56.0% vs 23.7%; P < .001). They also agreed more frequently that fellow students and faculty members would view them as being unable to handle their school responsibilities (83.1% vs 55.1%; P < .001).
"Students with higher depression scores also felt more strongly than did those with no to minimal depression that telling a counselor would be risky (53.3% vs 16.7%) and that asking for help would mean the student's coping skills were inadequate (61.7% vs 33.5%)," report the study authors.
Men agreed more often than women that others would not want to work with a depressed medical student (49% vs 29.4%; P < .001) and that they could endanger patients (36.3% vs 20.1%; P = .002).
Finally, first- and second-year students agreed more frequently than did third- and fourth-year students that seeking help for depression would make them feel less intelligent (34.1% vs 22.9%; P < .01) and that "depressed medical students would provide inferior patient care" (79.3% vs 66.9%; P = .007).
"The male vs female and first-year vs third- and fourth-year student data are important and certainly provocative, but we did not explore them in great detail in terms of other factors," said Dr. Schwenk. "If you take the data at face value, however, it suggests that men are somewhat more critical of students who are depressed than women are. That's somewhat worrisome, given the fact that women experience depression at a higher rate."
Overall, the study's results "suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment," summarize the authors.
Dr. Schwenk reported that his team hopes to expand this study and to "reach out to other schools" with the survey. "Clearly, one school does not constitute an adequate sample." Also, "in short order," they hope to design some intervention programs to be used in a medical school environment.
Deconstruct Stigmatized Attitudes
This study "serves as a reminder of how difficult it is to be a medical student. The initial encounters with severe illness and the extremes of life are poignant and profoundly affecting," writes Laura Weiss Roberts, MD, from the Department of Psychiatry and Behavioral Sciences at Stanford University, California, in an accompanying editorial.
Dr. Roberts, who was not involved with this study, writes that the study showed some encouraging results. "Third- and fourth-year students expressed less stigmatized views of depression in peers. These data suggest that the iterative experiences of medical training may inspire more accurate and empathic understanding of the illness experience, whether in a patient or a colleague."
She notes that the findings also "issue a clear invitation to intervene" with depressed and at-risk students. "Whether the stigma perceived by depressed medical students is a sign of illness...or an accurate 'read' of the culture of medicine, it is important to deconstruct stigmatized attitudes toward mental illness.
"Such efforts will be seen as superficial unless secure, affordable, and confidential pathways to mental healthcare, preferably outside of their usual training settings, are created for physicians in training across all levels," she adds.
Dr. Roberts writes that "few funds" are currently dedicated to medical education research, although it is a critically important area to explore.
"The future of medicine rests on the shoulders of today's medical students, and the care with which medical school administrators and faculty attend to their learning and well-being may bring good to them, as well as to the patients of tomorrow," she concludes.
This study was supported by the Department of Family Medicine at the University of Michigan. The study authors have disclosed no relevant financial relationships. Dr. Roberts reported receiving research funding from the National Institutes of Health, the US Department of Energy, and the Medical College of Wisconsin, and being the owner of Terra Nova Learning Systems.
JAMA. September 2010; 304:1181-1190.
Sunday, September 5, 2010
How Should I Prepare for an Interview?
Question
I’m looking ahead to my residency interviews and was wondering: What should I be doing now to prepare for them?
| Response from Daniel J. Egan, MD Associate Attending Physician, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY |
Preparing for an interview is different for each individual. Much of what takes place in interviews involves information you provided in your application, so if you have blemishes on your record, you will need to work out explanations of those elements. On the other hand, if you are a stellar student, you will be able to focus more on your achievements.
In general, the most important goal of preparation is to actually be prepared. Here are some basics:
- Learn as much as possible about the program to which you are applying. An unprepared applicant who does not know obvious details about a program would stand out to me as someone who did not do his or her homework. Your questions about the program can focus on elements not included on their Website (or perhaps on more recent events if the Website is outdated).
- Prepare responses to basic, common questions. Know your strengths and weaknesses; be prepared to discuss your choice of a specialty; prepare a concise explanation of your research; know why you would want to live in that program's city and train at that institution. Many interviewers ask all applicants similar questions. Talk to your friends and find out what they were asked.
- Prepare your own questions. Some interviewers prefer not to ask questions and would rather have the applicant take the lead in the conversation. Try to engage the interviewer.
- Give off a good vibe. Ultimately, interviewing is about finding a fit between a program and an applicant. Avoid coming across as aggressive or overconfident (but also not too shy).
- Be knowledgeable, but avoid being overly rehearsed or boring in your responses.
Finally, it is probably worth practicing your interview. Many medical schools hold mock interviews with older students or faculty members playing the role of interviewer. You can get good advice from more senior students who have recently been through the process. A mentor in your specialty may also be willing to practice an interview with you. Compare notes with your friends who are going on interviews to review their prepared questions and "rehearsed" answers. If you are very nervous and think you need more formal advice, you may want to hire a consultant.
At the end of the day, this is your chance to explore a program and to let them see you as an individual. The more conversational the experience you have, the better.
Tuesday, August 17, 2010
Interim in San Diego, Nov 4-6
This year’s AMA Medical Student Section (MSS) Interim Assembly Meeting will be held Nov. 4–6 at the Manchester Grand Hyatt San Diego, preceding the Interim Meeting of the AMA House of Delegates. Scheduled events include three days of education programs on a wide range of topics, policymaking sessions, the eighth annual AMA-MSS and AMA Resident and Fellow Section research symposium, and a national service project event.
Please keep the following deadlines in mind.
- Research symposium abstracts are due Aug. 31.
- Convention committee applications are due Sept. 6.
- Final resolutions with checklist are due Oct. 1; a draft resolution must be posted on the AMA-MSS health policy and news listserv by Sept. 10.
- Meeting registration and AMA Board of Trustees, chair-elect and regional delegate applications are due Oct. 1.
Visit the AMA-MSS Interim Assembly Meeting Web page for more information and for applications.
In addition, the AMA-MSS would like to hear your ideas for programs during the meeting. Ideas are due Sept. 6.
Monday, August 16, 2010
Apply to serve in the House of Delegates
In November during the AMA Medical Student Section (MSS) Interim Assembly Meeting, the section will elect regional delegates and alternate delegates to represent medical students’ collective voice in the AMA House of Delegates at AMA national meetings. Serving as a medical student regional delegate is an excellent way to participate in the policymaking process and help shape the AMA’s advocacy efforts.
Applications, including endorsement signatures, are due Oct. 1. Visit the AMA-MSS Interim Assembly Meeting Web page for more information and application materials.
Sunday, August 15, 2010
The system we will inherit: What does the Affordable Care Act mean for tomorrow's physicians?
Join AMA Immediate Past President J. James Rohack, MD, and AMA government relations advocacy fellow Nick Rohrhoff at 7 p.m. Eastern time Aug. 17 for an informative webinar about how the Affordable Care Act—the new health system reform law—affects future physicians.
Titled "The system we will inherit: What does the Affordable Care Act mean for tomorrow’s physicians?," this 60-minute program will explore health system reform from the perspective of America’s next generation of physicians. From traditional issues such as graduate medical education and the physician work force to emerging subjects like delivery reform, the program will cover material in the new law that matters to medical students and residents.
The webinar will address such questions as:
- How will health system reform affect my patients and my profession?
- Did the law deal directly with medical student issues?
- Is health system reform over?
Audience participation is encouraged. Space is limited, so register early.
Tuesday, August 3, 2010
For all you third years...Guide to scrubbing in.
http://www.medscape.com/viewarticle/725336?src=mp&spon=25&uac=147602PZ
Wednesday, July 21, 2010
Medical Student Perspectives: Find a Mentor who is Right for You
Many medical schools have established programs that will set medical students up with a mentor. But the following questions are not often addressed: How do I make the most out of my mentoring program? How do I pick a mentor? How often should I contact a mentor? What should I do if I don’t connect with my mentor? Do I really need a mentor? Other questions might have crossed your mind at some time, such as: I have a crazy amount of relationships to nurture at work, at school, with family, and with friends, so do I need another? What if my school doesn’t have a mentoring program—are there other options to help me find a mentor? Do I need a formal program to find a mentor?
Not all students would like a mentor; however, if you would like to commiserate with someone who has a few more years of experience to help shed some perspective on your temporary misery, a mentor might be ideal for you. But if that doesn’t sound appealing it is important to remember that a mentor is whatever you would like him or her to be. Would you like someone with whom to conduct research or just chat at lunchtime? Many mentors enjoy interacting with students on issues other than strictly medical school issues. The key is to figure out what type of mentor you would like to have. Be sure to define the relationship with your mentor. Factors you may be interested in considering in a potential mentor can be based upon where you both have lived or what specialties you are considering. If you begin a mentoring relationship and find that you are not satisfied, you are free to keep looking. If you are working with a formal program, you may notify the program that you are searching for another mentor, or if you are on your own, just refocus your efforts and time on finding another.
So why should you have a mentor? I’d like to tell you about a fantastic mentor of mine. My medical school had a class entitled Doctor-Patient Relationship. This class allowed second-year medical students to see doctors in practicing environments and then reflect thoughtfully on assigned topics. My randomly-assigned preceptor was Dr. Adler, whom I was asked to shadow. Dr. Adler was a gastroenterologist who had recently moved to Utah who I was eager to meet. Unfortunately, I had a sports-related traumatic-brain-injury and was in the hospital during my first scheduled appointment for this preceptorship! Dr. Adler was very understanding and accommodating and took me under his wing. He reminisced about his medical school days and internship experiences with fondness. He remained very interested in my education. I expressed interest in research and he mentioned that he would have a few opportunities available down the road. Two years later we were coauthors on three papers, two posters, and an up-and-coming book chapter. The relationship was not all business, however; we often laughed hysterically as we watched You-Tube clips. The moral of this story is that you should be sure to make the most of your mentoring relationships. One other tip that I would like to pass along: focus on finding mentors early during your medical school years. Opportunities may spring up over time as your relationships strengthen with your mentors.
If your school doesn’t have its own mentoring program, ACP has an online Mentoring Database that contains hundreds of physicians, both nationally and internationally, who have volunteered to mentor medical students. Go to www.acponline.org/medical_students/mentors/ and click on “Search the Mentoring Database”. There are many mentors within many fields of internal medicine who are eager to assist medical students. If for some reason you don’t want to use any formal programs, how can you find a mentor? Ask senior medical students if they have been able to find good mentors, and if so, what made them great mentors. As you begin to gather information you will also begin to define your personal parameters for a mentor. Keep your ear to the ground during lectures, and attend conferences and get to know physicians at those conferences. If you find a potential mentor outside of an official program, an easy way to begin establishing a relationship is by sending an e-mail to him or her. As you write your introductory e-mail, state who you are and that you are looking for a mentor through medical school.
Mentors can break up the monotony of studying in medical school, provide empathy when needed, perspective to the tough times, and inspiration for finding a profession into which you can mold your career.
Ryan C. VanWoerkom, MDFormer Council of Student Members Representative, Midwestern RegionFirst Year Resident, Internal Medicine, Oregon Health Sciences University
Not all students would like a mentor; however, if you would like to commiserate with someone who has a few more years of experience to help shed some perspective on your temporary misery, a mentor might be ideal for you. But if that doesn’t sound appealing it is important to remember that a mentor is whatever you would like him or her to be. Would you like someone with whom to conduct research or just chat at lunchtime? Many mentors enjoy interacting with students on issues other than strictly medical school issues. The key is to figure out what type of mentor you would like to have. Be sure to define the relationship with your mentor. Factors you may be interested in considering in a potential mentor can be based upon where you both have lived or what specialties you are considering. If you begin a mentoring relationship and find that you are not satisfied, you are free to keep looking. If you are working with a formal program, you may notify the program that you are searching for another mentor, or if you are on your own, just refocus your efforts and time on finding another.
So why should you have a mentor? I’d like to tell you about a fantastic mentor of mine. My medical school had a class entitled Doctor-Patient Relationship. This class allowed second-year medical students to see doctors in practicing environments and then reflect thoughtfully on assigned topics. My randomly-assigned preceptor was Dr. Adler, whom I was asked to shadow. Dr. Adler was a gastroenterologist who had recently moved to Utah who I was eager to meet. Unfortunately, I had a sports-related traumatic-brain-injury and was in the hospital during my first scheduled appointment for this preceptorship! Dr. Adler was very understanding and accommodating and took me under his wing. He reminisced about his medical school days and internship experiences with fondness. He remained very interested in my education. I expressed interest in research and he mentioned that he would have a few opportunities available down the road. Two years later we were coauthors on three papers, two posters, and an up-and-coming book chapter. The relationship was not all business, however; we often laughed hysterically as we watched You-Tube clips. The moral of this story is that you should be sure to make the most of your mentoring relationships. One other tip that I would like to pass along: focus on finding mentors early during your medical school years. Opportunities may spring up over time as your relationships strengthen with your mentors.
If your school doesn’t have its own mentoring program, ACP has an online Mentoring Database that contains hundreds of physicians, both nationally and internationally, who have volunteered to mentor medical students. Go to www.acponline.org/medical_students/mentors/ and click on “Search the Mentoring Database”. There are many mentors within many fields of internal medicine who are eager to assist medical students. If for some reason you don’t want to use any formal programs, how can you find a mentor? Ask senior medical students if they have been able to find good mentors, and if so, what made them great mentors. As you begin to gather information you will also begin to define your personal parameters for a mentor. Keep your ear to the ground during lectures, and attend conferences and get to know physicians at those conferences. If you find a potential mentor outside of an official program, an easy way to begin establishing a relationship is by sending an e-mail to him or her. As you write your introductory e-mail, state who you are and that you are looking for a mentor through medical school.
Mentors can break up the monotony of studying in medical school, provide empathy when needed, perspective to the tough times, and inspiration for finding a profession into which you can mold your career.
Ryan C. VanWoerkom, MDFormer Council of Student Members Representative, Midwestern RegionFirst Year Resident, Internal Medicine, Oregon Health Sciences University
Monday, July 5, 2010
Monday, June 21, 2010
2010 AMA-MSS Annual Meeting
June 10-12, 2010
Hyatt Regency Chicago
Chicago, Illinois
Programming Highlights
- View the complete meeting agenda
Educational programs
More than 700 medical students from across the country attended the 2010 AMA-MSS Annual Meeting, which offered more than 25 educational programs on a range of topics including medicine and the media, surviving and thriving in medical school and residency, benefits of advanced degrees, Healer’s Art, and more. A keynote panel explored the history and transformation of medical education in recognition of the 100th anniversary of the “Flexner Report.”
Medical Specialty Showcase
The AMA-MSS hosted its 7th Annual Medical Specialty Showcase, which was a resounding success. More than 50 specialty societies represented in the AMA-HOD were on hand to provide an introduction to their specialties and to offer materials to assist medical students in their career decision-making.
National Service Project event
Despite the weather, more than 40 students participated in an outstanding "National Get Outdoors Day" event at Lincoln Park Zoo as part of the AMA-MSS national service project. The students educated the public about the AMA’s Healthier Life Steps™ program, the concentration of the Section's national service project through 2011. Hundreds of visitors learned about four key health behaviors—poor diet, physical inactivity, tobacco use and excessive or risky use of alcohol. In addition, medical students facilitated healthy lifestyle activities for children, including exercise sessions, and body mass index and blood pressure screenings for adults.
Humanities Initiative
The AMA-MSS held its first annual Humanities Initiative, focusing on Empathy through Art and Poetry, at the 2010 AMA-MSS Annual Meeting. Thirty-three medical students from around the country submitted entries for viewing and judging at the AMA-MSS welcome reception. Congratulations to this year's winners:
- First place: Shawna Bellew, University of Central Florida College of Medicine
- Second place: Seema Varghese, Michigan State University College of Medicine
- Third place: Manuel (Trey) Penton, University of South Florida College of Medicine
- Fourth place: Sonya Hovsepian, Wright State University Boonshoft School of Medicine
Thank you to all who submitted entries, and to those who judged the entries.
Governing Council Elections
The AMA-MSS Assembly elected the following members of the 2010-2011 AMA-MSS Governing Council:
- Vice Chair: George Salloum, Wright State University Boonshoft School of Medicine
- Delegate: Steve Lee, Alpert Medical School of Brown University
- Alternate Delegate: Michael Best, University of Pittsburgh School of Medicine
- At-Large Officer: Busayo Obayan, Boston University School of Medicine
- Speaker: Andrew Lutzkanin, Pennsylvania State University College of Medicine
- Vice Speaker: Paul Mayor, Medical College of Georgia
At the conclusion of the meeting, Christopher Bucciarelli, University of Florida College of Medicine, commenced his term as AMA-MSS Chair, and Meredith Williams, Baylor College of Medicine, commmenced her term as student member of the AMA Board of Trustees (BOT). A special thanks to Hans Arora, AMA-MSS Immediate Past Chair, and Justin Mahida, past student member of the BOT, for their outstanding service.
Policy Highlights
The AMA-MSS Assembly considered 35 items of business spanning a wide range of issues, including taxes on medical school tuition, the cost of the USMLE and COMLEX licensing examinations, the role of physician extenders, and the repeal of the "Defense of Marriage Act." Thirty-one of these items were adopted in some form, seventeen of which will be forwarded to the AMA House of Delegates for consideration at the 2010 Interim Meeting in San Diego.
- Proceedings of the 2010 AMA-MSS Annual Meeting
Sunday, June 20, 2010
US Senate Modifies
Medicare Payment Legislation
Medicare Payment Legislation
On Friday, June 18, the US Senate passed H.R. 3962, now called the "Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010," which provides for an increase of 2.2% in Medicare physician payment for June through November of 2010. You may recall the US House passed another version of H.R. 3962 in late May, which called for multi-year increases or freezes in physician payments, in lieu of the 21% cuts that went into effect on June 1.
Now, H.R. 3962 must return to the House to determine whether that chamber will agree with the changes made to the bill in the Senate. The House is not expected to take any votes until Tuesday, June 22. Until the US House passes the bill and the President signs it into law, the Centers for Medicare and Medicaid Services (CMS) has instructed its carriers to process Medicare physician claims at a 21 percent lower rate as of June 18. CMS had placed a hold on paying physician claims with the 21% cut required by the flawed Sustainable Growth Rate formula. If and when H.R. 3962 becomes law, CMS will retroactively adjust any June claims that have been paid at the lower rate. It is unclear, at this time, whether physician offices will be required to resubmit those claims.
One of KMA's five principles for health reform is repeal of the flawed SGR formula. To contact your Congressman about the SGR formula and reductions in Medicare physician payment, click the link below.
One of KMA's five principles for health reform is repeal of the flawed SGR formula. To contact your Congressman about the SGR formula and reductions in Medicare physician payment, click the link below.
Click the link below to log in and send your message:
http://www.votervoice.net/
Friday, June 18, 2010
eVoice® Alert
June 18, 2010
Senate passes six-month SGR fix
The U.S. Senate passed an amended version of H.R. 3962, now called the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” by unanimous consent this afternoon. This legislation provides a 2.2 percent Medicare physician payment update for six months, from June 1 through Nov. 30, in lieu of the 21 percent cut scheduled for 2010.
Unfortunately, the U.S. House of Representatives is not scheduled to hold any floor votes until the evening of June 22. As a result, the Centers for Medicare and Medicaid Services (CMS) is instructing its carriers to lift the hold on processing claims for services provided on or after June 1, and to begin processing them under the law’s negative update requirement. In other words, claims will begin to be paid today at the 21 percent lower rate on a first-in/first-out flow basis.
Once H.R. 3962 is passed by the House and signed by President Obama, CMS will retroactively adjust any June claims that have been paid.
View an AMA news release about the Medicare physician payment crisis.
Thursday, June 17, 2010
eVoice® Alert
June 17, 2010
CMS will process claims tomorrow, June 18,
with 21 percent cut
As the clock continues to tick toward the June 18 final deadline for implementation of the 21.3 percent cut in Medicare physician payments produced by the sustainable growth rate (SGR) formula, U.S. Senate debate continued June 17 over H.R. 4213, the American Jobs and Closing Tax Loopholes Act. In addition to providing another short-term reprieve from the impending Medicare cut, the legislation would increase federal Medicaid funding and extend various expiring programs, such as disaster relief and long-term unemployment insurance benefits.
If legislation is not signed into law before the weekend, the Centers for Medicare and Medicaid Services (CMS) will have no option but to instruct its contractors to begin processing Medicare claims for physician services provided in June at rates that reflect the 21.3 percent cut.
Once the House and Senate act to avert the cut, claims will be processed as follows:
- If the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim.
- If the submitted charge is lower than the new rate, the physician should call the contractor.
CMS says almost all physicians submit claims for more than the Medicare rates. No one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive.
The Office of Inspector General and CMS are close to releasing a document to waive patient co-pay requirements for situations such as the retroactive increases that were made to the geographic practice cost index increases. CMS will share that document once it is available.
Congressional inaction is a dereliction of duty
Democrats and Republicans in Congress are responsible for the current Medicare payment debacle. Congress has missed three separate deadlines and is now allowing cuts to go into effect that they pledged they would not allow to occur.
We expect our elected officials to resolve budget issues without punishing physicians, seniors and military families. State medical societies and national specialty societies sent a joint statement to Congress on June 16 that emphasizes this point. Continue to let your representatives and senators know that their inaction is unacceptable, and that it is harming patients and physicians across the country.
Use the AMA Physicians’ Grassroots Network toll-free hotline at (800) 833-6354 to call your lawmakers and tell them to repeal Medicare’s SGR formula once and for all.
Details on Senate impasse over Medicare physician payment cuts
The debate and delay in the Senate centers on growing concerns about how much the legislation would add to the federal deficit. On June 16, a substitute amendment to the House-passed version of the bill, offered by Sen. Max Baucus, D-Mont., was defeated on a bipartisan vote of 45-52. That amendment would have afforded a 19-month reprieve from the scheduled Medicare payment cuts by providing a 2.2 percent update for the remainder of 2010 and an additional 1.0 percent update in 2011. In 2012, physician payments would have been reduced by 33 percent.
After the defeat of his first amendment, Baucus introduced a second substitute amendment late on June 16 with reduced spending and additional funding offsets. The SGR relief provision was scaled back to a six-month, 2.2 percent update that would expire Nov. 30, 2010, after which the 21.3 percent cut originally scheduled for 2010 would take effect. Reports from Capitol Hill on June 17 indicate that this package may still lack the bipartisan support needed to reach the 60-vote threshold that is required to end debate and pass a final bill.
On June 17, an amendment offered by Sen. John Thune, R-S.D., was defeated on a vote of 41-57. The amendment was far less costly than either Baucus proposal, and according to the Congressional Budget Office, would begin reducing the federal deficit. It also would have provided 2.0 percent Medicare physician payment updates for the remainder of 2010 and all of 2011 and 2012, followed by a steep payment cut of well over 30 percent and an additional statutory cut of 4 percent. The Thune amendment also included medical liability caps on non-economic damages and other traditional tort reforms.
Because the Senate is considering substantial revisions to H.R. 4213, the bill will have to be sent back to the U.S. House of Representatives for passage. While House leaders have indicated they are prepared to stay in session late tomorrow, June 18, so that a vote can be held on the bill, it is far from clear that the Senate will be able to complete its consideration before the weekend.
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