Students, residents, and educators writing on KevinMD about how physicians are made: medical school, the match, residency, duty hours, supervision, assessment, mistreatment, and the path from student to practicing physician. Many contributors write while still in training, and many write anonymously. For a maintained record of what students and physicians have said about medical school since 2004, see Medical school: what students and physicians say, in their own words. For what residents and attendings have said about residency itself, see Residency: what residents and attendings say, in their own words.
Placebos work. This isn’t news. The term “placebo” was coined 60 years ago to describe how one-third of people respond to pills without any active drug in them. Twenty-five years later, we learned how they work: through endorphins produced by the body that work just like morphine. Today placebos are everywhere: from mothers kissing boo-boos to international drug trials.
A recent paper, though, shows that all placebos aren’t created equal. As expected, …
It’s 11:00 a.m. when we finish listening to a somewhat pointless series of talks from various medical school administrators on interview day — one on financial aid, one on the medical curriculum, another on the school’s student organizations. It’s time for the medical school tour. All the applicants rise from their seats in unison, button their suit jackets, pat down any newly …
I was very happy to come across a new article in the Washington Post discussing the pros and cons of shortening medical school education to three years. This article could not have come at a more timely moment for me, as I just had a discussion about this very topic last week with one of my fourth year medical student colleagues.
Sitting in her Chicago condo as she completed modules for an …
Pretty much every conversation I’ve ever had about working to change physician culture boils down to two words: “medical education.” That was especially true at the 2013 Lown Institute Conference, which focused on the issue of right care: eliminating harmful overuse and harmful underuse. This comes down to reforming the way today’s physicians practice — eliminating the ordering of expensive tests and treatments that provide little to no benefit to …
One of the many important decisions a future physician will make in his or her career is the medical school they choose to attend. The highly competitive application process is supposedly designed to ensure that our matriculating medical students will be able and wanting to contribute transformative innovation to the communities and institutions in which they end up working. However, given the dynamic nature of our health care system, many …
One of my Physician’s Weekly posts last month was on the subject of surgeons possibly losing proficiency for doing open cases because of the ever-increasing popularity of laparoscopic and other minimally invasive techniques resulting in declining numbers of open operations for residents during their training.
Although some suggested that knowing how to do open cases would be unnecessary in the future, to me that is wishful thinking.
No one can deny that medical students today face an increasingly competitive environment with a strong focus on board scores and class grades as strong requirements for entrance into competitive specialties. Mirroring the trends in both primary and secondary school, a standardized test has become the yardstick by which all physicians-in-training are compared.
The most recent survey reported by the National Resident Matching Program, showed that scores on Step 1 of …
While on my inpatient psychiatry rotation, I had the opportunity to work with an adolescent female with a troubled past and a significant history of psychiatric illness. It was through coloring that her barriers broke down and we were able to establish a safe space for difficult conversations. She was safely discharged two weeks after her suicide attempt. As she left, she gave me a hug and handed me this:
I was a junior medical student, wearing a short white coat, pockets stuffed with reflex hammer and spiral bound Washington Manual of Therapeutics, rubber tourniquet and pens and pads. I was on a rotation out at the Dwight David Eisenhower Army Medical Center in Augusta, Georgia. DDEAMC was not too far from my home away from home, the Medical College of …
Is Physician “Shadowing” a Shady Practice? asks Dr. Elisabeth Kitsis in a post at the Doctor’s Tablet, a blog run through the Albert Einstein College of Medicine. She concludes that yes, it is, and invites readers to share their opinions on having high school and college students shadow physicians.
I was reminded of my fantastic 8 week shadowing opportunity as a college student through the Project AHEAD program at the Charles B. …
The dream was that reason, in the form of the arts and sciences, would liberate humanity from scarcity and the caprices of nature, ignorance and superstition, tyranny, and not least of all, the diseases of the body and the spirit.
-Paul Starr, The Social Transformation of American Medicine
In a local bookshop just outside of Boston, a small group made their way to their cherished celebrity bookclub. Tucked away on a foldable chair …
Just about thirteen percent of the 100,000 plus resident physicians in the United States are union members — and many more would choose to join if it weren’t for the fierce pressure exerted by some teaching hospitals, chairs and program directors. Although it is illegal to threaten resident physicians with retaliation for expressing their desire to form a union, the law is difficult to enforce. Ought medical educators examine …
Medical school becomes a blur after a few years in practice. You forget about all the hours spent in classrooms and then every night after a quick dinner. You somehow block out the “pimping” and public humiliation of being questioned about topics not quite under your belt. The worst feeling? The fear of wondering if you will master medicine …
Last night, I responded to a code blue while working the night float at the hospital. The patient was a relatively young female who had just completed a coronary artery bypass procedure. Per training, I began compressing her chest to induce blood flow to the rest of her body.
As I pushed, the incision reopened and blood began spewing everywhere. I could feel her ribs giving and cracking from the force …
Pauline Chen has once again written a brilliant piece in the New York Times: Are Today’s New Surgeons Unprepared? While many comments miss her underlying question, her exposition makes the problem clear.
How do we gain expertise? Current theory supports the idea of deliberate practice. How do we conceptualize deliberate practice? Start with a sports analogy. You are trying to learn to make a 6 foot putt. …
In a scene from the 1999 cult classic “Office Space,” three burned-out cubicle drones take a baseball bat to a malfunctioning printer. While I do not condone violence against innocent peripheral hardware, I admit I secretly fantasize about destroying medical center fax machines.
Recently, a chronically non-compliant end stage kidney disease patient on dialysis was admitted for minimally elevated troponins and non-ST segment EKG changes in the setting of a hypertensive …
As Dr. David Green reported recently in NEJM Journal Watch, the American Society of Hematology is the latest society to comment on appropriate and cost-conscious care in the ABIM Choosing Wisely campaign. I’ve followed the Choosing Wisely campaign closely and have been using it on the wards and in clinic as academic ammunition. A specialist society’s public advice about showing restraint is an excellent means to challenge the dogma of our …
When a doctor finishes medical school, he or she then faces what is truly the most difficult part of their journey into becoming a physician: graduate medical education. The goal of internship, residency, and fellowship training programs — what is collectively called graduate medical education, or GME — is to take newly minted doctors, just out of medical school, and turn them into competent physicians, able to practice in their specialty independently. And …
“Well I don’t know why I came here tonight, I got the feeling that something ain’t right,” the song hummed through the speakers of the DC medical examiner’s office.
Something definitely is not right, I thought as I watched the pathologist and his assistant begin the first autopsy of the morning. With rough strokes, the assistant dissembled the body before us. Unlike the cadavers we had dissected one year previously, this …
The culture of medicine has changed and a new generation of medical students has noticed this insidious path to disgruntlement. Reimbursement rates dominate conversations among health care professionals. Physicians are slowly burning out while younger faces are tempted away from humanitarianism by lucrative lifestyle specialties. Bureaucrats, technology, and increasing health-care costs have transformed the doctor-patient relationship, and students pick up on the increasing frustration in the profession.
