Dr Topol to med students: "When I was in medical school, the term "digital" was reserved for the rectal examination"

Here are some excerpts from the Baylor College of Medicine commencement address by Dr. Eric Topol, director of the Scripps Translational Science Institute, delivered yesterday, May 22, 2012. This should be a required reading for everyone involved in healthcare, which is basically everybody because each and every one of us will be a patient one day.

Eric Topol to medical students: "When I was in medical school, the term "digital" was reserved for the rectal examination."

"You sleep with your cell phone and prize it right up there with food and water. We have evolved to a new species of man. We are Homo distractus!"

The benefits of digital medicine are clear to Dr. Topol who shares the story of a patient he saw last week: "I asked him to put his fingers on the 2 sensors on the back of my iPhone case so I could do his electrocardiogram—ECG—that was normal. And free, by the way. Then instead of using a stethoscope to listen to his heart, I used a portable pocket-sized high-resolution ultrasound device and within a minute I could see every heart structure—the heart muscle thickness and function, the valves, the size of the 4 chambers. Why would I ever listen for lub-dub when I can see everything? I haven't used a stethoscope for over 2 years to listen to a patient's heart."

From Baylor College of Medicine (BCM) YouTube channel: 2012 Commencement Speaker, Dr. Eric Topol, spoke on May 21, 2012:



Here is Eric Topol's presentation at Health at Google:



References:

Baylor College of Medicine commencement address by Dr. Eric Topol, director of the Scripps Translational Science Institute

Comments from Twitter

Quoc-Dien Trinh, MD @qdtrinh: Makes it sound cool. “@DrVes: Dr Topol to med studs: When I was in med school, the term "digital" was reserved for the rectal examination"

What it's like to study medicine at Cambridge (video)

What is "the favorite" for medical students in the UK at the moment? Going into General Practice (at minute 2:45 of the video). They are also "very keen into going into a specialty such as pediatrics". This is a night and day difference compared to their counterparts in the U.S.



From Cambridge University YouTube channel: "At Cambridge, we offer two medicine courses - the Standard Course and the Graduate Course. With both, our aim is to educate students to become compassionate, thoughtful, skilled members - and leaders - of the medical profession.

Success in medicine requires application and hard work, both while studying and when in practice. However, it brings great rewards in terms of job satisfaction, involving as it does a combination of science and human interactions, and numerous career opportunities."

To find out more about Medicine at Cambridge, see http://study.cam.ac.uk/undergraduate/courses/medicine

Comments from Twitter:

Nick Bennett @peds_id_doc: Best medical school in the world. Seriously.

Medical School Life in Cambridge and Debrecen - @Berci compares the promotional videos http://goo.gl/BZm2w

A doctor who loves night shifts

Emergency medicine physician, world-class educator and blogger extraordinaire Dr. Mike Cadogan was recently interviewed by Elsevier Australia:

Interviewer:

What are the best and worst parts of night shifts? Do you have any tips for surviving nights?

Mike Cadogan:

I love night shifts. The dark corridors, the cool air, the rising moon, the autonomy of decision-making, the authority, the midnight snacks and the sense of joyous achievement walking home with the sun rising and against the tide of tired, depressed faces gripping their morning coffees and bemoaning the need to be at work on such a glorious sunny day…

Think positive, be strong and enjoy autonomy. Remember that everybody else is on night shift with you, and most of them don’t want to be there either…but there is no need to be grumpy, rude, or pompous. Make friends with the night owls and collaborate, you will find your workload will dramatically decrease… Make enemies with the permanent night staff at your peril!

References

Interview with Mike Cadogan, author of the acclaimed On Call: Principles and Protocols by Student Ambassador Emma Sharp.
Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

What young doctors read

From the former BMJ Editor-in-Chief:

"I meet with young doctors all over the world, and I usually ask them what they read. I ask for a show of hands and find fairly consistently that half read the NEJM, the Lancet, a local journal, and a specialist journal, a third the BMJ, and most a local newspaper.

About half are reading a novel, and about a third have read a poem in the past week.

Almost all are on Facebook but very few on Twitter."

A lot of them also use Wikipedia as textbook replacement but they will not admit it unless asked directly.

Here, in the U.S., the majority of young doctors use UpToDate as a primary source, if the subscription is purchased by their hospital.

References:

Richard Smith: Review of “bring back browsing”. BMJ Blogs.

Image source: OpenClipArt.org, public domain.

Comments from Google+:

jennifer gunter - I read textbooks and journals! A lot of them.

Ves Dimov - Good for you. I read most of my journals in Google Reader, then post the most relevant info from them on the blogs, thus creating a searchable archive.

Arin Basu - Ves, I remember some years ago you put up a graphic about your workflow. I'd like to revisit that workflow where you showed how you integrated your RSS reading, blogging, and other readings were coordinated. If you have the link to the resource, would you mind sharing it? Or may be put up the graphic here with some notes as a picture?

Ves Dimov - Sure. That's easy to find. I'm glad you found it useful at the time. It's from 2009:
http://casesblog.blogspot.com/2009/03/how-to-deal-with-information-overload.html

Nancy Onyett, FNP-C - I am not a physician, I am a family nurse practitioner owner in private practice. I read all the articles that are updated on my feed burner, and the medical journals that come in monthly and bimonthly JAMA, NEJM, American Family Physician, Pain Medicine News, Lancet, JCEM (Journal of Clinical Endocrinology & Metabolism), Maturitas.

Polish Your Online Image, AAMC Advises Medical Students and Residents

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

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

References:

Careers in Medicine. AAMC, 2010 (PDF).

Image source: OpenClipArt.org, public domain.

How to Use Social Media for Medical Education

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

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

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

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

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

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


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

References:

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

What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging

Blogs read by 20% of UK medical students, but only 8% write their own

A wide range of social media tools has become readily available in recent years, to the extent that the use of Facebook in particular is perceived as "second nature" by many students. There is increasing interest in the possibilities of using this social media services for medical education - blogs, wikis, Twitter and Facebook.

This UK study included a self-administered questionnaire survey of 212 first year medical students.

Over 90% used instant messaging. Social networking sites were also highly used - by 70%. There was no significant difference between males and females.

Blogs were read by 20% of students and a small number (8%) wrote their own blogs.

20% of males were users of media sharing and contributed to wikis.

Social bookmarking was rarely used by either gender.

Medical educators need to recognise the potential of social software in medical education but it is essential that students maintain the informality and privacy of these sites. The challenge is how to integrate social software into current curricula and institutional Virtual Learning Environments.

References:
Web 2.0 and social software: the medical student way of e-learning. Sandars J, Homer M, Pell G, Crocker T. Med Teach. 2010 Jun 18.

Comments from Twitter:

@DrVes I didn't expect that 8% of med students in the study wrote blogs - this is not my experience from teaching students and residents at Cleveland Clinic, Case Western and Creighton University.

@sandnsurf Medical education blog vs tumblr/posterous blog possibly. My students are at 10% for blog writing but 1% are actually medical.

@DrVes This is way higher than the stats here in the U.S. "Everybody's on Facebook, nobody has a blog"... :)

@doctorwhitecoat Not to jump mid convo, but at my school, I can say that most don't have blogs... at most maybe 3-5% and those that do... don't update.

@DrVes 2-5% is high. There was only one blogging student at Cleveland Clinic medical school who stopped after 1-2 years.

Related reading:

Assistant professor uses Twitter to teach students dental anatomy at Ohio State University - 113 of 200 students signed up, 56% http://goo.gl/jvyq7

Image source: Blogger.com.

How to identify medical students at risk of subsequent misconduct?

This small BMJ study suggests the following risk factors for subsequent professional misconduct:

- male sex
- lower socioeconomic background
- early academic difficulties at medical school

59 doctors who had graduated from 8 medical schools in the United Kingdom in 1958-97 and had a proved finding of serious professional misconduct in 1999-2004 (cases) and 236 controls (four for each case) were included in the study.

The findings are preliminary and should be interpreted with caution. Most doctors with risk factors will not come before disciplinary panels.

References:

Risk factors at medical school for subsequent professional misconduct: multicentre retrospective case-control study. BMJ 2010; 340:c2040.

Image source: OpenClipArt.org (public domain).

How to keep your brain in top performance shape - BBC video

Look After Your Brain - Brainsmart - BBC video.

Get these right and your brain will be in top shape:

- Diet - slow and steady release of glucose
- Water
- Exercise
- Sleep

Read more: http://www.bbc.co.uk/scotland/brainsmart

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

From Wachter's World:

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

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

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

References:

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

Are You Dependent on UpToDate for Your Clinical Practice?
Small association between use of UpToDate and reduced patient length of stay, lower mortality (study sponsored by UTD) http://goo.gl/zSG8R

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

Image source: UpToDate.

Turning medical residents away from copy-and-paste culture facilitated by EMR

From MedCityNews:

Cleveland VA is trying to cut out the burgeoning subculture of “copy-and-paste”: A phenomenon made possible by electronic medical records in which physicians copy old information about a patient and paste it into a new section of the chart.

The practice is seen by medical residents as a time-saver but the attendings consider it an “egregious problem” because the practice has the potential to perpetuate mistakes. For example, someone might copy and paste information from a patient’s medical history without verifying that the information is correct. Any errors that might exist will be repeated.

EMR can’t just disable the copy-and-paste function, since such a move would impact other programs.

References:

Turning medical residents away from copy-and-paste culture. MedCityNews.

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.

Medical school letters of recommendation have formally been replaced by tweets

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

Doctor_V:

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

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

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

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

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

Related resources

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

References:

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

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

Image source: Modern stethoscope. Wikipedia, public domain.

Physical Examination Videos

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

From Slate:

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

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

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

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

Comments:

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

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

References:

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

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

Image source: OpenClipArt.org, public domain.

$295,000 In Medical School Debt... Why do medical schools charge students so much money?

Rob Centor:

"Why do medical schools charge students so much money? It was not this way when I went to medical school. I paid an average of $1000 per year in the early 1970s.

Using an inflation calculator, that would become around $5000 per year in current dollars. Yet that same school and most state schools charge 3 times that much."

References:
http://www.huffingtonpost.com/2010/02/23/295000-in-medical-school_n_473601.html
http://www.medrants.com/archives/5327

Image source: OpenClipArt.org, public domain.

USMLE Algorithms - YouTube Channel

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

Example:


Pulmonary Embolus Algorithm.

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

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

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

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

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

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

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

- Medical specialties carried significantly more than surgical specialties.

- 33% carried cigarettes.

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

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

Related:

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

Video: Presenting to an Attending physician

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



Presenting to an Attending physician

Video: How to Interview for Medical School

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


How to Interview for Medical School Part 1


How to Interview for Medical School Part 2

This video is not from NSU-COM:


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