Tuesday, July 26, 2016

What are the residency prospects for graduates of offshore medical schools? 2016 update

Since I blogged about this two years ago, there is new data that may help clarify the situation for those who graduate from non-US medical schools. That post has had over 44,000 page views and 91 comments, some of which are responses from me to reader questions.

The National Resident Matching Program (NRMP) has published a 290-page summary [Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2014 NRMP Main Residency Match (5th edition)] of the 2014 match, the latest year for which complete information has been analyzed.

The number of US graduates participating in that year's match was 17,374 compared to 16,896 graduates of other schools including non-US IMG's (7334), US IMGs (5133), DOs (2738), US graduates from previous years (1662), fifth pathway students (15), and Canadian grads (14).

From the Main Match Results Data for categorical general surgery in 2014:
One way to look at these numbers is that if you are US senior applying for a categorical surgery position, you have a 922/1274 or a 72% chance of matching. If you are in the "others" category, it's 283/1108 or a 25.5% chance of matching.

Wednesday, July 20, 2016

In-Training: Stories from Tomorrow’s Physicians

A new book, In-Training: Stories from Tomorrow’s Physicians, is a collection of essays by medical students that originally appeared online. The book’s editors, Ajay Major and Aleena Paul, created the In-Training website as a place where students could express their thoughts and feelings about life in the pressure cooker that is medical school.

The 111 essays are brief and as is true of any collection of writings from diverse individuals, are of somewhat uneven quality. Some are good. Some are fair. Some are meh.

One of my favorite pieces was one by a doctor who had received his diploma 10 days before a flight home. During the flight, a woman collapsed—prompting the dreaded “Are there any physicians on board” announcement. The new grad was the only responder. Having experienced this myself a couple of times, I had no trouble identifying with the author who described his predicament well.

I learned something from another of the essays which described a novel intervention for wandering patients with dementia.

A unique feature of the book is that every story is accompanied by a few “reflection questions” prompting the readers to think about what they just read. The questions add value and could serve as the basis for stimulating group discussions.

Monday, July 18, 2016

New weapon to battle obesity or folly?

The FDA recently approved the AspireAssist, a tube placed into the stomach through the abdominal wall enabling a patient to drain a portion of gastric contents after eating. The idea is to remove about 30% of food intake after each meal. Food must be thoroughly chewed and taken with plenty of water in order for the material to drain properly. The manufacturer suggests draining the gastric contents directly into a toilet.

When I first heard of this device three years ago, I expressed my usual skepticism. However, a recent multicenter study presented at this year’s Digestive Disease Week looked at the use of the AspireAssist with counseling to counseling alone found that morbidly obese patients who used the device lost more than 30% of their excess weight compared to only about 10% for those in the counseling group. Bear in mind that the figures are percent of excess weight lost, not percent of total weight lost.

An interesting article on Stat News featured comments from both proponents and detractors. Here are some of them:

Wednesday, July 6, 2016

Just in. My wife named a top orthopedist


A couple of weeks ago my wife received this in the mail.

Of course we are thrilled that she was finally recognized as one of the top orthopedic surgeons in our city.

Last year I blogged about a similar honor that I received from the International Association of Healthcare Professionals. That eminent organization had named me a top surgeon. I was a little skeptical because at the time, I had been retired for two years.

I am sure the vetting process for my wife’s inclusion was quite thorough. However, they may have been mistaken about some important criteria.

For one thing, she is not an orthopedic surgeon. In fact, she isn't even a doctor. She is a nurse and manages an office for a large group of orthopedists. She is pretty good at reading x-rays and is a whiz at organization, staff management, patient interactions, suture removal, and fitting crutches. Maybe that counts for something.

From the format of the letters and the mention of the "renowned publication, The Leading Physicians of the World," it looks like the International Association of Orthopedic Surgeons might be run by the same outfit as the International Association of Healthcare Professionals.

The website does not list the cost but here are the benefits of being selected: wall plaque of achievement, leading physician feature video, leading physician press release, leading physician specialist online exposure, physician feature website, and [my favorite] endorsement of credentials.

We look forward to the selection of our dog Bailey as perhaps one of the leading neurosurgeons of the world.

I think she qualifies because she has been dead for three years.

Tuesday, June 28, 2016

Epidemic viruses contaminate healthcare workers’ mobile phones

As if bacterial contamination of cell phones wasn’t enough of a problem, a new paper finds that viral RNA can also be found on the devices. But before you put your phone in the autoclave, read on.

The study was conducted in France and involved 114 healthcare workers (35 senior physicians, 30 residents, 32 nurses, 27 nurse assistants) who used both mobile and cordless phones in a university hospital.

Phones were swabbed and tested for viral RNA, and the subjects answered anonymized questionnaires regarding their behavior.

Viral RNA was recovered from 38.5% of the phones with rotavirus RNA on 93% of the virus-contaminated phones.

About two-thirds of the healthcare workers used their mobile phones while caring for patients, and 28% of them said they never wash their hands before using the phones, 37% never used hand hygiene after using the phone, and 21% said they never performed hand hygiene either before or after using a phone. This held true for personnel who interrupted caring for patients to answer their phone.

In an article about the study, one of the authors said, “It was surprising that 20% of them admitted never carrying out any hand hygiene procedures, either before or after using their phone, even though all said they knew phones could harbor pathogens.”

Friday, June 24, 2016

Irrational fear of CT scans in appendicitis

By Skeptical Scalpel and Saurabh Jha*

Simple appendicitis cannot be distinguished from complicated appendicitis by clinical examination and laboratory findings say Finnish investigators. They looked at data from their randomized prospective trial of antibiotics vs. surgery for treatment of appendicitis and concluded that only CT scans could reliably differentiate the two entities.

The study involved adult patients from 18 to 60 years old; 368 of whom had uncomplicated acute appendicitis and 337 had complicated appendicitis—appendicolith, perforation, or abscess.

Duration of symptoms, C-reactive protein, white blood cell count, and temperature were significantly different between simple and complicated appendicitis patients. However substantial overlap of values meant they were not helpful in predicting the presence of complicated appendicitis.

Receiver operating curves for C-reactive protein and temperature areas under the curve do no exceed 0.77. Combining these parameters did not improve accuracy.

The paper concluded that CT scanning is essential in diagnosing acute appendicitis and identifying simple and complicated cases.

A companion study by many of the same authors looked at 1321 patients who presented with clinical and laboratory findings of possible appendicitis. Since their protocol called for confirmation of the diagnosis, all patients underwent CT scans, and 351 (27%) did not have appendicitis.

Thursday, June 23, 2016

Recording patient/doctor encounters: A modest proposal

This is a guest post by Dr. Drake Ramoray (A pseudonym. He is not affiliated with the actor, character, the show “Days of Our Lives,” or NBC.)

I have been assured by a very knowing American of my acquaintance in London, that a young healthy child well nursed is at a year old a most delicious, nourishing, and wholesome food, whether stewed, roasted, baked, or boiled ...—Jonathan Swift

I have A Modest Proposal. I suggest we just videotape all patient/physician encounters. Why rely on a possibly low quality audio recording where exterior noises or interruptions could interfere with the quality? Furthermore, perhaps my comment that may or not be taken out of context will make more sense if one can see my body language. Even better, lets just transmit the videos directly to CMS and your insurance carrier so we can add additional layers of bureaucracy and non-medical personnel to the mix whose pay has to come out of physician charges, taxes, or patients' premiums.