Vacation Notice

The majestic 700 ft. Cliffs of Moher, one of my favorite places in Ireland.

I will be in Ireland with possibly limited Internet access for the next 7 days.

Please browse my list of previous posts and read a few if you have time.

Any comments you submit may take a day or so to appear so please be patient.

Thank you for visiting my blog site and for reading my musings.

Social media solves a medical riddle

This foreign body was removed from a non-healing abdominal wall incision in an elderly lady with many comorbidities and previous operations. It was a rigid plastic tube which was 7 cm long and 2-3 mm in diameter. There were four transverse grooves at either end.

Physicians caring for her were unable to identify it. One of them emailed me the photos and asked for help. I didn't know what was, but I knew where to look for the answer.

I tried a Google image search, but the brownish discoloration of the object was interpreted as wood by the algorithm. None of the many images on Google resembled the foreign body.

Review: Online question bank for med students and residents

I just finished evaluating a study aid for National Board of Medical Examiners shelf examinations. It’s called ExamGuru, an online question resource for the major specialty rotations encountered by a third-year medical student.

The surgery shelf exam has a total of 395 questions. You can create your own multiple-choice tests of any length, timed or not, and you can focus on the subsections of surgery you want to emphasize.

What makes this set of examinations unique is that you not only get the answer, you also can see whether the question is easy or difficult and how you compare to your peers who have answered the question previously.

Questions that are too hard or too easy are revised or replaced.

How long is too long for robotic surgery?

A surgical chairman writes [some details were changed to obscure the surgeon’s identity]:

We currently have surgeons who are trying to establish themselves as experts in performing a certain robotic operation. As an open case, it rarely takes more than about 4-5 hours.

With the robot, it is generally taking around 6 hours as reported in the literature, and morbidity and mortality in expert hands appears to be pretty good.

What is happening in the real world is that surgeons are taking 12 or more hours to perform these operations robotically. I am aware of one death after a 14 hour procedure in another hospital. One case in my own institution took 16 hours, and luckily the patient did well. Of course this sort of data never gets reported publicly. 

A white coat is more than just a symbol

The raging controversy over whether doctors should wear white coats has been based on the theoretical problem of possibly infecting patients with organisms that can be cultured from white coats vs. the lack of an apparent benefit from wearing a white coat.

A 2012 paper by investigators from Northwestern University in the Journal of Experimental Social Psychology sheds some new light on the latter issue.

Rather than summarizing the study myself, I will quote the excellent New York Times article about the three experiments that were done [emphasis added by me]:

In the first experiment, 58 undergraduates were randomly assigned to wear a white lab coat or street clothes. Then they were given a test for selective attention based on their ability to notice incongruities, as when the word “red” appears in the color green. Those who wore the white lab coats made about half as many errors on incongruent trials as those who wore regular clothes.

Surgeons are burned out in, of all places, France

More than half of French gastrointestinal surgeons in training are burned out says a paper published ahead of print in the American Journal of Surgery.

Five hundred gastrointestinal surgery trainees were surveyed, and 65.6% responded. Of those responding, 52% had indications of burnout syndrome—emotional exhaustion, depersonalization of relationships, and lack of self-fulfillment at work—on the well-validated Maslach Burnout Inventory.

Other notable findings were 67% had insomnia, and 12% had thoughts of suicide.

On multivariate analysis, the significant factors associated with burnout syndrome included being confronted with aggression from patients, lack of gratitude from senior colleagues, trainees feeling they had too much responsibility, and not participating in extracurricular activities.

The prospects for switching to a different specialty

Could you comment on how an applicant switching into general surgery compares to one that applied directly from medical school would be viewed? I had a very difficult time choosing between specialties and have been regretting my decision not to apply into surgery. I am currently in a prelim year in medicine and am currently matched into radiology. I want to reenter the match process this year but am nervous to give up my guaranteed radiology position at a top program for an unknown where I can go unmatched or matched into an undesirable program. I graduated from a US med school. My USMLE Step 1 score was 235, Step 2 252, and I have published 2 articles in a surgical sub-specialty field.

You are what is known to the National Resident Matching Program (NRMP) as an "independent applicant" (graduate of a US med school going back into the match).

Go to the NRMP website, download the PDF "Main match results and data 2016" and look at Figure 6, you will find that 52.2% of independent applicants in general surgery failed to match compared to only 9.9% of US seniors.

 

This holds true for most specialties. Note that 43% of independent grads did not match in neurology.

Your USMLE scores are quite good, and the fact that you have published to articles will probably help a little. However, the reality is that you probably have about a 50-50 chance of matching in general surgery.

I wish I could explain why this is. All I know is it has been this way for years.

I can't tell you what to do. I suggest you give this some serious thought. It is probably not ethical for you to reenter the match and not tell your anesthesia program that you are doing so, but I suppose that is an option. If you don't match in general surgery, you would still have your anesthesia spot, but if you do match, you will leave your anesthesia program high and dry.

If you decide to apply to general surgery, you should go with mostly community hospital programs and send out lots of applications. By lots, I mean more than 50 or as many as you can afford.

You will be able to better assess your chances as you see how many interviews you are offered.

Good luck with your decision and please let me know how it turns out.