Monday, February 29, 2016

The ultimate resident evaluation

It comes as no shock to me, and probably many other current and former program directors, that a recent study showed faculty overall performance evaluations of residents do not correlate with their scores on the yearly American Board of Surgery in Training Examination.

According to the JAMA Surgery paper, faculty evaluations encompassed technical skill and the six core competencies—medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and system-based practice.

The paper analyzed data for 150 residents at different levels of training over 4 years and also found that even faculty evaluations of the category medical knowledge couldn’t predict who would get a good or a bad score on the test.

It’s great to know that at the authors’ institution, the average annual evaluation scores ranged from just over 75 to 100 with means and medians both slightly above 92—like Garrison Keillor’s mythical Lake Wobegon, “where all the women are strong, all the men are good looking, and all the children are above average.”

Thursday, February 25, 2016

More on activity restrictions after surgery

In early January, I blogged about the dearth of evidence about activity restrictions after surgery.

A number of people commented and most agreed that there is little basis for most of the activity restrictions surgeons currently use.

An anonymous reader told me about a 2008 study from Creighton University that generated some interesting data about intra-abdominal pressures associated with some common activities. Here’s a summary of the paper.

Tuesday, February 23, 2016

"Code Black" is still on TV. Did it get any better?

Despite some recent ratings problems, the TV show "Code Black" somehow remains on the air. It has lost viewers after five of the last seven episodes including a whopping 23.8% drop in the all-important 18-49 year-old demographic after the 2/17/16 installment.

It's still viable because of fans like Sharon who said on the ratings website: "The best medical show on. I have been in the medical profession 30 years and it depicts the most true to life situations of any of the medical shows I have watched. Love the show." Sharon must work on the psych floor.

I decided to take another look at it. Having seen the 2/17/16 episode, my opinion hasn't changed. Here's why.

Tuesday, February 16, 2016

Those who can, publish. Those who can’t, blog

What’s your view on social media and science? For example, the role of science blogs in critiquing published papers? "Those who can, publish. Those who can’t, blog," says Jingmai O'Connor.

According to, Dr. O’Connor is a professor at the Institute of Vertebrate Paleontology and Paleoanthropology of the Chinese Academy of Sciences, and her comment was part of an interview published last month.

Dr. O'Connor says, "It often seems those who criticize or spend large amounts of time blogging are also those who don’t generate much [sic] publications themselves." She thinks comments should be peer-reviewed and published only in journals. She worries about the public who may not realize "a published paper passed rigorous review by experts, which carries more validity than the opinion of some disgruntled scientist or amateur on the internet." She adds, "criticism in social media is damaging to science, as it is to most aspects of our culture."

Apparently she isn't aware that peer review is under fire from a number of respectable sources.

"If peer review was a drug it would never be allowed onto the market," said Drummond Rennie, a contributing deputy editor of JAMA. Richard Smith, former editor of the BMJ agrees "because we have no convincing evidence of its benefits but a lot of evidence of its flaws."

In 2015, 107 scientific papers were retracted by several journals because their authors, nearly all of whom were Chinese academics, had performed fraudulent peer review by creating fictitious names and email addresses of suggested reviewers so they could write glowing reviews of their own work. Some of these charlatans are from Beijing, where Dr. O'Connor is based.

Australian bloggers found an error that had somehow been missed during "rigorous review by experts" regarding the number needed to treat in a New England Journal of Medicine paper on targeted vs. universal decolonization to prevent ICU infection. They contacted the paper's corresponding author who acknowledged the mistake within 11 days. It took five months for a correction to appear online in the journal.

Whether Dr. O'Connor likes it or not, the future will involve more immediate feedback about research papers. For example, PubMed and PubPeer already allow comments, and the BMJ also has a section for online rapid responses.

Blogger Marc Bellemare, an associate professor of economics at the University of Minnesota, cites David McKenzie, an economist/blogger at the World Bank who thinks that blogs play an important role in disseminating information to the public and "raise the profile of bloggers and their institution."

But Bellemare feels blogging might not be for every academic He quotes Tyler Cowen of George Mason University, who when asked why don't more economists blog replied, "I believe it is because they can’t, at least not without embarrassing themselves rather quickly, even if they are smart and very good economists. It’s simply a different set of skills."

Maybe Dr. O'Connor doesn't have the skill set to blog. I say, "Those who can, blog. Those who can't, insult those who can."

Tuesday, February 9, 2016

Unproven athlete training and recovery devices

A recent Wall Street Journal article reported that #1 ranked Novak Djokovic and several other tennis players frequently spend time in hyperbaric chambers after matches. This supposedly helps athletes recover and prevents injury.
A hyperbaric pod
Malcolm Hooper, the owner of the Melbourne "clinic" where the hyperbaric pods are located and a former chiropractor, said he has "seen gains in his patients, and the research suggests hyperbaric treatment can help many ailments." The article also quoted several athletes who favored the treatment but cited none of the research.

Friday, February 5, 2016

What? A woman with no appendix undergoes attempted appendectomy

A surgeon found no appendix when he operated on a 69-year-old woman with abdominal pain in Saskatchewan. She had been admitted with chronic diarrhea and right-sided pain. A colonoscopy showed what was thought to be impacted stool in the orifice of her appendix, a finding often associated with appendicitis.

Laparoscopic surgery was done through three small incisions, and after an hour of searching, the appendix was not located.

After the operation, the doctor claimed the patient did not tell him she had had an appendectomy possibly during either gallbladder or tubal ligation surgery in the past. On one of those occasions, she may have had an incidental appendectomy—removal of a normal appendix to theoretically prevent appendicitis in the future. It's an operation rarely done today.

She was discharged after a brief hospital stay. There was a bit of a fuss about "unnecessary surgery" and what, if anything, the surgeon told the patient after the procedure. A phone conversation with him was secretly recorded by the patient's daughter. An investigation is underway.

You might be interested in two questions. Can you get appendicitis again after you've had an appendectomy? Other than previous surgery, is there another explanation for a patient who does not have an appendix?

Wednesday, February 3, 2016

Another reason not to rely on medical advice from the Internet.

On New Year's Eve, The Daily Beast published an article with suggestions about how to avoid a hangover.

Some of the tips were reasonable such as limiting yourself to one alcoholic drink per hour and maybe avoiding certain beverages like wine, bourbon, and Scotch, which contain congeners and have been associated with worse hangovers.

However, some of the advice is wrong.

The article recommends this on the day you plan to party:

6 a.m.: Rise and hydrate! Drink early and drink often. One of the main causes of a hangover is dehydration. Women should be drinking 2.7 liters per day, and men should get 3.7 liters. That's 0.7 gallon and 0.97 gallon, respectively.