Medical

Learn about medicine and how to become a physician in our articles for pre-medical students (including the MCAT), medical students, resident physicians, and practicing physicians.

The Fatal Failings of Evidence Based Medicine

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The medical system (and much of the culture) these days is focused on group outcomes, not individuals. Personally, I think that stinks.
In medicine, this failing comes from improper use of what was originally a good idea—evidenced based medicine (EBM). EBM was developed to help overcome anecdotal medicine, in which a seemingly successful therapy in one patient gets adopted by a physician as the “way to go” and then preached to his trainees as the management of choice, and over time becomes unexamined gospel. “Anecdote-based medicine” is a form of groupthink, and groupthink is bad in general and particularly bad for the patient sitting in front of us on an exam table.
There needed to be some way to help doctors realize that an individual patient response is not generalizable to others.
EBM evaluates groups of patients to determine statistical responses to interventions. It was created (initially) to help doctors determine whether an intervention is likely to work in an individual patient. In that way, it was originally kind of the obverse of anecdotal medicine.

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An Apology from a Resident

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Dear Third Year Medical Student,
Congratulations! Your two years of textbook learning are complete and you are ready to launch into your clinical training. It’s an exciting time and you’re likely super-eager to jump in, get involved and save a few lives (or at least stand by helpfully while other people save the lives; let’s not get ahead of ourselves). You have high hopes of becoming a key member of your team, taking care of your patients and learning as much as possible. What you will quickly discover is that your experience will be strongly colored by the residents with whom you will work closely. As a medical student, I had the opportunity to work with some truly great residents. Enthusiastic about their field, they worked to incorporate me into the care process and would take a moment, however brief, to draw attention to valuable teaching points that I might otherwise have overlooked.

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A Day in the Life: A Look at the Medical School Clerkship Year – Part II

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Make sure to check out Part I here!

The remaining day

Following rounds, teams will typically “run the list,”or quickly review the to-do items discussed during rounds and delegate the work as necessary. Since medical students typically cannot input orders, which include things like prescribing medications, scheduling diagnostic imaging and tests, and requesting labs, this usually involves more administrative tasks: obtaining medical records from outside institutions, following up on tests, and other ancillary tasks. Most rotations also incorporate some form of formal teaching in the curriculum. As such, students may be expected to attend lunch lectures with residents or may have their own lecture schedules. Some attending physicians enjoy giving quick teaching sessions and will set aside 30-45 minutes to talk about a particular clinical topic (e.g., management of diabetes, working up an acid-base disturbance, and other common issues) each day in addition to the more formal teaching opportunities scheduled by the clerkship.

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A Day in the Life: A Look at the Medical School Clerkship Year – Part I

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A caveat, an introduction

To try and describe the clerkship year of medical school – the year-long, in-depth experience for students to actively participate in patient care in a clinical setting, usually in the third year – to those who haven’t experienced it firsthand is a difficult task. I steadfastly believe that medicine is an experiential endeavor, one that cannot be truly understood by someone until he has undergone it himself. The fact that each trainee has his own unique set of “critical-incidents,” to use a term from the medical education literature (1), that profoundly shapes the physician he will become makes the task even more arduous. Nevertheless, I will do what I can to try and give a good look at a day in the life of a third year student and what the experience entails.

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Should You Retake the MCAT? A Guide to Evaluating Your Score

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Deciding to complete the MCAT for a second time is a decision that can have a significant impact on your chances of being admitted to medical school. It is vital that you correctly assess your first MCAT score to determine if retaking the MCAT is best for you. As a general rule of thumb, if your result is five or more points below your goal score, you should consider sitting for the exam again. However, there are also several factors to examine before solidifying your decision.

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What’s in Your iTunes? Podcasts for the Medically Minded

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Whether your goal is education or entertainment, there is likely a medically oriented podcast out there you will enjoy. I’ve included here a sampling of the ones I found most useful or enjoyable, grouped by type. The first are geared towards the present task at hand – surviving medical school in general, clerkships in particular. The second group can help you learn more about your future specialties of interest. The last section takes a broader look at the world of medicine, tackling issues from recent scientific breakthroughs to medical ethics – those topics you feel you should be keeping up on, but who has the time? If you have other podcasts you have found helpful or insightful, please share them via the comments link at the bottom.

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Benefits and Drawbacks: Taking a Gap Year Between Undergrad and Med School 

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Increasingly, medical school students begin their medical school experience one or more years after graduating from college. In fact, the average age of a first-year medical student is 23 or higher at the majority of institutions. However, the decision to opt for a gap year should not be taken lightly. A gap year can serve as a significant advantage, but it also carries several potential drawbacks.

Benefits

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Making the Transition to Medical School

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You’ve taken the MCAT exam, applied to medical school, received an acceptance (or two!), and finally decided which school you are going to attend. Now it’s time to prepare to start medical school.
The Association of American Medical Colleges (AAMC) has a few tips to help make the process of transitioning to medical school a little smoother:

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It's Not a Failure: Taking Personal Leave from Medical School

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August 2, 2009 is a day that will be forever engrained in my mind. “We would like to offer you a seat into the class of 2017 if you’re interested,” was the most wonderful phrase I had ever heard in my entire life. I had made it. I got accepted into my top choice D.O. school, right in my home state! However, the changes that ensued hit me like a whirlwind. The call occurred on the first day of orientation. I had 24 hours to pack all my things, move three and a half hours away from home, find a place to live, and start class on Monday. Of course there was slight hesitation in my mind, wondering if I should take a year off because I wasn’t prepared to go that fall. I didn’t even think I would get accepted, and here my dream came true!

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The Important Considerations for Starting a Career in Medicine

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You’ve finally finished all those years of training and now it’s time to make a decision second only to choosing a spouse—what you will do for the rest of your life. You’re probably thinking about salary and getting rid of debt, but those are secondary issues. First of all, your employment choice should fit with your long-term vision and plan for you and your family. Second, you should fit into the culture of your future practice or organization.
Long-term plan, what long-term plan? I’ve just been trying to make it through all these years of residency. Probably so, but now it’s crucial to think down the road at least ten years. Make sure that what you do next year gets you to your desired future. What do you want to be doing in ten years? Private practice? Hospital employee? Academics? Where? Does the proposed location meet the needs of your spouse and family?

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Lessons Learned on the Residency Admissions Trail

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This time last year, I embarked on my own medical residency admissions journey. I realized that the decision-making process involved in the ERAS and residency application cycle can be dauntingly ambiguous to many applicants, including myself. Gone are the lists of medical schools or colleges ordered by objective measurements such as research dollars, student-faculty ratios, and admission statistics of entering classes. While there is significant debate on which criteria should be included in ranking schools, the availability of that data at least allowed for individual interpretation based on personal beliefs.

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5 Steps to Preparing for Your Medical School Interviews

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After obsessively checking your email every five minutes for weeks, the appearance of your first interview offer brings with it a flood of relief and excitement. All that studying, volunteering, and writing of countless secondary applications has earned you a coveted interview slot. Yet coming on the tail of such excitement is that sense of panic. What now?

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Top Factors to Consider When Comparing Medical Schools

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Selecting a medical school is a significant decision, as the program you attend may play a key role in determining your career path. Whether you are completing final interviews or simply starting the application process, below are several factors to consider when comparing potential medical schools.

Location

The majority of applicants have a reasonable idea of the type of setting they would like to spend four years. In general, medical schools can be in urban and suburban settings. They are rarely rural. However, realize that the area a medical school is in affects more than your personal life and cost of living. Different geographic regions will expose you to different patient populations and disease processes. If you are extremely passionate about working with certain patients (e.g., the under-served urban poor), then take location heavily into account when choosing a program.

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20 Questions: Rebecca A. Lubelczyk, MD, Correctional Healthcare

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Rebecca A. Lubelczyk, MD, is a utilization review advisor physician for Massachusetts Partners in Correctional Healthcare in Westborough, MA, and associate clinical professor of family and community health at University of Massachusetts Medical School in Worcester. Lubelczyk received a bachelor’s degree in biochemistry from Vassar College (1992), and her MD from University of Massachusetts (1996). She completed a residency in general internal medicine at Brown University School of Medicine, Rhode Island Hospital (1996-1999), followed by a residency in post graduate year 2 and 3 at the outpatient community site at Rhode Island Department of Corrections (1997-1999). Dr. Lubelczyk also completed a general medicine fellowship at Brown University School of Medicine, Rhode Island Hospital (1999-2001).

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