healthcare

The Fatal Failings of Evidence Based Medicine

by

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.

Read more

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

by

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.

Read more

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

by

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.

Read more

20 Questions: Karla N. Turney, PharmD, Clinical Pharmacist

by

Karla N. Turney, PharmD, is an inpatient pharmacist for the Veterans Affairs Medical Center in Iowa City, Iowa, where she has been employed since 2006. She is also an adjunct faculty at University of Iowa College of Pharmacy. Turney has a bachelor’s degree in biology with a minor in psychology from Illinois State University (2001), and her doctor of pharmacy degree from University of Iowa (2006).
Prior to her work at the Veterans Affairs Medical Center, Dr. Turney had several professional practice experience rotations at sites including Osco Pharmacy, Crawford Diabetes Education Center, Fifth Avenue Pharmacy, Liberty Pharmacy, Wal-Mart Pharmacy, Siouxland Medical Education Foundation, University of Iowa Hospitals and Clinics, and University of Iowa College of Dentistry. In addition, she completed two pharmacy internships, one at Iowa Medical and Classification Center (2003-2005), and one at Iowa Drug and Information Services (2003-2005). Dr. Turney has presented on treatment of chemotherapy-induced nausea and vomiting in oncology patients and treatment of depression in oncology patients at University of Iowa Hospitals and Clinics, mumps at the College of Dentistry, oral diabetes medications at Crawford Diabetes Education Center, the new insomnia treatment Ramelteon at Siouxland Medical Education Foundation, and the Iowa mumps outbreak at the Iowa Pharmacy Association annual meeting.

Read more

20 Questions: Cindy Stowe, PharmD

by

Dr. Cindy Stowe is a graduate of the University of Kentucky College of Pharmacy, where she also completed a general clinical residency and a pediatric specialty residency. Following residency, she finished a pediatric pharmacotherapy research fellowship at LeBonheur Children’s Medical Center in Memphis, TN. Dr. Stowe has been a part of the medical staff at Arkansas Children’s Hospital since 1996 and has extensive teaching experience as a faculty member at both the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy and the College of Medicine.

Read more

The Important Considerations for Starting a Career in Medicine

by

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?

Read more

Lessons Learned on the Residency Admissions Trail

by

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.

Read more

5 Steps to Preparing for Your Medical School Interviews

by

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?

Read more

Ten things I learned in medical school (Other than, you know, the medical stuff)

by

I learned a great deal during the preclinical years of medical school, much of which served me well during my clinical training (although I never found a practical use for memorizing the Krebs cycle beyond boards exams). Clinical training was a whole new world, filled with hidden lessons that I didn’t find in any of my textbooks.
10. Late is a four-letter word. Be on time; rounds do not wait for the medical student. A lot of being a third year med student is simply being there. When I was on my surgery clerkship, New York was hit by hurricane Sandy. The next day, we were all there for morning rounds. On time.

Read more