medical education

Although the requirements vary from state to state, all states require that physicians obtain a certain number of CME credits every licensure period in order to renew their medical licenses. Also, although again the specific requirements vary by specialty board, in order to retain board certification physicians and surgeons must meet certain specific CME credit requirements. Indeed, a particularly annoying new requirement is that a certain number of these credits be "MOC" credits, where MOC stands for "maintenance of certification," a particularly contentious topic among physicians. Basically…

We've discussed it before, why are costs so much higher in US healthcare compared to other countries? The Washington Post has a pointless article which seems to answer with the tautology costs are high because healthcare in America costs more. How much more? Well, we spend nearly twice as much per capita as the next nearest country while failing to provide universal coverage: In the WaPo article they make a big deal of the costs of individual procedures like MRI being over a thousand in the US compared to $280 in France, but this is a simplistic analysis, and I think it misses the point…

Yes, this is a repost, sort of. I first put this up on denialism blog in December of 2008. For various reasons, I haven't had a chance to crank out anything fresh this weekend, but this is still a good one, and I've edited it to freshen it up a bit, so don't complain until you read it. --PalMD It's July again, and that means I have a crop of new interns.  I love new interns, because every topic is fresh, every moment a teaching moment.  I'm sobered by the statistic that predicts that only about 4% of American medical grads will chose primary care, but even when I work with  the…

Over a quarter century ago, a young woman was admitted to a New York hospital with fever and agitation. She never walked out. Libby Zion died while under the care of he primary care doctor and two medical residents. The exact cause of death was never identified, but the case led to a forced examination of medical residents' work hours. This was driven largely by Zion's father who felt that his daughter had been killed by inexperienced, poorly supervised, and overworked resident physicians. "You don't need kindergarten," he wrote in a New York Times op-ed piece, "to know that a resident…

When it comes to medical blogging, no one has been as consistently good, fresh, and snarky as Orac. Respectful Insolence sets the standard for all other medical blogs, and though Orac may not be a media star like some other med bloggers, his writing has had a significant impact on some important medical issues such as vaccination. The fact that he is often the target of vicious attacks by anti-vaccination activists and other quacks and wackos shows just how good a job he is doing. Though he has been criticized for being a bit loquacious, his thoroughness is one of the traits that makes…

Reuters Health Executive Editor and proprietor of the excellent Embargo Watch blog, Ivan Oransky, was kind to alert me to this topical paper that appeared in Monday's issue of Annals of Internal Medicine entitled, The Social Mission of Medical Education: Ranking the Schools. To the credit of the Annals, the full text of the primary article is currently free. An accompanying editorial is behind the subscription wall. The study was conducted led by Fitzhugh Mullan with Candice Chen, MD, Gretchen Kolsky, and Michael Spagnola from the Department of Health Policy at the George Washington…

A young relative of mine recently asked me my thoughts about medicine as a career.   It's a relatively common question in my mail bag, and a tough one to answer, especially when asked by strangers.  Career choices are very personal, so I don't like to give advice as much as let people know what they can expect from a career in medicine.  Here's one of the latest letters to show up in my inbox (edited by me for anonymity, etc.). Dear Pal, I'm a third year medical student at the end of my clerkships now, and I've found that I pretty well like everything.  I did my pediatrics rotation early and…

I have now completed almost a year of surgical internship, and as I'm sure you've noticed from my sparse blogging, I've had little free time for writing. It's a shame too because surgery is just so cool. Intern year is mostly about learning to manage surgical patients, basically people in varying degrees of health who have the added stress of having surgery recently performed on them. Although the 80-hour workweek and case requirements have pushed more exposure to the operating room into the process than previously existed, it's still mostly medical management of patients at this stage. We…

So who here has actually read the health care bill?. I've been devoting a bit of time each week to peruse more and more of it, and while there are endless obstacles to a complete understanding of it (including legalese and the annoying tendency of legislation to contain edits to other bills without including the text of the other bills being edited) it is telling that opponents of the bill are having some difficulty coming up with real criticisms of it. For example, the now infamous death panel fiasco was a willful misunderstanding of a completely wholesome concept, the idea that physicians…

I missed this note on Friday at the Wall Street Journal Health Blog but the National Institute on Drug Abuse (NIDA) has made available some great new curricular resources through their Centers of Excellence for Physician Information Program (NIDA CoEs) (press release) "Physicians can be the first line of defense against substance abuse and addiction, but they need the resources and the training," said NIDA Director Dr. Nora D. Volkow. "Our long term goal is for doctors to incorporate screening for drug use into routine practice like they currently screen for other diseases; to help patients…

Hella HeLa! Skloot is PWned, as it were. I learned late last night that author Rebecca Skloot was to be featured on the cover of this week's issue of Publishers Weekly. So, I clicked on the site this morning before the coffee was even done brewing and there is our wordsmithing hero. I know that "The Making of a Bestseller 2010" is sure to make any author nervous but my reading of the manuscript tells me that the prediction is entirely consistent with the work. Regular readers will know that we featured Ms Skloot here last week to brainstorm about her upcoming, self-supported book tour…

Some readers may be aware that Rebecca Skloot is about to release her much-anticipated book, The Immortal Life of Henrietta Lacks, a story that is about much more than the black Southern woman whose cervical cancer gave rise to the most famous human cancer cell line. (Crown, 2 Feb 2010, preorder here). HeLa cells, as they are known, have played a role in the development of vaccines for polio and cervical cancer, the part of last year's Nobel Prize in Physiology or Medicine to Harald zur Hausen, and the PhD thesis 20 years ago of a certain natural products pharmacology blogger. Having been…

Dr. Jerome Groopman, whose writing I generally enjoy, put out a book a couple of years ago called How Doctors Think. It examined, well, how doctors think, how they think they think, and what the future holds for diagnosing disease. It's a good book, but with some faulty assumptions. I'm not the guy to write about how decisions are made---I don't know enough about the field, a field which needs much more research. But most doctors do not, as is sometimes posited, make diagnoses via algorithm. Nor are we slavishly bound to statistical likelihood, as the use of likelihood ratios and, er,…

You might have noticed I've been busy for the last couple of months. This is because I've started my surgical internship, and when not working, am usually either sleeping or eating. I'm going to endeavor to write more though, because I think important things are going on in the world, and because it's somewhat therapeutic. I'll tell you first about a day in the life. What does a surgical intern do? Well, pretty much what most interns do in medicine. We are the ones who run the floor, who do the day-to-day stuff that keeps a medical or surgical service running. The work isn't that…

On July 4th at 5 a.m., I'm loading the family into the car and driving very far away, where cellphones, pagers, and most critically the internet, do not work. Blogging has been very hard for me lately. I love writing, but due to work and family mishegos it's been hard to keep up with the posting. I'm hoping a stint up in the woods providing medical supervision to 400 souls will be rejuvenating. While I'm gone, I'll leave you with some of my favorite posts about the human side of medicine. I hope you enjoy reading them again, or for the first time. --PalMD I am often the bearer of bad…

The medical education calendar begins and ends on the first of July each year, and in the hospital, that means a brand spanking new crop of young doctors. While this may sound a bit scary, the facts are a bit subtle (and not terrifying). Some of the questions regarding the so-called July Phenomenon are: Are hospitals more dangerous in July? Is care more expensive in July? Are hospital stays longer in July? The data show that there does not appear to be an increase in poor outcomes in July vs. other months, but in some fields hospital stays may be longer and care may be more expensive due…

Science has an editorial today discussing a topic near and dear to me, what medical schools should require from undergraduates before admission. Since I was a bit non-traditional as an undergraduate premed (I was a physics major), I am happy to see that they've ignored calls to overload undergraduate education with a bunch of pre-professional courses that prevent people from being anything but biology majors. How should preparation for medical study be assessed? Medical schools generally determine scientific readiness for admission by course requirements and scores on the MCAT, which mainly…

Although I saw this obituary over the weekend, I didn't get to posting it until today. I was reminded by a local friend, an outstanding young scientist in her own right, of the impact that Dr Schanberg had made on so, so many lives in science, medicine, and our larger community. I only had the honor of meeting Dr Schanberg once, shortly after his cancer diagnosis, while we were at a Duke Cancer Patient Support Center fundraising dinner. His wife of over 50 years, Rachel, is founder and former director of the organization which they started following the loss of their own daughter. Among…

Several of my blogging colleagues have been discussing over the last few days whether there is value in cultivating fellow scientists as readers of science blogs. While some find this a waste of time, others recognize that blogs provide a useful, real-time platform for disseminating information and discussing current issues and career development challenges that cannot be done well in print format. The informality of the blog also allows for frank discussion to be had between senior scientists, trainees, and the general public that do not often (if at all) occur at one's home institution.…

This war taking place in our nation's medical schools and academic medical centers. Orac at Respectful Insolence has been tracking this trend, as have those of us writing at Science-Based Medicine. It is a war between those who feel that medicine should continue to be based on science and those who want to integrate faith-based practices. The model for this war is not that of pedagogical disputes or funding scuffles. More than anything else, it resembles a religious war. The basic story goes like this: medical schools are in charge of educating future doctors. Individual hospitals are…