mudphudder

So one of the biggest challenges facing a mudphudder is the prospect of putting aside all research for several (anywhere from three to five) years during residency training.  Not that this is necessarily a bad thing–residency training is meant for producing competent physicians not researchers.  But having actively participated in research for the last six to seven years (even now I have a couple of first author papers in press from work I did after I went back to medical school), it will be challenging to give it up at the level where I’m at now–think going from a two pack per day smoker to maybe a cigarette per day, if that. 

This large gap in research activity can come at an obvious detriment to the scientist part of the “physician scientist”.  When I go back to having substantial research time, science will be vastly different than it is now.  Even since I’ve left the lab, the advances in my field of study have been astounding.  So this three to five years away from the lab can have significant impact not only on eroding a mudphudder’s knowledge of the field but also on laboratory skills as well. 

There are, however, a few options that can be pursued.  One option consists of fast-track residency programs.  These are basically abbreviated residencies in certain fields that allow the resident to jump to a fellowship (with research focus) sooner.  I’ve mostly heard about this for internal medicine-based residencies where the first two years of the residency would be completed at which time the resident would go to a research fellowship in, for example, oncology or cardiology (as opposed to staying for the third and last year of the residency).  I started thinking about all of this after I read what I think is an informative article about fast-track residencies in this week’s issue of Science.  The problem with fast-tracking is that it is not really accessible to certain residency types, in particular surgical specialties.  As it is, the eighty-hour work week is considered by many to have lead to abbreviated surgical residency training–forget about short-tracking. 

In that case, many surgical residencies now offer (or mandate that) residents take one or two years off in the middle of residency to do full time research.  This can be a nice fix for the mudphudder research junkies out there and is also helpful for the MDs who want an extended period of full time research experience. 

Now for my opinion on all of this stuff.  I like the concept of short-tracking in residencies where it is possible.  However, there is no question that clinical training suffers from what I have heard.  And to be quite honest, how can it not when you are only doing 66% of the residency (e.g. two out of three years in internal medicine)?  I think in the Science article, one guy said that a downside of fast-tracking was that we wouldn’t be able to supervise junior residents (i.e. that he would be giving up his chief year).  I can’t imagine how that wouldn’t impact a physician’s ability to lead a clinical team.  But I think this is not as big of a concern for mudphudders who want to focus primarily on research careers.  In fact, I think this is a good path for mudphudders who envision a career that will be mostly spent in the lab. 

I am not as big of a fan of the other option–taking one or two years off in the middle of residency for full time research–for mudphudders.  I think it’s a great opportunity for someone who hasn’t spent substantial time in the lab to take responsibility for a well thought-out project and take it to completion, in order to get a taste of real “research” but I think it’s a complete waste of time for mudphudders.  One of the biggest challenges I faced when going back to the wards was giving up the momentum I had built up over four years in the lab–in another year I could have written another two basic science papers.  But I gave it up for medical school training.  And now what momentum I had is essentially gone.  But I’m not regretful because studying for medical school is important too (I guess.  Depends on which day you ask me).  Anyway, in two years of lab work during residency, a mudphudder can build up momentum that will essentially be extinguished upon return to another two or three years of residency.  Well, not completely–the lab the mudphudder worked in will build on that momentum–but not the mudphudder.  Moreover, none of that work will like go with the mudphudder to fellowship or towards starting a lab–how could it?–the work would be three years old by then.  In my opinion, I think mudphudders who can’t fast track just need to pound through the residency and pick up full time research again after it’s over.  I think it’s a shame because a lot can happen in that many years away, which can dissuade a mudphudder from research, but I don’t think there is any other way to become competent in those clinical fields and use time efficiently.  In cases where it is not possible to fast-track, I think the next instance of substantial research time should be during fellowship or a post-doc, to be done just before taking a faculty job so that research momentum can be harnessed towards producing results. 

Everyone (e.g. residency directors and department chairs) want people who will go into academic medicine and become leaders in the field.  But obviously, no one ever made it easy to go into academic medicine.  And, the route is full of forks in the road, each of which could potentially add even more time to the training process (note I will be older than 35 when I get my first job), which isn’t necessarily a bad thing if the payoff is worth it.  You just have to think about what is best for YOU and YOUR career, not people who may have a vested interest in whether you spend all three years in residency or take two years off to do research.

April 12th, 2009 | Tags: residency | Category: md / medical student stuff, md / phd student stuff | Leave a comment

If you know that you will be moving–for whatever reason–I strongly suggest doing some serious investigation of housing options prior to 1.5 months before you have to move.  As you may know, I am now in the process of looking for a place to live during residency, which starts in late June.  And I am hurting.  I’ve already made two 8 hour treks and still haven’t found something that either has what I need or that I can afford.  Quite frankly, I should have been thinking about this even before the results of the match were released.  For those of you who will be going to through the residency interview process and match soon, start looking for places to live asap.  Most of the time, one can guess around what part of the rank list one will match too.  I was pretty sure I was going to match somewhere in my top 3 so I should have been seriously looking at places in those 3 cities back in february.  Instead now I’m hurting.  My taxes are due, I have to take USMLE Step II CK on monday, I need to complete and mail in my forms for medical licensure, my ill-advised, non-refundable  vacation is coming up and I need to take another 8 hour drive on monday afternoon.  Oh yes, I also need to get ACLS/ATLS certified too. 

So to summarize the lessons to be learned from this (i.e. what I should have done in hindsight): 1) get ACLS/ATLS certified asap–most of you will take a month off in december or january for interviews, get certified on one of your off days.  Also, most of your medical schools will offer these courses for free, so no excuses.  2) Start looking for residency housing ASAP.  If you know where you will be (to varying degrees of certainty), start looking even before the match.  Look in a few different cities if you have a gut feeling of where on your rank list you will land, but LOOK.

More lessons to follow as I find new mistakes I have made every day… 

April 11th, 2009 | Category: md / medical student stuff, personal | Comments (1)

  I don’t know if you all have heard about this but for those medical students, interns or residents who are doing ICU rotations and are looking for a good book to use, a buddy of mine who is a general surgery resident recommended “The ICU Book” by Paul Marino.  Apparently it is supposed to be one of the standard books that is used by residents all over for ICU rotations (MICU or SICU). I’ve read through most of it and found it to be a concise (at 1065 pages I guess that’s concise for what you need to know in the ICU) discussion of clinically relevant topics (with supporting literature) that one needs to know for management of patients in the ICU. There is also a little pocket version of it that is convenient for carrying around in your white coat.  
  Anyway, I found this to be really helpful for the ICU as did a number of residents I’ve talked to, so I thought I’d pass it on. God be with you for your ICU rotation.

April 8th, 2009 | Category: md / medical student stuff | Leave a comment

I will begin this post by saying that I DO NOT listen to music by Paula Abdul.  When I first got my ipod, I put all of someone else’s mp3 files on it.  Some of these mp3s included tracks by Paula Abdul.  In the last 3 years, I have just been too lazy to erase those files so I just flip over them when they come on.  Long story short, I pulled up to swipe into the hospital garage at the same time a big shot faculty from my department pulled up in the lane next to me.  With my window rolled down while I swiped in, the track changes to “Straight Up” by Paula Abdul.  Volume loud of course.  And the faculty member turns over and looks into my car, spots me and gives me an expression of WTF?!?!?!.  So now of course I feel like a complete tool especially since it’s not even music I listen to.  Not that I have particularly good music taste anyway–the preceding track was “Wheel in the Sky” by Journey so I don’t know how much better that is (whatever, Journey RULES).  But what if I did listen to Paula Abdul?  Would I be any less of man?  Probably yes but is it grounds for thinking less of me as a person (which is most likely what was going through the mind of this faculty member)?  Borderline yes/no but I think no. 

Which brings me to my point.  What is the deal with walking on egg shells around big shot medical people?  I’m all for giving up the respect and love for the old school–in fact I would err on the side of too much love and respect.  But sometimes it feels like I’m always looking over my shoulder whenever I break from the military-style march down the hospital hallways and act a little human.  I have one buddy who won’t get caught with a cup of coffee in his hand in front of some faculty (even if he’s in the cafeteria).  Wouldn’t you consider that going too far?   Part of it is the fact that those of us on the lower end of the totem pole are always being evaluated or trying to prove ourselves for the big guys at the top.  But part of it is also just the culture.  This kind of thinking is really ingrained in the culture of medicine (some fields more than others) and my feeling is that it can be one of the aspects that turns people off from a medical career.  I’d like to think that I’ll be able to change the system from the inside once I get on top but by then I’ll probably be too old and tired to even remember about this. 

So how far do you go?  I don’t know.  I guess as far as your comfort zone will allow you to.  At the very least, as I was advised once, try not to call faculty members “dude” or “man”.  And that’s probably the best advice you will find on this blog.

April 7th, 2009 | Category: md / medical student stuff, personal | Comments (2)

So I just took a board exam towards medical licensure called the “USMLE Step II, CS” (US medical licensing exam Step 2, clinical skills).  The USMLE consists of 3 steps, each of which is taken at different points of medical training.  Step 2 is traditionally taken at the end of medical school.  Up until 4 or 5 years ago, all 3 steps of the USMLE consisted of written exams.  And then, someone had the brilliant idea of introducing a clinical skills portion to Step 2.  This practical exam is comprised of a rapid-fire history and physical of 12 actors pretending to have various, common medical problems, with subsequent documentation of the encounters.  To imagine how ridiculous this whole process is, think about the episode of Seinfeld where Kramer pretended to have gonorrhea for medical students (see below, skip to time = 3:01).

Anyway, so this exam costs over $1000 for medical students to take.  Moreover, there are only 5 centers around the US where students can take the exam, so if you don’t live nearby you also have to pay for transportation and an overnight hotel stay.  The biggest waste of $1000, well more like $1400 after all is said and done, that I’ve ever seen.

The general principle behind Step II CS is reasonable: that a graduating medical student going into residency training should be able to take a basic, focused history and physical from a patient with a common medical problem, then write a note about it.  Having taken the exam now, I can tell you that anyone who even performed sufficient motions to get through medical school should be able to pass this exam.  And anyone who couldn’t pass this exam probably wouldn’t be going to residency anyway.  Given the expense we go through with residency interviews and the subsequent move to residency, it’s such a crock of shit to have to pay so much money for such a waste of time.

Of course after my rant, watch me fail the exam.  Whatever.  Refer to my previous blog entry.

March 27th, 2009 | Category: md / medical student stuff, personal | Comments (1)

The match is over and I know where I’ll be for the next chunk of my life.  I lucked out because I’m going to my top choice for residency.  But still,  I can’t help but feel like I’ll miss having the residency match process to always complain about.  Sort of like having a 25 pound tumor cut off.  It’s gone and it feels good to have the weight off, but it’s sort of weird to not have it around any more. 

Knowing life though, even as limited as I have, something new will shortly appear to fill void about which I can complain. 

Anyway, I’m pretty psyched but I’m still waiting for it to sink in.  I’ve been at the same institution for eight years (> a quarter of my life) and now I’m moving away.   

Thanks for everyone’s good thoughts! 

More later…

March 19th, 2009 | Tags: residency | Category: md / medical student stuff | Comments (2)

It’s almost over.  The search for a residency program.  We’ve talked about the pains of traveling for residency interviews, of getting stuck in snow storms, of getting our luggage lost, of crashing planes and of the flaws in the process.  And now it’s almost over.  But not over yet. 

This past Monday medical students found out whether we matched or not.  First of all, if you know someone who didn’t match into a residency, make sure you give them some love.  For the vast majority of us, this process is a real crap-shoot.  Unless you’re one of the chosen few, the rest of us are on pins and needles from November to March with regards to getting interviews, to matching and to where we are matching. After four years (or more if a student took time off to do research or earn another advanced degree) of hard time, it would be great to end it all with a parade and a pat on the back but that’s unfortunately not the case.  But it can be particularly rough when it ends without matching into a residency. 

I received good news but I also know a lot of good, smart and talented medical students who didn’t.  I was in touch with one person who I was sure would get into one of the top residency programs in my field but found out that he didn’t match.  It just makes you shake your head, and unfortunately it leaves him and other unmatched medical students with tough choices to make.  In fact, he asked me, “what would you do if you were in my shoes?”

There are really two options: (1) scramble or (2) take a year off and reapply next year.  Every year, residency positions in all fields go unfilled at random programs across the country and these are up for grabs by applicants who didn’t match.  “Scrambling” is when unmatched medical students try to get into these unfilled residency positions.  The upside of scrambling into a residency is that the student would get into a residency.  The downside of scrambling is that the student would probably get into a residency program of low quality (these are usually the ones who can’t get enough medical students to rank them) and the student may not even get a residency in the field he applied in. 

So given these choices, what would I have done?  I’ve been thinking about this for a few days now and I think it comes down to a few factors:

1. Temporal factors (such as the applicant’s age) that would affect whether the applicant would be willing to delay his career by one more year
2. How much the applicant wants to go into his field of choice, relative to the next best option
3. How realistic is it that the applicant can actually match into his field of choice

So let’s breakdown each of these factors. 

1. Some medical students will already have taken significant time off–or rather, will have done something outside the track to residency.  I did a PhD.  While not exactly time “off”–I was working (although some people would argue about that)–my time in graduate school did not move me any closer to residency.  Other medical students take a year or two off to do research or pursue a masters degree during medical school.  Some medical students will have taken substantial time doing something else between college and medical school.  In my first year medical school class, we had at least 4 30+ year old people.  In contrast, I was 22 years–fresh out of college–at the time.  These factors can clearly impact how one chooses which option to take after not matching.  If it is simply not realistic to delay ones medical career any longer, then the applicant has to scramble and hope for the best.  If the applicant hasn’t taken any time off at all, then taking a year off and reapplying may not be a bad idea.  Most applicants are in the middle of these two scenarios so the decision is also affected by other factors. 
2. Some medical students couldn’t imagine practicing any other field of medicine besides [insert field here].  I know one guy in the year below who was born to be a neurosurgeon.  Everything about him screams neurosurgeon.  He will probably match into his choice of neurosurgery residency, but if he didn’t match at all, there is no way this guy would scramble into a residency program that wasn’t neurosurgery.  No way.  Then there are medical students who can barely make up their minds because they really love two different fields of medicine or, on the flip side, don’t really find any particular field to be really appealing.  One of the things we do for residency interviews, regardless of our baseline interest, is to pump up our own perception of how much we love the field to which we are applying.  It’s necessary for the interviews.  But if even after all of that, you can see yourself practicing a different field of medicine, then your options for scrambling are even better.  Alternatively, if you take a year off, you could reapply in a different field if you are worried about getting into a “top” program. 
3. Finally, I think if you don’t match–just like any other unmet goal–you have to consider whether the residency (field or particular programs) you are shooting for is realistic given everything (your grades, board scores, etc).  I think it sucks to come to this, but it’s a fact of life.  At one point I realized that I would never slam dunk on a ten-foot basketball rim.  It broke my heart, but there you have it.  If you feel like it would be a stretch to match into that particular specialty, then consider taking a year off and matching into another field (see #2 above), albeit a better quality residency program.  Otherwise, just scramble into the best place you can land.  If the programs you applied to are unrealistic but not necessarily the field itself, then you could take a year off and reapply to more realistic programs, if you couldn’t see yourself practicing a different field of medicine.  If you are scrambling, then you are probably still a competitive enough candidate (although maybe not competitive for the top, top residency programs) that you could get a decent unfilled residency slot somewhere, if you would be okay with perhaps practicing a different field of medicine. 

So, I think those are the 3 main factors that need to be considered when deciding whether to scramble or give it another go next year.  And that’s why I, or anyone else, can’t really offer helpful advice–only the medical student can sort through all of that. 

For me personally, I’m too attached to the field I’m applying in.  Plus I’m pretty stubborn so I would in general be on the side of reapplying the next year.  Even with having taken 4 years ”off” to do a PhD.  But one thing I will say is that if you do take a year off with the intention of reapplying, then make that year count.  Do something that will significantly add to your CV.  Join a research lab related to the field you are applying in.  Work with someone on some public/health policy initiative.  Do something that you can talk about at your interviews.  Clearly I don’t know about all possibilities, but if you can dream it, then there’s someone out there who will work with you.    

Best of luck to you my friends.

March 18th, 2009 | Tags: residency | Category: md / medical student stuff | Comments (1)

The review of systems (ROS): the clinical catch all that covers everything and nothing at the same time.  For the non-medical readership, the “review of systems” is the part of the history that your doctor (or whoever taking the history) takes from you (or any other patient) where he asks about a bunch of seemingly random symptoms that you may have:

Have you had any fevers or chills?  Nigtht sweats?  Unexpected weight loss/gain?  Change in appetite?  Sore throat?  Runny nose?  Chest pain?  Difficulty breathing?  Cough?  Nausea/vomiting?  Diarrhea/constipation?  Difficulty/burning/pain with urination? 

So what is it all about?  The point is for the physician to do one last review of all symptoms you may have covering all of the major organ systems (click on the picture for an appropriately thorough ROS checklist).  This can be an obviously important part of the history (1) if the physician forgot to ask you about a symptom and (2) because potentially serious medical problems masquerading as more benign processes can sometimes be detected through the presence of specific multi-system symtoms.  At least that’s the rationale we’re taught in medical school.   In practice, we’re faced many times with patients who have very obvious medical problems.  For example, the guy who was just hit by a car and is wheeled into the ER with a broken bone sticking out of his leg.  Asking that dude about whether or not he has had a runny nose recently probably won’t be helpful in managing his broken leg.  In fact, asking him about a runny nose will probably get a response like “FIX MY FUCKING LEG!!!!”  

Another common situation where the review of systems is not always incredibly helpful is for the routine follow-up patient.  The patient who has been coming to the same doctor for years for the same health problem that has been stable for years.  Sure you ask about symptoms related to the health problem or progression of it but asking about completely unrelated health problems–especially if you are a specialist?  Not that helpful most of the time.  Don’t get me wrong though–the ROS is very appropriate and can be very helpful in a number of situations but not always.  Judge for yourself: asking someone who has been going to the same neurologist for a seizure disorder about diarrhea.  Doesn’t seem too relevant to me but then again, you could argue that I don’t know that much yet. 

So why does an in-depth ROS happen all of time?  Probably billing purposes.  That’s a dirty little secret, which we should probably keep to ourselves.  And the more systems that are asked about, the more that your physician can bill the insurance company:  5- vs. 7- vs. 11-system ROS.  SHOW ME THE MONEY!  And while I find this amusing, it’s actually not why I write this post.

I was at a cardiologist’s office recently where the physician’s assistant was talking to a returning patient who has been coming in every six months for a well established history of a benign, episodic arrhythmia.  I was sitting there and watched this PA speak to the patient before the cardiologist came in.  The PA asked about cardiac- and arrhythmia-related symptoms.   And then, the review of systems.  Fevers/chills, night sweats, abdominal pain, nausea/vomiting, diarrhea/constipation, even a repeat of the cardiac ROS.  And as I was watching, it was so obvious–from my perspective, the patient’s and from the way the PA was asking–that most of these questions were out of place.  Moreover, it was also obvious that the PA had no desire to hear “yes”.  Trust me, I know the feeling.  I mean, what if the patient said something like, “yes, I have a sore throat”?  The cardiology PA would’ve said something like, “go see your primary care doctor”. 

Anyway, I couldn’t help but wonder, is that what I look/sound like when I’m running through the ROS?

As I said, there’s a time and place for a 5-, 7- or 11-system ROS.  But when people try to force it, it just comes across so wrong.  Sometimes, you can actually look really smart by asking a seemingly unrelated question–in particular if the answer is “yes”.  The patient is like, ”Wow, how did you know?  You must be really smart to know that seemingly unrelated symptom is connected to my disease!”  In my experience, though, this only works when you know what you are talking about.  At least for me.  I’ve nailed it a few times when I have a good idea of what the patient has and I know about the multi-system symptomatology that accompanies the disease.  If I ask questions blindly and get an occasional hit, the patient will ask something like “Why–does that mean something?”  And then I’m stuck sitting there like, “uhhh, I don’t know” or “uhhh, probably not”, in which case I look stupid for asking about something that has nothing to do with why the patient is there. 

I hope I don’t get a lot of angry comments about the importance of the ROS–because I don’t disagree.  My only point is that there is a time and place for it and the varying levels of depth that one needs to go into–depending on the patient’s history, risk factors, past medical history, family history, etc–there’s a reason why we ask about those things people!  Yes every disease can have multi-system symptoms that could be helpful to ask about but how many people with disease X do you ask about symptom Y to get a positive hit?  100?  1,000?  1,000,000?  At some point, you have to balance the 24 hours in a day with the desire for thorough patient care. 

I can’t help but wonder if I look like as big of a tool as the PA when I’m running through the 11-system ROS on someone who came in for a dermatology follow-up on their acne.  In the last year, I have been using some clinical judgement in regards to how much of an ROS I go through with patients.  I’ve generally gotten very little flak about it, which is helping me build up some confidence that I’m asking the right questions in a focused history.  (Is it possible I’m learning something?!?!?).  Sometimes, I just gotta bite the bullet and do it for billing purposes (every service is different), so I do it.  But I can’t help but feel like a real tool when I’m doing it that way–sort of seems like abandoning clinical judgement for the judgement of insurance companies–and the patient can tell too.

What are you gonna do though?  That’s medicine: a balance of time, efficiency, patient care, and getting paid.  All very important, but I don’t even want to get into that now.  In any case, next time you go to see a physician, someone takes a history from you and ends it by asking about a hodgepodge of symptoms, you can (1) ask for a justification for asking about such symptoms–”why, is blood in my urine related to my needing refills on my seasonal allergy medications?”, (2) ask how many systems they have to probe in their ROS for billing the insurance company or (3) be nice and not give anyone a hard time.  If by chance you see me, the answer better be choice #3.  But then again, it could just be karma biting me on the ass for bringing this up to begin with.

March 15th, 2009 | Category: md / medical student stuff, personal | Comments (2)

I have now updated and reorganized the entirety of my medical mnemonics pages to make it considerably easier to read and even print.

Check out the newest medical mnemonics in the categories of:
cardiology
endocrinology
gastroenterology
hematology/oncology
nephrology
pharmacology/toxicology
psychiatry
radiology
rheumatology
surgery

March 13th, 2009 | Category: md / medical student stuff | Leave a comment

I ran across this free virtual anatomy software courtesy of our friend Dr. Shock: the “Visible Human Server” and thought I’d pass it on.  When I’m trying to study anatomy, I always find that a 3-dimensional approach is most helpful with an emphasis on looking at cross-sectional anatomy, which is the view physicians often run across when looking at CT scans and MRIs.  For you first year medical students out there taking your general anatomy course, definitely study some cross-sectional anatomy (which is always a popular source of anatomy exam questions), such as from Step by Step Cross Sectional Anatomy by Karthikeyanor Fundamentals of Sectional Anatomy: An Imaging Approach by Lazo.  A review of cross-sectional anatomy is also helpful for those of you medical students on the general surgery clerkship where you’ll be pimped on anatomy.  Painful–just painful.

March 13th, 2009 | Tags: anatomy | Category: md / medical student stuff | Leave a comment

Do you hate memorizing all of those equations for calculating creatinine clearance, total body free water deficit, or even conversions between the different steroids doses?  Well check out this website:

www.medcalc.com

or another related website

www.mdcalc.com

These are easy to remember urls and easy to use on the spot on the wards when you will actually need them.  General categories of clinical calculations include: general, cardiology, drugs/pharm, fluids/electrolytes, obstetrics, pediatrics, pulmonary and renal.

March 9th, 2009 | Category: md / medical student stuff | Comments (3)

Hi everyone–I just wanted to put a plug out there…I’ll be on the Dr. Anonymous blog talk radio show this Thursday, March 12 to talk about Match Day 2009.  If you’re free, tune in and listen to us talk about the bane of my existence for the last eight months.

March 8th, 2009 | Category: md / medical student stuff, md / phd student stuff, personal | Comments (2)

Here’s an image below showing serial MRI slices through the brain of patient I saw today who was admitted to our hospital for several months of headache and recent onset weakness:

Each one of those little white dots (numbering over 20-30 in total) is a suspected brain metastasis (try clicking on the image to blow it up and make it clearer) from an unknown primary cancer that we’re hunting for right now.  Even if those white dots aren’t brain metastases (let’s hope so for the patient’s sake), as one attending physician commented this morning, nothing good could produce a brain MRI like that. 

Just another reminder to enjoy life and not sweat all of the daily bullshit we deal with–it could be much worse.

March 3rd, 2009 | Tags: radiology | Category: md / medical student stuff, md / phd student stuff | Leave a comment

So I learned how to tie basic surgical knots from YouTube.  I tried to get my intern and residents to teach me when I was on my first surgical rotation but the intern was just way too tired (she really tried though) and the residents were too busy.  So I ended up finding a video on YouTube and practicing over and over and over again.  At least with a square knot, you can tell from looking at it if you’ve done it the right way.  Anyway, so I got good at tying surgical knots.  One day in the OR, I was called on to tie off a small vessel–glory of glories! 

And… Boom!  That’s the sound of the mudphudder dropping the bomb on that vessel.  Anyway, the vessel was tied off no problems and we moved on although the attending, fellow and resident started talking about how they first learned to tie a knot–all very sweet stories of mentorship and camaraderie.  When I was asked, I fessed up to learning from YouTube, at which point everyone stopped, looked up and there was an uncomfortable silence.   I don’t know, I thought it was pretty funny.  Whatever.  The patient went on to do quite well and I’m still dropping bombs in the OR (e.g. tying knots).  For those of you equally neglected medical students, here’s a link to some youtube videos on surgical knot tying.  It can be hard to learn, and certainly tested my patience, but if I can do it, so can you.  I found that watching others do it in the OR and asking residents to show me whenever there was a free minute was all helpful in putting it all together in my head. 

I will say that once I got to my proper general surgery clerkship, I received an actual tutorial on how to tie knots (so I wasn’t that neglected).  But, if you are on your surgery clerkship or will be soon and want a quick primer on how to tie those bad boys, grab a shoelace, something to tie it around and check out youtube.

March 1st, 2009 | Category: md / medical student stuff | Comments (2)

So my residency rank list was finalized last night at 9pm.  It is no longer in my hands.  Now some computer algorithm written by a guy who undoubtedly still plays Dungeons and Dragons will determine my future.  Note I didn’t say Advanced Dungeons and Dragons because that would have tipped some of you off that I once played–when I was 11 years old.  Okay 16.  Okay, last week.   

For those of you who are interested, I have attached a copy of the report published this year by the NRMP (National Resident Matching Program–the peeps who figure out where medical students go for residency) of a survey they took of residency program directors on what they look for in residency applicants.  For those of you who aren’t in medicine, this can give you an idea of which specialties attract the most anal-retentive students (i.e. the specialties where high scores in everything is important) and which specialties attract the slacker medical students who wouldn’t be able to get into any other specialty.  For those of you in medical school and thinking about residency, this might actually be helpful in planning out what you will need to focus on (I wish I had a copy of this several years ago).  And for those of you who already finished medical school, it might be fun to look this over and realize that you never would have made it into your specialty had you been applying this year as opposed to ten years ago.

February 26th, 2009 | Tags: residency | Category: md / medical student stuff, personal | Comments (2)

Four call nights and one GI virus in the last nine days and I’m done.  That’s it my peeps.  I am officially done with all call nights (and viral infections) for medical school.  The next two weeks should be smooth sailing.  Knock on wood–because right about now is when the bottom drops out.  Anyway, I have been a little occupied from writing posts consistently over the last week so I will start back off with my two cents on a little something that just kills me when I got to see patients.  And in fact, I don’t want to be a hater, but I have to call out the male patients on this one.

Why is it that you put your bedside urinals right where I’m going to walk?  Do you see the little table up to the side of your bed which is out of the way?  Why not put it there?  Here’s what kills me.  I can normally avoid the bedside urinal–and it is almost always at least partially full with the cap off–when it is in plain view and I can even anticipate it’s presence when it’s hiding under the bed just within range of my feet.  But, when I’ve been in the hospital for 16 hours per day and 5 hours of sleep per night for the last X-many days, my sixth sense for the bedside urinal is not as “on”. 

So, then I walk into the room, kick over the urinal, which as I mentioned is at least partially full with the cap off, pouring a puddle of piss onto the floor of the room.  Then when I bend over to examine the mess and my piss-splashed pants, of course everything in the breast pocket of my white coat falls out into the puddle of piss.  My pens, my notecards on my other patients, my chewing gum, and of course a $10 dollar bill.

It’s enough to make you want to flip out.  So for those of you who have to brave the wards, I recommend that you look out for the bedside urinals.  And for the guys out there, I hope you never have to be in the hospital.  But if you are and you have to use a bedside urinal, put the God-damned cap on when you’re done and put it somewhere where I’m not going to kick it over by accident.

February 20th, 2009 | Tags: humor | Category: md / medical student stuff, personal | Comments (2)

Sorry–it’s been a slow week for new content on mudphudder’s blog.  This has been a really busy week and I’m halfway home now.  I’ll write put some new material up this weekend and ask that you bare with me for the next two days.  It should be smooth sailing from there on out.

For now, if you haven’t already done so, please check out Praxis #6 Blog Carnival (my previous entry).

February 18th, 2009 | Category: health, md / medical student stuff, md / phd student stuff, news, personal, phd / graduate student stuff, research | Comments (2)

I received very few submissions for this edition of the Praxis blog carnival.  Actually, I don’t want to sugar coat it by saying there were “very few”…there was actually only one post submission by Dr. Shock. Another reader submitted his entire blog URL, but that doesn’t really count because blog carnivals are collections of individual posts (regardless, I went to his site to find an article, and one of his posts appears below).  The whole experience was sad, actually.  I contacted Martin (at The Lay Scientist), who started Praxis, to tell him about the dearth of article submissions.  He assured me that this happens often with new blog carnivals, and the best thing that I could do to keep Praxis going was to hunt down a few articles myself.  It wasn’t exactly what I had in mind when I decided to host, but you gotta do what you gotta do sometimes, right? 

The theme for my edition was inspired by the chorus of the song, “Ooh La La,” by The Faces and Rod Stewart.  If you’re not familiar with the song, the chorus lyrics are: “I wish that I knew what I know now / When I was younger. /  I wish that I knew what I know now /  When I was stronger.”  So, on my hunt for articles, I looked for posts that would actually teach a graduate student, young scientist or academic a few things that they may not know at this specific time in their lives or careers.

Dr. Shock - You can learn something new everyday on this blog…but how about one thing that I wish I knew when I was younger?  Maybe just how freakin’ good chocolate is for your health!  I would have ate so much more.  Anyone have any Chunky bars?

A Blog Around The Clock - A post about the interplay of politics, money and the power of the people.  It’s called, “Who Has Power?”  Now, tell me you didn’t wish you knew the answer to that when you were younger (and when you were stronger).  

Incoherent Mimicry - Mi teaches us that we should let loose every once in awhile.  She shares some interesting studies that show having a healthy social life may actually be beneficial to our health.  Perhaps this post will inspire some people to put their work aside on a Friday or Saturday night to spend some time with friends.

Comrade PhysioProf - A short post reminding us not to believe everything we read or hear in the media…more specifically, that any analogy between newspapers and universities in their quest for facts and truth is…well…how should I put it?  F-ing ridiculous. 

The Mad Scientist - I would bet most scientists would learn more from this post than from a whole month’s worth of Nature journals.  This medical student blogger says she wishes she knew how to dance when she was 15.  Now that she’s older (24…she’s really getting up there), she’s sharing with us just exactly how to bust a move on the dance floor.  I don’t know about you, but I’m bookmarking this one…I mean, how many scientists do you know who don’t look like complete tools on the dance floor (if they even get out on the dance floor)?

Leeat Granek, Ph.D. - A touching article about the true meaning of love by Dr. Granek at The Huffington Post entitled, “Everything I Know About Love I Learned From My Parents.”  A beautiful lesson in love that you’re never too old to learn.

Acadamnit - Gives prospective grad students (or one in particular) a few pointers on applying to graduate programs.

Medaholic - (For the medical students out there) Shows us that “Studying Can Be Fun”–what?  Did I read that right?  

Lastly, Dan at DailyMeds has a list of important things to take the time to do this year.  I say it’s not just a list, but timeless advice–words of wisdom–for the young and the old. 

Next edition of Praxis will be up at the home of its founder at The Lay Scientist on March 15.

February 16th, 2009 | Category: md / medical student stuff, md / phd student stuff, phd / graduate student stuff | Comments (6)

So, I will be hosting Praxis No. 6, which will go up next Sunday, February 15.  For those of you who aren’t familiar, the Praxis Blog Carnival is about the academic life.  Topics in the past have ranged from basic advice on studies and careers to life lessons on the academic path. 

Since I am hosting this edition, it turns out that I get to pick the theme.  As someone who’s made it through a few (I should say very few) stages on the way to a career in academics, I feel some duty to share my experiences so that others may gain some insight from my mistakes and occasional good judgment. 

While I can only pass down my experiences to graduate students and medical students, I think that people at all stages in academia (no matter how advanced) could benefit from hearing about what others have gone through–lessons that wouldn’t have otherwise been totally obvious. 

Therefore, my theme for Praxis No. 6 is the chorus of the song “Ooh La La” by Rod Stewart:

“I wish that I knew what I know now
When I was younger.
I wish that I knew what I know now
When I was stronger.”

That is one good song!  Use it as inspiration in any way to write about life in academia.  All are welcome to submit but please submit your entries by Friday, February 13 to me at mudphudder@gmail.com (please include “Praxis” in the email title so I know what it is for).  It would be great if you would stick to the theme, but I will include posts on other topics as well.

February 8th, 2009 | Category: md / medical student stuff, md / phd student stuff, personal, phd / graduate student stuff | Comments (2)

What is it about professional wrestling that makes it the common denominator for every red-blooded male regardless of age, race, socioeconomic status or health?  From the lowliest of lows to the highest of highs, no male can help but to crack a smile at the thought of professional wrestling.  And you know why?  Because no matter who you are, you know it still rocks.

I know what you are thinking.  And, YES,  the mudphudder does occasionally watch pro-wrestling.  An occasional dose of Friday Night Smackdown never hurt anyone.  More likely is the scenario where the mudphudder will be scanning the channels on TV, run across some pro-wrestling that’s on and pause long enough until a certain individual will nudge him to continue onwards.  Whatever.  Like “Pride and Prejudice” is any better.

I bring this up because we have a chronic schizophrenic on our service right now with very obvious thought disorder and who has that classic Parkinsonian mask-like face from years of taking neuroleptic medications.  Talking to him is like talking to a statue.  The other morning, it was brought up on rounds that he had been watching pro-wrestling on TV and when we asked this patient about it, his normally stone-faced, blank look lightened up and we saw a rare smile curl up on his face.  Not only that, but every other male, from medical student to resident to attending was smiling/chuckling too.  And to be quite honest, when we asked him who was wrestling that night, I’m not so sure we were doing that just to evaluate his mental status rather than just to talk some wrestling.

So I may have turned off two subpopulations of readers: 1) the ladies.  I’m pretty sure that all of the females on rounds were just shaking their heads during that portion of the conversation.  I can dig that.  I think it’s a mostly testosterone-driven phenomenon, so I can understand.  But the mudphudder makes no apologies for watching and talking pro-wrestling.  And 2) the sophisticated gentlemen who are above watching such baseless violence that is tearing at the moral fabric of our country.  Yes, I am referring to the closet pro-wrestling fan.  To this person I say, “Dude!  Let free your true self!  We love you for who you are!”  Once again, the mudphudder makes no apologies.

To conclude, I grew up during the reign of Andre the Giant and Hulk Hogan, who used to tell me to say my prayers and take my vitamins.  And I’ve watched pro-wrestling grow considerably over the last 25 years to become a part of our collective subconscious.  I mean, without having to provide an explanation to anyone present, how many times have you been talking trash talking and said, courtesy of Hulk Hogan, “Watcha gonna do when the [your name]-ster’s 23 inch pythons run wild on you?”  Hmm… Curiously, I used to say this in lab a lot to other graduate students, despite the fact that I don’t have 23 inch pythons.  Moving on though, how many times have you nailed an experiment in lab or scored a goal in your intramural league and screamed, courtesy of the Rock, “Can you smell what [your name] is cooking?!?!?!”

Yeah, I thought so.  That’s what I’m talking about.  Can you smell what the mudphudder is cooking?!??!

January 27th, 2009 | Tags: humor | Category: md / medical student stuff, personal | Leave a comment

Check out the 15th edition of SurgeXperiences hosted this week on Vagus Surgicalis, a blog by Aussie (pronounced “ozzie” I’m told) medical student Jeffrey Leow.  For those of you who are not familiar with it, SurgeXperiences is a blog carnival that compiles the surgical-related posts from the medical blogosphere.

January 19th, 2009 | Category: md / medical student stuff, personal | Leave a comment

Just a quickie post to let everyone know that Grand Rounds is up this week at In Sickness and In Health.  In case you are unfamiliar with Grand Rounds, it’s a blog carnival that’s hosted on a different site every week. The host chooses a theme (this week the theme is “connections”) and links to blog posts (from medically-oriented blogs) that tie in with the theme.  It’s always a great & informative read.  Here’s a link to the edition from this week:

http://insicknessinhealth.blogspot.com/2008/12/grand-rounds-vol-5-no-17.html

January 14th, 2009 | Category: health, md / medical student stuff | Leave a comment

“Hello, I am a medical student.  I have been assigned to join you for clinic today and afterwards, you need to fill out an evaluation of my performance that I need to take with me when I leave.”

[Fast forward 9 hours]  

“And now that clinic is over for the day, here is my evaluation form.  It should take no more than 2 minutes to fill out and seal in that envelope and then I will be out of your hair.”

How often do I find myself 2 minutes from being done for the day, and then the attending physician starts talking to the resident in the room about something ridiculous such as where they like to go shopping… For the next 30 minutes.  Helloooo????  The evaluation form in your hand…  Could you please fill it out?  Just check off the lowest grade in each category–whatever–just let me get out of here–or at least talk about something medicine-related from which I might learn something. 

Oh!  You’re done–no, no, no, don’t start calling your spouse on the phone to see who’s picking up the kids!  This will take you 2 minutes–15 seconds if you just mark off the lowest score for each and sign it. 

Geez, that kills me.  It’s like, does anyone here remember what it was like to be a medical student?  I’m pretty sure I told you all 5 times that I have a big exam in 3 days. 

I found myself in this situation a few days ago.  After I sat through a 30 minute discussion of places to shop in Vail, Colorado, the resident left and the attending started to fill out my form.  A minute later, the resident came back and the attending dropped my form–half finished, unsigned–so they could talk about something else. 

Am I missing something here or is this as ridiculous as it seemed to me?  When I mention this stuff to buddies who are in or have finished residency, the answer is: of course medical students get treated like crap–that’s just how it is.  I never know if that’s a joke or not.  Perhaps, there’s my answer right there.  I hope when I’m a resident and, later, an attending I have the decency to not make my medical students stand there listening to me gossip or talk about personal (i.e. not related to patient care or medical education) matters with other colleagues.  But then again, maybe I won’t because “that’s just how it is.”

January 13th, 2009 | Tags: consideration | Category: md / medical student stuff, personal | Comments (1)

Or can you? 

So every clinical department at academic medical centers around the country wants to hire physician-scientists.  Physician-scientist?  You do research?  Hired.  And that’s great–could be much worse–as the job market is quite good for any physician who also wants to do research.  But, there are still a lot of obstacles in the way of becoming a successful physician-scientist, most notably: funding and how to balance clinical vs. research time in order to generate one’s salary.  One complaint I’ve heard from almost every academic physician who also does research is regarding the departmental pressure to increase clinical responsibilities.  This is particularly true in clinical departments whose physicians usually generate a lot of revenue (e.g. some surgical fields, dermatology, radiation oncology) through clinical practice.  Often, junior faculty are hired as “physician-scientists” with a favorable research to clinical time split (e.g. 80:20%) but are very quickly sucked into increasing clinical activities from various soures of departmental pressure.  The problem is that whenever money is involved in the equation, it will usually be at the expense of research since clinical work is much more likely to bring in the $$$ than a research grant.  Sure everyone comes in with “protected time” but soon the phone calls start coming in from colleagues who want X, Y, or Z, including taking on new patients and of course all of the follow-up that comes with them as well.  This scenario seems to be particularly true for physician-scientists in the surgical fields who may feel a lot of pressure up-front to take as many surgical cases as possible. 

As I am just now starting to think about choosing jobs and balancing clinical with research responsibilities, many established people in my field have been warning me of the difficulty in getting significant research done.  With calls coming in to see this patient or that one and your department chair on top of it all pushing you to bring in revenue for the department, I’ve been told that it is near impossible to have substantial research time.  Now obviously, this is true to varying degrees depending on what field of medicine you practice.  But for me, these pressures are particularly true. 

So as I sit for my residency interviews and get some love for being a mudphudder and for having a research track record, in light of everything I’ve heard from practicing physician-scientists I can’t help but wonder what it is that clinical departments really want.  Actually, no–I think I do know what they want–they want it all–a physician who brings in tons of clinical volume and revenue and at the same does important research too–regardless of whether it is realistic or not. 

Which is why I offer this reality check to the ones on top–you can’t have it all. 

Being a successful physician-scientist (not just publishing a lot of case reports and review articles) is hard (I can probably count on one hand the number of practicing physicians who are either in HHMI or the NAS) and requires not only a lot of luck but also finding the right balance of clinical:research responsibilities that is independent of the agendas of others. 

So to those of you who are going through this right now, I say good luck.  And for those of you who have gone through it and/or have insight into the process (e.g. avoiding common pitfalls), please share this insight with us!

January 10th, 2009 | Tags: academics | Category: md / medical student stuff, md / phd student stuff, personal | Comments (1)

It’s the new year, and no doubt some of you are starting to prepare for your first USMLE exam. It is also the age of the internet, and while buying USMLE prep books will always be part of the drill, these days looking for USMLE study resources online isn’t unusual. The hard part, though, is googling the right keywords and then sifting through all the junk and finding the few useful USMLE websites that exist. Doing this takes time (trust me, I remember from when I had to do it). I thought I would put together a few (free) useful USMLE resources that I’ve found online that might help any upcoming USMLE test-takers out there.

 

Get some USMLE practice via Twitter

Those of you who have not signed up for a Twitter account, you may want to think about doing so if only for the free USMLE prep questions you can get delivered to your Twitter online account or to you via Text message. Some users who are sending out USMLE prep updates include: usmlemd and firstaidteam. Once you sign-up for your account, click on their Twitter account links and choose to “follow” them. It’s worth noting, as well, that usmlemd is also the individual who runs http://usmlemd.wordpress.com/, which is a USMLE prep site in blog format and a good resource to peruse.

 

One is the loneliest number…Need a USMLE study buddy?

http://www.usmlebuddies.com/

This site lets you post requests for a USMLE study partner or browse through requests to locate a study buddy for yourself. Requests are organized by USMLE Step 1, 2, 3 test takers. Each student requesting a study partner, lists their location, exam date, and email address.  Some students also list specific preferences (ie. female partner).

 

Where’s the beef?  Here it is!  Links to FREE USMLE questions & Qbanks

http://www.mommd.com/usmletestsampler.shtml

60 practice questions provided by Kaplan Test Prep organized into 10 question blocks.  Be sure to click on the links at the top of each section (for example, Questions 41 - 50) to be taken to the full text of those questions (and their answers).

ValueMD

Janky website, but lots of free practice questions. Downside: you have to register and login to access most of it. Also includes a QBank called Tommy’s Concepts with over 700 questions and answers.

http://www.testprepreview.com/usmle_practice.htm

A link heavy page, but skip down to the bottom of the page to where it says “Self-Assessment Modules.”  Questions are grouped into 20 different subject matters, and each subject matter contains 20 questions.  Bam, 400 free practice USMLE questions right there.  

http://www.lww.com/medstudent/usmle/

Lippincott offers a free 350-question practice test for USMLE Step 1. Even though it’s free, you have to register as a user on LWW.com to be able to take the practice test. You can opt to take the test in either review or test mode. You can also choose to take the test all at once or 50 questions at a time.

http://www.wikitestprep.org/

Free Step 1 questions written by students who took the test. Explanations are linked to wikipedia for more info. Features include qbank, comparing your results to other test-takers, creating personalized tests and flagging questions.

January 8th, 2009 | Tags: USMLE Step 1 | Category: md / medical student stuff, md / phd student stuff | Comments (2)

Anyone ever hear of an Institute for Simulation?  Me neither, but apparently one exists at the University of Washington.  The exact name is the Institute for Simulation and Interprofessional Studies (UW-ISIS), and they boast a program in medical simulation that aims to help doctors improve surgical dexterity, reduce error rates and foster effective teamwork.  

UW eventually wants all its students who are studying in health-related fields (medicine, nursing, etc) to use the cutting-edge virtual reality technologies available at the institute before working on real patients.  The Executive Director of the institute even envisions that this type of training could be used to weed out potential future surgeons.  He says: “I’d rather be able to tell some surgical resident, after 25 unsuccessful tries on a simulated patient, that maybe he ought to consider going into pathology.”  Hmmm…I don’t know about you, but I’d rather know that BEFORE I’m a resident.  

Some more food for thought: who’s to say a student who performs well on a computer in a simulation would work just as well under particularly stressful conditions in the O.R.?  That is, aren’t some things just simply impossible to simulate no matter how advanced technology gets?  I guarantee that a computer program will never fully simulate the stress of when a patient is bleeding in front of you–because of you.  

Regardless, I definitely see many positives in such a training experience–for example the very obvious benefit of practicing one’s skills at any time without the restriction of having to be in the O.R.  In fact, I look forward to trying my hand at some of those gadgets in residency.  Here is a link to the full article published January 4, 2009 on seattlepi.com (Seattle Post-Intelligencer).

January 5th, 2009 | Tags: surgery | Category: md / medical student stuff | Leave a comment

As a medical student you never really know what people expect from you.  Do too little and you’re “lazy” and/or “disinterested.”  Do too much and you’re “arrogant,” “overbearing” and/or “not a team player.”  One aspect of surgery I’ve always loved is the well-defined roles for everyone.  In the O.R., each attending has a slightly different expectation from medical students; you just have to figure out what that expectation is.

I’ve had very few painful experiences in the O.R., but one sticks out in my mind very clearly.  It was a bowel and partial liver resection, and four people were scrubbed into the case: the attending, the fellow, the third year resident and me.  It turns out that this attending (who is an amazing guy and surgeon) expects medical students to be in charge of suctioning.  Unfortunately, I was told to stand away from the suction so it was not within my reach, with the resident standing between me and it.  I was dreading it, but inevitably, the attending said, “suction.”  He looked up at me and said it yet again.  Then, still looking at me, he repeated, “suction.”  What to do?  Option #1: Push the resident, who had his hands in the patient’s abdomen, aside and grab the suction, or Option #2: Stand there sheepishly saying, “Uh… uhhh…  I… I don’t… I don’t have the…  I can’t get to the…”  I went with Option #2.  Finally, the resident grabbed the suction, suctioned the abdomen and then placed it back where it had been: out of my reach.  Hmm… Again, what to do?  I was pondering this question when again I heard, “Suction…  Suction…  Suction…  I need suction here.”  Oh crud.  The resident grabbed the suction again, but this time gave it to me so I could suction.  Great: my problem was solved.  So, being the good medical student that I was, I stood there, vigilantly looking for an opportunity to suction, when the resident took the suction from my hand, used it and put it back where it had been before: out of my reach.  “Suction…  Suction…”  Oh.  No. 

Let me just say that this cartoonish back-and-forth went on for another 4 hours.  It was painful.  Every time that resident took the suction from me and put it away–out of my reach–was like getting punched in the gut.  I knew what was coming next. 

But it’s all good…just one of those days, I guess.  Didn’t change the fact that for my money, it just doesn’t get any better than a good day in the O.R. with a good team.  After the case, I was sitting in the SICU with the resident when the fellow–who is now a good friend of mine–walked in, saw me and started laughing his head off. 

We all did.

January 2nd, 2009 | Tags: surgery | Category: md / medical student stuff, personal | Comments (1)

I will officially wrap up my holiday season today with the last installment in my “season of giving” posts.  And what better gift to give an authority figure and clinical role model than your innocence.  Yes!  Give it up!  Now, while what I refer to may be derisively called by some (such as ME), “getting my idea ripped off by faculty member who I went to for help in developing it,” others (such as the faculty member who ripped off my idea) would call it “giving a special piece of yourself to someone you look up to.”

So I used to believe in the complete purity and goodness of those in academia–the ivory tower: scholars, I said, who strive to educate.  I gave those beliefs along with my innocence to the faculty member who ripped off my idea.  Without getting into too much detail, about six years ago I had an idea for–let’s call it–a “scholarly enterprise.”  So I took this idea to one of our medical school faculty, a junior faculty member who was excited to help me (after discussion with a more senior faculty member who was quite helpful but didn’t have the time to help me).  “That’s a great idea!”  The next time I met with him, he told me that he had met and talked to someone else about this “scholarly enterprise” and found a way to turn it into a serious “money-making enterprise.”  He told me that he and this new collaborator might be meeting at place X at time Y, but that he would confirm it by email with me.   So time went by, drawing closer to time Y, so I sent this faculty an email without reply.  So when time Y arrived, I decided to go to place X just in case the meeting was going on.  As it turns out, the meeting was in fact happening and I was greeted with, “Oh, you’re here.”  Indeed, I was there.  Except that I wasn’t.  The conversation went back and forth between Faculty Mentor and the collaborator–on and on about how to transform the “scholarly enterprise” to “major money-making enterprise.”  Eventually the meeting was over–I think I was talked to about twice (once to assure me that they would allow me to be involved)–and I was left wondering what had happened.  The last thing I heard at the meeting was, “I’ll email you when we’re going to meet again.”  Indeed.  And yet, no emails. 

I still see Faculty Mentor around the hospital every once in a while and exchange pleasantries.  And sometimes he’ll ask, “So what’s going with your research…”  And it strikes fear in my heart: what he wants to steal my research ideas now?  Over the years I’ve come to learn from various people in-the-know that this individual does a lot of unethical things, in particular for money (Yeah, Bud–if you’re reading this–I know what you’ve done.  Probably the least of it too).

So what is the lesson of this story?  Easy, don’t trust anyone–especially if you are young and low on the totum pole.  If you are a student, forget about it.  You will get crushed like a bug and who’s gonna know about it?  Seems cynical, but I just showed you it can happen.  I had no recourse.  What good would it do anyway?  I took a good idea (really good, in my opinion) to a faculty member to help me develop it but my idea was ripped off and bastardized to maximize the revenue that could be made off of it.  I still remember that last meeting and how excited this guy was with his collaborator about how much money they would make.  And what is left of the Mudphudder?  Well, I plan on eventually going through with my idea.  I don’t know if I’ll really have the time again to do it, but I’ll try.  Also, if and when the bastardized version of my idea makes it to the market (if it already hasn’t), it’ll make it harder on me, but I’ll take a shot at it anyway. 

But at least Faculty Mentor has given me the gift of life-long emotional scars.  However, this is not a problem specific to or more rampant at my  institution or your institution.  It’s all over.  It’s a fact of academics–yes, I’ve met and spoken with people from all over with similar experiences.  But, I don’t honestly believe that most people in academics are like that.  In fact, probably 99% aren’t (that may be generous) but you just don’t know who the sleazeballs are.  In hindsight, there is no way I could have known.  So now, whenever I have a good idea, I either keep it to myself, waiting for the time that I become a faculty member with at least some recourse if someone tries to rip me off.  If and when I do say something about it, I only talk to a select few who I trust and even then, I protect myself. 

If you have no recourse against someone who could steal your idea and if there is no reason besides “ethics” for someone to not steal your idea, then I would recommend that you think twice before you share anything with anyone.  Unless of course, it is the season of giving and you are in a giving mood…

December 31st, 2008 | Tags: academics | Category: md / medical student stuff, md / phd student stuff, personal, phd / graduate student stuff | Comments (4)

How many times have you been faced with a patient who needs splinting for a sprain or a fracture?  Fractured wrist?  Splint it–follow up as an outpatient.  Here’s an instructional video posted on the New England Journal of Medicine website that is equally helpful for first-timers as well as pros looking for a refresher:

http://content.nejm.org/cgi/content/short/359/26/e32

December 26th, 2008 | Tags: techniques | Category: md / medical student stuff | Leave a comment