Wednesday, December 31, 2008

Top 8 Scrub Notes Posts Of 2008

As 2008 winds down, here are the top 8 posts of this past year! 
I do have a quick favor to ask of you, the readers of this blog. I try to view the blog on a few different browsers just to make sure it looks alright, but I can only check so much. If you happen to notice any formatting issues, please email scrubnotes(AT)gmail(DOT)com or comment below. Please include a brief description of the issue, your browser and OS. Thanks!

Happy New Year!

Sunday, December 28, 2008

Most Stressful Medical Specialty?

Stress is hard thing to judge within a medical specialty. Various factors play a role in creating stress, from the patients and procedures themselves, to one's work environment and career path. I'm not sure how to weight all these factors, but here's the sense I've gotten from the specialties I've been exposed to. 

5 Most Stressful Medical Specialties

1. General Surgery - perhaps I'm biased by the training, but I think given the career, it seems like a lot of stress, considering the income and hours down the road.
2. OB/Gyn - the training is hard, the hours are long, the liability high, and there's relatively less 'control' / predictability over how patients will do from what I've seen. 
3. Internal Medicine - again, just biased by what I see the residents go through. 
4. Surgical Subspecialties - stressful to train, but I think it gets easier in the career itself.
5. Emergency Medicine - while the career is good, I think the fact that these are 'emergencies' is stress inducing on its own, plus who wants to do overnight shifts when they're 60?

As for the least stressful medical specialty, I don't think you can wrong with the old "ROAD" mnemonic (radiology, ophthalmology, anesthesia, and dermatology). Some people would also throw pathology (heh, PATH / ROAD, get it?) and emergency medicine in there as well. While all are competitive to train for, I think the lifestyle down the road more than makes up for it, leading to less stress overall.

What do you think? Perhaps there are stressful specialties that I just haven't been exposed to?  

Saturday, December 27, 2008

Books For Surgery Core Clerkship / Rotation And Shelf Exam

As underclassmen have increasingly started asking me for advice on rotations, I thought I'd put together a few guides on good review books for surgery. The surgery core clerkship / rotation is one of the most important in medical school. The grade you receive on this rotation is on par with your medicine grade and second only to the USMLE Step 1 score in terms of factors that residency program directors evaluate. Your grade will likely be a mix of clinical evaluation and your shelf exam score. However, since the evaluations tend to average out to the same values, the shelf exam is what separates the great students from the good ones.

To do well on the rotation requires the usual medical student qualities of diligence and compassion, but the three main things to know are: know your patient, know your anatomy, and know the procedure. If you know those three things and study hard, you will succeed. But, how does a medical student acquire all that knowledge in short period of time? The key is studying good resources efficiently. Here are my recommendations:

Books For Surgery Core Clerkship / Rotation

For any rotation, I would suggest starting off by reading a clinical vignettes book initially, to get familiar with the cases seen most commonly by the specialty. Then, read a general textbook or review to learn more details about the patients and procedures. Finally, do practice questions in the weeks leading up to the test to solidify your knowledge. These principles are especially important during the surgery core clerkship, when your time is limited. Here are the books I used primarily:

Essentials of General Surgery
by Peter F. Lawrence

This textbook covers the major areas of general surgery in an easy to read fashion. The early chapters on fluids and electrolytes are also important, as many questions on the shelf exam deal with management of patients on the floor.  I read this book during the first half of my surgery clerkship and it served me well.

If you are familiar with the Case Files series, then you know that these books are a good way to get up to speed on any clerkship. They are quick to read, but really help you understand the basic concepts and cases within a specialty. Read this book right before your rotation starts or during the first week. 

by Bruce E. Jarrell

An excellent book full of different cases and their variations. I personally liked the clinical case format, especially how the book managed to discuss common complications. The pictures and diagrams are also quite helpful.

by Lorne H. Blackbourne

This book is particularly handy while you are on service with some time to spare, like me on my minimally invasive (ie bariatric / laparoscopic) surgery rotation. Put it in your whitecoat pocket and pull it out during those little pauses during the day. Flip to the section that covers your next case, and learn all the answers to common pimp questions. You'll look like a rockstar in the OR. 

Other Books For Surgery Core Clerkship / Rotation

For me, these books either overlapped with the ones I listed above, or were too advanced for my tastes. However, if you are interested in surgery or want to honor the surgery clerkship, then it is worth considering whether you want to obtain these texts. Sorry to those of you who see the list twice; the images do not show up in some browsers. 
If you are interested in good books for other rotations, check out Books For Pediatrics Rotation / Clerkship And Shelf Exam.

Find other books useful on your surgery clerkship? What books helped you the most on the surgery shelf exam? Share your knowledge!

Updated 2015-12-18

Friday, December 26, 2008

How To Scrub For Surgery

Scrubbing into an OR is part of any medical school education, but one that does not seem to be formally discussed much. A medical student's first time in an OR can be an intimidating experience for this reason. The OR has its own rules and culture, which may seem byzantine at first to the uninitiated. For me, the worst part was getting into the OR: specifically, how do I scrub for surgery?

I've tried to address this previously in posts like:
Perhaps you might be wondering why I am so concerned about scrubbing for surgery. Well, hearing about my first time might explain. The experience was horrible. I was doing a 1 month rotation in Mexico City, Mexico between my first and second years of medical school. I had never been in an OR before, much less on a rotation of any kind. Even though I had watched people in scrub in several times before I ever had to, there were all sorts of subtleties that escaped my notice. When my time finally came, the attending simply said "Go scrub" in Spanish with no instructions. The washing wasn't too bad, but putting on the gown was a disaster. I did not understand what to put on first, what I could touch, how to turn. The nurses tried to help, but I was already stressed and my Spanish wasn't that good! The instructions yelled in Spanish just confused me more! Finally, after struggling for a few minutes, I managed to get scrubbed in, but you can imagine how little confidence the surgeon had in me after that performance. While my little mistakes are no match for those of a resident placing a central line for the first time (as described in 'Complications' by surgeon Atul Gawande), they still left an indelible impression on me. Entering an OR for a laparoscopic procedure (heh, or IR suite) is not so daunting these days, but I'll never forget my first time!

Updated 2015-12-18

Thursday, December 25, 2008

Thank You!

A quick note of thanks to you, my readers, this holiday season! A special thanks to those of you who have commented and critiqued the site, helping me improve the quality and content. If you want to contact me more directly, please email me at scrubnotes at gmail dot com. 

Happy holidays!

Wednesday, December 24, 2008

Dale Dubin's "Rapid Interpretation of EKGs" Preview

I'm sure some of you came across this site while looking for something related to Rapid Interpretation of EKGs or Dale Dubin. Well, the book is a good primer on understanding EKGs, but some of may have your doubts before investing in a copy. 

If you want to preview the book before you purchase it, check out Rapid Interpretation of EKGs at Google Books. The preview will show you roughly 70% of the pages in the actual 6th edition, published in 2000. Google Books also has many other medically-related books that you can try-before-you-buy. If you like what you see, check out the full latest edition: 

Updated 2015-12-18

Tao Le With First Aid For The USMLE Step 1 2009

First Aid for the USMLE Step 1 2009: A Student to Student Guide (First Aid Series), the latest edition in the First Aid series, was recently published. The image above is of Dr. Tao Le, one of the authors along with Dr. Vikas Bhushan, holding the newly published 2009 edition. If you have the USMLE Step I coming up this year, or even next year, get yours today! Start taking notes and highlighting now! 

Image Source:
Updated 2015-12-18

Tuesday, December 23, 2008

What To Buy For Medical School (Or Not)

As a medical student, you are often faced with various offers for tools and resources to further your medical education. Are these worthwhile offers? Does one really need to have this latest gadget in order to treat patients? Well, here is a quick guide on what to buy for medical school, and what not to purchase. 

What To Buy As A Medical Student:

* ... that's about it. Almost everything else you can borrow and then return once the course or rotation is done.

What Not To Buy As A Medical Student:

* Fancy Ophthalmoscope - You will spend hundreds of dollars on a tool you will use only once or twice your first year. Then, you'll enter clinics and realize that the places where you really need an ophthalmoscope, they will provide one free of charge. Your scope will collect dust at home. And you will probably never see the optic disc properly anyway. 

Heh, unless of course you want to go into ophthalmology (or do international work). Then, by all means, please buy a real good ophthalmoscope so that maybe someday you'll see that disc!

* Heavy physiology textbook - Oh, your cover was so shiny; your illustrations, very clear. I used you for two weeks, passed my test, and now have a $80 door stop. Thank you, heavy physiology textbook.

* PDA - You were personal. You were digital. You were assistant-y. Yet, I never could whip you out fast enough to prevent the lacunae in my knowledge to be unveiled during a pimp session. 

* Beeper - Beeper, beeper, wherefore art thy beeps? I used to lie awake at night, waiting for that stat page from the intern, summoning me and my massive intellect to the ER. Yet, the page never came. Sadness. Also, why is it that in this day and age, only medical personnel and drug dealers still use beepers? Hmm... 

There you have it: Scrub Notes Medical Student Guide On What To Buy For Medical School (Or Not). Enjoy!

Monday, December 22, 2008

What Is A Good Radiologist Salary?

As I start my career, the issue of salary comes upon often, but almost as a taboo term. The idea of mixing money and medicine has obvious problems, but in today's world, it is a reality well worth considering. As the issue influences what medical specialty students choose (see: Medical Student Debt Influences Career Choices), a medical student must consider it, at least briefly. So, for me going into radiology, the question is: what is a good radiologist salary?

Surprisingly, this issue has come up during residency interviews. Some radiologists have mentioned salaries going into the 7 figures! However, the general data I see shows a range of $200,000 to $400,000 for radiologist salaries. Of course, this salary is affected by many variables, including location, years of training, geographic location, and especially by whether the diagnostic radiologist is an academic radiologist or private practice radiologist, with the latter making upwards of twice as much! As medical students make specialty choices while balancing college debt and medical school debt, it pays to keep these figures in mind!

For more information, check out this site about radiology salary information and other topics related to radiology.  

Sunday, December 21, 2008

Scientists Extract Images From Brains Directly

A recent post claims that Japanese scientists have discovered how to extract images directly from one's brain.
The scientists were able to reconstruct various images viewed by a person by analyzing changes in their cerebral blood flow. Using a functional magnetic resonance imaging (fMRI) machine, the researchers first mapped the blood flow changes that occurred in the cerebral visual cortex as subjects viewed various images held in front of their eyes. Subjects were shown 400 random 10 x 10 pixel black-and-white images for a period of 12 seconds each. While the fMRI machine monitored the changes in brain activity, a computer crunched the data and learned to associate the various changes in brain activity with the different image designs.

Sometimes I feel like everything important that needs to be developed has been already, but stories like this renew my hope in what lies ahead. Even if we understand how MRI works, we are still far away from understanding how the human brain functions. I can't imagine how such technology will develop over the next 10 - 20 years.

(Image Source: PinkTentacle)

First U.S. Face Transplant

The NYTimes has a story on the first U.S. face transplant. As interesting as this is, I still can't get over the results of the world's first face transplant (which occurred in France). The picture on the left is the patient Isabelle Dinoire immediately after the post-op, whereas on the right is one year later:

Not bad, right? Honestly, I had some kind of Frankenstein idea in my head about what a face transplant would look like, or perhaps something from Face Off, but this isn't so bad. It's more like a skin flap that just happens to be on the face. Hopefully this stays in the realm of reconstructive surgery, and never becomes something viewed as cosmetic. 

(Image Source: BBC News)

Anthony Walter: Orthopedic Surgeon or Renaissance Master? recently featured a piece on retired orthopedic surgeon Anthony Walter. My favorite line from "At Houston Surgeon’s Home, an Ode to His Wife and to God":
He said their reaction was understandable, given that the museum’s collection includes abstract art, which he disdains. “I am a huge threat because what I have done renders everything they have junk,” he said beneath the glinting chandeliers in his great hall. “I hope that doesn’t sound arrogant but the reaction of people who come in here tells me the power of it.”
Yes, of course. A huge threat. lol. No wonder some people subscribe to a certain stereotype of orthopedic surgeons! Reminds me of that joke about Larry Ellison, the CEO of Oracle Software: what's the difference between Larry Ellison and God?

God doesn't think he's Larry Ellison!

Saturday, December 20, 2008

Cuttino Mobley and Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) has caused Cuttino Mobley to retire from the NBA. Hypertrophic cardiomyopathy occurs when the myocardium is enlarged, usually for an unknown reason. The disease distorts the morphology of the heart, and at times of high flow, can cause the outflow tract of the left ventricle to collapse, leading to sudden death. Specifically, the theory is that systolic anterior motion (SAM) of the anterior leaflet of the mitral valve, caused either by Venturi forces or drag, can lead to the obstruction. According to JAMA, "Hypertrophic cardiomyopathy is the most common cause of cardiovascular sudden death in young people, including trained competitive athletes (most commonly in basketball and football and in black athletes)"

I always enjoyed watching "Cat" Mobley play on the Rockets, so I wish him well.  For more information on, check out "What is hypertrophic cardiomyopathy?"

Update: This post initially stated that Cuttino Mobley has hypertrophic obstructive cardiomyopathy (HOCM), but this appears to not be the case, based on the comments and reviewing the article.

Friday, December 19, 2008

How To Become A Radiologist

As some of you may know, I have decided to apply for a diagnostic radiology residency position. I'll save the 'why radiology' for a later post, perhaps, but for now, I wanted to discuss a common question posed to me by underclassmen: how to become a radiologist. 

Since the blog is targeted at a more general audience, I'll give a broad answer. Here are the steps required to becoming a radiologist (at least, in the United States)

1. Complete your primary education and attend a strong academic college for four years. Going to a good college will definitely increase your chances of attending a strong medical school. 

2. Complete the pre-med requirements of your college, take the MCAT, and apply to medical school. For more on this, check out:  The Official Student Doctor Network Medical School Admissions Guide available on 

3. After your admission to medical school, look into opportunities to shadow radiologists or do radiology research. Make sure in your later years to take radiology electives. Study hard and do well on USMLE Step 1! Doing well on USMLE Step 1 is essential for any residency program, but it is especially true for a competitive field like radiology. A good Step score will get your foot in the door at many programs, while a mediocre score will be harder to overcome. 

4. Apply for radiology residency programs as well as internship programs. Radiology applicants must do an intern year prior to starting their radiology residency. Many residents do a prelim medicine year or a transitional year. Some also fulfill the requirement through a prelim surgery year. A helpful guide to applying for residency positions is Iserson's Getting Into a Residency: A Guide for Medical Students, 7th Edition

5. Complete a 1 year internship

6. Complete a 4 year diagnostic radiology residency. During the residency, one must pass a written board exam, a physics exam, and an oral board exam, given by the American Board of Radiology. However, starting this year, the system is changing to two computer-based exams that incorporate physics, one given after the third year (PGY 4) of the radiology residency, and the second one given 18 months later. Both exams must be passed in order to become a board-certified radiologist

7. After the residency program, one can either enter into practice as a general radiologist, or complete a fellowship in a subspecialty of radiology such as interventional radiology, neuroradiology, or mammography. The fellowship training typically takes one to two years. 

8. The two major practice settings for radiologists are either private practice or academic radiology, with private practice being much more common.  

To summarize, that is:
  • 12-13 years of primary education
  • 4 years of college
  • 4 years of medical school
  • 1 year of internship
  • 4 years of diagnostic radiology residency
  • Possibly 1-2 years of radiology subspecialty fellowship
At a minimum, that is a total of 25 years of education! Ignoring the primary education, that is still nearly 14 years! While that does seem like a long time, radiologists are compensated fairly well and have a relatively good lifestyle (especially within medicine). Heh, still, makes one wonder whether they should be an x ray technician instead! While I'm somewhere in the middle of that path, it seems most people who have completed all of their training are fairly satisfied.

If you're truly interested in diagnostic radiology, it is a great field with lots of opportunities! Good luck! 

Thursday, December 18, 2008

The First Amnesiac's Hippocampus: A Life Forgotten

H. M., the patient whose injury during surgery led to the discovery that the hippocampus is involved in storing memories recently passed away. An interesting story of the life lost but still lived as medicine advanced.

Wednesday, December 17, 2008

Practical Gifts for Medical Students: A Holiday Gift Guide

Tis the season to be... well, consumers. I imagine some of you are considering buying gifts for loved ones who happen to be medical students. Well, what better time for a medical student holiday gift guide, right? While there are many general gift guides out there, some funny and some sentimental, the aim of this one is to point out practical gifts for medical students, ones that they may not care to buy for themselves but would appreciate receiving. In no particular order:

  • A Stethoscope - An excellent gift, especially for first or second year students who have yet to enter clinical rotations. Stethoscopes can be somewhat pricey on a student budget, but a nice one makes for a great investment. There's a wide selection of stethoscopes out there though, so shop around for one that makes the most sense for what your gift recepient is interested in. I personally have a Littmann Cardiology III (black) and think it's great. It's high quality, durable, and good for general use (which means, for most medical students). Plus, it looks quite professional.
  • First Aid for the USMLE Step 1 2009 - Heh, to the person you'd rather see spend the holiday in the library. Still, I kind of wish I'd started looking at this earlier during medical school, so it really would be practical
  • Palm TX Handheld - A nice tool to have around on rounds, especially with Epocrates loaded on it. Any time your patient is put on a new funny-sounding medicine, you can quickly look it up, as well as add notes about the drug. There is a lot of other medically-related software out there for the Palm as well, such as patient tracking software.
  • Medically-Related Leisure Reading - Sometimes, when a medical student wonders "Why am I going through all this?" it's nice to read a regular book addressed to a general audience about medicine and why doctors do what they do. My favorites are:
  1.  How Doctors Think by Jerome Groopman
  2. Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande
  3. Better: A Surgeon's Notes on Performance by Atul Gawande as well
  • USMLE Step I Qbank - If you know your gift's recepient is a second year medical student and about to take USMLE Step I, consider paying for a QBank for them. There are several options out there, but Kaplan is one of the most popular. Have them try out the service before purchase with the Qbank Challenge, which lets them do a sample test of 10 or so questions (the full Qbank has 2000+ questions):

    Kaplan Test Prep and Admissions (
  • Gift Card - The reality of medical school is that any medical student will have to study A LOT. To do so, this requires textbooks and review guides. An Amazon gift card will help any student easily purchase the texts and reviews they need, which can be a significant cost of medical education for a student, after tuition.

Hopefully this guide contained some good ideas. Have one of your own? Feel free to add it in the comments below. Happy holidays!

Updated 2015-12-18

Tuesday, December 16, 2008

Best / Cush Transitional Year Programs for PGY1

For whatever reason, the lists of cush transitional year programs are not as easily found as other material about applying for residency spots. I think it's primarily because the word 'transitional' is kind of vague. At any rate, here are some good links / discussions about the best transitional programs:
Feel free to add more links in the comments. Thanks!

Monday, December 15, 2008

Do Doctors Exercise?

The simple answer? No. A recent study shows that 4 out of 5 doctors do not get enough exercise. For the statisticians out there, yes this is not a great sample as it is small and made up of British doctors, but I don't imagine the numbers being much different here. I think more hospitals should have a gym attached for both patients, their family members, and staff in order to let patients rehab in a more dynamic way and staff easily access exercise facilities. Of course, all the usual precautions should be in place for patients but I can see it being quite helpful for some, especially those that seem to go stir crazy sitting in bed all day long.

Sunday, December 14, 2008

More Hotel Discounts for Residency Interviews

Hotel costs can add up when traveling to residency interviews. There are several ways to save money when making hotel reservations, assuming the program doesn't put you up themselves:
  • If the program has an agreement with a hotel for a special rate, try to utilize it. However, still shop around because you might actually be able to save more if you book it yourself via an online discount site like Hotwire.
  • If someone in your family or you yourself has a AAA membership, use it! You can save 5-15% at many hotels with a AAA card.
  • If you are a member of AMSA, they also offer savings up to 15% at select hotels.
Feel free to comment with other suggestions!

Saturday, December 13, 2008

Saving Money on Hotels for Residency Interviews

As I am flying out and staying at hotels for all these residency interviews, the costs really start to add up. There is a whole bunch of obvious advice out there already (stay with friends, book early, etc), but sometimes you just cannot avoid staying at a hotel and booking things close to your interview date. When this happens, how can medical students still save money on travel and lodging costs?

Well, two sites I would recommend are Kayak and TripAdvisor. Both sites let you quickly comparison shop between several discount sellers online. Nice features include searching around an address, which lets you enter the address of your interview location in, and then find hotels nearby. Kayak also has helpful mobile apps for iPhone/Android phone useres. Another suggestion would be to try to group your reservations so that you're booking from one site. For example, if you book 10 nights with, you get an 11th night free (with some restrictions, of course).

Anyone else have any good tips or website recommendations?

(Image Source:

Friday, December 12, 2008

Help for Poor Medical Students

While researching ways to save money on all these trips for residency interviews, I came across a blog dedicated to just that: Poor MD

Sounds like the blogger is a former 'poor' medical student who applied to a competitive field (radiology) and had to really watch every penny because (s)he has a family and three kids to take care of. Anyway, maybe some of you will find it helpful.

Thursday, December 11, 2008

Pull The Plug, Brian

From Family Guy:

With all the talk about palliative care, one wonders how many members of the public really view end of life issues as depicted in this clip. Then again, I guess I shouldn't look to 'Family Guy' for a substantive discussion of end of life care, but at least they could have include something more realistic, such as the lady giving Brian power of attorney. Also, why is Brian unplugging the EKG monitor? I think she'll survive that.

Wednesday, December 10, 2008

Happiness: The Social Virus

Happiness spreads through social networks much like the flu, according to a recent study on happiness in social networks:
In a good mood? Your neighbor, her friends and even her friends' friends should thank you – you're likely infecting them with your cheer. Happiness spreads through social networks about as easily as the flu, according to a new study. 
The researchers analyzed data compiled from nearly 5,000 interconnected people over a 20-year period. After establishing a baseline mood for each participant, the team found that when one person became happier, it rippled through the network, increasing the likelihood that others would become happier too. 
Sadness, thankfully, is not nearly as infectious. An attack of the blues creates a much smaller ripple than a case of giddiness, said head researcher James Fowler of the University of California, San Diego.
Even more reason for hospitals to recruit happy nurses and happy doctors and avoid the surly ones, no? For more about the psychology of happiness, check out:

Updated 2015-12-16

Tuesday, December 09, 2008

Drug Wars in Hospitals

No matter how bad things get with healthcare in the U.S., at least we don't face the prospect of drug wars in the hospitals:
The sedated patient, his bullet wounds still fresh from a shootout the night before, was lying on a gurney in the intensive care unit of a prestigious private hospital here late last month with intravenous fluids dripping into his arm. Suddenly, steel-faced gunmen barged in and filled him with even more bullets. This time, he was dead for sure.
Hit men pursuing rivals into intensive care units and emergency rooms. Shootouts in lobbies and corridors. Doctors kidnapped and held for ransom, or threatened with death if a wounded gunman dies under their care. With alarming speed, Mexico’s violent drug war is finding its way into the seeming sanctuary of the nation’s hospitals, shaking the health care system and leaving workers fearing for their lives while trying to save the lives of others.
“Remember that hospital scene from ‘The Godfather?’ ” asked Dr. H├ęctor Rico, an otolaryngologist here, speaking about the part in which Michael Corleone saves his hospitalized father from a hit squad. “That’s how we live.”
An explosion of violence connected with Mexico’s powerful drug cartels has left more than 5,000 people dead so far this year, nearly twice the figure from the year before, according to unofficial tallies by Mexican newspapers. The border region of the United States and Mexico, critical to the cartels’ trafficking operation, has been the most violent turf of all, with 60 percent of all killings in the country last month occurring in the states of Chihuahua and Baja California, the government says. And it has raised fears that violence could spill across the border, because dozens of victims of drug violence have been treated at an El Paso hospital in the last year.

I have not really followed the whole immigration / border security debate, but if we start drug wars in our hospitals, perhaps I should pay more attention. What was that talk about a wall again?

Monday, December 08, 2008

Interview Day: A Proposal

The Match is the yearly ritual in which 4th year medical students in the U.S. find out whether they matched to a residency program, and if so, where they matched. The process leading up to this point is long and convoluted. Although moving the system online has made things much easier, there is still a fair amount of inefficiency involved. I'm not sure there will ever be a perfect system, but one common frustration for us applicants is the haphazard nature in which we are notified of interviews, which leads to poor travel planning and excessive expense. One resident I spoke with said he spent around $12,000! As a future radiologist, he'll earn it back eventually, but consider that that figure is nearly a third to a fourth of his salary for his entire intern year!

At any rate, I have a humble proposal: Interview Day(s). Initially, the idea was to mirror Match Day and have a single day on which all programs release their interview invitations. Since Dean's Letters go out on November 1, a date like November 15 would seem reasonable. However, one can imagine the chaos that would ensue on that day. Discussions with friends led to an evolution in the thought. Instead of having a single day, perhaps the 4 Mondays in November could each be a single wave of interviews. Each wave would represent a region of the country, and all the programs in that region would release their interview invites on that day. While this may stress some programs, I would imagine applicants would find this beneficial for two main reasons. First, it would remove some of the uncertainty regarding when one should expect to hear from a program. Second, if you hear from all the program in one region at the same time, it makes it MUCH easier to coordinate your travel plans so that you are not repeatedly traveling back and forth across the country. Of course, the region going last would be at a disadvantage but possible remedies include rotating which region goes last every year. While I'm sure programs would not be in favor of this system because of institutional inertia, I cannot see how it would significantly change how they decide who to initially interview. If applicants benefit, and the cost to programs in terms of effort is relatively minimal, such a change should be made. I'm sure I'm missing something here, but the idea seems like it is worth consideration.


Sunday, December 07, 2008

Rich Kids Vs. Poor Kids Brains

A new study at Berkeley shows that rich kids' brains function differently than poor kids' brains using EEGs:

In a study recently accepted for publication by the Journal of Cognitive Neuroscience, scientists at UC Berkeley's Helen Wills Neuroscience Institute and the School of Public Health report that normal 9- and 10-year-olds differing only in socioeconomic status have detectable differences in the response of their prefrontal cortex, the part of the brain that is critical for problem solving and creativity.

Child wired for EEG to test brain functionElectroencephalography, or EEG, uses electrodes on the scalp and held in place by a cap to measure underlying brain activity. (Lee Michael Perry/UC Berkeley)

Brain function was measured by means of an electroencephalograph (EEG) - basically, a cap fitted with electrodes to measure electrical activity in the brain - like that used to assess epilepsy, sleep disorders and brain tumors.

"Kids from lower socioeconomic levels show brain physiology patterns similar to someone who actually had damage in the frontal lobe as an adult," said Robert Knight, director of the institute and a UC Berkeley professor of psychology. "We found that kids are more likely to have a low response if they have low socioeconomic status, though not everyone who is poor has low frontal lobe response."

While the patterns differ, I wonder how plastic these children's brains still are at this age, and whether the differences can be minimized if these children are moved / educated in a more enriching environment, and the study repeated 5 or 10 years down the road. From what I remember from neurology though, it seems that at 9 or 10 years old, their brains are pretty set, unfortunately. Studies like this will increase attention on the need for early intervention in terms of education to prevent students from falling behind (vs. the overemphasis on dropout rates in high school, a point at which it is almost too late to intervene for the majority of individuals in my opinion).

Saturday, December 06, 2008

What the...

Why is this the first image when I search for "medical student" on Google Image Search?

For the skeptics:

Clearly, as medical students, we need to post more pictures of us as just regular, normal folk, so that the public at large will see us that way. Or, at the very least, Google's Image bot.

Friday, December 05, 2008

One Billion IQ Points

Hypothyroidism and its effects on intelligence may pose the single most easily curable malady plaguing the world at large today due to the lack of iodized salt, according to Nicholas Kristof in today's NYTimes:
Almost one-third of the world’s people don’t get enough iodine from food and water. The result in extreme cases is large goiters that swell their necks, or other obvious impairments such as dwarfism or cretinism. But far more common is mental slowness.
When a pregnant woman doesn’t have enough iodine in her body, her child may suffer irreversible brain damage and could have an I.Q. that is 10 to 15 points lower than it would otherwise be. An educated guess is that iodine deficiency results in a needless loss of more than 1 billion I.Q. points around the world.

It's sad to think how so many things we take for granted, like iodized salt or chlorinated water, are luxuries in other parts of the world. It frustrates me when people knock government or public health initiatives and completely ignore all the benefits that such efforts have brought us. Hopefully articles like this one will spur philanthropic organizations like the Gates Foundation to pay more attention to this issue. As much as AIDS is a global health issue, one wishes that causes like potable water or adequate nutrition would receive equal attention.

Thursday, December 04, 2008

You've Got AIDS?

From Family Guy: "You've Got AIDS!"

Hm, the initial reaction, I think, is that this is clearly insensitive, but could one argue that such satire actually serves to raise awareness about AIDS and desensitize the issue, making its acceptance more commonplace? Hmm...

Wednesday, December 03, 2008

Medical Marvel: Infinite Memory

While reading random blogs online (Daily Dish, if you must know), I came across an interesting story about a woman with "perfect memory":

Price can rattle off, without hesitation, what she saw and heard on almost any given date. She remembers many early childhood experiences and most of the days between the ages of 9 and 15. After that, there are virtually no gaps in her memory. "Starting on Feb. 5, 1980, I remember everything. That was a Tuesday."

She can also date events that were reported in the media, provided she heard about them at the time. When and where did the Concorde crash? When was O.J. Simpson arrested? When did the second Gulf war begin? Price doesn't even have to stop and think. She can effortlessly recite the dates, numbers and entire stories.

"People say to me: Oh, how fascinating, it must be a treat to have a perfect memory," she says. Her lips twist into a thin smile. "But it's also agonizing."

In addition to good memories, every angry word, every mistake, every disappointment, every shock and every moment of pain goes unforgotten. Time heals no wounds for Price. "I don't look back at the past with any distance. It's more like experiencing everything over and over again, and those memories trigger exactly the same emotions in me. It's like an endless, chaotic film that can completely overpower me. And there's no stop button."

She's constantly bombarded with fragments of memories, exposed to an automatic and uncontrollable process that behaves like an infinite loop in a computer. Sometimes there are external triggers, like a certain smell, song or word. But often her memories return by themselves. Beautiful, horrific, important or banal scenes rush across her wildly chaotic "internal monitor," sometimes displacing the present. "All of this is incredibly exhausting," says Price.

Based on other research I have read casually, it seems that we evolved the ability to selectively remember items because it helped with learning. Having too much information was not beneficial. As the article notes, Price's episodic memory is nearly flawless, but her semantic memory (the memory associated with learning facts and concepts) is average, which is why she did not stand out in school. Still, if she exists, there are likely people with nearly flawless semantic memory, right? The whole thing makes one wonder where the true limits of human ability lie.

(Image Source: ImpactLab)

Monday, December 01, 2008

The Sports Gene?

Born to Run? Little Ones Get Test for Sports Gene:
When Donna Campiglia learned recently that a genetic test might be able to determine which sports suit the talents of her 2 ½-year-old son, Noah, she instantly said, Where can I get it and how much does it cost?

“I could see how some people might think the test would pigeonhole your child into doing fewer sports or being exposed to fewer things, but I still think it’s good to match them with the right activity,” Ms. Campiglia, 36, said as she watched a toddler class at Boulder Indoor Soccer in which Noah struggled to take direction from the coach between juice and potty breaks.

“I think it would prevent a lot of parental frustration,” she said.

In health-conscious, sports-oriented Boulder, Atlas Sports Genetics is playing into the obsessions of parents by offering a $149 test that aims to predict a child’s natural athletic strengths. The process is simple. Swab inside the child’s cheek and along the gums to collect DNA and return it to a lab for analysis of ACTN3, one gene among more than 20,000 in the human genome.

The test’s goal is to determine whether a person would be best at speed and power sports like sprinting or football, or endurance sports like distance running, or a combination of the two. A 2003 study discovered the link between ACTN3 and those athletic abilities.

The whole thing seems like a money-making scam to me. I say scam because the entire concept discounts the notions of practice, a work ethic, and intelligence in athletics. Except for certain endeavors, like weightlifting perhaps, raw athletic ability will only get an athlete so far. Beyond that, other factors come into play to determine success. I worry that children with "good" results will face even more pressure from their sports-crazed parents to perform up to expectations.


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