When I was in training, attending surgeons regularly complained about the low quality of the residents they were teaching. Most didn’t recognize the changing landscape of medicine which, to be brutally honest, had been far from an abrupt shift and much more of a gradual evolution that they didn’t feel the need to accept or even acknowledge. Those attendings dedicated to medical education frequently tried to explain the changes and encourage open-mindedness about alterations to the status quo, but this has never been a strong point among the stereotypical surgeon, who would commonly instead complain about how things were different when they were in training.
Kost A, Chen FM. Socrates Was Not a Pimp: Changing the Paradigm of Questioning in Medical Education. Academic Medicine, January 2015 90(1):20-24.
Yes, I wish the article were open access, but it’s still worth a read. And, you know, it gives me the inspiration for this picture.
Legalities: Image modified from “Socrates” by Ben Crowe (https://www.flickr.com/photos/croweb/2836991287) and “pimp hat” by Beth Kanter (https://www.flickr.com/photos/cambodia4kidsorg/2274922356), used per Creative Commons-Attribution-2.0 License.
[Last updated 30 June 2016]
Just a reminder of the steps to take in any surgical emergency. These are not evidence-based.
The attached files are nicely formatted, and additionally include contact info and a reading list. Share and enjoy.
- Call for help
- Gastric decompression
Microsoft Word: OSS – Surgical Emergencies
As always, these files that are the sole work of Christian Jones are hereby released into the public domain, with no rights reserved.
ProPublica has released the Surgeon Scorecard, their study (with accompanying app and news report) on complications in surgery. There have been many such national studies of Medicare and other administrative databases; this one is novel in that it evaluates the complication rate of individual surgeons, rather than grouping the complication rate by hospital. When ProPublica announced last week that they’d be releasing these reports, there was much gnashing of teeth regarding the interpretation of data, correction factors for operating on more complex patients, and public response to the findings. This is likely to become a pretty big story this week (at least); USA Today has already picked it up, and it’s right up NPR’s alley as well.
Data are good. Data we can share are better.
It’s easy to hold onto data we’re using for research. Despite the “security breaches” which fill news outlets with repetitive stories and warning, the data we tend to use in academics can typically be kept, quite securely, on a password-protected desktop in our locked offices, with little fear they’ll make it into the hands of ne’er-do-wells. Certainly this safety is still important—so much so that most institutional review boards require a specific statement regarding how we’ll handle our data to ensure it remains safe. “Protected health information” needs to be kept confidential, with hefty fines and public shaming for those who fail to adequately protect it.
Let me start by saying this isn’t a cry for help.
Physician burnout has been getting some press lately. Physician satisfaction, or the lack thereof, a bit less so, but it’s at least present. A few years ago, there were more articles supporting the high risk (if not prevalence) of more serious psychiatric disorders among physicians, with results similar to those we’re finding in the satisfaction and burnout studies: that certain specialties are more strongly associated with problems, that pay matters a little but not as much as one might think, and that they’re major problems that certainly need to be addressed.
My social media idol, Amalia Cochran, has “gone dark“, for at least another couple of days. She’s previously given some excellent advice to medical students, residents, and practicing surgeons. There’s been other excellent advice for all those new residents starting on July 1, equally applicable to those third-year medical students just starting clinical rotations. Specialty specific advice is rampant, but Skeptical Scalpel’s realistic, pragmatic, and timeless advice is applicable to all the new residents starting this week.
Not one to be left off the bandwagon, I’ve got my own advice for new residents. It’s just as pertinent to the newly ward-based medical students, as well as to those of us who have been practicing for a few years and need an occasional reminder. The advice isn’t as extensive as those lists given by my colleagues, and is probably less pragmatic because I don’t, quite frankly, have a reasonable way to help you implement the advice in your daily education and practice, and I don’t have an algorithm for working through the difficulties associated with it. It’s simple and complicated at the same time, and is something I struggle with every day.