Monthly Archive: November 2011

U.S. Residency Programs Under Probation

The ACGME is incharge of accrediting U.S. medical and surgical residencies. There are three decisions that can be made: Accreditation, probationary accreditation, or withdrawl of accreditation. The ACGME compiles an up-to-date list of residency programs under probation or with withdrawn accreditation in all specialties. I had previously reported on the list for 2012, but many of these programs have either dissolved or have been able to regain good standing with the ACGME. Rather than list all the current institutions on probation, a list which is always in flux, it is best to search the database yourself. You can search for all specialies, or by a single specialty. This is probably a very good thing to do when deciding where to apply.

Click here to search for programs under ACGME probationary accreditation 

Click here to search for programs whose accreditation has been withdrawn




The Best Free Software For Students

If you are anything like me, you will do anything to avoid paying thousands of dollars for the next Adobe product.  After ten years of higher education (and at least 4 to go!) I have tested hundreds of software packages; in this post I will list the best free and open source programs I have found.  Learn to love open source software…and you will soon learn how to spend those thousands of dollars you saved!  My software list will certainly not be a comprehensive list of all the great open source programs. For a complete list of free software programs I have three recommendations.

  • The best resource is which is a nearly complete collection of all reputable free software.
  • is a free website that lists hundreds of free software packages by category
  • is a compilation of hundreds of free and open source software programs that is easily searchable.



Google Chrome is a no-nonsense, super fast web browser.  Here is just one reference proving Chrome's speed superiority (from For mac users, Safari is a distant second.  While I used to enjoy Firefox, it takes nearly twice as long to load web pages than Chrome.  We all know how terrible Internet Explorer is.



OpenOffice is a well known counterpart to Microsoft Office.  The free software includes a fully capable word processor, a presentation organizer, and a fully loaded spreadsheet tool.  In essence, you get Word, PowerPoint, and Excel for free.  An added bonus, you can save any file in OpenOffice format OR in the corresponding Microsoft format so there will never be compatibility issues.



My love for Google products will now show through.  Google Calendar is simple and highly effective.  You can merge nearly all online calendars into your Google calendar account. You can send yourself reminders using email, phone call, or text message. You can list recurring events in any imaginable patter (e.g. same date each year, 2nd Saturday of March each year, etc.)



1. Gimp is a professional image editor with a student's pricetag.  This free program comes with nearly all the bells and whistles you would find in the newest version of Adobe Photoshop.  The user interface is not idea and takes some getting used to. However, with a price tag of $0 this is a great piece of software.


2. I have heard great things about Paint.Net.  I must admit, I have never used it because I have spent so much time using Gimp that I don't need anything else.  However, it is worth a try if you are looking for more free graphic editing options.



Audacity is a free, open-source program that facilitates the recording and editing of all audio and sound files.  I often use it to make my own 'radio edited' song versions.



Foxit Reader is far better than the free Adobe Reader. It requires far less resources when it is running on your computer, and it provides free mark-up tools including text editing, highlighting, commenting, and basic geometric shapes.



CutePDF Writer is the free version of CutePDFs vast line of products. The free writer allows you to convert any image, document, or screen shot to a PDF.  I use this product all the time. I save documents as PDFs and place them on my thumb drive rather than printing everything out.



There are actually quite a few free antivirus options out there. Many of the web giants (Google, Yahoo, MSN, etc) have their own free antivirus software. My personal favorite is Avast!, which the program that comes with GooglePak.  Just be sure you click on the FREE version, as they have other options.


PERSONAL FINANCE allows users to track all bank accounts, credit cards, loans, and investments in one place. The software is similar to costly software like Quicken, but is free and is web-based: which means you can check your information on any computer, any time.




The best resource in this category, I must admit, is not free. EndNote is a must-have resource for research and reports. It is user friendly and will save you hours of time by automatically plugging in your references and bibliography. There are a number of free programs that try to mimic EndNote's features. Some are good, but after trying them I ended up purchasing a student edition of EndNote because it is so much better.  Here is a list of free bibliography and reference managers. Or you can check out the wikipedia page which compares all reference managers, free and non-free.



R (The R Project for Statistical Computation) is a free text-based statistical computational software program.  It is not for the feint-hearted. The learning curve is steep, but once mastered, this free software provides all the tools to run any statistical analysis, graph, or plot.



Not all LaTeX editors are created equal.  WinEdt is a clean editor without the frills of other programs. I have used this software for 5 years and I have never had even one problem (something that can NOT be said about most LaTeX editors!)  The free version will frequently ask the operator to purchase the full version, but it is never required.



XMind assists individuals and teams in keeping track of ideas and goals. If you have never used mind-mapping software, you need to start. XMind creates the prettiest visual map, but there are other options that work just as well. FreeMind is another great one.



Did I forget something? If you know of more great, open source software please leave a comment.

Resident and Fellow Salaries and Benefits

2011 Average Resident and Fellow Stipends

Every year the Association of American Medical Colleges (AAMC) compiles a survey of intern, resident, and fellow salaries across the country.  While most medical and surgical residents are paid similar stipends, there are certainly differences.  This will become a somewhat important factor in ranking residency programs during the fourth year of medical school.  The recent AAMC resident and fellow stipend report can be found here as a pdf document. The complete document describes current resident salaries and displays a chart of the average resident salaries all the way back to the 1960s.  Additionally, it details the difference in stipends between the northeast, the south, the west, and the midwest. Finally, it explains in detail what is included in the average benefits packages (i.e. medical insurance premiums, retirment plans, life insurance, disability ect).

The report contains salary information for all training levels, intern thru post graduate year (PGY) eight. The national mean salary of each PGY level and the percent change from 2010 is shown below.  (taken from the AAMC document)

The next table displays the average first year resident (i.e. ‘intern’) salary each year since 1968.  The average increase in salary in recent years has been 2-4%.

As you will see in the complete document, the residency programs that pay the most are church sponsored hospitals in the northeast.  Those that pay the least are state hospitals in the south.

Conversion Disorder vs Factitious Disorder vs Malingering

Conversion disorder, factitious disorder, and malingering have one major characteristic in common: they represent conditions that are not ‘real’.  However, ‘real’ is a vague word and it is important to understand the differences between these conditions.  Properly diagnosing your patient with one of these psychiatric ailments will allow you to create appropriate plans of care for your patients.

1. Conversion Disorder: is a psychiatric condition that results in a neurological complaint or symptom, without any underlying neurological cause.  Patient’s may experience seizures (i.e. ‘pseudoseizures’), weakness, non-responsiveness, numbness, and even vision loss.  The symptoms are not intentional, the patient is not faking or intentionally creating his/her complaints, yet upon further investigation no biological explanation for the symptoms can be found.  The symptoms, therefore, are ‘real’ to the patient but are not caused by any ‘real’ pathology.  The current thought is that the symptoms are somehow caused by an overload of emotional stress in the body. The name “conversion disorder” comes from Sigmund Freud who stated that stress can cause a psychiatric ailment to ‘convert’ to a medical problem.  Do not fall into the trap, however, of many students/doctors/nurses who say the patient is ‘faking’.  While you may know that a patient complaining of sudden vision loss has a completely healthy eye without disease, the patient’s eye and brain are actually NOT processing any sight.  Alternatively, a case that I have seen a number of times, a patient with syncope from conversion disorder whose labs, tests, vital signs, and clinical status are completely normal will actually NOT respond to painful stimuli (sternal rub, nail bed pressure, supraorbital pressure) during an episode.  It is important to remember the unintentional nature of conversion disorder when discussing the condition with a patient.  To them it is REAL, even if to you it seems fake.

Studying for the Psychiatry Rotation?  Check out First Aid for the Psychiatry Clerkship

2. Factitious Disorder (a Somatoform Disorder): is a condition where patients intentionally fake disease, or intentionally cause disease in order to play the ‘patient role’.  The main distinction between this and conversion disorder is the intentional nature of factitious disorder. Often referred to a Munchausen Syndrome, factitious disorder is characterized by patients frequently feigning illness to obtain attention, sympathy, or other emotional feedback.  They achieve this goal through exaggerating symptoms, deliberately faking symptoms, or even intentionally creating real symptoms.  Patients have been known to contaminate their own body fluids, even injecting themselves with dirt, bacteria, or fecal matter in order to create illness that will then lead to primary emotional gain. A related disorder is known as Munchausen by Proxy, which is characterized by a person intentionally faking or causing illness in another (usually a child) in order to obtain the same emotional feedback.  Victims of Munchausen by Proxy are often children who return to the hospital time and time again with infections or other ‘ailments’ that are either fabricated or intentionally created by their caregiver.

3. Malingering: is the intentional faking or creating of illness in order to obtain secondary gain (e.g. workers compensation, disability payments, avoiding work or jail time, pain medication, etc.) Malingering is NOT a psychiatric illness; this is the first major distinction from the other two disorders. Malingering is an intentional abuse of the medical system to obtain personal benefit.  The difference between malingering and factitious disorder is the goal of the patient; malingerers abuse the system to obtain secondary gain while patients with factitious disorder attempt only to obtain emotional, or primary gain.  In simpler terms, the end goal of a malingerer usually involves monetary value, while the goals of patients with factitious disorder have no such value.


  • Conversion Disorder: Unintentional, due to emotional stressors, no ‘gain’ to the patient
  • Factitious Disorder (Munchausen): Intentional, primary or ’emotional’ gain
  • Malingering: Intentional, secondary and often monetary gain