Category Archive: General

Dealoz: Textbook Price Comparison

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Pre-Med, Preclinical Years, eResources

February 6, 2012

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Throughout college and medical school I had to buy thousands of dollars worth of textbooks. During my first year of medical school I came across the world’s best textbook website: http://www.dealoz.com/.  DealOz allows you to search all available websites, auction sites, book stores, and online sites for the textbook you are looking for. All you need is a title or IBSN and DealOz will do the rest of the work.  If you have every used www.kayak.com for flight tickets, DealOz works the same way by comparing all available options.

After inputting the book of choice, DealOz will compare all of these locations and report back to you the lowest price available. You can search for all available books, or you can choose to search only for ‘new’ books. DealOz will then link you to your seller of choice.  Try it, you will like it. I have saved hundreds of dollars using their website.

Again, here it is

http://www.dealoz.com/

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Internet based paging system

Categories:

Third Year, Fourth Year, eResources

January 18, 2012

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howstuffworks.com

If you need to send numeric or text pages to medical students, residents, or attendings Telepage Web Pager is the best website. Most hospitals have a built in method to text page anyone with a hospital affiliation. However, this web based paging system allows you to page anything you want to any pager in the country.  Try it, it’s free!

http://www.telepagewebpager.us/

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The Best Free Software For Students

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Pre-Med, Preclinical Years, Third Year, Fourth Year, eResources

November 13, 2011

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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 sourceforge.net which is a nearly complete collection of all reputable free software.
  • FileHippo.com is a free website that lists hundreds of free software packages by category
  • schoolforge.net is a compilation of hundreds of free and open source software programs that is easily searchable.

 

WEB BROWSER

Google Chrome is a no-nonsense, super fast web browser.  Here is just one reference proving Chrome's speed superiority (from cnet.com). 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.

 

WORD PROCESSING, PRESENTATIONS, SPREADSHEETS

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.

 

CALENDAR

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.)

 

IMAGE MANIPULATION / GRAPHIC EDITOR

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.

 

AUDIO EDITOR

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.

 

PDF READER AND WRITER

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.

 

PDF CREATOR / CONVERTER

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.

 

ANTIVIRUS SOFTWARE

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

Mint.com 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.

 

 

BIBLIOGRAPHY, CITATIONS, REFERENCE MANGER

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.

 

STATISTICAL ANALYSIS

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.

 

LaTeX EDITOR

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.

 

BRAINSTORMING AND MIND MAPPING

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.

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Resident and Fellow Salaries and Benefits

Categories:

Residency, Compensation, Financial

November 4, 2011

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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.

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How to instrument tie: A video tutorial

Categories:

Preclinical Years, Emergency Medicine Rotation, General Surgery Rotation, OB/GYN Rotation, eResources

October 6, 2011

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jpatrick.net

In recent posts I highlighted some great training videos on suturing and on one and two handed knot tying. In this post I will recommend a video tutorial for instrument tying.  As with the other suturing and knot tying skills, it is very important that medical students learn early in their careers how to instrument tie.  This is the bread and butter of knot tying.  If you are proficient with the instrument tie you will impress residents and attendings and they will be much more willing to give you responsibilities in the OR.  The video below is a straight forward review and tutorial of the instrument tie.  As with all other knots, remember that a square knot is not complete until you have made two opposing throws; otherwise you are tying granny knots.

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One and two handed surgical knot tying: A video tutorial

Categories:

Preclinical Years, General Surgery Rotation, OB/GYN Rotation, eResources

October 6, 2011

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In two recent posts I recommended some great video tutorials for suturing and for instrument tying.  This post will focus on learning how to tie one and two handed knots in the operating room.  As with previous skills, it is very important that medical students learn to tie surgical knots early in their training.  Let me offer one experience from medical school to illustrate this fact.  This is a true story.

After finishing rounds with the residents on my OB rotation I was assigned to work in the OR with the chief of benign gynecology surgery at a community hospital.  He also happened to be the rotation coordinator and was responsible for my grade and evaluation.  The first case was an open tubal ligation. As the case was ending the attending turned to me and said, “hey, we have to close the fascia, can you tie knots?”  Luckily, I knew quite well how to tie.  I picked up the suture and threw a few two handed knots down.  My attending was seriously impressed and told everyone on the team.  He gave me a raving evaluation and spoke specifically about how I was “well prepared for the OR.” So, take it from me, learn these knots! Always remember Rule #1: tie square knots, not granny knots! Two throws are required to complete the knot. 

1. The two handed knot.  This is the knot that you will actually use in the OR. Most surgeons never tie one-handed knots and some even forbid them.  So, this should be your bread and butter. After watching a few tutorial videos I am convinced that this is the best.  It comes from the University of Texas at Houston and walks you through the basics. The audio is very good, so find some earphones. Always remember that a square not requires two throws to be completed.

2. The one handed knot: This is a more confusing knot and far less high yield because very few surgeons ever use it or expect it.  It is notoriously difficult to teach and to learn.  The best video I have found is shown below.  Unlike the previous video, there is not audio to walk you through the knot.  Rather, the knot is completed slowly and each difficult section is repeated.  Remember, you must tie two throws to make a complete square knot. This is important when tying a one handed knot because the two throws are completed using two different techniques.

Finally, there is more than one way to tie a square knot.  Here is one more video that demonstrates the two handed and one handed method clearly. Similar to the second video, there is no audio.  Go get some gloves and some suture and practice along with this video.

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Top 10 Most Disgusting Medical Conditions

Categories:

Humor, General

October 6, 2011

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As a medical student and now as a resident, I feel quite comfortable with the day-to-day gross diagnoses in the hospital. In fact, until last week I was convinced that nothing phased me anymore. That was until a patient with myiasis walked into my hospital, and I nearly lost my lunch. The episode has made me think: what is the most disgusting diagnosis in medicine….is there anything more gross than myiasis? Well, after thinking about all the cases I have seen and looking at some gut wrenching images, I have come up with my Top Ten Most Disgusting Medical Conditions.

 
WARNING: THE IMAGES BELOW REPRESENT REAL MEDICAL PROBLEMS AND ARE EXPLICIT IN NATURE. DO NOT VIEW THESE IMAGES UNLESS YOU ARE PREPARED TO FEEL QUEASY.
 

1o. Hidradenitis Suppurativa:

A chronic inflammatory condition of the apocrine sweat glands, usually in the axilla (arm pit). It does not matter how many times you cut it out, it will always come back.

Archives of Dermatology


 

9. Fecaluria:

The passage of fecal matter through the urethra. The condition usually develops via a vesicointestinal fistula, or a connection between the bladder and the intestine.

Journal of RadioGraphics

8. Fecal Vomiting:

This can occur in very sick patients, usually due to a bowel obstruction or a gastrocolic fistula (connection between the stomach and the colon). No one wants to see a real picture of this…

 

7. Fulminant Human Papilloma Virus (HPV) Infection:

HPV causes most warts on our body, including the sexually transmitted forms. However, there is a rare genetic disese called Epidermodysplasia verruciformis which allows HPV to take over a person’s body. You may have heard of Dede Koswara, or “The Tree Man”, who suffered from this disorder, check out his story on ABCNews.

Note: I believe this disease is the same, or related to Keratosis Palmoplantaris…see image below

6. Cancrum Oris:

Also known as “Noma Disease”, this is a gangrenous infection that leads to destruction of the mouth and face. The disease is common in African youth.

5. Tapeworm (Cestoda):

Parasitic flatworms are not as uncommon as you might think. They live in your small intestine for years at a time, laying eggs and feasting off host blood and feces. One worm can go from egg to 15 foot long adult in only a few months. They can be contracted from eating under cooked meats, especially pork. One species, Taenia saginata, which infects cows and humans, has been found to grow up to 40 feet long.

cdc.gov

4. Echinococcosis:

Also known as hydatid disease, this is another parasitic tapeworm infection, which an twist. When the Echinococcis granulosus worm infects a host, it creates an other-worldly cyst in the body. The cyst continues to expand until it is either removed, or overcomes the host. More disturbing is that the echinococcosis loves to make its home in the host brain. The image below shows the removal of a hydatid cyst from the abdomen. This movie depicts removal of a cyst from the brain and is a very graphic, real-life example of how large the cysts in the brain get, and how they are removed.

3. Bed Bug Infestation:

Why is the Cimicidae parasite so high on the list? If you are asking that question, you have never seen a real infestation. While I was a fourth year medical student I was riding with an EMS team when we picked up a homeless man to bring to the hospital. While enroute to the ED we noticed hundreds of red sores. When asked about the wounds, the man did not know anything about them. Two minutes into the drive I saw movement around the man’s waistline. All of the sudden, 25-30 bed bugs crawled out of his pants and started doing their business on his belly and legs. The man felt nothing. I grabbed one bug with a towel to verify the infestation. Instantly, all 30 bugs rushed right back into the mans pants. If you don’t think a full on Cimicidae infection is gross….just wait until you see one. You will itch for a month.

wikipedia.org

2. Ascariasis:

The great white parasitic roundworm. Though not as common nor as long as her tapeworm counterpart, Ascariasis are far more cruel. Contracted from eating ascariasis fecal matter, the larvae hatch in your gut, they dig through your intestines, eat through your lungs, move into your respiratory tract, and get reswallowed into your gut where they grow very large and very numerous. The worms can grow up to 1 foot in length, measuring inches in circumference, and there may be hundreds in one intestine. The image below is an intestine that has been opened up after surgery.

 
The most disgusting medical diagnosis…

1. Myiasis:

Maggots eating your flesh…and you don’t even know it! How do flies get in your body to lay eggs in the first place? How do people not realize there are hundreds of maggots eating their dying skin? How does it all happen? I don’t know, but the simple thought of the whole cycle makes me feel queasy. One interesting fact is that the use of maggot therapy is on the rise. Some physicians are beginning to adopt a century old practice of cleaning necrotic wounds with maggots…interesting. If you are really brave, check out the video published in BMC Surgery of a surgeon removing multiple maggots from a woman chest.
 

Canadian Medical Association Journal


Dermatology Online Journal


Myiasis in a cat

 

Honorable Mention:

Hypertrichosis:

“Werewolf Disease” is a genetic syndrome resulting in hear growth on every inch of your body.

Dracunculiasis:

Or “Guinea Worm Disease” results from long skinny roundworms that live in blisters in the legs and feet.

Filariasis:

Another roundworm disease, this one causes blockage of your lymphatic vessels leading to elephantiasis.

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Book Review: How Doctors Think (2007)

Categories:

General, Book & Movie Reviews

October 5, 2011

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Dr. Jerome Groopman is an internal medicine physician at Harvard Medical School and has written a number of best selling books as well as frequent columns in The New Yorker. His recent book, How Doctors Think, is another New York Times bestseller and has received rave reviews from most sources.  I read this book during my fourth year of medical school and wished I read it earlier.  The book delves into the art of diagnosis and treatment and focuses on parts of these skills that are rarely discussed in medical school.  Dr. Groopman explains that many of the decisions we make as physicians depend on inner feelings and tendencies that even we are not always aware of.  If physicians are able to understand these tendencies, we will be better equipped to make correct decisions and less likely to make incorrect ones.  This is a very good book, one that will help medical students in their career and one that will allow patients to better understand their doctor.  I highly recommend it.  Below is Dr. Groopman’s biography from Amazon.com…

Jerome Groopman, M.D., holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston. He has published more than 150 scientific articles. He is also a staff writer at The New Yorker and has written editorials on policy issues for the New Republic, the Washington Post, and the New York Times. His previous books include the New York Times bestseller The Anatomy of Hope, Second Opinions, and The Measure of Our Days. Groopman lives in Brookline, Massachusetts.

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Book Review: Over our Heads (2011)

Categories:

Book & Movie Reviews, Compensation

October 5, 2011

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Dr. Rulon Stacey, PhD is the president and CEO of Poudre Valley Health System, he is the current president of the American College of Health Care Executives, and recently won the Malcolm Baldrige Award presented by President Obama. He recently published a new book: Over Our Heads: An Analogy on Healthcare, Good Intentions and Unforeseen Consequences, which outlines some of the problems with health care in our country.  In the book he uses an allegory of a grocery store owner to explain how government regulation has created a cumbersome and expensive health care system that is near the brink of failure.  He cites specific government bills and describes how each of them has affected the health care system.  The allegory allows the layperson to understand some of the difficult nuances of health care and government regulation.  I think this is an extremely important book written by a man who knows the system as well as anyone else.  I recommend the short read to all medical students and everyone else.  Below is the official book description from Amazon.

 

 


 

 

Costs continue to soar, and Americans already crippled by a sluggish economy struggle to pay escalating insurance premiums. Politicians, entertainers, and other public figures regularly demonize healthcare professionals as the ones who created this situation through either greed or mismanagement. Meanwhile, it seems as though government solutions just make things worse, and the problems keep piling up.

How did we get to this point? According to Rulon Stacey author of Over Our Heads: An Analogy on Healthcare, Good Intentions and Unforeseen Consequences the roots of the problem are inseparable from the solution. Government intervention, meant to make healthcare more accessible and affordable, has instead created a system so convoluted and complex that we can no longer keep up with current policy.

This book is Stacey's attempt to describe, in a concise and relatable way, where our national healthcare policy went wrong. His analogy centers on a grocery store in the fictional town of Capital Springs and details what happens when the city government decides to issue food vouchers in order to help the community s poor and then gradually begins to reduce their reimbursement.

As the mayor tinkers with the program, the results of his actions lead to higher prices, inadequate distribution, and a situation analogous to where healthcare finds itself right now. The book ends with the election of an even more generous mayor and a grim prediction of what will happen to the industry if current public policy remains unchanged.

Readers will learn three key lessons:
1. Government intervention, fueled by good intentions, caused this crisis.
2. Current public policy is based on faulty information and should be evaluated.
3. If left unchecked, health reform will continue to promise more healthcare for less reimbursement…and the whole system will surely collapse on itself.

This book will be welcomed by healthcare professionals searching for a way to tell their story, political reformers building a case for change, students seeking a defined case study on the healthcare cost crisis, and citizens seeking insights on how we got so far in over our heads and where we re likely to end up.

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Histology Websites

Categories:

Preclinical Years, General, Pathology, eResources

October 4, 2011

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Image from "Ed's Histology Review"

Histology is an extremely important topic during medical school, both in the pre-clinical years as you study anatomy and pathology, and during the clinical years when you are diagnosing patients. Many questions during school, including all three parts of the USMLE or COMLEX test will include histologic slides and ask for diagnosis or interpretation.  It is imperative that all medical students get a solid foundation in histology.  Years ago, most student would purchase histology textbooks.  However, recently, a number of medical schools have created free and easy-to-use websites for studying histology.  If you are still a book person, let me suggest Histology: A Text and Atlas which has great slides and explanations.  Otherwise, if you are like me and would like to save the money, let me outline some of the best histology review sites on the internet.

If you don’t want to spend the money and don’t mind using websites to study, let me recommend two fantastic  histology websites

If you know of other great websites, please let me know.

 

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