OSCEs and Exams

Limited blogging recently and in the near future due to upcoming OSCE and exams. This is my last hurdle before clerkship, so the stakes a pretty high (in my mind, at least).

All I can say at this point is that I really, really, really hate when I have to spend more time learning for a test than learning for practice. OSCEs are great in theory, but I find I'm preparing as much for how they'll be testing me than what they'll be testing me on. There's some good reasons for this - the logistics of an OSCE are nightmarish - but it's still frustrating.

Match Statistics - 2015

I like numbers. Comes from a background in math, I suppose.

So when the yearly match statistics from CaRMS come out, I get a little more excited than a normal person probably should, even someone who's future may be influenced by those numbers.

Each year, there are surprises in the match stats. Many of these are one-time anomalies, quirks that reverse themselves the year after. Some, however, continue trends or herald the start of new ones. This year had a few surprises which may turn into longer-run trends. Here were the ones I found most interesting.

1) Psychiatry got more competitive - while it expanded.

We need more psychiatrists. And we need them in low-service areas (psychiatrists in well-served areas tend to see very few patients). Mental health is just too important to continue in its current, underserviced state. This year match rates to Psych dropped, despite a moderate expansion of residency positions. Far from a one-time change, this seems to reflect a multi-year trend, albeit with a greater-than-expected change this year. From conversations with classmates, I can see Psych remaining more competitive than in past years.

The reasons for this increase in competitiveness are probably multi-faceted, but I think the big ones are jobs, work hours, and the overall growth of the field. Right now, only a few specialties have a good job market. Psych is one of them. Few specialties have low working hours. Psych is also one of them, depending on individual circumstances. Psych is also evolving quickly as a field, with meaningful advances in diagnostics and management of many psychiatric conditions, and more advancements on the way.

Psych still has a very challenging patient population and the pay is on the low end for physicians. It's encouraging to see that despite these downsides, the field's popularity is growing

2) Some surgical specialties not all that competitive this year.

If Psych was the surprise competitive specialty, Orthopedic Surgery, Neurosurgery and Urology were the surprise uncompetitive specialties, at least by surgery standards. And that's with a slight reduction in the number of residency spots for these specialties.

The reasons for this change likely parallel those for Psych - bad job market (especially in Neurosurg) combined with horrendous working hours (especially in Neurosurg). These are still surgical specialties so they've retained some popularity, but specialties should take note: students are not overly eager to struggle through a brutal residency without a reasonable payoff at the end.

3) What happened in Public Health?

I have little to say here - Public Health is a small field when it comes to residency positions, but clearly is in demand. Virtually half those who wanted a Public Health program failed to match to it.

There aren't too many specialties I have to research before commenting on, but I had to do some reading on Public Health as a specialty. After doing so, I'm still baffled. Public Health is a vitally important subject, but I have no idea why it would require an MD or a separate residency (as opposed to a Master's) to participate in. That makes its popularity confusing to me. If a person really wanted to work in public health, why not do a PhD in the field instead of an MD? If they wanted clinical practice plus a hand in public health, why not something like a Family Medicine residency + a Master's? An MD with a specialization in Public Health appears to lack the deeper training of the first route and similarly lacks the clinical acumen of the second, while taking longer to complete than either.

I feel like I'm missing something and would greatly appreciate being filled in on where I've gone wrong. It's very hard for me to tell why a specialty is so popular when I'm still figuring out why it exists at all.

Stories of Olde

Old stories or legends are interesting beasts. They contain oddities and contradictions that baffle us, sometimes making us judge our forebears for their silly or antiquated ideas.

Here's the thing - I (and millions of other people) just watched Avengers: Age of Ultron this past week, and it's hard not to draw parallels between the stories we care about today and the ones of centuries past. It's a pretty ridiculous story, containing elements of both reality and fantasy, just like the older fables. It draws on characters that have been around for decades and have changed significantly in that time - Thor, the Hulk and Iron Man were all created in the early 60's, Captain America's been around since the 40's. Heck, even the super-villain Ultron, a robot, was created in the late 60's and has undergone several re-imaginings.

On the DC-side of things, Superman and Batman have gone through dozens of different iterations since they were introduced in the late 30's. Hundreds of years later, when historians are sifting through our cultural legacy, they'll see a lot about these superheros. It's hard to see how they won't be treated as significant aspects of our lives - there's just too much about them out there, over too long a period of time, for them to be considered minor elements. I can see people in 2500 getting confused about the details of what we believed about these characters, just as we get confused about the details of some past legends from forgotten civilizations.

Not sure where I'm going with this, just a random thought, but it's fun to try to see our world the way we tend to view the world of the past.

Editing

I edit for the school's journal. It's a fun, generally rewarding experience. I get to read about fun topics in medicine - some familiar, some completely new to me - and I get to see the level of expertise in academic writing of my classmates. I also write for the journal, which is equally fun. I've gotten to write about some really interesting parts of medicine and hone my own writing skills.

I really encourage anyone in medicine (or considering medicine) to get involved with writing on an academic or professional level, and student journals are a perfect medium. They're just rigorous enough to push students a bit further, out of their comfort zone, without the frankly onerous restrictions involved in, say, publishing in a more standard peer-reviewed journal. All instances of academic or professional writing provide a chance to explore concepts and organize thoughts in a way simply studying topics can't.

I don't consider myself to be an overly strong medical student, but I do pride myself on the ability to discuss a wide variety of topics in medicine with little or no preparation. Doing things like academic writing is part of that - I feel I can engage in discussions because I've had many of them already, often with myself while writing articles (or, at times, blog posts like this).

The flip side is that both writing and editing are a LOT of work. I'm currently sitting with a stack of articles on my lap, awaiting my notes. There are some highly interesting pieces to read through on my pile, but each one is hours worth of work. Nothing to do but get to them!

Drinking the KoolAid

Complementary and alternative medicine gets brought up a lot at my school, usually not in an overly positive manner.

There's reason for that animosity. Every physician has a story of a patient that had a less-than-ideal outcome because they opted for care that either diminished the effectiveness of conventional medicine or replaced it entirely. In some instances, deaths have occurred. When there are people promoting and even profiting of those outcomes, it's hard not to get angry.

When you listen to the people providing these alternative medicine services, however, they believe strongly that they're helping. Many of these practitioners go through extensive training before they practice, training which reinforced the theories underlying their practice. When you're told over and over again that something is right, and most of the people you interact with believe in it as well, it's hard to accept or even contemplate that it might be wrong. So, these alternative medicine practitioners continue to believe they're helping in spite of contradictory evidence because it's simply inconceivable that that contradictory evidence could be right. They drank the KoolAid.

Here's the thing - every field has their own KoolAid, including medicine. For those who like to go back to the evidence, some of the KoolAid is easy to point out. There are many procedures or approaches in medicine that lack supporting evidence or have even been shown to be ineffective. Yet they are still a part of our practice. Traditional medicine does tend to be more responsive to evidence - clearly unhelpful procedures do work their way out of the system, over time, but it takes far longer than it should. I have had physicians, in front of a full class of medical students, discuss a procedure, admit that the available evidence shows that it works no better than a placebo, and then insist that it still has a role in medicine.

More importantly, there are certainly some things that we're doing that are ineffective or unhelpful and we have no idea that they are ineffective or unhelpful.

Complementary and alternative medicine should be scrutinized, but so should conventional medicine. I think conventional medicine holds up much better under that scrutiny - that's why I'm getting an MD and not an ND - but we should always be willing to hold conventional medicine to the higher standards we'd like to see applied to complementary and alternative medical practices.