Supply and Demand

I just spent the last hour going through the 30+ applicant emails I received for my position of a coblogger. They were some of the hardest emails I have ever had to write.

In summary, there were many more qualified people than there were spots. Almost everyone was talented, ambitious and genuinely interested in helping others. I could see myself working well with many of them. I had to turn down many very qualified people. The decisions weren’t easy. I still have to select a final co-blogger out of the final few. It’s going to be a difficult choice.

I am humbled that so many talented individuals would want to work with me at creating content. I feel blessed and am grateful to my readers.

This whole process reminded me of medical school admissions, a game of supply and demand.

Every year, there are many more talented and caring applicants – many who would make fine physicians – than we have medical school spots. Many of these applicants end up pursuing their careers in the States or internationally (Ireland, Australia, Caribbean). It’s a real shame we can’t admit them all.

To everyone who may have recently been rejected from medical school, sometimes it’s not your fault. You did everything you could and the numbers just didn’t land in your favor.

I hope everyone I had to send a “rejection” email knows I feel the same way.

Note: The image is that of a Nuclear “MIBI” Scan used to assess the supply and demand of the heart

Residency Workload

Dr. Pauline Chen has written a great article on Workload for Doctors in Training, a topic I have been thinking about lately. From being feeling overworked to being on call by youself, it really makes you wonder if there is a better way to structure residency. The comments from the article are worth a read too as many residents, staff and the public weigh in on this heated topic.

Much of the recent kerfuffle arises from an article published in JAMA on Duty Hour Reforms. A lot of medical bloggers that I follow regularly have commented on it more elegantly than I can – Sims and Choppers, Precious Body Fluids, Med Rants.

In Canada, at least at my institution, we don’t have a 80 hour work week limitation. Our contracts states that call shifts are to be a max of 26 hours, though I have stayed longer many times post-call. We don’t have a night float system yet. There are still some vestiges of traditional work hours and I really don’t mind them. I guess I can consider myself lucky?

But based on my experience as a medical student and resident, I believe that work hours are not the main issue to be addressed. Medical errors are more likely to be made when processes are rushed and when you have to make clinical decisions for patients you are not familiar with. More handovers leads to more chances for errors to occur. Lack of supervision can be an issue too, as quoted from the NYT comments, “young docs left to make immediate decisions, only to be berated for their mistakes a day or two later when attending (supervisory) rounds were made. The mistakes, of course, were patient care.” Though for the most part newer attendings are more involved (JAMA article co-authored by Dr. Abraham Verghese) and I’ve had good experiences with academic staff.

How this all will play out – I’m not entirely clear and sure if it will benefit or disadvantage residents and patients. I think we will start having work hour restrictions here in Canada soon, some provinces have already adopted them.

To my regular readers – I am alive, eating, sleeping and getting by but not much more. I have not had time to write much. A string of multiple calls in a row can really be draining and can really sap all the remaining energy and motivation out of you. I”m on call five more times in the next two weeks… I can’t wait for the next block.

To those who applied to be a co-blogger, I haven’t forgotten. I’ve gotten a great response and getting back to everyone has taken longer than expected. I’ll try to finalize things by the end of April.

(Photo Cred: Ghz from Flickr)

App Review – Journal Club

I am always in search of good smartphone apps and I just had a chance to review the Journal Club app which aims to bring summaries of the most important medical studies to your fingertips.

If there’s one thing that’s harder to remember than medical eponyms, it would be naming major clinical trials and their significance. The Journal Club app is available for both iOS and Android and is very simple to use.

The app is based off of Wiki Journal Club, a website run by residents from Standford and Georgetown. They select and review key studies that are important to know. Their goal as per their website is to provide open, user-reviewed summaries of the top studies in medical research

Interface

The app has a simple and clean interface that’s easy to navigate. When you open the app, it presents all the trials in an alphabetical order. You can also choose to sort by specialty or by disease (eg. Heart Failure) .

  

The app is really responsive and once you select a trial, it brings up an easy to read summary. It breaks down the sections starting with Bottom Line, which is a one sentence summary of the trial. The Major Points than outlines the key aspects of the trial and it’s findings.

Afterwards, there is information around the Study Design, Inclusion/Exclusion Criteria, Baseline Characteristics and Outcomes. At the end, they have a Reference section that includes links to the journal article, pubmed and PDF for download if available.

  

Pros

  • Easy to use interface, light app, fast to load.
  • Summaries are well done – concise but still has all the relevant information available
  • Broad range of trials available, there are about a hundred so far.
  • Great Formatting, easy to read font, information presented in an organized matter.
  • App will be updated along with their online wiki.

Cons

  • Still missing many landmark trials – especially in the Cardiology section, the one specialty you need to know trials for.
  • There are still many links to trials that say “That summary doesn’t exist yet.”
  • No search function
  • Would be nice to have swipe navigation but not a must
  • Navigation within each trial to the relevant sections could be improved to prevent excessive scrolling

Price

  • $2.99

Conclusion

  • Excellent app with great summaries of important trials.
  • Easy to use interface
  • Constantly being updated and with more summaries done the app will be even better
  • Missing many cardio trials. There’s a wiki Cardiology Trials Quick Review or you could try the CHF Trials app, which many cardiology fellows recommend.
  • This app has a lot of potential. The $2.99 goes to supporting their Wiki Journal Club and is a small price to pay.
  • Looking forward to more updates and can definitely recommend this app.

Check out Wiki Journal Club, where all their summaries can be viewed online for free, to get a feel for it. You can also volunteer to help grow their database of trials.

Disclaimer: I was provided with a free app for review. I have no other ties with Wiki Journal Club to disclose.

Recharging on Call

I’m on call and my pager has finally decided to quiet down for an hour (fingers crossed).

My phone’s battery life is at 24%.

It’s time for a recharge. I find an outlet to plug in my phone, and for the next while I recharge myself too.

I kick off my shoes, empty my pockets and try to forget that I’ll be in the hospital for another 12 hours. I find something to eat, I stretch. I take a moment to breathe and I try to forget about my electronic leash that is the pager.

I think about the relaxing things I will do tomorrow post-call. I remember to be grateful that I am in this career and although it’s hard work it can also be rewarding.

Battery life 65%

It’s these moments of quietness that can make all the difference on a call shift. It’s a opportunity to slow down after a busy non-stop day. To catch your breath and really reflect on what you’re really doing.

I hope I get some sleep tonight. If I can get at least 3 hours of sleep, I might even be able to stay up post-call and be productive with my daylight hours. Ahhh what I would give to be able to sleep six hours in my own bed every day of the week. As a resident, we have low standards and don’t ask for much.

*BEEP BEEP BEEP* – Why must all good things come to an end.

Battery life 81%

I wish I felt 81% refreshed.

(Creative Commons Photo credit: kool_skatkat)