Last night, I responded to a code blue while working the night float at the hospital. The patient was a relatively young female who had just completed a coronary artery bypass procedure. Per training, I began compressing her chest to induce blood flow to the rest of her body. As I pushed, the incision reopened and blood began spewing everywhere. I could feel her ribs giving and cracking from the force ...

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Pauline Chen has once again written a brilliant piece in the New York Times: Are Today’s New Surgeons Unprepared? While many comments miss her underlying question, her exposition makes the problem clear. How do we gain expertise? Current theory supports the idea of deliberate practice. How do we conceptualize deliberate practice? Start with a sports analogy. You are trying to learn to make a 6 foot putt. In scenario ...

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In a scene from the 1999 cult classic “Office Space,” three burned-out cubicle drones take a baseball bat to a malfunctioning printer.  While I do not condone violence against innocent peripheral hardware, I admit I secretly fantasize about destroying medical center fax machines. Recently, a chronically non-compliant end stage kidney disease patient on dialysis was admitted for minimally elevated troponins and non-ST segment EKG changes in the setting of a hypertensive ...

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As Dr. David Green reported recently in NEJM Journal Watch, the American Society of Hematology is the latest society to comment on appropriate and cost-conscious care in the ABIM Choosing Wisely campaign. I’ve followed the Choosing Wisely campaign closely and have been using it on the wards and in clinic as academic ammunition. A specialist society’s public advice about showing restraint is an excellent means to challenge the dogma of our ...

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When a doctor finishes medical school, he or she then faces what is truly the most difficult part of their journey into becoming a physician: graduate medical education.  The goal of internship, residency, and fellowship training programs -- what is collectively called graduate medical education, or GME -- is to take newly minted doctors, just out of medical school, and turn them into competent physicians, able to practice in their specialty independently.   And ...

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“Well I don’t know why I came here tonight, I got the feeling that something ain’t right,” the song hummed through the speakers of the DC medical examiner’s office. Something definitely is not right, I thought as I watched the pathologist and his assistant begin the first autopsy of the morning. With rough strokes, the assistant dissembled the body before us. Unlike the cadavers we had dissected one year previously, this ...

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While my career has included patient care, research and administration, I have always considered medical education my primary purpose. Having had the great opportunity to know many students and residents, having had the great opportunity to visit many medical schools, and having had wonderful colleagues, I have great concerns about the bureaucracy craze that has engulfed medical education. This morning I spent a few minutes reading tweets, and came across a ...

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The culture of medicine has changed and a new generation of medical students has noticed this insidious path to disgruntlement. Reimbursement rates dominate conversations among health care professionals. Physicians are slowly burning out while younger faces are tempted away from humanitarianism by lucrative lifestyle specialties. Bureaucrats, technology, and increasing health-care costs have transformed the doctor-patient relationship, and students pick up on the increasing frustration in the profession. The few oases of ...

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As an educator, I've come across some recent news stories that call to mind Dorothy's observation, "we're not in Kansas anymore." Consider the following two. 1. Sara Volz, a high school student from Colorado, won the top prize ($100,000) in the 2013 Intel Science Talent Search for her research of algae biofuels. She accomplished this outside of school in a home lab under her loft bed, sleeping on the same light cycle as ...

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“What is the one best test?” A test-taker's frustration boils over as they read this prompt and think, “in real life we would do all of the above.”  And for the most part, they are correct.  In the United States, medical trainees are taught for exam purposes to answer the one best test for diagnosis or the one best procedure for management. However, in practice the same trainees watch our role-models take ...

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