“Please don’t spoil the movie with your own soundtrack.” Remember hearing this message before the beginning of a movie in a theater and how most people turn their devices on silent to watch the movie? The cost of the movie ticket is considerably less than the cost of medical education, but I wonder if learners consider this phenomenon when they walk into their classrooms. Is the habit of smartphones in ...

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Dear medical student, resident, or fellow, You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got here. I want to remind you. I want us all to remember. You undoubtably were more mature than your peers. You undoubtably sacrificed to develop the persona that one day would impress ...

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It’s that time of year where upcoming fourth-year students are frantically preparing applications for their chosen specialties.   Statements like “I LOVE psoriasis,” and “’I’m fascinated by the colon,” are heard from eager, smiling, seemingly-passionate faces when asking preceptors for a "strong letter of recommendation.’" But what about you? You know, the one whose specialty decision-making process feels more like being tossed into an M.C. Escher lithograph than the instant, undeniable attraction ...

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I am blessed to love being a doctor.  As the child of two physicians, and the fifth generation of physicians in my family, I had no choice but to go to medical school.  But from the first day of medical school, I loved it.  What a privilege, to know how the human body works! And I didn’t think medical school was particularly fun: I thought it was hard. The first ...

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In the 2014 Forbes article “How A Nobel Economist Ruined The Residency Matching System For Newly Minted MD’s,” Amy Ho argues the way we place new medical school graduates into residency positions needs to be reassessed. She calculated the cost of applying to residency to be greater than $7,500 when taking into account loans and interest. If you have not participated in the U.S. medical educational industrial complex, ...

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There’s no doubt physicians entering practice today leave their residency programs with a tremendous amount of medical education and training; what seems like a lifetime’s worth of knowledge crammed into just a few, intense years of instruction. Unfortunately, all the time residents spend on rotations, lecture, journal club, and myriad other obligations leaves little opportunity for getting oriented to the more mundane, yet absolutely critical components of practice. As a result, ...

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A letter to my nephew, who is just starting residency. There will be days ahead when patients will bring you their most prized and flawed possessions -- their broken bodies, their flagging spirits, their waning hope.  They will wonder: "Can I get back to my loved ones, my life, my dreams?  Will you help me? Do you care?" You will not have all the answers, though you will have read a forest ...

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July is back, and clinical faculty at teaching hospitals have again braced for the annual deluge of new residents just beginning their specialty training. Unfortunately, our new doctors may be more unprepared than ever. The gap between medical school (the four years leading to the MD degree) and residency (advanced training in a particular field) has widened over the past several years. Changes in the health care system, shifting patient expectations, ...

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Much is made of the date July 1st in the medical profession.  Freshly graduated physicians begin their training career in medicine as interns.  Although technically physicians, these interns are new to the clinical practice of medicine and all that comes with that.  Much has been made of the experience of the new intern.  Samuel Shem's House of God is a renowned novel about medical training.  Countless television series, chronicle the ...

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Residency is a time of immense learning. You learn from your attendings, your patients, and your colleagues. Of all the teaching moments during my residency, one that frequently stands out in my mind now is the day when one of my co-residents told me about the “post-training phenomenon.” He had previously completed a different residency and practiced in that field for a decade prior to switching to our specialty. “Once you ...

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