Medical Rapid Review Games http://scrubwars.com Prep for the Boards (USMLE & COMLEX) and Clinical Clerkships Sun, 24 Jan 2016 01:45:15 +0000 en-US hourly 1 http://wordpress.org/?v=4.1.1 5 Unique Tips For Picking the Right Medical Specialty http://scrubwars.com/5-unique-tips-for-picking-the-right-medical-specialty/ http://scrubwars.com/5-unique-tips-for-picking-the-right-medical-specialty/#comments Mon, 06 Jul 2015 18:00:24 +0000 http://scrubwars.com/?p=857  

“I wouldn’t be burned out if I had studied the practice of my medical specialty as much as did perfecting my clinical skills in my third year.”  A Disgruntled Practicing Physician
Choosing the right medical specialty through your third year rotations and fourth year acting internships is like an arranged marriage: you get a short period of time to irreversibly (good or bad) change the course of your life. Getting advice on these topics range from informal advice from ward ...

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Choose the right medical specialty in the 3rd year.

“I wouldn’t be burned out if I had studied the practice of my medical specialty as much as did perfecting my clinical skills in my third year.”  A Disgruntled Practicing Physician

Choosing the right medical specialty through your third year rotations and fourth year acting internships is like an arranged marriage: you get a short period of time to irreversibly (good or bad) change the course of your life. Getting advice on these topics range from informal advice from ward attendings to hilarious stereotypes (http://theunderweardrawer.blogspot.com/2011/03/12-medical-specialty-stereotypes-2011.html) to formal studies on physician compensation (2015 Medscape Physician Compensation Report) and doctor attitudes towards their specialties (Medscape 2015 Physician Lifestyle Report). Most of the tips your hear about choosing the right medical specialty involve these common main topics: lifestyle, money, USMLE or COMLEX board scores, competitive specialties, and “follow your passion” type advice.  We are not against this type of advice, but there are more precise topics to examine in your clinical clerkships find the right residency and subsequent medical specialty. While we previously discussed 5 poorly considered factors when picking a medical specialty, here are 5 unique factors that are often overlooked: 

1) GRILL THE BILLERS & CODERS IN YOUR MEDICAL SPECIALTY

  Less than 1% of M3s probably find the medical billing and coding department for their hospital to ask those on the front-line of the reimbursement battles they experience on behalf of their medical organization. In short, billing/coding involves finding the right codes to match the documentation of clinical services provided and submitting these forms to payers (i.e. insurance companies, government entities, private pay patients) for reimbursement. Billing is relatively straightforward if the clinicians follow the proper documentation guidelines.  However, 70% of billing is “nagging” (trying to get payment timely, getting the proper amounts billed reimbursed, overcome administrative red tape inherent in the process).  By talking to these professionals, you will learn a great deal administrative information about a particular specialty including, but not limited to: a) most common errors physicians make in documentation b) reimbursement difficulties in various medical specialties and procedures c)various major government guidelines (i.e. HIPPA) d) evolving medical technologies (i.e. electronic medical record management systems) and e) a general understanding if doctors are actually making what you think they are making.

                   BONUS TIP- This is a great tip to bring up in your residency interviews because you will be talking about subjects that a) most attendings/physicians know anything about b) you will give them something novel to hear rather than clinical data c) you look like you are showing initiative and they will infer you will do this in their program d) looked like you picked your medical specialty due to intrinsic motivation reasons. 

2) EVALUATE NIGHTTIME CONTINUOUS SLEEP-

 For example, generally, radiologists, dermatologists, psychiatrists, and pathologists get more continuous nighttime sleep than surgeons, family practice physicians, pediatricians, and internists.  Remember, lack of sleep and intermittent sleep can make you tired throughout the day, which could potentially decrease your ability to deal with the non-medical parts of your life (i.e. spending time with family, optimizing finances, having fun, etc.). Continuous sleep is awesome and you should know this distinction going into your profession.

3) CHILDREN/ PRACTICE FLEXIBILITY- You may have children already or don’t know if you are having children.   Most of you will, some won’t for various personal reasons.  It’s much easier to have a child or raise a child as a psychiatrist than a surgeon. If you have children or plan to have any, consider not going into fields that required lots of overnight call, sudden emergencies, or frequent procedures/surgeries. Of course, lots of physicians have children in every medical specialty, but it’s really hard…. on both you and your families. This is especially key if you are the primary breadwinner or higher earner in your dyad. The underlying point to consider is know while a student if your medical specialty has the practical flexibility to absorb significant changes in your personal life.  The more flexible it is (i.e. options to do telemedicine vs. being stuck in the OR physically), the less stress on you.

4)DOES YOUR PERSONALITY FIT WITH THE MEDICAL SPECIALTY?-

 

 

Patient encounters vary tremendously across various specialties. See if your desired medical specialty matches your intrinsic and quirky personality characteristics.  Most med students focus exclusively on the clinical skills needed and entrance requirements rather than examining if they are a good fit with the medical specialty itself. While this subtopic could easily be several pages, here are some examples to consider when thinking about the right medical specialty:

  • ER is filled with physicians with a low attention span or need constant stimulation. Psychiatry often attracts more patient physicians with a high attention span and avoid medically-intense situations.
  • Those who like to work with their hands often choose specialties with procedures/surgeries.
  • Some of those who don’t like to engage in the interaction process with real patients consider careers like radiology and pathology.
  • Some fields attract those that who love differential diagnoses (i.e. neurology, internal medicine) while others focus on treatment efficacy (i.e. surgeons “heal with steal”).
  • .

  • If you love “thank yous,” then don’t be an anesthesiologist.

5) BEING OK WITH KNOWING LESS INFORMATION/SKILLS-It is ok to pick a medical specialty because you a) don’t want to remember many medical topics or b) your skills suck in many areas of medicine and you pick the specialty you can master. In medical school, you have to know almost everything to pass the various course and board exams. As a third year, you probably pretend you will go into that specialty to thoroughly evaluate the field. After graduating residency, generalists (i.e. family practice, pediatrics) generally have to know a little about alot of topics and specialists generally know alot about a specific field (i.e. dermatology, psychiatry). It is generally “easier” to learn alot about one topic (especially if you are interested in it) than remembering about many topics (especially if you don’t like many medical topics). In addition, sometimes you feel like you have one set of clinical skills and don’t think you can do anything else.

  •  a pediatrician must often keep up with their up-to-date reading of many different specialties because their patients/families will present many different complaints/questions throughout the day.
  •  a dermatologist generally needs to know extensively about dermatology, but feel comforted that they don’t have to know a great deal about OBGYN (which they will defer or “punt” to another specialty quickly).
  •  if you are good at poking, but would be a poor cutter (surgery), treating chart-o-megaly diseases (chronic conditions), and don’t like having lots of follow-up/long conversations with patients, consider anesthesiology as your desired medical specialty.  

 

The point is that, even though you are programmed in medical school to try to maximize your clinical skills in nearly every facet of medicine, it’s ok to pick a medical specialty because you don’t want to do alot or being forced to remember alot. This attitude is called being “deficient” in medical school, but “efficient” in clinical practice. 

 

P.S. If you would like to play a video game while reviewing high yield medical board facts (USMLE Step 1, COMLEX Step 1, USMLE Step 2 CK, COMLEX Level 2 CE) or high yield clinical facts for your clinical clerkships in third year, download free trials of them here.

 

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USMLE Step 2 CK & Medical Rotation Prep Video Game http://scrubwars.com/usmle-step-2-ck-clinical-rotations-prep/ http://scrubwars.com/usmle-step-2-ck-clinical-rotations-prep/#comments Sun, 14 Jun 2015 10:15:06 +0000 http://scrubwars.com/?p=820 Bring on the USMLE Step 2 CK / COMLEX Level 2 CE & clinical rotations. Goodbye USMLE Step 1 / COMLEX Level 1. Congratulations to all of the medical students who just took the first of 3 required USMLE/COMLEX medical licensing exams. Rest up for your medical clerkships in your third year clinical rotations. Thank you for all of your who have tried out and/or bought Scrub Wars’ preclinical medical boards edition. Though you are halfway to becoming an MD ...

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Bring on the USMLE Step 2 CK / COMLEX Level 2 CE & clinical rotations. Goodbye USMLE Step 1 / COMLEX Level 1. Congratulations to all of the medical students who just took the first of 3 required USMLE/COMLEX medical licensing exams. Rest up for your medical clerkships in your third year clinical rotations. Thank you for all of your who have tried out and/or bought Scrub Wars’ preclinical medical boards edition. Though you are halfway to becoming an MD statistically, it’s now going to feel like you are only 25% done. There are many well-publicized challenges about the third year in medical school where you focus on patient care in your medical clerkships. These include decreased sleep, unstructured work hours, knowing little/feeling stupid, difficult shelf exams, challenging rounding presentations, and the most dreaded of all… public pimping by your attendings, often designed to teach you by degrading your self-esteem. You may not know if these attendings will even contribute to your clerkship evaluations when the rotation is over, but the public humiliation in front of your classmates can range from humbling to downright horrifying. You need to show your attendings that you are prepared, intelligent, knowledgeable, and quick when asked these pimping questions. Unfortunately, most clinical study guides and apps prepare you by practicing clinical vignettes or rehashing your second year in a boring manner.

Med students- we heard you when you wanted a fresh fun way to reinforce what you learned for the USMLE, COMLEX, and AIPMGEE medical board exams. Once again, we heard you (through social media, feedback emails, and through exhibitor conferences at AAMC & AMSA) that you need to study high yield board facts as well as clinical pearls to consolidate what you are learning on the wards. We are creating Scrub Wars medical study apps for your clinical clerkships. Up to this point, surgery has been released (1000 questions for $9.99, try 20% of the app for free, https://itunes.apple.com/us/app/scrub-wars-surgery-rotation/id972006256?mt=8.

By July 2015, we expect to release Scrub Wars pimping apps for your other clinical rotations:
neurology
ER
family practice

Study for your shelf exams or pimping prep in between patients, before rounds, or in study groups with friends. More details to follow. Good luck in Third Year. The Peyronie Attending is waiting for you.

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Changes in the DSM V http://scrubwars.com/changes-dsm-v/ http://scrubwars.com/changes-dsm-v/#comments Fri, 24 Oct 2014 04:25:19 +0000 http://scrubwars.com/?p=395 Changes in the DSM V
As many of you know, the American Psychiatric Association has transitioned from the DSM-IV TR to DSM-V (Diagnostic and Statistical Manual of Mental Disorders) in 2013. Starting in 2014, both the USMLE Step 1 and Comlex Level 1, as well as the behavioral medicine courses taught in both allopathic and osteopathic medical schools, started to incorporate and use the psychiatric criteria from the DSM-V. Below are the high-yield changes that are relevant for medical students. 

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Changes in the DSM V

As many of you know, the American Psychiatric Association has transitioned from the DSM-IV TR to DSM-V (Diagnostic and Statistical Manual of Mental Disorders) in 2013. Starting in 2014, both the USMLE Step 1 and Comlex Level 1, as well as the behavioral medicine courses taught in both allopathic and osteopathic medical schools, started to incorporate and use the psychiatric criteria from the DSM-V. Below are the high-yield changes that are relevant for medical students. 

  • A less specific terminological change was made regarding the use of “general medical condition.” It is now replaced with “another medical condition” when it’s relevant.
  • As more has become known about neurodevelopmental disorders, the term “mental retardation” has become obsolete. To match this change, the DSM V uses the term “intellectual disability”. Eventually though, the term will probably be changed to “intellectual developmental disorder” as to coincide with US law and the ICD (international center of disease).
  • As far a communication disorders go, the DSM 5 contains childhood-onset fluency disorders (previously stuttering), language disorder, and speech sound disorder (previously phonological disorder). Lastly, the new DSM includes social (pragmatic) communication disorder. This is identified by constant and persistent problems when using verbal or nonverbal communication in social settings.
  • Autism Spectrum Disorder (ASD) was previously known as four different disorders: autism, childhood disintegrative disorder, Asperger’s, and pervasive developmental disorder. After further research, it was found that ‘autism’ is a spectrum rather than a separate disorder. More of a ‘gray’ rather than a ‘black’ or ‘white’ disorder.
  • Attention-Deficit/Hyperactivity Disorder (ADHD) is diagnostically the same in the DSM V, but there are a few smaller changes. There will now be examples to help identify the disorder at many different ages, symptoms are now generalized to “present prior to age 12” (rather than 7), a diagnosis combined with autism spectrum disorder is now allowed, and the threshold for symptoms in adults, and lastly ADHD is now in the neurodevelopment disorders section.
  • Specific learning disorders are defined as what was previously written expression, learning, mathematics, and reading disorders. Often the disorders will occur together. As well as this, this section acknowledges the known specific reading and mathematic disorders (dyslexia etc).
  • The Motor Disorders section includes Tourette’s, persistent motor or vocal tic disorder, unspecified/specified tic disorders, provisional tic disorder, developmental coordination disorder and stereotypic movement disorders. The criteria for tic disorders have been standardized and stereotypic movement disorder is now more clearly defined.
  • Schizophrenia Spectrum Disorders have two major changes. First is the addition of a new requirement that the individual must have at least one of the three symptoms (disorganized speech, hallucinations, delusions). Lastly, the bizarre delusions and auditory hallucinations are no longer required for a diagnosis. The subtypes for schizophrenia (paranoid, catatonic etc.) have been eliminated because of the lack of validity and reliability.
  • For Bipolar Disorders, there is now an emphasis on the change in energy, activity, and mood of the patient. Previously, the patient needed to show this, but major depressive and major manic episodes were needed. It is now more generalized to “mixed features.”
  • Trauma and Stressor-Related Disorders have changed significantly as well.
  • Adjustment disorders are changed from stressful reactions to both traumatic and non-traumatic events rather than just a “leftover” diagnosis when a match was not found in the DSM-IV.
  • PTSD symptom clusters changed from re-experiencing, avoidance, and arousal in DSM IV to intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity in DSM 5.
  • There have been some significant changes to the Depressive Disorders.
    • Coexistence of Major Depressive Disorder (MDD) with at least 3 manic symptoms, but fails to meet hypomanic and manic criteria, can now be given the specifier “with mixed features.”
    • Bereavement Exclusion was removed
    • “With Anxious features” added to both Depressive and Bipolar Disorders as a specifier to help incorporate a possible suicide risk since anxiety and suicide are closely correlated.
  • Obsessive-Compulsive and Related Disorders have been reorganized.

New disorders include hoarding disorder, excoriation (skin-picking) disorder, substance-/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition. Trichotillomania has been moved from impulsive control disorders to this category.

  • The term hypochondriasis is now referred to as “somatic symptom disorder” if no somatic symptoms are present.
  • The anorexia diagnosis no longer requires amenorrhea. Bulimia is no longer limited to binge eating habits at least twice a week, but is now only once a week.
  • With current research and debates on sexual and gender identity disorders, Gender Dysphoria has been added to the DSM V. This is seen in individuals with “gender incongruence” (sex does not match gender).
  • Gambling disorders (addiction) has been added to the Addictive disorders section as well.

These are only some of the more major changes between the DSM IV and DSM V. To read the official document with all of the specific changes, go to this link:http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf

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5 Unconventional Tips on Getting the Right Letter of Recommendation http://scrubwars.com/5-unconventional-tips-getting-right-letter-recommendation/ http://scrubwars.com/5-unconventional-tips-getting-right-letter-recommendation/#comments Mon, 21 Apr 2014 04:14:29 +0000 http://scrubwars.com/?p=391 5 Unconventional Tips on Getting the Right Letter of Recommendation
Requesting a letter of recommendation for residency can be an intimidating process. It may feel as if your entire future rests on the lines of those pages, so you want to be sure that they are completed to include only your best attributes. Evaluate who has assisted you along your journey, be it a professor or colleague that you have bonded with during your classes or rotations. Choose at least ...

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5 Unconventional Tips on Getting the Right Letter of Recommendation

Requesting a letter of recommendation for residency can be an intimidating process. It may feel as if your entire future rests on the lines of those pages, so you want to be sure that they are completed to include only your best attributes. Evaluate who has assisted you along your journey, be it a professor or colleague that you have bonded with during your classes or rotations. Choose at least three people, although more are advised, who think highly of your abilities and who would gra-ciously write a letter on your behalf. The majority of your classmates will address their favorite professor or attending directly, and although this ultimately gets the job done, the residency admissions office may look for more creative ways to accomplish the task.

1 – Shadow A Specialist

A good person to approach for a letter of recommendation is a medical specialist. Look for a program where you are able to shadow a professional in your field of study over the summer. If such programs are available through the local hospital, this can be an excellent way to see first-hand what working in the field entails, while securing a professionally written letter of recommendation.

2 – Contact A Resident

Contact a graduate student who has accomplished what you are working toward. Talk to them about how they got where they are now and feel free to ask for advice. They will be able to tell you first-hand the steps they took to get ahead and will most likely be glad to assist you through the lengthy process. They can also be a valuable resource when it comes to writing a letter of recommendation. Remember they are M.D.s too.

3 – Get In The Field

If you participated in a real life work environment, such as an ambulance or fire rescue squad, approaching the chief or patrol leader can be quite beneficial. They may be willing to write a recommendation about your skill, and work ethic, in addition to how you handle yourself under stress.

4 – Perform Medical Research

If during medical school, you did research for one of your professors, call him or her and schedule a time when the two of you can sit down and talk. Explain what you are trying to achieve and what you are looking for in a recommendation letter. If they saw potential in your work habits and your ability to persevere, this should be a simple way to attain a high-quality, personal letter.

5 – Contact The Professor of A Class That You Struggled In

This letter may prove superior to a class that you aced. The professor observed you struggling, and although you had trouble, ending up on top shows your willingness to work hard and improve. That professor will include your ability to work to your full potential to improve, and if you stayed after class on some occasions because you wanted help or additional instruction, this can provide clarity into your drive and motivation.

Conclusion

Unlike the other parts of your recommendation, the beauty of the letter of recommendation is that someone else does all the work. All you have to do is to present yourself in a positive light. The way you carry yourself, your motivation, and your commitment to schooling all aid in producing quality letters that serve to encompass your best attributes, written by instructors and mentors who know you not only in the classroom, but also understand your dedication to the craft in the practical world of medicine.

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5 Tips on Writing the Personal Statement for Residency http://scrubwars.com/5-tips-writing-personal-statement-for-residency/ http://scrubwars.com/5-tips-writing-personal-statement-for-residency/#comments Mon, 14 Apr 2014 04:09:27 +0000 http://scrubwars.com/?p=387 5 Tips on Writing the Personal Statement for Residency
Residency admission committees take into account a variety of factors when determining to whom they will offer a spot in their program. Most of the factors they consider are secondary to numerical grades or other’s opinions of you. The only factor that is specifically related to the resident applicant’s voice is their personal statement. For that reason, the personal statement provides a unique perspective into the residency candidate’s personality, goals, and ...

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5 Tips on Writing the Personal Statement for Residency

Residency admission committees take into account a variety of factors when determining to whom they will offer a spot in their program. Most of the factors they consider are secondary to numerical grades or other’s opinions of you. The only factor that is specifically related to the resident applicant’s voice is their personal statement. For that reason, the personal statement provides a unique perspective into the residency candidate’s personality, goals, and thought processes for pursuing that specific path of training.

Producing a personal statement that will stand out among high achieving medical students will likely make the difference between getting your first choice of residency and being left to settle for a residency program that is still available at the end of the match process.

What can you do to make your personal statement for residency stand out?

1 – Make your strongest point in the first paragraph

Unfortunate as it may be, if you don’t make a strong point for admission quickly, it is possible that your essay may never get read. Something that grabs an admissions officer in the first paragraph, is likely to be completely read and gain your admission, to at least the next round of evaluations. If your essay is slow to gain speed or catch the eye of one of the admission personnel, it is likely the remainder of your essay will never be read.

2 – Tie your personal life experiences into your essay

If you want the admissions committee to truly understand who you are, you will need to tie your experience in life into your statement. For example, if you traveled to a foreign country and a particular patient experience changed your life, write about that. If you worked in the field during your summers off (for example you may have worked in the emergency room as a volunteer) you need to make sure the committee knows about that. People are generally touched by specific examples rather than generalized statements.

Say this:

During a recent relief trip to rural Mexico after my first year of medical school, I counseled Carla M., a promiscuous fourteen year-old runaway female, about how safe sex procedures to protect one from both STDs and unwanted pregnancies. Opening these streams of thought in a young teenager, which were previously unknown to her, and realizing that I could change the course of her future adult life sparked my interest in specializing in a career devoted to caring for adolescents.

Don’t say this:

Since the teenage years were very formidable years in my life, I want to be a pediatrician specializing in adolescent medicine so I can make a difference in the lives of adolescents. I know I can make a big difference in the trajectory of the lives of teenagers so they become responsible adults.

The first example is more interesting, more descriptive, and more personalized (using a name, demographics, a specific example, and your role in this example) as opposed to making generalized impersonal ways regarding how you will help others.

Next time you watch a State of the Union speech. The President usually highlights certain policies by singling out guests they brought to the event and personalizes their story. It makes a big impact on both the retention of the message and the emotional bonding with the theme of the message as well.

3 – Be Concise

The admissions committee will likely have hundreds of personal statements to sift through, on their way to offering spots to medical students. Make sure you get your point across within a single page. Essays that drag on will get lost in the shuffle.

4 – Elicit the help of professional writers

Many medical schools or universities have a writing staff or English department to assist in the writing process. Though it is important that you write your own essay in your own voice, it always helps to have a second set of eyes read your essay and suggest changes. Consider hiring a virtual assistant through odesk.com or elance.com to have professionals edit your essay.

5 – Don’t be afraid to start over

With a push to get your completed application turned in, there is always the enticement to move swiftly through the process. While it is important that you meet all the deadlines, rushing through your essay is a major mistake and one that will likely cost you leverage in the admissions evaluation. If your essay doesn’t represent who you really are, it is best to reevaluate what you are trying to say and start from scratch.

Conclusion

With the personal essay being the single most important method of expressing your unique personality, goals and career direction, the best advice is to take it slow and rewrite, rewrite, rewrite…until it represents the best version of you!

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College Students Use Smartphones to Study http://scrubwars.com/college-students-use-smartphones-study/ http://scrubwars.com/college-students-use-smartphones-study/#comments Wed, 09 Apr 2014 03:59:37 +0000 http://scrubwars.com/?p=383 College Students Use Smartphones to Study
Make studying more convenient for medical students and they’ll study more. Sounds simple enough, right? We think so. As it turns out, students who study practice tests and flashcards on their mobile devices are getting a ton of benefits from their mobile study sessions. One of the biggest benefits students are taking advantage of is the opportunity to study everywhere they go.
For instance, 19% of students using their smartphones to study are doing ...

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College Students Use Smartphones to Study

Make studying more convenient for medical students and they’ll study more. Sounds simple enough, right? We think so. As it turns out, students who study practice tests and flashcards on their mobile devices are getting a ton of benefits from their mobile study sessions. One of the biggest benefits students are taking advantage of is the opportunity to study everywhere they go.

For instance, 19% of students using their smartphones to study are doing so while going to the bathroom and are gaining an average 40 extra minutes of study time each week. Hard to believe? Not really. After all, who wants to carry around a 37 pound textbook at all times?

This is exactly why we designed the Scrub Wars App, so that busy medical students like you can whip out your phone any time, any place, and get your study on…even while
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This infographic shows when and where smartphone studiers are learning, and whether or not those mobile study sessions are effective. What do you think? Is it time to jump on the mobile study bandwagon?

Original infographic source: http://www.StudyBlue.com

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5 Medical Practices Most Affected by Obamacare http://scrubwars.com/5-medical-practices-most-affected-by-obamacare/ http://scrubwars.com/5-medical-practices-most-affected-by-obamacare/#comments Mon, 07 Apr 2014 03:24:41 +0000 http://scrubwars.com/?p=378 5 Medical Practices Most Affected by Obamacare
No group of American professionals will be impacted in a negative manner by the Patient Protection and Affordable Care Act, otherwise known as Obamacare, more than physicians.
More government regulation and oversight will be thrust upon practicing physicians who have become increasingly dependent on government reimbursement for the medical services they provide. Some studies have shown that over 60% of physicians, currently in an active medical practice, will be considering early retirement due ...

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5 Medical Practices Most Affected by Obamacare

No group of American professionals will be impacted in a negative manner by the Patient Protection and Affordable Care Act, otherwise known as Obamacare, more than physicians.

More government regulation and oversight will be thrust upon practicing physicians who have become increasingly dependent on government reimbursement for the medical services they provide. Some studies have shown that over 60% of physicians, currently in an active medical practice, will be considering early retirement due to the anticipated changes they will be subject to because of Obamacare.

Who will be affected by Obamacare?

1 – Family Practice Physicians

The family practice physician of today is typically based in a private practice office setting. Other than making daily rounds to access his/her patients, there is minimal interaction with a medical facility. Any billing of medical service is done based on the patient’s visit to the family practice physician’s office. This medical care is reimbursed at a lower rate than if the patient had been examined in the hospital.

2 – Internal Medicine Physicians

For the same reason as the family practice physician, the reimbursement of this office-based specialty will see a reduced rate of return for their services. Internal medicine physicians do, however, have a larger number of clinical procedures they are trained to do. Those clinical procedures are billed at a higher rate than a typical office visit and as such will provide some moderate protection to the Internal Medicine doctors’ fiscal hit.

3 – Physiotherapy

Doctors specializing in physiotherapy will also see diminished reimbursement for their services. These physicians typically practice in a setting that is part office and part rehabilitation facility. Though the addition of services provided in a rehabilitation facility lessens the impact of Obamacare, it does not completely obliterate it.

4 – Hospitalists

Obamacare is on the side of the hospitalist. Hospitalists are typically internal medicine physicians with additional training in critical care medicine. These physicians do not operate out of an office setting. 100% of their practice time is spent in the hospital. Often times, the hospital, who understands better than the physician how to bill for maximum return, will be responsible for charging for the physician’s services. This adds an additional bonus, courtesy of increased reimbursement, for the hospital-based physician.

5 – Concierge Medicine Physicians

A relatively new medical model, the concierge physicians, will benefit from changes that occur from Obamacare. The concierge physician is typically an internal medicine physician who works on an out-of-pocket basis with all of his/her patients. It is expected that as patients become more disillusioned with the micromanagement of their medical care, due to Obamacare changes, they will embrace the concept of paying out of pocket for only what they need. In addition, Concierge medicine puts the power of managing one’s own healthcare at the fingertips of the consumer.

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5 Poorly Considered Factors When Choosing a Medical Specialty http://scrubwars.com/5-poorly-considered-factors-choosing-medical-specialty/ http://scrubwars.com/5-poorly-considered-factors-choosing-medical-specialty/#comments Mon, 31 Mar 2014 03:17:31 +0000 http://scrubwars.com/?p=374 5 Poorly Considered Factors When Choosing a Medical Specialty
There is a great deal to consider when choosing a medical specialty. Though some medical students may claim to have known what they wanted to be since they were young, the vast majority of students will not make a final decision regarding their specialty until they are well into their medical school curriculum. Some may even face the end of their internships without a clear direction. With that said, there are ...

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5 Poorly Considered Factors When Choosing a Medical Specialty

There is a great deal to consider when choosing a medical specialty. Though some medical students may claim to have known what they wanted to be since they were young, the vast majority of students will not make a final decision regarding their specialty until they are well into their medical school curriculum. Some may even face the end of their internships without a clear direction. With that said, there are issues you may not even be aware of, that could potentially alter your decision making process.

1 – Competition

Depending on your ranking within your medical school class you may be a very strong candidate for whatever you choose to specialize in. However, since there are only a few students at the top of their class, it is more likely that you are somewhere in the middle of the pack. Certain specialties only admit the top 10% of medical school graduates. It is important that you realistically evaluate where you rank in your class and choose a specialty where your chances are high of gaining admission into a quality program.

2 – Training Time

Considering the time that is required to complete a training program is often not realistically considered when choosing a specialty. For example, the younger medical school graduate may have grandiose ideas of becoming a cardiovascular surgeon, but the extensive time that is required for the general surgery residency and additional cardiovascular surgical fellowship, may be too long for an older student. The young female medical student, with the desire to start a family, may dream of being a pediatric ophthalmologist, but the required amount of time to completely meet the training requirements in this subspecialty may be so long that her additional life goals may be compromised.

3 – Financial Opportunities

By the time most students complete medical school, the amount of debt that has been amassed is quite significant. The ability to pay educational debt, while living a comfortable life, is not always an option for some of the lower-paying disciplines, such as family practice and internal medicine. The big picture view is a necessity when considering the reimbursement scale of a specific specialty.

4 – Status

Though most physicians hold a high level of status in their own general communities, the hierarchy between individual specialists is still very much a reality. With surgical sub-specialists leading the status pack, choosing to be a family practitioner can leave you feeling like “the low man on the totem pole.” If your desire is to lead among other leaders, a surgical sub-specialty should seriously be considered.

5 – ON-CALL Schedule

Some specialties are very on-site call intensive (i.e. surgery, anesthesiology, OBGYN). In addition, other specialties (i.e. family practice, internal medicine, psychiatry) are off-site call intensive (i.e. many calls can be handled from home). At the same time, some specialties rarely have calls at all (i.e. dermatology, pathology, radiology). You will need to evaluate how much you want to be disturbed by calls outside of your normal business hours.

Conclusion

Each specialty has its own particular set of positives and negatives. It is important that you evaluate what is most important to you, as a physician, and base your decisions on the factors at the top of your list.

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Medical Marijuana Infographic http://scrubwars.com/medical-marijuana-infographic/ http://scrubwars.com/medical-marijuana-infographic/#comments Wed, 26 Mar 2014 03:09:33 +0000 http://scrubwars.com/?p=370 MEDICAL MARIJUANA INFOGRAPHIC: MIRACLE DRUG OR MENACE TO SOCIETY

Few things are as controversial as the current debate over Medical Marijuana. Is it a miracle drug or a menace to society? With more states considering legalizing medical marijuana, med students and physicians alike will have to decide which camp they belong to.
This medical marijuana infographic presents both sides of the argument between supporters and opponents to determine if medical marijuana is a source of relief or an unhealthy ...

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MEDICAL MARIJUANA INFOGRAPHIC: MIRACLE DRUG OR MENACE TO SOCIETY


Few things are as controversial as the current debate over Medical Marijuana. Is it a miracle drug or a menace to society? With more states considering legalizing medical marijuana, med students and physicians alike will have to decide which camp they belong to.

This medical marijuana infographic presents both sides of the argument between supporters and opponents to determine if medical marijuana is a source of relief or an unhealthy addition to society. It does so by showing how people are using marijuana for relief, what the opponents feel about marijuana, and finally by analyzing the dangers of marijuana as opposed to other drugs.

medical marijuana infographic

As a med student, what do you think? Leave a comment and share your thoughts.

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The DSM-5 on the USMLE http://scrubwars.com/the-dsm-5-on-the-usmle/ http://scrubwars.com/the-dsm-5-on-the-usmle/#comments Mon, 24 Mar 2014 03:02:43 +0000 http://scrubwars.com/?p=365 The DSM-5 on the USMLE

THE DSM-5 ON THE USMLE: WHAT SHOULD YOU KNOW?
The American Psychiatric Association officially released its latest version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, in May 2013. The APA made several significant changes in to the diagnostic criteria in the DSM-5 even changed several diagnostic categories themselves. While these changes will have broad effects on the practice of psychiatry, the more immediate concern to medical students and recent medical ...

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The DSM-5 on the USMLE

The DSM-5 on the USMLE

THE DSM-5 ON THE USMLE: WHAT SHOULD YOU KNOW?
The American Psychiatric Association officially released its latest version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, in May 2013. The APA made several significant changes in to the diagnostic criteria in the DSM-5 even changed several diagnostic categories themselves. While these changes will have broad effects on the practice of psychiatry, the more immediate concern to medical students and recent medical school graduates is the effect that these changes will have on the USMLE boards.

The USMLE’s stance on the DSM-5
On November 4, 2013, the United States Medical Licensing Examination directors announced that they would be moving from the DSM-IV to the DSM-5 immediately. However, since Step 1, Step 2 CK, and Step 3 of the USMLE are each derived from a large pool of questions developed over a long period. In actuality, the transition between DSM versions will actually be far from “immediate.” In fact, the USMLE publishers acknowledge that the complete change will likely take several years.

According to sources at the USMLE, the first goal was to purge questions from the existing content pool that are based on the DSM-IV. In fact, they have insisted that any psychiatric diagnosis content not based on new, DSM-5 criteria has already been eliminated from all three steps of the USMLE. On the other hand, they admit that the transition clinical psychiatric terminology from fourth to fifth edition standards will merely begin in 2014. So it is quite possible that someone taking a USMLE exam within the next three years may be tested on questions from both the DSM-IV and DSM-5.

What is new in the DSM-5?
One of the main changes (mostly important for clinicians and those who are interested in billing for psychiatric services) is that the axis system of the DSM-IV has been largely revised. The DSM-5 now follows a multiaxial system in which diagnoses from Axis I, II, and III are all included on a single “axis” for purposes of diagnostic coding. Axis IV and Axis V, as they were known previously, have been eliminated. Clinicians now use a rubric called “dimensional assessments” to assess the severity of the particular patient’s symptoms or disorder and response to treatment. For medical students studying for the USMLE, changes in terminology will be the greatest “high yield” topics.

Intellectual Disability
An example of a change in terminology is that the DSM-5 no longer uses the term mental retardation. The term mental retardation is potentially pejorative and offensive to some people. For this and other reasons, the term mental retardation has been replaced by “intellectual disability.” Intellectual disability is a condition in which deficits in cognitive ability first occur during development and are consistent with a mental disorder as defined by criteria listed in the DSM-5.

Attention-Deficit/Hyperactivity Disorder
The diagnostic criteria for ADHD are largely similar in the fifth DSM version. The 18 symptoms listed in the DSM-IV are still used in the newest edition and are split into the domains of inattention and hyperactivity/impulsivity. It is now possible for patients to be diagnosed with ADHD and autism spectrum disorder at the same time. There have also been some changes with the age cutoffs—in essence, younger children need to exhibit fewer symptoms in early life in order to meet new diagnostic criteria.

Schizophrenia
The diagnostic criteria and guidelines for schizophrenia have changed rather significantly with the recent update. Because they are not useful from the diagnostic or treatment perspectives, schizophrenia subtypes (e.g., paranoid, catatonic ) have been eliminated from the new edition. Patients must exhibit at least one of the so-called positive symptoms (delusions, hallucinations, or disorganized speech) in order to qualify for a diagnosis. Also, some of the more structured requirements for hallucinations or delusions have been eliminated (e.g., bizarre delusions).

Bipolar Disorder
The biggest change to bipolar and related disorders is in Criterion A. Specifically, patients do not need to exhibit “classic” symptoms of major depressive episode and mania. Instead, the criteria has been “softened” a bit to include the concept of “mixed features.” Mixed features are intended to account for cases in which mania exists with only depressive features (rather than frank unipolar depression). On the other hand, it may also apply if the patient has clear depression with some manic or hypomanic behaviors.

Depressive Disorders
The diagnostic criteria for major depressive episode have remained more or less identical between the two versions. Of note, the bereavement exclusion of DSM-IV has been eliminated from DSM-5. This means that prolonged bereavement now qualifies as major depression, essentially. Also added to the DSM-5 were a number of specifiers, especially for suicidal thoughts and tendencies.

Anxiety Disorders
Obsessive-compulsive disorder, posttraumatic stress disorder, and acute stress disorder are no longer included under the categorical umbrella of anxiety disorders. Instead, anxiety disorders are mainly limited to generalized anxiety disorder, panic disorder, phobias, and social anxiety disorder. Changes within anxiety disorders, while great in number, are not likely to be tested on the USMLE because they are somewhat subtle. That said, it is important to note that panic disorder and agoraphobia represent two separate diagnoses in the DSM-5. Moreover, patients are no longer required to recognize that their anxiety is excessive or unreasonable. The newest edition requires only that the anxiety is out of proportion to the realities of the provocative situation.

Trauma- and Stressor-Related Disorders
This category is the new home to posttraumatic stress disorder and acute stress disorder, among others. It has undergone broad changes – perhaps as dramatic as any section of the DSM. The diagnosis of acute stress disorder, for example, no longer contains some of the more restrictive stipulations of earlier versions. Patients may qualify for a diagnosis of acute stress disorder if they exhibit 9 of 14 symptoms in certain diagnostic categories.

PTSD has changed dramatically in the DSM-5. Clinicians must specifically identify if the trauma was experienced by the patient, witnessed by the patient, or in some other way in directly experienced. There are four symptom clusters rather than three, including re-experiencing, avoidance, persistent negative alterations in cognitions and mood, and arousal. Certain features of PTSD, such as irritable/aggressive behavior or reckless/self-destructive behavior, are now more prominent among the diagnostic criteria for PTSD.

Conclusions
Students who are planning on taking the USMLE will need to consider how to study for the psychiatric portion of the test. The makers of the USM LE have attempted to adapt to the newest edition of the DSM, but these changes will take time. Therefore, examinees should focus on the high-yield changes listed in this article. The highest yield material are changes in terminology that appear in the DSM-5. Because the questions may still come up in an actual examination, students should also recall what these terms meant in the DSM-IV. While diagnostic criteria are different in the DSM-5, especially for disorders such as PTSD, most of the questions included on the USM LE will not drill down to this level of detail. On the other hand, top students will be aware of the key changes that were made to the DSM in the most recent update and be able to answer questions based on the DSM-5.

Vincent Stevenson is the creator of Scrub Wars (scrubwars.com and @scrubwarsapp), an innovative medical gaming app targeting the USMLE Step I and COMLEX Level I exams.

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