Polytrauma Patient Case

Photo Credit: Russell

Photo Credit: Russell Stitzlein

“Hey man, just giving you a heads up…I think we have an ankle fracture down here in the trauma bay.”

“Um…ok, you think you have an ankle fracture?”

“Yeah, the ankle is pretty deformed.  We don’t have Xrays yet.  The patient is in the CT scanner.  We’ll get Xrays when she gets back here.”

There was a time when getting a consult for a presumed fracture would have infuriated me  - it’s like consulting cardiology without an EKG.  At this point, however, I’ve come to accept it as a common (albeit annoying) occurrence and it’s not something I’m going to Iet bother me.  If we were to get consulted every time the ED thinks an ankle is broken we’d probably see three or four patients for every one real fracture.  With a few exceptions (especially true for ankle fractures), if a bone is broken it’s going … view full post »

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Prepare Wisely for the 2015 Match and Beyond

Photo Credit:  atomicShed / Foter / Creative Commons Attribution 2.0 Generic (CC BY 2.0)

Photo Credit: atomicShed / Foter / Creative Commons Attribution 2.0 Generic (CC BY 2.0)

As a program director, I hear about a lot of wonderful candidates who unfortunately were not successful in the match.  As these kinds of conversations unfold, it always becomes clear to me why these residency hopefuls did not match.  For example, I learned about a candidate who graduated from an excellent international medical school with fairly good USMLE® scores and reasonable clinical experience who only ranked 3 programs!  Another candidate failed the USMLE® CS portion twice and was going for a third.  I couldn’t help wondering why this candidate didn’t take immediate stock after the first failure.

I’m a believer in second chances and moving forward confidently.  However, in the business of obtaining a residency position, there are certain realities that cannot be ignored.  Data are abundantly available to help residency candidates maximize their chances for … view full post »

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USMLE Step 3 Changes

Stethoscope Connect the Dots 2 (1)Screen Shot 2014-04-02 at 1.46.56 PMNew Year, new exam, and a throwback to the basic science…

That’s right…think back to first year of medical school type of basic sciences. We have known about the changes in the USMLE® Step 3 examination for some time. The first announcement of some of these changes came back in 2012 for the 2013 examination and the trend continues for 2014. This trend parallels a growing number of medical schools’ curriculum changes which are attempting to blur the lines between the traditional divide between basic sciences and clinical sciences. No longer are we to furiously memorize and then forget the fundamental mechanisms of biochemistry and pathophysiology. Now, we must integrate our fundamental knowledge with the clinical signs and symptoms of the patient in front of us. I, for one, am a big fan of this…let me tell you why:

  1. We are scientists: a differential diagnosis is no more than a
  2. view full post »

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Matching into Residency is like Getting Engaged or Married

By Gary Bridgman (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

By Gary Bridgman (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

As the seasons pass, so does another Match season here in the United States.  25,687 applicants to this year’s NRMP matched into a residency position. The Match offered 29,761 first- and second-year positions, which is actually 500 more than last year and an all-time high. NRMP executive director Mona M. Signer said in a statement. “In the past 5 years alone, we’ve seen an increase of more than 4,000 positions, and more than half of those are in internal and family medicine. [1]” The match is a time in which both anxiety and excitement are in the air, and the entire hospital is buzzing about how the entire process went. The match is literally like an engagement or marriage being announced and if you think about it, hospitals are basically getting engaged to the … view full post »

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Congrats to all who matched!

UC Irvine / Foter / CC BY-NC-ND

UC Irvine / Foter / CC BY-NC-ND

Congratulations to all who matched this week! We wish you the best today as you find out where you will spend your residency training.

Let us know in the comments where you matched!… view full post »

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Residency Match Madness

Photo credit: pennstatenews / Foter / CC BY-NC

Photo credit: pennstatenews / Foter / CC BY-NC

March is upon us! And for many across the world, this means more than filling out college basketball brackets. There is a hum of excitement in the hospital as well… it’sMarch 17th, Match Day! It represents the culmination of years of medical training for a new group of residents, new friends and colleagues for the residency families they will join, and much needed replacements for tired interns.

The Match is an intense process. Indeed, in 2013 there were a record breaking 29,000 resident positions offered topped only by the 34,000 medical students who applied for them. Numbers like these motivate medical students/graduates around the world to polish their C.V. and personal statement, dress up, and fly around the country visiting hospital after hospital in hopes of finding a perfect pairing. The lists are viewed and reviewed (taking into account everything … view full post »

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SOAP: How It Works

Photo Credit:  Ennor / Foter / CC BY-NC-SA

Photo Credit: Ennor / Foter / CC BY-NC-SA

Match Day is right around the corner…literally. We understand this is a nerve-wracking time as you wait to find out if you matched into your residency program of choice. We don’t want to add to your stress, however in the instance that on the morning of March 17th, you receive that horrifying email confirming your worst nightmare notifying you that you did not match, there’s still a chance because there will be programs that have unfilled positions.

You should have received an email by now notifying you of your eligibility to participate in the Supplemental Offer and Acceptance Program (SOAP). SOAP consists of a series of rounds in which participating programs attempt to fill their unfilled positions. Note that this is not an indication of whether or not you have matched.

In order to be eligible for SOAP, applicants must … view full post »

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ED Case: Dislocated Patella

Photo Credit: Russell S.

Photo Credit: Russell Stitzlein

Things were a bit quiet the other morning so I decided to go up to the OR and join the rest of the team who were fixing a distal tibia fracture and see if I could learn a thing or two while waiting for the next consult to come in.  I wasn’t scrubbed in for more than five minutes when a page came through from the ED.  Normally the residents page to call consults, so when the circulating nurse read the text page and it was from one of the ED attendings, I asked that she call right away to see if it might be something more urgent than usual.  The ED attending relayed that she had a construction worker in the ED who had a crane lift swing and hit his leg, leaving him with a grossly deformed knee and an absent popliteal (major artery … view full post »

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Residency Application Series: Letters of Recommendation

FAN2014393 (1)How to Obtain Powerful Letters of Recommendation

I’m always asked if letters of recommendation are important.  They absolutely are, and I won’t even review an application until I have at least two letters uploaded, no matter how outstanding all of the other data might be.  I’m interested in who is writing the letter of recommendation.  For example, I look closely at letters from other program or associate program directors or vice chairs of education. They might say something like, “I’ll be recruiting this person to my own program,” which is a great testament to that candidate’s characteristics and strengths.  However, letters from hospitalist or ambulatory clinician educators and clerkship directors who have worked closely with the candidate carry as much weight.

You want to avoid having a lackluster and unusually short letters written about you.  “He was nice and always was punctual.”  This kind of letter indicates that the letter … view full post »

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Medical Specialty Series: Psychiatry

By Scray (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

By Scray (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

In our Medical Specialty Series, we’ll highlight the most popular specialties to help you get started as you research residency programs.


Psychiatry residency specializes in the areas of prevention, diagnosis, and treatment of mental, behavioral, addictive, and emotional disorders. It requires a holistic approach in which psychiatrists must understand the biological, psychological, and social components of illness. Psychiatry is unique in that psychiatrists are prepared to treat the whole person. In addition, psychiatrists work with individuals and families who are coping with stress, crises, or other problems, and are able to order diagnostic tests and prescribe medications.

There is a shortage of psychiatrists and this field offers many career opportunities in a variety of work settings from hospitals, community health centers, schools, rehabilitation programs, government, private practice, and much more. 


Dr. Alina Gonzalez-Mayo

“Psychiatry is the only thing I ever wanted … view full post »

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