News - Part 72

Medical practitioners careers (Part 7)

medical graduatesIt helps to avoid procrastination. Those who fail to address this area have problems coping with the real world, no matter how talented they might be.

Strategy #3

The second important skill is the ability to write in a clear, concise manner. For most of us, good writing is a learned skill that comes from practice combined with some guidance. The sooner you practice your writing and acquire that guidance the better. Read more »

Medical practitioners careers (Part 6)

Strategy #5

I suggest that major administrative responsibilities be left for relatively late in your career unless you decide that this will be your primary focus, in which case you will need additional training in administration. Your early years in any position are very important and I think it’s best not to clutter them with extensive administrative responsibilities, too many committees or generally unproductive time commitments. Accept your fair share but learn to say no. Because of the high prevalence of many diseases in the developing world, involvement in international health might be an attractive option for some of you, but it is preferable to establish yourself at home before taking on the rest of the world. Read more »

Medical practitioners careers (Part 5)

clinical practiceStrategy #7

To reduce the risk of burnout, try to position yourself so that you are in demand. Burnout can result from a feeling of being trapped in a role or job from which there seems to be no escape. The best protection for you will come from gaining skills and achievements in clinical practice or in the academic sphere that make you a marketable commodity. Read more »

Medical practitioners careers (Part 4)

Strategy #9

If you intend to establish yourself in research, you will face challenges as an independent investigator beyond those you encounter as a fellow or resident. You will become responsible for generating the funds and facilities to support your research, and the capacity to generate research funds will depend on your productivity. Read more »

Medical practitioners careers (Part 3)

medical specialistSelection of a niche within a specialty is a complex issue on which to generalize, but most training programs, through mentors who play key roles in this regard, deal effectively with this aspect of career development. I intend to focus on the steps that fellows and residents must take to minimize the long-term risk of professional dissatisfaction and burnout, while maximizing contentment. Taking the lead from a prominent late night television host, I offer my list of the 10 best strategies for finding and retaining satisfaction and fulfillment in a career as a medical specialist. Read more »

Medical practitioners careers (Part 2)

The modern emphasis on evidence-based medicine has come about for good reasons but the decreased use of old-fashioned clinical assessment of the individual patient interferes with the doctor’s capacity to administer “whole” patient care. Furthermore, health research has become increasingly sophisticated and specialized, leaving little or no room for the amateur, no matter how gifted. In the background of all these trends, there is the welcome increase in prevalence of women in medicine and the need to continue to address issues associated with this demographic shift. Read more »

Medical practitioners careers (Part 1)

medical residentsAfter many years spent in the protected, rather cocoon-like environment of a postgraduate training program, medical residents and fellows can find the prospect of emergence into the real working world somewhat daunting. This is a transition that is best anticipated and planned, recognizing that the life and the responsibilities of a consultant or an academic physician differ from those of a trainee. Recent surveys suggest that not all medical practitioners are content with their professional lives these days. Read more »

Routine second look endoscopy: SUMMARY

Only two of the six randomized studies were positive: 1) a seven-year-old abstract, still not published in full and 2) a study of 40 extremely high risk patients, mostly active bleeders with a high unexplained delayed bleeding rate. The Marmo meta-analysis may have been flawed, was heavily influenced by the one small positive study in highly selected patients and yet still showed only a very small benefit. It is unclear if patients presenting with active bleeding, or having other comorbid conditions that are associated with higher than usual rebleeding or mortality rates, might benefit from a second look. Read more »

Routine second look endoscopy: DISCUSSION

endoscopic hemoclippingIt is important to emphasize that 20% to 50% of rebleeding episodes occur in patients who are considered ‘low risk’, as determined by findings at the second endoscopy. Therefore, it may be dangerous to discharge a patient early, based on a favourable (according to the Forrest classification) endoscopic appearance. The rebleeding rate for a low risk lesion that is found one or two days after endoscopic therapy is likely to be much higher than that for the same lesion if found before therapy at the initial endoscopy. Read more »

Routine second look endoscopy: A recent meta-analysis

Marmo et al recently published a meta-analysis on this topic. Unfortunately, it is plagued by several problems. First, in the plot of odds ratios for rebleeding, the CIs for Messmann et al’s study are shown as not crossing 1.0, in spite of the fact that the differences in rebleeding rates in that study were clearly not significant. Second, there was significant clinical heterogeneity in patient characteristics and initial and subsequent treatment. Although statistical heterogeneity appeared to be absent, no attempt was made to correct for clinical heterogeneity (eg, no variables were assigned to each study to try to adjust for these differences). Read more »

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