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Dr. Jessica Molokie from the Not A Medical Marvel Podcast joins Ed to discuss her journey through undergraduate school and medical school. Dr. Molokie is a graduate of a caribbean school that will be starting her residency in Florida in June 2020. Attrition rate in US medical schools What to know about Caribbean medical schools FREIDA Follow on Social Media @medschoolmedic The Medschoolmedic podcast is a product of Overrun Productions, LLC. Tweet The post Episode 22- Dr. Jessica Molokie appeared first on Medschoolmedic.

In the setting of the novel coronavirus, or Covid-19, medical education is changing. How does it affect student currently in the clinical setting? How will it change the delivery of medical education in general? Does it change how aspiring medical students should approach medical school? Ed and Mike discuss all the changes they have seen since the outbreak of Covid-19 began. Johns Hopkins Coronavirus Resource Center Tweet The post Episode 21- Covid-19 appeared first on Medschoolmedic.

I. Background -Step 1 is the first in a series of medical licensing exams for student physicians in the United States -2019, Journal of Academic Medicine, group of medical students talked about the toxic Step 1 environment that develops during the preclinical years of medicine (https://journals.lww.com/academicmedicine/Fulltext/2019/03000/Student_Perspectives_on_the__Step_1_Climate__in.9.aspx) -A few days ago, NBME decided to make Step 1 pass fail to help with student wellness and reduce this toxic culture II. Pros and Cons Pros -Everything in this post by Dr. Brian Carmody MD (https://thehealthcareblog.com/blog/2019/03/20/usmle-step-1-leveling-the-playing-field-or-perpetuating-disadvantage/) A pass/fail USMLE is a means to an end. The exam wasn’t designed to be a metric of evaluating candidates, but rather a competency test. Other metrics are better to evaluate students. Cons -More difficult for non-top tier MD students, DO students, and foreign students to stand out in clerkship and residency applications. NBME made a statement about this in Academic Medicine journal (https://www.ncbi.nlm.nih.gov/pubmed/30570495):“Students and U.S. medical graduates (USMGs) from elite medical schools may feel that their school’s reputation assures their successful competition in the residency application process, and thus may perceive no benefit from USMLE scores. However, USMGs from the newest medical schools or schools that do not rank highly across various indices may feel that they cannot rely upon their school’s reputation, and have expressed concern in various settings that they could be disadvantaged if forced to compete without a quantitative Step 1 score. This concern may apply even more for graduates of international medical schools (IMGs) that are lesser known, regardless of any quality indicator.”Rebuttal: There’s more to the score. Specifically regarding IMGs: “We’re still going to have the same number of spots – and U.S. allopathic graduates can’t fill all of them. Sure, programs who currently match IMGs / DOs could certainly choose to stop interviewing them. In my opinion, programs who find value in training IMGs / DOs (or who need IMGs / DOs to fill their positions) will still choose to interview and rank IMGs, regardless of the evaluation methods available. In fact, if we had more meaningful metrics – metrics that actually predicted residency success, unlike the USMLE – more programs might be willing to consider IMGs. So why not choose methods that are more meaningful? -This will shift the focus to USMLE Step 2 CK and clerkship grades; just shifting the stress forward more. -Look at what happened to dental schools and dental residencies (thanks to /u/ivy-ch on reddit): “Part 1 dental boards went P/F about 5-10 years ago. It didn’t last long.  Eventually, residency programs needed something. We have too many schools which are P/F, not to mention that grading in dental school in the clinical years is messy, boarding on unethical. Eventually, specialties found other exams. Maxillofacial surgery started making applicants take the CBSE. Orthodontics starting making applicants take the GRE. Eventually, some genius decided to make a new exam called the ADAT (imagine the AMCAT – the advanced medical college admission test). Once that exam came out, general residencies, endodontics, periodontics, everyone wanted applicants taking that. Only difference is that our part II dental boards also went pass/fail. So as some posters have said, my guess would be medical part II becomes the important exam now.” -Program Directors, anonymous online, not fans of the change. See here: “In a climate of everything being pass/fail for the first 2 years, you want as much information that will differentiate you as an individual as possible. I am not looking forward to MS4 students who will forgo learning opportunities to study for step 2 which will be the test that differentiates you the most. Also, i have had residents who did very well on step 1 but not as well on step 2. This decision will decrease that student’s ability to get into a residency. If step 2 CK is made pass/fail…..then you will be judged solely on your medical school…period. Any bumps in the road that could have been smoothed over with outstanding scores (ex: failed a course as an MS1 but came back with 240s) are now more glaring. IMGs and Caribbean schools will be hosed. I trained some carrribean school grads with great scores that waaaay outperformed their US grad counterparts. That possibility will not happen if STEP 1 and 2 are pass/fail.” Tweet The post Episode 20- The New Step 1 appeared first on Medschoolmedic.

It’s a classic trope in medical school that students need to know everything, but is that actually the case? In this episode, Ed and Mike discuss:  Is it okay to not know everything? How should I flag questions on exams? Changing Study Habits in Medical SchoolWhat are pre-matriculation programs?What are some effective stress reduction techniques? Is there a certain amount of time I should be studying? Does everyone in medical school study for 18 hours a day?  FB/IG/Twitter: MedSchoolMedic Overrun Productions FB/IG: Overrun Productions T: OverrunEMS Tweet The post Episode 19- Know Everything? appeared first on Medschoolmedic.

Learning how to study in medical school can be difficult. Is there a right way? It seems that spaced repetition with programs like Anki might be helpful for most people. What about the right QBank? Ed and Mike discuss all this and more on this episode. Bickerdike et. al 2017 J. Medical Education Tabibian Et al 2019 Ebbinghaus forgetting curve Debunking Learning Styles Newton and Miah 2017 Tesia Marshik on Learning Styles Pomodoro Technique The MedSchoolMedic Podcast is produced by Overrun Productions T: @Medschoolmedic IG: medschoolmedic FB: @medschoolmedicpodcast Tweet The post Episode 18- Learning and Study Habits appeared first on Medschoolmedic.

MedSchoolMedic Episode 17 Show Notes On this episode, Ed and Mike discuss the value (if there is any) of standardized tests and the way that exams in medical schools are administered. Is the MCAT representative of how you’ll perform in medical school? Is Step 1 an accurate representation of how you’ll perform as a physician?  Is biochemistry essential for MCAT success? Does medical school focus too much on Step 1? 2016: Only a small correlation was found between MCAT and STEP 1 scoresThe result of one exam, on one day, has a strong effect on your future as a physicianhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045966/There is a documented negative effect on mental health among medical studentsUnderrepresented minorities perform more poorly on Step 1Students who failed were more likely from poor families, non-traditional students. Registering for the exam costs $635, and prep courses are expensive tooMost students that fail STEP 1 still end up in clinical practicehttps://oea.sites.medinfo.ufl.edu/files/2010/10/USMLE-step-1-failure.pdfPro/Con on InCUS site: https://www.usmle.org/inCus/#numericscores91% of those who failed Step 1 attempted CKhttps://www.usmle.org/pdfs/incus/InCUS_Reference_List-Section1.pdf **We know the audio is in mono. Sorry, Ed screwed up the recording.** Tweet The post Episode 17- Standardized Testing appeared first on Medschoolmedic.

This episode marks the reboot of the MedSchoolMedic Podcast! On this cross-over with MSM’s sister show The Overrun, Dan sits with Ed and Mike to discuss the journey from paramedic to physician…does it help? Can it hurt? How do you do it? If you’ve ever thought of going to medical school; give this a listen! Dr. Emma Cronk’s blog can be found here Tweet The post Episode 16- Medic to Med School appeared first on Medschoolmedic.

Should we be giving blood products to trauma patients in the pre-hospital setting? In theory, it would stand to reason that the patient has lost blood, and thus should receive more of it. But that doesn’t exactly pan out in the data. In 2016, the journal Shock performed a literature review to discuss this exact topic. In the end, it seems like little more than a good idea on paper. There is simply no unequivocal evidence (so far) that supports giving blood over a crystalloid for traumatic bleeding. But, it does seem that the use of pre-hospital blood products (PHBP) is gaining some traction, despite the apparent evidence. So what kind of trend are we seeing here? Are projects just ignoring the literature, or simply thinking outside the box? Paper of the Week Does the Use of Video Laryngoscopy Improve Patient Outcomes? Michael April, Brit Long. Annals of Emergency Medicine (In Press). MedBox YouTube: Prep4Step This channel is great resource for those beginning or refreshing themselves on topics related to the STEP exams. Or, if you just want a refresher on immunology, its great for that too. Sidenote: MSM Clinical Guy Dan got a shoutout on EMCRIT! References: Smith, et al. Shock, JEMS Follow MSM on Twitter, Instagram, Facebook   Tweet The post Episode 15- Blood Products appeared first on Medschoolmedic.

Everybody needs to calm down. Calm. The hell. Down. This week, the National Association of State EMS Officials (NASEMSO) published a working draft of the 2018 national EMS scope of practice model. This is, as stated in the title, a working draft that is open for discussion and thus is open to change. It contains some important opinions about how to progress the practice of EMTs, EMRs, and Paramedics. Here’s some highlights: EMTs should be able to give Narcan for opiate overdoses. Therapeutic hypothermia following cardiac arrest is not supported by the literature. Maybe EMTs should be allowed to give OTC pain medication, or even Fentanyl Intranasally. We should update how we treat hemorrhage and maybe consider wound packing to be an option. EMTs should be able to administer CPAP, and bronchodilators. Paramedics should be able to use ultrasound. But then there’s line 646 that mentions that endotracheal intubation should be removed from the scope of practice model. And everyone lost their minds. There’s a petition online. A PETITION. To allow paramedics to keep saving lives with endotracheal intubation. Nevermind that nationally our average intubation rate is in the toilet. Or that we don’t teach our medics how to intubate well, or often. Or that we don’t keep up with out training. No, we should file a petition so that NASEMSO knows how we feel. Did we ever file a petition about low wages? Or poor working conditions? Any petitions over ambulance literally falling apart, or EMS workers being assaulted? Of course not. But don’t you dare take away our tubes. Here’s the takeaway from the NASEMSO paper: It’s a working draft. It’s open for public comment. Write your state official and tell them that paramedic should be able to continue intubating. While you’re at it, tell them that we’re underpaid. Tell them that our working conditions are terrible. Tell them that we need more training, and better budgets. Tell your hospitals the same. Tell everyone. We could’ve spent the last 20 years training our medics to be better at airway control. Instead, we made sure that our ambulances looked sleek, and that everyone had a pulse oximeter. We could’ve stopped this suggestion before it started. We have ourselves to blame, and it’s on us to fix the problem. MedBox:  You are Now Less Dumb by David McRaney Tweet The post Episode 14- The NASEMSO Scope of Practice Model appeared first on Medschoolmedic.

We all have our preferences when it comes to intubation. Some prefer DL, others prefer VL. Personally, I’ve always been a proponent of DL. But when it comes to VL, I have my biases as well. So which one works better? It turns out that it depends on who you are and how often you intubate. Today we review a meta-analysis from Savino, et al. from Academic Emergency Medicine 4/2017. Tweet The post MSM Shorty- More on DL vs. VL appeared first on Medschoolmedic.

Sometimes thinking is hard. In EMS and in medicine in general, there are a lot of things to remember when encountering a patient. What are the right drug dosages? How do we calculate body surface area for burns? What about CPR? The answer to all of these is known as cognitive offloading. What this does is allow the brain to focus on things that aren’t complicated, which will lead to better results an outcomes. How does one accomplish this? Like so many other things in life, there are many ways. Today we review a few of these techniques. Related: The Checklist Manifesto Paper of the week “Increased cardiac arrest survival and bystander intervention in enclosed pedestrian walkway systems” Lee, et al. Resuscitation June 2017 Medbox Mastermind: How to Think Like Sherlock Holmes by Maria Konnikova Tweet The post Episode 13- Cognitive Offloading appeared first on Medschoolmedic.

Regular listeners will know that here at medschoolmedic, we love Ketamine. Earlier this year, in the American Journal of Emergency Medicine, Riddel et al. explored how effective ketamine would be when given as a first-line drug for excited delirium or agitation. They compared ketamine to haloperidol, midazolam, and lorazepam. See the abstract here Tweet The post MSM Shorty- Ketamine for Agitation appeared first on Medschoolmedic.

Mike Defilippo joins the podcast to discuss his summer of physician shadowing. What is involved in physician shadowing? Will shadowing help me in medical school, or help me get into medical school? What did he learn from the process? What are the advantages and disadvantages of shadowing? Perhaps most importantly, what did the patients think? More on shadowing can be found here, here, and here. MedBox Movie & TV reccos: Mike: Desperate Housewives, Star Wars: Rogue One, Moana Ed: Sherlock, The Imitation Game, The Twilight Zone Tweet The post Episode 12- Physician Shadowing with Mike Defilippo appeared first on Medschoolmedic.

Why use TXA? What is it, and how does it work? Tranexamic Acid, or TXA is a drug that helps control hyperfibronolysis, which is associated with increased mortality. Essentially, the drug works to stop bleeding. TXA has been used in surgical suites for ages, but only recently are we seeing it move to the realm of EMS medicine. So how does it work, and when should we use it? TXA is a synthetic lysine analogue that stops plasminogen from converting to plasmin. Specifically it does this by preventing the plasminogen from binding to the fibrin molecule. This stops the fibrin from cleaving, which leads to decreased bleeding. That’s a lot of science talk. Essentially, what happens is TXA stops the active part of the blood involved in hemorrhage from allowing hemorrhage to occur. TXA has a half-life of 2.3 hours, which becomes relevant when we discuss re-dosing. One big advantage to TXA is that there are no real contraindications to the drug. However, when a patient has reduced kidney function, it’s important to consider reducing the dose. So why use it? 25-35% of patient with traumatic hemorrhage will display some kind of coagulopathy in the trauma bay. In general, EMS can help lower those numbers by giving TXA early. The biggest, and arguably most important study surrounding TXA was the CRASH-2 trial. CRASH-2 showed a decrease in overall and hemorrhage-induced mortality. The dose from CRASH-2 was 1g TXA over 10 minutes, followed by 1g over 8 hours. It is important to note the variables of CRASH-2, specifically that the patients observed were in developing countries. TXA has shown to be an important and effective tool in the EMS arsenal when it comes to trauma resuscitation. When all the data is considered, it is a drug that should be available to all EMS systems, and should be available in all trauma resuscitation bays. Source Article  Follow MSM on Twitter, Instagram, Facebook Tweet The post MSM Shorty-TXA appeared first on Medschoolmedic.

It seems like with each passing day, we hear more and more about opioid overdoses. Its something that was discussed in the early days of this website. Yet, we still seem to hear about the dangers and emerging trends of opioid abuse, and how to handle it in EMS. It is important to understand how opiate addiction begins, how the patient handles the addiction, and how we as providers can make a difference. Opiates are everywhere. And they have been since the early 20th century. Morphine was the go-to pain reliever for ages until a new “hero” drug was created to help fix morphine addiction. Of course, this hero drug was heroin. We all know how that went. Yet we still see poor substitutes for addiction being offered. Drugs like Suboxone and Naltrexone serve as a surrogate for addiction, just without the pleasurable side effects. Additionally, there is a cultural component that needs to be addressed. When there is a batch of opiates that is around, and people hear that it’s good, naturally they’ll want to get their hands on it. It’s not different in non-addiction culture. If you hear about a new burger place that has the best burger in town, naturally you’ll head to that burger place. What about narcan? We know that it is easy to carry and administer. But what kind of results do we see after narcan is given? Do these patients need to go to the hospital? Luckily, we have a paper this week that addresses that very issue. Paper of the Week: Incidence of naloxone reducing in the age of the new opioid epidemic Kelbacher, et al. Prehospital Emergency Care Online 7 July 2017 Medbox: The Big Sick This movie is great, you guys. It follows a stand-up comedian who meets and falls in love with a woman who falls ill and eventually into a coma. It’s a romantic comedy that follows the reaction to illness better than I’ve seen in most films. Kumail Nanjiani’s Twitter Follow MSM on Twitter, Instagram, Facebook Tweet The post Episode 11- Opioids and Narcan appeared first on Medschoolmedic.

Why does the profession of EMS seem to move along so slowly? Why do the medications and technology seem to move along at a glacial pace? Today’s shorty explores these topics.   Follow MSM on Twitter, Instagram, Facebook Tweet The post MSM Shorty- The Slow Progress of EMS appeared first on Medschoolmedic.

MSM Clinical guy Dan Schwester joins the pod to discuss the SMACC conference, and rant with Ed about EMS in general. VF arrest mindset Cognitive offloading High-Fidelity simulation Pre-brief Debrief Stress and handling it Communication under stress “If you always do what you’ve always done, you’ll always get what you’ve always got.” Build a culture within your team, do the basics well Timeouts Challenge, don’t threaten your team Learn from every mistake and error Leading in resuscitation: Whoever grabs the AED is the leader Healthcare providers hesitate to start CPR and we don’t know why Don’t rely too much on survival to discharge Wait outside does not equate to wait inside Stop the mentality of “we’re right around the corner” Probe-Alert-Challenge-Emergency Resus paradigm Medics speaking up during SIM in London HEMS Pre-hospital Palliative care Patient-monitor-crew-surroundings (situational awareness) Scene safety What if you don’t have a choice We don’t teach how to assess and mitigate risk Just like firefighters Tribalism #Gelfest Follow Dan on Twitter Follow MSM on Twitter, Instagram, Facebook Tweet The post Episode 10 Pt. 2- SMACC Talk with Dan Schwester appeared first on Medschoolmedic.

MSM Clinical guy Dan Schwester joins the pod to discuss the SMACC conference, and rant with Ed about EMS in general. VF arrest mindset Cognitive offloading High-Fidelity simulation Pre-brief Debrief Stress and handling it Communication under stress “If you always do what you’ve always done, you’ll always get what you’ve always got.” Build a culture within your team, do the basics well Timeouts Challenge, don’t threaten your team Learn from every mistake and error Leading in resuscitation: Whoever grabs the AED is the leader Healthcare providers hesitate to start CPR and we don’t know why Don’t rely too much on survival to discharge Wait outside does not equate to wait inside Stop the mentality of “we’re right around the corner” Probe-Alert-Challenge-Emergency Resus paradigm Medics speaking up during SIM in London HEMS Pre-hospital Palliative care Patient-monitor-crew-surroundings (situational awareness) Scene safety What if you don’t have a choice We don’t teach how to assess and mitigate risk Just like firefighters Tribalism #Gelfest Follow Dan on Twitter Follow MSM on Twitter, Instagram, Facebook Tweet The post Episode 10 Pt. 1- SMACC Talk with Dan Schwester appeared first on Medschoolmedic.

In 2011, Weingart and Levitan published a paper in Annals describing how oxygenation works during an intubation attempt. This paper was a game changer. It is phenomenally robust paper that uses nothing but the facts and data. It is, in part, a systematic review of oxygenation. But more importantly, its a guide for how to oxygenate patients we are going to intubate. Today’s shorty reviews this paper, and covers all the highlights. Related: NO DESAT  Tweet The post MSM Shorty- Oxygenation appeared first on Medschoolmedic.

We’ve talked about flipping the EMS classroom before on this website. Today, we’re joined by paramedic and EMS educator Anna Brown to discuss ways to flip the classroom. We also discuss different ways to handle the classroom environment, and emerging trends in EMS education. What are difference between flipped and traditional classrooms? How do we improve outcomes in education? How to further EMS through education: Clinicians vs. technicians, volunteer standards vs. professional standards. What about certification levels? The different levels of certifications used to mean that there was future goal to aim for, and has that standard changed? If education is optional past the initial training for volunteers, why is it that professional providers bear the overwhelming responsibility for picking up the slack. Public outreach: How can professionals act as ambassadors to the EMS profession? Related: Is EMS a good career choice? MedBox:  Ed: Decode DC Podcast: Ex-lobbyist Jimmy Williams discusses the ins an outs of Washington and Washington Politics. Anna: The Handmaid’s Tale on Hulu, check out the book on Amazon Tweet The post Episode 9- Flipping the classroom with Anna Brown appeared first on Medschoolmedic.