Friday, October 20, 2017

The lost sheep: They’re MDs but can’t find residency positions

I haven’t written about offshore medical schools since this post back in January, but yesterday I received communications from two graduates of those schools which moved me. Both are edited for length and clarity.

This was an email. I read your article on Physician’s Weekly about unmatched MDs. I am a bit down and looking for advice. I graduated from a Caribbean Med school. I have failed attempts and many gaps. Academically I dug myself into a deep dark hole, but my desire to practice medicine kept me going. I recently took Step 3 and just received my scored (failed by 2 points). I do not know anyone in medicine that can help me get a residency. I know I will be a great physician. I am just a horrible test taker.

I didn't apply for the match since I was told that I needed to pass Step 3 to even try to match which would still be almost impossible even with a good score. I know many people who have not matched and have just given up on it. I have so much debt and no way of paying for it. What do you suggest I do? A friend thinks I should just take it again and apply, but I no longer have the funds especially since my chances are so low. I wish there was something more for me.

Any words of advice would be really appreciated.


Monday, October 16, 2017

Is an autonomous robot better than a human surgeon?

That was the headline on the website BGR [“a leading online destination for news and commentary focused on the mobile and consumer electronics markets”].

Engineers working with the Smart Tissue Autonomous Robot (STAR) claim it can cut skin and tissue with more precision than a surgeon.

A paper they presented last month at the International Conference on Intelligent Robots and Systems featured a video supposedly proving the point.

STAR works “by visually tracking both its intended cutting path and its cutting tool and constantly adjusting its plan to accommodate movement.” The intended cutting path must be marked by a human beforehand. So, it is not really autonomous; rather it is semi-autonomous.

The video can be seen in its entirety here or you can watch two excerpts below. The first is the robot using cautery to make a straight 5 cm skin incision which is compared to an unidentified surgeon cutting a similar incision. Watch approximately 15 seconds of this clip.



As you can see, the surgeon strays from the intended path about halfway through the process. But note that the surgeon is not holding the cautery the way most surgeons would use it. The proper way to hold the instrument is as if it were a pencil. No human could possibly cut a straight line holding the instrument as far away from the tip as the video depicts.

A second video shows the STAR excising a geometrically shaped pretend tumor.


Note: Although the video is being shown at 4X speed, it is still painfully slow. It is not clear what would happen if the robot encountered a blood vessel that bled despite the use of cautery, which by the way is not the instrument of choice for excising many tumors.

What we have here is a nice example of a “straw man” which is comparing a new technique against a phony one to make the new one look better.

Another website, IEEE Spectrum, went with this headline:

The headline should have read:


[Type straw man or artificial intelligence in the search field to your right on my blog site for more posts about these two topics.]

Thursday, October 5, 2017

The 2017 US medical school graduates: An in-depth look

According to a survey published by the Association of American Medical Colleges (AAMC), the 2017 graduating class has a median medical school debt of $180,000. The figure has remained stable for the last three years. Nearly 27% of students say they had no debt at all.

When the cost of pre-medical education is included the total debt climbed to a median of $195,000.

Despite those numbers, 54.5% said their choice of a career specialty was not based on the level of educational debt. Instead, over 98% said they chose their specialty based on its fit with their personality, interests, and skills.

The survey was offered to all 19,242 graduates of the 140 US medical schools with 15,609 (81%) responding. Some did not answer every question.

Most of the respondents (90%) were satisfied with the quality of their medical education. Only 7.6% said that if they could do it over they would not or probably would not enroll in medical school again; 9.1% gave a neutral response; 7.7% did not answer. Over the last five years, responses to this question have not varied much.

Tuesday, October 3, 2017

Why public reporting of individual surgeon outcomes should not be done


Please take a look at my latest post on Physician's Weekly. It's called "Why public reporting of individual surgeon outcomes should not be done."

Click here for the link.

Wednesday, September 27, 2017

Review of TV show "The Good Doctor"

Just when you thought there could not be another bad medical show, ABC TV presents “The Good Doctor.” It’s about an autistic young man going to California to become a surgical resident.

Just after he lands at the airport in San Jose, an overhead sign breaks and causes the unluckiest 8-year-old boy on earth to suffer three life-threatening injuries. The Good Doctor gives a bystander, who sort of sounds like a doctor but is not too confident, an anatomy lesson about where to hold pressure on a bleeding internal jugular vein. He then notices bulging of the left arm veins and diagnoses a tension pneumothorax.

He looks for a knife “with a seven-inch blade” at a TSA checkpoint, grabs a lesser knife, makes a chest tube and underwater seal from various supplies he finds in the airport, dumps half a bottle of whiskey on the kid’s chest, and inserts the makeshift tube. All of this happens on the floor of the airport concourse.

Of course the kid wakes up and starts breathing normally.

Meanwhile the board of directors of the hospital is debating the hiring of an autistic surgical resident. In this hospital, its president, who met The Good Doctor when he was 14, hires the residents, and the chief of surgery has no input. [Matching? What matching?]

Tuesday, September 26, 2017

Contradictory evaluations cause trouble, consternation

Two weeks ago I blogged about a resident who had been told she must repeat her fourth year of training. She countered with a lawsuit claiming that the surgery department and the medical school did not follow their policies in mandating her remediation.

She said written evaluations by faculty during her fourth year of residency were generally very good, but some oral feedback she received was negative.

From my experience as a surgical residency program director, I know inconsistent, vague, and unhelpful evaluations from faculty are common. For example, a medical student on Twitter recently posted the following:

The tweet prompted many comments from others; the best of which are these [names changed]:

That he seems well read and has a good depth of knowledge deprives him of good learning opportunities.

John sometimes stands too close when he presents.
3 months later. I don't understand why John stands so far away when he presents.

Tends to scare off new people./Makes everyone feel welcome & appreciated.

Dr. Doe, don't be too hard on the juniors. One week later. Dr. Doe, don't be too friendly to the juniors.

And my favorite

Jane should be aware of how she holds her shoulders. It changes the energy in the room.

Do you have similar evaluations to share?

Thanks to Natalie Wall (@nataliemwall) for allowing me to use her tweet.

Monday, September 18, 2017

A surgical resident’s legal battle with her program

My new post on Physician's Weekly is about a dispute between a resident and her surgical residency program that has escalated to court and the news media. Click here to read it.