Interesting Articles for DO students to read

[group_theory]

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Not sure how often osteopathic students read The DO, especially since it is now electronic instead of print version (it used to be mailed to your address) ... but there are several interesting articles that might be of interest to current osteopathic medical students.

Below are the links, along with excerpts from each articles The articles were written by Carolyn Schierhorn, staff editor for The DO.

Making the cut: How to specialize in general surgery
http://www.do-online.org/TheDO/?p=116131
To be considered a viable candidate at Botsford, general surgery applicants must serve an audition rotation with Dr. Parmely’s program. Normally, these rotations last two weeks, but Dr. Parmely will modify the rotation length to meet the requirements of individual schools. Because he gets many more applications for two-week rotations than he has openings, he also allows promising prospects to serve weekend rotations with him.

“Every student who comes here on an audition rotation has a checklist of mechanical skills to perform,” Dr. Parmely says. “But they are not here to do surgery; that’s what the residency is for. They are here to learn how to examine surgical patients, how to participate on a team and how to make decisions. They have to present cases to us on daily rounds and answer the questions ‘What’s wrong with the patient? And what do you want to do?’ ”

Dr. Parmely doesn’t primarily look for manual dexterity in students because trainees will acquire the technical skills of surgery during residency. “What makes a great surgeon is operating on the right patient with the right operation at the right time,” he says. “It’s decision-making. It’s all the medical management. That’s why it takes five years to become a surgeon.”
http://www.do-online.org/TheDO/?p=116131

Type A? Quick-thinking? Adrenaline junkie? Emergency medicine awaits you
http://www.do-online.org/TheDO/?p=106851
Ideally, students who think they might have what it takes to be emergency physicians would gain some exposure to the field prior to medical school. Dr. Dery worked as an emergency medical technician while in college and became friends with DO emergency physicians who became his mentors, wrote him letters of recommendation to osteopathic medical school, and later took him on rotation.

Dr. Sabando prefers residency candidates who have been EMTs or paramedics, served in the military, or had previous careers as nurses or physician assistants. But he also is impressed by those who have done research, taken basic and advanced life support classes, and served on medical missions. “I rarely interview the traditional student—someone who has gone through college and medical school but didn’t do anything additional along the way—and is now applying for residency,” he says. “That’s someone who has gone through the motions but doesn’t really understand what emergency medicine is.”

College students interested in emergency medicine should also consider serving on search and rescue teams, learning Spanish and other languages commonly spoken in specific areas of the United States, and honing their leadership skills in student-run organizations. Premedical students leaning toward osteopathic emergency medicine can look for opportunities to shadow DO emergency physicians and residents and join the undergraduate division of the Student Osteopathic Medical Association (SOMA), known as Pre-SOMA.
http://www.do-online.org/TheDO/?p=106851

Anesthesiology’s allure: High pay, flexibility, intellectual stimulation
http://www.do-online.org/TheDO/?p=88571
The right personality traits and interest in the field are not enough, however. Academic achievement and high board scores are important for anyone considering an anesthesiology residency.

The immediate past chairman of Drexel’s anesthesiology department, George Mychaskiw II, DO, notes that each year Drexel’s ACGME-accredited residency program receives more than 800 applications for eight positions. To land an interview at Drexel, osteopathic medical students need to score at least 200 on the USMLE or at least 500 on the first attempt for Level 1 of COMLEX-USA. The COMLEX scores for Drexel’s ranked candidates average around 570.
What’s more, says Dr. Mychaskiw, many of the more than 130 ACGME-accredited anesthesiology programs do not accept the COMLEX-USA and have higher cut-off scores for the USMLE.

Excellent academic credentials are essential for anesthesiology program candidates, concurs Dr. Kane, the director of an eight-position AOA-approved anesthesiology residency program at South Pointe Hospital in Warrensville Heights, Ohio. “We only look at students whose COMLEX or USMLE scores are in the top 10% or top 15% nationally,” he says.
http://www.do-online.org/TheDO/?p=88571

Want to be a dermatologist? Persistence pays in highly competitive, lucrative field
http://www.do-online.org/TheDO/?p=103521
Osteopathic medical students who are considering dermatology should start preparing for their uphill challenge at the beginning of med school if not earlier. While it is more difficult for DOs to get into one of the 115 dermatology residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) than into one of the 27 AOA-approved dermatology programs, prospective osteopathic dermatologists should hedge their bets and plan on taking the United States Medical Licensing Examination (USMLE) as well as the Comprehensive Osteopathic Medical Licensing Examination—USA, recommends Dr. Hibler. Many AOA-trained dermatologists have gone on to do ACGME subspecialty fellowships, he notes.

Getting into a dermatology residency normally requires high grades and board scores, but other factors may matter more. “Most dermatology residents are in the top 10% to 15% of their graduating class, but there are always exceptions,” Dr. Grice says. Someone who has shown intense interest in dermatology, who has made a favorable impression on someone in the field, or who has participated in groundbreaking research may get in despite not having stellar academic credentials, he notes.

“Some programs give board scores more weight than others do,” Dr. Hibler says. “In my experience, some of the brightest students with the highest board scores do not have good interpersonal skills and are not able to relate to patients. Therefore, I think it is unfair to exclude residency candidates with COMLEX scores in the 500 range.”
http://www.do-online.org/TheDO/?p=103521

 

[group_theory]

Snippits from The DO, articles written BY CAROLYN SCHIERHORN, staff editor for The DO

Ob-gyns revere their specialty
http://www.do-online.org/TheDO/?p=110481
All osteopathic medical students serve a core rotation in obstetrics-gynecology in their third year, as well as receive classroom instruction in the specialty in their second year. So students do not have to go out of their way to gain exposure to the discipline. And professors and preceptors can clearly see who is excited about it and who isn't.

Saul Jeck, DO, the chairman of obstetrics-gynecology at the Philadelphia College of Osteopathic Medicine (PCOM), coordinates a series of approximately 50 required lectures for second-year students, bringing in numerous outside speakers who practice locally. Students who are interested usually ask to rotate with me in my practice, he says.

Because an obstetrics-gynecology rotation is required, Dr. Jeck and PCOM's other preceptors observe a variety of student attitudes and abilities. You can tell which students are rotating only because they have to, because it's part of the curriculum, Dr. Jeck says. On the other hand, those who are excited love going to the hospital and being in the delivery room. It's magical.
http://www.do-online.org/TheDO/?p=110481

DOs a natural fit for physical medicine and rehabilitation
http://www.do-online.org/TheDO/?p=92101
More than 800 osteopathic medical students currently are involved in the AOCPMR's campus chapters. Student members can participate in clinical workshops sponsored by the society to gain exposure to PM&R diagnostic techniques, such as nerve conduction studies and musculoskeletal ultrasound. In conjunction with the AOCPMR's midyear meeting, students can take part in a national student conference that provides the chance to meet with PM&R educators, program directors and residents.

We've had hundreds of osteopathic medical students from all over the country attend our two major annual conferences, Dr. Kamen says. There is tremendous student interest in our field.

We find that the students who are interested in going into PM&R tend to be extremely well-informed, Dr. Richardson adds. They are so focused, so driven, so goal-oriented and such strong supporters of not just PM&R as a profession but also the osteopathic world in general.

Because of its desirability, PM&R is a moderately competitive specialty. For example, each year approximately 300 students apply for 12 positions in the ACGME-accredited Temple University-Moss Rehab Hospital PM&R residency program in Philadelphia. We interview 60 candidates, says Dr. Kamen, a preceptor in the program. So you need to have good credentials to get that far.
http://www.do-online.org/TheDO/?p=92101

How to specialize in osteopathic manipulative medicine
http://www.do-online.org/TheDO/?p=96971
Any licensed osteopathic physician can focus his or her practice on osteopathic manipulative medicine. No residency or board certification is required. Indeed, notes Michael A. Seffinger, DO, the immediate past president of the American Academy of Osteopathy (AAO), some DOs straight out of osteopathic rotating internships have set up cash-only OMM specialty practices in wealthy communities and reportedly make $500,000 or more a year working three days a week.

But, generally, those who specialize in OMM have additional credentials and are not in it mainly for the money, which tends to be in the mid-range for medical specialties; more than primary care but less than surgical specialties, says Lisa A. DeStefano, DO, who chairs the OMM department at the Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing.

...

Becoming board certified in NMM/OMM requires completing one of four residency tracks:

• A two-year program in NMM/OMM following a traditional osteopathic internship.
• A one-year program in NMM/OMM following an AOA-approved residency in another specialty, known as a "Plus One."
• An integrated three-year program in family medicine and NMM/OMM.
• An integrated three-year program in internal medicine and NMM/OMM.

Those selecting an integrated residency generally plan to become primary care physicians who emphasize but don't limit themselves to OMM. Those pursuing a two-year NMM/OMM residency right after their internship typically specialize in OMM. Those completing a Plus One residency often do so later in their career and sometimes drop their original specialty in favor of OMM, says Dr. Tettambel, an AOA board-certified obstetrician and gynecologist who for much of her career integrated OMM into her other specialty but currently focuses on OMM.
http://www.do-online.org/TheDO/?p=96971

 

[Owlie]

I've already read one so far. Very great! Thank you 🙂

 

[IDBasco]

How to specialize in osteopathic manipulative medicine[/B]
http://www.do-online.org/TheDO/?p=96971
Any licensed osteopathic physician can focus his or her practice on osteopathic manipulative medicine. No residency or board certification is required. Indeed, notes Michael A. Seffinger, DO, the immediate past president of the American Academy of Osteopathy (AAO), some DOs straight out of osteopathic rotating internships have set up cash-only OMM specialty practices in wealthy communities and reportedly make $500,000 or more a year working three days a week.

Well that doesn't sound bad at all given the upcoming ****storm in medicine.

Maybe those MD students will be more excited to learn OMM and get into our residencies than we thought. 😉

 

[group_theory]

Continuing the series (from The DO) ... again are some snippets from The DO, articles written BY CAROLYN SCHIERHORN, staff editor for The DO. The article about Psychiatry was written by Rose Raymond, staff editor for The DO.

Love at first sight? Ophthalmology seduces with variety, hours, outcomes
http://www.do-online.org/TheDO/?p=135181
With more than 50 applicants for every open residency position in 14 AOA-approved programs, ophthalmology is one of the profession’s most competitive specialties.
Many programs will not consider candidates with scores lower than the 90th percentile on the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), says Carlo J. DiMarco, DO, the executive vice president and CEO of the American Osteopathic Colleges of Ophthalmology and Otolaryngology—Head and Neck Surgery (AOCOO-HNS).


Ophthalmology is also less stressful than many other medical specialties, says Robert L. Peets, DO, who directs the AOA-approved ophthalmology residency at Grandview Hospital and Medical Center in Dayton, Ohio.
“Our specialty provides a great combination of office-based care and surgery, so we have a nice lifestyle,” Dr. Peets says. “We do take call. But for the most part, call is not horrible.” Many ophthalmologists are in group practices, so they share responsibility for treating trauma patients who have ocular emergencies after hours.

Applicants need outstanding credentials to secure spots in ophthalmology residencies, which are four-year programs that include a linked internship year. Generally, students match into ophthalmology from their fourth year of medical school, though transfers from other programs are not unheard of.
Because most fourth-years who try to match into ophthalmology fail to do so, many graduates try to match from rotating internships, a year spent in research or a pre-residency fellowship, or residency programs in other specialties.

Read more at http://www.do-online.org/TheDO/?p=135181



Work ethic, elite scores, dexterity key to becoming an orthopedic surgeon
http://www.do-online.org/TheDO/?p=129851
Orthopedic surgery is a fulfilling field for numerous reasons, Dr. Vander Lugt says. “You get to work with your hands. You get to work with various instruments. And you can help people get better and get back to work,” he explains.
The specialty appeals to results-driven individuals rather than those who like to puzzle over diagnoses or provide longitudinal care lasting years.

“There is an instant gratification that comes from repairing someone rather than taking care of someone with a chronic condition like high blood pressure,” points out Joel L. Rush, DO, who directs the AOA-approved orthopedic surgery residency at Broward Health Medical Center in Fort Lauderdale, Fla. “I especially enjoy orthopedics because I’m a tool junkie. I love that I get to use really cool nitrogen-powered saws and all manner of drills, chisels and hammers.”

With dozens—in some cases, hundreds—of applicants per position, all 40 AOA-approved orthopedic surgery residencies fill easily. Some programs limit themselves to candidates who rank in the top 10% of their class and score at least in the 90th percentile on the Comprehensive Osteopathic Medical Licensing Examination—USA (COMLEX-USA), Dr. Vander Lugt says.

Orthopedic surgery residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) are rarely a viable option for DO graduates because of demand by MDs for the highly competitive slots, Dr. Vander Lugt says. Only five or so DO students each year match into ACGME-accredited orthopedic surgery residency programs.

“It’s rare for us to take on residents who have never rotated with us,” Dr. Drouillard says. “For that to occur, someone has to have a spectacular interview, as well as spectacular credentials.”

Read more at http://www.do-online.org/TheDO/?p=129851

Not all in the mind: DO psychiatrists, too, favor whole-body approach
http://www.do-online.org/TheDO/?p=130621
Like Dr. Hegybeli, some osteopathic psychiatrists approach their discipline differently than allopathic psychiatrists do by incorporating OMT. While the majority of osteopathic psychiatrists don’t perform OMT on their patients, experts suggest many of them employ other tactics that set them apart from their allopathic colleagues.

Osteopathic physicians often thrive in psychiatry because the two disciplines’ values are closely aligned, says Alyse Ley, DO, an assistant professor of psychiatry at Michigan State University College of Osteopathic Medicine in Lansing.
“If you look at the core principles of osteopathic medicine, one of those is the mind and body connection, which is the same basic principle that is the foundation of psychiatry,” she says.

Thomas Wise, MD, a professor of psychiatry at the George Washington University Medical Center in Washington, D.C., sees commonalities between MD and DO psychiatrists. In fact, he says he thinks any differences are negligible.

Dr. Wise notes that there may have been more of a difference between allopathic and osteopathic psychiatrists years ago. These days, he feels the two are closer than ever.
“Now there’s such an emphasis in psychiatry to look at the needs of primary care and the integration of primary care both in allopathic and osteopathic schools,” he says. “My guess is the difference is less and less, if any.”

Read more at http://www.do-online.org/TheDO/?p=130621

 

[group_theory]

Snippits from The DO, articles written BY CAROLYN SCHIERHORN, staff editor for The DO

Analyze this: Radiology rewards problem solvers
http://www.do-online.org/TheDO/?p=125411
Radiology ties with orthopedic surgery as the top-paying medical specialty, with radiologists earning an average income of $315,000 a year, according to a 2012 Medscape survey. But no one should pursue radiology primarily for the pay, caution leaders in the field.
“Those who choose the specialty based on money will be disappointed,” says George E. Erbacher, DO, the immediate past president of the American Osteopathic College of Radiology (AOCR).

First, reimbursement for radiologists is declining as the U.S. health system shifts toward a payment model that emphasizes primary care. Between 2010 and 2011, radiologists’ compensation decreased by 10%, the Medscape survey notes.
Second, requiring many years of training, radiology is one of the most demanding specialties. Students match into a linked internship in their fourth year of medical school followed by a four-year diagnostic radiology residency. Most radiologists then complete one or more fellowships in such subspecialties as interventional radiology and pediatric radiology or in specific imaging processes and anatomical areas.

Third, radiologists put in long hours, so this is not the best specialty for those who seek work-life balance, despite the norm of six to eight weeks of paid vacation a year. Most diagnostic radiologists have a 10- or 12-hour work day, work some weekends and take call. Interventional radiologists work even more, says Dr. Wong, who has experienced many nights with little sleep during the course of his decades-long career.
“For many years, it wasn’t unusual for me to have a 12- to 14-hour day, then be on call and have to get up in the middle of the night for a patient who had a brain stroke,” points out the AOCR’s president-elect. “And often I’d be up the rest of the night and have to work a full day the next day.”


Diagnostic radiology is one of the most competitive specialties. With roughly 35 funded positions each year in 14 AOA-approved residency programs, the number of slots falls far short of demand. Most programs have dozens of applicants per position.
“On average, we get between 70 and 100 applications for one or two positions a year,” says Garden City Hospital’s Dr. Vollman. Botsford Hospital receives approximately 100 applications for its three annual radiology openings.

Osteopathic medical students who matched into diagnostic radiology as their first-choice specialty in 2011 had an average score of 574 on Level 1 of COMLEX-USA and 543 on Level 2-Cognitive Evaluation, while 100% passed Level 2-Performance Evaluation on the first attempt, according to Osteopathic GME Match Report—For the 2011 Match.

Read more at http://www.do-online.org/TheDO/?p=125411


Child’s play? Pediatrics requires patience, empathy … playfulness
http://www.do-online.org/TheDO/?p=123051
“If screaming babies disturb you or you get angry when kids seem to be obnoxious, you don’t belong in pediatrics,” insists Dr. Melnick, a former president of the American College of Osteopathic Pediatricians (ACOP). “Pediatricians have to be accepting of children. They must listen to kids without contempt or ridicule, understanding that children think and speak at a different level than we do.”

“As a pediatrician, you need great patience and great humility,” adds Ronald V. Marino, DO, MPH, who directs the AOA-approved pediatrics residency at Good Samaritan Hospital in West Islip, N.Y. “If you have to start an IV on a pudgy 18-month-old, a lot of times you’re sweating bullets because it’s so hard to find a vein. You can’t be cocky as a pediatrician. Plus, you’re going to get peed on and spit up on anyway.”

Because they interact with both kids and their parents, pediatricians need especially strong interpersonal skills. “You need to bond not only with the child but also with the child’s family,” says Eileen L. Hug, DO, the director of the AOA-approved pediatrics residency at Henry Ford Macomb Hospitals in Warren, Mich. “This is challenging because when a child is sick, the family is under a lot of stress.”

Today, 14 of the 18 AOA-approved residency programs in pediatrics are also accredited by the Accreditation Council for Graduate Medical Education (ACGME). Trainees in dually accredited residencies can apply to either AOA-approved or ACGME-accredited fellowship programs. Pediatric residency and fellowship opportunities will likely increase in a couple of years, with the AOA and the ACGME working toward a common accreditation system by 2015.

The new Osteopathic GME Match Report by the American Association of Colleges of Osteopathic Medicine provides a glimpse of 2011 graduates who matched into pediatrics as their first-choice specialty. These graduates had an average score of 486 on Level 1 of the Comprehensive Osteopathic Medical Licensing Examination—USA (COMLEX-USA) and 498 on Level 2-Cognitive Evaluation (CE), while 100% passed Level 2-Performance Evaluation (PE) on the first attempt.

Read more at http://www.do-online.org/TheDO/?p=123051

Like to puzzle over diagnoses? Internal medicine may be for you
http://www.do-online.org/TheDO/?p=119921
Internal medicine is a cognitive specialty, although some of the subspecialties involve a number of procedures, notes David F. Hitzeman, DO, a general internist in Tulsa, Okla. “Internists like dealing with complex issues in a very intuitive way, coming to a diagnosis and developing a treatment plan,” he says. “Internists also like direct patient care.” While general internists and some internal medicine subspecialists provide longitudinal care to patients, internists in hospital medicine and critical care focus on diagnosing and treating extremely ill inpatients.

Internists, who complete three years of residency training, constitute 40% of U.S. primary care physicians. Osteopathic medical students considering primary care sometimes struggle to decide between internal medicine and family medicine, but the distinctions are many. First, general internists traditionally limit their practices to patients age 17 and older and don’t provide obstetrical services. “When I ask people why they want to do internal medicine, a common answer is, ‘I don’t want to see kids,’ ” says Dr. Bray, who is also Broward General’s director of medical education.

But a growing proportion of medical students today are drawn to internal medicine because of the chance to subspecialize or pursue hospital medicine. The ACOI reports that among DOs completing internal medicine residencies in 2012, 42% entered subspecialty training and 36% became hospitalists.

Today, 103 AOA-approved internal medicine residency programs offer more than 1,600 funded positions. The AOA has also approved 11 combined programs in internal medicine-emergency medicine, one program in internal medicine-pediatrics and one in internal medicine-neuromusculoskeletal medicine. In addition, the AOA has approved internal medicine fellowship programs in many subspecialties.

Graduates who matched into their first-choice AOA-approved internal medicine residencies - these candidates had average scores of 482 on Level 1 of the Comprehensive Osteopathic Medical Licensing Examination—USA (COMLEX-USA) and 478 on Level 2-Cognitive Evaluation, while 94% passed Level 2-Performance Evaluation on the first attempt. Although these averages are lower than those of most of the other specialties, internal medicine candidates had the broadest range of scores.

While not all AOA-approved internal medicine positions fill, some programs are flooded with applications. Dr. Hitzeman received more than 80 applications this year for nine available positions at Oklahoma State University (OSU) Medical Center in Tulsa, where he directs an AOA-approved internal medicine residency program. Dr. Bray sifted through 400 applications for 14 internal medicine slots at Broward General.

Read more at http://www.do-online.org/TheDO/?p=119921

 

[as1212559]

Repped and subbed for later.


Will be reading the ER one and PM&R.

 

[V1987]

Looking forward to reading them! Thanks!

 

[V1987]

.

 

[HalfListic]

Great stuff, thanks👍

 

[DrBumblebee]

I'd like to add to group_theory's posts that American Osteopathic Association 1.0.3 is a great app to download on iPhone.

Here's the link: http://appfinder.lisisoft.com/app/american-osteopathic-association.html

Just sayin'.

 

[dsoz]

Those are great articles. And they don't just apply to DOs. It sound like good advice for all people interested in those specialties. I have bookmarked this thread and will definitely look back on it as my time for residency comes closer.

Thanks for sharing!
dsoz

 

[Yogurt4All]

Great articles, thanks for sharing!

 

[group_theory]

Continuing the series (from The DO) ... again are some snippets from The DO, articles written BY CAROLYN SCHIERHORN, staff editor for The DO

Family medicine lures with variety, strong relationships, growing influence
http://www.do-online.org/TheDO/?p=162811

During her third and fourth years of medical school, Robyn Dreibelbis, DO, fell for a succession of specialties. “I would finish a pediatrics rotation and say, ‘I’m definitely going to be a pediatrician.’ Then I’d go on a general surgery rotation and decide that I had to become a surgeon,” she remembers. “I loved absolutely everything.”

But when her time in medical school was running out and she had to figure out what to do with her life, she knew she had one clear choice. “Family medicine was the only field where I wouldn’t be limited,” says Dr. Dreibelbis, who has practiced in rural Oregon since 1998.

Family medicine entices those who thrive on variety. Most family physicians treat patients of all ages who have all manner of conditions.

...

Most directors of AOA-approved family medicine programs use board scores as a screening tool, preferring candidates who passed COMLEX Level 1 and Level 2, both the cognitive evaluation (CE) and the performance evaluation (PE), on the first attempt.

During the 2012 AOA Match, those who matched into family medicine as their first-choice specialty had average scores of 463 on Level 1 and 468 on Level 2-CE, according to a new report by the American Association of Colleges of Osteopathic Medicine. Of those residents, 81% passed Level 1 and 79% passed Level 2-CE on the first attempt.

The report shows that 97% of students matching into family medicine passed COMLEX Level 2-PE successfully on the first try, compared with 95.5% of all AOA Match participants.

http://www.do-online.org/TheDO/?p=162811


How to become a neurosurgeon
http://www.do-online.org/TheDO/?p=160031

The dismissive remark “It’s not brain surgery” for uncomplicated tasks reveals the common perception that neurosurgeons have preternatural intelligence and skills.

While they do need to be very bright and have great hands, neurosurgeons are not necessarily smarter or more dexterous than physicians in other demanding surgical specialties, those in the field insist. In fact, misconceptions about neurosurgery scare away some medical students who might excel in the specialty while enticing others to pursue it for the wrong reasons.

“If you think you might be interested in neurosurgery, you shouldn’t shy away from learning more about it because you feel your grades aren’t good enough,” says Oklahoma City neurosurgeon Dawn R. Tartaglione, DO, who serves on the governing board of the American College of Osteopathic Surgeons. “You’d be surprised at just whom this specialty suits.”

At the same time, those who are drawn to neurosurgery’s perceived prestige are in for a rude awakening, says Kailish Narayan, MD, the program director of the AOA-approved neurosurgical residency at Doctors Hospital in Columbus, Ohio.

“Some people say they want to do neurosurgery, but they don’t really know what it is,” Dr. Narayan says. “For example, they may see the glamour part and think it would be pretty cool to be a brain surgeon, not realizing that the majority of neurosurgeons do mostly spine surgeries.”

Neurosurgery requires physicians who have a special combination of traits, according to Dr. Narayan. Most surgeons are results-oriented individuals who like to fix patients’ problems. Neurosurgeons, though, must be able to take satisfaction from small improvements.

...

Student doctors should start shadowing neurosurgeons as early as their first or second year, suggests Dr. Seibly. “Students can come here to Advocate BroMenn during their breaks or summer vacation to spend some time with us and check out our program and learn more about neurosurgery before their fourth year, when they have to make more of a commitment,” he says. “What we don’t like to see is a fourth-year student who hasn’t spent much time in neurosurgery get into a program and discover it’s not for them.”

Interested students should try to serve their core rotations and other elective rotations at institutions that have neurosurgical residencies. That way, students may be able to spend some of their free time shadowing neurosurgeons and observing neurological surgeries.

http://www.do-online.org/TheDO/?p=160031

 

[group_theory]

Snippits from The DO, articles written BY CAROLYN SCHIERHORN, staff editor for The DO

Nice work—and you can get it: Outlook good in occupational medicine
http://www.do-online.org/TheDO/?p=156381
Among all medical specialists, physicians in occupational or general preventive medicine are most likely to be satisfied with their work-life balance and least likely to suffer from burnout, according to a 2012 study published in the former Archives of Internal Medicine. Yet few medical students know about this specialty, says Scott C. Jones, DO, MPH, the president of the American Osteopathic College of Occupational and Preventive Medicine (AOCOPM).

The overall field of preventive medicine includes general preventive medicine and public health, aerospace medicine, and occupational and environmental medicine. Most general preventive medicine specialists work for federal, state or local public health agencies or pursue careers in academia. Most aerospace medicine specialists work for the military, NASA or the Federal Aviation Administration.
...
Physicians who specialize in occupational medicine have many career options. They can be employed by large corporations in any industry or profession. They can be in private practice and contract their services out to other organizations. And they can run clinics that evaluate and treat workers from a variety of occupations and employers. Many employed occupational medicine physicians also do independent consulting work.
...
As did Drs. Jones, Walker and O’Connor, many physicians enter preventive medicine disciplines after becoming board certified in other specialties. But it is important for osteopathic medical students today to begin preparing for a career in occupational or general preventive medicine before finishing med school.

Preventive medicine residencies, which are two-year programs, begin in postgraduate year 2 and require a year of prior clinical training. Only one AOA-approved residency in preventive medicine currently exists—a dually accredited program in general preventive medicine and public health at the Palm Beach County (Fla.) Health Department. At present, this is the only preventive medicine program that will accept DOs who have completed just a traditional osteopathic internship or a year or more of another AOA-approved residency.

The Accreditation Council for Graduate Medical Education (ACGME) lists approximately 70 preventive medicine residencies, the largest proportion of which focus on occupational health. To gain entry into one of these residencies, osteopathic medical graduates need to serve an ACGME-accredited transitional year or a year in another ACGME-accredited residency program. This is an ACGME requirement for its preventive medicine programs that predates by many years the proposed changes to the ACGME’s common program requirements currently under consideration.

http://www.do-online.org/TheDO/?p=156381

Proctologists, urologists need compassion, sensitivity—and humor
http://www.do-online.org/TheDO/?p=154431

Both urology and proctology are surgical specialties that deal with the organs and processes involved in eliminating human waste. To be successful in either of these fields, physicians need to have utmost sensitivity and compassion, as well as exceptional fine-motor skills. Patients who see urologists or proctologists often have problems of a highly personal nature, such as incontinence, unrelenting pain or itching, and sexual issues.

Practicing these specialties provides a desirable balance between office and operating room. Urologists and proctologists not only get to know their patients but also fix their problems.

Their whole-patient approach to care and deep understanding of the interrelationship between structure and function make osteopathic physicians particularly well-suited to urology and proctology. Requiring top-notch communication skills, urologists and proctologists interact with many other physicians, including primary care specialists, internal medicine subspecialists and other types of surgeons.

Both specialties are also on the front lines of detecting and treating cancer, but the two differ significantly in their training requirements and career options.
...
Applicants to AOA-approved urological surgery residencies need good grades and strong scores on the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA). In 2011, those who matched into urological surgery as their first-choice specialty had an average score of 550 on Level 1, the fifth highest among all specialties, and an average score of 568 on Level 2, tying for third highest, according to areport by the American Association of Colleges of Osteopathic Medicine.

But the weight given to board scores and grades is program-specific. Dr. McIntosh, for example, does not require a high class rank or use a minimum COMLEX-USA percentile score to winnow down his list of candidates, even though he received 54 applications for one opening last year.

“We look for applicants to be in the top half of their class,” he says. “And we expect them to have successfully passed everything the first time around. Anyone who has failed a class or failed a board exam on the first attempt usually will not be invited to be interviewed.”

Program director Anthony M. Grimaldi, DO, who generally has some 40 applications for one opening, likes urology candidates to have above-average COMLEX scores, preferably in the top quartile. But he cares more about their interest in urology and their performance while rotating with his program, which he requires.

“I expect students to have read at least the basics in urology before they start,” says Dr. Grimaldi, who leads the urological surgery residency in suburban Chicago associated with the Midwestern University/Chicago College of Osteopathic Medicine. “They will move right into our program where I’m training interns and residents.
...
Along with neuromusculoskeletal medicine, proctology is a uniquely osteopathic specialty. This is because the allopathic medical profession years ago absorbed the role previously performed by proctologists into the specialty of colorectal surgery. Becoming a colorectal surgeon requires completing a five-year general surgery residency followed by a one-year fellowship in colon and rectal surgery, of which the ACGME lists 55 programs.

In contrast to the six years required for colorectal surgery, the two AOA-approved proctology residencies are three-year programs. Osteopathic proctologists do surgical procedures in the anus and rectum and perform colonoscopies, but they don’t perform colectomies, colostomies and other major gastrointestinal surgical procedures.

http://www.do-online.org/TheDO/?p=154431

 

[group_theory]

Snippits from The DO, articles written BY CAROLYN SCHIERHORN, staff editor for The DO

Neurology on the brain? Here’s how to specialize in it
http://www.do-online.org/TheDO/?p=141431

Carrying a black medical bag filled with tools—hammers, tuning forks and safety pins among them—the osteopathic neurologist enters the examination room prepared to spend a half-hour or more with the new patient. She takes a complete history and performs a thorough physical examination, using her palpatory diagnosis skills. Because the patient has partial lower-extremity numbness, she removes a tuning fork from her bag.

Striking the tuning fork with her hand, she places it on one of the patient’s big toes and asks if he feels the vibrations. “Tell me when it stops,” she says.

Then she places the vibrating tool against the patient’s ankle. “Can you still feel it? Tell me when it stops,” she says. Next, she places the tool on his knee. “Can you still feel it?” she asks again.

Neurologist Wynde K. Cheek, DO, of Helena, Mont., frequently performs this and other neurological tests to arrive at an accurate diagnosis. Loss of a sense of vibration would be an indicator of peripheral neuropathy, she says. But many different neurological disorders and conditions have similar presentations.

A member of the Board of Governors of the American College of Osteopathic Neurologists and Psychiatrists, Dr. Cheek emphasizes the joy she and other neurologists derive from their profession. Neurology combines the cognitive challenges of diagnosing difficult-to-distinguish disorders with the satisfaction that comes from establishing close, often long-term relationships with patients.

“When I did my first neurology rotation as a student, I absolutely fell in love with the whole concept of how the brain controls the body,” says Anne M. Pawlak, DO, who directs the AOA-approved neurology residency at Garden City (Mich.) Hospital.

“I really enjoy the specialty because I find it intellectually stimulating. I like solving puzzles,” adds Kristi Gill, DO, a chief resident in the AOA-approved neurology program at Botsford Hospital in Farmington Hills, Mich.

Neurology, which attracts a large number of women, is also known for having reasonable work hours. “Although you do have call, the hours are fairly compatible with having a good family life,” Dr. Gill says.

In addition, the demand for neurologists is growing, as baby boomers age and develop more neurological conditions, such as strokes, Alzheimer’s disease and Parkinson’s disease. “There are a lot of jobs out there for neurologists. That’s another reason I went into the specialty,” Dr. Gill says.

...

Neurology residencies are four-year programs, including an internship year. Students typically match from their fourth year of medical school, but some AOA-approved programs accept candidates from traditional rotating internships.

Because of the increasing number of DO graduates and the electronic application process, all AOA-approved residency programs, including neurology, have become more competitive. Even though neurology is far from being the most popular field, some institutions are having trouble accommodating students who want to serve neurology rotations.

“We’re having a huge scheduling issue trying to fit in all of the students who want to check out our program,” says Botsford’s Dr. Gill.

The neurology residency program in Erie, Pa., affiliated with the Lake Erie College of Osteopathic Medicine draws roughly 30 applicants for two or three openings a year, says director Jeffrey J. Esper, DO.

Dr. Esper requires all serious candidates to have at least a B average in their med school coursework, with a high score in anatomy. In addition, they must have passed the first two steps of the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA). But he doesn’t limit his selection to those above a certain score or percentile.

“I would rather take someone in the 79th percentile who has good interpersonal skills as well as an aptitude for neurology than someone above the 90th percentile who is difficult to work with,” Dr. Esper says.

In 2011, osteopathic medical students who matched into neurology as their first-choice specialty scored an average of 472 on COMLEX-USA Level 1 and 493 on Level 2, according to the Osteopathic GME Match Report—For the 2011 Match, published by the American Association of Colleges of Osteopathic Medicine (AACOM).

Most AOA-approved neurology residencies strongly favor applicants who have served rotations in their programs.

http://www.do-online.org/TheDO/?p=141431

Medicine’s detectives: Pathologists master the art of diagnosis
http://www.do-online.org/TheDO/?p=138851
Type A personalities who love the limelight they are not. Pathologists tend to be quiet, introspective, rather quirky individuals who enjoy solving problems, but they cannot be timid, says Jack S. Moskowitz, DO, who serves on the Board of Governors of the American Osteopathic College of Pathologists.

“Pathologists must be definitive and honest,” says Dr. Moskowitz, who practices in northern Ohio. “When I see cancer, I call it, but I have to be absolutely sure.” Pathologists sometimes press other physicians for more complete patient histories, which aren’t always available, and they may stress the need for a differential diagnosis when uncertain about results.

Because pathologists don’t share their findings directly with patients, they can leverage objectivity, Dr. Moskowitz says.

Although many would describe themselves as introverts, pathologists need to be good communicators.

“Pathology has moved away from the stereotype of loners practicing in a vacuuum,” says David Allison, DO, in his fourth year of an anatomic and clinical pathology residency at the University of Illinois at Chicago (UIC) College of Medicine. “It is definitely a team-based field.”

...

There are no AOA-approved residencies in pathology, so individuals pursuing this specialty are limited to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), of which there are more than 140.

The vast majority of pathology residents today are in four-year combined residencies in anatomic and clinical pathology, but some programs allow trainees to complete three-year residencies in either anatomic or clinical pathology if they plan to pursue a subspecialty in one or the other of these main pathology divisions.

In a nutshell, anatomic pathology involves diagnosing disease through the gross and microscopic examination of tissues and cells, as well as performing autopsies when indicated on entire bodies, while clinical pathology involves laboratory analysis of bodily fluids and tissues. General pathologists may do both anatomic and clinical pathology.

Medical students who want to become pathologists in the U.S. must take part in the National Resident Matching Program (NRMP). Students match from their fourth year of medical school—a transitional year is not required.

In the 2013 NRMP match, 583 pathology positions were available. With more than 100 applicants vying for each position, pathology appears to be highly competitive. But the prospects for snagging a residency spot aren’t as dire as they first seem because many of the applicants are international medical graduates, Dr. Black says.

“Most U.S. grads who want path will get it,” she says.

ACGME-accredited pathology residencies may favor graduates of U.S. medical schools for a variety of reasons, including number of years since graduation, the quality of medical education, perceived dedication to pathology, visa issues, and the less-than-fluent English language skills of some foreign applicants, according to Dr. Black.

...

“We’ll look at the medical schools they went to and their transcripts, and we’ll look at their board scores,” Dr. Friedman says. He prefers candidates who score at least in the 80th percentile on the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) or the United States Medical Licensing Examination (USMLE).

“If an applicant failed one step of the exam once but did well on the repeat, we’ll consider him or her,” Dr. Friedman says. “But if someone has more than one failure, we’ll move on to the next applicant.”

Dartmouth-Hitchcock’s pathology residency doesn’t require a minimum percentile but expects applicants to have passed all components of the USMLE or COMLEX-USA. “I will consider someone who has had maybe one failure if he or she is a really exceptional candidate in other ways,” Dr. Black says. “But if someone takes an exam again and fails it again, that’s really a red flag.”

Dr. Friedman has noticed that three-quarters of the roughly 20 DOs who apply to his program each year have taken at least Step 1 of the USMLE. In most cases, he doesn’t recommend this.

Osteopathic medical students who have strong COMLEX scores have no reason to take the USMLE because they risk getting lower scores, which will count against them, Dr. Friedman says. Pathology program directors who look favorably on DOs are familiar with COMLEX and don’t require the USMLE.

“If you do well on COMLEX, the USMLE will only hurt you,” Dr. Friedman says. “If you didn’t do well on the COMLEX, you can take USMLE Steps 1 and 2 to show that you are capable of doing well, but you had better do well. You’re not going to get in with a bad score.”

Both Dr. Friedman and Dr. Black try to filter out individuals who are simply applying to pathology as a backup if they don’t match into their first-choice specialty.

http://www.do-online.org/TheDO/?p=138851