Topics that annoy you?

[bizurk]

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While studying for Pt. 2, are there some diseases that annoy you every time? As in, they have awful names or criteria that just make you grumble?

Here's a few of mine to get it started -

Monoclonal Gammopathy of Undetermined Significance (silly name)
Minimal Change Disease (silly name)
All things schizo (-phrenia, -phreniform, -affective, -oid, etc)
Roseola (HHV6) vs Rubeola (measles) vs Rubella (German measles)
Pseudohypoparathyroidism
Hyperosmolar hyperglycemic Non-Ketotic Syndrome (for something this common, they couldn't come up with a better name? or at least a mnemonic that you could say? I've heard 'HonK' used, but it's by no means universal)

As far as criteria go:
The ATP3 criteria just seem overly complicated, especially when the endocrinologists, cardiologists and internists can't completely agree on what the goals are

I can usually get the questions, but I can never keep all the post-MI complications completely straight (Free wall rupture us. <2 wks, but most often 1-4 days, Intervent septum <10 days, Papillary muscle peak incidence 5 days, ventricular pseudo-aneurysm vs ventricular aneurysm, acute pericarditis vs dressler's pericarditis, etc etc)

Anyway, I know it's not strictly on subject, but it has to be more helpful than "OMG, I only got a 268, am I totally screwed now?" 😀

 

[kissmyasthma99]

Anything that starts with a XX yo woman Gx Px at XX weeks gestation.....

I hate OB 😀

 

[PistolPete]

All those random markers (ant-Jo, anti-La, anti-centromere) for rheumatoid stuff... I have to re-memorize that stuff EVERY time.. *shudder*

 

[bizurk]

All those random markers (ant-Jo, anti-La, anti-centromere) for rheumatoid stuff... I have to re-memorize that stuff EVERY time.. *shudder*

Yes!! Along those lines:
Dermatomyositis / Polymyositis / Childhood onset Myositis / CVD-assoc Myositis / Malignancy-assoc Myositis / Inclusion body Myositis 😡

Also, every time I read the seronegative spondyloarthropathy section in SUtM, I get more confused. They seem to apply the "can't see, can't pee...." thing to all of them.

 

[Captopril]

All things schizo (-phrenia, -phreniform, -affective, -oid, etc)

simple rhyme that helps me remember via DIT:
Schizotypal - you dress like a pickle (you are weird)
Schizoid - you avoid (it's like avoidant personality, except you don't give an F that you are alone all the time)

That just leaves schizophrenia, which you obviously know the definition of...and then schizophreniform which is just a short-term version of shizophrenia (a form of shizophrenia if you will).

 

[digitlnoize]

I think 99% of these tests are stupid. They're not testing our ability to be physicians, but our ability to memorize random minutiae or to pay for a review course.

How many of you have actually seen a case of these zebras? Our tests should be WAY more in depth on clinically relevant topics like CAD, DM, HTN, COPD, CHF, etc and WAY less of the Prader-Willi, Trisomy 13 crap.

 

[LouisianaDoctor]

I think 99% of these tests are stupid. They're not testing our ability to be physicians, but our ability to memorize random minutiae or to pay for a review course.

How many of you have actually seen a case of these zebras? Our tests should be WAY more in depth on clinically relevant topics like CAD, DM, HTN, COPD, CHF, etc and WAY less of the Prader-Willi, Trisomy 13 crap.

Yup. Totally agree.

The ones that I can never remember are all of the things like Tay Sachs, G6PD deficiency, etc. And biostats 🙂

 

[bizurk]

I think 99% of these tests are stupid. They're not testing our ability to be physicians, but our ability to memorize random minutiae or to pay for a review course.

How many of you have actually seen a case of these zebras? Our tests should be WAY more in depth on clinically relevant topics like CAD, DM, HTN, COPD, CHF, etc and WAY less of the Prader-Willi, Trisomy 13 crap.

I'll start by agreeing with you. The healthcare system and society in general, would be better served by armies of docs attacking all the HTN, DM2, chronic renal failure, etc...... but the counter-argument is this:

Mid-level providers and clerks with keyboards could manage most of the common conditions.... but if you get that dx on one Pheo out of 500 HTN pts, you've saved a life. 👍 Kinda like how any idiot can run the ACLS algorithms, but the difficulty is in physical dx, quickly figuring out why someone landed the PEA algorithm and fixing said problem

At the end of the day, however, it's probably just a matter of separating the wheat from the chaff. If they asked more common questions and fewer stumpers, there would be less utility in a test that ensures only the smartest people in the universe become dermatologists 😉

 

[bizurk]

Oh, and to get back on topic:

All the glomerular disorders annoy the feces out of me

FSGS, membranous GN, membranoproliferative GN

 

[greg1184]

Lipid storage disorders

In fact I didn't bother to study them, and to my big surprise, I didn't have a single question on step 2.

 

[myhandsarecold]

Systemic Lupus Erythemathosus 😡

 

[LouisianaDoctor]

At the end of the day, however, it's probably just a matter of separating the wheat from the chaff. If they asked more common questions and fewer stumpers, there would be less utility in a test that ensures only the smartest people in the universe become dermatologists 😉

A derm injected steroids into an abscess on my aunt's back!

 

[digitlnoize]

Mid-level providers and clerks with keyboards could manage most of the common conditions.... but if you get that dx on one Pheo out of 500 HTN pts, you've saved a life. 👍 Kinda like how any idiot can run the ACLS algorithms, but the difficulty is in physical dx, quickly figuring out why someone landed the PEA algorithm and fixing said problem

That's fine, but they don't ask that many questions on physical diagnosis. It's what's the lab test for this weird disease, or even worse...a rarely used synonym for a culture medium for a weird disease.

there would be less utility in a test that ensures only the smartest people in the universe become dermatologists 😉

You mean the richest people. The ones who can afford UWorld for a year or two + Kaplan courses + Falcon + 20 review books + a few other Qbanks for good measure + a flight to a Prometric center where you can bribe the officials (there are lists of these online in some clandestine FMG forums, btw...usually strange foreign countries).

The tests aren't designed to be used for what the PD's are using them for anyways. The NBME explicitly states that you're not to use USMLE scores to compare two residents, and that the exams are only designed for licensure purposes. So why don't they stop giving out the numbers?

In 2005, Rifkin and Rifkin compared the performance of all the first year Internal Medicine residents at a large academic medical center on standardized patient encounters to their scores on the USMLE Step 1 and 2. They found very low correlations. For Step 1, the correlation was 0.2 (df=32, p=0.27) and for Step 2 it was 0.09 (df=30, p=0.61). That's almost 0 correlation. Horrible.

A more recent study is very critical of the use of USMLE scores for selection of residents. This study by McGaghie and colleagues, found correlations from -0.05 to 0.29 to Step 1 and -0.16 to 0.24 for Step 2.

Why do we say we're objective when deciding treatment and use all the latest studies, but ignore the data when it comes to selecting doctors?

 

[theRainmaker78]

That's fine, but they don't ask that many questions on physical diagnosis. It's what's the lab test for this weird disease, or even worse...a rarely used synonym for a culture medium for a weird disease.

lol...

But to be fair it is the gold standard when it comes to medical exams worldwide.


The rest of your post is a gross exagerration of the reality in my opinion. Taking courses has no correlation with doing well on the exam. And since this is a national liscensure test I think it is pretty tightly controlled in terms of controlling fraud, bribery, etc... I've never heard of such prometric centers.

 

[digitlnoize]

So true...

But to be fair it is the gold standard when it comes to medical exams worldwide.
And it is the only way to objectively and fairly compare two candidates from different schools... No matter how irrelevant some of the tested material actually is.

Medical LICENSURE exams, yes. I would debate the objectively and fairly part and add:

What question does this score answer?

Does a high score mean an applicant will be a good doctor or a low score a bad one? The data says no.

Does a high score mean an applicant is good at taking standardized tests? Perhaps. Who cares? What bearing does that have on being a good physician (which is what we're trying to train, isn't it?)

It's time we stopped comparing applicants on their ability to memorize minutiae and started comparing them based on what matters, namely real-world clinical judgement and decision making, bedside manner, communication, and ability to manage others (which I have NEVER seen tested on a board question, despite the claim that physicians are supposed to be leaders).

I don't have a good, efficient way to do this really, but the current "sit through a zillion well-written, multiple choice zebra questions" format is not the right answer.

The USMLE (and COMLEX) are good national licensure exams, meaning if you pass them, you are deemed competent by a national agency. They are poor predictors of ability beyond this and should not be used as such.

 

[theRainmaker78]

I see ur point. But in the studies you mention above, I have to ask... When you are assessing those interns/residents- How do u objectively "measure" standardized patient encounters?

What parameters are you testing to judge their compentence in the clinic?

How do u know if those parameters actually mean they are doing a better job as doctors? Different minds operate in different ways....

The only objective measure of patient care I can think of would be something like "5 year mortality of patients of CHF".... and you obviously can't judge an intern on that

And then how would you then go back and judge medical grads? With LOR's... lol that would be THE MOST subjective method out there....

You see the dilemma

 

[digitlnoize]

I see ur point. But in the studies you mention above, I have to ask... When you are assessing those interns/residents- How do u objectively "measure" standardized patient encounters?

What parameters are you testing to judge their compentence in the clinic?

How do u know if those parameters actually mean they are doing a better job as doctors? Different minds operate in different ways....

The only objective measure of patient care I can think of would be something like "5 year mortality of patients of CHF".... and you obviously can't judge an intern on that

And then how would you then go back and judge medical grads? With LOR's... lol that would be THE MOST subjective method out there....

You see the dilemma

I agree that the studies likely have issues, but let's not forget that the NBME agrees.

Objectively, they could have used patient mortality, or disease control (A1C, PFTs, Lipids, etc). How about using patient surveys or outcomes to judge medical students?

I'm sure the guy whose life I saved would write me a great LOR. 😛

 

[greg1184]

Medical LICENSURE exams, yes. I would debate the objectively and fairly part and add:

What question does this score answer?

Does a high score mean an applicant will be a good doctor or a low score a bad one? The data says no.

Does a high score mean an applicant is good at taking standardized tests? Perhaps. Who cares? What bearing does that have on being a good physician (which is what we're trying to train, isn't it?)

It's time we stopped comparing applicants on their ability to memorize minutiae and started comparing them based on what matters, namely real-world clinical judgement and decision making, bedside manner, communication, and ability to manage others (which I have NEVER seen tested on a board question, despite the claim that physicians are supposed to be leaders).

I don't have a good, efficient way to do this really, but the current "sit through a zillion well-written, multiple choice zebra questions" format is not the right answer.

The USMLE (and COMLEX) are good national licensure exams, meaning if you pass them, you are deemed competent by a national agency. They are poor predictors of ability beyond this and should not be used as such.

Agreed for the post part. My biggest issue with this exam is that they make it a pass/fail exam even though that is a facade. If residencies are going to use the USMLE score as a competitive entity, don't make it p/f and allow us to take it at least once again. Every other test, the GMAT, MCAT, SAT, ACT, etc, allow students to take it again. The USMLE exam is the only exam that is one and done... if you pass. Everyone has a bad day, and every other exam group knows this.

I discussed this issue with one of the deans of my school, and I was preaching to the choir. The deans of my school (and other schools) in every national meeting have talked about this exact issue. It is the Residency program directors that have make this exam "one and done" in addition to a significant factor in admissions, which as you said is NOT how the NBME intended this examination to be used.

 

[digitlnoize]

Agreed for the post part. My biggest issue with this exam is that they make it a pass/fail exam even though that is a facade. If residencies are going to use the USMLE score as a competitive entity, don't make it p/f and allow us to take it at least once again. Every other test, the GMAT, MCAT, SAT, ACT, etc, allow students to take it again. The USMLE exam is the only exam that is one and done... if you pass. Everyone has a bad day, and every other exam group knows this.

I discussed this issue with one of the deans of my school, and I was preaching to the choir. The deans of my school (and other schools) in every national meeting have talked about this exact issue. It is the Residency program directors that have make this exam "one and done" in addition to a significant factor in admissions, which as you said is NOT how the NBME intended this examination to be used.

So why doesn't the NBME put a stop to it? Stop releasing the scores. End of story.

I know the PD's like having some way to compare us all, but it shouldn't be this.

How about everyone participating in the match simply refuses to release their scores? Problem solved. Like that'll ever happen...🙄

 

[sexyman]

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