Tag Archives: Fourth Year Medical Student Books

Just for Orthopods: Handbook of Fractures

Egol's Handbook of Fractures 4th Edition

The 4th Edition of Handbook of Fractures by Egol, Koval, and Zuckerman, is a must-have for interested medical students and orthopaedics residents everywhere.  It contains the essentials for an orthopaedic rotation and will give you a great foothold on the foundation of the specialty.  Note that it is not an all-knowing book of knowledge, despite being a “go-to guide” for the fundamentals.   It is a very condense text of fractures, dislocations, and stabilization techniques for upper and lower extremities, pediatric cases, axial fractures and dislocations, and also general considerations for the important categories of gunshot, pathologic, and multiple trauma cases, just to name a few.

 

This handbook is divided into 5 major divisions with chapters under each division: I. General Considerations (7 chapters including: GSW, closed reduction/casting/traction, periprosthetic fractures, orthopaedic analgesia), II. Axial Skeleton Fractures (3 chapters including: general spine, cervical spine, thoracolumbar spine), III. Upper Extremity Fractures & Dislocations (14 chapters including: scapula fractures, distal radius fractures, hand fractures), IV. Lower Extremity Fractures & Dislocations (17 chapters including: acetabulum, femoral shaft, patella, calcaneus, talus), and V. Pediatric Fractures & Dislocation (11 chapters including: shoulder, elbow, hip, knee, ankle, and many more).

Egol’s Handbook of Fractures has a lot of text, but is easy to read because important words are bolded and there are quite a good set of illustrations that go along with essential concepts.  Most chapters are subdivided, very logical, touch on epidemiology, anatomy, mechanism of injury, clinical evaluation, radiographic evaluation, classifications of fracture/dislocation, treatment, nonoperative vs operative cases, complications, and rehabilitation.

The primary target audience of the Handbook of Fractures is orthopaedic residents.  It covers a wide range of important and must-know concepts needed to succeed in orthopaedic residency.  The ambitious MS3 who wants to end up on top in an orthopaedic elective clerkship may also find this book enlightening and useful for impressing some attendings and residents (don’t show off too much though, jealousy must be kept at bay!).

This book is certainly not recommended for medical school courses in general, as time spent reading it would be low yield for general surgery rotations. This book is also pretty much useless for the USMLE exams because orthopaedic fractures, dislocations, and other material presented in this book are just not the materials you’ll see on the boards.  If you want to use it to get ready for an elective in orthopaedic clerkship or plan to go into orthopaedic residency, then go right on ahead and invest in one. Otherwise, it is recommended that you skim a library copy as needed.

 

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How to Pick Individual Residency Programs: FREIDA

AMA FREIDA Online

It’s application season, and while this takes place every year, we only go through it once (thankfully), and thus the >25,000 participating med students are unfamiliar with the process. There are a TON of considerations on selecting individual residency programs to put on your ERAS application. It can seem daunting to wade through the list of endless programs out there unless you are certain of a smaller specialty from the start. We’re going to start with the basics, for those of you who are really lost.

First, head over to FREIDA Online. It’s a searchable sortable database produced by the American Medical Association with over 9000 residency and fellowship programs.  After scrolling to the bottom of and agreeing to their policies, users can select their desired specialty (including sub-specialties and combination residency programs), geographic area, program size, and academic affiliation. Results can be further filtered by benefits, ERAS or NRMP participation, research requirements, or specialty training tracks.

Searches can be saved for later viewing, although this is generally not necessary. For the more popular specialties such as Internal Medicine, paring down the perceived 3 billion possible choices by all of these options still produces a list that still feels like 567,902 programs. In actuality, you should come out with a list of less than 100. It’s still overwhelming, but much better than when you started. Trimming that list down to your “short list” of about 20 total programs to which you will apply. The final push should come from academic advisors in your desired field. If all else fails, post a question to this post, and we’ll have someone look into it.

AMA logo, producers of FREIDAHopefully though, FREIDA Online will be a highly useful first step. For those of you wondering, the AMA application name stands for “Fellowship and Residency Electronic Interactive Database.”  Sounds about right. Good luck on the application process!

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Deja Review Emergency Medicine: A Great Quick Reminder

DejaReview Emergency MedicineDeja Review’s second edition of Emergency Medicine promises maximum retention with minimum time.  Using a ‘flashcard in a book’ question and answer format followed by a series of clinical vignettes designed to mimic classical presentations of the disorders presented therein, this copy of Deja Review “helps you remember a large amount of pertinent information in the least amount of time possible.”  So how much of this self-promotion is hype and how much is fact?

Emergency Medicine is divided into 18 chapters, each focusing on a particular overarching organ system or concept such as Cardiovascular and Vascular Emergencies or Toxicological Emergencies Each chapter is further subdivided into specific emergencies or presentations within these broader topics.  The subsections cover the most pertinent information regarding a specific presentation, such as etiology, exam findings and management.   It should be noted that the answers to the questions posed are very specific and typically not explanatory.  Following each chapter is a series of clinical vignettes which highlight key concepts of the diseases  or emergencies presented within the chapter.  A ‘Stimulus’ section found at the end of the book features 7 expanded clinical vignettes that include expanded presentations, images pertinent to the topic (MR, EEG, X-ray) and lengthy explanations regarding the answer choice.

emergency-reviewDespite being very bare bones, Deja Review Emergency Medicine, if used exactly as it is intended—as a last minute review solution—will probably serve those who choose to invest.  This is not a book for those who wish to explore the in depth intricacies Emergency Medicine has to offer.  Other comprehensive resources would likely benefit those looking for great detail regarding various case presentations and how to diagnose and treat cases seen in the emergency department.  But for someone who is looking for a quick and effective review of what Emergency Medicine has to offer in the week or so leading up to an exam or for rapid EM review, look no further.

 

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Déjà Review: USMLE Step 2 CK – Perfect for Some

Deja Review USMLE Step 2 CKStudents preparing to study for the USMLE Step 2 CK  should be well accustomed to the type of question encountered on the boards and shelf exams, and should have a decent sense of their own study habits and strengths. This is immensely important when deciding on a study plan for Step 2. The seemingly infinite clinical knowledge can be overwhelming, and a structured study plan truly helps.

Deja Review USMLE Step 2 CK, now in its second edition, continues to get mixed reviews by students studying for the boards. The format of the book is very straight forward: alternating sections of clinical vignettes, and rapid-fire two-column recall question and answers. The book goes through each of the core clerkship specializations that will be found on the USMLE Step 2 exam, starting with Internal Medicine, and progressing through Surgery, Neurology, Psychiatry, Obstetrics and Gynecology, Pediatrics, and finally Emergency Medicine. It is not a text book, or even a comprehensive review book such as First Aid, and as such should not be relied upon to learn new concepts. Its strength is purely in aiding with recall and making buzz word connections, and it does that very well.

However, the lack of teaching can be frustrating for students who do not already know or remember the material. DejaReview Step 2 CK shouldn’t replace question banks either. There are no answer explanations or experience in testing. Furthermore, the book is often times seen as unhelpful to students who do not learn well with recall type resources.

It is due to these reasons that there exists a split in outlook about this book. People who excel at rapid recall questions can easily carry this in a wide white coat pocket during the months preceding the USMLE Step 2 CK exam, for high yield on-the-go studying. It is a very strong review text that complements First Aid and USMLE World question banks, but it is not for everyone. Learning style really matters with this book, which is why there are such mixed feelings about it. If you are unsure of your learning style, it is recommended that you check out the format of the book before purchase. Try to browse through a copy at your medical library, or if you want to decide sooner, head over to Amazon, which gives a few of the question type pages found in the book. As far as price, Deja Review USMLE Step 2 CK gives a lot of bang in its 300+ pages for a low cost, so finding out it is not for you won’t set you back too far. Check out the links below to see what I mean.

 

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Careful Consideration: Pocket Neurology

Pocket Neurology LippincottPocket Neurology (also known as “The Yellow Book”) can be readily found in the white coats of many Neurology residents. Unlike its Medicine counterpart (The Green Book), Pocket Neurology does not seem to hold the same popularity among medical students. There are a few reasons for this. First, it hasn’t been around as long, and thus it hasn’t had time to built up the full extent of its reputation. Few attendings will readily reference it during rounds, and residents simply won’t expect students to own or have access to a copy. Second, Neurology is usually a clerkship of shorter duration compared to Internal Medicine in most medical schools, and therefore comprehensive pocket guides are less bang for the same buck.

What Pocket Neurology covers, it covers very well.  However the target audience for this title is not the same as for Pocket Medicine as a result of the focus in our medical education. We are taught the core principles of Internal Medicine from an early point on entering medical school, including history taking, physical examination, general findings, and many organ system courses focused on Internal Medicine subspecialties. It is because of this focus that new third year medical students can open a copy of Pocket Medicine and understand the more advanced topics without the need for referencing the basics.

This is not the case on a Neurology rotation, where most students are just starting to learn the specialty’s language, techniques, and the significance of common findings. For example, students may be frustrated if trying to use the book to assess the common presentations of migraine prodrome, despite a concise and comprehensive overview of headache differential diagnosis and workup. Getting past the basics quickly to fully utilize this book is highly recommended, as it will certainly be a strong resource to those who can wield it well.

As with all of the titles in the Pocket Notebook series, downsides include lack of space for annotation, and small print font, but these come with the territory of creating pocket reference guides.  Another consideration for this title specifically is an index section that is somewhat lacking.  Topics not contained within tidy concepts involve a good amount of searching in the appropriate chapter.  As a result, many residents will place labeled flags or earmarks on pages to quickly access commonly referenced topics.

Specific sections include neurologic emergencies, lesion localizing in clinical neurology, neuroimaging, vascular neurology, neurocritical care, acute intracranial hypertension, interventional neurology, seizures and other spells, electroencephalography (EEG), delirium, dementia, movement disorders, behavioral neurology, poisons and vitamin deficiencies, meningitis / encephalitis / brain abscesses, infectious diseases, headache, central nervous system vasculitis, pain, dizziness and deafness, demyeliminating diseases of the central nervous system, spine and spinal cord diseases, motor neuron diseases, peripheral neuropathy, radiculopathy and plexopathy, neuromuscular junction disorders, myopathy, electromyography (EMG), neuro-rheumatology, neuro-oncology, sleep medicine, pregnancy neurology, neuro-ophthalmology, consult issues, and selected pediatric disorders.

Overall, this is a title worth purchasing for all Neurology residents and medical students interested in the field. Medical students who wish to excel in their Neurology clerkship or enter a field that uses neurology such as Internal Medicine, Trauma, or Ophthalmology should consider purchasing Pocket Neurology with the above considerations, based on their personal preferences. This is probably not heavily needed for students who have no interest in neurology.

 

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Otoscope and Ophthalmoscope Set Alternatives: Med School Supply

Compare halogen and LED diagnostic kit bulbsWelch Allyn is the leading manufacturer of otoscopes and ophthalmoscopes, however the quality is also reflected in their higher prices. While many medical students want to purchase top name-brand equipment, and indeed this should be the case for such instruments as stethoscopes, this strategy is not always needed for diagnostic kits. Here’s the usual scenario: second year medical students from AMSA or some other group organize a “money-saving fundraiser” (let’s ignore that blatant oxymoron) and only highlight larger, more expensive, name-brand companies.   Often times there are even incentives to purchase the more expensive $500-$800 diagnostic sets to “save” on smaller instruments such as tuning forks or reflex hammers.

As mentioned in the Compare Welch Allyn series, it is incredibly important to talk to senior medical students at your school to ascertain the actual usage of instruments. This cannot be accurately assessed from manufacturer representatives, or even the second year medical students running the instrument sales.  If third and fourth year students carry their diagnostic sets with them at all times, a Welch Allyn set may be more beneficial.  If such diagnostic kits are used in a small handful of learning sessions that teach physical exam techniques during first and second years and are never utilized throughout the rest of medical school, we recommend the following.

Med School Supply Fiberoptic LED Otoscope Ophthalmoscope SetThe company Med School Supply (completely unrelated to this site despite the similar name) sells full-sized otoscope and ophthalmoscope sets for around $100.  Their standard model works just fine, although their LED otoscope set is actually more highly recommended due to the brighter, better lighting it produces.  You can clearly see the difference between their fiberoptic LED bulb and an older Welch Allyn halogen bulb in the top image of this article, and read more about the differences in the article How to Pick the Best Light Source.

Both kits work with standard otoscope tips, which means there is no reliance on this company for tips after purchasing one of their models.  Like the Standard Otoscope in the Welch Allyn description, Med School Supply otoscopes use a groove system to hold tips internally.  The ophthalmoscope uses the same halogen bulb for both kits, and is a solid basic model, without the bells and whistles as its WA counterpart. Unlike Welch Allyn, there is no built in rechargeable option for the handle.  These models take two C batteries, and that will last the entirety of medical school for the average user.

It is important to note that this company does not have the same quality control standards as Welch Allyn, so it is possible for them to sell and ship a set with a suboptimal component.  Nonetheless, they have a full lifetime warranty on all of their products, so any piece will be replaced free of charge with free return shipping at any point during your use of the instrument.  For the $400 difference between this and the Welch Allyn version, some find this compensated downside to be more than tolerable.

 

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Compare Welch Allyn Series: Building a Full Diagnostic Set

This is the sixth and final part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic set (otoscope and ophthalmoscope).


By now, you should have reviewed the other five articles in the series, and noted your preferences:
Compare Welch Allyn Series: How to Pick the Best Battery and Handle
Compare Welch Allyn Series: How to Pick the Best Case
Compare Welch Allyn Series: How to Pick the Best Light Source
Compare Welch Allyn Series: How to Pick the Best Otoscope
Compare Welch Allyn Series: How to Pick the Best Ophthalmoscope


Trade-offs of Pricing and Usage

It is important to remember that many medical schools only require use of personal diagnostic sets while learning how to perform a physical exam during preclinical years. Many rotations will either not require use of these instruments, or provide them to medical students and staff if needed. You should contact senior medical students at your school to ascertain the usage of these instruments when considering the price. For minimal use, you may want to consider purchasing from another manufacturer entirely. It is also a common mistake for incoming med students to assume these instruments will be used after med school. Specialties that use these instruments have more expensive versions or wall mounted models, and many specialties won’t need them at all.


Selecting Your Model

Most retailers do not carry all diagnostic kit combinations of the above Welch Allyn components. Most local companies will carry about 4 of the 75 total diagnostic kits manufactured by Welch Allyn, and that is actually sufficient for the large majority of med students. It is not uncommon for retailers to highlight the more expensive components, such as the PanOptic ophthalmoscope, and to list all other options by their model number. This can be a rather confusing selection process, which can be remedied below.

The following application is designed to assist in putting it all together and selecting the Welch Allyn diagnostic kit that is best suited for your needs and desires based on the results of the above articles. You may input your selections and the application will output the specific model number for your use with retailers. It will also output a list of the closest matches to your selection, in case your first choice is not carried by your retailer.


Please click one of the following from each category:

Relative Price $
$$
$$$
Case
Handle
Otoscope
Ophthalmoscope

Recommended Diagnostic Kit Model Number:

 

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Compare Welch Allyn Series: How to Pick the Best Otoscope

This is the fourth part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic kit (otoscope and ophthalmoscope). The focus of this discussion is on Welch Allyn diagnostic kit otoscope heads.

Unlike prior posts in this series that assist medical students in deciding on which type of products to purchase, this one will focus more on the variability normally encountered by medical students when they first hit the clinic.  Most retailers offer only one option for otoscopes in their diagnostic kit even though Welch Allyn manufactures two varieties, so purchasing decisions are not really an issue.  However med students still need to know how to use all the historically popular versions and accessories, and what to avoid if buying an older model.  As with ophthalmoscope heads, all of the below otoscopes are the 3.5 volt version, which refers to the standard power handles, and are in contrast to miniature “pocket sized” versions of these instruments.


Welch Allyn Compare Series: Pneumatic Otoscope

Pneumatic Otoscope

First, let’s review the older pneumatic otoscopes, seen right. The thing to take away from the discussion of this type of scope is that you should not buy one.  The general concept is the same as all the other otoscopes, without the shiny distracting bells and whistles you’ll never use.  However the big difference between this and the next Welch Allyn otoscope type is the tip.  Notice how the base of the tip is rather wide?  It is essentially the diameter of the barrel of the scope itself.  There is no inherent problem with such tips, as they work perfectly well if you can actually find them, but the chances of coming across one in hospitals and clinics is rather low unless that clinic is specifically using this type of otoscope.  So, if you happen to come across one in clinic, you now know to shove the wide-base tip into the wide barrel of the otoscope.  However you are also aware that buying one of these most likely comes with providing your own lifetime supply of tips.


Welch Allyn Compare Series: Diagnostic Otoscope

Standard Otoscope

Next, let’s look at one of the latest Welch Allyn models to become obsolete for absolutely no reason: the standard diagnostic otoscope. This is the model you are most likely to come across in clinics and hospitals, because they are generally a solid and reliable means of assessing ears. You will also come across other otoscope makers that produce similar looking scopes (to be reviewed in future posts).  If you do want to save money by buying an older used diagnostic kit, this is the otoscope head to get.

Unlike the previous otoscope, this model and the following one both use standard otoscope tips, but through different means.  The covered end of the scope (under the black plastic tip) is conical metal, and has a groove cut into the top of it that helps lock in a bump of plastic on the inside of the tip.  The common mistake med students make is just shoving the tip on without lining up bump with groove, which means the tip doesn’t actually make a secure connection with the otoscope and readily falls off during the examination. While it is especially hilarious to observe medical students accidentally detach the tip and find it dangling out of the patient’s ear (sometimes without their knowledge), this is generally a newbie move to avoid. You should be able to give a slight tug on the tip to ensure it is secure.

Welch Allyn Compare Series: Insufflator BulbThe other difference to note between this and its predecessor is the input for the insufflator bulb, which is an accessory used to push air into the ear and gauge movement of the tympanic membrane.  You may never use an insufflator bulb throughout med school, and should not buy one. Pediatric offices that require their use will supply them. Nonetheless, Welch Allyn decided to change up the industry standard of having a tube attach onto an external plug (female port) to an extra piece of plastic that gets plugged into a hole in the side of the scope (male port). You can see the additional end piece in the image on the right. I’m sure they saw a minor rise in sales because of that change, but medical students should not purchase this accessory.


Welch Allyn Compare Series: Macroview Otoscope

Macroview Otoscope

Lastly, we come to the unnecessary but unavoidable up-sell, the Welch Allyn Macroview Otoscope. Despite decades of doctors being able to visualize the ear canal perfectly well with standard otoscopes, Welch Allyn claims “this instrument is a significant advance in hand-held otoscopy…”

Their key selling points are that this otoscope doubles the field of view and increases magnification by 30% compared to other models. The former may be helpful, but otherwise you can simply move the scope if you want to view the tympanic membrane periphery.  That’s how doctors have done it for decades.  The increased magnification simply isn’t noticeable.  Remember back when you last used a microscope?  The lowest setting was the 10X lens, followed by the 40X lens.  That’s 400% greater magnification.  This offers a 30% increase, which would be like moving up to a 13X lens on your microscope.  In the world of light otoscopy, it sounds like a big improvement, but this really isn’t doing much. This also comes with “the ability to adjust focus for variable ear canal length or farsighted eyes,” which is yet another issue doctors have never really had a big problem with historically.

Welch Allyn Compare Series: Standard Otoscope TipThe macroview otoscope also uses standard tips, but instead of holding onto them by a groove internal to the tip, they actually secure the tip externally.  Ridges found near the tip base actually twist under the end of the otoscope head.  This is actually a nice improvement, as it does a better job of securing the tips.  Of note, you most likely should not need to purchase otoscope tips yourself, as clinics provide them.  Be sure to always grab 10 or so extra for your case, just in case you run into a clinic which is not so courteous.

Another key difference in the Welch Allyn Macroview Otoscope is that its lens cannot be rotated or slid aside for direct access to the ear with a curette through the barrel of the otoscope. This is often used to remove ear wax under direct visualization.  However, most attendings will not want medical students to be performing manual cerumen disimpaction, as there have been rare case reports of bones in the ear accidentally being removed during this process.  Remember: never manually disimpact unless you can directly visualize some portion of the tympanic membrane!

Despite this article poking holes in the advertising of Welch Allyn, this is overall a great otoscope to have.  It is reliable, sturdy, and a great tool to visualize the ear canal, which are all excellent qualities as it is most likely your only diagnostic kit option. Unlike differing ophthalmoscope designs that require different learning and skill sets to actually use, there is no difference in the physical use of any of the above otoscopes.  That essentially means you can purchase and learn on the Welch Allyn Macroview Otoscope, and still know how to use any standard wall-mounted otoscope in an office or emergency department setting.


In summary, the direct comparison is as follows:

Approx.
Price *
Type
of Tip
Curette
Opening
Available
in New Kit
Pneumatic Otoscope
$150 Large Base yes special order only
Standard Otoscope
$110 Standard yes no
Macroview Otoscope
$225 Standard no yes
* prices are for the otoscope heads only. handles are sold separately.

Prices are higher if you purchase components separately, so try to buy a value meal (a complete diagnostic kit sold as a single unit) unless you can find a really great deal.  With that being said, the above three scopes were added to the price-check plugin as a reference.

 

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