Tag Archives: med students

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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National Residency Match Program Releases 2011 Match Statistics

The National Residency Match Program (NRMP) and Association of American Medical Colleges (AAMC) recently released the 2011 match statistics, which had not been previously updated since 2009. A copy of this latest version can be found here:
 

pdf icon2011 NRMP: Charting Outcomes in the Match
Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2011 Main Residency Match – 4th edition

 
Specific data included in the NRMP match statistics includes:

  • number of applicants and positions in the main residency match
  • match rates by preferred specialty
  • number of different specialties ranked
  • USMLE Step 1 scores broken down by specialty
  • USMLE Step 2 scores broken down by specialty
  • Research experiences, abstracts, and presentations
  • number of work experiences
  • number of volunteer experiences
  • AOA rates by specialty
  • fourth years coming from schools with high amounts of NIH funding
  • fourth years with graduate degrees
  • all of the above information broken down by individual specialties

This last item is particularly helpful, as breakdowns include graphs that illustrate the percentage of fourth years who matched with a given USMLE Step 1 score. While this is not a perfect indicator of matching chances into your given field, the document as a whole is a good framework from which decisions can be made.

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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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250 Biggest Mistakes 3rd Year Medical Students Make

Book Review: 250 Biggest Mistakes 3rd Year Medical Students Make And How to Avoid ThemMany will argue that the first mistake third year med students make is buying this book, while others will claim that it is an essential and invaluable survival guide. 250 Biggest Mistakes 3rd Year Medical Students Make and How to Avoid Them by Dessai and Katta is the semi-popular successor of the 101 Mistakes book.  As the title suggests, it reviews all of the big issues bound to cause trouble on the wards. But how helpful is it really?  The answer depends upon the direction and perspective from which the book is examined.

If an attending were to be pulled aside and asked to write a list of all the things that bring down 3rd year med student evaluations, it may very well produce this book.  Therefore, many reason that the opposite must be true: buying this book prevents students from making these 250 mistakes, thereby instantly increasing their grades.  That’s essentially the fear hidden in the title of this book: buy it or you won’t get good evals.

Looking at the same scenario from the medical student’s point of view produces different results.  If a fourth year medical student were asked to write a list of all the things they wish they knew for themselves coming into med school (one of the very goals of MedStudentBooks.com), only a small portion of this book would be reproduced.  The reason for this distinction is because the large majority of “mistakes” in this book are common sense items that the large majority of medical students either don’t make, or adapt to with effortless efficiency.

So why the discrepancy in appreciation of this book from readers?  For medical students who have worked in “the real world” or have been held to rigid professional standards previously, pieces of advice such as “show up on time” or “dress professionally” or “get your work done on time” come as an expectation. Others however need gentle reminders that there is a clear distinction in the environment between preclinical and clinical med school years.  The majority of medical students come directly from college, and may face an actual professional setting for the first time in their lives at third year.  This latter group comprises the students who would most benefit from the nuanced recommendations of 250 Mistakes.

The big picture consists of the following.  First, med students should be professional. Second, they should ascertain the characteristics on which they are evaluated by directly asking residents or attendings at the start of each rotation, and reevaluating methods based on feedback along the course of the rotation. It can be an intimidating process for someone unfamiliar with the culture of medicine, but such open communication is a common occurrence.  Most attendings at teaching hospitals are happy to help, and do not mind offering feedback. It should be noted however that this falls under a common rule of medicine: don’t ask the question if you don’t want to know the answer.  Feedback is only helpful if it is used, and being defensive about feedback is looked down upon.

If you can accomplish these goals of professionalism and open communication that seeks out feedback for improvement, there’s not much else this book has to offer.  If however you are new to the working world or want a few gentle pushes in the right direction, this can certainly help.  Despite it’s 200+ pages, it’s a rather fast read with big bullet points.  The book itself is relatively cheap (compare prices below), but it can usually be found at your local medical library, or borrowed from friends or student lounges.

 

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If You Must: Stedman’s Medical Dictionary

Stedman's Medical DictionaryAnother common mistake new medical students make is securing a medical dictionary. Usually these are used as incentives for signing up with one of the medical societies that want your money, but as a whole, they are not needed.  That’s not to say they are inaccurate or unhelpful, so much as outdated.  If you need to look up the definition of a specific medical term, chances are you will be effortlessly turning to Dr. Google or Wikipedia, instead of digging out a book from your shelf and using your mastery over alphabetical order and small print font.

With that being said, there is a small sub-population of people who will argue over which medical dictionary is the best out there. The fact is, they all get the job done to about the same degree and ease.  If you have to pick one because your medical book starter set wouldn’t be complete without it, I would say go with Stedman’s Medical Dictionary.  It’s the one that has been endorsed by the American Medical Association (AMA), and is one of their incentives for joining (as referenced above).  This not only means that you have the opportunity of obtaining it at no additional cost if you were to sign up with them anyway, but it also usually means that they are plentiful and freely given away by other med students who didn’t want it.

Again, it’s a common mistake to buy a medical dictionary.  They just aren’t needed.  But if you insist on getting one anyway, grab a copy of Stedman’s.

 

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Sites to See: The Eyes Have It

University of Michigan Kellogg Eye Center: The Eyes Have It
As a complement to the latest post on ophthalmoscopes, we are happy to share an excellent online resource for medical students to learn about ocular findings and signs that may pop up on physical exam: The Eyes Have It, from the University of Michigan’s Kellogg Eye Center.

The Eyes Have It is a site that provides a split instructional and quiz portion to both review and solidify ophthalmology knowledge. The information is straight forward, and creates a great overview for med students in the primary care settings, and a starting point for ophthalmology clerkships.

Papilledema and Retinal Artery Occlusion

For the first-year medical students, after you purchase your ophthalmoscope for the first time, take a good hard look in as many eyes as you can.  When something looks weird, this is the site to go to as your first step.  For the third year medical students, here’s a pimp tip that will make you look like a rock star: involvement of herpes zoster on the nose is known as Hutchinson sign, and is a good clue that the eye is involves in the outbreak as well.  Bonus points are given to anyone who can comment on the pathology of the above two images from The Eyes Have It.

Iris Collage

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Compare Welch Allyn Series: How to Pick the Best Ophthalmoscope

This is the fifth 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 ophthalmoscope heads.

This is the topic that will have the most options and provide the basis behind one of the larger price differences in your diagnostic kit. Ophthalmoscopes, as the name suggests, are instruments used to look at the eyes, specifically the retina. Some med students will get through all of medical school without learning how to actually perform an exam using their ophthalmoscope, let alone utilize many of the bells and whistles that come with it. As with otoscope heads, all of the below ophthalmoscopes 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. If you’re interested in the bottom-line short version, scroll to the bottom.


Welch Allyn Compare Series: Standard Ophthalmoscope

Standard Ophthalmoscope

We’ll start as usual by reviewing the baseline model, seen right.  This has the basics that any med student would want, and will allow for visualization of the retina.  It feels and looks just like any other ophthalmoscope you would see in clinic, which means learning on this will prepare you for whatever you may find along medical school, with three additional filters you will most likely never use.

Aside from being able to change the light size or dim the light, this ophthalmoscope allows the user to change the light into a slit beam, for easier visualization of objects on the surface of the eye, as well as the depth of the anterior chamber. It also comes with a fixation aperture, which basically turns the light into cross hairs in case you want to double your ophthalmoscope as a sniper rifle scope. The actual reason for this configuration is for relative measurement and assessing blind spots.  This feature is rarely used even by ophthalmologists, usually in the setting of hospital consultation when there are limited instruments. The final added feature is the red-free filter, which is a funny way of saying “green light” used to contrast structures in the back of the eye from the otherwise red background on which they reside.  Again, chances are you won’t use any of these, and they won’t be taught in med school physical exam classes.

Welch Allyn Compare Series: Ophthalmoscope Apertures, including big, small, micro, fixation, slit, and red-reducing aperturesThe key component that will be used and comes standard on these types of ophthalmoscopes are the focusing lenses, which allow the user to adjust for the physical size of the eye and focus on a crisp image at the back of the eye.  This will come up in subsequent models.

Overall, this is the model of choice for the average med student looking to purchase a quality instrument without the markup associated with unneeded features.  However, many retailers do not offer Welch Allyn diagnostic sets with this lower-priced option, even though such sets are manufactured.


Welch Allyn Compare Series: Coaxial and AutoStep Coaxial Ophthalmoscopes

Coaxial Ophthalmoscope

The next step up is the coaxial ophthalmoscope, which is commonly one of the two models offered by retailers as an ophthalmoscope option in a Welch Allan diagnostic kit. Like the Standard Ophthalmoscope above, it has the same number of focusing lenses, and includes all of the above apertures, plus the cobalt filter.  This is a blue light used in conjunction with fluorescein stain placed in the eye, which produces neon green or orange concentrations of the dye within scratches or irregularities on the surface of the eye. The idea is that it highlights lesions on a clear medium that are otherwise difficult to visualize. This is helpful in field work during emergencies, but will not be a needed skill to use as a medical student, or a necessary tool in the middle of an actual emergency room that has full slit lamps with this feature.

Welch Allyn Compare Series: Opthalmoscope Cobalt Blue Filter

Welch Allyn claims, in their usual fashion, that this upscale model provides less glare, superior visibility, and a larger field of view compared to the standard ophthalmoscope. While bad or broken ophthalmoscopes are indeed a detriment to an ophthalmoscopic exam, I doubt anyone would be able to practically tell the difference between the coaxial and standard Welch Allyn ophthalmoscope.

For completeness, I will also mention that Welch Allyn manufactures the AutoStep Coaxial Ophthalmoscope, which is the exact same instrument, but with additional focusing lenses for super-fine tuning.  This model is not offered in any Welch Allyn diagnostic kit, and would need to be purchased separately.  However, as you can imagine, these additional focusing lenses are not a significant improvement and in no way recommended for medical students (or anyone else).


Welch Allyn Compare Series: PanOptic Ophthalmoscope

PanOptic Ophthalmoscope

The final Welch Allyn Ophthalmoscope to review is the PanOptic Ophthalmoscope, also known as the bazookascope. As you can see from the image, this is in a different league as the other varieties, as its price tag will also prove. Like the above opthalmoscopes, the PanOptic also fits on any standard Welch Allyn 3.5 V power handle.

Welch Allyn states the advantages of this scope include a five-times greater view of the back of the eye, and 26% increased magnification. As mentioned in the otoscope review, an oddly specific 26% increase in magnification is unnoticeable. The PanOptic Ophthalmoscope does however provide a significantly larger view of the retina, with significantly less skill required to use the instrument compared to the learning curve of the above models.  Simply holding this up to a patient’s eye will produce nice results.  Less time spent figuring out how to use the instrument means more time dedicated to figuring out what you’re looking at.  This is an underestimated double edged sword.

As long as a PanOptic is used, better visualization will be acquired.  However the large majority of clinics and hospitals in this country do not have this expensive piece of equipment.  It is exceedingly common for a medical student who learned on a Welch Allyn PanOptic to subsequently have no technical ability to use a standard ophthalmoscope in a practical setting, placing them at a severe disadvantage without their own instrument.

One of the main reasons med students purchase a diagnostic kit is to learn the technique of using these instruments, more so than to use them throughout (or after) medical school. Most clinics will provide med students with wall mounted versions of the standard ophthalmoscope, making it unnecessary to haul around a personal set. Due to the shape, these are also bulkier items that weigh down white coats and do not sit well in soft cases. Given all of the above, as well as the price below, it is exceedingly common for med students to attempt to sell their PanOptic ophthalmoscopes, finding them unnecessary.  Nonetheless, some percentage of students will continue to purchase these instruments to ensure they have the best possible view of the back of the eye.  This is one that definitely has its trade-offs.


In summary, the direct comparison is as follows:

Approx.
Price *
Cobalt Filter Ease of Use Exposure
Standard Ophthalmoscope
$170 No Learning Curve 5 degrees
Coaxial Ophthalmoscope
$190 Standard Learning Curve 5 degrees
PanOptic Ophthalmoscope
$550 Optional Easy 25 degrees
* prices are for the ophthalmoscope 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.


Still can’t decide? Let us help! Check all that apply:

My med school requires infrequent usage of diagnostic kits.
Money is of no concern in the purchase of my instruments.
I have a habit of losing things easily.
I want to learn physical exam techniques using equipment that will best prepare me for practical clinical settings.
I want to learn physical exam findings using the absolute best equipment at my disposal.

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