EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Category Archives: Journalism

Teaching & Learning in Medicine, Research Methodology, Biostatistics: Show Me the Evidence (Part 4): Causality, Airplanes and GIDEON

As accident re-enactments go, this one is pretty Riveting

Links courtesy of NJ.com and Exosphere3D – All rights reserved – Copyright 2011


The focus and calm of U.S. Airways Captain Chesley Sullenberger can be appreciated by listening to the audio portion of this re-enactment, as he made critical analyses – over a period of only a few minutes – on how (and where) to land a disabled aircraft sinking earthward over a densely populated area. His decisions saved 100% of the lives on board that day.

Hang out with a bunch of epidemiologists long enough and eventually the conversation while turn to Causality. They will tell you that there are some big differences in semantics between linking causation, etiology and “proof” that X exposure caused Z disease or health condition. When I looked up the terms “causation” and “causality” (on Google) there were major sidetracks, such as WBA (Why-Because-Analysis) as in, Why did the airplane crash? Why did the reactor experience a meltdown?

Why? From the viewpoint of a physician, an engineer or an epidemiologist… because of X-Y-Z.  

X-Y-Z could be bird strikes, human error, engine failure, weather conditions, crazed people bearing guns, lack of fuel or a thousand other accidents waiting to happen. Often the causes can be identified. Sometimes one can only attribute unanticipated events to gauzy, fuzzy concepts such as “it was a one in a million chance” or “this was God’s will”,  “causes unknown” or just plain Karma. The harder (non-fuzzy) data can be applied towards improvements in systems design, development of new vaccines, engineering safety… all targeted towards avoidance of future accidents (or disease outbreaks).


Epidemiologists save lives.  Sometimes this association accumulates slowly… as in proving associations between Exposure X and development of Disease Y decades later.  In other cases, evidence mounts up as an emergency, such as the identification of a novel virus identified as SARS in 2002.  But linking health effects of exposures over a human life-span is so much more elusive than showing evidence that birds got sucked into a jet engine at 2,500 feet (as above).

Turning to the PubMed database, a screenshot below from Medical Subject Headings List (MeSH) reveals how the term “causation” is mapped in the online thesaurus of medical indexing terms:

Image Source: NLM (http://www.ncbi.nlm.nih.gov/mesh) – All rights reserved – copyright 2011

One way to search a large database such as PubMed is to simply type in some words – for an example, Liver Cancer AND Epidemiology.  This pulls up over 18,000 retrievals…  too many (!), but by then selecting and applying standard Limit Fields such as Language, Journal Subset, Age Group, Gender and others, the retrievals can be filtered down to a more-manageable number.

A more precise way to search a large database like PubMed is to use the Medical Subject Headings list. In the example below, the term Liver Cancer was typed into the MeSH search page, which maps automatically to the preferred MeSH term — Liver Neoplasms. While this search still retrieves thousands of citation, they can be limited by selecting and applying any MeSH Subheading (or clinical qualifiers) that are appropriate to the search. These subheadings include clinical concepts such as Virology, Immunology, Genetics, Epidemiology, Transmission and 80 others.  Following is a screenshot of that type of search:

Image Source: NLM (http://www.ncbi.nlm.nih.gov/mesh) – All rights reserved – copyright 2011

Remember that a librarian’s idea of “causality” could be defined, in part, by the number or types of clinical subqualifiers selected (immunology, virology, epidemiology and those types of “background” concepts) to be combined with the formal MeSH term.

There are many ways to search. It helps a novice medical searcher sometimes to tell them just that: There is no one right way to search. Sounds enigmatic and it is.

Here is an example which I found recently in the medical literature, a 2010 article which discusses application of Bradford Hill criteria (listed here):

  • strength of association
  • consistency
  • specificity
  • temporality
  • biological gradient (dose-response)
  • biological plausibility
  • biological coherence
  • experimental evidence and
  • analogy

 Image: http://www.ncbi.nlm.nih.gov/pubmed/20644061 – All rights reserved – Copyright 2011


Those searching for practical answers about causality, transmissible agents, disease etiology, global prevalence or current treatments might want to search GIDEON (Global Infectious Disease Epidemiology Online Network), an interesting “niche” information source targeting the research requirements of epidemiologists, clinical & translational researchers, MPH students, toxicologists or anyone interested in tracking or diagnosing infectious diseases on a country- or world-wide scale (subscription required). Updated weekly, the database is produced by Gideon Informatics and hosted on the EBSCO platform.

A search for causality or epidemiology done in the resources indexed by GIDEON is quite unlike a search done in PubMed about the etiology of Liver Cancer. The producers collect, review and index factual data collected from around the globe; their data encompasses a wide and diverse group of human cultures, agricultural, societal, economic or environmental practices.

Below is a screenshot of one example of the type of data that can be searched on GIDEON: bacterium (causative agent), typhoid (identifiable infectious agent) and United States (location, recorded incidence over time):

.Finally, a screenshot of What’s New at GIDEON (May 11 2011):

Image Source: GIDEON – All rights reserved – copyright 2011

News, Libraries, Librarianship: Medlib’s Round Carnival Edition 2.5!

This is the June 2010 edition of Medlib’s Round Carnival.

This collection of links have been submitted by a (worldwide) group of dedicated bloggers… veteran medical librarians along with a new health science librarian, physicians and scientists contributing to the mix!

The broad  topic of this Carnival is about service. Librarians talk a lot among themselves about providing quality information services and library collections for their core users.   We are great believers in training our library visitors to recognize quality information sources, showing them what to search,  how to search and how to appraise those sources effectively; we also spend considerable time, effort and money to create digital or physical library collections that meet the information needs of our users.  Doing these things well is (actually) more difficult than it appears…  not as difficult as climbing the summit of Mount Everest but definitely made more challenging in an era of rapidly rising costs, disappearing personnel and shrinking budgets.

So without further ado, here is the Medlib’s Round Blog Carnival 2.5.

Jacqueline, blogger at Laika‘s MedLibLog recently wrote:  “It is so important that you know the pros and cons of databases and that you think before you even start searching“. Read her evidence-based discussion here:  “PubMed versus Google Scholar for Retrieving Evidence” (Jun 6 2010).

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Medical Library Association holds an annual conference, which this year was held May 21-26 in Washington, DCKrafty Librarian blogger Michelle Kraft was a conference speaker and official blogger at MLA.  She wrote MLA ’10 Week in Review, an excellent summary and set of links to presentations and other conference activities on her blog – especially valuable to those of us who weren’t able to attend the meeting.

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As a library student, you don’t get many chances to really dig your teeth into searching databases, unless you’re working on a thesis or have a really extraordinary work opportunity. Basic reference as a student usually involves basic searches for patrons, maybe some instruction, more than a little help given to new or remedial library users. This is why my experience with a systematic search team will be so memorable as a learning experience as I begin to launch my career as a health librarian. “

So wrote recent MLS graduate, Daniel Hooker, who blogs about Health Libraries, Medicine and the Web in a recent post about performing his First Systematic Search using the OvidSP search platform.  Check out the vintage librarian cartoon – what a laugh!

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Psychiatrist Walter van den Broek, who blogs at Dr. Shock, wrote an interesting post for the Carnival entitled “What’s Wrong with the Disclosure of Conflicts of Interest?” (Jun 6 2010).

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Relying on donations, librarian-volunteers collect and ship medical textbooks to American military personnel stationed in war zones throughout the world.  Their service mission is described on the blog Operation Medical Libraries:

” The mission of Operation Medical Libraries is to collect and distribute current medical textbooks and journals to war-torn countries through a partnership with American medical schools, hospitals, and physicians and the United States military… and

to foster the creation of permanent medical libraries and support the expansion of existing collections in conflict regions where health care education and the practice of medicine are suffering “.

Text Source: http://operationmedicallibraries.blogspot.com/ – All rights reserved – Copyright 2010

This post on the OML blog is about books sent to Afghanistan in 2009 and the photo below shows a happy library user in that facility:

Photo source: http://operationmedicallibraries.blogspot.com/2009/05/oml-library-in-bagram-af-provides.html – All rights reserved – copyright 2010

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Patients or family members are a common sight in the medical library, seeking current, credible medical information, or advice on where to find those patient education materials.  Technologist-librarian PF Anderson contributes two items to this Carnival on those topics:

Video Source: http://www.youtube.com – All rights reserved – Copyright 2010

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  • BitesizeBio, a blog written by and for lab biologists, offers practical advice on giving, receiving, qualifying and implementing advice in the Apr 26 2010 post, “The Art of Giving of Advice“.

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And that’s Medlib’s Round Blog Carnival Edition 2.5, folks!  Hope you enjoyed reading it. To all those who sent in submissions, I am grateful and send you heartfelt thanks!

The next edition of MedLib’s Round (July 2010) will be hosted at Laika‘s MedLibLog.

If you have material to submit for that edition, please use this form.  To subscribe to an RSS feed for Medlib’s Round, click here here.

News, Medicine, Librarians, Blogosphere: Participate in Medlib’s Blog Carnival – June 2010

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010

Big News!

EBM and Clinical Support Librarians@UCHC has been invited to host Medlib’s Round Blog Carnival for the month of  June 2010. How does this work?  Here is an excerpt from the Blog Carnival FAQ page:

Welcome to the Blog Carnival page! We love the idea of blog carnivals where someone takes the time to find really good blog posts on a given topic, and then puts all those posts together in a blog post called a “carnival”… Carnivals are an edited (and usually annotated) collection of links that lets them serve as “magazines” within the blogosphere…

Since blog carnivals include lots of posts on specific topics, they also serve as a place to connect with those who are expert (or at least highly opinionated!) and those who are interested in that field. Blog Carnival simplifies carnivals for two kinds of people:  People who read and contribute to blog carnivals, and  people who organize and publish blog carnivals.


What is the subject for Medlib’s Round Blog Carnival?

As a reference and public services librarian, over the years I have assembled a group of classic questions or library patrons in my mind that could be summarized as:  Questions (or People) I’ll Always Remember at the Health Science Library“.

This intent of this collaboration is learn more about the unique experiences of others librarians worldwide, or from those who work with health science librarians to teach, train and find medical information.  

Who should submit to the Medlib’s Round?

Bloggers from around the world

Medical/reference  librarians, folks who blog about clinical reasoning, evidence-based medicine, teaching and learning medicine (or practicing medicine).  I would appreciate hearing from physician- or scientist-bloggers who collaborate with health science librarians, medical students and others as they use digital library collections.

What should I write about?

Funny, sad, poignant, teachable moments (or people) encountered in your health science library.

  • Librarians: Please share some positive “memorable” encounters that took place in a public service/reference desk setting, over your career.
  • Clinicians, researchers,  pharmacists, graduate students, nurses: If your clinical or educational work as a scientist or care-provider has been positively enhanced by working with a librarian or librarian-instructors in health science library settings, please share your stories with us.

Is there a deadline to submit an entry?

Yes – please write your article, post it to your blog and send it to BlogCarnival.com no later than Tuesday, June 8th.

OK – I have an article to share.  Now what do I do?

First, go this link at BlogCarnival.com and paste the URL of your blog post using their online form.  You’ll need to also type in your name and email address.  (See screenshot below).  BlogCarnival will manage it from there.

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010



Questions – I have Questions. Who do I ask? Send an email message to ebmblog@gmail.com.  Thanks in advance!

News, Healthy Communities: This is Public Health

Today – April 7 – is World Health Day

in addition to

National Public Health Week 2010

Image credit:  http://www.nphw.org/nphw10/home1.htm – All rights reserved – Copyright 2010

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First, two items about international community health projects:

The Comprehensive Rural Health Project (CRHP) has been working among the rural poor and marginalized [in rural Jamkhed, India] for over 37 years. By partnering with village communities and expanding upon local knowledge and resources, the project aims to effectively meet the immediate and long-term needs of these groups, especially women. With values of compassion, justice, respect and trust, CRHP works to empower people, families and communities, regardless of caste, race or religion, through integrated efforts in health and development. ”

Text Excerpt from http://www.jamkhed.org – All rights reserved – Copyright 2010

These videos (filmed in 2007) briefly describe two of the CRHP projects:


Video credit: http://www.youtube.com – All rights reserved – Copyright 2010


The CRHP in Jamkhed operates a 40-bed low-cost secondary care hospital providing quality emergency, medical, surgical, and outpatient care for the 1.5 million people residing in the surrounding 8 block catchment area. Each year about 20,000 outpatients receive treatment, 250 deliveries take place (high-risk referrals), and 400 surgical procedures are performed. Most deliveries take place in the village and because we provide extensive training for VHWs (village health workers) and birth attendants these deliveries are very safe. “

Text Excerpt from http://www.jamkhed.org – All rights reserved – Copyright 2010


Video credit: http://www.youtube.com – All rights reserved – Copyright 2010


Next:  A novel community mental health outreach program.

Data collected by staff at the U.S. Department of Veterans Affairs (VA) agency show that approximately 20% of American veterans returning from Iraq or Afghanistan are diagnosed with mental health disorders.

Dr. Karen H. Seal was lead author on a recent research study published in the Journal of Traumatic Stress (Vol. 23-1  Feb 2010) which examined how former combat veterans are being diagnosed and treated for mental health disorders within the Veteran Affairs health system including post traumatic stress disorder (for years 2002 through 2008).

The authors’ conclusions?  Only about 30% of the population studied received the recommended treatments for PTSD through the VA healthcare system.

Janie Lorber wrote an article in The New York Times (Apr 2 2010) entitled “For the Battle-Scarred, Comfort at Leash’s End”  which describes the mission and work of a non-profit foundation called Puppies Behind Bars (PBB) that selects and trains volunteer prisoners to provide 24×7 care and training for puppies chosen to become companion-service animals for disabled veterans whose mental or physical disabilities have prevented them from easing back into the practical daily challenges of civilian life.

View this video link from the New York Times website for interviews with prisoners who are now actively caring for and training service puppies. 

PBB has established canine training programs for inmates housed in six prisons in New York, New Jersey or Connecticut;  there are currently 90 animals in the program.  PBB also trains dogs to serve a very different aspect of public health and safety: detection of explosive devices.

This therapeutic community effort extends benefits to both disabled veterans and the groups of incarcerated men and women training the dogs.  The dogs look like they are enjoying themselves too.

Photo credit: http://www.newyorktimes.com – All rights reserved – Copyright 2010


Finally: Here’s a link and calendar to special events at UConn this week that celebrate National Public Health Week 2010.

News, Medical Education, Med Schools in the Making and Doctors Day

Today, March 30th, is National Doctors’ Day 2010*!

Photo Source/Credit:  http://www.doctorsday.org/ – All rights reserved – Copyright 2010

( Link here for a short explanation of the Tradition of the White Coat )

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Found on American Medical News this Monday, a feature article describing plans in process for establishing 13 new allopathic schools of medicine in the U.S. (with nine in the preliminary planning stages).

(Link to a graphic from the AMedNews site showing their geographic locations.)

Locally, Quinnipiac University (Hamden, CT) announced their intention in January 2010 to seek accreditation to open a new medical college.  The school plans to begin admitting students in academic year 2014.

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A developing medical school in the United States or Canada must complete five steps to become fully accredited by the Liaison Committee on Medical Education (LCME)…. Each step has its own requirements, and a school may not recruit applicants or accept student applications before reaching Step Three. ”

Excerpt from New School Process Overview, found on the website for Liaison Committee on Medical Education, a division of AAMC

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LCME and U.S. Department of Education are the organizational agencies governing curriculum and educational standards that 117 U.S. and 17 Canadian allopathic medical schools must conform to.

Alternatively, osteopathic medical education is governed by U.S. Department of Education and the Commission on Osteopathic College Accreditation (COCA), an agency of the American Osteopathic Association.  Twenty-six colleges in the U.S. are accredited to grant Doctor of Osteopathic Medicine (DO) degrees; five new schools opened in the U.S. in the past several years.  

Click here to see a map of colleges of Osteopathic Medicine in the U.S.

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Finally: Published on Feb 15 2010, a reporter from the New York Times interviewed medical students who have chosen to attend some of the “newest” schools of medicine.  Read the article at this link..

* See also #doctors day on Twitter.

News, Health Care, Public Health, Statistics, Demographics: A Healthcare Bill and County Health Rankings

An important change in the health of current and future generations of Americans is shaping up today – March 23 2010 – as President Barack Obama signed into law the H.R. Bill #4872Health Care and Education Affordability Reconciliation 4 Act of 2010“.

A copy of the 153-page PDF version of the bill as written 3-18-2010 can be viewed here; note that this copy is only a working version.  There will likely be modifications made by legislators to the Act in the coming days and weeks. 

Link here to view a 3-page PDF document outlining the details of the “Patient Protection and Affordable Care Act“.  Many of the benefits described in this document will become effective in calendar year 2010.

Rivers of bandwidth and digital ink have been used up over this piece of legislation.  My (non-0fficial and personal) view of the events of this day is that it will be seen as a landmark day for future generations, very much like the passage of the Civil Rights Act of 1964 or the 1973 Supreme Court decision for Roe-v-Wade.  But as this isn’t a political blog, let’s move on to the topic of statistical resources about the health of Americans.


Recently mentioned on Twitter* was County Health Rankings which offers up a valuable collection of current statistical data on the health of Americans or their access to health care, organized at a county-level by state.  This is exactly the type of local, microcosmic health measurement/outcome data that our MPH students and faculty often ask for.  Nice.

Following is an excerpt from their About page:

This web site provides access to 50 state reports, ranking each county within the 50 states according to its health outcomes and the multiple health factors that determine a county’s health.  Each county receives a summary rank for its health outcomes and health factors and also for the four different types of health  factors: health behaviors, clinical care, social and economic factors, and the physical environment. Each county can also [be]  drilled down to see specific data (as well as state bench-marks) for the measures upon which the rankings are based. “

Text Source: http://www.countyhealthrankings.org/about-project – All rights reserved – Copyright 2010

County Health Rankings is a joint project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.


Today, starting from the main page (shown below), I clicked on the state of Pennsylvania:

Image Source: http://www.countyhealthrankings.org/ – All rights reserved – Copyright 2010

Then I used the pull-down menu to select a county in the state:  Philadelphia County (PA).  The “snapshot” of ranked data for this highly urbanized county in the south-east corner of Pennsylvania is displayed below; the numbers do not reflect favorably for the health of those residents:

Image Source: http://www.countyhealthrankings.org/ – All rights reserved – Copyright 2010

According to the health indicators ranked by County Health Rankings, Philadelphia County holds the (undesirable) distinction of the lowest score (or 67th) for the criteria measured – including “Health Factors” and “Health Behaviors”.

The data assembled on the site is not an exhaustive list of health behaviors or exposures – such as you would find on the NCHS site – but the data collected (incidence of Premature Death, Smoking Habits, Infections with Chlamydia, Births to Adolescents, Infant Mortality, etc.) serve as an approximate measure of the overall health and evidence of access to health care for that local population.


Current statistical or demographic data as provided by County Health Rankings complements information previously made available from non-profit American foundations or organizations.

Below are only a few of the available websites that are open-access and searchable for health-related outcome measures in US populations.  If you have other great sites, please send a comment!

Image Source: http://www.statehealthfacts.org/ – All rights reserved – Copyright 2010
  • Staff from the Agency for Healthcare Research and Quality manages HCUP-NET (Healthcare Cost & Utilization Project), described as “ a free, on-line query system based on data from HCUP [which]… provides access to health statistics and information on hospital inpatient and emergency department utilization“. This page has been invaluable for answering those in-depth reference questions about hospital administration and/or patient statistics.


Finally: Here is a link to a post I wrote in November 2009 which includes other related links to healthcare data or statistics about Americans such as Healthcare Rankings.

* And I thank the person who mentioned it on Twitter because I don’t know who did.

Academic Medicine, Teaching & Learning in Medicine: Announcing a New Series called Learning Medicine

It’s looking more like spring each morning in the Northeast, after a nasty late winter. There are daffodils poking out of the ground. The days are growing longer. This morning I saw a green bagel in the cafeteria because tomorrow is St. Patrick’s Day*.

This makes it a good time to try something new on the blog. Today marks the first post in a series which I have titled Learning Medicine: Ten Questions.

The series is intended as an open dialog between current and former medical students, educators, clinical researchers, PBL facilitators, librarians (and anyone else I can rope into answering 10+ questions!). The content or questions in the interview may vary, depending on the background and professional experience of the interviewee.

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Today, please welcome esteemed veteran blogger and physician Graham Walker!

A Background Question – Who Are You?

Graham Walker describes himself in this way:

I’m a second-year Emergency Medicine resident at St. Luke’s-Roosevelt Hospital System in New York City. I was originally a medical school blogger (at the now-defunct Over  My Med Body! ) blog. Recently I’ve returned to blogging as a contributor to The Central Line, the official blog of the American College of Emergency Physicians.

My interests include: surviving residency, technology and web design, simulation medicine, informatics, health policy and caffeine highs.  I’m originally from Kansas, went to undergrad at Northwestern in Chicago, studying social policy/health policy, then went to Stanford for med school with a concentration in Community Health.

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Making the transition from undergraduate/or pre-med to graduate medical student

Can you name 4 or 5 key things that (in retrospect) you wished you had known before you began your first day of medical school?

Oh boy. Hopefully I can still remember anything about being a premed!  Here goes:

1) Know how you study, and develop good study skills in undergrad. Medical school is tough — they say it is like trying to drink water out of a firehose — so make sure that you’ve got a system in place to organize information in your head and commit it to memory.

For some people that’s flashcards, for others it’s study groups; for me, I *still* find I have to write things down in a notebook to get them to stick.

2) Know how you relax, and don’t give up doing that. For some people, that’s going to the gym. For others, that’s playing the guitar. Or doing a hobby. Or keeping in touch with your family. Medical school (and residency even more-so) requires copious coping mechanisms so have yours ready.

3) Get by with a little help from your friends. Don’t be a gunner in medical school. You’re in — You get to be a doctor — Yay!  Med school will be much easier if you work together with your classmates rather than view them as competition — *especially* once clinics start.

4) It is normal to feel overwhelmed. Accept it and embrace it, and it won’t be so stressful. There are parts of it that you’re going to hate, that are not going to be intuitive. But it will get better!

5) Try to get yourself all figured out. Know yourself by the time medical school starts, because while you’re in the thick of things, it’s easier to have as many of your own internal issues worked out before trying to ascend Mt. Medical School. “

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Being a Person AND a Medical Student

Please tell us about some moments in medical school or clerkship that:

Made You Angry: I remember two instances that made me upset: one was the way some OB-Gyn residents were talking disrespectfully about a terminal cancer patient. (I actually kind of understand their perspective as a resident now, but still don’t agree with it.)

The other was a grossly abnormal physical finding in a patient that I found that a group of residents chose to ignore, because I was a medical student. As the medical student, you are — more than anyone — your patient’s advocate. Know when to speak up.”

Made you wish you had Studied More: “ The Boards. But you always wish you could memorize more. Do your best, and move on “.

Brought Tears to your Eyes:  “ I remember it like it was yesterday. It was on my medicine rotation, one of the first patients that I really felt was “mine.” My residents let me “be in charge” as much as I could, and I fought for him to get a much-needed foot amputation. I was off or post-call one day, and I remember coming back the next morning and finding out he had died.

I wrote up the experience: Wonderful, Just Wonderful, Dr. Walker at: http://www.grahamazon.com/over/2006/02/wonderful-just-wonderful-dr-walker/ “.

Made you Roll on the Floor Laughing:  “ Slap-happy post-call. I’m known for being a little hyper and a bit of a morning person, which usually drives people crazy. Also any shift in the Emergency Department “.

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Learning Medicine, Becoming a Doctor. Empathy, gravitas, demeanor, honesty

Part A:  How does one learn to “act like a physician”?   (It’s not really in a textbook.)

I certainly steal bits and pieces from different mentors and heroes of mine. A phrase from this attending, a style from that one. Tips and tricks along the way.

There’s no one way to “act like a physician,” and often it changes for the situation and the patient. I’m a different type of doctor when I’m seeing an infant compared to when I’m evaluating a trauma patient or interviewing a 95 year-old. Being able to adapt and change: maybe that’s the ticket. ”

One area the third-year medical students are concerned with is effective communications with patients and their families when managing someone with a terminal illness, in palliative care or especially when attending unexpected deaths due to accidents, homicide, military, etc.

Part B:  How does a physician learn to “deliver bad news” to a patient or their family members?

Get at or below the patient or loved one’s level. Empathize. Speak in private. Speak their language, if you can. (Learn as many languages as you can.) Make eye contact. Be direct, calm, and compassionate. Tell them however they’re feeling or reacting is normal and okay: everyone reacts differently.

Be present in the moment.  This is one of the hardest things for me to do now, and I have to remind myself of it, especially in a busy emergency department. Don’t worry about what’s happening to the rest of the team, or the other patients, or the rest of the department. Just be there, if only for a few minutes.   Apply the Golden Rule “.

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Congratulations – You are now a resident!  Choosing a specialty.

Match Day is Thursday, March 18, 2010. Can you describe the process that allowed you to select a medical specialty (Emergency Medicine) and why?

Man, it’s hard to remember, because my view of the specialty has changed so much as a resident. I remember really connecting with the type of attendings and residents who went into Emergency Medicine.  My type of people, I guess.

They say it’s much easier to rule out specialties than rule any in, and that’s very true. I was the type of medical student who enjoyed most of my clerkships, but in the end, I chose the one that I thought I’d enjoy, be challenged by, and excel at. ”

What advice would you give fourth-year students as they learn their Match and prepare for residency?

Get excited, relax, and get scared. Residency is not anything like a harder version of medical school, like I imagined it to be.  Enjoy your last few free months. Travel. Get married. Spend time with the people who are important to you.

Do. NOT. Study. And most of all: learn Spanish “.

Do you ever get enough sleep?

Yes, I do. My program is pretty resident-friendly in that regard, and I think it makes us all better, happier, more efficient, and more compassionate doctors. It’s hard to go the extra mile (which is what you realize you have to do as a resident) when you’re exhausted and cranky. ”

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Since this blog is written to inform readers about health science literature, trends in medical or scholarly communications, effective search strategies and sources, the next question focuses on your experience in learning to effectively use health science literature, sources for evidence-based practice or anything digital.

Have your information needs and/or searching behavior(s) changed between medical school and residency?  Are mobile computing resources and technologies important to you?

Definitely.  In medical school it’s all about learning about the basics, and the basics of how you treat X.

In residency, it’s much more about management, when to use what, finesse, and pattern recognition. I think it’s different for every specialty, too.

Regarding searching for clinical evidence, which sources, journals or databases have you found most-useful in answering clinical or patient care questions over time?

Great question. If I’m going to anything, it’s usually either UpToDate or E-Medicine or straight to actual papers, via Pubmed.

I really like JAMA’s Rational Clinical Examination series, as well as BestBets, The TRIP Database, Cochrane Reviews, and often just… Google.  I also keep a private little blog of things I’ve learned and journal articles I want to hold onto for future reference.”

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What aspect of medicine/science digital communication and/or particular use of the Web for medicine or patient care interests you the most? (This is a completely open-ended question.)

I love Podcasts, Videos, Image Banks and clinically-useful blogs. It’s a whole other style of learning that helps you learn more when you’re tired of reading journal articles, review articles, or textbooks. ”

~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~

Bonus Question: What question would you like to ask the readers? – or – What do you want medical students who read the EBM and Clinical Support Librarians@UCHC blog to learn from our interview?

I’d love to know how the students think medicine is going to change in their lifetime.

What do they think of the blurring of private/public life through [social media sites such as] Facebook?  Should we as doctors hide our private lives — that is, is it inappropriate for a patient to see a doctor, say, smoking or drinking on a site like Facebook?

~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~

And that’s the first interview for Learning Medicine: Ten Questions series.  Special thanks again to Graham Walker for sharing his time, expertise, advice and experiences.

~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~

Happy St. Patrick’s Day!

The Friday Post #44: Cephalopods, Coconuts, Cold Iguanas, Pinched

This is the first Friday Post #44 for 2010

Anyone who reads this blog might recall that I’m fond of cephalopods. Why? They’re smart (if not huggable), beautiful in their alien-marine type of way, their skin reflects their emotional states and there is still so much for humans to discover about their wily Octopus behaviors.  So, this Friday Post celebrates the Cephalopod class of Molluska.


Octopus Adopts a Significant Other (in this case, a coconut)

Video Credit/Source: http://www.youtube.com/user/museumvictoria – All rights reserved – Copyright 2010


and who knew Octopus could moon-walk?!

Video Credit/Source: http://youtube=http://www.youtube.com/watch?v=tteigkXaj6k – All rights reserved – Copyright 2010


An online library exhibit found on the Marine Biological Laboratory – Woods Hole Oceanographic Institute website features the exquisite anatomical illustrations of 19th Century German scientist, Rudolph Leuckart (1822-1890), who was considered the “Father of Parasitology” and a very influential zoologist in his era.

This virtual exhibit shows many of Dr. Leuckart’s beautiful, classic color illustrations; the chart below features a Cephalopod:


Image credit: http://www.mblwhoilibrary.org/exhibits/leuckart/wall_charts.html – All rights reserved – Copyright 2010


Watch where you walk

Although I have a number of relatives who live in Florida (where the license plates read “the Sunshine State“), none of them ever mentioned  kamikaze lizards, a species that has been severely affected by this week’s prolonged severe cold weather in the South. (News story from JustNews.com – WPLG Channel 10, Broward County, Florida). And these guys are big and green!

This could be the stuff of nightmares for some people.


Writings about this American Recession

In regards to money (or lack thereof), there is an interesting series of writings on Salon.com entitled Pinched.  A recent post by Ken Ilgunas (Dec 6 2009) relates his experience of living in a used 1994 van in order to afford to attend graduate school at Duke University.  He lives without running water, and with no certain address, but he is debt-free.  Worth reading, and especially for his discussion on the benefits and drawbacks of living simply.


That’s the Friday Post #44 for Jan 8 2010.

Enjoy your weekend!

The Friday Post #38: Strange Posts, Sleepy Chickens and Strange Sports

This is the Friday Post #38 for October 2 2009.

Strange?  Define Strange.

As a blog-administrator I get to filter all comments to the page before they are displayed publically.  The majority of the spam is deleted by myself or caught by Askimet, the utility in WordPress that takes care of that function.

On Tuesday, Sept 29 there was a link in my Comments section referring to a post I’d written earlier this week about LigerCat, a new PubMed search tool.  The in-coming link looked like this (screenshot shown below):



Image credit: http://www.wordpress.com – All rights reserved – Copyright 2009


Intrigued, I clicked on the address of the referring page and below is a screenshot of their synopsis of what I wrote:


PubMed Poke Apparatus grown in 2009?  Heaven help us all

Image credit: http://tiny.cc/I78dS – All rights reserved – Copyright 2009


Cartoonist Doug Savage writes a blog called Savage Chickens and invented the term “sleepworking” with this post from Aug 28 2008:


Photo credit: http://www.savagechickens.com/2008/08 – All rights reserved – Copyright 2009


These videos come with a couple of caveats: Don’t try this at home. Some activities could result in serious bodily injury. Never jump off a roof, no matter what your friends say to you.  In questionable taste.

Getting hit in the eye by a pair of flying sunglasses would be no laughing matter.  These videos should remind us that there is, and will always be, a need for a new generation of Emergency Medicine physicians due in part to the poor coordination (or questionable judgment) of young people when it comes to acting like daredevils on (or with) sports equipment.

However, the young men in question have obviously practiced their sports often, are well-trained in them, and (admit it) it is creepily fascinating to observe their accuracy.

.First:  Sunglasses Catching

Video credit: http://www.youtube.com/watch?v=-prfAENSh2k All rights reserved – Copyright 2009


Second:  Pants Jumping

Video credit: http://www.youtube.com/watch?v=pShf2VuAu_Q All rights reserved – Copyright 2009


Last:  Laptop Catching is so out of the scope of this blog, I’m not even going to post the URL for it.  You can find it on your own.


And that’s the Friday Post #38 for Oct 2 2009, folks.  Have a restful, enjoyable weekend!

News, Medical Students, Social Network Analysis: Digital Histories can’t be Deleted

The goals of this study were to describe reported incidents of medical students posting unprofessional content online at U.S. medical schools, describe current policies and views of medical school leaders regarding Web 2.0 use by medical students, and assess the relationship between unprofessional incidents and presence of policies.

Excerpt from an article published Sept 23/30, 2009 in JAMA (Vol. 302, No. 12: 1309-1315) written by Katherine Chretien, S. Ryan Greysen, Jean-Paul Chretien and Terry Kind


Medical Education is the theme of  this week’s issue of JAMA: Journal of the American Medical Association*.  Published in this issue is a seven-page article entitled “Online Posting of Unprofessional Behavior by Medical Students” written by four physicians affiliated with George Washington University and the Washington VA.

The questionnaire was sent out in March and April of 2009 to medical school deans or student affairs administrators at 130 allopathic schools of medicine accredited by the Association of American Medical Colleges.  The data was designed to be collected anonymously.  Staff from 78 medical schools chose to participate, with a return rate of 60%.

The questions in the survey focused on four principal areas: “School & respondent characteristics,  incidents of student-posted unprofessional online content, level of concern among student affairs deans or proxies and institutional policies and resources“.

About one-half of the deans or student affairs personnel who returned the survey reported that documented unprofessional behaviors by medical students were observed.

Following is a paragraph from the Commentary section of this article:

There are a number of actions that medical schools could take that might address some of the concerns raised by these findings. The formal professionalism curriculum should include a digital media component, which could include instruction on managing the “digital footprint,” such as electing privacy settings on social networking sites and performing periodic Web searches of oneself.  This is important given that residency program directors, future employers, and patients may access this information.

Excerpt from the above-referenced article published in JAMA (Vol. 302, No. 12: 1314).


The article will likely be read by many medical school administrators in the U.S. and abroad.  The literature is small but growing about what long-term effects one’s digital footprint (or captured misbehaviors) may have on a career in medicine. (As an example, two articles on this topic are linked here and here.) There were no social networking sites to capture a person’s online presence twenty years ago; the story is being told in the Now.

The JAMA article may serve as a wake-up call for those institutions of higher education who have yet to set up – or enforce existing – policies addressing online student profiles and conduct.

This week’s press coverage and subsequent discussions might also serve as a wake-up call to American medical students:   When is a good time to review your online profile? Answer: Quite likely, now.


Following are two related links.  First: click here for a collection of news stories or blog postings about this article, medical students and online behaviors compiled from Google.

Next: A different aspect of online identity and personal privacy issues was described by Carolyn Y. Johnson, who wrote an article published in The Boston Globe on Sept 20 2009.  Her report describes a 2007 research project conducted by two students at MIT enrolled in an ethics and law class.  Their software program, named Gaydar“, was used to import data from individual males’ Facebook pages, analyzing the relationships between stated  “interests”, “gender” and “groups of  friends” in order to make a statistical prediction about whether those men were gay.


.* JAMA is a subscription journal; if off-campus, use your proxy account number to connect in order to read full-text articles.