Smile. It's Infectious.

Hey y’all! This post is aimed at people who are making the transition from textbook-based science classes to article-based science classes. Scientific journal articles are dense compared to textbooks and aren’t written with the intent to teach basic concepts but rather with the intent to expand scientific knowledge. It can often be very confusing to figure out what is going on. Here’s how I was taught to read them 10+ years ago and how I still approach them today. 

(I) After reading the title, start for real with the Results section. 

Why would you do this when you know the abstract will give you a basic overview of the study and the introduction will set the context? Because you want to be an active reader. You want to figure out what happened in this study in a way that makes sense to you rather than be able to parrot what the author’s say happened. This is the major difference between reading a textbook (where you need to regurgitate the information later) and reading an article (where you need to be able to intelligently discuss the content either in class or in writing). 

Look at the tables and figures first. Can you tell what the independent variables were? What the dependent variables are? What might the relationship between them be? What trends or patterns do you see? Depending on your style, it may be a good idea to mark up your document with this information or jot some notes down somewhere else. 

Now read the text part of the results. What parts of the figures are the authors choosing to highlight in the text? Are there any results buried in the text that you can’t connect to part of a figure?   

Now pause and think. What is the most important result of the study? Highlight where this appears in the text and figures. Remember that important doesn’t necessarily mean statistically significant! A good p-value doesn’t signify real-world meaning; you need to make that connection yourself. Take a moment in this step to notice what results still don’t make sense to you– no need to panic or write questions down yet because you haven’t read the rest of the paper. 

(II) Get the gist of the Methods. 

Chances are your professor did not assign you this reading with the intent to make you replicate the study. You don’t have to understand every sentence (or even most sentences!) of the methods unless you’re an advanced graduate student. You do have to be able to explain in layman’s terms what the researchers did. 

Particularly important questions to answer that can be found in the text include: What were the independent variables? What were the dependent variables? What variables were controlled for, either statistically or through researcher manipulation? What statistical methods were used to look for an association?  In health research, we use the acronym PECOT to deconstruct method’s sections.  

P = population– who was being studied? 

E = exposure– what variable were the researchers trying to determine the impact of? This might be an intervention (ie., a smoking cessation video) or something outside researchers’ control (ie., at least 5 years of daily smoking). 

C = comparison– who is the population of interest going to be compared to? This may be a formal control group (ie., smokers who were shown a video on handwashing) or something outside researchers’ control (ie., former smokers of a similar demographic background who haven’t had a cigarette in 5 years). 

O = outcome– what were the researchers looking for? This is also known as the independent variable. 

T = time– how long were participants/subjects tracked and when were measurements taken? 

(III) Read the Introduction. 

Now that you have a very good idea about the design and results of the study, you’ll be better able to understand the introduction of the study. The basic goal of an introduction in any scientific paper is to explain why the study happened. The background may give you some helpful context, or it may be redundant at this point. I typically don’t spend much time on the introduction except for the end where the study purpose/research question and hypotheses are usually written. Mark these in the text! You should already have a good idea of the study’s purpose from the methods and results. Here’s some questions you should answer internally or in your notes at this point: 

Did the methods align with the purpose? 

Did the results support the hypothesis? 

What are the scientific implications of these results? 

(IV) Read whatever is at the end of the article: Discussion, Conclusion, Reflection, Limitations, Research Implications etc. 

It is very important that you save these sections for last because these sections are where researchers tell you what to think of the results. You need to be prepared to critically engage with their interpretation of the results by already having your own. That’s what the three questions above are about! Of course, the discussion was probably written by multiple advanced scientists and you are but a lowly student. That doesn’t mean you should accept their conclusions without seeing their logic. As you read the discussion, think about these questions: 

Do the researchers think the results support the hypothesis? 

How are the researchers interpreting the primary results? [Bonus: what other interpretations are there, and are they mentioned?]

What do the researchers think the scientific implications of these results are?

What limitations do the researchers acknowledge, and how could those limitations be impacting the results?

(V) Synthesize it. 

Try to boil down everything in the paper to just a few sentences that an 8th grader could understand. Whether you think through it internally or write it down is up to you. I usually print out my readings and write my synthesis on the blank back page using the following sentences starters: 

The researchers wanted to know whether… 

They found that… 

This means that… 

Taking the time to write the synthesis and any lingering questions you have can be really helpful if, like me, you do reading far in advance of class and need a quick refresher to glance at before class starts. It can also be helpful for paper writing or exam studying later. Consider revising your synthesis after you participate in the class discussion or hear your professor’s take on the article in lecture. Don’t rely on the abstract– that’s someone else’s synthesis, not yours.

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I hope this was helpful!! Don’t feel bad if this process is ridiculously time consuming. I have spent probably 3-4 hours on a 5-page study before. The goal of science writing is to be as concise as possible, which makes reading short articles more difficult than longer ones. I am a graduate student at a top American university, and I typically read 9-12 articles per week this deeply. If a professor assigns more than 4 research study articles per week for a regular course, make sure they explain what students are supposed to be getting out of each article so you can target your reading better. Chances are, you can skip some sections and focus on coming to class with clarifying questions rather than a firm understanding.

Happy reading!! 

“If I gave you a bowl of skittles and three of them were poison would you still eat them?”

“Are the other skittles human lives?”

“What?”

“Like. Is there a good chance. A really good chance. I would be saving someone from a war zone and probably their life if I ate a skittle?”

“Well sure. But the point-”

“I would eat the skittles.”

“Ok-well the point is-”

“I would GORGE myself on skittles. I would eat every single fucking skittle I could find. I would STUFF myself with skittles. And when I found the poison skittle and died I would make sure to leave behind a legacy of children and of friends who also ate skittle after skittle until there were no skittles to be eaten. And each person who found the poison skittle we would weep for. We would weep for their loss, for their sacrifice, and for the fact that they did not let themselves succumb to fear but made the world a better place by eating skittles.

Because your REAL question…the one you hid behind a shitty little inaccurate, insensitive, dehumanizing racist little candy metaphor is, IS MY LIFE MORE IMPORTANT THAN THOUSANDS UPON THOUSANDS OF MEN, WOMEN, AND TERRIFIED CHILDREN…

Full cardiac workup plus full PMH and PSH. Trop and 2hr trop negative. EKGs show NSR. Turns out they have an inherited disorder that predisposes them to develop blood clots. They take Coumadin, or rather they’re supposed to take it. The significant other rats then out and says the patient stopped taking it.

So naturally they get a CT scan and guess what? Go ahead. You’ll never guess.

The scan reveals a dissected aortic aneurysm. DISSECTED. AORTIC. ANEURYSM.

Oh. But it gets better. Name two things that don’t go well together. Here, I’ll help: dissected aortic aneurysm and Coumadin. Yeah. Bad. Not good. But remember, this patient stopped taking their Coumadin.

I know what you’re thinking: how is this patient living if their aorta dissected? A clot. This patient had a massive clot sitting at the dissected section of the aorta, preventing them from bleeding out.

And they wanted to go home and follow up with their cardiologist on Monday. To which I replied…

Six more to go

After 4 years of volunteering in the ICU of the local hospital for respiratory diseases I’ve finally started to really understand a lot of the diagnostic procedures and the meaning of their results.

So I’ve decided to share with you some of the materials I use to study the ICU Stuff:

ABG interpretation

https://abg.ninja/abg - The site gives you a results from ABG analysis and you have to make a reading of them, then it show you if you are correct or wrong and gives you a full description why. On this site there some other very nice medical quzzes as well - Glasgow coma scale, Cranial Nerves, Basic ECG etc.

Lung function tests

http://www.ums.ac.uk/umj080/080(2)084.pdf

http://www.ics.gencat.cat/3clics/guies/184/img/–americanfamilyphysician.pdf In these PDFs the basic aproach to spirometry is described, everything you need to know when you stumble across spirometry results.

Coagulation tests

http://thrombosiscanada.ca/wp-content/uploads/2013/08/Bloody_Easy_Coag_2013.pdf

http://www.pathology.vcu.edu/clinical/coag/Lab%20Hemostasis.pdf Very consise and well writen guidelines for coagulation tests interpretations.

Chest radiology

https://lane.stanford.edu/portals/cvicu/HCP_Respiratory-Pulmoanry_Tab_2/Chest_X-rays.pdf

http://www.southsudanmedicaljournal.com/assets/files/Journals/vol_1_iss_2_may_08/how%20to%20read%20a%20cxr.pdf Basic guidelines for reading a Chest X-ray

Echography - Ultrasound Imaging

http://www.sah.org.au/assets/files/PDFs/For%20Doctors/2011-crit-care-us-heart.pdf

http://www.cardioegypt.com/cardioeg/ACSCA2014-Presentations/002001.pdf

http://www.annalsofintensivecare.com/content/pdf/2110-5820-4-1.pdf

http://www.cardiovascularultrasound.com/content/pdf/1476-7120-12-25.pdf

Oh my goodness, I was literally JUST talking to one of my co-residents about how much I hate that piece of advice (or it’s counterpart “if your favorite place in the world is the OR, do surgery; if your favorite place in the hospital is the OR, do anesthesia.” Ummm my favorite place in the world is my bed.).

I could have been happy doing a lot of other things in medicine. I liked a lot of different specialities when I was in Med school, and honestly, I was better at a lot of it than I was at surgery! However, nothing excited me quite the way that surgery did, nothing made the hours go by quite as fast. Nothing made me quite as happy, though I could have had a satisfying career doing many things other than surgery.

What people mean when they say “if you could be happy doing anything else besides surgery, do something else” is that surgery is tough. It’s a long residency, and a brutal one, and depending on what subspecialty you do and where you work, it may not chill out that much as a junior attending. They aren’t wrong, it is tough. But tough doesn’t matter when you love what you do. Yeah my hours are long and both psychologically and physically exhausting, but I get to show up to work and operate on people (!!!).

What people mean when they say that phrase is that the culture of surgery is malignant. This may have been true in the past, but it really is changing. Some of the very best and most supportive teachers I have ever met have been surgeons. I have never been hit or had instruments thrown at me or been kicked out of an OR. The amount of patience I have been shown by my senior residents, chiefs, and attendings has been astounding. I have never been belittled by my superiors or peers or had opportunities taken away from me because I’m a woman. I can’t say that the culture is perfect in surgery yet, but the culture in medicine in general isn’t perfect either.

Other reasons people gave me to do anything else that made me happy? “You’re too nice to be a surgeon.” Well, I’m going to be one of the reasons that the ‘surgeons are assholes’ stereotype fades. “Surgery is hard for women.” Surgery is hard for everyone. The culture is changing. I have female mentors who successfully balance career and family, no reason I can’t have it all too. “Won’t your husband be mad?” No. I wouldn’t have married him if he couldn’t support me in my career. He’s a part of my world, not my whole world, you sexist turds.

the 10 unread books i bought last year, staring at me from my bookshelf:

Interview season is in full swing for the fourth year med students, and it was only but a few months ago that I was in your shoes.

Now that I’ve been on both sides, I want to share some topics I wished I had taken more seriously, and why I think you should, too when you’re creating your rank list. **EDIT: @agreekdoctor made an excellent point: ask these questions of several people, residents and program leadership, to check for any differences.

1. How many sites do residents train at? Very few programs these days have their residents stay at one hospital for the entirety of their training. Find out how far apart these sites are and what that means for your possible future commute, vehicle of choice, and gas budget.

2. How do meals work? As an intern, you’ll spend most of your year in the hospital. You are going to go home exhausted and make less than minimum wage for the hours your keep (this isn’t a joke, this is financial truth). So find out: is the hospital food edible? Do you get a cafeteria discount? How do interns and residents eat at work and off? Is it a meal plan or is a point system like back in college?

3. How do residents get prepped for the boards? Some programs make it a big priority to hold lectures or “boards prep crash courses” to insure that all their residents pass. Others throw the MKSAP books at you and tell you Godspeed.

4. Do the residents here hang out after work aka what do residents do for fun? This innocuous question (I’ve provided two phrasings) can tell you a LOT. This gives you a hint to some unspoken criteria that residencies might be considering: supportive, cohesive teammates versus isolated gunners, married residents versus single people, etc. This also tells you if people LIKE each other. AND tells you what the hell is there to do on your days off. 

5. What’s the policy on moonlighting? Moonlighting is the term for when a licensed resident works a few shifts for monetary compensation to bolster our meager salaries. Some programs forbid it, others are totally cool. If you know that you need to support a family, have massive student loans, or want to live in a city with a high cost of living, this will invariably become a consideration. You want to be able to have this choice.

6. Is there an education stipend? My program does not have a stipend. We were told “it was in the works.” This is VERY IMPORTANT. Without an education stipend, you will not get reimbursed for some very expensive shit like:

-Step 3 ($830 dollars)

-UWorld Qbank for Step 3 (from $100-300 depending on months)

-Licensure (+$1000)

-DEA license to write for controlled substances (+$1000)

-Expenses to go to required educational conferences (travel expenses, lodging, food, gas, cost to print the poster if you’re presenting)

-medical apps, new equipment, textbooks, study aids ($$$)

7. What electronic resources are made available to residents? This is the most polite way of asking “Do I have to pay out-of-pocket for Uptodate and Epocrates?” the top two websites and apps we use. Subscriptions to both cost money.

8. What things are provided free of charge by the program? Ask because that which is provided free at one program does not necessarily hold true at another. Extra tip: see if there’s money given to you for moving, because moving can be costly.

9. Have there been or will there be changes to program leadership? I used to think this was the stupidest question. And I now retract that opinion. This does matter to the continuity and management of the program. A bumpy, drama-filled transition in leadership leads to bad feelings that trickles down to the way attendings and other leaders of the program treat residents. The peds program at my hospital had really big changes in leadership and it’s resulted in really disorganized preparation for interview season, which has been incredibly painful for the applicants and the residents.

10. Do the senior residents who will be graduating feel ready to go into the world as practicing physicians? If all of them are terrified or apprehensive, YOU will certainly not be ready for the real world by the time you are in their shoes.

Today, it’s Marawi

ISIS just invaded the city of Marawi in Mindanao and they have put a hospital under hostage in the process. 

I do not know how long until the Philippine Army will be able to drive them out, and I do not know if the people escaping from Marawi will make it out alive.

but it’s not just adult actresses. anyone remember reading about the 2007 film where a 12-year-old dakota fanning played a girl who is raped onscreen by a 20-year-old male? the film was edited before release after huge outcry, but it premiered in its original form at fucking sundance.