Learning objectives in an average medicine training curriculum globally through the lens of a USMLE residency application

Standard letter of recommendation LOR template:

September 30th, 2020

Dear Program Director,

    I am pleased to write a letter of reference for Ms. _________ in her application for residency. I’ve had the pleasure of guiding Ms. _____ for the past four years. She completed two-month General Medicine rotations, every year, during her clinical years in medical school training, at PQRS Hospital, India. During that time, she was responsible for managing patients by taking patient history, conducting complete clinical examinations, calling in consults, reviewing lab reports, and monitoring patient care. Ms. _____ carried out these responsibilities with diligence and skill. She also attended various academic sessions and actively participated in daily rounds.

    I can strongly attest to Ms. ______ abilities as I’ve had the opportunity to oversee her in both the In-patient and Out-patient setting, taught her in class and worked with her during internship. She has gained experience in diagnosing and managing common medical conditions such as, Diabetes, Hypertension, Tuberculosis, Pneumonia, COPD, Stroke, poisonings and various infectious diseases. She has performed procedures such as pleural and ascitic tap, central line catheterizations, endotracheal intubation and local nerve block administration. She is also well practiced in procedures such as nasogastric tube insertions, IV-line insertions, Foley’s catheterization and drawing arterial and venous blood samples. She had taken the initiative to present various topics such as, ‘Epilepsy’ and Rheumatic Fever’ and actively participated in their discussions during academic sessions. Her enthusiasm to learn, team attitude, and professional work ethic was well appreciated, and she had hence been described as one of the best students on our team by our residents and attending physician.

    Apart from Ms. ______ impressive list of attributes, one well-appreciated trait is her willingness to take initiative. An example of such an instance was during her internship year, when due to unforeseen circumstances, a Health Camp had to be organised last minute. Ms. ____ was one of the few interns who volunteered to attend this Health Camp immediately after completing a night shift at the hospital. She spent the day taking history and examining over 100 patients of a homeless shelter for the mentally ill. Her dedication and passion for Medicine was apparent in her work ethic.

    Ms. ______ has a sound knowledge of general medicine and its various disciplines. In addition, she is hardworking and highly motivated with a good sense of ethics and responsibility. Her communication skills and the respect she demonstrated towards patients, staff and colleagues were impressive. I am confident of her capability of working in a team effectively and efficiently, as she had demonstrated good leadership on multiple occasions. Ms. _____ is a well-rounded and promising student whom I have no hesitation in recommending for your residency program. If you have any further questions regarding Ms. _____ or my experience with her, please do not hesitate to contact me.

Sincerely,

Dr. Xyz, MD

Professor & HOD of General Medicine

Pqrs Institute of Medical Sciences

,  State, India

Mobile No

E-mail: 

Blended bimonthly assessment September 2020 results

Following are the links to the submitted assignments by the students (interns, UGs, PGs year 1 and year 2) for the September bimonthly assignment posted for summative assessment on 7/9/2020 here:https://medicinedepartment.blogspot.com/2020/09/medicine-blended-assessment-biweekly.html?m=1

and in the links below one can find that the summative has been also accompanied by a numerical formative assessment of their online learning portfolios using both verbal and non verbal cues. 

Interns from 2015 MBBS batch posted in the department of Medicine from 23/06/2020 to 22/09/2020:

https://docs.google.com/document/u/2/d/1ouy_gqzmCw82ammZSucemG-75qa6x9nvNi6FovJ2FYI/mobilebasic

PGY1s from the 2020 MD General Medicine batch 

https://docs.google.com/document/d/1pEGZsz3VH9yjE_lDVBQwi7BjbxKFdFVsD2gCux2SAa4/edit?usp=drivesdk&ouid=100497219830377837116

PGY2s from the 2019 MD General Medicine batch :

https://docs.google.com/document/d/11jjVEcnHNlfLpFbfU-eTybTRfp1LPn38NFjA3hbhTvGU/edit?usp=drivesdk&ouid=100497219830377837116

UGs 2016 batch:

https://virtualmedicalcases.blogspot.com/2020/09/medicine-blended-assessment-45-year-old.html

https://rhea9895.blogspot.com/2020/09/two-similar-cases-yet-very-different.html

https://caseopinionsbyrollno156.blogspot.com/2020/09/medicine-blended-assessment.html

https://chitrasrinivas.blogspot.com/2020/09/biweekly-clinical-case-assessment.html

http://shivani2401elogbookmedicine.blogspot.com/2020/09/the-curious-case-of-anasarca.html

The formative assessment has been divided into non-verbal which assesses their competency in procedural domains including empathic communication and body language and verbal which assesses their ability to communicate their work through their day to day E logs.

Most students have done reasonably in the formative assessment in both verbal and non verbal communication domains although a lot remains to be improved on. 

Most students haven't done well at all in the summative assessment and many have not only plagiarised blatantly from articles on the internet (inspite of express instructions on how not to resort to that) but also copy pasted from each other's log books. Some of the top UG students have predictably done well on all fronts including avoidance of plagiarism. 

Medicine paper for October 2020 first week of blended assessment bimonthly

Answer all questions                                                      

Max Marks: 100 

Submit by:                                

Date: 7/10/2020 9:00 AM 

Below is an online formal question paper to be answered online using all available resources at your online disposal over a period of days and E logged in a manner demonstrated by past examinees in the link here https://medicinedepartment.blogspot.com/2020/09/blended-bimonthly-assessment-september.html?m=1

Please go through the patient data in the links below:

"57 year old man with jaundice, pedal edema and abdominal distension since three years and bleeding gums since three days"

https://swathibogari158.blogspot.com/2020/09/chronic-decompensated-liver-disease.html

1) What is the reason for this patient's ascites? 

2) Why did the patient develop bipedal lymphedema? What was the reason for the recurrent blebs and ulcerations and cellulitis in his lower limbs?  

3) What was the reason for his asterixis and constructional apraxia and what was done by the treating team to address that?  

4) What was the efficacy of each treatment intervention used for this patient? Identify the over and under diagnosis and over and under treatment issues in the management of this patient. 

A 54 year old male with cough,abdominal tightness,pedal edema and diarrhea.

https://sainiharika469.blogspot.com/2020/09/hello-everyone.html?m=1

1) Why were his antitubercular therapy stopped soon after his current admission? Was he symptomatic for ATT induced hepatitis? Was the method planned for restarting antitubercular therapy after a gap of few days appropriate? What evidence is this approach supported by? 

2) What were the investigational findings confirming the diagnosis of pulmonary TB in this man? 

3) What was the cause of his ascites?

4) What are the efficacy of each intervention mentioned in his treatment plan and identify the over and under diagnosis as well as over and under treatment issues in it. 

47 year old man with bipedal edema since one year and abdominal distension since one month

https://sushma29.blogspot.com/2020/09/ascites-secondary-to-nephrotic-syndrome.html?m=1

1) What will be your further approach toward managing this patient of nephrotic syndrome? How will you establish the cause for his nephrotic syndrome? 

2) What are the pros and cons of getting a renal biopsy for him? Will it really meet his actual requirements that can put him on the road to recovery?

Dissertation plan activity with post graduate students from all departments

Going by our learning from past experience in the thesis committee, this time we need to ensure that their thesis topic selection:

a) contains a proper problem statement, study design and expected outcomes and finally a title, which reflects all of that.

b) serves as a valuable tool to solve patient problems that the students encounter in their regular workflow 

c) enables them to develop different publishable findings from their thesis 

 d) does not become a burden on them making them resort to unethical practices. 

We are looking forward to developing the thesis topics of this current first year batch through a blended discussion with each one of them along with their esteemed faculty before it becomes too late for their protocol submission.

We have asked each thesis protocol going candidate to 

start sharing their initial thoughts on their own thesis plan in the online whatsapp group created specially for that purpose and encouraged them to just share enough that can be easily read in a text message and we shall collectively try to build on it conversationally. 

One of the problems with whatsapp conversations is that there is currently no scope to create a separate thread for each one of their thesis. 

To circumvent that we are asking them to put their preliminary thoughts into their blog and share the link and paste it with each one of their messages and keep adding the related conversations to it so that all the inputs related to their thesis gets archived in their own blog. 

The blog post here is a quick demo to produce a link that can be emulated by them in their text messages. 

Medicine blended assessment biweekly

Answer all questions                                                      

Max Marks: 100 

Submit by:                                

Date: 7/9/2020 9:00 AM 

Below is an online formal question paper to be answered online using all available resources at your online disposal over a period of two days and E logged in a manner demonstrated by past examinees in the link below and the link to your E logged answers shared in the same platform where you obtained the current link that you are viewing. 

Please go through the patient data in the links below:

1)Patient data collected and logged by intern Dr Alekya. 

45 yr old lady who is a housewife and had DM 2 since 5yrs and HTN since 1yr. She  was apparently normal 6months back,used to develop pedal edema on and off  aggravates on walking and relieves on taking rest for which she was taken to nalgonda hospital and the doctor had advised her to decrease the fluid intake and gave some medications.It was associated with shortness of breath grade 3.

5days back she had developed pedal edema which got progressed and developed abdominal distension,facial puffiness associated with decreased urine output,sob even at rest  and chest pain on right side, non radiating with intermittent palpitations.

More here: https://alekyatummala.blogspot.com/2020/09/45-yr-female-with-anasarca.html?m=1

1) What is your complete anatomic and etiologic diagnosis from the data available in the patient's online record linked above? (ignore the provisional diagnosis on admission mentioned in the case report)

2) What are the reasons for her:

Azotemia 

Anemia 

Hypoalbuminemia 

Acidosis 

3) What was the rationale for her treatment plan detailed day wise in the record? 

Particularly mention rationale and  efficacy for some of the drugs administered such as oral and iv bicarbonate? When is iv or oral bicarbonate indicated and why is it contraindicated in certain situations? 

4) What was the indication for dialysing her and what was the crucial factor that led to the decision to dialyze her on the third day of admission? 

5) What are the other factors other than diabetes and hypertension that led to her current condition? 

6) What are the expected outcomes in this patient? Compare the outcomes of similar patients globally and share your summary with reference links. 

7) How and when would you evaluate her further for cardio renal HFpEF and what are the mechanisms of HFpEF in diabetic renal failure patients?

8) What are the efficacies over placebo for the available therapeutic options being provided to her for her anemia? 

What is the utility of tools like the CKD-AQ that assess the frequency, severity, and impact on daily activities of symptoms of anemia of CKD? Is Telegu among the 68 languages in which it is translated? 

10) What is the contribution of protein energy malnutrition to her severe hypoalbuminemia? What is the utility of tools such as SGA subjective global assessment in the evaluation of malnutrition in CRF patients? 

2) A similar patient data as above with diabetes and renal failure with metabolic acidosis and hypoalbuminemia logged by intern Dr Bhavya here https://bhavyayammanuru.blogspot.com/2020/09/aki-secondary-to-uti.html?m=1

Please comment on the differences in the diagnosis, therapy and outcomes in both these two patients. 

Would you agree with the provisional diagnosis shared for this  58 M in the online case report linked above?

What are the findings in the ultrasound of both kidneys? How do you explain those findings? Would it explain the etiology for his renal failure? 

Please feel free to review the literature online before answering the above questions but take care not to plagiarise any of that literature while answering these questions. One can quote only one to two lines maximum from the reference literature and the references and links should be shared along with the quotes or paraphrased information derived from the referenced literature. 

Please check out some active learning discussion around answering this case based question format as well as avoiding plagiarism here https://medicinedepartment.blogspot.com/2020/05/frequently-asked-questions-around-case.html?m=1

Please check out these links to few answers in the past in E log books from our other students around different set of questions:

https://medcases.blogspot.com/2020/05/heart-failure-2.html?m=1

https://virtualmedicalcases.blogspot.com/2020/06/the-dark-side-of-depression.html?m=1

https://caseopinionsbyrollno156.blogspot.com/2020/05/trio-of-paraparesis-cases.html?m=1

For a past online question paper in a patient centered clinical problem solving version please check the link below:

https://medicinedepartment.blogspot.com/2020/01/patient-centered-questions-for.html?m=1