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ACOI American College of Osteopathic Internists
February Resident News
FEBRUARY 2010
TABLE OF CONTENTS



HELP US MAKE THE NEWSLETTER USEFUL TO YOU

The ACOI's newsletter for residents and fellows is about one year old and we continue to look for ways to make it more useful to its intended audience. To that end, beginning with this issue, we are including an interesting case submitted by an internal medicine or subspecialty trainee.

This new feature is open to everyone and I encourage you to submit entries for consideration. The format can be at your discretion, but it is important to include the following information: the clinical scenario or case; strategies and evidence; reasons for the presentation; conclusions; recommendations and references. Thanks to Robert Shmuts, DO, for the excellent case included below.

The ACOI sincerely wants to hear from you - whether it is to submit a case or to suggest other ways in which we can provide helpful information to you.

Brian J. Donadio, FACOI

Brian J. Donadio, FACOI, is the Executive Director of the American College of Osteopathic Internists. He may be reached via email at bjd@acoi.org.




FELLOWSHIP APPLICATION TIME

Time is rushing past and now many of you are starting to understand how to effectively care for patients, and how to get everything done that needs to get done each day. By this point, you probably have some time to sit and learn on your own. You can now feel confident in some of the aspects of being a physician.

For many of you, just as things are starting to fall into place, it is time to start the process of Fellowship application. It may seem very early in your residency, and now you have to make another life changing decision. Do I apply for fellowship? Which one and where? Most residents have some idea that they would like to specialize from the beginning of residency, so this decision will likely not come as a revelation. What often times is off-putting, however, is the speed at which residency passes the many things that must be accomplished so you are ready to apply for fellowship. And, during residency, thoughts you had before residency about fellowship are not as clear to you now. Once you have had the chance to rotate through the specialties and meet some specialists, fellowships that you did not think you were interested in become exciting and maybe what you thought you wanted to do is really not all it is cracked up to be. Once you work through this and make your decision, you have to make yourself a good candidate.

Here are five basic tips to help make a strong fellowship application:

Be a great resident
This may go without saying, but this can be hard to remember when you are very busy or very tired. Even if you are working on a rotation that does not interest you, still give 100 percent effort. You never know who talks to whom and if word gets out that you do not do a good job or are lazy, this will hurt you. Good reviews and letters of recommendation are essential to get where you want to go. Try to be the very best all the time. You never know who is watching.

Participate in research
Research is just about mandatory for fellowship application these days. This is particularly true for the most competitive fellowships (GI, Cardiology). Fellowship directors will ask what kind of research you have been involved in and who you have worked with in research. You can be assured that everyone else who is applying for that same position has done some amount of research. Get out there and get involved, this is a part of your CV that you cannot neglect. (I have discussed research as a resident and student in two previous articles in this newsletter, feel free to look at these for more insight into research).

Apply everywhere
Fellowships are competitive. Most programs have only a handful of positions to offer each year and many well-qualified candidates apply for these. You must increase your chances of matching by applying to as many places as possible. If you really want to be a fellow, you need to apply to every place that you could possibly see yourself attending. A colleague of mine applied to 68 cardiology fellowships, he got significantly fewer offers to interview, but is now finishing a good fellowship.

Find a mentor or advocate
Someone to help you through the process, give advice and to be your advocate is a great help. By this time, you should be hanging out in the department that you are looking to get a fellowship in (you should be asking about research, or doing extra rotations, or seeing patients in the subspecialty clinic) and the program director should know that you are interested in being a fellow. The program director can give you a lot of insight into your application, would be a great person to provide a recommendation, and can help provide experience to bolster your CV. A current Fellow is often another good source of information. They provide firsthand insights into the current program and have been through the application process.

Do well on Comlex/USMLE
You have come this far in your medical career and are now likely pretty good at taking standardized tests. Programs will look at these scores closely because they are one of the few objective parts of an application. Do as well as possible. Some programs may even have cut off points. They have a set number or score, below which the application is not reviewed. If you did not do well on one of these, explain why in your personal statement. Try to make it work for you.

Scott Girard, DO

Scott Girard, DO, is a hospitalist in Danville, PA. He completed his internal medicine training at Geisinger Medical Center in Danville in July, 2008. During his training, Scott served for two years as the resident representative to the ACOI Board of Directors. He now serves as liaison and advisor for residents and the College. He may be reached at slgirard@geisinger.edu.



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DEATH, TAXES AND....?

As physicians, we are all too well aware of the clichéd, anxiety-provoking constants of life… death and taxes.

There is, however, a third constant which is often forgotten until the month or week prior to its presentation. It is no less innocent in the anxiety that it provokes, but does allow the individual greater control of outcome. As lifelong learners, our third constant is the written test. The objective measure of knowledge acquired in a given period of time irrespective of how it is gained. Oddly enough, one would think that with all the years of schooling and test-taking, we have reached the peak of the mountain, become experts in our field and no longer need to be tested. Alas, that is not the case. Scientific developments occur at an exponential rate and we are bound by duty to our patients to keep current. Our College, bound by duty to society, must ensure this truth. Hence, we are tested. The origin of test-taking dates back to the times of organized schooling. In 387 BC at the Platonic Academy in Greece, Plato taught and tested using the Socratic method. In China, 111 BC, the medicinal text Huangdi Neijing was written, too, in question/answer format as a method of instruction for students. In Persia, during the third century, the Bimaristan, a place where academic scholarship and patient care coexisted, physicians were required to undergo a series of didactic instructions and tests in order to receive a diploma permitting them the privilege of practice. Always, the physician is tested to ensure academic integrity.

In keeping with the tradition of testing, each year we are asked to sit for an inservice exam, which for this academic year, is in less than one month. The exam is designed to be a tool to measure strengths and weaknesses in the various disciplines of medicine. It functions as a guide for Board preparation. There is no pass/fail moniker attached to the exam. Residents are compared against all the residents taking the exam. A few years back, the AOBIM conducted a study comparing the performance on the inservice exam and certifying Board pass rate. The results of the study showed the inservice exam to be a valid predictor of Internal Medicine board pass rate. So, if you do well on the inservice, you can expect to do well on the boards. If there are areas of weakness, you are afforded the luxury of a few months time before the boards to develop study action plans.

Granted, there is a skill to test taking. Sometimes, we may feel that a test does not accurately measure knowledge or reasoning. Well, herein lies the beauty of the inservice exam. By virtue of our length of training, we are given three opportunities separated by time and variation in test questions to prepare for the written boards. Meaning there are three opportunities to determine subject matter strength, weakness and question style and ample time to acquire knowledge necessary for passing the boards. Once the inservice scores are released, you should have a meeting with your program director (PD) going over the results. The experience of your PD can help guide you in the way to study for the Boards.

Remember, the inservice tests your knowledge not your ABILITY to learn. If you don’t do well your intern year, it is ok. Take steps to ensure that for the following year you have better results. After all, to quote another common cliché, “It is not survival of the fittest… It is survival of she who can adapt the fastest.” Being in the information age, physicians that demonstrate the ability to learn are better equipped to serve their patients.

Belinda Kakos, DO

Belinda Kakos, DO, is the Resident Representative on the ACOI Council on Education and Evaluation. She is a third year internal medicine resident at Henry Ford Health System-Warren Campus. She may be reached via email at bkakos1@hfhs.org.

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WHAT IS YOUR PERSONALITY? PART I

One of the main motivations for me as a physician is the education of students and house staff. It has been the primary motivation for choosing my place of residency and the driving force for my involvement in professional organizations. As such, I am constantly looking for better ways to interact with professionals-in-training. This has led me to explore research in interpersonal communication and self perception. Most recently I have begun to concentrate my studies on the four personalities: Director, Socializer, Thinker, and Relator. Over the course of the next few months, I would like to use this column to give insight into each of these personalities. My hope is that you, the reader, will be able to gain a better understanding of your own personality, and that you might be able to better communicate with your attendings and fellow house staff.

Before delving into details, I need to make a couple things abundantly clear.
  • There are no "good" personality types and "bad" personality types.
  • Almost everyone has one personality type as their norm (Primary personality type), but a different personality type when responding to stress (Secondary personality type).
  • Personality types can change, but that rarely happens unless there is a major, life-changing event.
  • Effective utilization of this information requires that individuals make changes in their own methods of communication, so that they might meet the needs of those they are communicating with. It is not effective if you only focus on whether your own needs are being met.
The Director
Strengths – The Director is constantly seeking challenges, is tough-minded, and an independent thinker. They are likely to explore ideas or problems thoroughly, and are quick to make decisions. Directors are systematic and exacting in pursuing their interests and goals. They tend to have a lot of energy which they direct at the project at hand.

Weaknesses – Directors are very susceptible to intense anger when they feel hurt, disappointed, or frustrated. They become very troubled by the idea that they “look bad” or are losing control. In an effort to avoid these negative feelings, Directors will often gravitate toward workaholism and have difficulty delegating responsibilities to others. The lack of trust for the Director makes them difficult for other personality types to relate to.

Relating to the Director - By their nature, they will be direct and informed. They gravitate toward men and women who are intellectually-exciting and like to discuss topics broadly and thoroughly. They are often-times admired by those around them and are fiercely loyal to those they befriend. Directors like to be figureheads and expect a hierarchy to exist in the workplace. Show an interest in what the Director is currently involved in because they like to be recognized for their accomplishments and look for others that share their interests. When questioning a Director, it is important to be respectful and be prepared for a lecture, which is their preferred method of teaching.

In the Medical Realm – Many people falsely believe that the Director is the optimal physician. Many people will, in fact, put themselves in a position best suited for a Director, hoping that they will be perceived in this manner. People who place themselves in situations that constantly force them to work outside of their comfortable method of communication will find that they are drained rather than driven by their work environment (Please refer back to Points #1&2). Director physicians can be found everywhere and in every field, but tend to predominate in large institutions with research options and chances for advancement and prestige. They enjoy a work environment that allows them to control their surroundings (like surgery). They almost universally enjoy teaching house staff as it maintains a hierarchy around them. The Director physician may or may not be a leader in the hospital administration as they have a difficult time seeing things from a perspective other than their own, but they do take a lead in their particular area of interest.

Take a moment to think about those attendings that you have served with. Can you identify a mentor or colleague that is a Director physician?

Next Month… The Socializer and The Thinker.

Mat Hardee, DO

ACOI Board of Directors Resident Representative Mat Hardee, DO, is a third year internal medicine resident at Northeast Regional Medical Center in Kirksville, MO. He may be reached via email at ACOIResidentRep@gmail.com.

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BOARD QUESTION OF THE MONTH

This series of questions is to help residents understand how board questions are written and what kind of infomation these questions are testing. In order for residents to better understand the process, the ACOI has asked several former certifying board members to write this feature. This month's question is by Vicky Leo, DO, a general internist and past chairwoman of the American Osteopathic Board of Internal Medicine. Dr. Leo practices in Leechburg, PA.

A sixty year old patient presents to your office in the fall for a routine physical exam. Past medical history is significant for hypertension, type I diabetes and renal failure for which he had a kidney transplant five years earlier. He had a Td booster ten years ago and a pneumovac four years ago. Which vaccinations should be offered to him?

a. Influenza and Td

b. Influenza and Tdap

c. Influenza, Td and pneumovact

d. Influenza, Td and varicella zoster

e. Influenza, Tdap and varicella zoster

The correct answer is B. Influenza should be offered annually. A Tdap should be offered once to all adults and then routine Td’s can be given every ten years thereafter. Pneumovac is indicated prior to age 65 in high risk patients. One or two doses prior to age 65 but five years apart may be given, followed by a booster at 65 or at least five years after the previous dose. Zoster vaccine is a live virus and should not be given to a solid organ transplant patient.




INTERESTING CASE OF THE MONTH

Presented by Robert J. Shmuts, DO, a second year internal medicine resident at UMDNJ-Kennedy Health System in Stratford, NJ.
Click the case title to view the report.





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STATE OF THE UNION SPEECH CALLS FOR CONTINUED HEALTHCARE REFORM EFFORTS

President Obama delivered his first official State of the Union speech before a joint session of Congress on January 27. While a large part of his speech addressed various components of the economy and efforts to create jobs, he did address the current state of the healthcare reform debate in Washington.

The President addressed the stalled negotiations and asked Congress to “take another look” at the proposals that have been advanced. He reiterated his belief that legislation is still needed and reaffirmed his position that individuals and families with existing insurance should be able to maintain their current coverage and still see their physician if they choose to do so. With respect to the troubled healthcare reform talks, the President concluded by saying, “If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know…I am eager to see it.”

It remains to be seen whether a compromise can be reached. The one thing that is almost certain is that it is highly unlikely that Congress will be able to send to the President’s desk a package as broad as those earlier approved by the House and Senate by narrow margins.

Tim McNichol, JD

Timothy McNichol, JD, is the Deputy Executive Director of the ACOI and is responsible for the College's advocacy efforts. He may be reached via email at tmcnichol@acoi.org
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NEWS OF NOTE


Review Course Essential To Exam Preparation
Registration is now open for the ACOI’s annual Internal Medicine Board Review Course, which will take place April 14-18, 2010. The Course is a compre­hensive review of general medicine and each of the subspecialties. It is an excellent way for practicing physicians to update their medical knowledge, as well as an essential part of the preparation process for the certifying and recertifying examinations in internal medicine. Special emphasis is placed on recent advances in various subspecialty areas and on clinical skills management as they pertain to clinical practice and the examinations.

The 2010 ACOI Review Course will be hosted at the Tradewinds Island Resort ($189 per night/plus taxes) in St. Pete’s Beach, Florida. The hotel is easily accessible from the Tampa International Airport and features spacious guest rooms, excellent meeting space and direct access to St. Pete’s white sand beaches. Registration materials are available at www.acoi.org or by calling 1 800 327-5183.

ACOI Staff Resources for Residents and Fellows
The ACOI staff and the Council on Education and Evaluation are important sources of information and assistance for osteopathic internal medicine residents and fellows. Two staff members are available on a daily basis to address questions and concerns. Christy Smith serves as postdoctoral administrative coordinator and can answer questions about general training requirements and specific individual training issues. Keisha Oglesby is the ACOI certification liaison. Residents and other certification candidates are urged to contact her to clarify questions about completion of certification requirements.
ACOI policy is that all phone calls and e-mails are acknowledged and returned within 24 hours of receipt. Please take advantage of these resources available to you.




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ACOI Contacts
Michael B. Clearfield, DO, FACOI
President
michael.clearfield@touro.edu
Thomas F. Morley, DO, FACOI
President-Elect
tmorley@comcast.net
Matthew R. Hardee, DO
Board of Directors Resident Representative
ACOIResidentRep@gmail.com
Brian J. Donadio, FACOI
Executive Director
bjd@acoi.org
Timothy W. McNichol, JD
Deputy Executive Director
tmcnichol@acoi.org
Susan B. Stacy, FACOI
Director of Administration and Finance
susan@acoi.org
Christina A. Smith
Post-Doctoral Training Coordinator
christy@acoi.org
Keisha L. Oglesby
Membership Coordinator/
Certification Liaison
keisha@acoi.org



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Council on Education and Evaulation
John B. Bulger, DO, Chairman
jbulger@geisinger.edu
Thomas J. Mohr, DO, Vice Chair
tmohr@rockyvistauniversity.org
Gary L. Slick, DO (AOBIM)
aobim@mail.com
Robert A. Cain, DO
racain@sbcglobal.net
Susan M. Enright, DO
senright@genesys.org
Joanne Kaiser-Smith, DO
jksdoc@aol.com
Robert T. Hasty, DO
hasty@nova.edu
Joanna R. Pease, DO
strixvaria@sbcglobal.net
Frederick A. Schaller, DO
frederick.schaller@touro.edu
Belinda Kakos, DO - Resident Representative
bkakos1@hfhs.org