Article Review: Barriers to effective teaching

I think there is no better or more rewarding job than being an educator, especially in the field of Medicine.

There are, however, significant financial, societal, curricular, and environmental barriers which prevent optimally effective teaching in Medicine. In a commentary piece in Academic Medicine, the authors review the barriers and some forward-thinking recommendations for our leaders in medical academia. While the focus of the article is on undergraduate medical education, many concepts apply to graduate medical education as well.
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By Michelle Lin, MD|2016-11-11T18:58:14-08:00Mar 21, 2011|Education Articles, Medical Education|

Paucis Verbis: Strength of diagnostic tests for cholecystitis

You have a 40 year-old man who presents to the ED for persistent right upper quadrant abdominal pain for 12 hours after eating a fatty meal. He has no fevers, nausea, flank pain, or dysuria. His physical exam shows no fever and only moderate tenderness in the RUQ without guarding. He has a Murphy’s sign which is improved after a total of 8 mg of IV morphine. His laboratory results, which include a WBC, liver function tests, lipase, and urinalysis, are normal.

Can you safely say that the patient doesn’t have cholecystitis? Can you discharge him for outpatient ultrasonography to assess for symptomatic cholelithiasis?

As bedside ultrasonography becomes more of a staple in Emergency Departments, it is easy to just perform the ultrasound yourself if such a patient presents. If you do not have an ED ultrasound available, however, you need to send this patient for a formal ultrasound because he is still very much at risk for cholecystitis despite having unremarkable lab tests and no fever.

JAMA published a meta-analysis of 17 studies on the test characteristics for cholecystitis. I found it odd that they defined a fever as temperature >35 Celsius. The best performing characteristic was a Murphy’s sign, although the positive likelihood ratio (LR) slightly crossed 1.0 (0.8-8.6).

PV Card: Diagnostic Testing for Cholecystitis

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Trowbridge RL, Rutkowski NK, Shojania KG. Does This Patient Have Acute Cholecystitis? JAMA. 2003;289(1). doi: 10.1001/jama.289.1.80

By Michelle Lin, MD|2021-10-16T19:25:53-07:00Mar 18, 2011|ALiEM Cards, Gastrointestinal|

Article Review: Emergency physicians interruptions

What exactly do ED attendings do on shift?

This novel prospective, time-motion study tracks the activities of ED attendings at 2 academic and 2 community sites. All sites used paper charting in the ED and computerized medical records for labs and radiology results.

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By Michelle Lin, MD|2016-11-11T18:59:17-08:00Mar 14, 2011|Education Articles, Medical Education|

Paucis Verbis: Right and posterior ECG leads

A standard 12-lead ECG can be very telling for patients with chest pain or shortness of breath. A right ventricular (RV) and posterior wall infarct, however, can present very subtly. You can obtain special right-sided (V1R-V6R) and posterior leads (V7-V9), if you are concerned. What are the indications for obtaining right-sided and posterior ECG leads?

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Go to the ALiEM Cards for more resources.

Addendum 3/11/11:

Right sided ECG leads (V1R-V6R) are positioned in a mirror image fashion from the standard 12-lead precordial leads.

Posterior ECG leads (V7-V9) are applied by moving V4-V6 in the posterior positions.

By Michelle Lin, MD|2021-10-16T19:28:52-07:00Mar 11, 2011|ALiEM Cards, ECG|

Trick of the Trade: Heat it up!

What is it about heat that makes everything feel better? Fireplace, hot tub, heat packs, electric blankets, and hot chocolate have got to be the best inventions EVER.

How can we apply this in Medicine?

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By Michelle Lin, MD|2026-06-16T16:03:14-07:00Mar 9, 2011|Tricks of the Trade|

Finding the right journal for your manuscript

When writing a manuscript, how do you choose what journal to submit to? You should factor in the journal’s impact factor and your manuscript content.

At the recent CORD Academic Assembly meeting, I learned of a website which helps you decide your journal.

JANE: Journal/Author Name Estimator

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By Michelle Lin, MD|2019-01-28T23:04:10-08:00Mar 8, 2011|Medical Education|

Trick of the Trade: Website resource on HIV medications

At our department’s first annual UCSF High Risk Hawaii Conference 2 weeks ago, Dr. Rachel Chin taught about complications from all of the HIV drugs on the market now. It’s a virtual alphabet soup: EFV, TDF, FTC, oh my. How do you keep track of them all?