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Showing posts with label USMLE. Show all posts
Showing posts with label USMLE. Show all posts

12.06.2008

Question Yourself before Chosing USMLE !

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24 comments

Hi Friends I wanted to post a blog on how USMLE can be
The questions you must ask to urself before coming to US or taking USMLE.....

First let me clarify that USMLE is a longer process than expected. It takes years to get into the system.Its money consuming and it tests ur patience.you will be facing lot of hurdles and there will be moments of despair and loneliness and deserted feeling.i am not scaring u its the truth.The competition is that severe.The people coming here are not just the graduates of foreign med school.Some people are even taking MPH or certain other courses just for the sake of getting residency.There is no genuine reason behind doing MPH(Master's in Public Health) 'cuz they r not gonna continue it as their career anyway.But being in US with legal status to work, some of them are doing research and even having publications.Also for being here,they r learning the culture of this country which helps them get absorbed in to this system quickly.So,that shows the level of competition.I don't suggest u do F1 courses.But they have some edge over ordinary IMG's.Of course u can work as a volunteer in any research with your Non-Immigrant visa too (Like B1/B2) but the chances r slim.
The questions U shud ask to urself are :

  1. Are you academecially bright or hard woker to get good score?'cuz score bring you interviews and ur communication skills help u get selected in the interview
  2. Are you financially sound?-Its gonna cost you a ton - Can be upto a maximum of $25000
  3. Do u have relatives here in US? They will help u for food shelter and may get you some observership or even recommendation?!
  4. Are you patient enough? - It takes years as I said atlest 1-2 years and as you know its a once an yearly process and the interview process it self takes 6months
  5. Do you have moral support? As I said some times u get lost in this alien country....so u need good friend it can be your spouce or some one who can give u very good advices..
  6. Do you have good communication skills?- I mean if you r shy U cannot go anywhere / do any thing in this country.Apart from that getting into residency requires this vital skill...thats what make you get selected for the interview...
Hope This Helps....!

Pavan

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2.27.2008

Process of Securing Residency....and the Steps u have to take...

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4 comments

How to start and go about the process of securing a residency
position:


1. Pick your desired residency (internal medicine, surgery,
radiology etc.) http://www.aamc.org/images/header_eras_1.jpg
2. Send away for an ERAS (Electronic Residency Application System)
application
3. Research your destination hospitals (see AMA's FREIDA online)
4. Complete and dispatch the ERAS application to ECFMG http://www.radswiki.net/main/images/thumb/5/56/Frieda.gif/250px-Frieda.gif
5. Register as an independent applicant with the National Residency
Matching Program. http://meded.ucsd.edu/assets/6/Image/Organizations/NRMP.jpg
6. Watch the Automated Document Tracking System (ADTS) for the
progress of your ERAS submission
7. Call/e-mail the hospitals that have received your ERAS
application, and ask about interview schedules. Request early
decisions based on your need to complete international travel
8. Attend for your interviews
9. Rank your favorite programs in NRMP's ROL (rank order list)
10. Submit your rank order list by internet to the National
Residency Matching Program
11. While awaiting the match results, research your visa options and
send for the licensing application packs for the states that you
feel most likely to match with.
12. Obtain your match results (or enter the scramble if unmatched)
13. Sign and return your contract
14. If immigrating on a J1 visa, get the DS2019 form from ECFMG and
apply through your local consulate. If immigrating on a H-visa,
you'll need to get your state license completed first (requires your
ECFMG certificate and a copy of the signed contract with the
hospital)
15. Organize accommodation, flights, cargo etc.

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Usmle In Detail... How to Secure Residency...U'll Find The Path Here!

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39 comments

How to start and go about the process of securing a residency
position:

A review of the necessary ingredients:

1. The Exams

The USMLEs (United States Medical Licensing Examinations) are a set
of medical exams designed to evaluate your readiness to safely enter
the American medical system. The organisation that watches over the
application of foreign nationals to the American Medical system is
the ECFMG (Educational Commission for Foreign Medical Graduates) and
they administer the USMLEs outside of the USA.
USMLE are multiple choice exams that are now only held on computer.
There are three parts, or steps, to completing the USMLE exams. The
computers that you can take them are available in a large number of
cities across the world on every working day of the year - you
Register with the ECFMG who administer the test internationally, and
reserve a place at your local centre for a time when you feel ready
to take the examination. Your nearest site can be found here.

The first part, USMLE step 1, is a multiple choice exam consisting
of about 300 questions taken over eight hours in one day at the test
center. The step 1 covers all of the basic sciences - Anatomy ,
Biochemistry , Physiology , statistics, Behavioural science,
Microbiology , Pharmacology , Pathology , ethics - and it is
typically taken in the first half of the medical school curriculum
at a time when these subjects have been covered. Scores are reported
as two digit (NOT %) and three digit scores. The percentage required
to pass is determined based not on a population curve, but on the
relative difficulty of the items as determined by the test
committee. That pass % is then set as being equal to a two digit
score of 75. The mean three digit score is 200. Many programs look
for two digit scores of at least 80-85 for entry. 66% of
international medical graduates pass this exam with each sitting,
while 91% of US medical students do.
The second part was recently divided into two parts, USMLE step 2ck
(clinical knowledge) and USMLE step 2cs (clinical skills). USMLE
step 2 ck+cs is the examination that American medical students take
before being allowed to graduate from medical school. USMLE step 2ck
consists of a similar one day computer based examination, and covers
all of the clinical sciences including medicine, surgery,
Paediatrics , obstetrics and Gynaecology , Psychiatry , forensics,
emergency care, ENT , Ophthalmology , tropical health, ethics. It is
usually taken in the final year of medical school, or beyond. 75% of
international medical graduates/students pass this on first sitting,
while 95% of american medical students do.
The USMLE Step 2cs examination is a newer requirement for ECFMG
certification. The USMLE step 2cs is an expensive ($1200)
examination is held in only a few American cities throughout the
year. It brings examinees face-to-face with ten simulated
('standardized') patients - ie actors pretending to have specific
complaints. You are tested on your ability to rapidly assess a
patient, communicate your thoughts to them, and to write a note
about your assessment and plans. Application is presently through
the ECFMG only. As of November 2002 (when the exam was called the
CSA), the pass rate was 80%, with 60% of failures being due to
language difficulties. As a result of this new examination, the
TOEFL will no longer be required. However the USMLE step 2cs will
have an expiry date for the first time.

USMLE step 3 (application on FSMB) is taken by American students
during their residency program within a year or so of graduation.
International students only need to take the USMLE part 3 if they
plan to immigrate on a H-1B visa (recommended over a J-1). This exam
is only given in the United States, requiring you to travel here to
take it. Also, only a few states (California, Connecticut,
Louisiana, New York, Utah, or West Virginia) allow you to take the
part 3 in their jurisdiction without being in an American residency
program. It is largely similar in scope to the USMLE step 2 with
more emphasis on practical management. The computerized test can be
taken geographically in any US state at a testing center as long as
you are sitting the test FOR Connecticut or New York. Application is
through the state medical board. This means you can take the test in
New Jersey having applied to the state medical board of Connecticut,
and having passed the exam, use that result to start residency in
Massachusetts.

The English Examination is not run by ECFMG any longer. If you have
taken the CSA you will be required to take a TOEFL (test of english
as a foreign language) examination. If you take the USMLE step 2cs,
you do not have to take an additional english examination. The TOEFL
is run in most countries by the Educational Testing Service. Click
here for more information on the TOEFL examination.

2. The ECFMG Certificate

This sounds straightforward but can be unexpectedly time consuming.
The ECFMG (Educational Commission for Foreign Medical Graduates)
certificate is a document proving that you have fulfilled the
education requirements needed to practice medicine in the USA.

The Necessary components are to have
1. - your medical degree and transcript verified by ECFMG (can take
a long time)
2. - passed USMLE 1 and 2ck
3. - passed the clinical skills assessment (or step 2cs)
4. - passed a TOEFL english examination (or step 2cs)
5. - paid ECFMG in full
All of these components must be valid at the time when you apply for
final certification. This certificate testifies to the fact that you
have fulfilled the requirements for entry into clinical training in
the USA.
Remember that the ECFMG certificate is only valid as long as its
components (eg USMLE step 1) remain valid; each component has an
expiry date. Your ECFMG certificate must be VALID when you apply for
a visa or start your training. The english examination component
expires after two years. Remember that if you have to revalidate
your english test, the results of a repeat english examination will
take some time to be processed to revalidate your certificate (this
delayed my visa application).

3. ERAS
The electronic residency application system (ERAS) is a method of
centralised, computerised application for residency. After you have
paid the required application fee and requested a 'Token' via the On-
line Applicant Status and Information System (OASIS), ECFMG will
send a unique identification number ('a Token') by e-mail. This
Token will permit the applicant to access the AAMC's ERAS website to
complete his/her ERAS application on-line. Simultaneously, you'll
have to mail photocopies of your supporting documents to ECFMG. On
this online site you have to
a. enter your personal details in a standardized curriculum vitae
b. enter a personal statement
c. designate the residency programs you wish to have your
application sent to.

The supporting documents that you have send in the mail include
1. your photograph
2. your examination transcript and
3. your letters of reference
4. your dean's letter /medical student performance evaluation

Foreign medical graduates send these paper items to the ECFMG who
act as your "dean's office". They scan your paper documents and
photo, match it to your online application items and e-mail the lot
to the residency programs you selected. You can select up to four
letters of recommendation to each program. You can follow this
process on the Automated Document Tracking System (ADTS) which
allows you to see when your application documents are downloaded by
the residency programs. ERAS, the ADTS and the NRMP are all run my
the AAMC (American Association of Medical Colleges). You should
complete all of the ERAS application procedures as soon as possible,
but by December 1st in your year of application at the latest.

The question of where to apply is frequently asked. Almost all
hospitals will take the best applicants they can get, no matter
their origin. There is therefore no such thing as 'FMG friendly'
hospitals, only hospitals that cannot recruit american graduates,
and have a preponderance of FMGs working there. You would do well to
try and avoid such institutions since there is often a reason that
they are deserted by American grads. If you do want to find such
places, you can find them listed in the unfilled list at
scutwork.com. The best advice is to discuss your plans with
colleagues who know your field, and get their advice about where you
would best be suited. You can use resources on AMA's FREIDA online
to narrow your search, and obtain contact information.

4. Interviews

The most difficult part in your application will be securing an
interview. Many program directors find it difficult to evaluate
foreign graduates, so are reluctant to make the effort to interview
them: there is certainly little doubt that there is substantial
variablility in the quality of graduates from disparate medical
schools.

There are no guaranteed methods to getting an interview at any of
the top hospitals. However you can increase your chances by
- doing an elective
- getting good USMLE scores
- doing well in your own medical school - having a research
publication
- having very strong letters of reference ffrom your dean and
referees

Never assume that your application is actually being reviewed by the
hospital you applied to. Make sure you get in touch with the program
coordinator after you have seen them download your items from ERAS,
asking when you can expect to hear about whether you will be given
an interview. All program directors are listed in the AMA green
book, and online at FREIDA. It is true that planning international
travel is more complicated than local travel, so you really will
benefit from an early decision. If you do get an interview, you
should be able to negotiate a day that works in your interviewing
schedule, but this can be variable.

The interview day itself usually starts the night before, where
you'll be hosted to a casual dinner with members of that residency.
This is where you get to ask all the hard questions about what life
is really like working in that hospital and program. Many residency
programs do look for FEEDBACK from those who have met you at these
dinners, so be on your best behavior.

The actual interview day will usually involve hearing a presentation
about the program, going to morning report/conference, and then
meeting individually with some of the selection committee during the
day. You may not be scheduled to meet with the program director
themself, but it is worth asking (given you have travelled so far)
to meet directly with them at the end of the day, to find out how
you got on, and whether you're in with a good chance at this
program.

Do follow up with the program director by email or letter after you
have left to solidify your intent or interest.

5. The Match

The Match is a centralised computer program that matches a
physician's highest ranked residency program with a hospital that
ranks them highly.
It is organised by the National Residency Matching Program (NRMP) .
Not all of the available spots are listed in the Match, and some of
the more competitive specialities participate only in the "Early
Match". See the NRMP site for more information. As an international
applicant, you must Register as an 'independent applicant' before
December 1st of your year of application at the latest

What happens in the Match is .....
(1) You apply to the programs in the hospitals that interest you
(2) those programs that are interested in you will invite you for an
interview
(3) after the interview, the hospital ranks you among all those
they've interviewed
(4) After all your interviews, you rank the programs that you want
and
(5) on a certain date in March, all of these preferences are chewed
on by a computer and the hospitals are matched with the applicants.

Those that do not 'Match' are notified two days before the official
results and can participate in the 'Scramble' where unmatched
physicians contact unmatched residency programs by phone and fax in
an attempt to find jobs. You can find the list of programs that
failed to fill all of their positions at scutwork.com or click
here . For more info on the scramble process click HERE.

You will optimise your chances of matching by...
(1) Being organised and ready
(2) having good grades, USMLE scores and references
(3) performing well at interview
(4) having done an elective at the hospital you're applying to
(5) knowing about your visa plans

Residencies can fill their positions in the match, before the match,
or in a brief 'scramble' after the match. On the Monday of match
week before the specific match results are available (always a
Thursday), unmatched applicants and unfilled programs are told (by
email) that they did not match/fill, and the listing of unfilled
programs is released. Unmatched applicants then have those next
three days to convince program directors of unfilled programs that
they are the right candidate to fill that job. Most use faxes, and
phonecalls since program directors are usually so overwhelmed as to
ignore email.
You can obtain a position before the match too. This happens when
programs are sufficiently impressed with you (or sufficiently
desperate for applicants) that in the days or weeks after the
interview, they offer you a position directly, providing you agree
to withdraw from the match right there and then, and sign the
paperwork. This works well for less competitive candidates who are
very unsure about their potential to match through the ranking
process, and are happy with the offer.

6. State Medical Licences

After you've successfully matched you need to secure your medical
license and your visa. The medical license is specific to the state
of your employing hospital. Information on contacting the state
medical boards is included in the USMLE /ECFMG [bleep] of
Information, and is also located at the Federation of State Medical
Boards Web Page. States differ significantly on their processing
times and requirements for licensure. You should check out the
details, including requirements for USMLE 3 eligibility at the AMA
GME handbook . (contact your residency program for further details)

7. Your Immigration Visa

Doctors who have graduated from foreign medical schools seeking U.S.
residency training (who do not qualify for permanent resident status
in the U.S.) usually seek either of two visas from the Immigration
and Naturalization Service (INS), the J-1 or the H-1B visas. Several
recent events affect the use of those two visas by foreign
graduates.

7A. The J-visa

The J-1 non-immigrant visa permits completion of an accredited
residency or fellowship program of up to seven years duration which
leads to board certification. Following this, the resident *must*
return to his/her native country or country of last residence for a
period of at least two years. ECFMG issues a form called a DS2019
which tells the consulate that you are eligible to enter the US. The
American consulate in your own country will decide whether to issue
the visa.
Your governmental health office must sign a document indicating the
need in your home country for physicians trained in your prospective
speciality. Occasionally (this is often an issue for Canadians) the
country does not recognize a need for residents in a particular area
and refuses to issue the form, but for most it is a simple
formality. J-1 visa applications are usually processed quickly,
though some countries have a longer processing time due in part to
the events of Sept 11, 2001.

It is important to note that coming to the US on a J-1 visa
absolutely limits you to staying here only until the completion of
any training (be that six months or five years) up to a MAXIMUM of
seven years. This is a training visa, so you cannot use to practice
independently as an attending. If you think there is a chance that
you would like the opportunity to stay in the USA after your
training, you should take the USMLE 3 and come on a H1B visa.
There are four ways to stay in the US on a 'waiver' of this two year
home residency requirement. For most, the only practical way to
avoid having to return to your home country is to agree to practice
in an underserved area for three years after you have completed your
training. These positions are competitive and the competition for
them is expensive. Again, please consider coming on a H1B visa to
avoid these problems.

7B. The H-1B Visa

The H-1B visa allows the prospective trainee to avoid the J-1 visa
requirement to leave the U.S. for two years by petitioning for
permanent resident status in the U.S. while in residency training.
An applicant for an H-1B visa must be

(1) ECFMG certified (ie have passed USMLE 1, 2ck and 2cs);
(2) must have ALSO passed USMLE step 3 AND
(3) must hold a license to practice in a U.S. state before
application (it takes about three weeks to get a training license
after your match).

Residency programs decide individually which type of visa they will
support for their candidates for residency training. Previously most
did NOT support H-1b applications, although the new visa laws passed
in October 2000 mean that now many that previously did not offer
them should do so. You should ask your programs directly which they
will consider for you. Remember that many have the default position
of refusing such visas (and even note such decisions on residency
and hospital websites), but if you learn about them, and talk to the
international officers at these institutions, many will reverse
their decision and apply for this visa on your behalf.
Currently all academic institutions have unrestricted access to H1B
visas, without a cap. This means that your H1B visa is likely to be
easily available, and processed quickly (though some can still take
up to six months). A standard H1b application can still takes about
2-3 months for processing, so to be ready for a July 1st start, you
have to be quick about your license and your visa application right
after you match, unless you use expedited processing which can be
achieved by paying an extra $1000 , and the visa will be approved
within approx 14 days.

You will have to think carefully about which visa is right for you.
Note that the Match takes place in mid-March, and for a July start
you would likely have only a short time to secure a state medical
license and submit your H-1B visa application.
Some good visa sites for physicians are as follows:

Here is an overview of the process

8. Costs

• USMLE 1 $825

• USMLE 2 $800

• (USMLE 3 $670 + travel [only if H-visa sought])

• CSA $1200 + travel

• ERAS $185 (Minimum)

• NRMP $40

• State license $240

• Interviews $1000 + travel

• ESTIMATED TOTAL $5,000 + travel to the US (two trips if H-visa
sought - one for USMLE 3, one for CSA with interviews)
• (total cost can run upto $10,000 depending on how long you stay in
US and how many programs you apply to)

9. What about Observerships?

Many residency programs look for letters of recommendation from
American physicians when reviewing applications. Medical students
can get these when they are on electives in US hospitals. It is
harder for those who already have their medical degree, since
observerships are much less developed than electives.
If you are thinking of trying to come and experience American
medical practice as an observer for a few weeks, the best thing to
do is to contact the departmental head of your preferred specialty
at a hospital that interests you. Your letter should contain an
introduction about you, and go on to explain what you hope to
achieve by spending time in an American Hospital. You could talk
about exploring differences in educational strategies, in medical
practice, or system organization. I would not specifically allude to
objectives such as getting letters of recommendation or applying to
residency. Assure the departmental head that you will obtain your
own liability insurance. You should include a copy of your
curriculum vitae and a photo. If possible, use contacts from home.
If you don't hear back, make personal contact with email or
telephone.

10. When should I go?

This is a tough question and there is no "right" answer. What is
certain is that if you want to get registered with the Board of the
Speciality that interests you, you must do all your training from
PGY-1 (post-graduate year one) to speciality in the USA. So for
example if you aspire to cardiology and be able to practice as a
cardiologist in the USA you must spend 3 years of Internal Medicine
Residency followed by 4 years of Cardiology Fellowship. While you
can do your basic medical training in your home country and join a
US fellowship, you will not be able then to practice as a
Cardiologist, as you cannot be 'board certified' without completing
a residency first. The point to remember is that if you just want to
spend 4 years training in the USA, you can just go over for a
fellowship - while if you want to practice in the USA you have to go
over for the whole lot

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2.26.2008

Get RSS Feeds for Any Medical Journal from Pubmed

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0 comments

MedPDA.net used the newly launched PubMed feeds to get RSS for any journal. He also explains how to set up the feeds yourself in the post How-to: RSS feeds for medical journals.

JAMA and Archives Have RSS Feeds Now

General and Internal Medicine

New England Journal of Medicine: RSS
Annals of Internal Medicine: RSS
JAMA (Journal of American Medical Association): RSS
BMJ (British Medical Journal): RSS
Archives of Internal Medicine: RSS

Nature: RSS
Nature Medicine: RSS

Hematology / Oncology

Blood: RSS
Journal of Clinical Oncology: RSS
Journal of the National Cancer Institute (JNCI): RSS
Haematologica: RSS
Bone Marrow Transplantation: RSS



References:
PubMed RSS feeds are now live
Getting RSS feeds for most medical journals - MedPDA.net
How-to: RSS feeds for medical journals - MedPDA.net
Use Plucker to get Journal RSS feeds in your PDA - Palmdoc.blogspot
RSS tutorial for STFM Board. Family Medicine Notes
A really simple guide to a powerful tool: RSS. BMJ Career Focus 2006;332:244.

(Source: www.medpda.net & http://casesblog.blogspot.com/)

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2.23.2008

Free Physical Examination Videos-For USMLE Step2CS

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7 comments

Hi Ppl I am adding a list Physical Exam Videos From The Same Free Site www.learnerstv.com....
Although i posted these on other Blog..i felt these will be useful to the Final Yr MBBS Students and USMLE Step2 CS......The List Goes Here...

Video Lecture Description Sub-Category Time Click to view video
Physical Examination-Abdomen-Part1 Physical Examination 8m 45s Click to view video lecture
Physical Examination-Abdomen-Part2 Physical Examination 11m 22s Click to view video lecture
Physical Examination-Breast-Part1 Physical Examination 9m 34s Click to view video lecture
Physical Examination-Breast-Part2 Physical Examination 9m 57s Click to view video lecture
Physical Examination-Upper Extremity-Part1 Physical Examination 12m 14s Click to view video lecture
Physical Examination-Upper Extremity-Part2 Physical Examination 13m 23s Click to view video lecture
Physical Examination-Knee Physical Examination 12m 14s Click to view video lecture
Physical Examination-Lower Extremity Physical Examination 11m 45s Click to view video lecture
Physical Examination-Full Female Examination from Head to Toe-Part1 Physical Examination 14m 10s Click to view video lecture
Physical Examination-Full Female Examination from Head to Toe-Part2 Physical Examination 6m 43s Click to view video lecture
Physical Examination-Full Female Examination from Head to Toe-Part3 Physical Examination 13m 42s Click to view video lecture
Physical Examination-Full Female Examination from Head to Toe-Part4 Physical Examination 10m 58s Click to view video lecture
Physical Examination-Full Cardiac Examination-Part1 Physical Examination 14m 18s Click to view video lecture
Physical Examination-Full Cardiac Examination-Part2 Physical Examination 11m 24s Click to view video lecture
Physical Examination-Full Male Examination from Head to Toe-Part1 Physical Examination 11m 28s Click to view video lecture
Physical Examination-Full Male Examination from Head to Toe-Part2 Physical Examination 8m 53s Click to view video lecture
Physical Examination-Full Male Examination from Head to Toe-Part3 Physical Examination 8m 58s Click to view video lecture
Physical Examination-Full Male examination from Head to Toe-Part4 Physical Examination 10m 00s Click to view video lecture
Physical Examination-Full Neonatal Examination.-Part1 Physical Examination 12m 36s Click to view video lecture
Physical Examination-Full Neonatal Examination.-Part2 Physical Examination 11m 24s Click to view video lecture
Physical Examination-Full Neonatal Examination.-Part3 Physical Examination 13m 14s Click to view video lecture
Physical Examination-Detailed Neurological examination-Part1 Physical Examination 12m 42s Click to view video lecture
Physical Examination-Detailed Neurological examination-Part2 Physical Examination 10m 27s Click to view video lecture
Physical Examination-Detailed Neurological examination-Part3 Physical Examination 9m 30s Click to view video lecture
Physical Examination-Detailed Neurological examination-Part4 Physical Examination 10m 03s Click to view video lecture
Physical Examination-Detailed Neurological examination-Part5 Physical Examination 11m 48s Click to view video lecture
Physical Examination-Detailed Neurological examination-Part6 Physical Examination 7m 44s Click to view video lecture
Physical Examination-Detailed Neurological examination-Part7 Physical Examination 9m 50s Click to view video lecture
Physical Examination-Full Respiratory Examination-Part1 Physical Examination 7m 57s Click to view video lecture
Physical Examination-Full Respiratory Examination-Part2 Physical Examination 8m 58s Click to view video lecture
Physical Examination-Full Thorax Examination-Part1 Physical Examination 10m 27s Click to view video lecture
Physical Examination-Full Thorax Examination-Part2 Physical Examination 9m 17s Click to view video lecture
Physical Examination-Oral Presentation-Part1 Physical Examination 8m 39s Click to view video lecture
Physical Examination-Oral Presentation-Part2 Physical Examination 6m 22s Click to view video lecture
Physical Examination-Oral Presentation-Part3 Physical Examination 9m 56s Click to View Video Lecture
To View TheVideos U need Real player & Flash Player installed on ur Computer...

u can get them Here....

download flash player Download Now

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Free Medical Video Lectures, Animations, E-book Download links....

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5 comments


Hi Guys I am Posting a New Blog With A Site providing LOTS N LOOOOOOOOTS Of videos,e-books,Video lectures......

Here is site which provodes Online Education to all...


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2.17.2008

Step3 How to crack CCS...

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6 comments

Hi guys i found this one posted on a forum and i brought it with the permission of the author ...to this forum hoping it will be helpful our members...i will add more experiences....

If you are travelling across timezones, arrive at your exam city two days prior to adjust. It is a long and tough exam, requiring max concentration.
Day 1 is tougher, I feel. There are seven one hour blocks of MCQs. On either day, you have 1min 15 secs per question, and you’ll need it because the questions are long.
-Because of the above, ALWAYS READ THE ANSWERS FIRST!
This will focus what you are looking for when scanning the question. For example, the actual choices may be about what ethical decision to make, but the body of the question will contain lots of technical waffle.
-Focus your studies on satellite/office settings. This is the bulk of the exam. In fact, those of you with family practice experience will love Step 3.

Day 2 includes ~3 shorter blocks of questions, followed by CCS.

Now on to CCS which is what this posting is mainly about:

-The CCS is really good fun to do actually! Very enjoyable.
The cases (nine in all) are usually quite easy to diagnose. The issue is how to manage them appropriately.
-Before doing the actual exam, you MUST play around with the five sample scenarios that you are given by USMLE. You should also do practice scenarios and think yourself through the case.
-When you start, you are given a one sentence introduction, like: “a 45 year old white man attends complaining of severe chest pain.”
Next, you will be shown the History of the Presenting Complaint, plus PMH, DH, Allergies, FH, ROS, etc.
Up to this point, you have no options, you just have to read through and note the key points.
Before you leave this page, you should do the following:
-Decide on a NARROW differential diagnosis (yes, even before any physical exam has been done).
-Make note of allergies, so you don’t accidentally administer the wrong Rx.
-Make note of risk factors like smoking, obesity, hyptn, etc., and at the end of the case, you will win points by COUNSELLING your patient about these. [in the Order page, you can type ‘counsel’ and click, which will show you all the choices of things to counsel on]
If pertinent, you can also end your case by ordering sensible screening tests, like mammography, pap smear, etc
Okay, now that you have read the full history and decided on a narrow differential, you must next answer this very important question:
Is the patient stable?
ie. will I need to do anything right now?
If yes, do not waste time proceeding to the physical exam, this is inappropriate. Imagine yourself physically there. If you had a man with severe chest pain before you, would you do a thorough exam first? No. You’d immediately bang on some oxygen, pulsox, iv access (for pain relief, among other things), EKG and portable CXR. Don’t forget ABCs, ever.
And if indicated, do not forget obvious tests like: ABG, PEFR, serum glucose, urinalysis!
They are so routine that you might forget about them.
And another important point, what if this happened in an ‘office’? You could get away with applying oxygen and perhaps an iv line/analgesia (if the simulator lets you), but you must very soon ‘move location’ to ER, where you can carry out further management.
If your patient is quite unwell, you will be justified to do lots of emergent things before the actual physical exam. Once you have done those, move on to the PE and click which systems you want examined. A cardio/resp/abdo exam should always be in there, I think, .. plus any other relevant ones.
Once you have read the PE findings, you will be able to narrow your differential even more. And, for example, once the CXR & EKG & blood results come back, you will have a primary diagnosis.
This will be the time to start specific management.
If you have ordered a number of tests and are waiting, you can move the clock forward to get those test results.
If your management is working, you will get feedback like ‘the
patient appears less breathless’ or ‘more comfortable’.
If you’ve gotten the diagnosis & therefore the management wrong, you may see feedback like ‘the patient is getting more breathless’, etc.
Remember the location! If your patient is quite unstable, eg. acute heart failure, MI, DKA, pneumothorax, MOVE THEM TO THE ICU. (In the USA, generally DKAs and pneumothoraces are cared for in ICU). If necessary, give them a central line, or PA catheter, or arterial line. If immobile, remember heparin.
If you see a well patient in an office, with a minor complaint, there is no need to rush. You have time to examine them. Then order any tests if necessary. If you need those test results to get your diagnosis, don’t leave the patient hanging around in your office all day and all night!
Every test you order will show you what time/day it will be back. In an office, most blood tests take about a day. So, send the patient home (with analgesia or whatever else needed) and give them an appointment to come back when the test results are ready.
Particularly in an office setting, you may need to see your patient two or more times over a few weeks, to make sure they are getting better. So, for example, if you see someone with Fe deficiency anemia, don’t just give them some ferrous sulphate and counselling, and not see them again!
And always remember to counsel them as required, eg. drug compliance, smoking cessation.
Altering patient location also applies in the reverse. If your patient on ICU is much better.. send them to a normal ward.
Remember that you will not benefit from overtreating. If you
do an invasive or expensive procedure when not warranted, you risk losing points.
You are expected to be the primary physician to the patient.
But in general, you will not be able to carry out specialised things like evacuating a subdural hematoma. So, if you need to order a specialised procedure, you will need to involve the relevant specialist.
By typing ‘consult’ in the orders page and clicking, you will get a choice of specialists.
BEFORE you refer to a specialist, you must have enough evidence of your reason for referral, otherwise they won’t come. I’ll clarify, if you see a patient with a cough, the pulmonary meds will most likely decline your referral. But if you perform imaging on the chest that shows a discrete lesion,
not only will you interest the pulmonologist, but perhaps also the oncologist. So my point is, you must have solid evidence for a referral, eg. by imaging.
Once you refer, you may find that they go ahead and operate on the problem...

Thanks to intellidoc who posted this...

This i give as experience1

I will post series of advises n experiences from now onwards....

Dr Pavan

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Google Docs A good site for PDF document creation& conversion,Save n Share!

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1 comments

Hi Guys as the point of converting word to Pdf arouse i know a better alternative for that ...Its Nothing But Google documents....(Click on the images below to see them)

The Link is ...http://docs.google.com

This is also a free service and unlike pdfonline.com..It has no limitations...

its very simple and Handy...as most of us r having Gmail Account .....u can see an option on top left of ur account named "DOCUMENTS" click on it


u ll be guided to a window where u have to sign in again with ur Gmail id ..This is one time setup...


Once u log into it...

U can see the sample page how it appears after u log into ur account...


1)Upload Word documents, OpenOffice, RTF, HTML or text (or create documents from scratch).
2)u can use its inbuilt editor to edit/format your documents, spell-check them, etc. when u feel the out put of ur pdf document is not good , like misalignments,border problems etc.,
3)u can directly save them in ur Google Docs and u can even Share That with ur friends
4)U can download them into pdf by clicking on"FILE" and "export as PDF"..the file is downloaded immediately to ur computer!


If u click "PUBLISH"it will be published over internet with a URL(I mean a website link) is given which u can share with ur friends..when u click it u can see the File directly !

Unlike PDFONLINE.com its not time taking and u can save ,share,edit documents....and its delivered as a download directly to ur computer when u click Export as PDF...rather than sending to e-mail..

Hope this Helps

Dr Pavan

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Take a 7Hr Sample Test at Lippincott Williams & Wilkins....For Step1

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0 comments

Hi Guys I hope my Posts....
Usmle Materials And Usmle Test,Ekg material are Helpful...


Now U can Take a sample 7hr test At Lippincott Williams And Wilkins website...
Now click the following link and Register for it..

Click HERE

It comes in two modes ..Test Mode n Review Mode...

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2.16.2008

Strategy for The Match -2009

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1 comments

So when put together all of the things in a time line fashion...FOr example if u would like to apply for Residency Match-2009...

U shud be..

Registered With ECFMG to get ECFMG/USMLE ID-Takes Upto 7days sometimes

Applied For Step1 in October2007 for the slot november-Jan

Took exam In December2007

Apply for Step2 CK and CS For the Slot Feb -April (For CS its 1year slot) in January2008-Send CIN form(Form 186 with Medical credentials if u Get diploma by that time)

Verification is almost 2 month process ..Mean while prepare for nex exam..

(Read the Blog on Credential Verification By Dr D HERE)

Took exam in March/April2008

Start process for Visa in April/May2008

Apply for and attend Visa Interview In MAY2008

Start to US and Take Step2CS Exam in June/ by July5th 2008

Gather LOR's ,Pay ERAS token fee(75$) and get AAMC ID-July1st/August 2008(Myeras opens o July1st)

Send documents thru post (U may even send early !) Between July1st- August1st 2008..

August is the main month Prepare the IMG friendly lists/Gather the Programs u like,Prepare Personal statement,Prepare CV add colours and essenses to it...

Dont Submit CAF ("Common application form" until u feel its complete) -'coz once u submit it it's locked...And it reflects ur Entire Qualifications,etc.,

Apply to Programs u like On the Night of August31-2008 after 12PM

And assign LOR's to atleast one programs 'coz they wont appear even If they r scanned unless they were assigned...

And from there to see the time line go to my blog..

Mean while dont forget to apply for Observerships/Externships 'coz they take long time to get a chance and they r a plus to ur CV..

I hope Most of u are already in the Middle of this path...And GL to all of u !

ERAS Calender for the Match-2009

Date Activity
May 2008 ERAS 2009 Applicant Manuals will be available for PDF download by chapter or in its entirety on our Web site. Schools may begin to generate and distribute MyERAS tokens to applicants.
July 1, 2008 MyERAS Web site opens to applicants to begin working on their applications. Osteopathic applicants may begin selecting and applying to osteopathic training programs only.
July 15, 2008 Osteopathic training programs can begin contacting the ERAS PostOffice to download application files.
September 1, 2008 Applicants may begin applying to ACGME accredited programs. ACGME accredited programs may begin contacting the ERAS PostOffice to download application files.
November 1, 2008 MSPEs are released to ACGME accredited programs.
December 2008 Military Match
January 2009 Urology Match
February 2009 Osteopathic Match
March 2009 NRMP Match results will be available.
May 31, 2009 ERAS PostOffice will close to prepare for the 2010 season.

(Data obtained from ERAS Website.. Go the Original Page ...HERE)

With Regards

Dr Pavan

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Get Ready For the Next Match Season -2009!

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0 comments

Hi Friends I wanted to Post a comprehensive Time Line of preparation for upcoming match...

Lets come in retrospective way..According to time line...

For The admission in 2009 july the procedure for the upcoming match starts on september 1st2008-Called 2009 Match

The procedure is like this..

ERAS is the post office which scans all of our documents(LOR's,CV,Personal Statements,Photo,Transcripts,ECFMG certificate) and send them to the programs to which we apply..

After we send documents...They'll reach in 3-14 days(depends on the method we sent it)...

After that ERAS takes around 15days to scan and keep them online..

So u have to send all doc's atleast 1 month before September1st to ERAS

After u finish off Step1,2ck and CS and completion of ur verification (If its done previously) U ll get your ECFMG certificate in Just 1week...

But Step2CS results come for every 3 months To get results by september1st u shud've taken exam by July5th

For that u shud have got the Visa by then...It takes 1month for the Visa Document preperation and attending the Interview..So u shud be ready by June1st with atleast Step1 Score(With Ck score added to it,It will be good)...

Score reporting takes 21days minimum...So u shud be ready with Step1 exam taken in the Month of April or May

If it were Step2CK u will take atleast 3 months for preparation From Step1 Exam/Score date So u shud've taken Step1 By December..

But to apply for Step1 It takes 14days For ECFMG to accept our Form183(Our Application for Step1 With our Principal's signature) and another3-5days and postal delays etc., so u must be applying in October for the exam in December...

I suggest most of you to apply for Step2cs while applying for Step1/Ck as it is so difficult to get a date for CS.

For My strategy for preparing for Match-2009 See the Blog...HERE

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Videos For Usmle..

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0 comments

Hi Guys, Because of legal issues i had to remove the Kaplan videos...Anyhow i am giving the links here...

Kaplan Ethics Part1

http://video.google.com/videoplay?docid=4564948952311982236

Ethics Part-2

http://video.google.com/videoplay?docid=2706705514826234261

For the entire series click on one link below and u ll see the entire list of videos In the right side pane...

Biochemistry-1

http://video.google.com/videoplay?docid=-5462149774934234579

Biochem-2

http://video.google.com/videoplay?docid=-6875240636373413381

Cariac Output http://video.google.com/videoplay?docid=5762610678107884461

The Other Useful Website is ..

Microbiology & Immunology

Antomy n Physiology Basics

Important site for more Videos is

http://freeusmle.com/default.aspx

(Disclaimer:I am in no way related to or responsible for the content of the websites the above links take you to. I just came across these websites while browsing the internet. I have no idea about the copyright or authenticity of the contents in these websites)

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Online tests,EKG Full Material...

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0 comments

http://www.learnerstv.com/onlinetest/medicine/index.php ...Medicine And other

http://www.med.uiuc.edu/question/.. various subjects

http://www.med.umich.edu/lrc/coursepages/M1/humangenetics/genetics/...

Genetics including Problems! (Like hardey -Weinberg...)

Immunology http://www.immunologyclinic.com/

ECG/EKG http://www.ecglibrary.com/ecghome.html Complete Ecg

Snell's Neuroanatomy..Good Questions! http://un-knownz.blogspot.com/2008/01/snells-clinical-neuroanatomy-...

Take 50 question sample test here.


PHARMACOLOGY Tests: http://www.som.tulane.edu/departments/pharmacology/medpharm/exams.html

Step1 Only---Customizable tests ! HERE

(Disclaimer:I am in no way related to or responsible for the content of the websites the above links take you to. I just came across these websites while browsing the internet. I have no idea about the copyright or authenticity of the contents in these websites)

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2.15.2008

An Img Experience...

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8 comments

I am Posting the story of a poor immigrant who managed walking up the hill on residency and finally succeeded ....Thanks To Intelligentdoc For sharing this With me...
And i hope this will be Inspirational to our members....

An IMG Experience

I graduated in 1998 from medical school and was not able to start my residency right away. In my country, residencies are not paid, so the majority of residents have to live with their parents or be sponsored by their wifes/husbands, coming from a humble family, and being single, that was not my situation.
I immigrated to the US in 2002, and started to re-learn English, those were tough times, no job, no english, and not a single clue about how to continue with my education. Finally after spending 2 years learning english and understanding the intrincacies of the ECFMG Certification - Match I decided to start, by then I was already 28 Years old, been out of medical school for 5 years, and the worst part, I wanted to do Surgery.
Talking to a lot of people, I quickly realized that things were going to be harder than I thought, I got a job as a computer programmer (!), and started from there, the long hours in front the computer, so far from what I love (my patients) made study every day a difficult task. after a couple of months fighting against the routine I was able to get started.
Setting up goals
The first thing I did, which, I think was key to success, was to stablish a detailed plan, all the way from Step 1 to residency. I joined several forums and was aquainted with the general timing of the exams, I learned that in order to be ready and on time, I would need to have my last exam done by the end of September (1st Rule of thumb), and that would allow me to start my residency by june Next year.
I decided to go in order, Step 1, CK, CS, that mean that I would tackle the hardest one first and would work my way through Step 2 without much problems.
Step 1
I decided to study for a full 8 months for step 1, and here comes my second rule of thumb for the USMLE: You will never be as ready as you would like to be for the Exam, just set a timing goal and adhere to it, if you wait to set the dates for the exam once you are ready, most likely that time is going to be more than what you really need.
After gathering the materias, I took the kaplan 150 question practice exam just to see and gauge an starting point. The results were not any good, I was close to 38%!!! in some of the areas, and my best score was not better than 60%. I took the decision to distribuite the time as follows:
6 months reading the Kaplan Lecture notes (3 Huge books by then)
1 month reading and reviewing First Aid
1 final month exclusively doing practice questions.
In between I started doing the Kaplan Qbank in tutor mode, that helps a lot, but in the end that final month was to be done simulating the actual conditions of the exam, in weekdays I use to do timed blocks of 50 questions and in the weekends try to do as many blocks as possible. In the final days of review I was doing an average of 75% in kaplan, enough to pass the Exam, I took the exam in the end of 2004 and got 85. It was not the score I would like to have, but I was relieved it was over.
Getting into a hands on clinical possition - Possible?
Just after getting my results on the exam, I was told by a friend that there was a position available for Foreign Graduated Physicians in a Hospital in Miami, the position is called House Physician, the state of Florida let people like me work as physician, mostly doing History and Physical exam in patients that either are going to surgery or are admitted in the wards. I was able to secure a position and started seeing patients again. Check in your state with the local department of health, they may have this type of position available.
Step 2 -
I Started to study for Step 2 a few weeks after taking Step 1. for step 2 I used only Kaplan Lecture notes and USMLEworld, after reading the book I did every single one of the 2000+ questions, and was able to repeat at least 800 of them. My final score for USMLE World was 58%, I was confident that this score would guarantee at least 90 in the exam. I spend 5 months preparing the exam, and I still remember taking Step 2, Everything seemed so easy, I got 92, almost 93.
Having fun, that’s what matter
By then I had been on my job as a physician for 6 months, doing at least 12 - 15 Cases a day, Step 2 CS was going to be a breeze, I prepared the exam for 15 days, mostly reading the material of First Aid, and the USMLE video, took the exam in Atlanta, in September, Last year, just as I had envisioned 2 years before… The first case was difficult, because I was very nervous, as soon as I exit trhough the door, somehow I realized that my dream was fulfilled, there were only 11 doors, between me and my ECFMG certificate, I just needed to have some fun in between. Results arrived 4 weeks later, I was a certified physician now.
Here comes the difficult part… maybe not
Getting into Surgical residency was going to be hard, I knew, my scores were not perfect, I had no research experience, and my age (30) and the time after my graduation (7 years) was a handicap in my application, but first I needed to get the Letters of recommendation, and after receiving 2 negative answers from attendings, I was able to get letters, from the chairman of the Surgical department at my hospital, a prominent Laparoscopic surgeon and the medical director of the hospital.
Next step was to compose my Personal Statement, it got to be something that while being true to myself also allow me to get the attention of the committees, I received help from a friend who was able to capture my ideas, and at the end the result was better that I was hoping for. I applied for a whooping 92 programs nationwide on the national residency matching program, spending close to $2000 in the process, I did this trying to cover my deficiencies with a massive ammount of program applications.
and then I started to receive emails from the different programs, the first 30 Emails were negatives, something like “thank you very much for applying, but you are not getting an interview here” It was November last year, when a friend told me that someone got into surgery after completing an Observership in a very big and important hospital in my city. despite everybody telling me that it was going to be near impossible to get a position in such that institution, I decided to try to sign up for an observership.
I was lucky enough to fill a position of someone who had already signed up but was unable to attend, that was the only spot that was available for the next 6 months in the trauma unit of the hospital, I was there 3 months, Dec, Jan and Feb, working around the clock with the Surgery intern and the Senior Resident.
At the same time I applied for residency in that hospital, and talked to the Senior Resident, letting him know that I wanted to stay for my residency. Somehow, they called me for interview, I was astonished. it was the end of 2005 when I got my interview, minutes before I was going to talk to the program director, the Senior resident Popped in and talked to him privately for a couple of minutes. My interview was a breeze.
Now, after writing this, I am heading to Jackson Memorial Hospital in Miami, FL; to finish the paperwork and to do the physical, I signed the contract in December,2005; 3 months before the match, and I will be starting my residency in General Surgery in June… Although I am anxious, I know that everything is going to be all right, I am confident that with hard work and the help of who is now my wife, that has supported me since I was in my country, I am going to be able to go through my residency, being successful, but most of all, having fun, enjoying it, as I have enjoyed every single step of the way, experiences, that happen only once, but last for a life time.
By the way, I was called by 13 different programs across the nation, never went to a single interview!

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HIV Replication 3D-Animation