Discover and read the best of Twitter Threads about #medtwitter

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Interested in how I teach #SoMe to medical students? Here are my slides from yesterday’s #MS1 presentation.

The format was different this year. Previously, I’ve taught 3 hr workshops to groups of 12.

All 186 students were together for this 40 min lecture then split into groups.
This is always a fun question to ask an audience! Every hand 🙋‍♀️🙋‍♂️ except for one student.

185/186 were on some form of social media.

#tweetorial #meded #medtwitter #SoMe #SoMeDocs
What about last year? The numbers were even better! Every student who participated in a poll was on some form of social media.

Why is FB so popular? The school sets up a student only group prior to the academic year. Many rejoin the platform for access.

#Tweetorial #SoMe #MedEd
Read 12 tweets
Alright, #medtwitter. Time for your #SundayService.

My residency program accepted two new trainees a year. In 2011, one was a blond, blue-eyed, corn-fed son of the Midwest.

The other was me.
1/
We were always treated differently, and it was never more clear than in how we were perceived when we struggled.

He was always given the benefit of the doubt, encouraged that training was hard sometimes but he'd get through it.

Support was always there for him.
Unsolicited.
2/
What I received was silence.
And whispers, so soft that I would mistake them for voices in my own head:
'Lazy' 'Unprepared' 'Unfocused'
'Do you think he's hungover?'
'He was probably up all night getting lucky'
3/
Read 13 tweets
My take on surprise billing legislation: Physicians all agree we need to take patients out of the picture when it comes to billing.

But insurance companies have capitalized on opp to lobby for federal “surprise billing” laws to give them more power to profit off backs of docs.
Current legislation in the Senate S.1895 @SenAlexander being considered eliminates ability of docs to negotiate with insurance companies. Never mind we are fighting prior auths, denials, and endless paperwork that prevent us from spending time with our patients.
Now they want to cut compensation and eliminate any way of fighting back.

This affects all physicians. Not just out of network physicians, in network physicians, academic, private, employed. All of us!
Read 10 tweets
We are starting! @StanfordMedRes grand rounds with @DrQuinnCapers4 on diversity in medicine. @HeartBobH introducing with a long list of accolades, including helping start #blackmeninmedicine. Room is packed and standing room only. #medtwitter
The lack of diversity in US physician workforce is a national emergency with @DrQuinnCapers4 @StanfordMedRes grand rounds. #medtwitter
What is happening? There is a leaky pipeline that starts in kindergarten. At every stage, there are obstacles to minorities trying to enter medicine. @DrQuinnCapers4 states we need to address the leaky pipeline at every stage. #medtwitter
Read 16 tweets
There are many guides on how to write a personal statement. I thought I’d share my own thoughts for all those #premed & #medstudenttwitter folks. This is just my opinion, but it’s served me well.

So here goes: a #tweetorial on the PERSONAL STATEMENT!

#meded #medtwitter
1/
Unlike another recent #medthread on the PS, I don’t think we should be using it to scare our applicants or to expect that they entertain us. Applying for the next level be it med school, residency, or whatever is stressful enough! Let’s support our applicants through it!
2/
First of all, I think the PS when poorly written can definitely lose you an interview. When written in a super compelling way, it may tip you toward getting an interview, but in the vast majority of cases, it doesn’t move the needle much. So first rule: don’t get weird.
3/
Read 15 tweets
A #tweetorial about defining your protocol for per-protocol effects, using the LIVE trial of personalized mechanical ventilation for acute respiratory distress syndrome (ARDS).

h/t @otavio_ranzani @f_g_zampieri

Original article in @LancetRespirMed👇🏼
thelancet.com/journals/lanre…
First, what is the research question?

The Lung Imaging for Ventilator Setting (LIVE) trial was designed to test if choosing ventilator settings based on lung features (focal vs non-focal) could help improve ARDS survival, relative to a one-size-fits-all ventilation approach.
Of 1080 potential participants w/ ARDS assessed for eligibility, 420 were eventually randomized to either the control arm (one-size-fits-all settings) or personalized arm (settings based on focal vs non-focal).

The treatment matrix is sorta complex, so I’m pasting it here👇🏼
Read 26 tweets
I'm seeing a lot of trending about the news of Jeffrey #Epstein's death.

I am also a suicidologist.

I wanted to correct some simple misinformation.

Thread.
Tw: Suicide, as I will be communicating directly about suicide.

Tw: child abuse, because of course, this involves a man accused of heinous crimes against children

#medtwitter #meded #psychtitter #SuicideAwareness
Misinformation: supervision would have prevented his death

Suicide is not preventable via lockup or supervision. Human ingenuity beats supervision 100% of the time.

* A review of 76 inpatient suicides showed that 50% died on 1:1 or q15 checks.
Read 5 tweets
Friday #Medthread! I’ve been chatting lately that I should write a #tweetorial about how I’ve put my social media related/based activities on my academic/professional CV. So, without further ado... 1/x
these are excited times, & hopefully this won't be uncharted territory for too much longer as standards are set and more institutions embrace social media related activities...BUT for now...how do you show your uniqueness and innovations via #medtwitter #SoMe?? 2/x
Disclaimers:
1⃣these are my opinions (grounded in experience & many discussions)
2⃣I use the OHSU CV template (Scholarship/Service/Teaching)
3⃣employers may not be ready to embrace

PS--bonus points--name the TV show the GIF is from!! (probably not known/respected enough...)
Read 18 tweets
Every summer my heart is heavy with memories of a time when I even came close to leaving #medicine-when career & motherhood collided and I didn’t ask for help.

I want to share that story in case it helps even 1 person.(Thread) #medtwitter #meded #womeninmedicine #TipsForNewDocs
I share this now because July is full of #tipsfornewdocs but August comes & we all get swallowed up in the hustle & bustle of heavy clinical loads- when orientation ends and the real work begins.
I had just finished #pediatric residency and started #anesthesia residency with a 6 month old baby. Orientation was over & we were deployed to do our first cases in the OR without an attending always in the room with us.
Read 19 tweets
I’m a fellowship director who just finished reviewing over 400 applications for 8 fellowship spots.

The following is a #thread on writing a personal statements.
(Spoiler alert: I find 99% of them to be TERRIBLE.)

#meded
#medtwitter
#medstudenttwitter
1/
The following are MY preferences and proclivities. Some will ring true for other PDs, some may not. And Turi McNamee wrote very eloquently about this in @AnnalsofIM in 2012. pdfs.semanticscholar.org/94f4/4d6b3da42…
2/
I’m going to tag @davidschulman , @jennifer_jwm , @KristinBurkart3 , @DrMCMiles, @GenevaTatemMD, who are PD colleagues in #pccm, and @sanjayvdesai , @TKapetanos , @MitchGoldmanMD, @abbyCCim, @jenchoi_iu and any others who are PDs. I’d love to hear from them on this topic.
3/
Read 28 tweets
THREAD: I’m a scientist and I gained 1K TWITTER FOLLOWERS in FIVE WEEKS. Here’s how I did it. #medtwitter #epitwitter #AcademicTwitter #AcademicChatter #phdchat
1. I changed my mindset about Twitter. When I first started my account, I thought of it as a personal platform where people yell at each other (true). But it’s more than that. It’s a PROFESSIONAL NETWORKING tool. Use it to find your tribe. I’m looking at you #epitwitter.
2. I made my profile searchable and memorable. Does your bio describe you or does it sound like a canned bio on your employer’s website (or worse: a dating site)? Describe your profession. Add some dimension like #vegetarian #endocrinologist. Give people a reason to follow you.
Read 16 tweets
1/ A quick glance at the foot of the bed unravels a rare answer to a common complaint... another #tweetorial to sharpen our #clinicalreasoning skills, #medtwitter! Try to solve this mystery case and see if you can... nail it!
2/ A 58 year-old man presented with gradual, progressive dyspnea. Two months ago he had no trouble ambulating, now he is limited to several blocks.
3/ Take a mental pause here to practice how you might approach “dyspnea”, and then listen to @BBroderickMD take us through it: bit.ly/32fCXXr
Read 18 tweets
Okay, #medtwitter, let's discuss this: inquirer.com/business/lambe…
I don't know Pollack but a few points about these cases in general:
1. Sexual harassment is usually not the only bad behavior; it's often one of a constellation of behaviors
2. The best question is not "what's wrong with this guy?" but...
“What’s up with the environment that allowed him not just to survive, but to thrive?”
3. In what way is this being addressed beyond his expulsion? Organizational M&M, anyone?
Read 12 tweets
Hey #tipsfornewdocs #medtwitter folks! I wanted to review side effects of immune checkpoint inhibitors (ICIs) for a non-#oncology audience. Immune-related adverse events (irAEs) present across all medicine specialties so we are all in this together. 1/x
The most common ICIs are against PD-1 (e.g. nivolumab, pembrolizumab) and PD-L1 (e.g. atezolizumab, durvalumab). I use a blanket term “PD-1” throughout. Anti-CTLA-4 (ipilimumab) is a distant second; often in combo or directly after PD-1 in #melanoma #lung #kidney cancers. 2/x
They have led to pharma riches and Nobel Prizes and lots of TV commercials because they work really well for some patients. People with advanced #melanoma, #lcsm etc who used to live ~1 year now can hope to live for several years or more. 3/x
Read 17 tweets
Want to hear a joke?

What's bumpy & painful, & "read" all over?

A #tweetorial/#medthread on ERYTHEMA NODOSUM!

Now that I've lost a few hundred followers from that terrible opener😳, let's get started👇👇

#MedEd #FOAMEd #dermatology #dermtwitter #medtwitter pc: @dermnetnz
1/
Why talk about erythema nodosum (EN) in the first place? Well, most medical professional recognize it, will see it, but may need some help past that! If that's you, read on.
1st, exam: As the name implies- red nodules! It's usually on the legs, & they are often ill-defined.
2/
EN is commonly seen in young healthy pts, & women >> men. Of course, the patient's history is critical, as EN is a reactive process to something else! It's inflammation in the subQ fat (a panniculitis). The rash itself isn't dangerous, but should prompt looking for a trigger.
3/
Read 13 tweets
Wrote this piece with the help of a great team including @DrKevinHill. Below I'll share some of my thoughts about #opioids and opioid use disorder and how they present in #hpm and #palliative care, plus why we need to do a better job of addressing #addiction at end of life. 1/x
2/x Training in #KY gave me a front row seat to the #opioidcrisis. With an interest in #hpm I kept wondering what would happen to these individuals who developed an OUD and years later were prescribed opioids. How would I keep those patients safe and manage their pain?
3/x I continue to think that our field will struggle in years to come when survivors of the #opioidcrisis age, develop serious illness, and develop pain. Thinking about this, and reading @jeff_deeney article in @TheAtlantic theatlantic.com/health/archive… made me want to do more.
Read 13 tweets
@813JAFERD @Orthofacts Sugartong or radial gutter

Something that is MOLDED to the arm especially dorsally (for dorsal fxs) to buttress the fx

NO MOLD NO HOLD

The point of the splint isn't just protect arm from exterior contact. If done well, can also maintain reduction (assuming that is done well)
@813JAFERD @Orthofacts Imagine the red is what the fracture WANTS to do. Muscle pull is trying to displace it backward RED=BAD

Geen is the force you apply to reduce it

GREEN=GOOD

ADEQUATE REDUCTION NEEDS LOTS OF GREEN

FOR IT TO STAY, SPLINT MUST CONTINUALLY APPLY GREEN FORCE
#medtwitter #FOAMed
@813JAFERD @Orthofacts GRAY in above diagram = PLASTER

Note it's NOT orthoglass

Also note how it doesn't help to extend the splint beyond the metacarpals SO DON'T

GREEN force is applied to the wrist

Splint doesn't work unless you hold splint material UNTIL it HARDENS obvi #MedTwitter
#NoMoldNoHold
Read 6 tweets
#MECFS citizen science: What are the answers to these 6 important questions on Myalgic Encephalomyelitis???

The insightful questions below come from this nice @diagnostic_mdpi review

#mdpidiagnostics #pwME #chronicillness #SickNotWeak #MyalgicE
mdpi.com/2075-4418/9/3/…
1. Is there a genetic susceptibility which leaves some individuals vulnerable to #MECFS after exposure to a virus, bacteria or toxic chemical?

#pwME #chronicillness #SickNotWeak #MyalgicE @diagnostic_mdpi #medtwitter #genetic
2. What is the key initial physiological trigger causing the dramatic downward spiral in health leading to #MECFS?

#pwME #chronicillness #SickNotWeak #MyalgicE @diagnostic_mdpi #medtwitter #immunity
Read 8 tweets
#Tweetorial vs. #UnsolicitedAdviceThread
🤔"What I wish I knew"🤔
#tipsfornewdocs #2wk

I was asked to do a wonderful Q&A during @umnmedresidency's first intern academic 1/2 day

Complied all tips👇

(💪work @Kay_L_Ingraham, @VigneshWP, @PendlKM) with co-panel (@jenwong101)
Before we begin.

Aside from trying to coax you to try twitter for #FOAMed #MedEd ...

Please know👉🏽not every tip will work for every person. Find what works for you!

Don't be overwhelmed
👉 Focus on something new each week or month!
** Audience ?s **

🗝️ Step 3 😱?👉focus on patient care unless you are taking w/in 3 months, just get signed up (it'll be OK)

🗝️ Research?👉focus on patient care and being a wonderful doctor (till spring @ earliest)

🗝️ Reading?👉read to care for your patient's illness

#theme?
Read 18 tweets
Thread:

#MECFS patients face disbelief that they are sick

Many #MECFS patients are told that they are simply tired, stressed, anxious, depressed, lazy or malingering

How can #pwME respond to such disbelief and lack of understanding??????

See thread below:
2. Below are 7 evidence-based scientifically supported findings that you can use to inform those who dont understand that #MECFS is a multi-organ, systemic and severely debilitating illness

From a lovely review by @HarvardAskDrK in @JAMA_current
ja.ma/2xF3WNT
3. #pwME have deficiencies in 3 organs important for the body's hormonal balances called the hypothalamic-pituitary-adrenal axis

Importantly, the deficiencies observed in #MECFS patients are quite different to that seen in #depression
Read 10 tweets
In 2001, I #failed 4 core science classes in #medicalschool. I didn’t go to class, I stayed up late at night reading the topics in every book I could possibly find. I barely passed my other courses. I couldn’t believe NEone passed..
1/
I had to go before the review and promotions committee and beg for a chance to try again. I don’t for the life of me see why they gave me the chance...

I can say, I tried hard, I just wasn’t smart about it.

In the summer before restarting m1, I came up with a plan..
2/
I approached each of the top 10% in the class I was now leaving. I asked them how they did it, down to the details on brands of pens, where they sat in class, what they ate, and when they went to bed.

Guess what...they were pretty uniform in their methods.
3/
Read 13 tweets
#MedStudentTwitter #IMResidency

It’s Personal Statement Season!

I help review med student statements and have a few thoughts to share to hopefully help students/faculty along the way.

Its a thread.

👉awesome PDs can chime in @carolinemilneMD @abbyCCim @CincyIM @AmyOxentenkoMD
1⃣Big Picture
The personal statement is an opportunity to weave together
* highlights from CV
* experiences
* personal attributes
Into a cohesive story that explains
- Why you are going into IM
- What you can bring to a program
#IM_PSTips
2⃣ To start, find your PS from your Med School Application

- Think about how you have grown since then...
- What experiences in med school helped you grow into the prepared student you are now ready for residency?

☑️ Write all of this down
#Reflect #growthmindset #IM_PSTips
Read 12 tweets
I listen to ~90 #Podcasts on a (semi) regular basis. Let me give you a rundown of ALL of them and why you should listen to some amazing #FOAMed, especially for all the new #EmergencyMedicine interns. #FOAMed #MedEd #medtwitter
First of all, you need a good podcast app. I absolutely love Downcast. Great app, gives you more control over playback, downloading, and allows you to categorize your podcasts into playlists (picture 2). This is where you get to customize your #FOAMed experience! #medtwitter
In no particular order,

- Anesthesia and Critical Care Reviews and Commentary (ACCRAC). Great insight into Crit Care from an anesthesia perspective. Coming from EM, this is great to listen to- much different from my day-to-day! #FOAMed #FOAMcc #CriticalCare
Read 88 tweets
Well @TheCurbsiders, thought I forgot about following up on this tweet?! Well, I did. I'm on the inpatient Hospitalist Service. Nevertheless, let's go down this rabid hole together...
So the question remains - what is the best pharmacologic intervention to reduce post-operative VTE after orthopedic surgery. A prior EBM presentation that I routinely give compares Apixaban vs Enoxaparin which finds that the NNT to prevent one major VTE of 166.
Great, so Apixaban may be better than Enoxaparin (with questionable cost benefit). Apparently, oral anticoagulants, in general, are likely more efficacious than Enoxaparin.
Read 8 tweets

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