Article in Today's Al Qabas about the new KIMS rules

13291 - 30/05/2010, Al Qabas (see below for English version)

لوزير الصحة إلغاء القرار الجائر بحق الأطباء


لكم تمنينا ان يرى النور اقتراحنا بإنشاء «سوبر هاي واي» للاطباء الكويتيين، لتحفيزهم على التخصص والابداع، كما حدث في السبعينات في اميركا، عندما اقترحه الرئيس نيكسون، فكان من بين الاسباب التي جعلت اميركا من اكثر دول العالم تطورا في مجال الطب. ولكننا للأسف سمعنا، من خلال شكوى تقدم بها لنا اطباء متدربون، انه بدلا من ان يكون هناك «سوبر هاي واي»، فإن الوزارة اصدرت قرارا يعتبر «حفرة داون واي» في الشارع الضيق الذي يسير عليه ابناؤنا وبناتنا من الاطباء!
لقد صدر قرار جائر منذ ثلاثة اسابيع من معهد الكويت للتخصصات الطبية التابع للوزارة، الذي يترأسه دكتور ليس طبيبا، يلزم الاطباء المتدربين قبل تاريخ 10 يونيو بأن ينقبلوا في تخصص من بين ثلاثة تخصصات فقط في البورد الكويتي، من غير ان يسمح لهم بالانتقال الى درجة الطبيب المساعد حتى يمارسوا هذه التخصصات لمدة كافية! فكيف يا معالي الوزير يختار هذا الطبيب المتدرب تخصصا غير مقتنع به تماما بسبب ضيق الوقت؟ كما يقول طبيب في شكواه: كيف أختار ولم يمض على تدريبي سوى اسبوعين فقط؟! كيف ولم يعرف الاطباء حتى الآن مدى توافق هذه التخصصات مع ميولهم المهنية؟ ان توافق التخصص مع الميول المهنية هو سر الابداع لدى الطبيب يا معالي الوزير، فجاء قرار الوزارة جائراً محبطاً لا يراعي مصلحة الاطباء.
لقد كان الطبيب في السابق يعطى سنة من التدريب لينتقل بعدها ليكون طبيبا مساعدا، وله ان يبقى طبيبا مساعدا، اما اذا اراد الترقية فعليه ان ينقبل في اي بورد سواء كان الكويتي، غير المعترف به عالميا، او اي بورد خارجي، فتكون للاطباء فرصة للممارسة قبل ان يقرروا تخصصهم وبأي بورد يلتحقون.
ما زاد الطين بلة ان القرار، الذي قيل انه صدر لتوفير اموال عن كل رأس طبيب متدرب للوزارة! قد نُقل للاطباء شفهيا، وبطريقة غير لائقة لا تخلو من الصراخ احيانا عندما يتقدمون للسؤال عن تفاصيل القرار التي يبدو ان رئيس المعهد الذي اصدرها لا يعرفها جيدا، فلا تعميم مكتوب ولا لائحة تنفيذية بالشروط والضوابط، وما زاد الطين بلة، فصار «صبخة»، ان هذا القرار قد ألغى مكانة مصداقية اختبار MRCP المعترف به عالميا، حيث قال المسؤول لطبيبة حاصلة على درجة الاختبار «بلّيها واشربي ماءها»! لان شرط الترقية والبعثة هو دخول البورد الكويتي فقط! فما هذا التخبط يا وزارة الصحة؟! هل يصدق معالي الوزير انه عندما سأل احد الاطباء احد المسؤولين بالوزارة: من سيؤدي العمل اذا صارت درجة الطبيب المساعد فارغة بالمستشفيات بسبب هذا القرار؟ اجاب ببرود: «نجيب هنود من بره يشيلون الشغل بربع معاشكم»!‍!! فيا معالي وزير الصحة ويا سعادة الوكيل الموقر، هذا القرار فيه اجحاف بحق مستقبل أهم مهنة في البلد، مما يستدعي إلغاؤه، لأنه جائر بحق الاطباء.
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إن أصبت فمن الله وإن اخطأت فمن نفسي والشيطان.

بدر خالد البحر
bdralbhr@yahoo.com

English Version

To the Minister of Health: Cancel the Unjust Decision Towards Doctors

We were hoping that our suggestion, to create a "super highway" career path for Kuwaiti doctors would see light, to encourage Kuwaiti doctors to specialize and innovate. When President Nixon made the same suggestion in America, in the seventies; it became one of the drivers for the advancement of healthcare there. Unfortunately, recent decisions made by the Kuwait Institute of Medical Specialization (KIMS) are the equivalent of digging holes in the career paths of junior doctors, instead of building 'super highways' to help them on the already narrow road of medical specialization

The unjust decision was passed three weeks ago by KIMS, which is headed by a doctor who's not even a physician himself. This decision reads, that all doctors must select three choices for a specialty to pursue in the Kuwaiti board before the 10th of June, of which they'll be accepted into one only. In addition, doctors won't be promoted to the level of assistant registrar without spending a set amount of time in their selected specialty. We pose the question to the Minister of Health, how can a doctor be forced to choose a specialty they are unsure they want to pursue, as is likely to happen when doctors are not given adequate time to think this decision through? A young doctor complained to me, "How can I choose a specialty when I've only been training for two weeks?".

How can doctors choose a specialty when they are yet to figure out which one agrees with their career inclinations? A doctor's innovation is closely tied with the synchrony of his or her career inclinations and the specialty they are enrolled into. I would like to voice my concerns to the Minister of Health that this decision is unjust and goes against the interests of physicians. In the past, a trainee doctor spent one year in training. Next, he or she was promoted to the grade of assistant registrar. Then, the doctor had the right to remain an assistant registrar or seek promotion via the Kuwaiti board, which is not internationally accredited, or any other foreign accredited board. As such, physicians were given an entire year to choose which board and which specialty they would like to be enrolled into.

What makes things worse, is that a trainee doctor was told that this decision was brought in place to decrease the amount of money spent on doctors. It was delivered in an inappropriate manner and questions regarding the minutiae of the decision were met with rude and loud responses. It appears that even the head of the institute is not aware of all the details of the decision. The decision was not put in writing and there are no clear rules and regulations that must be followed. Also, it appears that the MRCP (internationally accredited membership) has been rendered useless, as the only road to a promotion and scholarship is through the Kuwaiti board. What is with all this incompetence? A Kuwaiti doctors asked, "Who will cover the workload delegated to assistant registrars if no Kuwaitis are enrolled in it because of this decision?" The reply from the head of the institute was, "We'll bring Indians from abroad who will work for a quarter of your pay!"

Finally, I say to the Minister of Health; this decision is prejudiced towards the most important profession in the country and it is unjust towards the future generation of physicians; it should be revoked!

By: Bader Khaled Al Bahar
Published: Al Qabas Newspaper

bdralbhr@yahoo.com

(Kindly translated by Mohammad Hassan)

KIMS's new rules?

So word's been going around that KIMS are changing the scholarship rules for people who would like to specialize abroad. To be honest, I'm not well versed on the issue but what I can gather from people (which may not be entirely accurate so don't quote us!):

-High GPA
-High TOEFL score
-You need to get into the Kuwaiti board and pass their exam
-You don't get to choose which country you go to
-You don't get to choose which specialty you get into

I guess what's more frustrating than having new rules is not having a system in place where these regulations are spelt out (on KIMS's website or another regulatory body). Things are a bit murky for junior doctors at the moment with little guidance from administrators to help them plan their future.

Anyway, for interested parties, apparently there's going to be a meeting at Kuwait Medical Association's HQ at 8pm today, Kuwait time.

More information is available if you join this facebook group: http://www.facebook.com/group.php?gid=118389084868775#!/group.php?gid=118389084868775&v=wall

Let us know if you are in possession of any more information!

Dancing Arrythmias!

First Near-Total Face Transplant Performed by Cleveland Clinic

Fever Series (Challenge 2): 'high temp after travel' What's the diagnosis?

26 year-old female presents to the ER with fever and rigors. Her symptoms are particularly troublesome every 2 days. While taking bloods, the resident asks her about a recent holiday or travel abroad. She mentions being in West Africa for some period of time for voluntary work.

O/E she has elevated temperature of 39 C.

What is the working diagnosis?

What signs would you look for?

( A bonus mark for explaining the pathophysiology !! )

Nature Book Reviews: The Vanishing Physician Scientists?

The USA is the birthplace of many prominent physician-scientists and even there, it appears that the numbers of practicing physician-scientists are dwindling. This book, reviewed by the journal Nature, offers possible explanations for the drop in physicians who practice science.

The academic niche for physician-scientists has been degenerating for over three decades. In 1979, the director of the US National Institutes of Health (NIH), James Wyngaarden, initially highlighted an alarming drop-off in the number of physician-scientists and their success rates in NIH funding. Since then, the combined burdens of an increasingly stringent overall NIH budget, educational loans on young physicians (often in the six figures), the procedure-driven nature of modern clinical medicine, and the financial vise of managed care and its follow-on effects on the academic environment have created an increasingly ablative force on the necessary environment to maintain a proper balance in the numbers of physician-scientists. In The Vanishing Physician-Scientist?, edited by Andrew I. Schafer, currently chairman of the Department of Medicine at Weill Cornell Medical College, the fate of the physician-scientist is revisited from multiple angles: renewal versus extinction, the evolution of diverse lineages (MD-PhD, late bloomers with MD degrees alone, PhDs in clinical departments), implications for biotechnology and drug discovery, gender imbalance, pipeline versus attrition effects, role models, financial and modern lifestyle concerns and the fragile microenvironmental niche of academic medicine in general. The result is a fascinating must-read for those of us with a deep interest in the subject that goes beyond conjecture and anecdotal personal experience to recent academic survey data, population analyses, current NIH funding trends, outcome analyses of MD-PhD trainees and, most importantly, onward toward a series of cogent, specific and implementable suggestions for regeneration. As the last page is turned, a more sanguine view of the problem emerges, along with a few surprises.

The book is comprised of 15 chapters written by over twenty leading physician-scientists who offer a number of penetrating insights into the crux of the problem of regenerating a new cadre of leaders in academic medicine. For example, as noted in the book by Tim Ley, a former president of the American Society of Clinical Investigation, the demographics of physician-scientists have been relatively stable since 1990. The bulk of these researchers hold an MD degree alone, and their success rates for NIH funding are similar to others with PhD or MD-PhD joint degrees. A surprising trend of combined MD-PhD trainees moving away from scientific careers is also evident in survey analyses. Interestingly, a case can be made to enhance our focus on designing strategies for renewing the population of physician-scientists. Also, as noted by Ley, the pool of physician-scientists is still overwhelmingly male, despite the near equal number of females in medical school today, indicating a need to address gender-specific issues.

'Translational medicine' has become the mantra for every medical school dean in the US and elsewhere, and, as presented by Barry Coller, the physician-in-chief of Rockefeller University, in his chapter, regenerating the pool of physician-scientists is clearly central to this goal. Increasingly, scientific centers of excellence are forging close networks with leading medical institutions, creating an interactive, nurturing microenvironment for physician-scientists. In this new era, in which humans themselves are models for human disease, technological barriers are rapidly breaking down, as higher-throughput human genotyping, whole exome or genome sequencing and high-content chemical screening on human stem cell model systems are becoming customary. The major discoveries in genomics research coming out of the Broad Institute at the Massachusetts Institute of Technology, in close collaboration with physicians at Massachusetts General Hospital and elsewhere, come to mind. Finding the extreme and rare clinical phenotypes of major interest, and having the capability of calling back the patient for additional information, will be increasingly important going forward. However, as Coller clearly documents, academia must recalibrate how young physicians are recognized, protected and promoted as essential components of these large interdisciplinary teams.

The crucial role of the environmental academic niche for physician-scientists, and the need for its substantial modification, is a major point of discussion in many chapters. In terms of mentoring, the needs for earlier exposure to research in the core medical curriculum, as well as in post-graduate MD training, the inclusion of off-site mentors and exposure to successful physician-scientists that have managed to balance the scientific and medical demands of their profession with personal family goals are mentioned throughout the book. The need for the institution itself to create a more nurturing infrastructure is also highlighted.

Finally, as noted by the preeminent physician-scientist David Nathan, the former president of the Dana-Farber Cancer Institute and also the physician-in-chief of Children's Hospital in Boston, there has never been a more exciting time to be a physician-scientist. “They must not and will not vanish,” he writes. “Indeed, their future can be as bright as ever if we proactively fashion it with creativity, foresight, and vision.” This future is clearly being empowered by annotated digital medical records, expanding databases on genotype-phenotype disease correlations from global collaborations, and research centers and networks funded by major philanthropic organizations and individuals. Likewise, the ability to study human disease in a dish, offered by recent advances in human stem cell biology, are extraordinary, offering the possibility of studying extremely rare and highly differentiated human cells from people with specific, rare and/or common diseases. Clearly, a resurgence in human physiology is on the horizon, and this need alone is likely to lead to a new breed of physician-scientists. The future of biology might be summed up in three words: human, human and human. Stethoscope, anyone?

You can buy this book from Amazon here.

Fever Series (1st Challenge): 'A neck lump, high temp and loose pants' What's the diagnosis?

23 year-old British Caucasian university student felt some gland swelling at her neck. Upon further questioning, she reports on and off fever with overnight sweating, and noticed 7 kg weight loss. She travelled to Malaysia, Thailand and Hong Kong 6 months previously. BCG vaccination has been obtained. On examination, there is palpable rubbery cervical lymphadenopathy. Subsequent chest X ray uncovers increased mediastinal opacity and enlargement.

What is the differential diagnosis and course of action?

US Hospital Rankings

The new USNews rankings have been out for a while so here's the link for those of you who missed it:

USNews:

http://health.usnews.com/best-hospitals

Here is also Thompson Reuters' rankings which is divided into teaching/community hospitals:

Thompson Reuters Top National Hospitals:

http://www.100tophospitals.com/top-national-hospitals/

Neurosurgeons Go Paperless at Annual Meeting With iPod Touch in Their Pockets

From Medscape Medical News
Daniel M. Keller, PhD

May 3, 2010 (Philadelphia, Pennsylvania) — Using the iPod Touch isn't brain surgery, but when 1 neurosurgeon saw what his young daughter could do with it, he got a brainstorm. The American Association of Neurological Surgeons (AANS) was looking for something more to offer its members at its annual meeting than the same old shoulder bag filled with weighty program and abstract books.
Michael Oh, MD, associate professor of neurosurgery at Drexel University, Philadelphia, Pennsylvania, and West Virginia University, Morgantown, said his daughter "zooms around [the iPod Touch], and she has access to so much information that it would be a perfect thing to have at a medical meeting." He proposed the idea to AANS president Troy Tippett, MD, who wanted to find a way to make the association's annual meeting more creative in a way that would offer more benefits to members. Dr. Oh then became the chair of the AANS iPod Touch Taskforce Committee.
"The whole purpose of those meetings is to transmit and communicate new information," Dr. Oh said. The idea of adopting the iPod Touch was to make the 2010 scientific meeting "more in your pocket and always available and on demand."
So at this year's AANS annual meeting, held May 1-5 in Philadelphia, attendees are all given an iPod Touch loaded with an AANS application, abstracts, the meeting program, podcasts, videocasts, electronic versions of posters, and clinical guidelines.
They will also be able to instant message their colleagues via Wi-Fi, participate in interactive audience polling during courses and scientific sessions, schedule which sessions to attend, and see maps to find rooms in the convention center and vendor booths on the exhibit floor. If a room number or presentation time changes, their schedules will be automatically updated via dynamic links. They can see a city guide and even make restaurant reservations through the Open Table online service.
This year, the more than 400 posters appear only in electronic form as an abstract and slides, and there are no actual poster sessions. Attendees can search for posters by author name or keyword. If a viewer wants to talk with an author he or she can send an instant message with a question or arrange a time to meet. In the future, Dr. Oh said, viewers may be able to leave comments about each poster.
Getting Up to Speed
Communications director Betsy van Die said AANS has ordered 3500 iPod Touches to be given to all paying attendees. Because the use of this technology is new to them, the AANS has done a year-long program of education through biweekly newsletters and online tutorials. In addition, “marshals” wearing distinctive armbands will be available at the conference to help any attendees with their devices.
Dr. Oh said that once the AANS started planning uses for the iPod Touch devices, "We realized it wasn't just going to be for the meeting. It will probably transform how our membership really communicates with each other and with the organization.
"It offers...new ways to look at information, transmit information, communicate with our peers...[and] be that sort of common device that transforms our membership into a community. I think that's the long-term exciting part of this project." He expects people to bring their iPod Touches to next year's meeting to have them loaded with new content.

The AANS has budgeted for a 3-year program of using the iPod Touch devices. "Even in a down economic year, we were able to meet and exceed our budget for sponsors," Dr. Oh said, "so we're very pleased with that. I think that it helped that we had something new and novel to offer sponsors."
The cost of the devices is offset by an additional $100 being added to the registration fee. Gone are the old "door drops" of promotional materials from exhibitors. Instead, the AANS has offered exhibitors several forms of advertising on the iPod Touch, ranging in cost from $1000 to $10,000, plus the cost of product give-aways or services (eg, video production for videocasts).
Opportunities include blast emails, splash ads, banner ads, exhibitor Website listings, podcasts, videocasts, iPod Touch cases, AC chargers, iTunes cards, and individual custom applications. Ms van Die said 40 company-sponsored email blasts are scheduled for the meeting.
"Some of them have action items in them, like 'Come to our booth for a raffle drawing.' So there's been a huge amount of enthusiasm from the sponsors on this, and they're very excited that it's more interactive," Ms van Die explained. She said many other medical societies are interested in using the iPod Touch at their meetings, and they have contacted the AANS to see how it has implemented the technology and are waiting to see the outcome.
Dr. Oh and Ms van Die have disclosed no relevant financial relationships.
American Association of Neurological Surgeons (AANS) 2010 Annual Meeting.

A Brilliant Meeting for Medical Students with Passion and Interest in Science

The joint meeting of the American Association of Physicians and American Society of Clinical Investigators (AAP-ASCI) synchronized and coordinated by by the American Physician Scientist Association (APSA) takes place in the beautiful city of Chicago every year. I have been lucky to attend this year’s meeting despite extensive disruption of airline services due to the ‘volcanic ash’!!

If you are a medical student interested in research, this meeting should be one of the items in your to-do list! The AAP-ASCI-APSA meeting provides exceptional opportunity for medical students undertaking research or considering a science career in medicine. You get to meet up with first-class physician scientists and important policy makers in medical science.

The meeting started with a keynote lecture by Professor E. Albert Reece (pictured), Dean of the University of Maryland Medical School. His research team is trying to figure out the mechanism of birth defects in fetuses born to mothers with type 2 diabetes mellitus. While summarizing unpublished data, he emphasized the advantage of being a physician scientist whereby the problem is identified in the clinic and taken to the laboratory for thorough investigation.

E. Albert Reece

The Noble Laureate in Medicine and Physiology, professor Joseph Goldstein (pictured) from UT Southwestern Medical Centre inspired the audience as he explained the ingredients of being a good physician scientist. In order to get his message across, he used quotes from noble laureates and other notable scientists. For example, one of the interesting quotes were for Sir Peter Medawar (pictured); ‘the intensity of a conviction that a hypothesis is true has no bearing over whether it is true or not.’

Joseph Goldstein

Professor Goldstein also emphasized the following for those about to embark on science research;

1/ Have focused research strategy

2/ Don’t become wedded to a technical gimmick

3/ Don’t confirm a finding that no longer needs reconfirmation

Sir Peter Medawar

Following the publication of recent figures reflecting inequalities between male and female doctors in respect to a number of features including income and professorship positions, the meeting invited a panel of speakers to address the roots of this happening and how to change it. Deans of New York and Johns Hopkins were among the audience and contributed to the discussion in different ways.

Day 1 ended with a number of science talks on areas of cancer biology, mechanism of vascular disease, neurodegeneration and cell biology. Conference delegates were invited for dinner followed by drink receptions with live Jazz music at the Jay Pritzker stage in Chicago’s lively Millennium park.

Jay Prtizker

The Highlight of Day 2 was a speech given by the director of the National Institute of Health (NIH), Francis Collins (pictured) who was nominated by President Barack Obama in July 2009. Professor Collins supervised the Human Genome Project. If you don’t know him, I recommend Google; otherwise you might be able to see few clips of him playing guitar on Youtube !! He described four opportunities for the NIH to contribute to research in the US and worldwide;

1/ Using high throughput technologies to understand basic biology and uncover causes of diseases

2/ Translating basic science discoveries into better treatments

3/ Putting science to work for the benefit of health care

4/ Encouraging a greater focus on global health

Professor Collins PPP slides are available through the following link;

http://www.nih.gov/about/director/04242010presentation_aapasci.pdf

Francis Colllins with President Obama during a visit to the NIH

During dinner, He reflected on his experience as an MD/PhD student facing a high degree of uncertainty and feeling challenged in a lab that no one spokes English very well to offer some help !! Nonetheless, it was one of Winston Churchill’s quotes hanging on the lab wall that kept his enthusiasm going despite negative results and technical difficulty – ‘’ Success is made by moving from failure to failure to failure’’!!! Keeping this in mind, together with a motivating mentor, Collins research made it to shores with a discovery of genetic locus responsible for sickle cell anaemia. Reflection does not stop at this point for Collins as he pulls out his guitar (with a symbol of the DNA helix imprinted on it) and starts singing with talent !

Later talks focused on how a study of worm biology can yield a therapeutic potential in worms, the mechanism of degenerative disease in muscle disorders and genetic strategies to modify disease pathophysiology.

We were broken into three seminars of ‘how to write a grant’, ‘residency planning’ and ‘the transition from being a medic into a scientist’. I attended the later meeting attended by MD/PhD directors of Rochester University and Stanford University. Directors spoke of perseverance as a quality to cultivate in the beginning of one’s academic career. ‘Two important points you need to remember; select a suitable lab and have perseverance’’, one of the speakers said. Choosing a lab depends on the personality of the student and their supervisors – other important points are whether you prefer working in a lab where you prefer to be left alone to do your own experiments and present whenever you have data, or else a lab where you get monitored constantly and shown what to do. Selecting the appropriate supervisor should be an informed decision of the student following a meeting with the supervisor and exploration of what other students thought of the lab.

Exchange of research ideas and critical feedback of one’s own work take place mostly in the poster session. I have been lucky to have breakfast with Dr Germino, Deputy Director of the National Institute of Diabetes and Digestive and Kidney Diseases. He came afterwards to look at my poster and provided very helpful feedback. It got more exciting when I had another prolific discussion with Prof Marcus, a distinguished scientist from Cornell University. The beauty of the meeting is that you get a chance to meet up with successful and bright physician scientists.

The last day of the conference was highlighted by talks from important physician scientists such as John Niederhuber, Director of the National Cancer Institute, and a noble laureate Ferid Murad, the director of the institute of molecular medicine at the University of Texas. In addition, I had opportunity to listen to elegant presentation of interesting science on stem cell research.

The meeting ended with a lunch with residency directors and directors of MD/PhD programmes across the US.

Even though I travelled by myself to the meeting, I felt very welcomed and accommodated by APSA members including very respectable and approachable MD/PhD colleagues. This made my stay in Chicago even more exciting !!

In short, the meeting is highly enjoyable, very educational, mind broadening and full of opportunities for collaboration and exchange of thoughts, scientific criticism and feedback, but most importantly a great way to make friends !!

So you better watch out for the next AAP-ASCI-APSA meeting ; http://meeting.physicianscientists.org/

New Irish Intern Recruitment Process

For Irish graduates who are keen on doing an intern year, the application deadline is May 6th for jobs starting in July.

You can access all the relevant information here: http://www.hse.ie/eng/staff/jobs/Interns_SHOs_Registrars/Intern_Doctors/