My Dominant Hemisphere

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Archive for the ‘Healthcare Policy’ Category

Tech bytes: Konqueror and Java – Opera on Kubuntu 8.04

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Today’s tech bytes:

Some very nice people over at Kubuntu’s tech support IRC channel brought my attention to the fact that Kubuntu 8.04 doesn’t have an LTS version. Apparently, both the KDE 3.5.9 and KDE4 versions have not been given that status as KDE development has been in flux lately. So people, all those Powered by Kubuntu 8.04 LTS post-scripts in my previous posts stand corrected as …Kubuntu 8.04 (KDE 3.5.9).

Ever found the fact that from a fresh install of Kubuntu 8.04, Konqueror’s java behavior is a tad odd? No matter what you do, when you enable Tools>HTML Settings>Java, the java setting never sticks. It stays on the website you’re visiting but that’s it. As soon as you go to some other website, that java setting resets back to disabled. Furthermore, when you restart Konqueror, it’s the same deal again.

One nice person over at Kubuntu’s IRC channel was kind enough to share his solution. Goto Settings>Configure Konqueror>Java & Javascript>Java Runtime Settings. Uncheck/disable the option ‘Use Security Manager’. Click ‘Apply’>’OK’. Now enable java under Tools>HTML Settings>Java. Restart Konqueror. Yay! It sticks! Now, go back to Settings>Configure Konqueror>Java & Javascript>Java Runtime Settings. Check/enable the option ‘Use Security Manager’. Click ‘Apply’>’OK’. It’s a little weird but doing so doesn’t cause the funny java behavior to turn back on again and having any sort of security on a web browser is good :) .

Tried the latest Opera 9.5 Beta 2/weekly snapshot on Kubuntu/Ubuntu? If you live outside of the US, there’s a good chance that your system locale settings are set to use something other than English US by default. It so happens that this causes Opera 9.5b2 to crash with a segmentation fault. In order to enjoy Opera 9.5b2, make sure you have Sun Java set as the default Java version (use this howto) and set your locale to English US (en_US). On Kubuntu 8.04 (KDE 3.5.9) do the following as discussed here :-

  1. Goto System Settings>Regional & Language>Country/Region & Language
  2. Click on the ‘Locale’ tab
  3. Click on ‘Select System Language’ and choose ‘English US’
  4. Click ‘Apply’
  5. Restart KDE (log out and then log in) for settings to take effect

I have found the flash support to be a little flaky, at least with Opera 9.5b2. Opera, for me, often suffers from this grey box phenomenon. One moment a flash video works perfectly, other times I’d find grey boxes with audio but no sound. This becomes particularly the case when I’d have two or more tabs with flash video open in them and keep switching between them.

Quick user tip: To set your middle-click options, press the Shift key and then middle-click.

Is it just me or does Firefox 3 RC1 seem faster on Windows XP than on Ubuntu/Linux? For me, FF3RC1 on Kubuntu 8.04 still seems to take a lot more memory than on Windows. I guess their Linux development is slow or something.


Google announced their Google Health service recently. Privacy concerns abound.

That’s it for today folks. See ya!

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Copyright © 2006 – 2008 Firas MR. All rights reserved.

Written by Firas MR

May 25, 2008 at 1:21 pm

Why The WordPress Visual Editor Doesn’t Work With Konqueror

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Today’s technology tidbits:

The WordPress.com dashboard utilises the TinyMCE javascript visual editor when writing posts in the WYSIWYG format. Unfortunately as stated on its website, TinyMCE isn’t compatible with Konqueror. Why not? Well, here’s a quote from the freshmeat website for TinyMCE:-

…the day Konqueror and Opera implement the Midas specification I will look in to these browsers as target platforms as well…

I’ve noticed one aspect about Konqueror. Developers seem to focus on satisfying W3C standards as their primary goal, leaving the onus on compatibility issues to website and web-based app designers.

Anyhow, I do hope Konqueror and TinyMCE can work together someday soon.

Ubuntu UK’s recent podcast had some very interesting discussion on Linux and security. Nothing’s bullet-proof :-) .

Links of interest:

  1. Debian Med
  2. Linux for Clinics
  3. LinuxMedNews
  4. The Linux Medicine Howto courtesy of The Linux Documentation Project

That’s it for today folks. See ya :-) !
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Copyright © 2006 – 2008 Firas MR. All rights reserved.

Calling For A Common Worldwide Medical Licensure Pathway

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Medicine – Realm Of The Unknown

For ages, the medical sphere has been shrouded in mystery – for people outside of medicine that is. And this hasn’t been too good for the medical profession because many policy makers on matters of healthcare/medicine aren’t sufficiently acquainted with its many nuances to yield considered judgements. Sometimes you just can’t help get the feeling that doctors have a language of their own, with a community so tightly knit that it borders some sort of illuminati like cult.

Earlier, most of this mystery was limited to the knowledge base of medicine. Doctors were treated like gods walking on earth and people had no qualms whatsoever in having blind faith in them. With the rapid rise of web technologies however, doctors find themselves facing tough and pointed questions by their patients and policy makers about the decisions they make.

Some aspects, for the large part, still remain hidden away however. Stuff that affects policy decisions and how medical communities across the world interact with each other. Issues concerning licensure and taxonomy immediately come to mind.

An aspect of medicine that to this day, remains an enigma for many ‘outsiders’ is the entire academic hierarchy that applies to medical systems across the globe. Many ‘insiders’ end up at their wits ends too. The taxonomy is definitely confusing. What the heck is a Senior Registrar? Or for that matter, what in god’s name is the difference between house surgeons/officers, resident medical officers, civil surgeons, residents, interns, attendings, senior house officers and all that jargon? The world could definitely use a universal taxonomic architecture for medical systems akin to the WHO’s International Classification of Diseases (ICD) to streamline stuff and make interactions between communities easier.

Licensure – One Too Many Exams For A Globalised Age

When medical students step into the medical world, being relatively new ‘insiders’ at this stage, very few are cognizant of the fact that their careers depend on having to satisfy licensure requirements before even thinking about pursuing higher education. Getting through medical school is one step. After that, students are required to go through long winded licensure pathways before even beginning to gain higher training. Licensure serves as a quality control measure to ensure the safety of patients and is arguably, a necessary evil.

Modern society depends on the exchange of ideas and talent between countries. The same applies to medicine as well. Unfortunately, due to the myriads of medical licensure exams across different countries, this kind of exchange and collaboration can become extremely tedious and at times impractical. Getting into higher training for the international trainee becomes a daunting task. Take the following hypothetical scenario:-

Dr. Underdog went to medical school in a country bordering Angola and got his local medical license after graduating and passing local licensure exams. He now intends to gain higher training in colorectal surgery (… of all things :-) ) in the US. Before getting into a higher training program he needs an American license. He proceeds to sit for the United States Medical Licensure Exam (USMLE) and passes all 4 component exams in this process with flying colors. Good for him, Dr. Underdog’s thirst for knowledge is relentless. After gaining qualifications as a colorectal surgeon, he is now interested in learning a highly advanced and experimental procedure involving cosmic radiation and bizarre tumor polyps :-P , only available in Australia. He is now required to pass the Australian Medical Council licensure exams before he begins. He goes ahead with that and gains the skills he’s always dreamed about :-) . By now, Dr. Underdog has been through at least a dozen different licensure exams. The exams he gave in the US and Australia weren’t directly related to the subjects he studied at those places. Seeing great potential in this emerging pioneer, a group of people from a country near Chile invite Dr. Underdog over. They’d like him to impart some of the training he received to a couple of their fortunate students. Unfortunately, he needs to clear their local licensure exams before he can begin. He candidly goes through that as well. In this new land, Dr. Underdog meets a fellow international doc who’s been through twice the number of licensure exams as he has, to get to a position as senior faculty member while also dealing with some mind blowing research – literally involving blowing stuff :-P , partly as an outlet for his bottled up frustrations over licensure systems. … See how tedious it can get?

If I’m interested in gaining specialized skills and/or knowledge available in only certain parts of the world, I need to get straight down to business without having to worry about sitting for multiple licensure exams. Sitting for multiple licensure exams is not only wasteful of time and money, it is also redundant. Most of these exams test the same content anyway. Most importantly, as an aspiring international trainee, my focus has to be on the exams directly related to the training I intend to pursue rather than random licensure tests.

Solution? A universal licensure pathway ratified by an international body such as the WHO that should be acceptable to all countries.

At the moment, a few agencies such the Medical Council of Canada and the Australian Medical Council are conducting joint licensure tests. Their efforts in this direction are laudable and should be wholeheartedly welcomed. Hopefully other countries will follow suit and some day a universal licensure pathway will become a reality. Until then, international trainees can only follow in Dr. Underdog’s tortuous footsteps!

Readability grades for this post:

Kincaid: 10.0
ARI: 11.2
Coleman-Liau: 14.4
Flesch Index: 53.2/100
Fog Index: 13.1
Lix: 48.9 = school year 9
SMOG-Grading: 12.0

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Copyright © 2006 – 2008 Firas MR. All rights reserved.

Our Backyard

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Over 80% of healthcare privately owned. Roughly 13% of the populace insured. That’s incredible, India!
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Copyright © 2006 – 2008 Firas MR. All rights reserved.

Written by Firas MR

April 27, 2008 at 12:28 pm

Evidence Based Medicine in Developing Countries

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UPDATE 1: Check out multimedia from recent international meetings of the Cochrane Collaboration that have touched on this topic: here, here and here.

Have developing countries actually been active in EBM (Evidence Based Medicine)? This was a question that kept ringing in my head during a discussion I had with some of my buds recently. Speak to a Joe medic in any of the medical establishments in a country like India, and you can’t help feeling that developing countries for the most part have become consumers of research that cannot be applied to them. These medics are not only being taught but are also being tested on guidelines developed by a plethora of alien organizations such as NICE (National Institute of Clinical Excellence-UK), SIGNS (Scottish Intercollegiate Guidelines Network-UK), Cochrane (UK), ACP (American College of Physicians-US), CDC (Centers for Disease Control-US), NIH (National Institutes of Health-US) and many others in their curricula. Most of these guidelines have been produced for patient populations that are entirely foreign to them.

The only international body with a modicum of relevance to their lives and that of their patients and one which cuts across all geographical and cultural lines is the WHO (World Health Organization). Some might argue that such an enormous and overarching agency as the WHO is intrinsically incapable of producing practice guidelines that might be sufficiently context-centric to be of any use. The WHO sure has a lot of responsibility on its hands and it really is difficult to produce guidelines that apply to all geo-cultural contexts. Indeed, the WHO has produced only a handful of guidelines to date.

India and developing countries like it, desperately need indigenous agencies to construct and regulate guidelines that are appropriate to their peoples’ resources and needs. It is extremely common, for example, to see how guidelines by some agency are taken lightly solely because of resource constraints (transportation problems, lack of appropriate instruments, etc.). Actions that a clinician needs to make given these constraints, need to be backed by evidence. The whole idea of EBM is that actions need to be based on the ‘best available’ collective body of scientific evidence pertaining to a problem – pathological, economic, whatever. Doesn’t it make sense then, to look for ‘evidence’ backing a given course of action to our problems?

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We do have bodies like the ICMR (Indian Council of Medical Research) making progress, but honestly we aren’t doing enough. Over the course of my undergrad career, perhaps the only ICMR guidelines we came across were a handful of appendices at the back of a pediatrics textbook. I mean, come on! We can do better than that, right? The arguments linking this appalling void to decreased government funding are no doubt valid. Budgets allocated to healthcare are grossly below the minimum ’5% of Gross Domestic Product’ standard set by the WHO and quite surprisingly have kept declining. Amidst this budget-strapping,  public healthcare establishments are overwhelmed by the demand for clinicians whose focus is on the manual delivery of healthcare services rather than research. In the ‘medical automobile’, these clinicians are just too busy being passengers in their back seats to care about driving. This unbalanced emphasis has had a profound impact on the very nature of our medical society. Its effects are visible right from the very beginning, as medical students enroll into institutes. Students are not even remotely exposed to the tenets underlying academic medicine and there is absolutely no mentorship mechanism in place at any level, all the way up to post-graduation and beyond. Departmental research is obscenely underfunded and students lack motivation to get involved in the absence of a nurturing environment. To make matters worse, owing to the abject lack of any academic medical component whatsoever in their curricula, students find it near impossible to take time out to engage in any form of academic activity at all. Even if they do manage it, their efforts often receive no curricular credit. Post-graduate students take the thesis requirement casually and often resort to a trial-and-error hodgepodge approach in the absence of necessary guidance. The situation finally spirals down to a vicious cycle where the blind lead the blind. End result: Institutes in chaos whose sole purpose is to produce en masse, semi-literate manual clinicians of low-innovative-potential who can’t even search or appraise medical literature, let alone use it properly.

Let’s just try to understand why this is the need of the hour. It not only paralyzes our education system but also our fragile economy. How does it degrade our economy? Well, without national guidelines there can’t be a just audit system in healthcare establishments. Without audits, resources are squandered and quality of care declines. When quality declines, the disease burden in a population rises and that in turn leads to an economic vicious cycle as national productivity declines.

How do we solve this?

  1. Government funding on healthcare ought to increase. Clearly, providing concessions and subsidies to private establishments hasn’t and most definitely isn’t going to produce results. Private establishments only care about making money – from the public or the government, and that’s all. Unless incentives are provided to them to engage in academic medicine or research, they aren’t going to bear the torch. In a developing country like India, the sheer demand for manual services forms a competing interest for these entities.
  2. Even if public funding is lacking, it might be possible to develop meaningful research. Some of the most groundbreaking research comes out of very small undertakings. It didn’t take a million dollars for us to realize the benefits of surgical asepsis.
  3. Hierarchical translational research bodies ought to be created – private or public or a possible mix of the two. Guidelines need to be produced and taught at medical schools. Students should no longer need to put up with the arbitrary whims of their superiors in the face of inapplicable guidelines in their textbooks.
  4. Audit systems should be enforced at all healthcare establishments. Students and practitioners should be taught how to audit their departments or practices.
  5. An academic component should be incorporated into the medical curriculum at all career grades – whether optional or otherwise. Mentorship mechanisms should be brought into place and could be incentive driven. Sources of funding and grants should be made more accessible and greater in number.

I hope readers have found this post interesting :-) . Do care to leave behind your comments.

Readability grades for this post:

Kincaid: 11.0
ARI: 12.2
Coleman-Liau: 14.7
Flesch Index: 49.1/100
Fog Index: 14.7
Lix: 50.3 = school year 9
SMOG-Grading: 13.0

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Copyright © 2006 – 2008 Firas MR. All rights reserved.

International Medical Graduates and the NRMP 2007-08

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UPDATE, 2nd April 2008: This post is now open-access.

Now that the 2007–08 US Residency Match is over, let’s review some interesting statistics. Preliminary/Transitional programs will not be reviewed in this post. All programs covered are Categorical.

2008 NRMP Match data imply data gathered from the 2007–08 Match session for residency programs beginning in July 2008. FYI, programs and seats are not equivalent. Any given program will typically have >1 seat.

For your reading pleasure, this article has been framed in a Q&A format . Let’s begin right away:

  • What specialty do I stand a reasonable chance at?
    • Based on the number of unfilled programs (number in brackets indicates number of unfilled programs as opposed to the total number of unfilled individual seats),
      • Family Medicine (105)
      • Pediatrics (40)
      • Internal Medicine (31)
      • Pathology (27)
      • Psychiatry (27)
      • Emergency Medicine (11)
    • The above specialties also have more seats than the number of US seniors applying for them.
  • How is this relevant?
    • Well, typically if there’s a (>=) 1:1 US senior:Seat ratio, that means in order for you to secure a position you will need to displace a US senior. That can happen if the program views you as a superior enough candidate to justify hiring you over a US senior. And this is not all hunky dory for the average IMG Joe.
  • What about General Surgery?
    • For a total of 1069 seats, the number of US seniors competing was 1161. That gives us a US senior:Seat ratio = 1.1 . Therefore, seats in Surgery are far fewer than the number of US senior applicants competing for them, let alone non-US-senior applicants, and finding a position is going to be difficult as per the aforementioned Firas’s Law of ‘Displacement’ . Only 2 seats went unfilled for 2008.
  • How many applicants competed for Internal Medicine in comparison?
    • The US senior:Seat ratio was 0.6 . Not only that, a significant number of programs went entirely unfilled by any group.
  • Has there been a renewed interest in any of the above ‘high yield’ specialties?
    • Emergency Medicine saw an increase in the number of positions being offered, by 10% between 2004 and 2008. The number of US seniors filling EM positions has also increased by the same number during this period.
  • Has interest in US residency training or competition increased or decreased?
    • Increased. Overall, there has been a 13.4% increase in the number of Active Applicants (meaning applicants who did not withdraw their applications for some reason or the other) between 2004 and 2008. The increase in Active IMG Applicants (both US citizen and non-US citizen) has been even greater than this number during the same period. This could possibly be due to shrinking opportunities for quality training in other parts of the world.
  • Is Internal Medicine really that disliked by US seniors?
    • Match data indicate that IM is still where more US-seniors end up than in any other specialty.
  • Is an average, run-of-the-mill non-US citizen IMG more likely to succeed than not?
    • No. Although this will depend on the specific specialty in question. In general, by random chance alone, a non-US citizen IMG is more likely to be unsuccessful. Not only that; success rates have dropped from previous years. The match success rate for Non-US citizen IMGs and US-citizen IMGs for 2008 were 42.4% and 51.9% respectively.

That end’s my wrap-up for the NRMP 2008 data. For more in-depth coverage, the NRMP stats are available on NRMP’s website. Another great resource is Charting Outcomes in the Match: Characteristics of Applicants who Matched to Their Preferred Specialty in the 2007 NRMP Main Residency Match published by the AAMC available for free on its website.

Please feel free to leave behind your comments! They aren’t gonna cost ya anything !

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Copyright © 2006 – 2008 Firas MR. All rights reserved.

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