Category Archives: Medical students

How to Become an Endocrinologist

What is an Endocrinologist? Brief Overview:

An endocrinologist is a specialized physician. Endocrinology is a sub-specialty of internal medicine. In addition to understanding general medical treatment of the human body and primary care, endocrinologists complete additional training in treating the hormone system of the body, including ductless glands of internal secretion. Such glands include thyroid, adrenal, pituitary, pancreas, and glands in reproductive organs of men and women.

Some of the most common issues that endocrinologists help to diagnose, treat or manage is diabetes, irregular metabolism, growth disorders in children, weight issues, hypo- and hyper-thyroidism, and more.

How to Become an Endocrinologist – Education and Training Requirements:

Endocrinologists are physicians, and therefore they must obtain a medical degree (M.D., or D.O.) from an accredited medical school and complete all of the requirements to practice medicine as a licensed physician. In the United States that includes:

  • 4 years of undergraduate coursework resulting in a Bachelor’s Degree.
  • 4 years of medical school resulting in a medical degree from an osteopathic (D.O.) or allopathic (M.D.) program.
  • 3 years of residency training in internal medicine.
  • 2-3 years of required fellowship training in endocrinology (and nutrition if a 3-year fellowship).

Licensing and Certification for Endocrinologists in the United States:

Endocrinologists must complete the same credentialing as other physicians practicing in the United States,This includes passing all three parts of theUSMLE (United States Medical Licensing Exam), and obtaining a state medical license in the state he or she wishes practice.

Most practice opportunities will require an endocrinologist to be board certified in both specialties of Internal Medicine and Endocrinology.

In order to keep their license current, like all physicians, endocrinologists must successfully complete the required hours of continuing education (CME) and have their license renewed every 7-10 years depending upon state and specialty requirements. Also, the doctor must maintain an ethical standard of practice, as some disciplinary actions can cause a physician to lose his or her medical license if they are severe infractions.

Typical Workweek and Practice Characteristics:

Most endocrinologists will work over 40 hours per week in an medical office setting primarily, as they do not perform many, if any surgeries or invasive procedures. Endocrinologists conduct office exams and consultations with patients, order tests and interpret the results, and then decide on the course of treatment which may involve medication, dietary changes, or surgery. If the patient needs surgery, most likely the endocrinologist would then refer the patient to an appropriately trained surgeon to perform the operation.

Endocrinologists may be employed by a hospital or group, in a single- or multi-specialty practice, or they may own their own practice or be a partial owner of a group practice as opposed to being an employee.

Many of the patients treated by endocrinologists may be referred to the endocrinologist by another physician such as a primary care doctor, obstetrician/gynecologist,gastroenterologist, etc. Therefore endocrinologists’ work is very consultative in nature and they must be adept at working as part of a treatment team including other physicians, as well as nurses and allied health professionals.

Annual Income and Job Outlook for Endocrinologists:

According to the Medical Group Management Association (MGMA) 2013 Physician Compensation and Production Survey, the average annual income for an endocrinologist is $241,565. However, compensation can vary widely from $186,000 at the 25th percentile of earners, to $356,000 at the 75th percentile.

As with all physicians, outlook for endocrinologists is strong. According to the American Diabetes Association, nearly ten percent of all people in the U.S. have some form of diabetes, and many more are pre-diabetic. This, combined with the growth in the population, and the increasing age of the nation’s population, will continue to drive demand for endocrinologists.

Additionally, because demand for primary care physicians is going to be extremely high in the wake of the Affordable Care Act, endocrinologists always have that as an option if for any reason they can’t build a large enough practice of endocrinology patients solely. In other words, worst-case scenario, if demand were to diminish, which it is not expected to, endocrinologists could incorporate some primary care patients into their practices to help maximize their volume if needed.

10 Ways to Be a Great Student

1.  Take Hard Classes

You’re paying good money for an education, make sure you get one. There will be classes that are required for your major, of course, but you will have a fair number of electives as well. Don’t take classes simply to accrue credits. Take the classes that really teach you something.

Be passionate about learning.

I once had an advisor that said to me when I expressed fear of a difficult class, “Do you want to get an education or not?”

2.  Show Up, Every Time

Make your classes your highest priority.

If you’ve got children, I understand that this isn’t always possible. Children should always come first. But if you don’t show up for your classes, you’re not getting that education we discussed in No. 1.

Make sure you’ve got a good plan for seeing that your children are cared for when you’re scheduled to be in class, and when you need to study. It really is possible to raise children while you’re going to school. People do it every day.

3.  Sit in the Front Row

If you happen to be shy, sitting in the front row can be very uncomfortable at first, but I promise you, it’s one of the best ways to pay attention to everything being taught. You can hear better. You can see everything on the board without having to crane your neck around the head in front of you.

You can make eye contact with the professor. Don’t underestimate the power of this. If your teacher knows you’re really listening and that you care about what you’re learning, he or she will be extra willing to help you. Besides, it’ll feel like you’ve got your own private teacher.

4.  Ask Questions

Ask questions immediately if you don’t understand something. If you’re in the front row and have been making eye contact, your instructor probably already knows by the look on your face that you don’t understand something. A polite raising of your hand is all you need to do to indicate you’ve got a question.

If it isn’t appropriate to interrupt, make a quick note of your question so you don’t forget, and ask later.

Having said this, don’t make a pest of yourself. Nobody wants to hear you ask a question every 10 minutes. If you’re completely lost, make an appointment to see your teacher after class.

5.  Create a Study Space

Carve out a place at home that is yourstudy space. If you’ve got a family around you, make sure everyone understands that when you’re in that space, you’re not to be interrupted unless the house is on fire.

Create a space that helps you make the most of your study time. Do you need absolute quiet or do you prefer to have loud music playing? Do you like working at the kitchen table in the midst of everything or do you a quiet room with the door shut? Know your own style and create the space you need.

6.  Do All the Work, Plus More

Do your homework. Read the assigned pages, and then some. Plug your topic into the Internet, grab another book at the library, and see what else you can learn about the subject.

Turn your work in on time. If extra credit work is offered, do that too.

I know this takes time, but it’ll ensure you really know your stuff. And that’s why you’re going to school. Right?

7.  Make Practice Tests

While you’re studying, pay attention to the material you know will be on a test and write a quick practice question. Start a new document on your laptop and add questions as you think of them.

When you’re ready to study for a test, you’ll have a practice test ready. Brilliant.

8.  Form or Join a Study Group

A lot of people study better with others. If that’s you, form a study group in your class or join one that’s already organized.

There are lots of benefits to studying in a group. You have to be organized. You can’t procrastinate. You have to really understand something to be able to explain it out loud to someone else.

9.  Use One Planner

I don’t know about you, but if I had a separate calendar for work, school and life, I’d be a complete mess. When everything in your life is on one calendar, in one planner, you can’t double-book anything. You know, like an important test and a dinner with your boss. The test trumps, by the way.

Get a great calendar or planner with enough room for several daily entries. Keep it with you at all times.

10.  Meditate

One of the best things you can do to improve your entire life, not just school, is meditate. Fifteen minutes a day is all you need to feel calm, centered and confident. If you don’t know how,

Meditate any time, but 15 minutes before you study, 15 minutes before class, 15 minutes before a test, and you’ll be amazed at how well you can perform as a student.

Physiological & pathological breath sounds

Assessment of Breath Sounds

If possible, auscultation of the chest should be done with the patient in the seated position. The diaphragm of the stethoscope should be used. The examiner should warm the stethoscope between his or her palms before placing it on the patient’s chest. The stethoscope should be placed against the patient’s bare skin; the examiner should not try to listen through the patient’s clothes.

The examination should include listening to the anterior chest, the midaxillary region, and the posterior chest. The posterior chest should be examined from the apex to the base of the chest. The breath sounds should be assessed during both quiet and deep breathing. A full breath should be auscultated in each location. The examiner should listen for the pitch, intensity, duration, and distribution of breath sounds, as well as note any abnormal or adventitious sounds.[2, 3]

Types of Breath Sounds

Breath sounds can be divided into 2 categories: normal and abnormal (adventitious).


Normal breath sounds

Normal breath sounds can be further divided into 2 subcategories: vesicular and tracheal. Vesicular breath sounds are the sounds heard during auscultation of the chest of a healthy person (listen to the audio recording below). The inspiratory component predominates and is generated by turbulent airflow within the lobar and segmental bronchi, whereas the expiratory component is due to flow within the larger airways.

Tracheal sounds are the sounds heard over the sternum. They are louder and higher pitched than vesicular sounds are. With tracheal sounds, the expiratory phase is as long as or longer than the inspiratory phase.

Abnormal (adventitious) breath sounds


A wheeze is defined as a continuous musical sound lasting longer than 250 ms (listen to the audio recording below). It is thought to be due to oscillation of opposing airway walls that are narrowed almost to the point of contact. A wheeze may be either expiratory or inspiratory and may contain either a single note or multiple notes. Wheezing is common, estimated to occur in 25% of the population at some point. It is frequently more audible at the trachea than in the chest.[5]

Clinically, wheezing indicates airflow obstruction, though its absence does not exclude obstruction. Such obstruction may occur at any point along the airway. Conditions associated with wheezing include infection (croup, whooping cough, bronchiolitis), laryngeal or tracheal tumors, tracheal stenosis, tracheomalacia, foreign body aspiration, other causes of large airway compression or stenosis, vocal cord dysfunction, asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, bronchiectasis, hypersensitivity pneumonitis, and pulmonary edema.

A wheeze may be detected during forced expiration in normal subjects. Although wheezing is associated with airflow obstruction, the degree of obstruction cannot be reliably predicted by the presence or absence of wheezing. Generally, a polyphonic wheeze (ie, a wheeze with multiple notes) is characteristic of large airway obstruction, whereas a monophonic wheeze is more typical of small airway obstruction.[4, 5]


Crackles are defined as a short, explosive, nonmusical sound (listen to the audio recording below). The can be divided into 2 types: fine and coarse. Compared with coarse crackles, fine crackles have a higher frequency and a shorter duration. Fine crackles are caused by the sudden opening of a closed airway; coarse crackles are thought to be related to secretions.

Crackles may occur on either inspiration or expiration but are more common during inspiration. Inspiratory crackles may be classified as early inspiratory, midinspiratory, or late inspiratory. Crackles are more frequently heard in the basilar regions of the lungs because the distribution of airway closure is gravity dependent.

Crackles may be heard in cardiac disease, fibrotic lung disease, obstructive lung disease, and pulmonary infections. They may also be heard in healthy older individuals.[4, 6]

General characteristics of these crackles have been described for many different disorders (although there may be variations among individual patients). In idiopathic pulmonary fibrosis, crackles have been described as fine, short in duration, higher pitched, and occurring in late inspiration. A basilar predominance exists in early disease.

Asbestosis is associated with fine crackles. The presence of crackles has been shown to be associated with honeycombing on imaging and with the duration of dust exposure. In bronchiectasis, crackles have been described as high frequency and coarse. They occur in early inspiration or midinspiration and are thought to be secondary to bronchial wall collapse during expiration and sudden opening in inspiration.

In COPD, crackles are most commonly due to airway secretions and typically disappear after coughing; they may also be due to the opening and closing of narrowed bronchi with weakened airway walls. Crackles in COPD are characterized as coarse, early, and low pitched and tend to be infrequent.

The crackles associated with pulmonary edema are attributed to the opening of airways narrowed by peribronchial edema. They are described as coarse, late occurring, and high pitched. They may be inspiratory or expiratory.

In pneumonia, 2 types of crackles have been described. Early pneumonia is associated with coarse, midinspiratory crackles. Crackles during the recovery phase are described as shorter and occurring at the end of expiration.


Rhonchi are defined as low-pitched, continuous sounds that have a tonal, sonorous quality. They are caused by the rupture of fluid films and airway wall vibrations and are associated with disorders that cause increased airway secretion or reduced clearance of secretions. Rhonchi tend to clear with coughing


Twitter makes me a better doctor: 4 reasons why I use Twitter

Even as social media use among physicians gains popularity, I continue to hear doubts echoing from my fellow medical students, residents, and attendings, particularly about the use of Twitter.

Many of them ask how using Twitter has benefited me, and my answer almost always makes them stop and think.

My life has been enriched by the network of intelligent and forward-thinking people I have connected with on Twitter–many of them medical students, doctors, nurses, pharmacists, or other professionals who have made the leap into social media.

I have become a more well-rounded person and a more knowledgeable and confident future physician–and I’ve learned so much.

Why should medical professionals consider joining the Twitterverse?

The following are just a few reasons.

Stay up to date on news and literature. Doctors (and med students!) are busy and don’t always have time to seek out what’s happening in the world. Twitter conveniently brings news and research directly to your feed.

Doctors (and med students!) are busy and don’t always have time to seek out what’s happening in the world. Twitter conveniently brings news and research directly to your feed.

As a medical student and future pediatrician, I follow accounts of official medical associations, such as the AAP (@AmerAcadPeds) and AAMC (@AAMCToday), leading medical journals, including JAMA (@JAMA_current) and The Lancet (@TheLancet), as well as several different kinds of physicians who frequently tweet interesting new articles.

I first learned about last year’s pertussis epidemic in Seattle on Twitter, and have followed tweets about this year’s flu throughout flu season. I frequently stumble upon studies that may help me in practice; last week I learned that cefdinir and iron-supplemented infant formulas may cause non-bloody red stool when taken together. I also follow various media news outlets, such as CNN, The New York Times, and The Wall Street Journal to keep up with current events.

Share ideas and learn from others. Twitter is an open forum of conversation for the world. In my opinion, this is the most valuable use of Twitter.

I follow people who tweet about things that interest me, both medically related and not. As a medical student, I’ve used Twitter as a study tool, asking questions and gleaning knowledge from physicians, residents, and other students. I listen and converse in various tweet chats, such as the mobile health (#mhealth), healthcare social media (#hcsm), and medical education (#meded) chats. I hear patients share their stories and follow blogs.

Some of my favorite blogs are written by parents of children with special is a fantastic blog about Noah, a beautiful boy with Down Syndrome. The post of his birth story brought me near tears and provided an intimate look at his parents’ reaction to his diagnosis. I learned what they liked and disliked about their doctors’ delivery of the news, and how much they loved their son.

Blogs like this have given me a new perspective on this special families’ challenges and triumphs. This will undoubtedly help me care for my patients with special needs in the future.

Help patients. This does not mean doctoring patients on the Internet, following my patients on Twitter, or anything of the sort. Patients are online, though, and many are on Twitter. As medical professionals, we can help disseminate accurate health information on the web. Twitter provides a great avenue for physicians to steer people to reputable websites for health information, dispel myths, share helpful articles, and educate people on medical issues.

For example, I tweet and retweet articles from the CDC about vaccines, parenting advice from, and various other health tidbits from academic medical institutions.

It’s fun! Perhaps my favorite reason to tweet is that it’s fun! I love spending time on Twitter. I learn something new every day and read many hilarious or otherwise entertaining tweets along the way. I’ve connected with people I never thought I would, all with a myriad of ideas and opinions. The environment is so dynamic.

Twitter is an exciting mode of communication, and is something I engage in because I enjoy it. If you’re thinking about embarking on your own Twitter journey, but are worried about time commitment, just remember, what you do with it or how much time you spend on it is completely up to you. You don’t even need to be particularly tech-savvy to use it. It requires only the ability to type and click, I promise!

Of course, always be careful what you tweet and use good judgment. While Twitter may not be for everyone, I have found it both personally and professionally rewarding, and encourage all health professionals to give it a spin.

Brittany Chan is a medical student who blogs at, where this article originally appeared.  She can be reached on Twitter @BChanMed.

Traits Of Successful Med Students

“What does it take to succeed in medical school?” This is a question that I hear often. There is no single answer to this question, of course, as there are many different personality types that thrive in medical school. However, there are certain traits that nearly all successful med students share. Below I’m going to cover some of the most important traits of successful medical school students:

Time management skills. Medical school is incredibly demanding in terms of time. Between class work, study time, and countless other requirements, med students often feel like they are being pulled in many different directions at once. The reality is that in order to get everything done on time, you need to have strong time management skills. This includes the ability to plan your time, prioritize, and stick to your schedule. If you can’t use your time efficiently, getting through med school is next to impossible.

Ambition and Motivation – Medical school is a long and exhausting journey. If you’re not ambitious and motivated, you’re not going to be able to handle it. Successful med students are able to keep their heads up even as they are faced with seemingly endless challenges. They are able to persevere no matter how exhausted they may be.

Stress management skills – Stress is a constant in medical school. Students are constantly being pushed to the limits of their ability, and they are aware that slipping up could be disastrous for their career. As if that wasn’t enough, students typically don’t get the sleep they need and don’t have time to get much exercise. The result can be overwhelming degrees of stress and students that can’t cope aren’t going to succeed. Bottom line: If you’re going to succeed in medical school, you need to be able to thrive in stressful situations.

Genuine interest – Successful medical students are genuinely interested in their studies. This is essential, as the amount knowledge to be absorbed is overwhelming at times. If a student isn’t curious and doesn’t enjoy the material, it’s next to impossible to master it.

Interpersonal skills – The journey through medical school is filled with relationships. Students need to be able to work well as a team with other students in order to prepare for courses and study for exams. They need to be able to relate to professors and instructors, as well as physicians, patients and other professionals. The ability to communicate with others and succeed as a team member is absolutely essential for med students.

Long term perspective – As a med student, there will be days (and weeks) that are simply overwhelming. I can virtually guarantee you that you’ll think about quitting more than once. Successful students are able to keep these bad days in perspective – because they recognize that these challenges are simply steps in their journey to a successful and fulfilling career.

There is no single personality type that is best suited to success in medical school. There are, however, several traits that are essential for any successful med student. Read through this list again and ask yourself if you have these traits. If not, start working to develop them immediately – and you’ll be much more likely to thrive in med school!

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How Doctors Can Reduce Work Stress

Doctors carry a great deal of responsibility. Working long hours, interacting with many patients on any given day, and being subjected to life or death situations can become very stressful. Tack on the mental energy required to deal with fellow medical professionals plus balancing work and a personal life has the potential to lead to burnout and medical mistakes if you don’t know how to reduce everyday stresses.

There are several things doctors can do to maintain a healthy lifestyle in order to be more productive and not experience burnout.

The first step is to make a commitment to living a more mindful, balanced life. This requires a shift in mindset and paying attention to the things that are wasting your time while being more focused on your priorities. If you want to spend more time with your kids or a significant other, spend less time shopping online or watching mindless TV. Say “No” to the negative people in your life who suck your energy by their constant complaints.

One of the best ways to reduce stress is to get outside and exercise, whether it’s walking for 10 minutes each day or doing some type of outdoor activity. Besides the physical benefits of exercise including increased fitness and keeping diseases at bay, exercise helps to improve mental clarity including alertness and concentration.

Just about every doctor knows this, but how many actually do exercise on a regular basis is few, so it helps to have a reminder every once in a while. Finding a partner to exercise with helps to keep you on track and accountable.

Another great way to reduce stress is to find a hobby that activates your creativity. Do something fun that you can really get into so that it recharges your energy. A hobby helps you get “lost in the moment” and is very relaxing. You’ll go back to work feeling more inspired and passionate about what you do.

Much of our stress begins in our mind, so it’s also very important to develop a healthy positive mindset. Stop focusing on past mistakes and stop worrying about what could happen in the future. Negative beliefs can take a hold of our mind and have power over us, which can drain us emotionally and spiritually.

Reducing doctor stress is one step to developing a healthier and happier medical community. A more relaxed, calm doctor can be more effective in their work and contribute to a better healthcare environment.

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Should Medical Students Learn More About Nutrition and Disease Prevention?

In the U.S., more people are being treated by diseases that can easily be prevented such as smoking, obesity, and heart failure, just to name a few. In 2008, the Centers for Disease Control and Prevention (CDC) reported that five diseases account for more than 65 percent of the deaths of American men. However, when people finally go see the doctor for their ailments, all the doctor can do is attempt to offer temporary treatments.

Over the years there has been a lack of education about nutrition and diet in medical schools, and unfortunately, that trend continues in many of today’s medical curriculum. In an article by David Freudberg, “Medical Students Discuss ‘Red Flags’ About the Future of Health Care”, he says that medical school has not trained doctors to help patients with lifestyle choices.

Ask doctors how to treat diabetes, and they can give you a number of answers, but ask them exactly what can be done to prevent this disease, they may draw a blank.

A medical student’s answer to this is that the course of study for medical school is already daunting and stressful without having to add more classes on diet and nutrition. I’m pretty sure there are classes that are not exactly a necessity. For premed courses, you could probably cut out a chemistry or physics class and replace it with a nutrition class. Classes that have a practical application in the real world of medicine should have precedence over a traditional curriculum.

If you’re a doctor, it’s important to remember that you are not just someone there to just prescribe a pill and send the patient on their merry way. You also have to consider yourself a consultant, and many of your patients will have questions about what they should or shouldn’t eat so that they can be healthier. And even if they don’t ask, I believe it’s your duty to share your knowledge on actions they can take to prevent diseases. Having a good rapport and communication with patients can help prevent medical malpractice.

I also believe that hospitals or any organization employing healthcare professionals should provide ongoing classes or workshops on the latest information about diets and nutrition. We have to remember that doctors have to be good role models and eat healthy too. How can patients look to doctors as authority figures and follow their advice if doctors don’t maintain a healthy lifestyle as well?

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