R enita P ushparajah , MD

Volume 4; Issue 7
August 2015
The Pulse
A t l a n t i c
U n i v e r s i t y
S c h o o l
o f
M e d i c i n e
Renita Pushparajah, MD
Born the 10th of August, loved and cared for
by family, early in life it
would seem Renita Pushparajah was destined to a
life of service to her fellow citizens.
In This Issue:

Dr. Pushparajah

AUSOM History

ECFMG
Certification

Mental Health
& The MD

Physician Skills
Attending Boston University, receiving accolades from her undergraduate instructors and scoring well on the MCAT,
Renita began her quest
for a seat in a school of
medicine. After sorting
through the options Renita joined the growing success story of Atlantic University School of Medicine students and graduates.
Completing her basic
medical
sciences, scoring
 Antiarrhythmic
very well on Step 1, Renita began her clerkship
 ECFMG News
training at Jackson Park
Hospital in Chicago Illinois. Intending a career
www.ausom.edu.lc in Pediatrics, this highly
skilled student embarked
on her quest to build a
career through careful
selection and guidance
from AUSOM, Renita
built a portfolio which
enhanced her opportunity
and eventually securing a
position as a resident in
Pediatrics.
Completing Internal
Medicine at Harbor Hospital, a Sub Internship at
Cook County Hospital as
well as several other elective clerkships in several
states, Renita was given
the highest praise by each
hospital, receiving honors
and invitations to interview for positions in several ACGME positions.
Scoring very well on
Step 2 CK and Passing
the Step 2 CS exam,
Renita all but assured
her future as well as her
career in medicine.
Graduating on May
31, 2015 in New York,
Dr.
Pushparajah
matched through the
NRMP at Saint Peters
Hospital in New Jersey.
At the time of this publication, Dr. Pushparajah has begun her career
as a Resident in Pediatrics.
We congratulate and
applaud the hard work
done by this Physician
in training, and are
proud to have enabled
her career aspirations
and empowered her
success!
Dr. Pushparajah you
will be missed, you are
missed and we are confident that your example
will guide the students
who follow you.
Page 2
The Pulse
AUSOM
CELEBRATES
SUCCESS!
Volume 4;
Issue
E C F M G
7
C e r t i f i c a t i o n
R e q u i r e m e n t s
To be eligible for certification by ECFMG, an international medical graduate (IMG) must meet the following requirements.
Application for ECFMG Certification
International medical students/graduates must submit an Application for ECFMG Certification before
they can apply to ECFMG for examination. The Application for ECFMG Certification consists of questions that require applicants to confirm their identity, contact information, and graduation from or enrollment in a medical school that is listed in the World Directory of Medical Schools (World Directory) as
meeting eligibility requirements for its students and graduates to apply to ECFMG for ECFMG Certification and examination. As part of the application, international medical students/graduates must also confirm their understanding of the purpose of ECFMG Certification and release certain legal claims.
Examination Requirements
To meet the examination requirements for ECFMG Certification, an IMG must:
1. Satisfy the medical science examination requirement. USMLE Step 1 and Step 2 Clinical Knowledge
(CK) are the exams currently administered that satisfy this requirement.
2. Satisfy the clinical skills requirement. USMLE Step 2 Clinical Skills (CS) is the exam currently administered that satisfies this requirement.
There are time limits for completing the examinations for ECFMG Certification. For detailed information,
including information on time limits and using a passing performance on former exams to satisfy these
requirements, see Examinations for ECFMG Certification in the ECFMG Information Booklet.
Medical Education Credential Requirements
To meet the medical education credential requirements for ECFMG Certification, an IMG must:
be a graduate of a medical school listed in the World Directory as meeting eligibility requirements for its
students and graduates to apply to ECFMG for ECFMG Certification and examination. The IMG’s graduation year must be included in the ECFMG note on the Sponsor Notes tab for the school’s World Directory listing.
have been awarded credit for at least four credit years (academic years for which credit has been given
toward completion of the medical curriculum) by a medical school that is listed in the World Directory as
meeting eligibility requirements for its students and graduates to apply to ECFMG for ECFMG Certification and examination. There are restrictions on credits transferred to the medical school that awards an
IMG’s medical diploma that can be used to meet this requirement.
document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG must
also receive copies of the IMG’s final medical school transcript and, if required, transcripts to document
credits that were transferred to the medical school that awarded the IMG’s medical diploma.
Additionally, ECFMG must obtain primary-source verification of the IMG’s medical diploma and
transcript (s).
Page 4
The Pulse
I'm a Doctor, and I Have a Mental Illness
There you go, I wrote it. Nobody died. The world didn't end, and I didn't start hyperventilating. But why did I
find it so hard to write?
For the past six years I have experienced episodes of depression and anxiety. Throughout medical school I took
antidepressants and had difficult times, but generally I functioned normally, and only required some intervention from my general practitioner. But last year I reached a crisis point, and I have decided to share my story.
I had been working as a foundation year one doctor in an emergency department. After the initial trepidation, I
loved it. One day, a patient who had attempted suicide was admitted. Listening to that patient's story triggered
painful memories that I had buried long ago. Three days later, when at home and away from the distraction of
work, I had a mental breakdown.
In less than a week, I had changed from a well functioning junior doctor to "borderline psychotic"—the psychiatrist's words, not mine—paralyzed by fear, unable to sleep, eat, or speak properly. I struggled to determine
what was real, and had terrifying, intrusive thoughts.
A few weeks later, I opened up about what I'd been through in my past. I told my parents, who then contacted
the psychiatrist who was looking after me. I was immediately diagnosed as having post traumatic stress disorder.
I had intense trauma based psychological therapy and was put on a concoction of drugs. I could not see a way
out. I convinced myself that I'd never be able to return to work and have the career I'd worked so hard for. I felt
that I would be judged or seen as weak and unable to cope. In fact, the harshest judgment I experienced was my
own. I realized that I was approaching my illness differently from how I would do for a patient in the same position.
Why do people in the medical profession do this? Why do we resist opening up and judge ourselves differently
from our patients? Perhaps we need to live up to certain expectations set by us and by society. Maybe it is that
we don't like to admit to being unwell because it is our job to look after others, and our patients rely on us. Or
could it be fear of intervention from the General Medical Council and the negative impact that would have on
our careers that stop us from opening up about our problems? Today's litigious society has developed a certain
degree of paranoia in us about our day to day practice: perhaps it is this that prevents us from admitting that
we might not always be 100% capable. But it doesn't matter why. The point is, something needs to change. An
estimated one in three doctors have mental health problems at some point,[1] yet we seem so afraid to deal
with it, which is extremely hypocritical.
My experience was acute and unexpected, but most mental health problems exist under the radar. Medical students and doctors should be encouraged to seek help early and not be embarrassed or afraid to admit to mental
health problems. Medical schools, the UK Foundation Programme Office, and the NHS provide help and support. The only way to break the cultural stigma within the profession, however, is for more doctors with mental
health problems to speak up, and to show that seeking help does not make you a less competent doctor. Negative outcomes are far more likely to occur by trying to carry on without the right support instead of opening up
about your problems.
My recovery has not been straightforward, and there were setbacks along the way. It took almost six months—
and a lot of hard work—for me to return to my job. My supervisors and the occupational health department
have gone out of their way to make my transition back as smooth as possible, and I cannot thank them enough.
I have spoken to only a few colleagues about my illness, partly because it is difficult to talk about, and partly
because I am never sure how to explain it. But those I have spoken to about it have been supportive. I know
that because I survived these past months I can survive anything.
Stud BMJ. 2015;23
Volume 4;
Issue
7
Page 5
T e a c h i n g r e f l e c t i o n t o d o c t o r s t o
i m p r o v e p h y s i c i a n - p a t i e n t i n t e r a c t i o n s
Physicians in their medical residency training programs often focus on scientific reasoning and research evidence in their
efforts to provide medical care. While appropriate, this focus may overshadow subtle and indirect communication that reveals important information about the patient's experience with their illness that will help the physician provide better
care. A new study by researchers at Tufts University School of Medicine and Boston College presents the results of a strategy to train medical residents to reflect on interactions with patients as a way of understanding the meaning of both their
patient's, and their own, communication.
The study directors asked 33 family medicine residents in the Tufts University Family Medicine Residency program at
Cambridge Health Alliance to write "open-ended reflections" over the course of one year examining their interactions with
patients. The project, which used a qualitative research design, resulted in 756 private reflections that the research team
iteratively organized into three principal communication themes: (1) recognizing the interdependence of physician-patient
communication (2) attention to the subtleties of patient behavior; and (3) images of growth and awareness about physician
-patient communication.
In the report in the Journal of Health Communication published this month, the authors provide sample entries from residents on each of the themes and related sub-themes. On the theme of interdependence of the communication behavior,
which included sub-themes on how physicians restrict what patients will tell them; how learning and taking the patient's
perspective can help, and how better communication might promote behavior change, sample entries included:
This (teen) patient needed more trust and engagement. I wondered how I could have approached her better...
Today I had a very rich and satisfying visit supporting a pregnant mom when I considered her needs more broadly in preparing for birth instead of just checking vitals and blood sugar.
I told him these events could predict dementia. He looked at me blankly and said, "events?" I realized that I have to avoid
BOTH jargon and ambiguous language.
The second theme on the subtleties of patient behavior included sub-themes on the need to integrate the patient's background, attentiveness to patient emotion, and implications for drawing conclusions about patients. Quotes included:
I wonder what point I could have picked up the right clue that he was stressed and depressed by his family situation...
The patient's fear and sadness about death was like a dagger to me. I grew defensive and tried to be jovial. It was hard to
look him in the face...Today I felt helpless, overwhelmed, scared.
I enjoyed seeing this 21 year-old girl. I was expecting some anxious, non-compliant girl with social challenges, but she was
pleasant. I hate that I...make quick assumptions.
Physicians who described images of growth and awareness, the third theme, focused on personal improvement. The subthemes included recognizing communication missteps, understanding the learning process, and commitment to ongoing
learning and growth. Reflections included:
How do I engage the patient experience rather than trying to get to [the] "right" answer as fast as possible?
I was surprised that was more than one right answer. I was worried that I was incompetent, but now I realize there are
multiple right answers, and the situation and patient preferences make medicine more an art than I'd realized.
I've come to see reflection as a long-term goal...
"When new physicians notice and make sense of what they may have missed in a patient interaction, they may be prompted to move forward in a different way, instead of unconsciously allowing that behavior to become the norm in future patient interactions," said senior author Allen Shaughnessy, Pharm.D., M.Med.Ed., professor of family medicine at Tufts University School of Medicine and fellowship director of the Tufts University Family Medicine Residency Program at Cambridge Health Alliance.
~ Medical News Today
Volume 4;
Issue
7
C l a s s i f i c a t i o n s
Page 6
o f
A n t i a r r h y t h m i c
A g e n t s
As the number of available drugs with antiarrhythmic properties increased, the need for a conceptual framework for their
classification became increasingly important. The classification scheme most commonly in use today is the eponymously
titled Vaughan Williams classification. The basis of this classification is the grouping of agents according to their general effect.
In the years since the widespread adoption of the Vaughan Williams classification, there has been an exponential increase in
our understanding of cardiac electrophysiology, the mechanisms of cardiac arrhythmia, and the discovery of new ion channels. In light of these more recent advances, there has been some criticism of the Vaughan Williams classification, most notably by the arrhythmia working group of the European Society of Cardiology, who, in 1991, proposed an alternative classification commonly referred to as the Sicilian gambit.[2] While these investigators raised several valid concerns, the Vaughan
Williams classification remains in widespread use and is requisite knowledge for those working in the field of cardiac electrophysiology.
The list below contains the classically described members of each drug class but is not comprehensive.
Class I: Fast sodium (Na) channel blockers
Ia -Quinidine, procainamide, disopyramide (depress phase 0, prolonging repolarization)
Ib -Lidocaine, phenytoin, mexiletine (depress phase 0 selectively in abnormal/ischemic tissue, shorten repolarization)
Ic -Flecainide, propafenone, moricizine (markedly depress phase 0, minimal effect on repolarization)
Class II: Beta blockers (partial list)
Propranolol (decreases slope of phase 4)
Esmolol (decreases slope of phase 4)
Timolol (decreases slope of phase 4)
Metoprolol (decreases slope of phase 4)
Atenolol (decreases slope of phase 4)
Class III: Potassium (K) channel blockers
Amiodarone (prolongs phase 3; also acts on phases 1, 2, and 4)
Sotalol (prolongs phase 3, decreases slope of phase 4)
Ibutilide (prolongs phase 3)
Dofetilide (prolongs phase 3)
Class IV: Slow calcium (Ca) channel blockers
Verapamil (prolongs phase 2)
Diltiazem (prolongs phase 2)
Class V: Variable mechanism
Adenosine
Digoxin
Magnesium sulfate
Volume 4;
Issue
7
Page 7
ECFMG NEWS
To be eligible for ECFMG Certification, an international medical graduate (IMG) must have been awarded credit for at
least four credit years (academic years for which credit has been given toward completion of the medical curriculum)
by a school that is listed in the World Directory of Medical Schools as meeting eligibility requirements for its students
and graduates to apply to ECFMG for ECFMG Certification and examination. ECFMG’s transfer credit policy places
restrictions on credits transferred to the degree-granting medical school that can be used to meet this requirement.
Effective July 14, 2015, ECFMG modified its transfer credit policy for IMGs who apply to ECFMG for ECFMG Certification and for the United States Medical Licensing Examination® (USMLE®). Following is the modified transfer credit
policy, which represents an update to the ECFMG 2015 Information Booklet
Transfer Credits
Transfer credits are credits earned for a course taken at one institution (such as a medical school) that are accepted
by another medical school toward meeting its degree requirements. For example, a student attends a medical school
for one year and earns credits for 12 courses. The student transfers to another medical school, which accepts the
credits for those 12 courses toward meeting its degree requirements. The credits for those 12 courses are then referred to as transfer credits.
If you transferred credits to the medical school that awarded or will award your medical degree, you must disclose and
document these credits when you apply to ECFMG for examination, regardless of when the credits were earned. (For
more information, see Credentials for ECFMG Certification in the Medical Education Credentials section of the
2015 Information Booklet.) Failure to disclose and document these credits may have a number of negative consequences, including delaying exam registration and certification by ECFMG, and may result in a finding of irregular behavior.
Additionally, for the purpose of ECFMG Certification, credits earned on or after January 1, 2008 that are transferred to
the medical school that awarded or will award your medical degree must meet all of the following criteria:
If credits for more than eight courses were transferred, all credits must have been transferred from one medical school
to another medical school, both of which must be:
located in the United States or Canada and listed in the World Directory, or listed in the World Directory as meeting
eligibility requirements for its students and graduates to apply to ECFMG for ECFMG Certification and examination.*
Credits must be for courses that were passed at the medical school at which the course was taken.
If your transferred credits do not comply with all the criteria listed above, you will not meet the requirements to be registered by ECFMG for examination or the requirements to be certified by ECFMG. If your transferred credits do not
meet all the criteria listed above, you may request an exception from the ECFMG Medical Education Credentials Committee.
*Important Note: The requirement that credits must be transferred from one medical school that meets the criteria
above to another medical school that meets the criteria above does not apply to credits transferred only to the premedical portion of the curriculum of the medical school that awarded or will award the medical degree. If you transferred credits to the pre-medical portion of the curriculum at the medical school that awarded or will award your medical degree from an institution that does not meet the criteria listed above, you must provide ECFMG with a letter from
the medical school that awarded or will award your medical degree confirming that the credits were transferred to the
pre-medical portion of the curriculum only. This letter must be on the letterhead of the medical school and be signed
by an authorized official of your medical school. This letter must be submitted in conjunction with the application for
examination and must accompany the Certification of Identification Form (Form 186) or Certification Statement (Form
183). Applications received without this letter may be rejected. This letter is in addition to disclosing and documenting
all transferred credits as described above.
Volume 4;
Issue
Page 8
Update: World Directory of Medical Schools Replaces International Medical Education Directory for Purposes of Determining Eligibility for ECFMG Certification.
Effective June 30, 2015, international medical students and graduates (IMGs) must use the World Directory
of Medical Schools (World Directory) to determine their eligibility to apply to ECFMG for ECFMG Certification and the United States Medical Licensing Examination (USMLE).
As previously announced by ECFMG, the World Directory includes medical schools that do not meet
ECFMG’s eligibility requirements. Before applying to ECFMG for ECFMG Certification or USMLE, IMGs
should consult the World Directory, available at www.wdoms.org, to confirm that students and graduates
of their medical schools are eligible. Instructions for using the World Directory to determine ECFMG eligibility are available in the Important Notice: World Directory of Medical Schools Replaces International Medical Education Directory (IMED) for Purposes of Determining Eligibility for ECFMG Certification and USMLE®,
available on this website. This document also includes examples of the ECFMG policies that have been
modified as a result of the transition to the World Directory.
Atlantic
University
School of
Medicine
Atlantic University Admissions
PO Box 456
Island Park, New York 11558
Phone: (516) 368-1700
Fax: 888-639-0512
E-mail: [email protected]
http://www.ausom.edu.lc
You’ve spent months—even years—
preparing your applications to U.S.
residency programs… researching programs, gathering supporting documents, requesting letters of recommendation, compiling a CV, crafting
the perfect personal statement, ensuring everything was submitted on time.
You sent your applications and waited
patiently for interview invitations. But
what happens when you get that longawaited invitation for an interview?
The structure of the residency interview process varies from program to
program. You may be invited to an
informal dinner with program residents the night before your interview.
Your day may start with a presentation
on the program or it may start with a
hospital tour where you are introduced
to the staff. You may be the only can-
didate that day or you may be one in
a group as large as 30. Many programs
will inform you in advance how the
interview day will be conducted, so
you have an idea of what to expect
when you arrive.
Some of the best advice provided by
experienced participants is wow your
interviewers. Communicate effectively, talk about yourself, yet remain
humble, know the program to which
you are seeking admission extremely
well, demonstrate that you’re a team
player, exemplify your clinical
knowledge and skill, be inquisitive
and always have fun throughout the
process.
A happy and confident applicant is a
successful resident.