JAMAmia!

Its hazardous to form conclusions from articles reading merely abstracts. Thats something the physician who is just an MD loves to do.Its the way we are fed information- sometimes embarrassingly from medical reps than textbooks.Its because we do not find it interesting to go through the statistical analysis and would rather brush through the basic materials and methods and discussion - or worse just the conclusion.Or maybe we do not understand the statistical analysis sometimes. Sometimes we just don't have the time.

There's a sad angle of residents in countries like India not having access to full text because even teaching hospitals do not have subscription to paid journals!! Here I think the New England Journal of Medicine did us a great disservice by making access to full text articles pay to view.It was immensely disappointing to residents and hospitals like BJ where sometimes case discussions at the MGH substitute for M&M ( I seriously don't understand the logic of doing that because you do not have 'interesting cases'for M&M anyways!!)I had to do a collection drive from the residents to buy a subscription for the Dept of Medicine at BJMC.(The professors as usual did not pay up!!)But seriously aren't the editors of NEJM reading too much into the economic gains made by India ...seriously how much of that techie centered, oversexed economic growth has percolated in primary health care or health insurance reform or even health statistics?!This is really a rhetorical question because none has really...thats a unqualified statement I know...but the majority of the Mumbai populace still go to KEMH and not PD Hinduja Hospital.Thats where the people who later on practice at places like PDH train.And if they are not getting EBM access then its a serious educational access anarchy we have here.

It is predicted that India's economy will overtake the US economy in terms of size by 2024, but still the per capita income will be 1/4th that of the US. The health expenditure for India has been 6% of GDP...approx 60% this goes into national health programs and primary health care. What proportion goes to Medical Education I do not know. The health minister of Maharashtra claims they spend around 4-5 lac per MBBS student( a basis on which he enforces a bond amount of 5-35 lac on people pursuing post graduate courses)...thats a huge fib!! They end up showing expenditure incurred on running hospitals as that required for training students. The sufferers are the students/residents who do not get access to what a medical student form the US can get at a tap on his PDA.

Anyways..coming to the point- JAMA carries two interesting articles this week( remember I have access only to abstracts) One about the impact of the ACGME working hours regulation imposing a cap on the number of hours residents spend on call on the mortality rates at teaching and non teaching hospitals and VA. It concludes that there is no significant or marginal difference in either way( inc or dec mortality)at 2 years post the regulation.There are two points I do not quite understand on this- I am sure I would have got a clarification if I had read the discussion- what impact does the hospital status have on resident working hours if there is a guideline which is followed universally? And the conditions listed are all acute care conditions, the highest mortality would occur in the initial period- either in the ER or immediate care setting. Again, the group of conditions clubbed together are non homogeneous.In the VA hospitals the regulation resulted in an significant decrease in mortality i the medical group and not i the surgical group. I am not sure what conclusion to draw from the second part - again I have no access to discussion or the related editorial.

Yet another study makes a case for the most expensive exam I have ever given...the USMLE Step 2 CS. I do not think there is a more expensive exam administered for even management courses.But the study correlates scores on a Clinical Skills exam, which I believe should be similar to the CS- washing hands, greeting the patient,not forgetting the hi and goodbyes- to physician malpractice claims and complaints. And wonder of wonders, it does find a significant correlation. Statistical true lies? Post hoc ergo propter hoc? Again...no full text access.

The last article reiterates the first passage of this post :most residents do not feel comfortable with biostatistics.

The overall mean percentage correct on statistical knowledge and interpretation of results was 41.4% Higher scores in residents were associated with additional advanced degrees, prior biostatistics training, enrollment in a university-based training program and you will not believe this---male sex!!Estrogen be damned!!What the hell- I seriously do not understand.Despite being male;-)Someone get me the issue please!