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GODLEE, F., PAKENHAMWALSH, N., NCAYIYANA, D., COHEN, B., & PACKER, A. (2004). Can we achieve health information for all by 2015? The Lancet, 364 (9430), 295-300 DOI: 10.1016/S0140-6736(04)16681-6
GODLEE, F., HORTON, R., & SMITH, R. (2000). Global information flow The Lancet, 356 (9236), 1129-1130 DOI: 10.1016/S0140-6736(00)02752-5
ON-LINE POSTING OR DISCUSSION OF USMLE CONTENT CONSTITUTES IRREGULAR BEHAVIOR
If you post or discuss United States Medical Licensing Examination (USMLE) examination content via the Internet, you will be in violation of the USMLE Rules of Conduct, as outlined in the USMLE Bulletin of Information. Examination content includes, but may not be limited to, questions, case content, and answers.
The Bulletin specifically advises that, "you will maintain the confidentiality of the materials, including the multiple-choice items, and the case content for Step 2 CS and Primum CCS. You will not reproduce or attempt to reproduce examination materials through memorization or any other means. Also, you will not provide information relating to examination content that may give or attempt to give unfair advantage to individuals who may be taking the examination. This includes postings regarding examination content and/or answers on the Internet."
The USMLE program continuously monitors Internet forums and chat rooms. Examinees who post information about examination content are identified and referred to the USMLE Committee on Irregular Behavior. If the Committee finds that you posted examination content, your scores may be delayed and you may be subject to the following sanctions:
- Permanent annotation of your USMLE transcript (such annotations will read "Irregular Behavior/Security Violation" and will be seen by any entity that receives your transcript, i.e., residency training programs, state licensing authorities, etc.);
- A report to the Federation of State Medical Boards Board Action Databank (a central repository for formal actions taken against physicians and available to licensing and disciplinary boards, the military, governmental and private agencies, and organizations involved in the employment and/or credentialing of physicians);
- A bar from taking future administrations of USMLE.
A determination of irregular behavior can put your medical career in jeopardy. Do not endanger your career: Do not post information from exams you have taken and do not solicit others to provide such information.
For more information, refer to Testing Regulations and Rules of Conduct and Irregular Behavior in the USMLE Bulletin of Information, available on the USMLE website at www.usmle.org.
From the ECFMG Reporter
I am not always a big fan of the articles by BMJ’s Ethics Man Daniel Sokol because I think his articles are, more often than not, inclined towards the ideal without much regard for the practical, at least, from the perspective that I have, of working in a developing world medical institution. However, in this case, I must admit that he has nailed the issue head on. Apparently, it is not just the developing world where consent taking is a rather lowly menial work relegated to the junior most medical staffs to do!
I remember the case of a patient in surgery with scrotal edema, massive soft tissue infections, who was scheduled for a scrotal skin removal and refashioning, a procedure where the restoration of the normal anatomy and physiology was quite doubtful. After I was sent to get the consent from the patient, I described to him the procedure he was scheduled for, and what might be the possible outcomes, in a very brief and rough manner (based on what my resident had told me!). The patient was so scare that he absconded. Needless to say, the fireworks I had to face afterwards would have belittled any New Years’ celebrations!
In this article, what particularly interests me is that the author has written keeping in mind the conditions of the developing world in mind. A part that I absolutely loved is:
In rural India doctors told me that it was pointless to explain interventions to patients as they were too medically unsophisticated to understand. As a lecturer whose job it is to explain philosophical concepts to students whom unkind colleagues might call philosophically unsophisticated, I was not convinced. Is it not part of a doctor’s job to communicate medical information in a manner that is comprehensible to the patient?
I am sure I hate the unkind colleagues who hold such low opinions about medical students, but undoubtedly, this is a very true observation. I have seen, in my very short foray into the world of medical practice, most patients will be able to understand most of what they are about to undergo if explained in adequately clear, jargon-free vernaculars. For example, the lady who was so scared to go for her cesarean section ultimately consented when made aware of the dangers she was exposing her baby to.
In conclusion, I must admit that the entire process of consent taking is not just a mere irritating formality to be taken care of to facilitate the surgery/procedure, but is, in fact, a great opportunity to build the doctor-patient bridge that is nowadays so lacking!
Sokol, D. (2009). Informed consent is more than a patient’s signature BMJ, 339 (aug27 1) DOI: 10.1136/bmj.b3224
Plagiarism is a widely despised activity. So much so that doctors are requesting speakers to boycott a conference which is chaired by a plagiarist. As I read the article (first citation below) and how Iain Chalmers, in conducting a systemic review managed to unearth the fact that the study was plagiarized, and also copied facts and figures (thereby incriminating it of scientific fraud as well) the matter of plagiarism and its implication once again became clear. The fact that the authorities in question did not sanction the plagiarist, is an entirely different situation! but I digress, since this post was initially meant to discuss the aspects of self-plagiarism!
Although one might argue that copying from work one has done previously may not amount to a serious breach of rules and regulations, I believe this is just semantic trickery: tomayto/tomaato! Even copying from one’s own papers should be condemned, as has been (albeit in a very safe, diplomatic kind of manner) in the Lancet article (second citation). It is a cheap act because not only is it just simply a waste of time and money and resources, but also it is some what a scientific fraud, where the author, knowingly (well, it is difficult to copy large sections verbatim from a previous publication and then try to get away by laying the blame on one’s memory).
And worse than all these things is the thing that this action advertises the fact that the author not only has VERY loose moral and scientific values, and also exhibits a lack of intellectual wealth, something I would hate to see in a mentor of mine!
Mashta, O. (2009). Doctors try to get speakers to boycott international conference chaired by plagiarist BMJ, 339 (sep01 2) DOI: 10.1136/bmj.b3545
The Lancet, . (2009). Self-plagiarism: unintentional, harmless, or fraud? The Lancet, 374 (9691), 664-664 DOI: 10.1016/S0140-6736(09)61536-1
The flu shots are ready to fly. The UK and US lead the lists of the nations to have ordered flu vaccines, especially for the healthcare people, those that are, literally fighting in the trenches. No surprises, India has been caught napping! And with the winter approaching the flu epidemic in India can only get worse. The next time I see a patient sneezing in the ER, I am running for cover!
This editorial in the BMJ drew my attention especially because it is something right down my alley of interest. It says:
More than 75% of healthcare workers responding to a survey in Leicester, UK, indicated willingness to accept a pandemic vaccine.6 However, this survey was conducted when the main pandemic risk appeared to be H5N1, which is associated with a high case fatality rate, rather than the current H1N1 strain, which is associated with relatively low mortality. In the linked study (doi:10.1136/bmj.b3391), Chor and colleagues show that, in a sample of 2255 healthcare workers in Hong Kong hospitals, the intention to accept pre-pandemic vaccines increased from 28.4% for H5N1 vaccine during the World Health Organization alert phase 3 to 47.9% for H1N1 at phase 5.7 An online poll just conducted by the Nursing Times reports that 37% of frontline nurses who replied were currently planning to be vaccinated, 33% were undecided, but 30% were not planning to be vaccinated. In line with surveys of seasonal flu vaccine uptake, intended acceptance of pre-pandemic or pandemic flu vaccines was associated with receipt of previous seasonal flu vaccines, perceived likelihood of being infected, and belief in the efficacy of flu vaccines.6 7 Reasons for refusing the vaccine included concerns about safety and efficacy, and low perceived threat of a pandemic.
Some of the questions that haunt my mind (now that we know that the mortality of this Swine Flu pandemic is nothing terrifying, and somewhat along the lines of its rather less respected and feared cousin, the “normal” seasonal flu) are:
1. What about the adverse effects? With no real studies to rely on prior to administration of the vaccine on a large scale, the fear remains that there maybe some unknown adverse effects to the vaccines (despite all the pre release research and post marketing monitoring, vaccine associated adverse effects get a lot of mileage: remember the Autism and MMR vaccine debate, later disproved?).
2. Are they effective? Will they do me any good?
3. Costs, pricing, availability. This may not be much of an issue in the developed world, but sure is one here in the neck of woods! Despite government take overs, one worries what might be the battle the drug companies will have over it, especially in the developing world, where the govt. lacks the bucks and will to take up such a huge endeavor.
Jordan, R., & Hayward, A. (2009). Should healthcare workers have the swine flu vaccine? BMJ, 339 (aug25 2) DOI: 10.1136/bmj.b3398
