Ten Things to Love About America on Trump Days

In 2008, America was the first western industrialized country to elect Barack Obama as a non-white Head of State.. In 2016, ehe pendulum swung backwards in the election of ultra-white media-made business tycoon Donald Trump. As Trump rolls back progress made under Obama toward global cooperation in critical areas such as climate change and health care, it may help Americans to review what makes their country so great.

1. America has a great foundation. The 1776 Declaration of independence states that the new country freeing itself from England is based on an inalienable human right to life, liberty and the pursuit of happiness.

2. The 1786 Constitution set out the rights that would be protected. Those include the right to free speech and freedom of the press, the right to assemble and right to bear arms.

3. Amendments to the Constitution spelled out rights not foreseen by the forefathers in line with their intent. Thus, one-time slaves were acknowledged as full citizens, as were women with the winning of the right to vote.

4. The law rules in America. The ingenious part of the Constitution is its separation of the country’s governing powers into three branches, one that makes the law,another that puts is into practice and a third that mediates when the other two come into conflict. In the ned, the Constitution wins.

5. America provides legal protection. During the 250 years since its founding. America has developed a legal system in line with the constitution that ensures the rights of its citizens. That evolution in law goes on. As the Miranda law today protects the rights of the accused, legislation now is in the works to regulate gun traffic in the country..

6. America is helpful and forgiving. Social aid is available to those in need and bankruptcy laws get others out of financial troubles. Legal recourse is always available to those who feel slighted. When in doubt, call a lawyer or two.

7. If legal relief for a grievance is unattainable or out of reach, America is open to media outreach. If ticked off and unable to get action from landlord, the city or business, Americans are freed to contact media that in the US are fan-friendly, starting with local presses and stations.

8. America is friendly. Yes, America as a complex nation of immigrants sees daily violence in the jews but that is not the American norm. Conflicts are inevitable. They are put into perspective by a walk to the local bodega. The Mexican ot Indian behind the counter is there to please and that is the real person behind the currently scary label of immigrant.

9. America is the land of opportunity for change. Americans have a Constitutional right to assembly. They can organize marches, sit-ins, sit-downs and walk-outs. All that;s needed is a motivating cause. America gives the aggrieved the room in which to collectively express their displeasure.

10. America loves to party. A land of immigrants provides for holidays throughout the year. The all-American 4th of July and Thanksgiving Day are among the greats. Others include St. Patrick’s Day, Istaeli Independence Day, Puerto Rican and Caribbean Days That’s not even to mention New Year, celebrated by all the wide world over.

The list could go on and it builds with the thought of just how lucky are those who are in America. The path through 2019 may continue to be stressful but 2020 will bring an election and a Census conducted every 10 years. That will count us all without regard to status. Everyone here now is a resident, equally grateful to smile on a neighbor who could be from anywhere else in the world.

The True Benefits of Elder Care Services

Elder care has turned into a highly preferred solution and is being increasingly accepted in the majority of the countries having a largely growing elderly population. Provided the choice the maximum seniors wish to spend their twilight years within the familiarity and comfort of their own sweet home. The good news is today with the easy availability of elder care services an elderly person no longer require to shift to a hospital or nursing home. Nowadays these services are available in different forms ranging from nursing, basic assistance with day to day living to medication management.

Explore the top benefits of elder care services

Below is a list of the top benefits of availing the services of professional elder care. These include,

• Save precious time- there are different types of elder care services and these are quite time consuming. Often it becomes challenging for a caregiver in being capable of juggling the time needed. Thus, elder care assistance turns into a necessity that helps a family caregiver in investing more time on other vital priorities instead of the routine tasks that can be performed via a home specialist who has been trained specially for this task

• Professional assistance- a home caregiver can handle the routine as well as critical situations far better as they possess the needed training and experience

• Social interaction- No matter how close the caregiver may be to the patient there is indeed a limit to the amount both of communication and socialization with one another. To have someone from the outside will offer some benefits. It will allow the elderly in staying communicated and interacting with someone else and this will work wonders for his/her emotional well-being

• Uphold the old lifestyle- a caregiver can assist the senior in upholding the lifestyle which she or he was accustomed to at one point of time. In fact, it is a part of the caregiver’s training in sustaining the momentum

• Quality of life- Via the assistance of a caregiver the senior adult can enhance their quality of life. Instant help is accessible, thus there is no requirement of struggling with the day to day household work. A caregiver is specially trained for anticipating the requirements of the senior who is in their charge. The best part is the care level can be selected as per the requirement from merely a few hours daily to 24/7 assistance and companionship.

All these factors throw light that hiring professional elder care services are indeed worth it.

America’s Health/ Medical Care: Some Alternatives/ Options

For nearly a decade, politicians have seemingly, buried their heads, in the sand, and considered this nation’s approach to treating the health, and well – being of our citizens, and responded with bipartisan, politics – as – usual! Wouldn’t we be better served, if the response of some, was not, merely, articulating a message, about so – called, socialism, etc? It seems, many Republican opponents, to the Affordable Care Act, spent a disproportionate amount of time, merely opposing that law, rather than fixing its flaws, etc. While that law, certainly needs, tweaking, it attempted to address the fact, the richest country in the world (the United States of America), did not come, even close, to the best statistics, regarding morbidity, mortality, infant survival, and other, health – related items, as well as having the most expensive costs, for prescription drugs, in the world. Why are we, the only place, where citizens go bankrupt, trying to pay their medical bills? Why do we pay, so much more, for prescription drugs, than others pay for the exact medications? With that in mind, this article will attempt to consider, review, examine, and discuss, some of the alternatives, we might adopt, to improve upon, what we currently have.

1. The pre – ACA, status quo: Why was the Affordable Care Act, passed, during the early part of the Obama administration? What was its intent? Why was it needed? Prior to enactment, health care, in this nation, was often about, the haves, and have – nots! More and more, health insurance companies, appeared to be, wagging the dog, instead of health professionals! Individuals with pre – existing conditions were often, denied coverage, rates often accelerated, as we aged, and every year, quality medical/ health insurance, became more, and more expensive! Many millions had no, or very limited insurance coverage, and we often witnessed, people being forced to choose between quality care, and eating! Those supporting the act, seemed to believe, our citizens needed, and deserved, better care, and, quality treatment/ care. For many, they felt, medical/ health care, should be, a right and guarantee, rather than a possibility, only for the richest!

2. ACA passage: When the act, was passed, it was largely among party lines, and at the time, Democrats were the majority party. While the basic intent of the legislation, was well – intended, because of the nature of our political system, it was somewhat flawed, and many ramifications and contingencies, were not fully considered, etc. The costs did not decrease, as promoted, and while, they probably increased at a slower pace, it still hurt many of us! Instead of improving the details, and fixing it, properly, the Republicans devoted their time, and energy, to constantly, trying to repeal it, but, without offering any viable alternatives, and/ or solutions, to solve the challenges.

3. The Trump alternative/ strategy: When Donald Trump, ran for President, he articulated a message, declaring, he would fix the health care system, and it would be better, and less expensive. He promised, it would be easy, and created a slogan, Repeal and replace, as if, he had the secret formula! Rather than admitting the plan, his supporters proposed, was different, but worse, and was defeated, he reverted to his customary, blaming and complaining, and settled for subtle ways, to destroy it. One of these steps, was having the mandatory coverage, eliminated, which, made everyone’s insurance, more expensive, Another was reducing/ eliminating, subsidies, for the neediest, and creating an Affordable Care, alternative system. The ramifications of these steps, was hurting, rather than helping! Now, Trump’s Justice Department, is supporting, legal actions, to declare the entire act, unconstitutional, without seeming to realistically, consider, the potential negative ramifications, if they get, what they seek. It seems, a lot like, someone, who kills both his parents, and pleads for mercy, because he was an orphan!

4. Proposed Medicare – for – All: While, to some, this seems wonderful, the overall analysis, appears to be, over – simplified! Medicare, itself, is a flawed system, which taxpayers, contribute to, throughout their working lives, and, still requires over $1,600 additional contribution, per year, after we turn 65. In addition, it only covers about 80% of the Part B, part, and the supplemental insurance, which completely covers, most of these expenses, now costs over $3,600 per year. Even after these expenses, one needs, either additional policy, for a prescription plan, or, risks extreme, out – of – pocket costs. One further consideration is, believing doctors, will accept these reduced Medicare rates, for their entire patient base. Doesn’t it make sense, to tweak, and improve, rather than trying to re – invent, the wheel?

Is quality care, a right or a privilege? If, like most Americans (based on many polls), you feel it’s a right, demand your elected officials proceed, accordingly, rather than, in a politics – as – usual, manner!

How to Study for and Pass the Internal Medicine Boards

As the ABIM internal medicine certification exam approached, we received a large number of emails from our subscribers asking for suggestions on the best way to study for the boards. The truth is there is no one path to success though there are certainly ways to increase your likelihood of passing. Regardless of whether you are preparing for board certification or trying to achieve maintenance of certification (MOC), the best tried and true overall method is to “study early and study often.” Below we lay out possible strategies and tactics (in no particular order) for passing the ABIM board exam:

1. Know the basics of the internal medicine board exam

This is obvious but a lot of people simply don’t review this prior to starting their exam preparation and instead rely on their ABIM study source of choice to provide the information.

  • Review the ABIM exam blueprint and understand the topics covered on the exam
  • A large percentage (33%) of the exam is comprised of Cardiovascular Disease, Gastroenterology, and Pulmonary Disease
  • Over 75 percent are based on patient presentations – most take place in an outpatient or emergency department; others are primarily in inpatient settings such as the intensive care unit or a nursing home.
  • While it’s not a big part of the exam, be prepared and expect to interpret some pictorial information such as electrocardiograms, radiographs, and photomicrographs (e.g., blood films, Gram stains, urine sediments).

2. Use the in-training exam as a starting gauge

If you are a resident, the Internal Medicine in-training exam is a good starting point to see where you stand. It’s simply that – a barometer of where you stand. It will give you an idea where you may be weak and where you may be pretty strong. It will also give you an idea of how you compare with your peers. Don’t alter your ABIM study plan simply based on it but it does give you an early metric of the areas you need to focus on.

3. Get a study guide to prepare for the ABIM exam

It’s important to have a good study guide that is tailored for the exam. Some of the more popular and effective guides we’ve come across are the MedStudy Internal Medicine Board Review books and Harrison’s Principles of Internal Medicine Board Review.

4. Join a study group

Study groups, if utilized properly, are particularly effective because they allow you to learn from your colleagues and other exam takers. Oftentimes, people will form study groups with their colleagues (ideally limited to 3-4 people) at their residency program. Tactics to use in ABIM study groups may include:

  • Focus on a new internal medicine category by week. For example, focus one week on cardiology and the next on pulmonary care. The exam can be broken into a dozen or so categories (see the ABIM exam blueprint). The majority of the subspecialty questions on the Internal Medicine board exam will focus on cardiology, gastroenterology, and pulmonary care. However, do not neglect the other areas as the ABIM wants to ensure that internists have a broad base of medical knowledge.
  • Test each other with internal medicine questions you have written yourself. We are firm believers in the philosophy that the best way to learn is to teach. If you help others learn, your knowledge of medical concepts will be greatly strengthened.

We recognize that joining a study group is often not feasible – especially for those no longer in residency programs where everyone is preparing the boards. Fortunately, we live in a digital age where being part of a study group is much easier. You can connect with colleagues through Skype, Google hangout or a number of other channels. One of our favorite approaches is to remain informed and learn through the power of social media – in particular Twitter. In a previous post, we highlighted excellent Twitter handles to follow for ABIM exam review as you prepare for certification. If Twitter is not your cup of tea, you can also connect with colleagues through the Knowmedge ABIM community on Google+. Regardless of what approach you decide, studying alongside others preparing for the same exam is a great motivational tool for success.

5. Get a question bank that fits your personal needs

What is the value of an Internal Medicine question bank? This is a discussion near and dear to our heart, of course. Question banks have become a popular tool because they bring together a lot of material in a question format and help create a test taking environment. There are a lot of question banks to choose from – so what should you look for in an ABIM qbank?

  • High quality ABIM-style questions in a format similar to the exam: The exam is mostly filled with clinical vignettes and has straightforward questions as well. At a minimum, your ABIM exam question bank should have both of these types of questions. Quantity is important – but the quality of the questions and explanations is much more important.
  • Detailed explanations that review why the incorrect choices were wrong: A question bank that does not provide you detailed explanations is probably not worth the money and time spent. As you review questions, you will inevitably get some wrong – your choice of ABIM question bank should detail why your choice is incorrect and the reasoning behind the correct choice.
  • Ability to track your personal performance: Your choice of ABIM qbank should be able to tell you your performance overall and by category. Most – not all – question banks provide you a dashboard broken down by category. The Knowmedge question bank has gone an additional step to break the categories into subcategories as seen on the ABIM exam blueprint. This allows you to review your strengths and weaknesses at a granular level. Knowing you are weak at cardiovascular disease is great – knowing you are weak at arrhythmia questions is more valuable.
  • Add-ons – Notes, Lab values, Highlighting: Depending on how you study, these may be valuable features.

ABIM exam questions straight talk:

  • No question bank – not MKSAP, not Knowmedge, not any – knows what will be on the actual ABIM exam. Based on the ABIM Blueprint, you can make assumptions on what are the most high-yield areas to study. The point of a question bank is not to give you the exact questions that will be on the exam – it is to hopefully teach you concepts you may see on the exam and how to reason through what you don’t know immediately.
  • High-quality ABIM exam review questions can be found in many places – question banks are not the only place. There are study guides, books, and even free sources. So don’t simply base your decision on question bank on the questions. In addition to the quality of the questions, what truly differentiates one ABIM exam question bank from another is whether it will truly help you build a broad base of knowledge and help you retain information for the exam. If you are not comfortable reading a bunch of text – it won’t matter how great the questions are. If you are not an audio-visual learner, the Medstudy or Knowmedge videos won’t do anything for you (As clarity, the Knowmedge qbank contains text and audio-visual explanations for this exact reason). If you are an “old-fashioned” learner that prefers printouts – USMLEWorld is definitely not for you – those who have used them are well aware their software will block you from taking print screens or copying of their content. In short… don’t follow the herd – each one of us learns differently and you need to pick the best method for you.

6. Consider whether a review course is right for you

There are pros and cons to taking a review course for your ABIM exam prep. The pros are that it gives you a serious dose of review in a short period of time. It gets you focused if you weren’t focused and some courses are absolutely excellent – we know some internists are ardent supporters of some of the professors that teach these courses. The three most popular independent courses we are aware of are:

  • Awesome Review by Dr. Habeeb Rahman – The best known and most popular independent course. Dr. Rahman has a very unique style of teaching and accompanies his lectures with his own videos. During this six day course (Sunday – Friday), Dr. Rahman provides students his own set of notes and questions to practice.
  • iMedicineReview by Dr. Shahid Babar – This three day course (Friday, Saturday, Sunday) course comes with a set of 1,500 review questions.
  • Unique Course by Dr. Satish Dhalla – A six day course (Monday – Friday) taught by one of the Top Internists in the Nation as selected by U.S. News

The cons of a review course are that they are expensive (Often over $1,000 plus hotel stay) and can be inconvenient to travel to and from. Regardless of whether you attend a review course or not, it cannot replace the pre and post-course study time that is needed. It is complementary to study time and does not replace it.

7. Review our suggested ABIM test taking strategies

The ABIM exam questions are not intended to trick you – they are intended to challenge your knowledge and ability to bring together your understanding of many different concepts and topics. Below are some of the tactics you can use as you are practicing questions and/or taking the actual ABIM exam:

  1. For clinical vignettes, read the question (last line) first and then go back and read the scenario. This way you’ll know what to look for as you are reading the scenario.
  2. Try to answer the question even before seeing the answer choices.
  3. Pay attention for keywords that can clue you in on an etiology or physical exam.
  4. Watch for key demographic information – Geography, ethnicity, gender, age, occupation.
  5. The ABIM test is not intended to be tricky but we are all human so we miss keywords sometimes – such as “least likely” – pay attention to these.
  6. If you are challenged by a longer clinical vignette, note the key items and develop your own scenario – this may trigger an answer.
  7. Most internists we’ve spoken with say time is generally not an issue – but be aware that it is a timed exam and that you have approximately two minutes per question.

We cannot stress enough the mantra “study early and study often.” The exam is challenging but it can be conquered with diligence and proper preparation.

8. Understand and be prepared for ABIM test day

  • Be prepared and confident. No matter how you have chosen to study, on test day – confidence is critical!
  • Get a good night’s rest – last minute cramming and staying up late is only going to stress you out more.
  • Get there early – don’t risk getting caught in traffic. It’s much better to be a little early than be aggravated in traffic.
  • Take an extra layer of clothing. The last thing you want to do is be uncomfortable and cold because someone decided to turn on the air conditioner too high.
  • Test day is long! Be mentally prepared for it. From registration to the optional survey at the end, the day will be 8-10 hours long (depending on whether you are certifying for the first time or taking the maintenance of certification exam).
  • Keep some power snacks with you to take during break time.
  • Review the ABIM exam day schedule so you know exactly what to expect.

That’s a basic overview of how to study for and pass the ABIM board exam. As mentioned, there is no secret sauce or method to this – you simply need to have a broad base of knowledge. There is no substitute for studying early and studying often! If you are preparing for the ABIM Boards, we wish you well – we’re here to help so let us know if you have any questions! Happy studying!

Is It Hard to Become a Flight Medic?

Flight paramedic positions are extremely competitive. The most common Air Ambulance Flight Crew configuration in the United States is one pilot, one flight nurse and one flight paramedic.

According to the Bureau of Labor Statistics, Emergency Medical Technicians (EMTs) and paramedics held about 210,700 jobs in 2008.

The 2008 Atlas and Database of Air Medical Services (ADAMS) lists 699 rotor wing (helicopter) and 154 fixed wing (airplane or jet) air medical bases in 2008.

To staff an air ambulance base 24-hours a day, seven days a week, 365 days a year – a minimum of 4.5 full time nurses and 4.5 full time paramedics are needed. Multiplying a total of 4.5 flight paramedic positions per base times 853 total bases (RW and FW) equals 3838.5 flight paramedic jobs in the United States.

Since the Bureau of Labor Statistics does not distinguish between paramedic and EMT jobs, we divided the 210,700 total EMT and paramedic jobs to estimate 105,350 ground paramedics in the United States.

3838.5 flight jobs divided by 105,350 potential applicants equals 3.64 percent.

The result is fierce competition for each and every open flight medic position.

So what can you do to make yourself more competitive?

Here are five ways to improve your chances for a flight paramedic position:

1. Build experience working for a ground ambulance service.

2. Earn as many instructor certifications as possible.

3. Pursue critical care certifications as soon as possible.

4. Make your interactions with local air ambulance flight crews positive.

5. Request to meet with the program director or senior staff of air ambulance programs you’re interested in.

There is simply no substitute for experience. Many flight programs require a minimum of three years experience as a ground paramedic. The average experience requirement is 3 to 5 years of ground experience.

Instructor ratings are also helpful. They distinguish the average candidate from the exceptional. The theory is that if you can teach, you can do. Instructor ratings also show a commitment to improving your industry, as well as the ability to work well with your peers and other professionals.

Critical care experience, although not required, is something else that distinguishes applicants for flight crew positions. As soon as you start to reach a comfort level with your skills as a paramedic, it is highly recommended that you pursue critical care training as soon as possible. If critical care training is unavailable in your area, consider traveling to obtain certification. Yet another option is to work as an emergency room technician and gain exposure and experience to higher-level trauma inside a hospital setting.

Make your interactions with air medical crew positive. Remember, this is the team you want to be a part of. The more professional you present yourself the better.

As soon as possible, request to meet with program directors of air ambulance programs you want to work for. Ask them directly the best way to work for their program.

Flight paramedic positions require a herculean amount of effort. The good news is that almost every flight paramedic we work with reports the career is absolutely worth the effort.