One of the schools I'm applying to only allows a Personal Statement of 300 words or less. This is very short considering the lengths required by most schools. According to their website, they do this for two reasons:They take pride in the fact that they read every single word of every single application. (They don't dismiss students outright because of a single score.) Doing this takes up
300 Word Personal Statement – 2nd Draft
Here's the corrected version of yesterday's essay: In the Fall of 2002, a co-worker of mine asked me to take an Emergency Medical Technician (EMT) certification class with him and it changed my life forever. This class was exactly what I needed. The subject matter was raw, the weekly hands-on testing was intense and the consequences were serious. What we learned in this class would have a
"Where did you do EMT training at?"
Anonymous writes:"Where did you do EMT training at? I'm trying to find a good place. (P.S: You're blog is extremely helpful and inspiring. I rely on it for my motivational boost to work harder in order to get into Med school) :-)"I'm afraid I won't be of too much help in this area. I can only tell you about my own experience and in my experience I was just really lucky.I was fortunate that the
"is this jonathan that went to brazil in the summer of 2006?"
Anonymous responds to this and writes:"is this jonathan that went to brazil in the summer of 2006? if so, i think this blog might be about me 😀 i heard from a classmate here at keck about this blog and i wanted to check it out! good luck on the app process!"Ha!Yes, it is. Don't read this. How embarrassing.Like I said to you before when you weren't sure if you got accepted or not, if you can't
First Application is Away – Ross University
I've been hinting towards this. I've talked about it. And I know a lot of people aren't interested in this school because it's international.Ross UniversitySay what you want, but I've done my homework on the school. It's a good school.I've just completed and filled out their online application. Yesterday, I spent all day driving around to all my former schools ordering transcripts. My
AMCAS—The American Medical College Application Service
You should already know this, but if you didn't already how the application process works for the majority of U.S. medical schools, it's done through the AMCAS service found on the AAMC website: HERE.Here's a re-post of their own self-description:The American Medical College Application Service (AMCAS) is a non-profit, centralized application processing service for applicants to the first-year
The Student Doctor Network
Here's a site that I've heard of before, but I've only recently visited because one of my friends brought it up again. (She's currently applying to Pharmacy school.)www.studentdoctor.netIt has a lot of good information for many all different medical and science related fields found on their FORUMS including: Pre-med, medicine, doctors, optometry, pharmacy, psychology, veterinary, etc. But I
Crime Incident – Public Safety Announcement: STUDENTS
This doesn't have to do with medical school and it doesn't even have to do with me personally since I've never lived on campus. It was just sent on a mass email throughout the college and I've decided to pass it on here:"Dear Students, Faculty, and Staff,The University of California at Berkeley reported a crime on its campus that I wish to bring to your attention.Yesterday morning, shortly after
AMCAS Deadlines & Delays – Answered
Yesterday I wrote this:"Now I've heard that there is a processing delay between the time you submit your AMCAS application information and the time it gets to the schools you've selected. (I've personally selected 10 schools, not including the 2 caribbean schools I'm also applying to.) This information is important, especially to me, since I'm a little behind in submitting my applications!It's
Headstart on Secondary Applications – The Student Doctor Network
Anonymous writes:"Hi,I am also a pre-med student and recently came across your blog...I think that you should apply ASAP!! Most people apply during the summer, I completed my application in mid-july and thought I was late compared to other pre-med students at my university. From what I know most students have completed their primary already and are filling out secondaries. A lot have even
The Complete Medical School & Admissions Guide – Revisited
While I'm still in the process of crossing my fingers and hoping for the best, it's never too early to prepare for the next step. Everything up until now has been about preparation and the interview is no different. I'm using two different methods to prepare. First, I have to point out The Student Doctor Network one more time. It's a great resource with tons of first hand information about
Interview Status – Ross University
My blog has been silent for the past month for two reasons. After the rush to complete all my applications, it's hard to update with anything less than information regarding those applications. It's also that time of the semester where every other class has either an exam or a paper due within the next week or two.In other words, I'm busy and I'm waiting.Flash forward to today.I'm still busy,
Finished my first interview.
I thought it went great.The biggest question mark going in (a question mark that you have no control over) is the personality of the person interviewing you. Will you be able to build a rhythm between you and the interviewer in a very short amount of time. My interviewer was named Lori, the senior associate director of admissions and she was great. After that it was just answering the
"You have a 95% chance of acceptance…"
j/m.d. writes:"You have a 95% chances of acceptance if you can show the dedication that you obviously have and the amazing desire to want to undergo a rigorous profession. You did great, my friend. If nothing goes, you get on the waiting list which is automatic acceptance for the following semester, NO fears at all. I was accepted the day after, however I began to realize what studying medicine
"I was just wondering if I have to go to medical school i will have to start college allover again."
Anonymous writes:"this is really helpful. I am a junior at a Business School, majoring in Accounting. And I am presently 17 years old. I was just wondering if I have to go to medical school i will have to start college allover again. this was really helpful"As long as you finish your degree in Business, all you have to do is make sure you've taken the required sciences classes. These classes
Interview Feedback – Allopathic Medical Schools – Ross University School of Medicine (Dominica Caribbean)
Here is a link to my interview feedback for Ross University on The Student Doctor Network: LINK.For all those out there curious about specific questions that were asked, here's a list of just about every question that was asked (with follow-up questions):Tell me about your family?What interests you about becoming a doctor?When did you first hear about Ross?What does your family think about
ACCEPTED!
Ha! This will be my last blog entry on this blog.About 4 hours ago, I got the acceptance email I've been waiting for from Ross University School of Medicine. I applied for their January 2009 class. The January class was full and I'm bumped to May -- but I'm in!It's been a long time coming.I'll probably edit this post in the future to tell more of the details, but this is the last entry. I
What’s the right C-section rate? Higher than you think.
Editor’s Note: Dr. Mark Crislip has been kidnapped by anti-vaccinationists. Fortunately, we have sent our black Illuminati, pharma-funded, vaccine-wielding helicopters to rescue him, but unfortunately, as a result of his trauma, his usual Friday post is likely to be delayed either until this afternoon or Saturday. In any case, fortunately for us our latest addition to the SBM crew, Dr. Tuteur, was willing to fill in on short notice; so here she is. Dr. Crislip will post by tomorrow. To whet your appetite for his patented sarcasm, let me just say that he will be having a little fun with a certain article from The Atlantic about flu vaccines. There, now doesn’t that make you want to check back tomorrow to find out what his take is on the article? I thought it would.
Buried in the midst of it new report, Monitoring emergency obstetric care; a handbook, the World Health Organization acknowledges what obstetricians have been saying for some time. The WHO’s goal of a 10-15% C-section rate lacks any empirical basis.
Earlier editions of this handbook set a minimum (5%) and a maximum (15%) acceptable level for caesarean section. Although WHO has recommended since 1985 that the rate not exceed 10–15%, there is no empirical evidence for an optimum percentage or range of percentages …
Of course, they’re not going to give up their recommendation simply because there is no science that supports it, insisting that “a growing body of research that shows a negative effect of high rates.”
Dr. Marsden Wagner, former head of the Perinatal Division of the WHO, appears to be responsible for the purported optimal C-section rate of 10-15%, the level at which both maternal and neonatal mortality rates are supposedly the lowest. Ironically, Dr. Wagner is a co-author of a recent study that actually demonstrates the opposite.
The paper is Rates of caesarean section: analysis of global, regional and national estimates (Paediatric and Perinatal Epidemiology, 2007; 21:98–113.) The article explicitly acknowledges that the 15% C-section rate recommendation was made without any data to support it:
Since publication of the WHO consensus statement in 1985, debate regarding desirable levels of CS has continued; nevertheless, this paper represents the first attempt to provide a global and regional comparative analysis of national rates of caesarean delivery and their ecological correlation with other indicators of reproductive health.
The data regarding C-section rates below 10% is stark:
…[T]he majority of countries with high mortality rates have CS rates well below the recommended range of 10–15%, and in these countries there appears to be a strong ecological association between increasing CS rates and decreasing mortality.
How about the data on C-section rates above 15%? The authors claim:
Interpretation of the relationship between CS rates and mortality in countries with low mortality rates is more ambiguous; nevertheless, the sum total of the evidence presented here supports the hypothesis that, as has been argued previously, when CS rates rise substantially above 15%, risks to reproductive health outcomes may begin to outweigh benefits.
Not exactly. Indeed, not even close. The data show that low maternal mortality and low neonatal mortality are associated almost exclusively with high and very high C-section rates.
The article contains a variety of charts that make this clear. Of note, rather than graphing C-section rates against mortality rates, the authors chose to graph the log (logarithm) of C-section rates against the log of mortality rates. A log-log graph has the advantage of exposing tiny differences when all the values are bunched close together, but all the values are not bunched together in this situation. C-section rates occur along a broad range, and mortality rates occur along a broad range. As a consequence, the log-log graph magnifies the effect of tiny differences and minimizes the effect of large differences. Therefore, you need to be very careful in interpreting the graphs.
This is an adaptation of the chart that appears in the paper comparing C-section rate to maternal mortality (the authors claim that graphing C-section rate against neonatal mortality produces a similar result). The area representing a C-section rate of 10-15% has been highlighted in yellow. The horizontal blue line represents a mortality rate of 15/100,000. Lower mortality rates are below the blue line and higher mortality rates are above the blue line.
The data themselves are quite clear. There are only 2 countries in the world that have C-section rates of less than 15% AND low rates of maternal and neonatal mortality. Those countries are Croatia (14%) and Kuwait (12%). Neither country is noted for the accuracy of its health statistics. In contrast, EVERY other country in the world with a C-section rate of less than 15% has higher than acceptable levels of maternal and neonatal mortality. There nothing ambiguous about that.
The authors claim:
Although below 15% higher CS rates are unambiguously
correlated with lower maternal mortality; above this range, higher CS rates are predominantly correlated with higher maternal mortality.
No, that’s not what it shows at all. It shows that only countries with high C-section rates have low levels of maternal and neonatal mortality. A high C-section rate does not guarantee low maternal and neonatal mortality because C-section rate is not the only factor. For example, Latin America (represented on the chart by open diamonds) has a high rate of C-sections performed for social reasons, but does not have a low level of maternal mortality.
The bottom line is this: The only countries with low rates of maternal and neonatal mortality have HIGH C-section rates (except Croatia and Kuwait). The average C-section rate for countries with low maternal and neonatal mortality is 22%, although rates as high as 36% are consistent with low rates of maternal and neonatal mortality.
The authors’ claims are not supported by their own data. There is simply no support for a C-section rate of 15%, since virtually none of the countries with low rates of maternal and neonatal mortality have a C-section rate of 15% or below, and most have rates that are far higher. There is also no support for the claim that “the sum total of the evidence presented here supports the hypothesis that … when CS rates rise substantially above 15%, risks to reproductive health outcomes may begin to outweigh benefits”. When C-sections are performed for medical indications, there is no evidence that rising C-section rates lead to rising rates of maternal or neonatal mortality.
The authors own data indicate that a C-section rate of 15% is unacceptably low, and that the average should be at least 22%, with rates as high as 36% yielding low levels of maternal and neonatal mortality.
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The Tragic Death Toll of Homebirth
More than 10,000 American women each year choose planned homebirth with a homebirth midwife in the mistaken belief that it is a safe choice. In fact, homebirth with a homebirth midwife is the most dangerous form of planned birth in the US.
In 2003 the US standard birth certificate form was revised to include place of birth and attendant at birth. In both the 2003 and 2004 Linked Birth Infant Death Statistics, mention was made of this data, but it was not included in the reports. Now the CDC has made the entire dataset available for review and the statistics for homebirth are quite remarkable. Homebirth increases the risk of neonatal death to double or triple the neonatal death rate at hospital birth.
As this chart shows, the neonatal mortality rate for DEM (direct entry midwife, another name for homebirth midwife) assisted homebirth is almost double the neonatal mortality rate for hospital birth with an MD. This is all the more remarkable when you consider that the hospital group contains women of all risk levels, with all possible pregnancy complications, and all pre-existing medical conditions. An even better comparison would be with the neonatal mortality rates for CNM assisted hospital birth. The risk profile of CNM hospital patients is slightly higher than that of DEM patients, but CNMs do not care for high risk patients. Compared to CNM assisted hospital birth, DEM assisted homebirth has TRIPLE the neonatal mortality rate.
The chart shows the data for 2003-2004, but the data for 2005 has recently become available. Homebirth death continues to be far higher than death in the hospital for comparable risk women. In 2005 the neonatal death rates were CNM in hospital 0.51/1000, MD in hospital 0.63/1000 and DEM attended homebirth 1.4/1000.
No wonder the Midwives Alliance of North American (MANA), the trade union for homebirth midwives, is suppressing their safety statistics. From 2001-2008, they have collected the single largest repository of data on homebirth. The data is publicly available, but only to those who can prove they will use them for the “advancement” of midwifery, and even then, a legal non-disclosure agreement must be signed as part of the process. MANA’s data may very well confirm that homebirth with a DEM has triple the neonatal mortality rate of hospital birth for comparable risk women in the same year.
What is also notable is that the results are consistent with all existing scientific studies, including the Johnson and Daviss study (Outcomes of planned home births with certified professional midwives: large prospective study in North America). Johnson and Daviss actually showed that homebirth with a CPM has a neonatal mortality rate almost triple that of hospital birth for low risk women. The latest statistics are the most recent and most reliable confirmation of that fact.
There really is no question about it. Homebirth with a homebirth midwife dramatically increases the risk of neonatal death.
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The Skeptical O.B. joins the Science-Based Medicine crew
I’m very pleased to announce that Dr. Amy Tuteur, otherwise known as The Skeptical O.B., has joined Science-Based Medicine. Dr. Tuteur will fill in an area where we are lacking, namely an expert in women’s health and childbirth. For those of you who don’t know Dr. Tuteur, she is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School. Her book, How Your Baby Is Born, an illustrated guide to pregnancy, labor and delivery was published by Ziff-Davis Press in 1994. She runs the website AskDrAmy.com and has her own iPhone app, the Ask Dr. Amy Am I Pregnant Quiz. Dr. Tuteur blogs at The Skeptical OB.
We expect great things from Dr. Tuteur, and hope you will join us in welcoming her to the fold. She will begin tomorrow and will post new material every Thursday. Finally, with the addition of Dr. Tuteur, it should also be noted that, due to the demands of her day job, Dr. Val Jones will decrease her posting frequency from every Thursday to every other Thursday. She will thus not be posting this week, and her next post will be on Thursday, November 12.
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