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USMLE Step 1 During COVID-19: A Fog of Uncertainty

Marcus Wiggins
Puneet Kaur
Pranav Puri

By PRANAV PURI, PUNEET KAUR, and MARCUS WIGGINS, MBA

As current medical students, the ongoing COVID-19 pandemic represents the most significant healthcare crisis of our lifetimes. COVID-19 has upended nearly every element of healthcare in the United States, including medical education. The pandemic has exposed shortcomings in healthcare delivery ranging from the care of nursing home residents to the lack of interoperable health data. However, the pandemic has also exposed shortcomings in the residency match process.

Consider the United States Medical Licensing Examination (USMLE) Step 1. A 2018 survey of residency program directors cited USMLE Step 1 scores as the most important factor in selecting candidates to interview. Moreover, program directors frequently apply numerical Step 1 score cutoffs to screen applicants for interviews. As such, there are marked variations in mean Step 1 scores across clinical specialties. For example, in 2018, US medical graduates who matched into neurosurgery had a mean Step 1 scores of 245, while those matching into neurology had a mean Step 1 score of 231.

One would assume that, at a minimum, Step 1 scores are a standardized, objective measure to statistically distinguish applicants. Unfortunately, this does not hold true. In its score interpretation guidelines, the National Board of Medical Examiners (NBME) provides Step 1’s standard error of difference (SED) as an index to determine whether the difference between two scores is statistically meaningful.  The NBME reports a SED of 8 for Step 1. Assuming Step 1 scores are normally distributed, the 95% confidence interval of a Step 1 score can thus be estimated as the score plus or minus 1.96 times the standard error (Figure 1). For example, consider Student A who is interested in pursuing neurosurgery and scores 231. The 95% confidence interval of this score would span from 215 to 247. Now consider Student B who is also interested in neurosurgery and scores 245. The 95% interval of this score would span from 229 to 261. The confidence intervals of these two scores clearly overlap, and therefore, there is no statistically significant difference between Student A and Student B’s exam performance. If these exam scores represented the results of a clinical trial, we would describe the results as null and dismiss the difference in scores as mere chance.

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Omada Health’s Acquisition of Physera: Sean Duffy & Dan Rubinstein on ‘The Deal’ & What’s Next

By JESSICA DaMASSA, WTF HEALTH

Omada Health put to use part of their recent $57M funding round to acquire Physera, a musculoskeletal care company that uses telehealth and digital interventions to deliver ‘virtual physical therapy’ to those suffering from back, knee, and neck pain. How does the acquisition fit into Omada’s growth strategy? WTF Health’s Jessica DaMassa chats with both Omada Health’s CEO, Sean Duffy, and Dan Rubinstein, CEO of Physera, about the acquisition, the IPO buzz that continues to swirl around Omada, and whether or not the opportunity that COVID-19 has created for digital care will be lasting as we move forward.

Health in 2 Point 00, Episode 129 | Kaia Health, RapidSOS, Abacus Insights, Ready, and Doximity

Today on Health in 2 Point 00, we have more deals to cover continuing off of yesterday’s episode! Jess and I talk about Kaia Health raising $26 million in a B round led by Optum Ventures, RapidSOS gets $21 million for their emergency response tech, Abacus Insights raising $35 million, and Ready raising $48 million pairing home visits from EMTs and nurses with telehealth. In other news, Target is now offering free access to telehealth visits through CirrusMD, and Doximity is acquiring THMED (which is changing its name to Curative) to put together a database of doctors to improve healthcare staffing/recruitment. —Matthew Holt

Three Things I Hope Health Care Won’t Recover From

By RANDY CARPENTER

The loss of lives and livelihoods from COVID-19 are almost too much to comprehend. And yet, slowly, conversations are emerging about the positives percolating from the pandemic.

It’s human nature to want to look for the positives in even the worst of situations, and I’ve noticed that in both my personal and my professional circles of late, people are talking about the things they hope we don’t lose when things go back to “normal.” 

Chief among them, especially in my healthcare technology circles, is a level of humanity that our previously faster-paced lives, ways and organizations had perhaps too often and too easily dismissed. The humans on the frontline of care delivery, for example. The effects of social isolation on healthy people, much less those who are sick. The struggle and juggle of modern work-life balance. Inequalities in healthcare access and delivery.

We’ve long talked about technology’s ability to make some of these things easier, to close some of these gaps, but now we know just how possible they are when people, politics and policy unite in the face of a pandemic. We now know just how quickly even the largest and slowest-moving of health systems can change course and even course correct.

Until now, it’s been far easier to talk about the promise of technology, telemedicine and remote workforce scenarios than it was to actually deploy them. Because before, to deploy such solutions also meant loss; loss of control, loss of normalcy, loss of humanity. Until now.

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THCB Gang, Episode 14

Episode 14 of “The THCB Gang” was live-streamed on Thursday, June 18th. Tune in below!

Joining Matthew Holt were four regulars: health futurist Ian Morrison (@seccurve), writer Kim Bellard (@kimbbellard), MD turned leadership coach Maggi Cary (@MargaretCaryMD), Consumer advocate & CTO of Carium Health Lygeia Ricciardi (@Lygeia), and two guests: Emergency Room MD, IT consultant and so much more Medell Briggs (MedellBriggsMD), and patient advocate CEO of Patient Orator, Kistein Monkhouse (@KisteinM). It was a very thoughtful conversation about patient care, the role of social movements, what to do about structural racism in health care, and what new legislation might come from the federal level. You can watch below right now.

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

Health in 2 Point 00, Episode 128 | Proteus, Walmart, Kyruus, Headspace and CareAcademy

On Episode 128 of Health in 2 Point 00, Jess and I talk about Proteus filing for bankruptcy, Walmart buying the tech from CareZone for prescription drug management for an unconfirmed $200 million, Kyruus raising another $30 million for referrals and scheduling for large health systems, Headspace raising another $47.7 million, and CareAcademy raising $9.5 million in a Series A to provide online training for professional caregivers for seniors. —Matthew Holt

Your Face is Not Your Own

By KIM BELLARD

I swear I’d been thinking about writing about facial recognition long before I discovered that John Oliver devoted his show last night to it.  Last week I wrote about how “Defund Police” should be expanded to “Defund Health Care,” and included a link to Mr. Oliver’s related episode, only to have a critic comment that I should have just given the link and left it at that.  

Now, I can’t blame anyone for preferring Mr. Oliver’s insights to mine, so I’ll link to his observations straightaway…but if you’re interested in some thoughts about facial recognition and healthcare, I hope you’ll keep reading.

Facial recognition is, indeed, in the news lately, and not in a good way.  Its use, particularly by law enforcement agencies, has become more widely known, as have some of its shortcomings.  At best, it is still weak at accurately identifying minority faces (or women), and at worst it poses significant privacy concerns for, well, everyone.  The fact that someone using such software could identify you in a crowd using publicly available photographs, and then track your past and subsequent movements, is the essence of Big Brother.  

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THCB Spotlights: Allison Martin, UDoTest and Rahul Dubey, AHIP

This is one of the more unusual videos I’ve done as a THCB Spotlight. I’ve been advising Allison Martin at UDoTest for a while. Meanwhile, I met Rahul Dubey when he was running innovation at AHIP. Then I saw his name all over Twitter and everywhere else because he had let a large number of protesters into his house as the police violently broke up a BLM protest earlier this month. What I didn’t know was how well they knew each other, but I got them together late last week and it made for a fascinating conversation about society, health care, and the future. —Matthew Holt

Managing Surgical Wait Times in the Intra-COVID-19 World

Finding the Right Prioritization Model

By JUSTIN SPECTOR

Restrictions on elective surgical volume in hospitals across the United States are causing a dilemma heretofore unseen in the American healthcare system. Surgeons across services have large and growing backlogs of elective surgeries in an environment where operating room (OR) capacity is restricted due to availability of inpatient beds, personal protective equipment (PPE), staffing, and many other constraints. Fortunately, the U.S. is not the first country to experience and deal with this situation; for many countries, this is the normal state of medicine.

By combining the accumulated experience of health systems around the world with cutting-edge technologies, it is possible to make this crisis manageable for perioperative leadership and, potentially, to improve upon the preexisting models for managing OR time.

The first step in creating an equitable system that can garner widespread buy-in is to agree upon a method for categorizing cases into priority levels. Choosing a system with strong academic backing will help to reduce the influence of intra-hospital politics from derailing the process before it can begin.

Why Cases Should Be Prioritized

If your hospital has a mix of surgeons who perform highly time-sensitive cases — cases where patient quality of life is substantially impacted — as well as cases with minor health or quality of life outcomes, it is important to make sure there will be enough capacity to get the higher urgency cases done within a reasonable amount of time. This allows cases in the backlog to be balanced against new cases that are yet to be scheduled and will help to optimize the flow of patients through the OR.

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THCB Spotlights: Stacie Ruth, CEO and Nirinjan Yee, Head of Innovation at AireHealth

The AireHealth Nebulizer

Stacie Ruth left mega conglomerate Philips when she ran into the chance to revolutionize drug delivery via nebulizers, and co-founded AireHealth. Along the way she realized that changing care for patients with respiratory conditions was actually a bigger problem and opportunity. In April she met Nirinjan Yee from Breath Research who had built an AI system that took lung sounds to predict exacerbations. Last week they merged their companies, and I spoke to them about what the new AireHealth will be doing. —Matthew Holt

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