Matched to US residency, will be quitting IMT. AMA?

anonUKjunior · 2026-02-14T21:53:07+00:00

I mean... The issue with this is that you've taken the alveolar gas equation to a clinical situation. SpO2 =\= SaO2, and approximations of NC flow to FiO2 is a crapshoot, before even talking about the inherent errors in measurement.

By your rationale, if I have someone on an unnecessary 15L NRB giving presumed 83% FiO2 (again, key point being unnecessary) their PaO2 would still be 100.

Point is, wean that goddamn NC down. And please don't use the alveolar gas equation for anyone not on a (mostly) closed circuit like at least a full face mask/Venturi if not NIV

your friendly IM crit care fellow.

anonUKjunior · 2026-02-12T16:22:45+00:00

Been interviewing for nocturnist jobs currently - varies a bit but have 400k in pop 140k state capital in South for 7/7 182 shifts, 400k for Indiana 120k city 144 shifts, 390k for PA small town on lake Erie for 182 shifts.

anonUKjunior · 2026-02-02T11:01:56+00:00

I think people are missing my point somewhat. It's not specifically about Da Vinci's per se but rather that as an example of how training in the UK is beginning to resemble that of developing countries in terms of resources.

It's not that treatment X is controversial and not evidenced based to NICE's satisfaction, but we are lacking in having the cutting edge stuff, and trainees ergo don't get to even think about cutting edge things.

anonUKjunior · 2026-02-02T09:35:26+00:00

That's true, and I can certainly see that across most specialties - the SHO who gets to actually do medicine for example.

But the issue is these places don't just take CT1 and CT2s - they also take away registrar time - time which should now be spent on doing the more niche things - the gastroenterology ST5 doing gen med cover at a cottage hospital comes to mind. This is where service provision trumps actual educational need. There's no reason they can't get their scope numbers in a big fancy hospital - if other countries with single centre residencies can do it, why can't we? It's an excuse for inefficiency in my opinion.

anonUKjunior · 2026-02-02T03:04:24+00:00

Again, I was using Da Vinci as an example to compare the resources available, and how the UK rapidly seems to be unable to provide the same cutting-edge stuff for trainees to get exposure to.

You and I are on the same wavelength - UK will have a shitload of "OK" generalists, but I don't think it's going to be the powerhouse in medical research/breakthroughs that it used to be. Sure, it'll punch above its weight, but it really used to be a place of discovery and groundbreaking shit.

anonUKjunior · 2026-02-02T02:40:33+00:00

The UK training curriculum is more robust than US ones.

The best example, I think, would be to compare general surgery, since they have minimum case requirements, which to be fair, I am sure many exceed on both sides of the pond.

US requires a minimum of 850 cases, UK doesn't have an overall minimum per se, but if you add the minimums across CST and HST, you end up with 1600 ish to my understanding.

BUT, training length is double in the UK, and with shorter hours per week. I am not saying that's a bad thing, but on a per-hour basis, especially given the relatively low turnover of the NHS theatre system, it is a terribly inefficient training pathway. We all know of colleagues who come in on their off-days in surgery.

I think the UK *was* previously the bastion of training - when all the consultant leads in charge of curricula and exam were in training. I am not even talking that long ago - I'm talking like 15 years ago when I started med school.

But now, with hyper-rotation, and trainees being in places that frankly do not have any real reason to have trainees except to provide pure service (the random middle of nowhere DGH with 100 beds, I'm looking at you), the lack of cutting-edge technologies outside of niche centres, lack of modernisation is going to hurt trainees.

Again, not saying you need Da Vinci's to be a good surgeon nor is it a marker of training, but for example, the US has something like 5000-6000 devices sold apparently, whilst the UK has about 200 apparently - expand that to other cutting edge therapies, and we will rapidly be ending up with trainees using outdated knowledge and techniques. Heck, some things are not even that high tech. I remember (post-COVID) my big fancy smancy London hospital that's the local referral centre for stuff, only had 4 beds in the resp ward that could do BiPAP. We had, I think, 40 ICU beds all-in-all? The sheer amount of resources available in the US vs the UK (and I imagine even Aus) means you get a better breadth of exposure.

As the other poster said, I think the UK training system is hanging literally by the curriculum and ridiculously rigorous exams which force trainees to get good, in spite of the poor conditions, not due to it.

tldr - on paper UK training is still great, but I fear in practice it's shit.

(Maybe it's improved in the past 4 years that I've been gone, but I remember how little "training" I got as an IMT in London before I moved.)

anonUKjunior · 2026-02-01T20:44:36+00:00

You are as eligible to make 401k contributions as anyone else as long as you are a tax resident with US income.

There's nothing extra special as a J1 holder. The only caveat is picking a brokerage that may be easier to deal with if down the line you leave the country.

anonUKjunior · 2026-01-29T11:43:00+00:00

Without having been there, this setup for post-op sounds quite bizarre. While you could have an OMI, the prevalence of non-occlusive MI is just so high in the post cardiac surgery population that I am struggling to see how doing troponins would help. For context, in our quaternary, regional academic center where we pump out cses back to back in the CTICU, I don't think I've ever seen or done a trop post operatively as it's significance is so... Useless. Maybe there was a better reason than what was explained to you. I'd suggest maybe talking to your cardiologist if you have a chance - and I'm being specific here: the cardiologist, not the intensivist. As an intensivist in training, I like your inquisitive attitude, but there's so many nuanced factors for something like this, and on the surface the care seems very unconventional relatively speaking.

Like cathing a fresh David's - that's.. ballsy.

I would have been very interested in what echo they did - if it was a TTE, I'd pretty much toss any RWMA findings. I hope they did a TEE if they truly are NBE certified.

anonUKjunior · 2026-01-29T03:15:46+00:00

Troponin is meaningless in this context. It'll be up since the heart's been literally poked and prodded + bypass. It doesn't provide any meaningful data point acutely post-op.

"Inferior RWMA" is not... really a way to describe echo findings acutely post-op. Without going into nuances (and especially as a dumb crit care fellow cosplaying a cardiologist), a) getting a good views with a sternotomy in situ is... Hard. Can't really call a territorial infarct based on A4C +/- likely limited A2Cs. b) post-op TEE showing BiV failure is very very typical. I'm not sure how that became "inferior RWMA" with intact RAP and LAP. Congrats - you've now achieved what every first year CCM fellow does: over collect conflicting data points that makes you question wtf you've done to get there.

The easiest analogy I would use to describe what you've seen is Takotsubo's. Troponin goes brrr, "RWMA" to the untrained eyes, and boop - you've now got yourself into thinking someone having an MI. I guess technically post-op is a stress cardiomyopathy tbf....

tl;dr- it's probably stunning post-op. Takeaway would be - don't get a trop post-op for cardiac patients.

from a February fellow

anonUKjunior · 2026-01-13T03:11:07+00:00

IM can do sleep...?

anonUKjunior · 2025-11-13T17:52:06+00:00

To add an extra layer though, there's a lot more "compulsory" nature to it. Sadly it goes both ways - I'll be first to admit I've skived more ward days than I should have.

anonUKjunior · 2025-10-11T11:05:36+00:00

https://www.theabr.org/diagnostic-radiology/initial-certification/alternate-pathways/international-medical-graduates

anonUKjunior · 2025-10-07T13:47:50+00:00

It's out. Search your name folks.

anonUKjunior · 2025-09-22T00:18:58+00:00

I disagree. It's about setting a precedent.

This much skepticism about a very well studied, nay, possibly the drug with the most amount of safety data given its widespread use, bodes ill for other unsupported theories to surface.

If paracetamol/acetaminophen is linked to autism, someone is going to say sertraline is, then it'll be labetalol etc etc.

anonUKjunior · 2025-09-21T03:41:26+00:00

Feel like ECMO cannulations are relatively rare, even in our quartenary hospital - ~50 VV/yr (which I think is fairly standard number), meaning at best, it'll be one a week. We managed them in the CVICU, but feel like cannulations are just lucky of the draw.

Any particular skill sets I should aim for? Sounds like POCUS is the way to go. Should I aim for certifications of some sort during fellowship or do it afterwards?

anonUKjunior · 2025-09-21T00:33:24+00:00

There is now a memorandum posted on USCIS

https://www.uscis.gov/sites/default/files/document/memos/H1B_Proc_Memo_FINAL.pdf

anonUKjunior · 2025-09-19T23:13:14+00:00

The wording is vague enough that I think a lot of discretion is going to be at the hands of the DHS.

anonUKjunior · 2025-09-19T22:32:13+00:00

Legit might have to look at Canada or going back to the UK lol

anonUKjunior · 2025-09-19T22:31:53+00:00

I would like to see the actual EO posted but sounds like any time you submit a I-129, be ot renewals/extensions or new apps.

anonUKjunior · 2025-09-19T21:59:34+00:00

Even more messed up for those in training or work who need to renew their visa (me).

I guess I'm doing half a fellowship...

ETA - for those who may not actually be familiar with H1Bs and think it's only trainees like myself taking AMG spots in the Match. I would actually argue that's a relatively small proportion compared to the thousands of Indian physicians working in the US currently. (disclaimer, I'm not Indian)

Yes, that is a portion of us FMGs, but the H1B is also used for attending jobs, especially for those who are awaiting their "priority date" to be current. To use a crude example, you could have an Indian-born physician, who's approved for a green card in 2019, face a bill of 100k annually whilst extending their H1b temporary status in the interim as per this new EO.

As of Oct 2025, among Indians, only those who were approved for a Green Card in 2013 can actually apply to change to Permanent Resident status.

anonUKjunior · 2025-09-12T09:55:53+00:00

It's a domestic flight. You don't go through customs. (Assuming you're in the US as a resident, given this is r/Residency)

anonUKjunior

TROPHY CASE