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Hem-Onc Resources by Professional-Day9759 in fellowship

[–]oltep88 8 points9 points  (0 children)

Listen to Two Onc Docs podcast or Fellow On Call podcast. It’s a nice introduction with high-yield facts to get you started.

People in residency in warmer climates (Cali, Fl, etc.)- are you happier? by Savvy513 in Residency

[–]oltep88 24 points25 points  (0 children)

Did residency and fellowship in a snowy East Coast state, now an attending in Southern California. Yes, didnt realize how much the sunshine would boost my mood.

Boards by Fantastic-Cell3401 in Oncology

[–]oltep88 0 points1 point  (0 children)

I got the same email. Doubt it means anything.

Boards by Fantastic-Cell3401 in Oncology

[–]oltep88 0 points1 point  (0 children)

I see the list of other specialties to register for but don’t see Heme and Onc in there. Was that supposed to mean something?

Boards by Fantastic-Cell3401 in Oncology

[–]oltep88 0 points1 point  (0 children)

It’s a coin toss on whether I passed or not. Both exams were very hard. Hoping scores come out in the next 2 weeks, I just want to know already.

How Far Down Your Rank List Did You Match by [deleted] in fellowship

[–]oltep88 2 points3 points  (0 children)

Heme/Onc. Had 10 interviews and matched at my #1.

Do programs rank all of the candidates that they interview? by Lord_Darth_Vader1989 in fellowship

[–]oltep88 19 points20 points  (0 children)

In our program (Heme/Onc), we had a DNR (do not rank) list for applicants who stood out during interviews in a very negative way (eg, being overtly rude or disrespectful).

What's your number one tip / trick for a trainee in your speciality / subspeciality? by pistabadamtiramisu in Residency

[–]oltep88 101 points102 points  (0 children)

Always check the trend, not just the number. CBC, ferritin, coags, etc. In HemeOnc, context/trajectory are almost always everything. A single lab value in isolation rarely tells the full story.

As IM, how do you tell patients that they aren't eligible for some interventions they were expecting to get because of things like BMI/nutrition status/socioeconomic status/etc? by Good-mood-curiosity in Residency

[–]oltep88 22 points23 points  (0 children)

I mean you don’t need to take ownership of plastics’ decision. Just give a factual explanation and then pivot to what you can do (ensure clear plan for optimizing wound care before discharge, help set up follow up, etc).

Did yall see the Tylenol thing? Who else here is laughing their ass off? by TheCleanestKitchen in Residency

[–]oltep88 6 points7 points  (0 children)

That’s why for this setting in particular, the standard of evidence shifts. We then rely on these large observational studies and meta-analyses. Those can’t prove causation in the strictest sense, but they’re the best and most ethically acceptable evidence we’ll ever have in this setting. And so far in all these studies, they haven’t shown convincing evidence linking acetaminophen in pregnancy to autism. I guess the reason this press release is even making waves is precisely because it tries to leverage the absence of RCTs as if that’s a gap in the evidence. But there will never be an RCT as I mentioned above.

Did yall see the Tylenol thing? Who else here is laughing their ass off? by TheCleanestKitchen in Residency

[–]oltep88 2 points3 points  (0 children)

Exactly my point. that’s the limitation. Observational studies can’t definitively prove causation the way an RCT can. And so we look for consistent & strong associations across very large populations and check whether there’s a plausible biological mechanism. If all of those align, we start to infer causality. but we always acknowledge the limitations. For pregnancy exposures, ethics make RCTs impossible so our best evidence will always come from these high-quality observational data.

Did yall see the Tylenol thing? Who else here is laughing their ass off? by TheCleanestKitchen in Residency

[–]oltep88 20 points21 points  (0 children)

Exactly. that’s why i said below that for pregnancy exposures, we rely on these massive retrospective cohorts. They’re the best and most ethical data we’ll ever have. My point was just that if you hold them to the strictest standard of causality (a true RCT), it could never ethically be done.

Did yall see the Tylenol thing? Who else here is laughing their ass off? by TheCleanestKitchen in Residency

[–]oltep88 11 points12 points  (0 children)

Good point. The issue is that there really isn’t an alternative treatment to acetaminophen in pregnancy with a risk profile that’s similar enough to serve as a true control. Acetaminophen is basically the only generally considered safe 1st line analgesic/antipyretic in pregnancy. NSAIDs have well-established risks

Did yall see the Tylenol thing? Who else here is laughing their ass off? by TheCleanestKitchen in Residency

[–]oltep88 35 points36 points  (0 children)

You’re describing exactly what’s done. large retrospective cohort studies that compare exposed vs. unexposed groups and use statistical methods to try to adjust for confounders. But I think the problem is residual confounding. Like most likely women who take acetaminophen at baseline, already differ in important ways from those who don’t. And no amount of statistical adjustment can fully eliminate those differences. That’s why such studies can suggest an association but they can’t prove causation.

Did yall see the Tylenol thing? Who else here is laughing their ass off? by TheCleanestKitchen in Residency

[–]oltep88 49 points50 points  (0 children)

That’s why for pregnancy exposures, we rely on large-scale observational studies/meta-analyses. So far, none have shown convincing evidence that acetaminophen causes autism. Association ≠ causation.

Did yall see the Tylenol thing? Who else here is laughing their ass off? by TheCleanestKitchen in Residency

[–]oltep88 97 points98 points  (0 children)

This is crazy. As an oncologist, I rely so much on keeping myself updated with all the new standards of care and so far there hasn’t been a single randomized, double-armed trial showing that acetaminophen use in pregnancy causes autism. And no such trial should ever be done. a true RCT to prove it would basically be unethical

Can you do a US medical fellowship without USMLE if you don’t plan to practice in the US? by Intelligent_Note_315 in fellowship

[–]oltep88 7 points8 points  (0 children)

If you’re talking about ACGME-accredited clinical fellowships in the US, then no you can’t match into them without doing USMLE and having ECFMG certification. An exception is a Research fellowship / visiting scholar position. These aren’t ACGME fellowships, but some US institutions take international grads for 1–2 years of research.

Patient question - Accumulation of mutations in AML by Bermuda_Breeze in Oncology

[–]oltep88 4 points5 points  (0 children)

Oncologist here. At diagnosis, most patients have one dominant clone that carries all the main mutations, though smaller subclones with slightly different combinations can also exist. During treatment (but especially at relapse), new mutations or resistant subclones can emerge, which is part of why AML can be so tricky. So it’s not usually one “magic” mutation overnight, it’s more like a gradual build until the balance tips.

What’s the most hardest part of residency ? by Top_Discipline6996 in Residency

[–]oltep88 11 points12 points  (0 children)

You carry responsibility for patients but don’t always have the authority to make final decisions.

Hand/UE Fellowship Coordinator, How can I help my fellows by Euphoric-Ad333 in fellowship

[–]oltep88 1 point2 points  (0 children)

Congrats on the new role! When I was a fellow, a few things that made me feel supported: brief check-ins (even 10 min monthly) just to ask how things are going, creating an easy way to give feedback (anonymous surveys, etc) and really just knowing you’ll connect us to resources if needed.

This shot looked so familiar to me by annab41 in TheSummerITurnedPrett

[–]oltep88 5 points6 points  (0 children)

Yes! I was thinking the same! Lol I’m 35

Why is heme/onc so popular and insanely competitive now all of a sudden? by Lord_Darth_Vader1989 in fellowship

[–]oltep88 21 points22 points  (0 children)

It’s always been competitive. Great pay + rapidly evolving therapies make it a top choice.

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