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Hand Sanitizers

This was originally a post on Integrative Wellness and Movement’s Facebook page, but so many people asked me that I’ve written a short summary with reference links here.

Hand hygiene is super important. Must have at LEAST 60% ALCOHOL to be effective.

Some chemicals used in hand sanitizers in the past have been found to be harmful and/or carcinogenic. The FDA has banned the use of these chemicals in hand sanitizers. Companies that make hand sanitizers have had to develop new formulations.

List of banned chemicals in the hand sanitizers are:

  • Benzethonium chloride
  • Chloroxylenol
  • Chlorhexidine gluconate [1]
  • Cloflucarban
  • Fluorosalan
  • Hexachlorophene
  • Hexylresorcinol
  • Iodine complex (ammonium ether sulfate and polyoxyethylene sorbitan monolaurate)
  • Iodine complex (phosphate ester of alkylaryloxy polyethylene glycol)
  • Methylbenzethonium chloride
  • Nonylphenoxypoly (ethyleneoxy) ethanoliodine
  • Phenol (equal to or less than 1.5 percent or greater than 1.5 percent)
  • Poloxamer iodine complex
  • Povidone-iodine 5 to 10 percent
  • Secondary amyltricresols
  • Sodium oxychlorosene
  • Tribromsalan
  • Triclocarban
  • Triclosan
  • Triple dye
  • Undecoylium chloride iodine complex

In addition, other chemicals for consideration were:

  • Polyhexamethylene biguanide
  • Benzalkonium cetyl phosphate
  • Cetylpyridinium chloride
  • Salicylic acid
  • Sodium hypochlorite
  • Tea tree oil
  • Combination of potassium vegetable oil solution, phosphate sequestering agent, and triethanolamine

Directly quoted from “Safety and Effectiveness of Consumer Antiseptic Rubs; Topical Antimicrobial Drug Products for Over-the-Counter Human Use”:

(https://www.federalregister.gov/documents/2019/04/12/2019-06791/safety-and-effectiveness-of-consumer-antiseptic-rubs-topical-antimicrobial-drug-products-for?fbclid=IwAR0PGwhIyCTj_epCJP8MuGpYrlL1c73diuEuJPj0fmqBXY7lZd0Jfv1G28A)

“In addition, in the 1994 TFM (59 FR 31402 at 31435) FDA proposed that the active ingredients fluorosalan, hexachlorophene, phenol (greater than 1.5 percent), and tribromsalan be classified as not GRAS/GRAE for the uses referred to in the 1994 TFM as antiseptic hand wash and healthcare personnel hand wash.”

References

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Interviewing 5: Be the Professional That You Are

Interviewers want to be able to picture you as a professional and as a good fit in their “company culture”. Education is a business. Schools have a “culture”. You want their impression to be: “Wow, I can see him/her in our clinic working with our patients” or “She/he would really make a great doctor.” Act the part!! Three months later, you want them to still remember your face when they’re reviewing your file.

  • Dress professionally. Image is everything sometimes (although ideally it shouldn’t be, we live in a non-ideal world). Suit and tie for guys; suit jacket for gals (dress, skirt, or pants is okay). When I was interviewing, everyone was suited up including the interviewers and staff. Avoid contrasty patterns and avoid loud colors—choose dark conservative colors instead. Don’t show too much skin. Don’t wear crazy jewelry (nothing too dangly). Hide large tattoos. Remove piercings. Wear minimal makeup and no scented anything (lotion, perfume). This is a situation where less is more.
  • Look people in the eye.
  • Firm handshakes.
  • Remember peoples’ names.
  • Don’t be too loud or boisterous . If you have a big personality, tone it down a notch.
  • Speak professionally.

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Interviewing 4: Questions to Ask Your Target

You should always research your target school, its research opportunities, and who’s who in the department and staff. Some questions to start your brainstorming are as follows.

  • What do you enjoy most about being a Naturopath?
  • Why did you decide to become a Naturopath?
  • Was there anything you wish you knew before you became a Naturopath?
  • What challenges have you faced as a Naturopath?
  • What advice would you give someone about learning/navigating the business-end of practicing medicine, especially private-practice? 
  • How did you prepare for the NPLEX(Naturopathic Physicians Licensing Examinations)?
  • How do you see the ND field evolving in the next 5-10 yrs?
  • Is it difficult to obtain malpractice insurance?
  • Why did you decide to teach here?  What led you down this path?
  • How have you made naturopathic medicine your own…how did you carve out your niche?
  • Who inspired you to become a naturopath?
  • How is technology used to enhance learning–classroom and/or labs?
  • As a medical student, what were your biggest concerns or challenges?
  • As an instructor, what are the 3 greatest pitfalls you see students encounter?
  • What 3 pieces of advice would you give to an entering medical student?
  • Did you ever think of quitting teaching/medicine? Why?  What has kept you going?
  • List 3 areas in which pre-med students could be better prepared.
  • How would univesal healthcare affect naturopathic doctors?
  • What are 3 challenges facing the field of naturopathic medicine in the next 4 years?
  • What is your practice philosophy?
  • Has this school or any of its programs ever been on probation or had its accreditation revoked?Is the next accreditation visit for the ND program this winter/spring of 2019?Did the ND program conduct a self-study in preparation and would it be possible for you to share 3 key findings?Is a car necessary for clinical rotations?
  • What would you change about the program?
  • Do you expect any changes to the program in the next few years, especially changes that will affect the 2019 cohort?In what areas does the program need to improve?
  • What do you think is the strongest aspect of this naturopathic medicine program?
  • Why do you like this school?  Why do you like working here?
  • How has this program changed in the last 5 yrs?
  • How is technology used to enhance learning–classroom and/or labs? 
  • How would you describe the “culture” within the ND department? 
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Interviewing 3: Know the World Around You

Knowing the world around is important so that you can empathize with the “plight of others”. It’s about you and taking a stand on controversial issues. Where is your foundation? What do you believe in? All of this is built on who you are and knowing who you are.

Here is a general list of topics you should study up on.

  • Association of American Medical Colleges’ (AAMC) admissions initiative.
  • AAMC’s core competencies for entering medical students.
  • Bioethics. Be able to state case examples.
  • Four pillars of medical ethics.
  • Law and ethics.
  • Difference between ethics and morality.
  • Affirmative action.
  • Capitation payments.
  • HMO vs. PPO vs. EPO vs. POS
  • Universal health.
  • Socialized health.
  • When does life begin?
  • Abortion.
  • Primary, secondary, tertiary, and quaternary care.
  • Different health care frameworks in other countries around the world.
  • Rural health.
  • Healthcare access and underserved areas.
  • Rural healthcare.
  • Top 10 domestic health care issues and challenges.
  • Top 10 global healthcare issues and challenges.
  • Top 10 Center for Disease Control issues and challenges.
  • Top 10 World Health Organization issues and challenges.
  • Global Health Security Agenda.
  • Healthcare trends in 2019 (or the current year).
  • Innovation and technology in healthcare.
  • Healthcare without borders.
  • Telemedicine.
  • Consumer-driven healthcare.
  • HIV and AIDS crossroads.
  • Noncommunicable disease.
  • Fake news and misinformation.
  • Disease X.
  • Women’s health.
  • Environmental impacts.
  • A changing workforce.
  • Mental health.
  • Violence and healthcare.
  • Immigrants and refugees.
  • Disease detection, outbreak prevention, response, and containment.
  • Opioid crisis.
  • WHO blueprint list of priority diseases.
  • Empathy vs. sympathy.
  • Altruism.
  • Malpractice vs. negligence.
  • Medicare vs. Medicaid and new challenges this year.
  • Patient protection and affordable care act.
  • Socialized medicine vs. single payer vs. what we have now.
  • Biggest challenges facing healthcare.
  • What do you think about the ACA?
  • Is the ACA sustainable.
  • Shortage of doctors in underserved areas.
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Interviewing 2: Styles

There are many styles of interviewing but let’s just touch on a few. You should be prepared for anything. So mentally, visualize different scenarios. Visualization exercises help a lot.

Open-file. This means that the people interviewing you have read your file/application packet extensively. They will definitely ask about different points that stand out to them.

Closed-file. The people interviewing you have not read your file/application packet. They will rely on what you tell them. They will be forming their opinions on how you represent yourself. They will read your file later, so what you say better be in agreement with what is in your file.

Partial-file. The people interviewing you skimmed or partially read your file/application packet.

1:1. One interviewer to one interviewee.

1:m. One interviewer to many interviewees. You’re going to have to pay attention to what other students say and respond appropriately. Support your colleagues. You’re also going to have to remember what questions was asked by the time you get your turn to answer.

M:1. Many interviewers to one interviewee. If you’re lucky, there will be 2:1—that’s just a conversation between 3 people and the least “scary”.

M:m. Many interviewers to many interviewees. This is trickier to remember everyone’s name, everyone’s response, and remember the question by the time it gets to you.

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Interviewing 1: Know Yourself

Know yourself.

This is the time to be mindful and do personal reflection and self-assessment. You must be responsible and accountable for every choice, decision, and action (good or bad) in your life—in work, school, and personal domains.

This is my biggest number 1 tip for interviewing for medical school, residency, or anything else. It all starts with knowing yourself.

You’ve written your short essay responses, your c.v./resume, and you’ve sent your transcripts in. Keep copies of everything you turn in. Review these pieces of your application packet and know them intimately. You don’t want to go in and be clueless about the material you’ve turned in.


Some questions you should be prepared to answer.

  • How are you today? (there are no inconsequential questions)
  • Tell me about yourself.
  • There will be specific questions about the application packet you turned in (e.g. resume/c.v., essay questions, transcripts).
  • Are there any red flags in your educational/employment history that you need to explain?
  • Why medicine?
  • Why this medical program?
  • Why this school?
  • Why should we pick you?
  • Why not allied health (nursing, nurse practitioner, physician’s assistant, physical therapist, osteopath, chiropractic, etc.)?
  • What makes you think that you can handle the rigor, intensity, workload, and stress of medical school?
  • What are your strengths?
  • What are your biggest weaknesses/challenges?
  • What inspired your interest in medicine?
  • What qualities make a good physician? What qualities make a poor physician?
  • What experiences have you had in a clinic or hospital setting?
  • What experience do you have caring for patients?
  • What experience do you have in the medical setting?
  • What do you bring to our school/program community?
  • What aspects of your life make you a good candidate?
  • What reservations do you have about the medical field?
  • Tell me about an experience you’ve had working in a team? What was your role in the team?
  • What does teamwork mean to you?
  • What makes a good team?
  • What role do you typically play in a team?
  • Tell me about a mistake you’ve made and what you learned from it.
  • Tell me about a time you were not as dependable as you’d like to have been.
  • How do you deal with stress?
  • How do you deal with stressful situations?
  • How do you deal with negative comments about your profession (e.g. alternative medicine is quackery)?
  • What has been your most rewarding experience working with others?
  • Why did you choose your major?
  • How has your major prepared you for a career in medicine?
  • What’s your favorite class and why?
  • Discuss a book you recently read for pleasure.
  • What are some of your hobbies?
  • How do you spend your free time?
  • What are your specific goals in medicine?
  • What areas would you like to specialize?
  • How do you see yourself practicing?
  • What will you do if you don’t get into medical school?
  • How would a friend describe you?
  • What is your greatest fault?
  • Tell me about your family?
  • What does your family think about your decision to pursue medicine?
  • What support system do you have?
  • How do you intend to pay for your education?
  • If you could change one thing about yourself, what would it be and how would you do it?
  • How effective do you feel dealing with people other than your peers?
  • How do you deal with people from different cultural or socioeconomic backgrounds?
  • What do you think is the hardest part of this profession?
  • What is a normal day in your life like?
  • Do you have any regrets?
  • What are you passionate about?
  • What are the low points in your life and why?
  • Tell me about a time when people’s actions depended on a decision that you made.
  • Is there anything else you’d like us to know about you?
  • Do you have any questions for us (you definitely should have questions for them)?
  • List important qualities of being a good student.
  • What makes you happy?
  • Who are your role models?
  • What do you believe in?
  • Are you religious?
  • What do you care about and illustrate that by telling us about an experience.
  • Describe an unusual event in your life.
  • If you were granted 3 wishes, what would they be?
  • How do you define success?
  • How do you want people to remember you?
  • What kind of legacy do you want to leave behind?
  • How do you define failure?
  • How do you handle or respond to criticism?
  • How do you handle conflict?
  • Describe your learning style.
  • Tell me a joke?
  • Teach me something non-medical in 5 minutes.
  • Describe your style of communicating and interacting with others.
  • Describe a situation in which you were dependable and demonstrated initiative.
  • Describe your experience with diversity or diverse populations.
  • Describe a situation where you had to deal with difficult teammates and how was that resolved.
  • How do you handle change?
  • How do you adapt?
  • Tell me about a time that you were criticized unfairly.
  • In what course did you get the worse grades and why.