The Importance of the USMLE Step 2 Clinical Skills Examination

“Do you smoke, drink coffee or consume alcohol? If you answered yes—how often?”

As a patient, you may feel overwhelmed having to answer each question as thorough and concise as possible to attain the best possible physical examination. Though these may seem like basic questions, it is important for your doctor to not only have a familiarity, but a well-rounded knowledge of the importance of each question asked during an examination to update your personal and family medical history. The Step 2 Clinical Skills examination is, in my opinion, the most important building block—per se—within the series of the United States Medical Licensing Examination. It was designed to evaluate medical student’s knowledge of history-taking, clinical communication and physical examinations.

It is of crucial importance to understand health history and the correct method in which to conduct a complete physical examination to avoid medical error and to make for better practices—inhibiting malpractice and patient negligence.

The United States Medical License Examination (USMLE)

Preparing for the USMLE requires skill, determination and practice—a knack that a medical doctor must attain before taking a patient’s health into their own hands. This three step examination was designed to assess a soon-to-be medical practitioner’s ability to convey a vast array of knowledge and concepts within a medical setting. The trio of patient-centered skills builds off of one another to ensure a clear and concise medical examination. Determining the importance of one step of the USMLE exam over another can be hard to define since each is important to grasp while receiving a medical education.

If you are currently studying for the examination, have previously taken the licensing exam or plan to buckle down within the coming year, it is important to know the importance of the USMLE Step 2 CS and why the second step of the licensing exam will significantly increase your knowledge to aid in medical preparedness.

The Step 2 Clinical Skills Test:

The Step 2 CS examination is a practical exam—designed with patients in mind. Most students within their fourth year of med school will take Step 2 of the USMLE. Preparing for this section of the test may be more difficult to do as this exam relies on a standardized patient review and a pass or fail basis, unlike the other two sections of the licensing exam.

Recent Changes to Step 2 Clinical Skills Examination

Proper communication and interpersonal skills are imperative to have within the medical field. Standardized patients will be asked to assess the initial diagnostics, examination findings and the history and physical examination findings.

The patient note, which used to be the least important factor of passing Step 2, now holds the most weight for whether or not the examinee will pass or fail.

A Wholesome Education: Reflected by the Step 2 Clinical Skills Exam

Practicing medical students will have a seamless transition from the classroom to their professional role with a wealth of knowledge and insight into patient health and history-taking. Having a well-developed patient relationship may not come easy and takes time to formulate both with patient to doctor interaction and the ability to care for a culturally diverse blend of individuals in today’s society. Learning how to be empathetic and well-informed will aid in a more accurate accumulation of information and the skills to properly diagnose patients with differing needs.

Author Bio:

Dr. Swartz has over 20 years of experience in the medical industry, focused on enhancing medical education. In 2003, he founded a prep course called C3NY to improve the education and preparation for students within the field of medicine.

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Before completing their final year of training, senior medical students participate in the competitive application process run by the National Resident Matching Program, known affectionately  as “The Match”, to determine where they will begin their careers as physicians.

In many ways, the process is reminiscent of applying to medical school – personal statements, letters of recommendation, credentials, standardized test scores, and extracurriculars are all reviewed by admissions committees who then decide whether they will grant an applicant the privilege of interviewing.  However, unlike medical admissions, which are determined solely by the school’s committee, residency matching involves a mysterious, all-knowing computer program that reconciles the “rank list” of the applicant and all of the participating institutions, and generates a result that both parties are bound contractually to fulfill.

Greetings, human doctor. Feed me your hopes and dreams so that the most rational location for your collection of biomass to perform its duties may be generated.

Actually, in reality, it’s probably more like this:

“Oh, hai guyz! I’m Whiskers, the IT Kitten. Ur entire future will b deetermind by which wirez I choo on – lolz!”

Anyway, the day began in the auditorium where we spent our first two years trying to “drink from the fire hose” to build our clinical knowledge base.  A few friends and I decided to sit in our old seats (yes, it was cute as hell).  Some folks from the school’s administration spoke to us, but I’d bet good money no one remembers a thing they said.  Our musically-talented classmates entertained us with a rendition of “Call Me Maybe” to help us pass the time:

“Hey, I just met you

and this is crazy

Here’s my rank list

so match me maybe!”

Finally, it was time, and we were corralled into the main lobby to collect the envelopes that held the answer to the biggest question of our careers thus far.  On-lookers, well-wishers, and even a few hospital employees crowded the balcony above the lobby.

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Some final wishes of good fortune were exchanged as we redistributed ourselves amongst friends and family.  The Dean said a few words and led the count-down as High Noon approached:

“10, 9, 8…” Every student’s eyes are fixed on their envelope (or the clock), and their families’ eyes are fixed on them.  Some begin to raise their cameras.

“5, 4, 3…” A few flashes.  Everyone I can see has at least one finger already inside the envelope, ready to pull the trigger when the signal is given.

“…ONE – Open your envelopes!” A burst of cheers, some camera flashes, followed by a brief pause and relative silence as the papers were drawn from their envelopes and unfolded.

Then, the first scream.  And another.  Then, more erupt from all parts of the lobby, like popcorn, until the room is filled with a roar so loud I can no longer hear the people closest to me exclaim where they’ve matched.  The building was electric.  Cheers, hugs, tears, more screams & yelps, more tears; the names of cities and hospitals bounce off me as I move through the crowd to find more friends.

The cacophony died down over the next several minutes, as more handshakes and high-fives were distributed.  Phone calls, photo ops, and Skype sessions on smart phones continued in the background.  People began to file out of the building for celebratory lunches with their families.

I’m glad all of those cameras and smart phones were there – I barely thought to take any pictures.  Overall, the day was an amazing experience, and my colleagues matched at some very impressive institutions, in very competitive specialties, proving that my class really was as gifted as I thought they were.  Next year’s graduating class has their work cut out for them.

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The correct answer is D) Nephrolithiasis.

Some of you chose the correct condition, but on the wrong side of the body.  Remember that the patient had pain on the left, and that when we read a CT scan, we are always “facing” the patient – that is, what’s on the right of the screen is actually the patient’s left.  In the axial CT images below, the patient’s feet would be projecting out of the screen towards you (i.e. you are looking at a slice of them from below).

Non-contrast CT scan is the gold standard for detecting kidney stones, though this patient received contrast because other causes of abdominal pain may have been ranked higher in the ordering physician’s differential.  I want to point out several findings in the patient’s scan that aid in diagnosis.

Hydronephrosis of the left renal pelvis. Click to enlarge.

Immediately apparent is hydronephrosis (literally, “water kidney”) – or dilatation of the renal collecting system – on the patient’s left (red arrow).  This results from obstruction of the free flow of urine somewhere distal to the swelling.  Also note that contrast has not illuminated the left renal pelvis the way it has on the right.  Finally, the left kidney itself appears to have a lower signal intensity (brightness) than the right.

In the other images (refer to original post), multiple other stones can be detected in the kidneys.  The last two images show the obstructing stone.

Obstructing left-sided nephrolith. Click to enlarge.

On the above image, the stone is clearly seen at the point of obstruction (red arrow), and perhaps more subtly you will note the “wispyness” of the ureter and surrounding area, indicating acute inflammation in the area.

Explanation:

Nephrolithiasis technically refers to stones in the kidney – the acute pain from “passing” a kidney stone occurs as the stone passes through the muscular tubes that connect the kidneys to the bladder, called the ureters.  Thus, the term for this patient’s actual condition would be “ureterolithiasis” – but this term is not often used, especially in the emergency department.

Kidney stones, or renal calculi, are typically formed from dietary minerals (most often calcium) and/or organic compounds (oxalic acid, uric acid, etc.).  When urine becomes “supersaturated”, these compounds precipitate out of their suspension to form a solid, which acts as a nidus for further crystallization.  They are nearly twice as common in males, where they present in early life (20s-30s); females typically present for the first time somewhat later in life, as this patient did.  First-time stone “attacks” after the age of 50 are somewhat uncommon.  The majority of renal calculi pass spontaneously, but those larger than 6mm are significantly less likely to do so.

When a stone’s passage is intermittently obstructed in the ureters, their intermittent contractions cause sharp, unilateral (one-sided) abdominal or back pain that may radiate toward the groin – known as “renal colic”.  The pain can be quite exquisite, and patients typically cannot find a comfortable position, causing them to writhe in bed (or pace, if they prefer to stand).  Nausea and vomiting are not uncommon, and diarrhea may also occur.  Patients may have gross (visible) blood in the urine, or smaller amounts detectable only on urinalysis.

Thanks for participating.  If you would like to submit a case or guest post, please use the contact page.

Filed under: Medicine ]]> http://abnormalfacies.wordpress.com/2013/03/25/answer-to-medical-challenge-sudden-pain/feed/ 0 diamondsandcoal Hydronephrosis of the left renal pelvis. Click to enlarge. Obstructing left-sided nephrolith. Click to enlarge. http://abnormalfacies.wordpress.com/2013/03/23/medical-challenge-sudden-pain/ http://abnormalfacies.wordpress.com/2013/03/23/medical-challenge-sudden-pain/#comments Sat, 23 Mar 2013 15:08:08 +0000 Jim http://abnormalfacies.wordpress.com/?p=1579 ]]> Case:  A 43 year old female presents to the emergency department complaining of sudden-onset, sharp, left-sided abdominal pain that radiates to the groin, followed by nausea, vomiting, and diarrhea.

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Based on the images and history provided above, what is the most likely diagnosis?

• A) Appendicitis
• B) Diverticulitis
• C) Hernia
• D) Nephrolithiasis (kidney stone)
• E) Ruptured ovarian cyst

Check back in 48 hours for the answer and explanation.  If you would like to submit a guest post or a medical case of your own, please use the contact page.

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   So, I’ve made it to 4^th year. There were times when I wasn’t sure I would, many times actually; mostly when confronted by a consultant with a question about a syndrome I have never heard of and a drug that I’m pretty sure doesn’t exist in front of a patient who is expecting me to be reciting this stuff like a book….

4^th year is the year every medical student has nightmares about; it is the first year where you are actually expected to know things. But every cloud has a silver lining right? This year it definitely did. To accompany me on my final 2 years of being a student I received a shiny new iPhone from my medical school to use as a ‘learning tool.’ My Blackberry just wasn’t cutting it these days so this upgrade made me positively ecstatic, and not because I was going to use it to further my education. We were asked to download a few apps as to use as resources but I didn’t get round to doing that for 2 weeks because Siri was occupying my free time. When I did finally get round to doing it though I found that these apps really do come in handy! They are great for convincing your consultant that you know everything because you can look up the patient’s condition on the ward round before he has chance to turn on you with his questions that he is hoping you will not know the answer to. I have found that they really help to consolidate your learning too, as you tend take things in more when you are looking things up as you see the patient.

I have just finished my paediatric placement and really have found my iPhone invaluable. Please remember though that apps are not a substitute for good medical knowledge and common sense, they are merely a reference; otherwise you could find yourself being sued for medical negligence in the future. These are some of the apps that were recommended to me by other students and even the odd consultant.

1.      Medscape

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Medscape was the first app I downloaded as it was recommended by my registrar on my first day. It is a very useful one to have as you can look at recent healthcare news articles (it makes you more appealing to consultants if you are up to date with current knowledge,) educational articles and it was also be used to look for credible references. I have used Medscape for a while now, especially when trying to find references for a literature review, and was really happy to find it as an app. I find it particularly useful when it comes to looking up specific conditions as it is really easy to navigate.

2.      The New England Journal of Medicine

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This fits in again with the theme of keeping up to date with the news and with current affairs. It shows their articles from the past 7 days, and just having a glance through once a week means you will have something to bring up with one of your senior doctors which will make you sound pretty keen and interested.

It also has a section for images and one for video, which I actually came across by accident but found very helpful. Every week new videos are put up, mostly showing you how different procedures should be carried out correctly. You may not need to know all of these procedures at this level but it is good to be aware of them for future reference.

3.      Pocket ECG

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I have come to terms with the fact that the ECG may just be something that I am never going to get. This app was recommended to me by a junior doctor who has the same passionate distaste for ECGs (good to know I’m not the only one,) and I have found it helps with the understanding.

There are headings of a number of different abnormalities that can show up on an ECG, then those lead to a picture of what the ECG would look like and an explanation. I also find this useful as a reference; when I am handed an ECG and given 5 minutes to interpret it I try first to think of what it can be and then compare it with the picture on the app. There is also a quiz on there which really helps you to see whether you are gaining an understanding or not.

4.      Mobile MIM and Vue Me

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These apps were made by the same company and are actually quite ingenious. The Mobile MIM allows physicians to look at radiographs on a mobile device (yes I have actually seen radiographers carrying iPads around to confer with other doctors) and allows you to look at the images in incredible detail. You can zoom in and even adjust the lighting so that you can see specific structures more clearly. There are some sample patients on there too so you can also use it as an educational tool.

Now here’s the clever bit; Vue Me is an app which is used by patients so that physicians can transfer their scans them to be viewed on a mobile device. This is done via ‘Breeze’ and allows these high resolution images to be sent via bluetooth or wifi. The app has also taken data protection into account as all images are encrypted when they are sent and you need a pass code to open them. This really is leading the way for patient centred medicine, where the patient is involved in all aspects of their care.

 5.      Radiology 2.0: One Night in The ED

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Keeping with the theme of radiology, this app talks you through cases that common in A&E, using a CT image to illustrate. You try to work out the diagnosis yourself and then can choose to read the discussion.

6.      Prognosis: Your Diagnosis

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Ill admit it; I downloaded this app because it looked fun, but it is actually a really good revision tool! It gives you case studies and you have to work through different parts of the consultation to decide what investigations to do, work out a differential diagnosis and then form a management plan. In 4^th year it really is important to get into the habbit of thinking about management plans, because in under 2 years we will be expected to be able to make them for ourselves.

7.      Psych Terms

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I have my psychiatric placement next and the thought of it terrifies me. Not because I am not interested in psych, but because there are so many words that I just do not understand! This acts as a quick reference for all of those words and phrases psychiatrists like to throw around to make themselves sound profound. Much quicker than looking it up in a book, and the definitions are really concise and easy to understand.

In no other speciality could you see the words ‘psychic abilities,’ ‘life after death’ and ‘scientific’ be used to describe an aspect of it. The next 6 weeks could be very interesting…

8.      Visual Anatomy Lite

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I haven’t done anatomy or cadaver dissection since 2^nd year, so I sometimes find it difficult to remember what does where…particularly when it comes to the bones and muscles.

This app is a good visual guide and although I use it to refresh my memory you could also use it as a learning tool to test yourself with as you can remove the name tags.

As you can see, some of the images are quite detailed and you can zoom in if you need to. There is also a section for images from Gray’s anatomy, which I have found are among the best for education and revision.

9.      Micromedex

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This is a drug reference app and the easiest one to use that I have come across. I am often asked to look up a particular drug on the ward rounds but there always seems to be a shortage of BNFs around. You simply type in the drug and it tells you everything about it, including drug interactions and contraindications, which are essential to know about before you actually prescribe anything. It was actually a pharmacist who recommended this to me so if its good enough for them its good enough for me!

10.  Camera

Ok, so this technically is not an app, but it may be the most useful thing I have on my phone. As a medical student you are never still for more than one minute. I often see something I would like to look at again for teaching purposes but do not have the time to write it all down (such as a useful diagram or table in a book,) so I have started to take pictures of them and put them in a separate folder. There may also be times when you see a patient with an interesting condition, and you would like to document the physical conditions so that you are more likely to remember the case at a later date (this is good for revision). You have to be very careful here though, patient safety and confidentiality is something you much always strive to uphold, so before you take a picture of them OK it with their attending doctor or nurse first, make sure you don’t have any identifiable features in the photo (such as their face, wristband or an unusual tattoo) and of course ask the patient if it is OK! Many will be happy to help you with your learning, but some may find their condidtion a sensitive topic, so tread carefully.

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If you would like to submit a guest article or suggest a topic for a future post, please use the Contact page.

Filed under: Medicine ]]> http://abnormalfacies.wordpress.com/2013/01/27/medical-apps-making-life-just-that-little-bit-easier/feed/ 2 niqui-visualanatomy diamondsandcoal Click to enlarge. Click to enlarge. Click to enlarge. Click to enlarge. Click to enlarge. Click to enlarge. Click to enlarge. Click to enlarge. Click to enlarge. http://abnormalfacies.wordpress.com/2013/01/10/mediku-cafe-world/ http://abnormalfacies.wordpress.com/2013/01/10/mediku-cafe-world/#comments Thu, 10 Jan 2013 17:43:02 +0000 Jim http://abnormalfacies.wordpress.com/?p=1549 ]]> ICU beds are limited, and are much more expensive than “regular” floor beds (costing up to thousands of dollars each day).  Therefore, patients in the ICU are frequently assessed & re-assessed for the level of care their illness necessitates – their “candidacy” for ICU-level care, if you will.  Clinical evaluations aside, there are certain signs that let us know it’s time for a patient to leave (complaining about the food or that there aren’t enough channels on the television are two of my favorites).

This mediku is inspired by a patient who was an inappropriate overnight admission to the ICU to begin with.  By the time we rounded on her in the morning, she was feeling well enough to show us her “Café World” app – yep, time to go.

GI bleed lady,
Showing me your iPhone games
…Out of my unit

(If you would like to submit a mediku of your own, or any other guest post, please use the contact page.)

Note that this is simply a small observational series and was conducted independently, without any IRB or peer review process.  Despite the informal nature of the data collection, the findings will be presented in a traditional format.

Background:

In spite of growing national awareness, greater emphasis on obesity and diet-related illnesses in the media, and a booming weight-loss industry, Americans continue to struggle to maintain healthy weights – recent data demonstrate that two thirds of Americans are overweight or obese[1].

It has been documented that family physicians spend more time discussing weight loss than internists[2], but less data is available for other specialties.  The objective of this study was to determine how often non-primary care physicians discuss weight loss with patients in a context where maintenance of a healthy weight would be directly related to patient presenting complaints (i.e. a rheumatology practice).

A rheumatology practice was determined to be an ideal setting, given that a majority of patients present with osteoarthritis (OA) complaints. Research has demonstrated that each 1-pound reduction in weight translates to a 4-pound reduction in stress on the knees[3], and that weight loss is associated with a subjective improvement in function in persons with OA[4,5].  Thus, weight management is expected to be prioritized for a large proportion of patients in whom it would be appropriate.

Methods:

During 4 consecutive weeks at a suburban outpatient rheumatology practice, patient-physician interactions were observed for opportunities to discuss patient overweight/obesity in patients with a BMI > 25 kg/m².  Patients included were male and female, ages 18-94 years.  Only patients for whom the entire patient-physician interaction was observed were included, and data from patients who were first seen by one of the practice’s nurse practictioners (NPs) or who were interviewed by the observing medical student were excluded.

Any mention of weight loss or obesity was documented, and dialogue was graded as either physician-initiated (PhI) or patient-initiated (PaI); the number of times a patient mentioned their weight before it being acknowledged by the physician was also documented.  For all interactions, the discussion of weight loss or obesity was categorized into those merely mentioning weight loss (weight loss only; WLO), diet (D), exercise (E), or both diet and exercise (D&E).

Results:

The interactions of 169 individual patients were included during the observation period.  A total of 117 (69%) of these patients met criteria for overweight/obesity.  Weight management was discussed in only 17 (14.5%) of interactions with overweight/obese patients (Table 1), and was nearly twice as likely to be patient-initiated (9.4%) than physician-initiated (5.1%).  In total, patients mentioned their weight without prompting from the physician in 18 (15.4%) interactions.

Table 1. Patient & weight discussion characteristics.

Physicians were more likely to mention exercise when discussing weight loss than diet, and none discussed diet alone (Table 2).  Exercise without mention of weight or weight loss was mentioned in 3 interactions.  Eighteen (15.4%) overweight patients spoke about their weight, which was acknowledged by the physician only 11 (9.4%) times, and was thus ignored or overlooked by the physician in 7 instances.

Table 2. Physician’s weight management advice.

If acknowledged, weight loss was generally addressed by the physician after a single mention, but on several occasions was not acknowledged until mentioned by the patient multiple times, and on one occasion was mentioned 5 times by the patient before being acknowledged.  In 6 (5.1%) instances, the patient’s weight was discussed outside of the exam room with either the observer or another healthcare provider, but not with the patient.

Discussion/Conclusions:

Physicians are reluctant to discuss weight loss with patients in whom it is indicated and likely to be beneficial.  Barriers to discussing weight loss must be considered and addressed, including physician attitudes towards the effectiveness of discussing weight loss, efficacy of weight loss as it relates to the patient’s presenting complaint, lack of physician incentives, the belief that weight management is the responsibility of the primary care physician, and lack of physician self-efficacy with regard to nutritional advice[6,7].

Patients are also unlikely to discuss their weight, mentioning it in only a minority of interactions where it would have been appropriate.  Patients may have their own barriers to discussing weight loss, including self-esteem, prior unsuccessful attempts at weight loss, and the belief that it’s the physician’s duty to begin the discussion.

Limitations to the study include the presence of an observer in the room, OA of the knee(s) not being the primary complaint of the patient, and the observation of only one interaction per patient, amongst others.

Efforts should be focused at lowering the barriers to in-office discussions of weight management, just as we strive to encourage smoking cessation at every visit, regardless of specialty. Current and future generations of physicians must be encouraged to discuss weight loss when appropriate, and we should strive to let no patient request to do so go unacknowledged.  In many cases, a proper discussion about weight loss cannot be conducted in the allotted time, especially if other issues are the primary reason for the patient’s visit.  Thus, patients should be encouraged to make a dedicated appointment with the advising physician, their PCP, or another qualified consultant for more dedicated assessment and planning, and all offices should be prepared to make such referrals if they are unable to provide the necessary services.

References:

[1]  “FASTSTATS – Overweight Prevalence.” Centers for Disease Control and Prevention. CDC, 10 Oct. 2012. Date accessed: 20 Dec. 2012. <http://www.cdc.gov/nchs/fastats/overwt.htm&gt;

[2]  Pollak KI, et al. “Predictors of Weight Loss Communication in Primary Care Encounters.”  Patient Educ Couns. 2011 December; 85(3): e175–e182.  PMCID: PMC3154469

[3]  Messier SP, et al.  “Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis.”  Arthritis Rheum. 2005 Jul;52(7):2026-32.  PMID: 15986358

[4]  Christensen R, et al.  “Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial.”  Osteoarthritis and Cartilage.  2005 Jan;13(1):20-27.

[5]  Bliddal H, et al.  “Osteoarthritis – a role for weight management in rheumatology practice:  an update.”  Clinical Obesity.  2011 Mar;1(1): 50-52.

[6] Befort CA, et a.  “Weight-Related Perceptions Among Patients and Physicians.”  J Gen Intern Med. 2006 October; 21(10): 1086–1090.

[7]  Vetter ML, et al.  “What Do Resident Physicians Know about Nutrition? An Evaluation of Attitudes, Self-Perceived Proficiency and Knowledge.”  J Am Coll Nutr. 2008 April; 27(2): 287–298.

Your buddy, Dilaudid.

My back is hurting
I’m allergic to morphine
Need Dilaudid now

Stay tuned, in the next 48 hours I’ll be releasing a form of medical school entertainment never before seen on AF!

“Doc, my joint’s in pain!”

Hmm . . . stick a needle in it

Rheumatology.

Oh, and because there’s plenty of ultrasound employed, I am once again encountering the term “sontimeter” – pray for my sanity.

The topic arose recently in the oncology clinic (of all places), when my mentor shared findings published by the Mayo Clinic that called for clinical trials of green tea compounds after observing that some of their lymphoma patients experienced clinical responses with supplementation.  Until the jury is out, he will continue to recommend green tea consumption to his patients – but I decided to take this opportunity to brush up on the milk-in-tea debate.

It has been proposed that proteins in cow’s milk form complexes with the biologically active compounds in tea, and either inhibits their absorption or impairs their activity in the body (and unfortunately there is evidence that soy milk does the same).  As is often the case in nutrition science, findings to date have been equivocal, with some researchers endorsing the theory as others dismiss it.

Probably the best paper to date that I have read on this issue is one from the European Heart Journal in which researchers tested both the in vitro and in vivo effects of milk on tea.  They concluded, with good reason, that milk does in fact impair at least some of the many biologically active compounds in brewed tea.

Addition of 10% milk significantly impairs the vasodilatory effects of tea in 16 healthy female volunteers.

The researchers also tested the “milk protein hypothesis” and incubated endothelial cells along with tea and various isolated milk proteins, again demonstrating that the casein proteins appear to be the culprits.

Caseins are the primary inhibitors of vasoactive tea compounds.

Also examined was the effect of milk on various tea constituents.  Clearly demonstrated are greater than fivefold reductions in ECG & EGCG, two compounds found in green tea and shown in a multitude of studies to have beneficial health effects (and as a result, they are now marketed in many over-the-counter green tea & weight-loss supplements).

Milk sequesters several biologically active tea compounds, but has no significant effect on methylxanthines (caffeine and theobromine).

The authors believe these conclusions support both the lack of beneficial effects of tea on heart disease observed in populations from the UK, as well as the lack of antioxidant benefits observed in milk chocolate versus dark chocolate.

At this point, you may be wondering if there are any benefits whatsoever of adding milk to tea, and in fact there are.  Research has shown that absorption oxalate, a compound primarily found in black teas that can contribute to the development of kidney stones, is inhibited by the addition of milk to tea (likely a result of the calcium content of milk).  Adding cold milk to tea also lowers the temperature, and accumulation of thermal damage over time from consumption of hot liquids has been linked to esophageal and gastric cancer.

So if you consume all types, like I do, you may wish to practice moderation:  drink your white and green teas “naked”, save the milk for the black stuff, and let them all cool down a bit before enjoying.

References:

Shanafelt T.D., et al. Clinical effects of oral green tea extracts in four patients with low grade B-cell malignancies.  Leukemia research 1 June 2006 (volume 30 issue 6 Pages 707-712 DOI: 10.1016/j.leukres.2005.10.020)

Noda C., et al.  Induction of apoptosis by epigallocatechin-3-gallate in human lymphoblastoid B cells.  Biochemical and Biophysical Research Communications.  2007  November.  362 (4):  951-7.

Hursel, R.  Consumption of milk-protein combined with green tea modulates diet-induced thermogenesis.  Nutrients.  2011 August; 3(8): 725-733.

Lorenz, M., et al.  Addition of milk prevents vascular protective effects of tea.  European Heart Journal. 2007 January; vol. 28:  219-223.

Hertog MG, et al. Antioxidant flavonols and ischaemic heart disease in a Welsh population of men: the Caerphilly Study. Am J Clin Nutr 1997;65:1489–1494.

Savage GP, et al.  Bioavailability of soluble oxalate from tea and the effect of consuming milk with the tea.  European Journal of Clinical Nutrition (2003) 57, 415–419.

Deandrea S, et al.  Is temperature an effect modifier of the association between green tea intake and gastric cancer risk?  European Journal of Cancer Prevention. January 2010; 19(1): 18-22