Medical Education

The CommonHealth blog drew my attention today to the story of a group of students who jumped into action after the Boston Marathon bombings. As one of the pre-med students explains in the Times Higher Education piece, the incident - as horrific as it was - solidified her decision to go into medicine:

Near the marathon’s finish line, 50 Boston University pre-med undergraduates had been volunteering in the medical tent, filling out record forms and carrying supplies, when the bombs went off.

…

Some of the Boston University volunteers worked to clear the aisles as the floor of the tent ran red with blood. They saw the wounded, including children, arrive with missing limbs, and physicians fashion tourniquets from belts and shirts. One was ordered to set up a morgue.

“There was nothing in a classroom that could have prepared us for this,” [Yeon Woo Lee] said. “Some of the students in my group were barely 18. People stayed calm. Nobody panicked. It was scary, but I’m glad that I was there to help out and very proud.”

The experience for her and the others, she said, was horrifying and inspiring. “It was a terrible, terrible, terrible week with a lot of pain and suffering, but at the same time there’s nothing else in the world I would rather do now than go into the field that I chose to dedicate my life to,” Ms Lee added.

Previously: “We are not innocents:” What prepared medical professionals to treat Boston bombing victims

When Bay Area high-school students arrived on Stanford campus last Friday for Med School 101, little did they know they were about to spend the day practicing medical procedures on simulated patients, examining brain tissue samples, studying anatomy on a life-sized iPad, or learning how to use crowd-sourced research data to build and launch a company.

The day-long program kicked off with a welcome speech from Ann Weinacker, MD, chief of staff at Stanford Hospital & Clinics, who spoke to the crowd of 140 about the range of career options in science and medicine. “There is no end to the opportunities,” she told students. “You can bring babies into the world, you can help people die with dignity, you can go into research and help cure cancer.” Weinacker ended her talk with by telling students to ultimately “follow your heart and do what inspires you.”

Following Weinacker’s presentation, students headed off to sessions on a variety of medical and scientific topics taught by some of the country’s top experts. We’ve chronicled the excitement of the day and range of students’ educational activities in tweets and photos on our Storify page. We hope you enjoy perusing the collection of student experiences.

Previously: Image of the Week: Studying brains at Stanford’s Med School 101, Live tweeting sessions at Stanford’s Med School 101, Med school: Up close and personal, A quick primer on getting into medical school, Teens interested in medicine encouraged to “think beyond the obvious” and High-school students get a taste of med school
Photo by Norbert von der Groeben

As a reminder, our annual Med School 101 event kicks off this morning on the Stanford campus. At the day-long gathering, 140 high school students from ten Bay Area high schools will participate in a variety of sessions on medicine and science-related topics at the Li Ka Shing Center for Learning and Knowledge.

We’ll be live tweeting talks from Josef Parvizi, MD, PhD, associate professor of neurology and neurological sciences; Gilbert Chu, MD, PhD, professor of oncology; Sakti Srivastava, MD, associate professor of surgery; and other proceedings from throughout the day. Follow the coverage starting at 9 AM Pacific time on the @SUMedicine feed or by using the hashtag #SUMed101.

Previously: Live tweeting sessions at Stanford’s Med School 101

Tomorrow, around 140 students from ten local high schools will arrive on the Stanford campus to participate in our annual Med School 101 event.

Designed to expose high-school students to medicine and related fields, the event is organized by the medical school’s Office of Communication & Public Affairs and sponsored by Stanford Hospital & Clinics. At the day-long gathering, students will attend sessions at the Li Ka Shing Center for Learning and Knowledge on a range of medical and scientific topics. They’ll hear from some of the country’s top experts and get the opportunity to engage in hands-on activities such as performing surgery on simulated patients.

We’ll be live tweeting sessions from Josef Parvizi, MD, PhD, associate professor of neurology and neurological sciences; Gilbert Chu, MD, PhD, professor of oncology; Sakti Srivastava, MD, associate professor of surgery, and other event happenings throughout the day. You can follow the coverage beginning at 9 AM Pacific time on the @SUMedicine feed or by using the hashtag #SUMed101.

Previously: Med school: Up close and personal, A quick primer on getting into medical school, Teens interested in medicine encouraged to “think beyond the obvious” and High-school students get a taste of med school
Photo by Norbert von der Groeben

I spent my spring break on the Rosebud Reservation, in South Dakota, as part of a joint Stanford undergraduate and medical school class studying health disparities in a rural, reservation setting. For two days, I shadowed doctors and other health-care professionals at the local hospital, which is run by the Indian Health Service (IHS).

I myself am an enrolled Osage from the Osage reservation in Oklahoma. I’m a pre-medical student, and one of the reasons I want to go into medicine is to improve health in Indian Country. I knew the patient’s side of the IHS already, but I wanted to get a perspective from the provider’s side, which made this trip a no-brainer.

Healthcare at the hospital is free – paid for through the U.S. Federal Government’s discretionary budget – because of a long history of treaties in which Indian tribes exchanged land with the United States in return for food, education, and health care.

Being familiar with Stanford Hospital, I was amazed by the breadth of responsibility that IHS doctors had. The family physician I shadowed ran an outpatient clinic, managed the medical ward (which it seemed she took calls for almost every night), served as first assistant in some surgeries, and was about to also take shifts in the emergency room.

I wondered about the wisdom of this until the doctor reminded me that she was trained for everything she did. The legal pressure in mainstream America conditioned me into a mindset of medical specialization, but on a rural reservation there are no specialists. And, it soon dawned on me that my doctor’s wide scope of practice developed out of necessity. Poor equipment, an overload of seriously ill patients, and a lack of access to higher-level care demanded that the already short-staffed IHS doctors go above and beyond what is normally required.

When I asked the nurses how often they had to ‘MacGyver’ equipment, the answer was not just “sometimes” or “often” – ad hoc solutions were a way of life.

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One day after medical student Raymond Tsai penned for Scope a popular and widely shared blog entry (1,750 Facebook shares and counting!), he found out he would be doing his residency in family medicine at UCLA. As it turns out, and as reported by a colleague who covered Friday’s Match Day activities here, Tsai wasn’t the only Stanford graduate-to-be to choose this area of medicine:

“[The day] was… somewhat unique in that almost half matched in an area of general medicine — pediatrics, general surgery, ob/gyn,” [Charles Prober, MD, senior associate dean for medical education] said. “Eight students are going into family medicine. (The annual average at Stanford since 2007 has been just two to three.) Each of them are very interested in changing the way medicine is practiced in the U.S. from the grassroots level up.”

Prober was referring to a new and growing emphasis on primary care within the medical field as a whole, spurred by a variety of factors, including a nationwide shortage of primary care physicians, the Affordable Care Act leading to millions of newly insured patients and the crisis in burgeoning health-care costs. Through the new health-care law, the federal government has increased financial incentives to make training in primary care, which traditionally pays significantly less than specialty medicine, more attractive.

“The writing is all over the wall that we as a country need primary care, and family medicine is really where most primary care doctors come,” said Erika Schillinger, MD, clinical associate professor of medicine and director of predoctoral education for family medicine, who was thrilled that eight students matched in family medicine this year.

Previously: Image of the Week: Match Day 2013, My parents don’t think I’m smart enough for family medicine: One medical student’s story, Match Day 2012 decides medical students’ next steps, A match made in heaven? Medical students await their fate and Who got matched? A breakdown of Match Day 2011
Photo of Raymond Tsai and Dr. Erika Schillinger

Two days ago, on Match Day, Stanford medical students, and others at institutions around the country learned where they’ll be heading to residency in July. In this photo, Stanford student Danica Lomeli hugs her father, Luis, while her mother, Diana, reacts to the news that Danica will be doing her residency in family medicine at UCLA.

This year’s class was particularly successful, with all 91 students matching, 70 percent receiving their first choice and 85 percent one of their top three choices. Students matched in 15 different states, with two-thirds divided between Massachusetts and California. Nineteen matched with Stanford residencies.

Previously: Good luck to medical students on Match Day!, My parents don’t think I’m smart enough for family medicine: One medical student’s story, Image of the Week: Match Day 2012, Match Day 2012 decides medical students’ next steps, A match made in heaven? Medical students await their fate and Brian Eule discusses Match Day book

This morning, medical students at Stanford, and thousands more around the country, will gather at the same time for the annual Match Day celebration. Arriving dressed up and nervous, the students will join family, friends and faculty members as they prepare to hear where they will be “matched” for their residencies, the next phase of their medical training. We wish our students at Stanford and around the country the best of luck!

For those not familiar with Match Day, it’s a nerve-wracking affair during which each student receives a letter at 9 a.m. Pacific time detailing where they will spend the next four to seven years of their lives completing residencies. The post-graduation assignments are determined by the nonprofit organization National Resident Matching Program, which uses a computer algorithm that aligns the choices of the applicants with those of the residency program.

My colleague Tracie White will be joining anxious students this morning on the Stanford campus to capture the excitement of the day. Watch for her story later on Scope.

Previously: Image of the Week: Match Day 2012, Match Day 2012 decides medical students’ next steps, A match made in heaven? Medical students await their fate and Brian Eule discusses Match Day book
Photo fro by Norbert von der Groeben

I’m not sure why my parents were surprised when I told them that I was applying to go into family medicine. It seemed like a logical transition after spending six years working in public health and primary care before medical school, but from the perspective of Taiwanese immigrant parents, I couldn’t have made a more absurd career choice. I was confronted with comments such as, “Most people choose careers to make money - why aren’t you?” Even more jolting was when they asked, “Why are you throwing away years of hard work and accomplishments?” I was flabbergasted by the line of questioning, but they’re my parents, so I had to answer the fundamental question - why family medicine?

For me, the answer is simple: I went into medicine to improve the health of my community and our society, and when I think about the most pressing health issues facing our nation, it’s preventable lifestyle disease. According to the Centers for Disease Control and Prevention, more than 75 percent of our health-care costs and 7/10 of deaths stem from chronic diseases that are largely preventable.

The potential for primary care to fix our society’s biggest health-care problem and to have a real impact on overall population health is why I’m choosing to go into this field

As a medical profession, we’ve largely been unsuccessful at getting people to engage in healthy behaviors. Luckily that’s where family medicine doctors are uniquely positioned to succeed. For one, the family physician has the breadth of training to serve everyone in a community, and in doing so, can influence community behavior as a whole. This approach is vitally important since lifestyle choices are never made in the clinic; they’re made in communities based on social norms set by families and peers.

Second, as I’ve learned through my own journey of overcoming obesity by losing 40 pounds in the past year, so much of one’s ability to implement healthy lifestyles hinges on one’s sense of self-efficacy. Again, that’s where the family physician comes in. A family physician has the benefit of deep interpersonal relationships developed through continuity of care to more effectively cheerlead and coach a patient to success. If executed correctly, family medicine has the potential to succeed in promoting healthy lifestyles, improving community health, and actually preventing disease in ways we haven’t been able to before.

The potential for primary care to fix our society’s biggest health-care problem and to have a real impact on overall population health is why I’m choosing to go into this field. Increasingly, policy makers are turning towards primary care to fix a health-care system that’s becoming more expensive than we as a society can afford. As that happens, I want to be at the front lines leading the charge and developing impactful solutions.

When I told my parents this, their response was, “There are already a lot of smart people who trying to fix this problem and unable to find an answer - so what makes you think you can?” In essence, they don’t think I’m smart enough for family medicine. The problem that primary care has been charged to solve is so big that my parents don’t think I can do it.

Maybe my parents are right, but that won’t stop me from trying. Ignoring the issue doesn’t make it any less urgent. To communicate this to my parents, I responded with a Chinese proverb they taught me long ago, “Plugging up your ears so you don’t hear the fire alarm doesn’t mean there isn’t a fire.”

Raymond Tsai is a fourth-year Stanford medical student who is going into family medicine. (He finds out tomorrow, on Match Day, where he will be doing his residency next year.) He chronicles his journey to adopt a healthy lifestyle on his personal blog.

Photo in featured entry box by jasleen_kaur

There’s an interesting guest post on the SA Incubator blog about a publication created by medical students for medical students. In the piece, Ajay Major and Aleena Paul from Albany Medical College describe their motivation for launching in-Training, which they call the “the first online newspaper for medical students.” The co-founders write:

…With in-Training, we recognized the need for a proper forum for medical students to showcase their literary and artistic endeavors. Without such a forum, the knowledge accumulated by medical students who experiment in the humanities would remain fixed and incapable of flowing to peers. Medical schools would continue to sit like islands in the fray of a tumultuous health system, isolated from one another in thought and expression.

in-Training seeks to meet this dire need for a communal gathering place for medical students. We are the agora of the medical student community, and as such, we strive to publish innovative thought in the arts, politics, science, and literature. We provide a virtual forum for medical students to participate in the shared experience of being a physician-in-training and to learn from the reflections and wisdom of their peers. Since we went live last year, we have published over 100 articles from medical students at over 30 institutions in the United States and Canada.

Topics of posts range from physician burnout to the health benefits of yoga to training on LGBT health issues. A past entry examined the importance of reading fiction while in medical school and highlighted a talk by Stanford physician-author Abraham Verghese, MD.