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Medical Education, SMS Unplugged

Escaping the medical school bubble

Escaping the medical school bubble

Hamsika at Castle Rock

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

A few months ago, I read the following quote: “Don’t live the same year 75 times and call it a life.” For some reason, this quote got to me. This year is my 18th consecutive year as a student, and there are too many days that seem the same, where I’m caught in the tasks and obligations of school and extracurriculars and forget to take time out of the day just for myself.

Fortunately, I’m surrounded by classmates who are very much aware of the bubble but also skilled at disconnecting from the med school busyness. A couple weeks ago, I took a leaf out of their book, woke up at 5:30 AM, and joined four of my fellow classmates for a hiking trip at Castle Rock State Park.

Castle Rock is about a 45-minute drive from Stanford and filled with beautiful redwoods, moss-covered trees, and stunning views. Much of the group had to be back on campus at 1 PM for meetings and such (can’t escape the bubble forever!) so we chose to do a ~6-mile hike, giving us time to pause along the way whenever we felt like it.

There were moments when all of us were quiet, relishing the moist, woody smell of the forest and appreciating the absolute silence that surrounded us. Of course, most of the time, we were chatting it up. Despite the fact that all of us are together almost every day, taking the same classes and working together on group presentations that accompany our coursework, it felt like we hadn’t really talked in ages! During our three-hour hike, we bonded over so many different topics – where we wanted to live when we graduated from medical school, things we’ve struggled with this past year, our families, and so much more.

This isn’t the first time I’ve had a chance to escape into the wilderness with classmates. Last year, med school kicked off with a pre-orientation camping/backpacking trip called SWEAT (Stanford Wilderness Experience Active (Orientation) Trip). SWEAT was a 4-day, 3-night adventure, and, like this hike, was an incredible bonding experience – one that even included a few bear sightings.

The point of this entry is to 1) make it seem like I have a life outside of med school (Kidding! Kind of…), and 2) emphasize how important it is to take the time to do things you love and enjoy. One of the things I struggled the most with – both when I went to college and when I came to med school – was figuring out how I could incorporate the things I’ve always loved doing – dance, drawing, reading, etc. – into a life filled with classes, deadlines, and meetings. While the classes will soon come to an end, the deadlines and meetings and obligations certainly won’t. And that’s when I’ll make a conscious effort to traipse off to a dance class, a bookstore, or a hiking spot like Castle Rock.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo courtesy of Hamsika Chandrasekar

Medical Education, Medical Schools, SMS Unplugged

Buzzwords in medical school

Buzzwords in medical school

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Learning in medical school often feels like learning a completely new language. There are numerous acronyms (OPQRST, CAGE, etc.) and molecules (IL-1, TGF-beta, etc.) and more. But most striking to me are two particularly ubiquitous buzzwords: “high-yield” and “protected time.”

I feel like I heard both these terms – and particularly the former – thrown around every single week of this past school year. “High-yield” has been used to refer to, as you might guess, the material that yields the highest amount of gain – i.e. for us students, it’s the material that’s going to show up on our tests. This term pervades not only conversations among classmates but also study materials. First Aid – one of the main Step 1 book resources – takes pains to highlight “high-yield” concepts, and Pathoma – another Step 1 resource – goes even further, identifying ideas that are not just “high-yield” but also “highEST-yield.”

This idea of focusing on “high-yield’ concepts bothered me at first and continues to bother me a little bit today, largely because my classmates and I often determine for ourselves what is “high-yield” and what is “low-yield,” dedicating our study time to the former and ignoring the latter. The worst part is that we may be ignoring information that may be “low-yield” in the context of exams but actually “high-yield” in the context of patient care. The flip side of this is that we only have a certain number of hours in the day; perhaps it makes sense for us to be judicious about what we focus our attention on?

Another phrase that has been widespread in medical school is the term “protected time.” I started hearing this during the very first week of medical school, when we had part of our afternoon off for “protected study time.” Later in the year, I attended a panel featuring five pediatricians. The question of work-life balance came up, and one of the doctors mentioned that she carved out “protected time” to be with her 2-year-old daughter every evening between 5 and 7 PM. This statement was met with general appreciation but also minor panic. There are so many aspects of our life that deserve “protected time” – family, friends, time for creativity, and more – and yet, again, there are only 24 hours in a day. Where does “protected time” start and end? And what does it include? And is it really reasonable to expect “protected time” when there are so many patient -care demands for physicians to navigate?

As I’m about to enter my second year of medical school, some of my questions remain unanswered. How can my classmates and I make sure to learn medicine well enough and thoroughly enough that we can both meet and exceed expectations in patient care? Is identifying “high-yield” material an ineffective, shortsighted approach? And how do we identify what falls under “protected time”? Here’s hoping I figure out this tentative balance during this upcoming year!

Hamsika Chandrasekar just finished her first year at Stanford’s medical school. She has an interest in medical education and pediatrics.

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From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.)

Pediatrics, SMS Unplugged

Behind the glass window: Experiences in an infant follow-up clinic

Behind the glass window: Experiences in an infant follow-up clinic

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

behind window - smallAs I mentioned in my last entry, I’m in Boston this summer. I’m one of several interns who are part of the Newborn Summer Student Research Program, coordinated by the Harvard Program in Neonatology, in partnership with a number of Boston hospitals. Aside from connecting us with excellent research mentors, this program ensures that participants get some clinical exposure as well. Over the past 5 weeks, I’ve had a chance to shadow physicians in the Boston Children’s Hospital neonatal intensive care unit (NICU), the Brigham and Women’s Hospital delivery room, the BWH nursery, and most recently, the BCH Infant Follow-Up Program (IFUP).

It’s this last shadowing experience – in the infant follow-up clinic – that I want to touch on in this entry. When I first heard about this clinic, I thought it was for babies who were being seen soon after birth, just to make sure everything was okay. As soon as I walked into the clinic, I realized that IFUP was not for newborn babies but rather for kids of all ages, who were being followed up on for various developmental issues that had arisen during their previous time spent in the NICU.

During my brief time in the clinic, I met patients ranging from 22 months to 10 or more years of age. I use the word “met” loosely here, for in fact, I did not meet a single patient in person during my time at the clinic. I stood with some fellow interns and some physicians behind a one-way mirror, quietly observing as various tests were run on these children. At first, I found myself fascinated by the physician administering the various tests (ex. the Stanford Binet, the Beery VMI), for I had never seen them given in a clinical setting.

Soon, however, my attention slipped from the physicians to the children being tested. I felt such a complex mixture of emotions: sadness, for many of these kids had never experienced a week devoid of doctor’s appointments; amazement, at how far these children had progressed developmentally given where they started; and humility, for it was pure luck that prevented me from sharing the same developmental struggles that these little patients did.

As these thoughts swam around in my mind, my attention slipped once more, from the children in the room to their parents. I felt drawn into the emotions that flitted across these parents’ faces – pride when their kids correctly answered the physician’s questions, a pang of pain when a question was answered incorrectly, a sense of helplessness when the physician mentioned that the child would need yet more therapy. In response to the latter, one mother said, “I’ll do whatever it takes.” Such a simple statement, something I’ve heard several times before in movies and TV shows, but hearing it here, in a clinical setting, while standing unseen behind a glass wall, my heart broke. I wanted to reach past the divider and give these parents and these little kids huge hugs, to tell them it would be okay.

I can’t quite say why this clinical experience touched me so much. Perhaps it’s because the glass wall between me and the patients, physicians, and family members was less like a barrier and more like a window, offering me a view into the lives of not only patients but also the family members who love them so much and the physicians that strive to do everything in their power to help them heal.

Hamsika Chandrasekar just finished her first year at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by A

Medical Education, SMS Unplugged

Fewer than six degrees of separation: the small world of higher education

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

six degreesSeven months ago, almost on an impulse, I decided I wanted to spend summer 2014 doing research back in Boston (home to my undergrad institution), instead of at Stanford. To this end, I started looking into possible research mentors, and after browsing through the Boston Children’s Hospital website, I found one person whose research interests aligned with my own, sent this person an e-mail and went back to studying for finals. Less than an hour later, I received a response. Two days later, we spoke on the phone. By the end of the week, I was all set for a summer in Boston.

What struck me the most about this entire exchange was not the speed with which it was conducted but the happenstance that accompanied it: I found out during the phone meeting that my now-mentor had actually attended Stanford medical school as well! What, I wondered, were the odds that the single person I chose to e-mail had graduated from the same institution that I now attended?

I thought about this coincidence more in the months that followed, and the more I thought about it, the less it felt like pure luck. Indeed, the past year has shown me just how small the world of higher education can be. Nearly 50 percent of my 102-person med school class comes from four institutions: Harvard, Yale, MIT and Stanford. One of my closest friends in medical school not only went to college with both the girls I’m living with this summer but also lived with one of my current roommates during a summer in undergrad. One of the other med students with whom I’m working with this summer gave med-school advice to the girlfriend of one of my undergrad buddies and – get this – both this coworker and I, unknowingly, performed at the same dance competition last year.

Moments like these make me feel that the “six degrees of separation” theory would more appropriately be called the “two (or fewer) degrees of separation” theory in the world of higher education. And what I’m wondering is whether or not this is a good thing.

Don’t get me wrong – I love playing the Name Game when I meet someone new (“Hi, I’m Hamsika! Where are you from? Yale? Oh, wait – do you know person X, person Y, or person Z? You know all three! No way!”). But there’s something to be said for diversity, not only in terms of race and culture (the two that seem to receive the most media buzz) but in terms of educational background, as well.

I summarized my thoughts on this “small world of higher education” phenomenon to a Harvard Med friend (incidentally, I met this friend at Stanford Med’s Admit Weekend) a few nights ago, and his response was – “Well, it kind of makes sense. If you go to a school like Harvard for undergrad, you’re probably going to end up at a similarly high-ranked institution for grad school. And,” he added as almost an afterthought, “your parents are probably decently well-off, as well.”

Could it be that we’re creating a self-perpetuating cycle in which the world of higher education becomes smaller and smaller and those who miss the “train,” per se, particularly at the “station” of undergrad education, are “derailed”?

I can’t say I know the right answer, but I’d love to hear your thoughts, as the topic of education – as you might notice from the two-liner at the end of each of my entries – is of particular interest to me. Feel free to add a comment below!

Hamsika Chandrasekar just finished her first year at Stanford’s medical school. She has an interest in medical education and pediatrics. 

Photo by Beth Kanter

Medical Education, SMS Unplugged

From NICU to nursing home

From NICU to nursing home

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

NICUThis quarter of medical school has by far been my favorite, because almost everything we do has an explicit clinical correlation. Each week we work in small groups of 10 or so students to go over patient cases, practice respiratory and cardiovascular (our two organ blocks this quarter) physical exam skills, and interface with real patients in the hospital. These experiences have been both exciting and humbling, and two in particular – one in the NICU and one at a local nursing home – stand out the most in my mind.

I visited the NICU for the first time two weeks ago, to shadow the physicians and residents as they conducted morning rounds. I saw the tiniest babies I’ve ever seen in my life, buried by wires and hooked up to incredibly sophisticated technology, like ECMO and a Berlin Heart. I’ve visited the NICU two more times since then, swept away by the fast-paced nature of the ICU setting, amazed by the large number of specialists working together to coordinate each baby’s care, and – more than anything else – touched by the gentle kindness of parents. There is one parent in particular to whom my heart went out, because each time I visited, I saw this father sitting next to his child’s crib, tenderly holding the baby’s hand and reading the baby stories out of books. This image is etched in my mind, and I hope it always remains so because this parent, with his simple gestures of affection, gives me insight into just how heartbreaking it is for a parent to bring new life into this world, only to have that new life marred by the possibility of death.

Equally humbling are the experiences of patients at the opposite side of the spectrum – i.e. not neonatology but geriatrics. The same week as my first NICU visit, I joined classmates on a visit to a local nursing home, as part of our POM (Practice in Medicine) clinical skills curriculum. The very first thing our facilitator asked us to do was comment on our feelings about geriatrics and on aging. I brought up the fact that aging – and in particular, care of aging individuals – is handled differently from one culture to another. For instance, in many Indian families, including mine, grandparents live with their daughters/sons and grandchildren, and there is no doubt in my mind that I want my parents, when they grow older, to come and live with me. This group discussion was followed by patient visits, and once again, I was touched the things I saw. One particularly sweet woman meandered over to me and – ever so gently – placed a hand my shoulder, telling me quietly that she would be leaving the nursing home soon because she and her husband both felt stronger. I can’t explain why this moment felt so poignant to me. Perhaps it was because this patient – who didn’t know me at all – saw my white coat and implicitly, as she placed her hand on my shoulder, placed her trust and friendship in me as well.

I know that these patient experiences are the firsts of many I’ll be a part of during my years in medical school and beyond but it’s these firsts that I want to remember because they capture my wonder for medical advancements, passion for family- (not just patient-) centered care, and gratitude for being able to be a part of the medical community. I hope to share many more such firsts with all of you, as my journey continues these next three years.

Hamsika Chandrasekar is a first-year medical student at Stanford’s medical school, with an interest in medical education and pediatrics.

Photo by bradleyolin

Medical Education, SMS Unplugged

Aloha! Stanford Medicine livin’ it up in Hawaii

Aloha! Stanford Medicine livin’ it up in Hawaii

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

This past February, five fellow Stanford med students and I found out that we had been accepted to present at this year’s Western Group on Educational Affairs (WGEA), an annual meeting focused on topics in medical education. This year’s conference took place March 23-25 (i.e. last week) in – wait for it – HAWAII!!!

As you can imagine, the six of us were pretty excited when we found out, particularly since the conference dates coincided with the end of our Winter Quarter final exams and the start of our spring break. Our excitement grew further when we generously received funding from Stanford to support our trip!

As with many trips these days, ours kicked off with an airport snapchat of me, Victoria (MS1) and Fred (MS1):Photo1

Which was followed by, naturally, another snapchat, upon arrival in the Aloha State:

Photo2

And then finally, by some non-snapchat phone photography – with each photo, just so you know, taken with a background soundtrack of “oohs” and “aahs” and “oh-my-goodness-how-is-this-place-so-beautiful:”

Photo3

Rest assured, we didn’t spend our entire time at the beach (Full disclosure: We did totally consider this option but our upstanding moral compasses rightfully led us away from the beach and back to the conference). There were three days worth of sessions, from students, staff, and faculty not only from schools in the U.S. but also from countries like Canada, Japan, and Thailand.

We came away from the conference with multiple new friends and rich discussions surrounding new initiatives in medical education. Two of my favorite sessions featured a discussion on the imposter syndrome (IP) in medicine, where individuals attribute their success to external factors and not themselves, and a joint presentation and activity on shared physician-patient decision making. In the former, we actually took a survey, the Clance IP Scale, to measure where we stood on the spectrum of IP experiences. (Highly recommend this, super interesting). And in the latter, we role played shared decision-making in pairs. To my pleasant surprise, this role playing didn’t feel unnatural or intimidating, and in fact, it closely mirrored what we learned in our Practice of Medicine (POM) clinical skills class.

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Medical Education, SMS Unplugged

Reality Check: When it stopped feeling like just another day in medical school

Reality Check: When it stopped feeling like just another day in medical school

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

In many ways, the first year of medical school feels just like undergrad to me: I spend much of each day in basic science classes, regularly meet with my academic advisor, work on problem sets with classmates, and try – as unsuccessfully as I did in college – to maintain a regular work-out schedule.

Hamsika sketch1

Of course, there are aspects to my first year that were not present in my undergrad years. Patient presentations are a familiar component of our classes, with our instructors bringing in a patient and their family, who in turn share their unique stories with us and give us the privilege of asking them questions about their conditions and their care. In addition, we spend two hours every Monday and Friday in the clinical skills component of our Practice of Medicine (POM) course, learning the core components of the patient interview and the physical exam.

Both patient presentations and POM sessions have been the highlights of my first year but neither experience has made me feel like a “real physician.” Yes, I’m drawn into patients’ hopes, struggles, and experiences during patient presentations, but it’s a faculty member with extensive clinical experience, not me, who guides the conversation. In POM, I appreciate the opportunity to practice with standardized patients (SPs) and classmates in a safe environment, but it feels very much like “playing doctor” because – let’s be honest – both the SPs and I know my medical knowledge is pretty limited at this point.

Hamsika sketch2

For some reason, it wasn’t until we learned the genitourinary exam that the reality of becoming a doctor began to sink in for me.

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Medical Education, Medical Schools, SMS Unplugged

Top 10 reasons I’m glad to be in medical school

Top 10 reasons I’m glad to be in medical school

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Stanford School of Medicine class of 2013 before the Dean's Welcome Reception and Stethoscope Ceremony on Friday, August 23, 2013.  ( Norbert von der Groeben/Stanford School of Medicine )A friend of mine e-mailed me this blog entry awhile ago. Titled “10 things you need to give up to become a doctor,” the piece describes “your free weekends,” “your desire to change the world,” and eight other similarly positive items as areas of life that medical students need to sacrifice on their path to becoming a doctor.

As I read through this entry, my mood grew increasingly dismal. By opting to go to medical school, had I really committed myself to a lifetime that, according to the author, would be devoid of creativity, good health, big dreams, and more? I refused to believe that was true.

So, instead of dwelling on aspects of my life that may or may not be compromised on my path to becoming a physician, I want to highlight parts of my life that have been enriched by my medical school experience thus far. Here we go: The top ten reasons (organized loosely by importance) that I’m glad to be in medical school:

10. Four extra years of free two-day shipping via Amazon Student
I’ve ordered everything from tuning forks to trash bins – and I look forward to my future purchases being delivered via drones. Thanks, Amazon!

9. Daily dose of cheaper-than-Starbucks caffeine
For everyone paying $2.95 for a latte at Starbucks, be jealous! Stanford medical students get $2.70 lattes (+ an extra 25 cents off if you bring your own mug) at the Med Café every day.

8. 24/7 gym access
The 4th floor of Li Ka Shing is strictly for medical/bioscience students only and houses study rooms, a lounge, and a gym. Not that I ever have the urge to work out at 4 AM, but if I wanted to, I could!

7. Having friends come to me when they’re sick and feeling like I can diagnose them
Friend: “I’m feeling a little sick.”
Me: “I CAN HELP.”
(Five minutes later)
Me: “Actually, come see me again in like 4 years.”

6. Sleeping in scrubs like it’s no big deal
Because, really, they’re the most comfortable pieces of clothing I own.

5. Living life on pass/fail
It feels like this is the first time in my life where I’ve been given the freedom to learn at my own pace, in my own style. There are very few assignments in medical school, and as such, we can take the material presented to us and decide for ourselves how to master it. I can’t describe how incredibly refreshing this approach is.

4. Being on a text-message basis with role model physicians
Following my first patient encounter, one of my advisors texted me, saying: “You are a skilled, empathetic interviewer. I greatly enjoyed working together yesterday and look forward to more experiences.” Needless to say, my advisor’s thoughtful, compassionate words completely made my day.

3. Full-length white coats
At Stanford, medical students receive white coats that are just as long (i.e. up to our knees) as coats worn by MDs in the clinic – a constant reminder that there are no hierarchies: We are part of a single medical team, with the shared goal of caring for someone in need.

2. Being surrounded by inspired, motivated classmates
From founding non-profit organizations to creating World Health Organization reports to winning international awards for their research, my classmates are among the most accomplished, friendly, and down-to-earth individuals I have ever met.

1. Finding meaning every day of my life
Whether it’s through a patient visit, an anatomy lecture, a morning at pediatrics rounds, or a standardized patient encounter, I’m reminded every day that what I’m learning is directly linked to caring for others.

Hamsika Chandrasekar is a first-year medical student at Stanford’s medical school, with an interest in medical education and pediatrics.

Photo by Norbert von der Groeben

Medical Education, SMS Unplugged, Stanford News

Introducing SMS Unplugged

Introducing SMS Unplugged

Five years ago, I sat down to write my college application essays and found myself struggling most with questions that read, “Tell us why (insert school name) is the right fit for you.” Despite having perused college websites for hours on end, looking up interesting courses, professors, and organizations, I had very little sense of what the students at each college were like, and as such, I had trouble saying with confidence that I would fit in at the various schools to which I was applying.

Every medical student has a number of amazing, humbling “firsts:” first time interviewing a patient, first time seeing a baby born, first time comforting a family that has experienced the death of a loved one. These are moments that should be captured, frequently revisited, and never forgotten.

Searching for more insight into college student life, I stumbled across MIT’s admissions blog, where a select number of students and admissions officers wrote entries on their day-to-day lives, detailing everything from grocery shopping to homework to summer adventures. As I read entry after entry, I gained incredible insight into MIT culture and began to feel connected to the students there. Several months later, when I was accepted at the university, I immediately applied to be an admissions blogger, recognizing how influential these blog entries were to my understanding of and appreciation for MIT.

Over the next four years, I wrote nearly 85 entries on my life in college and through these entries, had the privilege of interacting with prospective students, current students and alumni who shared their thoughts with me through blog comments or e-mails. In addition, these entries gave me the opportunity to take a step back and reflect on my MIT experience as it sped by, with days fading into months and months fading into years.

As a current medical student, I recognize now more than ever the importance of sharing stories and reflecting on experiences. Every medical student has a number of amazing, humbling “firsts:” first time interviewing a patient, first time seeing a baby born, first time comforting a family that has experienced the death of a loved one. These are moments that should be captured, frequently revisited, and never forgotten.

This ambition to reflect on medical school and related experiences is the inspiration for “SMS Unplugged,” a new series here on Scope wherein five medical students (myself included) will write about their respective medical school lives. The goal is simply to share our stories, with anyone who might be interested, and when we graduate with MDs, to remember what inspired, humbled, and motivated us along the way.

There are some individuals whom I’d like to take a moment to thank, for without them this blog idea would have remained just an idea, not a reality:

  • Dean Charles Prober, MD – for listening to me as I excitedly described this medical student blog idea and for facilitating my interaction with the medical school’s communications office
  • Michelle Brandt and M.A. Malone – for helping integrate SMS Unplugged into Scope and selecting the five blog writers for this new series
  • Michael Nedelman, second-year medical student – for the name of this series, SMS Unplugged
  • Natalia Birgissonm, first-year medical student – for collaborating with me to get this idea off the ground by creating a blogger application and acquiring funding for this initiative

On behalf of all five SMS Unplugged writers, I want to say thank you in advance to you, the readers, for taking the time to read our pieces. It is such a privilege for us to share our medical school journeys with all of you.

Hamsika Chandrasekar is a first-year medical student at Stanford’s medical school, with an interest in medical education and pediatrics.

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