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Medical Education

Events, Medical Education, Stanford News

TEDMED, in pictures

TEDMED, in pictures

A group of MD and PhD students represented Stanford at TEDMED 2015, which was held last week. Several students have written about their experiences on Scope, and here now are some of their photos from the two-and-a-half-day event.

More photos of Stanford Medicine events, people and places can be found on Instagram.

Photos by Eric Trac, Afaaf Shakir, Chao Long, Lichy Han and Thomas Chew

Anesthesiology, Medical Education, Sports

How to combine anesthesiology, internal medicine and rock climbing

How to combine anesthesiology, internal medicine and rock climbing

Michael Lin, M.D. at the Stanford Hospital and Clinics on Wednesday, September 23, 2015.

I’ll admit it: I’m in awe of, and a little intimidated by, medical residents. Between the early call times, long hours, and flurry of patients and cases, I often find myself wondering how these doctors-in-training manage to do it all.

So I was amazed to learn about Michael Lin, a fourth-year resident in Stanford’s combined internal medicine-anesthesia residency program. While most residents focus on just one field – like dermatology or surgery — Lin spends his time training in both anesthesia and internal medicine. He’s equally at home in the operating room prepping patients for surgery and in the internal medicine clinic treating outpatients.

But Lin also manages to squeeze in rock climbing outings to the gym and to meccas such as Yosemite National Park.

During a recent interview, I had the chance to speak with Lin about his dual interests, his experience at Stanford, and why doctors make great rock climbing partners. Here’s an excerpt from our Q&A:

What initially drew you to both fields?

When I was a medical student, I was interested in critical care and I was trying to decide which training route I wanted to take during my residency. I met with a lot of anesthesiologists and pulmonary critical care doctors who said that you get certain, specific skill sets from the medicine training and the anesthesia training. I realized that I didn’t want to choose. I wanted both skill sets.

One thing that has really drawn residents into this program is the critical care component. The ICU is really the intersection of medicine and anesthesia. You’re encountering critically ill patients with severe pathologies, so you need skills in acute resuscitation and advanced medical support that anesthesiologists are accustomed to providing in the OR, but you also need to treat the underlying pathology that landed them there in the first place, which is more aligned with the work of internal medicine physicians.

And as for why doctors make the best rock climbers? Lin has a simple response: “They’re detailed oriented and stay calm under stress, and you can trust them with your life.”

The only downside, he says, is that they always seem to be on call.

Previously: Stanford Internal Medicine Residency program to host Google+ Hangout, My couple’s match: Applying for medical residency as a duo and “We are a team”: Advice for new residents from chief residents, in their own words
Photo by Norbert von der Groeben

Medical Education, Pediatrics, Stanford Medicine Unplugged

Empathy and the darker side of pediatrics

Empathy and the darker side of pediatrics

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


I’m currently just over halfway through my pediatrics rotation, having recently finished up four weeks on inpatient peds and just started my month of outpatient peds.

Before this rotation, when I thought about pediatric medicine, I thought about diagnoses like asthma, croup, foreign body ingestions, and rashes. I never really thought about child abuse, or – as the medical terminology goes – “non-accidental trauma.” And yet, I saw all too much of it this past month on the wards.

Our 6 a.m. sign out one morning went something like, “Patient X, here for NAT, steadily improving, currently in CPS (Child Protective Services) custody, awaiting foster family placement.” When we met this young patient later that same morning, I found a strong mix of emotions stirring inside me: first disbelief, then overwhelming sadness, then – rapidly – anger.

How could ANY parent do this to their baby? This question repeated itself in my mind, over and over and over. I literally could not wrap my head around it. Here is this beautiful, helpless little human being – what could possibly make someone do harm to this child?

I was distressed and distracted throughout rounds that morning, until finally – unable to stay quiet – I confided my thoughts to one of the other members on the medical team, who said: “I know it feels hard to understand. But, take just a moment, and think about it from the parents’ perspective: They are no longer allowed to visit their own child. And they have to explain to literally everyone they know – friends, family, colleagues, other children in the home – why they no longer have their baby.”

Her words stunned me into momentary silence. Never had I thought to empathize with the parents of our NAT patient.

Somehow, I had taken that 2-minute sound bite uttered during morning sign-out and transformed it into a mental battlefield, with the health-care team on one side, fighting valiantly to protect this child, and the parents on the other, a medical story of “good” vs. “evil.” But my fellow team member was right: This situation was awful all around. These parents no longer had a child, the child no longer had parents, and sometimes – if the patient had siblings – the siblings too were taken into CPS custody.

This experience taught me how absolutely vital it is to find ways to empathize with every patient and every family, no matter what the circumstances. 

I feel like this is particularly relevant in the inpatient setting, where we see patients for days – which sometimes become weeks and months – at a time. We connect with our patients: They’re often the first people we see when we get into the hospital and the last ones we see when we leave. We feel like we know all about them, about their families, about their values. But we don’t.

We’re witnessing this small window of their lives that has brought them to the hospital. And as easy as it is sometimes to ask question and judge – particularly in the setting of something as sensitive as child abuse – it’s not our place to do so.

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

Photo by 3rdparty

Humor, Medical Education, Stanford News, Videos

“Dear Future Doctor, here’s a few things you’ll need to know”: Med students release parody video

"Dear Future Doctor, here's a few things you'll need to know": Med students release parody video

Ready for the first-ever musical parody produced by Stanford medical students? Filmed on campus last month and released this afternoon, Dear Future Doctor features a group of mostly first-years singing and dancing to the tune of one of Meghan Trainor’s recent hits. Featuring characters like the Late Doctor, the Greedy Doctor and the Celebrity Doctor, the song also – in the words of producer/writer/editor/first-year student Gun Ho Lee – aims to teach a lesson “on what the future doctor is NOT to do.”

The song “is meant to be a satire of the 21st century American medical system,” director/writer/ second-year student Joshua Wortzel elaborates. “In her song, Meghan Trainor pokes fun at some of the unfortunate aspects of modern courtship and gender norms” – and Dear Future Doctor, in turn, pokes fun at some of the things that “we medical students learn about becoming doctors.”


Events, Medical Education, Science

To boost diversity in academia, “true grit” is needed

To boost diversity in academia, "true grit" is needed

photo (1)With evangelical fervor, Freeman Hrabowski, PhD, president of the University of Maryland-Baltimore County (UMBC), challenged the School of Medicine to tackle inequality throughout its ranks, an effort that — if successful — could spill out to benefit society at large.

“It takes effort, being proactive, not being defensive, and being honest and transparent,” Hrabowski told a packed crowd here yesterday. His talk was the part of the Dean’s Lecture Series, which is focused on diversity.

A mathematician, Hrabowski is a national leader in the field of science education and is author of the recently published book, Holding Fast to Dreams: Empowering youth from the Civil Rights crusade to STEM achievement. He was incarcerated during a Civil Rights march in the 1960s and currently campaigns for inclusiveness at all levels of academia.

Dean Lloyd Minor, MD, lauded Hrabowski: “Personally, I have found Freeman to be an enormous source of inspiration, advice and of wisdom in my leadership career. He is an exceedingly wise leader, who measures his leadership by the lives that he impacts.”

Confronting entrenched notions about race and gender and STEM fields (science, technology, engineering and math) won’t be easy, Hrabowski admitted. He said it requires “true grit,” which is also the name of his university’s retriever mascot, True Grit.

One of the most critical points is the first undergraduate science course that high-achieving students take, he said. At UMBC, staff have created a new chemistry center and reorganized the curriculum. It’s also important to upend the cutthroat atmosphere in STEM fields and promote teamwork and cooperation, he said.

As a top institution, Stanford has a responsibility to promote diversity and inclusiveness, Hrabowski told the audience.

“When people look back at Stanford Medicine 100 years from now, who will they say you are?” Hrabowski asked. “The problems we face are more difficult than ever. The challenge is to keep learning and struggling with the issues.”

Previously: Intel’s Rosalind Hudnell kicks off Dean’s Lecture Series on diversity, Former Brown University President Ruth Simmons challenges complacency on diversity and Diversity is initial focus of new Stanford lecture series
Photo by Becky Bach

Medical Education, Stanford Medicine Unplugged

Mysteries of medicine: Why I’m not learning as much as I thought I would in medical school

Mysteries of medicine: Why I’m not learning as much as I thought I would in medical school

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

3137589159_c3d1222038_oBefore I began my first year of medical school, I imagined that learning diseases in medicine would follow a fairly well-defined, sensible format. First, we would learn about the normal physiology of the body – what is happening inside a healthy, normal body. Next, we would learn about exactly how the disease process disrupts this normal physiology and about the signs and symptoms that we can observe in a patient with the disease. Finally, we would learn about treatments that help the patient get better by targeting the underlying process that is disrupted in the disease.

Instead, as one of my colleagues eloquently noted in this very blog, I’ve quickly learned that many conditions in medicine are nothing more than labels. We observe a collection of symptoms, give it a name, and may or may not stumble across the underlying cause or any (if we’re lucky) effective treatments.

I used to think that this kind of empirical, trial-and-error approach was an outdated relic of the past. In the Victorian era, syrups given to calm fussy babies contained large concentrations of morphine – presumably before it was known to be a potentially dangerous and addictive narcotic. For many years, lobotomies were routinely used for the treatment of neurologic and psychiatric conditions, before we had knowledge of the critical importance of the parts of the brain that were being removed. Surgical procedures used to be performed with bare, unwashed hands, before we understood the concepts of infection and transmissible disease.

As easy as it is to look back on prior eras and marvel at how little they seemed to understand about certain drugs, diseases, or treatments, medical school has taught me that we can easily say the same thing about ourselves, here in the year 2015. The way that acetaminophen (Tylenol) relieves pain is still not well understood, despite the fact that millions of people take it every day. Similarly, electroconvulsive or “shock” therapy sounds like it should be outdated, but in fact remains one of the more effective treatments for severe depression. The causes behind an entire field of autoimmune diseases remain mysterious in most cases.

Because of this, I can’t help but wonder what medical students one hundred years from now will say about us when they look back at our era of “modern” medicine. I have no doubt that they will talk in amazement about some of the things we do. In the meantime, I’ve been learning to accept that being a doctor will require us to simply suspend our disbelief from time to time and admit that, every once in a while, we will need to do things for no better reason than because – for some reason – it works.

Nathaniel Fleming is a second-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Image courtesy of Shaheen Lakhan

Medical Education, Mental Health, Research, Surgery, Women's Health

Stereotype perception linked to psychological health in female surgeons

Stereotype perception linked to psychological health in female surgeons

8116089104_be12619731_oFemale surgeons who believe there’s a stereotype that men are better doctors are more likely to suffer from psychological distress, according to a recent study led by a former Stanford resident.

First author Arghavan Salles, MD, PhD, looked at the correlation between the perception of a stereotype — whether individuals think others believe certain groups are superior physicians — and the overall mental well-being of residents.

The team surveyed 382 residents from 14 medical specialties. To examine views on stereotypes, participants were asked: “Do you think residents in your program expect men or women to generally be better [doctors]?” They were also given standard psychological assessments.

Female surgeons were the only group where stereotype perception was correlated with psychological health. Surgery has traditionally been dominated by men and remains a specialty chosen by about twice as many men as women, leading to the persistence of gender stereotypes.

“As a surgical resident, I was aware of the stereotype that men are better surgeons than women. Although I found the stereotype upsetting, I didn’t think about it too much,” Salles told me. Then, after studying stereotype perception while pursuing a doctorate in education, Salles decided to combine her two specialties to determine whether residents experience stereotype threat; a question that no one had asked before.

The link she found has implications for physician productivity and patient care, Salles said.

“I think it’s important to realize that in the world of medicine, although the ratio of males to females is changing, some of these old stereotypes still have an impact on the practitioners,” said co-senior author Claudia Mueller, MD, PhD.

The belief that others think women aren’t good enough adds an unnecessary stressor to the female residents’ already harried lives, Mueller said. It could also contribute to the high attrition rate of females in surgical disciplines, the study states.

Mueller said the study, which appears in the Journal of the American College of Surgeonsis noteworthy for its rare integration of two quite disparate fields, surgery and psychology.

The authors suggest that simply increasing the number of female surgeons may help dissipate the stereotype. Sharing information about the stereotype may also help, as could investigating any practices that may have a differential effect on men and women, the researchers write.

Salles is now querying residents, faculty members and members of the public to see how prevalent stereotypes about gender-based differences in ability actually are.

Previously: How two women from different worlds are changing the face of surgery, Keeping an even keel: Stanford surgery residents learn to balance work and life and Stanford Medicine magazine opens up the world of surgery
Photo by Phalinn Ooi

Medical Education, Patient Care, Stanford Medicine Unplugged

When medicine isn’t enough: Establishing a therapeutic relationship

When medicine isn’t enough: Establishing a therapeutic relationship

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

4375292195_40cb7547d7_zI spent the last two months on my internal medicine rotation. Medicine is an interesting clerkship because we see medically complex cases, but also because we get to spend a lot of time with our patients. Patients can be in the hospital for days or weeks, and we have sustained exposure to them on a daily basis.

I developed good relationships with many of my patients, but one in particular stood out. I’ll call him Bill. Bill was sort of a stereotypical big, blue-collar, somewhat intimidating guy, but he ended up being easy to talk to. He came in to the hospital complaining of shortness of breath. His diagnosis was easy – he was having a congestive heart failure (CHF) exacerbation.

Heart failure is a term that encompasses many different conditions, but the fundamental problem is the heart is not beating properly. Without an adequate heartbeat, blood does not circulate well throughout the body. As a result, fluids can get backed up, leak out of the vasculature and pool in the lungs. The fluid buildup caused Bill to feel short of breath.

Bill presented with an uncomplicated CHF exacerbation, so we diuresed him (meaning we gave him medications that caused him to pee out the excess fluid). He no longer had any issues breathing after that so we sent him home.

After his discharge, I continued to see other patients without thinking about Bill. He was an open and shut case from a medicine perspective. But a few days later, my team got a call from the ED. Bill was back with another exacerbation.

CHF is a chronic condition with no cure, but can be well managed with medications and a low-sodium diet. Bill was not consistently taking his medications, nor did he follow his diet.

Admittedly, this wasn’t entirely his fault. He lived in a shelter where the diet was whatever was provided, and he mentioned that it was difficult to keep track of his medications. But he was still making choices that negatively affected his health. For example, he had just eaten an entire party-sized bag of pretzels. As you might imagine, party-sized pretzel bags don’t fit into a low-sodium diet. I wanted to understand why he ate them, and hopefully get him to stop.

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Immunology, Medical Education, Medicine and Literature

Stanford alumnus writes children’s book to inspire next generation of curious minds

Stanford alumnus writes children’s book to inspire  next generation of curious minds


Soon there will be a new superhero children’s book available, but these superheroes aren’t from Marvel comics. The book, Rose’s Superhero Birthday: An Immune Cell Treasure Hunt, is about the immune cell superheroes that keep us healthy.

Angela Landrigan, PhD, did her graduate and postdoctoral training in immunology at Stanford’s medical school, where she studied how immune cells respond to cancer. She now works at a private company that develops software used to analyze immunology “big data.” She’s also a busy mom to two energetic, curious girls, which led her to write and illustrate a children’s book to make learning about the immune system fun. I spoke with Angela last week about her new book, which she plans to distribute on her website.

What inspired you to write a children’s book?

My kids led me to write this book, particularly my 4-year-old Violet. Sometimes I work from home analyzing datasets, and she’ll look over my shoulder and ask me all these deep questions about cells and what they do. Plus we talk through the details of everyday things, like if she gets a cut or flu shot. I realized that kids can pick up a startling amount of detail, and they’re so thirsty and eager for knowledge.

So I wrote the book to answer Violet’s questions, then I quickly realized that I have the opportunity to teach more children and even parents and caregivers about how our immune cells work. Immunology is becoming an increasingly popular topic in the public health conversation — anything from vaccine awareness to disease epidemics. My book can help people to have less fear of the unknown and to be better equipped to make decisions that influence their own lives and public health.

How did you develop the characters and storyline for your book?

The main character emerged because my daughter Violet wanted me to tell her new stories every night before bed. So I created this character who goes on adventures.

The book follows a 7-year-old girl named Rose, who is really excited about science. She asks her immunologist-Mom for a science-themed birthday party with a B-cell birthday cake and a treasure hunt for stuffed animal immune cells. The next day, Rose invites all her friends over for a play date to create and act out a play on how immune cells work together in concert to get rid of a virus.

I’ve tried to capture the joy of creation, exploration and discovery of childhood, while engaging kids to think deeper.

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Medical Education, Medical Schools, Stanford Medicine Unplugged

Considering premed? Some things to think about…

Considering premed? Some things to think about...

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

MatchDay14-Ever since I was little, people asked me if I would become a doctor like my dad. I wasn’t sure until I shadowed a doctor my freshman year of college. As soon as that happened, I started looking for guidance on how to choose between my many interests so that I could both be true to myself and become the best candidate for medical school that I could be.

I was lucky to have many great mentors who took the time to thoughtfully answer my questions, and now I’d like to pay it forward. For anyone in the early stages of premed that wants advice, here are my thoughts on certain areas.


  • Medical schools will likely want to see evidence that you’ll be able to keep up with the academic rigor of their program. This sounds obvious, but the way that you can demonstrate this is to do well in your classes as an undergraduate.
  • Don’t take more classes than you can master. There are many interesting courses available in college but you need to be strategic about giving yourself the time to excel in your classes and giving yourself time to just be.


  • Give yourself time to see what extracurriculars you gravitate towards naturally. When you find them, pick one or two and invest time and energy in them. Take them in interesting, unique directions:
    • If research is your thing, then ask interesting questions. Schedule time every few months to actually speak with the faculty overseeing your research.
    • If volunteering is your thing, then be a leader in your field. Identify a need that has not been filled or an organization that inspires you and work hard on that.
    • If you’re an athlete, then be a leader on the field and off. Be a mentor to younger teammates.
  • At the end of the day, medical schools want to see your leadership and legacy as an undergrad.

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