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Medical Education, Medical Schools, Stanford News, Surgery

After work, a Stanford surgeon brings stones to life

After work, a Stanford surgeon brings stones to life

MA15_Profs_Greco_480pxClassrooms, research, grant writing, faculty meetings… It can be easy to forget that professors have a life outside of the classroom, perhaps with surprising hobbies and talents. The new issue of Stanford Magazine highlights the extra-professional lives of some of the university’s extraordinary professors, including Ralph Greco, MD.

Greco is a sculptor of stone as well as a surgeon. His work decorates his home and has sold for as much as $8,500. Perhaps his most notable sculpture is the abstract “S” that graces the Department of Surgery. He created the work of art from a 400-pound marble boulder that was gifted to him at a graduation dinner when he was the director of the general surgery residency program.

It’s perhaps not surprising that the multi-faceted Greco is an advocate for work-life balance among surgeons. He established a support program after the suicide of a surgical resident, and because he says sculpting can be “too self centered,” he pursues other interests as well. Check out the article to learn more.

Previously: Program for residents reflects “massive change” in surgeon mentality and New surgeons take time out for mental health
Photo by Nicolo Sertorio

In the News, Medical Education, Medical Schools, Research, SMS Unplugged

Research in medical school: The need to align incentives with value

Research in medical school: The need to align incentives with value

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.

7336836234_05b7e59045_zIt is a truism of American medical education that students should do research. Stanford medical school’s website espouses a “strong commitment to student research,” because it makes us “valued members of any medical field.” A similar message can be found at almost any other institution. It’s not just medical school either. Many undergraduate programs tout their research offerings for pre-medstudents, while residencies and fellowships often encourage their trainees to pursue investigatory projects.

There are several reasons for the emphasis on research in medical training. One obvious explanation is that schools want to prepare students for a career in academic medicine, through which physicians can combine scientific discovery with clinical insight to drive medicine forward. More broadly speaking, research is a way to develop analytic and critical thinking skills. These abilities not only help students better understand disease – they teach us how to read and interpret scientific literature to keep up to date with the latest advances in the field.

I believe in the value of engaging in research, but I recently came across the work of two prominent academic physicians who question whether it accomplishes these goals. The first is Ezekiel Emanuel. While he may be best known for his work on the Affordable Care Act as a special advisor to the White House, Emanuel’s background is in academics. After completing an MD/PhD at Harvard, he stayed on as an associate professor; he’s now a vice provost and professor at the University of Pennsylvania.

In his book, Reinventing American Health Care, Emanuel discusses how to make medical education more effective, and he specifically targets the research paradigm as an inefficiency. Whether or not it is explicitly stated, many top-tier programs require their students to do research in addition to their clinical training. To Emanuel, this constitutes “exploitation of trainees for no improvement in clinical skills.” He argues that eliminating such requirements can streamline medical education and boost the physician workforce. The physician shortage is one of the most discussed problems in health care. Trimming the length and cost of training can help address it. Reducing research requirements would allow students to prioritize their clinical work or other relevant interests.

“Exploitation” is perhaps an overstatement, but Emanuel addresses a legitimate concern about whether students’ time is best spent on research. And findings from researchers like Stanford’s John Ioannidis, MD, amplify the concern.

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Medical Education, Medicine and Literature, Medicine and Society, Mental Health, Patient Care

Using graphic art to understand the emotional aspects of disease

Using graphic art to understand the emotional aspects of disease

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When it comes to describing the feelings of hopelessness of depression, the fear and anxiety of having an operation or the unrelenting pain of a chronic condition, sometimes words are not enough. But, as some patients have discovered, art can be a powerful medium for portraying and translating these complex emotional experiences. Cartoons can also help future medical professionals empathize with patients and consider their experience from more than a clinical perspective.

An article published last week on the anthropology blog Teaching Culture explores the use of graphic art in medical anthropology courses. It takes its inspiration from Allie Brosh’s comic Hyperbole and a Half, in which she uses a crudely drawn figure to transport readers through the painful inertia and numbness of her depression. I stumbled upon this comic a few years ago when a dear friend was depressed. At the time, I didn’t understand how that could be or what that meant. Brosh’s bizarre, raw, and yes funny, comic resonated not only with what I saw my friend going through, but with my own experience, even though I was not depressed. It enabled me to empathize and to offer her support that was more relevant.

The article also describes a curriculum that incorporates “graphic pathographies” – graphic novels and comics about experiencing illness – into a course for pre-med students. The coursework “examines the multifaceted relations between biomedicine, culture, and the art of care, and places a special emphasis on how creative and humanistic approaches to illness and healing might enrich clinical practice.”

When I asked for his thoughts, Errol Ozdalga, MD, a professor of general medicine involved with the bedside medicine Stanford 25 initiative, commented:

Graphic art is an expression that is probably under-utilized. At Stanford, our guest services offers patients the chance to do guided imagery by expressing their feelings via drawing. Many physicians are unaware this service exists. It’s an opportunity to better understand our patients’ perspectives and promote the importance of connecting to patients among our students.

Previously: Engaging with art to improve clinical skills, Image of the week: a medical-focused manga comic and Stanford nurse’s whiteboard artistry brings cheer to patients, co-workers
Photo by Krystal T

Events, In the News, Medical Education, Medical Schools, Stanford News

Match Day at Stanford sizzles with successful matches & good cheer

Match Day at Stanford sizzles with successful matches & good cheer

Rowza Rumma, hugs Jennifer DeCoste-Lopez, at Match Day 2015 at Stanford School of Medicine on March 20, 2015. ( Norbert von der Groeben/Stanford School of Medicine )Across the country at the exact same time — 9 AM in California — on the third Friday in March, graduating medical students assemble for Match Day, the day they receive their assignments to residencies.

It’s a spectacle — a cross between a graduation celebration replete with champagne and balloons and a theater audition with tears and heartbreak. The Stanford students, no surprise, are top-notch, so there were more grins than groans and plenty of congratulations and good cheer for all.

The stats themselves stand out: 77 students were matched Friday and they’re heading to 14 states, with California and Massachusetts leading the list. (A map showing where everyone is headed is below.) General medicine is the most popular specialty, followed by anesthesia, neurosurgery and pediatrics. No Stanford students were matched in urology, radiology and psychiatry.

Before the event, I checked in with two graduating students, Mia Kanak and Rowza Tur Rumma. Both are accomplished health professionals with interesting backgrounds and plans to make the world a better place. Kanak is a Tokyo native who hopes to help impoverished children. Rumma wants to translate the success of the world’s best operating rooms into practices that work in the poorest nations.

As I wrote in a story:

For [Rumma], the day was both exciting and nerve-wracking. “I think it’s hard to not have the jambalaya of those issues in our minds,” she said. Clutching the red envelope and a cell phone, she was dialing repeatedly, trying to get in touch with her parents in Bangladesh to share the moment with them.

Finally, her father on the phone, Rumma slit open the envelope, a relieved grin spreading across her face. “It’s Brigham,” she said, her first choice. Brigham and Women’s Hospital offers opportunities for its surgical residents to specialize in global health, just the program Tur Rumma was hoping for. For the residency, she was interviewed by Atul Gawande, the well-known author and surgeon, and was able to discuss her work during a summer program in Bangladesh, where she worked to implement — and adapt — a checklist of steps to reduce surgical complications adopted by the World Health Organization.

Kanak also secured her first choice, a berth in the Boston Children’s Hospital‘s pediatrics program.

“I want to say how proud all of us at Stanford Medicine are of your accomplishments today,” Dean Lloyd Minor, MD, told the group after envelopes had been torn open. “And now, on behalf of everyone, a toast to your success, to the impact you’re going to have on the lives of so many people moving forward: Best wishes!”

View Stanford Residency Match Day 2015 in a full screen map

Previously: Stanford Medicine’s Match Day, in pictures, It’s Match Day: Good luck, medical students!, At Match Day 2014, Stanford med students take first steps as residents and Image of the Week: Match Day 2012
Photo of Rowza Tur Rumma by Norbert von der Groeben; map by Kris Newby

Events, Medical Education, Stanford News

Stanford Medicine’s Match Day, in pictures

Stanford Medicine's Match Day, in pictures

There was a lot of excitement at the medical school campus today, where 77 students found out where they’ve been “matched” for their residencies. Norbert von der Groeben captured the celebration through a series of photos; watch for more on the morning’s event here on Monday.

Previously: It’s Match Day: Good luck, medical students! and At Match Day 2014, Stanford med students take first steps as residents

Medical Education, Medical Schools, Stanford News

It’s Match Day: Good luck, medical students!

It's Match Day: Good luck, medical students!

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Updated 2 PM: A sampling of photos from today’s event can be found here.

***

7:30 AM: Today, small envelopes containing big news will be handed out to medical students at Stanford, and those at 155 medical schools across the country, as they gather to learn where they’ll spend the next three to seven years during their hospital residencies. We wish students at Stanford and around the country the best of luck!

The annual rite of passage for doctors-to-be is known as Match Day and is the culmination of the endless hours of hard work, countless nights of studying, years of college and grueling interviews. Residency assignments are determined by the National Resident Matching Program, a nonprofit organization that was created in 1952 at the encouragement of medical students to establish an orderly and fair mechanism for matching the preferences of applicants for residency positions in the United States with the preferences of program directors. The organization uses a computer algorithm to align the choices of students with those of the residency programs.

My colleague Becky Bach will be joining students this morning on the Stanford campus to capture the ceremony and excitement. Watch for photos and details from the festivities here, and on @StanfordMed and the medical school’s Facebook page.

Previously: At Match Day 2014, Stanford med students take first steps as residents, Image of the Week: Match Day 2013 and Match Day 2012 decides medical students’ next steps
Photo by Norbert von der Groeben

Medical Education, SMS Unplugged

Top 5 reasons medical students should do community service

Top 5 reasons medical students should do community service

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.

Arbor Free ClinicAs the process of applying to medical school, and then later residency, becomes hyper-competitive, us medical students often feel forced to pursue our passions only in ways that are “high-yield.” It may seem counterintuitive, but the further we go in our medical training, the more inertia we seem to have about giving our time and energy to the every day people in need. We’re so pressed for time from our participation in cutting-edge research, highly scalable health-policy work, and exciting start-ups, that we sometimes lose touch with the very people whose need first sparked our commitment to medicine.

We all know that helping people is the right thing to do. I don’t need to wax on about how we can be the people we want to be – how it’s a choice. This post is for the moments when we succumb to focusing solely on our resumes and our future applications. This post is about how using our skills as medical students to help people will actually help us professionally. It’s like when companies align their triple bottom line. We can do that, too.

And, so, the reasons:

1. To get individualized mentorship. The free clinics run by medical students have doctors who walk one or two pre-clinical students through the entire patient encounter – from taking the history to doing the physical to presenting the patient. This kind of one-on-one training is very rare.

2. To practice applying clinical skills. As a pre-clinical student in a free clinic, you actually get to do a physical exam on real patients rather than actors pretending to be ill. You get to work through a real-life clinical reasoning case and generate a differential.

3. To remember why you wanted to go to medical school. Medical school can be really hard, mostly because it may be the first time that you’re surrounded by peers who work just as hard as you do. But get back in touch with the desire to help people, which is what brought most of us to medicine in the first place, and you can replenish your sense of purpose as a medical student.

4. To figure out what you like clinically. Most of us are either honest with ourselves about not knowing what kind of medicine we want to practice or fool ourselves into thinking we know what we want to do based on a few shadowing experiences. Either way, getting involved and taking an active role in patient care can help you determine whether you like cardiology versus neurology, or it can solidify the hunch you already had.

5. To get a leg up when applying to residency. A Harvard surgery resident recently talked about what gave her an advantage when she was applying to residency; her answer was both research and her involvement in free clinics. She said that because she worked in a free clinic every Thursday evening doing diabetic foot exams, she was more comfortable in a clinical setting, she was more self-guided as a clinical student, and therefore, she was more competent when she did her sub-I’s.

Most medical students have a competitive streak. When you do something, you want to be good at it. So set yourself up to be good at your clinical rotations. Set yourself up to be taken seriously as a doctor whether you plan to pursue research, policy, or entrepreneurship. Set yourself up by volunteering in your community’s free clinics.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo courtesy of Arbor Free Clinic

In the News, Medical Education, Mental Health, Surgery

Surgeon offers his perspective on balancing life and work

Surgeon offers his perspective on balancing life and work

5136926303_a3d0bb0767_bMany of us strive to balance our life and work so we can be successful, happy and healthy. Yet, for people with unpredictable work schedules, such as doctors who must treat medical emergencies that have no regard for the nine-to-five work week, it can be hard to achieve this balanced bliss.

Much has been written about this topic, but the candor of this recent blog post from Robert Sewell, MD, a general surgeon at Texas Health Harris Methodist Hospital, caught my eye. In the piece, which originally appeared on the Family Physician blog and was posted on KevinMD yesterday, Sewell gives a brief account of what it’s like to be a surgeon and discusses the challenges and rewards of this career choice. He starts by providing a bit of his own back story:

I got married during medical school, and like every surgeon back in those days I told my wife, “I will always have two wives, you and medicine.” While some spouses accepted that dictum, others, including mine, resented it. Shortly after starting my practice it became clear that our relationship had been strained to the breaking point by my singular focus on achieving my life’s goal.

Sewell acknowledges that it’s desirable to balance the amount of time you devote to your work and personal life, but that as a surgeon it’s not always possible to do so:

Perhaps the most important lesson I learned is that a successful life and marriage requires balance. Too much emphasis on any one aspect throws both you, and those around you, out of balance. This should have been obvious, but as a surgeon, it was an extremely difficult lesson to learn, largely because of the nature of what we do. A kid with acute appendicitis, or an accident victim who is bleeding out from a ruptured spleen, simply can’t wait for a recital or soccer game to be over.

In the last two decades I’ve witnessed a significant effort by many young physicians to push back against those career pressures, as they seek more balance in their lives. While that is certainly a good ideal, being a surgeon is simply not a nine to five job. It’s a calling, and if you are truly called to the profession it’s in your blood.

Previously: Helping those in academic medicine to both “work and live well”Program for residents reflects “massive change” in surgeon mentalityNew surgeons take time out for mental healthUsing mindfulness interventions to help reduce physician burnout and A closer look at depression and distress among medical students
Photo by Colin Harris

Medical Education, Patient Care, SMS Unplugged

An introvert in medicine: Taking the plunge

An introvert in medicine: Taking the plunge

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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

Does the profession of medicine favor certain personality types over others?

When I was younger, it seemed like all of my doctors were gregarious, self-confident, and humorous, leaving me to wonder if one can “make it” in medicine without being outgoing. This seemed a natural consequence of the fact that so much of medicine is team-based and demands constant interpersonal interaction with colleagues and patients. For many introverts, a career in which a substantial amount of time is spent interacting with complete strangers — often in a deeply personal context — might seem like an odd choice.

Indeed, my experience in medical school so far has lived up to this idea in many ways. Group learning has been a fixture of our curriculum since day one, as has the fabled tradition of being put on the spot and quizzed by teachers in front of peers. Networking is still the preferred method for finding research opportunities. And the famous learning philosophy of “see one, do one, teach one” has been jarring for me as somebody who likes to take time for deliberation and reflection — a bit like being pushed out of an airplane at 10,000 feet.

All of this would suggest that extroverts might be at an advantage during medical school. And yet, it’s undeniable that a great many people who do not identify this way survive, and even thrive, in medicine, suggesting that there is hope for the rest of us.

For me, one of the most helpful aspects has been the formation of strong relationships during school. Having slowly built my own “team” of classmates, faculty, and mentors over the last several months, the pressure of the more challenging moments of medical school has been eased by our mutual respect and understanding. Being pushed out of the airplane isn’t so bad when you’re strapped to an expert skydiver who is looking out for you.

Sometimes, though, it’s not possible to rely on those relationships. When I have only a few minutes to perform a full exam on a new patient, I’ve had to learn to trust my own strengths. I might not win over patients with personable charm and witty humor, but I’ve found that a warm, but quiet, steadiness can achieve a similar level of connection. I’ve been encouraged to find that there are many different ways to make the personal connection that allows us as doctors to improve the health of our patients.

In fact, this has been one of the most important lessons that I’ve learned so far: learn from others, but don’t feel like you need to be just like them. Instead of worrying about whether I have what it takes to become that funny, charming doctor I had when I was growing up, I’ve begun to chart my own path. This takes time, support, and even some discomfort – but then, like jumping out of an airplane, who ever said that learning to be a doctor was easy?

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

Photo by Lachlan Rogers

Media, Medical Education, Medicine and Society, Research, Stanford News

Anthropologist discusses Wikipedia’s implications for health information

Anthropologist discusses Wikipedia's implications for health information

pid_24010Many of us turn to Wikipedia for quick answers to medical questions: What’s an amniocentesis, or what’s the difference between autism and Asperger’s?

Stanford University Press recently published Common Knowledge: An Ethnography of Wikipedia by anthropologist Dariusz Jemielniak, PhD, who studies managerial culture and has long been active in the Wikipedia community. As a fellow anthropologist, I was curious about his perspective and I wondered how medical knowledge is different in the age of Wikipedia.

When I interviewed the personable Jemielniak, he offered some insightful answers to my questions:

How empowering is it for people to have knowledge at their fingertips, on the internet? How is this different from finding information in reference books?

The basic difference is that on Wikipedia it’s usually put in lay terms. It’s readable, it’s comprehensible… With information, people have the perception that they know something about their condition. I’m not sure if they’re right – obviously, knowledge is not just one tidbit of information. On Wikipedia you can’t learn the relations between all kinds of knowledge – you need to have a medical degree to really understand that – but patients feel they are operating in a situation of informational deficit… Information on Wikipedia probably makes people have this feeling of empowerment, though I’m not really certain whether in all cases this contributes to their overall health. Sometimes they’ll misunderstand, misconstrue, or misinterpret because they don’t have the systematic knowledge.

In your ethnography, you discuss how the decentralized power in Wikipedia’s management changes the knowledge structure away from institutions and certified expertise. Without an authority structure, how do you determine who’s an expert?

On Wikipedia, the point is you don’t have to know if someone is an expert… Trust is transferred from formal expertise to procedure. If you follow procedure to the letter, by default you’re producing proper knowledge. If you use correct sources, if you cite all the sources that you found, if you’re doing justice to whatever you read, by default on Wikipedia it’s assumed that you’re just as good as an expert.

What about biases? In the book you say biases usually get toned down through copious editing.

I think on Wikipedia there’s a strong scientific bias of a sort. If a community of people are contradicting what is considered to be the scientific knowledge, quite likely those activist groups will be ignored. If there is consensus in the academic world, this is what will prevail in Wikipedia.

You say Wikipedia is never “published” but in an ongoing process of creation. Is this better for updates about new research?

By all means, I think obviously. Thirty seconds after the new pope was elected this new information was on Wikipedia. On Britannica you’d probably have to wait one year. Traditional media takes a year to go through the publishing process. The continuous release mode that Wikipedia operates on allows for instantaneous improvements and corrections, which is wonderful, it’s really great.

The pope is one thing, but research? How often are pages on research updated?

One of the problems is that research on Wikipedia is accurate at time of writing the article, but gets obsolete if people do not update. Articles that are most updated are ones people care most about… The real question is how many people actually read the incorrect information? Chances are, if there’s a big proportion of people who care about a topic… the more likely it is to be updated.

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