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Medical Education, Medical Schools, Mental Health, Stanford News, Surgery

New surgeons take time out for mental health

New surgeons take time out for mental health

rope webI spent a recent morning watching about 30 Stanford surgical residents take time off from their operating rooms to participate in a series of team-building games out on the alumni lawn on campus. These are busy, dedicated professionals who are passionate about their work, so getting them to take time off is hard. “I can tell you a surgical resident would rather be in the operating room than anywhere else on earth,” Ralph Greco, MD, a professor of surgery, told me as he sat on a nearby bench watching the residents play games.

In a story I wrote about the games, I describe how the Balance in Life program, which sponsored the day’s event, was founded following the suicide of a former surgical resident, Greg Feldman, MD. Greco, who helped build the program, was committed to doing whatever he could to prevent any future tragedies like Feldman’s, as I explain in the piece:

“The residency program was just rocked to its knees,” he said, remembering back to the death in 2010 of the much-loved mentor and role model for  many of the surgical residents and medical students at the time. Feldman died after completing his surgical residency at Stanford and just four months into his vascular surgery fellowship at another medical center. “It was a very frightening time,” Greco said. “Residents were questioning whether they’d made the right choices.”

Today, the Balance in Life program includes, among other thing, a mentorship program between junior and senior residents, group therapy time with a psychologist and a well-stocked refrigerator with free healthy snacks. Residents themselves, like Arghavan Salles, MD, who participated in the ropes course, plan and coordinate activities:

“Some people think this is kind of hokie,” said Salles, who was one of a group of residents who helped found the program along with Greco following Feldman’s death. “Surgery is a super critical field,” Salles said. She paused to instruct a blind-folded colleague: “Step left! Step left!” “You face constant judgment in everything you do and say,” she added. “Everyone is working at the fringes of their abilities. They’re stressed.”

While writing this story, my co-workers suggested I read a September editorial in the New York Times that brought the issue into sharp focus. Spurred by the suicides two weeks prior of two second-year medical residents who jumped to their deaths in separate incidents in New York City, Pranay Sinha, MD, a medical resident at Yale-New Haven Hospital wrote about the unique stresses of new physicians:

As medical students, while we felt compelled to work hard and excel, our shortfalls were met with reassurances: ‘It will all come in time.’ But as soon as that MD is appended to our names in May, our self-expectations skyrocket, as if the conferral of the degree were an enchantment of infallibility. The internal pressure to excel is tremendous. After all, we are real doctors now.

Pranay’s message was similar to the one promoted by Stanford residents during the games: The key to battling new physician stress is realizing that you are not alone, that your colleagues are there to support you. “It sounds touchy feely to say that we care,” Salles told me. “But at the end of the day, if we want to have better patient care, we need to take care of each other too.”

Previously: Using mindfulness interventions to help reduce physician burnout and A closer look at depression and distress among medical students
Photo by Norbert von der Groeben

Medical Education, Medical Schools, Stanford News, Videos

Stanford students design “enrichments” for lions, giraffe and kinkajou at the San Francisco Zoo

Stanford students design "enrichments" for lions, giraffe and kinkajou at the San Francisco Zoo

My job took me to the zoo.

It was a rather unorthodox assignment for a medical writer, but one of our faculty at Stanford medical school was teaching a rather unorthodox class at the San Francisco Zoo. A dozen Stanford sophomores signed up to spend two intensive weeks there learning about animal welfare and behavior and designing “enrichments” to make life more interesting for the lions, a giraffe and a kinkajou at the zoo.

These included a “Poop Shooter” to lob animal poop into the lion’s cage, a urine-soaked scratcher for a lone giraffe and a “Robo-Flower” to automatically dispense smoothies to the kinkajou, a tree-dwelling rainforest mammal that looks like a cross between a squirrel and a raccoon.

“Zoo animals have pretty good welfare already,” said Stanford’s Joseph Garner, PhD, an associate professor of comparative medicine who helped design and lead the class. “So it’s not about fixing things. It’s about how we can turn this animal on a little. How can we help the keepers manage the animal and improve the experience for guests.”

“It’s like if you lived in the same room your whole life. We want to change it up, keep it fresh and interesting – something novel,” said student Jennifer Ren.

For Floyd the giraffe, the students shook things up a bit by building a scratcher soaked in female giraffe urine to make it appealing to him. Instead of lurking in a corner of his paddock near the female enclosure, Floyd ventured out into his large pad to explore his new toy, where he was a lot more visible to zoo-goers.

“The giraffe is one of the largest and strongest animals on the planet, so building something that he is not going destroy in 30 seconds is a real challenge,” Garner said.

For the lions, the students adapted a conveyor-belt system to periodically shoot giraffe poop into the lion’s cage, where the male lion in particular found the aromatic pellets extremely interesting.

“Lions lie around all day watching and waiting. But when the zoo put the enrichment in, it was like somebody just flipped a switch,” Garner said. “The male lion was up and about and smelling and searching for the giraffe droppings, and performing all of this wonderful lion behavior.”

The students took their assignments very seriously, videotaping the animals’ responses and designing charts and graphs to measure the results, which they presented at a zoo ceremony last Friday in which they were celebrated for their contributions.

The students said they came away with a whole new perspective on zoos and wildlife behavior, as well as a gratifying sense of having designed something to improve the animals’ lives.

Previously: How horsemanship techniques can help doctors improve their art
Photo in featured entry box by Norbert von der Groeben

Medical Education, Medicine X, Stanford News

Lloyd B. Minor, Stanford medical school’s dean, shares five principles of leadership

Lloyd B. Minor, Stanford medical school's dean, shares five principles of leadership

Dean_MinorOne of the highlights of this past weekend’s Medicine X was a course – “Navigating Complexity and Change: Principles of Leadership” – taught by our own leader, Lloyd B. Minor, MD. I sat in on the thoughtful and robust discussion, which focused on five principles that Minor developed throughout his career as a scientist, surgeon and academic leader. Students in the class were a mix of ePatients, researchers, entrepreneurs, and physicians, including a neuroanesthesiologist at Yale School of Medicine.

The first principle that Minor introduced was listening and learning, which, he said “underlie success in everything.” He went on to say, “I think a lot of leadership problems and failures come about when leaders are not, first and foremost, good listeners.”

Listening to others in the organization articulate their core values and vision provides a cultural context and helps leaders avoid the pitfall of their viewpoint being seen as counter to the organization’s. It also allows leaders to better understand those who disagree with them, he said. Drawing on his recent experience transitioning from provost and senior vice president of academic affairs of Johns Hopkins University to dean of Stanford’s School of Medicine, Minor explained that holding town hall meetings with Stanford faculty, students and staff were crucial in order to engage the community in charting a vision. “Vision is a derivative from listening and learning,” he told the class.

The next principle Minor discussed was building diverse teams. “Successful organizations thrive on diversity, and building diverse teams is one of the most important responsibilities of a leader,” said Minor. He emphasized that racial, gender and socioeconomic diversity, and diversity of viewpoint, are equally essential. Master Class students were advised to identify their weaknesses and surround themselves with individuals who have different backgrounds and cultural contexts and who possess strengths that can compensate for those weaknesses. In addition, if leaders listen and learn from a diverse team that provides constant feedback then they’ll create more opportunities for collaboration.

Once leaders have built diverse teams, the third principle comes into play: empowering teams. “You need to demonstrate the type of team behavior that you want individuals to exemplify to the rest of the organization,” he said. “That will determine how effective those teams are and enable you to be a better leader.” Among Minor’s tenets for empowering teams are: establishing a system of equitable accountability, allowing people to realize and correct their mistakes, establishing incentives, recognizing individuals or teams’ successes, and developing skill sets.

Minor went on to discuss the principle of managing and leading, stressing the point that while management and leadership have different areas of focus, being an effective leader requires one to be capable in management. “There is nothing that will derail leadership faster than poor management,” he explained. Leaders must not only articulate an organization’s vision and core values and build diverse teams to carry out those actions, but respond in a timely fashion, communicate, organize and coordinate.

Minor closed out his talk by touching on transitions. “This is a principle that is often missed and one that often leads to bad consequences for the individual, as well as the organization,” he explained. Leaders need to take time to reflect on both their transition to subsequent roles and the future of the organization. He warned that failing to carve out time to do so could result the erosion of leaders’ physical and mental health and damage the organization. A common mistake that he spoke to students about is when leaders refuse to let go of their former role and try to do the same job in a new position. To make sure Minor himself remembered to abide by this principle during his transition to Stanford, his wife gave him a business card holder for his desk with a quote from Lord Chesterfield that reminds us that in order to “discover new oceans, you must have the courage to lose sight of the shore.”

More news about Stanford Medicine X is available in the Medicine X category. 

Previously: Stanford Medicine X 2014 kicks off todayCountdown to Medicine X: 3D printing takes shapeCountdown to Medicine X: Specially designed apps to enhance attendees’ conference experience and Countdown to Medicine X: How to engage with the “no smartphone” patient
Photo by Stanford Medicine X

Events, Medical Education, Medicine X, Patient Care, Stanford News, Technology

Stanford Medicine X: From an “annual meeting to a global movement”

Stanford Medicine X: From an "annual meeting to a global movement"

MedX_musical_finaleAs Medicine X came to a close Sunday, ePatient and American Idol participant Marvin Calderon Jr. gave a special vocal performance that moved audience members to their feet and ended in an explosion of colorful streamers falling from the top of the main auditorium at the School of Medicine’s Li Ka Shing Center for Learning and Knowledge.

The three-day event, which was attended by more than 650 people and watched via live webcast by several thousand more, is Stanford’s premier conference on emerging health-care technology and patient-centered medicine. The conference hashtag #MedX was a top-trending term on Twitter in the U.S. throughout the conference, with more than 48,000  tweets sent out between Thursday and Sunday.

Medicine X has historically examined how social media, mobile-health devices, and other technologies influence the doctor-patient relationship. But this year, the program also focused on how partnerships forged between health-care providers, patients and pharmaceutical industry would define the medical team of the future, amplify patients’ voices, and shape medical education. Along with the topics of relationships and connectedness, a number of key themes emerged over the course of the conference, including engagement, empathy, and the imp0rtance of  treating the whole person.

Daniel Siegel, MD, clinical professor of psychiatry at UCLA, touched on several of these themes during his opening talk about developing a healthy mind, an integrated brain, and empathetic relationships. “Our relationships give us a sense of being seen, of feeling felt, of feeling connected. Those are the fundamental ways we create well-being in our bodily lives,” he said. “We live in connection to each other… Relationship experiences that are stressful early in life can lead to medical problems later.”

Several sessions put a special spotlight on the importance of treating the whole person and the link between mental and physical health. Patients shared their experiences with depression and anxiety, and many revealed how they had to grieve the loss of their healthy self in order to accept their new life. They also spoke about how they felt weakened by their mental-health condition and struggled to be empowered, or proactive, in their health care. Gonzalo Bacigalupe, EdD, MPH, a psychologist and professor of counseling and school psychology at the University of Massachusetts Boston, told patients, “Maybe the ‘e’ in ePatient is not enough. Maybe you need a ‘c’ that stands for connected. If you are connected, then the burden that you are feeling can be shared.”

Larry Chu and patient - smallSentiments about the need to foster empathy in medicine were discussed in parallel panels and during coffee break chats. Emily Bradley, an ePatient with a rare type of autoimmune arthritis, told attendees at a session about invisible pain, “I don’t fault my loved ones for not understanding my pain. I don’t want them to understand and I’m glad that they don’t. I think what’s missing is empathy.” Liza Bernstein, an ePatient advisor and three-time cancer survivor, told attendees at the closing ceremony, “Empathy doesn’t need that much. All empathy needs is us.”

The conference also tried to keep a focus on all different types of patient populations – including those who underserved. “There is a disconnect between solutions being build and the needs of vulnerable populations,” said Veenu Aulakh, executive director of the Center for Care Innovation during a talk on the “no smart-phone” patient. “We need to be designing [solutions] for today, not the future, and the 91 percent of patients that have a text-enabled phone.”

Larry Chu, MD, executive director of the conference (pictured above with Bernstein), warmly greeted the audience each morning – and on Saturday had a special announcement:  the launch of Medicine X Academy, a new effort aimed at continuing to build community among all stakeholders in health care and filling important gaps in medical education. The initiative will include a second conference in 2015 titled Stanford Medicine X ED (currently scheduled for Sept. 23-24, 2015). Joining Chu on stage to talk about the initiative, Bryan Vartabedian, MD, a Baylor College of Medicine physician and a longtime speaker at the conference, told attendees that medical education is “ripe for disruption.” And he noted that Medicine X – which has evolved “from an annual meeting into a global movement,” was poised to take it on.

Speaking of a global movement, there was very much a sense during the weekend that what was happening was bigger than just a conference – with at least one panel moderator telling attendees, “This conversation doesn’t end when we leave the stage.” And Bernstein summed up the three days of panels, presentations and powerful Ignite talks from ePatients saying, “I leave here re-energized, recharged, re-inspired and I hope you do too. Stay in touch on Twitter and see you next year!”

More news about Stanford Medicine X is available in the Medicine X category.

Previously: Medicine X explores the relationship between mental and physical health: “I don’t usually talk about this”, At Medicine X, four innovators talk teaching digital literacy and professionalism in medical school, What makes a good doctor – and can data help us find one?, Medicine X aims to “fill the gaps” in medical education, Stanford Medicine X 2014 kicks off today and Medicine X spotlights mental health, medical team of the future and the “no-smartphone” patient
Photos by Stanford Medicine X

Chronic Disease, Medical Education, Medicine X, Mental Health, Parenting, Stanford News

Medicine X explores the relationship between mental and physical health: “I don’t usually talk about this”

Medicine X explores the relationship between mental and physical health: "I don’t usually talk about this"

standing o at MedX - smallThis year, Medicine X examined the relationship between physical and emotional well-being with three breakout panels. Psychologists and ePatients came together in two of the sessions to discuss depression in chronic illness and coping through online communities, as well as the topic of mental health and the whole person.

The conversations centered on five themes: how the uncertainty, fear and overall stress of living with a chronic illness, or being a caregiver, can lead to depression and anxiety; why patients’ desire to be empowered can prevent them from seeking help; why eliminating the stigma associated with mental health conditions is so important; the need to better integrate the training of future doctors and mental-health professionals; and ways patients can identify that they may need mental health services and how to find them.

Ann Becker-Schutte, PhD, a Kansas City-based psychologist who participated in both panels, told the audience, “Living with any of these illnesses, whether it’s rare or well-known, requires a lot of work. There is a burden of gilt, fear and shame that are all rolled into one. It’s not unusual for anyone facing these conditions to get tired and just say ‘I’m done’.”

Sarah Kucharski, a Medicine X ePatient advisor diagnosed with depression, anxiety and fibromuscular dysplasia, gave the audience insight into how depression can take over – explaining that she was shocked to learn during a therapy session that a recent string of major life events (getting married, having bypass surgery and buying a house) had elevated her score on the Holmes and Rahe Stress Scale to roughly 500. “I had no ideas that such things had a rating or that they could be cumulative,” she said. “As a result, I try to be more cognizant and slow down.”

Other ePatients spoke candidly and courageously about some for their darkest moments, with many saying it was challenging to discuss their experiences with depression and anxiety outside their inner circles. ”I don’t usually talk about this,” said Hugo Campos, an ePatient with an implantable cardiac defibrillator in his chest. “This will be particularly difficult to admit in public.”

Campos opened up about the severe depression he encountered during the month following a procedure to implant into his chest a cardiac defibrillator, which shocks the heart to control life-threatening arrhythmias and prevent sudden cardiac arrest. Since the device was implanted preventatively, he felt that by having the surgery he had somehow failed himself and continued to be unsure if the device was necessary. There was also anxiety and fear about the device spontaneously shocking him. He turned to his online community to learn how to cope with these feelings. “I felt I would be better of speaking with my peers online, rather than a professional who did not have an implantable device and didn’t know what I was going through,” he explained.

Scott Strange, who was diagnosed with Type 1 diabetes in 1970 and also struggles with chronic depression, also turned to the Internet for support. “My journey to acceptance started when I found my online community. Until I found them, I never really faced it.”

Strange talked about growing up with the knowledge that not properly monitoring his glucose and insulin levels could be fatal. He also addressed the shame and exhaustion that results from “busting your rear end and trying to do everything your doctor says” and not seeing an improvement in your health.

While some turned to their patient communities online, others turned to someone outside of their social networks. When the demands of being a caregiver began to overwhelm Erin Moore, the mother of a four-year-old son with cystic fibrosis (CF) and three other children, she opted not to discuss it with someone well-versed with her situation. “Initially I sought help outside of the CF community because I was aware of how many people rely on me for my strength and I didn’t want to admit a weakness.”

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Medical Education, Medical Schools, Medicine X, Technology

At Medicine X, four innovators talk teaching digital literacy and professionalism in medical school

At Medicine X, four innovators talk teaching digital literacy and professionalism in medical school

med ed panelOne of my favorite talks yesterday at Stanford’s Medicine X was “Fostering Digital Citizenship in Medical School,” where four esteemed panelists talked about the innovative programs they’ve put in place at their institutions.

The physicians joked several times that a good panel often involves controversy or conflict among speakers – but the four of them weren’t in disagreement about much. They all believe that things like understanding social media and knowing how to build one’s digital footprint are crucial skills for doctors-to-be, even if those aren’t an obvious focus for the students themselves. “We can’t expect students to understand” this, said Warren Wiechmann, MD, an associate dean at UC Irvine School of Medicine. “They’re focused on learning core forms of medicine.” (Wiechmann started in 2010 a program to provide each incoming medical student with an iPad and has since added to the school’s curriculum courses on topics such as social media, wearables, and new digital trends in medicine.)

Kyra Bobinet, MD, PhD, who worked alongside Stanford anesthesiologist (and Medicine X executive director) Larry Chu, MD, to develop and teach Engage and Empower Me, an online course that focuses on patient-engagement design, noted that it’s academic leaders’ job to be “forward-thinking” for the students “so they’re so they’re not behind” when they become physicians. And Bryan Vartabedian, MD, who created at Baylor College of Medicine Digital Smarts, a four-year curriculum that focuses on “professionalism, safety, and mindfulness with social media,” agreed. “We’re asking big questions here,” he told the audience. “What does a doctor need to know 20 years from now? Will he (or she) know how to send a tweet? Do we have to be platform-specific [when teaching]?”

A portion of the 45-minute talk was devoted to the difficulty of incorporating new things in a medical school’s curriculum, which is, panelist Amin Azzam, MD, said, already “chock full.” Said Wiechmann: “The big dilemma is what do we take out to put in in?” In turn, many of the schools’ instructions on digital professionalism and literacy come in the form of elective courses.

When discussing other challenges, Wiechmann said the “line ups not very deep” when it comes to leaders in medical school who know about digital media. These topics aren’t “even on the radar” of many faculty-instructors, he said. The panelists also mentioned that the students – most of whom barely remember a time before e-mail, and many of whom consider themselves tech-savvy – don’t always think they need training on digital issues. “In one way they know a lot about technology, but they don’t get how to be doctors,” pointed out Azzam, who developed a University of California elective course that allows 4th year medical students to edit Wikipedia for academic credit. (“We want them to be digital contributors, not merely digital consumers,” he explained.)

Vartabedian said the information that Baylor provides to their students is contextual. Teaching medical students about smartphone use or social media in general wouldn’t be terribly helpful, he pointed out – but it becomes valuable “if you talk about it in the wards.” What should you do, for example, if a patient engages you via Twitter?

The end of the discussion shifted to patient engagement and the need to educate students about just the thing Vartabedian mentioned (i.e. how to interact with patients on social media) and how the e-patient movement works. “I have a responsibility as an educator to put this content [about patient engagement] – more than, say, biochemistry – in front of students,” said Wiechmann.

More news about Stanford Medicine X is available in the Medicine X category.

Previously: Medicine X aims to “fill the gaps” in medical education, More reasons for doctors and researchers to take the social-media plunge, A reminder to young physicians that when it comes to social media, “it’s no longer about you”, A conversation about digital literacy in medical education, Advice for physicians when interacting with patients online and How can physicians manage their online persona? KevinMD offers guidance
Photo by Stanford Medicine X

Medical Education, Medicine X, Stanford News, Uncategorized

Medicine X aims to “fill the gaps” in medical education

Medicine X aims to "fill the gaps" in medical education

Larry Chu  - intro remarks - smallWhen conference director Larry Chu, MD, took the stage this morning to welcome attendees to Day Two of Medicine X, few people knew he had big news to share. But moments after summarizing yesterday’s “great discussions,” which show, he said, what can be accomplished when “we pay attention to all voices,” he announced the launch of Medicine X Academy. It’s an umbrella, he explained, for a variety of  initiatives that will take MedX beyond conference walls and “quicken the pace of changing the culture of health care.” With the academy, he and his group will continue building a community and work on filling important gaps in education – with a focus on, among other things:

  • the importance of participatory medicine and the use of social media in patient engagement
  • the use of technology to meet the needs of millenials
  • the development of ways to best serve underserved or aging individuals
  • the inclusion of end-of-life issues in health-care discussions

The academy will offer massive open online courses and patient education programs and will host a new conference – MedX Ed – to occur just before next year’s regular Medicine X event. Noting that MedX has morphed from an annual meeting to a “global movement,” conference speaker Bryan Vartabedian, MD, noted that it’s “very well prepared” to address issues in medical education. “We have a global community of innovators and, most importantly, we have the proper mindset” to enact change, he told the audience.

The news got those in the audience (many of whom had barely had their first sip of coffee) buzzing. “Very cool – New #MedX ED conference will translate ideas into actionable parts of medical education,” wrote one attendee on Twitter, adding this was a necessary thing. “This is bigger than just ‘walking the talk’,” agreed another. “We’re going to change the future of health care.”

More news about Stanford Medicine X is available in the Medicine X category.

Previously: Relationships the theme of the day at Stanford’s Medicine X, Stanford Medicine X 2014 kicks off today and Medicine X spotlights mental health, medical team of the future and the “no-smartphone” patient
Photo by Stanford Medicine X

Medical Education, Public Health, Stanford News

First Health 4 America fellows celebrate completion

First Health 4 America fellows celebrate completion

Mary Anna Weklar fellow chats with Judith Prochaska PhD, MPH associate professor at the Stanford Health 4 America Certificate Awards Ceremony on August 28, 2014. ( Norbert von der Groeben/ Stanford School of Medicine )What brings together an Alaskan native, a yoga teacher, two lawyers, a drug developer, a pediatrician, a former Peace Corps volunteer and ten others? The Stanford Health 4 America program.

This nine-month fellowship program popped out its first cohort of fellows last week, a set of 17 folks ranging from “senior” to recent grad and they’re aiming to shake up the field of medicine. For any skeptics out there, these folks are the real deal: They strutted their know-how at a poster-session/graduation ceremony this week, and the topics featured real research that took Stanford expertise into the community.

“They really want to change the world,” Christopher Gardner, PhD, director of nutrition studies at the Stanford Prevention Research Center and a professor of medicine told me. “I thought, ‘I can’t just teach them the same old thing. I have to really teach them something that is out of the box.’”

The program meets for “30 Thursdays” as director Sonoo Thadaney, MBA, likes to say. The fellows split their time between course work and hands-on community internships. Fellow Reynold Lewke, JD, MBA, guided Redwood City youth on safe biking routes while hooking them on mobile exercise tracking tools. Fellow Drea Burbank, MD, scoured the database of an online medical website to examine the correlation between questions about e-cigarettes and doctors’ answers. Fellow Diana Delgadillo, who commuted all the way from Bakersfield to attend the program, helped a group of low-income Hispanic women develop healthy-eating behaviors. Some of these projects are ongoing, and you’ll surely be hearing about them, and the fellows behind them, in the future.

The program itself has big plans, including a name change to Stanford Health 4 All to reflect its global focus, Thadaney said. In addition, the program is working to expand to offer a master’s degree, a PhD minor, an undergraduate minor and a medical school concentration. It’s taking applications for the 2015-2016 cohort on its website now.

Becky Bach is a former park ranger who now spends her time writing, exploring, or practicing yoga. She’s currently a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Stanford Health 4 America kicks off
Photo, of Fellow Mary Anna Weklar talking with Judith Prochaska, PhD, MPH, by Norbert von der Groeben

Medical Education, Medical Schools, Stanford News

Medical students start “transformational” journey

Medical students start "transformational" journey

With the help of Lars Osterberg MD, MPH, and Dr. Neil Gesundheit, MD. they give Brandon Turner  his official white coat at at the Stanford Medicine White Coat and Stethoscope Ceremony on Friday, August 22, 2014,at Stanford School of Medicine.  ( Norbert von der Groeben / Stanford School of Medicine )

The new school year has begun for students across the country, including Stanford’s 90 first-year medical students – who started class on Monday and spent last week at orientation activities anxious and excited for the  journey to finally begin.

To help the students prepare, faculty talked to them about the emotional and academic challenges of medical school and emphasized that it can be metamorphic and, not surprisingly, somewhat stressful. “They are seeing life and death,” said one faculty member at orientation, who added that medical school “is a transformational time the likes of which I don’t think you see in any other level of education.”

The week of preparation concluded with the traditional stethoscope ceremony, which I wrote about in an article published online today. The ceremony symbolizes the importance of the personal connection between doctor and patient, and during the event each student walks across the stage to accept their stethoscopes. As Laurie Weisberg, MD, president of the medical center alumni association, told the students:

The great thing about the stethoscope is you have to be close to your patient to use it. This is your chance to truly interact with the patient. You are listening to what the patient has to tell you.

In his address to the students, Dean Lloyd Minor, MD, told them the four-year, or longer, journey would change the way they see the world and that they “will learn some of life’s most valuable lessons from your patients.” He also highlighted some of the demographics of the new class:

Fifty-one percent of you are women; 15 percent of you are from communities underrepresented in medicine; 21 of you were born outside of the U.S., coming from China, Columbia, India, Vietnam, just to name a few. You come from a diverse and wide range of universities — 10 of you from Stanford, 13 from the Stanford of the East [Harvard]. Eighteen of you already have a master’s or a doctorate, and many of you have already published research, participated in varsity athletics, shined in the arts and contributed to your community.

Previously: Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicine, Top 10 reasons I’m glad to be in medical school and “Something old and something new” for Stanford medical students
Photo, of Brandon Turner receiving his official white coat at a ceremony last Friday, by Norbert von der Groeben

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.)

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