Published by
Stanford Medicine

Category

Medical Education

Applied Biotechnology, Bioengineering, Medical Education, Stanford News, Videos

An online film festival for medtech inventors

An online film festival for medtech inventors

biodesign-process

The Stanford Biodesign program recently posted 296 short education videos on medical technology innovation. From needs finding through business planning, it offers entrepreneurs hours of useful advice on developing medical products.

This video library, which was launched with the second edition of the Biodesign textbook, is free to all. Its well-designed online interface makes it easy to access the advice that medtech innovators need, when they need it.

To create the video library, Biodesign hired filmmakers from both inside and outside of Stanford to capture the essence of the 2013-14 Biodesign fellowship program. During this ten-month program, multidisciplinary teams undergo a process of sourcing clinical needs, inventing solutions and planning for implementation of a business strategy. The program’s track record for bringing new medical devices and technologies to patients is impressive: Biodesign fellows have founded more than 30 companies in the last 14 years.

Each three- to four-minute video features interviews with faculty, fellows, CEOs, investors and alumni who have gone on to launch companies. A few of my favorites are:

The Biodesign video library, which was supported by the Walter H. Coulter Foundation, is an extension of the program’s mission — to help train the next generation of leaders in biomedical technology innovation. While the Stanford-based Biodesign program admits only 12 full-time postgraduate fellows a year, now these lessons-learned can be shared with medtech entrepreneurs around the globe. Just B.Y.O.P. (Bring your own popcorn.)

Previously: A medical invention that brings tears to your eyesBiodesign fellows take on night terrors in children, Stanford Biodesign Program releases video series on the FDA systemHeart devices get at mobile makeover
Illustration from Cambridge University Press

Aging, Cancer, Emergency Medicine, Medical Education, Pregnancy, Stanford News

Stanford Medicine magazine reports on time’s intersection with health

Stanford Medicine magazine reports on time's intersection with health

Why is it that giant tortoises typically live for 100 years but humans in the United States are lucky to make it past 80? And why does the life of an African killifish zip past in a matter of months?

I’ve often mused about the variability of life spans and I figure pretty much everyone else has too. But while editing the new issue of Stanford Medicine magazine’s special report on time and health, “Life time: The long and short of it,” I learned that serious scientists believe the limits are not set in stone.

“Ways of prolonging human life span are now within the realm of possibility,” says professor of genetics Anne Brunet, PhD, in “The Time of Your Life,” an article on the science of life spans. My first thought was, wow! Then I wondered if some day humans could live like the “immortal jellyfish,” which reverts back to its polyp state, matures and reverts again, ad infinitum. Now that would be interesting.

Also covered in the issue:

  • “Hacking the Biological Clock”: An article on attempts to co-opt the body’s timekeepers to treat cancer, ease jetlag and reverse learning disabilities.
  • “Time Lines”: A Q&A with bestselling author and physician Abraham Verghese, MD, on the timeless rituals of medicine. (The digital edition includes audio of an interview with Verghese.)
  • “Tick Tock”: A blow-by-blow account of the air-ambulance rescue of an injured toddler.
  • “Before I Go”: An essay about the nature of time from a young neurosurgeon who is now living with an advanced form of lung cancer. (The neurosurgeon, Paul Kalanithi, MD, is featured in the video above, and our digital edition also includes audio of an interview with him.)

The issue also includes a story about the danger-fraught birth of an unusual set of triplets and an excerpt from the new biography of Nobel Prize-winning Stanford biochemist Paul Berg, PhD, describing the sticky situation he found himself in graduate school.

Previously Stanford Medicine magazine traverses the immune system, Stanford Medicine magazine opens up the world of surgery and Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions.

Medical Education, Patient Care, Stanford News

Stanford student earns national recognition for research on medical communication

Stanford student earns national recognition for research on medical communication

scope photo winning poster

Stanford medical student Genna Braverman, a member of the 2013 entering class, recently won “best poster” at the national meeting of the Society of Teachers of Family Medicine. The poster visually represented a qualitative analysis of nearly 800 written student reflections collected over the past seven years, describing communication challenges the students encountered when learning how to practice family medicine.

When I talked recently with Braverman about her work, she emphasized that it can be quite a challenge to convey qualitative work in a visually compelling, streamlined manner. But the subject matter is something she’s always been interested in – interpersonal dynamics, the doctor-patient relationship, and communication issues were on her mind before medical school, and her interest intensified after she took courses in bioethics at Stanford.

Braverman enjoys a close relationship with her adviser, Erika Schillinger, MD, who she called an “amazing, inspiring mentor.” Her interest was piqued after listening to Schillinger speak, and confirmed when they met and she learned of all their overlapping interests. Schillinger mentioned a large dataset of student reflections she was interested in analyzing, and Braverman thought the project sounded like just what she was hoping to spend her summer and fall working on.

About the findings, she told me, “In the written reflections, students overwhelmingly wrote about communication challenges that related to working with patients and their families, and the main themes we found were challenges in exchanging verbal information, navigating emotionally charged situations, and negotiating the terms of the encounter.”

The poster represents only a portion of the entire research project’s findings. In addition to these written responses, there was data collected afterwards from focus groups, in which the researchers found an interesting divergence. “Many, many more students discussed challenges communicating with other members of the healthcare team (particularly with their attending physicians) in the context of an evaluative environment,” Braverman said.

So what do these results suggest should be done? Currently, communication curricula focus on the content and process of the medical interview, while psychodynamic factors – including those aspects of the encounter that are emotionally charged or conflicting – receive less time and energy. Schillinger is very interested in curricular reform early in medical school, and this research suggests that the sizable communications curriculum in the first two years should be reevaluated. Particular areas of interest might be agenda setting, use of interpreters, and time management

In her career, Braverman hopes to combine patient care, teaching, and research, and so she’s pursuing academic medicine. She told me: “I find the variety of work appealing… I want a chance to work with patients directly but also to help advance the field. Teaching is very important to me.”

In addition to her adviser, she said her teachers Sylvia Bereknyei, DrPH, and Janine Bruce, MD, were instrumental in pushing her to earn this recognition.

Photo courtesy of Genna Braverman

LGBT, Medical Education, Medical Schools, Research, Stanford News

Stanford study shows many LGBT med students stay in the closet

Stanford study shows many LGBT med students stay in the closet

doctor by rainbow flagFears of discrimination from faculty, peers and patients continue to pressure many in the lesbian, gay, bisexual and transgender community to stay “in the closet” while in medical school, according to a Stanford study published today in Academic Medicine.

Some medical students worry that “coming out” could affect their grades; others are influenced by homophobic or sexist remarks overheard from peers and faculty to keep their sexual or gender identity hidden, according to the results of an online survey sent by the study’s authors to medical students throughout the U.S. and Canada. One respondent recounted an appointment during a surgery rotation with a transgender patient who was “treated like a freak by the residents and attendings behind closed doors, joking at his expense.”

The study, authored by members of the Stanford Lesbian, Gay, Bisexual & Transgender Medical Education Research Group, was accompanied by a commentary that maintains the medical community is less accepting of sexual and gender minorities than the business or law communities. From a press release I wrote on the study:

“There is still this huge percentage of medical students who are afraid of discrimination in medical school and how it could affect the rest of their careers,” said Mitchell Lunn, MD, a co-author of both papers and co-founder of Stanford’s LGBT research group. “We are supposed to be a field that is accepting of people and one that takes care of people regardless of differences, and yet we can’t even do that for people who are part of our own community.”

The study found that a third of sexual minority medical students choose to remain “in the closet” during medical school, 40 percent of medical students who identify as “not heterosexual” are afraid of discrimination in medical school, and two-thirds of gender minority medical students (those identifying as something other than male or female) conceal their gender identity during medical school.

Continue Reading »

Health Policy, Medical Education, Public Health, Public Safety

Why I never walked to school: the impact of the built environment on health

Why I never walked to school: the impact of the built environment on health

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.

kids walking to schoolMy California-acclimated body was a little shocked by the 15-degree weather I encountered while visiting my Kentucky hometown over winter break, but I was still determined to bundle up most days and to get outside for long walks with my mom and daughter. One day as we were struggling to catch an opening in traffic to cross the blindly curving road leading out of our subdivision, it occurred to me that the cold was the least of our barriers to getting a little exercise.

“I don’t think I could design a more dangerous place to walk if I tried,” I observed in frustration. Another car whizzed by within a couple feet of my daughter’s stroller. “This town was definitely built for cars, not people.”

For most of my childhood, my family lived right in the middle of town, within about a mile of many of the places a young family might visit on a daily basis. Grocery stores, school, church, the public library, restaurants, the park where I played softball, and my grandmother’s house were all close enough that they should have been an easy walk. But that one mile might as well have been twenty, and I can count on one hand the times I walked to those destinations. I tried a few times, but to get there on foot I’d have to navigate roads lined by steep hills or ditches with no sidewalks or crosswalks. There is one underpass that would require a pedestrian to climb onto a narrow strip of gravel and inch along the wall, close enough to the fast-moving traffic to be unbalanced by gusts from each passing car.

Because of these real physical barriers, the local cultural wisdom took it as self-evident that cars were the only reasonable way to get around. Walking and biking were recreational activities to be done in endless circles around the cul-de-sac, not viable modes of transportation. The risk of walking wasn’t just a theoretical one: Our roads were decorated with a couple of makeshift roadside altars made by the families of teenagers who had died while trying to cross the street. More recently, I was disappointed to read an article confirming my suspicions that cycling in the Southeastern U.S. is drastically more dangerous than in other regions.

Continue Reading »

In the News, Medical Education, Research, Science, Science Policy, Stanford News

A conversation with John Ioannidis, “the superhero poised to save” medical research

A conversation with John Ioannidis, "the superhero poised to save" medical research

ioannidis at deskI always relish a good Q&A. As a writer, I know how hard it is to craft questions that elicit insights into a person — or his or her work. That’s why I jumped at the opportunity to spotlight a recently published Vox interview with John Ioannidis, MD, DSc, director of the Meta-Research Innovation Center at Stanford.

Ioannidis is blunt, and prolific, with his criticisms of science.

Among his concerns: Researchers usually publish only results that show statistical significance, failing to share numerous experiments that didn’t work out, which would also be illustrative. Many studies aren’t reproducible: Sometimes due to a lack of data, other times just due to shoddy procedures. Researchers “spin” data to please their funders.  And in universities, scientists are compelled to publish, a system that favors quantity over quality. Peer review has gaps. And the list goes on and on.

What, then, to do?

Here’s Ioannidis (referred to by the writer as “the superhero poised to save” medical research) in the Q&A:

Maybe what we need is to change the incentive and reward system in a way that would reward the best methods and practices. Currently, we reward the wrong things: people who submit grant proposals and publish papers that make extravagant claims. That’s not what science is about. If we align our incentive and rewards in a way that gives credibility to good methods and science, maybe this is the way to make progress.

One problem is education, he says:

Most scientists in biomedicine and other fields are mostly studying subject matter topics; they learn about the subject matter rather than methods. I think that several institutions are slowly recognizing the need to shift back to methods and how to make a scientist better equipped in study design, understanding biases, in realizing the machinery of research rather than the technical machinery.

There’s much more in the piece, including a glimpse of Ioannidis’ “love numbers” system.

Previously: Shake up research rewards to improve accuracy, says Stanford’s John Ioannidis, John Ioannidis discusses the popularity of his paper examining the reliability of scientific research and “U.S. effect” leads to publication of biased research, says Stanford’s John Ioannidis 
Photo, which originally appeared in STANFORD Magazine, by Robyn Tworney

Health Policy, Medical Education, Patient Care, SMS Unplugged

The downside of a free lunch: Incentives and the medical student

The downside of a free lunch: Incentives and the medical student

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.

money on hook  smallDoctors are people, too, and they respond to incentives. That was the message we got from a recent health-policy class session that discussed various ways of paying doctors for their work, and how this can play a role in patient care. In an ideal world, physicians would be motivated only by what is best for their patients; however, the reality is that doctors, like all people, can be influenced by external factors such as money, autonomy, and time.

This got me thinking about the incentives that currently shape my life as a medical student. While we would all like to say that the choices we make are determined only by our own internal desire to maximize our learning and become the best future physicians possible, even the most idealistic student among us would have to admit that incentives, big and small, influence our decisions every single day.

On a day-to-day basis, incentives determine how we budget our time and focus our efforts. For example, given the huge demands on our time and our budgets, the promise of a free lunch provides a strong incentive for us to attend lunchtime seminars and panel discussions – even if the subject matter is not of immediate interest or relevance to us.

In class, because of the Pass/Fail grading system during our pre-clinical years, our external incentives are not our class grades, but instead the standardized board exam that will play an important role in our residency applications. Our collective ears perk up every time our professors say “This always shows up on the boards,” even if we are told that the particular information is rarely (if ever) applied in real-world clinical practice.

In the bigger picture, as we begin to explore various specialties and avenues for practicing medicine, it is impossible to ignore the reality that average salary, lifestyle, and autonomy vary hugely from one specialty to the next, and from one type of practice to another. Not feeling very passionate about private-practice urology? Does that change when you find out that urologists make about twice the annual salary of a family medicine doctor?

The reality is that our intrinsic motivations to make the world a better place by becoming the best possible physicians do not always align with the incentives that medical school, and the larger health-care system, provide. We are incentivized to spend time and effort on things that will not help us be better doctors, and in the long run we might even be incentivized to make decisions that will reduce the amount of good we can bring to the world. Is it the job of policymakers and medical educators to better align incentives to create the desired outcomes for our health-care system? Or do we, as future physicians, need to shoulder more responsibility to do the right thing, passing up the literal and figurative “free lunch” in the process?

Maybe there is an ideal middle ground for each of us – a place where the incentives align at least reasonably well with our own internal goals. In that case, one of our tasks as medical students for the next several years will be to find it.

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

Photo by Tax Credits

Events, In the News, Medical Education, Medicine and Society

Intel’s Rosalind Hudnell kicks off Dean’s Lecture Series on diversity

Intel's Rosalind Hudnell kicks off Dean's Lecture Series on diversity

STANFORD, CA - JANUARY 23, 2015--Rosalind Hudnell ? Chief Diversity Officer, Global Director of Education and External Relations at Intel Corporation, gives a speech on the Fresh Perspectives on Diversity at Dean?s Lecture Series on Friday, January 23, 2015, at Stanford School of Medicine at Berg Hall. ( Norbert von der Groeben/ Stanford School of Medicine )

In 1971, just three years after the death of Martin Luther King, Jr., ninth-grader Lloyd B. Minor was bussed from his white Little Rock, Arkansas neighborhood to a formerly black school. What he saw there stuck in his memory: Plaster peeled off the walls, and the library had only a few tattered books.

“What I had been told was separate but equal was certainly separate, but in no way was it equal,” Minor said. “That caused me then to see that diversity is a moral imperative.”

Now, as dean of Stanford’s School of Medicine, Minor, MD, has made diversity the initial focus of the newly launched Dean’s Lecture Series.

“Diversity is at the core of everything we do,” Minor said at the inaugural lecture last Friday. “To be a highly performing organization, we have to embrace diversity because… creativity doesn’t come from a monolithic, stereotypic focus.”

The featured speaker at the first lecture was Rosalind Hudnell, chief diversity officer and global director of education and external relations at Intel.

“I’m so jealous of the representation of women and people of color in medicine,” Hudnell told the audience. Nearly every child wants, maybe just for a moment, to be a doctor, inspired by the respect the profession commands in society and its portrayal on popular television shows from Marcus Welby, M.D. to Grey’s Anatomy, she said. By contrast, about 40 percent of college students drop out of engineering after the first year.

In 2013, Intel’s approximately 100,000 employees were 76 percent male and 86 percent white or Asian, and Hudnell said Intel has been working hard to diversify its workforce. The company recently captured headlines by pledging $300 million over three years to recruit and retain more minorities and women.

“We’ve spent the last decade building capability,” Hudnell explained. “Then, we stepped back and said, ‘So, why aren’t we better?’”

The key is to set goals and hold everyone accountable, she said. Now, Intel is committed to reaching market representation across its workforce by 2020. Hudnell admitted she isn’t quite sure how that’s going to happen, but she’s confident it will. “It’s time to use our capability and lead.”

And in that regard, she believes Stanford’s School of Medicine has an advantage. “I think, quite frankly, you are incredibly blessed and lucky to have a leader who truly gets it,” Hudnell commented. “It really does take a consistent, resilient leader… They must have a personal belief in their soul and in their DNA that diversity is the ultimate goal.”

Continue Reading »

Events, Medical Education, Medical Schools, Stanford News, Videos

What’s it like to be an internal medicine resident at Stanford?

What's it like to be an internal medicine resident at Stanford?

“I remember being in your shoes,” Ronald Witteles, MD, said to prospective residents during a recent Google+ Hangout sponsored by the Stanford Internal Medicine Residency program. “I really felt that Stanford was the best fit for me, so I crossed my fingers and came out here. It’s been everything I hoped it could be and more.”

Witteles is the resident program director, and he joined a panel of faculty, residents, and physicians to share stories and answer questions from prospective residents and the interested public about life at Stanford.

During the Hangout, department chair Robert Harrington, MD, spent time discussing Stanford’s tradition of innovation – highlighting the Biodesign program, a collaboration between the School of Medicine and the School of Engineering, and the Department of Medicine’s Clinical Excellence Research Center, which organizes research teams to discover and design new methods of health-care delivery. When asked to comment on the school’s innovative reputation, he replied: “There is a spirit of innovation across the residency, across the department, and across the university that I think is unique, and is one of our defining characteristics.”

Several programmatic changes were also addressed during the hour-long conversation. Witteles talked about a new initiative called Pathways of Distinction, or POD, which will allow residents to select one of seven individualized pathways that align with their academic and professional interests. Each POD, he explained, will provide residents with a unique opportunity for mentorship and development outside of their primary education in internal medicine.

Additional audience questions ranged from the level of autonomy afforded to residents (the answer: a significant amount, but you’re never left by yourself), to favorite things about Palo Alto, which garnered enthusiastic group consensus about the vibrant food scene and the close proximity to nature. Watch the full conversation above.

Previously: Stanford Internal Medicine Residency program to host Google+ Hangout

Events, Medical Education, Medical Schools, Stanford News

Stanford Internal Medicine Residency program to host Google+ Hangout

Stanford Internal Medicine Residency program to host Google+ Hangout

Are you interested in internal medicine? Or wondering what doing a Stanford residency is like? Then join Stanford’s Internal Medicine Residency program tomorrow for a Google+ Hangout, where program leadership will talk about the current landscape of internal medicine, share program highlights and answer your questions.

During the discussion, you’ll meet faculty and physicians who are transforming the field of internal medicine. You’ll also hear from current and former residents who will reflect on their experiences at Stanford. Ronald Witteles, MD, assistant professor and director of Stanford’s residency program, will moderate the conversation. Other panelists include:

  • Robert Harrington, MD, chair of the department of medicine
  • Abraham Verghese, MD, physician and vice chair of education
  • Neera Ahuja, MD, associate professor and associate director of Stanford’s residency program
  • Wendy Caceres, MD, clinical instructor and former resident
  • Jim Boonyaratanakornkit, MD, chief resident
  • Kathryn Weaver, current resident

The discussion begins at 1:30 PM Pacific Time. Visit this page to participate in the hangout.

Lindsey Baker is the communications manager for Stanford’s Department of Medicine.

Stanford Medicine Resources: