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Global Health, HIV/AIDS, Medical Education, Medical Schools, Stanford News

Stanford med student chronicles his experience working in rural Kenya

Stanford med student chronicles his experience working in rural Kenya

Hodgkinson and others in Kenya

Growing up in Kakamega, a rural county in western Kenya, medical technologies and services were extremely limited for Luqman Hodgkinson, PhD. Now a first-year Stanford medical student, Hodgkinson is spending the summer months back in his hometown conducting research and chronicling exciting new developments in medical education – the opening of the first medical school in the region.

With a population of nearly two million, Kakamega is the second largest county in Kenya behind only Nairobi. But with only 12 physician specialists, the vast majority of residents don’t have access to advanced care.

Earlier this year, Masinde Muliro University of Science and Technology (MMUST), a leading public university in Kenya, received authorization to become the very first medical school in Kakamega; it’s expected to enroll its first class of students this fall.

Hodgkinson has received a faculty position as an adjunct associate researcher at the new MMUST School of Medicine and will serve as the designated ambassador from MMUST to Stanford.

As Hodgkinson writes in his first blog entry en route to Kakamega, “Relationships are very important in medicine and this is also true for a medical school that is at the beginning of a bright future.”

His first research project in Kakamega focuses on the efficacy of community outreach programs designed to improve adherence to antiretroviral medications among adults with HIV/AIDS. Under the mentorship of Michele Barry, MD, FACP, senior associate dean for global health at Stanford, Hodgkinson is working with Emusanda Health Centre to evaluate the efficacy of these programs and demographic factors that may impact medication adherence.

He writes in his blog: “Medical research of all kinds is greatly needed in Kakamega to advance the health of the community, particularly in the area of HIV. In Kakamega County, the HIV prevalence is 5.6 percent. Addressing the local HIV pandemic is what inspired me many years ago to pursue medicine and now for the first time I am on my way to join this endeavor.”

Hodgkinson will be blogging from Kakamega throughout the summer, sharing updates from his research activities and collaborative opportunities for members of the Stanford community to get involved with the new MMUST School of Medicine. Follow along on the Center for Innovation in Global Health website.

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Photo – of (left to right) clinician Jorcelyne Makori, peer educator James Okwiri and Hodgkinson – courtesy of Hodgkinson

Medical Education, Medical Schools, Medicine and Society, Stanford News, Surgery

How two women from different worlds are changing the face of surgery

How two women from different worlds are changing the face of surgery

IMG_1038“I hope you’re not serious about doing something in medicine.”

These words are all too familiar to Annete Bongiwe Moyo, a senior medical student at the University of Zimbabwe College of Health Sciences in Harare, Zimbabwe, and a former Stanford visiting scholar. In Zimbabwe, where the proportion of men to women in medical school is roughly 3:1, women are encouraged to take up professions as teachers, artists, caregivers – not doctors. And for a woman thinking about becoming a surgeon, well, she might as well keep dreaming.

Though the odds were stacked against her, Moyo made the decision to become a doctor at a very young age. But it wasn’t until she met Stanford surgeon Sherry Wren, MD, that she started to believe that becoming a surgeon was a realistic goal.

The outlook for women in surgery in Zimbabwe is not terribly unlike that in the U.S. when Wren began her residency at Yale University almost 30 years ago. After receiving her medical degree from Loyola University, Wren became the first woman from the university to specialize in surgery. At that time, only 12 percent of surgical residents were women, and the number of women surgeons in the workforce was far less.

But Wren has never let her womanhood hold her back. In fact, her powerhouse personality, fearlessness and passion for her work are the very traits that define her. She has worked all over the world, applying her skill and resourcefulness to provide the best possible care, often with extremely limited resources in remote locations. In many of these places, Wren is often the first woman surgeon anyone has ever seen.

Shocked too was Moyo when Wren appeared on her surgery rotation at the University of Zimbabwe two years ago. Here’s how Moyo recalls their first encounter – one that would have a lasting impact:

[Wren] was a visiting professor in a grand rounds. Medical students are not usually invited to grand rounds, but that day, we were permitted to attend. When the presentation was done, she asked a question, and when she looked my way, she could tell I knew the answer. She called on me, but one of my professors said ‘Wait, she’s a third year student, she may not know what you’re talking about.’ But Prof. Wren insisted, and I answered correctly. So she asked another question, and I got it right. And then another, and I got it right again.

The mood had shifted in the room. No one expected a junior female medical student could be capable of such an eloquent response. No one had ever given her the chance.

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Medical Education, Medical Schools, Medicine and Society, Research, SMS Unplugged

Research in medical school: The need to align incentives with value (part 3)

Research in medical school: The need to align incentives with value (part 3)

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 during the academic year; the entire blog series can be found in the SMS Unplugged category.

This is the final post in a three-part series on research in medical school. Parts one and two are available here.

confusion-311388_1280In my last two posts, I explored the research paradigm of American medical training. The takeaway was that research requirements may create inefficiencies that have a host of consequences, including an unnecessarily long training process, a potential physician shortage, and an underutilization of talent.

In this post, I’ll lay out a vision for a training process that can produce a more effective physician workforce. The role of a physician has changed over time, and the education system must evolve to keep up. I’ll consider three topics: what students should get out of medical training, how schools and residency programs can help them do it, and how the system at large can enable schools to make changes.

What should students get out of medical training?

First and foremost, medical training should produce doctors who have a strong understanding of human health and disease and have the clinical skills to translate that understanding into patient care. The goal should be to produce good clinicians – that’s what the vast majority of doctors will focus on in their careers.

With that said, I accept the premise that medical training is not exclusively about clinical skills. Physicians are bright, capable individuals, and are uniquely positioned to improve the health status of their patients by other means. Schools should empower their students to pursue those opportunities. For the reasons I discussed in my last post, medical schools have decided that the primary way to do that is through research.

Research is one way to push extraordinarily important advances in medicine, but it isn’t the only way. Doctors can also improve their patients’ health by taking on roles in community health, policy, entrepreneurship or management, among others. These involve many of the same skills and techniques as research, but medical trainees don’t get exposed to these opportunities. We should.

How can schools fulfill this mission?

So how can the education system make this happen? At some point, whether it is in college or medical school, students should be given the flexibility to explore multiple domains of medicine and health care. They should then be able to pick the one or two that fit their interests and pursue them in more depth. Many students will choose to do research, while others will select other specialties. If students explore these opportunities and decide that they would rather focus on being an excellent clinician, that should also be doable.

This would allow physicians to become more effective leaders and decision-makers in the health care system. The traditional training process treats medicine as a universe of clinical practice and research, but the physician workforce has unfulfilled potential across a spectrum of other fields.

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Events, Medical Education, Medical Schools, Science, Stanford News

Stanford Medicine grads urged to break out of comfort zone, use science to improve human health

Stanford Medicine grads urged to break out of comfort zone, use science to improve human health

On Saturday, 195 graduates of the School of Medicine sat under a large white tent on the Alumni Green pondering the next chapter in their medical training. Many of them hadn’t been sure if they would make it to this milestone and, for some, the future seemed uncertain. But the message from Lucy Shapiro, PhD, a recipient of the National Medal of Science, was clear, “Step out of your comfort zone and follow your intuition,” she said. “Don’t be afraid of taking chances. Ask, ‘How can I change what’s wrong?'”

Shapiro told the Class of 2015 how she spent years performing solitary work in the laboratory before she “launched a one-woman attack” to influence health policy and battle the growing threat of infectious disease on the global stage. My colleague Tracie White captures Shapiro’s powerful speech in a story today about the commencement ceremony:

Her attack began with taking any speaking engagement she could get to educate the public about antibiotic resistance; she walked the corridors of power in Washington, D.C., lobbying politicians about the dangers of emerging infectious diseases; and she used discoveries from her lab on the single-celled Caulobacter bacterium to develop new, effective disease-fighting drugs.

Her lab at Stanford made breakthroughs in understanding the genetic circuitry of simple cells, setting the stage for the development of new antibiotics. Shapiro told the audience that over the 25 years that she has worked at the School of Medicine, she has seen a major shift in the connection between those who conduct research in labs and those who care for patients in clinics.

“We have finally learned to talk to each other,” said Shapiro, a professor of developmental biology. “I’ve watched the convergence of basic research and clinical applications without the loss of curiosity-driven research in the lab or patient-focused care in the clinic.”

grads walkingShapiro went on to tell the audience that bridging the gap between the lab and the clinic “can make the world a better place.” Lloyd Minor, MD, dean of the School of Medicine, agreed with these sentiments and told graduates that there has never been a better time for connecting advances in basic research with breakthroughs in clinical care. “You are beginning your careers at an unprecedented time of opportunities for biomedical science and for human health,” he said.

The 2015 graduating class included 78 students who earned PhDs, 78 who earned medical degrees, and 39 who earned master’s degrees. Among them was Katharina Sophia Volz, the first-ever graduate of the Interdepartmental Program in Stem Cell Biology and Regenerative Medicine. “Everybody here is reaching for the stars. We can do the best work here of anywhere,” she said.

Previously: Stanford Medicine’s commencement, in pictures, Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicineStanford Medicine honors its newest graduatesNational Medal of Science winner Lucy Shapiro: “It’s the most exciting thing in the world to be a scientist” and Stanford’s Lucy Shapiro receives National Medal of Science
Photos by Norbert von der Groeben

Events, Medical Education, Medical Schools, Stanford News

Coming up: A big day for Stanford Medicine’s Class of 2015

Coming up: A big day for Stanford Medicine's      Class of 2015

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Tomorrow, Stanford Medicine’s graduating class will walk away from campus with a new title: Doctor!

The speaker for the medical school commencement will be Lucy Shapiro, PhD, whose unique worldview has revolutionized the understanding of the bacterial cell as an engineering paradigm and earned her the 2014 Pearl Meister Greengard Prize and the National Medal of Science in 2013. The diploma ceremony will be held on Saturday from 11 a.m. to 1 p.m. on Alumni Green in front of the Li Ka Shing Center for Learning and Knowledge.

All of us at Scope wish the very best for the new graduates.

Previously: Match Day at Stanford sizzles with successful matches & good cheer, Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicine and Stanford Medicine honors its newest graduates
Photo by Andrew

Medical Education, Medical Schools, Mental Health, Stanford News

A call to action to improve balance and reduce stress in the lives of resident physicians

A call to action to improve balance and reduce stress in the lives of resident physicians

4086639111_a7e7a56912_zIn November of 2010, those in Stanford’s general surgery training program experienced an indescribable loss when a recently graduated surgical resident, Greg Feldman, MD, committed suicide. His death wound up being a call to action that brought about the Balance in Life program at Stanford, according to program founder Ralph S. Greco, MD.

With the Balance in Life program now in its fourth year, Greco; chief surgical resident Arghavan Salles, MD, PhD; and general surgery resident Cara A. Liebert, MD, have learned much about the daily stresses that resident physicians face. In a recent published JAMA Surgery opinion piece they wrote:

As physicians, we spend a significant amount of time counseling our patients on how to live healthier lives. Ironically, as trainees and practicing physicians, we often do not prioritize our own physical and psychological health.

A recent national survey found that 40% of surgeons were burnt out and that 30% had symptoms of depression. Another study reported that 6% of surgeons experienced suicidal ideation in the preceding 12 months. Perhaps most startling, there are roughly 300 to 400 physicians who die by suicide per year—the equivalent of 3 medical school graduating classes.

Greco, Salles and Liebert explain that the Balance in Life program is specifically designed to help resident physicians cope with these stresses by addressing the well-being of their professional, physical, psychological and social lives. To accomplish this goal, the program offers mentorship and leadership training activities; dining and health-care options that are tailored to the residents’ busy schedules and needs; confidential meetings with an expert psychologist; and social events and outdoor activities that foster support among residents.

The authors concede that the program may not fix every stressful problem that their residents face, but it does let the residents know that their well-being is important and valued. “This may be the most profound, albeit intangible, contribution of Balance in Life,” the authors write.

Although the program (and the JAMA article) is geared for people in the medical field, it’s not much of a stretch to see how its core principles can apply to any work setting. Learning how to manage stress and reach out to colleagues for support is a valuable skill and, as the authors write, to provide expert care for others you must first take good care of yourself.

Previously: After work, a Stanford surgeon brings stones to lifeSurgeon offers his perspective on balancing life and workProgram for residents reflects “massive change” in surgeon mentality, New surgeons take time out for mental health and Helping those in academic medicine to both “work and live well”
Photo by Gabriel S. Delgado C.

Medical Education, Medical Schools, Mental Health, SMS Unplugged

Free from school

Free from school

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

Editor’s note: After today, SMS Unplugged will be on a limited publishing schedule until September.

girls running

Summer. It beckons with strawberry warm rays of sunlight, afternoons spent splashing in a pool, and the joys of watermelon-flavored popsicles. We, second-year medical students around the country, look out our windows and see children, newly freed from school, frolicking in the playground next door – and feel miserable. For this is the time when we are experiencing the worst of medical school.

We have completed the pre-clinical curriculum, some of us barely crawling across the finish line. We have spent weeks cramming for the USMLE, an exam described in no softer terms than “the most important exam you will take in your life.” And we are becoming familiar with a new kind of anxiety as we prepare to enter clinics for the first time. Or, rather, my classmates are – I chose to take time off between second and third year.

In the midst of Stanford-high expectations for our professional performance, we are seldom taught exactly how to take care of ourselves. I knew that I needed to change something halfway through second year when I found myself outlining a novel instead of studying during finals week. I nearly failed two exams. But I was happy.

I felt satisfied.

And so, I set about finding a way to incorporate more of writing into my medical school experience. Stanford has funding called Medical Scholars, which is set aside for every medical student to take a year off to work on a significant project or research experience. Their office willingly helped me apply for and receive this funding to work on my novel full-time for a year. I can’t imagine this level of support for an artistic endeavor from any other medical school. And so very soon, I too will be frolicking in the grass, newly freed from school.

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Medical Education, Medical Schools, Stanford News, Technology, Videos

Using the “flipped classroom” model to bring medical education into the 21st century

Using the "flipped classroom" model to bring medical education into the 21st century

To make better use of the fixed amount of instructional time available to train doctors, Stanford and four other institutions are collaborating with the Robert Wood Johnson Foundation on an initiative to dramatically change medical education. They’re doing this by reversing the traditional teaching method of classroom time being reserved for lectures and problem-solving exercises being completed outside of school as homework. This “flipped classroom” model aims to help students engage with the material that they’re learning and create a foundational context for this new knowledge so they’re more prepared to apply it at the bedside.

The above video describes the initiative and how educators are creating new interactive teaching tools to integrate the basic science curricula with the diseases, infections and conditions that students will see during their clinical training. As mentioned in a previous post on Scope, students have been involved in every step of the process to make sure the new curriculum is clear, compelling and relevant. “It’s really rewarding to have this opportunity to impact the education of other medical students all across the country,” Jennifer DeCoste-Lopez, a final-year Stanford medical student, comments.

Stanford is partnering on the initiative with Duke University, the University of Michigan, the University of California at San Francisco, and the University of Washington.

Previously: Stanford Medicine’s Lloyd Minor on re-conceiving medical educationFlip it up: How the flipped classroom boosts faculty interest in teaching, A closer look at using the “flipped classroom” model at the School of MedicineUsing technology and more to reimagine medical education and Using the “flipped classroom” model to re-imagine medical education

Events, LGBT, Medical Schools, Medicine and Society, Patient Care

Advice for clinicians on addressing gender- and sex-related issues

Advice for clinicians on addressing gender- and sex-related issues

2633907150_6303146d75_zFor great patient care, a doctor needs to understand the patient’s life and the patient needs to feel comfortable sharing. This can be especially challenging when it comes to the LGBT community, which was part of the impetus for a talk on the Stanford Medicine campus last week. The event focused on challenges faced by sexual and gender minorities (SGM) in medicine, not just as patients, but as physicians and medical students as well.

Matthew Mansh, a fourth-year Stanford medical student; Gabriel Garcia, PhD, professor of medicine and associate dean of medical school admissions at Stanford; and Mitchell Lunn, a research fellow at UCSF and a graduate of Stanford’s medical school, are all part of Stanford’s LGBT Medical Education Research Group. After hearing the three speak, I walked away with a greater understanding of how important and challenging it is for doctors to have intimate conversations with their patients.

Of the three, Lunn’s talk was the most oriented towards helping practitioners be more sensitive about  He began by laying out some terminology (terms are moving away from assuming two genders – bisexual is falling out of favor, for example), but emphasized that even the most sophisticated labeling won’t tell you which organs patients have or which sex acts they’re doing. Providers have to ask and be comfortable with the terms they should use to ask, Lunn said.

Coming from an anthropology background, I know how hard it can be to not make assumptions. But Lunn emphasized that it’s crucial for clinicians to try: Patients overwhelmingly answer when asked about things in their lives, and they subsequently receive better care, such as screenings for HIV and hepatitis. Among the barriers to providers asking about sex and gender practice/expression are fears of being intrusive, cultural differences, ignorance regarding the clinical relevance of such questions, patient’s lack of genital complaints, and uncertainty of how to ask. Most of these can be combated with provider education; as for how to ask, Lunn says it doesn’t matter as long as the doctor’s questioning makes no assumptions and is the same for everyone.

Intake forms could ask preferred pronouns, for example. Stigmatizing language like “atypical practices” and questions like “Are you married?” should be avoided. Questions about sex and gender practices can be grouped with those about drug use, wearing a seat belt, and going to the dentist – the goal is to normalize these conversations; people don’t want to be targeted or singled out. In every intake visit, Lunn says to his patient: “I talk to my patients about gender identity – do you know what I mean by that?” Crack the door like this and most who are gender nonconforming will go through it, he assures.

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Medical Education, Medical Schools, Research, SMS Unplugged

Flip it up: How the flipped classroom boosts faculty interest in teaching

Flip it up: How the flipped classroom boosts faculty interest in teaching

flipped classroom

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.

Recently, the flipped classroom — a model of instruction in which didactic content is delivered outside the classroom (usually online), and in-person class time is used for active learning — has infiltrated the educational landscape from kindergarten to professional school.

As a current medical student, I generally agree with advocates for using the approach in medical education. For example, Stanford’s Charles Prober, MD, senior associate dean of medical education, argues in a New England Journal of Medicine commentary that the opportunity for enhanced time-efficiency, student self-pacing, and classroom time freed up for more interactive learning make the flipped classroom a potentially attractive approach for educating physicians. I say “potentially” because, like anything else, the flipped classroom is a good approach only if it is done well. For me as a learner — even a modern, Millennial learner — I’d much rather attend an engaging lecture or study a well-written textbook than watch a lousy online video or struggle through a poorly facilitated interactive classroom session.

So I have to admit I harbored some skepticism when, about about a year ago, Prober invited me to become involved the Re-Imagining Undergraduate Medical Education Initiative, an ambitious project to create a new, flipped classroom-based microbiology and immunology curriculum in collaboration with four other U.S. medical schools, which Scope covered last year.

Although I was excited to have a role in such a large-scale project, I worried that the hype of the flipped classroom trend would overshadow what I thought should be the priority: training our future doctors with the highest quality education — not just the flashiest.

Happily, my worries have proved unfounded. I have seen the faculty and staff from the five schools work tirelessly to produce an impressively high-quality final product. In fact, I have even come to believe that the flipped classroom model intrinsically helps incentivize medical faculty members to prioritize teaching.

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