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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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Medical Education, Medical Schools, SMS Unplugged

An extra year of medical school? Sign me up

An extra year of medical school? Sign me up

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. 

sandglassesThe process of training to become a physician is a complex and mysterious process to most outsiders, but there are two things that everybody seems to know: 1) how expensive it is, and 2) how long it takes. (One of the first things people ask when I tell them I’m a first-year medical student is, “So, how many years do you have left?”)

Because these issues represent major barriers to entry to the medical profession, some medical schools have begun piloting MD degree programs that are designed to be completed in three years rather than the traditional four. The benefits are easy to see: By shortening the training by one year, students save on a year of expensive medical school tuition and are also able to contribute to the health-care workforce one year sooner.

In a climate where much of the discussion is about how we can shorten and streamline medical education, many people are surprised to hear that I, like many of my Stanford classmates, will actually likely choose to take an extra year during medical school – for research, service, or an additional degree. Given that I also spent two years working between college and starting at Stanford, my inefficient path will have added three or four extra years on to my education when all is said and done.

Am I foolish for condemning myself to years and years of training before actually starting my “real life” as a doctor? For me, the thought process behind extending my training an extra year is actually very simple: I just really like being in medical school. How many other opportunities will I have to take classes in medicine, law, and statistical programming – all in the same term? When else in my life will I be able to soak up wide-ranging experiences from general pediatrics to neurosurgery, without committing to either?

To be sure, I don’t view these experiences as being part of the “most direct path” to becoming a competent, successful physician. But from a selfish perspective, they might help me better find a career path that suits me well. And from a societal perspective, I like to think that these larger life experiences will help to shape and define my unique set of values, philosophies, and skills as a caregiver to people in need – a framework that goes beyond the highly standardized requirements for medical training.

This is not to say that years of additional time are the best thing for everyone. I admire and envy those people who already know what they want to do and how they want to do it, and three-year MD programs offer those people a chance to make much-needed contributions to society as quickly as possible. However, to the degree that longer programs allow us the flexibility and independence to develop ourselves, I believe that they are an invaluable option for many aspiring doctors.

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

Photo by Leland Francisco 

Medical Education, Medical Schools, Stanford News

Cracking medical school admissions: Stanford students use their expertise to help others

Cracking medical school admissions: Stanford students use their expertise to help others

Rachel-Rizal-003-172x250Rishi-Mediratta-001-196x300Thousands of high-school and college students are anxious about getting into medical school one day, and Rachel Rizal and Rishi Mediratta, both fourth-year students at Stanford, know what keeps these aspiring doctors up at night. For the past several years, Rizal and Mediratta have acted as admissions counselors for their many pre-med friends and acquaintances and offered professional admissions consulting – and now they’ve written and published a book, Cracking Med School Admissions, based on their blog.

I had the chance to sit down and speak with the friendly pair outside of Stanford Hospital one breezy spring day. Both are moving into new career phases: Rizal is broadening her knowledge of business through an administrative position in Stanford Health Care, and Mediratta will be completing his pediatrics residency at Stanford. They credited their co-authors of the 100-page book, Devin Nambiar and Stanford student James Xie, who weren’t able to join us.

They told me the most popular entries on their blog have been ones that focused on common application mistakes, acing the interview, and that ever-vexing question, what to wear. And the takeaway message from all? Hopeful students need to be humble, empathetic, and above all, good communicators.

How did Cracking Med School Admissions come about?

Rizal: We’re a team of med students who love advising to the point where we were exchanging emails and asking, “Oh, how do you advise this person for letters of recommendation, how do you advise this computer science major?” So we thought, “Let’s write a book!” We wanted the book to be fun and very readable, so we did it in a Q&A format. If there’s a question where we have different perspectives then we give different examples. We have checklists, and we have sample essays from people who got into great schools.

Mediratta: We’ve been advising undergrads and high school students for a long time [and] every fall and spring we speak to post-bacs who are applying to medical school. There are so many questions that they ask after a presentation [that] you get a sense of what common questions are, and common difficulties.

What are some important insights about admissions? 

Rizal: Most med schools in California are turning more to this Multi-Mini interview process where it’s speed interviewing… Instead of speaking to two people for thirty minutes to an hour, it’s like a round robin and every ten minutes you get a different interviewer with a different question… It’s a lot of fun. I sometimes sit on the reviews for Stanford and we have that process.

Mediratta: I think medical school admissions are going to start favoring students who can think on their feet, see two sides to an issue: ‘These are the pros, these are the cons, and I would choose this approach.’ It really forces students to think for themselves… People will learn the medicine, but if you get people who are already strong communicators… it makes for a really strong doctor.

How do academic and extracurricular experiences fit into the application? 

Mediratta: A lot of people will write more about the hospital or different organizations they worked at, but they don’t write about what they’ve learned from the actual process… Lots of times their experiences come together and point in a certain direction, and it’s often when you reflect on it that you realize that.

Rizal: One question we get asked a lot is, “So I have all this clinical experience, but I also have this hobby of biking around the world [- and what should I about that]?” One girl we advised last year really loved fashion and created her own clothing line and then had to figure out how to market it. It’s important to highlight that in your application because it makes you interesting… More importantly, it really shows different aspects of your personality that could relate to medicine. For example, there are a lot of students who do teaching before they go into med school, and in order to be a teacher in a class you have to have patience and great communication, and really be able to understand – and although that’s not really medicine that’s very applicable to time in the clinics.

Mediratta: We have friends who have majored in both the sciences and non-sciences. It’s all about taking a step back and figuring out what your passion is. If you’re passionate about public health, did you pursue work in college or after college? Did you take some time off? That really demonstrates passion for that career.

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In the News, Medical Education, Medical Schools

Soon-to-be medicine resident reflects on what makes a good teacher

Soon-to-be medicine resident reflects on what makes a good teacher

doctors talkingIlana Yurkiewicz, a fourth-year student at Harvard Medical School, will begin an internal medicine residency at Stanford in June, and she hopes to bring teaching to the forefront of her time here. She recently wrote a post for her blog, Unofficial Prognosis, hosted by Scientific American, in which she discusses how grateful she is for the teachers who mentored her, and what she would like to improve as she takes on teaching responsibilities as a resident:

As a third and fourth-year medical student, I sometimes felt like a dolt on the wards. The thing is – and forgive my self-assurance here – I don’t think I’m a dolt in real life. Just like the students Dr. Fitzgerald described who had interesting lives outside of medicine and suddenly became dull on the wards, so, too, I could relate.

…Sometimes the most negative experiences for me weren’t the result of any particular individual, but a culture that treated me in certain ways – that set certain expectations for who a medical student was and how she should be treated, and then acted to mold me toward those expectations. It was these unspoken pressures that made me feel my most dolt-like – or at least, didn’t do much to counteract it.

She lists five specific ways she thinks the culture of teaching medical students can be improved, and she reflects on the teachers who positively impacted her experience:

The compassionate internal medicine resident who not only served as a role model in patient interactions, but who also recognized the effects that witnessing mortality might have on students, frequently checking in on how we were doing. The anesthesia nurse who patiently taught me how to place IV’s, going over each step meticulously, and not judging or pulling the equipment from me when I did not succeed, but instead offering specific tips that enabled me to get it right the next time. The intern who gave us third-year medical students full responsibility over our patients, letting us direct the conversations and treatment plans, but never absent, always sending resources and offering feedback to help us improve. And there were many more.

What did they have in common? They were patient. They focused on what matters. They put the patient at the center of care. They created cultures where everyone was respected and open communication was welcome. They were enthusiastic about having medical students active and involved. And the educational glue: they made medical students feel autonomous yet supported at the same time. That’s how you learn; by doing, supplemented with regular feedback. That’s how you get better.

Previously: Stanford Medicine’s Lloyd Minor on reconceiving medical education, What’s it like to be an internal medicine resident at Stanford? and Program for residents reflects “massive change” in surgeon mentality
Photo courtesy of Office of MD Admissions

AHCJ15, Big data, Events, Medical Education, Medical Schools, Stanford News

Stanford Medicine’s Lloyd Minor on re-conceiving medical education

Stanford Medicine's Lloyd Minor on re-conceiving medical education

Stanford Dean of Medicine, Dr. Lloyd Minor.Stanford Medicine is no stranger to pioneering changes in medical education, so a panel on re-inventing health provider education at the Association of Health Care Journalism 2015 conference this past weekend was the perfect fit for Lloyd Minor, MD, dean of Stanford’s School of Medicine. During his talk, Minor highlighted three topics that the school is pursuing in order to “re-conceive education so it better meets” today’s needs: team work, data sciences, and value-based health-care delivery.

Eschewing the old model of the omnipotent and self-sufficient doctor, Minor called for schools to “embrace from the very earliest stages that the delivery of health care is a team endeavor.” (The days of “see one, do one, teach one” are hopefully over, he said.) As paper records become a thing of the past and genome sequencing becomes even less expensive, we also need doctors who are very comfortable analyzing “big data.” “We have available to us a huge amount of data from which we are not extracting enough information,” he said before noting that many Stanford med students take classes in computer programming and data science. And, after highlighting the work of Stanford’s Clinical Excellence Research Center, Minor described how the new cohort of medical professionals has to have expertise in analyzing innovations based on value, defined as “outcomes divided by cost” – simply improving outcomes is not enough.

According to Minor, the basic goal of innovation should be to embed within the medical school curriculum as much flexibility as possible, since the workforce of the future needs to be diverse in terms of its talents and abilities. After discussing how many medical schools are exploring the “flipped classroom,” he noted that “Rote memorization is not the learning technique that’s going to address the problems that society has every right to expect health-care professionals to address. One project, one intervention at a time will achieve that transformative impact.”

Fellow panelist Henry Sondheimer, MD, senior director of medical education at the Association of American Medical Colleges, also discussed “seismic shifts” in medical education that require “a different culture, a different kind of student, and a different kind of physician.” This move from being hierarchical, autonomous, and competitive to being collaborative, service-oriented, and patient-centered is facilitated and reflected by changes such as the new MCAT, which assess not what students know but how well they can use what they know, and includes a new section addressing the psychological, social, and behavioral determinants of health. He stated that in a world where 32 percent of 2nd-year medical students attend lectures rarely or never, 14 percent regularly attend lectures at other medical schools, 40 percent source medical information from YouTube, and 87 percent from Wikipedia, education is not about memorization, but about connectivity. And this is not just in the U.S.: Speaking about a recent trip he took, Sondheimer reported that “Every single medical student at the University of Zimbabwe has a tablet.”

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Events, Medical Education, Medical Schools, Pediatrics, SMS Unplugged

A Match made at Stanford: From medical student to resident

A Match made at Stanford: From medical student to resident

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.

IMG_1127On March 20, in synchrony with thousands of senior medical students across the country, I received an envelope that determined where I would be spending the next three years of my life for residency training.

My academic advisor, Oscar Salvatierra, MD, had come out of retirement to share this day with his students. He had supported us over the years, from studying for our first-year exams to choosing a specialty and applying to residency. He supported my husband and me in the additional challenges of tackling medical school as a married couple, guided us through my husband’s decision to pursue a combined MD/PhD degree, and even weighed in on our decision to have a child during medical school. Now, on Match Day, I was so grateful that he was the one to call my name and hand me my letter.

“Open. Open. Open,” my daughter demanded, grasping for the bright red envelope with the same steady persistence that she normally uses to ask for raisins. My husband took her from my arms so that my shaking fingers were free to open the envelope and unfold the letter. It was real, right there in black and white: I’ll be staying at Stanford for a pediatrics residency.

I grinned, then I cried, then I started soaking in the hugs and congratulations of my family, friends, and mentors who all knew how desperately I had hoped for this outcome. But the fun part about Match Day is that there is more than just your own news to celebrate. Within minutes, I was fighting through the crowds to track down my friends and classmates to find out where they had matched. I was incredibly impressed, but not at all surprised, to hear about the excellent programs they will be attending across the country.

As I stepped back into my apartment later that morning, clutching my residency Match letter, it felt a lot like bringing a newborn baby home from the hospital: it was odd and unsettling to walk back through familiar doors into my familiar home when our family’s life was all at once so deeply changed. In residency (like becoming a parent), I am going to have to work harder than I’ve ever worked before, and be challenged in ways I haven’t even imagined. But at the same time, I have no doubt that it will be worth it, and that this was exactly what I want for my life.

I hope that my classmates are feeling the same excitement to start the next phase of the journey. Congratulations to the Stanford Medicine Class of 2015 on an incredible Match!

Jennifer DeCoste-Lopez is a final-year Stanford medical student who will soon start a residency in pediatrics at Stanford. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo courtesy of Jennifer DeCoste-Lopez

Events, Medical Education, Medical Schools, Medicine X, Stanford News, Technology

Registration now open for the inaugural Stanford Medicine X|ED conference

Registration now open for the inaugural Stanford Medicine X|ED conference

15168705662_f658f6aa3a_zSome exciting news for those who have followed our Medicine X coverage in the past or who have attended the popular event in person: The first-ever Stanford Medicine X|ED conference will be held on campus this fall. The two-day event, scheduled for Sept. 23-24, will bring together innovative thinkers to explore the role of technology and networked intelligence in shaping the future of medical education.

Lawrence Chu, MD, associate professor of anesthesia at the School of Medicine and executive director of Medicine X, explained in a release that he launched the conference because “changing the culture of health care starts with redefining medical education.” He hopes the gathering will “address gaps in medical education to drive innovation and make health care more participatory, patient centered and responsive.”

Digital media pioneer Howard Rheingold will kick off the conference with a keynote address, with the rest of the first day of the conference focusing on five core themes, including engaging millennial learners, opportunities and challenges for innovation in medical education, interdisciplinary learning, and how digital media and massive open online courses are redefining the educational landscape. Abraham Verghese, MD, vice chair for the theory and practice of medicine for Stanford’s Department of Medicine, will deliver the closing keynote.

Day two of the program will include a range of interactive and educational opportunities, as I describe in our release:

The conference will offer tutorial-style classes called “learning labs” on topics such as incorporating instructional technologies into curricula, and using social media to promote patient safety. Additionally, attendees can participate in 90-minute workshops on using 3D printing in medical education, interprofessional care models and methods for bringing real patients’ stories into medical education.

Conference-goers can also enroll in master classes where experts in specific disciplines will conduct small-venue seminars. Confirmed master-class speakers include [Lloyd B. Minor, MD, dean of the School of Medicine]; Bryan Vartabedian, MD, assistant professor of pediatrics and director of digital literacy at the Baylor College of Medicine; Bertalan Meskó, MD, founder of Webicina; and Kirsten Ostherr, PhD, professor of English at Rice University and director of the Medical Futures Lab.

“Health care has changed dramatically in recent years, but the way we teach the next generation of doctors has largely remained the same,” Minor commented. “Stanford Medicine X|ED brings together some of the most innovative minds in medicine, technology and education to re-imagine medical education for the new millennium.”

Registration details can be found on the conference website. Medicine X, Stanford’s premier conference on emerging health-care technology and patient-centered medicine, will kick off the day after Medicine X|ED.

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

Previously: Stanford Medicine X: From an “annual meeting to a global movement” and Medicine X aims to “fill the gaps” in medical education
Photo of Chu by Stanford Medicine X

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