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SMS Unplugged

Medical Education, SMS Unplugged, Women's Health

Learning the pelvic exam with Project Prepare

Learning the pelvic exam with Project Prepare

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.

This past Friday, half my class crowded into a small room in the basement of the Li Ka Shing Center. When we walked in, we saw our names written on the board, under one of the following headings: “Male Pelvic Exam,” “Female Pelvic Exam,” and “Female Breast Exam.”

It felt like a safe space to make mistakes, ask questions, and fumble a little bit – without feeling like I was in over my head

For many of us, this was our first session of Project Prepare – a 3-session, 8-hour course designed to teach medical students how to provide supportive care for patients in the area of sexual health. (The history of the program is included in this article.) The teachers in Project Prepare take the dual role of patient and educator, using their own bodies to help students learn how to perform pelvic and breast exams.

This was my first day of the course, and I was scheduled to do the female pelvic exam session with a patient-educator whom I’ll call Stacie. I had heard from other classmates who had already done this session that it was “intense” and that it took some time to emotionally recover afterwards. I’d heard from others that it was “incredible;” one classmate even said it made her to want to be a Project Prepare patient-educator herself. The many mixed messages rolled together in my mind and distilled into a single overwhelming sense of anxiety.

But Stacie made everything so easy. She didn’t beat around the bush about how awkward or uncomfortable the experience could be. The first thing she asked us was, “What have you heard about Project Prepare?” and when I said I’d heard it was “intense,” she responded, “Why do you think that is?” In doing so, she set the tone for the rest of the afternoon: gentle, filled with open-ended questions and non-judgmental responses.

Over the next three hours, Stacie guided a fellow classmate and me through the exam techniques and word choice that accompany the 5-part female pelvic exam. She pointed out nuances that would never have otherwise crossed my mind, like how saying “that’s perfect” and “great” are fine in other parts of a medical interview or exam but painfully awkward and even inappropriate in the context of a pelvic exam.

After the session, I looked up Project Prepare, curious as to how many medical schools invite the team to their campuses. I was surprised to see that only Stanford, Touro University College of Osteopathic Medicine (both in CA and NV), Kaiser, and UCSF are on Project Prepare’s list of clientele. Though I still have two sessions left, it is so clear to me that Project Prepare is a unique, effective way of teaching students the pelvic and breast exams. As a medical student, the idea of doing these delicate exams for the first time on a real patient (one who is not simultaneously a trained educator) is terrifying. I had this experience last year, at Stanford’s Arbor Free Clinic, where I performed my first pap smear, with the guidance of an attending physician. I recall how scared I felt that I might hurt my patient and somehow “mess up.” In contrast, my experience with Project Prepare felt like a safe space to make mistakes, ask questions, and fumble a little bit – without feeling like I was in over my head.

This week, I have two more sessions with the Project Prepare teaching team, and this time, my feelings leading up to the sessions are colored with excitement rather than anxiety. To the Project Prepare patient-educators: Thank you so much for sharing your time, your knowledge, and most of all, your bodies, with us, as we take this journey from classroom to clinic. Our medical school experience feels more complete because of you.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Previously: Reality Check: When it stopped feeling like just another day in medical school

Medical Education, Patient Care, SMS Unplugged

Dreaming vs. doing: How my definition of compassion changed during medical school

Dreaming vs. doing: How my definition of compassion changed during 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.

dreamingI woke up gasping for breath. My patients had died, and I was dying with them. Gradually, my mind unclouded and I realized that it had been a dream, but that realization didn’t soothe my worries. I lay in bed wide awake, anxious. I was picturing the woman who couldn’t speak due to a stroke, who squeezed my hand and raised her eyebrows urgently, asking me for something I couldn’t identify. Then I was remembering the very sick elderly man whose wife brought homemade soup to the hospital every day, and who always had a warm smile and a flurry of gratitude in Mandarin for anyone who entered his room. Their faces swam through my mind for a long time before I returned to sleep.

I was in the midst of my first clinical rotation. After two years focusing on the basic science of medicine, finally caring for actual patients was exhilarating and all-consuming. Even after long days in the hospital obsessing over what else I could do for my patients, I would talk about my clinical experiences on the phone with my mom, on runs with my friends, and over dinner with my husband. I lived and breathed my new role so completely that in my dreams, my patients’ deaths were synonymous with my own.

Now, two years later, I still love my days spent caring for patients in the hospital and clinic, but I don’t dream about my patients anymore. I rarely talk about my work over dinner. This wasn’t a purposeful change, and sometimes I wonder if it means I care less than I once did. I worry that I am Exhibit A for the predictable erosion of empathy that we’re all told to expect by the time we graduate from medical school.

In my more self-forgiving moments, I tell myself this change in how I experience patient care means that I’m learning to compartmentalize my experiences to survive the many emotionally demanding years ahead of me in the medical profession. Based on what I hear in the periodic group reflection sessions that we have in medical school, many students, as well as senior physicians,  agree that this kind of compartmentalizing is the key to avoiding burnout. After all, being completely present for the patient sitting in the room with me means learning to put aside other concerns – including thoughts about my other patients. The same goes for my ability to be present in the rest of my life as a wife, mother, or friend. However, in spite of all this, there is still a part of me that wonders if my growing ability to mentally put my patients’ problems aside will translate into a decline in empathy and passion for my work. After all, I didn’t come to medical school just to survive it – I came to medical school because I believed caring for patients was my calling. What does it say about me that I can so easily leave that passion at the door of the hospital?

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Medical Education, SMS Unplugged, Surgery

Rituals of the body – honoring the loss of bodily wholeness in medicine

Rituals of the body - honoring the loss of bodily wholeness in medicine

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.

footWatching my first below-the-knee amputation on my surgery rotation, I felt a curious mix of revulsion and detachment. The woman on the operating table had a gangrenous infection that had spread across her foot. Her long history of smoking and her delay in seeking medical care meant that she had stiff, black toes by the time a surgeon first saw her. The only treatment was amputation.

In the operating room, the patient was draped such that only the leg was visible and exposed. The first incision was easy, a semicircle around the calf, and then the surgeons dissected down further until they hit bone. A bone saw sliced its way through the tibia, while the slimmer fibula was taken apart in chunks with a bone cutter. The skin and muscle were cut in a flap; the flaps were brought around over the bone and sewn together to create the stump.

The amputated leg sat on the scrub nurse’s table, next to a tray of retractors. The foot was balanced upright. The skin was smooth until the edge, where it gave way to jagged edges of flesh, remnants of blood vessels, and two cross-sections of bone. I felt unsettled with the amputated portion of the leg so close to me, a graphic reminder of what was lost.

What was it that troubled me? Maybe it had been the ordinariness of the moment when the body was divided up, its fibers severed with precision and focus, but no surprise, no significance. This patient would wake up some hours later, still groggy from the haze of anesthesia. Though she had signed a consent form, though this surgery had saved her, I wondered how she would she feel when she looked down at her leg.

Even in the absence of phantom pains or other sensory reminders of the missing part, dealing with an amputation is hard. It breaks the taken-for-grantedness of the body. It forces people to move through the world in new ways. These experiences made me think, can we imagine any ritual to mark a loss of bodily integrity? A pause to appreciate the work the body has done, and to prepare ourselves for its new form?

I witnessed many bodily transformations on my surgery rotation, as we do in medicine every day. But in our increasingly technical engagement with patients, do we forget the many social and cultural meanings of the body and its parts? Like why a patient may ask for his rib back after it is excised from his chest well to relieve obstruction, or why grieving parents of a stillborn child may want to bury the baby with her placenta? Perhaps a ritual could help physicians recover the awe and the empathy toward bodies we care for, and further connect to how our patients make sense of these changes.

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Medical Education, SMS Unplugged

“It’s tough feeling like you’re always in a position to be judged” and other thoughts on medical school

"It’s tough feeling like you're always in a position to be judged" and other thoughts on 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.

One of the hardest parts about medical school for me has been the constant pursuit of approval. Having a pass/fail system during pre-clinical years helped ease things some, but there remains a personal desire to prove myself. In front of attendings, all I can focus on is performing my physical exam just right, presenting in the perfect manner, and nailing the assessment and plan. Unfortunately, my strong desire to look good in my evaluators’ eyes has led to missing learning opportunities at times. For example, I often passed up offers to do a procedure I really wanted to do, for fear that I would look bad if I messed up.

It’s tough feeling like you’re always in a position to be judged.

As I find myself in the middle of residency applications, I realize that this feeling of scrutiny has been elevated to a whole new level. And from this point, I’ll be judged on what is already done and how I’ve been evaluated on my rotations over the last few years. I can’t do anything more to change the “me” that those who review my application see. Part of the process is an interview, but it seems as if the interview has been taking place since I began medical school.

I’m extremely grateful for the training and preparation that Stanford has provided me, and I’m confident in my application – but the uncertainty is real. And the way I see it, my success with residency applications isn’t just reflective of me: I want to make my family and the Stanford faculty and mentors who have supported me along the journey proud.

As stressful as this process and the worry about judgment are, though, I’ve been trying to re-focus myself and “check my privilege.” To even be in the position of applying and interviewing for residency is huge. I’m months away from being able to put MD behind my name. As much as I could complain about how hard medical school has been, I’ve been blessed with a wonderful opportunity to be in a position to care for people when they most need it. And, in fact, of all the evaluations that we’re required to seek during a rotation, the ones I value most are from patients and their families.

For me, medicine comes easiest when my patients and their health outcomes are front and center in my mind -  not whether I stand out to my team or answer a tough question correctly. And so with my future patients in mind, it’s time to suit up (tie-clip and all). The work’s been done.

Moises Gallegos is a fourth-year medical student. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Photo in featured-entry box by Yuya Tamai

Medical Education, SMS Unplugged

Why “looking dumb” in medical school isn’t such a bad thing

Why “looking dumb” in medical school isn’t such a bad thing

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.

hands in air - longerIf I had to choose one theme that has stood out in the first weeks of medical school, it would be this: questions, questions, and more questions. In the first class on our first day of medical school, our professor set the tone by laying down the requirement that we ask a minimum of ten questions before the lecture was over. Based on my experience in large undergraduate lectures, where questions were as rare as rain in Palo Alto, I naively thought this would be a challenge for us. To my surprise, we met the challenge and probably asked at least twenty questions in that first class alone.

This first day set the tone for the rest of our time together so far, and my class has quickly gained a reputation among the faculty for the volume of questions that we ask. It’s a common occurrence for a lecturer to be moving along smoothly, only to look up and see four or five hands in the air, of people waiting patiently to ask for clarifications, pose hypothetical situations, or simply admit that the last lecture slide was way too confusing. More than one class session has been derailed and run out of time because of our frequent interruptions. One of our professors memorably poked fun at us by hinting – not very subtly – that our class had no problem with “looking dumb” in front of our peers.

Given the amount of important information and interesting ideas that I’ve learned through my classmates’ questions, I’ve quickly come to feel that learning how to ask questions is an important part of my early medical training. However, this can be a difficult thing. By asking a question in public, you’re more or less admitting to everybody in the room that you didn’t know the answer; that you needed help from somebody else to get the information. Only certain learning environments – namely, with a close group of non-judgmental peers and willing professors – are conducive to this.

With that in mind, what will happen with our class as we move through our medical training? I’m hopeful that our willingness to ask questions will continue, along with the receptiveness of our teachers and mentors. As first-year medical students, we’re not expected to have a vast medical knowledge yet, so admitting “I don’t know” is relatively easy. But what will happen in a few years, when we reach the clinics and are expected to be able to put the knowledge from our first two years to use? Or more importantly, what will happen when we are fully trained physicians, and our patients expect us to have all the answers? When we don’t have the answers, will we be as willing to ask for help as we are now? As a patient, I would certainly hope that my physician would be willing to ask the right questions when needed. Because of this, I think our class can and should aspire to keeping the flood of questions coming.

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

Image by Kaz

Obesity, Pediatrics, Public Health, SMS Unplugged

When the wheels on the bus (don’t) go round: Driving the spread of local health programs

When the wheels on the bus (don't) go round: Driving the spread of local health programs

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.

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A few years ago, I was doing a summer internship in which I looked at health outcomes for hospitalized patients. I sat in an office and read about patients with issues like high blood pressure and cholesterol. At a certain point, I realized that the reports on their outcomes were interesting, but the real solution to the problems I was studying was happening outside my window. My window overlooked a park, where kids would run around all day until they were exhausted. And it got me thinking that if all kids were as active as those ones, there would a lot fewer reports for me to read.

So last year, I worked with several medical and law students to design a county-level childhood obesity prevention policy. The need for such programs is self-explanatory: More than one third of children in the U.S. are overweight or obese. By the time people reach adulthood, that proportion goes up to two thirds. By creating a team of both medical and law students, we hoped to come up with approaches that achieved the goal of improving health, and did so in a practical and implementable way.

Over the course of several months, we analyzed dozens of programs that have been used to bring down childhood obesity rates in various communities across the country. The programs ranged from well-known approaches (e.g. a soda tax or menu calorie counts) to some more obscure ones. My personal favorite was the “Walking School Bus” (WSB). Think about how your parents used to tell you that things were tougher in their day when they had to walk to school (in the snow, going uphill, barefoot, etc.). The goal of a WSB is to bring that world back. The catch is that parents/adults walk along a predetermined “bus” route, pick up kids along the way, and then walk them to school. Kids get a supervised walk that allows them to get some exercise every day.

Case studies, and one meta-analysis, suggest that WSBs are an effective way to increase the amount of exercise kids get. But odds are, you’ve never heard about them before. Neither have most school officials, local politicians, and others in a position to take action on childhood obesity. That’s because WSBs are not widely used. This realization led me to an interesting question: Which factors make a local program or intervention spread to other communities? What does it take to turn a single success story into a widespread strategy?

These are hardly new questions. Every business or non-profit that plans to scale up considers it. Atul Gawande, MD, attempted to figure out why certain medical interventions spread in a New Yorker article last year. Whether you’re talking about social programs, technology, or just an idea, the question remains. I don’t pretend to have the answer, but my work reviewing obesity prevention policies did lead me to a few conclusions about the spread of local programs.

First, success is necessary but not sufficient for a program’s spread. Just because it proves to be successful does not mean anyone else will adopt it. WSBs were one example. Granted, WSBs are not adaptable to every community – they require schools to be within walking distance and rely on good weather. But the same story is true for other approaches. For instance, joint-use agreements are a strategy where schools open up their facilities (e.g. outdoor fields, basketball courts, etc.) after school hours to give children and families access to recreational space. Despite a correlation between these agreements and better health outcomes, they remain in limited use in many of the communities where recreational space is most lacking.

So if success doesn’t lead to a program’s spread, what does? I believe one factor is the involvement and enthusiasm of multiple stakeholders, potentially including local government, businesses, school administrators, and involved community members. A second factor is the development of measurable and achievable goals. It is nearly impossible to see incremental changes in health outcomes, so programs designed to change health must establish metrics that can demonstrate progress.

The list of lessons from our survey of local programs goes on, but the biggest takeaway is clear. Problems in health care require not only a solution, but successful execution.

Akhilesh Pathipati is a second-year medical student at Stanford. He is interested in issues in health-care delivery.

Image by EME

Medical Education, SMS Unplugged

Escaping the medical school bubble

Escaping the medical school bubble

Hamsika at Castle Rock

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.

A few months ago, I read the following quote: “Don’t live the same year 75 times and call it a life.” For some reason, this quote got to me. This year is my 18th consecutive year as a student, and there are too many days that seem the same, where I’m caught in the tasks and obligations of school and extracurriculars and forget to take time out of the day just for myself.

Fortunately, I’m surrounded by classmates who are very much aware of the bubble but also skilled at disconnecting from the med school busyness. A couple weeks ago, I took a leaf out of their book, woke up at 5:30 AM, and joined four of my fellow classmates for a hiking trip at Castle Rock State Park.

Castle Rock is about a 45-minute drive from Stanford and filled with beautiful redwoods, moss-covered trees, and stunning views. Much of the group had to be back on campus at 1 PM for meetings and such (can’t escape the bubble forever!) so we chose to do a ~6-mile hike, giving us time to pause along the way whenever we felt like it.

There were moments when all of us were quiet, relishing the moist, woody smell of the forest and appreciating the absolute silence that surrounded us. Of course, most of the time, we were chatting it up. Despite the fact that all of us are together almost every day, taking the same classes and working together on group presentations that accompany our coursework, it felt like we hadn’t really talked in ages! During our three-hour hike, we bonded over so many different topics – where we wanted to live when we graduated from medical school, things we’ve struggled with this past year, our families, and so much more.

This isn’t the first time I’ve had a chance to escape into the wilderness with classmates. Last year, med school kicked off with a pre-orientation camping/backpacking trip called SWEAT (Stanford Wilderness Experience Active (Orientation) Trip). SWEAT was a 4-day, 3-night adventure, and, like this hike, was an incredible bonding experience – one that even included a few bear sightings.

The point of this entry is to 1) make it seem like I have a life outside of med school (Kidding! Kind of…), and 2) emphasize how important it is to take the time to do things you love and enjoy. One of the things I struggled the most with – both when I went to college and when I came to med school – was figuring out how I could incorporate the things I’ve always loved doing – dance, drawing, reading, etc. – into a life filled with classes, deadlines, and meetings. While the classes will soon come to an end, the deadlines and meetings and obligations certainly won’t. And that’s when I’ll make a conscious effort to traipse off to a dance class, a bookstore, or a hiking spot like Castle Rock.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo courtesy of Hamsika Chandrasekar

Ebola, Global Health, Infectious Disease, Patient Care, SMS Unplugged

The hand-sanitizer dilemma: My experiences treating patients in Uganda

The hand-sanitizer dilemma: My experiences treating patients in Uganda

Ugandan hospital - smallSMS (“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.

A thick green glob landed on my scrub top at the same time that the first drop of sweat rolled down the small of my back. I tried not to grimace and discretely walked over to the hand-sanitizer dispenser. But like every other hand sanitizer I had tried, this one was empty. Yesterday I had also discovered that the only bathroom in the hospital had no toilet paper. It was 7 AM, and I would be using my pocket toilet-paper stash to clean off sputum from the hacking patient that apparently all the doctors knew to avoid standing in front of. The day was off to a good start.

How, I wondered as we continued rounding, did doctors respond to this dilemma – having to care for patients without being able to fully protect themselves – when they were in health centers treating Ebola. I tried not to think about what I would tell my parents if I developed rare infectious symptoms in a few days. We were in Uganda, countries away from the Ebola outbreak, but there were still plenty of infectious agents we could and probably were exposing ourselves to.

Just as I was wracking my brain for the names of the bacteria and viruses that might be deadly, I noticed one of the doctors rest his hand on a patient’s shoulder. And it dawned on me that the real dilemma was not about what I, who had access to the best medical care, might pick up, but rather about what I might pass from patient to patient.

It’s ironic that in the U.S., patients have to remind doctors to reach out and touch their shoulder or hand at an appropriate time – to make patients feel that the doctor connects with them on a human level. Yet here in Uganda, the  doctors know when to reach out to their patients, they know how to talk to the patient’s family. My clinical-skills professors would love to see this.

But if the hand-sanitizer dispenser was empty for me, it was empty for the  Ugandan doctors as well. We were told as first-year medical students that we would fail our “Practice of Medicine” final if we forgot to sanitize our  hands upon entering our standardized patient’s room. So what were we to do when we had more than twenty patients in one room, each with at least two family members, and no hand sanitizer for anyone? How many of these dozens  of people were walking around with my hacking patient’s sputum on them as  well?

The doctors certainly could be spreading infectious agents. But given the proximity of patients on the wards, those very same infectious agents had likely already been spread between the patients overnight – before we even arrived that morning. I couldn’t help but wonder which was more important to the patients who had a 50 percent chance of survival: to feel that their doctor was treating them as a human being or to increase their chance of survival by a negligible margin? How big or small would the margin introduced by the doctor’s touch have to be to tip the scale one way or another?

Before I could finish thinking through my ethical dilemma, we left the ward to scrub in for surgery. There I found the only working hand-sanitizer dispenser.

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

Photo of Ugandan hospital by Natalia Birgisson

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.)

Pediatrics, SMS Unplugged

Behind the glass window: Experiences in an infant follow-up clinic

Behind the glass window: Experiences in an infant follow-up clinic

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.

behind window - smallAs I mentioned in my last entry, I’m in Boston this summer. I’m one of several interns who are part of the Newborn Summer Student Research Program, coordinated by the Harvard Program in Neonatology, in partnership with a number of Boston hospitals. Aside from connecting us with excellent research mentors, this program ensures that participants get some clinical exposure as well. Over the past 5 weeks, I’ve had a chance to shadow physicians in the Boston Children’s Hospital neonatal intensive care unit (NICU), the Brigham and Women’s Hospital delivery room, the BWH nursery, and most recently, the BCH Infant Follow-Up Program (IFUP).

It’s this last shadowing experience – in the infant follow-up clinic – that I want to touch on in this entry. When I first heard about this clinic, I thought it was for babies who were being seen soon after birth, just to make sure everything was okay. As soon as I walked into the clinic, I realized that IFUP was not for newborn babies but rather for kids of all ages, who were being followed up on for various developmental issues that had arisen during their previous time spent in the NICU.

During my brief time in the clinic, I met patients ranging from 22 months to 10 or more years of age. I use the word “met” loosely here, for in fact, I did not meet a single patient in person during my time at the clinic. I stood with some fellow interns and some physicians behind a one-way mirror, quietly observing as various tests were run on these children. At first, I found myself fascinated by the physician administering the various tests (ex. the Stanford Binet, the Beery VMI), for I had never seen them given in a clinical setting.

Soon, however, my attention slipped from the physicians to the children being tested. I felt such a complex mixture of emotions: sadness, for many of these kids had never experienced a week devoid of doctor’s appointments; amazement, at how far these children had progressed developmentally given where they started; and humility, for it was pure luck that prevented me from sharing the same developmental struggles that these little patients did.

As these thoughts swam around in my mind, my attention slipped once more, from the children in the room to their parents. I felt drawn into the emotions that flitted across these parents’ faces – pride when their kids correctly answered the physician’s questions, a pang of pain when a question was answered incorrectly, a sense of helplessness when the physician mentioned that the child would need yet more therapy. In response to the latter, one mother said, “I’ll do whatever it takes.” Such a simple statement, something I’ve heard several times before in movies and TV shows, but hearing it here, in a clinical setting, while standing unseen behind a glass wall, my heart broke. I wanted to reach past the divider and give these parents and these little kids huge hugs, to tell them it would be okay.

I can’t quite say why this clinical experience touched me so much. Perhaps it’s because the glass wall between me and the patients, physicians, and family members was less like a barrier and more like a window, offering me a view into the lives of not only patients but also the family members who love them so much and the physicians that strive to do everything in their power to help them heal.

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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