Published by
Stanford Medicine



Anesthesiology, Medical Education, Sports

How to combine anesthesiology, internal medicine and rock climbing

How to combine anesthesiology, internal medicine and rock climbing

Michael Lin, M.D. at the Stanford Hospital and Clinics on Wednesday, September 23, 2015.

I’ll admit it: I’m in awe of, and a little intimidated by, medical residents. Between the early call times, long hours, and flurry of patients and cases, I often find myself wondering how these doctors-in-training manage to do it all.

So I was amazed to learn about Michael Lin, a fourth-year resident in Stanford’s combined internal medicine-anesthesia residency program. While most residents focus on just one field – like dermatology or surgery — Lin spends his time training in both anesthesia and internal medicine. He’s equally at home in the operating room prepping patients for surgery and in the internal medicine clinic treating outpatients.

But Lin also manages to squeeze in rock climbing outings to the gym and to meccas such as Yosemite National Park.

During a recent interview, I had the chance to speak with Lin about his dual interests, his experience at Stanford, and why doctors make great rock climbing partners. Here’s an excerpt from our Q&A:

What initially drew you to both fields?

When I was a medical student, I was interested in critical care and I was trying to decide which training route I wanted to take during my residency. I met with a lot of anesthesiologists and pulmonary critical care doctors who said that you get certain, specific skill sets from the medicine training and the anesthesia training. I realized that I didn’t want to choose. I wanted both skill sets.

One thing that has really drawn residents into this program is the critical care component. The ICU is really the intersection of medicine and anesthesia. You’re encountering critically ill patients with severe pathologies, so you need skills in acute resuscitation and advanced medical support that anesthesiologists are accustomed to providing in the OR, but you also need to treat the underlying pathology that landed them there in the first place, which is more aligned with the work of internal medicine physicians.

And as for why doctors make the best rock climbers? Lin has a simple response: “They’re detailed oriented and stay calm under stress, and you can trust them with your life.”

The only downside, he says, is that they always seem to be on call.

Previously: Stanford Internal Medicine Residency program to host Google+ Hangout, My couple’s match: Applying for medical residency as a duo and “We are a team”: Advice for new residents from chief residents, in their own words
Photo by Norbert von der Groeben

Medical Education, Medical Schools, Sports, Surgery

Applying athletic and musical coaching techniques to surgical training

Applying athletic and musical coaching techniques to surgical training

5866567170_aa28901818_zPerforming in a harmonious group is a key characteristic in the success of athletes, musicians and surgeons. With this in mind, physicians at the University of Texas Medical Branch at Galveston worked with members of the Choral Arts Society of Washington D.C. and the U.S. National Rowing Team to develop a new coaching model for training surgeons that draws on strategies from the musical and sports world.

Findings (subscription required) from the study were recently published in a special edition of the journal Surgical Clinics of North America. A release offers more details about the training approach:

It has been shown that deliberate practice is crucial to expert performance. Deliberate practice, which entails setting a well-defined goal, being motivated to improve and having ample opportunities for practice and refinement of performance through structured feedback, is a hallmark of this model.

The model also employs a coaching team that is well rehearsed in the day’s training procedure and is in constant communication so that trainees receive immediate correction when needed.

“Coaching teams not only are more efficient at communicating but also have been shown to make fewer mistakes in high-risk and high-intensity work environments, compared with individuals,” said [Kimberly Brown, MD, associate professor of surgery at the University of Texas Medical Branch at Galveston.] “This fact is of greater relevance when performance requires multiple skills, judgments and experiences.”

Brown said that when all of the coaches and learners are actively engaged throughout the training session, the other team members also contribute more to their highest capacity. This leads to a multiplying effect on the team as a whole, resulting in a team’s best possible performance.

Previously: Spanish-speaking families prefer surgical care in their native language, study finds, Clementines help surgeons-in-training to practice and Surgical checklists and teamwork can save lives
Photo by Army Medicine

Public Health, Public Safety, Research, Sports

Study shows football helmet safety tests may not capture common cause of concussions

Study shows football helmet safety tests may not capture common cause of concussions

boy-164286_1280The football helmet is perhaps the most iconic piece of safety equipment there is, but we’re just now beginning to understand how helmets can — and should — protect the brain.

Blows that rotate the head are known to cause brain trauma, yet a new Stanford study (subscription required) has found that this kind of movement isn’t included in the tests currently used to evaluate a football helmet’s safety.

In the study, bioengineer David Camarillo, PhD, and his team investigated the types of head movements that cause concussions using computer models of the brain and data collected from Stanford football players wearing mouthguards instrumented with accelerometers (device that measures changes in velocity).

Using the computer model, they found that the brain’s movement increases when the head oscillates (moves back and forth) at 15-20 hertz and it completes a single oscillation in about 50 milliseconds. The field data from the accelerometers showed that the players typically experience head oscillations around 20 hertz.

When the research team compared these results to the scenarios used to test the safety of football helmets, they found a mismatch. The standard tests used to evaluate football helmet safety (acceleration tests and a test that drops a helmet-wearing dummy head from various heights) fail to include the rotational movements known to cause concussions; they also generate faster head oscillations (100 hertz); and measure head acceleration for only 15-36 milliseconds.

“The problem with having a model that doesn’t re-create what players actually experience in the field, is that you could optimize a helmet to perform well in the drop test that unintentionally performs poorly in the field,” said Fidel Hernandez, a doctoral candidate in mechanical engineering and one of the study’s lead authors, in a Stanford News story.

This is a big deal because roughly 70 percent of football players in the United States who rely on helmets to keep their head’s precious cargo safe are under the age of 14, and they receive, on average, a whopping 240 hits to the head each season.

Camarillo and his team hope their findings can be used to make more realistic and useful helmet tests.

Previously: Stanford bioengineers and clinicians team up to shed light on how concussions affect the brainForces at work in concussions more complicated than previously thought, new Stanford study revealsNow that’s using your head: Bike-helmet monitor alerts emergency contacts after a crash and Study shows concussion recovery may take longer for female, younger athletes
Image courtesy of Pixbay

Ethics, In the News, Medicine and Society, Science, Science Policy, Sports, Stanford News

Stanford expert celebrates decision stopping testosterone testing in women’s sports

Stanford expert celebrates decision stopping testosterone testing in women's sports

Female track and field athletes no longer need to have their natural testosterone levels below a certain threshold to compete in international events, the so-called “Supreme Court of sports”, the Court of Arbitration for Sport, ruled Monday.

Katrina Karkazis, PhD, a Stanford senior research scholar who was closely involved with the case, got the news on Friday, while she was in a San Francisco dog park. “What a day!” she said. “I was madly refreshing my email — I thought we were going to lose… I just started screaming and crying.”

Karkazis, who is an expert on ethics in sports and also gender, said she spent a year of her life working on the case.

She served as an advisor to 19-year-old sprinter Dutee Chand, who challenged the regulation that female athletes must have certain testosterone levels or undergo medical interventions to lower their testosterone to be allowed to compete against women in events governed by the International Association of Athletics Federations (IAAF), the international regulatory body of track and field.

The ruling suspends the IAAF’s testing regimen for two years, but Karkazis expects the decision will lead to permanent changes in women’s sports, including a reevalution by the International Olympic Committee.

“I’m thrilled,” Karkazis said. She said she was also surprised. “I didn’t think it was our time. I thought there were still too many entrenched ideas about testosterone being a ‘male hormone’ and it not belonging in women.”

Karkazis gained international attention after penning an op-ed in The New York Times in 2012 when the IAAF and the International Olympic Committee crafted a new policy banning women with naturally high levels of testosterone from competing.

“You can’t test for sex,” Karkazis said. “It’s impossible. There’s no one trait you can look at to classify people. There are many traits and there are always exceptions.”

She said that now women who have lived and competed their entire lives as women will be eligible to compete, a default policy she believes is sufficient to ensure a level playing field.

Previously: “Drastic, unnecessary and irreversible medical interventions” imposed upon some female athletes, Arguing against sex testing in athletes and Is the International Olympic Committee’s policy governing sex verification fair?
Photo by William Warby

Research, Sports, Stanford News

New research offers comprehensive picture of the lingering effects of sports injuries

New research offers comprehensive picture of the lingering effects of sports injuries

15403-injuries_newsIn an effort to better understand the lasting impact of sports injuries, Stanford physicians collaborated with the university’s athletic department to enroll nearly 1,700 student athletes in an electronic pre-participation evaluation (ePPE) program and track their health over a three-year period.

During the course of the study, which was published in the current issue of The American Journal of Sports Medicine, the researchers documented 3,126 injuries (1,473 for women and 1,653 for men) that caused athletes to miss an average of 31 days of competition each. Musculoskeletal injuries were the most common, but athletes also suffered from concussions, eating disorders and infectious illnesses. As reported in a Stanford news story today, the research provides new insights into the lasting impact of injuries in greater detail than ever:

Among the findings, 11 percent of the students still suffered symptoms from a previous injury at the time of their next ePPE. Head injuries accounted for 9 percent of all injuries. Although only 3 percent of women reported a diagnosed eating disorder, 15 percent of all women reported a history of stress fractures, which can be associated with low body fat, from either disordered eating or overtraining.

[Gordon Matheson, MD, PhD, who led the study,] said that although the data are eye-opening, interpreting the material and deciding what is particularly meaningful may be an even bigger effort.

“We know that student-athletes have a lot of injuries from sport participation. But unless we have pooled, aggregate data like this, it’s difficult to measure trends and spot areas of concern applied to prevention,” said Matheson.

Researchers hope to partner with other universities to expand their data set and learn more about why some players are symptomatic at the time of follow-up evaluations and, ultimately, help make sports safer.

Previously: Female high-school athletes suffer more overuse injuries than their male counterparts, Director of Stanford Runner’s Injury Clinic discusses advances in treating six common running injuries, Lingering effects of injuries sideline many former college athletes later in life and Sports medicine specialists, educators endorse checklist to reduce injuries among youth athletes
Photo by Andrey Popov/Shutterstock

Health and Fitness, Pediatrics, Research, Sports

Female high-school athletes suffer more overuse injuries than their male counterparts

Female high-school athletes suffer more overuse injuries than their male counterparts

When I was younger, the prevailing parenting advice regarding athletics and children was to identify a sport your child would enjoy early on and have them focus on it throughout adolescent so she would have a competitive edge. Which is how I ended up playing on a boys soccer team at the age of five — there were no all-girls soccer teams in Austin, Texas in 1983. Soccer continued to be my sole sport throughout high school and college. Eventually, I had to give it up because the constant ankle injuries I endured meant I spent more time in rehab mode than training mode.

Never once did a physician or a trainer suspect that the injuries were related to overuse, despite the long hours I logged on running paths, in the weight room and on the field. So I was interested to read about recent research showing that girls are at a much higher risk than boys when it comes to overuse injuries in high-school sports.

In the study, researchers at the Ohio State University Wexner Medical Center reviewed 3,000 male and female injury cases over a seven year period across 20 high-school sports including soccer, volleyball, gymnastics and lacrosse. According to a release:

[Researchers] found the highest rate of overuse injuries occurred in girls track (3.82), followed by girls field hockey (2.93) and girls lacrosse (2.73). Overuse injuries in boys were most found in swimming and diving (1.3).

“These young people spend more time playing sports both in competition and in practice. So, there’s a correlation there between the amount of time that they’re playing and the increased incidence of injuries,” said [Thomas Best, MD, PhD,] who is also a professor and Pomerene chair in Ohio State’s department of family medicine.

The participation and intensity of high school athletics has increased over the past decade. According to Best, some high school athletes spend more than 18 hours a week participating in athletics and many participate in multiple sports concurrently.

Watch the clip above to learn more about researchers’ findings and recommendations.

Previously: Researchers call for improvements to health screenings for female college athletes and Stanford physician discusses prevalence of overuse injuries among college athletes

Events, Health and Fitness, Sports, Stanford News, Videos

Stanford Football team physician shares tips for staying healthy while working out

Stanford Football team physician shares tips for staying healthy while working out

Last month, more than 750 people gathered on the Stanford Medicine campus for the annual Health Matters event. There, Jason Dragoo, MD, team physician for Stanford Football and the U.S. Olympic Committee, delivered a talk about preventing injuries and improving fitness performance. As he explains in the above video, he and colleagues dramatically changed the conditioning program for football players over the last five years: gone is the traditional weight room packed with machines and racks and in its place is a training facility stocked with kettle bells, Pilates equipment, medicine balls, wooden sticks and core boards. As a result, the injury rate dropped more than 70 percent and the team’s success has skyrocketed. 

Watch Dragoo’s full presentation and learn how you can apply the workout tactics employed by Stanford Football to avoid injury and improve your own exercise regimen. And check out the Stanford Medicine YouTube channel for more Health Matters videos, including:

Previously: Stanford Medicine’s Health Matters event, in pictures and Stanford’s Health Matters happening on Saturday

Ethics, Health and Fitness, Medicine and Society, Orthopedics, Patient Care, Sports

Thinking through return-to-play decisions in sports medicine

Thinking through return-to-play decisions in sports medicine

2913800550_7fc291c915_zIn an opinion piece appearing in the AMA Journal of Ethics today, two Stanford physicians – Michael Fredericson, MD, and Adam Tenforde, MD – explore the ethics of how doctors should advise patients recovering from an injury.

Consider this scenario, the case which opens the piece:

Jordan is a 17-year-old senior in high school who has been his football team’s star quarterback, led his team to two state championships, and has a real possibility of receiving a full scholarship to a top college sports program next year. In his last session of summer training camp, Jordan took a fierce hit… [an MRI] showed that Jordan had a torn labrum in his right shoulder that would require surgery and months-long recovery, meaning that he would miss the rest of his final season.

[His physiatrist] had known instances in which this particular type of injury ended a quarterback’s athletic career. She had also read about a few cases in which athletes recovered fully from the injury. Since so much of recovery depends on the injured person’s following the rehabilitation and physical therapy plans, [she] wanted Jordan to approach his injury with the optimism that adherence to the plan would enable him to return to athletics. At the same time, she did not want to hold out false hope that might keep Jordan focused exclusively on football when, in the long term, that might not be the best use of his senior year.

The most important part of what we’re trying to convey when treating athletes is that as team physicians our goal is the health and well being of the athlete

When college scholarships and admissions decisions are on the line, a doctor’s recommendations affect more than her patient’s physical health. How to weigh the different interests at stake? Fredericson and Tenforde make clear that medical decisions must prioritize the long-term health of the athlete. When I interviewed him, Fredericson, a professor of orthopedic surgery, director of PM&R Sports Medicine, and team physician for Stanford Athletics, told me:

The most important part of what we’re trying to convey when treating athletes is that as team physicians our goal is the health and well being of the athlete. Ultimately, we are the ones who are trying to protect their health. Sports physicians have gotten a bad rap; people think we’re trying to help coaches, or help athletes at the expense of their overall or long term well being. We might push the process to help try to get them better more quickly, but ultimately we have their long-term best interests in mind.

Continue Reading »

Research, Sports, Stanford News

Stanford bioengineers and clinicians team up to shed light on how concussions affect the brain

Stanford bioengineers and clinicians team up to shed light on how concussions affect the brain

9764280602_4d132cd012_zIn an effort to better understand and prevent concussions, bioengineers and clinicians at Stanford have turned athletic fields into laboratories to tackle fundamental questions about brain injuries. A story recently published in Stanford Magazine offers a detailed look at the ongoing research involving high-tech, data-gathering mouth guards worn by players during games to record the impact of hits and advanced imaging studies to measure subtle changes on athletes’ brain scans.

Kristin Sainani writes:

Unfortunately, after years of inattention, the science of concussions remains in its infancy. “We don’t even know what a concussion is at a basic, biological level,” says Mona Hicks, who oversaw traumatic brain injury research at the National Institutes of Health for nine years and is now chief scientific officer at One Mind, a nonprofit focused on brain disease. This scientific void creates uncertainty when it comes to addressing such controversies as how long to hold concussed athletes out of play, whether to ban heading in youth soccer and how much to change the game of football.

David Camarillo, assistant professor of bioengineering and a former football player at Princeton University, is studying the physics of such hits. His lab has outfitted most of Shaw’s team with high-tech, data-gathering mouth guards that the players wear during games. Seattle-based X2Biosystems had developed prototypes for a commercial product; Camarillo’s group customized the design for research use. The devices measure how violently a player’s head gets tossed around during collisions, falls and other impacts.

“My long-term goal is to prevent concussions,” Camarillo says. “The first step is to understand what causes them.”

Previously: Forces at work in concussions more complicated than previously thought, new Stanford study reveals, Stanford undergrad studies cellular effects of concussions, Developing a computer model to better diagnose brain damage, concussions and Stanford researchers working to combat concussions in football
Photo by West Point – The U.S. Military Academy

In the News, Sleep, Sports, Stanford News

Sleep = one of the keys to Golden State Warriors’ success

Sleep = one of the keys to Golden State Warriors' success


All-Star shooting guard Klay Thompson loves to take three pointers, and he’s good at it – he’s second in the league in made threes this season. (His teammate and fellow “Splash Brother” Stephen Curry holds the number one spot.) Thompson also loves to sleep, and perhaps the two aren’t unrelated. The Associated Press was there when Stanford sleep researcher Cheri Mah paid a visit to the Golden State Warriors’ locker room last week, sharing some tips with the team.

Much of Mah’s work focuses on sleep and athletic performance, and she says sleep is something that’s often put on the back burner, especially with elite teams who have grueling  schedules. From the piece:

“It’s one of the first things we sacrifice but one of the most important,” Mah said Thursday. “Changing time zones frequently, that can affect circadian rhythms. Really, it was addressing improving and optimizing sleep and recovery.”

Getting more sleep is something Thompson has no problems with. “I know how important recovery is,” he said in the article. “We play such a long season. And I love to sleep, so it was good hearing that if you want to be at optimal peak performance you’ve got to get your eight hours, or at least try to. You can’t be hanging out long hours at night.”

Previously: Superathletes sleep more, says Stanford researcherAsk Stanford Med: Cheri Mah responds to questions on sleep and athletic performance, Expert argues that for athletes, “sleep could mean the difference between winning and losing,” Why your sleeping habits may be preventing you from sticking to a fitness routine and A slam dunk for sleep: Study shows benefits of slumber on athletic performance
Photo by Chilli Head

Stanford Medicine Resources: