Medical Education

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.

After my recent post about choosing to start a family while in school, a friend and student at another med school responded:

At least for me, another thing that comes into play is the debt load… I myself will be carrying a debt load akin to a mortgage by the time I graduate (not by choice; my tuition and fees alone work out to $55k/yr) and as someone who will most likely [be] in his mid 30s… before he starts making real money, this has really hit close to home.

Fair point. According to this nightmare-inspiring AAMC fact sheet (.pdf), the median graduating debt for U.S. med students is $175,000. That debt undoubtedly looms large in major career and life decisions such as specialty choice, where to live, and when to start a family.

Thankfully, my debt will be nowhere near that figure, and I’d like to share the reasons why. I hope this will encourage those of you applying to medical school to think broadly about factors that will impact your debt at each school on your list. When I began the application process I never would have guessed that Stanford, with a “sticker price” of $65K per year in tuition, would be my most affordable option.

Of course, everyone’s situation is different, and I can only speak from my own experience. However, it is telling that our average debt is consistently among the lowest in the country, despite our location in a region known for its sky-high cost of living.

So here’s a few of the reasons why my household of two med students and a baby will graduate with a very manageable debt burden:

1. A solid need-based financial aid package
The packages Stanford offered to my husband and me were comparable to those offered by peer institutions. That means tens of thousands in grants, plus loans that don’t accrue interest during training.

2. Teaching assistantships
The TA program is one of my favorite things about Stanford Med! The opportunity for students to teach is integrated into our curriculum and encouraged in a way that, as far as I know, doesn’t exist at any other school. We serve as very well-paid TAs (regardless of financial need) for both core preclinical courses and fun electives. As an aspiring educator, this is a dream come true. I develop my teaching skills, reinforce my knowledge of important material, get to know the students in the classes below me, and work with faculty mentors who are passionate about education – all while dramatically lowering my debt.

3. Med Scholars program
Med Scholars supports student scholarly projects (anything from working in a lab to writing a novel), by granting tuition support and a living stipend. Assuming we write a solid proposal, there’s enough funding for every student regardless of financial need, so we’re not left scrambling for scarce outside research funding.

4. Outside scholarships
My husband and I have both benefited from generous outside donors, to whom we are immensely grateful.

5. Never having to buy my lunch
In the preclinical years, rarely a day went by that I didn’t get free lunch (and sometimes dinner) through seminar series, elective courses, or student group meetings. During clinical rotations, the feast continued: Many departments have daily seminars with lunch provided. For the rare day when I don’t get fed, I can always pack my own simple but nutritious lunch for about $1.50. So there is really no reason to spend my student loan money on expensive cafeteria food.

6.“Odd jobs”
Our flexible school schedule gives me time to earn extra income through jobs like babysitting and tutoring.

7. Biking everywhere
Stanford and its surroundings are super bike-friendly, making me healthier, happier, and blissfully unaware of fluctuating gas prices.

8. Groceries from The Milk Pail Market
At this quirky little store within biking distance of campus, I can fill up my cart with enough veggies, fruits, beans, and grains to feed us for a week – all for less than $20. My medical advice is to skip their unpasteurized milk, though!

Stanford med students Nuriel Moghavem and Trishna Narula co-chaired an AMA Medical Student Section Regional 1 conference last weekend at the Li Ka Shing Center for Learning and Knowledge. Ninety students, including 40 from Stanford, participated in the two-day event, which involved meetings, breakout sessions with industry leaders and social outings, plus an optional trip to a local winery the following day. Moghavem shared his thoughts on the weekend’s proceedings in the Q&A that follows.

How did you decide to focus on healthcare technology innovation?

When we were putting together the proposal, we thought a lot about what makes Stanford different from other schools that might host this conference, and how we could add educational and inspirational value to the trips of students coming from other states. Stanford obviously has many things that set it apart, but we thought that the energy of the health tech field would really capture the imaginations of our attendees.

What were some key takeaways from the sessions?

Our keynote speaker was Atul Butte, MD, PhD, a giant in the field of big data analytics and [someone who is] incredibly knowledgeable about the process of bringing a medical discovery to the market. Everyone in that room was rapt and half probably left wondering why we all weren’t millionaires already. We then had some breakout sessions from telemedicine and technology startups that again pushed our attendees’ understanding about the future of medicine. I think the main takeaways were that technology is changing health care, and the “visibility” – if you think about it like driving a car in the fog – probably isn’t more than two to three years ahead. Technology has the promise to entirely overturn our idea of how health is fundamentally defined and approached in ways that we simply can’t anticipate at this time. It’s big stuff.

What took place at the AMA Leadership School Workshop?

The Leadership School is a national initiative to put tools in the hands of emerging leaders to empower them to expand their efforts. The workshop they led during our conference was an excellent morning icebreaker – asking attendees to share media related to their own personal “brand” (a favorite image, a Google search of themselves, etc.). Through the exercise, we all shared interesting personal details about our lives, interests, passions and hobbies, and we learned a valuable lesson in controlling one’s brand and online presence.

You are a busy medical student. Why do you feel it’s important to participate in leadership opportunities in your field?

As medicine becomes increasingly driven by public policy, it’s important that we cultivate a generation of leaders in medicine with the tools to engage in policy. This conference was, for us, an opportunity to get 70 of the brightest future physicians in our region (which spans from Hawaii to South Dakota!) in one room to discuss that very issue and to develop those skills. We don’t just think it’s important for emerging physician leaders to participate in policy matters, we think it’s critical for the future well-being of our community and perhaps our country for them to do so.

Co-organizer Trishna Narula later shared with me, “while this was a great opportunity for the AMA to benefit from the health technology hub at Stanford, it was also another large step for Stanford Med to push to the forefront of health policy and advocacy.”

Previously: Top 10 reasons I’m glad to be in medical school, Future doctors have a lot at stake, even if they don’t know it: A student’s take on the Affordable Care Act and Stanford Medicine X seeking students for leadership program
Photo by James Pan

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.

A friend of mine e-mailed me this blog entry awhile ago. Titled “10 things you need to give up to become a doctor,” the piece describes “your free weekends,” “your desire to change the world,” and eight other similarly positive items as areas of life that medical students need to sacrifice on their path to becoming a doctor.

As I read through this entry, my mood grew increasingly dismal. By opting to go to medical school, had I really committed myself to a lifetime that, according to the author, would be devoid of creativity, good health, big dreams, and more? I refused to believe that was true.

So, instead of dwelling on aspects of my life that may or may not be compromised on my path to becoming a physician, I want to highlight parts of my life that have been enriched by my medical school experience thus far. Here we go: The top ten reasons (organized loosely by importance) that I’m glad to be in medical school:

10. Four extra years of free two-day shipping via Amazon Student
I’ve ordered everything from tuning forks to trash bins – and I look forward to my future purchases being delivered via drones. Thanks, Amazon!

9. Daily dose of cheaper-than-Starbucks caffeine
For everyone paying $2.95 for a latte at Starbucks, be jealous! Stanford medical students get $2.70 lattes (+ an extra 25 cents off if you bring your own mug) at the Med Café every day.

8. 24/7 gym access
The 4^th floor of Li Ka Shing is strictly for medical/bioscience students only and houses study rooms, a lounge, and a gym. Not that I ever have the urge to work out at 4 AM, but if I wanted to, I could!

7. Having friends come to me when they’re sick and feeling like I can diagnose them
Friend: “I’m feeling a little sick.”
Me: “I CAN HELP.”
(Five minutes later)
Me: “Actually, come see me again in like 4 years.”

6. Sleeping in scrubs like it’s no big deal
Because, really, they’re the most comfortable pieces of clothing I own.

5. Living life on pass/fail
It feels like this is the first time in my life where I’ve been given the freedom to learn at my own pace, in my own style. There are very few assignments in medical school, and as such, we can take the material presented to us and decide for ourselves how to master it. I can’t describe how incredibly refreshing this approach is.

4. Being on a text-message basis with role model physicians
Following my first patient encounter, one of my advisors texted me, saying: “You are a skilled, empathetic interviewer. I greatly enjoyed working together yesterday and look forward to more experiences.” Needless to say, my advisor’s thoughtful, compassionate words completely made my day.

3. Full-length white coats
At Stanford, medical students receive white coats that are just as long (i.e. up to our knees) as coats worn by MDs in the clinic – a constant reminder that there are no hierarchies: We are part of a single medical team, with the shared goal of caring for someone in need.

2. Being surrounded by inspired, motivated classmates
From founding non-profit organizations to creating World Health Organization reports to winning international awards for their research, my classmates are among the most accomplished, friendly, and down-to-earth individuals I have ever met.

1. Finding meaning every day of my life
Whether it’s through a patient visit, an anatomy lecture, a morning at pediatrics rounds, or a standardized patient encounter, I’m reminded every day that what I’m learning is directly linked to caring for others.

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.

My upbringing and career goals can be summarized as a collection of “in betweens.” I was middle child in a family that was first generation in the United States, and I grew up bridging my parents’ history in Mexico and the American Dream they hoped for. I was raised in Pasadena, Calif., enjoying the perks of an affluent suburbia but witnessing the challenges my parents faced as low-to-middle-income laborers. I had little dental or medical care as a child, as health insurance was inaccessible and my parents were unable to pay out of pocket. I grew up in between socioeconomic lines, blessed by my parents’ sacrifices to support me as the first person in my family to pursue higher education, but aware of the struggles that poverty creates.

One of the reasons I decided to pursue medicine is a desire to serve as a connection between the underserved poor and health care. I wanted to translate my experiences growing up in a Hispanic household without health insurance and with little knowledge of the health-care system into a career meant to empower underserved populations and improve their overall health. However, the image of the health provider I desired to be was at one time very narrow.

Initially, I was focused on making my way into the hospital, unaware of the health impacts that come from other fields. But through a series of undergraduate courses and extracurricular programs, I discovered the impact that public-health interventions, policy and ideology can make. I came to realize that in order to address health-care needs, it’s important to understand the circumstances creating them. It’s not just about dealing with high blood pressure, obesity and mental health – it’s about drawing awareness to their causes and coming up with ways to prevent them. My career goal became to position myself between providing direct patient care and defining health prevention and maintenance practices.

When I was deciding where to go to medical school, I initially dismissed Stanford. I felt its lack of a public health school would hinder my goal of becoming both a health-care provider and a health-care promoter. Second Look Weekend not only dispelled this false vision of Stanford, but also introduced me to the Stanford that I’ve come to value highly: a center of excellence that positions itself between academic medicine and community outreach, and between scientific advancement and public health empowerment. From learning about social determinants of health in the Community Health scholarly concentration, to providing services such as health education through free clinics, Stanford creates an environment to learn about and participate in numerous public-health approaches. In doing so, it exemplifies what I believe is important in defining what the future of medicine is: caring for people and communities before and beyond the hospital.

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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.

“Just so you know, I’ll probably start crying any moment,” I warned. I could already hear my voice cracking, a Pavlovian response to this sort of meeting. After all, this would be the sixth faculty member whose office I had cried in since starting med school less than a year before.

“That’s fine. You crying won’t stop us from talking.”

I had permission to cry, so I went ahead and started crying.

I had spent my entire adult life so far striving to succeed in pre-medical courses, clocking long hours in lab, and tirelessly volunteering – all because I felt called to become a doctor. I wasn’t just going through the motions: I loved my pre-med activities and I loved medicine, and my first year of med school only strengthened that passion.

But I was just beginning to fully grasp the commitment I had made. It was unbearable to think that a decade of training would pass before certain aspects of my personal life would be within reach. These worries grew, and I sought advice from faculty mentors – hence, my tearful tour of six professors’ offices. Some offered stress-reduction suggestions: “Have you tried yoga or meditation?” (Yep, this is definitely California.) Others thought I hadn’t found my true passion yet and tried to help me tease it out. I was incredibly appreciative of the time they spent strategizing to make my path more bearable, but none of it got to the root of my anxieties.

In Faculty Office Number Six, my heart raced as I built up the nerve to confess the extent of my treason against the medical profession.

“I just worry I won’t have time for other things. Like my garden…”

But of course, I could bear not growing vegetables for a few years.

“…And getting exercise…”

This is not a plausible problem to cry over. She wasn’t buying it. ‘Just say it,’ I thought.

“…And actually… I think I want to have a baby. ”

Typing these words three years later, my heart is in my throat remembering how it felt to confess to a department chair at the School of Medicine that I wanted to have a baby. Having a baby in med school is Just Not How It’s Done. It is irresponsible, presumptuous, and especially inexcusable for someone in her mid-twenties who could easily wait until after residency. I braced myself for her reply.

“Then why on Earth don’t you have a baby?”

Not the answer I expected.

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Only 10 percent of 12- to 17-year-olds who need substance abuse treatment receive services, according to the most recent National Survey on Drug Use and Health (.pdf). To address this issue, the National Institute on Drug Abuse (NIDA) released new resources today that assist substance abuse treatment specialists, health-care providers and parents in treating teens struggling with drug abuse and identifying those who might be at high risk.

As NIDA Director Nora Volkow, MD,  explained in a release, “These new resources are based on recent research that has greatly advanced our understanding of the unique treatment needs of the adolescent.”

The online educational resource highlights both the patient and physician perspectives and provides videos demonstrating skills to use in screening adolescents at risk for or already struggling with substance use disorders. Although it was created with medical students and physician residents in mind, the curriculum is free and available for public access.

An online guide covering treatment approaches was also released. Highlights include:

• Thirteen principles to consider in treating adolescent substance use disorders
• Settings in which adolescent drug abuse treatment most often occurs
• Evidence-based approaches to treating adolescent substance use disorders
• The role of the family and medical professionals in identifying teen substance use and supporting treatment and recovery

Previously: Could better alcohol screening during doctor visits reduce underage drinking?, To reduce use, educate teens on the risks of marijuana and prescription drugs and How to prevent prescription-drug misuse among teens

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.

A recent survey published in H&P, the Stanford medical school magazine, asked twenty graduating students to recommend books to read during the clinical rotation in internal medicine. Surprisingly, the top vote-getters weren’t books at all. The two most popular resources were both banks of practice questions, while the next two included a review book and a pocket handbook. (The top four resources: MKSAP question book, USMLE World question bank, Step Up To Medicine review book, and Pocket Medicine.)

“Is this how our students learn the subtleties of sickness and health? What happened to textbooks? We had to read Harrison’s Principles of Internal Medicine cover to cover!” remarked one professor after reading the survey.

For what it’s worth, Harrison’s did receive one vote in the survey. But the results reveal a profound generational change in how medical students are learning the fundamentals of human health and disease. The recent explosion of printed and digital resources offers students alternatives to the classic texts that previous generations swore by. As a result, medical tomes are no longer the primary means by which students learn medicine, but just one piece of an increasingly complex puzzle.

Medical school is often compared to drinking from a fire hose; the student’s job is to imbibe as much knowledge as possible without getting bowled over. This is not a new phenomenon. Western physicians have been producing vast compendia of knowledge for millennia. The ancient Greek physician Galen published hundreds of treatises, aided by an army of scribes and students who recorded his every word while he saw patients.

The modern academic physician also leads an entourage of student doctors during daily rounds. But instead of scribing away on scrolls or stone tablets, today’s trainees scroll through their web browser on tablet devices. While one resident looks up drug dosing on UpToDate, her colleague consults Diagnosaurus to make sure he didn’t miss anything in the differential diagnosis. Meanwhile, the medical student quickly does a practice question on the USMLE World online question bank to test if he really understands the treatment algorithm.

The shift away from voluminous texts starts early in medical school, when the first exams come up before any of us has made it all the way through Gray’s Anatomy. Students opt for streamlined review books and digital resources in part because they are, well, streamlined and digital. Instead of reading about each step in the Krebs cycle, download an app with vivid pictures and animations. Instead of lugging a cardiology textbook to the library, go for a run while listening to a podcast about congestive heart failure. And if Google doesn’t have the answer, consult the online version of Robbins Pathology (soon to be powered by Google).

Students also point out that reading textbooks is “passive learning,” which many studies have shown to be less effective than “active learning” such as answering quiz questions. Others may want to tailor resources to their individual learning styles; visual learners frequent websites like SketchyMedicine and Picmonic, audiophiles stock up on lectures from iTunes U. Medical schools (including Stanford) even collaborate with web-based platforms like Khan Academy to digitize their curriculum.

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Each year, Stanford Medicine X brings together stakeholders in health care to discuss the intersection of emerging technologies and medicine. According to director Larry Chu, MD, students have always been “a vital part our conference, from planning and staging to participating from the audience and on the stage” – and this year Medicine X is making its commitment to medical trainees more visible through a student program.

The student leadership program offers up to 10 spots for students to attend the conference, scheduled for Sept. 5-7, and is open to those studying premed, medicine, pharmacy, or nursing, as well as to PhD candidates and those in allied health professions.

“Creating lasting and sustainable change in health care means working with tomorrow’s leaders today,” Chu said of the importance of the program, which has a fast-approaching deadline. Chu is accepting student applications through Monday, Jan. 20.

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

Previously: “You belong here”: A recap of Stanford Medicine X and A conversation about digital literacy in medical education
Photo by StanfordMedicineX

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.

Going home for the holidays means trekking to a small town in northern Iceland for Christmas, and then to the suburb of Miami known as Little Cuba for the New Year. As with so many 21st-century families, my parents are happily divorced and remarried. I have every kind of sibling known to the English language – full, half, step, and ex-foster siblings total eight loved ones I pray for before bed.

Every December, I land in Iceland having slept little, eaten less, and inevitably forgotten my winter coat. But I land at home. This is a place where scathing water bubbles to the surface of the land so hot it is piped into houses at 194 degrees Fahrenheit. Here like nowhere else can you take an endlessly long, hot shower without feeling guilty.

In fact, the Christmas that we installed a hot tub in our backyard, my stepmom joked that we could fill it with hot water from the hose since the plumber hadn’t arrived. I was out cross-country skiing to my grandparents’ for cookies and tea when my dad made good on her joke.

A while later, when I was back home and showering after my excursion, my sister Tatiana forced the lock on the bathroom door open. She pulled me out of the shower, threw a towel at me and barreled past with a bucket of dirty water. As she dumped the water into the shower, she shouted at me to get dressed. Dad had flooded the basement.

I walked out in my towel and joined the assembly line that my family had formed. My dad stood at the front, passing up buckets of water as he sloshed through the basement in his fishing boots. Petra, my stepsister, flashed jokes that had us laughing as we spent the afternoon clearing the basement.

This year’s Christmas adventure was learning to snowboard. Dad woke us up every morning as soon as the lights on the ski slopes turned on. Luckily, my sister Helga is still only seven, so she doesn’t last more than a few hours.

The second day, Petra and I almost crushed Helga when we all fell off the ski lift. We came home for lunch and my little brother, Birgir, regaled my dad and stepmom with stories of how we survived. After lunch I walked through the basement to put the helmets away and passed the buckets we’d used to clear the basement flood. I touched the jacket I’d worn when Dad and I biked through the highlands and the game of Trivial Pursuit that my stepbrother, Asgeir, always wins. I smiled thinking how this home is filled with memories of childhood and love.

And it dawned on me that I have been so busy with medical school, I forgot about my dreams outside of medicine. For I dream that I will become a gifted surgeon, able to help heal those in need. I dream that I will work in developing countries and leave my mark upon the world. And while I have those dreams, I also dream that some day my own basement will flood and my children will laugh as they run around in the mess. I dream that someday my children’s children will visit me on their own for tea and cookies.

Returning for winter quarter, I’m thankful my family continues to ground me amidst the whirlwind of Stanford medical school. I’m thankful they remind me every time I come home that the greatest accomplishment of my life will be to raise a family of my own whose laughter rings in the memories that fill our home.

Natalia Birgisson is a first-year medical student at Stanford. 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 by Peter Espe

We’ve written before about art’s intersections with medicine. For example, Audry Shafer, MD, director of Stanford’s Program on Arts, Humanities, and Medicine, explains how art in the medical setting can help patients and caregivers communicate an experience. A multidisciplinary undergraduate course helps students understand the structures of human viruses through sculptural renderings. And physician-author Abraham Verghese, MD, professor of medicine, advocates for attention to bedside manner through literature as well as policy.

Over on The Arnold P. Gold Foundation’s blog, Johanna Shapiro, PhD, a professor at UC Irvine School of Medicine, makes another case for letting your pre-med son or daughter major in philosophy (or sociology or art history). She writes:

To me, the most important meta-questions a future physician can engage with (preferably every day of her life) are fundamentally moral ones:

• What kind of doctor do I want to be?
• Who am I and who can I become within the practice of medicine?
• How do dominant discourses in medicine and society influence me, my patients, and our community in negative or positive ways?
• What is my commitment/responsibility/ to my patients and my community and how can I best serve them?

Arts and the humanities serve not to make you a better person, Shapiro writes, but to encourage you to continually examine and evaluate your actions – a useful course of study in any profession.

Previously: Stanford humanities course helps counteract the “powerlessness and shame” of addiction, More than medicine: Stanford medical students embrace their artistic passions through unique program and Live tweeting journalist Sheri Fink at Medicine and the Muse Symposium