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.

In a little over a month I’ll be finishing my master’s program; 10 days later I start the first rotation of my fourth year. I’ve begun to feel a mix of emotions. Anxiety as I review medical topics, trying to bring them out of distant corners in my memory where (I hope) they still exist. Excitement at the idea of getting back to patient contact, which even through the stress of being a medical student I have never doubted is where I want to be. To psych myself up, I’ve reflected on the clerkships that I’ve completed (read: survived); below are lessons, encounters and unforgettable moments that I’m blessed to have experienced.

Pediatrics: Yes, it was difficult to see kids when they were sick. It was also hard to complete a physical exam on fussy children. The laughter and high-fives made up for both, though. Even patients with chronic illness were inspirational, resilient and great to sit and talk with. What made my peds rotation even better: the wooden heart that a patient decorated for me, thinking that I was her “real doctor.” Win.

Psychiatry: While I completed my rotation in a locked ward, I never felt threatened around the patients. On the contrary, I was surprised by the connections that I formed with them. My takeaway memory:
Me to my wandering schizophrenia patient: “Mr. H, do you know where you are? What day it is?”
Mr. H: “Yes, I do… Why? Are you not oriented yourself, Sir?”
Given how tired I was at the time… likely not. Touché.

Ob/GYN: At the risk of sounding pretentious, I’m proud I can say that I’ve helped bring life into this world. Childbearing and childbirth, in its complexity, is beyond beautiful. Overwhelming? Yes. Amazing? Definitely. I wasn’t able to convince any new mothers to name their children after me, but I was offered a job as a birthing nurse given my awesome coaching skills. We’ll see how med school works out.

Family Medicine: The level of connection  between the doctors I worked with and their patients was incredible. Working to address all the patients’ issues in short appointments was trying, and often impossible, but the gratitude of patients was humbling. It was interesting, too, to see the incorporation of complementary medicine – and try it out. Acupuncture? Check.

Surgery: The smell of post-op infections is something I’ll never forget. So is the time a grateful patient stopped me in a hospital corridor to remind me that I placed an NG tube for him (with success). Beyond unforgettable: massaging a patient’s heart through their chest after a thoracotomy. I don’t see myself as a future surgeon, but I respect the skill. Also hard to forget: tying many, many, knots (mostly on strings attached to nothing).

Medicine/Sub-I: The hardest yet most instructive month of my life. The level of responsibility for patients was overwhelming and empowering. I oversaw patients from tears on admission to smiles on discharge. I experienced for the first time the death of a patient along with a deeper connection with his family than I would have thought possible as a student. I don’t miss my pager going off many times, but I do miss that patients asked for me.

Going into clerkships I felt uneasy about being in a position to care for people given that I was still in the process of learning medicine. What I’ve come to realize is that often the medicine I learn in books is best utilized alongside other care we can offer: a conversation, an inviting smile, a genuine concern. I can’t wait to wear my Medical Student badge and white coat again.

Moises Gallegos is a medical student in between his third and fourth year. 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 box courtesy of Moises Gallegos

Life’s problems and people are often complex, ambiguous and soft to the touch. This holds true even in the medical sciences and professions that require precision in data collection and analysis; critical thinking skills and a broad, flexible world view are therefore necessary components of a balanced education. The School of Medicine‘s dean, Lloyd Minor, MD, explains in a recent op-ed for the Stanford Daily why anyone invested or even interested in medicine should pay attention to the humanities.

From the piece:

Consider the child with autism or the adult with Alzheimer’s disease. A physician can make a diagnosis but cannot offer a cure or a satisfying answer to the question “why?” Even for conditions that we can prevent or treat, patient behavior can significantly impact the success or failure of an intervention. For the hypertensive patient, no amount of prescribed medication will impact the social factors that may be inhibiting lifestyle modification. The specificity of scientific interventions does not account for the messiness of human life.

We as physicians heal best when we listen to and communicate with our patients and seek to understand the challenges they face in their lives. The perspectives on illness, emotions and the human condition we gain from literature, religion and philosophy provide us with important contexts for fulfilling these roles and responsibilities.

Previously: Becoming Doctors: Stanford med students reflect and share experiences through podcasts, Thoughts on the arts and humanities in shaping a medical career, Encouraging alternative routes to medical school and Stanford dean discusses changing expectations for medical students

Scenes from this year’s Med School 101: In the video above, three high-school students describe their interests in science and the sessions they attended at Stanford Medicine’s recent daylong event for local teens. One of the presenters, Anand Veeravagu, MD, also weighed in, saying: “I really wanted to share with them my journey from graduating high school all the way to being a neurosurgery resident and what that involves.” (A lot of training!)

For those interested in seeing more, images from the event can be found on our Flickr photo set.

Previously: The brain whisperer: Stanford neurologist talks about his work, shares tips with aspiring doctors, At Med School 101, teens learn that it’s “so cool to be a doctor” and Med School 101 kicks off on Stanford campus today

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 first two years of medical school – the “pre-clinical,” mostly classroom-based years – were an intensely shared experience with my classmates. At the stethoscope ceremony initiating us into med school, their heartbeats were the first I listened to upon being presented with my stethoscope. A few days later, we all nervously huddled together as our anatomy lab cadavers were undraped for the first time. We drew each other’s blood, percussed each other’s spleens, and ultrasounded each other’s abdomens.

Outside of class, my med school friends remained a constant presence in my life. We volunteered together on weekends to mentor pre-med students, give flu shots, or work in the student-run free clinics. A group of us would meet up for regular games of “Fridayball,” a completely made-up sport that we nonetheless took pretty seriously. I trained for and finished my first half-marathon and triathlon with a few of my classmates, which I never would have done without their encouragement. We went hiking and camping together. We helped each other move, gave each other rides to the airport, and cooked each other comfort food.

Then the pre-clinical years ended, and suddenly our paths diverged. Many of us jumped straight into clinical rotations, where we were scattered across dozens of clinical teams at five different hospitals. The MD-PhD students (my own husband among them) stepped out of the medical curriculum to dedicate the next few years to their research. Others took a year or two to pursue a research project or a second degree. Although I have continued to see my friends pretty regularly to catch up over lunch or coffee, go for a hike, or celebrate a birthday, school no longer brings us together on a daily – or even weekly or monthly – basis.

I miss being constantly surrounded by my friends as part of my daily routine, but I guess I can’t really complain: Most adults don’t get to see their friends at school every day. As it is, I am thankful to have found incredible friends who still go out of their way to be there for me, even now that our schedules don’t easily match up. Like the friend who skipped class to drive me to the doctor when I was sick. Or the friend who answered the phone late at night to help me recover important files I had accidentally deleted from my computer. Or the friend who stops by every month or so just to bring us a giant pretzel from his favorite bakery.

I think I will always have some nostalgia for the natural, easy closeness that came with the first two years of medical school. But maybe the time we spend together now is meaningful precisely because it isn’t as easy to come by.

Photo courtesy of Jennifer DeCoste-Lopez

Over on the “This May Hurt a Bit” blog, Harvard Medical School student Shara Yurkiewicz shares her experience of witnessing a common surgical procedure turn fatal after the patient’s blood pressure suddenly dropped and failed to recover.

In the emotionally honest account, Yurkiewicz tells the patient:

[The surgery] was going so smoothly that we were humming along to “Who Says You Can’t Go Home?” It was during the bridge of the song that your blood pressure suddenly dropped. The anesthesiologist called it out. I looked at the monitor and saw numbers flashing in red.

There was a lot of red, actually. Blood in the wound, blood in the suction container, blood in transfusion bags, bloody footprints on the floor. No more than with any other patient. But I think somewhere along the way I learned to take the sight of liters of blood for granted.

I was scared. I stopped watching them stitch and stared at the monitor, which suddenly seemed like my closest connection to you. They called out the medications they were giving you to raise your blood pressure.

After a few minutes, it worked. Your blood pressure slowly climbed to green numbers. I was still shaking as I silently willed the numbers to stop bouncing around.

Unfortunately, Yurkiewicz was unable to will the patient’s blood pressure to remain stable, and the fast-working surgeons were unable to save him. As she says good-bye to the patient, she writes, “You can learn a lot from watching. Thank you for letting me watch.”

Previously: Reality Check: When it stopped feeling like just another day in medical school, Sleep on it: The quest for rest in the modern hospital, Introducing SMS Unplugged and Facing mortality
Photo by U.S. Navy

Josef Parvizi, MD, PhD, knows firsthand how art can influence medicine. While at a concert featuring music created by digitizing space sounds, he was inspired: “Why can’t we make music by digitzing brain waves?”

Parvizi, a neurologist who specializes in epilepsy, told local high-school students attending Stanford’s Med School 101 recently that the beauty of being a physician-researcher at Stanford is that you’re “surrounded by brilliant people in all areas.” So he took his literal brainstorm to Chris Chafe, PhD, in Stanford’s music department, and the result is a newly patented “brain stethoscope” that can translate brainwaves into music. Parvizi demonstrated the difference between normal brainwave music and the music produced by a brain experiencing a seizure in this YouTube video about the research.

In addition to the brain stethoscope, Parvizi has developed a procedure utilizing electrodes to detect the exact area of the brain that is causing the seizure, and then working with brain surgeons to operate on the affected area. At last week’s event he told the story of a patient who for 20 years had seizures that caused her leg to flail out to the side, greatly limiting her ability to do the things we take for granted every day, like driving or taking a shower. Showing a picture of the happy patient in her car holding up her driver’s license, Parvizi said, “This patient has been seizure-free for six years, driving and enjoying life like never before.”

Parvizi described being a physician-researcher this way: “Like riding two horses standing up with one foot on each horse, you have to keep your balance and it takes some skill.” But, he says, being a physician-researcher allows you to help thousands of patients with your research, and one patient at a time with the application of that research.

He advised the students to “do work you are excited about,” and in looking for a mentor, “be persistent, not pushy.” Parvizi told the story of how as a medical student he contacted the pioneering cognitive neuroscientist Antonio Damasio, MD, PhD, after reading his ground-breaking book, Descartes’ Error. “This was before the Internet, so I wrote to him and sent him faxes. I finally called him and told him I would be coming to the States and would like to meet with him. He told me he would give me 15 minutes. I told him, ‘I am coming all the way from Norway,’ and he said, ‘I will give you 15 minutes.’” That meeting set the course for Parvizi’s career, a career he clearly relishes.

“It took me 22 years of school and training, and that sounds like a lot, but it went by fast because everything is so interesting and exciting,” Parvizi told the group. Snapping his fingers and smiling, he said, “It went by just like that.”

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics. Parvizi and Chafe will be demonstrating their brain stethoscope on April 29 from 5:30-7 PM at the Center for Computer Research in Music and Acoustics, as part of  the program’s Recombinations series.

Previously: At Med School 101, teens learn that it’s “so cool to be a doctor”, How epilepsy patients are teaching Stanford scientists more about the brain, Implanting electrodes to treat epilepsy, better understand the brain and Ask Stanford Med: Neurologist answers your questions on drug-resistant epilepsy
Photo by Norbert von der Groeben

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 February, five fellow Stanford med students and I found out that we had been accepted to present at this year’s Western Group on Educational Affairs (WGEA), an annual meeting focused on topics in medical education. This year’s conference took place March 23-25 (i.e. last week) in – wait for it – HAWAII!!!

As you can imagine, the six of us were pretty excited when we found out, particularly since the conference dates coincided with the end of our Winter Quarter final exams and the start of our spring break. Our excitement grew further when we generously received funding from Stanford to support our trip!

As with many trips these days, ours kicked off with an airport snapchat of me, Victoria (MS1) and Fred (MS1):

Which was followed by, naturally, another snapchat, upon arrival in the Aloha State:

And then finally, by some non-snapchat phone photography – with each photo, just so you know, taken with a background soundtrack of “oohs” and “aahs” and “oh-my-goodness-how-is-this-place-so-beautiful:”

Rest assured, we didn’t spend our entire time at the beach (Full disclosure: We did totally consider this option but our upstanding moral compasses rightfully led us away from the beach and back to the conference). There were three days worth of sessions, from students, staff, and faculty not only from schools in the U.S. but also from countries like Canada, Japan, and Thailand.

We came away from the conference with multiple new friends and rich discussions surrounding new initiatives in medical education. Two of my favorite sessions featured a discussion on the imposter syndrome (IP) in medicine, where individuals attribute their success to external factors and not themselves, and a joint presentation and activity on shared physician-patient decision making. In the former, we actually took a survey, the Clance IP Scale, to measure where we stood on the spectrum of IP experiences. (Highly recommend this, super interesting). And in the latter, we role played shared decision-making in pairs. To my pleasant surprise, this role playing didn’t feel unnatural or intimidating, and in fact, it closely mirrored what we learned in our Practice of Medicine (POM) clinical skills class.

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“I was once in high school,” anesthesiologist Sean Mackey, MD, PhD, told a roomful of ninth-through-twelfth-graders Friday at Med School 101. Now he runs a large NIH-funded lab, takes care of patients, makes scientific discoveries, and helps people get better. Mackey delivered his talk on pain and the brain to the aspiring medical professionals at a high level. “This is the same talk that I give a national audience of experts,” he said – for his younger audience he just explains the jargon. And he includes clips from The Princess Bride, selected with the help of his 17-year-old son, to illustrate certain pain points.

Classes at Med School 101 tend to swing this way – with the instructors not mincing science while still making learning about medicine as fun as it is. In its eighth year, Med School 101 drew 140 students from 10 local high schools to Stanford’s Li Ka Shing Center for Learning and Knowledge to try on white coats, so to speak. Ann Weinacker, MD, chief of staff at Stanford Hospital & Clinics, welcomed students in the morning and shared, “It is so cool to be a doctor.”

Sleep expert Rafael Pelayo, MD, explained to the students attending his lecture why we sleep and outlined some common sleep disorders in adults and children and how medical science has addressed them. “When I started at Stanford 20 years ago, we didn’t know what caused narcolepsy,” Pelayo said. “Now we know it’s an autoimmune disease.”

For her session on global health, Sherry Wren, MD, a professor of surgery, talked about her experience volunteering with Doctors Without Borders in Africa. She caught students’ attention with some sobering statistics: Only 3.5 percent of surgeries worldwide are done in low-income countries; 2 billion people have no access to surgery; and in Africa alone, 42 million people presently have problems that could be treated by surgery.

In the ever-popular session, “So you want to go to med school?” with Charles Prober, MD, senior associate dean of medical education, students named different specialties within medicine and Prober explained their functions and sub-specialties. Questions on preparing for a career in medicine, and on what it takes to get into a good medical school, flowed, with Prober telling the students that the name of their college doesn’t matter as much as what they do there. (Check out the @SUMedicine Twitter feed and the hashtag #SUMed101 for more.)

While Prober mentioned the “big three” list of uses for an MD – patient care, research and education – many of the presenting faculty described other ways to be involved in health care, including public health, nursing, and physician assistant roles.

One young lady told me she was in seventh grade when she got the idea that she might want to be a doctor, but really solidified her plans in eighth grade. Where is she now? “Ninth grade.”

Previously: Med School 101 kicks off on Stanford campus today, Live tweeting sessions at Stanford’s Med School 101, Bay Area students get a front-row seat to practicing medicine, scientific research and A quick primer on getting into medical school
Photo, of students in a brain-focused session, by Norbert von der Groeben

As a reminder, our annual Med School 101 event kicks off this morning on the Stanford campus. At the day-long gathering, around 140 high school students from ten Bay Area high schools will participate in a variety of sessions on medicine and science-related topics at the Li Ka Shing Center for Learning and Knowledge.

Previously: Live tweeting sessions at Stanford’s Med School 101
Photo from last year’s event by Norbert von der Groeben

On Friday, around 140 students from ten local high schools will once again come to the Stanford campus for our annual Med School 101 event.

This is the eighth year of the event, which is organized by the medical school’s Office of Communication & Public Affairs and sponsored by Stanford Hospital & Clinics and was designed to expose high-school students to medicine and related fields. At the day-long gathering, students will attend sessions at the Li Ka Shing Center for Learning and Knowledge on a range of medical and scientific topics, including disease-causing bacteria, food allergies, and traumatic brain injury.

We’ll be live tweeting two of the sessions: a talk on sleep and related disorders from one of our leading experts, and a discussion on what it really takes to get into medical school from Charles Prober, MD, Stanford’s senior associate dean of medical education. You can follow the coverage beginning at 9 AM Pacific time on the @SUMedicine feed or by using the hashtag #SUMed101.

Previously: Image of the Week: Studying brains at Stanford’s Med School 101, Bay Area students get a front-row seat to practicing medicine, scientific research, Med school: Up close and personal, A quick primer on getting into medical school, Teens interested in medicine encouraged to “think beyond the obvious” and High-school students get a taste of med school
Photo from last year’s event by Norbert von der Groeben