Is It Time Yet To Redefine Medical Education?

The ins and outs of medical education are hard to imagine as an outsider to the field. However, once you are in it, it’s a rabbit hole with not escape. Even as a lowly first year medical student, I am often embroiled in engaging articles or scintillating conversations about the state of medical education. What have we done that has worked well in the past? Is it working at its optimal capacity right now? What kind of scope do we have to improve it for our future generations of doctors? From the times of apprenticeship as the primary way of learning the art of medicine to the current paradigms of systematized education by the 2+2 model (2 years of basic science education followed by 2 years of clinical education), we have definitely come a long way. However, like everything in the world, the new establishment comes with its own set of drawbacks. While I am engaged in the day and night struggle to ingrain those molecular biomarkers of immunology or those atypical antipsychotics commonly prescribed for schizophrenia, the context of it all often seems out of reach. I constantly question myself: How does this all apply to a patient? This imagination process is often unfortunately left to the individual student, pending future patient contact in 2 years time. So what can really be done to improve the current setup...

The Devil You Know: A Day In The Doctor’s Office

An excerpt from Dr. Fizzy’s new book: The Devil You Know, available now! “Jason Burnham?” I call out. A man in his late twenties rises reluctantly to his feet. Damn, he’s handsome—he’s got a soldier’s solid build with firm muscles lining his arms and visible under his T-shirt. I can tell by the look on Mr. Burnham’s face that he isn’t terribly thrilled that I’m the one who’s going to be examining his testicles. I’m sure he’d prefer a male doctor. Still, I think it’s melodramatic the way he acts like a man being led to the electric chair as I take him to the newly cleaned examining room. “Mr. Burnham,” I say to him. “My name is Dr. McGill. Would you please change into a gown for me?” Jason Burnham nods miserably. Examining testicles is not my forte. I’ve gotten better at it since my patient population has become primarily male, but I’m nowhere near as good at that as I am at, say, finding the cervical os. Testicles just seem so… delicate. Obviously. But I’m getting better. As far as I can tell, the key to doing a good testicular exam is not accidentally saying something dirty during the exam, which is extra challenging when your patient is so damn attractive. I’m going to work on that today. I return to Mr. Burnham, who is now sitting miserably...

How To Write The Best Recommendation Letter

When you apply to study at any institution you will usually be asked to provide a few recommendation letters from people who know you well. This is more to see what character trades you have and how people perceive you. It is important for the institution to get to know you apart from your academic record. Your character is just as important as your grades and this is part of the process to get acceptance. The question then remains, how do you get these great recommendation letters for your application? Here are some tips you can apply to get these recommendation letters. Be honest and open If you need a recommendation letter for residency, you have to be open and honest with your professors and ask them straight out. By sharing your needs with them, you place the ball in their court. Explain to them how the residency application process works and that this is a requirement. Also mention whatever you would like to have on your recommendation letter. You do not want to tell them how to word it, but just mention a few achievements to refresh their memory. This probably won’t be news to your professors as many students ask for a recommendation letter. Remind them When you are asking for recommendation letters, remind your professor of some of the outstanding work you’ve done. If you have...

Do Teaching Hospitals Offer Better Mortality Rates?

There are many misconceptions about teaching hospitals, but the easiest mistake to make is to assume that because residents with less experience are involved at the hospital it means that patients will receive a lower standard of care. However, a new study published in JAMA shows that what may sound like a logical conclusion does not hold up. When researchers in the Boston area, led by Laura G. Burke, MD, MPH, Instructor in Emergency Medicine at the Harvard T.H. Chan School of Public Health, set out to examine this very question, they found that data from previous studies was, in many cases, decades old. To gather new data, the researchers looked at hospitalizations from 4,483 different hospitals across the U.S, taking only data from 2012-2014. The researchers then examined the mortality rates for specific medical conditions and surgeries, such as stroke, heart failure or hip replacement. In their analysis of 21.5 million hospitalizations of Medicare patients, the researchers found that the 30-day mortality rates were significantly better at major teaching hospitals, even when patient data was adjusted for age and the severity of illness, or when the hospital data was adjusted for size of hospital, etc. The 7-day and 90-day mortality rates were also better at the major teaching hospitals when compared to non-teaching hospitals. Because of their close association with medical schools, teaching hospitals may be at the...

Taking Sick Days in Medicine

As my regular readers may have noticed, I tend to write about what I know. I think it’s the best way for me to choose what to write about because then I don’t feel like a phony, which is something I sometimes feel just as a by-product of being a student of medicine. Another way in which I feel like a bit of a phony is when I get sick and have to miss school. It’s especially tough on rotations because you feel like you’re letting everyone down, as if the whole team is somehow there for you when in reality they would function completely the same without you (although they may miss your positive attitude/humor/white coat pocket snack stash). For example, I get migraines often and they are only partially managed with medication. Sometimes the meds just don’t work or I’m not able to take them in time. Once I went a whole month without them because there was a snafu with the pharmacy and I couldn’t refill them. During that time I was so nervous I would get a migraine and have to call in sick that the whole time I was filled with anxiety over the mere possibility. Even if I do actually take the sick day I just sit at home feeling nauseas and ill, arguing with myself over whether I am sick “enough” for...

Chef Uy Presents: How To Cook Tomato Basil Soup

Natalie Uy is a resident in Internal Medicine who loves to eat and doodle. Her food blog, Obsessive Cooking Disorder, is a collection of recipes she made during her study breaks and stories on my medical / life adventures. Here is her recipe on how to prepare Tomato Basil Soup. B does not like modern art. He’s not a fan of art museums, but he especially avoids any museum titled with the word “modern art.” He did take me to the SF MoMa when we started dating 6 years ago, but that has since stopped lol. Now that he lives in NYC, we are surrounded by amazing art museums. I did convince him (and my visiting brother) to try the Guggenheim to see the Agnes Martin exhibit, but that sort of minimalism didn’t go very well. B doesn’t like modern art because he always says, I could have done that. To which I say, but you didn’t. One piece that has always caught my eye was Andy Wahol’s Campbell Soup Cans pop art, which is conveniently located in the NYC MoMA. First exhibited in 1962, the 32 canvases, each featuring a different flavor, was grouped together like in the grocery, and rocked the art world. It reignited the age-old debate about art versus commercialism (which remains a fascinating discussion even now, as it came up during my Art History classes at Stanford). Fun...

Virtual Reality is the Future of Medicine

What does it really feel like to manage an emergency in the operating room? The Cleveland Clinic Department of Thoracic and Cardiovascular Surgery is using virtual reality (VR) simulations of OR cardiac emergencies to replicate the experience as closely as possible and train cardiac surgery residents. “The two-minute video shows how Cleveland Clinic is using virtual reality scenarios to teach cardiac surgery residents how to maintain ideal performance under the pressure of OR crises.” The VR simulations incorporate scenarios from real operations to create an immersive, realistic, 360-degree experience that includes the viewpoints of multiple members of the surgical team. The scenarios map right decisions, wrong decisions, and their consequences. This video, narrated by Douglas Johnston, MD, the cardiac surgeon who heads the program, shows the scenario of a patient who has gone into ventricular fibrillation as seen through the VR headset of a surgical resident. From the study on pubmed.gov: The traditional system of clinical education in emergency medicine relies on practicing diagnostic, therapeutic, and procedural skills on live patients. The ethical, financial, and practical weaknesses of this system are well recognized, but the alternatives that have been explored to date have shown even greater flaws. However, ongoing progress in the area of virtual reality and computer-enhanced simulation is now providing educational applications that show tremendous promise in overcoming most of the deficiencies associated with live-patient training. It will...