Non-invasive reading [i.e. echocardiograms]

Today’s inane image of the day:

The Heart & Vascular Services at Beaumont Royal Oak have been headquarters for my summer cardiology experience [“internship”]. I can actually find my way around at least a small part of the hospital now!

Nine of us elected to do a Cardiology “internship” [I’m hesitant to call it a true internship as most of what we’re doing is like “advanced shadowing” since it’s definitely more hands-on than shadowing prior to medical school and everything makes so much more sense, however, we still aren’t doing as much as if we were doing a clinical clerkship] [more appropriately, it is a summer Cardiology experience] – and I hope I’m speaking for my group when I say that it has been tons of fun. As with most things, there are definitely high points and mundane points, but overall I am extremely happy that I elected to spend six weeks hanging out with the Cardiologists/Cardiac Surgeons.

Our particular program is setup such that our weekly schedule mimics a Cardiology fellow’s monthly schedule – basically, each week we rotate through a different service [e.g. inpatient, SICU, Cath lab, etc]. We are expected to attend noon conferences [and there’s really no reason for us to skip this – they provide lunch everyday] and Cath conferences [early morning on Tuesdays]. Additionally, each of us spends at least one half-day in clinic following our mentor [each of us were assigned an attending]. Finally, we are also assigned a fellow to follow around each week [the only exception is the SICU/surgical week] – from my experience so far, the fellow generally dictates our schedule outside of the “required” activities.

My first week was spent in “non-invasive reading” which basically translates into performing and interpreting echocardiograms. Imaging is definitely one of my interests so I was pretty excited to start off with this service. The fellow I was assigned to had worked with our TBL group during clinical case studies so I was already somewhat acquainted with him.

The schedule for the week was pretty much performing ultrasounds in the morning [both transesophageal and transthoracic], noon conference, then reading/interpreting the images in the afternoon. Although this may seem somewhat slow-paced… I thought it was an extremely appropriate way to start off, plus I was able to get some experience doing the transthoracic ultrasounds [not that we saved any of the images I got, but hey, I could totally do a mean four-chamber apical view!]. Plus, I’m a big fan of dark rooms with images [this is, of course, assuming I have coffee] [this does not mean I’m going to become a radiologist].

I thought that the best part of my first week was probably picking the brains of the fellows – it’s great to hear their experience going through medical school, residency then finally this fellowship [two of them actually took a year to be a hospitalist prior to starting their Cardiology fellowships – I didn’t realize that this was so common]. Their advice was priceless and they were just a lot of fun to hang out with.

Anyway, I have to get up early to make it to Cath conference – I hope you’re enjoying your summer [I know I’m loving the sunny days!].

ACP leadership day

Today’s series of inane images:

Last week I had the opportunity to attend the American College of Physicians [ACP] Leadership Day on Capitol Hill.
Since it was my first visit to Washington D.C., I made sure to visit the National Mall. We started with the U.S. Capitol Building since it was right down the street from our hotel.
Sadly the Washington Monument is closed to visitors due to a past earthquake. 

The Lincoln Memorial was well worth the long trek across the National Mall.

A couple weeks ago I had the opportunity to attend the American College of Physicians [ACP] Leadership Day on Capitol Hill with two of my classmates, a Wayne State medical student, a Beaumont resident physician and three other ACP fellows practicing in Michigan [including one of our lecturers and the governor of the ACP Michigan Chapter, Dr. Carl Lauter]. Because I am not too well-versed in the area of legislation, I thought that this would be an optimal opportunity to catch myself up.

Basically we spent an entire day learning about the ACP Key Priorities which were:

  1. Eliminate Medicare’s Sustainable Growth Rate [SGR] and Transition to Better Payment SYstems
  2. Ensure Full Funding for Essential Health Programs [e.g. National Health Service Corps, National Institutes of Health (NIH), etc]
  3. Enact Meaningful Medical Liability Reforms; Authorize and Fund a National Pilot of No-Fault Health Courts
  4. Fully Fund Graduate Medical Education; Re-align the Program with the National’s Workforce Needs
You can read more about these topics and ACP’s stance here [I actually thought that this PDF was a really quick and easy read that helped me understand what the current structure is and where the ACP wants to take it]. After getting to know these issues, the following day we went to speak to Representative McCotter and Levin as well as Senator Levin to advocate for ACP’s policy statements. Although we only briefly saw Congressman Levin and spoke to the staffers for McCotter and Senator Levin, it was still a great way to practice advocacy.

Anyway, I’m not an extremely politically-oriented individual, but I thought that the experience was a wonderful way to learn about current health policy [and a perfect excuse to explore the D.C. area with my wonderful classmates!].

In other news, I’m starting my Cardiology Internship tomorrow! Should be a fun time [plus, I’ve missed seeing my classmates – it seems so weird going for such a long time without seeing them!].

OUWB – A flawed curriculum?

Today’s inane image of the day:

Hey Class of 2016, here are the USB flash drives you’ll be receiving in August with your laptops – I had to box each and every one of them for you…

I received the following comment from an Anonymous poster on my entry, “A bump along the road to summer“:

Hi Amanda, Great blog! You are obviously a really bright student. I know you’ve had to do some re-mediation of course work at OU. Do you feel there is a flaw with the curriculum at OU? You seem way too smart to have to re-mediate any work, especially a clinical diagnosis type write up. Does OU “fail” a certain amount of students per block? Thanks for the input! Hope you are enjoying the summer.

Since I thought that this posed an interesting set of questions, I decided my response warranted an entire blog entry. 

First, OUWB does not have a quota of students that it needs to fail for each course. This ultimately works in our favor since it fosters an environment of collaboration and teamwork. If we all do well, we all pass [I do believe there was an Anatomy practical exam where the entire class passed]. However, because the bar to pass is set relatively high [usually 70%], this isn’t necessarily an easy feat and there tend to be a couple of students who just barely miss the mark. That is where exam remediation comes into play.

I’ve noted this before, but I’ll repeat it once again – exam remediation does not equal course remediation. It does not appear on your permanent record or your transcript. Essentially, it acts like a second chance to prove that you know the material. The only thing setting it apart from the first pass is that even if you score within the “Honors” range in your remediated exam, you cannot receive that grade since you failed the exam the first time around.

Keep in mind that I have only needed to remediate exams, not courses

Second, I had my concerns about the curriculum when the academic year had just started – it seemed harsh that students who had earned enough points to pass a course had to re-take an entire examination if they just barely failed. However, the reality is that most things only make sense when considered retrospectively; making every exam high-stakes prepares us for the concept that every assessment counts and ensures that whatever weaknesses we might have had are addressed immediately. My experience failing and remediating an exam in BFCP forced me to review the subjects that I was weak in [e.g. Microbiology, Anatomy, Immunology] and made sure that I was truly competent. And looking back, I definitely remember the microbes I reviewed for that exam.

Did failing a couple exams send me spiraling down a path of self-doubt? Yes. Did they seem to add stress to an already stressful situation? Yes. But did it help me feel more confident in the material? Absolutely. 

Third, if the question was more along the lines of, Do you think that you weren’t taught the material well enough and that’s why you failed? Well, this is a difficult question to answer. We haven’t had an exam where the majority of the class failed, and most of our averages have been relatively high. This leads me to believe that most of the class is learning the material somehow.

So what happened in my personal case?

The short answer: a lot of things. I tend to procrastinate on studying by dedicating time to extracurriculars [e.g. this blog, AMWA, etc]. I am also lazy when it comes to memorizing things. This combination, along with the fact that I attended every single lecture during the M1 year [i.e. I didn’t have as much white space to study as those of my peers that may have missed some class] didn’t quite set me up for success. However, I’ve learned over the course of the year how to prioritize, memorize and utilize my time in class. Overall, I feel like I’ve come a pretty long way since last August.

Do I think OUWB has a flawed curriculum? No. Do I think that we still need to work out some of the kinks like essentially every other medical school? Yes. In the end, there will always be aspects of a school that could be improved, but if the LCME put its stamp of approval on a school, then I trust that it will graduate competent physicians.

Anyway, I hope this answered your question. As always, please feel free to post a follow-up if I didn’t quite hit the spot!

[And I am indeed enjoying my summer! I hope all of you are, too!]

Block 3 – Respiratory

Today’s inane image of the day:

Yes, yes, I know I’m recycling images since this originally appeared in an earlier entry,  however, I think it’s the most appropriate photo to depict our Respiratory block so I’m sticking to it!

As with our last two blocks (Neuroscience and Cardiovascular), I thought it might be helpful to write about how things went during our last block of the M1 year: Respiratory. Now that we’ve completed a couple of these organ system courses, I realize that I need to go into each new block with an open mind about how it will run — there are definitely some uniformity between each system [e.g. Anatomy, NBME exams], however due to the fact that each course is organized and run by a different faculty member in addition to the inherent differences in the subject matter, there are bound to be differences. This being said, Respiratory had it’s pros and cons but overall I thought it put up a pretty good fight.

Course Overview
This block was 6 weeks like the Cardiovascular one. Each week we had a graded Moodle quiz that consisted of 20 questions that opened on Friday and was due by the end of the day Sunday. As always, we had TBLs, Anatomy labs and lectures. Additionally, we had a couple of Microbiology labs and a ventilator one. There were no clinical case studies. Our grades were determined by performance on the weekly quizzes, TBLs, Anatomy practical and final exam.

What I loved
Microbiology lab. Since the Respiratory system is so open to the environment we live in, it makes sense that there would be an emphasis on microbes. This being said, one of my favorite faculty members, Dr. Harriott, made sure that we really understood all the clinically significant information in lecture and through two fun, hands-on, laboratory exercises. We cultured our own throats and went through various stations associated with clinical vignettes to determine the causative agent. Through these stations, we performed catalase tests and tried to identify gram positives/negatives through the microscope [and more… I’m just drawing a blank now]. Basically, she did a wonderful job making Respiratory Microbiology fun and easier to remember.

Ventilator lab. I was a bit skeptical about this lab, but it ended up being a really interesting experience. The gist of it was to learn about the different settings that ventilators can be set to [e.g. volume vs pressure control] and experiencing how it feels to breathe on one. I was definitely apprehensive about trying out a ventilator, but it helped me understand why it can be such an unpleasant experience for patients. Furthermore, we got to play with the controls and become familiar with the device which will undoubtedly come in handy later on.

More study time. Dr. Rodenbaugh [our faculty course director] really pushed for carving out more white space for us and I really appreciated it. Although we still had a ton of lecture, just a couple hours each week really made a huge difference in being able to digest the material being thrown at us.

Final exam. As with the Cardiovascular block, our final exam was an NBME one, which made it more fair and straightforward.

What could be improved
Textbooks/course pack. The course required two textbooks by Dr. John B. West [one of which is featured in the photo above]. I really tried to give these books a chance, but I was not a fan of them. Additionally, Dr. Rodenbaugh compiled an iBook course pack [it was also available in PDF for the students without an iPad] that followed his lectures really closely. Although I thought the iBook had a lot of potential for making learning the material more interactive, I didn’t find it very helpful [keep in mind that I used the PDF version]. Maybe if I had used the iPad version I would have found more utility. Regardless, any textbook in its first edition is bound to have some flaws and I’m sure that Dr. Rodenbaugh will be integrating our feedback into improving the resource for future classes.

Quizzes. Although I found the quizzes to be helpful in the Cardiovascular course, this was not the case for Respiratory. I attribute this primarily to the fact that they were just too long… 10 questions is pretty reasonable to work at during the weekend, but 20 made it more of a burden than a learning tool. I just remember spending hours trying to bump my score above the 70% mark and feeling frustrated by the questions [they were a mixture of professor-generated and USMLEasy ones].

TBLs. I personally liked the Clinical Case Studies in Cardiovascular… however, I still maintain that the team-based learning exercise has the potential to be a great learning and assessment tool if it is designed to be more clinically-oriented. For some reason, the Respiratory TBLs didn’t quite meet my expectations — I thought that the background reading and the assessment questions needed some improvement.

Final thoughts
Overall, I thought the course was above average but that it could use some work to bump it up to exceptional. Dr. Rodenbaugh worked really hard with what he had and I applaud him for his dedication to making the course as successful as possible.

A bump along the road to summer

Today’s inane image of the day:

Over Memorial Day weekend, Mike and I made our way to Western Michigan to South Haven for a quick day visit. Here’s the scene at the beach… even though it was rainy earlier and the water was chilly, there were still a number of dedicated beach-goers!

Although May 25th was our last official day of classes, sadly it wasn’t quite my last day. Our Art and Practice of Medicine [APM] course only had two graded items for the entire year — both of which were exams that took place during our last two weeks of classes. The requirement for passing was a 75% on our written exam and 85% on the OSCE — although I passed the written portion, the OSCE didn’t go as well. As with all of our other courses, I had to remediate the exam.

On the upside, of the six or so exams we had to take, this was the most predictable one — there is a set format and a very specific number of tests to memorize. Furthermore, I failed on two accounts: 1.) I didn’t ask enough open ended questions and 2.) I didn’t include enough detail in my write-up [honestly, I don’t know what I was thinking when I was doing it — looking back at how sparsely filled-in each section was, I guess I had temporary amnesia]. Basically, I had a pretty good idea of what I had to fix and could do them relatively easily.

On the downside, I was extremely disappointed in myself and went as far as to question my ability to become a physician [yes, I know that this was taking it too far, but hey try failing something like this and see how it makes you feel!]. All of the other courses require at least some rote memorization [something I really do not enjoy doing] and I could always blame insufficiencies on my laziness to memorize certain things. But this course is essentially the heart of medicine; we interview patients and perform physical examinations to lead us to reasonable differential diagnoses. Not doing well in this course could translate into not “being good at medicine.”

This discussion leads me to the question of whether certain skills and traits can really be taught through the medical curriculum. Can we be taught empathy and compassion? Can we be taught caring behavior? Or are we just shown what these things look like and through enough practice, we are expected to mimic it? Surely the admissions process disqualifies applicants who do not meet these criteria, but it’s not a perfect process so it makes sense that certain humanistic aspects of medicine need to be covered during medical training. These are interesting questions that I often ponder during our APM and Medical Humanities [MH] courses [with no definite conclusion].

Anyway… with all of this being said, I passed my exam [apparently with flying colors] and officially started summer as of Friday. Yay!

Look forward to a review of our Respiratory block, what I’m doing this summer and the exciting news I wanted to share with all of you!