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!].

Day 237: Block 2 – Cardiovascular

Today’s inane image of the day:

Lilly’s Pathophysiology of Heart Disease was the textbook most, if not all of us used for the Cardiovascular block. I personally thought that this was one of the best textbooks I have ever read [and likely one of the only textbooks I truly read from cover to cover].

Block 1 [Neuroscience] was somewhat of a disappointment, so it seemed that it could only get better from there. And it did with our Cardiovascular system block.

I want to preface this post by noting that even if Neuroscience went relatively well, I believe that I would have still written a positive review of Cardio — lectures and assessments were as organized as they could be for a first run-through and every lecturer has been enthusiastic and extremely approachable. Not to say that there weren’t bumps in the road, but looking back, they were all minor and overshadowed by how smoothly everything else went.

How the block was organized
We had ~6 very packed weeks of lectures then an Anatomy practical and final NBME exam to wrap things up. Each week featured a “theme” — for example, one week we discussed acute coronary syndromes and everything related to them [i.e. atherosclerosis, hypertension, heart attacks, pharmacology, etc] then ended most weeks with a Clinical Case Study [more on this later]. We only had one TBL during the block, but I definitely preferred the Case Studies as the main form of active learning. Finally, each weekend a 10-question quiz opened up on our online course management site that was worth a couple of points [we had unlimited tries and the grade was whatever our highest scored quiz was].

As with previous courses, we still had Anatomy lab each week and in lieu of Radiology lectures we had Cardiac Imaging labs. Basically they were similar to what a Radiology lecture would be like, but since much of cardiac imaging can be done by Cardiologists now, it makes sense that they would teach us the material.

What I loved
The textbook. For most of the year, I have been learning primarily from lectures and Powerpoint slides and only referencing the textbook when I felt like something wasn’t clear. This seemed to be the most efficient way to study because most of our textbooks are really quite monstrous in size and some tend to have convoluted explanations. But when one of my classmates pointed out how clear and concise Lilly was, I decided to try it out… and was pleasantly surprised. There are a bunch of extremely helpful figures and tables nestled into each chapter and the text is really very readable. Furthermore, it’s compact… so it’s manageable to read and portable [I took it with me to California over Spring Break without breaking my back!].

Clinical Case Studies. I wasn’t sure what to expect from these, but was very satisfied with how they turned out. Basically, we are given a short Powerpoint file with a history of present illness, past medical history and pertinent information from the physical exam and are expected to come to the session with a problem list, differential diagnosis and an idea of where to go from there [i.e. what labs/tests/imaging studies to order]. During every session, there were a ton of Cardiology fellows around [so many that each group had one!] to guide us through the process. We would start with discussing what we prepared and our thoughts then the fellow leading the case would ask the whole group what to order next. The complete Powerpoint file for each case contains links to the results of various tests [or to a slide that says a test isn’t indicated] as well as further information. Finally, every case had some sort of twist so we had to try to put the clinical picture together and determine what might have gone wrong [we’re basically pretending to be doctors on a case in slow motion]. Overall, I definitely learned a lot from these sessions — passive listening to lectures can only get you so far [and that’s not very far when you’re sleep deprived] so this form of active learning was definitely welcome.

The organization. I really cannot stress the importance of this enough. The week’s lectures were opened up ~1 week in advance. Only minor modifications were made [for the most part — there were maybe a few lecturers that made significant changes to the presentation, but that’s bound to happen]. The schedule did not suddenly change on us. For the most part, we knew what to expect and how to prepare for it.

The weekly quizzes. Since we had as many tries as we wanted and only the highest grade counted… this was an extremely low-stress way to force us to review material. Even if I didn’t want to take my notes, it forced me to at least think about the material, even if I was guessing on some. [I think I racked up something like 20 tries on one quiz because I refused to flip through my notes…heh!]

Weekly lunch/review. At the end of each week the lecturers came in to answer any of our questions from past material and also brought pizza/salad with them. Even though it felt kind of wrong eating cheesy, buttery goodness while discussing atherosclerosis… well… everything in moderation, I guess.

Final exam. Although things were different this time around, in retrospect, I loved the changes. Not only did we get an NBME exam that was taken using their USMLE examination interface [that’s right! we’re getting experience now with that rather minimalist interface! I’ve become a computer-strikeout-answer pro — yes, it actually takes skill to learn how to strike an answer out…], but we also have the whole weekend off. Yes. All 2.5ish days of the weekend are free! Woohoo! So, although I have no idea if I passed this exam… at least the weight of it has been lifted and I have a glorious weekend of decompressing ahead!

What could be improved
Lack of suggested reading assignments. [This is a minor point.] For the most part, Lilly’s chapters correlated with the week materials [e.g. during our valvular week, I read the valvular heart disease chapter], but sometimes I wished the lecturers would point out important pages to preview or review. Not all of the professors used images from the textbook, but for the ones that did, it would have been easier to keep up earlier on [I figured it out within a couple of weeks, but still…].

Communication. Everyone working in a group setting could work on this [myself included!] and I think that you can always fall back on this as an area of improvement. Specifically, I thought that although I really enjoyed hearing certain things over and over again, that sometimes the redundancy was a bit too much. For the most part, each lecturer knew what the other lecturers discussed, but there were still some times when I heard the same concept repeated almost the same way and I didn’t think it really helped much. This is most likely a preference thing, though.

Consistency in quality of lecture slides. As with any academic institution, some Powerpoint presentations are formed better than others. Truly, I think it’s an art — being able to cram a ton of important information into slides and keep it interesting? Well, that’s quite difficult and I don’t claim to know the secret to doing this well, but with how many slides I’ve seen in my years… I have an idea of what I like. For example, placing images on a slide without labels doesn’t really help us when we go back to review the slide: Is that little black thing the problem? Or is it that white stuff? Or maybe that growing thing off the side? Wait, is that normal? Or, putting a couple of words on a slide: Mitral valve, stenosis, regurgitation. So I just used up 1/6 of my page to print 4 words? I’m trying to be environmentally-friendly here! 

For the most part, this wasn’t a problem, but hey, it doesn’t hurt to mention it.

Time in lecture. Being the person in charge of turning on the recording equipment and assisting the lecturers with their education technology needs [i.e. where did my Powerpoint file go? how do I go back? why did the screen go black!? *throws hands in the air*], I need to be at every lecture. Of course, I could have someone cover for me… but I’m pretty proud to be one of the few ridiculously dedicated lecture-attending-students [you know who you are!]. Anyway, we spend a lot of time in lecture and sometimes I find that it is more detrimental than helpful to sit in our rather uncomfortable lecture hall chairs [future classes, you are so lucky]. There are definitely some places that could be shaved down as to reduce a couple of hours each week of lecture-time, but I understand that with the first run-through that everything has to be as complete as possible.

Final thoughts
Dr. Goldstein and Dr. Augustyniak [I couldn’t find a link for him anywhere…] really did a wonderful job with this course and overall, I’m extremely satisfied. Our Respiratory block is starting off strong on Monday… but it’s Friday now so I’ll worry about that stuff come Sunday evening.

Have a wonderful, relaxing weekend everyone!

Day 224: Unseasonal

Today’s inane image of the day:

I went to San Diego for an evening during Spring Break to avoid this scene of gloomy, overcast skies. At least there were palm trees and was a gorgeous body of water outside of our window! 

I have so many ideas for future entries, but have been out and about enjoying the beautiful weather [70s all week and sunny!] and mingling with some awesome admitted students [last week was Second Look Experience] that I haven’t really had a moment to sit down at my computer and write.

Our Cardiovascular final exam is creeping up so it’s time for me to ramp up the studying. There are a number of factors that are different for this exam: 1) it’s our first cumulative final exam; 2) the questions are written by the NBME [they also write the USMLE]; 3) it’s on the computer [since they are NBME questions, they can only be accessed through their online system…very much like the boards!]; 4) it’s on a Friday [historically, our class has used the 3 day weekend before an exam to cram… now, that option is no longer available].

Anyway, back to the pharmacology [did you know that one side effect of ACE inhibitors that some patients may not tolerate is a cough?].

Day 207: Riding along

Today’s inane image of the day:

In Michigan, you never know what surprises Mother Nature has in store for the weather… I’m not complaining about this one though!

Expect a number of more interesting entries next week while I’m relaxing over Spring Break [only ~3 days left!] — in the meantime, let’s just say I’m trying my best to keep up with the material. Our second block [Cardiovascular] has been running swimmingly [the textbook is clear, concise and actually making for relatively good bedtime reading and lecturers have been prepared and enthusiastic], which has been a breath of fresh air in contrast to Neuroscience.

In other news, we are narrowing down the options for our Capstone projects. Lately, I’ve been picking up my activity over on Twitter through healthcare social media chats and in the midst of Sunday evening’s chat, I uncovered what I hope will be my focus for Capstone. Although I’m bubbling with excitement to get started, I probably need to submit an IRB proposal before collecting any data so the idea has been left to simmer and grow on the back-burner.

Last weekend, I volunteered alongside several of my classmates at the Cranbrook Horizons-Upward Bound (HUB) program to answer the participants’ questions about medical school. It was a wonderful experience that reminded me of how much I loved volunteering my time as a mentor/tutor in the Elementary Mathematics Laboratory program and working with middle schoolers while running the Engineering Club. I’m thinking about volunteering some of my evenings this summer with the HUB program… but we’ll see.

[Who’s excited for the iPad 3? I am!]

Day 203: Cardio experience prior to med school

Today’s inane image of the day:

As an undergraduate student in Biomedical Engineering [University of Michigan], we built a basic circuit to view EKGs — last week as a medical student, we hooked up the leads to this magic box [containing the circuit] and saw a beautiful signal. It’s so different on this side of things — instead of building the hardware, we’re just using it to analyze the waveforms.

Being in the midst of the Cardiovascular block has been a constant reminder of how much interaction I had with the field prior to medical school. My Senior design project “client” [the person we were building a medical device for] was an Interventional Cardiologist and through this interaction I had the opportunity to shadow him in the clinic and OR. It was an enriching experience to understand and watch stent placement through a single wire inserted in the thigh area. Already, technology has led medicine to a place where so much can be done through a single, small incision.

Last summer, I worked at Terumo Cardiovascular Systems on their heart-lung machine. This opened the doors to a completely different prospective; we were the diligent people trying to design, test and sell a medical device. In a way, I was on the starting-end of the device while physicians were the end point users [keep in mind that engineering is a cycle — there really is no true “end”]. I learned about the intricate details of how a heart-lung machine operates, how it is built in the factory, how it is tested for safety and how it can fail. Additionally, I learned how difficult it is to be a medical device company in the U.S. — FDA regulation is quite stiff [and for a good reason], which tends to result in many, many, many failed attempts to bring a product to market.

These two experiences really make me look like I’m preparing for a life in Cardiology. And to be honest, I’ve considered it. The heart is a magnificent organ; it’s essentially a glorified pump, but it makes sense. It’s a logical organ with a well-defined purpose. Not to say that other organs don’t make sense, but this particular organ system has always held a special place in my heart.

I’m sure you guys are getting sick of my discussions over specialties, but I think it’s fun to ruminate over every feasible direction I could go in. Anyway, time to get back to work!

Day 193: Decompression

Today’s inane image of the day:

My favorite study tools…

The exam came and went. All I can say on the matter is that I’m very glad that Neuroscience is over.

Yesterday we delved right into our Cardiovascular block with some basic lectures and exposure of the heart in Anatomy Lab. Our cadaver has an extremely hypertrophic heart — it was “a rush” [as Dr. Forbes loves to say] to pull out the lungs in order to expose the muscular organ that maintains our blood flow.

My updates might be sporadic this week due to some serious catching up on life that needs to happen.