Not all information is created equal

David-Edwards-bannerAs I mentioned in a previous post, I’ve been a graduate student for four years, now starting my fifth. And as a result, I’ve reached a kind of informal, gray-haired milestone where I want to share everything I’ve learned with the younger generation. So gather ‘round, children, because I’m about to impart some “wisdom” (that last word notably accompanied by quotation marks).

I was recently asked the following: What’s the single greatest piece of advice you wish you had known when you started graduate school? It’s a pretty standard question—the “where do you see yourself in five years” of career reflection—but one I didn’t immediately know how to answer.

After thinking about it, I would say that the biggest thing I’ve learned is this: Not all information is created equal. It’s a simple realization, I think, but one that has played a significant role in shaping both my current trajectory through graduate school and my future career ambitions.

I should point out that the statement “not all information is created equal” is inherently prejudicial, asserting that some information is worth more than others. And I know it sounds antithetical when spoken at an institution of higher learning. We should value all information equally, right? When it comes to education, shouldn’t we take the Vegas buffet approach—to loosen our belts and scoop as much onto our plates as possible?

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The fourth trimester

Ally Gallagher, M.D. Class of 2020

Ally Gallagher, M.D. Class of 2020

After 40 plus weeks of laborious (pun intended) and miraculous work, a baby is born into the world. It is a long-awaited joyous day. For months, friends and family help prepare for the new addition. The nursery is arranged, clothes laundered, stuffed animals lined in a row, all ready for this little person to arrive. But after delivery, it is ironically the babies themselves who are not so ready for this new beginning.

Lo and behold, “the fourth trimester:” a name assigned to the first 13 weeks of a baby’s life. It is a period of great change and rapid development as a newborn adjusts to life outside the womb. Before birth, newborns have known a world very different than ours. One that is dark, warm and filled with muffled noise. One in which they are constantly held, fed and coddled. The transition earth-side is wrought with frightful stimuli. The lights, the sounds, the air! Newborns are forced to adapt to uncertainty and cope with insecurity as they learn to thrive in a new world.

As I began medical school with a three-week-old daughter (crazy, I know!), the irony was not lost on me that just as she was adapting to a new world, so was I. The white coat ceremony was a birth of sorts. Just as my daughter Sadie’s clothes hung in anticipation in her closet, our pressed coats waited for us as first years. On the day of our ceremony, we were welcomed into the world of medicine by OHSU faculty and alumni. Our families and friends celebrated and applauded this monumental milestone. While it was an exciting day, it also marked the start of a frankly frightening transition.

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When human health affects environmental health

OHSU StudentSpeak is pleased to present this guest post by M.S. student Brittany Cummings, a 2016–17 Robert E. Malouf Fellow funded by Oregon Sea Grant. She is pursuing a master’s in environmental science and engineering under the guidance of Tawnya Peterson, Ph.D., assistant professor, and Joseph Needoba, Ph.D., associate professor, both with the Institute of Environmental Health. The article originally appeared in Confluence, an Oregon Sea Grant publication.

Oregon Sea Grant scholar Brittany  Cummings samples Columbia River water to determine metformin levels. (Photo by Claudia Tausz, OHSU)

Oregon Sea Grant scholar Brittany Cummings samples Columbia River water to determine metformin levels. (Photo by Claudia Tausz, OHSU)

I am an Oregon Sea Grant-funded scholar who has been given the wonderful opportunity to attend the Institute of Environmental Health at OHSU in Portland.

Marine science at a school of medicine? That’s right! My research is based on the idea that our environment becomes unhealthy when its inhabitants are unhealthy. Under this guiding principle, my colleagues and I are trying to determine the concentration of the antidiabetic drug metformin and its main breakdown product, guanylurea, in the surface water and sewage effluent of the lower Columbia River basin. Since spring 2016, we have been collecting water samples at various points along the lower Columbia. We have also enlisted the help of volunteers from Columbia Riverkeeper to collect additional samples.

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What does my day-to-day job in a hospital teach me?

Suchi blog pic 350x211As I turned the last page of my text book “Your brain at work” by David Rock, I settled into my litany of thoughts of how my daily work at a hospital impacts my decisions. The book discusses how we can efficiently train our pre-frontal cortex in the brain to achieve maximum efficiency at work. I asked myself “How different would my career choices have been if I were not working in a hospital system like OHSU?” OHSU is academic health care system which has a hospital, a dedicated children’s hospital, research institutes, medical school, nursing school and dentistry school and a joint public health school (with Portland State University). It is a complex system which embodies different disciplines of health care.

My career at OHSU started with working in the research lab. While working as a researcher, I always sensed the huge gap of information exchange between the researchers and patients. Even if the field of medicine has been progressing rapidly, the patients are still not up-to-date with the ongoing research. I wanted to fill that gap. As I work in a hospital, I come across patients all the time and my mind always asks, “Do these people know about the latest cool technology in medicine? Would a better knowledge of the changing medicine make them hopeful for a cure? Will that experience be positive?” These activities provoked the biological seat of my brain, the pre-frontal cortex and I took the decision that I wanted to pursue a career where I could communicate about the latest findings of medicine to the community. I enrolled in the MBA program at OHSU and am currently working on how to make patient lives better. Delving deep, I think working in a hospital trains our pre-frontal cortex better and as all good things come in small packages, training the pre-frontal cortex is primary to achieving self control, developing compassion, better problem-solving and developing empathy.

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Little joys

Kayly Lembke“One can have, it turns out, an affection for the war years.” – Steve Martin

Listicles are often berated as lazy, short, psuedo-pop articles not worth the time it takes to spell check listicle. Short? Yes. Pop? Sure. Lazy? But effective. I am, by nature, a list maker. As this is my fifth fall at OHSU, and fall is my favorite season, I have naturally been reflecting back on my time here as a Ph.D. student. For all the hard times in graduate school, for all the times the world was ending, or inspiration was gone, or hope had faded, there are some times to which I will always return with fondness, and some memories I shall always cherish. Here is a list of those memories, those little joys.

Things I love about graduate school:

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When seeing becomes a different kind of believing

There is something wonderful when you truly see a person for the first time. I’m not talking about “Hey, we ran into each other and now we’re friends,” but rather I mean the moment when you thought you knew someone or you had an idea about them and you realize you never really knew them at all.

Over the last six months in my Population Health course and while working at the Maybelle Center, this has been my daily experience in Old Town, a community in Portland’s historic Chinatown that is mainly filled with individuals who are marginally housed or living outside. The stark contrast between hospital and home is odd. Getting to know a patient, or even a colleague on an inpatient acute care unit, compared to getting to know them in the community is incredibly polarizing. In the community there is a type of vulnerability and unabashed honesty in seeing the lives of those we care for in the place that is their home.

During the first year and a half of my nursing education the majority of the work has been preparation. Prep the drug list for your patient tomorrow, prep the discharge planning, prep a care plan, prep what you think the priorities of care are (which you are usually wrong), read their notes from three years back in Epic (that probably no one has looked at for quite some time), prep your hand off, prep on the disease process, prep, prep, prep. Is this important? Definitely. Does this fully prepare you to see the patient in front of you and give them the care that they need? Not even close.

Last spring term, my partner and I were placed at the Maybelle Center for Community to care for and learn from individuals who were considered marginally housed. We sat in the community room after being introduced to our first client and exchanged maybe twenty words total, feeling as if we were probably the last people in the world he wanted to be drinking his coffee with. 

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The times, they are a-changin': When scientific research isn’t enough

David-Edwards-bannerI recently marked my four-year anniversary of starting graduate school. When I reflect on the years that I’ve spent here, embedded in the practice of science like a mosquito in amber, I’m reminded of a line from that Bob Dylan song: “Then you better start swimmin’ / Or you’ll sink like a stone / For the times they are a-changin’.”

The times are a-changin’ indeed. The biggest thing I’ve learned from my experience here is that science is everything. Science offers us students—most of us overeager, street-dumb twenty-somethings—an unparalleled opportunity to peek behind the curtain of existence. Science allows us to dive deeply into truth-with-a-capital-T and retrieve information to help save the lives of those around us. It’s amazing…and it’s why I entered graduate school in the first place.

But science isn’t exclusively good. Science, the exhausting, elbow-greasy practice of it, is also a blackened altar onto which we sacrifice so much of our lives and our freedom. Science is a jealous god, one who hears the cries of its greatest worshippers and sometimes, more often than we’d like to admit, capriciously holds back its favor and love. We become a wandering people looking to the sky for manna and seeing only thunderclouds forming on the horizon.

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Learning begins at the end of your comfort zone

StudentSpeak is pleased to feature this excerpt from Caitlin Harrington Brown, MS4. Caitlin’s original post appeared on the web site for Women in Thoracic Surgery.

Caitlin Harrington Brown, member of the M.D. Class of 2017

Caitlin Harrington Brown, member of the M.D. Class of 2017

Surgeons are like professional athletes. They commit years to rigorous training, and spend hours preparing for a specific case, and then before they know it, it’s game day. All that pre-game prep is all well and good, but it’s what happens on game day that actually counts.  Every patient and case is different. Surgeons are prepared for the unknown in a very high stakes environment because they are trained to be problem solvers and be clutch in a crisis. They use their knowledge and their technical skill to fix complications, even if it’s the first time they’ve seen that particular problem. Their ability to operate when facing the unknown does not mean they are comfortable – it means they are competent and confident.

As medical students on a surgery rotation, we have been told that a large part of our attendings’ and residents’ analysis of us is their assessment of our decisiveness. We are seeing things for the very first time, and they are looking for us to apply our knowledge to an unknown situation and confidently make an educated choice.  When you first experienced this, it felt uncomfortable, right? Maybe it still does, and there is a reason for that! Making an educated guess feels like we are unprepared, probably because we spend the first two years being told exactly what to study for on an exam, and then suddenly find ourselves on clerkships where any question is fair game at any time. It’s hard to prepare for this, and if we don’t know the answer, it feels awful. But like with all things in surgery, there is a reason why our teachers put us in this position.

Continue reading on the Women in Thoracic Surgery site.

Pause here

Adalie-bannerWhen I got accepted to OHSU’s PA program, my husband and I made the decision to keep our home base in Bend and have me return from Portland every weekend. I have, to date, driven 349 hours in 51 round trips. The repetition of this endless loop sometimes gets frustrating [Why do slow drivers suddenly speed up at passing lanes?], but overall I like the weekly echo. My mind can wind down after a crazy week, and I have time to think slower, longer thoughts.

On the drive I pass by some small towns and many scattered remote homes. Seeing those, my thoughts pause on the topic of human migration. I am speaking of migration in its purest form, without influence from strife or other external factors. Moving for the sake of newness. Relocating for the sake of adventure. [Does victimless human migration even exist? Probably not, but let’s pretend.]

With this pureness in mind, what makes a person decide that a location is good enough to stop and make a home of? Like, imagine all you know of the land is that an ocean is due west, and you have just crossed an interminable desert to happen upon a lovely green dip by a river. Why pause there? Why not keep going and aim for something better? [Again, imagine you have a choice in where to stop. Again, imagine that there are no losers in this game; no displaced persons pushed out from your desire of a better life.]

The ability to stop on the journey and be ok with that land as your new home takes a calm sort of confidence. A complete ability to trust oneself. To know that you and your family can flourish here. That the horizon is fine being left alone for now. This isn’t a loud, showy confidence that needs an audience nodding approval at your decision, but arises from a core of self-assuredness.

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Just tell me a story…

Anthony-Lumbad bannerI think we can all relate in the fact that we each know people who seem more adept at storytelling. They build suspense, they hold the punch line until exactly the right moment, they kill it during wedding cocktail hours. They somehow captivate attention, an unofficial prerequisite to succeed in clinical year of PA school. At least, that’s what I’ve experienced. The challenge lies in convincing the most educated person in the room to listen to the least educated: that’s right, yours truly. It’s the inherent nature of being a student and especially evident in a teaching hospital with experts at the top of their field. On morning rounds, we interview our patients looking for salient characteristics of their disease. We work through OPQRST; when was the Onset, what Provokes it, what’s the Quality, et cetera, and present our patient’s case to the attending physician. But what seems to result from 15% eagerness and 85% absolute terror, our once organized information comes out seemingly garbled and out of context as the gaze from five white coats pierces through us. Sufficiently flustered, we smear historical details, lab values, and physical exam eponyms between the patients we are managing. We ask ourselves “how is this happening to me? I took such good notes…”

At times like these, I reflect on advice I received from an emergency physician early in my clinical training: “Just tell me a story, Anthony. Two people may have the same disease, but how they got here will always be different.” After this exchange, I quickly realized how inadequate “OPQRST” is with information gathering. Based simply on pertinent positives and negatives we try to place patients into discrete categories: cardiac vs pulmonary, sick vs not sick, admit vs discharge. But in this binary outlook, I believe we start to lose sight of who our patients really are. As we ask them to change out of their clothes and into hospital gowns, we unintentionally strip away their personality and quirks that make them unique human beings. Out of efficiency, we search for patients by medical record number instead of by name. We refer to them as bed 5 or exam room 1. We orally present a patient’s “case” to our teams as if we’re defending them in trial rather than addressing their health. No wonder it’s easy to mix up the details of their hospital admission. At this point, our patients are no more memorable than the bland textbook pages where we first read about them during our didactic training.

My point is this: put down your moleskine-bound notebook, the proverbial security blanket for health professional students everywhere and speak about your patients from your interactions rather than your notes.

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StudentSpeak

StudentSpeak

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