The question we all know is coming

I am halfway through my third year of medical school and so far, I absolutely love it. I feel one thousand times more like a doctor than I did six months ago, and I’ve learned more in these six months that I had in the six years prior. And I’m not just saying that – third year is high yield beyond belief.

By this point, we’ve all answered the golden question hundreds of times. Everybody asks it – family, friends, doctors, patients, strangers on the street – they ask in all types of ways, but it’s always the same underlying inquiry: “What are you thinking of doing after med school? What specialty are you going into? Have you thought about what kind of doctor you want to be? So, David, have you given any thought to what you might actually want to do with your life?”

As a first year student, I would answer this pressing question with whatever I felt like in the moment – cardiothoracic surgery one day and dermatology the next. If I had just read an article about ICU medicine, “pulm crit care” would roll right off the tongue. For most of my first two years, these words were sexy-sounding ideas that would light up people’s eyes and had no base in reality: “Wow, David, you’re going to be a plastic surgeon!?” Which was my cue to say, “Yep, absolutely, it’s a done deal.”

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Understanding the symbolic power of my white coat

Like many Americans, I have been confused, surprised, angered and saddened (often all at the same time) by recent events in Ferguson, Cleveland, New York and too many other cities across our country. More specifically, I cried when I learned of the grand jury’s failure to indict Darren Wilson in the murder of Michael Brown, an unarmed, black teenager in Ferguson, Missouri.

In response, for the first time ever, I decided to attend a rally and march in Portland protesting these events and the underlying challenges they present for our society. For me, this decision also required me to consider for the first time the role of my white coat in making a statement at the rally. Would I attend the rally as a future physician, a citizen or some combination of both? And what is the significance of my choice?

Our white coats, short though they still are, are symbols of our profession. Our profession is one held up by many in this country as one of educated, responsible, kind individuals, and we are conferred rights, privileges and responsibilities by virtue of our engagement in this profession (much like, some might comment, police officers). We were told so at our white coat ceremony, when we stood and took the Oath of Geneva for the first time. We are told so when we are held to the highest standards of professionalism, defined by our profession and our academic institution.

Can I, then, represent my profession, not just my person, at this protest? I protest what happened in Ferguson as an American, as a person of color, as a citizen, as a civilian and as a human being. Do I also protest it as a medical student?

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Trust the Process

Ann McWhorterStudentSpeak is pleased to publish this guest post by Ann McWhorter. Ann is in her last week of the Accelerated Nursing program at OHSU.  Nursing is her second career, after more than 20 years practicing law.  She intends to pursue a career focused on older adults and end-of-life care.

As I near the end of my journey through OHSU’s accelerated nursing program, I am reminded of the mantra we heard so often at the beginning: Trust the process.

That first term, I was struck by the warmth and generosity that surrounded me – in the faculty and in my classmates. As a second-career student, I have studied and worked in many settings where standards were high and the people around me were impressive. But never had I been in an environment so filled with smart, impressive people motivated not by personal gain or competitiveness but by the desire to be of service.

It was clear from the outset that the faculty had the best of motivations. They are, after all, nurses. And they are among the best and brightest nurses. They wanted us to succeed. They wanted us to grow into well-rounded professionals, equipped with knowledge and skills ranging from pathophysiology and patient assessment to a broad and deep understanding of the healthcare system and opportunities to improve it, the experiences of patients and families, and the social and economic determinants of health. They worked hard to keep improving the program, coordinating content and timing across courses to reinforce concepts and make our learning experience the best they could. In short, I could see quickly that these nurse educators were good people, worthy of my trust. So I relaxed my guard, and I trusted the process.

It has been hard, hard work. It has taken humility and perseverance to make my way through this learning experience. But as I near the threshold of my new career and a lifetime of continued learning, I look back satisfied that my trust was well-placed.

Algorithmic Medicine

C++, JavaScript, HTML5. These languages are the backbones to the computer programs we take for granted every day. My mom, a software engineer, will repurpose symbols and codes into commands that yield computer applications and webpages. What is software? No idea. But what I do know is that there are commands and functions that allow a user to interact with the computer and perform specific tasks.

To me, medicine seemed like the furthest thing from software engineering. It is about patient relationships, communication, and improving quality of life. Yet, somehow, I discovered a connection between algorithmic codes and the practice of medicine. The challenge of the third year of medical school is not only the long hours and new expectations; it is learning the codes and cues that make up the language of medicine. I spend every day trying to rewire my brain; creating algorithms that I can access on command. This may be a gross over-simplification, but let’s just run with it. In my new system, symptoms are no longer descriptions of a patient’s experience but a command input that enters my brain to trigger an output that stipulates the possible diagnoses, work-up, and treatment.

For example, a patient in the ER tells me he is having chest pain. Input: chest pain. Output: 5 most dangerous causes of chest pain: myocardial infarct, aortic dissection, pulmonary embolism, pneumothorax, Boerhaave’s syndrome

I tell people that “I am working” to simplify what I am really doing: creating a systematic thought process that I will hone over my career. Two years of lectures, excessive highlighting, and one USMLE national exam later, I have a lot of data with no organizational system. My brain feels like a file cabinet that needs to be alphabetized, cross-referenced, sorted based on pre-test probability, and then converted into electronic format. Needless to say, there is much work to be done. Every day a new piece of the puzzle falls into place.

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What is a preceptorship?

That was the exact question I was asking myself when I started medical school and even up until my first day at the clinic. There isn’t a very good definition on Wikipedia and it’s definitely not in ye ole trusted Miriam Webster. Even asking older students led to a multitude of definitions ranging from “glorified shadowing” to “being a doctor’s assistant.” Both of which were not entirely satisfying. It wasn’t until I started a couple weeks ago, that I uncovered what a preceptor was: a role model for patient interaction.

It’s difficult to learn how to build a relationship with a patient or deliver bad news purely from reading journal articles and practicing with classmates. Reading evidence-based practices for introducing yourself and shaking hands is helpful, but not the same as doing it with someone you’ve just met. Sitting down and setting an agenda for a fake patient interaction with your friend that you spent all of last night studying metabolism with, is not the same as starting your first conversation with a patient. As much as you pretend to not know each other and create that reality, you can’t help but talk about that one quiz question from last week or your fellow classmate’s birthday dinner tomorrow night. It’s great practice – with your classmates you can feel free to completely mess up, to forget a couple points and try out new questions – but not the same as sitting down with someone who is genuinely sick or in terrible pain and trying to communicate with them. Class gives you the tools to communicate with patients, but preceptorship allows you to watch a professional do what you’ve spent weeks practicing with style and grace.

In my preceptorship, we work with many people who are needing end-of-life care. Most of our patients are very sick and have been sick for a number of years.

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New Kid on the Block

I’m in grad school.

It’s kind of weird for me to say that because it still feels new to me.  I’ve been in the Behavioral Neuroscience Graduate Program at OHSU for just little over a month, and there are so many things I want to share: moving to a new city, my first rotation, being back in class after a two year hiatus… I’ll spare you from most of it for now.

I imagine my first month in Portland has been similar to the initial response a mouse experiences in the open field arena.  You know, novel environment, isolation from cage mates, and all that.  There’s a fear of danger but a desire to explore the unknown.  I’ve already learned a lot from my initial exposure to grad school though.  For example, homesickness can hit you hard no matter how short the time away.  Cry, call home, do what you need to, but remember to appreciate that you have a home worth missing.  Or on a more practical note, with the recent power outage on campus, I’ve learned class material—like what to do in the case of missing data—can quickly become relevant during your rotation.  (I mourn your loss, missing circadian activity data.) And of course there’s the scientific research, the reason I’m here.

When offered an opportunity to write for StudentSpeak about my graduate experience, my interest was immediately piqued.

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A belated welcome!

A warm welcome to my new OHSU student colleagues! It is hard to believe that the fall term started over a month ago. The new student orientation is over and midterms are upon us.

I wanted to take a few minutes and share some thoughts with my fellow mid-career adult students. First, take a minute to congratulate yourself on your decision to further your education. Few people who are mid-career return to further their education, or perhaps initiate a career change. Even further complete their goals. The commitment of the faculty here at OHSU is to help you succeed. You will be one of those who make it!

To accomplish this you will need the support of your family and friends though not all your friends will be up for the challenge. Stay with the friends who support your choice; they will help you succeed.

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T-minus 2000 hours

Prior to PA school, I primarily worked as a pathology technician performing gross dissections (in the macroscopic sense, but often in the literal sense too) of human tissue in Anatomic Pathology. I could slice my way through gallbladders like it was nobody’s business, releasing that sludgy green-brown material known as bile that lets french fries, cheese and everything sacred exist in my diet. I could describe every minute detail of a perforated appendix on my pathology reports, forming a word-picture vivid enough that my supervising pathologist would rarely have to re-examine my work. I was GOOD at my job – and then I came to PA school.

OHSU’s 2000-hour direct patient care requirement, the equivalent of 12 months of full-time work, was daunting to a lab rat like me. I felt like I was constantly counting down from 2000 to satisfy the pre-req. During this summer quarter, most members of our class awkwardly clutched oto-/naso-/opthalmoscopes because very few of us had ever used the equipment before. Where I first felt a divide with my lab background was when we learned how to take a history of present illness. My classmates who were EMTs, paramedics, MAs, ER scribes and CNAs seemed to have the medical interview roll off of the tips of their tongues. By far, exploring the seven dimensions of an HPI has been the most challenging aspect for me as a PA student. In the lab my “patients” were tissue and had I started talking to them, it would’ve been a clear sign that I had enough formalin exposure for the day.

Jump ahead to fall quarter and our clinical medicine coursework is now in full swing.

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Dream big, Little One

StudentSpeak is pleased to publish this guest post by Jessica Petrovich, MS2. Jess participated in one of OHSU’s Science Education programs helping inspire and support underrepresented students in the sciences.

Dream Big, Little One. It is scrawled in my mother’s handwriting on a scrap of paper. Underneath it she taped a small photo of me as a toddler, staring hopefully at some unidentifiable object in the background. Well aware of the risk of exposing my inner cheese-ball, I have to admit that this scrap of paper has been on my fridge for the last six years. Sometimes, when I feel myself melting into a puddle of hopelessness and self-doubt twelve hours before a big exam (that’s kinda my thing), I stare at it until I am convinced that everything will be okay. Everything will be okay. Everything will be okay.

Truthfully, I have experienced nothing but support and enthusiasm throughout my education. There are plenty of kids who are not as fortunate. In my “gap years” between college and medical school, I taught elementary school for AmeriCorps. Many of my students came from families that were struggling to learn English. Often, when parents were balancing two jobs just to put dinner on the table, academic resources and support were compromised.

It worried me to hear that students as young as six didn’t like science and that “math was stupid and just too hard.” By the first grade, they had already resigned to the idea that they just weren’t cut out for those subjects. I spent the next two years trying to change their minds. Entering medical school last year, I wasn’t sure how I would incorporate my enthusiasm for mentoring kids, but then I found a program called On Track OHSU.

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Family ties

StudentSpeak is pleased to publish this guest post by Jesse Goldfarb, MS2. Jesse participated in OHSU’s student-led peer mentoring program for first-year and second-year students.

Questionably competent second-year medical student, 24, seeks slightly less competent and moderately impressionable first-year.

I don’t have any real little siblings. My mom wouldn’t have one for me. And when thinking on that deficit, all I am left with are her empty, feckless excuses. “Your father and I are divorced,” she would say. Well, not good enough, Mother. “Jesse, I’m past reproductive age.” Uggghh, whatever Mom.

I would daydream about it. Teaching a little brother that if he forgets the words to the Blessing of the Candles on the first night of Chanukah, he should just make up new words with a lot of ‘cccchhh’ sounds in them. Or introducing a little sister to The Pixies when she was feeling angsty or to David Foster Wallace books when she was feeling… well, angsty. Or just asking them to stand up for their friends and to not be mean to anyone and to think for themselves and to find the things that they loved and explore them with everything they had. I never got to do any of that.

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StudentSpeak

StudentSpeak

Ever wondered what life is like as a student at OHSU? What does it take to become a researcher? Just how gross is gross anatomy? Welcome to the blog that answers these – and many other – questions. It’s students writing first-hand about their commitment to careers in science and health care. It’s honest about the challenges as well as the joys. It’s not always pretty. But it is our story. Thank you for sharing it with us. And please, let us know what you think.

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