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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One down, seven to go

The leaves are turning, the clouds are rolling in, Portland is once again being spritzed like a grocery store vegetable, and the cohort of 2016 has finished their first quarter of PA school!

Reflecting on my first quarter, it has been both exciting and challenging. I began not knowing what to expect. That first morning in the Collaborative Life Sciences Building, I met an incredible group of people: faculty, staff and students. One of the things that struck me right away was how diverse, interesting, and professionally well prepared my classmates were. Quickly we have become a family where each person is valued and brings something unique to the group. As graduate education is both rewarding and incredibly rigorous, the fact that OHSU fosters a non-competitive, collaborative environment was one of the many factors that made it my first program of choice. I feel very fortunate to progress on this journey with a group of people who support one another and to be able to work with incredibly knowledgeable faculty and staff who are 100% invested in our success.

The past quarter has had several highlights. I am astounded at the amount I have learned in such a short time! For example, in the past two months, I have learned how to perform a head to toe physical examination. Next quarter, I look forward to putting these skills to use when I begin my clinical mentorship with a PA practicing in family medicine. Further, last week the first year PA students attended an event called Grand Rounds where second clinical-year students presented a patient case to their peers and faculty. I was happy to realize that after only two whirlwind months, I was not only able to understand the content of their presentation but think clinically through the questions they presented. They did great!

The most exciting experience of the quarter without a doubt was the OSCE (Objective Structured Clinical Examination) that my class participated in right before the end of summer term.

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Little Big Sib

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

Medical school is exhausting. I doubt that is a shocker to anyone. There were times over the past year I wondered if it was actually survivable. When I have been asked to do something hard, I have looked to other people who went through it before me and had the good fortune to find great peer mentors throughout my education.

Here at OHSU, two med students from the class ahead of me took a special interest in helping me out. One of them was my Big Sib, Kim, and the other a friend-of-a-friend, Curtis. Over the course of the year I received encouraging notes in my mailbox, treats, e-mails with resources, study guides, textbooks, advice about picking a research project, even connection with my current PI and help with my research. I always knew if I had a question, or couldn’t figure something out on my own, I had someone to ask. Just knowing I had people to fall back on was comforting.

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It’s a seller’s market here in Portland

I’m sure I’m not the only student who was affected by the absolutely insane real estate market here in Portland. Right after I received my acceptance to OHSU, being the overachiever I am, I started looking for apartments in the South Waterfront. In Eugene, finding an apartment wasn’t too hard, probably because everyone who lived near campus was a student who moved out in July and moved in in September. Unfortunately, this isn’t the same for Portland, where people actually live here for an extended period of time. The market was cutthroat to say the least. I remember asking repeatedly for time off work to make the boring two hour drive from Eugene in order to stumble into just one more apartment viewing. On top of that, viewing the apartments was one disappointment after another.

Running primarily off Craigslist, I saw apartments ranging from living above someone’s detached garage to gorgeous 1940’s spacious duplexes where the landlord only accepted the rent/deposit in all cash. I had been lured with the phrase “you’re the perfect candidate for this apartment, we would love to move you to the top of the list” only to get a call an hour later saying that someone else was quicker. I had been strung along for months with the hopes of an apartment in a renovated 1910 hotel, but I couldn’t sign a lease because my PDF application was too hard to read, even though it was typed. I had driven up for an open house, stepping in the door only to see some other person talking with the landlord saying “I’ll be right back with the deposit check.”

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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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