Predicting the future of science and the Ph.D.

David-Edwards-bannerAs a child, whenever somebody asked me about my future, what I planned on doing when I grew up, I already knew the answer: I was going to be a physician. I enjoyed medicine, I liked helping people, and doctors, as a whole, seemed confident and glamorous. Becoming a physician was a confluence of everything I loved and wanted in a career. The question wasn’t hard, and the answer never changed.

Until, that was, I entered college. For a variety of reasons, I realized that I preferred medical research to clinical practice. I switched my interests over to graduate school instead of medical school and, years later, I am the struggling, nervous, easily excitable fourth-year graduate student who’s writing to you now.

And yet, despite this seemingly decisive change in my professional aspirations, I never regained that confidence I had as a child. I recently had my dissertation committee meeting, and when I was asked directly about my future plans (academia, industry, etc.), I admitted somewhat sheepishly that I didn’t know.

That’s the truth—I don’t really know. I have no idea about my future, other than (a) I will probably graduate with my Ph.D.; and (b) I will have significantly more white hair as a result of the effort.

But the indecision isn’t unique to me (despite the Imposter Syndrome-like feeling sometimes that I’m the one graduate student unable to pick a freakin’ lane career-wise). Not only are other students also having these tumultuous self-reflections, the entire scientific Ph.D. enterprise is undergoing seismic evaluations of its utility and effectiveness in training the next generation of scientists.

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Let’s get colorful!

StudentSpeak is pleased to present a guest post by Rajkaran “Raj” Sachdej, a second-year M.D. student and member of the Middle Eastern & South Asian Association (MESAA).

Yai re, yai re, zor laga ke naache re. Yai re, yai re, mil ke dhoom machaye re. Chal mere sang-sang. Le le duniya ke rang. Ho ja rangeela re.

MESAA-flashTrace your steps from the last time you walked into the Collaborative Life Sciences Building (CLSB). You jumped off the yellow and blue streetcar, trod neon-green bike paths, tripped over the silver tracks, smirked at the “platinum” LEED award and slammed the blue handicap entry access button – only for the colors to cease as you face white walls and concrete floors for the rest of the day.

Don’t get me wrong. The CLSB and its sleek, modern design has its merits. However, when it becomes your second home for 10 hours each day, cabin fever begins to set in and the chair sounds of 2-South certainly don’t help. Short of playing indoor paintball to break the monotonous stress of studying in a building lacking campus culture, on November 9, 2015, MESAA found a way to paint the town red.

MESAA, the Middle Eastern and South Asian Association, is a new student-led interest group. We aim to highlight medical and social issues of our communities while celebrating and sharing our iridescent cultures. Where better to show off those colors than the blank backdrop of the CLSB?

Aside from finding ways to bridge the spectrum of cultures, MESAA had one goal – to make people smile. But how? It was pretty obvious to us. Dancing is an integral part of both Middle Eastern and South Asian childhood experiences. From Bollywood performances at Diwali to dabke at your cousin’s wedding or bhangra for Vaisakhi to talent show belly-dancing – these experiences paint the pictures of our childhoods. Immediately, plans for a dance flash mob formed.

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So you want me to climb Everest?

Moss-BannerI was lucky enough to attend the annual OSNA Convention at PCC Sylvania where nursing students from programs all over Oregon came to expand their horizons as future or current nurses. There were breakout sessions led by professionals from many different areas of health care and leadership, from flight nursing to social innovation, and everything in between. I had the opportunity to sit in on a few breakout sessions, one of which delved into healthcare equity, and I was amazed, yet again, at the depth and width there is in the nursing profession.

The women who led the Healthcare Equity session, Nancy Sullivan and Christine Tanner, walked us through the limitations and injustices within our current insurance system. They not only shared statistics, but also stories about the people behind the numbers: stories about families crippled by monthly medical expenses and individuals who still aren’t able to navigate our convoluted system. Sitting there trying to soak in, question, and grapple with everything these women were sharing, I began to feel like I was dropped off in front of Mt. Everest and expected to give it a go – I mean for the sake of humanity. I’m the person that shows up without a rain coat or accidentally wanders off a trail because I am out of breath a quarter mile in. Everest has about zero appeal to me, and actually the idea of climbing it makes me want to pass out. Essentially, the level of brokenness in our healthcare system was so overwhelming it made me want to pass out a little.

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Are we there yet?

Lauren-LieblingWhen I first started at OHSU I had a certain impression of how the next 26 months of my life would unfold. Like so many of my peers, it had been a while since I had experienced a full-time classroom immersion. I anticipated that the didactic year of the program would be the more challenging of the two years that lay ahead. I had visions of few hours of sleep, little free time, high levels of anxiety and a sigh of relief come June of 2016 when I would become a clinical year student. I expected the clinical phase to be challenging in its own ways, but also somewhat comforting and reminiscent of my life before I enrolled at OHSU.

I know that I am not alone with this impression; in the early weeks of school as my cohort and I adjusted to our new roles, I often heard rumblings intended as encouragement, “We just have to make it to June… we just have to make it to clinical year.” Many spoke as if in the moment that we were cut loose from the classroom, school would suddenly feel easier. As the day that I transition to clinical year draws nearer, I must admit, my sentiment towards the didactic experience and the unknown chapter ahead have shifted.  

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At home on the range

StudentSpeak is pleased to present a guest post by Karli Erickson. Karli’s husband, Anfin, is a third-year medical student who hopes to specialize in general surgery. Together they enjoy two lively daughters and an 80 lb. Goldendoodle. When she’s not practicing the (very fine) art of homemaking, Karli is an OHSU Resource RN on 12C Labor and Delivery.

Ericksons-SS

“I think we should take up bird hunting,” my husband, Anfin, and 3rd year medical student says to me when I arrive in Heppner, Ore. with our two daughters. “Because we love dogs,” he adds to my furrowed brow. A few weeks into his rural rotation and that’s the big discovery he’s made.

For five weeks 3rd year medical students work on their clinical skills in smaller communities. We were in Heppner, Ore., population 1,307 according to Wikipedia. So just a touch smaller than Portland. The rotation is a great clinical opportunity for students, but logistically challenging for students with families.

For starters, timing. I was on maternity leave for the rotation. I’d make a joke about our perfect timing, but I’d only partially be kidding. When the rotation rolled around, our daughters were 2 months and 21 months. Families are welcome to accompany the student, but are responsible for their own housing.

In Heppner, the one and only housing option we found was a lodge that did long-term rentals. We will forever be grateful that the Kilkenny’s lodge was available to rent, and that the Kilkennys were both kind and accommodating. With cost and time constraints we only spent the last two weeks with our student, aka Papa, but it was worth it.

Out at our 20 acre lodge we had workable wifi and cable television, which is a television more than we ever have. Cell service, however, was limited in the area. The hospital had service; Verizon worked in the lodge; and according to our hosts, AT&T in the front yard. Alas, we mistakenly did not prepare a flow chart of protocol for communication mishaps.

See, we only had one car. If post-clinic Anfin was called into the ER, it could make for a late night. I would have had to wake the girls and pack them in the car to go fetch him. Thus, nearly every day the girls and I chose isolation and adhered to bedtimes over having a vehicle. As luck would have it, the one day we kept the car to explore Heppner’s very nice playground, disaster struck.

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Ready

Kakaday-BannerOriginally published on The Biopsy.

“Are your ready to see this patient?” asked my attending.

This patient was a young mother-to-be, otherwise healthy with her first baby on the way. I had hardly conducted any prenatal checks myself nor led a gynecological exam. I was vaguely familiar with the questions I should ask and distantly comfortable with the physical exam maneuvers I was to perform.

I had done them before, once, in a time that seemed so far past. Mentally, I weighed the pros and cons of leading this appointment. The cons seemed to stack up.

“Are you ready?” echoed in my head.

The hollow spaces hissed back, “No.”


She withered into a sliver of a woman after I told her the news, “Stage 4 pulmonary adenocarcinoma. You have lung cancer that has spread throughout your body.”

“But I was so healthy?” You could see her life decisions replaying in her eyes through a lens of doubt, questioning everything.

“I am incredibly sorry. I honestly don’t know what to say.”

So I sat there while she delicately sobbed her regrets away. My hand reached out and held hers. I’d occasionally add prognostic words – chemo, palliative, radiation, family – but they just evaporated into the room’s dark cloud.

“I’m not ready for this,” her eyes pleaded with mine.

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Finding ohana at OHSU

Pham-BannerHaving attended the University of California, Los Angeles for my first degree, I was initially drawn to Oregon Health & Science University for its reputation as one of the nation’s leading medical institutions. Upon the completion of my undergraduate career, I explored avenues in nursing-related research that worked mostly with underserved populations. OHSU’s outstanding research accomplishments pushed me to apply to its School of Nursing.

Being from Honolulu, Hawaii, I was initially hesitant to attend OHSU because I had never been so far removed from the comfort of family or friends (or the ocean). However, I ultimately chose OHSU because of my interview experience; I was especially impressed with the admission committee’s emphasis on working with the underserved. In my own life, I have undergone a range of meaningful experiences that have empowered me with the sensitivity to better understand the structural causes of health disparities. I have made it a priority to maintain this social awareness in a way that prioritises a balance between professional growth and personal health. OHSU wants to help its students maintain this balance. Students are given a plethora of resources that promote self-care and personal attentiveness. There are meditation rooms, student lounges stocked with coffee and tea, counseling services and even a light therapy room – all places where students can give themselves “personal attention.”

On a smaller scale, it is quite comforting to be able to walk through the halls of OHSU and be greeted with familiar faces and kind smiles; as an island girl, it makes my transition to the mainland not as intimidating and so much easier. The smaller university setting provides the opportunity for the cultivation of genuine relationships between the instructors and their students. Here, professors know your name, and questions are not considered a nuisance or a disruption during class time. OHSU gives students the opportunity to develop quality connections with clinical instructors and academic advisers because the small student-to-faculty ratio provides faculty with the space to be attentive to each student’s individual needs.

My feelings may be best encapsulated through a quote from the film, Lilo and Stitch. Lilo reminds us, “Ohana means family. Family means nobody gets left behind or forgotten.” In Hawaii, your ohana means everything, and I am so eternally grateful to be a part of the OHSU ohana, because boy, we sure do stick together!

(excerpted from the original blog post found at Times Higher Education)

“PA school cannot be done alone.”

Chris-Dirda-bannerI heard some variation of this phrase throughout my application process – during admissions lunches, from current students and from practicing providers. Prior to PA school I was usually a pretty independent person when it came to studying, and I took this to reflect on changing these habits to adopt a more group-study focus.

Six months into the program I found that this saying had a much broader meaning than I originally thought. I found that I had to rely on my family more than I could have even anticipated. For example, some nights before tests I’m not home until well after my wife and child are asleep. And my wife took a big risk in quitting her job and moving to a city where she had no connections. It was, and continues to be, difficult for me to ask them to make the sacrifices they do, but I know I could not make it here without them.

Beyond family, I found that I’ve needed my classmates more than I ever did in undergrad. By spending such an incredible amount of time with these people they became intimately involved in my life. Outside of studying, we commiserate, vent, blow off steam, explore Portland and have gotten to know each other well. Classmates regularly scheduled activities and get-togethers, especially after major hurdles in the program, and many turned out for them. The other day I thought about what an amazing job the admissions committee did in choosing our class. It really made all the difference in getting through these first few quarters.

For future PA students, or anyone in related programs, my advice would be to really get to know your classmates and spend time outside of class with them. It will be almost impossible to avoid doing this given the nature of these intense programs anyway, and it will make the time that much more enjoyable. If you do have family joining you through the experience, thank them regularly for the sacrifices they make to support you.

Three tips for Step 1 studying

Ally-Rich-bannerFrom what I can tell on social media, these lists of things are really popular to read. So, I give to you, the second year medical students, THREE TIPS FOR STEP 1 STUDYING:

  1. DO identify a person in medical school a year or two ahead of you to whom you can relate. For example, if you have a tendency toward anxiety, appreciate highly structured days, and tend to panic when plans don’t go exactly your way, I could totally be your person. I had a person like this who told me exactly what she did to prep for Step 1 and it was extremely helpful in creating my own plan. I identified with her when she spoke up at a peer-to-peer advising event, explaining that she spent Spring Break of her second year studying for Step 1, something that was entirely unnecessary. The connection was immediate.
  1. DO figure out what you need to succeed during study period. Then, block out what everyone else is saying that they are doing. Have confidence in your plan and stick to it! My person didn’t start studying during Spring Break because she thought she required this extra time to gain a knowledge advantage (I believe the popular term for this type of student is ‘gunner’), but because she knew that if she didn’t study she would spend her Spring Break stressing about not studying. It was for peace of mind. The daily exercise that one of your classmates may require may only add to your stress. Maybe what you need is a healthy pint of ice cream, or a family dinner, or a long walk with your dog. If I’m your person, you either need a brisk jog or a glass of wine. Stress. Evaporated.
  1. DO prepare for the feeling that you are failing Step 1. I hope this doesn’t trigger panic, as that is not my intention. On the contrary, I hope that you can acknowledge the feeling, take it in stride, and not let it affect your performance. I am happy with how I did on Step 1, but somehow I missed the memo about how terrible Step 1 makes you feel. I remember having a moment in the midst of the exam where I imagined what my life would be like if I simply went back to waiting tables. As a side note, I don’t recommend zoning out in the middle of Step 1, as the time crunch is real.

I hope that you enjoyed reading this list. Maybe it will get shared across all of Facebook and I’ll be a social media CELEBRITY. Hopefully it helps one or two of you MS2s during your study period and beyond. Also, I’m really not an anxious person. I just run a lot and drink wine occasionally.

The Power of Continuity: Reflections from the Safety Net

StudentSpeak is pleased to present this guest post by Sylvia Peterson-Perry, MS3 who is dually-enrolled in the M.D. and MPH programs. 

Sylvia-sharpI first met John* while on my 3rd year inpatient internal medicine rotation at OHSU. He came in to the hospital for a swollen, painful left leg, was a current active IV heroin user, was homeless, and had no possessions but the dirty clothes he was wearing. He ate the hospital food more eagerly than any other patient I had during my 5 weeks on the wards, and was so excited when he was able to shower and change into hospital clothes. Not long into his hospital stay, John was found to have a huge intramuscular abscess, which we drained and treated with IV antibiotics – the medical management of his condition was relatively straightforward. However, the rest of John’s care was anything but – this hospitalization had been a wake-up call to him, and he was hoping to get in to treatment for his opiate addiction; he had no place to stay after we discharged him (with a still draining wound); he had no way for us to contact him for follow up; he didn’t even have clean or warm clothes. Most of the time, I think this would have been one of those cases that contribute to the depressing research on medical students losing their empathy and becoming more cynical during their 3rd year**. From my understanding, the usual situation for a patient like this would be a conversation with a social worker, who could maybe provide a few days in a motel and a list of shelters and places to go for donated food and clothes, encouragement (and maybe a list of resources) to stay off of heroin, and then discharging him essentially to the streets, where using again and being hospitalized again for the same condition is almost inevitable. This then contributes to burnout and associated victim-blaming thoughts and comments from providers that patients like this never change and aren’t worth putting effort into, because they will just go back out and use.

Fortunately, this was not the case with John.

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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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