Thursday, August 31, 2006

Protection of Human Subjects Training

I don't think I've mentioned yet that we were required to do an online training session concerning the protection of the rights of human subjects in research. About a month ago this announcement just appeared on the portal telling us that we had to complete it by September 1, which is, um, tomorrow! Naturally, even though we were all told not to wait until the last minute to do the training, we have almost all waited until the last minute to do it, including me. There are about twenty little modules you are supposed to read through, and they cover things like special protections for vulnerable subjects (prisoners, children, students/employees, etc.), HIPAA rules, and other issues about ethics in research. Each module has a multiple choice quiz at the end. They aren't very hard to do, but they're not the most exciting thing in the world, either. I just finished mine and emailed the certificate they give you at the end to the office. The best news about the whole thing (that's sarcasm here, if you weren't sure) is that we will have to redo it in a few years because the training expires. Sigh.

I didn't realize before I got here how much time I would be spending on these kinds of things. I guess it is still hard for me to remember sometimes that from now on, I'm not supposed to be a layman any more, because I still feel like I'm a layman. It's kind of funny to see my classmates wearing their beepers or when all of us get dressed up and wear our white coats for a patient presentation, because of course none of us knows anything about treating people yet. But in a few more weeks starting in October, we are going to start going to our clinical preceptors and actually learning how to be a doctor. That is both exciting and scary to think about!

Wednesday, August 30, 2006

Preparing for New Groups and Objectives

The new groups for PBL starting in October and going through all the rest of the year are now up on the portal. So of course we all had to spend some time today going through them to see who we would still be with next block from our PSS group. One of my PSS group members is with me in the first PBL group. The groups will be changing each block though, so we won't be together any more after that. Our first block is going to be the cardiovascular system. We have to get a ridiculous number of books. This is going to be an expensive semester! The good thing though is that most of these books are used for the entire first year. After this we will only have to buy a couple of books each block that specifically pertain to that organ system.

On a mostly unrelated note, for every PSS, we have a list of objectives that we are supposed to get out of doing the reading for that day and also from the problem set. Today's PSS went fine, but the objectives for the session had absolutely nothing to do with the reading that we had. I guess the course director figured out the same thing, because she sent us a revised list of objectives afterward. It's not a big deal in the whole scheme of things, but since my group likes to prepare the objectives and go over them before starting on the problem set, it kind of made things confusing for us today.

Tuesday, August 29, 2006

Tay-Sachs Disease Seminar and Class Meeting

We were supposed to have a patient today, but this was changed yesterday, and no email was sent out. Not all of us checked the portal this morning, so several people showed up to class today dressed in their shirts, ties and white coats. The seminar speaker and topic were both interesting, but I was disappointed that we did not have a patient after all.

Tay-Sachs disease is a genetically inherited lipid storage disorder where there is a deficiency of a certain lysosomal enzyme that breaks down a type of glycolipid called ganglioside GM2. Since they can't be broken down, these lipids tend to get stored in the neurons, resulting in a lethal disease. The patients are usually infants when they first start showing the effects, although adolescent and adult onset forms of the disease are also known but are rarer. The infants wind up regressing developmentally, go blind and deaf, develop seizures, and die as young children by age four. The disease is more common in children with parents who are related to each other, and also in Eastern European Jews.

After our seminar, we had another class meeting. The administration wanted to talk to us about our orientation experiences, and the general consensus was that we spent way too much time listening to people talk to us with powerpoint slides, and there was not enough of a hands-on experience with many of the aspects of the curriculum they were presenting to us. The social activities and the student handbook were more helpful to us. We also wound up spending about half the time discussing what we were supposed to be accomplishing in the lab this summer. It seems that a lot of us initially thought that we were supposed to actually complete a project. Dean Fishleder assured us that this was not the case, and that the main point of the summer project was for us to gain some lab experience, learn new techniques, and get involved in a project and in the workings of the lab in general.

Monday, August 28, 2006

Back to PSS and Registration Deadline

Today we went back to our regular PSS groups. We were discussing regulation of signaling pathways in relation to transcription factors. Most of the questions in our problem set were about estrogen receptors and tamoxifen, which made for a pretty interesting session. One interesting thing that I learned today is that tamoxifen can also be used in men who have breast cancer, assuming that their tumors are estrogen-dependent. Also, I hadn't ever considered this before, but somehow tamoxifen is selective for estrogen receptors in the breasts. This may not sound all that amazing, but it is when you consider that when a patient takes a dose of tamoxifen, it goes all over their body. It's not like the drug molecules "know" that they're only supposed to go to the breasts, and there are lots of other cell types all over the body that have receptors for estrogen that could potentially also bind tamoxifen. But the thing is that you don't want tamoxifen to be active anywhere else. Apparently the developers of tamoxifen tried and ruled out several other estrogen antagonists that did not have the proper selectivity before deciding to carry tamoxifen forward as a drug.

Today was the last day to register for classes over at Case. Those of us who are doing MS degrees were supposed to register for courses by today, but it turns out that you can retroactively add classes later, up until next week Friday. I have decided that I am definitely going to get an MS. This semester I will not be taking a real class, but I will be taking a required seminar where I'll have to go over to Case on the weeks when they have a speaker. Next semester I will take the first real class toward my MS. Most of the M1s are not taking much in the way of extra classes yet. Our PAs don't want us to be overloaded during our first real semester here.

Saturday, August 26, 2006

FAQ #6: How Much Research Background Do You Need to Apply to CCLCM?

This is a subject that comes up fairly regularly, and it is impossible to say that any specific amount of time or accomplishment in a lab is necessary. Also, no research accomplishments can in and of themselves guarantee that you will get admitted here or anywhere else. With those caveats, I would answer this question by saying that your research experiences should be "significant."

What does that mean exactly? Well, it will vary by the person, but I would liken applying to CCLCM to applying to an MD/PhD program. You really do need to have a research background of some type if you want to come here, along with all of the shadowing and volunteering ECs that all medical schools look for in their applicants. Most of the students in my class have spent at least a year working in a lab, and many of us have spent significantly more time than that. As I've mentioned several times already, some of my classmates even have graduate degrees. So if your research experience consists of washing glassware for a semester, I would say that this is inadequate.

That being said, no one expects you to come in here having published ten papers, either. I think if you have done an undergraduate honors thesis, or you have have taken a year or two off to do research after college, that is "significant." Also, the research does not have to be in a biomedical science lab necessarily. We have several people in our class with backgrounds in engineering, physical sciences, computers, social sciences, and ethics. So if you go to a school where you can't do biomedical research, or if you're really interested in working with a professor in a different field, then there's nothing wrong with choosing a lab in another field, or doing research in a non-science area. You should do research in a subject that interests you and that you are enthusiastic about.

One other test you can use if you're trying to decide whether your research background is "significant" is whether the professor you're working for can write you a good letter of recommendation that describes your research abilities with specific examples. If so, then again, that would count as "significant" research. But if this person doesn't even know who you are, that's not a good sign.

Friday, August 25, 2006

Conclusion of Bioinformatics

We spent more time today learning more about the same protein we've been looking at all week. Basically we wanted to find out which chromosome its gene is on, which we did. We also found out which genes were its nearest neighbors. From what we can tell based on the gene maps we had, none of the neighboring genes overlaps with the one we were looking at. After we looked at the human version, we went and looked at the same gene in mice. It turns out that the gene neighbors are the same in mice as they are in humans, except that the order on the DNA was reversed. This apparently means that the gene is on the opposite strand of DNA in mice versus in humans. Today was our last day of bioinformatics, and I am seriously glad. I can appreciate the importance of bioinformatics, and it's good that some people want to do it. But I'm not planning to be one of them ever again!

The rest of the day was pretty long for me. Our journal club articles were both on Marfan syndrome. That is a genetic disorder of a protein in the extracellular matrix called fibrillin. I'm not really sure what Marfan syndrome has to do with bioinformatics, but it was interesting to read about nonetheless. I went to the lab in the afternoon, and I didn't wind up finishing my work until about 8:30. After that I was pretty much ready to just go home and crash.

Thursday, August 24, 2006

Pathology, Histology, and SEM Lab Tours

After getting over my initial annoyance at having to be at school bright and early this morning instead of getting to sleep in a little, I have to tell you that I think pathology is awesome! We went on a tour of the pathology lab, and it was really interesting. They had us gown up, and they showed us a colon with polyps in it and a rectum with a cancer in it. We also saw a liver with cancer in it. The liver still had the gall bladder attached, and the gall bladder is very easy to recognize because it is bright green. When the resident cut it, all kinds of dark green bile came oozing out. I never knew until today that bile was so green. The last thing we saw in the path lab was a tech who was dissecting lymph nodes from a patient with breast cancer. She let me touch the nodes, and they feel kind of like hard lumps. Some were enlarged, which she said was not a good sign.

Afterward, we went to the histology lab, and we saw how they make slides. It's a very complicated, multi-step, labor-intensive process. The tissues have to be sectioned, embedded in paraffin wax, trimmed, placed on slides, stained, fixed, labeled, and distributed. I didn't have an appreciation until now of how much work goes on behind the scenes like this. When you go to have a biopsy or a surgery as a patient, there are a lot of people in the hospital who work to prepare your slides for the pathologist.

The last thing that we did was to see the scanning electron microscope (SEM). It was a little confusing because we really didn't know what we were looking at, but the operator was explaining some of the structures to us. We were looking at a kidney slide, and he showed us part of the glomerulus, which is the capillary bed that acts as a filter for the nephrons in the kidneys. The impurities that your kidneys filter out leave the glomerulus and pass into the nephron, where they ultimately get excreted in the urine. We also saw some rough endoplasmic reticulum, and he tried to zoom in on a ribosome for us, but it was too dim for us to be able to see it. I guess I'll just have to take the textbook's word for it about what ribosomes look like.

All I can say after this is that pathology is definitely on my list of possible specialties. I'm not sure yet what I want to do when I grow up, but this is something that I'm considering. It's just really interesting.

Wednesday, August 23, 2006

More Bioinformatics and a Mystery Solved

We had another bioinformatics PSS today; basically we kept going from where we left off yesterday. My group spent most of the time trying to figure out what domains were present in our protein, and what domains were homologous to it in the proteins of other organisms. We found lots of other vertebrate proteins (frogs, birds, mice, etc.), but we also found some insects (flies, mosquitoes) and even some bacteria, viruses and fungi. Of course, the farther out you go evolutionarily, the less correlation there is between those proteins and human proteins.

Today I finally solved a great mystery. I kept hearing this random beeping noise every so often. It wasn't horribly loud or annoying, just four beeps, then nothing. It turns out that it was my pager, and it is apparently beeping at me because I've received some pages over the past two months. There were five total, and I figured out how to retrieve them after a while of playing around with it. Ironically, only one was actually meant for me. There was one page that was clearly intended for someone else....I don't know that person, and I was not in on that particular tidbit of news, but it was interesting to read all about it! One other was some random phone number that I didn't recognize, and the last two were just single digits. I have no idea what those are about. The bad news is that I haven't figured out how to erase the pages yet, so the stupid thing is still beeping at me. For now, I've muffled it in several layers of bags, and I'll read the instructions later when I have more time. I don't even need it yet, but I already am finding out that I do not like having my own beeper. That, and it is a very bad idea to send personal messages by could be sorry if you screw up and send it to the wrong person.

Tuesday, August 22, 2006

Bioinformatics PSS and Birthdays

We did our first PSS on bioinformatics today, and it was a lot better than yesterday if for no other reason than that we were actually doing something. Basically, we were given a protein and instructed to use the NCBI (National Center for Biotechnology Information) website to find out various things about it, such as what proteins in other organisms it is homologous to, how many isoforms of it there are, and how those isoforms are related. There were eight questions total, and we got through two of them and most of the third, so we will finish the rest of them tomorrow and Friday. I felt that the website we were using to look up this information wasn't particularly user-friendly, but apparently there is another European site that is easier to use, so I think tomorrow we are going to try that. On the other hand, there were some neat features of the site, like the tool that it uses to match up the proteins. It's kind of impressive how much homology there is between the human version of the protein and the versions in mice, frogs, zebrafish, and even rice plants.

On a completely different note, this is kind of a freaky thing: there are four people in the class whose birthdays are all this week, one after another. Since there are only 32 of us, that's a pretty impressive coincidence. Actually, it seems like half the people in my class have their birthdays in August; there were some more birthdays earlier this month, too.

Monday, August 21, 2006

Good Times Cruise and Bioinformatics Seminar

Last night we had a cruise sponsored by the CCF alumni association. It was apparently for residents and employees of CCF as well as the medical students. They had a small ship called the "Good Times" that took us for a two and a half hour ride up what I think was the Cuyahoga River. The scenery was basically just piles of dirt or rocks and other urban landscape, but the cruise itself was fun. I think almost all of the medical students came, and they served us dinner, gave out prizes, and played music. One of the students in my class won some passes on Lolly the Trolley. Lolly is something that cannot be described; it has to be experienced to fully appreciate it. We got a tour on it last spring during the second look weekend.

Today we had a seminar on bioinformatics instead of a PSS. We are going to be working on bioinformatics all week. (Bioinformatics is the use of computers to analyze problems in biology like protein and nucleic acid structures, relationships, etc.) I think it would have been a lot more effective and useful if the speaker had gone over some sample searches with us and had us do them in class with her and the tutors available to help us instead of just presenting a powerpoint lecture with us listening passively. It seems like the best way to learn how to use these databases is to actually spend time using them. For the rest of the week, we are going to be working in small groups on problem sets though, so we'll have the chance to try it ourselves. These groups are not the same as the PSS groups we've been working in so far, although some of my PSS group members are also in my bioinformatics group.

Saturday, August 19, 2006

FAQ #5: How Much Harder Is Medical School Compared to College?

This is a very difficult question to answer for two reasons: people's college experiences vary significantly, and people's learning styles and medical schools' teaching styles also vary significantly. So with the caveats that I'm speaking only for myself, and also that I've only finished my fifth week of medical school, I would say that so far at least, medical school has not been "harder" than college was in terms of the level of conceptual difficulty. But it is definitely more challenging than college, for at least two reasons.

One thing that makes medical school more challenging compared to college is that the pace in med school is a lot faster. Topics that might take you several weeks to cover in college get covered in med school in a day or two. We are doing our entire biochemistry/molecular biology unit in 10 weeks, for example, which is way less than even a single college semester. (That's why college biochem is a pre-req for this program!) Plus, in med school, you have to do a lot more of your learning independently, especially in a program like this. There aren't any teachers here to spoonfeed this information to you in lectures; you are responsible for doing the reading and seeking out whatever extra help that you need on your own. Overall, I think that it's great to be able to learn things at my own pace, but it's a little scary sometimes too, because you still have to keep up with the class's pace. For that reason, I study every single day here, whereas in college I could get away with not studying every day for a lot of my classes, and for some of my college classes I'd even only study the day before the exam. It's very clear to me already though that the procrastinate-and-cram strategy so many of us used to get through college won't work very well at CCLCM.

The second thing that makes medical school more challenging than college is that your classmates are a lot brighter and more motivated on average in medical school. A lot of people, myself included, were used to being the big fish in the little pond in college. Many if not most of us were the top students in our classes. So now all of a sudden the bar is raised, because basically everyone here is really smart and a really good student, or they wouldn't be here. I think you will find that to be true at any medical school around the country, but considering that we have been working together in small groups to solve problems here at CCLCM, I am constantly being made aware of how much I don't know that other people in my class do! It can be a little intimidating to be in this kind of high-intensity environment sometimes. But I think that overall it is to my advantage to be going to school with so many highly accomplished people, because I am learning a lot from my classmates and not just from my books and the faculty.

Friday, August 18, 2006

End of the Fifth Week

It's hard to believe, but we're officially halfway through the summer session already. Most of my friends who are starting med school at other schools are just starting now, and some won't be starting for a few more weeks yet. In a way, it feels like I've been here for a very long time, just because so much is packed into each day. I can't say that I've learned much about medicine per se so far, but I've definitely learned a lot of molecular biology. And that is going to change when we start our clinical preceptorships in October. Our clinical preceptors have already been assigned to us. Mine is an internist.

Speaking of molecular biology, today was another PSS day. We covered translation of mRNAs to protein and processing of RNAs after they are synthesized in the nucleus. I think that today the questions were about the right level of difficulty and the length of the problem set was also about right. We weren't done early, but we weren't struggling to finish, either. The journal club articles were both related to nucleic acids. They were shorter this week than usual, but that doesn't mean they were any easier to read!

Tonight I am going to see Little Miss Sunshine with some friends. We actually don't have any reading from our books for next week because we are doing a special unit on bioinformatics. But we have a ton of lecture slides that we are supposed to read on line. I was looking through them, and there seriously have to be about 1500 of them, arranged into 18 sections. Luckily, most of the slides are pretty brief. But wow, that will definitely keep us busy this week.

Thursday, August 17, 2006

Starting a New Experiment

We're now basically halfway through the summer basic science module, and I'm getting ready to start a new type of experiment in the lab. So far I've mostly been learning molecular biology techniques and doing simple but necessary things like preparing buffers. I've learned to run a gel and do a Western blot, which I thought was really neat the first time I did it because we had read about these techniques in class. I didn't think it was nearly as neat the second time after the novelty of it had worn off though! On the bright side, I've gotten pretty good at loading and running the gels now. The first time I did it, it took me a few tries before I figured out how to get the samples into the wells where I wanted them to be. Everything is very small scale.

The new experiment is going to be something entirely different that doesn't involve gels or Coomassie stains or antibodies against antibodies against the protein. I've got a ton of reading to do about it this weekend. What I'm going to be doing is studying how a protein binds to its ligand, and the tricky part is figuring out how to quantify the amount of ligand that binds. We're still working on coming up with a reliable way to do that. No one has ever made this measurement for this protein, so if we can get this experiment to work, we will actually be contributing something new and useful to the larger projects going on in the lab.

Wednesday, August 16, 2006

PSS Overload and Evaluations

I don't think that I realized until now how mentally exhausting the PSSes are. Normally we have Tuesdays "off" so to speak, because seminars don't require nearly as much preparation nor participation in comparison. But now that we've had three PSSes in a row, all I can say is that I am very grateful that we don't usually have them every day in a row like this! Today's PSS went over transcription, and for some reason there were way more questions than usual. We managed to finish them in time, but just barely, and we were definitely feeling rushed. Normally, there are only three to four pages of questions, but today there were five pages. Wow, that was way too much.

In other news, we have received evaluations from all of our group members now, and also from our facilitator. As I've explained before, the evaluations are supposed to tell you about your strengths and also about the areas that other people feel you should try to improve. The student evaluations are anonymous unless the students choose to put their names in the comment section. My group members were only evaluating me on professionalism, but the facilitator was also evaluating us on our knowledge and contributions to the group as well as our professionalism. I think that my group members and facilitator did a decent job with the evaluations. I already had a pretty good idea about what my biggest weaknesses were, and several of them agree with me. The funny thing though is that there were a few comments from different people that were total polar opposites. I guess that means that I'm probably doing about right in those areas!

Anyway, some of my classmates had been concerned that the student evaluations would be nasty or cruel, but they weren't like that at all. I thought that several of them were actually very helpful, because I hadn't thought about some of these issues. Sometimes you really need someone to point certain things out to you (in a nice way, of course). I got a few evaluations that were extremely detailed, with specific examples of things that those people thought I did well or could have done better, and those were the ones that were the most helpful. Even this business of writing evaluations is a work in progress. My group is going to spend some time on Friday talking about how we can work even more effectively as a group, although we all agree that we've come a long way since a month ago.

Tuesday, August 15, 2006

Extra PSS and Planning

We had an extra PSS today instead of seminar. I'm not sure if it was because there was no seminar planned, or if they were just wanting to make up for us missing class on Labor Day. We covered DNA replication, which again was largely review, and we were done early with the questions again. Most of our questions had to do with diseases caused by extra triplet repeats, like Huntington's Disease and Fragile X Syndrome. So our facilitator gave us a few extra questions to look at about another disease called dyskeratosis congenita that is caused by mutations in telomerase, which is the enzyme that builds up the ends of the chromosomes during replication. I learned a couple of interesting things: First, the telomerase complex contains RNA as well as protein in it, and if the RNA is mutated, that is what causes the dominant form of this disease. (Mutation in the protein causes a sex-linked recessive version that is more common.) Second, when DNA replicates, it goes bidirectionally from the origin, even in eukaryotes.

One other thing I have been realizing is that I need to start planning my studying better. It's hard sometimes to finish the reading without staying up half the night if I don't get started over the weekend so that I can get a little ahead. I did that this week, and it has definitely helped, although I still should have tried to get more reading done. I am still trying to figure out exactly how far ahead I need to get on the weekend to be optimally prepared and not have to stay up late during the week, and I'm thinking that I need to do about half of the next week's reading. That is, I should finish the reading for Monday, Tuesday, and Wednesday over the weekend so that I can spend the evenings during the week working on Friday's reading and also on the journal articles. I am going to try doing that this weekend, and I'll let you know how it works out. What I can tell you for sure is that there's no way to finish Friday's reading on Thursday night without staying up half the night if you wait to start until Thursday night!

Monday, August 14, 2006

House of Blues

I went to a comedy show last night at the House of Blues in downtown Cleveland. It was surprisingly good; the main act was called Last Call Cleveland. They did a bunch of skits and little songs, and they also showed several clips of other acts they had done while they were setting up for the next skit. One cute clip showed two of them at a lake trying to attract a duck using bigger and better lures, until finally a female duck came and the duck flew away with her. In one of the funniest ones, they got a guy who does TV ads for a local furniture store, and they had him go to the beach and do his ad for random people who were at the beach. I hadn't even seen the commercials, but it was still really funny. What made it so funny was the looks on the people's faces when this guy came up to them and did his spiel. Apparently Last Call Cleveland has a pretty good local following, from what I can tell.

Today was another PSS day. This week we are working on nucleic acids, starting with DNA. Most of the material from the reading was review about the structure of DNA, how DNA replication is semiconservative, etc. We finished our questions early too, because some of them came right from the reading. In the afternoon it was pouring right around the time I wanted to go home from the lab (of course!), but I managed not to get too wet. Other than that, the weather has been pretty nice this week: 80ish during the day and mid sixties or so at night.

Saturday, August 12, 2006

FAQ #4: What Is Your Typical Summer Schedule Like?

This schedule will only cover the basic/translational research first block, since our schedule is going to change in October once we start the organ blocks. Here is the general schedule by day for the first block:

8AM-10 AM: PSS
10AM-5PM: work in the lab
5PM onward: study, hang out with friends, etc.

8AM-10AM: Seminar
10AM-5PM: work in the lab
5PM onward: study, hang out with friends, etc.

Same as Monday

No classes, so the day is spent in lab and studying.

10:30AM-12PM: Journal Club
12PM-5PM: work in the lab

No classes, so we have time to study, go out, etc.

As far as how much studying we do, that definitely varies quite a bit. Some students came in knowing more than others (I already told you we have two PhDs in the class!), and some students naturally just work harder or pick things up faster than others. We typically have about 20 pages of reading to do per PSS. So I would say that for me, I probably spend a few hours studying for each PSS, maybe one or two hours studying for a seminar (they usually have assigned reading too, but not as much as the PSSs do), and a couple of hours preparing for a journal club. That is assuming, of course, that you are not the person presenting; the journal club director has told us that we can expect to spend 15 hours preparing for our own presentations. The general consensus of those who have already presented though is that it's probably a lot more time than that. I've heard a few people say that it took them close to double that amount of time.

Friday, August 11, 2006

Town Hall Meeting

We had our first town hall meeting today. Basically there is a Case medical student government, and we at CCLCM have our own student representatives. They served pizza and soda (yay!), and the meeting was kind of just an introduction to let people know how these meetings work, as well as to introduce some of the new CCLCM student groups. One of my favorites, at least as far as names go, is SINNAPS, which is the group for students interested in neuroscience, neurology, and psychiatry....I can't remember what the last S stands for. But there are other groups too, including the free clinic that I already told you about, the ultimate frisbee club, a marathon club, our own AMSA chapter, and an AIDS interest group. We also were told that the M1 class will have to elect our own representatives soon, about parking at Case and at CCF, and we were given a warning that the refrigerator was going to be cleaned out in the student lounge at the end of next week. It does stink in there, so that's not a bad thing.

Case also had a student activities fair, and a couple of students in our class went and signed up for the email lists for all of their clubs on behalf of the rest of the class. I don't think that too many CCLCM students participate in most of the Case clubs though because the campus is just far enough away that it is difficult to coordinate schedules. On the other hand, they have a lot of neat clubs. It would be fun to participate in some of them, especially the ones that revolve around cooking ethnic food!

Thursday, August 10, 2006

PSS Evaluations

We are now finishing our fourth week, and that means that it's time to start evaluating our PSS group members. The way it works is that you log into the CCLCM portal, and you have the option to fill out assessments on the other students. Since this is our first time doing this, we are only evaluating one competency, and that is professionalism. Basically, we are supposed to look at whether our group members come to class prepared, how they interact with other group members, etc. We are also supposed to make suggestions as to how they can improve their professionalism in the group setting. It's actually pretty challenging to write the evaluations, because we are also supposed to give specific examples. It's not like I've been taking notes all month long or anything about all of my group members, so I'm basically having to do this from memory. Some of my classmates are taking the "less is more" philosophy about filling them out, but I can't help but think about the fact that what I write is going into someone else's permanent record, and their PA is also going to see it.

We are also going to get evaluated by our PSS facilitator within the next week or two. I assume it will be on the same competency, although I'm not sure. I should know more soon.

Wednesday, August 09, 2006

Dean's Dinner

This evening was a late one because we had a Dean's Dinner. The way the Dean's Dinners work is that my whole class goes to the Foundation House for a talk by a senior, well-established scientist, and then we get dinner too. I think I already told you about the Foundation House. It's the same place where we had our CCLCM white coat ceremony on the first day of orientation.

Anyway, considering that several of us hadn't initially wanted to go, and considering that we were grumbling about them making us go and not warning us that we HAD to go until the last minute, and considering that I spent the entire afternoon in a rush trying to get my experiment finished in time so that I could make it to the Foundation House for this #@*& talk by 5:30, I have to confess that the talk was fantastic and well worth attending, and I'm glad they made us go. The speaker is the head of the Taussig Cancer Center here at CCF, and he is an expert in bladder cancer. Besides the fact that his research is really interesting, he is a great speaker too. He was joking around with a bunch of the students and with Dean Fishleder during the talk. After the talk, we had dinner, and then he was telling us about his programs to increase minority access to cancer treatment. He had been in Los Angeles at USC before he came here, and they had started a program there to improve access. He is interested in doing the same kinds of things here as well, and he invited us to get involved.

One other really nice thing that he did was to tell us how he got to where he was. He's from Australia, and he got his MD and then his PhD. The professor that he worked for when he was a grad student is still a mentor of his, and he spoke to us quite a bit about the importance of mentorship in affecting what you do and where you go in your life. Dean Franco and Dean Fishleder talked about the importance of mentors in their lives as well, and so did Dr. Drake, who will be our anatomy professor starting in October.

Speaking of anatomy, it turns out that we will continue to have anatomy sessions during M2 and not only in M1. Doing dissections during M2 is optional as I've said, but studying anatomy with the prosections is part of the regular curriculum for both years. We will also be having optional office hours and optional online tutorials to do, so there is no shortage of help to learn anatomy. I'm pretty excited about starting, and I'll post more about anatomy class as I go along, because as far as I know, there is no other school anywhere that does anatomy the way that we do it.

Tuesday, August 08, 2006

First Patient, Free Clinic, and Social Events

The seminar today started out with the patient and her physician telling us about her heart arrythmia. Turns out that I was wrong about it being a potassium channel problem. I thought that the problem would be due to a potassium channel either opening too late or closing too soon. It's actually a problem with a sodium channel that is expressed in the heart. In her case, the channels stay open too long, and that leads to all kinds of heart and neuromuscular problems. After that, a CCF physician presented to us about channelopathies, but it was all basically from the readings. The patient is now on a sodium channel blocking drug, and fortunately that seems to be helping her.

Some of the second year students are starting a free clinic, and they invited us to join them. We had a meeting about it at lunchtime to pick officers and a name, but we're still working on the name. The plan is for the clinic to be held on Friday afternoons at a community center near the campus, but some people also suggested doing it on weekends too. There is already a free clinic in Cleveland, but they are not open at that time, and that way we could avoid duplicating their efforts. The clinic will include an AIDS outreach effort, fundraising, and maybe even a research project in the future.

Today there are a bunch of social events too. The girls in the class were all invited to go for dinner at La Dolce Vita in Little Italy. It's not that they're trying to exclude the guys, but the restaurant has a lady's night. And then afterward most of us are going out for one student's birthday.

Monday, August 07, 2006

Some Cell Membrane Stuff

This week's theme is about cell membranes and the proteins in them, and that is what our PSS today was about. We had to read an article for today's session about how excess cholesterol, besides causing atherosclerosis, can also cause heart problems due to there being too much cholesterol in the heart cell membranes. This is a problem because cholesterol affects the fluidity of the membranes and makes them less fluid at physiological concentrations. Apparently that stiffening of the membrane leads to all kinds of other problems, like with ion channels and other membrane proteins not being able to change their conformations like they're supposed to do.

Tomorrow, we are seeing our first patient, and he has an arrythmia. Presumably it's due to a potassium channel problem, because we had a 56-page review article to read for tomorrow about all these different channelopathies, and that was one of the channel diseases that it mentioned. In college you learn about potassium channels and sodium channels and how they are responsible for action potentials in neurons. But there are also calcium channels and chloride channels that can cause diseases if they aren't working properly, and then there are several subtypes of each, as well as other channels that aren't specific for a single ion. Some channels are expressed in certain tissues and not in others; some are voltage-gated while others are ligand-gated or voltage-insensitive; some activate or inactivate slower or faster than others do. It's kind of mind-blowing to read about them all.

Saturday, August 05, 2006

FAQ #3: Is It Too Claustrophobic Having Such a Small Class?

What I think this question is getting at is whether a class of 32 is too small to have a good social life. I'd have to say that overall, no, I don't think that this is a major problem. In terms of finding good social opportunities, that is entirely up to you. There are some people who spend a lot of time hanging out with fellow classmates, and some people who don't. Some people hang out with the UP students, and there are a bunch of them. If you want to find friends from outside the CCLCM program, it's pretty easy to do that. The Case medical school building is only about a mile away from the LRI. And there are lots of other graduate and professional students around; Case has a law school and a dental school too.

What tends to happen is that people just kind of gravitate toward others with like interests. There are a ton of student groups on both campuses, and it's easy to find like-minded people just by joining one or two of those groups. And then a lot of times a few people decide to do something and invite everyone else. A lot of us eat lunch together in the CCLCM student lounge, and there are plenty of parties and impromptu get-togethers. Actually, I think that the hard part is having to turn down some activities that sound fun because I just don't have time to do them all.

Friday, August 04, 2006

A Long Day

Fridays are always long days. That sounds funny on one hand, because there are plenty of medical schools that have class from 9-5 every day, and we have very little class time. But when you're used to only having class for two hours most days, and then suddenly you have it for four hours, the mental exhaustion is noticeable. Plus, our class sessions are just very intense. You can't sit in there and zone out like you can in a lecture, because our classes are all active participation. Part of it too is that there is so much extra preparation for Fridays. I found myself having to look up things constantly while I was reading the journal articles.

Lab was kind of a let-down today. My experiment from yesterday didn't work, and I'm not sure why. The woman who is teaching me the techniques suggested that maybe my buffers weren't at the right pH, but I wonder if I didn't make a mistake somewhere in terms of what to mix with what and when. There are a lot of steps, and none of it is very difficult, but there are a lot of places where I could have made a mistake. One mental lapse, and two days' work might be lost. Anyway, the net result is that I have to repeat the experiment on Monday. The good thing to come out of this is that I will have an extra chance to repeat the procedure and it will be a lot less confusing now that I have gone through it all once.

Thursday, August 03, 2006

Starting to Put Things Together

Today was Thursday, so we didn't have any class. I had a long day in the lab today, but I got a lot accomplished. I feel like I am finally starting to get more comfortable with the techniques we've been doing. I've actually done some of them before, but of course every lab does things differently. I can already see a difference in my level of skill, though, and that is very gratifying.

We have journal club again tomorrow, and I'm noticing that it's getting easier to read the journal articles too. It's not that they are any easier than the ones we had to read last week, but I am starting to be able to put some of these concepts together in a way where I remember oh yeah, I just read about that last week. This relates to that by this mechanism. At the beginning, I felt like nothing really seemed to go together or be connected, and now all of a sudden I am starting to see the relationships between things. I have more appreciation for how this program has been set up in terms of how much they integrated it. That's not to say that I'm not annoyed at having to do some of the assignments or that I find everything equally valuable as a learning experience. Nothing is perfect. But I can definitely see that I am starting to adapt to this system. It's a lot of work being in med school, but I'm feeling like I can handle it.

Wednesday, August 02, 2006

Class Meeting and Enzymes

Yesterday, we had the c/0 2011 class meeting after the proteomics seminar. They wanted to tell us about the MS options that are available to us. There are several possible routes, including clinical trials, mechanisms of disease, pathology, epidemiology/biostatistics, anatomy, bioethics, biochemistry, public health, business administration, and coming soon, pharmacology. Some MS programs require a bunch of extra classes, but it turns out that several of them only require a few extra classes on top of what we're already doing for our CCLCM curriculum. So now it looks like the majority of the class is planning to do one of these programs. Even some of the people who came here already having graduate degrees were saying that they thought they would get a second MS. It really makes sense to get one, especially considering that we are going to be here for five years anyway.

Our PSS today covered enzymes. One thing we came to realize is that a lot of terms are used interchangeably to mean different concepts. That caused some uncertainty about how to answer some of the questions, because we didn't always know which definition to use. Overall though I think the PSS went well. Our group has really gotten to the point where we work well together and the sessions are helpful learning experiences. Tomorrow we are going to learn how to use the PBL room equipment, and between that and the library information session, we should be in excellent shape for the rest of this module.

The other good news is that the heat wave we've been having in Cleveland is about to break. Tomorrow is supposed to be stormy, but the good part is that the high is only 82. We are all ready to have some cooler weather.

Tuesday, August 01, 2006

Proteomics for AMD

We had a seminar today about proteomics as a tool to study age-related macular degeneration (AMD), which is the leading cause of blindness in this country. Basically what happens is that the patient gets protein deposits called drusen under the retina in the very center of it, and the presence of drusen either lead to getting AMD or are caused by it. One of the risk factors for getting AMD is smoking. As if there weren't already so many bad consequences from smoking, here is yet one more. Proteomics is the study of all of the proteins that are present in a cell. The researchers are studying retinas from AMD patients versus normal patients to see which proteins are expressed in one but not the other. The hope is that they can use this information to help them predict who is likely to develop AMD, and then they can start treating those people early on. There is no cure for AMD, but it is possible to slow the progression of the disease by doing things like giving anti-oxidants to the patient.

There were three speakers. The first one was a clinician who does research on AMD, and he showed us pictures of what the drusen look like. The second one was a mass spectrometrist who used mass spec to separate and identify proteins. (He really works on small peptides made by cutting the proteins up with the protease trypsin.) The third speaker was another researcher on AMD, but he was more interested in characterizing the proteins themselves that are part of the drusen.

Proteomics seems to be pretty painstaking and tedious work. There are thousands of proteins in the sample being studied, and somehow the ones of interest have to be detected and identified out of all that mess. That is not an easy problem to solve, but it's doable.