Proteins and Little Italy

We had a PSS today, and this week we are covering proteins. Today's PSS focused on how protein function is related to protein structure. Again, this was a topic that most of us already were familiar with, and the questions weren't too tough, so the PSS went smoothly. Afterward, I went to the lab and spent some time learning about one of the instruments and trying to figure out what I was going to do tomorrow. The graduate student who is helping me wasn't there today, so hopefully I'll get to do more tomorrow.

This evening, I went to Little Italy for dinner with a friend. I haven't told you about Little Italy yet. It's this really neat area right next to the Case campus where there are a bunch of Italian restaurants, cafes, stores, and apartments. A lot of the Case students live in Little Italy because they can walk to school from there. The Feast of the Assumption is coming up, and there were signs about it everywhere. I really like just walking around Little Italy and seeing everything there, but it wasn't a great day to be outside today. The last few days have been very hot and humid here in Cleveland. Our heat index hit 100 today, and it's supposed to be really hot tomorrow, too. Hopefully things will get back to normal by the end of the week.

FAQ #2: What Made Me Decide to Come to CCLCM?

A few days ago, I gave the short answer that it was mainly the curriculum and the financial aid that made me decide to come to CCLCM. I've been describing the curriculum quite a bit, so you already have a sense of what is so unique about the way that medicine is taught here. It's not always easy to be a part of such an unusual curriculum, but overall I would say that the program is pretty much what I expected it to be so far.

Financial aid is self-explanatory as a reason. The cost of attendance for CCLCM students is the same as for any other Case student: about $39,000 for tuition each year, and about $61,000 total when you include living expenses. That extra $22,000 includes things like health insurance (we get student health insurance through Case unless we have other insurance), transportation, books, personal expenses, and of course room and board. The cost of living in Cleveland is pretty reasonable, especially when you compare it to major cities on either coast. CCLCM has its own financial aid that is separate from the main UP financial aid administered through Case.

One thing I was not particularly excited about initially was the city of Cleveland itself. But I have actually been pretty pleasantly surprised. There are more things to do here than I expected. I went and saw the Rock and Roll Hall of Fame, which was pretty neat. There are some cute trendy areas with stores, bars and restaurants within a few miles of campus. We've had several parties and events of our own at CCLCM, and we are also invited regularly to social events over at Case. There are tons of student groups on both campuses like AMSA, interest groups for specific specialties (ex. surgery), and an ultimate frisbee group. We have free access to three different gyms at CCF and Case. If you like outdoor activities, there are some beautiful parks in the area called the Emerald Necklace. Actually, if anything you have to be careful not to overextend yourself by doing too many outside activities!

End of the Second Week

Our PSS went well today. It helps a lot when the topic is something that is especially interesting. Not that it isn't still a lot of work to do the reading and prepare, but everything we study certainly isn't equally interesting! We worked as a large group again today, and most of us prefer being in the larger group instead of dividing into subgroups. So I think that is what we are going to do from now on.

The journal club went pretty well too, as far as I can tell. There were four students presenting (two in each group), and they presented different papers in each group. One group was discussing papers about apoptosis, and the other group was discussing papers about angiogenesis. We never get to see the papers that the other group reads, but I think that the point of the journal club is less to teach us the science behind the papers and more to teach us about critically evaluating the literature. We also spend some time discussing research techniques. The presenters are evaluated by two faculty and two students. The student evaluation job rotates each week, so we each do it once during the summer, and we evaluate both presenters for that day. We are supposed to look for things that we thought they did especially well and things that they should try to improve. Being an evaluator is probably not as stressful as being the presenter, but it's still a lot of work!

One thing I can tell you too is that the journal club papers are really, really hard to read. I mean that there is just no way that you can read them once and understand everything that is going on. It helps a lot though to have someone leading a discussion who has learned more about the background of the paper. I felt like I understood the papers a lot better after journal club was over than I did when I just read them by myself the first time.

I finished my research plan this afternoon, and my research preceptor approved it. So now I feel like I can take a well-deserved night off. It was a hard week, but I'm starting to get more into a routine and things are going more smoothly. It kind of amazes me to think that I've already finished two weeks of med school. The summer is going by really fast.

Portfolios and Journal Club

Today I wrote the draft of my research plan that is due tomorrow, and I just have to insert a figure and get my research preceptor to approve it. Once I do that, I will be submitting it to my portfolio. I haven't said much about the portfolios so far, but that's because they weren't even up yet until yesterday. The portfolios are how we get evaluated here, so they're definitely worth discussing though. They are completely electronic and accessible to us 24-7 through the CCLCM portal. Right now the only people who apparently have access to mine are my PA and me. Not that there's much in mine to see at the moment.

I spent some time looking through my portfolio, and now I understand why it took this much time for the computional staff to get them ready. There are several tabs in there. One is for me to upload things that aren't directly related to the curriculum but that I think are important to include. One is for all of the modules that I'll be doing for the rest of this year. So for example, there is one for this summer's module on molecular cell bio and basic science research, one for the cardiology block, and so on for all of the other organ blocks. There are several subfolders nested inside the current one for each of the assignments that I need to complete this summer, such as writing my research plan, presenting my journal club paper, and the PSS sessions. There is even a separate folder for that bioinformatics session we had this past Tuesday. I have no idea what I'm supposed to put into that one! And there is another folder for my powerpoint presentations. Apparently I am supposed to upload my powerpoints after I give my journal club presentation and my summer research presentation. There is a binder they gave us at orientation with info about the portfolio, and I suppose I ought to read that at some point in my ample spare time.

Since I know some of you upperclassmen are reading this blog, do you have any tips about how best to do the portfolio??? I have to confess that it's a bit intimidating to see dozens upon dozens of empty folders waiting to be filled!

Tomorrow our PSS is covering apoptosis, which I think is a particularly fascinating area. I'm looking forward to this one. We have journal club afterward, and this week we're going to be divided into two groups of 16 since there will be students presenting. Two students present in each group each week for eight weeks, so everyone goes once. I already told you that two people in our class came here to med school already having their PhDs, and several other people came already having MSs. The powers that be decided to have each group start out with one of the PhDs and one of the MSs presenting, since they've already had some experience with doing this. That seems to be a pretty sensible way to start things off.

My First Fun PSS

Today has been a pretty good day. I got a lot of work done, and class was actually fun instead of stressful or just plain confusing. In fact, our PSS went really, really well---the best one yet. We even finished a few minutes early. I think that the PSS went so well partly because we have finally gotten the hang of doing it, and partly because the questions we got asked came mainly from the reading for today. We were working as a large group again, and it was my turn to be the timer.

I don't think I told you that there are four jobs that rotate among the eight of us. They are the leader (self-explanatory), the reader (responsible for reading the objectives and questions), the scribe (basically our group secretary), and the timer (keeps us from spending too long on any one question). In our group, we have worked it where we change jobs each session, and each person in the group alternates between having a job and not having one. So since I had a job today, I won't have one on Friday, but I will have one on Monday of next week, and so on. Last week, I was the leader, and that is a much harder job than being the timer! I haven't been the scribe or the reader yet.

My group has also come to the realization that we do not make good use of the online resources when we look up information during our PSSs. I mean, Google Scholar and Google Image can only take you so far, right? So we decided that we would get the librarian at the Lerner Institute library to work with the eight of us for an hour or so to help us become better at accessing the online resources. There was a brief orientation to the online resources at the beginning of this summer module, but it was not really all that helpful because there just wasn't enough time. Some of the other groups are also getting individual help, and we thought it was a good idea for us to do it, too. We are planning to do our library session on Thursday morning.

That's about it for now. I have some reading to do for my lab, because our research plans are due this week. I still have to write mine, so that's on the agenda for tonight and tomorrow. We have no classes tomorrow, so that helps a lot as far as getting caught up is concerned.

Biostatistics and Basements

I started my day out with a desperate attempt to find the uniform office so that I could pick up my second white coat. It's in the basement of Building H, which is the main hospital. That sounds easy to find, right? But it isn't. The Cleveland Clinic, like many large, old hospitals, has had various random sections added on it since it was first built, and there are all kinds of tricks that you need to know to successfully get from one area to another. Needless to say, I do not know these tricks. When I first got down to the basement, I was somehow wandering around in what looked like a janitorial storage area. I asked a man where I needed to go, and he told me I was in Building M, and pointed me toward Building H. I wandered around through the Radiology Department in the basement of Building H for a while before a resident down there finally showed me the right place to go. It wasn't that the people I had asked for help earlier didn't want to help me, but they didn't know where to go any better than I did. I took the skyway back to the Lerner Institute, and that was much easier. If you're ever wandering around the Cleveland Clinic, I advise you to take the skyway. There are signs posted up there telling you where to go.

Our seminar today was biostatistics, and I have to tell you that today's seminar leader, Dr. O'Brien, was fantastic. He's just really funny and kind of crazy, which actually makes what would otherwise be a relatively dry subject somewhat interesting. He said that he'd be teaching portions of our biostatistics/epidemiology course next summer, so we'll be seeing more of him. A few people in my class are considering getting MS degrees in either biostats/epi or clinical trials. I think if I did a MS, I'd do the clinical trials one. It overlaps with biostats/epi quite a bit, but there are a few less courses. I am not planning to do a MS though.

In the afternoon, I was in the lab, but I mostly was trying to get caught up with my studying. I'm still behind, unfortunately, but hopefully I'll be caught up after this week. Tomorrow is another PSS day. We're going to be going over the cell cycle, which thankfully is something that is not totally new to me.

My Brain is Tired

Somehow today seemed like a very long day, and I think a big part of that is because it was just so full. It's amazing how packed the days are when you're in medical school. I'm guessing that this is the case at every medical school, though, not just here.

I started my day by wrestling with the printers at school so that I could print out my assignments for tomorrow. We're doing a biostatistics seminar, and we were assigned two articles to read. One has a bunch of questions with it, and I don't even understand all of the questions let alone know how to answer them. I just finished reading the two articles, and I get the impression that one is supposed to be a "good" example in terms of the statistics, and the other is supposed to be "bad." I even have an idea of which is which. But best of all, I think that this is the soonest that I've ever been done with any day's assigned reading. I might even be ambitious enough to start working on Wednesday's reading after I finish posting this while I'm on such a roll.

We had another PSS today, and this time we tried working as one big group. There are definitely pros and cons to each method. It's good on one hand to be present for the entire conversation instead of only half of it like when we divide into subgroups. But on the other hand, I definitely feel that I learned a very little about everything instead of a lot about the things that I worked on, and the reverse was true for the smaller groups. The rest of the group seems pretty divided between liking splitting up and liking working as one big group. We decided to continue trying to work as a big group, but we are going to spend more time discussing the big picture and how the questions for that day match the objectives we have for that day. Learning this way is harder than learning from a lecture, but it's a lot more gratifying, too. As hard as it is, I'm still glad that I came here, and I feel like the struggle is going to be worth it in the long run.

In the lab this afternoon, I did some more reading and some studying. So far, I still haven't really done any lab work, but it looks like I'll be getting to start by next week for sure. There is a grad student who I'm supposed to start working with next week. That's about it for today, except that I am also getting my Case white coat embroidered. It was only $10, and it's a fundraiser for the Case AMSA (American Medical Student Association). I am not sure that I'll ever wear my Case coat (I don't know how common it is for CCLCM students rotate through the University Hospital), but all the UP students were doing it, so I figured that I would too.

Speaking of CCLCM students rotating, today was the first day of rotations for the M3s here. They were all at school bright and early, dressed up and ready to go. I was talking to a few of them, and they were excited and nervous at the same time because they weren't sure what to expect. I was trying to imagine myself in their place two years from now with my beeper and my white coat and stethoscope and everything else, and it still feels like that day is far off and not something that really applies to me. I guess it will come though soon enough!

FAQ #1: What Kind of Student is CCLCM Looking For?

I didn't do much of anything exciting today besides studying, so I thought I would respond to one of the questions that a few readers have asked me. Namely, they wanted to know what the CCLCM admissions committee is looking for from applicants.

Here is my answer to this question:

"I think that the biggest thing the school is looking for is people who are intellectually curious. You don't have to have an extensive background in research necessarily, although many of us do, like I said earlier. This program does tend to attract people who are really into research. There aren't any people with PhDs in the entire first-year class of the Case UP out of 132 UP students, but we have two PhDs in our little group of 32! But we also have some people who are straight out of college and who didn't really do much research at all in school. Most of us are somewhere in between; we did a little research in college and maybe took a year or two off afterward and worked in a lab. So I guess the best advice I can give to you is to show that you're interested in learning and passionate about scholarship, even if it's not in a lab. There isn't one single thing that the 32 of us have in common besides that intellectual curiosity; it's an amazingly diverse group for there just being 32 of us."

I also asked Dean Franco, the CCLCM Associate Dean for Admissions & Student Affairs, for her opinion. Here is what she said on this subject:

"I am only one voice on the committee, but hopefully this would be our consensus opinion. Yes, intellectual curiosity is a big one. All students interviewed have some research experience, not always in science, but for the majority , it is in some scientific endeavor. We look for people who enjoy other people and have successfully worked in groups. We look for students who want to make a contribution to the world and have shown they will make a time sacrifice to do that. We like letters from references who really know the applicant's passion for whatever is important to them. Students have to manage under the work load, so academic success is required, but we do not have a specific MCAT or GPA cut off. If a student demonstrated they could recover from a rough start, we consider the circumstances. Our interviewers look for authenticity, sincere caring, and a desire to do one's best. When the same people are on the Admissions Committee and do the teaching, we know we are responsible to find those that will fit into this program and thrive. [CCLCM] isn't for everyone, and that is ok....We are looking for those who share our mission and want to be part of the family. That makes it all worthwhile."

I hope this information is helpful for those of you who are applying to CCLCM this year. I will answer other questions from readers in future posts.

End of the First Week

We had our third PSS today, and again, it went fairly smoothly. We finished all of the questions a few minutes early, actually. Afterward, we were discussing how things went this week with our facilitator, and several of us (including me!) felt that we understood the things that we had looked up ourselves well. But we had to go back later and read the questions that the other subgroup was working on later, because we weren't getting it during class. That being said, on Monday most of us felt like we didn't get much of anything at the time, and I for one feel that getting half of the material during class is better than getting none. We decided that now that we have some experience with PSS, we would like to try to work together as a big group again on Monday. If it doesn't work, we can always go back to dividing up the work again.

After PSS, we had our first journal club (JC) meeting. The way JC works is that the entire class is divided into two groups of 16, and two people present within each group every week. Each student gets 45 minutes total to present, including audience questions and discussion. There is a different faculty moderator in charge each week, and they are the ones who assign the papers to us. The papers are chosen based on their impact, their intensity, and on what topics we are covering in class that week. We were learning about intracellular transport and endocytosis this week, so the paper was about a potential method to treat a lysomal storage disease called Niemann-Pick disease. Fortunately the type A form of this disease is rare, because it is lethal and currently untreatable. Basically what happens is that people who are affected by Niemann-Pick disease are missing an enzyme called acid sphingomyelinase (ASM). This enzyme hydrolyzes a lipid called sphingomyelin, and so people who don't have the enzyme wind up storing these lipids in all kinds of bad places in their cells and tissues since they can't break them down. What the study authors wanted to do was to give them ASM and get their cells to take up the enzymes in a specific manner so that the cells would now be able to break down the lipids. So far this has been done in animals, but not yet in people. It's a neat idea, though.

At the end of the presentations, we had a brief discussion about what the presenter did well, and what he could have done better. This week it was a professor who presented to give us an idea about how we should do our own presentations. The first students will be presenting next week. My group will be doing one paper about a protein called VEGF, and the other is about the VEGF receptor. I'll tell you more about them next Friday.

Fourth Day of Medical School

We didn't have any class today, so I was able to sleep in an extra hour before I had to get up to go to the lab. No one was there when I got in, so I went and "studied" for a while (by which I mean that I fooled around with my computer for an hour, and spent about 20 minutes actually reading my textbook). When I got back, the lab people were all there. I basically spent the rest of the day searching for procedures for my project. I found one that I thought was pretty good and showed it to my preceptor. We discussed it and decided that I should meet with another researcher for some more help tomorrow after class. So that's another day with no research accomplished, but I did have some excellent Chinese food for lunch.

In the afternoon, I had to go meet with my PA, but it was just a brief chat. She basically wanted to know how things were going so far, and how my classes were, that kind of thing. Also, she reminded me again that if I needed to talk about anything that I could call her. I was telling her about our crazy PSS on Monday, and some of the other funny things that happened this week. I can't say that I feel terribly stressed though, at least not yet! But I do have a few more pages to read for tomorrow, so I need to go do that.

Third Day of Medical School

We had our second PSS today, and it went MUCH better than the one we did on Monday. First of all, we were more organized, and that allowed us to be more efficient. Second of all, we had a better sense of how much time we could spend on any one question. The facilitator barely had to help us at all; we were really on track. Not only that, I also think that I got a lot more out of the PSS today than I did on Monday. But as frustrated as we were on Monday, it was still a good experience in that it helped us figure out how to function better as a group. Our next PSS is Friday; tomorrow is a research day, and I also have to meet individually with my PA.

I went to the lab again today, but I didn't get much accomplished because the experiment that they did yesterday was done incorrectly, and also because the prof decided to change my project. I'm going to be looking at how a drug inhibits a protein now instead. So no more bacteria, which I can't say terribly upsets me. I don't know if you've ever worked with bacteria or not, but if you haven't, take my word for this: they really stink.

This evening I found a bunch of papers that I can read to help me learn the techniques, and I am going to start working on my reading for Friday too.

Second Day of Medical School

Today we started out by having an ethics seminar, followed by a small-group discussion of three ethics case studies. There were three main topics covered in both sessions: falsifying data (ex. dropping data points that don't support your hypothesis), fabricating data (i.e., making up fake data), and authorship issues. There are three things needed in order to "earn" authorship rights: you have to have intellectually contributed to the project and/or done a significant amount of the work, you have to have contributed to writing the actual manuscript, and you have to have signed off that you agree with the final paper. We also discussed examples where one or more of these factors was missing. Authorship is definitely a tricky issue.

After the session, we took photos for the CCLCM viewbook. There is an undergrad working in the admissions office, and she was our "patient." Let me remind you that we just are in our second day, and we have absolutely no clue what we are doing. But wow, did we ever look good in our white coats and with our stethoscopes. The good news is that I was able to hear the girl's heart beat, and she's definitely alive. But in case you were wondering, those photos of the M1s examining patients are totally staged.

We had a couple of hours off, and then we had to do our CPR training. Wow, that was really intense. We were there for FIVE HOURS. There are three CPR tests that you have to pass, plus a written test. The first test was to do CPR on an adult with another person to help you, and to activate and use an automatic external defibrillator (AED). The AED is easy to use; it's the actual CPR that's tough. Then we had to give CPR to an infant; you don't use an AED on an infant, and they're a lot smaller and easier to manipulate. In a way, that makes them scarier though. Finally, we had to do one-person CPR on an adult with no help for two minutes (five rounds). That's tough. I actually have a bruise on the heel of my hand from pushing on the manniquin's chest so much. The written test was pretty easy if you had read the book, which I had. There were twenty questions. If you ever have to take the CPR test, remember that the rate of compressions should be 100 per minute. The ratio is 30 compressions to 2 breaths for adults, and the same for kids unless a second person is present, in which case you do a 15 compressions to 2 breaths ratio. There you go. That's CPR in a nutshell.

Now I'm just fried, but I have to read for my PSS tomorrow. I hope that these topics aren't things that I don't know much about, because I don't think I can learn much more today.

First Day of Medical School

Today was our first day of actual medical school. We started out with a half-hour orientation in the library, followed by an hour and a half-long problem-solving session (PSS) where we were divided into four groups of eight. The PSS basically consists of us being given several questions to answer. Some can be answered from the assigned reading, and some have to be looked up using various library or internet resources. Most are pretty direct (ex. explain how X or Y works), but a few are research-type questions (ex. how would you show X or Y experimentally?) We didn't know what we were doing at first, and so it was kind of bedlam. But this was our first time, so some confusion was to be expected. The good thing is that there is a facilitator who is there to guide us and get us back on track if we go off on a big tangent, and we really needed her today! I think one of our biggest problems was that we spent too long on the first question. Later on, we figured out that it would be a lot more efficient if we divided up the group of eight into a few smaller groups, and gave each smaller group one question to answer. Then we could all get together as one big group to discuss them all. We also want to try to figure out how to project our notes on the screen so that we all can see them instead of just one person having them on the screen. We do our next PSS on Wednesday, and we are going to try spending one hour answering the questions in subgroups of two or three, and then the second hour discussing them all together as the entire group of eight.

After PSS, I went to the lab and got started on my project. I am going to be learning to grow bacteria, isolate the protein of interest, and then study it. I told the researcher who was going over the procedures with me that it looks pretty work-intensive, and she agreed. She said it takes three weeks to get the protein produced and purified, so that is a third of my summer right there. They are going to do an experiment with it tomorrow, which I am going to miss, but they said they'd go over the data with me on Wednesday. I won't be going to the lab tomorrow because in the afternoon, we are doing mandatory CPR training. This evening I read the CPR textbook. In the morning, we have an ethics seminar at Lerner. Luckily, it doesn't have any reading for us to do!

Wine Tasting and the Case White Coat Ceremony

Let me start by saying that the wine tasting last night was amazingly fun. Not only were there a zillion different kinds of wine from all over the U.S. and the world, there were also a ton of different kinds of cheeses. I think that I enjoyed tasting the cheeses even more than the wines, because you can only drink so much wine before you start getting tipsy and they all begin to taste alike. I learned a few interesting things at the wine tasting: smoked blue cheese is really, really good; there are certain wines that go along with certain cheeses; and Ohio actually has wineries. I wasn't that impressed with the Ohio wine, but in case you're ever in the northeastern Ohio area and you need to know this, the Ohio Chardonney (a white wine) was much better than any of the red wines. I think I drank more wine at the cheese tables than I did at the wine tables. They kept insisting that such-and-such cheese went so well with such-and-such wine. By the end, I was just eating and drinking whatever they gave me. And for future reference for myself, I really like Riesling.

I also found out that you can never be sure when or where you will have your skills as a physician called upon. This is a little bit freaky: I was standing talking with the two friends I had come with, and all of a sudden there was a crash. A man had slipped and fallen, and he was bleeding like crazy from his nose and a facial cut. One of my friends who had already finished her second year of medical school immediately went to his assistance. I don't do my first aid training until Tuesday, so basically I was not able to be useful at all. The freaky part is that the three of us had been talking about the first aid training that I was about to do this week, and then bam, there was someone who needed some! The man was ok, and we went on our way after the ambulance was called.

Ok, so now on to the White Coat Ceremony. We started out with a breakfast at the Intercontinental Hotel on the Cleveland Clinic campus. There are two hotels at CCF: the Intercontinental Hotel, and the Intercontinental Suites Hotel. The Intercontinental Hotel (minus the Suites) is the really posh one, although they are both pretty posh. Breakfast was good. I got to meet the spouses, significant others, and families of several of my classmates, plus introduce them to mine. After we had breakfast, it was time to leave for Severance Hall, which is located on the Case campus about a mile away from CCF.

First, we took pictures with our academic societies...well, at least the UP and MSTP people did. The CCLCM students don't have a society, so we are kind of our own society. We were the last to get our picture taken, and Dr. Fishleder (the dean) was missing. So we wound up standing there for a while until they found him, and the other students were seated already in the small auditorium by the time we got in there. We had been given index cards that told us where we were supposed to sit based on alphabetical order. They also gave us all copies of the oath, which all 174 of us were going to read after we received our Case student coats.

At 11:00, they had us file into the big auditorium and sit alphabetically again. Dean Horwitz made a small introductory speech first, and then Dean Heneghan from Case gave her own speech. She talked about the words that mattered to her as a physician and as a person, including "no" and "love." We found out that she will be leaving to go to San Fransicso with her family because her husband got a job there. That is too bad; I like her. I met her last year when I interviewed for the UP.

Then it was finally time for us to get coated. As they called each student up in alphabetical order, they also flashed our pictures up on a screen above the stage. For the CCLCM students, they used our pictures from our own White Coat Ceremony last Monday. Dean Franco gave me the coat, I shook hands with Dean Heneghan and Dean Fishleder, and then with the university president and the medical school president and several distinguished Western Reserve SOM alums whose names and accomplishments I am afraid that I don't remember. The UP and MSTP students were coated by their society deans, but Dean Fishleder coated us. The coats are short and have a CWRU SOM seal on them, along with a pin with the student's name on it and another little pin that says "Humanism in Medicine." I may not ever wear the coat again unless I rotate through some of Case's hospitals, but it was still nice to be a part of the ceremony. Plus, it was so cold in Severance Hall that it was nice to have the coat on.

Finally, it was time for us to recite the oath. Like I said before, each entering class at Case writes its own. Here is the CWRU SOM oath for the entering class of 2006:

Our Code of Professionalism
July 16, 2006

"We, the entering class of 2006, do fully commit ourselves to the art and science of medicine. Our journey bears with it the responsibility of serving humanity with compassion. As future physicians:

We will develop a foundation of scholarship and inquiry, striving to master the practice of medicine.

We affirm that lifelong curiosity and self-improvement are fundamental to high quality care.

We seek to cultivate our professional and technical abilities and to learn from our mistakes.

We aim to build a relationship of trust between physicians and patients.

We will emphasize open communication with respect for patient confidentiality.

We pledge to be tolerant and respectful of our diverse patients and colleagues.

We will treat every patient with humility, empathy, and compassion.

We will be honest and never compromise our integrity.

We will empower people to take charge of their own health by providing resources and education.

Finally, we will pass on our collective wisdom to future physicians.

By upholding these principles, we strive to justify the public's confidence in our profession. We hope to bring an increased level of service and compassion to patients and communities. We envision a world with improved access to care and greater quality of life for all. Ultimately, we promise to provide care that we ourselves would like to receive."

After that, we took a class picture with all 174 of us plus the deans, and there was a reception. And that was the end of the White Coat Ceremony.

Ok, I need to go finish reading for my problem solving session tomorrow. The good thing is that I did finally finish those safety modules, so I'm making progress. I've also been doing some reading for my lab project this summer. More about that later.

Finally, a Day Off!

Today I actually got to sleep in past 6 AM, although it wasn't an easy thing to do; I was basically wide awake by 7 AM. Apparently I am already accustomed now to getting up early. It hasn't been as difficult to adjust to that as I thought it would be.

Since tomorrow will be busy, I've spent a few hours today working on the assigned reading for Monday's seminar. I'm about halfway done with that. This whole section is a review of the eukaryotic membrane-bound organelles, which I already know well. But I am certainly not going to complain if we start a little slow! I've also managed to complete four of the six safety training modules. They are so mind-numbingly boring that I don't think I can do any more today. The good thing is that, unlike the HIPAA modules, the safety modules give you the info to read first, and THEN ask you questions. That seems like a sensible way to present them, right? But the HIPAA modules give you quiz questions first, and then present the information afterward. The thing that annoys me the most about that is that after I missed some of the questions on the HIPAA modules, the program suggests re-reviewing the material. Re-reviewing???? I missed those questions because I had yet to do any reviewing in the first place! Needless to say, I did not take the program's suggestion.

Tonight, some of the M3s are having a party, and all of the classes are invited. There are only 95 of us total in all of CCLCM, so that isn't as bad as it sounds. I've also been invited to attend a wine-tasting by some outside friends, and I think that's what I'll probably do.

Fifth Day of Orientation

Today was basically a day to write our code of ethics. We met at the Lerner Institute at 7:45 AM, and we were bussed over to the main Case campus from there. There are 142 University Program and MSTP students plus the 32 of us, and we were all divided up into eighteen small groups. Mine had one other CCLCM student, and the rest were from the UP and MSTP. We went over two clinical cases that were facilitated by an M4. The purpose of this was to come up with some ideas about what we thought constituted professionalism. We then merged our small group with two other small groups, and pooled our suggestions. Several common themes emerged, such as being non-judgmental, tolerance, competence, discretion/confidentiality, scholarship, empathy, compassion, advocacy, mentorship, trust, and integrity. Each of the six larger groups then selected two representatives to meet together in a final group that would make the final code that will be read on Sunday.

One group selected 3 people, because we wound up with a total of 13 students who wrote the final code. There were 3 CCLCM students, 9 UP students, and one MSTP student. It took about four hours to write the code, with a brief break in between to hear Dean Horwitz give a televised speech on the features of the new and improved UP, which is called the Western Reserve 2 Program. You can read more about it on the Case website if you're interested. But in a nutshell, they are basically integrating more public health and scholarship into the UP. The result is that they follow a schedule more like ours, with the major exception that they finish in four years instead of five because they don't emphasize research as much as CCLCM does.

I thought that the experience of writing our own code was really neat, and well worth doing. None of us was totally happy with the final result, and we each felt there were things we could have added or cut out, but we also agreed that it was a better code than we would have wound up with if we had permitted just one person to compile all of the principles together on their own. We will recite the code at the White Coat Ceremony on Sunday, so I will post the text for you then.

Fourth Day of Orientation

Today we had the morning off until 11:30, at which time they gave us lunch. We heard from a member of the CCLCM student government. Basically, both the M1 and M2 classes elect four members of the student government, and these people are responsible for serving as liasons with the CCLCM administration, as well as with the main Case campus. They also conduct town meetings and present student concerns to the deans.

After this presentation, we had another computer tutorial. Today we mostly focused on how to navigate the portal. I'm not sure whether I've explained before that CCLCM is a very technology intensive program. Nearly all of our curriculum and assignments are available on line, as are our portfolios, our assessment questions (more about them later), and our microscopy slides. Apparently we don't actually use microscopes here. Dr. Mehta, the computer specialist, also showed us how to do some really neat things like highlight or write on power point presentations while using the computer as a tablet. But THE coolest thing that we saw today was that it's possible to use the Microsoft student notes program to not only take our own notes, but to connect with other people so that we can all have the same notes, and all edit them at will. That is just amazing. It works kind of like AIM or other chats that allow you to go into group rooms, except that here we're doing it through a sort of word-processing program that is more than just a word-processing program. It also allows us to grab pictures or screen shots off the internet and drop them in, or to draw our own diagrams. There is a tablet tutorial that comes with the computer. I haven't had a chance to take it yet, but I'm planning to do it this weekend. But if you were wondering, the tablet PCs are just amazing.

Later in the afternoon, we went to Case and got our student IDs. The weather had been rainy this morning, but it turned out to be a beautiful sunny day by this afternoon, if a bit muggy. Some of us still needed vaccines, so we went to Student Health Services to take care of that. Afterward, we were shuttled back to the Lerner Institute, and we had the rest of the afternoon free. In the evening, there was a reception at MOCA, which is an art museum at the edge of the CCF campus. Most of the class attended, as did several of the physician advisors, College staff, and other people affliated with the CCLCM program. I saw my PA there, and we are going to meet to discuss my academic plans sometime next week.

Tomorrow we are basically just going to Case to write our oath for the White Coat Ceremony on Sunday. In the afternoon, I need to go to the lab and meet with my preceptor. Apparently there is some kind of safety training that I need to do. Speaking of safety training, we got six new online modules added today for safety training. I had just finished the HIPAA ones, and now I have to do all of these too. Sigh. I am ready for orientation to be over so that we can get on with the real stuff.

Third Day of Orientation

Today we had our TB tests read, and then we heard several more talks about various subjects like student health, the CCLCM office staff and their responsibilities, financial aid, and employee/student wellness. The student health is nondescript and about what you'd expect: as Case students, we would go to the Student Health Center there, and we are eligible for the Case Student Health Insurance Plan. We were then introduced to many of the people who work behind the scenes to run our program. Some of them were people we had "met" by email, so it was good to finally put the names with the faces. Financial aid is an important issue at an expensive, private school like Case. CCLCM has its own financial aid independent of Case, and that tends to work out in our favor in terms of getting a good aid package. Finally, the wellness talk was to let us know about the services that are available to us as students through CCF, which are mainly free access to the CCF gym and free lifestyle and mental health counseling services if needed. We also were told what to do in case of an accidental needle stick, which is basically to report it so that prophylactic measures can be taken.

Several of us have already been going to the CCF gym, and it's a pretty nice gym, especially for the price. It's located in the Walker building, which is about 4 blocks away from the Lerner Institute. They have just about everything there: a weight room, cardio room, gymnasium with basketball courts, an indoor swimming pool, and an indoor track. There are also lockers available for daily use and free towels for us to use, too. I plan to go after class every day from now on. Speaking of lockers, we have lockers in the Lerner Institute as well. I know that every med student says that med school is just like high school, but the fact that we have lockers like this definitely adds to that aura.

I did two more HIPAA modules today, so only two left to go. More tomorrow. I'm exhausted.

Second Day of Orientation

Today was a long, tiring day. We got our offical CCF ID badges, which is nice, because now we can get into the buildings without having to get someone to let us in. They gave us breakfast again, and then we had several presentations about the curriculum for this summer and for the next two years in general. During the summer, we will be having small group discussions covering biochemistry and molecular biology topics, as well as journal club. Mondays, Tuesdays, and Wednesdays we have discussion from 8-10 AM, and then we spend the rest of the day working in the lab. Thursdays are research days: no class. Fridays we have discussion from 8-10 and then journal club from 10:30-12. This will be our schedule until the end of September, starting this Monday.

We also heard more about the evaluation process. I will write more about that in a later post; I'm just too tired right now. At lunchtime, we were divided into groups with our new physician advisors (PAs). These are the people who will be responsible for helping us evaluate ourselves and assemble our portfolios. We signed up for library accounts so that we can check out books. I think it's pretty neat that the Lerner Institute has its own library. Case, of course, has several libraries, including one that is a medical history library with a museum in it. Since we are Case students, we also have access to Case's libraries.

After lunch, we had a second computer tutorial and learned more about the e-portfolios that we will be compiling on ourselves. However, the portfolios are not actually set up completely yet, so we basically just saw a demonstration of how they work. Again, I am not going to get into all of the details right now, but basically there are nine competencies that we must demonstrate. Each time we accomplish something that is evidence of one or more of those competencies, that evidence is put into our portfolios. And that is how we will prove that we've accomplished those competencies so that we can be promoted to the next year.

Afterward, several of us bought our books for the summer. We were told to get biochemistry, cell biology, and genetics. Some of the upperclassmen had said that we didn't really need the books that were recommended. But since there were reading assignments out of them, we M1s decided to buy them anyway. I also started working on those HIPAA modules and looking through the portal.

Tomorrow we have to be back at 7:30 AM again, but the good news is that the day will be short.

First Day of Orientation

Today was just an incredible day in so many ways. It's going to be hard to put all of my thoughts and feelings down in words like this, but I will do my best. My first day as an M1 was quite emotional, to the point of being overwhelming sometimes.

We got to the Lerner Institute at 7:30, and they had us register and gave us all nametags. A lot of us already knew each other from having gotten together last week and over the weekend. They also gave us really nice messenger bags that have the school's name embroidered on them. Inside the messenger bags was a bunch of info about the school, some maps, and about a zillion forms that we had to fill out. One form was for radiation safety rules, and we literally had to initial EVERY rule. Another was for our background check.

Dr. Kathy Franco is the Dean of Student Affairs and Admissions at CCLCM, and she opened by welcoming us here and reminding us that we are a family. We also were introduced to the rest of the office staff, including Wilma Doyle, the Administrator. Like I told you in an earlier post, CCLCM students do not skip class, because our classmates are depending on us. So Wilma explained to us that if we DID ever not come without calling in, she would be showing up at our homes to find us. Literally. (She's actually done it once before!) After that, there was an outreach officer from the CCF police force who spoke to us for half an hour about staying safe on campus. I learned several interesting facts: CCF has the third largest police force in Cuyahoga county (after the cities of Cleveland and Parma); they have almost 200 officers and security guards. Also, the crime rate on campus is incredibly low. No violent crimes at all, with the exception of a few incidents of domestic violence. The biggest problem, of course, is theft of personal items, so it's important to keep our valuables locked up and to not permit people we don't know into the secure areas of the building. He also presented stats for the rest of the city of Cleveland, and the difference is pretty stark. Out of approximately 400 cars stolen precinct-wide, only five were on the CCF campus. (CCF occupies approximately 10% of the precinct geographically.)

We then had a very fast succession of mini-talks. First was the CCF fire marshall, who is an extremely funny guy. Then came the Hazmat coordinator to talk about chemical safety. Third was the director of environmental health and safety to talk about radiation. After him, we heard from the director of library services. And THEN we got to the 1001 little errands that had to be done. We completed all of our forms, took TB tests, paid for parking permits, and got our locker assignments and our locks for them. And we got our pagers. Holy cow, my very first day of medical school, and I already have a pager!!! What the heck for? No one knows exactly. It's not like anyone is going to have to page me for an emergency PBL session or anything. But be that as it may, the pagers were issued. Some of my classmates had a good time playing with them, and every so often a random one would go off here and there for the rest of the day. We were also given a learning style assessment to do for homework. This is supposed to help us figure out how we learn best and understand other people with different learning styles better.

We also prepared for the CCLCM white coat ceremony. Unlike Case, CCLCM issues long coats, and they put our names in them. We each had an individual picture taken while wearing our white coats. Dr. Drake, our anatomy prof, took us to see a bronze statue in the hospital that the staff members are thinking of making the school emblem. It's called "Man Helping Man," and it is dedicated to all of the people who have donated their bodies, organs, and tissues to medicine and research. Afterward, we went to the Foundation House. This is an old, refurbished house owned by CCF that would be perfect to play Clue in. Here, we had our ceremony. First, we heard a speech by Dr. Young (a physician here) about the meaning of professionalism, as well as about what makes medicine different than other professions. The biggest difference, according to Dr. Young, is that unlike plumbing, law, or architecture, medicine has that extra virtue to it. It's not just a job, and you don't stop learning or living it until the day you retire.

One of the things that really got to me is that the program for the ceremony said this on the cover:

Welcome to Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and to the Profession of Medicine.

Wow, that is sounding pretty real there. It has started to hit me that I am a first day first year medical student beginning in the profession of medicine.

After Dr. Young's speech, Dr. Franco called each student up one at a time, and we shook hands with her and Dr. Fishleder, who is the executive dean. Dr. Fishleder also gave each of us a book that is an anthology of essays and short stories written by various physicians. Dr. Franco had written a personalized note to each of us in the front cover. Once we all had our white coats, we took a group picture of the entire class of 2011. So that makes it official. It's too late to back out now.

Just so you know, this was all before lunch. We had lunch after the group picture, and we met several other members of the staff at that point. These were mainly people who are involved with helping us with our curriculum, academic planning, evaluations, etc. We returned to the Lerner Institute, and then came the best part: distribution of the tablet PCs. They're Gateways. If you've never seen a tablet PC, you can check them out on Gateway's website for yourself. Dr. Mehta is the Director of Education Technology, and he spent a few hours teaching us how to use the computers today. We also got CCF emails and Case emails, and we found out about a bunch of online tutorials that we have to take for doing animal research and HIPAA. I am too tired to post about the computers right now, but I will tell you more about them later on in the week. We have more training sessions with them coming up.

After the computer training session, we were done for the day. There was a CWRU Society Dean's Mixer held off campus, and some of us went. But it was optional, so a lot of people didn't. Tomorrow is going to be another long day.

Today Is the Last Day Before Orientation!!!

Tomorrow at 7:30 AM, I will officially become an M1 (first year medical student). It's going to be a busy day between getting our new ID badges, taking our class pictures, and starting to learn more about what we are going to be doing here for the next five years. But besides all of that, we are going to get our new laptops, and that is the part that excites me the most right now.

I don't think I've told you yet that CCLCM provides every M1 with a new laptop at no extra charge. I saw the ones that the current M2s are using, and they are really cool. They're tablet PCs. You can write on one side of the screen, and the computer is able to convert that into files. If you write legibly, it can even convert your writing into type. It also allows you to draw sketches and have them saved on the computer. The other side is a normal computer screen. You just flip the top of the computer over to switch from one to the other. Ostensibly these are supposed to be our PBL computers, but the word from the upperclassmen is that they're plenty of fun to play around with, too.

I'll have more to tell you tomorrow. It's just kind of incredible to think that after all this time, I am finally a medical student. While you're applying, it's hard to envision that light at the end of the tunnel. But you have to keep moving forward, and then eventually one day you get there.

A Little About My New Classmates

Some of us new students have been meeting each other informally before school starts. It looks like we have a very diverse and interesting class. We range in age from 18-31. We come from all over the United States from a variety of different colleges and universities. There are also several students from other countries in our class, including Ghana, Canada, Japan, and India. We have a wide range of ethnicities and backgrounds for such a small group. Two of the new students came in already having their Ph.D.s, and several of us have taken a year or two off to do research in between college and medical school. Many of us are planning to get a M.S. in clinical research during our five years here. We have one classmate who competes in triathlons, one who is a rower, one who played college golf (and several of us who like to play as amateurs!), one who scuba dives, and lots of sports fans in general in the group. We have one student who worked as an EMT, one who did research in Poland, one who did research in Antarctica, and one who did research in Iceland. All in all, it's a pretty impressive group of people, and I am looking forward to finding out more about them next week during orientation!

White Coat Ceremonies Are Next Week!

Today I went over to the Case campus and found out where Severance Hall is. That's where we're going to have our white coat ceremony next weekend. Most medical schools have these white coat ceremonies where they give the new medical students their first white coats. It's a formal event, and the students' family and friends are invited to see them officially become medical students. You've probably heard of the famous ancient Greek doctor Hippocrates, who is said to have written the Hippocratic Oath. (See below.) Some schools have their students recite the Hippocratic Oath during the white coat ceremony. What we do here at Case is to write our own medical ethics oath to use during the white coat ceremony. Every medical class at Case writes its own oath, so this year's oath will be different than last year's. I think that's neat.

It's kind of interesting for those of us in the College Program. At Case, we use short coats like the University Program students do to designate that we're students. Only people who have already earned their MD degree wear the long coats. However, at CCF, we use long coats, even as students. So we CCLCM students will be doing everything twice: two white coats, two white coat ceremonies. I'll tell you more about them next week.

This is the Hippocratic Oath, translated from Greek:

I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath.
To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
To please no one will I prescribe a deadly drug nor give advice which may cause his death.
Nor will I give a woman a pessary to procure abortion.
But I will preserve the purity of my life and my art.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."

Getting Ready to Start Medical School at CCLCM

Hi, and welcome to my blog. I'm inviting you to join me on my journey as a new Cleveland Clinic Lerner College of Medicine (CCLCM) student. If you've never heard of CCLCM or don't know much about it, don't feel bad. It's a small program, and it's fairly new. There are only 32 of us per class, so our program is much smaller than the average medical school class is. This year (2006-2007) is just the third year that CCLCM has been in operation. The program is a joint effort between the Case Western Reserve University School of Medicine (CWRU or Case) and the Cleveland Clinic Foundation (CCF). We are officially CWRU students, and we will get our MD degrees from CWRU. However, several aspects of the CCLCM program (sometimes called the College Program) are different compared to the larger University Program that most Case medical students take.

One thing I have to warn you about up front is that Case, and CCLCM in particular, is a pretty maverick school. None of our three curriculum paths (MSTP, University Program, or College Program) is a very traditional medical school experience. In this blog, I'm going to primarily focus on CCLCM, but I recommend that you research all three programs if you are interested in applying to Case. You can click on the links that I posted above for CCLCM and the University Program and below for the MSTP.

The first thing that you should know is that CCLCM is a five-year program instead of four years like typical medical school programs are. You're probably already aware that many medical schools offer combined MD/PhD degree programs, and Case too has its own NIH-funded Medical Scientist Training Program (MSTP) for students who want to earn both degrees. The MSTP is ideal for students who want to go into medical research and become physician scientists. But not every budding physician scientist wants to go to school for the full 7-8 years that are required to complete an MD/PhD. The good news is that they don't have to do that. Five year research programs like CCLCM are a good compromise for students who want to get some research training but who also want to finish school sooner than they would in an MSTP. All CCLCM students receive an MD with Special Qualification in Biomedical Research from Case. Our program is also amenable to earning an MD/MS from Case; doing this basically requires taking a few extra classes.

Probably one of the most interesting things about CCLCM is that we don't have any grades, class rankings, or tests. That sounds pretty weird to a lot of people, because when you're a pre-med, your tests and grades are such major parts of your course experiences. There are even lots of med schools that give grades and rank their students, and nearly all of them give tests. But at CCLCM, we assemble competency portfolios instead. I'll talk more about that in a later post. Second, we don't have any regular lecture-type classes at CCLCM. Instead, we do all of our pre-clinical work in problem-based learning (PBL) groups, seminars, and journal clubs. Third, we don't dissect cadavers as first year medical students (M1s). Instead, we use prosections, where a resident has already done the dissection for us. Oh, and one other thing: we don't use preserved bodies at CCLCM. So there's no formaldehyde in our gross anatomy labs. There are lots of other unique and interesting features of our curriculum. You can learn more about the program at the CCLCM website.

We spend our first summer before M1 doing basic science research. So that means CCLCM starts a lot earlier than most medical schools do, in early July instead of late August. Orientation begins on Monday, July 10, and we have to be there bright and early at 7:30 A.M. Yikes; I am not a morning person. But I'm going to have to rapidly become one, because our PBL sessions and seminars are at 8 A.M. four days a week, for the next two years. We start our research and biochemistry seminars the following Monday, July 17. I'm so excited!!!

Right now I am getting myself ready to start school. I found an apartment here in Cleveland, and I'm starting to learn my way around the CCF and Case campuses. Wow, they're both absolutely enormous. It's easy to get lost. I need to do some more errands, so I'm going to sign off for now. But I wish you a happy Fourth of July, and thanks for reading. :-)