Yesterday morning and today we had biostats, and the attendence was kind of slim. Some people have been kind of trickling in half an hour late or not coming at all for the whole summer. But it has gotten much worse more recently as our workload has really started piling up. I wound up skipping class myself this morning to finish analyzing the data from my summer research project. As it turns out, most of my classmates apparently decided not to go today either, and we finally got an email about it from the dean this afternoon.
I always feel bad about missing a class, especially considering how much Case charges for tuition. (We're up to $41,000 for this year....yikes.) But unfortunately there are only 24 hours in a day, and I had to get this work done so that I could submit my abstract with some results. It would be nice if the assignments could be better coordinated so that as our research requirements gear up at the end of the summer, we wouldn't have as much class work to balance with the research stuff.
Speaking of research, yesterday we had another patient, a case this time. I missed the OR part because I was in class, but I went to the ICU afterward to help monitor the patient there. It's a lot less hectic in the ICU than it is in the OR. On the other hand, the patients' families come in to see them in the ICU, which changes the dynamics considerably. It feels a little awkward, actually, because we wouldn't even need to be there at all if the patient hadn't joined our study. I kind of felt like we were intruding on the patient's family's time, which is a little silly considering that the patient hadn't woken up from the anesthesia yet.
I almost forgot to mention that yesterday, our extra biostats homework for grad credit was due. I was not terribly pleased to find out that we now have a SECOND assignment to do on top of it. The biostatistician was being cavalier about it, saying not to worry because it wouldn't be due until the end of fall semester in December. I asked him to please give it to us early, because I don't want to be working on biostats after this block is over. Things are going to get busier for us, not easier, once we start our regular classes! He did send out the assignment, and it's basically the same as what I just turned in yesterday, but on a different article. It's annoying and stupid that I have to do almost the exact same analysis over again for another article, but at least it will be relatively easy this time now that I know exactly how to do it. A while back, he told us that he wanted us to get really familiar with this software, and one thing I will say for him is that he's definitely accomplishing his goal. :-P
Thursday, August 30, 2007
Tuesday, August 28, 2007
Classes, Proposal and Clinic
Today was a very long day, but I have gotten a lot done so far this week. Yesterday we had stats class, and in the afternoon I got my research proposal draft finished. It's due Friday, so I'm actually ahead with my work for once. This morning there were a couple of talks I was interested in attending, but I didn't make either one of them. We had epi this morning (about surveys, not the most interesting) and then I went to clinic.
Clinic was crazy busy. My preceptor didn't have a resident to train today. So I wound up seeing six patients, five on my own. Most were here for fairly mundane things. But there was one patient who had been barbecueing over the weekend and had somehow been splashed smack in the face with boiling hot marinade sauce. It is kind of a bizarre accident to have, but the poor man had serious enough burns on his face that he had gone to the ER to be treated. Fortunately his burns are healing well and they don't look infected. My preceptor described the shape as being "serpiginous." I had never heard that word before, but sure enough, it's a real word.
Describing a skin lesion, it means that it has a wavy kind of margin, like the lesions on the foot in this picture. Think like a serpent.
Clinic was crazy busy. My preceptor didn't have a resident to train today. So I wound up seeing six patients, five on my own. Most were here for fairly mundane things. But there was one patient who had been barbecueing over the weekend and had somehow been splashed smack in the face with boiling hot marinade sauce. It is kind of a bizarre accident to have, but the poor man had serious enough burns on his face that he had gone to the ER to be treated. Fortunately his burns are healing well and they don't look infected. My preceptor described the shape as being "serpiginous." I had never heard that word before, but sure enough, it's a real word.
Describing a skin lesion, it means that it has a wavy kind of margin, like the lesions on the foot in this picture. Think like a serpent.
Friday, August 24, 2007
Classes and Biostats Homework
Yesterday I had epi, and we spent more time going over diagnostic tests. There was one sentence in one of the articles we were asked to read that made absolutely no sense to me. I asked the instructor about it, and he started congratulating me for having caught that and said he had no idea where it came from either. I don't think it requires much to notice it, because it completely doesn't fit in with the rest of the paper. It's like the authors just lifted a sentence out of some other paper and dropped it into this one! In the afternoon, I was hoping to go consent more patients with the resident, but we didn't end up going. We had two study patients having their surgeries yesterday, but they were both controls.
Today we had journal club. I didn't enjoy this one as much, mainly because I was one of the student evaluators. It's a lot harder to follow the flow of conversation when you're busy taking notes and filling in all of those little boxes on the eval sheet. Plus, the internet kept going in and out, so I had to pay attention when I was trying to save to make sure I was connected at the time. The first paper was about using MRI as a screening method to detect breast cancer, and we had a really good discussion that unfortunately I could only partly participate in. The second paper was about the relationship between obesity and cancer. Some good issues came up during that discussion as well, mainly about whether the difference in mortality due to cancer was caused by obesity itself, or by the fact that it is harder to diagnose and treat tumors in people who are obese.
I spent most of this afternoon working on my biostats homework. I was trying to verify the sample size that the statistician had come up with, and I couldn't get it for several reasons. First, this trial is way more complicated than anything we've done in class. For example, there are three interim stopping points, and all of that has to be accounted for statistically. Second, the particular calculation the statistician used is not available on the software we are using, which is called PASS. In the end, I got close to the statistician's number, and I explained in my paper why I couldn't duplicate it exactly.
Right after I finished doing all of this, I received an email that had been sent out to our entire class. Some of my classmates had gone to speak to the dean with a petition concerning the workload we have been getting this summer. They got a few concessions, one of which was that the people who are not taking biostats for grad school credit don't have to do this homework assignment. Since I am taking biostats for credit, it doesn't affect me. It would have sucked though if I weren't taking it for credit, because I literally had just finished the assignment right before the email arrived! But the students did get one of our CAPPs for Week 6 taken away, and apparently our fourth biostats group project will be shorter now.
This block has been very intense. It was definitely a lot more work and harder than I had expected it to be. I think that probably all of us were expecting it to be more like last summer, which was relatively laid back. It has also been very difficult to balance our classwork with research. In spite of the onerousness of writing eight zillion essays, I have to admit that these homework assignments have taught me way more than any of the seminars or readings we've been asked to do have.
Today we had journal club. I didn't enjoy this one as much, mainly because I was one of the student evaluators. It's a lot harder to follow the flow of conversation when you're busy taking notes and filling in all of those little boxes on the eval sheet. Plus, the internet kept going in and out, so I had to pay attention when I was trying to save to make sure I was connected at the time. The first paper was about using MRI as a screening method to detect breast cancer, and we had a really good discussion that unfortunately I could only partly participate in. The second paper was about the relationship between obesity and cancer. Some good issues came up during that discussion as well, mainly about whether the difference in mortality due to cancer was caused by obesity itself, or by the fact that it is harder to diagnose and treat tumors in people who are obese.
I spent most of this afternoon working on my biostats homework. I was trying to verify the sample size that the statistician had come up with, and I couldn't get it for several reasons. First, this trial is way more complicated than anything we've done in class. For example, there are three interim stopping points, and all of that has to be accounted for statistically. Second, the particular calculation the statistician used is not available on the software we are using, which is called PASS. In the end, I got close to the statistician's number, and I explained in my paper why I couldn't duplicate it exactly.
Right after I finished doing all of this, I received an email that had been sent out to our entire class. Some of my classmates had gone to speak to the dean with a petition concerning the workload we have been getting this summer. They got a few concessions, one of which was that the people who are not taking biostats for grad school credit don't have to do this homework assignment. Since I am taking biostats for credit, it doesn't affect me. It would have sucked though if I weren't taking it for credit, because I literally had just finished the assignment right before the email arrived! But the students did get one of our CAPPs for Week 6 taken away, and apparently our fourth biostats group project will be shorter now.
This block has been very intense. It was definitely a lot more work and harder than I had expected it to be. I think that probably all of us were expecting it to be more like last summer, which was relatively laid back. It has also been very difficult to balance our classwork with research. In spite of the onerousness of writing eight zillion essays, I have to admit that these homework assignments have taught me way more than any of the seminars or readings we've been asked to do have.
Wednesday, August 22, 2007
Classes, Biostats Projects, Research and Dean's Dinner
This week in epi we are covering diagnostic tests and what they mean. For example, if you go get screened for lung cancer, how do you know whether the screening is actually worthwhile in the sense that it is extending your life? It turns out that it probably isn't, in that case at least. Because of biases due to the length of time the tumor is known about or the greater likelihood of slow-growing tumors to be detected by screening, it often looks like screening is working even when it isn't. Finding the lung tumors earlier doesn't lead to decreased mortality in the studies that have been done so far. Apparently even small tumors can metastasize before symptoms develop.
I spent Tuesday afternoon in the OR helping with another surgery patient who was an interventional case. It went very smoothly. We have figured out how to more or less run the procedure like clockwork now. This patient was having a coronary artery bypass graft (CABG, pronounced "cabbage"), and I watched the surgeon remove some blood vessels from the patient's arms. That kind of surprised me, because I had thought they only used leg vessels for CABGs. Maybe there weren't any good vessels left in the patient's legs. I've already seen several patients this summer who are having a third or even fourth CABG, so that wouldn't surprise me.
This morning we had biostats again, and it was all right. We're covering regression, which is kind of anticlimactic considering that my partner and I were already doing that two weeks ago for our group project. Speaking of which, we presented our third group project this afternoon, and my partner and I didn't have much of anything to present. We basically already did everything we could do for the second project. On the bright side, it make the discussion much shorter, but I don't feel like I learned as much this time.
We had a Dean's Dinner this evening at the Foundation House, and the speaker was a molecular pathologist from the Clinic. We already knew him from our genetics seminars last year. This was a really good talk that was almost like hearing a medical mystery. The speaker had a young patient with a certain set of problems that no one could figure out the cause of, and it turned out that she had a brand new lysosomal storage disorder that had never been described before. Luckily for her, this particular deficiency doesn't affect the brain like most of them do, so she isn't retarded.
I spent Tuesday afternoon in the OR helping with another surgery patient who was an interventional case. It went very smoothly. We have figured out how to more or less run the procedure like clockwork now. This patient was having a coronary artery bypass graft (CABG, pronounced "cabbage"), and I watched the surgeon remove some blood vessels from the patient's arms. That kind of surprised me, because I had thought they only used leg vessels for CABGs. Maybe there weren't any good vessels left in the patient's legs. I've already seen several patients this summer who are having a third or even fourth CABG, so that wouldn't surprise me.
This morning we had biostats again, and it was all right. We're covering regression, which is kind of anticlimactic considering that my partner and I were already doing that two weeks ago for our group project. Speaking of which, we presented our third group project this afternoon, and my partner and I didn't have much of anything to present. We basically already did everything we could do for the second project. On the bright side, it make the discussion much shorter, but I don't feel like I learned as much this time.
We had a Dean's Dinner this evening at the Foundation House, and the speaker was a molecular pathologist from the Clinic. We already knew him from our genetics seminars last year. This was a really good talk that was almost like hearing a medical mystery. The speaker had a young patient with a certain set of problems that no one could figure out the cause of, and it turned out that she had a brand new lysosomal storage disorder that had never been described before. Luckily for her, this particular deficiency doesn't affect the brain like most of them do, so she isn't retarded.
Monday, August 20, 2007
Pain Management Clinic
We actually had TWO patients for today, but I didn't help collect data on either one because I went to the Pain Management Clinic (PMC). It was a very eye-opening experience. My longitudinal preceptor sends patients to the PMC all the time, and I wanted to get a sense of what they do there. First of all, it's incredibly busy. One of the fellows told me that CCF's PMC is one of the largest and busiest in the entire country, and I believe it. I also got an appreciation for how much training it takes to become a pain management doctor. This particular fellow had gone through a year of internship, three years of anesthesiology residency, and is now doing the pain fellowship.
Mainly what they do is stick some really huge needles into people's backs, necks, and even heads. It's not acupuncture. They're injecting anesthetics like lidocaine directly into the spinal column or nerves of the scalp, which is called a nerve block. Some of the patients are addicted to narcotics, and the goal of giving them nerve blocks is to control their pain to the point where they can be weaned off the narcotics. The most fascinating patient I saw was one who gets constant headaches. The fellow injected anesthetic directly into the patient's scalp, and within 20 minutes, the headache was gone. The fellow said relief might last for several weeks or months, even though the anesthetic itself wears off after several hours. The doctors don't really know why these nerve blocks work, but I got the impression that it's sort of like rebooting a computer. Sometimes when the circuits are frozen and just not responding properly, you hit "restart," and suddenly it works fine.
Mainly what they do is stick some really huge needles into people's backs, necks, and even heads. It's not acupuncture. They're injecting anesthetics like lidocaine directly into the spinal column or nerves of the scalp, which is called a nerve block. Some of the patients are addicted to narcotics, and the goal of giving them nerve blocks is to control their pain to the point where they can be weaned off the narcotics. The most fascinating patient I saw was one who gets constant headaches. The fellow injected anesthetic directly into the patient's scalp, and within 20 minutes, the headache was gone. The fellow said relief might last for several weeks or months, even though the anesthetic itself wears off after several hours. The doctors don't really know why these nerve blocks work, but I got the impression that it's sort of like rebooting a computer. Sometimes when the circuits are frozen and just not responding properly, you hit "restart," and suddenly it works fine.
Sunday, August 19, 2007
FAQ #30: Do Other Schools Besides CCLCM Offer MD/MS Degrees?
Yes, there are at least a few other formal 5-year MD/MS programs that I know about. Here's my alphabetical list of formal 5-year MD/MS programs. If anyone knows of any others that I should add, hit the comment button, and I'll be happy to add the links. Keep in mind also that a lot of med schools offer informal options to take a fifth year and get an MS. So even if you go to a medical school that doesn't have a formal MD/MS program, you still may be able to get the MS.
1. Albert Einstein College of Medicine (AECOM) Clinical Research Training Program (CRTP). Gives an MD/MS in clinical research. Medical students apply during their third year and do research in their fourth year.
2. Cleveland Clinic Lerner College of Medicine (CCLCM) at Case Western Reserve University (CWRU). Options include an MD/MS in clinical research or one of several basic science MS degrees, or a 5-year MD with Distinction in Biomedical Research. Premedical students apply to the program separately from the main Case program. The last three years are flexible, and the research year can be done during the third or fourth years (or some mixture). There are several combined masters programs available through Case for both CCLCM and UP students. UP students will probably need to take a fifth year to complete most of these masters programs.
3. Harvard-MIT's Health Sciences and Technology (HST) Program. Offers an MD/MS or an MD/PhD. Premedical students apply to the program separately from the main Harvard program. It seems to be geared toward people who want to do engineering type of research.
4. UMDNJ-Robert Wood Johnson Medical School MD/MS in Biomedical Informatics. UMDNJ-RWJMS medical students begin the MS after their second year. Note that this program takes 5.5 years to complete. There is also an MD/MS in Jurisprudence, which seems to be geared toward people who are interested in health care regulation and policy. The MD/MSJ can be finished in five years.
5. University of Pittsburgh's Clinical Scientist Training Program (CSTP). Offers a clinical MD/MS or MD with Certificate in Clinical Research. U Pitt also offer a basic science MS option for people who want to do research in basic sciences. Premedical students apply to the program while applying to U Pitt. Students do research in their fourth year.
1. Albert Einstein College of Medicine (AECOM) Clinical Research Training Program (CRTP). Gives an MD/MS in clinical research. Medical students apply during their third year and do research in their fourth year.
2. Cleveland Clinic Lerner College of Medicine (CCLCM) at Case Western Reserve University (CWRU). Options include an MD/MS in clinical research or one of several basic science MS degrees, or a 5-year MD with Distinction in Biomedical Research. Premedical students apply to the program separately from the main Case program. The last three years are flexible, and the research year can be done during the third or fourth years (or some mixture). There are several combined masters programs available through Case for both CCLCM and UP students. UP students will probably need to take a fifth year to complete most of these masters programs.
3. Harvard-MIT's Health Sciences and Technology (HST) Program. Offers an MD/MS or an MD/PhD. Premedical students apply to the program separately from the main Harvard program. It seems to be geared toward people who want to do engineering type of research.
4. UMDNJ-Robert Wood Johnson Medical School MD/MS in Biomedical Informatics. UMDNJ-RWJMS medical students begin the MS after their second year. Note that this program takes 5.5 years to complete. There is also an MD/MS in Jurisprudence, which seems to be geared toward people who are interested in health care regulation and policy. The MD/MSJ can be finished in five years.
5. University of Pittsburgh's Clinical Scientist Training Program (CSTP). Offers a clinical MD/MS or MD with Certificate in Clinical Research. U Pitt also offer a basic science MS option for people who want to do research in basic sciences. Premedical students apply to the program while applying to U Pitt. Students do research in their fourth year.
Friday, August 17, 2007
Research Is Picking Up
We had another patient yesterday morning, so I came in really early again. There was a talk I wanted to go to in the morning about translational research, but unfortunately it didn't work out. This patient got the interventional treatment, so we had a lot of work to do. One resident stayed with the patient, and the other resident and I went to consent another patient for today. The patient agreed to participate, so I had to come in really early today too. Today's patient was another control though, so again I had some extra time to read before class.
Yesterday's class was epi and covered more about clinical trials. Right afterward, I had to go back to the hospital for a research group meeting. It turned out that I was the only one there for my project, because both residents were still in the OR. So I was the one who gave the update on how our project was going. Then I ate lunch and went back to the OR too. This was a pretty long surgery. The patient got up to the ICU around 3:30 PM after a 7 AM start!
Our patient for today got a late start, so I left for class this morning without knowing whether he would be a control or an intervention. We had our normal Friday journal club, and it was good. One paper was about a drug that is used to prevent clotting by inhibiting platelet activity. The other described a really huge clinical trial where they screened older men for abdominal aortic aneurysms. The aorta is the huge artery that comes out of the heart. It travels down into the abdomen before branching and heading into the legs. Some men, especially if they smoke, can develop weak spots in the wall of the part of the aorta that is passing through the abdomen. Because it is under very high pressure, the weak spots can start to balloon out, and this is the aneurysm. Large abdominal aortic aneurysms are very dangerous. If an aneurysm bursts and the man isn't in a hospital (most of these abdominal aortic aneurysms are in men), he has a good chance of bleeding to death before help arrives. Anyway, it turns out that screening men who are in their late 60s with ultrasound does detect aneurysms and lead to lives being saved.
There were over 60,000+ men in this study, so it's a pretty impressive trial! Men are being screened in the US now too.
After class, Dean Franco showed the same movie about the history of the Cleveland Clinic that I saw a few weeks ago. I went and saw it again even though I had already seen it once. Watching it this time with just the other medical students was a very different experience compared to watching it with the CCF employees. For example, the movie mentions that one of the founders of the Clinic graduated from the predecessor of Case's medical school in just nine months with highest honors. Naturally, that part was particularly amusing to all of us, considering that we will be taking 58 months to get through med school! The part near the end of the movie where they showed the first class of CCLCM medical students doing PBL got a bunch of laughs too.
I didn't have much to do this afternoon except that I went with one of the residents to consent two more patients for next week. One was there with his wife, and she was even more scared about his upcoming surgery than he was. It is going to be his first surgery, and of course heart surgery is a pretty major operation. So it's completely understandable to be frightened. Even though CCF is one of the best places in the world to get heart surgery done, they can't save everyone. As the resident was explaining the research project, all of a sudden, the wife pointed at me and right in front of me, blurted out to the resident that she and her husband didn't want me to be the one doing the procedure on her husband! I was trying so hard not to laugh that I couldn't even be insulted. She has no idea how many more years of training I have to get through before I'll be able to do anything to a patient without supervision! I'm just glad that I didn't laugh in front of them though, because I don't know how I would have been able to explain that I wasn't really laughing at THEM.
I am dead tired. There is a CCF cruise on the Cuyahoga River this weekend, but I'm not going to go. I have too much work to do. Plus, since it's on Sunday night, with my luck, I'll wind up having to get up at 5 AM on Monday for our next patient. It's bad enough to be this tired on Friday, but I don't really want to start out the whole week feeling like this.
Yesterday's class was epi and covered more about clinical trials. Right afterward, I had to go back to the hospital for a research group meeting. It turned out that I was the only one there for my project, because both residents were still in the OR. So I was the one who gave the update on how our project was going. Then I ate lunch and went back to the OR too. This was a pretty long surgery. The patient got up to the ICU around 3:30 PM after a 7 AM start!
Our patient for today got a late start, so I left for class this morning without knowing whether he would be a control or an intervention. We had our normal Friday journal club, and it was good. One paper was about a drug that is used to prevent clotting by inhibiting platelet activity. The other described a really huge clinical trial where they screened older men for abdominal aortic aneurysms. The aorta is the huge artery that comes out of the heart. It travels down into the abdomen before branching and heading into the legs. Some men, especially if they smoke, can develop weak spots in the wall of the part of the aorta that is passing through the abdomen. Because it is under very high pressure, the weak spots can start to balloon out, and this is the aneurysm. Large abdominal aortic aneurysms are very dangerous. If an aneurysm bursts and the man isn't in a hospital (most of these abdominal aortic aneurysms are in men), he has a good chance of bleeding to death before help arrives. Anyway, it turns out that screening men who are in their late 60s with ultrasound does detect aneurysms and lead to lives being saved.
There were over 60,000+ men in this study, so it's a pretty impressive trial! Men are being screened in the US now too.After class, Dean Franco showed the same movie about the history of the Cleveland Clinic that I saw a few weeks ago. I went and saw it again even though I had already seen it once. Watching it this time with just the other medical students was a very different experience compared to watching it with the CCF employees. For example, the movie mentions that one of the founders of the Clinic graduated from the predecessor of Case's medical school in just nine months with highest honors. Naturally, that part was particularly amusing to all of us, considering that we will be taking 58 months to get through med school! The part near the end of the movie where they showed the first class of CCLCM medical students doing PBL got a bunch of laughs too.
I didn't have much to do this afternoon except that I went with one of the residents to consent two more patients for next week. One was there with his wife, and she was even more scared about his upcoming surgery than he was. It is going to be his first surgery, and of course heart surgery is a pretty major operation. So it's completely understandable to be frightened. Even though CCF is one of the best places in the world to get heart surgery done, they can't save everyone. As the resident was explaining the research project, all of a sudden, the wife pointed at me and right in front of me, blurted out to the resident that she and her husband didn't want me to be the one doing the procedure on her husband! I was trying so hard not to laugh that I couldn't even be insulted. She has no idea how many more years of training I have to get through before I'll be able to do anything to a patient without supervision! I'm just glad that I didn't laugh in front of them though, because I don't know how I would have been able to explain that I wasn't really laughing at THEM.
I am dead tired. There is a CCF cruise on the Cuyahoga River this weekend, but I'm not going to go. I have too much work to do. Plus, since it's on Sunday night, with my luck, I'll wind up having to get up at 5 AM on Monday for our next patient. It's bad enough to be this tired on Friday, but I don't really want to start out the whole week feeling like this.
Wednesday, August 15, 2007
Research, Class, and Literature in Medicine Seminar
We had a research patient today, so I had to come in really early again. When we did the randomization, this patient turned out to be a control. So we didn't have to do too much. Every patient gets randomized by a computer, so we never know until right before the surgery whether any particular patient will be a control versus in the interventional group. I haven't been in the OR for any other controls before today, but they basically just get the standard surgery procedures. I think the resident felt worse than I did about the fact that I had to get up at 5 AM and then there wasn't anything for me to do. But I understand that research is just like that sometimes, and it gave me time to do some reading. Not that I terribly love getting up at 5 AM if it's not absolutely necessary, mind you!
We had stats again today, and the statistician I like was leading the seminar. It was good because he made up some new examples and we went through them using JMP. I feel like I'm finally starting to get the hang of using that program. Do I dare say that it's almost fun?
I spent the afternoon working on my CAPPs for Friday and studying, and then there was an optional literature in medicine seminar in the evening. I had gotten the impression that the speaker was some kind of bigwig in the field of medical humanities, and it sounded like it would be a cool talk. So I signed up to go and did the reading assignments. Unfortunately, I was really disappointed with the seminar. I wound up leaving halfway through. As I think about it, I guess what disappointed me the most is that for a seminar which was billed to be something that would make us better doctors and help us empathize with patients more, it was just, so, well, sterile and academic. The guy was talking about different ways of viewing the aging process. Implicit in all of this was the idea that the medical view was not necessarily the most patient-centered view. That's probably true. But I can't help finding it ironic that the guy's analysis was itself not very patient-centered.
I think the seminar would have been a lot more meaningful if we had read a patient's account of the dying process. There is a hospice center right on the edge of campus, we have a geriatrics unit at the Clinic, and I have no doubt that the issue of dying is an important one for medical students to think about. I guess I just don't feel like this seminar gave me very much insight on dealing with aging and death: not my own, and certainly not anyone else's, either.
We had stats again today, and the statistician I like was leading the seminar. It was good because he made up some new examples and we went through them using JMP. I feel like I'm finally starting to get the hang of using that program. Do I dare say that it's almost fun?
I spent the afternoon working on my CAPPs for Friday and studying, and then there was an optional literature in medicine seminar in the evening. I had gotten the impression that the speaker was some kind of bigwig in the field of medical humanities, and it sounded like it would be a cool talk. So I signed up to go and did the reading assignments. Unfortunately, I was really disappointed with the seminar. I wound up leaving halfway through. As I think about it, I guess what disappointed me the most is that for a seminar which was billed to be something that would make us better doctors and help us empathize with patients more, it was just, so, well, sterile and academic. The guy was talking about different ways of viewing the aging process. Implicit in all of this was the idea that the medical view was not necessarily the most patient-centered view. That's probably true. But I can't help finding it ironic that the guy's analysis was itself not very patient-centered.
I think the seminar would have been a lot more meaningful if we had read a patient's account of the dying process. There is a hospice center right on the edge of campus, we have a geriatrics unit at the Clinic, and I have no doubt that the issue of dying is an important one for medical students to think about. I guess I just don't feel like this seminar gave me very much insight on dealing with aging and death: not my own, and certainly not anyone else's, either.
Tuesday, August 14, 2007
Classes, Research, and Clinic
This week we have two stats classes and two epi classes. Both stats seminars are being led by the guy who throws the silver dollars, but he didn't bring any in yesterday. He still had a good seminar though. I was supposed to go shadow a physician yesterday afternoon, but he thought I was coming next week instead of yesterday. I wound up spending the afternoon reading for my research instead.
We had a patient for our study this morning, so I had to come in at the crack of dawn again. We got everything ready and randomized the patient, and it turned out that she was a control. Since the controls just receive standard care (no intervention beyond what is normally done for them during surgery), that was basically the end of our involvement. Of course, it was kind of disappointing for us after we got all ready for a case, but at least it gave me time to finish reading the second chapter for class.
Today's epi class covered clinical trials, and it was very good. Afterward, I studied stats for a while and then went to clinic. Originally, I was planning to go to clinic next week, but I switched to today because of the shadowing snafu. I saw four patients: one with a sinus infection, one with back pain, and two who were just here for physicals. One of the people getting physicals also needed a Pap smear, but my preceptor did it since we were way behind schedule. I also found out that my favorite nurse is transferring to another department. Not that the other nurses aren't just as nice, but this particular one has always been especially cool about teaching me how to do things. It's obvious that she really likes to teach.
We have another set of epi CAPPs and SAQs due again this Friday. I have started working on them, but I didn't get as far with them as I would have liked. It's hard to do much in the evenings during the week because I basically feel completely exhausted every night when I get home. The days are all really full and long, and it doesn't help that surgeries start so ridiculously early....
We had a patient for our study this morning, so I had to come in at the crack of dawn again. We got everything ready and randomized the patient, and it turned out that she was a control. Since the controls just receive standard care (no intervention beyond what is normally done for them during surgery), that was basically the end of our involvement. Of course, it was kind of disappointing for us after we got all ready for a case, but at least it gave me time to finish reading the second chapter for class.
Today's epi class covered clinical trials, and it was very good. Afterward, I studied stats for a while and then went to clinic. Originally, I was planning to go to clinic next week, but I switched to today because of the shadowing snafu. I saw four patients: one with a sinus infection, one with back pain, and two who were just here for physicals. One of the people getting physicals also needed a Pap smear, but my preceptor did it since we were way behind schedule. I also found out that my favorite nurse is transferring to another department. Not that the other nurses aren't just as nice, but this particular one has always been especially cool about teaching me how to do things. It's obvious that she really likes to teach.
We have another set of epi CAPPs and SAQs due again this Friday. I have started working on them, but I didn't get as far with them as I would have liked. It's hard to do much in the evenings during the week because I basically feel completely exhausted every night when I get home. The days are all really full and long, and it doesn't help that surgeries start so ridiculously early....
Friday, August 10, 2007
Journal Club and More Time in the OR
Both of the journal club articles we discussed today were about genetics. When I first saw that last night, I did not feel terribly gung-ho about reading them, especially since one of them was about 17 pages long! But they both turned out to be pretty interesting after all. One article looked at several dozen genes that had been published in the literature as risk factors for cardiovascular disease. These authors did a much larger study on those genes, and they were not able to find that ANY of the genes increased people's risk of getting cardiovascular disease. The really long article considered genetic risk factors for several different diseases using a technique where they could look at the entire genome and not just certain genes. Interestingly, they found that certain loci on the genome were present more often in people with certain diseases, and that these loci don't necessarily correspond to genes! One of the things you learn pretty early on in a molecular bio class is how most of the human genome is "junk" DNA that doesn't code for anything. But obviously we ought to be more careful about writing it off as being useless. Just because we don't understand what it does doesn't mean that it must not do anything.
The resident I'm working with this summer paged me in the morning and told me to contact him if I wanted to come work in the OR with him after class. Luckily I had a pair of scrubs with me, so I went to the OR after lunch. It was kind of a comedy of errors. First I went to the cardiac ORs, because that's where we usually meet. But he was over in the general ORs, which are in a different building. So I went over there to the floor he told me, and he wasn't there. I ran into two other members of our research team and started working with them instead. In the meantime, the resident and I were sending one another a flurry of pages.
Him: Where are you? Come to the second floor OR.
Me: I'm already here on the second floor! I'm helping Allen and Seth (two other team members) collect data.
Him: I don't see you here anywhere.
Me: I'm with Allen's post-op patient in Bay 7.
Him: I can't find you. I'm starting to get worried.
Me: Allen and I walked around all of the bays and we didn't see you. I'm confused.
Finally, the resident showed up to where I was, and it turned out that he had told me the wrong OR. Evidently, there are two second floor ORs in this building. On the bright side, I am now very proficient with using the CCF intranet paging system. It's pretty cool. You can page people by phone from anywhere, but if you're on campus, you can also page them by intranet. I like that better, because then you can type an actual message to them like the resident and I were doing, and they'll get the message on their pager instead of just your phone number. I also have finally memorized both of my pager numbers. (Yes, I have not one, but TWO pagers, because I got a second one just for this summer.) Every time you send a page, you are supposed to put your name and beeper number at the end to make it easier for the recipient to get back to you. So now I have typed my own pager number enough times that I remember it without having to look it up.
The resident I'm working with this summer paged me in the morning and told me to contact him if I wanted to come work in the OR with him after class. Luckily I had a pair of scrubs with me, so I went to the OR after lunch. It was kind of a comedy of errors. First I went to the cardiac ORs, because that's where we usually meet. But he was over in the general ORs, which are in a different building. So I went over there to the floor he told me, and he wasn't there. I ran into two other members of our research team and started working with them instead. In the meantime, the resident and I were sending one another a flurry of pages.
Him: Where are you? Come to the second floor OR.
Me: I'm already here on the second floor! I'm helping Allen and Seth (two other team members) collect data.
Him: I don't see you here anywhere.
Me: I'm with Allen's post-op patient in Bay 7.
Him: I can't find you. I'm starting to get worried.
Me: Allen and I walked around all of the bays and we didn't see you. I'm confused.
Finally, the resident showed up to where I was, and it turned out that he had told me the wrong OR. Evidently, there are two second floor ORs in this building. On the bright side, I am now very proficient with using the CCF intranet paging system. It's pretty cool. You can page people by phone from anywhere, but if you're on campus, you can also page them by intranet. I like that better, because then you can type an actual message to them like the resident and I were doing, and they'll get the message on their pager instead of just your phone number. I also have finally memorized both of my pager numbers. (Yes, I have not one, but TWO pagers, because I got a second one just for this summer.) Every time you send a page, you are supposed to put your name and beeper number at the end to make it easier for the recipient to get back to you. So now I have typed my own pager number enough times that I remember it without having to look it up.
Thursday, August 09, 2007
Classes and Biostats Projects
Yesterday, we had biostats. The seminar leader was my favorite biostatistician. Reading that last sentence back to myself, I have to laugh. It sounds funny to say that I have a favorite biostatistician, but I do. He will be teaching the advanced stats class that I have to take for my MS, so I'll have another chance to work with him next year or whenever I get around to taking that class. One of the things that I like about this guy so much is that he's just an awesome presenter. He is very good at getting us involved and participating. And he does and says crazy things, so we never know what he'll do. Today he brought in a plastic baggie full of silver dollars, and he was throwing them to people who answered some of his questions. I ended up with two of them. He said he wasn't going to let us keep them unless we were able to catch them. Nobody dropped theirs, so I don't know if he was serious about taking them back if we had dropped them!
After class, my partner for the biostats group project and I finished up our presentation. The stats TA was there, so we were able to get some help to solve the problem of trying to eliminate confounding variables. The statistical solution the three of us came up with is way ahead of what we were supposed to do for tomorrow. But on the other hand, our project is a lot more interesting now than it would have been if we had just stuck to what we were asked to do. We ended up with at least one interesting result that we wouldn't have gotten otherwise.
This morning we had epi, and then I had to run for a research group meeting. During lunch, I was looking over our biostats presentation again, and I realized we had written one of our conclusions backward. I'm really glad that I reviewed the project early enough that I had time to fix it! The same biostats instructor that I like was the one in charge of our small group, and it was really fun. Since my partner and I had gone last two weeks ago, our classmates made us go first this time. This meant that our presentation wound up being the longest, because this biostatistician likes to interrupt and tell stories early on while there is still plenty of time. He told us that some of what we had done was "naive," but that the techniques we used are also what the stats faculty were planning to have us do for the fourth project at the end of the summer. Whoops!
After class, my partner for the biostats group project and I finished up our presentation. The stats TA was there, so we were able to get some help to solve the problem of trying to eliminate confounding variables. The statistical solution the three of us came up with is way ahead of what we were supposed to do for tomorrow. But on the other hand, our project is a lot more interesting now than it would have been if we had just stuck to what we were asked to do. We ended up with at least one interesting result that we wouldn't have gotten otherwise.
This morning we had epi, and then I had to run for a research group meeting. During lunch, I was looking over our biostats presentation again, and I realized we had written one of our conclusions backward. I'm really glad that I reviewed the project early enough that I had time to fix it! The same biostats instructor that I like was the one in charge of our small group, and it was really fun. Since my partner and I had gone last two weeks ago, our classmates made us go first this time. This meant that our presentation wound up being the longest, because this biostatistician likes to interrupt and tell stories early on while there is still plenty of time. He told us that some of what we had done was "naive," but that the techniques we used are also what the stats faculty were planning to have us do for the fourth project at the end of the summer. Whoops!
Tuesday, August 07, 2007
Classes, Stats Project, and Clinic
Yesterday we had another stats seminar, and it was basically uneventful. Today we had epi, which was also fine. But this particular speaker has a tendency to get behind and go over time. Usually it doesn't bother me that much, but today I wound up walking out while he was still talking because I had to meet with my PA right at 11:00. I have finally filled out all of the forms to apply formally to the Clinical Research Scholars MS program, so I needed some papers signed. We also talked about the OSCE that I'm missing, and that I have been going to extra clinic sessions to keep practicing my physical diagnosis skills.
Afterward, my partner and I were working on our second statistics project, which we will be presenting on Thursday. It was kind of tough to decide what to do since we already answered most of these questions last week. We were trying to come up with a way to factor out some confounding variables so that we could figure out how much of the difference between our two groups was due to one single variable. But we had to call it quits before we figured it out because it was time for me to go to clinic.
I expected to get out of clinic early, but instead I wound up being there for longer than usual. The weather today in Cleveland was very bad, and I figured all of that rain and lightning would keep the patients home. Well, one did cancel, but all of the others came anyway. I saw one patient with an earache and another one with shingles on my own, and then I went with my preceptor to see two other patients who were getting full physicals performed.
My last patient was having dizzy spells, so I decided that I wanted to find out if she had orthostatic hypotension. A person who has this condition can get dizzy and faint if they get up too quickly, because their heart doesn't compensate fast enough to get the blood back up into their head from their legs. It is fairly common in older people, especially if they are taking certain medications. The test is simple: you take the patient's blood pressure once while she is lying down, and then again after she has been standing up for a few minutes. However, I wound up having to repeat the test, because my preceptor wanted me to take the patient's blood pressure three times while she was standing (after 2, 5, and 10 minutes) rather than only once. I also didn't know that I should get her pulse as well. It turns out that some patients might get a faster than normal pulse to try to compensate for having less blood returning to the heart. The problem with this is that if your heart starts pumping blood too fast, then there isn't enough time for the ventricles to fill up all the way before they pump the blood out.
All in all, it was a very tiring but good learning experience. I wound up staying afterward for about half an hour to talk to my preceptor about what I should be working on to improve my clinical skills for this year. The clinical faculty had already been discussing my progress anyway because I will be missing the fall OSCE, and apparently the physical diagnosis course director was very happy to find out that I took the initiative to set up these extra clinic days. My preceptor also offered to write an extra evaluation for me so that I can include it in my portfolio as evidence toward my clinical skills competency for this year. We agreed that I should start working on tailoring the history and physical exam to the patient's pathology, as opposed to trying to just get through a memorized list of skills and questions.
There is one downside to starting to learn clinical skills as early as we do, which is that a lot of times, you wind up memorizing questions and going through procedures without understanding exactly why you are doing certain things. Last year I got very frustrated with the physical diagnosis class at times for exactly that reason. I think that this year it will start coming together a lot better though, because we finally are reaching a point where we have enough background knowledge to understand what we're trying to do with various tests and questions.
Afterward, my partner and I were working on our second statistics project, which we will be presenting on Thursday. It was kind of tough to decide what to do since we already answered most of these questions last week. We were trying to come up with a way to factor out some confounding variables so that we could figure out how much of the difference between our two groups was due to one single variable. But we had to call it quits before we figured it out because it was time for me to go to clinic.
I expected to get out of clinic early, but instead I wound up being there for longer than usual. The weather today in Cleveland was very bad, and I figured all of that rain and lightning would keep the patients home. Well, one did cancel, but all of the others came anyway. I saw one patient with an earache and another one with shingles on my own, and then I went with my preceptor to see two other patients who were getting full physicals performed.
My last patient was having dizzy spells, so I decided that I wanted to find out if she had orthostatic hypotension. A person who has this condition can get dizzy and faint if they get up too quickly, because their heart doesn't compensate fast enough to get the blood back up into their head from their legs. It is fairly common in older people, especially if they are taking certain medications. The test is simple: you take the patient's blood pressure once while she is lying down, and then again after she has been standing up for a few minutes. However, I wound up having to repeat the test, because my preceptor wanted me to take the patient's blood pressure three times while she was standing (after 2, 5, and 10 minutes) rather than only once. I also didn't know that I should get her pulse as well. It turns out that some patients might get a faster than normal pulse to try to compensate for having less blood returning to the heart. The problem with this is that if your heart starts pumping blood too fast, then there isn't enough time for the ventricles to fill up all the way before they pump the blood out.
All in all, it was a very tiring but good learning experience. I wound up staying afterward for about half an hour to talk to my preceptor about what I should be working on to improve my clinical skills for this year. The clinical faculty had already been discussing my progress anyway because I will be missing the fall OSCE, and apparently the physical diagnosis course director was very happy to find out that I took the initiative to set up these extra clinic days. My preceptor also offered to write an extra evaluation for me so that I can include it in my portfolio as evidence toward my clinical skills competency for this year. We agreed that I should start working on tailoring the history and physical exam to the patient's pathology, as opposed to trying to just get through a memorized list of skills and questions.
There is one downside to starting to learn clinical skills as early as we do, which is that a lot of times, you wind up memorizing questions and going through procedures without understanding exactly why you are doing certain things. Last year I got very frustrated with the physical diagnosis class at times for exactly that reason. I think that this year it will start coming together a lot better though, because we finally are reaching a point where we have enough background knowledge to understand what we're trying to do with various tests and questions.
Friday, August 03, 2007
Journal Club
I led my journal club session today, and it was a fun discussion. Both of the articles (mine and the other student presenter's) were really interesting. I think I've already said that my article was on drug eluting stents. I had some extra data from the Cleveland Clinic interventional cardiology labs that the director allowed me to use. We didn't have as much time to look at it during class as I would have liked, but it was still neat to see some in-house data anyway. (It appears that implantation of drug eluting stents does not increase people's risk of dying in procedures performed at the Clinic.) The other paper was looking for an association between sugary drinks, obesity, and type II diabetes. Not surprisingly, the association was very strong. What is even more interesting is that even diet soft drinks are associated with higher levels of obesity and diabetes. But this is probably because people don't change their eating habits even when they switch drinks. In other words, if I still go to McDonald's and get a Big Mac, fries, and an apple pie, I am eating so many calories that it doesn't matter very much if I got a diet Coke to go with it!
I've already mentioned that this year's journal club is much less formal and a lot more fun than last year's was. I think it's partly because of the different style of the discussions, and partly just because I find the material so much more interesting. Each presenter has a faculty "content expert" whose job is to help us analyze the paper. My content expert was an interventional cardiologist since the paper was about stents. He also happens to be the person in charge of my MS program (Clinical Trials), so I already knew him from before. I also got help with the stats from the TA, because we haven't covered most of the stats they used in the paper in class yet.
After class, I was talking to the other content expert about what it means for family history to be a risk factor for diabetes. People tend to want to write it off as just being genetics (i.e., if your parents had diabetes, you'll be at a higher risk to get it too), but you also have to take into account that families share many lifestyle habits and living conditions as well. So if a person's parents become diabetic because they have horrible diets and lifestyles and they are obese, but that person watches his diet and exercises regularly, it's hard to say how much risk of becoming diabetic he has. Even if he's more genetically predisposed to get diabetes in comparison to people with no family history, he can still alter his risk by removing himself from the kind of environment (low exercise, high calorie, high sugar) that would tend to trigger development of diabetes. The problem, of course, is that temporary fixes like going on a diet don't cut the muster. You have to make a lifestyle change (ex. stop eating at McDonald's altogether) and follow it for the rest of your life.
I've already mentioned that this year's journal club is much less formal and a lot more fun than last year's was. I think it's partly because of the different style of the discussions, and partly just because I find the material so much more interesting. Each presenter has a faculty "content expert" whose job is to help us analyze the paper. My content expert was an interventional cardiologist since the paper was about stents. He also happens to be the person in charge of my MS program (Clinical Trials), so I already knew him from before. I also got help with the stats from the TA, because we haven't covered most of the stats they used in the paper in class yet.
After class, I was talking to the other content expert about what it means for family history to be a risk factor for diabetes. People tend to want to write it off as just being genetics (i.e., if your parents had diabetes, you'll be at a higher risk to get it too), but you also have to take into account that families share many lifestyle habits and living conditions as well. So if a person's parents become diabetic because they have horrible diets and lifestyles and they are obese, but that person watches his diet and exercises regularly, it's hard to say how much risk of becoming diabetic he has. Even if he's more genetically predisposed to get diabetes in comparison to people with no family history, he can still alter his risk by removing himself from the kind of environment (low exercise, high calorie, high sugar) that would tend to trigger development of diabetes. The problem, of course, is that temporary fixes like going on a diet don't cut the muster. You have to make a lifestyle change (ex. stop eating at McDonald's altogether) and follow it for the rest of your life.
Thursday, August 02, 2007
A False Alarm
Yesterday was a really long, tiring day. I got in at 7:15 to go to the O.R. because we were supposed to have another heart surgery patient for our study. But it turns out that we didn't have a case to do yesterday after all because no one had gotten the patient's consent. We are not able to get consent on the day of surgery, because otherwise patients do not have time to consider whether they want to participate. So unfortunately we had to let this patient go.
In the afternoon, one of my classmates wanted me to take her to the gym and show her how to lift weights, so I did. I haven't been going to the gym regularly myself though since I got back to school, and I tried not to do too much so I wouldn't be too sore. I don't know how she's feeling today, but I'm only a little sore. I've decided that I want to start working out regularly like I was before. I'll go again on Saturday.
We had epi this morning and some of the articles for today were pretty funny. My favorite was a study from several decades ago that was comparing the performance of surgery residents who had gotten grades in med school to other residents who went to pass/fail schools. The authors concluded that residents who had gotten medical school grades performed better in residency than residents who had gone to P/F med schools. But we spent quite a while ripping apart the authors' methodologies to the point where it was pretty clear that their results were not exactly convincing. For one thing, they had no way to evaluate the residents from P/F schools on the basis of what kind of grades they had gotten as medical students, which was how they determined the caliber of students the residents from graded schools had been. So it's completely impossible for them to even know whether their two groups of residents had equivalent characteristics as medical students. Then at the end, they bemoaned the decreasing standards in medical education due to social experiments. I bet if the authors are still alive today, they must really hate to see how many med schools are starting to move in the direction of P/F grading, at least for the first two years.
I am pretty much done with my journal club presentation for tomorrow. I met with my content advisor on Monday afternoon and the stats TA yesterday after class. There are some tough statistical concepts in this paper that we haven't covered in class yet (or maybe ever!), so I am only going to present a general overview about what they were doing.
In the afternoon, one of my classmates wanted me to take her to the gym and show her how to lift weights, so I did. I haven't been going to the gym regularly myself though since I got back to school, and I tried not to do too much so I wouldn't be too sore. I don't know how she's feeling today, but I'm only a little sore. I've decided that I want to start working out regularly like I was before. I'll go again on Saturday.
We had epi this morning and some of the articles for today were pretty funny. My favorite was a study from several decades ago that was comparing the performance of surgery residents who had gotten grades in med school to other residents who went to pass/fail schools. The authors concluded that residents who had gotten medical school grades performed better in residency than residents who had gone to P/F med schools. But we spent quite a while ripping apart the authors' methodologies to the point where it was pretty clear that their results were not exactly convincing. For one thing, they had no way to evaluate the residents from P/F schools on the basis of what kind of grades they had gotten as medical students, which was how they determined the caliber of students the residents from graded schools had been. So it's completely impossible for them to even know whether their two groups of residents had equivalent characteristics as medical students. Then at the end, they bemoaned the decreasing standards in medical education due to social experiments. I bet if the authors are still alive today, they must really hate to see how many med schools are starting to move in the direction of P/F grading, at least for the first two years.
I am pretty much done with my journal club presentation for tomorrow. I met with my content advisor on Monday afternoon and the stats TA yesterday after class. There are some tough statistical concepts in this paper that we haven't covered in class yet (or maybe ever!), so I am only going to present a general overview about what they were doing.
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