Grand Rounds, Vol. 2, No. 51: Celebrating Education

Welcome! First off, if you haven’t already, I invite you to hop over to see my Pre-Rounds host interview on Medscape (requires free login). 

In keeping with the September tradition of “Back-to-School,” this week’s Grand RoundsClock_tower_1 celebrates education.  That is, participating medical bloggers were asked to highlight posts that reflect in some way on the indispensable role that universities and other training centers play in making medicine happen.  God knows, all the medical professionals (and lots of the rest of us) have spent an unspeakable amount of time studying.  And we continue to learn throughout our careers and lives — which is one of the brighter sides of being human.

With a dash of flavor to “keep it real,” let’s have a look at a series of fictional

EMAILS HOME FROM A FIRST-YEAR STUDENT:

Student_using_notebook

re: Settling In

Hi Mom, Hi Dad,

All good here. Kind of hectic.

It seems that September is National Cholesterol Education Month, so we had a unit on the use of statins, which are treated kind of like wonder drugs.  Apparently Kaiser is pushing high doses, but not everyone in the medical community agrees.

And I’m trying to get to the gym regularly, especially after our recent lecture series on the benefits of exercise.  You were right, of course: simple movement can go a long way towards keeping the body resistant and preventing so many disorders.  But most patients say they “don’t have time to exercise” — and then it’s too late.

On top of that, the food’s pretty bad.  Hot dogs with a side of lucky charms?  It’s like they say, “off to school, bring on the pounds.”   There has to be a better way!  I even read that in a recent study of 101 childrens  hospitals in the US and Canada, there were 29 fast food outlets in the 24 hospitals surveyed! Can you believe that?  But you know what?  It’s up to the parents to set the example, after all.  So thanks, you guys!

More from campus
soon,

Yours,
MS

——————

re:  Higher Education?!

Hi M&D,

Sorry it’s been a while.  We’ve been slammed.

Met the nursing instructors today.  What a determined and perceptive bunchXteacher these (mostly women) are.  For all their varying personalities, they all have it nailed when it comes to the “manners” of professional interaction.  I’m watching and learning…

Also got a term project assignment on “photic sneezing.”  Ever heard of that?  It’s a rare condition where sneezes are preceded by a sharp, acute, aggressive wave of nausea. Pretty mysterious.

I’m supposed to work on it with my friend Jennifer.  But guess what happened to her when she went kite-sailing on vacation in the Caribbean?  She actually got stung by a sting-ray, just like that guy Steve Irwin in the news!  Thank God Jen’s sting was in the leg and not the chest.  The doctors say the wound probably penetrated Steve Irwin’s heart and that a medical professional would have told him not to pull the animal’s spine out himself, but to wait for proper surgery. Poor guy. Scary!

Anyway, some kids already tried to steal some equipment from the multimedia lab.  Two new buddies of mine are taking the fall, even though they weren’t the instigators. Why do people confess to things they didn’t do?  Must be that deeply ingrained historical and religious tradition of catharsis and therefore “relief” — at least that’s what my psych major roommate says.

I’ll call you
Sunday.

Yours,
MS
——————

Re: Good Internet

Hello Parents,

Especially you, Dad.  I know you always worried about me “wasting so much time” on the Internet.  But you will be happy to know that it’s an official part of our curriculum.  And we’re not just playing with MySpace.  You can’t imagine the things you can learn on the Web. Like Dr. Kavokin’s online lesson on “how to spot a bad mole.“  I kid you not. Robotics_000

We also looked at an online intro to the medical journals — that features a seven-minute video.  And in what is referred to as “peer learning,” it’s amazing what online support groups can do for families dealing with difficult conditions, like pediatric liver disease.

Plus, for example, you know there are lots of cancers that grow completely unnoticed, like utherine cancer. So they’re now urging patients to take the online quiz to find out if they have some of the subtle symptoms.

We were even asked to read on the Internet 10 chapters on what it’s like when the doctor becomes the patient themselves, like after a stroke.  Moral of the story: people matter more than jobs.  And to go with it, a recent survey of what contributes to longevity — apparently it’s mostly about working less and enjoying life more.

I wonder why they had us read that stuff when we still have YEARS of studies ahead.  I guess it’s just to remind us there’s light at the end of the tunnel…

Thanks for the care package, btw.

Yours,

MS

——————

Re: Exploring

Hi Guys,

So I’m thinking harder than ever about what my professional focus will be.  I really want to love what I do, you know?  My roommate says he may never learn to love psychiatry, despite how much fun others make it sound. But that might just be sour grapes when lectures get cancelled and Clinical Skills sessions go bad.  Which happens…

It seems more 3rd year medical residents are choosing to become super-specialists rather than generalists, according to the New England Journal of Medicine.  I’m not sure if that’s good or bad.

I really thought I would love working in the ER, but that was before I read the new book called “Just trying to save a few lives: tales of life and death in the ER” by Pamela Grim, M.D. about “the darker world of a lone star ER doc.”

Med_students_1 A guest speaker today was telling us how in the teaching hospital, death isn’t necessarily the end; last night she helped resuscitate a man by pounding on his chest, just like on TV, and this nurse was pregnant(!), so a lot of others had to jump in and help out.  They brought the patient back four times that night, but he didn’t make until noon the next day.  And considering some of the tactics used, you have to wonder if it’s in the interest of the patient, or more for the fellows’ research…

On top of that, the administration decided the intro students should have “pen pals” this year — can you believe it?  And mine works in the ER. She’s a medical student in South Africa — who also blogs about her experiences over there.  In one night she saw an 18-year-old boy with diabetic ketoacidosis (DKA), several stabbing victims, a man who’d been hit by a car, and one man who announced that he was a sex offender. Geez!  I’m not sure that’s the life for me.

btw, my friend Jen got paired with a guy spending three months teaching in Sarawak, South East Asia – where medical science is hampered by stifling air pollution and political upheaval. I don’t envy him.

Anyway, no worries.  We’re safe enough here, unless you count the lack of sleep :)

With Love,
MS

——————

Re: Learning Curve

Hi There,

You guys wanted more details on our class material, so here it is:

Today we heard a rousing debate about how much training hospital chaplains should have, which was really interesting, ’cause I thought they were just there as greeters and for cleaning up a bit, but it turns out the comfort and prayers they offer are often what matters to patients and their families most.

While we’re on this unit learning about the “Patient Experience,” we also had a guest lecture from a certain Dr. G on “How to Survive in the Hospital.” Essentially patients have to do a lot of homework on their own physicians, medications, and treatments. And be prepared to answer the same basic questions ad naseum, right Mom?  I know you know what I mean. Dorm_room

I also read an eye-opening piece on patients’ experience with student doctors — what do residents actually learn when the leading doc treats the patient like a specimen rather than a person? It’s not about proving your authority over the patient, after all!

In “Medicine and Society,” we had Prof. Gaia  Bernstein of Seton Law School present his studies on genetic discrimination. He researches technology and its effect on law and society with special emphasis on genetic discrimination and privacy.  I remember he said: “I believe the greatest concern is actually under-utilization of genetic testing technology caused by fears of genetic discrimination.”

Yet sadly, it seems that fewer schools offer law and science and law and genetics courses these days.

We also went over the universal health care dilemma, i.e. “the grass is always greener…”  I guess we collectively want what the Canadians have, and they want what we have. But you end up getting what you pay for, right?

What’s really frustrating is learning about The System (healthcare coverage): now I know why you guys complained so much.  HMO’s often actually prevent patients from having access to technologies and treatments that can prevent surgery and complications down the line.

And you know what else?  You’d think everybody’d done it by now, but some medical practices are still struggling with converting to electronic medical records.  We got some hot tips from a GP in NY today.

Finally, I forgot to tell you about a symposium on chemotherapy for breast cancer we had last week. I thought it was standard across the board, but it seems there’s still some debate on whether the results are worth the negative side effects, especially in younger patients.  Makes me think of Aunt Rose…

Love to you both,

MS


——————

Re: Prepping for Hands-On

Hello Both,

Hope you’re healthy! Getting over my cold here, finally. 

They’re busy prepping us for the hands-on training we’ll finally be Anatomy_model getting next term. We’re learning about how to tell who’s at risk for certain conditions, using tools like the Swedish Dimentia Risk Score.  You can never tell in advance with absolute certainty who’s going to get any disease, but if the risk is high, you can implement some “lifestyle and pharmaceutical interventions.”  No secret there.

Did I tell you we did our first dissection of human cadavers last Wednesday? Some guys thought it was funny to name the cadavers; some guys didn’t. Ugh.

With regards to the living, the lead MD over here says the most important thing to learn in medical school is how to “eyeball” a patient’s condition.  And of course, staying in the constant mindset of being “on call,” ready at a moment’s notice to the the middleman between the resident and intern.

He also joked that some doctors prefer their patients asleep — like when performing an adult circumcision – yikes!

And he likes to remind us that some things are hard to learn in school, like understanding the anxiety of patients going to see a new doctor. He reminds us to draw on our own personal experiences for this, because it can be pretty tough being on the other side of the medical ledger.  Like when doctors (even sometimes med students) get the unenviable job of telling patients they’re terminal. Then sometimes, even the person delivering the diagnosis cries.   

And sometimes, the diagnosis is a total surprise to everyone, like early teen pregnancy.

We watched a live tele-session from a workshop for Health Aides called “Boils 101″, to get the sense of hands-on experience with rural AlaskansReally_tired_student suffering from MRSA.  Each of those sessions was attended by 8 to 12 trainees, who spent just half of their time in a classroom setting — the kind of ratio they’d like all senior students to have. 

One big thing the experts keep repeating is that we need to change the way hospital executives are educated.  We’ll all need to think differently about what the future role of our hospitals will be, meaning we new recruits will have to become part of a new healthcare model, or better yet, help INVENT IT.

So you can see your tuition dollars are hard at work! 

Hugs and Kisses,

MS

Computer_keys PS – Pls don’t be late picking me up.  I may collapse if I don’t get a timely break here :)

PSS – Don’t forget to participate in TMBN’s Healthcare Blogging Survey. It’s for a good cause. 

PSSS – See the Grand Rounds next week at Tundra Medicine Dreams.

PSSSS – You can “digg” this post at Digg.com by clicking HERE. Thanks!


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20 Responses

  1. hgstern
    hgstern September 12, 2006 at 6:22 am | | Reply

     
    Wow, Amy, wonderful job! Timely and creative…Kudo’s!

    Thank you for hosting this week.
     

  2. Fard Johnmar
    Fard Johnmar September 12, 2006 at 6:28 am | | Reply

    Wow! What an amazing edition of Grand Rounds! Very creative. Also, thanks for mentioning the survey!

  3. difficultpt
    difficultpt September 12, 2006 at 6:48 am | | Reply

    Wonderful as usual, Amy! Thanks for hosting–you’ve done an outstanding job!

  4. Gerry Pugliese
    Gerry Pugliese September 12, 2006 at 7:18 am | | Reply

    Nice job! Lots of good stuff in there.

  5. Mona Johnson
    Mona Johnson September 12, 2006 at 7:34 am | | Reply

    Good work, Amy – love the “emails home” format!

  6. Giskin Day
    Giskin Day September 12, 2006 at 8:45 am | | Reply

    This is inventive and informative! Well done and thank you for putting in the effort.

  7. enoch choi
    enoch choi September 12, 2006 at 9:02 am | | Reply

    Thanks for the props! wow! the first link, i’m honored! What a creative way to put all the posts together, this is lovely.

  8. Dr Emer
    Dr Emer September 12, 2006 at 9:07 am | | Reply

    Excellent presentation! Your hard work and creativity shows. Thanks for hosting.

  9. TheTundraPA
    TheTundraPA September 12, 2006 at 9:18 am | | Reply

    Outstanding job Amy! You’ve certainly raised the GR hosting bar another notch. I’m “chuffed” as Borneo Breezes would say (who, BTW, is a gal, not a guy) at what a hard act I have to follow! Thanks for hosting.

  10. Moof
    Moof September 12, 2006 at 9:19 am | | Reply

    Great job! You put a lot of work into that! :o )

  11. enoch choi
    enoch choi September 12, 2006 at 9:19 am | | Reply

    one clarification to readers is that Kaiser uses generic statins at a higher dose to achieve the same lowering of cholesterol that a more potent statin at a lower dose achieves, such as Lipitor. They believe they can save $ by using generics and achieve the same health outcome. Branded statins such as Lipitor are trying to say that cholesterol lowering isn’t the only way they help, and that you have to use THEIR drug to get the other effects.

  12. Paul Auerbach
    Paul Auerbach September 12, 2006 at 9:41 am | | Reply

    What a terrific format – thanks so much for making this effort.

  13. Dr. Deb
    Dr. Deb September 12, 2006 at 11:51 am | | Reply

    Charming and informative!

  14. Fat Doctor
    Fat Doctor September 12, 2006 at 5:12 pm | | Reply

    Very, very nice. A good read, and I learned some good info. Thanks for all of your hard work!

  15. Kerri.
    Kerri. September 12, 2006 at 7:51 pm | | Reply

    I realized too late that I had missed the submission deadline – I wish I had submitted in time to be a part of this Round!

    Terrific job hosting, Amy. Bravo!!

  16. ipanema
    ipanema September 13, 2006 at 5:52 am | | Reply

    Oh this is lovely! Well done!

  17. That Girl
    That Girl September 14, 2006 at 7:25 am | | Reply

    Thanks!!

  18. stacy
    stacy September 23, 2006 at 10:48 am | | Reply

    Sorry I’m late – been really sick.. just wanted to comment and let you know that this GR was amazing! :) :)

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