10 Reasons to Come to Penn

Now that it's almost Penn Preview, here are 10 some-typical-and-some-slightly-more-atypical reasons why Penn is the best med school on the planet and Philly is a great place to live, in no particular order except #1 (at the end):

10. The city—it's pretty! This one is not because I'm running out of reasons already. This is what I see on my way home from school every day:

A little bit of extra happiness every day adds up to a lot over four (or eight) years!

9. The second anatomy exam. Which is the only way to take an anatomy exam, as far as I'm concerned. It's taken in learning teams, and each learning team dresses up to a theme.

We had a Pac-Man team,

Photo by Dr. Rubinstein

a Sesamoid (Sesame) Street team,

Photo by Dr. Rubinstein

and an Avengers team,

Photo by Dr. Rubinstein

among others.

Our team dressed up as Dr. Fisher! He's one of the anatomy professors, and he wears black scrubs and black gloves every day. He even took a picture with us :)

Photo by Dr. Rubinstein

(The rest of the pictures, taken by Dr. Rubinstein, the Mod I director, are here.)

8. Learning teams. I'll be really honest here: I don't think anyone starts out loving their learning team. Well, actually, maybe some people do, but I think for most people (myself included), there's an adjustment. When you randomly put seven people in a group, there will probably be some people who wouldn't normally interact much with each other. But, I also don't think there's anyone who doesn't end up loving their learning team, and that's the important part. 

Photo courtesy of Winnie Lin

7. Everyone in Suite 100 is super nice and wants to help you. Suite 100 also has everything from mailboxes to tissues to candy.

Dorothy!

Maggie!

Maureen!

6. Every student gets an iPad. Because we can download lecture slides onto our iPads and take notes from there, (nearly) everything is electronic. I mean, seriously, you decide:

5. All the med buildings are connected, and mostly above ground—that means avoiding the elements when it’s raining/snowing/too hot/too cold, without giving up the benefit of sunlight. Here’s one indoor trip I took with Rebekah, who is on my learning team, with a detour to show off how pretty the buildings are (apologies if anyone gets dizzy/sick):

No sound, because played at 5x recording speed, we sound like chipmunks. Literally.

Here’s a rough map of where we went. Green rectangles are elevators.

4. SPOOF! Spoof happens every spring, and it is basically what it sounds like. It’s always hilarious, and also always includes a “first-year skit,” which is written, directed, and performed by first years. This year, the first-year skit was “Perelman Avengers.” This is Casey, one of our classmates, demonstrating Perelman Avenger Dr. White’s power stance (Dr. White teaches anatomy and writes the USMLE review book for anatomy, and is awesome!):

3. VC2000. I know I’ve written about this before, but it is really convenient if you ever need to miss class for anything, or just to review lectures afterward—for example, I’ve used VC to catch up when I missed class because I was shadowing at HUP, and Rebekah used VC to stay up-to-date with the lectures last time she was at a conference. Many people also VC because they just prefer to watch lectures at home. It has lots of useful features:

2. Three free classes in whatever you want. Mine this semester is ESE603, Simulation Modeling and Analysis, and I'm enjoying it, but there is definitely the option to take classes that probably sound more fun to everyone else. For example, my roommate took a Wharton class last semester, and one of my learning team-mates is taking a bioethics class. All of Penn is also on one continuous campus, which means getting to class isn’t a problem!

1. The students. This time last year, I was mostly choosing between two places. When I came to Preview, I had so much fun that I ended up missing my train back to school and booking a last-minute bus ticket on a friend's phone instead. I decided that was a pretty good indication that I should come here, and it's been one of the best decisions I've ever made. I guess what I learned is that some things, like the atmosphere at a school, are hard to quantify. But, it's those un-quantifiable things that make a decision which might seem whimsical at first the right one in the end.

[Penn]WikiHow: How to Dissect an Eye

WE DISSECT EYES IN BRAIN AND BEHAVIOR!!! We also dissect brains, but I’m not sure if there are rules against taking pictures of them, whereas I’m pretty sure HIPAA doesn’t apply to cows’ eyes, so it seemed safer to skip the brains and go with the eyes for posting pictures on the Internet. I also didn’t want to get any of my camera-containing devices dripping in formaldehyde, since the brains are preserved.

Here’s how to dissect a cow’s eye in five easy steps, learning team-style:

Warning: This post is full of potentially graphic pictures.

Disclaimer/anti-warning: However, they were taken with my silly-phone (i.e., not smartphone), since I forgot to charge my iPad that day, so they might actually just be too blurry to see.

Plug for Penn, since it’s getting to be recruitment time: Every student gets an iPad! We take notes on them, instead of lugging huge stacks of paper around.

1. Three eyes per learning team magically appear in the first-floor Stemmler lab rooms.
   
2. Find the optic nerve and the extra-ocular muscles (muscles around the eye that control eye movement), and cut off the muscles.
   
3. Cut away the front part of the eye. Now you can see the lens (that round blob in the middle), and the vitreous humor behind it. The retina, which contains the photoreceptors that allow us to see, is in the wall around the vitreous humor.
   
4. Play with the vitreous humor. It’s surprisingly jello-like—on a scale of 1 to 10 where 1 is water and 10 is jello, I’d probably give it a 6.5. If you look through the vitreous at the lens from the other side, you can see a shape exactly like the Mercedes-Benz logo on the back of the lens. Nature’s form of product placement?
   
5. Look at the rest of the eye, without the vitreous humor. It’s blue in cows, which helps collect light that isn’t absorbed by the photoreceptors the first time around. That’s why they can see better in the dark than we can. However, it also means that their vision is kind of blurry. (Wikipedia has a better picture)
   

Ta-da! Basically, Brain and Behavior is super cool.

A VC Day

PennInTouch with a
slightly depressingly-
far-away graduation
date.

Hi everyone! My name is Jessica, and I’m a first year MD-PhD student. I’m from Centreville, Virginia, which is about 20 minutes outside D.C. I did my undergrad at MIT, where I majored in bioengineering and minored in music, and just graduated in June 2012. I’m interested in a bunch of things, both on the research (tissue engineering, microfluidics, computational biology…) and medical (peds, cardiology, neurology…) sides, so I’m not quite (read: not at all) sure what I “want to do” yet, but my expected graduation date is apparently Spring 2020—see screen capture from PennInTouch—so I guess I still have plenty of time to figure it out. This is also my first blog post, so I’m kind of nervous, but here goes:

You may have heard that Penn has something called VC2000, which is like Reunion Hall CSPAN (Reunion Hall is where we have lecture). All of our lectures are recorded and put on VC, so that those who can't attend a lecture in person can watch them from home later. It’s pretty popular!

Anyway, I took advantage of VC recently too, but not to sleep in (although some do); instead, I shadowed at HUP’s electrophysiology lab! It was amazing. The backstory is that we have a project for our Mod 6 Doctoring class called ITAP (Interprofessional Team Assessment Project), where we’re supposed to observe a medical team in action and analyze how they work together. So Thursday morning, Russell (who is on my learning team) and I went up to the 9^th floor of Founders in HUP to watch the electrophysiology team do their daily morning meeting. We watched how the team members interacted as they discussed the patients they’d be seeing that day, determined what procedures they’d be doing, and made some decisions as to how certain patients should be cared for. After we’d fulfilled the bulk of our ITAP responsibilities, we stuck around to talk to/do some short interviews with some of the team members (also for ITAP), and of course, to watch the procedures.

First, I went to see an ICD replacement, while Russell headed off to watch an atrial flutter ablation. ICDs (Implantable Cardioversion Defibrillators) are about half-cell-phone-sized, battery-powered generators that use electricity to effectively shock the heart back into normal rhythm when the patient has dangerous irregular heartbeats. Here’s a Youtube video of one in action: 

And here's the corresponding article in Sports Illustrated:  http://sportsillustrated.cnn.com/vault/article/magazine/MAG1165292/index.htm.

ICDs have a limited lifespan, though, so they need to be replaced every so often. The procedure for replacement was very different from what I expected—only a local anesthetic is used, the incision to take out the old ICD and put in the new one is just a few inches long, and the entire process took about half an hour. Only the generator—not the wires that connect it to the heart—get replaced, and a lot of double- and triple- and quadruple-checking goes on to make sure the wires are reconnected correctly. I didn’t understand much, and it didn’t seem like a good time to interrupt with a million questions, but it looked and sounded like each wire is color-coded, labeled with what part of the heart it’s coming from, and labeled with a serial number to make sure that it connects to the right place in the generator. The patient was actually awake until the very end, when the electrophysiologists induced an irregular rhythm in order to test the new device.

Since the ICD replacement went so smoothly and quickly, I went to find Russell, who was watching an atrial flutter ablation, after it was done. The setup for the atrial flutter ablation reminded me of an airport control tower. Since the ablation done by inserting a catheter into the femoral vein and guiding it up into the heart, X-rays are used for imaging throughout the process. In order to minimize X-ray exposure for the doctors who are doing these procedures every day, one of them is in the room with the patient doing the ablation while another one is in a “control room,” watching and guiding. Everyone inside the procedure room is wearing lead jackets to protect themselves from the X-rays, and the control and procedure rooms communicate via headset.

On every monitor in the control room, a large number of indecipherable squiggles were running across the screen. Luckily for us though, it turns out the ablation procedure includes a 30-minute wait, so during the waiting period the attending paused to explain these squiggles, and what on earth an atrial flutter ablation is anyway.

Image adapted from the National Heart, Lung
and Blood Institute. Original image here:
http://www.nhlbi.nih.gov/health//dci/
Diseases/holes/holes_types.html

Heart muscles contract when they are stimulated by electricity, which is made in some special heart cells and is sent throughout the muscles. Normally, the electrical current passes through the atria in the upper part of the heart once, causing them to contract and pump blood into the ventricles, which then pump blood into the body. However, in atrial flutter, the electricity keeps on going around and around the atrium instead of disappearing. As a result, even though the atria contract more often, each contraction is less efficient, and this can cause all sorts of problems, including blood clots. To fix the problem, electrophysiologists can make a series of tiny burns in the wall of the atrium; this is called ablation. Then in the future, if the current tries to go around the atrium instead of stopping like it should, the electricity will get stuck where the burns were placed, and the atria will continue to contract normally.

When the half-hour wait was over, it was time to see whether the ablation had worked. To do this, the doctors stimulated the heart muscle with electricity in one location, and then measured how long it took to get to two other places in the atria. Based on which of these two places “felt” the electricity first, they could tell whether current was still passing through the area they had intended to ablate. To give an idea of the level of precision involved, they were looking at differences on the order of tens of milliseconds—for comparison, test your reaction time here: http://www.humanbenchmark.com/tests/reactiontime/ (average appears to be ~215ms. Guess I'm way below average!). Fortunately, the equipment being used could detect time differences that are much shorter than human reaction times, and they saw the stimulation pattern they expected, which meant that the procedure had worked.

After watching the ablation, we decided it was time to end our brief foray into real life after med school, and headed back to the biomed library to catch up on some rheumatology lectures. Shadowing was great, though; and we learned so much! I loved shadowing in the EP lab, but for those who aren’t as interested in cardiology, Penn also has many other shadowing opportunities, both at HUP and at CHOP—in fact, shadowing in the emergency departments at both hospitals is an established "thing" and is fairly common among our classmates. Some people also just set up shadowing times outside of the emergency departments, with small group preceptors, for example. Whatever your interests, shadowing opportunities are fairly easy to come by here, and definitely worth missing lecture for once in a while!