Inspiration and the Medical Student

My last post started with the idea of finding Inspiration, of the sort that drives one to create, to achieve, to question, to learn. The natural next question is what I plan to do with that Inspiration.

We’re told as children to dream big, that the world is ours for the taking. It’s no less true now—I’d be hard-pressed to find a better and richer environment in which to learn—but things have changed. As a high school or college student, I had the bandwidth to pursue those dreams. Sure, I still wanted to do more than I was able, but my internal checks and oft-waning interest for my latest obsession set up a sustainable way to balance my time against my passions. But as a medical student, it’s simply no longer possible to operate the same way. I realized this a few weeks ago as I found myself having ten conversations a day with my classmates commiserating about how 24 hours in a day is just too little, but it’s only starting to strike me now. 

I’ve certainly tried to do it all by going the extra mile to free up my time. But somehow, days blend into weeks, weeks to months, and I’m still sitting on that to-do list that’s gotten only marginally shorter. I want to be clear: I’m not saying that medical students don’t have the ability to pursue anything outside of their classes. Looking at the amazing things medical students are doing every day across the country would disabuse anyone of that notion. What I’m saying is that for very disparate career interests, even within the field of medicine, it’s exceedingly difficult to build solid skill sets as a student. For example, I have a strong interest in the innovation happening in the healthtech start-up world, I love writing and medical journalism, I’d like to pursue pharmaceuticals and drug engineering, and I want to do some academic research as well. These aren’t just passing interests; I would commit to doing all of these things as a career to better inform the way I care for patients and approach medicine.

To those reading, it would seem that I’m complaining about growing up. After all, it’s universally true that with adulthood come responsibilities and a narrowing of horizons. First with a college degree, then a focused graduate degree, and then often a more focused job.  I’m not presumptuous enough to think these issues are limited to medical students, or even students. But it’s a little different for us as medical students: we spend those formative 20s (and sometimes 30s), when much of our generation is exploring and trying and doing, in school and in training. Our capacity to extend and challenge ourselves becomes greatly diminished simply because our road consumes so many hours of our days and years of our lives. None of this is new, I realize. And none of this was new to me when I applied straight from college. I’m proud of my decision and excited for the future, but I need to have those difficult conversations with myself now. What do I want to do? Where do I want to make an impact? And as negative as it sounds, what doors am I willing to shut? Since I can’t both invent a device and revamp Medicare (I’m sure someone has, but c’mon, I have to play the odds), what next?  So I’m not complaining about growing up. Instead I’m realizing I can’t so easily take on the world anymore.

So to answer my first question: my Inspiration is being put to use leaving ajar as many doors and creating as many windows as I can. It’s far too easy to get bogged down by grades, and classes, and The Next Step. It’s even easier to shrug off goals because school is just too busy. To all my friends and peers with whom I’ve sympathized about running out of time, I get it. I don’t have the time either. But we have to make the time. We can’t sell ourselves short—the world is ours for the taking, remember?

To read more of my musings, follow my personal blog.

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.

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!

A Message from the Medical Student Government (MSG)

To the Incoming First-Years -

Congratulations on your decision to come to the Perelman School of Medicine at the University of Pennsylvania! On behalf of the Medical Student Government (MSG) and the rest of the student body, I’d like to welcome you to the Penn Med family.

The next four years (or more for half of you) will be some of the most formative of your life. I’m excited for all of you because medical school here at Penn is something you will truly experience as a community. You will spend hours on end with each other dissecting in the anatomy labs, studying with groups in the library, and learning the intricacies of medicine. You will be given access not just to the human body, but also to patients’ lives. It is a hallowed experience that will bind your class together always.

I urge you to get to know as many of your classmates as possible. They are some of the most amazing, interesting and accomplished people in the world. In fact they may be so impressive that you feel you don’t belong, and for that I would like to commend you on your humility. You absolutely belong and the people you find here will become your best friends and resources for years to come. They, along with an incredibly supportive administration, will spur you forward to accomplishing your goals.

The Medical Student Government’s role is not only to help you through this period academically, but also to develop the Penn Med community through events and support of student groups. You can look forward to Field Day (think BBQ, faculty Dunk Tank and Slip ‘n’ Slide), Formal, a Spelling Bee and Medical Quizzo. We’ll be inviting you to welcome events in the fall where you can meet the MS2-MS4 students who will help guide you through the years. If you'd like to be part of the MSG team, class representative and co-chair elections will take place this September.

Please feel free to contact me with any questions you have. We’re so excited for your arrival!

Again, congratulations!

Grant W. Mitchell
MSG President

Welcome to Perelman! (You Now Have One of the Longest Email Addresses in the World)

As an MS4, I’d like to congratulate all you new rock star MS1s on working hard to get to medical school. You’re about to embark on an incredible journey of learning, love, laughter, and other words not in my vocabulary that start with the letter “L.”

Medical Student Government-organized
basketball at the Wells Fargo Center
after a 76ers Game

Time flies in medical school. To be cliché, I feel as though it was yesterday that I sat in my own White Coat Ceremony feeling nervous yet excited about the experience that was to come. I remember putting on my white coat and thinking to myself, “Wow, I’m going to be a doctor one day…”  Now, I see my classmates applying for residency and finishing their clinical electives. That “one day” of being a doctor is now only 9 months away for the MS4s. Yep, time flies; but that’s because you have a lot of fun in medical school.

Penn Medicine does a Ninetendo Halloween

Since I’m having so much fun in medical school, I decided to take a year out to pursue a Master’s in Translational Research (MTR), one of the many dual-degree programs available to you at the Perelman School of Medicine. What is “translational research”? Most people define it as research that can easily be applied “bench-to-bedside,” i.e. you make some therapy or gene discovery in the lab and then take it to a patient. You’ll definitely hear about the program throughout your time at Penn though, and if you think you may be interested in taking a year out to do some research and adding more letters behind your name after you graduate, please consider it.

My specific translational focus is on surgical education and simulation. I want to better understand how surgeons acquire expertise and to apply educational interventions in the simulation center to improve patient outcomes by reducing morbidity and mortality related to technical errors. Or, in English, “Can we use video games to train better surgeons and prevent mistakes in the operating room?” Penn let me turn my love of video games into a research career.

Medical students assisting the former Chief of Surgery at the

VA in simulated aortic aneurysm surgery at the

Penn Clinical Simulation Center

Penn gives you the opportunity to pursue your passion -- research, community service, world travel, consulting, or working in the TV business. The best advice I can give you is to take advantage of the many resources that will be available to you. Talk to fellow classmates, upper classmen, faculty, and Suite 100; everyone is more than happy to help you make the most of your medical education and your time here at Penn. To borrow an advertising slogan from an Italian chain restaurant, “When you’re here, you’re family.”

Oh, and about that email address, just write “yourpennkey@mail.med…” on any school event form and you’ll avoid writer’s cramp. Trust me, I’m almost a doctor.

To the Perelman Class of 2015

My name is Katie Dillon, and I am an MS 3/4. I am so excited to meet all of you MS1s and welcome you to an amazing next four years. I want to reassure all of you that finally, after the months on the interview trail, agonizing over options, and weighing finances, you have made the right choice. I chose Penn three years ago because I was looking for a school that would give me rigorous training (obviously!), but would also allow me to have interests outside of medicine. I was an anthropology major in college and I wasn’t ready to completely give up the reading, writing, and discussions I enjoyed so much. Penn is an incredible place that wants you to pursue your passions and will often pay for you to do so. In the past three years I have traveled to Thailand for research, taken classes for a Masters in Bioethics, played a ton of golf and tennis, hung out at the Jersey Shore, and eaten at many of Philadelphia’s fabulous BYOBs.

Since I’ve been at Penn, and especially after my time on the wards, I’ve come to realize that I am most passionate about women’s health, and I want to be an Ob/Gyn. Right now I’m especially interested in infertility-I think the medicine is fascinating, there is a ton of great research in the field, and there are even some questions that benefit from a little ethics training. This year I am taking a ‘year-out’ and conducting research through the Doris Duke Clinical Research Fellowship. Twelve medical schools in the country offer the fellowship, and I have been lucky enough to get to stay here at Penn and work in the Division of Reproductive Endocrinology and Infertility on a number of exciting research projects with terrific faculty.

I am eager to keep you updated on the progress of all of my activities this year, from my research to my ethics classes (Zeke Emanuel, Rahm Emanuel’s brother, just joined the department!) to use of my newly-found free time now that I’m taking a break from the hospital and no longer working ‘rotation hours’. I hope that you’ll enjoy following along, and I wish all of you a fun-filled orientation week!

Back to School

Hello all!

I would like to take this first post to quickly introduce myself but also to wish the new first-years a warm welcome. I couldn’t be happier that you are all here-now we are no longer the lowest on the totem pole. Kidding, of course. I hope and trust that you’ll like Penn as much as I have. I think that you start orientation soon which is actually awesome (and believe me, I went into it with a lot of eye rolling) so have fun and we can’t wait to meet you!

And of course welcome back to my fellow 2014ers, I hope all of your summers have been amazing. From the Facebook posts and emails I’ve been getting I think that’s the case: surfing in Nicaragua, planning a wedding, volunteering at a clinic, learning acupuncture in China, working with refugees in Philly, working with an oncologist in NYC-and that’s just my learning team. To the 2013/2012ers, I don’t need to welcome you back as you’ve been working your butts off whilst we young-uns have been gallivanting around enjoying the last bits of freedom before we delve into the abyss that is cardio/renal etc.

Using VisualDx Mobile with some pediatric residents in derm clinic

OK! Now on to more important things-me :) Who am I? My name is Hayley and I am just starting my second year at the Perelman School of Medicine. I am originally from Boston, went to Brown, graduated on 2009, took a year off and worked in Malawi before heading to Philly for med school. I will be blogging my way through the year in order to give everyone a glimpse of what life is like for one PSOM-er.

I am currently writing this post from Botswana where I spent the summer (you can check out my adventures at hayleyinbotswana.blogspot.com) doing dermatology work at Princess Marina Hospital. Penn has a fantastic partnership with Botswana and I have had the most amazing summer. As I wrap up my time in Bots and prepare to head back to school I thought I’d end my first post by letting you know what I am looking forward to this year and what I am dreading:

• Absolutely dreading heading back to my apartment because I know that in my haste to leave, I dumped all my (clean) laundry on my bed without folding it. What a welcome home present for myself. Ugh.
• Can’t wait to get some Yogorino on Rittenhouse Square and watch all the cute puppies.
• Not excited about trading this perfect Botswana weather for the heat wave I’ve heard about in Philly.
• Pumped about planning some events for the Elizabeth Blackwell Society (for female medical students) as well as visiting Covenant House (teenage homeless shelter in Germantown, PA where I volunteer with a few other med students).
• Very very scared to begin our cardiology block: it has a reputation of being extremely tough. I know that I will be fine once I start but I’d be lying if I said I wasn’t a bit nervous.
• Happy to re-start Pilates classes. Africa and exercise didn’t mix as much as I’d hoped.
• Mainly I am so excited about seeing all of my friends and hearing about their summers. As I mentioned above, I have been blown away with the updates I’ve been getting via the interwebs so I’m eager to hear about it in person.

Signing off for now!