Let the Good Times Roll…on Medical Education: The Doctor Shortage

Catey Harwell, MS2

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One of the hot topics at the GSA/OSR Joint Regional Conference is that of the impending doctor shortage. Estimates predict that the U.S. will see a shortage of between 46,000 and 90,000 doctors by 2025, particularly in surgical specialties, which I find somewhat surprising given the recent push for primary care. You can check out the AAMC report here. The AAMC is really making this a focus. In fact, they’ve put together a series of brief videos to highlight what this could mean for doctors and patients. While the videos may come off as a bit cheesy, they may very well represent reality in a not too distant future.

Because it takes so long to become a doctor, this isn’t a problem that can just be “dealt with” in 2025, we need to start finding solutions now. One of the big concerns I hear from fellow students, and a concern I have myself, is the unrelenting competitiveness for residency positions. There just doesn’t seem to be enough spots…but are there? According to data presented in another session by the National Resident Matching Program (NRMP) at the conference, there are. Here are how the numbers shake out:

~18,000 allopathic seniors

~3,000 osteopathic seniors

~27,000 first year positions (PGY1)

More residency-specific data can be found here.

Unfortunately, the number of students graduating from medical schools (osteopathic and allopathic) is increasing at a faster rate than residency positions are being added. That’s where we start getting into trouble.

Let the Good Times Roll…on Medical Education: Effective Study Habits

Catey Harwell, MS2

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Last week, I attended the Northeast and Southern GSA/OSR Joint Regional Meeting in New Orleans along with my fellow UofL OSR reps. The AAMC hosts a conference for their Group on Student Affairs (GSA) and Organization of Student Representatives (OSR). This Spring, it was a joint conference with the Southern and Northeast regions. The states included in these regions are listed below.

One particularly interesting session, at least to me, outlined study behaviors that have been shown to be effective and ones that have been shown to be ineffective in the literature. For example, behaviors that do NOT work include:

-Re-reading – this is passive and it can provide a false sense of knowing the material

-Laptop note taking – students are not forced to summarize and identify main points, which are considered important for effective, active learning

– Study aids – basically someone else is doing all the work

– Highlighting – this may actually hurt performance (!); it doesn’t help connect concepts across chapters/paragraphs

– Flash cards – when you make them yourself, you often don’t have time to use them effectively

What DOES work:

– Time management – taking the time to put together a study schedule helps you manage your time effectively; planning ahead also allows for “distributed practice” (rather than trying to learn everything in one cram session)

– Selecting main ideas – summarizing and identifying key points facilitates learning and retention

– Actively process information – each person select different information that he/she needs to focus on (i.e., don’t just copy your classmates notes from class)

– Practice retrieval – basically, self testing; start early – don’t wait until the day before you take the exam to start doing practice questions, you need to be consistent with it

While some people may mourn the fact that highlighting has not been demonstrated to be an effective studying tool, what I’ve found that seems to work for me is a multi-modal approach – I’m listening to a lecture, reading along, and taking notes in the margins on key points all at the same time. And questions…lots of questions, in a simulated test-taking situation, too, with adequate, thorough review of the answers. At least, so it goes in an ideal study world. I’ve got the study schedule in place for Step 1, now it’s just down to the execution.

Ready, set…rank!

Allison Hunter, MS4

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It is hard to believe that after almost two months of grueling interviews, four years of medical education (and not coincidentally more debt than I care to think about), countless cups of coffee, and relationships that have changed me forever, we (by that I mean the Class of 2015) are less than a week away from submitting the infamous “Rank List.” This individual list subjectively numbers programs from top (most desirable) to bottom (least desirable) of where to pursue residency. I feel like I should know my list by now—I spent essentially the last four years in preparation for this decision, right?

As an applicant for orthopaedic surgery, I was never one of those who “always knew” THAT’S what I wanted to do with my life. I always envied those types—the kind who saw it, knew it, and pursued it. Instead, my relationship with this chosen specialty was more like an interwoven story line. I was exposed to orthopaedics early, as a college student. No sports injury to report, just a plain ‘ole shadowing experience. I LOVED it. I felt like I was on E.R. (throwback show from the early 2000s) with my first “fight or flight” response during a multi-injury Trauma case, while I also felt the ballet-like controlled pulse with attention to detail during my first Hand case. The alternating tempo, the vibrant personalities, and the fundamental principle of helping others by restoring mobility, strength, and function really drew me in. In any event, since college and back-and-forth through medical school, one thing remained: orthopaedics was my Holy Grail. It became the one specialty that I used for comparison against all the others, and ultimately the one field I kept coming back to, despite earnest exploration of most other aspects of medicine.

Fast forward and here I sit a fourth year medical student, sorting through the list of all the potential programs where I will pursue residency training. It is no small decision…just the next five years of my life (the better part of my 20s) and my future career—uuuh, no pressure? Weirdly, even knowing the weight of this choice, I am not that nervous. I am happy, thankful, grateful, and excited to be in a position to even make this decision! Knowing that, it is important to understand that a lot does go into the decision-making process…quality of the program, location, camaraderie among the residents, operative experience, mentorship, research opportunities, and I could go on and on. I pour over the decision with color-coded spreadsheets, pros and cons lists, and a “favorites” call list of family and friends that have helped to guide me through the process. But, at the end of the day, I think my mom said it best when she offered this piece of advice: “Go with your gut feeling. ‘Gotta trust it: personally and professionally!”

So, Mother Dear, that is exactly what I am doing. I am going with my gut! My rank list is in. Certified on NRMP and out of my hands. I may not get my number 1, and truthfully I know I could be happy anywhere so long as orthopaedics is in my future. But, I can say with certainty that I ranked what felt right. Now all there is to do is wait! March 20, 2015 can’t come soon enough!

Refueling that Fire: Reflection from the AMA Region V Conference

Arooshi Kumar, MS2

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Two weekends ago, post-block exam five for the MS2s: Mellad Khoshnood, and I as well as three MS1s, Raijta Kumar, John Mittel, Reba Hodge road-tripped to Detroit, Michigan to attend the American Medical Association’s Medical Student Section (AMA-MSS) Region V Conference. The AMA is the largest organization of physicians and doctors-in-training, while the MSS arm of the AMA is the largest and most influential health organization in the nation for medical students. Region V consists of Michigan, Ohio, Kentucky, Indiana, and West Virginia. While we primarily attended this conference to represent the University of Louisville SOM in the AMA-MSS Public Health Case Competition, we left inspired and surprised by how much impact the AMA has on medical education, health policy, and clinical practice. Hearing from an array of accomplished physicians and esteemed members of the AMA-MSS leadership, I, particularly, left with a renewed vision of why I initially wanted to be doctor.

During my undergrad career, the internship opportunities I participated in piqued my interest in neuroscience and health policy research. I explored the disparities in healthcare coverage for cancer diagnostics across the nation and methods to eliminate a vicious eye disease in Africa. These opportunities sculpted my ultimate goal of becoming a physician translating research into pertinent clinical health policy. However, once medical school started, my interest in health policy took a backseat to the notes, books, and lectures that came my way.

This AMA conference reminded me that even as medical students, we have a voice to drive change. The Public Health Case Competition provided a formal platform for a group of us medical students to brainstorm, plan out, and propose a theory of change to resolve a large-scale health issue. In order to devise a comprehensive solution, we were required to factor in the social, political, economical and cultural implications of our solution which demanded much research from our end. Moreover, we had to include a feasible budget (having $1M to spend), timeline, and had to provide metrics on how we would test the efficacy of the solution. The entire experience was mentally stimulating, physically exhausting, and at times frustrating. Most importantly, it served as a simulated, yet, realistic portrayal of the complexity one faces when trying to solve real world public health problems.

After presenting our solution, we had the opportunity to hear from some exceptional speakers. The AMA-MSS Governing Council Chair described ways the AMA impacted his medical school experience and the opportunities he gained from it. He illustrated how proposals to either change an existing health policy or create an entirely new one has the potential to be passed by the AMA-MSS and then by the AMA House of Delegates, usually consisting of practicing doctors. If successfully passed through these bodies, the proposal can then be taken to Congress in DC to become an official law. In addition, the Chair described AMA-MSS as an incredible medium for networking, affording medical students vast opportunities to meet medical students from across the nation embodying various ideas, perspectives, and experiences.

It’s easy to lose sight of our initial goals during medical school, especially during our 1st and 2nd years, when we are more removed from the clinic. However, I encourage all medical students to continue to fuel your interests in medicine by attending relevant conferences like the AMA and talking to people who are just as passionate and excited about contributing to change you hope to be apart of! Never forget that even as medical students, we have a voice, a vision, and a (developing) mental capacity that can lead to actionable change when nurtured in the appropriate environment with the proper tools and contacts.

The Healing Place

Matt Woeste, MS2

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‘Siri, take me to The Healing Place—Women’s Campus,’ I said into my iPhone as I drove west on Broadway toward the medical campus. “I found one location matching your description: 1503 South 15^th Street,” she said. In my second year of medical school, I have mostly oriented myself to my new home of Louisville, KY. I know my major landmarks, navigate to most places without the aid of GPS, and finally differentiated the highways that make our “inner” and “outer” loops. On this particular day, however, I found myself traveling to a part of town I have tried to avoid since becoming a Louisvillian. ‘15^th street?’ I thought to myself with several loud groans. Fifteenteeth street takes you to West Louisville. For those fearless urban explorers or dwellers, please excuse my previous thoughts: I grew up in a rural area of Northern Kentucky—I’m used to the simple pleasures of country roads and any need to drive in the city is considered a stressful situation. I’m sure you can understand my anxiety as I headed toward a rough neighborhood within my new city. I was on my way to participate in a student run clinic, an option I chose for my second year elective.

The Healing Place (link) is a rehabilitation facility primarily for those struggling against drug and alcohol addictions. I was assigned to the women’s campus for part of my elective time. In the second year you are able to choose from several elective options, with the student run clinics being one of the most popular choices. The Healing Place has two campuses (Men’s and Women’s) with the Hope and GLOH Clinics also being destinations for this elective option. At the end of first year, several of my classmates decided to be student directors where they help coordinate classmates and the logistics of each location and services we can provide.

By the time of my first experience at the Healing Place I was beginning to feel comfortable with my patient interview, but still realized I had much to learn in order to be as fluent and competent as the volunteer attending physicians. At each location there are typically 4-5 second year students, a fourth year, and one or multiple attendings. The students will interview their own patient, present the case to the fourth year who helps you with your delivery when presenting to the attending. After you have traversed through the hierarchy, you meet again with your patient to give them a treatment plan. Although I don’t have a medical license number, helping and learning to write out prescriptions is a cool feeling—something we don’t get to experience in our Longitudinal Standardized Patient Program. The Healing Place has tight restrictions on the medication you can provide to patients because of their history of abuse. Often I found in clinic that the proper treatment solution didn’t come from the prescription pad, but from simply asking how they were managing their program or just inquiring about their past. The patients were never shy and always willing to share, albeit, sometimes more than I needed to know!

I came back to the Healing Place to learn more about the facility through our Community Preceptor requirement in ICM. Instead of going straight to the clinic I was given a tour with several classmates. We went from wing to wing seeing the process of rehab. On day one, many residents start in Detox. Through an open door we kept our distance to allow those trying to shake the pain and symptoms of withdraw. After women have become clean of any drugs or alcohol, they are placed in “OTS #1” which stands for Off the Streets step 1. By following the rules and schedule of the Healing Place the women can move through the ranks of OTS #1 on to OTS #2. With each promotion your freedom is regained bit by bit. For example, in detox you surrender your cell phone and are isolated from communicating to anyone outside of the complex. Daily chores in OTS are rigorous and must be followed. Rise and shine is at the bright and early time of 5:30 AM. It is a requirement that each bunk is made, bathrooms are cleaned, and floors are swept. After OTS, the women go to “Phase.” Phase is one of the last steps before reintegrating into society and is also the stage where they have the most freedom. We attended a “Community”—a meeting where the women have the right to vote and elect their peers to fulfill certain duties around campus. For example, there were positions for managing grounds cleanup or laundry duty. When electing someone to these, the nominator would offer praise to their nominee and explain why it would help them become a better participant or even how it changed their outlook on life with intentions for them to do the same.

I sat next to an older woman during Community. We can call her Jane. Jane had previously been injured and became addicted to her pain medications. She introduced herself to the group as an alcoholic. The Healing Place follows the guidelines and principles of “Alcoholics Anonymous” so many will identify themselves as an alcoholic when speaking, but may identify however they choose. As Jane further elaborated on hardships of her past, (details that will remain private) I began to realize that the difficulties of medical school we face – the task of conquering board exams, and pressure to be a competitive applicant for residency – were quelled in comparison to struggles of our future patients, those like Jane. I headed home from my final visit with this new perspective. And maybe, West Louisville isn’t as ominous as I thought after all, as near the intersect of West Hill and 15^th sits a place of healing for many women hoping for a better future.

Learning moves outside the lecture hall

Beth Seagraves Brooke, MS1

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Along with a systems-focused curriculum, this semester brings new learning experiences. Though most days are still spent in our lecture hall, we now have days when we learn outside the classroom.

In problem-based learning (PBLs), groups of students gather to discuss clinical cases. The first dealt with an aortic dissection. Using information we learned in class, we discussed the patient’s vital signs, lab tests and scans. We arrived at a diagnosis and differentials. After listing several learning objectives, we agreed on a handful that we researched on our own that evening.

The following day, we shared what we learned and discussed the original diagnosis and eliminated differentials. We listed what symptoms were common among aortic dissections and aneurysms and what we, as future physicians, needed to be thinking of when ordering urinalysis, blood tests and X-rays.

I found the PBLs a laid back, fun way to practice using the information we’ve been learning this year. It’s also a great way to practice working with a team to arrive at a diagnosis and treatment plan for a patient. We have another PBL in a couple weeks integrating information on respiratory and renal systems.

We’re also spending more time in the Paris Simulation Center, which houses the school’s simulated patients. In small groups, we work with a Ph.D. and a M.D. to discuss a clinical case. The simulated patient’s physical status changes to mimic worsening conditions or improvement as we progress through the case.

Last week, since we were learning respiratory, we discussed pneumothorax.

Caption: Dr. Matthew Bozeman walks first year students through treatment of a pneumothorax.

The case centered around a patient who was struck in the chest during a soccer game. His blood pressure was dropping, his respiration rate was elevated and his O₂ levels were down. Through each step, we discussed arterial blood gas (ABG) levels, metabolic panel and vital signs. We also used a stethoscope to hear diminished lung sounds on the simulated patient’s left side and discussed his X-ray.

The purpose of the simulations (SIM Lab) is to show us how the concepts we learn in class apply to clinical situations. It gives us an opportunity to think through the physiology of the patient’s case and gain a better understanding how the body responds to an injury, pathology or treatment.

Next to clinical rotations and preceptorships, it’s hands-on learning at its best.

Embarking on new paths

Beth Seagraves Brooke, MS1

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Hi! I’m Beth, a first-year medical student here at University of Louisville School of Medicine. I’m one of more than a dozen non-traditional medical students in the Class of 2018. Non-traditional usually means people aged 27 and up who are making a career change. My first career was in journalism. I returned to school in 2011.

For me, the first semester was a struggle to balance home and school life. Though I succeeded in passing my courses, I did not succeed very well in life. As many faculty members have said repeatedly, “Medical school is a 60-70-hour-a-week job.” They are not exaggerating. Sometimes it’s more.

It was hard to keep up with all the material. I could barely find enough time to prep for class, review notes and study for quizzes, lab practicals and exams. Task after task began falling off my schedule. Eventually I didn’t even use a schedule. I knew where and when I needed to be and that’s all I could manage. Chores piled up until after each exam, time to call friends and family began to disappear and I did not make time for myself.

But, don’t fear. This is common. And most first-year students experience it. We’re blessed at U of L to have wonderful faculty who are aware of the difficulties we face and are always available for advice and help.

I debated whether to share my struggle with you, but if I can’t be honest what would be the point of this blog? Right?

This semester started four weeks ago and I am happy to say that I’m on top of things. I’m exercising a few times a week, I’m able to balance home life a little better and I’m even enjoying weekly dates with my husband. The pressure has eased up a bit and I’m getting a better handle on things.

I’m also beginning to enjoy some of the many extracurricular opportunities at U of L, such as an interactive wellness session with the Kentucky Center’s Arts in Healing program held in early January.

This month brings with it decisions and deadlines for summer activities and opportunities for next year. I’m excited to see what I’ll get into in the next few months. Stay tuned!

Impending exams and flash napping

Catey Harwell, MS2

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Student wellness initiatives are really gearing up here on the Health Science Campus (HSC) thanks to the election of two new student wellness officers (thanks Rachel and Justin!) and their collaboration with Student Affairs (thanks Tony!). With Step 1 looming in the not too distant future for every second year, a session teaching students how to “flash nap” seemed appropriately timed. For those of you not familiar with flash napping, it’s about taking 10-40 minutes to “intentionally, efficiently, and effectively nap.”

The antithesis of the flash nap is the so-called “crash nap,” which I know all too well. Although I’ve never been much of a napper, there are those times when I get far enough behind on my sleep that I can do nothing else but crash in the middle of the day – typically after a big exam or more recently as a result of jet lag. I wake up 1+ hours later feeling like I’m moving through molasses. My thoughts are slow and I know that any chance I had at being productive the rest of the day are out the window.

Flash napping offers us a chance to savor those mid-afternoon slumps (I know I’m not the only one to get those!) and come back feeling more focused, alert, and able to handle whatever life throws at us. That sounds like a great plan to me, especially for those six weeks in April and May when my life is going to be absorbed by the monotony of Step 1 prep. I guess I better get practicing so by that time I’ll be a professional-level Flash Napper!

 

 

A Typical Day as a Second Year Med Student and New Mom at ULSOM

Allison Lyle, MS2

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Hi! My name is Allison and I am a second year medical student at ULSOM. In the summer after my first year, my husband David and I welcomed our first child, a daughter named Natalie, into our family. I wondered (worried, really) how a baby would figure into my second year, with a heavy course load as well as studying for the USMLE Step 1 exam; after some trial and error, we fell into a routine that seems to work well for all three of us.

This is what a typical day looks like for me:

5:00am

Natalie is usually awake by now, and she’s a pretty good alarm clock for me. While David gets ready for work (which for him is over an hour north of Louisville), I get Natalie’s daycare bag packed and my backpack and lunch together. If I’m running on schedule, I’ll start laundry or run the dishwasher, and set something out to thaw for dinner before I leave, which frees up more time in the afternoon and makes life much easier for me once I get home.

6:30am

This is usually the time I drop off Natalie at daycare and make my way into school for the day.

7:00am to 5:00pm

During the daytime hours, I’m usually on campus in class or studying in the unit lab, the lecture hall, or the library—all of which were recently renovated. During the lunch hour, I tend to use this time for myself, by either attending a student organization talk, reading medically-related articles on blogs, or even reading a book just for fun to clear my mind from what I worked on in the morning.

Our class schedule varies day by day. I tend to cherrypick the classes I attend this year moreso than I did last year; with Step 1 rapidly approaching, it’s not enough to study or review what we are learning in class for the next exam, so I try to make the most efficient use of my time by using free time or even classtime going over current information, reviewing lots of practice questions, and integrating my knowledge with First Aid, a resource nearly all medical students use to prepare for Step 1. Most classes at ULSOM are not mandatory, and all are recorded on the Tegrity system so we can review lectures at our convenience, which includes speeding them up. The Tegrity system is a great way to catch information I missed in class, to clarify information that wasn’t clear in the notes, or to experience for the first time (which I had to rely on frequently while I was pregnant during first year!).

During second year, usually on Mondays, we have mandatory classes known as TBLs… sessions for Team Based Learning. (This is one class that stays fairly consistent, compared to the rest of our class schedule.) These consist of 10-15 question, individual quizzes that cover information we learned the previous week, and generally combine information across disciplines, such as Pathology and Microbiology or Pharmacology. The goals of these quizzes are to assess our knowledge and identify the gaps—which we then discuss in our small groups of 6 students as we take the same quiz together. Once we submit the group quiz, we go over any rough areas as a class, highlighting areas that there may have been some difficulty or clarity issues. At the end, we take another quiz together in our small groups to assess how much we have learned during that TBL time. Overall, I enjoy this experience; I find it immensely helpful to hear how others solve problems, which helps me to remember things better for the block exams, which for us are generally once a month.

I am asked quite frequently about how I manage to be a med student and a mom—it can be pretty challenging, but by keeping a schedule and sticking to it, second year so far has gone pretty smoothly. One lesson I have learned during my time as a student has been that making adjustments to find out what works best for my family and me is essential. This realization is what has lead me to stick to my 7am-5pm schedule even on days when I don’t “have” to come to campus; I come anyway, I stay the allotted time and keep focused on the task at hand, and everything has been working great for classes as well as family time.

5:45pm

By 5pm I pack up my belongings for the day and head home to pick up Natalie from daycare. This is the time I generally use as “me” time—playing with my daughter and getting her ready for bed, finishing dinner, and spending quality time with my husband. At night, I generally review the day’s material, work more practice problems, review First Aid, or work on side projects that interest me, such as my research project for the global health distinction track (one of four such distinction tracks offered by ULSOM).

Because my daughter has to be picked up from daycare before 6pm, I try to squeeze in any volunteer or shadowing/precepting hours between the 7am-5pm window. This isn’t always feasible, so I am lucky to have my parents nearby. Having the backup in case I am running late or stuck in traffic is a lifesaver for this medical student!

Friday nights:

Fridays are a lot different from the rest of my time during the week. This is the designated “Date Night” for David and myself. I’m a firm believer in resting to regain my focus after a long week, and this is one great way to maintain my personal interests outside of medical school. Even during first year when we would have the occasional exam on a Monday, I never regretted spending this time away from the books to reconnect with my husband and daughter.

By the weekends I am usually exhausted, but overall, I love life as a new mom and second year medical student at ULSOM!

“You’re gonna do just fine Doc”

Evan Torline, MS2

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As I popped off the cap of the needle and flashed my eyes from it to the patient sitting in front of me, I became acutely aware of the great responsibility I have as a student of medicine. As a second year medical student, it’s not every day I get to shed the pile of books I’m studying and get busy with actual clinic activities, like giving flu shots, but this day was different.

I have the opportunity to co-direct one of the free student-run clinics here at school, and this fall we were able to secure enough flu vaccines for our patient population. The patients we see are all part of half-way house programs in Louisville, so we decided we would pick a day and set up a flu clinic on site. The weeks leading up were filled with excitement as we prepared and practiced how things would be organized (I even practiced giving my first shot to another director who had never had one before). It would be a day of firsts for most of us, but we soon got the hang of things as we set up our equipment and discussed our plans. One thing I really enjoyed about it was the ability to discuss and explain things to the patients. As they were lining up we got all kinds of questions, everything from, “What’s a flu shot?” to, “I heard those things give you seizures.” I thought to myself, “Hey, here’s a chance to actually use and share the information I’ve been learning.” It was an experience, though a small one, that edified the work I put into learning information that can sometimes seem trivial.

Eventually, my first patient came over and sat down. I introduced myself and what I would be doing. As I proceeded to deliver the vaccine to him, I asked myself, “Am I ready for this?” After giving him his shot he looked at me and said, “Hey, you’re pretty good at that. You’re gonna do just fine Doc.”

A big thank you to Dr. Wheeler for his guidance and oversight, and my fellow student directors Emily Knittle, Dhruv Sharma, Cliff Freeman, and Ashley Lee.