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(Re)Searching for Answers

The word “scientist” often evokes thoughts of lab coats, mice, and untamed hairdos. Although there is some truth to those images, they don’t tell the entire story. For people who don’t interact with researchers daily, it feels a bit mysterious. But we all reap the benefits: from safety improvements in vehicle design, to medicines that treat or manage conditions, to knowledge gained about biological and environmental processes. This truth is why proposed budgetary cuts to the NIH (National Institutes of Health) were swiftly rejected this fall with bipartisan support.

One of dozens of informed consent documents I’ve accumulated as a research participant

I’ve experienced the process of clinical research from both sides – researcher and participant. As a research assistant, my duties have included subject identification and enrollment, detail-oriented data collection/entry/management, performing chart review of medical records, background and literature reviews. Going through the informed consent process with patients and their families was a means of protecting their rights and aiding in their decision making.

As I start on my clinical rotations, I’m even more appreciative of the power of research. What we learned in the classroom setting is based on a foundation of scientific inquiry. It is staggering when I consider the gravity of the thousands of work hours it takes to determine treatments, therapeutics, and alter protocols. Medicine is dynamic, and questioning the What and the Why are crucial to advancing health care. Many of the interventions that we learned are more nuanced in reality; these lessons come from more up-to-date evaluations comparing approaches.

A big thank you if you’ve ever volunteered for research; it has meant so much for medical progress and the advancement of safety measures. For those of you who are interested in taking part at the University of Michigan, this site (https://umhealthresearch.org/), can help you get started exploring studies you might be eligible for – whether as someone affected by a certain condition or as a healthy control. In the past few years, I’ve given samples of blood and saliva, received an fMRI, answered questions about my health behaviors, and completed a dexamethasone suppression test to assess cortisol levels. Being a part of research from the perspective of a participant has opened my eyes and allowed me to experience firsthand some modalities, procedures and medications that I may soon be recommending to patients as a physician-in-training. It has given me even greater empathy and understanding for some of their fears, concerns and questions. (Plus, the occasional compensation is a nice perk…to think, my spit is worth $20!)

Of course, the scientific method can be implemented in each of our daily lives to solve practical problems — ask questions, collect evidence, implement new strategies, and continually refine. This may take the form of finding the optimal time to commute to work to minimize traffic, thinking of better ways to organize the kitchen cupboards, or indulging in allowing yourself to take a deeper dive and search for answers when random thoughts pop into your head. (Highlights from my Google search history include “What does a pansystolic murmur sound like?”)

Using patient-centered decision-making, I’ve witnessed physicians demystify the jargon of scientific literature, explaining risks and benefits of options, while also clarifying potential/anticipated side effects or other outcomes to help come to a mutual agreement moving forward. No matter what specialty I end up choosing, I hope I have the opportunity to similarly engage with my patients to convey evidence-based recommendations.

Charmayne is a non-traditional second-year student at University of Michigan Medical School. In addition to the wealth of knowledge she has amassed in her preclinical years at a Big 10 institution, she has attempted to learn a little bit about football, though she still refers to it as “tackleball.”

Whirlwind

I am sitting in an airport. I seem to be doing this a lot lately. Residency interview season is now in full swing; I’m in the middle of my scheduled interviews. Traveling around the country has been a lot of fun but is also rather tiring.

I actually started writing this post a week ago; I am sitting in an airport once again. Thankfully, this is my last one before I take a week off for Thanksgiving.

Lessons I have learned on the residency interview trail thus far:
⁃ TSA Pre-Check is amazing: I went through the approval process back in January and it was honestly some of the best money I have spent. It allows me to pass through security a bit faster, without having to remove my shoes or belt, leave my laptop and liquids inside my carry-on, and frankly just have an easier time with it. I ended up getting Global Entry, a program which allows expedited customs when entering the U.S. Global Entry costs $100 and automatically confers TSA Pre-Check, while TSA Pre-Check alone costs $85.
⁃ I am tired. Traveling across time zones is not an easy task, particularly in the evenings and early mornings. There have absolutely been times when I almost fell asleep standing up at the resident dinners because of this. My suggestion is to try to sleep whenever possible – on the plane if you can but definitely consider napping in between your arrival to the city and the resident dinner. On a similar vein, try not to schedule 6am flights, because they could entail waking up around 2-3am and I never thought I’d consider surgery hours as sleeping in.
⁃ Because of ACGME requirements, a lot of programs within the same specialty do similar things. Nevertheless, each program has its own flavor and definite vibe. Pay attention to this during the interview to see where you’d best fit in.
⁃ It’s a lot of fun to meet all of the other applicants and residents at your programs, but you will not remember their names for the most part (at the moment, I’m struggling to remember what day of the week it is let alone any names). So, if you really connect with a resident, write down their info immediately so you can easily contact them later with questions.
⁃ Write down program info right after finishing the interview because everything is blurring together at this point. I try to write down some notes while waiting at the airport for my return flight to jog my memory later. Another option I’ve heard of is to speak into your phone and record a voice memo (that way, your thoughts are even more unscripted without the automatic censoring that occurs when your thoughts go faster than your fingers).
⁃ Similarly, write your thank-you notes as soon after the interview as possible. With 3-5 interviews at each program, the notes can pile up quickly and it’s harder to remember what you actually discussed even the next day.
⁃ You will be fed, a lot and often. Honestly, it’s a lot more food than I’m used to eating in a day, let alone multiple days per week. Interview suits tend to feel progressively tighter during the interview season so plan accordingly when choosing your outfit.

Despite the increasing fatigue, I am really enjoying the process. And, I’m getting a lot of time to work on my Christmas present for my grandmother – embroidering gingerbread houses to combine into a quilt. I’m certainly making good progress during all my layovers 🙂 My mom came with me on this trip, so we both worked on our needlework while flying!

Sara is a fourth-year medical student at UMMS. When not in the hospital, she can usually be found on the golf course or at a Michigan sporting event cheering on the Wolverines.

Doctor’s orders: 1 run/day, in the AM

During every major life transition, medical school included, one of the primary pieces of advice I have always been offered is some variation of, “Prioritize your wellness! Continue to engage in the things that you love.” I was, admittedly, skeptical about this prospect coming into medical school. How do you balance “Prioritize your wellness!” with “Buckle up—medical school is a lot”? Three months in, I’ve realized that these two things are not, and should not be, mutually exclusive. Medical school is a lot, but it would be a lot more difficult if I didn’t take time to do the thing that I love, which is running.

Sunrise over the Huron river during a summer run!

Running is, for me, a time to just be. When I’m out on the trail, I can’t be doing anything other than just experiencing the flash of a still-dangling autumn leaf out of the corner of my eye, or feeling the welcome sharpness of the winter air hit my lungs with each stride. It’s a time to unwind and remove myself from the stresses of everything back at the start of the trail—and even though the finish line is also the starting line (have to get home to shower!), I never fail to return home with a different perspective on something.

I’ve realized that medical school is, in so many ways, like running. (You knew this metaphor was coming, didn’t you?)

  • It takes a lot of time, but it’s not time wasted—it’s time during which you are learning and exploring. My long training runs are one of my favorite parts of my week because with each step, I can literally feel my forward progress as I trudge along towards my goal. Medical school is the same way. Sometimes, it feels like we’ve been handed a straw and are asked to drink the entirety of Lake Michigan through that straw—but then, somehow, Friday arrives and it’s time to prepare for the quiz, and we realize that maybe we did learn a thing or two that week.
  • Hills become views. At one point during a recent race, there was a huge hill up ahead, and I felt pretty disheartened as I approached and began to climb up it. But then, at the top, I picked up my head and noticed the incredible view that climbing that hill had afforded me, and it made it all worth it. Similarly, during those long nights in Taubman Library cramming for an exam, I feel like I’ll never learn it all—but then, when I speak with a patient and use a piece of knowledge I learned in class, it’s such an amazing moment.
  • It’s about the people. A group of my friends (see photo!) came to meet me at the end of the Detroit Marathon, and knowing that they were there motivated me through to the finish. That’s also why medicine is so rewarding for me. The days can feel incredibly long, but when you have those amazing one-on-one interactions with patients—well, it makes it worth it.

Greeted by Hanna, Alec, and Boone at the finish!

That extended metaphor was cliché #1 of this piece, and here’s cliché #2: don’t stop doing what you love, neither in medical school nor in any of your other pursuits. Time spent doing that thing is not time spent away from doing what you “should” be doing; rather, it is time spent investing in yourself in ways that will make you a better physician (and person!) one day.

Jackie is a non-traditional first-year medical student who is passionate about learning. If you’ve lost sight of Jackie, you can almost definitely find her either out running on one of Ann Arbor’s trails or having two scoops of chocolate PB in a local ice cream shop.

Making the Most of My Double Gap Year

I did not intend to do a double gap year, but when I realized my original plan was not going to occur, I quickly reshuffled my priorities and redirected all of my efforts.

First, I made a list of all the things that brought me pure joy and committed to giving my best effort in each activity. Additionally, for each activity I was engaged in, I would place no restrictions or stringent expectations on the activity. What I mean to say is, I went into each experience with an open mind.

After I finished studying for the MCAT, the first activity I did was visit Italy for a month, which was on my list.

Next up: I established a volunteer/shadowing position at Children’s National Medical in Washington, DC, in the in-patient/out-patient Hem-Onc department. I developed a deep passion for pediatric hem-onc due to my own battle with acute lymphoblastic leukemia (ALL) as a child. Fueled by this passion, I shadowed physicians at the same hospital where I was treated, and which is also a nationally recognized pediatric cancer center.

This intellectually stimulating clinical experience was a huge gift, but not without costs. I was not paid, so I had to cover my own transportation and food expenses. Some would argue that was valuable time lost not working, but I knew it was right for me. It certainly has made learning my med school lecture material easier after having frequently observed a variety of clinical diagnoses.

This was not even for the photo: this is how you would regularly find us in clinic!

In addition to volunteering, I would alternate days where I shadowed at International Pediatrics, a Spanish-speaking primary care private practice. With both of my parents having emigrated from El Salvador, I felt it important to maintain regular exposure to the world of medical Spanish.

This is how I remained active in medicine clinically, but I also remained active in medicine outside of the doctor’s office.

During the summer between gap years, I returned to camps for children with chronic illnesses that I attended as a youth with ALL. To re-energize, I planned several trips to beaches I have always wanted to see and sprinkled in a few trips to Ann Arbor.  

Unrelated to medicine, I became involved in tutoring grade school because my sister is a teacher. I greatly enjoyed working one-on-one with the kiddos, helping them reach the goals they set for themselves academically.

For anyone considering taking a gap year: do activities that bring you pure joy, and do not concern yourself with how those activities impact the competitiveness of your resume. I think this is – in my humble opinion – what admissions takes notice of, or at least, what it seems my fellow peers have in common.

In the end, the activities I participated in may not have been extraordinary. However, they were fulfilling to me, and I gave a full effort in each of them.

In addition to my double gap year activities, I am deeply thankful for the chance I had to further establish community, especially within my church. I also got to spend quality time with my family, particularly with my nieces who keep me silly and light-hearted. It’s your passion along with the support of your community that will keep you fired up and strong all throughout your career.

Sylvia is a first-year medical student at the University of Michigan Medical School. She is interested in pediatric oncology. When she has energy left after a long day of studying she makes 1 or 2 more pages of progress in reading a novel before falling asleep.

Hello There, Fall

I think it can go without saying that it’s been a while since my last post. I promise that it has been a very busy time in the life of every M4. Since the last time I wrote, I completed several rotations, submitted my application for residency, and started interviewing!

Surprise Motley Crew reunion at the med school. I’m so grateful for these ladies!

The last time I wrote, I was on my ICU sub-internship. After that rotation, I spent most of July as a staff counselor of Camp Bold Eagle, the summer camp of the Hemophilia Foundation of Michigan. Camp Bold Eagle was amazing! I was a counselor and was able to spend the summer helping kiddos with bleeding disorders have a really fun summer camp experience. Even though interventions for hemophilia and von Willebrand’s disease have made huge leaps, it can be incredibly scary to live life knowing that you can have bleeds that can be life-threatening or damaging to joints. The goals of Camp Bold Eagle include giving kids with bleeding disorders a chance to just be kids at summer camp and also teaching campers how to transfuse their clotting factor, which is a huge step toward independence.

On the last night of each camp session, the campers who learn to successfully transfuse their factor are given the Butterfly Award, and it is a huge deal. Every year, Michigan medical students go to the camp to act as cabin counselors and also to learn a bit about providing first aid in a non-traditional setting. For the first time in my life (and probably only time), I provided boat-side first aid (while treading water in the middle of a lake, no less). There were two week-long sessions, and I spent one week with 6-7 year old boys and the second week with 11 year old girls. The weeks were very different experiences, and I loved them both.

Part of camp involves learning how to self-infuse factor. Counselors have the chance to learn how to self-infuse saline. It may have taken a couple tries…

In August, I was back in Ann Arbor for my General Medicine sub-internship. I had a really amazing experience. I loved the team of residents, and I saw a really good spread of medicine during the month. I also had a unique experience in that many of the “difficult” patients on our team happened to be a part of my census. Through my interactions with these patients, I learned how mental health can significantly affect health delivery and perception of patients, as well as how to have difficult end-of-life discussions. Overall, I had a really fantastic experience.

September brought my pediatric rheumatology rotation. I learned how to do a really good musculoskeletal exam, and I found rheum pathology really interesting. Peds rheum was really enjoyable and satisfying because many of the rheum diseases that affect kids can be medically managed with few lasting effects as compared to years ago when treatments were much less adequate. My next rotation was infectious disease, and I had a great time. I saw some really interesting cases, and I learned a lot about antibiotics and antibiotic stewardship. There is a lot of public health intertwined in infectious disease, so I had a fun time reaching back into my public health roots.

Definitely not the worst view to wake up to. One of the fun camp events was Polar Bear, where we ran into the cold lake every morning and dunked our heads under the water. Campers and counselors who participated every day were members of the Polar Bear Club (ahem, proud member).

September also brought the submission of ERAS, our residency application. Sometime over the summer, I decided on my specialty, and it turns out that my gut feeling was right all along. As soon as I stopped fighting myself, I knew that I had found the specialty that was perfect for me. When I met the residents on various rotations, I knew that I had found my people.

I had my first few interviews this week, and I’m so excited to see what this interview season holds for me. I’ll be checking in periodically from the trail, and I’m sure that I’ll be sharing my adventures. I know that there will be a lot of driving and flying involved, and I’m guessing that also means somehow learning how to pack light over the next couple months (still a work in progress).

Until next time, thanks for reading! I know I’m enjoying the fall weather and football season, and I hope that you are too!

Angelica is a fourth-year medical student at the University of Michigan Medical School. When she’s not on the wards, you can find her on a run around Ann Arbor or passionately discussing medicine and public health over tea.