When we think of the classical innovator, the imagery of an individual exiled to his/her garage tinkering for hours and possessed by an idea with an awkward personality and unruly hair to match. The Wright Brothers, Edison, Tesla, Bath…names that have been ingrained in the pages of history only to be supplanted by an audaciously contrasting picture of the stereotypical Silicon Valley entrepreneur, lavishly clad in shorts, slippers and a t-shirt. Indeed, entrepreneurs and innovators come in all shapes and sizes, but what if I told you that you, as future health professionals, may be part of a growing wave of entrepreneurs across the nation?
Between board exams, standardized assessments and clinical duties, this concept may sounds completely preposterous, outlandish, blasphemous, especially as you continue to be inundated with the breadth and complexity of your training. To venture outside the confines of the Krebs cycle and metabolic acidosis would be almost inconceivable to a traditional medical trainee. But alas, we continue to exist in an exponentially dynamic era of technology that is far removed from its primitive beginnings of vacuum tube arrays that occupied entire rooms. Between creating funky Instagram filters and being ferried home in self-driving cars, technology has also made significant strides within the field of medicine over the last few decades. Today we live in a period of immunotherapies, personalized medicine based on individual genomics, wearable health devices with ECG, 3D printed prosthetics and organs, to name a few. Indeed, it has occurred to me that the greater role of technology in medicine likely means that perhaps physicians can have a pivotal role within the innovation landscape of health care technology.
Fortunately, the University of Michigan has implemented the Paths of Excellence (PoE) program as an extracurricular activity to supplement our core curriculum for this very purpose: The opportunity to significantly augment our education across multiple disciplines and become “an agent of change.” This sounds promising, but how does one in the midst of their medical training prepare himself/herself to become an agent of change? Perhaps it starts with searching deep within about what we are passionate about. As you can surmise from my technology monologue in the beginning of the article, I am personally passionate about the ways in which physicians can be pivotal in modernizing medicine through technology.
Early in medical school, we learned about eight possible PoE paths: Ethics, Global Health & Disparities, Health Policy, Innovation & Entrepreneurship, Medical Humanities, Patient Safety/Quality Improvement/Complex Systems, Scholarship of Learning & Teaching, and Scientific Discovery. We were given an introductory lecture for each Path and an opportunity to apply to whichever Path we were most interested in through an online application. I was personally intrigued by Innovation & Entrepreneurship and Scientific Discovery, so I decided to apply to both. I am particularly interested in learning more about the innovation in medicine as well as the outcomes research surrounding new innovations, so both of these Paths were a good fit for me personally. While both have been incredible, I would like to focus on Innovation & Entrepreneurship (I&E) as a concept that is likely new to most of us as perpetual students within a long medical training.
As a San Francisco Bay Area native, I am familiar with entrepreneurship in the context of computer science innovations. I was often surrounded by my classmates who had buried themselves in a basement well stocked with Mountain Dew and ramen noodles, emerging the following year with devices creating ripples in space-time. I may have exaggerated a little, but the Silicon Valley lingo of block chain and artificial intelligence was a foreign concept to a Cell Biology major (i.e., me!) in medical school. However, the question of innovation in medicine was still lingering to me, and I&E was very beneficial to my learning more about this thriving area.
The I&E Path is very proactive in having regular meetings with students, bringing in special guest speakers, and having three advisers designated to guide students in formulating a project for capstone purposes. The I&E Path is also partnered with Fast Forward Medical Innovation (FFMI) at UM. FFMI’s mission is to make biomedical innovation and entrepreneurship a natural academic behavior that accelerates UM’s ability to move great ideas to patient impact.
Together, I&E and FFMI have several opportunities for students to learn and work with faculty to experience medical innovation happening right here at UM. Here are some of these opportunities:
Foundations of Innovation – a program tailored to M1s who are interested in learning about innovation and commercialization. This course covers a variety of topics including: Needsfinding, Customer Discovery, Stakeholder Mapping, Design Thinking, and crafting a perfect pitch.
FastPACE, a 4-week hybrid biomedical innovations and commercialization course under FFMI in which medical students can be given the opportunity to work with existing teams in beginning to understand the framework of commercialization. This course takes place twice a year – fall and spring.
FullPACE, (A more comprehensive version of FastPACE) takes students through a 12-week course structured into lectures and mentored sessions from faculty, industry experts on the basics of market discovery, regulatory frameworks, intellectual property and strategies for commercialization and seed funding. As a result, the course aims to facilitate learning with a project concept you are inspired to pursue with a multidisciplinary team. This course takes place during winter semester.
Kickstart and MiTrac – Offer the opportunity for I&E students to intern with faculty on their early-stage/mid-stage funded projects. FFMI serves as a “match maker” for students and interested project teams.
The FFMI team is a fantastic resource to tap into. They’ve graciously dedicated their time on numerous occasions to help me brainstorm possible project options to consider. In parallel, students can also take advantage of MI-Pitch Club to test drive concepts that are beginning to take shape by creating a short presentation for monthly pitch clubs and receive feedback. An integral component of MI-Pitch Club is the Design Challenge, a 1-hour team challenge to come up with a 60-second pitch outlining a solution to a problem posed at the event. Therefore, the event not only helps upcoming innovators develop critical thinking skills, but also helps them learn the components of pitching a successful concept to potential investors. An additional opportunity for I&E students to gain exposure to innovation is Sling Health. Sling Health is a national network of student-run, non-profit biotechnology incubators with a chapter at the University of Michigan. This group allows for students from multiple educational backgrounds to submit project proposals and pursue mentored investigations of new innovative concepts with hopes of leading to commercialization. One of our very own alumni in the medical school was instrumental in starting this chapter at the University of Michigan.
The I&E Path of Excellence has an illustrative guide on their website, which offers a pathway to your education in innovation and biomedical commercialization. Your path could include participating in MI-Pitch Club followed by signing up for elective courses and finally culminating in a capstone project concept. Examples of elective classes best taken in the Branches include: The venture capitalist, business development, and student-led innovations electives that are usually 4-weeks long or more. Overall, a student’s approach to entrepreneurship is not limited to the programs and groups described above, but the I&E Path has made significant efforts over the years to create partnerships and help organize a student’s journey in the form of a general curriculum as a guide to entering a completely novel space for many. The I&E Path is very supportive of self-driven efforts towards projects of individual efforts, and I would highly recommend speaking to the Path coordinator and director for brainstorming project topics (contact info provided below).
Regarding my own personal journey, I had been waffling quite a bit without having a clear interest in mind until my third year of medical school. Several emails later and through a faculty contact I had made in my M1 year of medical school, I was very fortunate to join an innovations team under the Coulter Translational Research Program that was developing a biomedical device to efficiently leak check large bowel anastomosis intraoperatively. The opportunity to learn basic financial modeling, interpret market research data, decipher the regulatory landscape of this class of biomedical devices, and develop a reimbursement model with the team was tremendously gratifying and illustrated the complexity of approving devices in medicine. Whether it be a device that 3D reconstructs the brain and electro-mechanically tracks instrument position in neurosurgery, or simply a new scrubbing soap, I learned quickly the importance of considering the customer and barriers to approval in all aspects of device planning. The team went on to win $80,000 in seed funding for advanced prototyping, and the project became the basis for my Capstone for Impact project.
While the experience built fundamental innovations skills and allowed me to learn from a tremendously talented team, it was more than ever a crucial catalyst in my life as a student. Not only was it empowering to identify the contributions a physician can make in a multidisciplinary innovative team, but it was also inspiring to further pursue a deep passion for health information systems as a current project I am working towards with the Department of Computer Science.
The prospect of finding or creating a new project and working through the hurdles characteristic of all health care innovation may seem initially daunting, but migrating out of one’s comfort zone and working through the hoops from the most basic level can be a tremendously fulfilling experience as a student. The very process of identifying your passion, identifying barriers, distilling down a problem to its very essence and working to make an idea a reality is perhaps a paradigm for what we all strive for as future physicians, whether your passion rests in quality improvement, health policy or scientific research. As students who are continuing to navigate in the new curriculum and take advantage of the many educational facets it offers, I hope you feel as enlightened as I was with the Paths of Excellence, and strive to be ambassadors for our profession to deliver the highest quality patient care.
Candice Stegink, MA, the I&E Path of Excellence coordinator, contributed to this blog post. If you are interested in learning more about the program, please contact her at email@example.com or the Path Director Mark Cohen, MD, at firstname.lastname@example.org.
As a Junior in college I attended a medical student panel. One of them said something that stuck with me: “Back in undergrad my life had so many responsibilities and so many extracurriculars. In medical school those aren’t there. It’s hard for sure, but it’s simple.” I felt stretched thin back then, balancing schoolwork and everything else had been a bumpy road. I was excited for the simplicity that awaited me.
Cut to August 2018. It was my first day of medical school at Michigan and already my inbox had a bunch of emails about responsibilities and extracurriculars, the same ones I had been told weren’t there! I barely knew how to find my way to lecture, and so the thought of running for president of a student interest group seemed like too much too soon. I worried about making the same mistake again.
But allow me to make the case for why it isn’t a mistake,
why it isn’t too much too soon, and why putting yourself out there is the best
thing you can do as a first-year student at UMMS.
So, I closed my email. I didn’t want to deal with it at that moment. Our class had a get-together across town that I went to instead. I got there and sat down next to two people that I didn’t recognize and who I thought might be second-year students. I introduced myself, and sure enough they were.
“Great!” I thought, “I can get the scoop on what to do about my inbox.” We talked for several hours about anything and everything I could think to ask. They said almost everyone participates in something outside of lecture. They also told me I should join Biorhythms, a medical student dance group that puts on shows for the school twice a year.
Back then, I had zero dance experience. I am 6’2’’, lanky, and uncoordinated. Imagining myself dancing on stage seemed offensive, and I didn’t want to put an audience through such a thing. But the more I thought about it the more I wanted to do it. I had just started medical school. That was a huge change, and it was a chance to grow in directions I never had. Why not embrace it?
I felt a bit awkward at first since it was mostly M2s, M3s, and M4s. But it was so dang fun that none of those feelings lasted. Soon I found myself excited for practice, excited to interact with the senior students and check in on their lives. I began to see the upperclassmen outside of Biorhythms, in the hospital, in the library, out and about. It felt so great to have a broader circle of friends, friends that aren’t studying the same thing as me, thinking the same thing as me, or worrying about the same thing as me.
I didn’t know what it was like to be on a pediatrics sub-internship, to do a surgery rotation, or to submit an ERAS for residency. I didn’t fully know what it was like to have their lives and they didn’t fully know what it was like to have mine. We would just put our med student hats away and be friends instead, dancing around, cracking jokes, and getting to know each other in genuine and authentic ways.
But at the same time, I still was an M1 who had a lot going on. The senior students I met might not have been worrying about what I was, but at some point, they had. I felt fortunate to have a group of friends that had gone through what I was going through. Ones who were always willing and able to help me out, and I leaned on them quite a bit throughout my first year. Being a medical student is complicated business and knowing people further along who can uncomplicate it is huge.
So, Biorhythms was awesome. The show in January 2019 was a
blast. I got to spend a few more months with some of the M4s I had met prior to
their graduation in May. But that’s not all. I had so much fun dancing, meeting
people, and putting myself out there that I was asked to be a co-director for
the following Biorhythms show. It was an incredible opportunity that I loved
doing. It was a unique and gratifying experience that made my M1 year special.
I say this because I believe in the Butterfly Effect, the idea that seemingly minor events in the present cascade into major events of the future.
Looking back, I think about what might have been were I too reluctant to take on any extracurriculars, had I been too hesitant to sit down with M2s I’d never met and ask about what I could do with my spare time, had I been too risk averse and shied away from something I’d never done before. I see myself losing out on the incredible opportunities afforded to me had I not taken that small first step.
I’m still 6’2’’, lanky, and uncoordinated. But now I can proudly say I have dance experience. Who knows where trying new things will take you, or what will happen when you deliberately leave your circle of comfort and meet new people at different stages of life? But that’s exactly why you should make it a point to find out, to see what happens and where you’ll go. It might make you a bunch of new friends, connect you with mentors, provide you with a unique opportunity, or in my case all the above.
So, to any of you reading this who are about to begin
medical school: get out there, take advantage of what’s around you, try things
that make you a little nervous, and don’t keep your head down. You’ll be glad
During their last week of classes, 29 M1s took a break from Behavioral Sciences to join the incoming medical school class for CAMP (Creating Adventurous and Mindful Physicians). Now in its second iteration since its founding in 2018, CAMP puts M0s in the midst of rugged nature for three days and nights before they start their medical school journeys.
For this year’s CAMP, the name of the game was
expansion. More than 120 Michigan Medical students took over the nearby
recreation areas of Pinckney and Waterloo this year.
Our presence in the area was hard to miss, and
CAMPers quickly became known by fellow hikers and mountain bikers as “that
group of medical students.” Our numbers notwithstanding, we championed the
backcountry principle of LNT – Leave No Trace. “Take nothing but pictures;
leave nothing but footprints; make nothing but memories” embodies the ethos under
which CAMP operates. CAMPers were taught, among other outdoor skills, how to
most successfully Whale Spit their toothpaste and bear bag their food in order
to minimize the impact of our daily routines on the natural surroundings.
Though it is always easy to lose yourself in
the woods, guides made sure that their CAMPers were never so lost that they
forgot the journey ahead. CAMPers were encouraged to take Mindful Moments, to
reflect on their fears, worries, and hopes about medical school, and to take stock
in the friendships and introductions made during their time on CAMP.
This year, among all of the groups, more than 160 miles of trails were conquered, dozens of weasels were bobbed, and hundreds of s’mores were devoured over the campfire (thanks to Dr. Skye and Dr. Huang!).
It was the day after I pulled my U-Haul trailer into Ann Arbor. I kissed my wife and three little boys goodbye and walked out the door just as the moving truck pulled up with everything we own to unload, only I wasn’t staying to unpack. I was starting medical school … four weeks early, was I crazy!?
My three little study-buddies
I was joining 24 of my classmates in the Leadership and Enrichment for Academic Diversity or LEAD program. LEAD is a three-week med school primer filled with Anatomy, Histology, team building, workshops and … amazing lunches ☺.
At the tender age of 33, with thousand of hours navigating planes around the world as an Air Force pilot I found myself struggling to figure out how to ride a city bus to school and get to Taubman Library … seriously humbling. Despite all of this, and with a little help (as always) from the amazing Becky Weeks, I found my way to campus. I walked into the oddly familiar room with white boards as walls and started meeting my new teammates … hoping I could remember their names. As our group explored the first of 77 rounds of fun facts and introductions, I found myself digesting what I was hearing … research backgrounds, ivy league schools, 1st generation, city year, medical professionals … my new peers were amazing people who had done amazing things. It’s not just their accomplishments, they were truly awesome people. They were great to talk with, they were kind and they were sharp. I found myself feeling the full weight of imposter syndrome. I mean I’ve spent my life flying planes surrounded by so called “elite” men and women in aviation, but suddenly I was feeling like “just an old military guy from Arkansas.” Did they mix my file up with someone else’s?
The crazy thing is that by as early as the end of day two, I realized that everyone had some level of the same feelings as I did. Now this next part is very cliché and I promise no one is paying me to say it, but that’s when I remembered one of the key reasons I chose Michigan: it wasn’t the buildings, the free water bottles or even the curriculum… it was the people! The current students, the faculty, but most importantly, it was my future classmates who I met at interviews and second look. I chose Michigan because the people I met were amazing and I wanted to learn and grow with them for four years. Yes, this group’s accomplishments were intimidating but I mean Emmitt Smith is an amazing running back and very intimidating … but that is why I’d WANT to be on his team. Talented teammates help make great teams (shout out to my 90s Cowboys RIP). From that moment on I no longer saw people with whom I didn’t compare, but friends and allies from whom I could learn.
After those first couple of days our group bonded into a family. I got to live vicariously through group texts about 10 p.m. meet ups to eat or go out, join my friends after class for margaritas and learn about everyone’s amazing story. Even those of us with kids or other situations who couldn’t make some of the fun social events weren’t left out. I was overwhelmed with love and support, people changed times and schedules just to include me … wow!
LEAD team out after a great day of class
As we progressed, we encountered firsts. Some of us worked with our first donor in the anatomy lab. We all worked through the trepidation of making our first incision, the amazement of holding and learning about a human heart and brain. For me it was an interesting evolutionary process in the lab. I have worked in combat zones with patients living, near death and dead, but it’s different when your goal is learning from the person rather than ensuring the person survives. My evolution went from over-conservative reverence for the amazing gift our donors gave us, almost fearful to dissect, all the way through to reminding myself that this was not a body but a person, an entire generation of love and story. We got to see where we would one day be, with our M1 student TAs and gain insane respect for Dr. Orczykowski’s and Dr. Sullivan’s mental database of anatomical expertise.
I witnessed the passion of Dr. Hortsch in histology and downloaded all 32 apps we needed to be successful in medical school. As I reflect however it’s not the slides I remember. It’s Dr. Okanlami’s patient presentation where we got to learn and break barriers as people and future physicians. It’s a professor’s funny shirt and personal story. I remember a friend hanging out with my seven-year-old and bonding over ice cream and magic, selflessly running inside to grab him a napkin when he spilled cookie dough on his kicks. I remember a classmate selflessly opening her apartment to all of us, and another buying out the inflatable float section at DICK’s Sporting Goods so we could float the river.
Don’t get me wrong. Everything was not perfect. There were boring moments and even frustrating times. My experience doesn’t lack any of this, but even in these situations, I remember peers asking great questions and working through issues and concerns. I hit a point where I felt tired of talking about “feelings” and all the “fluffy stuff.” In retrospect, I’ve realized part of the reason I felt tired of this is because I haven’t been raised with proactive approaches to overall wellness, and again, it sounds cliché, and again, I promise I am in no way a paid sponsor of any agenda. But seriously, it felt foreign to focus on learning and wellness in non-tangible or testable areas. At the end of it all, I’m glad we did it and I’ll never know who else it benefited during any given day of those sessions.
Just a few of the LEAD class of 2019 with brand new white coats!
If you have the opportunity, I highly recommend participating in LEAD. The program won’t help you pass a quiz or be any more ready for that first firehose lecture. It WILL equip you to help soften another classmate’s anxiety during Launch week or help someone find their way to class on time. It will also provide an early chance to really get to know your classmates. In my military past, I knew I could count on the person next to me. We were family. I can honestly say that I can call any of my LEAD teammates at two a.m. any day of the week and they will have my back. I know the same is true of my other 152 classmates I met at Launch!
If anyone has any questions about my experience, shoot me an email and checkout the amazing OHEI site.
One pleasantly surprising thing about clerkship year was how often I would come across attendings whose level of dedication to their craft was jaw-dropping. But when I met Dr. Jessica Mellinger on the Medicine GI service and learned about the Michigan Alcohol Improvement Network (MAIN), a multidisciplinary alcoholic hepatitis clinic she and her colleagues had just started, it was a rule-out-TMJ kind of situation. Then I went to shadow her in the clinic and met Dr. Scott Winder, a psychiatrist. I won’t belabor the mandibular metaphors, but I will say that the humanity was palpable. Watching him put every single ounce of himself (which is a lot, he’s a pretty tall guy) into the motivational-interview approach he took with the new patient that day actually sent chills down my spine. I’m pretty sure the patient felt it, too.
Yet, I’m also pretty sure that alcoholism continues to ravage that patient’s already precarious mind and body. Indeed, despite the best efforts of MAIN clinicians, his prognosis is quite poor. It turns out both research and clinical efforts in alcoholic liver disease are woefully underrepresented in hepatology. The same is generally true of addiction within psychiatry. It takes a certain kind of person to persevere in building therapeutic alliance with patients whose addictions repeatedly sabotage their physical, mental and social lives. It takes a whole different breed to show up with sleeves rolled, radically loving and unconditionally ready to engage patients in a new line of change talk. After all, only with such an attitude is there a chance that the patient will leave feeling more empowered to confront their vicious disease than when they came in. That’s what the MAIN providers do on the regular.
My Branches Apprenticeship Elective in MAIN has so far afforded me opportunities in longitudinal patient care, systems improvement and research, training in addiction pharmacology and psychotherapy, and an orientation to integrated care models. But to me its greatest value has been in forging close relationships with people I was able to pre-screen as role models. When I then asked Drs. Winder and Mellinger to speak to the Internal Medicine and Psychiatry Student Interest Groups this past February, they brought the same kind of all-in attitude they bring to patient care.
So, my advice to fellow medical students: as you advance through the sometimes mundane, often challenging world of core clerkships, keep an eye out for those one or two people who when you meet them, a little voice inside you asks how this person even exists. Then ask them about their side gigs.
Implied in the title of “apprentice” is the expectation that you will develop an intimate relationship with an expert who provides instruction and guidance. It was this implication that drew me to the longitudinal apprenticeship program at UMMS. I am a fourth-year medical student aspiring to be a vascular surgeon and, having not rotated through vascular surgery during my surgery clerkship, I was determined to find a way to develop relationships within the department. Obviously, research opportunities and sub-internships provide channels for making yourself known within a department, but I found that my experience in the longitudinal apprenticeship program lead to research opportunities and allowed me to develop rapport with faculty prior to beginning a sub-internship.
The school’s first apprenticeship program, called Longitudinal Clinic, was designed for the Patients and Populations Branch. This was the first year it was expanded to students in all of the Branches including my Procedure-Based Care Branch. As a pilot program, it was not quite perfect yet, but it was perfect for providing something of an introduction into a department as well as developing a relationship with a mentor. The first time I worked with my mentor, a vascular surgeon at Michigan Medicine, I was the only medical student present for a case and was able to participate in operative tasks that are somewhat rare for a medical student. Afterwards, the attending walked with me to chat for a bit and then walked around the department with me to introduce me to other faculty. To be trusted with increased responsibility in the OR and have an attending physician actively take an interest in my career goals was an incredibly rewarding experience.
The advice I would give to anyone considering a longitudinal apprenticeship would be, without a doubt, to take advantage of it. However, I do think I benefited from this experience in large part because I had already determined what I wanted to do with my medical career and could focus all of my efforts into participating in opportunities within the department and developing a relationship with a mentor. One could argue, however, that this program will also provide in-depth exposure to a particular field of medicine for students uncertain of what career they would like to pursue. Regardless, I found this program to be phenomenal and it provided the perfect opportunity to develop a relationship with a mentor capable of helping me pursue my career goals.