Congratulations, you finally made it!
You pushed past when you wanted to quit.
White coat in hand, smile on your face,
I’m sorry to tell you that medicine will put you in your place.

Nothing could have prepared you for what is going to come.
Dress up, talk to some patients… sure, it’s all in good fun.
Just you wait and see, soon the real work will kick in.
To be a doctor is what you wanted; you need to see it through thick and thin.

22 lives gunned down ruthlessly by hate: mourning the dead, Sun City defaced.
Come on, you need to get in there and learn — can’t let a crisis go to waste.
People shattered, destroyed…look at the physician, the patient, the family.
Don’t worry, we’ll talk about some wellness to restore all of your sanity.

A novel strain virus sweeping the entire globe with no plans of stopping.
Medical supplies, health care providers, and signs of hope seem to be dropping.
But you’re essential, a vital part of the healthcare team, you need to graduate on time.
We don’t know what’s going to happen to you but get in there, it’ll all be fine!

The push and pull you feel of needing to do more but not knowing how to.
Seeing how little you actually know despite everything you’ve been through,
Fearing that you didn’t realize what you’ve gotten yourself into.

Medicine will make you realize your place.
It gives you a reason to look forward and brace
Whatever may come because nothing can replace

Becoming someone who will be there
For those who need you most when they’re in despair.
These may not be your battles to combat right now,
But soon your day will come and you’ll know exactly how.

I wish I could have told you, the day you put on that coat,
Some days it’s going to be really hard to stay afloat.
But I can tell you this: despite what’s going on and what you’ll see,
The worst of it all is worth learning how to be the doctor you’re meant to be.

Poetry Thursdays is an initiative that highlights poems by medical students and physicians. If you are interested in contributing or would like to learn more, please contact our editors.

The post In My Place appeared first on in-Training.

They did not want to disclose that I was dying. Out of respect for my family’s wishes, my cultural values and ultimately myself. But they forgot to respect my right to know, my right to choose which way to go, my right to see tomorrow and the fading of the sunset glow. What if I wanted to shove that tube down my own throat to keep my lungs from turning into collapsed bags of air or pull it out to expedite the deflation and demise? Or rather, experience summer night once more, intoxicated by fantasy and blissful affection under the forested hum of a ballad that all made sense when nothing mattered anymore.

But they would never know. Until I was dead and it was too late.

Every day I lay on the hospital bed, unfamiliar to me, with its profound sterility. Everyday as the monitors buzzed and beeped, fluorescence and horrid scents seeped into my senses. The days I spent there piled up like heaps of decaying leaves, awaiting a visit from the Grim Reaper. Everyday, a group of white coats would come into my room, look at the undulation of numbers on the monitors and pontificate about what to do next. Their faces were pasted with concern that palpated through their cold stethoscopes into my paper skin as they held back the words flickering in their eyes.

That I was dying. And it was too late.

These venerable humans attempted to provide me with sensitive care but required a medium to speak, my own child, who believed I should not know of my untimely demise. I wondered if they would have treated me differently if I had understood their verbiage, if I spoke their native tongue. Would they have waited this long to disclose my fate and continued to view me as a human to be pitied, or would they have bypassed my family in the name of autonomy and told me the calamitous truth of my fleeting existence.

I had incurable cancer. And it was too late.

But if they would have told me, I will never know. My thoughts, composed of a different alphabet. My emotions, inexpressible through their vernacular. My desires, goals, and passions, they would never comprehend, no matter how hard they tried. Part of me did not fault them for their sheer lack of understanding. Because not even I can say I understood. I forced my mind to shut the thoughts out, lock the door. Build a trench allowing no one in or out of my mental castle.  I just wanted peace and quiet. I wanted silence. But at that time that word meant something very different.

What I was avoiding was imminent. And it was too late.

Maybe they knew I was not ready to accept this path. Maybe they had more insight than I gave them credit for. But it is hard to remain ignorant to an undeniable truth when you feel your very soul slipping into the ethereal energies, your muscles disintegrating into desert sand. How naive they are to believe they understand when the last breath will be. They do not understand the weight of a failing body, the way its skin falls from bone, the putrid odor that can never be cleansed.  Only I reside in this body that no longer feels my own, one that can no longer support this soul. Only I exist in this flesh, every moment of every day. I know I am dying. You cannot hide that from me.

But I was already ‘dead.’ It was already too late.

Poetry Thursdays is an initiative that highlights poems by medical students and physicians. If you are interested in contributing or would like to learn more, please contact our editors.

The post Tomorrow appeared first on in-Training.

Mask on.
Your own protective prison
the air is stale but clean, you hope.
You don’t dwell on things you can’t change.

Check the morning news and choke
warning:
droplets filtered but rhetoric unencumbered.

Another day begins
wading into the fire wearing nothing but your robe
armed only with words of encouragement
chalked on the sidewalk in painstaking calligraphy.
You take up the sword
but the blade is dull.

On the frontlines
you stand at attention
hoping to pass for the hero they call you
facing off against today’s enemy:
the row of rooms marked “COVID+”

Each time you enter you wonder,
to save a life
must you wager yours?

At 8 PM sharp,
the claps and cheers of thousands
ring out across the city
but you don’t hear them.
They fade beneath your patient’s rattling lungs
drawing each breath as if questioning its worth.
Suddenly you hear only the hiss of your own breath
deafening, evanescent.

Finally home, peeling off layers
first sweat and grit
then scrubs
then skin.
You put on your new skin, the one that watches “The Office”
and bakes banana bread
and calls your family with a smile on your face.

And only when you have gone to bed
eyes closed, mind ablaze

Mask off.

Image Credit: “COVID-19 Frontline Health Workers” (CC BY-NC-ND 2.0) by UN Women Asia & the Pacific

Poetry Thursdays is an initiative that highlights poems by medical students and physicians. If you are interested in contributing or would like to learn more, please contact our editors.

The post Frontline appeared first on in-Training.

Pre-rounding was going well; the patients were getting better and the team was making record time. I commented to the resident how satisfied the attending would be with the efficiency of his work. He just laughed and said “look” as he gestured down to his list of patients. I saw the name, and a sense of dread sank in during the rest of the silent walk down the hall.

Having walked the halls many times in the past weeks I knew exactly how close we were to the room. Fifty steps. Why do I feel this way? I got into medicine to help people. Twenty-five steps left. Why do I feel guilty? Time to focus, we are here. The resident and I paused, and our silence was broken by the creak of the door.

This was the textbook “difficult” patient, the one that I was warned about in my preclinical years. No matter what I did to help, any setback would always be my fault. It was frustrating at times, but I did what was necessary to help her while minimizing her effect on my mood as I cared for other patients. Looking back it is clear that her moods were a reflection of  the massive uncertainty that had been suddenly thrust upon her; but in the moment, every time I walked towards her room I could not help but take her and her husband’s distrust personally.

One foot in the door and I was aggressively confronted by the gaze of her husband. I saw her lying tearful in the bed.

What did I do to deserve this forceful confrontation; have I been unkind? Why do I keep getting assigned to this patient? Was it a rite of passage? Was this a form of hazing? Was I somehow making her worse by being here?

“Hello ma’am, how are you feeling this morning? How has your pain been overnight?” I asked. She forcefully gestured to her arm but remained silent. Her arm appeared large and edematous, in stark contrast to her slight frame. Her peripheral lines from the previous day’s surgery were absent.

My guilt shifted to sadness. Did I really do this to her? Was it my fault?

“Well, you gave her a clot in her arm, that’s what,” said the husband. “She said from the start that she didn’t think she needed the IV antibiotics, now look at what you have done to her!” If the look the husband gave us carried the weight of his emotion, we would all collapse like a tower of playing cards.

How can he honestly think that we did this to her on purpose? I was doing the best I could. Why can they not see that I was only there to help?

She let out a soft whimper, her first sound since entering the room; I turned to her to offer comfort. Before I could make a sound, she cried out, “Go get the REAL doctor, I don’t want any more residents or students. You all are the reason I’m still here! Every time you do something I have to stay here longer.”

Why couldn’t I connect with her like my other patients? I looked towards the resident as he gritted his teeth and smiled; the look in his eyes told all.

“Ma’am, we understand that this is frustrating, but this does happen occasionally,” he said.

“I don’t care! First it was the abscess, now the clot. I thought that you were all here to help me, not make me sicker! I want you all to get out and tell the REAL doctor to come see me,” she yelled, “GET OUT!” I silently nodded, turned, and retreated behind the resident, followed closely by her husband who slammed the door behind us.

It would always be my fault. I would be the one who gave her the abscess, sepsis and deep vein thrombosis. I would be the medical student feeding her “false information.” Each accusation slowly chipped at my sense of ability, allowing the doubt in closer.

Until one day…

“We’ve had a tough night,” her husband explained shamefully, “the surgical team came by in the afternoon to break the news.” I caught her gaze once again, but that day the daggers were replaced with a softness that was not previously present in her brown eyes. She did not speak, but her body language was humble and contrite.  The attending slowly floated across the room to make therapeutic contact with the patient the way we are all taught in medical school. Did she deserve that sympathy after all she has put us through?

She had been diagnosed with not one, but two forms of cancer. She was the same patient whose words always seemed to cause negative emotions to well up, but the team no longer seemed to mind. There seemed to be an understanding that she now acknowledged our attempts in healing her. It was not to say that the past did not happen, as it will always hang in the air between us, but this change in dynamic seemed to re-energize the team.

The next day dread was not a prerequisite on the walk to the room as the team entered with heads and spirits held high. Why were they all so happy? Do they not remember how rude she was just the other day?

“Good news!” the first doctor in the room exclaimed. “Now that we know what we are dealing with, we should be able to get you home tonight or tomorrow. Your infection has resolved, and we can schedule your follow-up outpatient with the oncologist.”

“Thank you…” she said, “for everything.”

Then it hit me like the first forceful blow of chest compressions, as her first words in days burst through my continuous internal monologue. This isn’t about me.

Realizing that I was the problem, not me personally but my attitude, I stood once again lost in my own thoughts. At that point I should have thanked her, a name and a face never to be seen or heard from again. Before the realization had fully set in I found myself nodding and smiling as I left the room with the team. The next day she was gone, and in a week I would be too.

During the entire time I had spent with this patient, I had subtly been making our interactions about myself, asking why I was to blame, why I was inadequate. Perhaps it was a hunger to learn or a selfish need to prove that I am capable that temporarily overcame my normal character. Lost in my own frustration, I forgot that I was indeed doing my job, and doing my best to be there for her. The disparity between what the patient needed and what I anticipated based on previous patient interactions was unexpected. I had become accustomed to the generally positive interactions with patients as the team laid out the plan of action. Before this time, or in the time since, I have yet to encounter a patient who expressed such powerful raw emotions. While we did not always enjoy being the sounding board for her emotions, the team’s management of her numerous comorbidities freed her to safely explore her emotions without plunging into the depths of her uncertainty.

There is a fine line between patient care and caring for a patient. In our short four years of training we learn about appropriate patient care and effective decision-making. In contrast, caring for patients is something that continues to develop over the lifetime of a physician’s practice. This encounter forced me to really reflect upon my feelings toward this patient and others that I have had like her. I realized that while it may sometimes be uncomfortable, it is important to continue to do what you think is in the best interest of the patient, while tending to the needs of the patient as they work through their circumstances at their own pace. There will come a time in each of our careers where we will face these feelings of self-doubt, perhaps some sooner than I. It is not a race to some great revelation, rather it is more important how one reacts to these feelings and proceeds forward.

Doctors are not more than human. They are not like the glorified actors on TV. They have bad days and emotions like the rest of us. But they have them on their time, trained to compartmentalize patient care from their own feelings.

By now she probably hardly remembers the medical student as more than a blip on her radar. This interaction turned out to be one that I will not soon forget. Many of my peers would likely refer to the case as “low yield” because it was a medically straightforward case, but her lessons extend far beyond any test.

Uncertainty is an integral part of medical training. Uncertainty in the differential, uncertainty in the effectiveness of treatment and most importantly uncertainty in yourself.

Trust in your training and welcome opportunities to grow.

Image Credit: “Grandparents” (CC BY-NC 2.0) by Razortapes

The post Long Walks in a Short Hall appeared first on in-Training.

I am okay being alone; it’s not hard to do.

For other people, they can’t do it as if they were left scarred anew.

The trick is to keep your mind busy.

You move so fast that the room feels dizzy.

You move so quickly that your feet leave the ground.

Even flies start to question how you get around.

Continuing to work will keep you from being vexed.

The bees will look in to see what you’ll do next.

But if you take this approach make sure you slow down;

you don’t want to forget that the Earth is still round.

Remember there are others in the same spot as you.

Reach out because, right now, that’s all you can do.

Poetry Thursdays is an initiative that highlights poems by medical students and physicians. If you are interested in contributing or would like to learn more, please contact our editors.

The post Isolation Treatment appeared first on in-Training.

Peering outside to witness an elderly woman walking her dog first thing in the morning – mask on, gloves on.

Passing by a beach normally teeming with families, lovers, life – now barren.

Riding bikes through the center of Coconut Grove, typically smelling of car exhaust and ethnic foods – now eerily devoid of traffic and human interaction.

A coronavirus – a positive-sense, single-stranded RNA virus as we have drilled into our memories – causing this void. Something so minuscule. Something invisible to the naked eye. The people of the world confined within the walls of their homes. Or a minimum of 6 feet away from another human being in a public space — so long as there are less than ten people in the area. All due to this obscure villain of the world.

It almost seems unreal. The world has stopped as we anxiously await the “all clear” from some ambiguous authoritative figure. The elderly woman continues reusing her mask and gloves because the store shelves have lacked stock for weeks. The beaches remain untouched. The busy streets are vacant. We have been halted in our tracks against all desires and efforts.

The world is quarantined, but we have learned to be human again.

Rather than tirelessly working or studying, we are forced to engage with one another in meaningful ways. We find novel alternatives to maintain relationships with those who mean the most to us during this daunting time with no foreseeable end. We reach out, check-in, virtually visit with our people. We adapt.

We learn to be children again. Playing board games, riding bikes, doing puzzles, speaking to friends on the phone without having a purpose for the call. We relearn the value of community, the beauty of nature, the joy in the banality of everyday life. Life has come to a dramatic halt, but in this, we find ourselves again. This does not negate the overwhelming stress and anxiety being experienced by the masses. It is only to find the silver lining in it all.

The silver lining of an elderly woman being able to safely walk her dog on empty streets.

The silver lining of a beach unfettered by plastic bottles and bags left behind by careless beachgoers.

The silver lining of a city street now free of pollutants, allowing for truly fresh air to fill the lungs of those who seek it.

The world is quarantined, but we are liberated just the same.

The post Silver Lining appeared first on in-Training.

Editor’s Note: in-Training is thrilled to present the educational animations below, created by Ariana Kam. They highlight efforts undertaken in Australia to establish a medically supervised injecting center in response to Australia’s heroin epidemic in the 1990s. 

Artist Statement

I am a student at Boston University School of Medicine, and I use visual media to highlight personal stories of addiction and recovery. In collaboration with the Australian-American Fulbright Program, I spent 2019-2020 examining the treatment of substance use disorders in Australia through the lens of animation. As part of this project, I created a pair of educational animations focusing on the Medically Supervised Injecting Centre (MSIC) in Sydney’s Kings Cross. This series, entitled Up the Cross: The Uniting Medically Supervised Injecting Centre, examines the founding, protocols and benefits of the MSIC, which was established in 2001. Research by the University of Sydney reveals that since the MSIC’s founding, facility staff have supervised over one million injecting episodes with zero overdose-related fatalities.

Up the Cross comprises “Part One – Beginnings” and “Part Two – Harm Reduction Methods.” “Beginnings” highlights the sociopolitical climate which allowed for the opening of the MSIC in the Kings Cross suburb. “Harm Reduction Models” explores how the clinical model of the MSIC contributes to harm reduction.

My hand-drawn animations and shadowy palette capture the essence of The Cross suburb, depicting its “moth to a flame” character, 19th-century architectural origins and dense maze of inner urban lanes. The films’ characters are imagined as native and feral fauna. The narration is drawn from my 2019 interview with Dr. Ingrid Van Beek, the founding Medical Director of the Kings Cross MSIC.

As “Beginnings” describes, the Uniting MSIC was proposed as a response to the Australian heroin crisis of the 1990s. By 1999, the number of heroin deaths nationwide exceeded the national road toll, drawing significant public attention to the country’s drug problem. The New South Wales government chose to launch a trial injecting center in Kings Cross given that this suburb presented with the highest rate of overdose deaths in the country. The Uniting MSIC finally opened its doors in 2001 and continued to function on a trial basis until 2010, when it gained a permanent legal license for operation.

“Harm Reduction Methods” explores how Van Beek and others developed a regulated model for a safe injection facility in Kings Cross. Van Beek describes the three service stages of the MSIC: client assessment and registration, the supervised injecting episode, and the after-care stage. She notes how each stage presents an opportunity for crisis counselling and treatment referrals.

In summary, the aims of this animation project include:

1. Educating healthcare providers, social workers and the general public
2. Facilitating discussions about diverse public health interventions
3. Fostering a sense of community among current and former users
4. Destigmatizing substance use and treatment

I hope that Up the Cross will ultimately educate and inspire a wide array of audiences, including medical professionals, users and the general public.

The post Up The Cross: The Uniting Medically Supervised Injecting Centre appeared first on in-Training.

“I think his work will be regarded as a landmark in the field in the years to come. Without further ado, here’s Alex!”

My principal investigator (PI) had just given the introduction to my thesis defense. I was nauseated. Heart pounding. Head spinning. Four years of research has led up to this moment. I took a deep breath before I made my way towards the podium. As I gazed into the crowd of people that had pushed the room to capacity, familiar faces in the crowd caught my eye — my family, my friends, fellow graduate students, collaborators and lastly my fellow co-workers.

I’m going to miss all this.

Exhaling slowly, I finally managed to soak it all in and began my dissertation defense. Finishing graduate school has been a real mix of conflicting emotions. My last few weeks in lab were spent trying to hold on to and relish every moment. I would tease the lab techs I had grown to know that time was running out to blame everything on me. I appreciated the little things: the mice trying to bite my fingers off, my PI endlessly revising my thesis and even the mundane pipetting.

One of my last tasks was to clean out my bench and organize my notebooks. Flipping through the pages, I reflected on my growth as a scientist and as a person. I had overcome failure after failure to start my own project, learned and perfected techniques I hadn’t heard of before graduate school and made lasting connections with my colleagues and co-workers. These experiences fuel my desire to remain in science, but I can’t linger in the past. I closed my notebooks and stacked them on a shelf. I must now prepare for the tough transition back to medical school and finish my medical education.

I cannot help but feel a little bit uneasy about the coming changes. The last standardized test I took was Step 1 in 2016. I have forgotten the feeling of sitting down and studying material until I knew every detail. When I transitioned into graduate school, I traded computer exams for experiments, standardized exam books for lab notebooks and listening to lectures for preparing my own. There was suddenly no clear metric to measure my progress. Instead, progressing forward sometimes meant scrapping plans and starting anew. After four years of adapting my schedule based on the results of my experiments, I once again look forward to having a guided regiment based on monthly shelf exams and the ever looming threat of standardized tests.

While schedule changes will surely be challenging, I face perhaps an even bigger challenge of adjusting to my role in the hospital. On the surface, there may not seem to be much of a difference between being a graduate student in a lab and a medical student in a hospital. I worked with lab techs, post-docs and principal investigators similarly to how I’ll be working with the nurses, residents and attending physicians.

However, the hierarchy in science is fluid. I was considered an expert in my field and openly challenged my principal investigator when he gave me experiment ideas and designs. In fact, he welcomed my questions, criticisms, and input. With limited clinical experience, I’m hesitant to act similarly towards my attendings. Depending on the rotation and attending, instead of asking questions and offering critiques, I will have to hold my tongue and accept the established practices and protocols set in place for me. I won’t have to learn from failure, but this will surely frustrate the inner scientist in me. I can only look forward to when I’ve risen up the ranks and can start to question and implement change to set hospital protocols.

Change is a constant in life. Although I face another hard transition, I am genuinely excited to start clinical rotations. I’ve been dreaming about this moment ever since I declared I was pre-med in college. All the organic chemistry, pharmacology and pathophysiology that I’ve learned has led to this moment where I can finally enter the hospital as a full-time student. I am far from where I need to be to become an independent physician-scientist, but I embrace the challenge ahead of me. The clinical years will only grow me as a person, and I look forward to what lies beyond them.

The post Looking Towards Clinicals After Graduate School appeared first on in-Training.

A mourning sun cries as she tucks away
the night to uncover red and blue
slumps of fabric and skin on gritty sand below.
Brazen tides return to grasp at the shore,
but the boy lies still in darkened, sodden clothes.

They cling to what is pale and small,
he who was delivered into lullabies dissolving
screams and bullets into the haunted night,
forced to flee from a sea of violent red
to the turbulent sea of blue.

I think of him and grieve —
still.

Author’s Note:

Aylan Kurdi was a 3-year-old Syrian boy of Kurdish descent who drowned on September 2, 2015 while trying to reach the Greek island of Kos by boat. Of his four-member family, only his father survived the journey. Published images of Aylan’s body brought swift attention to the ongoing Syrian refugee crisis and Syrian Civil War, resulting in international calls for action. More than 12.8 million Syrians have been driven out of their homes due to civil conflict, with over 6.7 million Syrians forced to flee the country and 6.1 million people who remain internally displaced.

The world’s response in 2015 to Aylan’s story was one of outrage and wracking grief. Of the many themes that emerged from subsequent discussion, it was a sense of fractured moral duty to one another that prevailed. Days after the photo of Aylan was released, the New York Times published an opinion piece titled, “Who Failed Aylan Kurdi?” A Los Angeles Times article printed soon after seemed to answer with the headline, “How the World Failed Aylan Kurdi.” The sentiment implies and emphasizes a shared responsibility that comes with simply being part of humanity. Close to five years later, the most charging elements of Aylan’s story persist in our politics and our policies within, at the edge of, and beyond our borders — a fight for human dignity.

Our work in medicine gifts us a unique vantage point of the human experience. Without diminishing the spectacular beauty of diversity, our patients remind us that we as people are intrinsically more alike than different — in both body and spirit. As today’s medical students, we are tomorrow’s physicians and leaders; we cannot deny the context in which we have taken on this role. Apathy and inaction toward global crises threaten to allow this sense of communal failure to persist, or worse, for us to become numb to its weight.

This topic is one I feel strongly about. While living in Melbourne, Australia in 2015, I participated in research on Australian immigration policies and focused on the Australian government’s treatment of refugees and asylum-seekers detained on the nearby island of Nauru. The first time I saw Aylan’s photo, I was on my way to a local primary school in a predominantly immigrant neighborhood with a large refugee population. Almost all of the children I worked with as a teacher’s aide were either refugees themselves or born to refugees, barely older than Aylan. This made his story and the ongoing events especially gut-wrenching to process.

What is happening outside our clinic doors will inevitably find their way inside. It informs the weights our patients carry with them when they enter and after they leave. It constructs frames and walls that line our patients’ paths, bending and molding their determinants of health and well-being. Each of us fills the space of many roles in our communities, but we are all humans first. As those given the honor of intimately entering others’ narratives in the name of protecting the body and mind, it is beyond our business but our moral duty to pay attention, speak up, and proactively defend threats to human rights and life when we see them. If we do not address what is happening outside our clinic doors, we are not adequately caring for the people sitting inside on the examination tables in front of us.

Image credit: “Aylan Kurdi Made in #waterlogue” (CC BY 2.0) by robertsharp

Poetry Thursdays is an initiative that highlights poems by medical students and physicians. If you are interested in contributing or would like to learn more, please contact our editors.

The post Aylan appeared first on in-Training.

Yet another Black man murdered.

I am not Black, I am not White, but I am American.
We were established on the idea of a collective “we” – we, the people, despite creed or color.
The culmination of atrocities is to you, to me, to us.
We face this injustice as one.
We must.

The world is changing; we are changing —
Faster, more impactful responses to injustices.
Police reach into communities to establish or rebuild trust.
Good intentions undercut by a history and recurrence of heinous crimes;
Generations lost by discrimination, by hatred.

Lives dedicated to the movement for equality,
The overturning of the pervasive bias of colored criminality,
The fight against a system of profit over humanity,
The illegalization of civil rights abuses and indignity,
The intolerance of the status quo and inactivity.

We rally again.

Protesters indiscriminately gather in solidarity — afraid for their lives.
Enforcement stands armed prepared to face enraged masses — afraid for their lives.
Commentators vocalize their outrage, their disappointment.
Leadership mimics commentators’ responses.
Amid the chaos, communication is severed.

Stop, there has to be more.

How can you fear for your life while instilling fear in those you wish to establish peace with?
How is your voice heard if it’s fettered by vulgarities to those who you wish to reach out to?
How do you condemn violence while inciting it?
How do you expect the oppressed to set aside arms when you approach with an arsenal?
How do you turn your back on human beings imploring you to heed their cries?

A call to action.

Divide no more.
Partisan no more.
Absent representation no more.
Oppression no more.

I see you, I hear you, I feel you.
My brother, my sister, my person.
I am you and you are me.
We are them and they are us.
We stand together.
We seek peace, equality, freedom.
We strive for justice and absence of fear.

We demand leaders to stand up — not with guns and tear gas, but with pen and paper;
Not by screaming into the void, but by drafting an actionable plan.
We expect demonstrative change in legislature, in police force, in social programs.
We beg for the lives of us all.

The post A Call To Action appeared first on in-Training.

I am distracted and exhausted with my own thinking these days. I write this against the backdrop of the COVID-19 pandemic and the protests around the US in response to the murder of George Floyd. It is overwhelming. I’m left to wonder if there will be any concrete change that comes out of all this. I’m left to question exactly what change I personally would want to see. For example, I question if our current educational model, at all levels, is doing enough to address the lack of understanding within our society.  Specifically, is medical education doing enough to address future physicians’ abilities to understand the perspectives of their patients? As a medical student, my growing disillusionment begins with medical school and the lack of opportunities afforded to us during our education to discuss matters such as racial inequality.

Just because we have achieved a higher level of education does not afford us the right to assume we have achieved an equally higher level of understanding about social constructs. It takes constant self-reflection, thought and discussion to achieve even a baseline understanding of topics such as racial inequality — an understanding which cannot be garnered solely through reading textbooks and earning degrees. However, our education as medical students does not actively challenge us to have these discussions with ourselves or with each other. This lack of opportunity for discussion impedes our ability to understand how race affects ourselves, our peers, and our future patients. For many students of color, especially Black individuals, the discussion regarding racism is one they have already been forced to have with themselves every moment of their lives given their lived experience. Therefore, if we all do not actively engage in such discussions with each other in school, we neglect a collective responsibility we have towards not only our patients, but also our colleagues.

We spend so many hours learning how to treat patients on a scientific level that less emphasis is placed on how to treat patients on a human level. But the responsibilities of a physician are split 50/50, necessitating both an understanding of medical principles and an understanding of people, including their perspectives and backgrounds. Just as we are expected to know more than the average person regarding medical science, we should also recognize we are expected to have an above-average understanding of topics such as racial inequality. Ultimately, such topics directly affect our patients.

The requirement that we master both these concepts is what I believe makes the medical profession unique. Unfortunately, while the responsibilities of a physician are split 50/50 in practice, I am disheartened to think that the focus of our education is perhaps split 90/10 with the heavier emphasis placed on scientific knowledge. You hear all the time that education is the key to uprooting ignorance. So I’m now left wondering, what is my education doing to help further my understanding of people?

Yes, we will all be working with patients during rotations and that will help a little with understanding the patient experience. But is it enough? Is it enough to leave the task of mastering the other half of a physician’s responsibilities solely to an individual’s personal desire to learn from their own isolated experiences? The onus falls heavily on the individual student to extract meaning and grow from interactions during clerkships. However, if students are not guided properly, there is no guarantee that we will truly learn about how racial factors impact medicine on a systemic scale as well as how they impact people’s daily lives. When left to their own devices, the students who already engaged with racial issues will continue to engage. For others, without an outside force such as an educational curriculum challenging them to put in more effort than they currently give, the inertia to not engage is too strong to overcome. Without formal training, it is difficult to successfully nurture a deeper understanding of racial issues.

If there is anything medical school teaches us, it is that passively reading or watching something doesn’t actually help you understand the material. There has to be an active learning component to it. As a physician, a superficial understanding won’t be enough. Active learning can be achieved either independently or by working with others. When trying to understand scientific concepts, learning can be easily achieved individually. However, actively learning about the topic of racial inequality is far more difficult to do by ourselves. To nurture a deeper level of understanding, this learning requires discussion with others, especially others who might not share the same opinions or perspectives as you. After all, there is no point in having discussions if you aren’t challenged during them. Or if you aren’t open to having your opinions grow and change. Unfortunately, a sufficient forum for such discussion is not built into our current education. Until systemic changes occur in our education, we will continuously sideline the discussion of race as an “independent study.” However, a topic so important should not be left up to the individual.

What type of systemic changes could help medical education provide a better environment to develop an understanding of issues that plague Black patients? In a report published in 2019 by WhiteCoats4BlackLives, they detail a list of what an anti-racist curriculum would look like. They call on changes to the existing curriculum including the use of appropriate language that does not refer to race as a risk factor, the creation of mandatory in-person training to teach students about how to be actively anti-racist, and access to structures that allow honest feedback from students on how the curriculum is accomplishing its goals. These are only a few things they outline in their report, and I encourage you to read more of what they propose here.

Furthermore, from the conversations I have been hearing personally, there is a newfound emphasis on increasing the diversity of medical students. In addition, I believe it is just as important to increase representation among lecturers so that Black students are able to easily see and seek physicians like themselves as mentors. Simply put, it is important to increase representation of Black individuals in medical training. Increasing representation also inherently creates more opportunities to have meaningful discussions about race. These discussions could serve as a catalyst for change in the system of medical education or as a catalyst for deeper understanding within individual students.

Moreover, these discussions can be constructed in small-group discussion-based classes that provide space to talk about issues like race in a candid manner. In the end, I believe that every medical school should have the following two objectives in mind as they discuss curriculum changes: 1) medical education must help students first become comfortable talking about the subject of race and 2) medical education must help students become confident in our understanding of systemic racism and how it affects medicine.

These ideas are not groundbreakingly new. I question why there have not been speedy and active changes already occurring. As members of higher education, to some extent, we are all privy to the problems with what we aren’t taught. Medical educators need to self-reflect: what has been holding us back to enact change and how do we move past that? This moment in history is the ultimate opportunity to create lasting, systemic changes within medical education. I fear if we miss this chance now, we might not get it again.

Image credit: “lecture hall” (CC BY-SA 2.0) by Genista

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It was a Thursday night, and I was with my two friends, Jess and Kevin, on the dark road back to Boston. We were on our surgery rotation in a distant town. During the week, we cohabitated in a bare-necessities house near the hospital. As the only one with a car, it became my routine to wait until everyone’s long shifts were over and drive everyone back. We tended to fill these rides with conversation, the topic of which was often our experiences on the wards. Tonight was not any different.

Trying to keep my tired eyes on the road, I just listened to Jess and Kevin talk.

The conversation turned to the concept of “imposter syndrome” — that feeling of not belonging in a space you were accepted into institutionally. Kevin described how all of third year has been draining in an unexpected way. He went on to say it has been hard for him to be himself completely, or to feel like he fits in. Jess validated this and brought up that it probably had a lot to do with how they were raised.

For context, Kevin is Vietnamese and Jess is Chinese. They got to discussing the similarities in how they were brought up — how respect for parents and other older family members was paramount and manifested in actions, not just words. For them, as children, it was not socially acceptable to speak up to or question a senior family member. The connection between this upbringing and their ability to navigate the archaic hierarchy of medicine was not lost on them. It was not easy for them to speak up or chime in during rounds, to offer their knowledge or perspective to a group of seniors.

At that point, a lightbulb went off in my own inner monologue: of course.

Before witnessing this conversation, if you had asked me how it feels to be a part of the medical teams, I would have said easy. I would have bragged about my ability to speak up to superiors — how I easily fight for a plan others initially disagree with or bring up more radical advocacy notions that question someone’s management. These are things I have come to hold as core aspects of my personality. In listening to Jess and Kevin, I realized how ignorant that really was.

What I have been interpreting as character traits are products of my White cultural upbringing. In my life, less emphasized were the values brought up by Kevin and Jess in the car that night — that of respect for authority and the importance of group cohesion over the needs of the individual. While I am not implying this is the situation for all students of Asian descent, it was a clear cultural difference between me and these two friends. My upbringing placed more value on individual expression, achievement, and choice. From childhood, I have been primed to speak up and demonstrate my ability, regardless of who I am speaking to. In fact, it has been encouraged. And this has served me well on the wards.

Feeling that my voice is wanted and even necessary in the clinical setting does more than ease my experience, it offers tangible benefits. To understand how, it is necessary to understand how we are assessed.

Medical students receive “clinical grades” that transform their performance in the clinical setting into a numerical or categorical term. Some components of these evaluations include knowledge, measured by our ability to diagnose and plan for a patient’s care. In practice, the moments to showcase our skills are not clearly defined. So, demonstration of knowledge involves both successful identification of those moments and what many physicians label as “confidence” to seize the moment. Over and over again I have heard seniors tell students, “It doesn’t really matter what you say for a diagnosis or plan, just say it with confidence.” This confidence emphasized by evaluators, who are responsible for our grades, is not an objective measure of ability, but instead the result of how comfortable a medical student is in a space. And if you are White, I promise you are probably a lot more comfortable than a student who is not.

You are more comfortable because you are familiar with the culture of medicine, and how to navigate it. This is because, in many ways, the culture of medicine is White culture.  White physicians make up 56% of the workforce, more than any other race or ethnicity. I have been on a variety of medical teams during my third year, but it is safe to say the majority of those teams were White people. I knew I moved through these spaces easily for many reasons, but being White is a big one that needs to be said out loud. And when you look and feel more comfortable in a space, it is easier to perform “well,” or to sound confident. This is directly related to what academic medicine characterizes as “objective” evaluations of students, and there is data to support this.

A study summarizing 6,000 Medical Student Performance Evaluations found that White students were more likely to be described as “standout” and their abilities to be “exceptional” and “outstanding.” Black students, meanwhile,  were more likely to be described as “competent.” They found that medical students who were not White received lower grades than White students in most of their clinical clerkships. These clinical grades carry weight — not only do potential residencies see them; they are also used to select for prestigious society memberships such as Alpha Omega Alpha. White students are 6 times more likely to be inducted into Alpha Omega Alpha compared to Black students, and 2 times more likely compared to Asian Students.

As we neared our exit, I shared my own experience with Jess and Kevin, detailing my surprise at never having developed the dreaded “imposter syndrome.” I told them how listening to their conversation made me realize, and more critically evaluate, the reason behind this. I know a lot about White privilege and the socioeconomic implications of it. Medical schools actually elucidate the results of White privilege by teaching us about racial disparities. But we rarely discuss the huge ways in which the predominant White culture of medicine diminishes the subjective experiences of minority students and their “objective” evaluations.

This moment in the car on the way home was an important reminder of that.

But this reminder needs to go further. There are many ways in which I, as a White medical student, can improve this problem. For example, I can make note of when I need to pipe down and instead help amplify another student’s voice while in the clinical setting. I can support students who have adverse experiences due to their race by joining their voice when they speak to the administration. The reflection I engaged in in the car was a passive happenstance, but active and continued reflection, instead of when prompted by students of color, is critically important. Additionally, it is crucial we support institutional-level change. For instance, some schools are suspending their affiliation with the Alpha Omega Alpha. Supporting movements to end metrics that favor the White medical student, like the USMLE STEP scoring system, is another way. This list is by no means exhaustive; these are just examples of steps that remove barriers for students of color. There is a lot of work to be done to make medical education — particularly in the clinical realm — a safer space for our non-White students.

This car ride was a reminder that the first step is always the same: sit back and listen.

Image provided by author Nat Mulkey.

The post You’re Not a Bold, Knowledgeable Medical Student — You’re Just White appeared first on in-Training.

Medicine is a discipline that claims to be based on empirical and scientific truth about human nature. Instead, its knowledge and practice are often steeped in biases like racism. For example, medicine was used in the nineteenth century to justify slavery due to the “biologically inherent superiority” of White races. Dr. Thomas Hamilton was a Southern physician in the nineteenth century who used torturous medical experiments on slaves in an attempt to prove false narratives on physiological differences between the skin of Black and White people. One of his experiments included blistering the skin of slaves to “prove” their skin was thicker. And the Tuskegee syphilis trials leave a long legacy of medical mistrust.

Many racial biases still exist and affect the care of people of color, especially Black patients. A 2016 survey found that about one-third of medical students and residents surveyed believed that Black people have thicker skin than their non-Hispanic White counterparts (NHWC). This pervasive and racist idea contributes to the inadequate pain management of Black patients and is sadly not the only myth that is still perpetuated in the realm of dermatology.

Dermatological health disparities have long been well-documented in people of color: non-white patients have higher rates of morbidity and mortality associated with dermatologic disease as compared to their NHWC. Additionally, under-recognition of erythema migrans in Lyme disease has resulted in increased rates of late manifestations in Black patients. Black children, based on race alone, are also less likely to see a medical provider for their eczema in the ambulatory setting. These disparities may have to do with the fact that representation of race and skin tone in medical textbooks are predominantly skewed towards White skin tones. As a result, inclusivity in dermatological education is long overdue. Given that dermatology is the second least diverse specialty in medicine, action should also be taken to reduce this educational disparity. Medical students themselves have already begun to advocate for this change.

The White Coats for Black Lives organization was created in 2014 in response to the non-indictment of officers responsible for the deaths of Michael Brown and Eric Garner. Medical students across the country have more recently flocked to social media, posting images of themselves with the hashtag #whitecoats4blacklives after the police murder of George Floyd. At the time of writing this piece, a petition advocating for medical schools to include Black and other minority representation in clinical teaching had amassed 189,120 signatures. Students are even taking to journal submissions, writing about their personal experiences with discriminatory medical education and recommending avenues for change. In an effort to decolonize medical education, one passionate Black medical student wrote a book called Mind The Gap, a handbook of clinical signs on Black and Brown skin. Through action, students have shown that they will no longer take part in discriminatory medical education that not only promotes systemic racism but also hinders their ability to be competent physicians.

One further solution is to increase exposure to pathology on Brown and Black skin amongst medical students, as this is proven to increase confidence in diagnosing a variety of dermatological diseases. In addition to diversifying images of dermatological pathologies in textbooks, the field can also diversify research to identify potential racial or ethnic disparities in the diagnosis and treatment of dermatologic diseases These changes are especially needed given that the projected growth rate of minority populations is increasing every year. The non-Caucasian US population could be approximately 48% by the year 2050. Many of us become physicians to help our communities; yet, only learning from textbooks often steeped in the racist legacy of medicine is insufficient. And so, medical education must change the curriculum to ensure proper representation of darker skin tones.

Other specialties have already distinguished themselves as leaders in health inequities. In fact, family medicine (FM) was born during the time of the Civil Rights movement and Vietnam War protests as part of the “countercultural” movement with social responsibility at its core. At the root of FM is the understanding that economic, social and cultural forces impact access to health care and that it is paramount to acknowledge these forces to provide health care for all people. As such, FM strives to continuously address the social determinants of health and reaffirm its unique position in influencing needed changes in health care. It is important for the field of dermatology to similarly emulate FM’s goal to alleviate health disparities because, as it currently stands, Dermatology only caters to a small population of primarily light-skinned individuals. With a more comprehensive education that includes Black and Brown skin, dermatology can further embrace the Hippocratic oath and appropriately treat all patients knowing that skin diseases may present differently on various skin tones.

Given the current political change in our nation and the more ubiquitous momentum behind the Black Lives Matter movement, dermatologic medical education should take this opportunity to reflect on its own implicit bias and include Black and Brown skin images in the teaching of dermatological conditions. Actively including more representation in dermatological textbooks is crucial to dismantling internalized racist beliefs that students already consciously or unconsciously hold and to increasing their awareness of how diseases can present on different skin tones. This is more than just a matter of diversity; it is a matter of providing equitable life-saving care.

Image credit: Anatomies (CC BY-NC-ND 2.0) by starsnostars

Tyler Thorne (1 Posts)

Contributing Writer

John A. Burns School of Medicine

Tyler is a third-year medical student at John A. Burns School of Medicine in Honolulu, Hawai'i class of 2020. In 2015 he graduated from Cornell College with a Bachelor of Arts in psychology. He enjoys scuba diving, weightlifting, and hiking in his free time. In the future, Tyler would like to pursue a career in orthopedic surgery.

The post More Than Skin Deep: Underrepresentation of Brown and Black Skin in Medical Education appeared first on in-Training.

As I sat down to reflect on my third year of medical school, I was once again unhinged by the feelings I thought I had suppressed only a few months prior. My monthly emergency medicine periodical had arrived, and I was looking forward to reading the unique case reports. It didn’t take me long to see this would be a more earnest edition; the topic was the familiar COVID-19.

I made it to the periodical’s more subjective pieces and was struck with a moment of stillness; maybe it was the impending rain outside. Two words from the page jumped out significantly: vulnerability and courage. These words have always had different meanings to me. Until recently, vulnerability meant weakness, allowing oneself to fall behind without a chance for recovery. Courage, on the other hand, had the opposite meaning: betting all my chips on prevailing at any cost.

These two words “vulnerability” and “courage” placed closely together reminded me of a particular patient I encountered not too long ago. Until that moment, I had not realized that she remained quietly in the shadows of my mind, watching to see if I would be vulnerable for my future patients. As the clouds darkened outside my dining room window, I began to relive this patient experience.

It was a night in early January, during my obstetrics and gynecology rotation. One of the weeks I spent there was a night call on labor and delivery. In retrospect, this was my favorite week of medical school besides being in the emergency room. The residents were cheerful, despite our lack of sleep. The nurses seemed to always be well-rested, maybe their secret brand of coffee. and even the patients, despite me being unable to understand what they were going through, made me feel as if I was doing them a rewarding service. My first night went well, three successful deliveries. It was the third night shift that upended everything I thought I knew and worked for.

I will never know her name because she never had one. The only history I was given from my resident was: “This mother is in labor, any minute now. She came to her first prenatal appointment with us last week. She lives miles away in a very rural town and had little access to care. Maybe you should just wait for the next delivery.”

I could not just give away a good learning opportunity. I had spent the previous week on day shift labor and delivery, so I was feeling more comfortable around childbirth. I was even beginning to enjoy the adrenaline of donning personal protective equipment and preparing for this “challenge.” Handing a baby over to mom is undeniably worth all of the time spent to get to this point. So, for this delivery, I did all the normal actions to prepare: shoe covers, gloves and gown. What I did not have was a contingency plan in case I experienced a personal emergency.

As we approached the room, my resident said, “prepare yourself.” She knew the seriousness of the situation long before but there was no time to explain. We walked in and the family was already crying. This was a natural reaction I had witnessed among other families during childbirth, but the air felt heavier than normal. Most rooms I previously entered had a board of patient demographics and the baby’s name. Some rooms even were scattered with beautiful flowers and balloons to celebrate the upcoming joy. This room had nothing besides mom’s name on the board. There was no indication of excitement centered around a newborn. While everyone sat quietly, I delivered a baby girl, at term, whose blood had stopped circulating long before we met.

I had never seen a family weep this severely, and I wanted to weep for them. Internally, I did, long enough to finish all stages of birth. I remember, as the resident and I delivered her, it seemed as if the air was sucked out of the room and the temperature rose drastically. I did not hear a cry as her head passed the perineum, nor did I feel the usual active movements of body tone.

What I saw was a lifeless, innocent face with blistered and discolored skin. We made eye contact for a brief moment; she looked perfect and still and had no way of knowing what occurred. The neonatal team stood ready for transfer to the warmer and quickly wrapped her in blankets and a homemade knitted hat. As I stayed to deliver the placenta. I heartbreakingly witnessed the family break down in tears at the sight of this baby girl. I stayed in the room for a brief period to console them, and then quickly excused myself so the family could have their time alone.

After I left the room, I was at loss as to what to do next. I sat and took the time to recover my thoughts. I knew the family would be assisted to a different unit with more privacy. I went back one last time to be a body of presence and hugged each of them. I honestly didn’t know what to say, which may have been for the best because they didn’t say anything either. Some moments in life speak for themselves.

For some time afterward, I was not quite sure what the lesson behind this experience would be. “Why should I make a lesson out of an innocent life lost,” I thought to myself. I am still seeking those answers. This morning, sitting in my dining room, those feelings re-emerged. I don’t know if this nameless infant walks the hospital halls at night, visits her family to support them or even holds my hand and guides me to ensure that I continue the right path. All I can say is that I felt an overly visceral reaction to those two words on the page: vulnerability and courage.

I cannot for one second say I was prepared for that situation, and I admit I could never be prepared for a moment like that again even if I was pre-briefed. What I can say is that it was those same two words, vulnerability and courage, that allowed me to share this experience and will allow me to continue to fight for my patients. In desperate times, families need us. They look to us for courage even when we are just as broken on the inside as they are. In that context, we must remain vulnerable for them. We are equally as human as the patients we treat.

As COVID-19 is the word on everyone’s mind, I hope sharing my experience of vulnerability can help others as we continue to face these daily challenges. In truth, the future will never be certain. As I prepare for my return to the clinical setting, my nameless hero stands with me. She will be there in good times and in bad. She will always have the same gentle, innocent demeanor and will carry this message: stay vulnerable, even when scared of the future and maintain courage in the face of adversity.

The post The Unnamed Hero appeared first on in-Training.

I didn’t know
many can’t
sip coral pulpy bitter
juice from narrow glasses.

Didn’t know to
savor cold bites
popping naked
segments from the yellow rind.

A gift without
use: knowing. No
spot on the shelf.

Juice folds
on the tongue
in light gray afternoon.
Raindrops land outside.

Poetry Thursdays is an initiative that highlights poems by medical students and physicians. If you are interested in contributing or would like to learn more, please contact our editors.

The post Drinking Grapefruit Juice appeared first on in-Training.

I experienced a stark transition coming to medical school. I not only felt I lacked the time to explore personal interests outside of medicine but also felt as though I had no ownership of my educational path (besides my academic performance). The flexibility of undergraduate education was quickly replaced by a predictable weekly schedule to be followed uniformly by all 130 students in my class. I found myself constantly stuck in a one-track mindset, unable to let myself explore anything deemed irrelevant to the current organ system block. I spent much of my first year feeling as though something was missing, something beyond mastering the role of antidiuretic hormone or the adverse effects of amiodarone. With so much structure inherently present in my education, I wanted to explore a topic beyond our traditional curriculum while connecting with both my peers and potential mentors.

At my institution, elective courses are a required part of our first- and second-year curriculum. In theory, these courses offer a reprieve from our highly structured core curriculum and a chance to explore topics that interest us. My experience with elective courses, however, was that they lacked student input and were rarely updated to suit the changing interests and passions of the student body. In response to this lack of student-driven course offerings, I decided to create my own.

By writing this, I do not mean to imply that creating an elective is groundbreaking or an incredible feat of academic prowess. It was actually a lot easier than I expected due to the outpouring of support from my peers and the faculty who worked with me to make it successful. I want to share my experience as a way to illuminate an opportunity present at almost every medical school that may only rarely be taken advantage of. When I began thinking of establishing an elective, I wished there had been a roadmap to follow to understand where to start and how to invest my time. Hopefully, by detailing my own process, which I’ve broken down into three phases, other students may feel that they too can take ownership of their education by developing something rooted in their passions for others to enjoy and learn from.

Phase 1: Finding a core group of faculty.

At my institution, to develop an elective you need a schedule, syllabus, list of core readings, and faculty sponsor, all of which I did not have. All I had was a topic. I wanted to try to build an elective around the topic of leadership development. I wanted to be able to hear from leaders representing academic institutions, community hospitals, private practices, and local government about how they got to where they are today and what lessons they felt they could pass down to the next generation. I did not personally know any of those leaders or have a list of potential speakers prepared when this all began. In fact, the closest thing I had done to designing a curriculum was creating an Anki deck. I started small by bringing this idea to my academic community director who oversees around 20 students per class and who is our point of contact for personal advice. Just by bringing the idea to her, a plan began to take shape through connections. She connected me to our Dean of Student Affairs who then connected me to our Dean of Graduate Medical Education, and just like that, I had found the faculty nucleus that the elective would evolve around. It was through this first step in the process that I learned I did not need to have all the answers, but, rather, I needed to tap into the wealth of resources already around me.

Phase 2: Developing a curriculum and recruiting speakers.

This step is where the most variability will exist as every elective focuses on different topics and, subsequently, is structured differently. I definitely felt intimidated by developing a curriculum from scratch with no previous experience, but looking back I can absolutely attest to it being doable for anyone motivated. In developing the bones of the curriculum, I polled my fellow students on leadership topics they would be interested in. This is known as a “needs assessment” in the world of education. We then compiled the identified topics into eight classroom sessions over ten weeks, beginning with broad topics like “developing your personal leadership identity” and then transitioning to the more granular topics like “effectively giving and receiving constructive feedback in your career.”

With each topic, we needed a speaker. As a student, I had few connections to lean on besides past mentors. Once again, it was the strength of having a core group of faculty who also felt passionate about this topic that made the process easy. The success of the curriculum coming together in its early stages hinged on being connected to resources and not being afraid to ask for help. Support came from fellow students, residents, and even administrators who wanted to contribute their thoughts on how to craft a successful curriculum. For other students developing electives, finding speakers or generating topics may not be their biggest challenge like it was for me. Still, there will undoubtedly be questions along the way about how best to engage students and how to create something that makes a lasting impact. I found success by prioritizing the student experience based on interests identified through surveying my classmates; I then built a curriculum out with that as the established centerpiece. Effectively communicating my intentions to class participants, whether students or presenting physicians, then attracted others looking to take part in building something meaningful together.

Phase 3: Active course delivery and gathering student feedback.

I assumed that more experienced educators do such a great job planning their curriculum that they can sit back when the course actually arrives. What I found instead was that the delivery of the new course was pretty much a weekly experiment identifying what worked and what didn’t. Coordinating the daily reality of a course actually required my constant engagement — everything from helping speakers find parking to breaking awkward silences when no other students wanted to answer an open-ended question. It was in those moments, though, that I fully felt a sense of ownership in having created a space where those awkward open-ended questions were being asked in the first place. Gathering student feedback was also extremely important to me: we had intentionally left some flexibility in the structure of class topics throughout the elective to allow for redirecting if necessary. Students filled out surveys every two weeks about what was going well, what wasn’t, and what they wanted to gain from the remainder of the course. Each week we would then relay that information to our next speaker so they could adjust and add to their presentation when possible. A big reason I feel this experience is something worthwhile for others to pursue is that both the speakers who presented and the students who were enrolled put so much thought into trying to improve it week by week.

***

Hopefully, sharing my experience illuminates how no prior knowledge of curricular development is needed to make an impact and develop an elective as a student — just an idea, some motivation, and a supportive network. Hopefully, other students feel empowered to try to express themselves and connect with like-minded peers through building something together. Not only did I gain friendships with students I may not have interacted with otherwise, but I was also able to connect with faculty members who may be key stakeholders in my future while showing them what I am passionate about. I firmly believe that student-driven courses can help medical education continually evolve and can show our faculty and administrators what we want to learn and how we want to be educated.

I am the first to admit that at times I have felt lost and insignificant in my medical education. Building an elective flipped those feelings and fostered a sense of connection. It created an opportunity where I could own a piece of my education and allow my passions to become evident to others.

Image credit: “Lecture Hall” (CC BY 2.0) by Accretion Disc

The post Building a Sense of Ownership in My Medical Education Through Elective Curricular Development appeared first on in-Training.

Investigate.
Deeper,
deeper,
deeper:
To a depth of understanding beyond understanding.
We search to find the functions, the mechanisms, the failure, and treatments
of the human condition.
From brains to muscles, from livers to corpuscles,
we map pathways and replicate disease.
We watch cells die or multiply too much.
New treatments arise but rarely cure;
and our burden remains:
To continue the studies
of mice and men.

Image credit: “Bio Lab” (CC BY 2.0) by Amy Loves Yah

Poetry Thursdays is an initiative that highlights poems by medical students and physicians. If you are interested in contributing or would like to learn more, please contact our editors.

The post Studies of Mice and Men appeared first on in-Training.

As physicians, we are immediately thrust into a leadership position from the moment we finish medical school. Despite this, most medical students will obtain little formal leadership training. We seek to improve our leadership abilities as burgeoning physicians. We developed this podcast to challenge ourselves to explore ideas in leadership development and how they apply to medical training. We hope to educate and motivate others to further develop themselves as leaders in healthcare. We have three episode types: 

Inside-Out Leadership: In order to be an effective leader an individual must seek first to improve themselves. In this category, we compile and discuss seminal works in personal development, literature we have personally found impactful and recent publications that we feel have helped us as as growing leaders.  

The Main Course: The Main Course is our leadership development series where we learn from leaders around the world about what it takes to improve leadership skills. These discussions will not only draw from healthcare leaders, but also leaders in other professional fields. We hope that by learning from those in leadership already, we will be better prepared for entering healthcare team as leaders ourselves. 

Healthcare 101: In order to be an effective healthcare leader, you must first understand the system to which you belong. We will be working to learn more about the healthcare system from leaders within it, books, and our own endeavors. We will focus on growing our listeners basic understanding of the the system of healthcare in the United States, the changes that may occur in the coming years, and how this will impact our future as physicians. 

Image Credit: Provided by Caleb Sokolowski and Peter Dimitrion

Leading the Rounds: The Medical Leadership Podcast

As physicians, we are immediately thrust into a leadership position from the moment we finish medical school. Despite this, most medical students will obtain little formal leadership training. We seek to improve our leadership abilities as burgeoning physicians. We developed this podcast to challenge ourselves to explore ideas in leadership development and how they apply to medical training. We hope to educate and motivate others to further develop themselves as leaders in healthcare.

Peter Dimitrion (1 Posts)

Columnist

Wayne State University School of Medicine

Peter is a second-year MD/PhD Candidate at Wayne State University School of Medicine. In 2016, he graduated with Honors from the University of Pittsburgh double majoring in chemistry and molecular biology. He then earned an M.S. in Biotechnology from Johns Hopkins in 2018. Peter currently holds a Thomas C. Rumble Fellowship and the Jerry A & Mary D Martin Memorial Scholarship from the AHEPA Educational Foundation. In his free time, he enjoys rock-climbing, cooking and hiking. After graduating from medical school, Peter would like to pursue a career in Dermatology as a physician-scientist and pursue a career as a physician-writer as well.

Leading the Rounds: The Medical Leadership Podcast

As physicians, we are immediately thrust into a leadership position from the moment we finish medical school. Despite this, most medical students will obtain little formal leadership training. We seek to improve our leadership abilities as burgeoning physicians. We developed this podcast to challenge ourselves to explore ideas in leadership development and how they apply to medical training. We hope to educate and motivate others to further develop themselves as leaders in healthcare.

The post Leading the Rounds: The Medical Leadership Podcast appeared first on in-Training.

For my mom

Chanukah

Latke grease and shrinking blue candles —
The nostalgia invisible, because you still haven’t told us.
This year my gift to you is being an ass, for I am
The Son who Needles. But my latest taunt
Lights new flames of hurt in your eyes, and I know immediately
That something is different now:
You say, You will miss me when I’m gone.
You mean, I am sick, and you have taken me for granted your whole life.
Your voice is hot with oil and the dark wisdom of elders.
I remember that the miracle of Chanukah is a children’s story.

Yom Kippur

You call me on a Thursday to tell me
You were diagnosed with leukemia in October.
I put on my medical student cap and ask about
Biomarkers. Every year on Yom Kippur
I try to remember the sins I’ve committed.
But this year, beneath the cleansing saltwater of my tears,
I finally remember all of the small, terrible things I’ve done to you.

Passover

We haven’t seen you since you told us, and
We haven’t had a family Seder since we left for college;
But this year we brothers conspire with
Kind intent at last. So when you walk into The Den
To find us all Home, unannounced, and when you finally
Let the sobs from which you’d always protected us
Buckle like crashing waves from your strong, tired face, I remember
The fierce, imperfect blood that once filled your ancestors in Egypt,
And now fills you, and even your children; and I remember
The Red Sea you held open for us
Just long enough.

Image Credit: “2007_0623_194620” (CC BY-NC-ND 2.0) by gotmikhail?

Poetry Thursdays is an initiative that highlights poems by medical students and physicians. If you are interested in contributing or would like to learn more, please contact our editors.

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You don’t deserve abuse because you’re a medical student.

You don’t have to “tough it out” because you’re a medical student.

You don’t have to sit in silence and painfully nod along with an attending’s racist, misogynistic lectures because you’re their medical student. You don’t need to pick the skin off your cuticles to stop yourself from replying. You don’t need to learn how to hide your grimaces behind your mask because you know you’ll have to listen to them attack your identity for the next several weeks.

My first interaction with my new attending immediately set off alarm bells in my head: when I introduced myself, he commented on what a difficult name I had and asked twice if he could call me “Abby.” Throughout the day, he would go on to flippantly joke about mental illness, insist COVID-19 was a liberal political ploy, scoff openly at the message of the Black Lives Matter movement and call every female in the office (including patients as well as myself) inappropriate pet names like “baby girl” and “little lady.”

As he casually spouted countless racist or sexist views, I held my tongue and hid my discomfort. He was a white male attending in a suburban clinic and worked exclusively with other white male attendings; it didn’t appear he had ever been challenged about his views or his behavior. As a woman of color and a student, I certainly wasn’t going to speak up myself. This rotation was 1:1 with the attending and without other medical students, interns or residents to validate my concern, I convinced myself I would just have to make it through the next two months.

From just one day in the clinic, I had compiled a list of 13 bullet points that outlined the most flagrantly inappropriate comments and actions from my attending. But I still didn’t trust my experience — was I overreacting? Was I being too sensitive? Was I going to ruin this attending’s life by voicing my concerns? As “just a med student,” did I even deserve the right to feel uncomfortable?

When I tentatively mentioned to colleagues and mentors the litany of offensive, problematic statements my attending physician had said during the first two days of my rotation, a common response was, “welcome to medicine.” That struck a nerve. I didn’t want to accept that statement as fact, I didn’t want to accept this environment as inevitable, and I didn’t feel that we, as the next generation of physicians, should have to. More than my own discomfort, it was the frustrating complacency of that “welcome to medicine” statement that finally convinced me to reach out to my school about the attending.

I wasn’t alone in my hesitancy to bring my concerns to my administration. The 2019 graduation questionnaire by the American Association of Medical Colleges (AAMC) noted that though 40.1% of graduating medical students experienced mistreatment during their time in medical school, only 23.2% of those students reported their experience. Students cited fear of retaliation, doubt that an event was important enough to report and the belief that nothing would be done about the situation as reasons for not reporting.

These were all thoughts that ran through my head; at the bottom of the hierarchy of medical education, we don’t trust ourselves enough to believe that what feels wrong might actually be wrong. Most insidiously, a 2018 study found that one of the leading reasons medical students don’t report mistreatment during their clinical years is the perception that mistreatment is a normal part of medical education, a rite of passage if you will — “Welcome to medicine.”

When I came forward, I realized I was lucky because I had the most supportive medical school administration I could have hoped for. When I tentatively asked, “Is this really that bad?” they replied with a resounding “YES!” making it clear that they were on my side. They took me seriously and removed me from that rotation the minute they heard my concerns. I felt like my safety was their highest priority and I’m grateful for that.

While my medical school acted swiftly in my defense, I later learned that other medical professionals were less supportive. After I left my rotation, I heard from students working in the same office that the other attending physicians were whispering about “that poor medical student” who “did the right thing” by leaving the clinic. Those physicians discussed amongst themselves how that attending had been becoming increasingly problematic, how his conspiracy theories were getting increasingly incredulous and he was becoming increasingly irreverent towards patients and students. They had known before my name had ever even shown up in the office inbox that this attending was a questionable teacher and provider, but never brought their concerns to the attending himself or the schools who subjected their students to him.

I struggled with pangs of betrayal and loneliness: these physicians had nodded to me in public and had gossiped about “that poor medical student” in private. While I was fielding microaggressions one-on-one across a desk, berating myself to get a grip, fighting against my own instincts, they had known all along that I was going to struggle and left me to flounder anyways. Those white male physicians, who held the most power in that clinic and would face few consequences by speaking up about a sexist and racist colleague, did nothing.

It genuinely baffled me that they could have these discussions about how inappropriate this attending was and still smile at me walking beside him every morning. I can’t help but wonder- perhaps they were so complacent because they didn’t see this as an anomaly in medicine. Perhaps they thought it was something students needed to get used to. Perhaps they too thought, “Welcome to medicine.”

I didn’t learn much medicine the first week of my rotation, but I learned something else: I don’t want to subscribe to the culture of medicine that makes students believe they have to tough it out. Medicine isn’t an old boys’ club anymore. If we can’t expect attendings to speak up on our behalf, then we will have to advocate for ourselves. I don’t mean to say that there aren’t thoughtful, supportive attendings that continue to fight for us — there are, and I’ve had the privilege of working with many of them.

This experience has shown me, however disappointing the thought may be, that I can’t necessarily count on that. But the old guard is not the future of medicine — we are. Even as medical students, when we see things that we believe are wrong — whether that is sexist and racist comments from attendings, overly harsh treatment of trainees or impolite comments about patients — we have both the opportunity and the responsibility to act on them by bringing them up to the administration that oversees medical education. And when we eventually find ourselves in those positions of power as senior residents, attendings or medical school faculty, we must remember what it felt like to be at the bottom of the hierarchy and speak up for those below us. We can work towards a better system than, “Welcome to medicine.”

Image Credit: “Best Shoes for Nurses” (CC BY 2.0) by gm.esthermax

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