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System-Based Practice

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During third year, I attended a Minority Women in Medicine roundtable here at OSU and left feeling inspired, charged up, and ready to take on any challenge that comes my way as black women in medicine. What I appreciated most about this event was being able to hear from successful women in medicine and in this intimate setting, ask them how they did it – How they got to where they are, how they are able to balance motherhood and medicine, balance marriage and medicine, navigate race in the work place, gender and more. No questions were off limits. In this setting, I was able to hear some of the challenges one of my role models experienced over the years. She is black woman, the program director of her department, practicing in a specialty I plan on going into. She is also a mother and a wife. She is what I’ld like to call “Black girl magic.” She carries herself with an incredible poise and confidence that I aspire to emulate. However, as much as I’ld like to put her on a pedestal, highlight her various accolades, and praise how approachable she is as an individual, I would be remiss if I did not also highlight that she like I and every other person, has also encountered challenges over the years. These challenges were present in medicine, in motherhood, and other facets of her life. It was a reminder to me that no one’s life is in fact perfect. What matters however, is how you respond to the challenges you encounter. Resilience is absolutely key, so is staying optimistic and having a positive outlook.

Currently, reportedly only 2% of all physicians are black women (see TIME article here). This under-representation, I do believe affects healthcare delivery and outcomes, considering a much larger portion of our patient population are black, and research as shown patient outcomes are better when treated by a physician who looks like them. Although this statistic is shocking, I remain optimistic. One, because of OSU’s relatively larger acceptance of a underrepresented minorities into medical school, thereby making a huge contribution to diversifying medicine; two because of my work with SNMA, an national student organizations which also works to diversify medicine; three because of my work with my community health education project, helping to educate an underserved population about metabolic syndrome; and four, because I know I will make an impact no matter where I go for residency and where I go to practice as an Attending. My goal is to remain resilient, encourage other minorities to pursue medicine, serve as mentors for others, and continue to change and challenge the healthcare system from the inside out.

Community health education project presentation

 

SNMA Executive board 2017-18

 

SNMA’s Black Panther Movie event

Interpersonal Communication

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“Lo siento, no hablo español” (I’m sorry, I don’t speak Spanish)

“I wish I spoke Spanish,” I said to myself. “I seriously wish I did.”

I was in the trauma bay, on my surgery rotation as a 3rd year, gowned up and ready with my trauma shears. A patient was being brought in by EMS team in 10 minutes. On the whiteboard was a description of the trauma incident, patient characteristics, possible injuries, and important vitals/ hemodynamic status – it was a motor vehicle accident, young female, no seat belt. In the midst of those words, something stood out to me – “Spanish speaking. Does not speak English.” For what was possibly the hundredth time in my life, I thought to myself, “Man, I wish I spoke Spanish.” I could hear my husband teasing me as he often those when we talk about Spanish, “Derin, how is it that you’ve been to Peru, El Salvador, Puerto Rico, and still don’t speak or understand Spanish? Are you even making an effort to learn?” He was fluent in Spanish and rightly could tease me about it. My excuse was always the same – I didn’t take Spanish in high school, and the little Spanish I pick up on my travels, I often forget once I’m no longer immersed in the country. Still, in this particular moment, here in the trauma bay, with a language barrier ever so imminent in such a critical situation, I couldn’t help but think, “Derin, you’ve seriously gotta learn Spanish.”

My senior resident saw the words on the board as well, looked around the room and said loudly, “Anyone speak Spanish in here? Anyone?” Thankfully, a 4th year medical student stepped forward, “I do!”

“Are you sure? Fluently?” My resident asked

“Yes, I’m fluent, “ the medical student responded

“Ok, perfect.”

I was relieved, as I imagined others in the room were. In the trauma bay, you need to act quickly, you need to be efficient. A language barrier can be detrimental in ensuring optimum ambulatory care. Asking if the patient is hurting anywhere, confirming allergies, and past medical conditions before obtaining CT images were critical. Unfortunately, waiting for MARTY machine (for language translation) is not ideal in an emergent situation like this.

Our patient arrived in a stretcher with a neck brace on due to possible C-spine injury. She had multiple abrasions, with some dried blood on her extremities, she looked visibly scared. As my resident began to run the trauma, and others in the room began checking the patient’s airway, breathing, and circulation, the 4th year medical student was also talking to patient in Spanish, explaining what was going on and asking pertinent questions.

It’s been a year since that incident and it’s stuck with me. No, I’m still not fluent in Spanish, but I’m fully aware that knowing even a little bit can be the difference between life and death in a critical situation. Therefore, my goal is still to learn basic medical Spanish. A significant population of the U.S. is Spanish speaking and being able to communicate effectively is part of providing excellent care. Though, I may never be fluent, I do believe in critical situation like above, been able to communicate even just the basic words are important.

As a fourth year and future resident, I anticipate that a similar situation like this will happen in the near future, likely multiple times over. I also recognize that communication is more than just language, even as a soon to be physician, its more than just communicating with patients. It also involves collaborating effectively with other healthcare team members, listening, observing, conducting timely documentation and even preparing and distributing educational materials to individuals and groups. I have had the privilege of doing all of this in the past 4 years.  On my Ross ICU, I learned to communicate effectively on the critical status of my patients. In presenting my research at a national conference, I learned to communicate to members of the medical profession on my findings and the significance of it, and even on my trauma surgery rotation, when doing a secondary survey of a trauma patient, I learned to communicate clearly and effectively as well. As an incoming intern, I am confident in this competency, being also aware that there is room to improve. My goal, specifically, is to improve on my written documentation and verbal communication with Attendings.

On my Ross ICU rotation, communicating with the team on rounds

Presenting and communicating my research findings to the medical community

The pager is incredibly important in communicating on the trauma surgery rotation

Practice-Based & Lifelong Learning Story

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“So how are you going to do it? With you starting rotations, your husband starting his intern year, and being long distance? Have you figured out your visiting schedule? Who’s going to make the drive and all that?“

My friend looked at me waiting for an answer. She wasn’t the first person to ask me this question, nor was she the last. Work-life balance, or rather work-life integration (a term I feel is more accurate), is a concern I had with starting clinical rotations back in third year. In the midst of the excitement and celebration of starting third year of medical school and finally practicing medicine, was also the realization that I was about to begin one of the most demanding periods in my life thus far. I was a newly wed, long distance with her spouse, whom is also in medicine and beginning his intern year in a surgical specialty, while I also find my footing in my clerkship. It was admittedly daunting to think about. How does one juggle marriage, medicine, long distance, and a spouse in an equally demanding career? The first two years of medical school had been a challenge on their own. In addition to the rigorous basic science courses, the various organizations I was a part of and had a few leadership roles in, trying to continue to my self-care activities of sleep and working out – I also alternated with driving or taking a flight to see my significant other. As a third year at that point, I was no stranger to trying to “juggle it all” and I have no doubts that this will continue to be a life long learning experience.

 

I am now a 4th year medical student, 2 months away from graduation, and I can confidently say, this work-life integration is not only do-able but filled with so much joy. During third year, I strove to be efficient in my studying, with the realization that every hour counts. I prioritized my well-being and exercised 3-5 days each week – mostly being motivated because I signed up a half-marathon was determined not to drop out of the October 2018 race (my way of celebrating my 28th birthday). At the same time, I was able to spend quality time with my husband, with me traveling to Cincinnati where he had relocated to or him making the trip to Columbus. We attended a weddings, celebrated friends’ achievements, and found joy in our moments together – throughout third year. There were certainly incredibly challenging times, especially around shelf exams, where I thought “how can I possibly do this?” or “This is all too much!” He was my cheerleader through it all, reminding me over and over again to study, do UWorld questions, read, read, read, because he knew what it took to succeed and wanted me to do the same. I listened to him vent after a long, stressful shift and he was a listening ear to my challenges.

 

Work-life integration has been a beautiful thing for me thus far. Challenging no doubt, but I am doing it, thriving, all by the grace of God, and for that I am thankful. Fourth year has admittedly been easier, with the flex months we’re granted, along with less testing and exams. However, as I start residency in a few short months, I know once again I’ll be in another season of learning, practicing how to integrate my work and life outside of medicine. My goal is to be an excellent physician – which would include learning as a resident as well as reading at home, perhaps 1 hour a night, as well as continuing the things that bring me joy outside of medicine – spending time with my family, working out 3-5 times a week. It is a life long process, a life long practice and I am excited to take it on. I am married to medicine both literally and figuratively and I wouldn’t change a thing.

Medical Knowledge & Skills

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“Learning is not attained by chance, it must be sought for with ardor and diligence.”

Abigail Adams

As I reflect on the past four years of medical school, I am truly amazed at the knowledge and skills I’ve gained throughout my clinical rotations. The rigor of the first two years of medical school was unlike anything I had ever experienced. Then I started third year and the first clinical ring was also challenging – trying to attain adequate presentation skills, how to properly conduct a thorough history and physical, and aside from the clinical skills, being able to apply medical knowledge on the day to day in the wards. It was certainly challenging. On my second ring, I took on a different approach to my learning – read, read, read and digest everything. Attaining a sophisticated level of medical knowledge was important to me and I took on the philosophy best indicated by this quote: “Learning is not attained by chance, it must be sought for with ardor and diligence.” For the rest of my clinical rotations third and 4th year, I expanded my knowledge and skills in a variety of ways. I now feel at ease choosing a medical topic/ clinical concept to present to my residents and fellow medical students during rounds, my heart no longer races at the thought of possibly performing a clinical skill such as putting in an IV, suturing, or inserting LMAs in the OR. Learning is indeed a process, and one that has to be worked at everyday. I’m thankful for the various opportunities during my third and 4th year to expand my knowledge base and improve on various skills. As an incoming resident, I know my knowledge base will be stretched in further. I look forward to rising to the challenge and further increasing my clinical knowledge.

Medical knowledge improvement

 

Ross ICU – honors narrative

 

 

Professionalism

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What features of my personality do I want to be more evident to the patients for whom I will have responsibilities?

This is a question I’ve been reflecting on throughout third and fourth year. On my inpatient pediatrics rotation in third year, taking care of “little kiddos” like my residents like to call them, was very different from taking care of adults. Yes, there’s the difference in clinical presentations and various illnesses and pathology, however there was also a difference in how to communicate and relate to kids. As someone who strives to maintain a high level of professionalism in the hospital and work place, transitioning to working in a children’s hospital was somewhat of a challenge. Normally, I’m used to putting on my “work face,” my “time to get serious face,” “the I’m all professional face” as soon as I walk in through those hospital doors. However, during my first week of my inpatient pediatrics rotation, I watched as my fellow medical student on the team, make silly faces with some of her patients, giggle and talk in high-pitched animated voices, and find creative ways to make them laugh or feel comfortable around her. I was impressed. I saw her seamlessly maintain her professionalism, yet showcase features of her personality to her patients. It challenged my notion of what “professionalism” truly meant. Perhaps it’s not putting your big girl pants on and pretending to be grown up. When you have little kiddos as your patients, professionalism has to be weaved in with finding creative and fun ways to relate to your patients, show your personality, ease their anxiety, and make them feel slightly more comfortable, though they are in a vulnerable state. Dare I say, it is an art. A challenge I am tackling each day, as I walk into my patients’ rooms.

During fourth year, it started to feel easier. As I became more knowledgeable, more comfortable interacting with patients, I was able to let my personality shine through. I was honored when my classmates recognized me as someone that was not only professional but compassionate and humanistic, and was thus inducted into the Gold Humanism Honor Society (videos and pics below). On my different rotations during fourth year – acute pain, advanced anesthesiology etc, I made jokes with my adult patients, and made them smile and laugh. As I start residency, I realize one can still maintain a high level of professionalism and still showcase their humanistic qualities and personality. I realize I will be faced with emotionally challenging situations and being burnt out is a very high possibility. However, with the lessons on professionalism gained during medical school at OSUCOM, and the help of my co-residents and residency program, my goal is to continue to demonstrate compassion, respect, sensitivity to my diverse patient population, and the ethical principles of my profession, while appropriately showcasing my personality.

Gold Humanism Honor Society Induction

Patient care

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“Hello, good morning! My name is Derin Adejare and I am a medical student, part of your care team. Just want to check on you and see how you’re doing.“

I had a routine. I was on my internal medicine rotation and feeling more confident on how to do third year, and play the role of a student doctor (emphasis on “student”). In the beginning of the rotation, I was nervous. The whole idea of walking into a room, possibly being the first person on my team to see the patient, and knowing that my residents and attending depend on me to take a comprehensive history, made me nervous. To add to this, coming up with differentials, diagnoses, and treatment plans, while also attempting to study during any down time in the day, seemed overwhelming. So I wrote. I wrote about my concerns on my personal blog and received an unexpectedly encouraging comment from a reader, who happens to be a surgeon:

“If you knew all of the answers you wouldn’t need 3rd year. Show up, care, do your best.“

To me, what stood out was the word “care.” So I focused on what I did best, walking into a patient room, upbeat, with a smile on my face – bringing the sunshine if you will. As bad as the patient might look, I could at least be a smiling face to them. One particular patient noticed and acknowledged this. She was a patient with decompensated systolic heart failure, chronic obstructive pulmonary disease, acute on chronic kidney disease and a myriad of other commodities. She was my patient. Each morning, I’ld gather myself, take a deep breath and walk into her room with a smile on my face, “Hello, good morning!”

On one day, I walked in as she was being cleaned by her nurse. She looked up, saw it was me at the door and instantly beamed, saying “Hey, it’s my smiley girl!” In that moment, I felt a sense of pride. She knew me as the “smiley girl” and seeing me brought a smile to her face. Even in the most unfortunate of circumstances, being severely sick in the hospital, she knew me as someone who cared. To me that meant a lot. It was a reminder that patient care goes beyond just ordering the labs, making the diagnosis, and treating the disease. It also meant being present – bringing some of those “positive vibes” with you into a patient room. If you’re an upbeat person, letting your patients get a glimpse of that sunshine. I’ve seen some of my attendings make jokes that put a smile on a patient’s face, and that to me, is all part of patient care.