Posts

Working Together (Patient Care)

by

Working Together (Patient Care)

Competencies:

  • Approach the care of patients as a cooperative endeavor, integrating patient’s concerns and ensuring their health needs are addressed.
  • Understand the role of disease prevention and health promotion in relation to individual patients and/or patient populations and utilize these principles in clinical encounters.

Reflection:

Effective patient care requires the collaboration of multiple healthcare professionals in order to address the different needs of the patient. This relates to the CEO of interpersonal communication. When a patient comes in, physicians are only one part of the equation, they may also interact with a nurse, an administrative assistant, a PA or NP. All of these people working together are able to get a comprehensive look at a patient and help them with their various needs whether it be a complicated problem, a simple checkup, a scheduling issue, or coordinating follow up. In addition to coordinating all of these things for an individual patient, the team has to consider the other patients in their office as well as the larger public around their patients. This is where public health considerations are helpful so that healthcare professionals are able to view the larger ramifications of their own and their patient’s decisions on the community. This is part of the reason that I chose to pursue my master’s in public health.  Patients sometimes choose healthcare options that not only risk their own health but also that of those around them. Even after having the consequences of their decisions explained to them, they may stay with their original option for personal, religious, or other reasons. Being able to identify these reasons and try to work around them was instrumental to my MPH. When these obstacles cannot be worked around, understanding their impact on the community and what steps can be taken to limit that impact is just as important. Moving forward I plan to continue trying to learn about patient’s reasons for making various medical decisions. You can only read so much from a book, ultimately each patient is going to have their own reasons for their healthcare decisions. My goal is to reach I point where I can compromise with most patients so that we stay true to their beliefs without harming the public.

Below is my personal statement for my MPH:

During my sophomore year of college, I began expanding my horizons. I was doing well in my classes and was well-established in my research so I decided that it was time to take on more responsibility. One of my professors turned my attention to a local elementary school with a struggling after school program intended to give kids something productive to do and keep them out of trouble. What I expected to be a volunteer experience turned out to be so much more; in fact, I may have taken away more than I ended up giving. My perspective shifted. Through my experience, I began to see that medicine is not a linear science practiced in a vacuum but rather a branched interweaving of science, society, communities, and individuals. While at Reynolds Elementary School, I assisted in supervising the children and helping them with their homework after school. Although their excited hugs and smiles were rewarding for me, they often masked greater problems that the children were struggling with. It soon became evident that the community needed much more than I would be able to provide. The area surrounding the elementary school consisted of government-subsidized, section 8 housing. As a result, many of the students attending the after school program were from underprivileged families. They could not count on having a meal when they returned home; they often were unsupervised, and they lacked regular health care. This was not necessarily the fault of the parents or guardians, it was the consequence of their circumstance. While working with the program, I was able to watch it grow into something truly amazing. In the beginning, there was a lack of able volunteers. My professor and I set up a partnership that allowed university students to assist in their available time. During the first year, the program received a grant for food-based services which allowed it not only to feed the students but also to provide meals for family members who did not attend the school. By the second year, a pediatrician had partnered with us to give the kids regular check-ups. Two children that I worked with, Carla and Christopher, were siblings of six and five years who had not seen a doctor since they were born. The pediatrician diagnosed a heart murmur in Carla as well as an issue causing Christopher to slowly lose vision in one of his eyes. While I am not privy to the specifics of their conditions, it is possible that these would have caused much larger issues had they continued to go undiagnosed. To many individuals—and I was certainly guilty of this— the idea of a meal or a visit to the doctor’s office can seem unimportant or even a nuisance, but it means so much more. It really speaks to an urgent topic: In the midst of our prosperity, we cannot forget our greater responsibility. As doctors, we must fight to ensure that all people receive a standard quality of care. Taking from the complex interplay that I witnessed at Reynolds Elementary, I try to place everything that I continue to learn in my career into societal context. Though my work at Reynolds was a great experience that opened my eyes to socioeconomic factors and social determinants of medicine, it did not give me the skills to effectively alleviate those factors. While the program we initiated helped the community immensely, it was only a temporary fix, dependent on the continued efforts of volunteers. The solution did not address the root causes of the community’s hardship.

Having now completed three years of medical school I have noticed the repetition of similar trends in the patients I treat at local free clinics and even the patients in OSU’s hospitals. A lot of them don’t have access to necessities such as regular healthcare and by the time they are seen by a healthcare professional they have suffered undue morbidity. It is for this reason, that I want to pursue my Masters of Public Health. Society’s belief in equality for all is inconsistent with the reality that someone’s zip code or financial status can be as big a predictor of their health as their medical history. I want to treat patients as a physician but also be able to effect change in the greater community that surrounds those patients. An MPH will give me the tools to understand social inequities in healthcare and bolster my ability to address those inequities through research and policy change. I want to pursue my MPH at The Ohio State University because I like the idea of having a faculty mentor that works with me throughout my entire academic career as well as the ability to collaborate with faculty from all disciplines of public health. I believe that an interdisciplinary approach provides more unique viewpoints that generate more sustainable and innovative ideas. Additionally, I firmly believe that a program that aims to serve the community should reflect the community it serves. Similar to an interdisciplinary approach a diverse group brings unique perspectives that would not be attained otherwise. I appreciate Ohio State’s commitment to diversity in all of its graduate schools. Having already started my medical doctorate at Ohio State my desire is to seamlessly transition between schools and utilize the resources of both programs to further my academic career. Lastly, by staying at the same institution, I am able to continue my service to the community through my work with the local free clinics. I believe that treating the individual patient and improving the surrounding community are one and the same. Acknowledging one while ignoring the other is a disservice to both. A holistic approach grounded in public health and medicine will allow me to offer communities the best quality of care. While working with others in the field, I hope to create effective solutions to transform healthcare landscapes both locally and abroad.

Learn, Review, Repeat (Medical Knowledge and Skills)

by

Learn, Review, Repeat (Medical Knowledge and Skills)

Competencies:

  • Demonstrate a broad working knowledge of the fundamental sciences, principles, and processes basic to the practice of medicine and apply this knowledge in a judicious and consistent manner to prevent common health problems and achieve effective and safe patient care.

Reflection:

Medical knowledge is fundamental to being able to take care of patients. A great portion of medical school is spent obtaining medical knowledge but it can be difficult to retain knowledge learned early on in your career as more and more time is spent learning new things without time to review. Review is not always built into the curriculum, so it is up to the medical student to balance their time in order to learn and retain while still being able to have time for other aspects of life. An added difficulty that arises in the third year of medical school is studying for shelf and board exams while on rotation. In addition to studying and reviewing you have to add in researching your patients, and learning higher-level topics within the subject of your rotation even if they won’t be on your tests. Once a student has managed to do all of these things they can look forward to the fourth year where they’ve gotten past the majority of these tests and can now spend time adequately preparing for their rotations are reviewing. A great example of that is the urology rotation that I’m currently on. One of the first rotations that I was able to truly focus on and it showed. My attending has been a urologist for over 20 years and received great training of his own but continually states to me how impressed he is with my medical knowledge and my basic science knowledge. I believe this is partially due to my ability to focus on this rotation while not studying for additional tests, however, I’m also surprised by the information I’m able to draw upon when asked about things I learned at the beginning of medical school. As I continue to train in medicine, I plan to continue my review of topics, especially ones that I use less often so that I am able to retain a broad knowledge of fundamental medicine.

 

Mid-Rotation Evaluation (Urology)

Quality Improvement (Practice-Based & Lifelong Learning)

by

Quality Improvement (Practice-Based & Lifelong Learning)

Competency:

  • Evaluate the performance of individuals and systems to identify opportunities for improvement.
  • Seek out and apply best practices, measure the effect of changes and develop strategies to improve performance.

Reflection:

            Practice-based and lifelong learning is necessary in order to stay current medicine and ensure your patients receive the best care available and potential students receive up to date information. Medical school and residency training are long, grueling processes, but no matter how intense or long the programs are the educations provide they are not future proof. Medicine is constantly shifting and evolving, the only way to keep up is to continue learning. This learning may come in many different forms such as reading papers, attending conferences and “CME” cruises. But healthcare providers can set up their own projects, learn from their data as they collect it, then impart that knowledge on to others in the working environment. I undertook such a project with some of my peers going into anesthesia as well as an anesthesiologist at NCH. We were looking at the problem of bacterial contamination of different surfaces in the operation room, mainly anesthesia-related surfaces which were not sterile and expected to have higher amounts of contamination. Since operating rooms are expected to be areas of low contamination due to the risk of the surgical infection our goal was to reduce the contamination of the surfaces and thus the overall contamination in the operating rooms. We used ATP monitoring to measure the bacterial load on the surfaces. After measuring the contamination on various surfaces, we performed a root cause analysis to delineate potential sources. Based on our analysis, we decided to pursue two interventions to reduce contamination. After tracking changes in contamination post-intervention the results suggested that the interventions succeeded in reducing contamination. While this was great to see there was still more work to be done, potentially examining more interventions, and since that ultimate goal was to reduce surgical site infections, we would also need to measure any changes in their rate of occurrence. In order to continue improving, I plan to keep developing new quality improvement projects and tweaking them to try and be more efficient and thorough, until I ultimately get a chance to implement them again. My goal is to reach the end goal of this quality improvement project then find different additional problems to address in healthcare and work toward improving them.

     

Sit Back and Listen (Interpersonal communications)

by

Sit Back and Listen (Interpersonal communications)

Competencies:

  • Produce timely documentation and communication that is clear, concise, and organized, in a way that optimizes patient care and minimizes medical errors.
  • Use effective listening, observational and communication that is clear, concise, and organized, in a way that optimizes patient care and minimizes medical errors.

Reflection:

Interpersonal communication is an extremely broad topic that is necessary for medicine but can be a difficult skill to quantify and thus learn. However, since it’s applied in almost all interactions there are plenty of opportunities to pick it up. One example is interprofessional care, medicine isn’t a solo sport, it’s a team event involving a diverse group of healthcare professionals, the patient, their family, and potentially others. When coordinating the ideas and beliefs of so many people it’s helpful to have a leader to organize the chaos so the patient can have a clear set of options and recommendations to work with. The leader of this team is often a physician on the primary team as their in the best position to coordinate care. Knowing this, physicians should always be open to and prepared to direct a group when it’s in the interest of the patient. Another example is effective listening, observational and communication techniques. As a medical student and future physician, I am always trying to learn from though around me. Whether that be residents and attendings, other healthcare professionals, my peers, or my patients. Sitting still and listening is often one of the most productive things you can do from a learning standpoint. This is especially true with patients, we busy many physicians go into rapid-fire question mode but often letting a patient tell you’re their story will yield relevant details you never thought to ask for. Whether learning from another healthcare professional there’s always a time to talk as well to elicit more information. As I continue my training, I continually work at honing the balance between these two, especially with patients. My first goal is mainly directed towards patients, trying to find the line where I can efficiently obtain their stories but also not be in the room for an hour talking about the patient’s 7th cousin thrice removed. My second goal is to improve my leadership skills, I believe this will come partly through doing as I progress through my training as well as from continuing to learn so I am able to effectively guide and answer the questions of my team.

Above is my evaluation summary from my anesthesia sub-I.

Understanding The Interaction of Healthcare Institutions (Systems-Based Practice)

by

 

Understanding The Interaction of Healthcare Institutions (Systems-Based Practice)

Competencies:

  • Understand the institutions and individuals that participate in healthcare delivery and the role of the physician in the healthcare system.
  • Appropriately use system resources and assist patients in accessing health care that is safe, effective, patient-centered, timely, efficient and equitable.

Reflection:

Efficiently and effectively delivering healthcare is vital to ensuring that all patients receive the standard they deserve in a timely fashion. However, completing this monstrous task is easier said than done and requires the cooperation of a variety of healthcare professionals across the different institutions in medicine. Paramount to achieving this cooperation is understanding the roles that our colleagues fill and when they can be utilized. During my education, I’ve become particularly interested in the role public health has played and continues to play in the development of medicine. Between my third and fourth years of medical school, I took a leave of absence to pursue my master’s in public health. While receiving my MPH I had several goals, first I wanted a different lens with which to look at my patients. One that not only considered them but also their family, their neighbors, and all others they may interact with. Now when seeing patients, I think more broadly about their care. For example, how their insurance will affect their care or how their personal insurance utilization may affect their family’s coverage. Second, I wanted to improve my research capabilities. While I’ve picked up a lot of research skills throughout undergraduate and medical school a lot of these skills were learned on the fly and at a superficial level. During my masters, I was able to gain a deeper understanding of fundamental topics such as what p-values really mean and how they’re calculated. From there I was able to build up to more advanced topics. Now when conducting research I’m able to perform a lot of my own statistics, and I’m able to recognize when I need the help of a statistician and articulate what type of calculations need to be done. Achieving MPH was a large step in advancing my understanding of medicine and where other team members can play a role but there is, of course, plenty to still learn. I plan to continue to incorporate my MPH both in my regular clinical practice and in future research endeavors. In addition to this, I hope to have the opportunity to work with other healthcare professionals that I haven’t had as much exposure to in medical school such as pharmacists, case managers, and imaging technicians.

 

Above is my most recent publication where I performed statistical calculations for risk ratio, odds ratio, confidence interval, p-value and more.

 

Taking Initiative (Professionalism)

by

Taking Initiative (Professionalism)

Competencies:

  • Consistently demonstrate compassion, respect, honesty, integrity, accountability, altruism, prudence, social justice and commitment to excellence.

Reflection:

Professionalism is an essential skill for healthcare providers. Upon arriving at medical school, I thought professionalism was fairly basic and simply included things like dressing appropriately for work, arriving on time and speaking to others respectfully. While these are parts of professionalism, it consists of many more skills including compassion, honesty, integrity, accountability, altruism, prudence, social justice, and a commitment to excellence. Many of these are learned throughout life long before medical school but are consistently honed as one gains more experience. Though I did not initially consider all of these traits to be part of professionalism, I believe I have effectively displayed many of them throughout medical school. Effectively utilizing these attributes can be difficult as a medical student when you are often in unfamiliar territory and unsure of the dynamic. However, with experience, you begin to understand areas where it may be appropriate to take initiative without a need to have a superior explicitly tell you what to do.

During my sub-I in the Ross ICU, there was always a lot of work to be done. Patient statuses were always changing and thus they needed to be constantly monitored and have the appropriate adjustments to their care. Of course, as a sub-I, you want to have a good understanding of all of your patients and be able to develop well thought out plans for them but this can be taken a step further. During my rotation, I truly was treated as once of the interns (at least when legally possible). A lot of times the team was stretched in all directions with various patient needs, while I could have followed my residents around to observe what they were doing I sought out opportunities to share and lessen their workload. This often involved receiving patients and handoff from surgery or the floor, being able to obtain the information necessary to advance the care of the patient, put in appropriate orders and begin writing patient notes. This way when a resident returned from their other duties they simply had to review and sign my orders and everything else was already done. I found this rotation extremely rewarding because of the level of responsibility afforded to the medical students and our ability to share significant amounts of the workload with our colleagues. I believe this is a great example of how a medical student can show they have a commitment to professionalism.

While on my rotation I feel I was an effective and professional member of the team who took on additional responsibility without overstepping my abilities and hindering the care of patients or creating more work for residents. As I continue my medical education, I will become proficient in more skills to be able to help even more effectively than a medical student can. My goal as an attending is to become reasonably proficient in all skills used in my field of practice with special care not to forgot basic skills as I develop more advanced ones. This way I’m able to effectively and efficiently care for my own patients but also provide assistance to my colleagues when they need it.

 

Above is an example order set being placed, although for a fake patient.