Author: Taylor Johnson

The Physiatrist

PM&R is not a field of medicine that I was familiar with coming in to medical school. The early favorite for me was orthopaedic surgery. I had shadowed surgeons in undergrad and had always wanted to work with athletes. I thought ortho would be the perfect fit. The Medical Specialty Preference Inventory (MSPI) is a tool designed to help medical students identify specialties that match their interests. The survey itself is about 40 items long and takes about 10-15 minutes to complete. It was no surprise that my MSPI results from my first semester of med school (pictured below) strongly indicated a preference towards ortho.

However, as time went on my preferences for what I want in a specialty evolved and new interests emerged. Although surgical procedures still interested me, I became more invested in the patient’s story and curious about how their life would change after surgery. On my neurology rotation I cared for patients who suffered from strokes, altered mental status, seizures, and weakness. The most we could do in the acute setting was make a diagnosis and stabilize them medically prior to discharge. I found myself wondering what was next for those patients and if they would ever be able to function at the level they had prior. When one of my patients required an EMG, I saw that there were two options for the consult: Neurology or PM&R. I had no idea that PM&R physicians performed EMGs and I became curious about what else fell into the scope of practice of a physiatrist. After doing more research about the field I was intrigued enough to schedule an elective rotation at my school’s inpatient rehabilitation hospital. I spent 2 weeks on the Stroke service working with a small team of just myself, the attending and a PGY2. After those two weeks, I was sold on PM&R! Shortly after completing the elective, I decided to repeat the MSPI. I think the results of that MSPI are very telling (see below).


With a firm dedication to a future career in physical medicine and rehab, I scheduled two, back-to-back rotations at Dodd Rehabilitation Hospital (OSU’s acute rehab hospital) at the outset of my fourth year. I spent one month each on the spinal cord injury (SCI) and traumatic brain injury (TBI) services. My month of SCI resulted in a Dean’s Letter of Commendation (below), and my elective in TBI resulted in a grade designation of Honors!

I’d like to highlight a quote from the evaluation above:

“Ms. Johnson has been an invaluable member of the SCI team at Dodd Hall. She numbers among the best medical students I’ve worked with, and she is going to make an excellent physician & physiatrist in the future” 

In addition to my two rotations at Dodd, I wanted to see how other PM&R programs are run and how the culture of those programs may differ in other regions of the country. I was accepted to attend away rotations at the University of Pennsylvania and Thomas Jefferson University this fall, and I can’t wait to get back to seeing PM&R patients. As a further indication of my commitment, I joined the American Association of Physical Medicine and Rehabilitation as a student member, and began receiving the PM&R journal in order to stay up-to-date on current advances in the field.

aapmr.org

I haven’t yet decided if I’ll pursue a fellowship after residency. As of now, I have interests in sports medicine, TBI, spine, and peds. Although I’m not set on any one specialty, I like the idea of performing in-office procedures. I imagine practicing at either an academic institution or a multidisciplinary practice along with professionals in other, related fields of medicine. I hope to attend a well-rounded residency program that treats a wide spectrum of conditions and will provide ample opportunity for me to explore my many interests. I’m also looking for a program with residents who are active in the community. Most importantly, I want to be a part of a program with a “tight-knit” group of residents and program leadership that is supportive and invested in the success of the residents.

The Academic

During the first two years of medical school I passed all of my exams and performed well on simulated patient experiences (OSCEs), but I was never one of those students who got honors or letters. Aside from an amazing internship after my first year, I was unable to obtain much research experience and had no publications to speak of. Like most medical students, I was used to being academically competitive. Feeling like an average student in my first two years was brand new to me and somewhat unsettling. Luckily, things changed in third year.

When I finally started on the wards it was like a breath of fresh air. I remember thinking, this is why I came to medical school. The hours upon hours of studying and sitting for exams are all part of the process, but the bulk of medical knowledge and skills is developed through direct patient care. At the beginning of third year there was still a major learning curve, but thankfully I worked with amazing interns, residents, and attendings at The Ohio State who saw my potential and pushed me from an average student to an excellent one. Below are excerpts from clinical performance assessments I received throughout my third year.

“Taylor gathered patient data in a thorough yet efficient manner, demonstrating well-developed interviewing and physical exam skills. She created concise, but complete and well-organized written and oral presentations. Her extensive and accurate differential diagnoses and management plans displayed a thorough understanding of the patients’ issues. Taylor was proactive in obtaining information relating to her patients’ tests and procedures and used her strong knowledge base to apply this information logically to patient problems. She was not afraid to take on the more complex or difficult cases, exhibiting great clinical reasoning and decision making skills above the expected level of her training.”

“During internal medicine, Taylor rotated on the general medicine wards, infectious disease consult service, and hepatology wards. She was an enthusiastic and hard-working student. She had great interactions with her patients and established great rapport. She did a great job gathering pertinent details in her histories. Taylor delivered excellent presentations that were well-thought-out, clear, and succinct. She quickly identified illnesses and proposed management plans. She took on complicated patients as well.”

“She was able to perform an excellent neurological examination and interpret abnormalities on the exam in the clinical context of the patient’s presentation. Her history and physical presentations were clear, logical, and always highlighted the most relevant and pertinent details. She was empathetic and had an excellent bedside manner. She developed great working relationships with rest of the team and everyone enjoyed having her on the neurology service.”

As a fourth-year medical student it has been my goal to further expand on my medical knowledge and skills. This year, I’ve diligently used resources such as UpToDate, the OSU clinical practice guidelines, and peer-reviewed journal articles to help develop assessments and plans for my patients. I also take the opportunity to practice my medical decision making by discussing plans with my patients and addressing questions in the room, instead of deferring to the rest of the team as I did during third year. I no longer rely on the resident note to help me organize my problem list and on a few occasions my residents have actually used my note as a template for theirs! Below is an assessment and plan I wrote for a complex patient on the General Medicine service during my internal medicine mini-internship.

I’m not just an average medical student. I feel that I have the potential to be an excellent resident, bringing an eagerness to continue expanding on my medical knowledge base. I also aim to make meaningful contributions to my chosen field of medicine by publishing original research, and hope to begin developing those skills during residency.

The Mentor

Being a mentor is something that I have gravitated towards for many years now. I have always had a hunger for knowledge and an eagerness for sharing that knowledge with others. Years of participating in extracurricular activities and attending summer enrichment programs have helped me develop excellent interpersonal communication skills that further enhance my ability to naturally step into a mentorship role. Part of the fulfillment of being a medical student has been taking advantage of this tremendous privilege by disseminating my story, pitfalls included, to other aspiring med students in attempts to help them succeed.  As I’ve progressed in my medical education I’ve enjoyed the natural progression from mentoring undergraduate students to mentoring current medical students; the physicians of tomorrow. As the president of the Association of Women Surgeons, I helped coordinate the first-ever mentorship event providing mentors for both medical students and pre-medical students. As a graduate of the MEDPATH program (Ohio State’s pre-medical post-baccalaureate program), I routinely attend panels and help coordinate meetings to offer tips and tools for the upcoming classes. As a senior medical student, I have taken pride in my newly-appointed role of “teacher” for the junior medical students I have worked with. Below, I provide examples of my continued efforts to be a mentor to those coming after me.

After completing the Nth Dimensions summer internship, an eight-week internship that involved hands-on clinical, surgical, and research experience in orthopaedic surgery, I gave this presentation to first-year medical students interested in the field. The program is specifically geared towards women and other traditionally underrepresented minorities in highly competitive fields of medicine. With the help of another med student who completed the internship in Radiology, we organized this event to share our experiences with hopes that more students from OSU would take advantage of the amazing program. Chipotle was included!  I am pictured standing at the podium. Date: November 16, 2017. Feel free to click through the presentation below!

 

A screenshot of a “thank you” text from the third-year med student I worked with during my mini-I. Identifying information has been redacted.

I will always find a way to be a mentor in some way. During my internship and residency, I look forward to continuing to teach and mentor medical students as well as residents in subsequent classes. I’ll covet the day when I become an attending and I can finally provide shadowing opportunities and author letters of recommendation for promising young students eager to enter the field of medicine, as I once was.

The Professional

When I was younger, I equated being a professional with having a job. And I equated having a job, with being “grown up”. So when my friends started working around age 15, I thought that it was time for me to do the same. When I inquired about this to my parents, they told me something that stuck with me. They said “school is your job”.  Both of my parents were the first in their families to attend college and stressed the importance of higher education to me and my sister from a young age. Thankfully, my parents were in a position financially where as long as we worked hard in school, earned good grades…and did our chores, they were able to help us out with money. Not having to worry about finances and being able to focus all of our energy on academics was truly a blessing. We took advantage of this and both my sister and I attended professional school (she graduated from Wake Forest Law in 2016).

School has been my job now for over 20 years. And although I have had other jobs here and there while in college, being a student has contributed the most to my professional development. In order to succeed as a medical student at The Ohio State, one has to embody certain aspects of professionalism that are routinely assessed through standardized patient (SP) interactions and small group activities throughout the first two years. We are evaluated on our compassion and respect when interacting with SPs, our honesty and integrity is constantly measured through group assignments/projects, and mandatory events help to develop accountability and punctuality. But another way in which I demonstrated professionalism in those first two years was through my work with student organizations. During my first semester as a medical student I applied for a position on the mentorship committee of Women in Medicine and helped organize a large mentorship event for my peers. I was also active in the Association of Women Surgeons and as a second-year I had the tremendous honor of being elected President of that organization. Below is the presentation that my treasurer and I gave at our first intro meeting as the new leaders of AWS. Feel free to click through!

As I continued on to 3rd and 4th year, I couldn’t commit as much time to student orgs and the mandatory curricular events became fewer and farther between. However, I continued to seek opportunities for professional development. Earlier this year I developed an idea for a Quality Improvement project and assumed the “team-leader” role for that project, which is ongoing. In addition, I continue to seek out volunteer opportunities in my community. Through volunteering at professional hockey games, The Arnold Classic, high school sporting events, and helping out with pre-participation physical exams for high school students, I’ve been able to remain involved in athletics, one of my true passions, as well as work with other medical professionals in a team atmosphere.

While volunteering at The Arnold I met people from many different medical professions. There were attending physicians, medical residents, nurses, podiatrists, EMTs, PAs, physical therapists, and other medical students.

This photo was taken on my personal Snapchat (copyright) account, while I was volunteering at a local high school.

 

 

 

 

 

 

 

 

 

 

 

 

 

In the eyes of my younger self, I will be a real professional next year. But thankfully, I have already begun developing attributes of a professional. During residency I will continue to seek leadership and volunteer opportunities as I have done throughout medical school and will continue to embody what being a professional means to me.

The Health Promoter

When I was a sophomore in college, I participated in a summer internship called the Premedical Urban Leadership Summer Enrichment (PULSE) program at Cooper Medical School of Rowan University. THe program provided academic, clinical, research, and service learning opportunities with a focus on urban health needs. We spent the summer in Camden, NJ- a city located directly across the Delaware River from South Philadelphia. Camden has an overwhelmingly negative reputation due to high rates of drug use, gang violence, poverty, and homelessness. Through this internship, I was able to provide free health screenings for children and also volunteered at the local Family Success Center where we promoted healthy eating habits and the importance of daily exercise. This was my first exposure to community health, and I really enjoyed being in a position to disseminate knowledge to kids and adults who due to social circumstances may not routinely see a physician.

As a second-year medical student I worked on a similar initiative with 3 of my peers. This program, “5-2-1-0 Healthy Kids!” was designed as a simple way to instill healthy eating and exercise habits in young children in order to combat childhood obesity. The numbers 5-2-1-0 stand for the daily servings of fruits/vegetables, limit of hours that should be spent looking at a “screen”, minimum number of hours of physical activity, and amount of sugary drinks that should be consumed, respectively. Overall, the reception of our program with children and families was very positive and we obtained promising results, which we presented at our school’s Annual Community Health Education Poster Symposium in January, 2018 (see poster below!).

In addition to working with children and their parents in the above endeavors, I also worked as a health coach and continue to promote health with every patient I encounter in a clinical setting. I understand that people obtain information about healthy lifestyles from a variety of sources; but I also understand that it’s our role as physicians to present our patients with evidence-based suggestions that have been proved to decrease mortality from heart disease, diabetes, hypertension, and other sequelae of obesity. For example, I never miss an opportunity to reiterate the importance of smoking cessation and limiting alcohol use. Furthermore, I’ve learned to ask pointed questions such as “do you feel safe at home?” and “are you having any trouble affording these medications?” because I realize that circumstances such as violence in the home or poverty are major barriers to optimization of one’s health. It’s my ascertainment that most people want to be healthy. As a physician, it’s my responsibility to work in conjunction with social workers, patient advocates, nutritionists, diabetes educators, and possibly even law enforcement, in order to eliminate any barriers preventing patients from being as healthy as they can be.

The Ally

When I was on my Family Medicine rotation during my third year, I discovered that there was a Transgender Primary Care Clinic (TPCC) that operates out of the same clinic where I was completing my FM clerkship. A few years prior to this, I had played rugby with a “transman” (someone who was assigned female at birth but identified as male). He was allowed to play on our womens’ team because he hadn’t begun taking masculinizing hormones (testosterone or “T”). He wanted to start T, but didn’t have access to a doctor who could prescribe it. He didn’t want to buy it himself and take it incorrectly or in a way that would not be safe. Ever since then I had been curious about access to hormone therapy and the care and management of transgender patients in general. So while on my FM clerkship, I asked if I could spend one day in Transgender clinic. My preceptors were happy to oblige my request.

I spent one afternoon seeing patients in the trans clinic and I loved every minute of it. My single experience at TPCC was enough for me to decide that I wanted my quality improvement (QI) project to be centered on this population and helping them receive the care that they need. Over the subsequent months, my classmate and I built a team and devised a plan to revamp the informed consent documents at TPCC. However, our project hit an early roadblock. The leader of the quality improvement project curriculum identified that the outcomes of our proposed project were not measurable and therefore would not meet requirements. Thus, we went back to the drawing board, consulted the physicians working at TPCC, and devised a new plan. Our new project focus as well as our problem statement and planned outcome measure are detailed below.

Proposed QI Project, May 2019

This project is ongoing, but there are many takeaways from the past few months working on this project that can be highlighted. This has been my first attempt at developing and initiating a quality improvement project from scratch; a daunting task for any medical professional, let alone a student. I’ve learned that early and frequent communication with all members of the team are essential to keeping the project moving forward. I’ve also learned that setting a timeline is essential, even if that timeline needs to be extended once or twice or a dozen times. I’ve learned that to do quality improvement work, you must have a significant driving force or else you may lose sight of your original goal. And lastly, I’ve learned that I still have a lot to learn! (and that’s okay!).

Medicine is a career rooted in lifelong learning, and I’m not shying away from it. During my residency I want to further develop my skills in orchestrating quality improvement. It is of immense importance for healthcare providers to be continually looking for areas in which patient care can be improved. I also plan to continue educating myself about the ways in which I, as a physician and ally, can provide the most sensitive and appropriate care for transgender patients. I’ll start by attending the Eleventh Annual Ruberg Symposium, whose theme and keynote lecture this year happens to be “Multidisciplinary Care for Transgender Patients”! See the agenda for the Ruberg Symposium here!

Registration for 2019 Ruberg Symposium.

 

The Team Player

Patient care is a team effort in the paradigm of modern medicine. For a medical student at a large, academic medical center, it can be difficult to identify your role on that team at times. This is especially true when it comes to the most medically complex patients- such as those routinely treated at Wexner Medical Center at The Ohio State University. I have been no stranger to teamwork in the past and as a third year medical student I looked forward to proving myself a useful team player. During my first inpatient medicine rotation, I began to develop my goal of being not just an excellent medical student, but a valued and essential member of the patient care team. Below is a link to a journal entry that I wrote during the early days of my first inpatient rotation.

Journal Entry

For convenience, and to save the reader from having to interpret my handwriting,  it reads:

“5/17/18
Senior resident (name redacted) (IM-Peds) discussed the importance of being early + prepared for rounds as well as following up w/ patient care throughout the day. (Consider taking on more pts?). I need to be an advocate for my patient as well as the bridge to the care team. I need to become more a part of the care team by taking initiative in expediting the process of obtaining outside medical records, labs, imaging, or anything else for the team + my patient. Continue to work on patient presentation as well as assessment + plan. Be confident, speak up, and take advantage of any and all learning opportunities.”

From early on in my third year, I was identifying ways in which I was falling short and seeking feedback for areas in which I could contribute more to the team. It would take time, but continued efforts throughout third year and the beginning of fourth year allowed me to reach a level of patient care that I am proud of. I now feel fully capable of contributing to the care team by comprehensively evaluating my own patients. This is accomplished by obtaining accurate and pertinent medical histories, conducting appropriate and thorough physical examinations, synthesizing all relevant data to generate prioritized differential diagnoses and formulating plans of care that reflect an understanding of the patient’s situation as well as the environment in which health care is delivered. Below are two excerpts from clinical performance evaluations that I felt were thorough summaries of my patient care attributes.

This comprehensive evaluation is from my Pediatric rotations, which were my final rotations of third year (April 2019). Click for larger image. 

This evaluation came from my internal medicine mini-internship, which I completed August 23, 2019. Click for larger image. 

Another evaluator from my mini-I wrote…

“continue to find your ideal workflow for prerounding/note writing. You did excellent this month, but next year the workload will increase and you’ll have to find ways to become faster. Nothing to really do now, but you’ll be an intern before you know it! Great working with you”. 

Although I am very proud to have received such positive feedback, I am not satisfied, as I know that there is still room for improvement. I look forward to continuing to hone the excellent patient care abilities I’ve displayed during medical school in order to become a more efficient physician during residency and beyond.