Author: doo.4@osu.edu

Integrative Health Elective

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Completed Modules List

In the month of January, I completed an elective on Integrative and Complementary Health at the OSU Integrative Health Center. I had prior experience with herbal medicines, acupuncture and chiropractic medicine but never delved into osteopathic medicine, ayurveda, or mind-body interventions. This month was very eye-opening and I learned a lot about the supplements and alternative therapies that can be used in conjunction with modern Western medicine to not only lengthen but also improve quality of peoples’ lives.

My experience in integrative health truly enhanced my understanding of patient care. The primary care physicians at the integrative health center took an extensive medical history and spent anywhere from 40 minutes to an hour with each patient. This was a completely different approach from the 15-20 minute encounters I’ve seen in other internal medicine clinics. During that time, I learned more about the patients’ lives and personal stresses that greatly impacted their health and ability to access health care. The PCPs were able to review patients’ current medications and also advise certain vitamins and supplements as well as refer patients to nutritionists and mind-body therapists among others. In this way, my integrative health elective taught me about more ways that I can practice health promotion and disease prevention outside of the traditional Western medications.

I believe I will definitely utilize my knowledge from this elective in my future practice. Whether I pursue primary care or a specialty, my knowledge about alternative medicine can be used to provide great patient care. During my month long elective, I also completed an herbs and dietary supplements course through OSU. This was very informative and I am planning on furthering my integrative health education through the Integrative Medicine Pilot program offered this spring to OSU medical students.

Research Publication

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Pre-menopausal Breast Cancer patients and Osteoporosis

During the summer between M1 and M2 year, I was fortunate enough to conduct research with my longitudinal practice preceptor, Dr. Charles Shapiro. After spending time at the Stefanie Spielman Breast Center I wanted to learn more about the long-term effects of chemotherapy. We decided to explore the effects of chemotherapy on premenopausal patients. Many breast cancer patients undergo chemotherapy-induced ovarian failure which predisposes them to early onset osteoporosis. We researched the current literature and found that there weren’t any standardized algorithms to manage this issue. Therefore our article created a suggested algorithm and emphasized the need to identify one primary doctor who can be responsible for tracking these patients’ risks for osteoporosis during and after chemotherapy. It was a great learning experience and I was amazed by how much I learned during the short summer break!

My research project enhanced my medical knowledge by teaching me more about scientific inquiry and the process behind identifying deficiencies in current medical literature. While breast cancer is one of the most researched cancers in the world, there are still areas that require further information. By reading through current studies on my specific topic I’ve also evaluated and learned more about the contraindications and efficacies of treatments for women undergoing early onset osteoporosis.

As a medical student that is pursuing internal medicine, this knowledge will be helpful when I encounter oncology patients. Though this topic is very specialized, the process of identifying research topics and systematically investigating a subject will be useful for me in whatever area of medicine I choose to pursue. I plan on pursuing research during residency to further this experience in the future.

Sub-Internship Evaluation: Demonstrating Medical Knowledge

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Throughout my medical school training I’ve worked consistently to build up my knowledge base while also learning how to provide great patient care. My sub-internship rotation in general medicine felt like the culmination of all the learning and training I had done throughout my first three years of medical school. I was able to manage patients efficiently, give detailed clear presentations, answer calls or speak with consultants and even find time to attend lectures and check on patients at the end of the day. This was one of the most challenging rotations I’ve had but also the most rewarding and I felt like a true member of the team. This rotation really solidified my interest in internal medicine.

Overall this rotation fulfilled the objective of medical knowledge by practicing patient care daily with pre-rounds where I assessed the patient, reviewed vitals and results while continuing to think about diagnoses and treatment options. I also learned about the social aspect of medical knowledge that involves factoring in patient sleeping and meal times as well as nursing shifts when determining when to administer medications for patients. Finally, I learned how to juggle multiple patients and problems while staying calm and collected!

I have no doubt this competency will be further developed during my residency. 🙂

Work and Life Balance: Extracurricular Activities

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As a medical student, many days are filled with studying and reviewing disorders and their treatments. However I was fortunate enough to explore my many interests outside of medicine.

1) One of my main passions is music. I’ve been playing flute and piano since I was 6 years old and minored in flute performance at my undergraduate institution. As a natural continuation of this, I joined the OSUMC orchestra as the flautist for 2 years. We played music every Thursday evening ranging from Christmas music to Classical and even movie soundtracks. It was an unforgettable experience where I made lots of friends, relieved some stress and also was able to share my talents with others during our seasonal concerts.

OSUMC orchestra

 

2) I also spent quality time with friends whether at home or at the OSU football games!

OH-IO  Home roommates

 

3) Spending time in nature with hikes to Hocking Hills and other parks helped me appreciate the world we are surrounded in and the wonderful friends who can accompany me during the journey.

hocking hills

 

4) Finally, I also hope to pursue some short missions work during my medical career and got to explore the possibilities when I visited the Global Missions Health Conference in Louisville, KY! I was amazed to see so many medical professionals who were passionate about missions work and this conference gave me many ideas about how I will carry out my medical practice in the future!

GMHC

I chose this collection of photos to demonstrate my strengths and interests that I’ve either discovered or cultivated during my four years in medical school. Through these activities, I also learned how to create an appropriate balance of personal and professional commitments. I will take the next steps to further developing this competency by continuing to pursue my passions outside of medicine during residency and beyond.

Professional Strengths and Weaknesses Reflection

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Strengths-and-Weaknesses-Direction

I believe that my personal strengths are mainly in my enjoyment of listening to others and to be considerate and kind when forming relationships with other people. I also take responsibility for my actions and welcome feedback from others. Being a great listener will help me to be very receptive and empathetic towards patients’ concerns. In this way I could be a better medical student who can learn not only from lectures but also from the real life situations and concerns that patients will express. In addition, my strength in accepting input from others can help me greatly with interpersonal communication because this would be more conducive to successful teamwork in the future.

Besides my strengths, I also have areas that I would like to improve on. I believe my weakness lies in appropriate time management. Oftentimes when I was meeting patients for the first time in clinic, I had a hard time interrupting them and moving on with my questioning. I wanted to make sure the patients were able to express all of their concerns but at the same time I wanted to make sure that my history taking was comprehensive enough that I would not miss the diagnoses and risk giving mediocre health care. This delicate balance I believe is part of the art of medicine and one which I am still honing. I do enjoy listening to patients and really strive to be an advocate for them by hearing their stories and re-expressing their concerns to the rest of the team. However, I must realize that with the limited precious time that medical students and professionals have with our patients, I need to eventually switch from open-ended to more direct questions.

The above reflection was written in the beginning of medical school. Now as a fourth year, I believe my strengths remain the same and luckily I have not become less empathetic towards patients through the course of medical school. I chose this reflection for the competency of “practice-based and lifelong learning” as it discusses my strengths and weaknesses. Furthermore I was able to identify the role of a medical student and highlight the importance of interpersonal communication as a physician.

I will be developing this competency in the future by constantly reflecting on my strengths and weaknesses throughout my medical career.

Community Health Education Surveys

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As mentioned in a prior Community Health Education post. This project really helped me to learn more about breast cancer as well as the education that is necessary for patients and families. I also learned how to work effectively with other medical students as well as nursing staff and did extensive research to develop the following surveys. These were given to the breast cancer education participants before and after the education sessions. They were the essential tools for our group to have quantitative and qualitative results for our project.

Survey A Chemo Preclass Questions UPDATED

Survey B Chemo Postclass Questions UPDATED

I selected these surveys to exemplify the competency of “interpersonal communication” as this artifact reflects the process that was involved when providing these survey to our patient population. Firstly, this information tool was created by using current information technology (PubMed) that found one prior survey from Emory University. We used this current literature as a format and proceeded to collaborate with the Breast Center nurses and staff to formulate our own survey.  Secondly, we communicated continuously with the nursing staff so that these surveys were administered before and after the chemotherapy education classes. Therefore interpersonal communication was essential to the success of these surveys.

I would like to conduct clinical research during my medical career which will further my development in this competency.

Psychiatry Rotation: Reflection on Professionalism

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While participating in my inpatient psych rotation at Harding, I found that all attendings and residents always kept the highest standard of professionalism. When patients were undergoing psychosis, anxiety, and a multitude of different moods and feelings, it can be difficult to understand exactly what the patients are expressing during their encounters. Some patients would mumble, other would stare for several minutes and still others would be pacing and speaking in a flight of ideas. However, the faculty members were always calm and patient while giving respect to the patients who sometimes spoke nonsense during the interviews for rounds. In one particular experience, one of our patients constantly had loose associations and her thought content was very disorganized. However, the attending was always appreciative of the patient for participating in the interview and actively listened to the patient’s incoherent explanations.

This experience taught me that professionalism requires patience and understanding while also being able to quickly analyze and determine the next plan of care for a patient even when a patient is incomprehensible. Though it was difficult to grasp what the patient may be saying, the doctors never appeared flustered or overwhelmed. On the contrary, my attending tried to clarify the information as much as possible and maintained a trusting patient-doctor relationship. This experience impacted my professional development as it taught me that being a professional does not only mean finding the answer to a problem to help care for a patient. Being a professional also means listening to a patient’s needs, respecting the patient and trying your best to treat the whole patient: physically, emotionally, and intellectually.

I felt my reflection in the psychiatry ward demonstrated professionalism. The physician took his role as patient care provider seriously and consistently maintained compassion, respect and altruism in the truest sense.

I plan to develop in the competency of professionalism by emulating this psychiatry physician’s actions when I interact with all of my patients.

Health Coaching

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During my first year of medical school, I found health coaching to be an interesting concept but was also skeptical about its effectiveness. Essentially health coaches meet with patients who have chronic health issues such as diabetes, smoking, alcoholism and spend time formulating ways to improve a patient’s health. The health coach does not provide solutions but instead helps guide the patient to create her own step by step plan on improving health. This seemed rather inefficient as the discussion would take a long time and the patient would need to be motivated to start thinking about making a lifestyle change. However after our simulated health coaching sessions, I could see the benefits of this method of coaching. A patient has the luxury of sitting down with a professional to discuss her health and leaves the session with a reasonable plan to improve her health. Furthermore, the patient gains a sense of accomplishment from generating a plan from her own ideas that would fit well with her personal schedule. Finally, the patient is able to stay on task by meeting frequently with a health coach to track her progress and adjust the plan accordingly. Therefore I gained a newfound appreciation for health coaching through this exercise. I was also able to help out other medical students as my video was used as part of an e-module for health coaching.

I chose to use health coaching as a demonstration of the patient care competency as it emphasizes the idea that patient care is a cooperative endeavor. The old idea of a paternalistic physician is no longer and is now replaced by informed and interactive decision making. Health coaching really displayed this idea as it attempts to draw out solutions for disease prevention and health promotion by encouraging patients to suggest ideas that are feasible for them.

In my future career, I plan to recommend health coaching to my patients so they can reap the long term benefits from this practice.

The video below shows the longer version of my health coaching interview session where the patient and I discussed small steps to help better control her diabetes.

https://vitals.osumc.edu/articulate/4737/player.html <– shorter version on slide 9

 

Community Health Education Project Poster

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During our first and second year of medical school, students were designated into groups of 2 to 3 to create a community health education project at our longitudinal preceptorship sites. I was assigned to the Stefanie Spielman Breast Center.  Our group met with a nurse practitioner/researcher to discuss interventions that were necessary at the breast center. Though many interventions have already been implemented in the center such as support groups as well as fitness classes and nutrition consultations for patients and family members, there was yet to be a comprehensive information session for newly diagnosed breast cancer patients. Fortunately, the breast center had just started creating information sessions for breast cancer patients and family members that were usually scheduled several days after a patient learned about their diagnosis. This was important because at the day of diagnosis, most patients and family are overwhelmed by the new information and cannot process all the scientific terms and treatment options that are discussed with the doctor and nurse. Therefore, this information session provides a way to go over the disease process, the treatment options, and the amenities offered at the breast center in a calmer setting. Afterwards, it also provides a space for patients and family to ask questions they may have to doctors, pharmacists and nurses.

Our role was to determine whether these information sessions were indeed effective and the most direct way was through pre and post surveys. The idea was discussed with nurses and a brief meeting about the implementation of the project was posted as an audio file on the “OSU breast channel” podcast. The survey drafts were finalized and we also did an online search to refer to other institutions’ surveys but there were only one or two published. Therefore, this was a relatively novel endeavor for this specific patient population. In a course of a month, we had gathered several surveys and found that indeed the information sessions were effective. This whole process helped me learn about the steps involved in clinical research and it was very satisfactory to find answers to our clinical question. Finally, this project opened a pathway for more questions and research to be implemented in the breast center which I am looking forward to reading about in the future!

The CHE project fulfilled the “systems-based practice” competency by teaching me about the interdependence of different fields in the healthcare system such as medicine, nursing and pharmacy. Furthermore, this project showed that appropriately using system resources can improve health care.

I will be reading more about system-based practices and conducting CHE projects in the future to further develop this competency.

**Please click on the image or link below to take a closer look at the poster.

CHE-Poster-Group-34-updated-2-1ggcp74 (1)

Community Health Education Poster

 

Patient Experience Elective

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In the summer between second and third year of medical school, I chose patient experience as my advanced elective. Our main assignment was to make a video demonstrating patient care at OSU. Our group of three medical students interviewed OSU staff, organized a meeting with patients and even tried our hand at acting to create this fun and informative final product! We explored the concept of diversity and how it’s utilized in hospitals (OSU as our example). Furthermore, we demonstrated some potential situations where diversity can become an important aspect of patient care such as when one’s culture utilizes alternative medicines. This project really helped me to see beyond the basic health care needs and routine history taking and physical exam techniques I had honed throughout medical school. I learned more about the necessity to learn more about alternative medicine, the importance of body language when speaking to patients as well as the importance of demonstrating autonomy, beneficence, non-maleficence and justice. This elective helped me to delve deeper into the humanistic aspects of medicine and further confirmed my interest in becoming a great patient advocate throughout my career. In addition, this piqued my interest into exploring what else alternative medicine has to offer for patients.

My patient experience elective fulfilled the “interpersonal communication” competency by helping me to understand how human diversity can influence or interfere with the exchange of information. I understand that different cultures have varying perspectives on medicine and I must accommodate each patient accordingly.

As I practice medicine in the future I will develop my interpersonal communication by using interpreters and also learning more about different cultures. I am currently taking a course in medical Spanish, learning Italian and actively trying to improve my medical Korean to help my future patients!