Month: February 2021

Systematic Overhaul

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CEO: Practice-Based and Life Long Learning

Objective: Seek out and apply best practices, measure the effect of changes and develop strategies to improve performance

The start of medical school was a bit rocky. It was quite the transition from undergraduate education and I realized that I had to change the way I studied in order to succeed. I had to find different strategies and try them out to find what style led to the best results. As I look back on that period of my journey, I realized how similar my approach was to our AHSS project. Our group had to identify the problem, seek out the best practice guidelines and develop a strategy to address and fix the problem. That is the same framework for how I adjusted my studying as a first year. I identified my problem, worked to develop a plan of attack, and ultimately put it into effect to see how my grades would be affected.

Admittedly, our AHSS project was dealing with a topic of higher importance than my studying as we were working to identify the cause of increased thromboembolic events in post-operative patients and why the administration of heparin after neuraxial anesthesia was poor. We worked with our faculty advisor, following the same thought process that I went through as a first year. We identified that the problem lies with the lack of education and reminders regarding heparin administration in the pre-operative period after receiving a block. After deliberation and discussion, we planned to attack the problem on multiple fronts, with a presentation during ground rounds, a best practice advisory alert on the EMR, and a mandatory qualtrics form that all providers were required to fill out. Our hopes are that these actions help to improve the initial problem and adherence to the guidelines.

This is part of the survey for our intervention. It has important themes that I have put in my own practice for when I have identified problems in my life and how I went about improving them. One of these is obvious, but it is identifying the issue. Sometimes this is easier said than done, and it often takes an extraneous source that alerts you to the presence of this factor. It can come in the form of a test grade, a thoughtful friend, or anonymous comment. The next important theme that translates into my life is that one has to identify any contributing factors to the problem. For me in my first year, those issues were feeling the pressure from my friends and the resistance to change that I felt as I blindly thought I could just continue my undergraduate study techniques without change. But that, like a lot of quality improvement projects, is the root cause. A fear or refusal to change. There is something so innate and comforting about the familiar. So when one faces change, it is almost natural to retreat to what you know and try to ignore the glaring facts that are present. I think that this applies to life and also to medicine. Sometimes, time is all we need to see change. But often, we need to put in the effort to make a change in order to see a different result. That is the conclusion I have drawn from this experience. I will try to approach each problem I encounter in the future with this same framework.

 

 

Paying it Forward

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CEO: Systems-Based Practice

Objective: Identify and utilize professional role models as a means of growth and accept the responsibility of acting as a role model and teaching and training others

The mentor-mentee relationship is a special bond. It involves trust, dedication and hard work on both ends to ensure that the mentee has the best opportunities to succeed. I searched for someone I could call a mentor throughout medical school, and was fortunate enough to find the perfect one during my third year. Before I found him, there were others that I looked to for advice and knowledge, but they were not the mentor that I knew would be there for any question I had. I realized that I never had someone I could really call and trust as my mentor before. Not in undergrad or in medical school. So finally hitting the jackpot with someone who was invested in my success and was willing to help me out in any way was enlightening. He became my research mentor with whom I published a case report. My dutiful advisor as I navigated the residency application process. And a thoughtful voice as I formulated my rank list. I would not be here or have accomplished the things I have without his influence. But the most important thing he has imparted to me is the value of mentorship and the key principle of paying it forward.

I had the opportunity to mentor some junior medical students as I have progressed through my education. They came to me with some questions and I tried to answer them to the best of my ability. I provided advice and helpful hints along the way in the hopes that it would help them with whatever challenge they were facing next. But I realized that I was not doing enough as a mentor to them. In fact, I think that I had overstretched myself with having too many mentees. So the first learning point I had regarding being a good mentor was to not take too many students under my wing, because I would not be able to give them my 100% effort. I made a promise to myself that I would strive to be the type of mentor that I had. One that was there for all my panicked emails with a prompt response that reassured me that everything was going to work out.

My first opportunity to try and become the mentor I was striving to be came when a third year medical student interested in anesthesiology asked for my advice and help. I kept my mentors words in mind about paying it forward. And to my delight, it seems like she feels exactly the way I did when I found my mentor. My only hope is that I can be half the mentor that I am trying to become. To have my mentee feel like she can trust me and my advice. That she can look to me when she has frantic questions and I can provide the prompt response that she needs. That way, I can follow in the foot steps of my mentor. By paying it forward. And hopefully, my mentee will do the same when they become a mentor.

Level Up

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CEO: Patient Care

Objective: Comprehensively evaluate patients by a) obtaining accurate and pertinent medical histories; b) conducting appropriate and thorough physical examinations; c) gathering detailed ancillary information; d) synthesizing all relevant data to generate prioritized differential diagnoses and e) formulate plans of care that reflect an understanding of the environment in which health care is delivered.

All throughout my life, I have been an avid fan of video games. One of the most common themes across genres is the mechanic of “leveling up”. This can be achieved once a character completes enough tasks or earns enough points to reach the next level. This comes with its own challenges, as the difficulty often increases alongside the character progression. But, the character will continuously become more adept with their skills and powers and have a better understanding of the game the more time they spend in that world. So yes, things will get harder as the game goes on, but the protagonist has the knowledge and experience to face those challenges head on and prepared.

I think this analogy closely resembles my journey throughout medical school. As I look back on the road from pre-med to soon to be graduating physician, there have been many instances where I can identify a level-up. The most poignant for me was the transition from the books to the clinic. I had spent so much time in my first years trying to learn the knowledge and medical terms that could allow me to be a competent medical student on the wards. So finally stepping foot in the hospital as a third year was one of the biggest level ups I have ever had.

But I found that I was not completely ready for that next level. There was a steep learning curve to being a clinical medical student and I had to try and collect more information being able to proceed. When a level or stage is too challenging, a useful strategy is to revisit past levels and practice so that you can get the preparation you need to successfully complete that level. So that is what I had to do. I went back and brushed up on my anatomy and made sure to read thoroughly on my cases for the next day. Trying to go beyond so that I was ready for any challenge or question that would be thrown my way.

My last and most recent level up was during my emergency medicine rotation. It was my last rotation of the year, and perhaps the culmination of everything I have worked to thus far. I found myself feeling comfortable with the tasks assigned to me. “Is this what being an intern will be like?” I thought to myself. In my opinion, the last level to complete in medical school is the penultimate transition to residency and intern year. Hoping that all the four years of studying and work would prepare me to be a competent PGY-1. So I was pleased to see the comments that my attendings had for me after working with them. I felt like I had reached the final level. Achieved my final form.

But things do not stop there for me. This game continues on as I transition into residency. There are countless more levels to unlock and complete. Many more challenges and obstacles along the way. But as I look at how far I have come, there is no doubt that I can continue forward.

 

Carving the Path Ahead

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CEO: Professionalism

Objective: Consistently demonstrate compassion, respect, honesty, integrity, accountability, altruism, prudence, social justice, and commitment to excellence in all professional and personal responsibilities.

This picture has so much more to it than just depicting a group of Asian Americans representing their college at a national conference. It doesn’t speak to the struggles we had in starting an organization that was absent from our student landscape at OSUCOM. In no place is it mentioned how we had to advocate for interest amongst the student body or the number of cold emails we made to different organizations for support. No, the details are buried in the picture. But, it was one of the proudest moments for each us. A culmination of the hard work we put forth during the summer and year to get the group going.

I can still remember our strategy meetings as executive members regarding what we wanted this group to become. We shared all you can eat sushi as we discussed what roles were best suited for each person on our committee and how we wanted to get buy in from our class and the incoming one. We were dedicated and invested into making this organization into something we could be proud of. And part of that was understanding the delayed gratification we might have to endure. As I look at what we started 3 years down the line, I could not be more proud of what we accomplished and what this organization is becoming. There is significant involvement throughout all the classes. Thanks to everyone involved, the Asian Pacific American Medical Student Association (APAMSA) chapter at OSU is stronger than ever.

This is perhaps one of my best memories with this organization. It was our first outreach event that we had planned that involved having an interactive experience involving medicine and science at a Christmas party for inner city children. We taught them how to take blood pressure, perform an eye exam and the biggest hit, making slime. It meant a lot that we were able to make this event happen. And it showed the potential that we have as a group regarding how we can contribute to our community.

APAMSA has been a huge part of my growth and development as a future physician. It was the first time where I was part of group that specifically represented a population that I identified with and one that I resembled. I learned about the pitfalls and health gaps that plague this group. And it ignited a fire for me to be an advocate and role model. I hope that I can contribute to the health progress of this population a resident wherever that may be. And that my patients can trust me to have their best interests in mind regarding their health and wellness.

I am grateful for the experiences and knowledge APAMSA has given me. It has contributed to my growth as a future physician and as a socially aware member of society. My goal for residency is still somehow be connected with this group, hopefully at whatever institution I am at. I want to be there as a future mentor for Asian medical students who can advise them on their path toward success. That way, I can continue giving back to a community that means so much to me.

 

Research for the Teachers

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CEO: Interpersonal Communications

Objective: Effectively prepare and deliver educational materials to individuals and groups.

Teaching is something I have always enjoyed throughout my undergraduate and medical school career. I can remember the joy of lecturing on the basics of chemical bonds and reactions as a Chemistry teaching assistant. In medical school, I always made an effort to teach any first or second year student that was shadowing or working in clinic with my attending. Another core component of this were research presentations where I could present findings from my work and hope to leave a helpful point that will help someone down the line.

My first opportunity to present my work was during the MDSR presentation the fall of my second year of medical school. I had to make sure I practiced giving my talk and preparing answers to any potential questions I would receive. It was a difficult preparation, as I was not yet in the clinical environment or had any experience working with the topic I was presenting on. So as I reflect on that presentation, I know that it was very basic and my explanations were simple. But it was still a crucial moment for my journey, as I was able to practice in an environment that I hope to become familiar with in my career.

Flash forward to more than a year later and I was giving a similar talk, but had a wealth of clinical knowledge and experience that I could call upon. I found my presentation was much more informative as I could relate my findings to actual clinical experience that I had during my anesthesia rotation. This experience was even more meaningful as it was during the Asian Pacific American Medical Student Association regional conference, a organization that holds  a special place in my heart as the OSUCOM branch was something that my friends and I founded during our second year. It was a different feeling to be able to speak on the intricacies of intraoperative coagulation management to a group of peers that looked like me.

I grew up in a very small town without much diversity. So finally being able to share intellectual curiosities with a group of medical students of Asian decent was significant. It signified a high point in my medical school and professional career. It was an important step in my journey of who I am and what defines my identity. I enjoy teaching. I enjoy being able to present on a topic that interests me. And most importantly, I hope to be able to continue to educate the Asian community.

As a resident, I want to continue to teach at any opportunity I get. My goal is to become the type of resident that my medical students can rely on to share high yield knowledge and information that can benefit them in their respective careers. My knowledge will progressively become more specialized as I progress through training, but my role as an educator will not change. It is my duty to continue being a good teacher and mentor to anyone that trusts me will that responsibility.

Practice Makes Perfect

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CEO: Medical Knowledge and Skills

Objective: Understand the indications, contraindications, and potential complications of common clinical procedures and perform the basic clinical procedures expected of a new PGY-1.

In my future career as an anesthesiologist, I will be expected to perform many different procedures. From central lines to neuraxial anesthesia, my skill set will need to be robust in order to do what is best for my patients in preparation for their procedure. Most basic and perhaps vital is insertion of an intravenous line (IV). I have had some opportunities to practice with placing IVs during my medical school career and have been able to get a lot of feedback from residents and attendings regarding proper technique and recommended strategies for particularly difficult veins. But I have yet to practice with using ultrasound guided technique, something that I know will become more widely used in the future. Thankfully, I had the opportunity to use the ultrasound during a simulation session during the Part 2 curriculum. This was an important experience, as I was able to hone the basic skills of how to hold the probe, how to obtain the best image, and the best way to advance my needle.

Although placing an IV may seem mundane to some, I truly enjoy the procedure. It is very satisfying once you get that flash of venous blood and advance the catheter into the vein. And having that ultrasound probe in my hand during the simulation felt comfortable, like I was meant to use it during my career. I imagine that feeling is similar to my colleagues pursuing surgery with a scalpel in their hand.

Part of why I chose to pursue anesthesiology is because of the opportunity to do procedures every day. And that is also why I hope to complete a fellowship in cardiothoracic anesthesiology. In this field, I will expand my skillset to be able to perform and interpret transesophageal echocardiograms to provide real-time feedback on the cardiac function of my patient. Central venous lines and arterial lines will become second nature as each patient will require them prior to their procedure.

I will be rotating through many different services during my intern year prior to starting my anesthesia training, but I am going to try my best to get opportunities to do any procedures that are available. My goal for that important year is to hone my medical knowledge and start preparing for my anesthesia training.

As I reflect on my journey to becoming an anesthesiologist, this moment was crucial. It signified an opportunity to practice an important skill that I will no doubt use extensively during my future practice. And most importantly, the smile on my face is real as I genuinely enjoyed having the probe in my hand and a needle in the other. I know that there will be times where that smile might be replaced with a grimace or a somber frown as things might not always go as planned. There will be occasions where I question my choices and doubt myself. But I hope that in those times, I can remember this innocent moment as a third year medical student and the excitement I felt about such a basic procedure. The joy in the little things is what will carry me forward both in my career and in life.