Author: Yusra Shao

Beyond Competitions

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Peer Feedback- Highlighting their Observation of my Interpersonal Skills

“She’s also amazing at presentations and should probably get a JD/MD joint degree,” a peer wrote about me after a debate activity in our small group session. I have always been aware of my public speaking ability and have seen it as a talent I can use to benefit others. I enjoy being on stage, holding the microphone, having all eyes set on me and using my body language and tone of voice to deliver my point. My peer’s comment reflected my own desire to use this ability to enrich my career and give back to the community.

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Fundraising at Youth Group’s First Annual Banquet- Raising $7000

In college, I was invited to deliver a talk on Islam at a public middle school. I understood the sacredness of that stage through which I was to deliver a message to the young minds. I took it as an opportunity to create a spirit of interfaith harmony and mutual respect. For the first time, I took my skill beyond a mere competition and used to it to leave a lasting impact on the future generation. Since then, I’ve delivered multiple motivational speeches within my community and have coached the youth in public speaking, fostering in them the confidence and skills to address an audience.  My formula is simple: write your speech yourself, keep it short and memorize your speech so your hands are free to gesture. I have seen a tremendous growth in the skills of my youth and am excited to see how this growth will help them in their professional lives.

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Poster Presentation- at American College of Physicians 2016 Ohio/Air Force Scientific Meeting

My public speaking skill has also helped me in my career. I feel confident when presenting cases on rounds and can focus on compiling well thought-out differential and plan. I’ve enjoyed presenting my research poster at conferences and speaking at my free clinic’s’ fundraising dinner, describing our current work and future directions. Furthermore, understanding the audience as a public speaker has translated into successful teaching skills. After I substituted for a kindergarten teacher at our Sunday School last week, a parent inquired with amazement what my teaching method was that kept students engaged and entertained. My teaching skills have also allowed me to effectively counsel patients on sleep apnea and fibromyalgia during rotations.

I see myself continuing to teach as an attending physician and public health activist, presenting lectures to medical students, teaching residents in a clinical setting and delivering seminars to general audience on preventative topics in ophthalmology. Even during residency, my presentation skills will help me deliver effective case presentations at didactic sessions. More importantly, my teaching skills will help me explain new diagnoses to patients, counsel them on treatments and coach them on disease prevention. Medicine is a career where physicians are constantly engaged in some form of teaching, either to their peers, to students or to their patients. My public speaking skills will allow me to fulfill these roles in my career and will also continue to be a form of public service as I mentor youth and address audiences on topics that affect us all.

Equipped

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Staff- Noor Community Clinic

The volunteer physician asked me if there was a way to refer her patient for a pap smear. The patient, an elderly female, complained of vaginal spotting. She did not have health insurance and had presented to Noor Community Clinic, a free clinic in Columbus. I had started volunteering with the clinic as an undergraduate data assistant summarizing paper records electronically. I was now a first-year medical student serving on the leadership committee for the clinic as referrals coordinator. On every clinic day, I would discharge patients giving them instructions on how to obtain their free radiographic and laboratory studies. Furthermore, if any patient required specialty consultation, I would assist volunteer physicians in filling out referral forms for the local hospital and ensure that all required documents were mailed to the specialty office. I would also give patients instructions on how to sign up for financial assistance with the local hospital to receive specialty care. Since most of our patients were not fluent in English, it was my job as the referrals coordinator to call specialty offices on their behalf, ensuring that all documents were received and that an appointment was made. I would then communicate that appointment date to my patients.

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Receiving Plaque at Annual Recognition Luncheon- Noor Community Clinic. Middle: Dr. Malika Haque, Medical Director, Noor Community Clinic. Right: Samia Miniato RN, BSN, Chief Nurse and Clinic Coordinator, Noor Community Clinic.

Unfortunately, the wait at the local hospital for a new patient appointment was very long. In my experience, scheduling a gynecology appointment for my elderly patient would have taken at least three months. We did not want to wait that long given a concern for pre-cancerous or cancerous lesion of the cervix since our patient had been non-compliant with cervical cancer screenings due to being uninsured. To my relief, I had recently updated our clinic’s catalog of medical services provided by local non-profit organizations that we could refer our patients to. One of those organizations offered free pap smears and mammograms. I informed the volunteering physician of this resource and directed the patient on how to receive her pap smear. Since I was familiar with medical resources that were available in the community, I could provide my patient with timely and effective medical care. Patients are frequently unaware of healthcare resources available to them and look to their physicians for guidance in difficult circumstances such a domestic violence, addiction, and teenage pregnancy. It becomes the physician’s duty to keep himself/herself informed of available resources so they may guide their patients. As an ophthalmologist, I may see patients who require closer primary care follow-up due to their uncontrolled diabetes causing a retinal bleed or require social work consultation due to ocular trauma occurring from domestic violence or driving under influence. I, despite being a specialist, must be able to identify such circumstances and be willing and equipped to provide further guidance for the betterment of my patients.

Suturing: a Handicraft

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My first open surgery was a trans abdominal hysterectomy on my general gynecology rotation. After retracting at the abdomen for three hours, the attending asked the senior resident to allow me to close the wound. My breath stopped for a moment. I had only gotten one day of suturing practice during orientation week and did not have any sutures to practice at home. After several failed tries at suturing and knot tying, I asked my senior resident if I could take some sutures home. I wanted to master the art of suturing before the next surgery. I did not want to miss another opportunity to close an incision because I did not know the basic steps of tying a knot. I considered it my professional responsibility to acquire and master the skills I was expected to learn as a medical student.

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Sutured Cushion Cover

My senior resident was unable to find any sutures for me so I started practicing knot-tying with my shoe laces during free time. I watched YouTube videos to guide me and every morning I tied my shoes with a surgical knot. I started enjoying the hand motions and it became an exciting way for me to begin my day on surgery rotations. But I still had no practice suturing. I did not have a needle driver or sutures to practice with. After gynecology came my plastic surgery rotation. To my relief, I was never asked to suture on the rotation since patients trusted plastic surgeons to close their incisions in the most refined manner. The rotation was going smoothly until the last week of rotation, when my attending physician asked me to close the incision for a Trapezius flap. Once again, my breath stopped. He handed me the needle driver. I looked at it from all directions, holding it in my hand in all angles, trying to find the most feasible way of starting the suture. My attending, seeing me struggle, asked if I had any sutures at home to practice. I reported that I did not. He requested the scrub tech to lend me a needle driver and some expired sutures. That night, I took the needle driver home and practiced suturing on my cushion cover. With every subsequent stitch, I could see my skill improving. I was unearthing the secrets of suturing long hidden from me. It became a nightly routine to come home and practice suturing my cushion cover before going to bed. In less than a week’s practice, I felt comfortable to start my obstetrics rotation and was ready to be asked to close a wound.

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End of Rotation Feedback- OB/GYN, Highlighting the Improvement in my Surgical Skills

To my excitement, my intern resident allowed me close every cesarean section I was in with her. Suturing thick, stretchy skin after a pregnancy was very different than suturing cotton. My intern resident and attending physicians demonstrated how to manipulate the skin and the angle of my needle to facilitate easy strokes. After practicing subcutaneous sutures on long cesarean section incisions for two weeks, one inch incisions after robotic surgery on gynecology oncology rotation seemed far simpler. The surgical nurse mentoring me on gynecology oncology commented “look at those fingers tying away those knots; someone’s been practicing their knot tying.” My senior resident on gynecology oncology remarked “your suturing is really good.” The chief resident on my general surgery rotation allowed me to close an abdominal incision with deep dermal sutures. Observing my work, he commented “that’s looking good.” I had come a long way in my suturing and knot tying skills. Every stitch felt fluid, my feet were firm, I could breath. I looked forward to hearing the words “you’ll close this incision.” More importantly, I was now enjoying surgeries and wanted to pursue a surgical subspecialty.

I demonstrated a strong sense of professionalism by making effort in overcoming my deficiency and striving to meet expectations set for me as a medical student. I foresee that during ophthalmology residency, I will be expected to learn numerous surgical and exam skills. Mastering those skills will require practice and determination. I look forward to utilizing wet labs and every surgical opportunity to gain the skills that are essential for me to become a competent ophthalmologist. Furthermore, being able to take feedback from my seniors and implementing it in my practice will allow me to improve my skills. Even as new technology arises after I become an ophthalmologist, I will seek training in them. As a physician, I feel that I am accountable towards my patients and my profession. I see it as my ethical obligation to excel in the knowledge and skills set out by my profession in ophthalmology.

I Learned to Strike a Balance Between the Two

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At Summer Camp in Columbiaville, MI- July 2016

As I prepared to graduate college and start medical school, I decided to start a youth group at my local mosque. I had immigrated to the United States with my family five years ago and the struggle of holding on to my identity while trying to assimilate in the new culture was still fresh in my mind. Yet, through resilience, open-mindedness, and self-reflection, I had overcome the pressure of trying to “fit in” and had come out of high school and college with a strong sense of who I am and what I can offer to the world. As I saw the youth of Muslim-immigrant families at my local mosque struggling with their identity, I wanted to provide them a platform where they could explore their unique self, their talents, and find value in giving back. With the overwhelming expectations of medical school approaching me, I wasn’t sure if I could fulfill my duties towards this newly born youth group. But I knew that my life would remain deficient if I only devoted myself to medicine and gave-up on my passion for youth and community. Hence, I recruited a board of high school students to help me run the youth group and I became their advisor.

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Collecting Money for Zoo Trip- April 2014

I still remember the glittering eyes of my board members at our fundraising banquet at the end of our first year. Pictures of laughter danced on the projector as we screened photographs from our year’s events including a movie screening at the local movie theater, a zoo trip rooted in team building activities, card making for the sick, a painting competition, and bonfire. In making these events successful, my teenage board members had helped make venue reservations, collect RSVP and ticket money, develop game ideas, and create graphic fliers. Yet they had required a lot of coaching through the year in accomplishing these tasks and I could not stop smiling as I saw the final product: a group of youth who were now confident in their potential and ready to take on greater projects. Remaining involved with the group, conducting weekly meetings, and executing monthly events had often been challenging with the rigor of medical school. But through trial and error, I learned to strike a balance between the two. I ensured that no events were scheduled during exam week and I allotted specific hours in my day to carry out youth group related work without letting it distract me during my allotted study time.

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Fire- Acrylics on Canvas

This ability to compartmentalize my time also helped me in my personal life. I scheduled a couple of hours every weekend to spend with my family and planned my weekend studying around it. I even learned to set out time for gym and painting. Finding work-life balance did not come to me naturally. It required constant evaluation of my involvements and values to prioritize what mattered to me the most. It required that I communicate with my family and youth group members, ensuring that they understand my commitment towards my career and towards them. I realize that balancing career and personal life is not static but a constant process. As I start residency, my responsibilities and commitments will change and I will need to adjust my life accordingly yet again. I am optimistic that my strong sense of personal values and the ability to compartmentalize my time and prioritize my involvements will help me achieve work life balance in every stage of my career.

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Gift Wrapping for Refugee Families- Eid 2016

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Hiking at Hocking Hills- June 2016

From Uptodate to Medical Journals- a Journey

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End of Rotation Evaluation- Cardiology

I had heard the phrase “evidence based medicine” repeatedly during the first two years of medical school. This phrase became a reality in my third year. Text books were a good starting point when reading about a diseases but often lacked details and nuances seen in real-life cases. Hence I began my third-year rotations using Uptodate.com to gain a more comprehensive clinical knowledge of diseases. I used the website to devise a diagnostic and management plan for patients presenting with acute anemia on the pediatrics hematology- oncology service.

However, uptodate was not a sufficient learning resource for my surgical rotations since I was required to know human anatomy and familiarize myself with surgical steps before scrubbing into any case. Therefore, I used the database accesssurgery.com to gain a more in depth knowledge about the indications, risks and benefits of different surgical procedures and to review human anatomy as the readings laid out surgical procedures step by step. Had I not sought for a learning source beyond uptodate.com, I would not have been successful during my surgery rotation and received the following evaluation “ [Yusra] showed high level of knowledge and interest in and out of the OR. Very sound understanding of anatomy and physiology.”

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OSUWMC Guideline for Diagnosis and Manegement of Hepatorenal Syndrome

When internal medicine rotations started at the end of my third year, I felt very comfortable using uptodate and accesssurgery. I now wanted to challenge myself with searching for management guidelines and robust clinical research that guides management. On my hepatology rotation, I used my university hospital’s central website to find a clinical guideline for treating suspected hepatorenal syndrome in liver failure. On my cardiology rotation, I took care of a patient who had undergone stent placement after an NSTEMI. When developing his management plan, I wanted to know how long the patient will need to be in the hospital before he can be discharged. Uptodate did not provide a concrete answer but alluded to a risk stratification system. Hence, I used my university’s database of online journals to find a journal article further exploring risk factors. In light of my research findings, I proposed on rounds that we discharge my patient that day as he had completed 24 hours of monitoring. When asked to explain my recommendation further, I handed my attending physician a printout copy of the research article I had found and summarized the research findings. My attending physician agreed that discharging my patient that day was plausible but wanted to monitor him for another since he was in the grey zone of cardiac risk factors. My attending physician commended me on integrating research evidence in developing my plan. I also learned from this experience that, before applying the results of any study to clinical practice, I must ask myself: does this study apply to my patient? In response to this incidence, my cardiology evaluation read “ [Yusra] actively sought out literature to support plans and ideas on patients” and that I am “able to use resources for patient care.”

As I reflect on my journey from using uptodate to finding research articles in medical journals, I realize that identifying learning resources required practice and learning itself. My experience with doing background research to write manuscripts for a case report and retrospective study on breast cancer has further enriched my experience with evidence based medicine. This experience is important because, as I learn about ocular diseases in residency, I will need to identify authentic learning resources and reliable research studies to enrich my medical knowledge and inform my decision making. I realize that medicine is a career of lifelong learning and I’m encouraged that I have developed the skills of identifying and integrating external learning resources in my practice. This skill will be beneficial throughout my career.

Let’s Not Tap Her

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Peer Feedback- Highlighting my Patient Interview Skills

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End of Rotation Evaluation- Hepatology

“Yusra is functioning at a level that is above most of her peers” an attending wrote about me at the end of my ambulatory general medicine rotation. He further wrote “She is on her own developing a good differential and explaining what she believes to be the most prudent next step which is often correct. I am very impressed with her.” Starting third year, I wasn’t too worried about interacting with patients. I had felt comfortable doing this during standardized patient interactions in my first two years of medical school and had often heard from my peers that I “consistently exhibit[s] compassion and ease when speaking with patients.” I was more concerned about developing and prioritizing a differential diagnosis for my patients’ chief complaints and presenting accurate history and supporting evidence for my differential diagnosis . I understood that clinical medicine has two key components: patient interaction and clinical reasoning. When my ambulatory attending, during the third month of my third year, wrote that I was presenting patients’ histories in a concise manner and developing good differentials, I was encouraged that I was on the right track. I wanted to continue practicing and mastering these skills during the remainder of my third year. Furthermore, his comment that I was often accurate in presenting the most prudent next step in patient management encouraged me to continue challenging myself in this regard and continue presenting management plan for my patients.

Arriving at a final diagnosis and developing a management plan was often challenging on sub-specialty services as patients presented with complex medical conditions. However, I learned through experience that if I use clinical evidence to develop and prioritize my differential diagnosis in a problem focused format, this will automatically lead me to a management plan. I used this strategy during my hepatology rotation at the end of my third year when the cause of renal failure in the setting of hepatic failure was not always clear. In the last week of my rotation, I presented an overnight admission who I considered to be in type two hepatorenal syndrome given her creatinine and urine chemistry trend, with acute anemia from a suspected variceal blead and tense ascites due to diuretic non-compliance worsening her pre-renal acute kidney injury. I proposed that instead of performing paracentesis, we continue to infuse her with albumin and conduct endoscopy to control any source of bleeding. I thought paracentesis would worsen intravascular volume depletion and acute kidney injury while an active bleed was suspected. I was controlling the quivers of my voice while I presented this case because I was intimidated by its complexity. To my excitement, my attending physician agreed with summary of the clinical picture and management plan. Furthermore, I proposed that the patient should be sent home with home health since she was non-compliant with medications; ensuring diuretic compliance was essential to prevent another hospitalization. I sensed the smile on my attending’s face when I proposed this plan since last week he had coached me to be farsighted in anticipating patients’ medical in developing discharge plan. I could integrate his teaching in developing my patient’s management plan.

At the end of my rotation, my hepatology attending wrote that I “performed at the level of a mid-year PGY1.” I could achieve such excellence in patient care because of my desire to constantly challenge myself and integrate in my practice any feedback I received from my seniors. I am encouraged that I have built strong roots in patient care skills during medical school that I can further build upon during residency. Ophthalmology, being a specialized surgical field, will expose me to clinical knowledge and instruments I have never learned before. It will be important for me to continue to challenge myself in areas of clinical knowledge and patient care and look up to my attending physicians and senior residents for guidance. Through self-determination, constant practice, and setting my eyes at the goal i.e. to become a competent ophthalmologist, I will be able to perform well during residency and master the skills of patient care as they pertain to ophthalmology.