Systems-based practice, Mentors, and Vlogs..Oh My!

Here is a reflection I created in 2017 when thinking about how institutions and individuals participate in health care delivery.

My goals still includes continuing to learn how to best utilize resources for patients to get them the best care possible, being a mentor, especially to underrepresented students, working toward being the best physician for my patients possible.

Med Students without Borders

When you first learn about the Community Health Education Project in the LSI curriculum you couldn’t help but groan. On top of all your studying you had to complete a group project that required a year long commitment and planning. However, finding a way to implement new healthy strategies in the community around you was something worth the time and effort. Fortunately, I was able to find an amazing group of people who shared a common goal of having a good time working together, making real change in the community, and growing our skills on team work as communication.

We had decided to partner with a group called Sisters without Borders. Their program was designed to serve members of the Ghanaian community. We decided, after a review of the literature, that we wanted to focus on individuals that meet criteria for having or being at risk of metabolic syndrome. Metabolic syndrome had been recognized as one of the leading predisposing factors for various chronic health conditions that contribute to morbidity and mortality among people of African descent. Furthermore, members of the Ghanaian community in Columbus were particularly at risk due to the reported low health literacy. Our primary question was how much the Ghanian community of Columbus knew about metabolic syndrome and what percentage of participants showed signs of metabolic syndrome. 

Artifact 1: Facts and figures from literature review

Artifact 2: Logic Model

We decided to do three separate events aimed at conducting health screenings and improving the education regarding metabolic syndrome in the Ghanaian community in Columbus. The first event was the “Kick-off event” which was the annual Summer picnic/ Health fair hosted in part by Sisters Across Borders’.  During this time our CHE group also conducted diabetes screening as certified screeners through Central Ohio Diabetes Association (CODA). We also be measured blood pressure and other vitals. Interestingly, there was an Afrobeat exercise session led by an Ohio State medical student. It was so much fun having the community dancing along. During the kick-off event, we distributed flyers for our next event in which our cooking event will occur and food giveaways were provided.

Artifact 3: Kick-off Event

Our second event was planned as collaboration with a Ghanaian organization and food pantry. However, at the last minute the partnership fell through and we were unable to do the distribution of groceries. We also had one more set back during this time 2 of our 6 members had to drop out of the group. This required a substantial amount of communication and organization as the planning and execution required a lot of work. Fortunately, everyone was able to regroup and finish out our goals.  Our third and final event was a two-hour event held at a community center. In addition to conducting screenings such as vision exam, diabetes screening, and blood pressure checks, we also had a cooking demonstration (food samples of healthier alternatives to African foods –  Jollof quinoa, a sweet potato lentil soup, and baked plantains) on how to make nutritious and healthy meals that may decrease the risk of having metabolic syndrome. There was also  a session where we presented key information on what metabolic syndrome is, risk factors, and how to prevent it. The audience was very engaged and asked a myriad of questions after the presentation. Overall, we received a positive reception to the event. 

In conclusion, partnership with Sisters Without Borders allowed us to work with a population at high risk for metabolic syndrome, educate on the disease, conduct preventative screenings, and provide tangible lifestyle changes that can be incorporated into their daily lives. By conducting two events in venues most frequented by this population, we were able to get a good turnout and high participation. The Sisters Without Borders team guided us every step of the way, provided feedback and thoughts, and ensured that this was a true partnership with open communication. The culmination of this project resulted in a group poster presentation in which we reported our findings. As a resident and future attending I hope to continue to be an apart of the community in regards to health education and increasing health literacy. These communities commonly are underserved and are in need with someone with connections or a specific interest in helping improve health outcomes.

Artifact 4: Poster and Presentation

 

Dermatology Office – Quality Improvement

HSIQ stands for Health Systems, Informatics, and Quality Improvement (HSIQ) education. This project entails taking a problem and trying to find the best way to solve it through many evidence based methods. Our project decided to focus on how to improve press ganey’s scores the dermatology department at OSU West. Over the last 6 months they administrations had noticed their scores were below 85% and they really wanted to improve this measure. Our idea for solving this issue was to provide patients with the ability to report their own thoughts on how they disease course was improving through Patient Reported Outcomes (PROs).

Artifact 1: Problem Statement

Artifact 2: Process Map


Artifact 3: Cause and Effect Diagram

Artifact 4: 5 Why’s

We started out with 4 members of our group and we were moving smoothly. Our faculty advisor was very attentive to our group and we had great ideas in formation. Unfortunately, our key member, the leader, had to drop out of the group in the middle of our planning phase. Initially it was a shock to all of us but I’m really happy to say that each individual team member took on the extra work with a smile and grace. We are now in the final phase of our project with 12 weeks of data collected. I believe this was an excellent lesson in resiliency and team work. We all know that sometimes things happen but what’s most important is how you move forward from adversity. We were all able to identify our strengths and weakness in a group setting and really shine in our new roles.  I hope to continue to build and utilize these skills as residency will require me to work in teams even more than medical school. Being flexible and a good communicator when issues arise is important to not only save yourself from stress but also allows you to think more clearly about what the next best options are. I also hope to be involved with quality improvement in the future as it is a simple way of find the resolution to many problems that occur in the work place.

Artifact 4: QI evaluations

Overcomer

For over 48 hours we pondered our fates. During this time my emotions were raging from extreme elation from being finished with my first medical school exam to despair because in all honesty, I thought I’d failed.

I had studied so hard to the point where I could move through my notes in my head but when I hit the second question of my exam none of that mattered. The reason I studied so hard was because of a bad experience I had had with the MCAT. I ended up doing very poorly on the CARS section and I had promised myself I would do better in graduate school; Not only mastering my classes but also doing well on step 1. Yet, by the time I hit question 20 on my first medical school exam, most of them unanswered, I began to panic and my hopes for doing well dwindled down to me hoping that I would at the very least pass. It was as if all the knowledge that I had somehow accumulated over that short 5-week period wasn’t even the basic understanding to answer these complex medical questions.  With my last bit of resolve, I whispered a soft prayer, determined to put my best foot forward and fight for every question I could, there would be no more skipped questions. Out of 103 questions I was maybe sure about 30 of them and guessed on the rest. This was my first encounter with these second and third order questions of which I’ve come to understand is just the nature of the beast of being in medical school.

In the end, I was so happy with how that block went (I ended up with 96%) and I hoped this would continue into the future. I also began to understand that the work that I put into my studying can exponentially pay off. Yet as a whole, I liked how we were able to incorporate this basic science knowledge into clinical applications throughout the course. I believe this kind of learning gave new meaning to the basic science topics because I knew it would help me care for patients in the future. In my opinion, I believe this kind of learning would also allow information to “stick” better in my brain.

My study habits consistently developed over the pre-clinical years which allowed me to continually do well in class material. Every block presented new challenges and pushed me to discover new ways over covering such a large amount of information. I became confident in my abilities to acquire knowledge for long term retention.  In the end, I was overjoyed that I was able to get a 252 on my step 1 board exam.

 

Coming from a community that is always thought to do poorly on standardized exams, this meant a lot to me that I had done well. I wanted to be able to help other minority students learn how they best study. Around the same time, I had received great feedback from my peers about helping others understand topics during small groups and wondered how I could use this to accomplish my goal. I loved teaching. There was just something about the process of working with others to develop a deeper understanding of a topic. It was such a rewarding feeling to know that you played a small roll in someone’s ‘A-Ha’ moment when a learning objective finally clicks.

Fortunately, I was presented with an opportunity to tutor throughout my 2nd and 3rd years.

I remember sitting in that meeting after we were chosen as tutors. I was the only black girl in the room.  It’s amazing how imposter syndrome can find its way into your mind even if you know you exceeded the criteria for being chosen. Sitting there, I contemplated how so few of people who look like me ever get to be at tables likes these. I knew then I had to do more than helping the few I could during our study sessions.

Over the course of a year I began developing a blog, sincerelystarling.com, to help a wider base of students who may be struggling with medical school and to overall help more minorities do well on their boards. It is my belief that seeing someone with similar circumstances to you has overcome a particular hurdle has a enormous impact on helping you overcome that same hurdle. Representation matters. My content mainly focuses on how to excel during the pre-clinical years, study tips and tricks, as well as how I studied for step 1.

 

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#ontheblog! Test-taking Strategy & Ting | …I can’t remember a time when there wasn’t a huge exam looming over my head. Can you? Having good test-taking skills can unfortunately make or break you on this journey…We focus on the struggle to triumph, && rightly so, but for every one of those there are twice as many stories about how someone didn’t get into medical school for the 4th time or their residency of choice… it’s so unfair… but at the end of the day, a test/score will never define who you are or the type of doctor you will be! ▪️ Here’s a few of my favorite tips that’s helped me over the years. Check out the blog for fixes & more in depth explanations. ▪️ Did you see your go to strategy on the list? Comment your favorite numbers below! Didn’t see your fav listed? Let me know what it is in the comments!

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It’s been over a year since I started my blog and I’ve had over 10k views. I have received tons of comments and thank you notes from people studying medicine all around the country and world. It’s been a very rewarding process to know that I played a small part in helping my community do better in this area.

As I reflect on all that I have been able to accomplish during medical school I realize that this is only the beginning. Medicine is a never-ending learning process and constantly requires you to be an independent learner.  Residency will entail utilizing those same skills and developing them to be even stronger as we will have clinical responsibilities we did not have before. My goal is to continue to teach my peers and those coming after me throughout my career as a physician.

Pandora and the Wards

My first ring of rotations was a hard one. I started out with Internal Medicine, Neurology, and Psych thinking that because I had done well on my step exams these clinical experiences wouldn’t be too difficult. Boy, I was very wrong. The world of clinical medicine for a fresh pre-clinical student was like a new world, Pandora from Avatar if you will. You arrive in this new world seeking refuge from the drudgery that is the classroom, books, and the dreaded step 1 back on Earth hoping for a new and brighter future. The world is as beautiful as you expect but if you are caught unaware this new place could swallow you whole. Your uppers explain the rules to you. “You are not in preclinical anymore. You are on the wards, ladies and gentlemen. Respect that fact every second of every day. If there is a Hell, you might wanna go there for some R & R after a tour on the wards…If you wish to survive, you need to cultivate a strong, mental aptitude. You got to obey the rules: Ward rules. Rule number one…”

The interesting part of medicine is that the rules can change depending on the Ward you’re in. This is where many mistakes can be made. I found myself making a big one on the first day of my acute coronary syndrome rotation. I had known the basic gist of pertinent information and presentations from my past two rotations but I was still new to what would be pertinent to this rotation. I made the mistake of not pre-rounding on the heart monitor overnight on a new patient. What made it worse was that I didn’t have a chance to discuss my findings and plan with the intern over this patient. It was something very simple but I still had forgotten to do. When it came to my turn to present I reported a normal cardiac physical exam finding when in fact the patient was in Afib from overnight. The attending, as well as the team, were very surprised and had asked me what I had seen on the heart monitor. I answered I must have missed it and tried to regroup but the intern was already taking over the presentation because this new finding was essential to next steps within the plan. I felt very silly…to say the least. I felt incompetent. I felt that I had blown my first impression. And in fact, I did. No matter how much I improved over that rotation I still kept that mistake with me and I believe it decreased my overall confidence. It most likely showed through my presentations and my evaluations reflected that.

It was a hard pill to swallow, especially coming from such high expectations in Part 1. However, I think it was a necessary one. I had always had trouble with confidence in myself with public speaking and this was what my nightmares were made of. Yet, from this experience with failure, at least failure in my eyes, I was able to really reflect on my presentation style, how to be a better clinician overall, and how to be more confident in myself. Through this, I learned to think more critically, become more efficient, look more deeply, and re-check myself for logic and clarity. I had decided I wasn’t going to let my fear of public speaking control me anymore and now in my second ring, I can move through presentations in a succinct and organized manner with a style that is all my own. I have grown tremendously, and I couldn’t be happier with my development of my clinical skills.

Despite learning curve that is third year I remain most proud of my interactions with patients. On several occasions I have had the opportunity to delve into my patients lives. For example, I met an older African American woman who was Bipolar, that had been off her medications for 2 months and had become suicidal due to an extreme physical illness.  I saw a woman that could have been my mother in not only look but in demeanor.

We began speaking more about her family and she began to tell me stories about how things were going wrong in that area of life. I then began speaking to her about similar family issues that I’ve had in my own and I think it was then that she warmed up to me. We spent a long time discussing our families and how having a mom just being there sometimes makes things ok. All the while I started to notice her smile, laugh and warm up even more to me.  We then started on the topic of religion and she told me all about her issues with her pastor, not being able to make it to church, her history of being Jehovah’s witness to becoming Baptist, and her love for Jesus.  I was surprised by my personal reaction to this conversation because I usually contain myself more when speaking to patients about religion but I felt that the rapport that we had built would allow me to speak more freely. As she told me more about her religious background, I began to speak encouragement into her through scripture that had come to mind as well as remind her of how much Jesus loves her. It was by the end of our conversation that I had noticed a stark difference to the person I had only just met a few hours ago. We ended the conversation with prayer and she thanked me with the biggest smile on her face. Later in the day, she sent a nurse for me to come to see her. She had started a gratitude book and had begun filling it with prayers and things she was grateful for. She asked me to fill it with a word of encouragement and I was humbled to even do so. I filled it out and by the end, it was time for me to leave. I did not see her again but our last encounter made me hopeful that she had found some semblance of peace and remembrance of God’s purpose for her being here.

There have been many changes I have seen in myself from the beginning of medical school to now. Taking the time to reflect on these small changes have made a few things more apparent to me. Although they may be minor, I think they are the beginning steps of a what I’ve always dreamed of being, a Physician. First, let me start off by saying that doing what’s best for the patient is what we all signed up for when we decided to become doctors, at least most of us anyway. We are then taught the best way of gaining information from those patients to help them. This includes approaching the care of patients as a cooperative endeavor, integrating patients’ concerns, and ensuring their health needs are addressed.