Author: wilson.2296

Professionalism

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Competency: Accountability, Prudence and Commitment to Excellence

This domain really stuck out to me when I went through the list under professionalism. The reason is does so much is because of the word ‘accountability’. To be a successful physician, they need to display all of the qualities in this domain, but I think ‘accountability’ permeates through the most, all the way down to the Hippocratic oath. Obviously, physicians have a commitment to deliver optimal care to patients to the best of their ability, but they also have commitments to their patient’s families, colleagues and communities. The reason this quality sticks out to me is because it’s the quality I have prided myself on ever since my first job when I was seventeen years old.

My first job in high school was working at a Schlotzsky’s deli in Dayton, Ohio. I got a position making sandwiches and pizzas in the kitchen at minimum wage. As a teenager in high school, I was thrilled to be making any sort of disposable income, but there was always something about working on a team to provide a service to other people that always gave me a greater appreciation for that job than the pay. Schlotzsky’s Deli was a small-scale operation as opposed to the job I worked through most of college at Buffalo Wild Wings. I worked at the B-Dubs on Ohio State’s campus for almost five years. This was a large restaurant that would have anywhere from 30-60 employees working at one time depending on the night. This was my introduction to large-scale, team-based operations, similar to how a hospital operates. Every employee had a set collection of responsibilities depending on the job they were working that night, they had to be trustworthy that they could carry out their job or else the others around them and the service that we provided suffered for it. The top quality that I have prided myself on as an employee is that I am trustworthy and accountable to get my job done and then find ways to help those around me. I am a first-generation college student who grew up in a blue-collar home and was taught from early on the importance of having a job and letting people know that they can depend on you to get the job done. I don’t consider myself to be the smartest person in the room, I don’t make excuses and I don’t like a lot of pizzaz or flash. I am very much a nose-to-the-grindstone kind of individual, and that first developed from my parents and home life growing up.  That mentality was validated and continued to grow during every job I have worked to this point. From when I started working at Schlotzsky’s Deli in high school, to the college job at Buffalo Wild Wings, when I was adjunct faculty at Columbus State, and I felt that continued to grow as I first hit the wards as a third-year medical student. I may not have all of the medical knowledge in the world, but I could always find ways to make a positive impact on the team, find ways to help others out and do my best when it came to my student responsibilities on the team. Even if my effort didn’t produce the best results, the team will always get 110% effort from me at the time, and then I will do what is necessary to improve so I can get better results next time. This mentality will certainly continue to carry over as a future intern and resident.

The aspect of professionalism that I hope to improve on in the future is better navigating those difficult situations with patients and their families. Going into internal medicine, I am going to be having difficult conversations with other people pretty often and the better I can get having these conversations not only will help me mentally process the emotional side of things for me, but most importantly help my future patients and their as much as possible. I hope to have senior residents, fellows and attendings that will be open to sitting down with me to reflect on these situations and give me their insights into how to better explore them with prudence and grace. I also hope to be able to listen to these senior members of the care team have those difficult conversations with others. I have also been a situational learner and I think that would really help to improve the way I go about those similar situations. That is my plan for improving my professionalism as I take this next step in my medical career.

Artifact 1:

These are some of the positive comments on the CPAs from my heme 5 elective during my M4 year. I thought this was one of the rotations that I performed the best on and some of the comments showed how I stayed accountable to the rest of the team.

Artifact 2:

These are some of the peer assessment comments from my anatomy group all the way back in the neuro block of M1 year. I can think these comments highlight my ability to work as part of a team and being there for other people.

Systems-Based Practice

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Competency: Understand the interdependence of the component parts of the healthcare system and the potential for unintended consequences within the system

Medicine and the healthcare system are, by far, some of the most complicated systems that I have had the chance to be involved with and study. Of course, I already knew this coming into medical school, but you get a whole new perspective on it when you become involved in the day-to-day operations in the hospitals. Understanding the logistics of inter-department relationships, navigating insurance for patients and optimizing the care for patients only scratches the surface of what takes place in a hospital like the Wexner Medical Center. As far as my understanding goes, I feel like I have a decent grasp on working with individuals outside of my team and what needs to be done to get things like procedures and appropriate living arrangements for patients outside of the hospital. But things like medical insurance, billing and the other financial aspects of healthcare I’ll will have to improve my knowledge on as a resident as I take the next step in my journey in medicine.

One of the operations in the healthcare system that I have really appreciated having the chance to be a part is quality improvement. Coming into medical school, I imagined the process to optimize hospital operations would be complicated and involved, but I didn’t think it would go the route of how the ‘DMAIC’ approach to quality improvement had us go through for our project. The obvious benefit of being involved in AHSS as a medical student is that I will have to contribute to quality improvement projects as a resident in the future and this will help me to be prepared. The bigger benefit of AHSS is now I have an outlet to improve something in the hospital if there is an area that could be looked at for the benefit of patients or my colleagues. My AHSS group’s project is gauging usage of an opioid-abuse screening tool in the ED at OSU East hospital. This project stuck out to me as someone who is originally from Dayton, Ohio and that being one of the cities in the Midwest hit the hardest by the opioid epidemic. I wanted to be involved in a project that could make any contribution to bringing that horrible epidemic to an end. I have been really impressed by the initiative of my groupmates and our physician sponsors to help bring about a chance that can be a benefit to people. And it hasn’t just been our group involved. We have worked closely with other ED physicians, triage nurses and social workers to help optimize education and usage of this screening tools. I know as a future physician that I can’t carry out change by myself. Just like everything else in the hospital it takes a team effort to accomplish these kinds of goals and our AHSS project has given me great appreciation for bringing many different people together can help accomplish something great.

My goal as a future resident is to better understand these aspects of the healthcare system that I am currently less familiar with. Billing and insurance are going to be two of the biggest things in my life moving forward, and those are certainly areas I need work in. I am hoping that the more I understand about the healthcare system, the better prepared I will be down-the-line to be involved in advocation for healthcare policy and help make changes to better the care for patients.

Artifact 1:

This is the process map that I created for our group’s AHSS project during our M4 year and will present in the upcoming weeks.

Artifact 2:              CHE Presentation Corrected Equitas.pptx           

This is the final presentation from my group’s CHE project during our M1 and M2 years.

Interpersonal Communication

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Competency: Effectively prepare and deliver educational materials to individuals and groups

Before I stepped into Meiling Hall as a medical student, I had the chance to take a faculty position teaching anatomy at Columbus State Community College during my gap year. This wasn’t a position that I was looking for in December of 2016, but a friend of mine from graduate school texted myself and one of our other classmates and said that Columbus State was looking for adjunct faculty for the upcoming semester. I had never really thought of myself as an effective instructor. I got some formal instruction in education as a graduate student, but it certainly wasn’t a focus of the program unless you wanted it to be. At the time of this text, I was working two jobs that paid the bills, but neither one really allowed me to grow professionally. So, I took a stab in the dark, applied for the faculty position and ended up getting offered one of the positions for their spring of 2017 semester.  It only took a few weeks into teaching my first course that I fell in love with being an educator and wanted to weave that into my professional pursuits. Fortunately, medicine is certainly not lacking in teaching opportunities and will make it easy to have teaching as part of my practice.

I kept that position at Columbus State during the first two and a half years of medical school, finding times in the week when I could teach and not have any interference with med school responsibilities. The one downside to this position was that I didn’t really get to create my own educational materials. Powerpoints were made for us beforehand and encouraged to be used as they lined up with the examinations at the end of each block. I got to do the lesson planning, but it would’ve been nice to have the chance to make some of their online materials and see if I could deliver it in a way that jived with the students. During the summer in between M1 and M2 year, I got the chance to volunteer with MD camp and give a lecture to the students on GI and renal anatomy. I got to create the powerpoint myself, deliver the lecture and then assist them in the cadaver lab to identify the anatomy practically. To say that this powerpoint wasn’t very good would be an understatement, but it was a great learning opportunity for me. Like I said, I didn’t have much formal teaching education as a graduate student, so creating educational materials and my ability as a lecturer still needs a lot of work. I really appreciated having the chance to teach these students and to look back on the powerpoint I made and the way I delivered it. I want the chance to teach medical students and residents in the future, on the wards and in the lecture hall, so every chance I have to get up in front of people and teach will help me on the way to being a successful educator.

Another way that I want to use education and educational materials in the future is with the patients I will eventually treat. Especially in the hospital, I believe there is a lot of opportunities for patient education on their pathologies and the procedures they undergo. I want to be able to create a series of whiteboard talks that I can deliver in patient’s rooms on different topics that are at a level that is easy to understand. I saw the benefits of something like this firsthand when I was on my mini-I rotation in transplant nephrology. There was a patient that was having a bedside paracentesis done one day and I was assisting the senior resident with it. The patient had a lot of questions about why there was fluid in her belly, how it got there and what will be done with it once the fluid is taken out. My senior gave me the chance to sit done with the patient and talk about all of her questions with her. She was greatly appreciative of the information and I believe I delivered it in a fashion that didn’t go over her head. I am a big believer in patient’s taking ownership of their care and transparency of what is happening to them in the hospital. Becoming better as a teacher and creating educational materials will give me the opportunity to make things clearer for patients that I see in the hospital.

As a resident, I am hoping to take advantage of as many teaching opportunities as I can. I am hoping for placement at an academic medical center so that I have the chance to work with medical students during my time as a resident. There are also a good number of programs that I applied to that have some sort of clinical educator track/curriculum that I am also hoping to get involved in. Residency will be most important for me to become a successful healthcare provider, but that doesn’t mean it can’t be an opportunity to improve upon my other professional pursuits.

Artifact 1: https://drive.google.com/file/d/1R8A6DadSkqDSLnBpYUVvI6_cJvpj0y8n/view?usp=sharing (GI Presentation)

Artifact 2: https://drive.google.com/file/d/1a4_JB0rOy81JagaZsj33JecA12T20Vgk/view?usp=sharing (Renal Presentation)

I have the links to my GI and Renal Anatomy presentations that I gave for MD camp in between my M1 and M2 years.

Practice-Based and Lifelong Learning

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Competency: Identify one’s own strengths, weaknesses and limits; a) seek and respond appropriately to performance feedback; b) maintain and appropriate balance of personal and professional commitments; c) seek help and advice when needed

This domain really stuck out to me when putting this portfolio together because what this domain wants me to write about was commonly asked about at most stops on my residency interview trail. Interviewers, particular program directors, commonly wanted to hear about my strengths, weaknesses, things I want to work on, ability to heed feedback and what I was most proud of during medical school. After eleven interviews, I have a lot of material in my mind to write about on this competency!

First off, I’ll talk about my strengths and weaknesses. In the beginning of medical school, my strengths pretty much just included a good work ethic, kind demeanor and being a team player, all qualities I had developed through every job I had worked up to that point. My weaknesses at that time included pretty much everything else that pertained to being a physician. Fast forward three and a half years, my strengths have really changed and weaknesses I hadn’t realized before had revealed themselves to me. In addition to what I said earlier, I now consider my strengths to include ability to quickly connect with patients, taking thorough histories, navigating difficult conversations/situations and being organized with presentations and writing notes. I would say that my weaknesses include not being aggressive enough when it comes to asking about doing a procedure or taking a patient, being too narrow on assessments and plans and continuing to read up on certain patient’s conditions. I’ve picked up on these strengths and weaknesses from feedback reports on different rotations, and I think they are all in line with how I feel my performance as a medical student as taken place. I know feedback is never going to go away as a resident, fellow or attending, and I look forward to hearing what people have to say about me because it gives me the chance to improve. I’ll use this feedback to continue working on these weaknesses as a resident. I am hoping by the time I finish residency that I won’t have any hesitancy to offer up my services to do a procedure or take a patient because I’ll have that experience and confidence to handle so much more than I can now. Ultimately, this results in better patient care, and that is the most important thing.

One of the common questions that I have encountered while on the residency interview trails is to tell the interviewer what the one thing that I have been most proud of during medical. Initially, this was a difficult question to answer. Just in the natural course of being a medical student, there are so many things to be proud of. But once it dawned on me what my most proud accomplishment was, it became my answer every time this question was asked. That answer was my school-life balance that I managed to strike as a medical student. I remember, as an undergraduate and graduate student, having some trouble separating school and life. I would get so bogged down with studying, extracurriculars or both, that I would forget about spending quality time outside of those things with friends and family. Coming into medical school, I know how easy it could be to get buried in the books. I made a commitment that that wasn’t going to happen to the point where it affected my personal relationships. I was engaged to my now wife at the time, and the time I spent with her and our marriage was the most important thing to me, and I would not let that suffer during medical school. I committed to only doing school-related activities during the hours of 8am-5 or 6pm—about a normal workday. The rest of my time was committed to family, friends and hobbies. I am so happy that I stayed true to my word on this. I have had success as a medical student, but I have gotten to have so many great experiences and adventures with my wife and our friends that has ultimately enhanced my experience as a medical student. I plan to keep to this sort of plan as a resident as well. I know that that is a little bit tougher because the hours are longer, but I’ll be able to strike that perfect balance to make residency as good of an experience as medical school was. I have some pictures from our adventures at the bottom of this post.

Artifact 1:

The picture on the left is from my wife and I’s honeymoon in the Dominican Republic during the winter break of my M2 year. The picture on the right is our trip to Mount Rainier National Park outside of Seattle, WA during my M3 year. Traveling is a big interest of both my wife and I and we hope to really expand our horizons once the pandemic is over!

Artifact 2:

These are my CPAs from my most recent rotation in the ED at Riverside Methodist Hospital. While the comments are brief, the areas for improvement line up the views of my weaknesses in making sure to have broad differentials and comprehensive plans for patients.

Medical Knowledge and Skills

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

Something that is going to be important for me going forward in my career in medicine is procedures. I am applying for residency in categorical internal medicine, but what happens to me after that is still up in the air. I’m pretty sure I want to pursue fellowship after residency, but the subspecialty that I want to go after is still a little undecided. Right now, I am learning towards nephrology, in particular, interventional nephrology. Other subspecialties that I am thinking about right now include gastroenterology and pulmonology/critical care, both heavily procedure-focused fields. So, for me, procedures are going to be at the heart of my future practice in some way, shape or form. One of the ways I have wanted to shape my medical school education was to put a focus on preparing me to perform procedures at a high level at the beginning of intern year.

Since starting the third year of medical school, I have tried to put myself in position to at least help residents and fellows with procedures, if not be able to perform some under supervision. I have been very fortunate in this pursuit that the residents and fellows that I have worked with have had great patience and given me the chance to do a good number of supervised procedures on the wards. I remember my first time doing a procedure on a real person in the neurological ICU and then up to the last one I did during my most recent emergency medicine rotation. Each time I have had the chance to do a procedure it has helped to further reinforce that desire to have these physical interventions be a permanent part of my medical practice in the future. It also inspired me to seek out more knowledge about procedures and how they fit into the tapestry of patient care. That curiosity has brought me to my advanced competency in Critical Care and Procedures.

The critical care and procedures advanced competency is a four week deep dive into common procedures performed in the ICU, the indications, contraindications and the current research behind particular techniques. This course gives a lot of more time in the clinical skills and simulation labs along with shadowing different personnel in the ICU such as the pharmacist and respiratory therapist, so that we gain further appreciation for the multidisciplinary approach to critical care medicine. I’ve really enjoyed the course that Dr. Exline has put together and has given me that little bit of extra confidence that will hopefully carry over into intern year and having to do procedures all of the time.

Thanks to my experiences on the wards and in my advance competency, I feel that will have some extra confidence heading into my intern year to help with and perform procedures for the patients that I see to. As a resident, my goal for improvement in this area is to be involved in as many procedures as possible. I feel the best way to become successful at procedures is to get as many repetitions as you can on them. I know there are some residents that don’t like to be involved in procedures and can do the minimum amount to be signed off on them in their program. I do not intend to be this way. I want to be as involved as I can while also being accountable to those around me that my share of the daily work will also get done. This is my plan for improvement moving forward in this area.

Artifact 1:

This is an excerpt from our course description for the advanced competency in critical care and procedures rotation. This shows the objectives of the course and what is expected of us to become more competent in.

Artifact 2:

This is my appointment for my ACLS renewal coming up on March 5th. I am committed to keeping up certifications for interventions that has potential to save patients lives.

Patient Care

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Competency: 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

One of the parts of assessment weeks that I always looked forward to each block or ring were the OSCEs. Even though OSCEs always gave me some level of anxiety and dread due to knowing that someone would be watching behind the glass and I would have to go back and listen to myself on the recording, I really looked forward to seeing the grading and feedback from evaluators. The reason for this is I always seemed to make pretty good leaps in ability to interview and evaluate patients with each block that passed by during part 1, and this was something I was really proud of myself for. I can remember the very first OSCE that I did, and I was terrible at interviewing patients. I didn’t know the proper questions to ask, an order that made sense and I was constantly thinking about questions to ask that I didn’t really pay attention to what the SP was saying to me because I was always in my head thinking of what to ask next, let alone try to put together a differential diagnosis and plan for that person. After that first OSCE, I knew I needed to develop an approach to interviewing patients that would provide me a standard interview that I could tinker with during interviews depending on the type of patient.

There was one particular website that really helped me during this time. It was the module that initially taught us about patient interviewing during Longitudinal Group, and I really dove into it and wrote out a standard interview that could use in some form for every patient that I come across. I memorized this standard interview and used it for every OSCE afterwards. It gave me a lot of confidence, and that confidence only grew and grew with every OSCE and the more repetitions that I got with interviewing.

Fast forward three and a half years later, after countless reps seeing patients in the hospitals and clinics, I can finally say that I feel competent stepping into a room and evaluating a patient, gather their HPI and put together a halfway decent differential and plan. I think this finally struck me during my emergency medicine rotation of this year. A lot of my attendings needed me to see patients quickly and didn’t give me a lot of time to chart review. Even without that preview of the patient, I could walk into their rooms and successfully nail down their HPI, cover a comprehensive ROS, gather their medical history and put together appropriate differentials and treatment plans. Reflecting back on my presentations to these attendings and thinking about how I relayed all that information off the top of my head without any sort of paper to help me fills me with immense accomplishment considering where I was at the beginning of medical school.

Of course, there is still a lot of work for me to do, especially when it comes to forming differentials, diagnostic and treatment plans. I feel that I have accomplished the mission of being a really good reporter and then being to sift out what is and is not important, but now my goal is to excel at forming assessments and plans. I can be a little bit tunnel-visioned at times when it comes to these parts of the presentations, and just like with interviewing patients in the beginning, will continue to improve as I get more reps during residency. By the end of residency, I hope to have the same feeling forming assessment and plans that I do now with interviewing patients. That is the next step in my development as a prospective physician.

Artifact 1: https://www.youtube.com/watch?v=V8l8_G_ce_Q

This first artifact is a video that I would watch before every OSCE. It’s pretty funny and good way to cut the anxiety I felt before the assessment. Another reason I would watch it is because it was a good reminder of where I started and how far along I had come. It is dramatized, but lets me look back at my growth and be proud for what I had accomplished.

Artifact 2:

These are some of my comments from my recent rotation in the ED at Riverside Methodist Hospital. I felt I had really come into my own with interviewing and assessing patients. I hope to take the next step and have this same feelings with differentials and plans during my upcoming residency.