Physician Guest Writer
Stanford University School of Medicine
Daniel Orlovich, MD, PharmD is a resident physician in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University. He attended medical school at the University of California Irvine. He has written for the American Society of Anesthesiology, California Society of Anesthesiology, Anesthesia Patient Safety Foundation and Anesthesiology News.
You see, when starting your anesthesiology clerkship it feels as if you are learning a completely new skillset and knowledge base. Of course you are drawing on common principles in physiology, pharmacology, and anatomy. But how they play out, and how you apply those concepts, are fresh. Here are some tips to maximize your learning, assist your resident and really start to appreciate the field.
Ten male students crowded around a clean-shaven instructor who asked a series of questions. The students had meticulously prepared and would maintain close proximity to well-rehearsed answers. Hopefully the questions are simple, they thought. One by one, they answered, at times stumbling through their responses. This was expected. The students were learning and the incorrect answers allowed room for humility. Such a scene could easily describe an American teaching hospital, or, a Republican presidential debate.
In this column, I hope to explore various qualities of a physician that we learn through medical school experiences — whether it be through class, shadowing, research, or even interacting with peers — but also to introduce a patient’s perspective in each case. Midway through my junior year of college, I was diagnosed with Cushing’s disease, a rare endocrine disorder that affected every aspect of my life. Throughout the next year and a half, I lived as a patient of my disease, while simultaneously trying to hold onto my plans and aspirations of becoming a physician.
On your mat, you struggle to lie on a bent leg, intensifying your stretch as your hip pleads for you to give up. Many yoga instructors describe hip-openers as a “dynamic” pose because the body is in a constant flux between comfort and discomfort. But there is a moment when your internal struggle abruptly ends.
When I started medical school, I was most excited to start learning again. Having spent the last couple years as a teacher in a classroom, I sorely missed the experience of being the student. Reflecting on my college days, I missed the intellectual conversations generated in our seminars, hours poring over literature under dimly lit alcoves of Sanborn Library, even the far-too-frequent all-nighters spent hashing through complex biochemical pathways with my study group.
The epidemics of diabetes, cardiovascular disease, cancer and dementia roll through the US and across much of the world, eerily reminiscent to the sweeping cholera outbreaks of Snow’s era. Even in the majority of low- and middle-income countries, these chronic illnesses have already displaced infectious diseases to become the leading causes of death and disability. Yet, the majority of these are potentially preventable.
I walk down Summit Avenue in St. Paul, Minnesota this evening, and it is packed with people. People grieving, people chatting, people holding one another, people holding banners and people giving speeches. July 7, 2016: a black man named Philandro Castile had been killed barely twenty-four hours ago by a police officer.
During my first year of medical school, I had the privilege of speaking at several high schools and colleges. The purpose of these interactions was to shed light on what I did to matriculate into medical school, my experiences as a medical student, and to answer any questions. No matter where I went though, one question always followed: “What is the hardest part of medical school?”
About eight months into my first year of medical school, an incoming student asked me how to prepare for the upcoming journey. I could relate to the panicked, excited feeling of the duty to prepare for medical school after an intense visit day. Yet, instead of defaulting to my ingrained answer of, “Nothing can prepare you for medical school,” which I believe was not in the student’s interest to hear, I carefully considered her question and answered, “It’s very important to be a good listener.”
A ubiquitous hierarchy pervades all levels of medicine. Medical students are anchored firmly at the bottom of medicine’s social ladder, rendering them functionally powerless. Although students theoretically have a “voice”, their precarious position low down makes them apprehensive to use it. Students’ grades, evaluations and recommendations, etc.– which have real, tangible impacts, not only on students’ academics, but also their future careers and lives — are contingent on appeasing those higher up on the so-called social ladder.
Traditional “clerkships,” as they are known, are two-to-eight-week-long clinical experiences in each of the many medical specialties taken during the third and fourth years of medical school. During these programs, students see patients and learn directly from the doctors responsible for their care. It’s a combination of structured didactic learning, self-directed experience and day-to-day grunt work. After the month-plus spent in, for example, neurology, students get comfortable thinking about common problems people seeing neurologists might have and the options for dealing with those problems … and then they move on to the next clerkship.
Medical education has remained largely unchanged since 1889, when a young William Osler was recruited to be the chair of medicine at the newly formed Johns Hopkins Medical School in Baltimore. Borrowing principles he learned at universities in Europe, he established the Hopkins’ residency model, originally named because doctors-in-training lived in the hospitals where they apprenticed. He also recognized the importance of bringing students to the patient’s bedside during their early training, understanding that basic scientific principles are better retained when applied to real-world illness.
Contributing Writer
University of Minnesota Medical School
My name is Nate and I am in the Class of 2017 at the University of Minnesota Medical School in Minneapolis. Writing is an excellent release from the hustle and rigor of medical education. It is also an activity where I get to make the decisions, which is somewhat unfamiliar at my stage of training.
