Thursday, May 31, 2007

The Quest for Summer Medical Education

So, since I have 4 months of summer vacation, I decided I should do something more productive with my time than sit here and do nothing all day. Last summer I was taking a class to get my EMT-B license (Emergency Medical Technician – Basic; the lowest level of Ambulance training there is), shadowing an ER doc, let's call him Dr. M, at my local ER, as well as shadowing a neurosurgeon (actually, the Head of Neurosurgical Trauma), Dr. C (who should really be called Dr. Ridiculously Smart & Awesome…or something along those lines).

First, a bit of history:

Dr. M was the doc who was always on at the ER when I was doing my Volunteer shifts. When it came time to do my preceptorship in the summer before first year, I chose Dr. E (another ER doc), because he seemed 'cooler'. Bad choice. He is an amazing doctor and gets the job done, but I felt he could be quite rude, at points, and had a bit of a short fuse. To be honest, I'm kind of like that too, at times, which may be why when Dr. E went on vacation, I asked Dr. M if I could shadow him. Dr. M has been doing practicing Emergency Medicine for 30 years. He's a Navy guy, but is very relaxed and laid back, and tends to let the younger docs pick up more shifts, so he can have more vacation time (after 30 years, I'm sure I'd be doing the same). So I started shadowing Dr. M on most of his shifts, and he never seemed to mind. When I left, he said I could come back whenever, and I took him up on that when I returned last summer. The Medical Staff office has a short form you can fill out, defining yourself as a medical student, and allowing you to "Observe" a physician – essentially a shadowing position, exactly what I was looking for.

I was introduced to Dr. C by the Volunteer Coordinator, a nice lady who looks after the Volunteers. She felt that this would be a good fit, as Dr. C was new to the hospital, but was very eager to teach students. I started shadowing Dr. C in his office, which is in a Medical Office building on the hospital campus, and once I got the "Observer" status, I was allowed in the OR as well – he even taught me how to scrub in. He also said that I could come back this summer, but we'll get to that later. Funny story about my first day with Dr. C: I was going to his office straight from EMT class (class ends at 12, first patient is at 12.45). The hospital was only 20 minutes or so away, so I figured I had plenty of time. I threw my volunteer outfit in my backpack to get changed in the Volunteer office. All was going well until I was about to turn into the hospital campus, when I realized I was wearing my flip-flops, and didn't have any shoes. What was I to do? So I start going as fast as I can towards my house, obeying all speed limits, of course, but every single thing that goes wrong can. The exit for my house off the freeway is blocked. One street from my house, there is a large forklift in the middle of the road, suspending a large amount of wood in the air. There doesn't seem to be much movement, the forklift operator seems to be staring off into nowhere. Of course, I encounter this on the way back to the hospital as well. Overall, I was maybe 30 minutes late, gave a fake excuse of traffic and an accident on the freeway, and all was well. I tell them of this story now, and they love it – but it was way too nerve-wracking for my first day.

So, back to the real reason for this post: This summer. Having shadowed physicians for 2 summers now, I'd like to try and practice my skills (see my previous post). The first thing I did was write a letter to a family friend, who is a Family Practice doctor in a private office:

"Dear Dr. B,

My name is AMiB; I believe you know my parents D & D of [our Pharmacy]. I have recently completed my second preclinical year at the Bute Medical School, University of St. Andrews, UK, and am looking to spend my summer developing clinical aptitude in preparation for my clinical years to come. As part of our curriculum at the Bute, I have completed my theoretical studies of the Cardiovascular, Respiratory, Gastrointestinal, Renal, and Reproductive Systems; studying, in turn, the Anatomical, Physiological, Pathological, and Pharmacological aspects of each. As well as these, we have learned basic clinical and communication skills (see attached sheet of Scope of Practice). I feel that I must disclose, however, that both the Central Nervous and Endocrine Systems will be covered next year (our final preclinical year), and as such my knowledge of these fields is lacking.

My ideal situation for this summer would be that of a medical student, seeing patients, presenting to an attending Physician (preferably you or one of your partners, if willing), and learning about necessary treatments. I believe that learning by doing is a method that has been tried and tested in the medical education tradition for years, and I would like to continue that this summer. The knowledge I would gain, and the communication skills I would develop would be an invaluable addition to my medical education, and I would be deeply grateful.

If you are unable to have me for too long or feel that I am asking too much, I would still be honored if you would let me shadow you for a few days to get a feel for what Family Practice is like. Also, if you know of any clinics in the area that accept medical students in this role, or know of any other physicians, in any specialty, which might be willing to have me around, please put them in contact with me.

Attached, you will find my Scope of Practice, letter of indemnity coverage from the MDU (Medical Defense Union), and a letter from the Dean of my medical school approving my work for this summer."

I haven't yet received a response, but am hopeful. I also wrote a letter to an Internal Medicine doc that I met in the ER last summer. He is from India, and I'm hoping I might be able to pull the "we Indians got to stick together" card. But we'll see.

So yesterday I went to the hospital to see what I could do. Dr. C's office was all out to lunch, so I went and said hi to the Volunteer office. They offered me a Volunteer position, but there are a few people ahead of me to get set up with doc's, and I'd rather give that opportunity to a high schooler looking for something to put on their college app – after all, that's what I did. I went to the ER, and it turns out Dr. M is on vacation for all of June. I went to the Medical Staff office, and all but pleaded with them to give me privileges. Nothing. All I can do is Observe. They mentioned something about California State law and not being able to practice medicine without a license. They made it sound like I was trying to open up my own hospital – all I want to do is a simple H&P! Maybe start an IV or two, CVS exam…anything? Jeez…

Today I went back, said hi to Dr. C's office. This is why I think he is Dr. Amazing – he is going to ask around with some of his colleagues, Internists, Family Practice, and see if anyone is willing to take me on for the summer. He said he'll get in contact with me, so I'm anticipating an email from his office manager. While I'm not too hopeful, I'm really wishing something will come of it.

So I left my hospital, and went to another hospital down the street – they're all owned by the same overall organization/corporation (non-profit), but this was a different hospital campus altogether, and hopefully I might be able to find something here. Nope. Their office gave me the same deal – actually, their "no way" was much more enthusiastic than I got at my hospital. They told me that the law prohibits any patient contact from someone who is not licensed to practice medicine in the State of California. However they do have clerkships for final year students, but it is very difficult for International students to get approved for this.

I left very frustrated with the whole system. Honestly, why is it such a big deal? I'll sign your HIPAA forms, I won't give out medical advice, but let me do something! Sometimes, part of me wishes that I stuck with it and went through the American medical education system. I guess all I have to do is wait one more year until my clinical years start, but I tend to be a bit impatient sometimes.

If anyone out there has any advice, any connections, or any loopholes they know about, please, share them with me, either in the comments, or at veerthetiguy –AT- sbcglobal –DOT- net.

I'll be sure to keep everyone updated about the situation, but it looks like it'll be Observation only once again…

Until later,


Saturday, May 26, 2007


"After taking Urigrow(R) for just one week, I could see results like a thicker stream, less spray, more froth, and louder, deeper sounding urination."
From a recent episode of Saturday Night Live, if anyone was wondering.

Enjoy :-D

Tuesday, May 22, 2007

"Well, the patient doesn’t appear to be UNDERweight…"

So for the past two days I’ve been a simulated patient for the 3rd year OSCEs. This is my second time doing this, and it’s definitely a different experience being on that side of the bed. Yesterday I was the patient for a neck exam (“This patient has come in today because of a suspicion of an overactive thyroid. Perform an examination of the neck, focusing on the thyroid gland.”), while today I was the patient for cardiovascular system exam (“Please perform an examination of the cardiovascular system, leaving out abdomen, peripheral pulses, BP, etc” [it’s only a 5 minute station – how much can you really expect to get done?). It’s always fun to notice the slight differences from student to student, whether it is because they were taught by a different demonstrator, learned little tricks during practicing, or just practiced differently. You can also almost always tell who has practiced, and who hasn’t (which is funny, because they knew exactly what was going to be on the exam because they were told so weeks in advance). I found that the students with excellent communication skills and confidence in speaking would be very nervous when it came time to the examination; and those that were quiet or shy would know exactly what signs to look for and didn’t miss a thing. Maybe it’s compensation, maybe not. But there were also the handful or so who were amazing at both – and it’s probably those who got full marks, although having peeked at the marking sheet, it didn’t look like their attitude to the patient or whether they hurt me during examination or not (seriously, some of those guys can be rough!) had any effect on their grade.

Best lines from the two days:
• During neck exam, on General Inspection: “Well, the patient doesn’t appear to be underweight…”
• During CVS exam, when finding apex beat: “Apex beat is not palpable due to excess body fat.”

And now I embark on my long night of packing, as I leave for home on Thursday.

Until next time,

Saturday, May 19, 2007

Two down…Four to go!

As of yesterday, and pending exam results, I am officially done with my second year of medical school. 2/3rds of the way done with my time in St. Andrews, and 1/3 of the way done with my entire medical school career. It's quite scary actually. Having read so many news articles and blog posts about problems in the healthcare systems in both the US and the UK, I get worried of what the future holds in store for me. However, my long-term fears are overshadowed by my short-term fears, namely my exam results for this semester, and the USMLE Step 1. Having seen more and more examples of how much there is left for me to learn to even pass, let along score well on, this exam, I have decided to start studying (although lightly) this summer, rather than leaving it all until the summer after my final preclinical year. I've been mentally compiling a book list (and hoping that my parents will shell out even more money towards my education than they already have). Besides my sister's copy of First Aid for the USMLE , I've already purchased a copy of Goljan's Rapid Review Pathology, and will be looking into some other titles like Board Review Series Physiology and Lippincott's Pharmacology. Hopefully I will be able to focus and motivate myself to actually spend a significant portion of my summer reading medical textbooks. We'll see how that goes.

However for the rest of the summer, I will hopefully be returning to my local Emergency Room to learn from the amazing professionals that are ER doctors and nurses. Last summer I shadowed a couple of ER docs, but as a Medical Student Observer. My role was literally to be a shadow – wasn't technically allowed any patient contact – no histories, no exams, nothing. It's understandable, seeing as how we're not a Teaching Hospital. But it's a bit frustrating KNOWING how to start an IV, but not being allowed to do so. So I found out that the good people at the MDU (Medical Defense Union) do free indemnity insurance for their Medical Student members, membership of which was also free, and I signed up for (to get a free dictionary) at the beginning of first year. So I went to their site, filled out a simple form, and now have a document stating:

    "Please accept this letter as confirmation that you can look to the MDU for discretionary benefits during your elective in the USA, including:

  • Assistance with clinical negligence claims and indemnity for legal costs and damages awarded against you
  • Subject to each claim being considered on its own merits there is no limit on the value or number of claims which can be considered for any member who has this type of student membership
  • Access to our 24-hour medico-legal advice
  • Access to indemnity for Good Samaritan acts"

However, there's a catch:

    "These benefits are available provided that:

  • The elective is authorised and approved by the Dean of your medical school.
  • Any work that you undertake is at the request, and under the direction, of an appropriately qualified practitioner.
  • Any work that you do must be within your competence and expertise."

Now as you can see, I have emboldened one of the main hurdles I have to get over: getting permission from the Dean of my school. I have sent him an email explaining my position, but have yet to hear back from him (apparently he is out of town till Monday – hopefully I will hear word then).

Now, if everything goes well with the Dean and the MDU, then the last major hurdle I would have to jump is to actually get the hospital to let me do things. When I get home, I am going to try and set up an appointment with whoever is in charge of Medical Privileges. This might be hard to do, but I am going to try my hardest. Hopefully I can combat the "our insurance doesn't cover you" argument with my MDU form, and provide a scope of practice for me that is approved by my Dean. I am very sceptical that I will be able to convince them, however, which is why I am trying not to excite myself too much. But honestly, is it such a big deal that I want to practice my H&P's? I'd rather not spend three and a half months lying around at home doing nothing (it sounds appealing now, but quickly becomes boring). This is why I'll also be taking an ACLS (Advanced Cardiac Life Support) class, to hopefully get a certification that I can add to my CV.

That, and I can always look forwards to our family vacation.


Until next time,


Friday, May 11, 2007

Manchester Hospital Allocations

Today was the last day to fill out the form for our Hospital Choices for our clinical years in Manchester. So obviously, I filled them in yesterday :-P

My choices were in the following order:
1. South (Wythenshawe)
2. Preston
3. Central (Manchester Royal Infirmary - MRI)
4. Salford (Hope)

Will elaborate further after exams (Short Answer Questions on the 14th, Multiple Choice on the 16th, and OSPE [Objective Structured Practical Exam] on the 18th)


Tuesday, May 1, 2007

Grand Rounds

Grand Rounds are up at Shrink Rap.

My post, "In My Mind", has been fortunate enough to be included in this weeks roundup. So head on over and get a overview of the past week's medical blog posts!