This past weekend, four of my M1 classmates and I had the wonderful opportunity to attend the 2020 APAMSA Region V Conference – Finding Your Voice hosted by the APAMSA chapter at the Ohio State University College of Medicine! The Asian Pacific American Medical Students Association (APAMSA) is a national organization that brings together medical and pre-medical students across the U.S. through local, regional, and national events. The organization’s mission is to promote the health of the Asian and Pacific Islander American (APIA) community and to address issues that disproportionately affect APIA individuals while serving these populations in a culturally sensitive manner.
Shannon Jiang, Curtis Kuo, Daniel Yang, Angela Yim, and I represented the UMMS chapter of APAMSA, also known as the United Asian American Medical Students Association (UAAMSA) here on campus. We made the three-hour drive to Columbus, Ohio last Friday afternoon, and had the chance to get to know each other even better than we already had through some fun conversations on the car ride and throughout the weekend. When Saturday morning came around, we headed off to the incredibly beautiful Ross Heart Hospital for the conference, and met several medical and pre-medical students from all across the Midwest region. First, we heard from State Senator Tina Maharath, the first Asian-American woman ever to be elected to the Ohio Senate. She overcame great adversity as the daughter of Laotian refugees, and she is now tremendously involved in her community and advocates for diverse representation in politics. I was then mesmerized by Dr. Peter Lee, a practicing cardiothoracic surgeon who impressively merged his various passions including Tae Kwon Do and space into his career path in medicine and research. He pursued degrees at various institutions including the International Space University, and he has flown several microgravity and spaceflight projects with support from the NIH and NASA (so cool!).
Afterwards we had several breakout sessions including a resident panel, a leadership workshop, and a discussion on breaking the APIA mental health stigma. One of the panelists that spoke to us is currently a general surgery resident who graduated from the University of Michigan Medical School and actually started the Medicine in Mandarin course that over a dozen of my classmates participated in this year! Another session featured Dr. Ron Jacob, a former Be The Match Executive Director, who addressed the inequality of available life-saving blood, stem cell, and marrow donors for ethnically diverse patients. And the last breakout session featured a dermatologist and a facial plastic surgeon who shared their personal stories and achievements (lots of words of wisdom). Finally, to end the conference, we heard from two women who have dedicated much of their lives to building strong communities through leadership in community-based Asian organizations that strive to address health concerns within the Asian population in Ohio through free clinics and local screenings.
I was thoroughly fascinated by each of the speakers and all the stories that they shared! The marvelous thing about conferences (for me, at least) is their power to inspire and reinvigorate my passion for medicine. I love having the chance to get out of the library and Ann Arbor for a weekend so I can meet and make connections with medical students at other institutions while learning about their experiences, be reminded of the importance of giving back to the community particularly in the context of health care, and hear about the roller coaster of a journey that successful practicing physicians have lived through.
Hi! We are Anita and Ione, and we’re writing today in the wake of our return from a four-week trip to Uganda and Rwanda where we participated in an experiential course about Social Medicine.
We first heard about this course nearly two years ago through the Global Health & Disparities Pathway of Excellence, of which we are both a part. At the time, we were in the midst of our core clerkship rotations, deep in the weeds learning about the presentations of various clinical pathologies and the process of disease diagnosis and management. The title of SocMed’s course, “Beyond the Biologic Basis of Disease: The Social and Economic Causation of Illness,” stood out as a chance to revisit and go deeper into the structural framework that shapes health outcomes. We both kept the course on our radar as we moved through the Branches phase of the medical school curriculum, and the stars aligned for both of us to enroll in the January 2020 course in Uganda and Rwanda, with the generous support of Global REACH.
On a village visit in Northern Uganda to learn about culture as it relates to health
Arriving in Uganda at the start of the course, we joined a diverse cohort of learners from a spectrum of nationalities, ethnicities, professions, and personal experiences for a truly global educational immersion. Approximately half of the course students were from African countries, and the other half were from Western countries. The structure of the lesson plans offered ample opportunities to share and learn about the similarities and differences of our different contexts. Thus, as students we were also each others’ teachers, and through this approach we learned from our fellow classmates in ways that would have been impossible to organize into any kind of syllabus.
The curriculum of the course ensured that we spent our days exploring the structural causes of disease and the response of health systems to these structural causes, not only through conventional techniques like classroom-based lecture, discussion, and group projects, but also through reflective writing, dramatic expression, and place-based site visits. These layered exercises in critical thinking and action (termed praxis) encouraged us to interrogate how and why health systems are structured, and the considerations that must be given to demand, resource availability, and resource distribution. Moreover, the course structure left space to discern the values that define these health systems, and what implications that has for health equity.
Anita and Ione at the peak of Mount Kalongo!
However, we didn’t stop at the level of health systems: we also investigated the role of social movements in addressing structural causes of disease, and implementing the principles of advocacy for change. We practiced engaging with these practices in an intrinsically personal way: by drawing upon our personal histories and situating those within the work we do, we can approach action, agency, and change from a place of authenticity and security. Moreover, we can give ourselves the space to reflect on how we, too, are a part of the structures we choose to critique, and how power dynamics and systems of oppression that we might learn about in an abstract sense unfold on deeply personal levels. After completion of this course, we both feel inspired and motivated to use our voices as future physicians to engage with our communities at a grassroots level, and organize to effect change at a structural level!
Each year, the Universidade de São Paulo Medical School in São Paulo, Brazil hosts Winter School. It is a program that brings together medical students from all over the world to further develop and explore their interests in various medical specialties such as psychiatry, neurology, tropical medicine, surgery, cardiology, OB-GYN, and dermatology, just to name a few. Didactics and hands-on clinical experience take place at the Hospital das Clínicas medical complex, which is the largest hospital system in Latin America. While participating in the program, students are integrated into medical teams according to the specialty of their choice and take part in clinical care alongside residents, medical students, and attendings just as they would at their home institutions. University of Michigan Global REACH offers travel grants to medical students who participate in Winter School.
My classmates. 24 countries…60 new friends!
What really set the tone for the entire experience was the official welcome on orientation day. There was genuine excitement among the members of the University that we were joining their school, even if for a short time. As they introduced the history of the school and the mission statement for Winter School programming, the term “academic internationalization” stuck out to me. It was the term they used to communicate their belief that their medical students were better able to provide care to their patients when they invited other cultures and ideas into their sphere of practice. This openness laid a foundation of respect, curiosity, humility, and cooperation so that as we set off onto our respective rotations, we did so excited to learn about one another and this new health system we were so privileged to join.
During my rotation in Trauma Surgery, we completed a mixture of didactics, ultrasound/surgical skills labs, OR observation, and rounding with patients on the ED, ICU, and general wards. These experiences typically sparked in-depth case discussions as we followed our patients throughout the course of their treatment and explored the nuances of care within our international team. What was awesome about the clinical experience was that our reception on the wards as Winter School students was just as welcoming as it had been on orientation day. Everyone was excited to chat with us, to teach, and to give their time to make this experience a superb learning opportunity.
I still remember some of the “cool” cases we saw, but more than anything what I remember is how the attendings and residents went above and beyond to make sure we felt valued as clinical colleagues and as guests in their country. For the duration of Winter School, the attending physicians and residents halted all of their normal clinical activities and dedicated all of their energy to teaching Winter School students. That was no small feat for such a high-volume medical center. The dedication of so many resources to our learning and growth is something for which I will always have tremendous gratitude. At the conclusion of this time, I was truly saddened to leave the new friends I had made from around the world and this beautiful city. This was truly one of the greatest experiences I have ever had during medical school, and I think there is no substitute for what we can learn when we pair an open invitation with an open mind.
Hello! We’re Courtney and Jourdin, two M4s who have finished interviewing (for EM and OB/GYN — wish us luck in the Match!) and who spend a lot of time together as Smoker Musical Dance Demi-Czars, Biorhythms choreographers, baby animal parents, foodies, and close friends.
We also both happen to be first-generation, low-income (FGLI) students.
Though definitions may vary across institutions, most define a first-generation student as someone for whom neither parent has a Bachelor’s degree. Low-income students are often identified by eligibility for Pell Grants — grants the federal government provides as part of financial aid for undergraduate students meeting an income threshold. As you can imagine, there is often overlap between these groups. Approximately 12% of our medical school community identifies as first-gen, and multiple students hail from low-income backgrounds. As M4s, we know how difficult it can be to navigate the new environment of medical school, especially without loved ones who can provide guidance. We both have struggled, lacking the social capital (and more often than we’d like, monetary capital) necessary to thrive in medicine’s typically affluent environment.
Though already friends for years, we actually didn’t know of each other’s FGLI identities until it came time to share our Impact Project ideas with the rest of our class. Here at Michigan, everyone completes a Capstone for Impact. This project can be anything. From research to workshops — your only limitation is your imagination. The school administration is extremely supportive from both a mentorship and financial perspective to really help students leave something behind at Michigan.
Both of us hoped to spend the Branches, our third and fourth year curriculum, helping to improve the experience of both prospective and current FGLI students through targeted programming and mentorship. We were thrilled to find out that we both had a shared experience and could combine our efforts. With help from some amazingly invested Admissions Office friends (shoutout to Carol and Becky!) and our fantastic mentor Dr. Okanlami (check him out on twitter!– @okanlami), our little passion project has really taken off.
FGLI students brainstorming ideas for support!
We have been so excited to see the level of support from various offices across the school, and the level of engagement of our fellow FGLI students. This engagement has been instrumental in our progress, as we used student opinions gathered from focus groups and surveys to drive our efforts. From the insight of students, we have been able to establish outreach to prospective students and send representatives to Admissions events, work with the school to secure funding and resources for FGLI students, work on consolidating the existing resources into a more visible format, and we have just recently launched a peer mentorship program. This last effort is particularly near and dear to our hearts as we both remember the loneliness that can come from trying to overcome the challenges of being FGLI in medical school when you feel like you are alone in the struggles you’re experiencing. We hope that this will provide a first step to establishing a flourishing FGLI community at Michigan, where people feel they can be open with these often invisible identities.
More recently, we’ve been trying to ensure sustainability — at UMMS, at the University of Michigan more broadly, and nationally. We have been very deliberate in our efforts to identify underclassmen who can carry on and expand our project at the Medical School, to ensure that students will continue to benefit from these efforts after we graduate (In May! So soon!). Earlier this week, we attended a First Gen Community Dinner for students across the undergraduate and various graduate schools, which gave us further opportunities to network and build relationships with people on campus who are passionate about these issues. We are also currently working with students from several medical schools across the nation to develop a national FGLI organization.
Taking on this enormous project in the context of continuing our normal medical school rotations has been challenging, but so rewarding. It has really affirmed for the both of us that Michigan is a special place where your goals and vision will be truly supported, and where you will be allowed to make a difference even as a student!
As I look back over the last few years, I find myself overwhelmed with how much has changed. In February 2018, the last time I wrote a Dose of Reality blog, I was just returning to school after having been on a yearlong personal leave. I had started a peer support program the year prior out of a selfish need to be surrounded by classmates who would unconditionally support me through my struggles. After opening up about my depression and anxiety, I got overwhelming support from the medical school community, but felt that a more structured setup should be available for other students to seek out help before a crisis hits.
In 2018, with more stable footing, and a better handle on my mental health disabilities, I was able to complete the first-year curriculum and move into the second year Clinical Trunk. Three months into the Clinical Trunk I found myself in another crisis, having just failed my first shelf exam. I was spun into another unfortunate predicament, which led me to have to reevaluate my status at the medical school. Under policies that have now changed, I had to step out of school once again, and prove to not one, but two, committees that I should stay in the school. During this time I found that the peer support advocates were such an important support for me. Instead of having to overcome yet another barrier to finding support, it was easily available with a single email. I could reach out to fellow advocates without shame or guilt, and I knew that I would be able to get through the hardship because I wasn’t alone.
Now as 2020 begins, I have finished my core clinical trunk courses, and find myself returning to the passion that drew me to found the Peer Support Advocacy Program.
The program officially had its first training in July 2018, and has since trained over 30 medical students. The training curriculum was compiled with input from various members of the medical school and central campus communities. The training focuses on the importance of emotional intelligence and the ability to be a referral agent to students who contact the advocates. Our role as advocates is to first and foremost be a good listener, identify when we can make suggestions, and help determine when our peers need resources outside of our own capabilities.
Through suggestions of the initial group of advocates, a paging number was established so that medical students could reach out 24/7, and receive support within six hours of outreach. A listserv email was also created for students to reach out with generalized questions when they didn’t know where to go. The listserv and pager are meant to cater to medical students, who work at all hours of the day and night, and may need support outside of the Monday through Friday 8-5 window in which most faculty and staff who run the medical school work.
Over the course of 2018 and 2019, programming efforts were made to help place a focus on student well-being. This mainly occurred through drop-in meetings focused on de-stigmatizing mental health in medical students and other health care professionals, and through advocate outreach in the Taubman Health Sciences Library (THSL); mainly going around to check-in during intense study periods. Marketing efforts are still in the works, with printed fliers up around THSL, counselors and other staff referring to the group, and an online presence. A page was created on the OMSE website about the program, and how to get in contact with various trained advocates. I encourage anyone reading this to follow the link to look up some of the amazing, candid, biographies of some of our advocates.
Because of the public nature of this website, I received inquiries from different medical students around the US. I emailed and called with them to help them set up similar programs at their medical school. As I started learning more about the deficiency of this type of program nationwide, myself and two staff co-leads of the program created a poster presentation, and attended the central and southern GSA/OSR joint regional meeting in April 2019. At that conference, we met more students, staff and faculty who were interested in promoting the well-being of medical students at each of their campuses. We exchanged ideas with others around the nation, and look forward to partnering more intentionally with many of those we met to create a more robust national standard for peer-led wellness programming.
On our own campus, M-HOME has worked to have peer programs, including Winding Roads, M-PACT, Near-Peer Mentoring, eMpower and Peer Support Advocacy work together to create a more cohesive road map for students navigating the different peer support resources offered. These talks continue, as each of the groups finds its place within M-HOME and the larger medical school community.
Over the next year, I hope to see the Peer Support Advocacy Program continue to grow, especially in its marketing and visibility efforts. I have just recently connected with the new Michigan Medicine Office of Wellness, and hope that the growing collaboration with strengthen our efforts. I feel so grateful to my fellow advocates, who are dedicated to change the culture of medicine, to become a more inclusive and understanding environment for health care professionals with mental health concerns, conditions, and disabilities.
Have questions? Or need to talk? Email firstname.lastname@example.org and one of our peer advocates will reach out to you. Check out our page on the OMSE website!
I used to think that the key to studying was how many hours you could put into it, but I have come to realize just how wrong that is, at least for me. Since starting medical school I have learned something that I wish I knew earlier when it comes to studying: quality is much more important than quantity. What this means is that study breaks are very important!
I also used to think yoga was just a bunch of stretching. The phrases Namaste and downward dog really didn’t mean anything to me, and being someone who could barely touch his toes, I always wrote off the practice of yoga entirely. That is until I decided to take advantage of the free, weekly classes that UMMS provides its students at Red Yoga. Without being too dramatic, I would say that taking up yoga has made such a positive impact on my life.
In my short time practicing yoga, I have come to learn a few things:
- Yoga really is much more than just a bunch of stretching.
It is as much of a mental exercise as it is physical, and that’s why I think it makes for the perfect study break. It offers me the time and space to put down my schoolwork and just focus on me and my breathing. It really is hard to describe, but the feeling I have after class is incredible. When I lay on my mat trying to find stillness I feel relaxed and empowered. Rejuvenated and confident. Sure, I feel tired from the class itself, because yoga is actually incredibly challenging, but overall I feel recharged! It’s quickly become my favorite workout.
- It’s okay to fail, and in fact, that’s a good thing!
This is something that I think is healthy for everyone, especially medical students. Even at Michigan where we have a wonderful pass/fail curriculum, there aren’t too many components of a medical student’s life where failing feels good. When you push yourself outside of your comfort zone by trying a new pose, holding one for even longer, or reaching for even more flexibility, it means you are challenging yourself and striving for growth. When you can’t hold that pose any longer and you fall, that just means you have the opportunity to get up and try again. When it comes to yoga, there is no good or bad. No 75% passing rate you need to attain by the end of the class. You’re not competing with anyone but yourself. For me, this means leaving the studio feeling better than when I walked in.
All that matters is you set an intention for yourself and you learn from your experiences. Yoga has taught me about the process of self-growth, and I think the positive components of this mindset and practice can be translated to medical school and life in general.
- It offers you friendship, community, and great music.
Being in the Taubman Health Sciences Library with your classmates for great periods of time serves as a special form of bonding. But, when you have the opportunity to take a fun study break and exercise with your classmates it really fosters that sense of community, which is nice to have in a medical school. You see students from all years and you get to even make friends with the instructors and others from class outside of the medical school. Also, I’d be doing a disservice to all of the amazing instructors at Red if I didn’t mention that they play bomb music during all of their classes. The best part is you don’t have to try and remember any of the lyrics during class to google later, because they are always happy to share their playlists with you, which supplies you with great music for future study sessions. I wouldn’t even know of some of my absolute favorite songs if it wasn’t for starting yoga!
I have come to learn that medical school will push you outside of your comfort zone. It challenges you to work very hard so that one day you have the privilege of working very hard for your patients in order to provide the excellent care that they deserve. With that said, the nice thing about UMMS is they are constantly providing us fun ways to take those much needed and much deserved study breaks. Other than funding medical student yoga at Red, there are so many other fun events such as intramural sports, whirly ball matches, ice cream socials, cookie decorating, apple orchard visits, pumpkin carving, house dinners, CAMP, and of course the M-Home Olympics. These are just a few of the many fun events that UMMS offers its students to promote wellness and the chance to connect with other students and faculty.
UMMS cares about their students and wants to make sure that they are taking time for themselves along their journey. Because of UMMS I’ve found one of my new favorite things to do. One of my best friend’s mother once told them, the best kinds of doctors are relaxed and flexible. As I said, I used to struggle to touch my toes. But now, I have already noticed I am so much more flexible and I feel more relaxed. Here’s to hoping it really does make me a better (future) doctor!
Smiling medical students after a great work out.
A Sunday yoga class that will help fight the Sunday Scaries!