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My journey to a research year in global health

My journey to a research year in global health

Are you a prospective medical student wondering how you can incorporate global health into your medical school career? Are you a current medical student considering a research year or a dual degree? Or maybe you are one of my family members who wants to better understand why I am living in Uganda for a year? Here is a bit more information about how I decided to take a year away from medical school to pursue global health research.

Global and public health are the passions that brought me into medicine. My mother immigrated to the US from Venezuela, and I grew up hearing stories that compared her life in Venezuela to my life in the US. From a young age, I was acutely aware of my own privilege and of global health disparities. I expected that I would get a Master’s in Public Health (MPH) during medical school, so much so that I applied to several dual degree MD/MPH programs in addition to MD programs.

My mentors came to Kampala and gave a talk on mentorship! Pictured are Dr. Kolars, Dr. Moyer, Catherine and Hilda.

During my clerkship year, I had two important realizations: (1) I absolutely love clinical medicine, and (2) I miss the global and public health roots that brought me into medicine. Armed with the knowledge that I made the right career choice, but also eager to learn about ways to diversify my future career and incorporate global and public health, I consulted multiple mentors. Pivotal insight came from a peer mentor, a fellow medical student, who had applied to multiple research fellowships as well as MPH programs for her gap year. It was invaluable to hear about her thought process, how she approached researching each program, and what she did to be successful in her applications. The University of Michigan Medical School invests in teaching medical students about mentorship and leadership, and my mentors were pivotal in helping me think through my gap year plans and successfully apply to a research fellowship.

In retrospect, I am glad that I did not have to decide about a dual degree during my first year of medical school. The experiences during my clerkships heavily influenced my thinking about the gap year. As I checked in with myself during the clerkships, I realized that I loved working again and learning on the job. I felt so much fulfillment from studying material that directly applied to my patients. I also realized that I struggled to focus during our three-hour lectures on Friday afternoons, and I didn’t feel as much eagerness to return to the classroom just yet. Another important factor for me was, and is, cost. I only explored fully funded programs, including funded research years and MPH scholarships.

At the NIH in Bethesda, Maryland for the Fogarty Orientation!

Ultimately, I learned of the NIH Fogarty International Center global health research fellowship through my mentors. The fellowship is a 12-month global health research training program for post-doctorate and doctoral trainees in the health professions. It is awarded through the University of Michigan, which is part of the Northern Pacific Global Health (NPGH) Fogarty research fellow consortium that includes the Universities of Washington, Hawaii, Indiana and Minnesota. Respective projects range from researching the continuum of care for triple negative breast cancer to diagnostic algorithms for tuberculosis meningitis to community-based death investigation of childhood mortality. What excited me most about the Fogarty program is that it would allow me to genuinely delve into global health research, own my project from start to finish, get on-the-ground experience, and have the space to reflect on what I want my career path to look like going forward. During my research about the Fogarty program, I felt that the fellows and program directors strived to approach global health research in an ethical, collaborative and sustainable manner.

Mentor team meeting in Kampala with Dr. Cheryl Moyer, left, and Dr. Peter Waiswa, center.

In order to apply, I had to find a research mentor based at the University of Michigan as well as a local research mentor based in one of the consortium’s partner countries. Next, I had to develop a project with my mentors, write a research proposal, and outline my previous experience in research and working abroad. I prioritized finding an excellent mentorship team because my prior research experiences taught me that mentorship can not only influence the success of the project, but also can define the extent of my personal growth and learning. Since I was in the midst of my core clerkships, I met potential mentors during the evenings and on my days off. I found that dedicating specific time and energy to networking with and identifying faculty who would be best positioned as well as willing to support me was an invaluable step of the application process. I am fortunate to have found a phenomenal research triad in Dr. Cheryl Moyer, Dr. Peter Waiswa and Dr. Joseph Kolars.

Many people asked me why I did not consider a two-month away rotation with a small research component instead. The short answer is I didn’t feel that would adequately allow me to reach my goals. I preferred to seek an immersive experience where I could fully own a project, learn research skills while directly applying them to my project, and gain an intimate understanding for what it takes to conduct global health research. My journey to the Fogarty fellowship required me to reflect on what I want and how I learn best. I can confidently say I made the right decision. I am incredibly grateful to the University of Michigan Medical School and the Fogarty International Center for the opportunity to pursue my passions.

Stay tuned for another blog next year with updates about my research project!

Snapshot of rooftops in Kampala

Traveling to San Diego for AMA Interim Meeting

Over the past week, I’ve been taking advantage of a flexible fourth-year schedule to be in San Diego, CA for the American Medical Association (AMA) 2019 Interim Meeting. This year, I serve as the student voice on the AMA Council on Medical Service, which seeks to understand the social and economic aspects of health care delivery in order to recommend relevant policy changes to the AMA House of Delegates.

One of the reports produced by the Council addressed additional mechanisms to address high and rising pharmaceutical prices, with recommendations that were adopted by the House of Delegates. The Council also addressed Financial Incentive Programs (FIP), in which insurers or employers encourage patients to use tools to compare prices on health care items and services. The House adopted a set of guiding principles that employers and insurance companies should incorporate into FIP design to promote transparency, prevent sacrificing quality, and avoid fragmentation of care.

View from the Michigan State Medical Society reception

The Medical Student Section introduced several policies this meeting that passed, and one that I am particularly proud of asks all medical schools to protect medical students from the financial costs of potential needle-stick injuries (and other exposures to infectious or environmental hazards in the course of their medical student duties). Timely intervention is needed to prevent disease and cost should not be a barrier for students.

Throughout the residency interview process, I’ve run into friends and colleagues from around the country that I’ve met through the AMA. I’m grateful to be able to hear their perspectives on all the places they’ve trained. During interview season, I’ve also been grateful for our medical school’s HOST program, which has helped me connect with medical school alumni to stay with for interviews. It has made the process more enjoyable and affordable. Only 120 more days until Match Day!

In addition to crafting policy, I fit in a visit to the San Diego Zoo!

 

 

 

 

 

Learning Outside the Classroom – The Doctoring Curriculum

There are many great medical schools out there, but there is one thing that distinguishes the University of Michigan Medical School from all of the rest. It is the reason I chose to attend and the reason I continue to fall in love with it day after day. It is the people that make this place the best place.

During our first year, we are assigned to a small group of 10-12 students and two faculty members in a course called “Doctoring.” We meet every week for four hours to learn about the things you can’t learn in lecture or from a textbook—we learn about the things that will make us great physicians one day. We are taught about how to do different aspects of the physical exam, how to deliver bad news, how to listen effectively to our patients, how to combat bias, and so much more. We are given time to work with standardized patients, which are people from the community who volunteer to serve as our “patients” in order to allow us more opportunities to practice our skills. Not only has the course made me feel much more prepared to engage with patients during clerkships next year, but I was fortunate enough to be assigned to the best doctoring group with the most supportive classmates and the most incredible faculty members.

We have the youngest person in our class and the oldest person in our class with a total age gap of 21 years. Each person has a unique background and incredible experiences. We have a wide variety of religious beliefs, races, ethnicities, and more. Despite all of these differences, when we come together for our weekly sessions, we mold quickly and easily to the little family that we have become. We catch up for several minutes about how everyone has been doing and then we proceed through our session. We usually laugh so hard we cry, Dr. Klein tells a funny joke, Dr. Fine amazes us with his eloquent words, and we chow down on the snacks that everyone brings. Not only do we get to enjoy spending time with each other in the classroom, but Dr. Klein often has us over to her home to enjoy dinner. Their previous doctoring students are invited so that we can get the chance to meet more M2, M3s, and M4s. The four hours we all get to spend together are always the best four hours of my week.

The greatest group of people you will ever meet, right before performing our cardiac physical exam!

Dr. Fine and Dr. Klein (and the rhyme is fun, too!) always go above and beyond to teach us everything they can to make us better future doctors. For example, they held an extra session last week to review heart sounds with us so we could feel more confident about identifying them. They both seem to have a way of explaining things that just “clicks.” Somehow, we always end up having hundreds of questions for them and they are always so patient and willing to answer anything we ask them. They always offer the best advice and recommendations on how to communicate with patients. I hope one day I can be half as good of a doctor as they are. I often think about how fortunate I am to be learning from some of the greatest doctors out there.

Furthermore, one of our faculty members serves as our evaluator and the other serves as our coach. Our coach has no impact on our grade, which allows us to have someone we can go to with any concerns we have and to serve as another way for us to seek support should we need it. Dr. Klein has become more than a coach to me, she has become the best mentor I ever could have asked for. No matter what I need, she will drop anything to support me. She listens with the truest concern and empathy, and always knows just the right things to say. She creates a space where I feel like I can tell her anything that’s on my mind. The last time we had a 30-minute meeting scheduled, we ended up meeting for over an hour just to catch up on everything going on in my life. The best feeling is knowing there is someone there for you providing unwavering support in anything you need.

I am so thankful for all of my classmates, advisors, staff, faculty, and instructors at the University of Michigan Medical School, but I am even more thankful for my doctoring group who has taught me so much more than what I could learn in the classroom.

Dual Degree MD: Pursuing an MBA in the UK

In between my M3 and M4 years, I pursued an MBA at the University of Cambridge in the United Kingdom. While obtaining a dual degree at the University of Michigan Medical School is relatively common, running halfway around the world to do so is not. I went through a mix of emotions as I left Ann Arbor to travel to Cambridge, including excitement, fear, and curiosity. I was excited to open up this brand-new chapter of my life in a totally different country at one of the world’s most famous universities. I understood that I would be attending the same institution where individuals such as Newton, Darwin, Hawking, and Mandela (only to name a few) made their mark on humanity. Yet, I was afraid to leave everything and everyone that I knew back in the USA. Suddenly, I would be in a long-distance relationship, six time zones apart from my family, and immersed in a professional and cultural world completely foreign to me. Fortunately, a medical student in the year above me (Steph DeBolle) trailblazed the path for me at Cambridge, but nevertheless, I knew that it would be me and me alone out there for a full year.

On my first day of school, I felt like a Kindergartner starting fifth grade. Prior to business school, I hadn’t even opened up a corporate finance book, and now, I would be in the same classroom as people who oversaw eight-figure transactions at organizations such as Apple, LVMH, and Alibaba. Moreover, as the second youngest person in my class, I felt as if my experience (or lack thereof) could not possibly contribute to the overall diversity of the class. I mean, one of my classmates was an Emmy Award-winning director—come on!!! Nevertheless, I knew that by the program’s completion, I wanted to obtain the strategic toolkit necessary to streamline adequate health care delivery for low-income individuals.

After getting into the stream of things, I began to realize that the business school at Cambridge was a ton of fun. I mean a TON of fun. Cambridge is a unique place. Not only is the city itself breathtakingly beautiful with over a thousand years of heritage, but it also sits just 48 minutes away from the heartbeat of Central London. Therefore, I not only lived in a picturesque city surrounded by the glorious English countryside, but I also had easy access to one of the world’s most buzzing and sought-after cities. My classmates quickly became my friends, and through working alongside them on projects as diverse as innovation benchmarking to pharmaceutical market expansion, they taught me a wide range of skill sets that I would have most likely never learned while in medical school. Additionally, since over 90% of my class was from outside of the UK, my friendship circle became rich in both national and professional diversity.

Crowd surfing at a Coachella themed party in Paris, France.

One of my favorite parts about the University of Cambridge is the college system. The university itself is made up of 31 different colleges that are sort of like Houses in Harry Potter. Each college has a campus, where conference rooms, bars, and boathouses can be found. I was part of St. Catharine’s College, a historic college housed in the center of the city. While at Catz, I played on the football team, where I was continuously ridiculed for calling the game soccer.

However, my sports involvement was not just limited to Catz football. One of the highlights of the MBA was MBAT, a European athletic competition held each year in Paris, France. Imagine something like this: what if all of the universities in the Midwest, such as Michigan State, Northwestern, OSU, and others, each participated in a giant three-day sports tournament that capped every night a massive themed party. Now imagine that this tournament was full of super fun with athletic individuals from all over the world and housed in Paris. That was MBAT. There, I played soccer, basketball, dodgeball, and touch rugby. To say it was a blast is a massive understatement.

With my Global Consulting Team in Beijing, China.

Throughout the course of my MBA, I participated in projects that took me as far as Bangkok and Beijing and as near as East London and Ipswich. I helped organize a conference that featured the former President of South Africa and I met the former CEO of ICBC. I skied in the Swiss Alps and swam in the Albanian Mediterranean. My friends are currently working for Amazon, Google, and Shell, and they live in cities like Tokyo, São Paulo, and Singapore.

Out at the main Souk in Doha, Qatar.

For me, pursuing an MBA at Cambridge was nothing short of remarkable and as a future physician, I plan to translate my business background into equitable health care delivery for low-income patients. Moreover, if I ever choose to partake in global medicine, the world will now be much easier to access due to my personal connections. For me, going to Cambridge made the most sense. Even though I had to temporarily leave everything behind, I certainly gained more than I could have ever imagined. I believe that no matter what you want to do while you are a medical student, a path for you exists. Whether it was pre-formed by someone else or completely off the beaten path, where there is a will, there is a way. Therefore, I say go for it!

Apprenticeship in the Branches – a day in the life

My Thursday morning that week offered quite a different pace than my research rotation. I was in a bustling Pediatric Cardiology clinic, reading EKGs and staring at the black and white images of echocardiograms with my attending. We came back to the workroom and I prepared for our next patient, a pre-operative visit. I went in first, asked pertinent questions, conducted a physical exam, and stepped outside the room to review the patient’s case with my attending. We then both went in together to discuss the procedure and answer the multitude of questions of the appropriately nervous parents of an infant with a cardiac defect.

The next week, as I practiced inflating the catheter balloon after the procedure was over, I reflected on how crazy the past few hours were. They were almost seamless with the team working together as one unit. I recalled the numbers signifying chamber pressures mumbled through the headset, the precision of the interventionalist’s hands guiding the wire into the heart using only 2D images to guide her, and the immense gratitude of the baby’s parents at the success of the procedure. Dr. Whiteside and I went through the procedure in more detail afterwards, she had just completed closing an atrial septal defect, a hole between two of the chambers (atria) of the heart. I was able to conduct a pre-operative clinic visit, shadow Dr. Whiteside (a pediatric interventional cardiologist), and learn more about the field of Pediatric Cardiology through the apprenticeship in the Branches, the last phase of our curriculum.

An apprenticeship allows for students to work with a faculty member once a week. Depending on your field of interest, this can be in a clinic, which allows for the opportunity of following patients longitudinally, or in the OR if procedures are more of your interest. The flexibility of the Branches allowed me to do both. I was able to work with Dr. Whiteside in her clinic, see patients independently, and establish longitudinal relationships with patients and their families. I was also able to shadow her and her colleagues in the catheterization lab, which furthered my passion for pediatric cardiology.

The apprenticeships also give you a closer look into the life of an attending physician. It allows you to build a closer, longitudinal relationship with a faculty member and develops into a mentorship role as well. I was able to work with Dr. Whiteside and learn from a clinical perspective, but our conversations spanned from tips for applying into residency to her experience as a fellow and attending in Pediatric Cardiology to our favorite episodes of House Hunters. This kind of relationship and coaching would not have been possible without a program like the apprenticeship, or the Branches.

Med school is making me a better runner, and here’s why

One of the most frequent questions I’ve received is: medical school and competitive running, how do you do them both? Along those same lines, many people have asked me if I plan on continuing to run at a high level as a medical student or if I even will continue to keep up the sport at all.

I had deferred from answering these questions on this blog given that when they began pouring in, I had spent mere days enrolled as a student. Honestly, I feared answering how I did both before I was confident that I could do both. After years of hearing people say that medical students could not pursue anything outside of their studies, I certainly harbored a few doubts.

I am now five weeks, three quizzes, and well over three thousand slides into medical school, and I am excited to report: running and medical school, I am doing them both.

Not only am I doing them both, but I am actually getting the most consistent and solid training I have had in years. A cursory look back in my log shows that I have run more weeks in a row since I started training in April than I have in over three years. I am investing money in the bank each week with two workouts, a long run, and two lifts, the same framework that led me to success in earlier parts of my career. In other words, my training is as good as or better than it has ever been.

Logistically, I believe I am able to find this balance for a few reasons:

  • Running on teams in high school and college was one of the most formative and important parts of my life. It taught me countless lessons about life and the sport, and I am beyond thankful for it and the relationships I made as a member of those teams. However, as Ecclesiastes 3 mentions, there is a time and place for everything, a season for everything under the sun. Right now, I am in a season of life where time is a little bit more in demand than during high school or as an undergraduate, so official membership on a team with daily meetings adds a time-consuming element that I cannot afford. Rather, as a post-collegiate, I am able to pick and choose when I am able to invest time in running and working out with others, but also run or work out between classes and adapt to my schedule on the busier days.
  • UMMS’ exam system is called “flextime quizzing,” where exams open on Friday afternoons and close on Sunday evenings. We are able to take the exam whenever is most convenient for us during this timeframe. This makes it possible for students to have different study habits during the week because we aren’t all forced to take an exam on Friday evenings. Some students grind to the nth degree (you go, Glen Coco) during the week, take their quizzes at 3:00pm on Fridays, and are free until Monday at 8:00am. I take a little more relaxed approach, mixing studying and training during the week and quizzing on Saturday afternoon or evening. This flexibility in exams dispels the idea that medical students can’t pursue anything outside of their studies, and it shows that Michigan believes that its students are at their best when they have the opportunity to continue to pursue what made them special in the first place.
  • I am a pre-clinical student, which means that for the most part, I am not yet on the wards. A majority of our learning right now occurs in a classroom or small group setting; we are even able to stream most lectures. This means that I have a fair bit of control over my time and learning style. Next year, when I become a clinical student on rotations, I am going to have to change my approach to running again. I hope that I have another one of these posts to explain how I am doing it!  
  • Anatomy lab showers. Gotta make do with what you’ve got.

Furthermore, for me personally, I think there are actually benefits to pursuing medical school and running simultaneously! Medical school is actually making me a better runner right now, and here’s why:

  • First of all, running in medical school has given me vastly more flexibility in my training schedule, allowing me to more closely match my body’s needs. Instead of having a strict schedule to adhere to based on the availability of my teammates, I am able to assess where my own body is at any given time on any given day, and then work relative to that level of physical and mental readiness. This means that for the first time potentially ever, I think I am truly running easy runs easily, choosing four miles instead of six when needed, and ripping off some faster splits when my body is primed and ready.
  • Since running is not my only high-level pursuit, it means that I stress far less over it. This leads to a much more stable, measured day-to-day effort, and hence the ability to rack up training long-term. This long-term training is key to building up an aerobic base for performance later in the season, and it’s also something I have not been able to do well in years.
  • The challenges of medical school have helped me, to use a cliche, see the forest for the trees. I now more than ever see running as a gift and a break, something to look forward to after a long day of studying. Workouts, rather than a big red X in the calendar to be feared, are again a highlight of my week. Performance in these workouts means little compared to the freedom and joy that time outside and pushing my body give me, so there is no need to panic over a slower interval. Furthermore, after spending so much time studying and achieving intangible things, it is comforting to log miles and write them in my running log, markers of accomplishing little somethings in a long day of lots of work, but with not much to show for it.
  • Thus far, school is unimaginably unmanageable. There is just too much information to know it all, and to know it all perfectly. Recognizing this is helping me to shed my perfectionist tendencies and focus on the process of learning and being a human being. I think being an adherent to “the process” (-Mike McGuire) instead of living or dying by the outcome is only going to help my running, too.

In whatever career field you’re in, I believe that it’s essential to continue to do the things that make you you. It keeps you grateful for life and your career, and it makes you resilient when your career (or life) gets hard. Running and faith are two important things that keep me grounded and grateful, so it’s essential that I keep pursuing them in addition to my studies.

For those of you interested in my upcoming running-related goals… (1) qualify during a spring race for the US Olympic Trials 10,000m in June 2020, and (2) get fit and race a bit along the way!

This post originally featured on Erin’s personal blog, which you can follow here.