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Calling for Better Measures: Health Policy Research

I first became interested in health policy when the Affordable Care Act was being discussed in the news. I was in high school at the time. I remember feeling uncomfortable with how money (or lack thereof) affected people’s access to health care and decisions made by their doctors. Several years later, I have a slightly better understanding of the “why” and “how,” but I still do not like it. Since money will always affect healthcare, whether we like it or not, one career goal of mine is to help make sure there is as little harm to patients as possible.

At Michigan Medical School, I have learned about many fascinating health policy topics as a part of the Health Policy Path of Excellence. One example is government health care programs that assign hospitals financial penalties and rewards based on their performance on quality metrics. The idea is to give hospitals financial incentives to treat their patients better – instead of making more money only by treating more patients.

This sounds like a great idea in theory, but it is hard to implement in reality. Things get complicated when hospitals are compared to each other, since different hospitals take care of different populations of patients. Hospitals should not be penalized if the patients that walk in their doors happen to be sicker. Also, if payment programs do not account for patient characteristics, hospitals might avoid treating patients who are sicker at baseline. This could lead to inequities in care. Fortunately, there is a potential solution to these issues: a statistical method called “risk adjustment.”

However, what variables should be measured as part of the risk-adjustment process is controversial. Study after study has found that social factors (like wealth and education) are just as powerful as medical factors (like hypertension and diabetes) in their effects on health outcomes. This begs a very interesting question: should “social determinants of health” be included in risk-adjustment models used to model medical outcomes? If so, how should they be measured? (There are compelling arguments both for and against risk adjustment for social factors. You may be surprised. If you are curious, you can read more here!)

I was able to take a stab at this question while working on a research project with mentors at the U-M Medical School, the School of Public Health, and the School of Nursing. We just published a paper in JAMA Network Open, finding that the current methods used by programs like the Hospital Readmissions Reduction Program (HRRP) to account for social risk factors may be less successful than they claim to be. So, if programs like HRRP want to better incentivize health systems to address health disparities, they should consider better statistical methods.

hospital readmissions

One of the reasons I came to UMMS was the opportunities in health policy research. The school has not disappointed. I am grateful for the wonderful team I was able to work with. Doing this kind of research requires more legwork than any medical student could handle on their own. For example, obtaining hospital data from Medicare is a process that takes several months to years. UMMS had the resources to help make it happen. Also, the UMMS curriculum has several sessions on health policy and health services research throughout M1 year. The Health Policy Path of Excellence runs policy seminars and connects students with mentors who have similar interests. These experiences have been some of the highlights of my medical school education.

Most importantly, I have found many classmates with similar interests, and I have learned a ton from them inside and outside of class. Everybody at UMMS – students, faculty, staff, administration – is incredibly “gung ho” about what they do. It is such a wonderful community to be a part of.

I really enjoyed doing this project. I am sure these experiences will come in handy no matter where I end up. And if this work can have even the slightest influence on people’s health, even better!

What to Know About Applying to Medical School as a “Non-Traditional”

“Nontraditional.” What does that even mean? It implies that there is a “traditional” medical school applicant, which is probably accurate. The vision we have in our minds is that they have come straight from undergrad with some form of premedical-related science degree. Maybe we imagine other similarities they have in terms of race, gender, and socioeconomic status. Why this is important to deconstruct is that the essence of nontraditional can mean many different things, but one common root vision — diversity. Whether it’s demographic, psychographic, or cognitive diversity, all one must do is throw a stone at a medical school website to find this term on almost every landing page.  And while there is an allure to being in the new nontraditional group, there is also risk. A major theme nontraditional applicants will have to repeatedly address on the interview trail is essentially, “How do we know you’re really dedicated to medicine? And can you handle the rigors of it? And what will you bring to make our educational environment (and ultimately) medicine better for it?” I hope to help you explore those questions to find your own answers by way of my Q&A with U.S. News & World Report recently on this very topic:

If a medical school applicant is older than is typical among aspiring physicians, what advice would you give him or her? 

Your “nontraditional” background is an asset, not a liability. You have had more time to cultivate your interests, demonstrate competence, and often have a stronger “sense of self” and real world resilience. If you have come to know deeply that medicine is your calling, you should absolutely pursue it. Ask yourself, what is unique about my journey/perspective that directly relates to how I plan to move medicine/health care forward. Being able to articulate this uniqueness with “show rather than tell” examples, while simultaneously demonstrating your commitment to medicine, will make you a very compelling candidate. Nontraditional students sometimes feel self-conscious that they are perceived as less competitive than those who have been on one track since the beginning. But life, medicine, and self-identity are rarely linear and so it is important to see yourself not as a “train switching tracks” but rather a “train gaining speed/momentum,” as one of my mentors put it so eloquently.

If this person has been out of college for a while (or even if they haven’t), what advice do you have for how they should prepare for the MCAT exam? 

  1. Learning the content: The best thing is to try to make sure you have taken as many of the prerequisite science classes as possible that the MCAT will test (Physics, Chemistry, Biology, Psychology, Sociology). If you haven’t completed them all before the exam, like I had not, there are a plethora of resources to identify the highest yield subjects and teach yourself. The best resource for this is AAMC’s own MCAT prep material and sample tests.
  2. Studying the content: Studying comes after learning, but not all study methods are created equal. It can be easy to watch YouTube videos on what worked for this person, but that can consume a lot of time trying different things with low outcomes. A pivotal turning point for me in my studying, and something that has saved me in medical school, was learning my own learning styles and then preparing with strategies most effective for my learning styles. There are free online assessments you can take or resources many colleges/junior college counselors can offer.
  3. Preparing for the marathon: the MCAT is about 8 hours long so knowing the content is not good enough, you need to build the mental endurance to be able to recall under a time-pressured environment for a sustained amount of time. It’s critical to take practice MCAT exams, ideally written by the real MCAT writers (by AAMC), and see how long you can test before your mind “hits a wall.” Note what helps you regroup and keep going (like taking a quick stretch or deep breaths) and what is maybe hurting your physical endurance (perhaps a caffeine crash). This should be your own personal reflection that you keep tinkering with until you have optimized your body and mind for the endurance of the day and execute with as little “new inputs” as possible.
  4. Reflect/grow: critical to getting better is auditing your own thinking.  After each practice exam you should go question by question and ask, “if I got this right, what led me to the right answer?” and “if I got this wrong, what led me to the wrong answer?” You will start to see your blind spots that need attention and also your natural intuitions. I still do this in medical school and learn new things about how I absorb different types of content one way vs another. I turned this into a list of about 50 things I could mentally reference when I was stuck on a question. You will likely have moments when you get a less-than-amazing practice score and that can feel consuming, so it’s important to have, what I call, a “Bounce-back Strategy” when your mood tanks, which it will. Maybe you watch your favorite TEDTalk on Gratitude and go for a swim. Perhaps you buy yourself flowers and write a thank you letter to someone who has always supported you. Having a plan for the storm will help it pass sooner. A negative mindset is like infertile soil, it’s not very fruitful conditions for learning long-term, in my experience.

How can they fulfill medical school prerequisites if they did not already do so during Undergrad?

First create a list of the courses you need based on the schools you want to apply to (it will be on their website). For most schools the science prereqs will be: 1 yr Physics, 1 yr Biology, 1 yr Inorganic Chemistry, 1 yr Organic Chemistry. A small minority will require additionally Biochemistry and/or Genetics. Many schools will allow you to apply as long as these courses are planned for completion before matriculation. The Chemistry is sequential, which means if you have neither course that puts you at least two years out so factor this into your timing as probably the “Critical Path.” Then you need to find these courses. Some people find a postbaccalaureate program that will hit all these requirements. If you work full-time like I did though and can’t enroll in a full-time postbac program, you can “collect” these classes from colleges in your area. Depending on your location, you may have an undergraduate institution close by that will allow you to enroll as some type of “lifelong learner” to take the courses there without formal degree plans from their institution. Another option, and what I did, is to find the courses scattered around different junior colleges in the area. This was the only way for me to meet the requirements by taking them around my full-time work schedule (early in the morning, late at night, on weekends). Some people worry that will “look bad” but when asked on the interview trail why I had so many student IDs (?!) it was a source of pride for me to explain that if I had to manage multiple schedules, travel hundreds of miles at odd hours to take these courses to pursue my medical dreams than that was exactly what I was going to do. I think most schools ended up seeing it as proof of commitment.

Where can they find assistance and guidance during the medical school application process? 

First, the AAMC is the absolute best resource and starting place to create a list of critical deliverables (Primary Application: Undergrad transcripts, MCAT, Personal Statement, Extracurricular activities, Letters of Recommendation) and due dates (Primary Application, Secondary Application, MCAT/CASPR, Interview timeframes, and Commit dates).

Second, having a pre-health advisor and mentors is KEY for maximizing your responses. If you don’t have a pre-health advisor like I didn’t, you can request one from NAAHP (volunteer.advisor@naahp.org) and get matched with an advisor who has volunteered to help nontraditional students. My Advisor Gina Camello at USC was critical for helping me wrap my head around the process, requirements, and refining my personal statement through many, many drafts (Thank you, Gina!). Other mentors who were critical came from my involvement with The American Medical Women’s Association. So many physicians who have charted this path before me have been so generous with their time and wisdom on how to be successful in getting into medical school and beyond.

What should they keep in mind about the medical school application timeline? 

It seems like a long time but there is much to do and gather. The best thing you can do is get organized and know what needs to be completed by when and give yourself lots of buffer time. Things like getting official transcripts sent can take much longer than you anticipate. If you’re going to ask for letters of recommendations from specific individuals, give them enough time and information to be successful in helping you. I studied for the MCAT for 8 months. It took 6 months of drafts before my personal statement was succinct enough to be worthy of application, and I had considered myself a prolific writer before this. A high quality application takes a lot of time and introspection so make sure you get highly organized and give yourself enough time to complete things because there’s no shortage of stories of people who dropped out of the application process because it was coming down to the wire for submitting items, and the pressure was too much.

What can they do to highlight the ways in which their life experiences make them strong candidates for medical schools? 

I think it’s important to find out what about your life experience is unique, what’s your “differentiator,” and how does that apply to what your vision is for your future medical career. Admissions teams highlight repeatedly that applicants who really know themselves on this level and can “show don’t tell” stand out as the most serious candidates. “Show don’t tell” means have specific life stories/examples ready that can back up the points you want to illustrate. Anyone can say “yes, I am resilient,” but having a real-world scenario where you proved that will be taken much more seriously. If you are a nontraditional candidate, by linear time definition alone, you may have an advantage in likely having had more opportunities to attain these skills and stories.

What should they consider when deciding whether medical school would be worthwhile, and how should time, family and financial commitments play into their evaluation of whether the medical career path is a viable option for them? 

There’s a common quote in medicine that if you can see yourself being happy doing anything else, you should do that instead. I completely agree. Medical school is hard: mentally, physically, emotionally. But there is a Nietsche quote that, “He who has a why […] can bear almost any how.” And I think this is true for medicine. Your “why” has to be so strong to be able to keep you going through a profession like this that requires so much from you. For a while I had this dream, but thought I was “too late” or “too old now.” I was reminded that [paraphrasing] time passes anyway, you may as well be doing what you love [Earl Nightingale], and I knew that at the end of my life if I didn’t try I would deeply regret it because I know I have something very important to contribute to medicine. I also was held back for a while thinking that committing to medicine would mean sacrificing family and going into financial debt.  However so many mentors (especially through AMWA) reinforced that many successful physicians also have rich family lives. My calling for medicine had grown so loud that when I was finally ready to apply I was willing to give up any amount of time, family, or money to see this through. As it turns out, you don’t have to be this extreme. I’ve learned that life is a great balancing act and with the right strategies, planning, and preparation you can have all the things!

How can they explain to admissions officers why they decided to enter medical school later, and what can they do to illustrate the career journey that brought them to this point?

There are many jobs that “help people” so that is not enough of a reason for any Admissions Office to feel confident about a candidate, so you should be able to articulate specifically why a “physician” vs. other roles.  This is why it’s important to spend some volunteer time shadowing or on medical missions so you can really be sure this life is for you. A good format to answer “why medicine” in conversation or your personal statement that I was exposed to is to break it down into: 1. When your interest was piqued about medicine; 2. Further development of that interest; 3. Final commitment point. When you apply later in life, Admissions teams want to make sure you’ve given this tremendous thought and that your diverse life experiences have informed the natural culmination to this decision.

How can they get relevant recommendation letters if it’s been a while since college?

First, applicants should know what the requirements are from different schools because some will want science professors, some will want non-science, etc. These are key to know and identify as early as possible, especially if you will need to (re)build these relationships. If you have spent a majority of your time in a professional career or other venture, you should absolutely consider getting letters from people in these spheres. I had letters that covered career, volunteer work, science instructors, and long-time mentors. If you have been out of school for a while and your letters are as diverse as your experience, that’s okay! I would also try to identify people who can speak to a range of your attributes that you’d like to demonstrate. Maybe your director at work can speak to your innovative qualities, your volunteer manager can reflect on your ability to execute, your science teacher can reflect (beyond your science aptitude) on your teamwork with classmates, etc.

What types of nontraditional medical school applicants tend to be especially competitive? 

In my humble opinion from observing the process, what is competitive to one school is a liability for another. What that means is that certain schools want to be known for certain values and have curriculum, opportunities, and faculty to represent those interests. The most important thing is fit, not to win them all. For example, with my technology background and vision for the future of tech/med intersection, not all medical schools valued or had support for that direction and that’s okay. For me, good “fit” meant being at an institution that valued diversity, inclusion, and pioneering new health technology (which is exactly what I found at the University of Michigan). Other schools may have seen my background and thought “what can we offer someone who is passionate about tech if we don’t really invest in that for our students or faculty?” A great way to know if a school is going to want to invest in you and the uniqueness you bring is to do research on the projects their faculty are involved in because I think it shows what the institution values. If your dreams are surgical and a majority of their projects are mostly around Primary Care, no matter how eloquently you describe being inspired by the graceful gesticulations of Reconstructive Surgery, it may not be a match. The other positive tip about researching projects at the institution is that perhaps you find a lab/team you want to work with if accepted and when at that interview can speak more concretely about that school and your plans. That shows Admissions that you will hit the ground running if admitted and have done research about their school that makes them feel that their institution is really special to you and not just a “copy, paste, change name, someone please accept me.” You are going to spend the next 4+ years at this institution so it is very important that you have done enough research about the school to know that you actually want to go and could be successful/contribute there.

What kinds of premed life experiences are especially attractive to medical schools?

Again, sort of depends on the school and what they value. Forward-thinking, tech-inclined schools will be excited about your passion for and experience with new technology or methods. Rural schools may be more impressed with your experience on topics that affect their patient populations more severely like health care access or perhaps substance abuse. It can be a good idea to see what kinds of things the school gets research funding for because that may tell you what traits they care most about. As a general blanket statement, most schools will highlight research, diversity, and service. I think ultimately, though, the premed life experience that ends up being most attractive are ones that are: unique (so you will have a different perspective to share), altruistic (so you are internally, mission driven), and authentic (which shows you are introspective and resilient).

Finding Connection in the COVID-19 Pandemic

I remember walking home from the hospital the day medical student rotations were suspended. It felt like being woken up in the middle of a vivid dream. I was so immersed in clinical learning that although I was aware of the virus’ spread, its direct effect on me was unexpected. I felt disoriented. My typical agenda when I arrived home was to prepare for the next day. However, there wasn’t going to be a next day. At least not for another month or two. I needed a new plan. I reached for my phone and called a classmate. I desperately wanted to know, “What now?”

Amazingly, similar conversations occurred throughout the country. Medical student response teams at various institutions rallied in swift and inspiring fashion to transform health care. At the University of Michigan Medical School, more than 20 student-led initiatives were developed.

For the next few weeks, I rarely left my house. Surprisingly, it wasn’t because of a conscious effort to socially distance. I was immersed in a project to transform prenatal care, and while some described sentiments of isolation, I felt more connected than ever before. Shifting between Zoom meetings and phone calls, I found the my relationships with my classmates, faculty, and the community grew and matured.

In medical school, opportunities to see classmates are labile. During the first year, we spend long hours together in study groups, but during our clinical rotations, we are dispersed to a variety of sites. We share a communal experience, but we rarely have the chance to enjoy the frequent interactions we experienced at the start of medical school. Service-learning projects in response to COVID-19 rekindled many of these friendships. I had the chance to see my classmates at their very best as leaders, artists, engineers, and writers. I recall during one Zoom meeting troubleshooting how to ensure non-English speaking patients would be able to receive information regarding changes to prenatal care. In just a couple days, students who spoke seven different languages volunteered to call non-English speaking patients who otherwise might have been left in the dark.

Faculty also had the chance to see us students in a different setting. Clinically, we are at the very beginning of our training, and it is often hard to show initiative and leadership. The COVID-19 service-learning projects allowed us to showcase the diverse set of talents we brought with us to medical school. Similarly, faculty have the chance to show us a different side of themselves as they engaged with the community and hospital leadership.

The conversations I had with patients were particularly meaningful. COVID-19 has claimed more than 70,000 American lives thus far, and earlier this month, 6.6 million people filed new claims for unemployment over the course of a week. Patients are anxious, unsure what the future holds for their medical care and overall health. Furthermore, aggressive social distancing and rapid changes in institutional policy has made people feel isolated and less informed.

I made over a hundred calls to patients, providing information, reassurance, and resources. Prior to each call, I felt shaken by the adversity the patients must be experiencing. The experience of being pregnant is laden with uncertainty, and I imagine the pandemic only exacerbates these sentiments. Yet, as I informed patients of reductions in appointments and shifts to virtual visits, they expressed a sincere desire to do their part to help with social distancing and thanked me for my involvement in their care.

COVID-19 placed us all in positions we could never have anticipated. My conversations with patients showed me how, to varying degrees, we are all on the “front lines” as each of us has a role to play in fighting the pandemic. We are bonded by forging through the uncertainty, and drawn to one another in ways we, only a few short weeks ago, could never have anticipated.

 

The COVID Staffing Project: Three Medical Students’ Contributions

On Saturday, March 28, a group of developers, engineers, analysts, medical students, and surgeons met virtually over coffee to develop a new initiative: the COVID Staffing Project. The goal was to develop a suite of staffing projection and allocation tools that would help Vanderbilt University Medical Center (VUMC) – central Tennessee’s largest hospital system – prepare for an imminent surge of COVID patients. 

The project leads – two academic surgeons, one at VUMC and one at Michigan Medicine – laid out the project aims and the technologic and implementation gaps that needed to be addressed. The project team spent the weekend working from couches and home offices, switching between all-team conference calls and smaller group huddles. Unique perspectives from the Center for Surgical Training and Research (C-STAR), the Department of Learning Health Sciences, the Center for Healthcare Engineering and Patient Safety and the Procedural Learning and Safety Collaborative quickly converged into an initial project plan with 250 person-hours of total work logged by Sunday evening.

Part of the COVID Staffing Project team

By Monday, a Covid Staffing Project website had been launched, with three initial tools and many more in development. As of today, nine tools are available, along with user guides, instructional videos, educational modules, and provider care resources – all at no cost. Hundreds of health care professionals have visited the website and joined informational webinars. Connections have formed with residency program directors; clinicians at large teaching hospitals in the southeast and midwest; rural nursing home networks; an ambulance fleet in Alberta, Canada; and an epidemiologist constructing state-level patient projections in India.

In retrospect, no one knew exactly what would develop from that Saturday morning. The inherent uncertainties of typical research projects and health endeavors – publication, transferability, impact doubts – were all doubled as the team put their pre-COVID research projects and coursework on hold, in order to tackle an acute health care systems problem.

As medical students and junior researchers, we have collaborated on several previous projects with C-STAR and other research groups. We understand the typical flow of academic medical research. Define your question, explore the literature to determine the “gap” you endeavor to fill, design your analysis or intervention carefully, and follow a prescriptive format to write up your results. We are used to working closely with our research mentors, on a predetermined timeline and with a clear sense of our roles. The COVID Staffing Project flipped this structure on its head. The pandemic created an urgent need for our tools – yesterday. We had no precedent or guide, and each of us needed to map the project goals to our individual skills in determining the value we could add.

Ultimately, each of us determined our roles. Erkin, whose background is in engineering, took point on designing the architecture of the modules and a plan for them to flow into each other synergistically. His mental model became our project roadmap. Ken, who is proficient in several coding languages, built the COVID-19 Response Planner, an application to help hospital administrators allocate staff to different phases of COVID responses, based on patient demands. Alex jumped in to articulate the initial mission and vision of the COVID Staffing Project, collaborated in building the first and second versions of the website, and drove early external communications to disseminate our tools. Alex also worked with Erkin in designing the Daily PPE Calculator, which can estimate a given hospital or other health system’s 24-hour Personal Protective Equipment (PPE) needs. Each of our contributions to this project combined our previous skill sets and medical knowledge with new responsibilities, not unlike our previous experiences as clinical students.

We are thrilled to have taken part in the COVID Staffing Project’s development and growth. The impact that an enthusiastic, thoughtful and skilled team of researchers can have on an immediate public health problem is something we will take with us through the remainder of our medical careers.

Lions and Tigers and Bears, Oh My: Why Learning About Animals Can Help Med Students Become Better Doctors

It looked like any of the number of procedural rooms that I had been in during the past four years of medical school. Behind a glass partition, there were rows of medications ranging from blood pressure drugs to birth control pills, many of which I had seen prescribed to my own patients. There was an x-ray machine in the corner, and a CT machine waiting next door. Various pieces of ventilating equipment were neatly stacked in metal bins and shelves lining the walls. It looked so familiar, that I could almost forget the reality: I was at the Detroit Zoo, and all of these medications and equipment were used to treat the exotic animals that reside there.

It was for this very reason–to understand the connections between human and animal health–that my classmate Kate Heckman and I developed a Comparative Medicine elective for upperclass medical students to take during their time in the Branches. The idea for comparative medicine, defined as the study of similarities and differences between animal and human medicine, is not new. It has been endorsed by famous physicians ranging from the historic Hippocrates to the more recent Dr. Virchow (who is known as “the father of modern pathology”). In fact, even the Center for Disease Control promotes the One Health Initiative, which aims to increase collaboration between physicians, veterinarians, and other health professionals.

Although there was a strong academic precedent for creating the course, I had a slightly different motivation in developing this elective. Growing up, I always had a wide range of academic interests. However, once in medical school, I was quickly overwhelmed by the sheer volume of information available for a medical student to study. Worried that I would be an incompetent physician if I did not commit to learning as much of it as possible, I focused all of my energy and time on studying human physiology, anatomy, and medicine; gradually, all of my other academic interests and passions fell to the wayside. I was worried that I was coming out of medical school less curious and less creative than I was when I started. The idea of developing a course in a field that interested me, but had little exposure to in medical school, seemed like the perfect opportunity to return to my roots and rekindle my passion for learning.

Although Kate and I had no prior experience with course development, we were mentored by Drs. Fox and Alsup, faculty within the medical school anatomy program, who helped us with the paperwork and administrative process of gaining course approval. Dr. Nemzek, a faculty member at the University of Michigan’s Unit for Laboratory Animal Medicine (ULAM) assisted us with curriculum development and connected us with various field experts for course lectures. Furthermore, with grant funding from the Medical School, we were able to cover the costs of educational sessions arranged at the Detroit Zoo and Michigan State University Veterinary School as well as fund a pet CPR certification course for students enrolled in the course. All of this exemplifies our Medical School’s approach to student-led projects; not only does Michigan encourage students to pursue their interests, but it provides the support and resources necessary to help them succeed.

In planning the lecture portion of our course’s curriculum, we found numerous physicians who, on top of their expertise in human medicine, had strong background knowledge in animal medicine and physiology. Our lectures included a discussion of how brain structure varies between species, and how this correlates to animal behavior led by Dr. Selwa, a neurologist. Dr. Green, an otolaryngologist, spoke on animal pharynx structure compared to human anatomy, explaining why humans can talk while other animals can’t. An emergency medicine physician held a Jeopardy-style trivia competition to teach about management of animal bites and stings. I was especially impressed that many of these lecturers studied comparative physiology and medicine on their own time, purely for their own interest. I was reassured to realize that being a good physician does not necessitate purely focusing one’s attention on human medical journals and literature.

However, my favorite parts of the course were the experiential learning trips that we arranged within the University of Michigan as well as community organizations and other academic centers. At Michigan, we visited the Unit for Laboratory Animal Medicine, where we learned about the ethics of animal research, the contributions that animal-based research has made to our understanding of human disease and medical care as well as the strengths and weaknesses of our current animal models of disease. I was pleasantly surprised to learn about the extent of research and effort that veterinarian staff at ULAM employ to give their animals a good quality of life, including strategies to provide social and intellectual enrichment.

We loved having the opportunity to learn from the veterinary experts at Michigan State University!

We also arranged a trip to the highly renowned Michigan State University School of Veterinary Medicine. We were given a tour of the facilities and learned about innovations in animal medicine that could potentially lead to development of new treatments for human diseases in fields such as oncology and ophthalmology. At the anatomy lab, we were tested with labeling the joints of a full-scale horse model. As we struggled through the exercise, asking questions such as “Do horses have elbows… or are they just called ‘front knees?”, I was struck both by how limited my knowledge base in comparative anatomy was, and yet how many correlations there are between the bones and anatomical structures of a horse and those of a human (I also learned that the “front knee joint” is actually called the carpus). Most of all, I was impressed by the enthusiasm of the staff and faculty at the Veterinary School in teaching medical students. They shared their delight in the course and expressed the value that they felt could be gained by further collaboration between our two fields, and by this point in the course, I could not help but agree.

Our course ended with an afternoon spent with Dr. Duncan, the director of veterinary medicine at the Detroit Zoo. She gave a brief talk on the Zoo’s program for maintaining heart health in the great apes, during which I was surprised to discover that the heart disease processes that gorillas face are similar to those I had seen in many of my patients at the hospital, as were the treatments–although I have never had to sneak medications to my patients through juice boxes, as the veterinary staff do. We were then given a tour of the procedural facilities, where animals are given physical exams and are treated for various ailments. Once again, my classmates and I were amazed at the degree of overlap in the equipment and medications used at our hospital and here at the zoo. We also learned that, for animals with complex or highly specific disease processes, zoo veterinarians often consult their human medicine counterparts with expertise in the disease to help with management and treatment of the animals. It was a career opportunity that few of us realized existed, and many of us resolved to take part in someday.

During the yearlong process of developing the comparative medicine course, the question that I most frequently received from classmates, family, and friends was “why?” Why should medical students spend their time learning about animals, when there are so many human medicine topics to study? At the time, I would fumble for a response, mumbling something about “gaining a background for research” and “expanding our knowledge base.” But now, I would argue, why not? I came to medical school worried that if I didn’t focus all of my attention on human medicine, I would become a worse physician in the future. As I look forward to graduating in one month, I realize that the effect is actually the opposite. By taking time during my third and fourth years of medical school to explore my interests in narrative writing and comparative medicine, I have not only become a more well-rounded student, but I have found myself asking more questions, reading more books, and most importantly, enjoying learning and studying once again. Exploring passions that lie outside of strictly human medicine can allow for medical students and physicians to retain the curiosity and passion that allowed them to succeed academically, and will continue to serve them in their care of patients.

Michigan Medical Students Respond to COVID-19 Pandemic

There was a certain foreboding quietness in the wards during the weeks before the onslaught of COVID-19. With classes canceled for pre-clinical medical students and most elective surgeries or non-urgent clinic visits rescheduled, the hospital, which often functions at full-capacity, seemed empty. Besides more masked faces roaming the corridors and checkpoints at all the hospital entrances with guards asking, “Do you have symptoms of cough, cold, or flu?”—not much looked differently from days before COVID-19 made its way to our state. However, the entirety of Michigan Medicine felt very different.

As a clinical medical student, my classmates and I have felt a certain tension between our role as learners and wanting to be on the front lines during this time of crisis. We want to be in the hospital, yet we also do not want to get in the way. Is our presence within the hospital space as learners an asset to reduce burden on nurses and physicians as they provide care to COVID-19 patients, or are we using up valuable PPE and being agents of viral spread? On March 17, the Association of American Medical Colleges and Liaison Committee on Medical Education decided the latter, issuing a statement recommending that medical schools pause all clinical rotations until at least the end of the month. Within minutes of this announcement, a dismissal email from the deans was in our inboxes.

In being removed from the clinical setting, I felt denied the great privilege that the health care profession bestows: to serve others in moments of crisis. I personally believe that medical students can be useful; we just need the appropriate training and direction. We can do ‘scut work,’ like calling consults, writing notes, or admitting non-COVID19 patients, freeing up more time for residents and physicians tending to the unfolding crisis. While I agree we are not yet equipped to be essential personnel at the front lines, I believe that the opportunity to volunteer in some capacity in the clinical space should be open to us. We, too, have an ethical responsibility to patients. We took a pledge at our white coat ceremony saying so.

The outbreak has underlined the health care system’s lack of preparedness on many fronts—particularly in providing appropriate resources to vulnerable patient populations and health care providers who are still expected to go to work. While schools and daycares are sending kids home, parent doctors and residents are scrambling to find childcare. Additionally, there have been little to no guidelines regarding how to best protect certain patient populations, such as people experiencing homelessness, who have nowhere to safely practice social distancing. These challenges are just in addition to concerns surrounding availability of PPE, ventilators, and our blood supply.

Since being dismissed from the clinical space, my classmates and I have been mobilizing to address some of these gaps and support our disrupted community. We have become babysitters for physician residents and grocery shoppers for our elderly neighbors. We have been calling local home improvement stores to collect PPE and staffing blood drives and COVID-19 hotlines. We even made our own bottles of hand sanitizer from scratch and assembled hundreds of sack lunches in a classmate’s apartment for distribution at local homeless shelters. Medical students may not be allowed on the front lines, so for now we have assumed a role on the home front, serving and organizing at a distance, awaiting the day when we are called back to work.

Addendum: Since writing this, select medical students have been allowed back into the clinical space on a volunteer basis to work as respiratory therapy extenders and discharge support on internal medicine services.