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Chief Concern Course (a.k.a. How to Reason Like a Doctor)

Imagine you are a 1st-year emergency medicine resident. Your attending is on call for the night shift you are working, and you are about to see your very first patient on your own. Before entering the room you read in the chart: 65 y/o cis-gendered woman presents with chief concern of chest pain that has been constant for 3 days.

You ask yourself, what could be going on? What should I prepare for before I see the patient? You quickly start to formulate your differential diagnosis, a list of possible diagnoses that could explain the patient’s chief concern and story.

An intimidating part of being a new medical student is figuring out how to come up with a differential diagnosis for the patient sitting in front of you. There are so many questions running through our minds as we learn more clinical skills and knowledge that it can be overwhelming to know where to begin with a patient presenting with shortness of breath, stomach pain, or chest pain. That is where the Chief Concern Course comes in!

We are put in small groups of about 20 students and one faculty member physician and are provided a brief blurb about a patient. Before class, we are asked to come up with about 5 diagnoses, just like a doctor does before they see the patient. At the beginning of our virtual session, we all throw out any diagnoses we have based on the minimal information we were given in our prompt. This list is usually huge! We learned pretty quickly that some common presenting symptoms, like chest or abdominal pain, can be due to a variety of different systems — cardiovascular, pulmonary, musculoskeletal, gastrointestinal, or neurological to name a few! So without a lot of information, we have to start with a wide list. As we learn more about the patient and continue through the encounter, this list narrows. We start with asking questions and taking a patient medical history, performing a physical exam, and finally requesting labs and imaging. At the end of each session, with our monster list of diagnoses in hand, we are put into breakout rooms of smaller groups of 3-4 students to work on our next steps.

Back in the emergency department, you have developed your initial differential diagnosis, including gastrointestinal causes like cholecystitis or gastroesophageal reflux, cardiac causes like myocardial infarction or pulmonary embolism, pulmonary causes like pneumothorax, and musculoskeletal concerns like costochondritis. Now you are ready to enter the room to see the patient. What questions will you ask? What do you want to know more about? What will help you narrow down your list of diagnoses?

What additional information should we gather from the patient’s history?

In class, imagining we are about to interview the patient, we are placed into our smaller breakout rooms for our first objective: develop a list of questions to further gather information about the patient. A critical part about being a first-year medical student is learning how to take a thorough patient history. Thankfully, throughout our Doctoring sessions (Learn more about our Doctoring course here), we have learned how to inquire about the basic patient history, which includes information about their present illness, past medical, surgical, family and social history, medications, allergies, and a detailed review of systems. While this seems like a lot at first, surprisingly the more you practice the more it becomes second nature! What Chief Concern allows us to discuss, as a group, some of the key questions we’d like to ask the patient first. Because our medical knowledge is limited, this can be really tricky to narrow down relevant questions! We have really enjoyed working together with our classmates to come up with our plan for asking the patient’s history, especially because everyone remembers different key points from lectures and has different prior experiences and knowledge they bring to the group. This makes for great discussions and always serves as a great reminder that while we may think we know the exact questions that are relevant, often there are questions that would investigate diagnoses we hadn’t even considered.

After our first small breakout groups, we come back together to now ask our faculty lead the history questions we just generated, and they provide us the answers as if they were the patient. This is where we really start to think critically about which of our diagnoses are moving up on our list and which ones we can move down as being less likely. Some groups do this in real time by using the virtual whiteboard to start prioritizing a list! Here is an example of the resulting prioritization from one of our collaborative sessions:

What parts of the physical exam are we most interested in obtaining?
Next, we get another opportunity to work with our breakout groups, but this time our goal is to discuss what we would be looking for in our physical exam of the patient. As we organize a list of what we’d prioritize in a physical, it helps to break it down into what pertinent positives and negatives we’d expect to find. For example, if we have a pneumothorax on our differential diagnosis for shortness of breath we would want to auscultate for absent breath sounds. If breath sounds are present that would be considered a pertinent negative for a pneumothorax.

When we return to the large group again, our faculty lead provides us with the full history and physical exam write-up. We now get to read through the most comprehensive information about our patient, and it is a great time to ask all our questions that we have about the presentation. Often, the patient case is not very clear cut or obvious, and there are multiple signs and symptoms that still fit with multiple diagnoses. This is where we now get to prepare our case (almost like a lawyer!) for what we think the top diagnoses are and what we plan to do about it, which is called the Assessment & Plan.

What imaging, labs, and/or interventions should we do to further diagnose or treat the patient?
In the emergency department or on an inpatient floor, as you are asking questions and gathering information, you will be mentally prioritizing the diagnoses, just as we did in class. In our experience in medical school, we are still honing our skills of balancing which diagnoses are most likely given the patient’s history with which diagnoses are life threatening and need to be managed urgently. This is where the assessment and plan comes into play!

The assessment is a list of just a few (about 3-5) diagnoses that are considered most important to focus on by the clinician, either because they are most likely or the most necessary to address. It includes a summary of the patient and important information discovered. Each of these diagnoses is listed with the factors that make them more likely and the factors that make them less likely. When we present our assessment to our attendings, they should be able to have a good idea of the patient’s story and key findings so far.

The plan is usually a bulleted list of interventions or diagnostic tools that creates a step-by-step guide for you or other providers to follow for the care of this patient. These tools are listed in order of what needs to be performed first and either grouped by specific symptom/problem or by organ system if the patient is in critical condition. These interventions could include things like IV fluids, medications, or even surgery. Diagnostic tools could be simple and quick like an EKG or complex and expensive like an MRI, depending on what is necessary.

After developing our assessment and plan, we come back to the large room and discuss our work as a group. It is a collaborative effort as we complement and critique each team’s work with input from both students and the faculty. It is a great opportunity to explore what it means to be a part of a healthcare team! After we each present, we are finally provided with the end to the clinical case. Our faculty runs through the results to any tests, labs, or imaging we ordered in our plans and unveils the final diagnosis. It is the end to a great full day of clinical reasoning, and we feel a little bit more prepared to reason through real patient stories in the coming years.

Put yourself back in the shoes of that first-year emergency medicine resident. Your history taking and physical exam has helped you discover the following:

History of Present Illness:
The patient’s chest pain is right-sided and radiates to her upper right shoulder and arm. She said it began 3 days ago after she ate a big helping of lasagna. She went to urgent care the next day and they gave her Pepcid AC, which didn’t help the pain at all. She then tried swallowing a baking soda mix, which also did not help the pain. She says it is really hard to get out of bed, because she can’t put weight on her right side. She denies any nausea, vomiting, shortness of breath, or lower leg swelling.

Past Medical History:

  • Prediabetes x 4 years
  • Gastroesophageal reflux disease (GERD) x 10 years (has not had issues in years)
  • Eczema x 3 years

Family History:

  • Father: died @ age 65 of cirrhosis d/t previous alcohol use
  • Mother: died @ age 78 of Myocardial Infarction (MI, a.k.a. heart attack)
  • Older brother: died @ age 53 of venous thromboembolism (VTE)

Physical Exam/Vitals:

  • BP 132/82, HR 75, RR 15
  • No audible heart murmurs or irregularities
  • Normal lung sounds
  • Right upper quadrant (RUQ) tenderness to palpation
  • Physical exam otherwise unremarkable

As an early practice, take this information (clinical story, given possible diagnoses, and reasoning strategies) and think about which diagnoses you would include in your assessment and do some research to find out what your next steps might be for this patient. Try to develop your own assessment and plan! We hope to see you alongside us in medical school and in the clinic in coming years where you can refine these skills!

Tipping Pointe: Balancing My Dual Passions of Ballet and Medicine

I grew up as a ballerina. Ballet was my life, my identity. When I discovered a passion for medicine, many people questioned how I could reconcile dual interests in both ballet and medicine- such seemingly different disciplines. However, since entering the field of medicine, I have developed a fondness for the differences between these two worlds, while also continually being struck by the parallels I find every day between the two.

Still enamored by both ballet and medicine, I have come to appreciate even more the opportunities I have had both in tutus and in scrubs, and further come to relish even more so the similarities I find across both. It seemed a natural step for me to join the Medical Humanities Path of Excellence at the University of Michigan Medical School, one of several interest-based pathways students have the opportunity to join. In the Medical Humanities Path of Excellence, I’ve connected with likeminded classmates and faculty also interested in the arts and the intersection of the humanities and medical sciences. For my Capstone for Impact, I wanted to create a lasting art exhibit that would allow me to share my experience and connect with others who may have similar experiences blending their worlds and passions across disciplines.

For my project, I dove into a new form of art for me – photography! This exhibit depicts my journey integrating my love for ballet and medicine. Through the process of staging and capturing these images, I came to realize even more similarities between dance and medicine than I had before. Trying to integrate such seemingly different objects and imagery, I was struck by both the tension and dichotomy as well as the harmony and blending of the two worlds. When ideas for certain images came to mind, I was surprised each time by how seamlessly the scenes came together. My two worlds blended together even more smoothly than I ever imagined, something I have experienced in my life over the past few years as well as through the journey of taking these photos.

The collection begins with still life images, consisting of objects typically associated with medicine strewn with subjects classically associated with ballet and the arts, creating a playful tension between the two while also showing how seamlessly they can appear to integrate. These first few images are meant to be subtle. The photos become increasingly more forward in demonstrating the melding of ballet and medicine as the collection progresses. Furthermore, the editing and lighting in addition to the subjects become more dramatic in each subsequent photo. This parallels my own feelings toward reconciling my passions for art and medicine. Initially, I tried to keep my worlds separate and not allude to one or the other my dual allegiances. However, as is demonstrated through the images, over time I have become bolder in demonstrating my passions for both dance and medicine, and finding ways to ensure both remain a part of my life.

This exhibit is meant to evoke the feeling behind my personal transition from one career to the next, from ballerina to doctor. My hope is that this collection will inspire others to give thought to ways in which seemingly dichotomous aspects of their lives may be more similar or harmonious than they once thought, and to find beauty in the contrast. I had a blast creating this project and was delighted by how well received it was by my peers and mentors. This is just one example of the incredibly unique opportunities allotted to University of Michigan med students.

Here is my photo collection – I hope you enjoy!

 

1. Tutus and S2’s
Early in medical school, our white coats and stethoscopes feel like a costume we don. These items feel like props from a child’s game of dress-up when we first put them on, but over time they become as much a part of us as a sign of our occupation. This photograph shows a stethoscope hanging amidst a wardrobe of ballet tutus and costumes. A tutu transforms the ballerina into a character for the audience and into a new version of herself for the performance. Similarly, the stethoscope is itself a symbol of medicine that transforms us from students into doctors.

2. Backstage
Putting on stage makeup and doing one’s hair becomes somewhat of a pre-show ritual for dancers. While execution of the choreography takes precedence for the audience, the hair and makeup are crucial to the performances well and also take time and dedication to perfect. Medical students spend countless hours training in physical exam maneuvers to prepare for seeing patients. While the reflex hammer may be an infrequently used tool amidst our equipment, it represents the tireless hours of preparation that go into evaluating, diagnosing, and treating each patient just as the makeup indicates the disciplined ritual of dancers preparing for each show with care.

3. E sharp
Music is an integral part of dance; it drives the movement and emotion of choreography. Here an eye chart is casually placed next to sheet music, accompanied by a tuning fork. This image is meant to evoke the playful dichotomy of the science of medicine next to the art of music, tied together by the tuning fork, which is used in both.

4. Simple. Interrupted.
This photograph shows a surgical needle driver and sutures being used to stitch a ballet shoe. This is meant to show a direct integration of the passion and skills of medicine and ballet complementing each other.

5. Breaking Scrub
The mayo tray with its surgical instruments is the surgeon’s toolbox. A ballerina’s pointe shoes are the primary tool she uses in her craft. This photograph displays a pair of pointe shoes among medical instruments and supplies on a surgical tray, exemplifying the contrast of the satin shoes amongst the cold metal instruments. While medicine, and surgery in particular, are often focused on as a hard science, they too are an art as physicians individually find solutions to the endless novel problems that patients present.

6. On Call
Here a dancer stands en pointe in a white coat, holding a stethoscope at her side. This image is meant to evoke a sense of both the tension and reconciliation of these two seemingly opposite worlds colliding.

7. Tipping Pointe
This final image is meant to be playful and thought provoking. I would like to leave this final image open to interpretation by each viewer. Perhaps one sees a dancer flippantly disregarding a stethoscope, abandoning science for art; perhaps one sees a physician skillfully balancing the stethoscope as well as her dual passions. To me, this image depicts the balancing act that we all undergo as we dedicate our lives to medicine and helping others, while also trying to remain well-rounded and continue to pursue our other passions, whatever they may be, that make us who we are.

Health Policy Beyond Healthcare Policy: Lessons from a Dual Degree

A few weekends ago, I, a medical student interested in ob/gyn and domestic health disparities, was the French representative to the (mock) United Nations at a summit on climate refugees. It was, in a word, unexpected. How had I found myself addressing the UN General Assembly? While the specifics of that January morning are still a bit confusing, it happened because this summer I decided to pursue a dual degree in Public Policy at the University of Michigan Ford School. A bit of an unexpected detour to my medical education.

Last spring, as COVID-19 descended on Ann Arbor, I witnessed the stories of this pandemic. On phone calls to tell patients about the transition to hybrid virtual prenatal care, pregnant patients told me of empty grocery stores, dissolving support networks, and job loss. As the pandemic worsened, it became clear that there was differential impact. Health disparities that had once felt abstract were suddenly in sharp focus and the medical community could not look away.

As a former social worker I am good at identifying problems, and as a medical student I am good at identifying the consequences of those problems. But I didn’t have the tools to address the issues these pregnant patients were facing: a disorganized food distribution network, loss of neighborhood cohesion, an economy in freefall. It was not news that these variables affect health, but what was less clear to me was what I could do about it. Carrying these patient stories, I decided to enroll at the Ford School of Public Policy because, as COVID-19 made clear, health starts outside the hospital.

Every day at Ford, we explore the biggest problems affecting our world. In fact, today alone I discussed optimal public insurance payment levels, affordable housing tax breaks, and privacy rights. I most appreciate the opportunity to go deep into complex problems. Some of my work has clearly been about health: I’ve explored the ethics of cost-benefit analysis of family planning programs, evaluated the ways trade policy affected the domestic supply of medical masks, and examined why the Affordable Care Act did not dissolve when the insurance mandate was nullified. But it isn’t health policy I’m interested in. The primary reason I came to Ford is to understand the scaffolding that supports my patients and shapes their lives. This year, I’ve written policy proposals for unemployment insurance, a campaign plan focused on childcare deserts (“no American family should need to make 1950s choices in a 21st century economy!”), and conducted an analysis of election day operations in Detroit. After all, more generous unemployment insurance keeps workers healthy, safe childcare helps stabilize families, and analyzing elections taught me about how complex systems, like hospitals, succeed and fail.

Complex problems require multi-tiered solutions, and while physicians and social workers are indispensable to any solution, so too are policymakers and community advocates who shape the communities our patients live in. The opportunity to pursue both ends of this continuum has been inspiring.

Space Medicine at Michigan Medical School: Creating an Online Elective

My interest in the space sciences began in 5th grade when I read a biography on Robert Goddard (creator of the first liquid-fuel rocket). To say reading was a hobby would be an understatement because I could never be found without a book in my hands, but the stories I most enjoyed reading most were those that got me closer to space and the stars – stories such as biographies of Edwin Hubble, Neil Armstrong, Buzz Aldrin, or Sally Ride. As a child, I would fervently follow all NASA updates, mesmerizingly look at the night sky for hours, and watch all the space-related documentaries I could find.

Contributing to the advancement of the space frontier became my greatest childhood dream. To make this dream a reality, I always naively believed that I had to pursue a career in engineering. So, when I fell in love with biology and medicine at the end of high school, I thought my dream would remain just that. I did not know how to marry my love for medicine with my avid interest in space until I eventually learned of aerospace medicine (and its subset field of space medicine) whilst researching medical schools. Albeit a little late, I realized that I no longer wanted to delay pursuing my passion for space, and – as Professor Randy Pausch once said in his famous book The Last Lecture – I wanted to make my childhood dream a reality. Thus, when I was accepted to the University of Michigan Medical School in 2017, I committed to making a career for myself in space medicine and to bring it to my school and my peers.

Since then, I’ve immersed myself in the field and tried to soak up everything about it. I first attended the Red Risk School webinar series as an M1, which was how I learned of the Aerospace Medicine Association’s (AsMA) meeting the following month. I instantly spoke to my school counselor, Amy Tshirhart, to arrange for time off to attend the meeting. Amy knew of my interest in space medicine, and she has been my greatest advocate in pursing this interest during medical school – for which I will be eternally grateful! Attending that AsMA meeting in May 2018 was nothing short of a breath of fresh air for me. I felt rejuvenated and at awe at the world I stumbled upon where everyone shared the same passion for medicine and space as I did. I was shocked that I did not know about this community earlier, but I was committed to getting involved as soon as I could.

Over the next few years of medical school, I slowly but surely began to reach out to faculty who could mentor me in this interest. It took me a while to collate a list of names – as this is quite a niche field – but everyone I spoke to was immensely supportive of my interest and supportive of helping me further develop it! This is what has been the best aspect of being at a school like the University of Michigan; instead of giving me a puzzling look when I said I am interested in space medicine, everyone at the school instead responded with curiosity, awe, and an equal eagerness to bring this unique topic to the school and share it with others.

With support from faculty and peer mentors (both at U-M and within the national aerospace medicine community I was now connected with) I applied to and have gotten accepted to NASA’s Aerospace Medicine Clerkship and the University of Texas Medical Branch’s Course in Principles of Aerospace Medicine – both of which I am scheduled to attend this year. Just earlier this week, I also submitted my application to a new medical student rotation at SpaceX! The opportunities for students are expanding, and I have been very excited about this!

Despite this rapid growth of space medicine though, to date, there are sparse formal educational opportunities available for medical students to gain more knowledge and exposure to the field. The few opportunities that do exist are found at select universities and are in-person experiences, thus limiting their accessibility. As a result, many students around the country, and here at UMMS, remain unaware of the application of and possibilities within the field of space medicine. This was how I became passionate about increasing students’ knowledge of and access to this field. Quickly, I realized that a short, online mode of delivery for this content does not currently exist, and this is the gap I hoped to fill. This led me to work on two projects that are quite near and dear to my heart.

First, I led the development of a two-week online and self-paced Introduction to Space Medicine elective for Branch medical students, which launched this January! The aim of this course is to create an online curriculum that informs students about the field and principles of space medicine. The goal is to inspire students to engage with and contribute to the ongoing efforts within the field of space medicine, to explore the possibilities of building a niche in this field for their future careers, and to become the next generation of leaders in space medicine. Through a series of readings, PowerPoints with integrated case studies, journal articles, online lectures/videos, podcasts, other supplementary assignments, and quizzes/assessments, students will gain insight into the field of space medicine, the effects of microgravity on human physiology, the health challenges associated with prolonged spaceflight and aviation, and current clinical applications to mitigate these risks. Through this course, students will also be introduced to the work of various leaders in the field of space medicine, and interested students can ask to be connected to these folks as career and research mentors.

This course has been well received by the 20 enrolled students thus far, and my next goal is to expand it to other schools at the University of Michigan and other medical schools nationwide. I developed this course with the help of a six-student team (across three different medical schools) and my faculty course director, Dr. Jim Bagin (ex-NASA astronaut and faculty in the Department of Anesthesiology). I owe a lot to my team to helping make this vision a reality! My partner in crime in this project, Riley Ferguson, has also arranged for this course to launch at her medical school (the University of Cincinnati College of Medicine) in January of 2022!

Second, I created a chapter for the Aerospace Medicine Student and Resident Organization (AMSRO) in the Fall of 2020 to serve as an interest group at the school, and I have been using the platform to help other interested students gain a footing in this field. I organize monthly talks and seminars which have drawn students from all over the world (UK, Russia, Saudi Arabia, India, Hong Kong, Malaysia, and Australia)! At the end of the day, I am most happy to cultivate students’ interests in this way and to promote connections and mentorships in this field for all.

Overall, though it certainly took me some time to find the space medicine community, now that I have, I am more eager than ever to dive in and contribute. I am humbled to see what has come of a vision I had early on in medical school, and I am excited to see what more will come of it! I know that with the support of the administration here, space medicine at UMMS will continue to grow and reach more students each year and expand nationwide!

Ultimately, my long-term goal is to combine my medical training and passion for space by contributing to the advancement of commercialized spaceflight one day. Achieving an enhanced understanding of this topic is of particular importance with the advent of commercialized spaceflight at the near horizon. As part of the next generation of physicians, I want to be ready for the responsibility to tackle the health challenges of this ultimate medical frontier, and I very much plan on making a niche in my future career for this work! I can only thank UMMS from the bottom of my heart for allowing me to pursue my passion for space medicine, helping me set my career trajectory in motion, and helping me get closer to making my childhood dream a reality.

Health Equity Scholars Program: Nutrition Lessons with the Detroit Food Academy

The Health Equity Scholars Program (HESP) is a student organization here at the University of Michigan Medical School with the primary goals of building collaborative community partnerships, addressing health inequity, and providing educational opportunities for students. We hope to create sustainable change, meaningful partnerships, and prepare future leaders to work in the health equity space. Our main community partners are Peace Neighborhood Center (PNC) located here in Ann Arbor and Detroit Food Academy (DFA) in Detroit. Under the guidance of our faculty mentor Dr. Brent Williams, our leadership team is filled with M1s working to arrange educational seminars for our peers, create new community partnerships, and foster existing ones. Pictured below is our phenomenal leadership team (on Zoom of course)!

HESP 2020-21 Leadership Team: Lucy St. Charles, Shriya Suresh, Lahari Nandikanti, Morgan Bradford, Rachel Croxton, Trisha Gupte, Annika Brakebill, and Sadhana Chinnusamy

Recently, in collaboration with Detroit Food Academy (DFA), we hosted seminars on nutrition for students in DFA’s after-school cohorts. DFA was founded in 2012 and is a 501(c) non-profit organization dedicated to inspiring young Detroiters to explore the culinary arts and food entrepreneurship. HESP’s long standing relationship with DFA has historically involved UMMS medical students running annual health education days for DFA students each summer. In July 2020, these health educational sessions were adapted to a virtual setting for the first time. Upon receiving positive feedback from students on this virtual experience, our incoming leadership team was eager to expand upon our relationship with DFA and explore opportunities to deliver a session to students during the school year for the first time.

Through administering a survey to the after-school cohorts at DFA, we learned that students were extremely interested in learning more about the nutritional contents of the foods they cook with each week. To address students’ interests, we created an interactive educational session on nutrition for the virtual setting. We held three of these lessons in the month of January, and with each one, cultivated an immense amount of gratitude for the conversations we had with the incredible students of DFA!

Every DFA session begins with a check-in; music selected by the teachers and students plays in the background to ease the awkwardness often associated with the beginnings of Zoom calls. For our first nutrition session, we couldn’t help but sway along to the beat of an already personal favorite of ours, “Do It” by Chloe x Halle, alongside the DFA students and facilitators. Next, we each described how we were feeling that day and then answered the question, “What are positive and negative ways in which you cope with stress?”

Following this check-in, we kicked off the lesson by asking students to come up with their own definitions of nutrition. In just a few short minutes, our conversation centered around what the foods we eat do for us. To delve deeper into how different nutrients work to nourish our bodies, we covered examples of macro- and micronutrients. For each nutrient, we talked both about how it works in our bodies and about what types of foods the nutrient can be found in.

A slide taken from our nutrition presentation highlighting the macro nutrients

Perhaps the most engaging and exciting part of our lesson was the portion covering what variety in nutrition can look like. We asked students to think about three meal items they would include in a healthy plate and created a word cloud with all of the foods they came up with. Here is an example from one of our sessions included below!

Word cloud created by DFA students when asked to about a healthy plate

After reflecting on the word cloud in each lesson, we found that Western foods like grilled chicken, steamed broccoli, and roasted carrots tended to take up the most space. With each lesson we discussed how there could always be more room for variety in the ways we envision what a healthy plate looks like. To explore this topic further, we asked students to identify differences in nutrition guidelines from around the world. We also shared a resource we came across called The Institute for Family Health, which showcases a series of healthy plates from different countries.

To wrap up our lesson, we asked students to reflect on what nutrition looks like in their lives. This part of the lesson was especially exciting as we greatly enjoyed hearing about the different types of foods students have been loving recently. In thinking about the different macro- and micronutrients included in these foods, we helped students apply topics from the lesson into their everyday lives. Additionally, we also gained inspiration for many new foods we now want to try!

Creating Impact through the Luke Clinic Baby Book Project

I started volunteering at The Luke Project 52 Clinic at the beginning of the Branches curriculum, during my 3rd year of medical school at the University of Michigan. One of my good friends and recent alum, Dr. Meghan Rowe, had chosen the clinic for her continuity site, so she would make the drive every other week for her last two years of medical school. Living in Detroit for a month-long rotation with the Detroit Public Health Department, I decided to join in one day and see if I could help out. I realized immediately how incredible this organization is. The Luke Clinic was founded to address the high rates of infant mortality and health disparities in Detroit and surrounding areas. They offer free prenatal, postpartum and infant care to any family in Detroit, and most patients are under- or un-insured. The cornerstone of Luke Clinic’s philosophy, which the clinic co-founders Brad and Sherie Garrison emphasize, is the relationships providers build with the families that visit. The clinic seeks to offer support and care for new parents at what can be an incredibly transformative and vulnerable period in someone’s life.

The Luke Clinic Mobile Van – photo credit to Meghan Rowe.

The clinic noted that, due to limited access to medical care, some children may go months to years without regular check-ups. When they do see health care providers, factors such as housing instability make it challenging for children to stay within the same health care system, and it can be hard for providers in different systems to closely monitor child growth and development. Pediatricians keep track of children’s growth and development, including meeting milestones such as having a social smile, learning to say some words, or sitting independently. When health care providers notice a child may be behind in one or more developmental milestones, early interventions can make a big impact to ensure that children grow to their full potential.

To address this need, Dr. Rowe started working on the Luke Clinic Baby Book for her capstone project. She talked with new parents and staff at the clinic to create the very first prototype – an illustrated book with space to keep track of basic health information such as height and weight, educational information for parents on developmental milestones, and plenty of space for pictures to make the book fun. After her graduation, since I loved visiting Luke Clinic so much, I continued this project as part of my Capstone for Impact (CFI) in the Branches. I have been able to bring my creative experiences from every step of my education into this project.

Some pages we designed for the Baby Book.

As a high school newspaper editor, I spent a lot of time working with Adobe InDesign and was thrilled to transfer the book into InDesign to create a visually appealing and beautiful workbook. As an engineering major in college, I took many classes with our school’s design department and utilized many of these design skills in development of this book. As a medical student applying into pediatrics, I have learned so much about child growth and development, and the common challenges new parents at the clinic face, incorporating this knowledge into the book using accessible and plain language. I’m thankful that CFI supports the opportunity to take creative risks. My process of developing the book included printing out Meghan’s first prototype, seeking user feedback by talking with new parents waiting in the Luke Clinic lobby, and meeting with nurses, doulas and physician staff at the clinic to identify needs. I then got the chance to create and illustrate the health education materials and re-organize the book for a second prototype.

Each member of the health care team offered important thoughts on how to make this book relevant and useful. New parents were excited to have space for baby pictures, to write down their questions and keep track of important phone numbers. They wanted information on how to feed their baby in their early days and when to call the doctor. Clinic staff and providers shared thoughts on how to present health education materials in a way that was accessible but not scary— for example, while the average child will pull up to stand by age one, it is not unusual for a one-year-old to still be learning this skill. I hope to translate this book into Spanish and Arabic for the clinic’s families, print it to be both durable and enjoyable to use, and distribute it to new families at the clinic. I would like to evaluate how families use the book in the future and would also very much love to share the digital file with anyone else who may be interested in this resource!