As I look back over the last few years, I find myself overwhelmed with how much has changed. In February 2018, the last time I wrote a Dose of Reality blog, I was just returning to school after having been on a yearlong personal leave. I had started a peer support program the year prior out of a selfish need to be surrounded by classmates who would unconditionally support me through my struggles. After opening up about my depression and anxiety, I got overwhelming support from the medical school community, but felt that a more structured setup should be available for other students to seek out help before a crisis hits.
In 2018, with more stable footing, and a better handle on my mental health disabilities, I was able to complete the first-year curriculum and move into the second year Clinical Trunk. Three months into the Clinical Trunk I found myself in another crisis, having just failed my first shelf exam. I was spun into another unfortunate predicament, which led me to have to reevaluate my status at the medical school. Under policies that have now changed, I had to step out of school once again, and prove to not one, but two, committees that I should stay in the school. During this time I found that the peer support advocates were such an important support for me. Instead of having to overcome yet another barrier to finding support, it was easily available with a single email. I could reach out to fellow advocates without shame or guilt, and I knew that I would be able to get through the hardship because I wasn’t alone.
Now as 2020 begins, I have finished my core clinical trunk courses, and find myself returning to the passion that drew me to found the Peer Support Advocacy Program.
The program officially had its first training in July 2018, and has since trained over 30 medical students. The training curriculum was compiled with input from various members of the medical school and central campus communities. The training focuses on the importance of emotional intelligence and the ability to be a referral agent to students who contact the advocates. Our role as advocates is to first and foremost be a good listener, identify when we can make suggestions, and help determine when our peers need resources outside of our own capabilities.
Through suggestions of the initial group of advocates, a paging number was established so that medical students could reach out 24/7, and receive support within six hours of outreach. A listserv email was also created for students to reach out with generalized questions when they didn’t know where to go. The listserv and pager are meant to cater to medical students, who work at all hours of the day and night, and may need support outside of the Monday through Friday 8-5 window in which most faculty and staff who run the medical school work.
Over the course of 2018 and 2019, programming efforts were made to help place a focus on student well-being. This mainly occurred through drop-in meetings focused on de-stigmatizing mental health in medical students and other health care professionals, and through advocate outreach in the Taubman Health Sciences Library (THSL); mainly going around to check-in during intense study periods. Marketing efforts are still in the works, with printed fliers up around THSL, counselors and other staff referring to the group, and an online presence. A page was created on the OMSE website about the program, and how to get in contact with various trained advocates. I encourage anyone reading this to follow the link to look up some of the amazing, candid, biographies of some of our advocates.
Because of the public nature of this website, I received inquiries from different medical students around the US. I emailed and called with them to help them set up similar programs at their medical school. As I started learning more about the deficiency of this type of program nationwide, myself and two staff co-leads of the program created a poster presentation, and attended the central and southern GSA/OSR joint regional meeting in April 2019. At that conference, we met more students, staff and faculty who were interested in promoting the well-being of medical students at each of their campuses. We exchanged ideas with others around the nation, and look forward to partnering more intentionally with many of those we met to create a more robust national standard for peer-led wellness programming.
On our own campus, M-HOME has worked to have peer programs, including Winding Roads, M-PACT, Near-Peer Mentoring, eMpower and Peer Support Advocacy work together to create a more cohesive road map for students navigating the different peer support resources offered. These talks continue, as each of the groups finds its place within M-HOME and the larger medical school community.
Over the next year, I hope to see the Peer Support Advocacy Program continue to grow, especially in its marketing and visibility efforts. I have just recently connected with the new Michigan Medicine Office of Wellness, and hope that the growing collaboration with strengthen our efforts. I feel so grateful to my fellow advocates, who are dedicated to change the culture of medicine, to become a more inclusive and understanding environment for health care professionals with mental health concerns, conditions, and disabilities.
Have questions? Or need to talk? Email email@example.com and one of our peer advocates will reach out to you. Check out our page on the OMSE website!
I used to think that the key to studying was how many hours you could put into it, but I have come to realize just how wrong that is, at least for me. Since starting medical school I have learned something that I wish I knew earlier when it comes to studying: quality is much more important than quantity. What this means is that study breaks are very important!
I also used to think yoga was just a bunch of stretching. The phrases Namaste and downward dog really didn’t mean anything to me, and being someone who could barely touch his toes, I always wrote off the practice of yoga entirely. That is until I decided to take advantage of the free, weekly classes that UMMS provides its students at Red Yoga. Without being too dramatic, I would say that taking up yoga has made such a positive impact on my life.
In my short time practicing yoga, I have come to learn a few things:
- Yoga really is much more than just a bunch of stretching.
It is as much of a mental exercise as it is physical, and that’s why I think it makes for the perfect study break. It offers me the time and space to put down my schoolwork and just focus on me and my breathing. It really is hard to describe, but the feeling I have after class is incredible. When I lay on my mat trying to find stillness I feel relaxed and empowered. Rejuvenated and confident. Sure, I feel tired from the class itself, because yoga is actually incredibly challenging, but overall I feel recharged! It’s quickly become my favorite workout.
- It’s okay to fail, and in fact, that’s a good thing!
This is something that I think is healthy for everyone, especially medical students. Even at Michigan where we have a wonderful pass/fail curriculum, there aren’t too many components of a medical student’s life where failing feels good. When you push yourself outside of your comfort zone by trying a new pose, holding one for even longer, or reaching for even more flexibility, it means you are challenging yourself and striving for growth. When you can’t hold that pose any longer and you fall, that just means you have the opportunity to get up and try again. When it comes to yoga, there is no good or bad. No 75% passing rate you need to attain by the end of the class. You’re not competing with anyone but yourself. For me, this means leaving the studio feeling better than when I walked in.
All that matters is you set an intention for yourself and you learn from your experiences. Yoga has taught me about the process of self-growth, and I think the positive components of this mindset and practice can be translated to medical school and life in general.
- It offers you friendship, community, and great music.
Being in the Taubman Health Sciences Library with your classmates for great periods of time serves as a special form of bonding. But, when you have the opportunity to take a fun study break and exercise with your classmates it really fosters that sense of community, which is nice to have in a medical school. You see students from all years and you get to even make friends with the instructors and others from class outside of the medical school. Also, I’d be doing a disservice to all of the amazing instructors at Red if I didn’t mention that they play bomb music during all of their classes. The best part is you don’t have to try and remember any of the lyrics during class to google later, because they are always happy to share their playlists with you, which supplies you with great music for future study sessions. I wouldn’t even know of some of my absolute favorite songs if it wasn’t for starting yoga!
I have come to learn that medical school will push you outside of your comfort zone. It challenges you to work very hard so that one day you have the privilege of working very hard for your patients in order to provide the excellent care that they deserve. With that said, the nice thing about UMMS is they are constantly providing us fun ways to take those much needed and much deserved study breaks. Other than funding medical student yoga at Red, there are so many other fun events such as intramural sports, whirly ball matches, ice cream socials, cookie decorating, apple orchard visits, pumpkin carving, house dinners, CAMP, and of course the M-Home Olympics. These are just a few of the many fun events that UMMS offers its students to promote wellness and the chance to connect with other students and faculty.
UMMS cares about their students and wants to make sure that they are taking time for themselves along their journey. Because of UMMS I’ve found one of my new favorite things to do. One of my best friend’s mother once told them, the best kinds of doctors are relaxed and flexible. As I said, I used to struggle to touch my toes. But now, I have already noticed I am so much more flexible and I feel more relaxed. Here’s to hoping it really does make me a better (future) doctor!
Smiling medical students after a great work out.
A Sunday yoga class that will help fight the Sunday Scaries!
Mount Ojibway, Isle Royale National Park: elevation 1,152 feet
Thus read the signpost I’d hiked so far to reach. My friends and I gathered together to gaze across the untouched landscape of primitive Isle Royale down to the spectacularly beautiful Lake Superior far below.
Sound like a dream? Absolutely!
Think I’m describing a vacation? Think again!
In my wildest hopes, fears, and dreams for medical school, never did I imagine that my education might involve a seven-day remote backpacking trip. You would appreciate the improbability of this, too, if you could only see how I scream and run from the spiders in my house, or witness my unhealthy dependence upon the microwave oven. Nonetheless, here I was, in the midst of some serious applied learning for my Wilderness Medicine elective course. Following this impossibly scenic – but brief – Mount Ojibway lunch break, the day’s agenda still included four more miles of hiking, a lecture about avalanches from my classmate Bri, some regrettably opportune blister care training courtesy of Emergency Medicine resident and trip leader Erika, and a group dinner around an eagerly anticipated campfire.
Bella, Joel, Brooke, Megan, Cameron, and Courtney represent University of Michigan even on our remote weeklong backpacking trip on Isle Royale. Go Blue!
How did I come upon this Wilderness Medicine educational opportunity, you ask? The answer lies in the Branches. Anyone who is ever-so-slightly familiar with the University of Michigan Medical School has likely heard all about our new curriculum, which features a unique 17-month “Branches” phase. The “Branches” refers to elective educational time following the standardized core didactic and clinical curriculum, which allows students to customize their medical education. This affords ample time for research, volunteerism, international experiences, career exploration, educational enrichment, or whatever pursuits fit your educational mission.
I’m someone who likes to know a little something about everything, so I capitalized on my Branches time to experience (seemingly) every medical subspecialty known to mankind. You name it, I did the elective: Critical Care, Ophthalmology, Anesthesiology, Emergency Medicine, Gastroenterology and Hepatology, Plastic Surgery, Otolaryngology, Radiology, Dermatology, and more. (I even created my own elective in Comparative Medicine along with my classmate Erika!) It is almost unheard of for a physician to have formal, dedicated exposure to such a variety of fields, but this diversity of experience will prove invaluable in my future Internal Medicine practice: starting as a resident this July, I will serve as the first point of contact in the medical system for patients with any and all medical problems.
The Wilderness Medicine course was just as invaluable an experience as these electives, and arguably the most fun. This class offered a medical approach to all things austere courtesy of University of Michigan’s Emergency Medicine doctors Nate, Will, Bella, and Erika. Notable lectures covered animal attacks, lightning injuries, submersion injuries, altitude illness, and avalanches. Outside of the classroom, our hands-on experiences were truly wild. We learned about caving rescue operations from the experts at Buckner Cave in Indiana, then tried our hand at rescuing a volunteer “victim” – our poor, brave classmate Laura – from a section of the cave that was only 12 inches tall! (I’m still not sure how we pulled that off.) We practiced recognizing toxic plants and learned to distinguish them from edible look-alikes at the Michigan State University Botanical Gardens – yes, taste-testing was involved for those of us confident in our knowledge! We put our water purification skills to the ultimate test while camping, under risk of acquiring a friendly moose tapeworm. Needless to say, this knowledge base in common wilderness practices and emergencies will serve me well when any “outdoors-y” medical questions arise from patients, friends, or family.
Bri, LaVana, Laura, Megan, and Cameron show off their casting work following an emergency splinting lecture from the Orthopedic Surgery residents for the Wilderness Medicine class.
Upon reflection, though, I’ve realized that Wilderness Medicine – for all its crazy adventures – was not so different from the rest of my medical school experience. After all, I’ve spent the last four years conquering the unknown and doing things I never would have imagined!
For example, I still remember my terror at the prospect of seeing my very first patient. I was on the inpatient Obstetrics service, and my patient had given birth via cesarean section (“c-section”) the day prior. I stalled pretty impressively by reading her chart, taking the stairs, and sipping my coffee, thinking “I can’t do this.” But when I pictured this scared woman lying in a hospital bed hoping to see a doctor – and let’s be honest, when my coffee ran empty and I was almost out of time before the team’s morning meeting – the words “I can’t” turned to “I must.” I’m sure I was anything but adept and confident, but hey, every medical provider starts by seeing their first patient ever. Since then, seeing patients has become second nature through practice, practice, practice.
My subsequent clinical experiences would only bring more stretching and unexpected undertakings: delivering babies, procuring organs for life-saving transplant operations, suturing wounds, responding to emergencies, and performing CPR, to name a few. Not to mention amassing an amount of knowledge I never would have believed possible for such a short (yes, short!) period of study as medical school.
Even now, as a fourth-year student who has finished applying for residency, I’m taking on new things. In dermatology clinic today, I performed my first punch biopsy of a difficult-to-diagnose skin condition. With close guidance from my supervising dermatology resident physician – shout-out to Dr. Hawkins – the procedure was a success! We hope that our Pathology colleagues, who will evaluate the biopsy, can help us confirm a diagnosis for this patient soon.
All in all, Wilderness Medicine was the highlight of what has been a challenging but rewarding four years of medical school. This course underscored the most important thing I’ve learned from medicine – I am capable of more than I imagine. I’m excited for the next phase of my adventure as my classmates and I begin residency this summer. Bring on the challenge – it’s what we do!
“Not in my operating room” he told me, with an air of finality. I had just finished pitching initial plans to address the absence of environmental sustainability at Michigan Medicine, but it wasn’t going well.
Through inefficient energy use and waste production, Michigan Medicine, like many other health systems in the U.S., is straining our planet’s ability to support human life. Daily, we are inundated with news about the climate crisis, so we take care to recycle and turn off the lights when leaving a room, but research shows that to truly create a sustainable society, larger systems, like Michigan Medicine, will have to undergo significant transformation in their daily practices. Even small changes at enormous institutions can have exponential impact–and yet, change is very difficult.
I first observed this problem during my surgery rotation, but in the turmoil of my clerkship year, I was limited to just observing what I considered wasteful and inefficient practices. Now, with the freedom of the Branches I was going to address it, head on. After finishing my clerkship year, I spent months I reviewing the literature, studying hospital trends, surveying employees, and evaluating possible solutions used by other hospitals around the country. Finally, I had an action plan. The first step was unveiling the plan to a surgeon mentor, the mentor; a faculty member well-known to medical students for providing the resources and inspiration to transform medicine. But after listening to my plan his reaction was lukewarm at best.
I was deflated, frustrated, and admittedly maybe even a little unsurprised. It felt as though my hard work researching, observing, and developing solutions had been futile. I started to question if these goals were even aligned with a thriving health system. Maybe if the rest of society made big changes, health systems wouldn’t need to be environmentally sustainable. On that day, I couldn’t yet see what the future would bring but since then, I’ve continued to learn a lot about the challenge of transformation. Here are some of my most important lessons:
- Find your allies. I discovered over the next months that many of my fellow medical students were also thinking about the problem of environmental sustainability in the health system. We had been working in silos and had reached the same lack of enthusiasm from the faculty we approached. A common message we all received was: “I agree personally with your position, but we have other priorities at this time.” We decided that we could achieve much more through collective efforts, so we formed White Coats for Planetary Health (WCPH). After drafting our vision, we invited members of the medical student body to a meeting to gauge interest in this topic and mobilize support and the result was inspiring. More than 10% of the UMMS student body expressed their interest, and many of them showed up physically ready to help us mobilize our efforts.
- Take unlikely chances. In the midst of this student support, RISE (which you can check out here) announced a funding opportunity arose to use “educational practices and interventions to address key health issues currently facing society”. We decided WCPH needed to expand its vision. RISE seeks to empower passionate faculty, staff, and students at Michigan Medicine, to pursue ideas which could positively transform human health through medical education. We imagined what might be possible if this grant award and associated support could create formal curriculum in sustainability and climate change for medical students. We could empower an entire cohort of medical trainees to take mitigating and adaptive action in the complex to curb the negative impact of environment on human health. In a few short months, the work of six dedicated medical students had created a group, developed collective goals, found diverse support, and made headway in challenging current systems. I began to understand that the ripple effect of hundreds of trainees engaging sustainability in their future careers could be enormous.
- Persistence is a form of leadership. As a medical student, you learn to be comfortable following. Yet medical students will soon transition to residency and eventually the practice of medicine and need to become leaders to create new solutions for the diverse and evolving challenges we will encounter in our daily work. Newly invigorated by my fellow student allies, I met with the surgeon mentor again, determined to sway him with evidence of student support. As it turned out, that deflating conversation several months prior, had been a pivot point for him. After our meeting, he started observing hospital’s practices, reading the literature and engaging with experts abroad. His perspective had taken a radical turn, and now he wanted to know how we could make change faster.
- Challenge yourself to develop adaptive expertise. Adaptive expertise, as compared to ‘routine expertise’, is the ability to use trans-disciplinary knowledge to innovate solutions for novel challenges. This expertise is desperately needed in a modern health system where health professionals must adapt to change, generate new knowledge about complex systems, and direct it at improvement of self and work environment. As we move toward change in healthcare, we are often limited by real and (perceived) constraints. RISE is attempting to challenge those constraints in health sciences education in order to transform our current system of science, health, and healthcare delivery.
When a physician with great impact and influence told me “no”, the standard medical student response may have been to take note of an ‘incorrect’ answer. But instead, I persisted in order to address a real problem in our medical school and health system. Along the way, I learned about the importance of allies in confronting the status quo, the unexpected opportunities of taking big chances, and the uncomfortable challenges of leadership and adaptive expertise. Through all of this I’ve realized the power of perseverance–because transformation is rarely linear.
Look forward to a future post about our progress making our health system more environmentally sustainable in the new year!
 Bell E, Horton G, Blashki G, Seidel BM. Climate change: could it help develop ‘adaptive expertise’?. Advances in health sciences education. 2012 May 1;17(2):211-24.
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
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!