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Training to be the LEADers and Best

It was the day after I pulled my U-Haul trailer into Ann Arbor. I kissed my wife and three little boys goodbye and walked out the door just as the moving truck pulled up with everything we own to unload, only I wasn’t staying to unpack. I was starting medical school … four weeks early, was I crazy!?

My three little study-buddies

I was joining 24 of my classmates in the Leadership and Enrichment for Academic Diversity or LEAD program. LEAD is a three-week med school primer filled with Anatomy, Histology, team building, workshops and … amazing lunches ☺.

At the tender age of 33, with thousand of hours navigating planes around the world as an Air Force pilot I found myself struggling to figure out how to ride a city bus to school and get to Taubman Library … seriously humbling. Despite all of this, and with a little help (as always) from the amazing Becky Weeks, I found my way to campus. I walked into the oddly familiar room with white boards as walls and started meeting my new teammates … hoping I could remember their names. As our group explored the first of 77 rounds of fun facts and introductions, I found myself digesting what I was hearing … research backgrounds, ivy league schools, 1st generation, city year, medical professionals … my new peers were amazing people who had done amazing things. It’s not just their accomplishments, they were truly awesome people. They were great to talk with, they were kind and they were sharp. I found myself feeling the full weight of imposter syndrome. I mean I’ve spent my life flying planes surrounded by so called “elite” men and women in aviation, but suddenly I was feeling like “just an old military guy from Arkansas.” Did they mix my file up with someone else’s?

The crazy thing is that by as early as the end of day two, I realized that everyone had some level of the same feelings as I did. Now this next part is very cliché and I promise no one is paying me to say it, but that’s when I remembered one of the key reasons I chose Michigan: it wasn’t the buildings, the free water bottles or even the curriculum… it was the people! The current students, the faculty, but most importantly, it was my future classmates who I met at interviews and second look. I chose Michigan because the people I met were amazing and I wanted to learn and grow with them for four years. Yes, this group’s accomplishments were intimidating but I mean Emmitt Smith is an amazing running back and very intimidating … but that is why I’d WANT to be on his team. Talented teammates help make great teams (shout out to my 90s Cowboys RIP). From that moment on I no longer saw people with whom I didn’t compare, but friends and allies from whom I could learn.

After those first couple of days our group bonded into a family. I got to live vicariously through group texts about 10 p.m. meet ups to eat or go out, join my friends after class for margaritas and learn about everyone’s amazing story. Even those of us with kids or other situations who couldn’t make some of the fun social events weren’t left out. I was overwhelmed with love and support, people changed times and schedules just to include me … wow!

LEAD team out after a great day of class

As we progressed, we encountered firsts. Some of us worked with our first donor in the anatomy lab. We all worked through the trepidation of making our first incision, the amazement of holding and learning about a human heart and brain. For me it was an interesting evolutionary process in the lab. I have worked in combat zones with patients living, near death and dead, but it’s different when your goal is learning from the person rather than ensuring the person survives. My evolution went from over-conservative reverence for the amazing gift our donors gave us, almost fearful to dissect, all the way through to reminding myself that this was not a body but a person, an entire generation of love and story. We got to see where we would one day be, with our M1 student TAs and gain insane respect for Dr. Orczykowski’s and Dr. Sullivan’s mental database of anatomical expertise.

I witnessed the passion of Dr. Hortsch in histology and downloaded all 32 apps we needed to be successful in medical school. As I reflect however it’s not the slides I remember. It’s Dr. Okanlami’s patient presentation where we got to learn and break barriers as people and future physicians. It’s a professor’s funny shirt and personal story. I remember a friend hanging out with my seven-year-old and bonding over ice cream and magic, selflessly running inside to grab him a napkin when he spilled cookie dough on his kicks. I remember a classmate selflessly opening her apartment to all of us, and another buying out the inflatable float section at DICK’s Sporting Goods so we could float the river.

Don’t get me wrong. Everything was not perfect. There were boring moments and even frustrating times. My experience doesn’t lack any of this, but even in these situations, I remember peers asking great questions and working through issues and concerns. I hit a point where I felt tired of talking about “feelings” and all the “fluffy stuff.” In retrospect, I’ve realized part of the reason I felt tired of this is because I haven’t been raised with proactive approaches to overall wellness, and again, it sounds cliché, and again, I promise I am in no way a paid sponsor of any agenda. But seriously, it felt foreign to focus on learning and wellness in non-tangible or testable areas. At the end of it all, I’m glad we did it and I’ll never know who else it benefited during any given day of those sessions.

Just a few of the LEAD class of 2019 with brand new white coats!

If you have the opportunity, I highly recommend participating in LEAD. The program won’t help you pass a quiz or be any more ready for that first firehose lecture. It WILL equip you to help soften another classmate’s anxiety during Launch week or help someone find their way to class on time. It will also provide an early chance to really get to know your classmates. In my military past, I knew I could count on the person next to me. We were family. I can honestly say that I can call any of my LEAD teammates at two a.m. any day of the week and they will have my back. I know the same is true of my other 152 classmates I met at Launch! 

If anyone has any questions about my experience, shoot me an email and checkout the amazing OHEI site

Like Dean Gay says, as always Go Blue!!!

An Apprenticeship in Humanity

One pleasantly surprising thing about clerkship year was how often I would come across attendings whose level of dedication to their craft was jaw-dropping. But when I met Dr. Jessica Mellinger on the Medicine GI service and learned about the Michigan Alcohol Improvement Network (MAIN), a multidisciplinary alcoholic hepatitis clinic she and her colleagues had just started, it was a rule-out-TMJ kind of situation. Then I went to shadow her in the clinic and met Dr. Scott Winder, a psychiatrist. I won’t belabor the mandibular metaphors, but I will say that the humanity was palpable. Watching him put every single ounce of himself (which is a lot, he’s a pretty tall guy) into the motivational-interview approach he took with the new patient that day actually sent chills down my spine. I’m pretty sure the patient felt it, too.

The MAIN team (left to right) me; Anne Fernandez, PhD (Psychologist); Kristin Klevering, MSW; Jessica Mellinger, MD; G. Scott Winder, MD

Yet, I’m also pretty sure that alcoholism continues to ravage that patient’s already precarious mind and body. Indeed, despite the best efforts of MAIN clinicians, his prognosis is quite poor. It turns out both research and clinical efforts in alcoholic liver disease are woefully underrepresented in hepatology. The same is generally true of addiction within psychiatry. It takes a certain kind of person to persevere in building therapeutic alliance with patients whose addictions repeatedly sabotage their physical, mental and social lives. It takes a whole different breed to show up with sleeves rolled, radically loving and unconditionally ready to engage patients in a new line of change talk. After all, only with such an attitude is there a chance that the patient will leave feeling more empowered to confront their vicious disease than when they came in. That’s what the MAIN providers do on the regular.

My Branches Apprenticeship Elective in MAIN has so far afforded me opportunities in longitudinal patient care, systems improvement and research, training in addiction pharmacology and psychotherapy, and an orientation to integrated care models. But to me its greatest value has been in forging close relationships with people I was able to pre-screen as role models. When I then asked Drs. Winder and Mellinger to speak to the Internal Medicine and Psychiatry Student Interest Groups this past February, they brought the same kind of all-in attitude they bring to patient care.

So, my advice to fellow medical students: as you advance through the sometimes mundane, often challenging world of core clerkships, keep an eye out for those one or two people who when you meet them, a little voice inside you asks how this person even exists. Then ask them about their side gigs.

Front Row Learning

Implied in the title of “apprentice” is the expectation that you will develop an intimate relationship with an expert who provides instruction and guidance. It was this implication that drew me to the longitudinal apprenticeship program at UMMS. I am a fourth-year medical student aspiring to be a vascular surgeon and, having not rotated through vascular surgery during my surgery clerkship, I was determined to find a way to develop relationships within the department. Obviously, research opportunities and sub-internships provide channels for making yourself known within a department, but I found that my experience in the longitudinal apprenticeship program lead to research opportunities and allowed me to develop rapport with faculty prior to beginning a sub-internship.

The school’s first apprenticeship program, called Longitudinal Clinic, was designed for the Patients and Populations Branch. This was the first year it was expanded to students in all of the Branches including my Procedure-Based Care Branch. As a pilot program, it was not quite perfect yet, but it was perfect for providing something of an introduction into a department as well as developing a relationship with a mentor. The first time I worked with my mentor, a vascular surgeon at Michigan Medicine, I was the only medical student present for a case and was able to participate in operative tasks that are somewhat rare for a medical student. Afterwards, the attending walked with me to chat for a bit and then walked around the department with me to introduce me to other faculty. To be trusted with increased responsibility in the OR and have an attending physician actively take an interest in my career goals was an incredibly rewarding experience.

The advice I would give to anyone considering a longitudinal apprenticeship would be, without a doubt, to take advantage of it. However, I do think I benefited from this experience in large part because I had already determined what I wanted to do with my medical career and could focus all of my efforts into participating in opportunities within the department and developing a relationship with a mentor. One could argue, however, that this program will also provide in-depth exposure to a particular field of medicine for students uncertain of what career they would like to pursue. Regardless, I found this program to be phenomenal and it provided the perfect opportunity to develop a relationship with a mentor capable of helping me pursue my career goals.

Music and Medicine

Nearly two months ago, I had an epiphany about the similarities between two areas of my life that are important to me. My stepson had alternated between recordings of “Für Elise” and “Moonlight Sonata” on YouTube one night while doing homework, so my husband asked if I wanted to surprise him by taking in Ann Arbor Symphony Orchestra’s performance of Beethoven’s Ninth Symphony. I enthusiastically agreed and the next evening we all got dressed up and without telling him what we were doing, went to the theater and purchased last-minute tickets.

Ann Arbor Symphony Orchestra (April 2019)

Our seats might have been considered nosebleed by some (and surely, each step brought a bit of trepidation as we climbed to a dizzying height), but once we were settled in, we realized it was the perfect vantage point to take in the entire panoramic view. Hill Auditorium is a gorgeous facility where I’ve seen everything from Handel’s Messiah to Snarky Puppy. It’s also the location where I received my White Coat nearly three years ago.

Despite the significant height difference, these are indeed my proud parents; it is a privilege having these folks in my corner. (White Coat Ceremony, July 2016)

All eyes were fixated on the performers up front, scanning the different sections. The most famous movement of the piece, commonly known to many listeners as the “Ode to Joy” theme, is full of moments of crescendo when the instruments and voices swell, concurrent with an emotional response from the audience. The sound reverberated throughout the building and made my heart race, much like on the day I nervously walked across the stage and entered my journey into becoming a physician.

My mind went to the scene of a patient with a racing heart due to unstable atrial fibrillation who required cardioversion earlier that week. You see, the evening of the concert, I was in the midst of a string of overnight shifts as part of my Emergency Medicine rotation. The parallels between the “resus” (resuscitation) bay and the activity on stage in the concert hall were many. Just as each group of instruments has their assigned part to play (literally), members of a health care team have their own roles. While most are adept at carrying out their part with little instruction, it is necessary to continually check in and take cues from the conductor. In the Emergency Department, the maestro may be an attending physician; often though, the faculty member stands back while a resident (physician in training) directs and guides the action, much like the concertmaster is an instrument-playing leader of the orchestra.

As a medical student, I often feel like the tambourine player in these situations: not yet useful enough to be integral in every song, but occasionally given a “solo” and allowed to intervene in an important and noticeable way, like pushing the SYNC and SHOCK buttons of a defibrillator to deliver electrical energy to that patient in the unstable cardiac rhythm. Or, for the patient who dislocated their patella (kneecap), grasping their ankle and gently extending their leg while a resident applied firm pressure on the knee to pop it back into place. These are moments that, much like a moving piece of music, make me hold my breath, filter out the distractions in the periphery, and focus on the art in front of me.

A few hours after the last note had been played, having changed out of my dress and heels and clad in scrubs and white coat, I felt lighter, and ready to work in “concert” with the rest of the group. Walking into the team area, there were numerous exchanges going on, the chatter of various tones and cadences. In between pagers going off, phones ringing and overhead announcements, conversations took place between techs and patients as they were wheeled to their rooms. “Music to my ears,” I thought, as I sipped my coffee and settled in for my Saturday night shift in the Emergency Department.

Parliamentary Procedure and Other Lessons Learned at the AMA’s Annual Meeting

This weekend, June 6th-8th, instead of studying for the Infectious Disease/Microbiology quiz, I opted to go the American Medical Association’s (AMA) Annual meeting in Chicago as U of M’s representative.

I joined our chapter of the AMA in January with the goal of creating and influencing policy to protect the health of our patients, learning more about how to effectively advocate for patients as a future physician, and, of course, getting that sweet, sweet weekly copy of JAMA. Since joining, I’ve participated in social media campaigns in support of specific legislation, directly lobbied lawmakers on behalf of patients, and helped write a resolution advising the Michigan State Medical Society to take a stand against gun ownership for people convicted of intimate partner violence. Organized medicine has proven to be an awesome experience. Until this weekend, though, I hadn’t taken part in one of the key activities of medical student AMA membership – the Annual Meeting of the Medical Student Section (MSS) Assembly.

I took the train to Chicago and got in late Thursday night. After an early breakfast on Friday, I got my credentials (a piece of yellow paper with UMMS written on it) that indicated I was a voting member of the MSS assembly. I didn’t realize how heavily these types of assemblies rely on Parliamentary Procedure (or Parli Pro, as self-proclaimed Parli Pro nerds call it) to keep things moving. The whole scene of the first session was one of ceremony and formality that I didn’t expect – a blur of motioning, seconding, and objecting to the various resolutions that medical students from across the country had submitted to be debated and adopted (or rejected) as AMA-MSS policy. Resolutions are proposals that ask the AMA to take a specific political position or to initiate an action. If a resolution passes with a majority of votes in the MSS, it can then go on to the full AMA Physician section to be adopted (or rejected) as the official stance of the AMA.

After the first session, we split in to smaller regional meetings. These regional meetings have a very ‘The War Room’-esque feel about them. In our region, medical students from Michigan, Indiana, Ohio, West Virginia, and Kentucky tried to reach a consensus on a wide range of resolutions that would be coming up for a vote in the afternoon and strategized about the best way to get resolutions authored by our students passed by the majority. After an hour and a half of deliberation, we broke for lunch and the afternoon session.

During the large assembly gatherings, if anyone in the room feels strongly about a resolution, they are encouraged to find a microphone and make their case to the group for passing or rejecting (or reaffirming or referring for study or tabling, etc., refer to paragraph 2’s comments on Parli Pro) it. I’m not a big fan of public speaking even to just our Leadership small groups, let alone hundreds of medical students at once. However, there were two resolutions that came up that would seek to expand the AMA’s efforts around ensuring patient safety and well-being throughout their recovery from opioid use disorder (OUD). This is a personal and academic interest of mine, and I didn’t want to miss my chance to inform my colleagues; decision about the policies. I nervously went to the mic and urged the Assembly to bear in mind the social and economic determinants that our patients with OUD and other addictions face, and to recognize that we should bring the resources of the AMA to bear on those problems where we can.

I’m not sure how much of an effect a single testimony like that actually had on people’s votes, but I was proud to stand up for vulnerable patients in that moment. Moments like that are why I joined the AMA in the first place. I’m on the train back to Ann Arbor while I write this, and I still need to take that Infectious Disease quiz. But I’m glad I didn’t miss a weekend full of learning, networking, and advocacy.

Staying Organized in Medical School

Medical school is complicated, and it can be easy to get lost in the process. Just three objects make my world a little easier to manage.

Paper Planner: I am a pen-to-paper gal, so I use a planner to keep myself organized. I divide each day into three sections: academics, wellness and other. For academics, I include the number of lectures I need to study, required activities, pre-work reminders and assignments. I try to keep this section less cluttered by using my phone for referencing the school class/activity calendar. My wellness section often includes yoga class times, personal training goals, and the occasional reunion with friends who are not in medical school. My other section is full of tasks such as folding laundry, preparing lunch for the next day, attending events at Michigan Medicine, and practicing for Biorhythms, a student-run dance organization at UMMS. I plan as far ahead in advance as possible to (1) maximize my study time, and (2) maintain professional and personal relationships.

A snapshot of one of the pages in my First Aid book and my new planner for the clinical trunk year.

First Aid for the USMLE Step 1: I use the First Aid (FA) text to complement my weekly sequence learning. This book was written to help students condense preclinical information into more than 650 pages of must-know concepts. Fortunately, FA was provided to incoming first-year medical students a couple of months into the first year. I wish I had received it sooner though because it helps me stay focused on retaining the most high-yield information. In addition, each sequence is taught by different instructors with their own style and determination of what is and is not significant to learn in the first year. As a result, FA complements what may or may not be included in classroom learning. I hole-punched the text at a local print shop to put it in a binder. Not all the information I need to know for the USMLE Step 1 exam is provided in the book, so I needed the space to include my notes from lectures and small groups. Some organization and preparation now will help me be as ready as possible for the USMLE Step 1 study period after my second year.

Tablet: Throughout my undergraduate studies at the University of Michigan, I used paper for all of my note-taking. Like I mentioned before, I use a planner to stay organized. I did not think I would like using a tablet for studying purposes, so I started medical school by printing out the lecture slides and writing directly on them as I had always done before. What I quickly realized was that (1) I was not helping the environment by printing so much, (2) I did not have the space to hold all those notes, and (3) I would spend as much money printing and purchasing ink throughout the year as I would investing in some convenient technology. On my iPad, I keep all the slides in dividers and subjects in an application called Notability, so I never leave notes at home! I can also easily transport my iPad to and from school, which makes room in my backpack for my binder of the First Aid book discussed previously. I chose the iPad because I determined that it was the best way for me to study efficiently. However, there is no specific technology that is mandatory for students to have or use. The UMMS Financial Aid Office is also available to help students finance educational items…such as a tablet!

Spending 30 minutes updating my planner every week, consistently devoting a few hours every Saturday to adding information to my First Aid book, and regularly charging my tablet has made the transition to medical school just a tad less difficult. Every person is different, so when you matriculate as a medical student, spend some time adjusting to the pace of school and finding ways that work for you to stay organized.