Our last block of the semester focused on the GI system as well as some Complementary and Alternative Medicines. Both of these topics are very interesting to me for two completely different reasons. The former is interesting because I have unfortunately spent a lot of time in the clinic and hospital due to my own GI problems, and the latter because I'm very interested in medical anthropology and the culture of medicine.
Growing up I would often have these painful stomach episodes, leaving me unable to move for hours at a time. It seemed to occur randomly and at its worst, I was having an attack three to four times a week. Although I saw a few doctors when I was younger, my parents chalked up my episodes to over-exaggeration and/or my unwillingness to eat a balanced meal. However in college I found myself visiting the E.R. on multiple occasions because of the unbearable pain that was lasting ten to twelve hours at a time. Although the residents and attendings conducted many tests on me, and although I visited a GI specialist, I was never diagnosed with anything specific. Instead I was told to eat less and take Omeprazole (Proton Pump Inhibitor) before my meals. In reality it just took time and a lot of trial-and-error to be able to reduce the number of attacks.
At the time of this "diagnosis" I was incredibly frustrated with medicine. I had been having these attacks since a young age, they were causing me to lose a significant amount of weight, and they were unbearable. I didn't quite understand how having a diagnosis could be any worse than not having one. However this unit has helped me see just how horrendous GI syndromes and diseases can be. I recall being tested for Crohn's Disease and ulcerative colitis. Looking at the treatment pyramid for these irritable bowel diseases, it's obvious that there is no solution. Unlike other syndromes and symptoms that can be treated, individuals with these diseases become victims of their own bodies. Even chronic Irritable Bowel Syndrome can cause a lot of pain with little hope for a solution. To some extent the GI system is still a mystery to much of medicine; it is often about "managing" rather than "curing" the dilemma.
The other aspect of this block that is fascinating to me is the use of herbal medicines and CAMs in the treatment of different diseases. It was made pretty clear during our lectures that there are often more problems associated with alternative medicines rather than benefits, and that it can become difficult to support the use of these when there is little-to-no evidence of success.
In a medical anthropology class I took my junior year, I remember learning how we as a society look at alternative medicine as a cultural thing. Take for example Traditional Chinese Medicine or even Voodoo. While it is easy as an American to hold some skepticism in terms of the efficacy of these medical practices we often fail to realize that Western medicine- biomedical medicine- is a culture in itself. And just like any culture, it is hard to force down everyone's throats. From what we learn as Pharmacology students, and more so as medical students, it is hard to imagine believing that bio-medical medicine is not the right answer to many diseases. There is scientific evidence to support all of it! But at the end of the day, doesn't it matter what the patient also wants? Won't that affect the outcomes too?
When I was shadowing a family practice physician a year ago, I remember meeting an elderly, Cambodian woman who had just been diagnosed as having diabetes. As we are learning in this current unit (Endocrine), diabetes is an incredible dangerous and chronic disease, but if it is handled carefully, patients can live fairly healthy lives. As the physician emphatically explained that treatment was necessary and that the patient should see a diabetes counselor the patient listened quietly and patiently. When the physician had finished however, the patient explained as best as she could that treatment- management- was not going to be okay. In her community and culture, people had previously been diagnosed with diabetes, but they had sought out traditional Cambodian remedies. The patient was convinced that she could be cured by this alternative medicine just as her friends and family had been.
Unlike many other physicians, the one I was shadowing had had a lot of previous experience working with different cultures and addressing the use of CAMs. She was incredibly respectful of the patient's wishes, and came to an agreement: the patient should test her blood sugar everyday and let the physician know if it got above a certain threshold. She also encouraged the patient to visit a diabetes counselor in addition to trying out her traditional medicines.
In the end, it's not always easy to say what is the right treatment for a patient. From the culture of western medicine, it may be clear cut. But not every patient holds the same values or wants the same outcomes as this culture. As I aspire to go to an allopathic medical school in the United States, I obviously stand by the tenant that physicians should use evidence-based medicine. But I also aspire to work in under-served communities and to provide health-care globally. Even though these are MY goals, I strongly believe that every physician and health-care provider will encounter at least one patient who holds another medical culture above western medicine. Therefore all physicians need to be culturally competent and prepared to help their future patients as best as they can.
Thursday, December 20, 2012
Wednesday, December 5, 2012
To the Prospective Student, From a Current One
Every once-in-awhile my sleeping pattern gets thrown out of whack, and I find myself awake at the ungodly hour of 5 AM. And every once-in-awhile, I like to read other peoples' blogs. However it occurred to me this morning that perhaps prospective applicants to Special Masters Programs- SMP for short- (including this one in Pharmacology at Tulane) may happen upon our list of student blogs and seek out student feedback and advice on applying. While I recognize that picking my name out of 28 is unlikely, I still feel obligated (and I really just want to) to offer my two cents to all those future applicants and ye who is considering medical school "one day."
I know that for myself, who applied to medical schools as a senior in college, it came as a somewhat disappointing surprise that I would need to restart an application process in March of my last semester. After speaking to an advisor about my own, individual circumstances, and getting feedback from some alumni friends, I realized that I didn't have many options that would help me ultimately achieve my goal of getting into medical school. One very viable -and almost necessary route- however, was to apply to one of a number of post-baccalaureate programs across the nation. Coming to this decision did not reduce my stress whatsoever. Unlike college or even medical school applications, post-baccalaureate programs come in a variety of flavors, have no obligations to an overhead, regulatory organization, and can be a right-bother to deal with. Few people know much about them which only adds to the hesitancy so many graduates have about applying to them.
I started my hunt on the AAMC website; they have a database devoted to post-baccalaureate programs and are really helpful in allowing one to narrow down the many options. But after that, it really is up to the applicant to find out what's best. My own personal checklist included the following:
1. What kind of post-baccalaureate program is it? Now this can be a tricky one. I know that when I first considered programs, I steered clear of anything with a "Masters" attached to the title. Why? Because I assumed it meant a greater than one year commitment and a thesis. However I was pleasantly surprised to find that this is not the case for MOST SMP's. Sure, there are the occasional ones that require the thesis (Boston for example). But most SMP's have a one year curriculum that is tailored to students who are looking to gain admission into professional school in the near future. Additionally, many Masters programs will focus on a certain concentration (Pharmacology, for example). While I do know that medical schools often look upon SMPs more favorably, there are definitely non-masters programs that are considered good as well. (Personally I love being at an SMP that is focused on Pharmacology; not only is there more structure and connectedness to the material I learn, but I also have the added advantage of understanding a subject that is so important in medical school BEFORE I get there.)
2. What affiliations does the program have with medical schools? This is actually also a doozy, because in my own research, I found that fewer and fewer programs have formal agreements with their affiliated medical schools. Do take what I now say with a grain of salt- it's often like a game of telephone with even greater levels of speculation. Back to programs: A few still guarantee a seat into the next year's class (and if you have the criteria to get into one of these - like Tulane's Anatomy Masters- than do it!), but most applicants to SMPs fall just short of such programs. Others guarantee an interview, while others yet will put their own masters students in a "separate pool" when they do apply. I think what really matters, however, is that the program is both affiliated with a school that has it's OWN medical school, and that it grants you access to faculty members who are involved in teaching medical school classes, in medical school admission, or both. (The Tulane Pharmacology SMP has no formal guarantees, but there is definitely a lot of support from the faculty and staff.)
2. What are classes like? Are they with medical students? How will you be graded? This is definitely one of the most important things to consider in applying. The advantage of sharing classes with medical students is that you are basically proving you can do it too! The material will be relevant to you one day, and you are often being taught by physicians. A downside is that you may be graded directly against these same students. That's definitely a worry. However some programs will grade you against (but separate from) the medical school curve. Other SMPs will only have a few classes with medical students. Others won't have any. (I really like the way that the Tulane Pharmacology program is set up in that we have Medical Pharmacology with the 2nd year medical students both semesters. All of our other classes are just us. This results in a really nice balance of being exposed to what medical school is really like, while getting the background, pharmacology-specific details in our individual classes. I also like that we started almost a month before the medical school; this allowed all of us to get to know each other in a classroom setting, as well as to become familiar with the Pharmacology faculty.We're also compared to the medical student performance on our MedPharm exams, but are not graded with them.)
3. How big is the program? As an alumni of UW-Madison, I can safely say that bigger is not always better. Don't get me wrong- a huge campus brimming with some 40,000 students makes for an amazing, intellectual environment. But if you're considering applying to one of these SMPs, it's important that you consider what you yourself need to succeed. I KNEW coming out of college that I valued the smaller class size above almost everything. Even if you succeeded at a large university, consider this: in a smaller environment (like at Tulane), you get to know every faculty and staff member, you create lasting relationships with the majority of your class, and you lose some of the cut-throat competitiveness that comes with a large program. (Being here at Tulane, I am confident that my decision to go with a smaller program has led to my current success as a graduate student. Additionally, there are so many other students and people around you! You won't ever feel the need for company because there are many ways to meet students in different programs and ways to get out into this vibrant community. I myself am the class representative, and I'm having a blast getting to know the other representatives from the other Biomedical Sciences graduate programs).
4. How old are they? Is there a tradition of success? This is huge. With more and more undergraduates defining themselves as "pre-meds," and with an increasingly older entering medical school class, post-baccalaureate programs are popping up left and right to fill the demand. And that is where you need to look at numbers critically. Older programs are often the successful ones. And even then, look at the specific success rates. Are 70% of students getting into their desired professional school? Over how many years (1? 2? 10?)? What is "desired professional school"? If you know you want to go into medical school, and say more specifically: allopathic medical school, is that what the statistics are saying? (Tulane by the way, is one of the older programs and has a great success rate for getting students into allopathic and osteopathic medical schools. I think it's something like 80% in a few years.)
5. Can you reach the program via phone call or email? Will they answer your questions? Additionally- their website?
Unfortunately without a uniting organization to hold all post-bac programs to the same standards, it can become hard to get the answers to all those important (and listed above) questions. The best thing to do is to call the program yourself. If they are willing to talk to you and answer your questions honestly, that's a huge plus. If they seem unavailable or disorganized: bad sign. Another good place to check is the program's website. The same rules apply- do they answer your questions? are the organized? (Tulane is AWESOME in this respect. As I've already mentioned, I love the Pharmacology department. They are helpful, supportive, kind, brilliant and fun! It really feels like they are all here to see each of us succeed in our goals, but they often remind us to enjoy the journey along the way.)
6. Are there additional opportunities/requirements?
Going to an SMP does indeed mean changing your previous studying habits and time-management techniques, but it doesn't mean you should drop everything. Once you feel settled, you may be interested in pursuing additional activities to balance out all the studying. It's good to know if the program you're interested in allows students to get involved in research, and maybe even pursue a thesis. You may also want to join a program that places a special emphasis on a unique feature. (For example, I was drawn to Tulane in part because of the commitment students and staff have to volunteering. It's even worked into our curriculum!) Other programs offer different ways to get involved, as well as optional electives.
7. Other important stuff that I don't have much to say about:
While this is a lot of information, it's definitely something that I wish someone had told me while they were in an SMP. I am incredibly happy about the choice I made to apply to a variety of programs, and more so in my decision to come to Tulane University. I've already learned so much, on everything from pharmacology to how to study better, on serving the community to building relationships. Yes, I was worried about my "next step" when I realized I wasn't going to medical school right out of college, but at the ripe old age of 23, I'm learning that life really is about the journey you take to reach your goals. Even while keeping an eye on the end-goal is necessary, don't be afraid to take the less-traveled path.
I know that for myself, who applied to medical schools as a senior in college, it came as a somewhat disappointing surprise that I would need to restart an application process in March of my last semester. After speaking to an advisor about my own, individual circumstances, and getting feedback from some alumni friends, I realized that I didn't have many options that would help me ultimately achieve my goal of getting into medical school. One very viable -and almost necessary route- however, was to apply to one of a number of post-baccalaureate programs across the nation. Coming to this decision did not reduce my stress whatsoever. Unlike college or even medical school applications, post-baccalaureate programs come in a variety of flavors, have no obligations to an overhead, regulatory organization, and can be a right-bother to deal with. Few people know much about them which only adds to the hesitancy so many graduates have about applying to them.
I started my hunt on the AAMC website; they have a database devoted to post-baccalaureate programs and are really helpful in allowing one to narrow down the many options. But after that, it really is up to the applicant to find out what's best. My own personal checklist included the following:
1. What kind of post-baccalaureate program is it? Now this can be a tricky one. I know that when I first considered programs, I steered clear of anything with a "Masters" attached to the title. Why? Because I assumed it meant a greater than one year commitment and a thesis. However I was pleasantly surprised to find that this is not the case for MOST SMP's. Sure, there are the occasional ones that require the thesis (Boston for example). But most SMP's have a one year curriculum that is tailored to students who are looking to gain admission into professional school in the near future. Additionally, many Masters programs will focus on a certain concentration (Pharmacology, for example). While I do know that medical schools often look upon SMPs more favorably, there are definitely non-masters programs that are considered good as well. (Personally I love being at an SMP that is focused on Pharmacology; not only is there more structure and connectedness to the material I learn, but I also have the added advantage of understanding a subject that is so important in medical school BEFORE I get there.)
2. What affiliations does the program have with medical schools? This is actually also a doozy, because in my own research, I found that fewer and fewer programs have formal agreements with their affiliated medical schools. Do take what I now say with a grain of salt- it's often like a game of telephone with even greater levels of speculation. Back to programs: A few still guarantee a seat into the next year's class (and if you have the criteria to get into one of these - like Tulane's Anatomy Masters- than do it!), but most applicants to SMPs fall just short of such programs. Others guarantee an interview, while others yet will put their own masters students in a "separate pool" when they do apply. I think what really matters, however, is that the program is both affiliated with a school that has it's OWN medical school, and that it grants you access to faculty members who are involved in teaching medical school classes, in medical school admission, or both. (The Tulane Pharmacology SMP has no formal guarantees, but there is definitely a lot of support from the faculty and staff.)
2. What are classes like? Are they with medical students? How will you be graded? This is definitely one of the most important things to consider in applying. The advantage of sharing classes with medical students is that you are basically proving you can do it too! The material will be relevant to you one day, and you are often being taught by physicians. A downside is that you may be graded directly against these same students. That's definitely a worry. However some programs will grade you against (but separate from) the medical school curve. Other SMPs will only have a few classes with medical students. Others won't have any. (I really like the way that the Tulane Pharmacology program is set up in that we have Medical Pharmacology with the 2nd year medical students both semesters. All of our other classes are just us. This results in a really nice balance of being exposed to what medical school is really like, while getting the background, pharmacology-specific details in our individual classes. I also like that we started almost a month before the medical school; this allowed all of us to get to know each other in a classroom setting, as well as to become familiar with the Pharmacology faculty.We're also compared to the medical student performance on our MedPharm exams, but are not graded with them.)
3. How big is the program? As an alumni of UW-Madison, I can safely say that bigger is not always better. Don't get me wrong- a huge campus brimming with some 40,000 students makes for an amazing, intellectual environment. But if you're considering applying to one of these SMPs, it's important that you consider what you yourself need to succeed. I KNEW coming out of college that I valued the smaller class size above almost everything. Even if you succeeded at a large university, consider this: in a smaller environment (like at Tulane), you get to know every faculty and staff member, you create lasting relationships with the majority of your class, and you lose some of the cut-throat competitiveness that comes with a large program. (Being here at Tulane, I am confident that my decision to go with a smaller program has led to my current success as a graduate student. Additionally, there are so many other students and people around you! You won't ever feel the need for company because there are many ways to meet students in different programs and ways to get out into this vibrant community. I myself am the class representative, and I'm having a blast getting to know the other representatives from the other Biomedical Sciences graduate programs).
4. How old are they? Is there a tradition of success? This is huge. With more and more undergraduates defining themselves as "pre-meds," and with an increasingly older entering medical school class, post-baccalaureate programs are popping up left and right to fill the demand. And that is where you need to look at numbers critically. Older programs are often the successful ones. And even then, look at the specific success rates. Are 70% of students getting into their desired professional school? Over how many years (1? 2? 10?)? What is "desired professional school"? If you know you want to go into medical school, and say more specifically: allopathic medical school, is that what the statistics are saying? (Tulane by the way, is one of the older programs and has a great success rate for getting students into allopathic and osteopathic medical schools. I think it's something like 80% in a few years.)
5. Can you reach the program via phone call or email? Will they answer your questions? Additionally- their website?
Unfortunately without a uniting organization to hold all post-bac programs to the same standards, it can become hard to get the answers to all those important (and listed above) questions. The best thing to do is to call the program yourself. If they are willing to talk to you and answer your questions honestly, that's a huge plus. If they seem unavailable or disorganized: bad sign. Another good place to check is the program's website. The same rules apply- do they answer your questions? are the organized? (Tulane is AWESOME in this respect. As I've already mentioned, I love the Pharmacology department. They are helpful, supportive, kind, brilliant and fun! It really feels like they are all here to see each of us succeed in our goals, but they often remind us to enjoy the journey along the way.)
6. Are there additional opportunities/requirements?
Going to an SMP does indeed mean changing your previous studying habits and time-management techniques, but it doesn't mean you should drop everything. Once you feel settled, you may be interested in pursuing additional activities to balance out all the studying. It's good to know if the program you're interested in allows students to get involved in research, and maybe even pursue a thesis. You may also want to join a program that places a special emphasis on a unique feature. (For example, I was drawn to Tulane in part because of the commitment students and staff have to volunteering. It's even worked into our curriculum!) Other programs offer different ways to get involved, as well as optional electives.
7. Other important stuff that I don't have much to say about:
- What is the cost? This is often the biggest limiting factor for many. And don't forget the cost of moving, travel and living when you calculate this.
- What city is it in? Let's be real: you don't want to live in Podunk, Nowhere for a year. Important side note in my shameless plug for Tulane: hurricanes really aren't a big deal. According to our program director Dr. Clarkson: "It's either time for a mini vacation or a Hurricane party."
- Do they encourage students to apply to medical school while they are in the program or after? Some programs say one thing, others say the opposite. Part of this is dependent on how much YOU need to prove yourself in the program. If you do: don't apply that same year
- Will the program provide letters of recommendations? They better.
- Are there opportunities at the school or in the city for any additional time you take off? Personally I think Tulane University and the city of New Orleans provide ample opportunity for me this next year. And to be honest: I'm super pumped!
While this is a lot of information, it's definitely something that I wish someone had told me while they were in an SMP. I am incredibly happy about the choice I made to apply to a variety of programs, and more so in my decision to come to Tulane University. I've already learned so much, on everything from pharmacology to how to study better, on serving the community to building relationships. Yes, I was worried about my "next step" when I realized I wasn't going to medical school right out of college, but at the ripe old age of 23, I'm learning that life really is about the journey you take to reach your goals. Even while keeping an eye on the end-goal is necessary, don't be afraid to take the less-traveled path.
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