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20
2016

The Write Stuff: M4 Jennifer Tran shares her journey through blogging

Butterflies wreak havoc on Jennifer Tran’s stomach when she thinks about speaking in public.

“I’m not great at it,” she said. “I get really nervous. But I enjoy sharing my thoughts and ideas with others.”

So Tran, a fourth-year student in VCU’s School of Medicine, turned to blogging.

“For me, writing is a way to reflect on things I’ve done,” she said.

Tran began blogging as an undergraduate student at the University of Virginia for the Asian & Pacific Islander American Scholarship Fund. A recipient of the scholarship in 2007, she wrote career and motivational pieces for other scholarship winners.

After graduating in 2011 with a degree in biology, she worked for a year at the National Institutes of Health before coming to the MCV Campus. During her second year of medical school, she began blogging for the AAMC’s Aspiring Docs Diaries, and during her third year for Merck Manual website’s Student Stories, a medical education blog.

“I hope those who read my blogs get a real sense of what the day-to-day life of a medical student is like,” says the Class of 2016’s Jennifer Tran. “I hope they inspire and educate young people who are thinking about a career in medicine.”

“In medical school, you are always on the move,” she said. “Writing gives me a chance to stop and really think about things.”

She’s written about clinical rotations, encountering a simulated patient (mannequin), the value of mentors, lessons learned from her first patients, volunteering with the underserved, being a fourth-year, Match Day, traveling abroad and taking national exams, among other things.

“I hope those who read my blogs get a real sense of what the day-to-day life of a medical student is like,” she said. “I hope they inspire and educate young people who are thinking about a career in medicine.”

In one blog, for example, she talks about her pediatrics rotation: “Pediatrics wasn’t what I expected. Going into the clerkship, I thought this was going to be one of my top three, even toppling family medicine or internal medicine as my intended field of choice. Back in college, much of my medical volunteering and shadowing was in pediatrics. I had found kids to be so fun, their conditions to be interesting, and the attendings to be some of the most kind teachers. Yet, after six weeks, I find myself no longer wanting to be a pediatrician. I still really like kids, laughing and playing with them, but I’m not sure I want to forever be perceived in a kid’s mind as the evil one or the one that is trying to hurt them.”

She’s also written about her dream of becoming a family physician and serving the poor, a goal strengthened by the School of Medicine’s International/Inner City/Rural Preceptorship Program. I2CRP is a four-year program that fosters the knowledge, skills and values needed by doctors to provide quality and compassionate care to the less fortunate.

“Blogging has really helped me be sure of what I want to do,” she said. “It’s helped me solidify my career goals. It allows me to reflect on experiences – what I liked about them and perhaps what I didn’t like. It keeps the experiences fresh.”

Working with the underserved, Tran said, will allow her to provide quality medical care to those who might not otherwise receive it.

“I’m really drawn to this area,” she said. “I’ve seen people who live on the fringes of the healthcare system. It’s my mission to make sure they get the care they need.”

Tran, who is heading to Brown Medical School’s Memorial Hospital of Rhode Island for her family medicine residency, is the eldest child of Vietnamese refugees and the first in her family to attend college. For her, becoming a physician is almost surreal.

“My parents are very proud,” she said. “But I have not come to terms yet that I’m going to be an actual doctor. As a medical student, there is always faculty there to supervise and help. As a resident, my name will be on the patient’s record. It will all count. For me, it’s a bit scary. ”

The perfect topic for yet another blog.

“Writing is such an individual thing and a great way to share your hopes and your fears,” Tran said. “It’s something I’ll always find time to do.”

An excerpt from a blog for Aspiring Docs Diaries about her volunteer experience at the Remote Area Medical (RAM) expedition in Wise, Virginia, during her second year.

“In my role as a volunteer, I was able to listen to patients’ stories and gain an understanding of their health problems in the context of the socioeconomic obstacles that they face on a daily basis. Each day of the clinic, I met patients who had been up at four o’clock that morning, so that they would be one of the first hundred in line for the opening of the clinic at six o’clock. I talked to patients about different chronic conditions, such as hypertension, diabetes, and obesity. Nevertheless, hearing some of the stories and seeing some of the medical conditions broke my heart at moments.

“With access to a primary care physician, the pain of a broken bone that did not heal correctly, the inability to read a book, the chronicity of arthritis in one’s joints, among other complaints, may have been resolved sooner so that these patients could return to having the best quality of life possible. Yet, by the end of the clinic, I realized that my efforts and the endeavors of all the RAM volunteers were worthwhile and at times, potentially life-saving. We were able to provide preventive care and other specialty services in over 3,000 patient encounters, giving people health care they would have otherwise gone without. It was my first RAM expedition, but I do hope to return in the future. Most importantly, this clinic has helped me reaffirm my passion for helping the medically underserved, which is something that will enable me to persevere through the long year of challenging, but interesting, courses.”

Continue reading at AAMC’s Aspiring Docs Diaries.

By Janet Showalter

20
2016

A dozen fourth-years do clinical rotations in Italy and Spain

Katie Waybill, M’16, was awestruck by the pace of life in Messina, Italy.

“It was so much slower,” she said. “It really gave us a chance to feel the culture of the city, to live every moment.”

Waybill was one of six fourth-year medical students to travel to Italy in February as part of a four-week international exchange between the VCU School of Medicine and the University of Messina. Another six students just returned from Spain as part of an exchange with the University of Cordoba.

“It’s so much better when you are learning a language to be immersed in the environment,” said the Class of 2016’s Ellie Balakhanlou. “I feel like I left there more competent because I was forced to get out of my comfort zone a little bit and really converse in the language.” Pictured here: The students on the Cordoba rotation on a trip into the High Atlas Mountains, where they visited some Berber villages.

“This is a great way for our students to see how healthcare is performed in other parts of the world,” said Chris Woleben, M’97, H’01, associate dean for student affairs who helps coordinate the exchange. “This experience helps our students become well-rounded in dealing with patients who come from different backgrounds.”

The medical exchange between the three schools began 10 years ago. This year, about 30 students from the MCV Campus expressed interest, with 12 selected through a lottery process. When they applied, they selected the specialty that interested them the most and were matched with physicians to shadow.

“Medical students there don’t get as many hands-on experiences as we do here,” said student Sushmita Gordhandas, who traveled to Spain. “But I still learned a lot. It was interesting to see how different healthcare is in another country.”

Gordhandas, who will be moving to Seattle for her OB-GYN residency at the University of Washington, rotated in radiology while in Spain. She saw a variety of cases, from a brain tumor to broken bones.

“In the U.S., there’s more of a mindset that your life is your job,” she said. “In Spain, you do your job and go home to your family. You work hard, but family is the priority. That was one difference, but the biggest thing we encountered was the language barrier. That was a little challenging, but it all worked out. We had friends on our side.”

Many of their counterparts who already had rotated on the MCV Campus as part of the exchange were happy to lend a helping hand, and many of the assigned professors spoke English.

“Some of the residents had already been here and were familiar with MCV,” said Waybill, who will stay in Richmond to complete her internal medicine residency. “Their English was really good. They helped us so much.”

For Ellie Balakhanlou, the trip to Cordoba gave her the opportunity to flex her Spanish-speaking muscles.

“It’s so much better when you are learning a language to be immersed in the environment,” she said. “I feel like I left there more competent because I was forced to get out of my comfort zone a little bit and really converse in the language.”

“It was a clinical rotation for us, but we learned so much outside of that,” said Waybill, who rotated in radiology. She reviewed chest x-rays and saw everything from bowel cancer and congenital heart anomalies to pneumonia. She also had the opportunity to run CT scans on two Vatican mummies. “I am so appreciative for the chance to live in another culture.” Pictured here: The students on the Messina rotation on a day trip to Sicily.

Balakhanlou will stay at on the MCV Campus for her residency in physical medicine and rehabilitation. While in Spain, she was part of the physical rehabilitation rotation and worked with cardiac, pulmonary and pediatric patients.

“I got to do some exams and talk with the patients,” she said. “It was great. The doctors introduced us as Americans and all the patients were so welcoming. They joked with me that I got the chance to practice my Spanish with them while they got to practice their English with me. It was a fascinating experience.”

Each group made time for sightseeing. In Italy, for example, the students spent a weekend in Tuscany, visited the Leaning Tower of Pisa and saw Greek ruins in Agrigento.

“It was a clinical rotation for us, but we learned so much outside of that,” said Waybill, who rotated in radiology. She reviewed chest x-rays and saw everything from bowel cancer and congenital heart anomalies to pneumonia. She also had the opportunity to run CT scans on two Vatican mummies. “I am so appreciative for the chance to live in another culture.”

With a growing number of students applying for the exchange, the medical school hopes to expand the program to include more countries in the coming years.

“In an ever increasing globalized world, it’s important to have inter-cultural experiences,” said Michael Ryan, M.D., assistant dean for clinical medical education. “It makes our students more valuable and better equipped to understand our complex world.”

And become better physicians in the process.

“Health care is different no matter where you go,” Waybill said. “No one system is perfect. But if you can take the strengths from all, it will allow us to have a cohesive relationship with other nations and work toward a stronger healthcare system for everyone.”

By Janet Showalter

18
2016

Pair of M16 marathoners top off four years with personal records

When classmates Amanda Filiberto and Suzanne Giunta stood at the starting line of the Boston Marathon in April, there may have been a sense of déjà vu. They’d raced those same streets two years ago when they were second-year students, and had returned this spring to cap off four years of medical school – and four years of 5 a.m. workouts.

“The Boston marathon is electric,” says Filiberto, a member of the VCU School of Medicine’s Class of 2016. “There is no other race like it. There are volunteers and people cheering for a full 26.2 miles. There is something about the entire experience that makes those 5 a.m. runs in the snow, sleet, rain, wind or whatever so worth it.”

For Giunta, Boston was the eighth marathon she’s run since beginning medical school. Like Filiberto, she was a runner in college.

“I ran varsity cross country and track at the University of Rochester, then transitioned to marathon running once beginning school at MCV,” says Giunta. “It’s been quite a ride balancing my studies with my training, but I’ve loved having running as my stress reliever and have been lucky enough to see significant improvement in my times throughout the last four years.”

Giunta and Filberti Boston marathon 1 crop

Classmates and training partners Suzanne Giunta (left) and Amanda Filiberto at the finish line of the 2016 Boston Marathon in April.

The Boston Marathon was a personal record for her with a time of 3:06. She averaged 7:05 minutes a mile, which placed her in the top 1.4 percent of all Boston’s female finishers.

“Ending medical school with such a great performance was incredible and I was very happy with my time.” She says that the best part of the weekend, though, was having two of her best friends come to watch the race and getting to start the race with her training partner, Filiberto.

Filiberto has run five marathons and six half marathons while in medical school. Her time in Boston this year was 8 minutes faster than her 2014 time – coming in at 3:16. Though it was a personal record, she wasn’t satisfied with that, “because I trained really hard and knew that I was in excellent shape and could run faster.”

So she quickly signed up for the Long Island Marathon near her hometown of Northport, New York. Running it just two weeks after Boston, she turned in her best time ever – 3:03:59 – and finished first among the women.

“I was a sprinter/middle distance runner for four years at Brown University, and once I graduated I never thought I would run competitively again,” says Filiberto. “Suzanne was actually the one who got me started on the whole distance running thing and encouraged me to run the Richmond half marathon in November of our first year of medical school. I still remember the very first 8 mile run we went on together – and ever since then I’ve been hooked.

“Having a training partner to hold you accountable has made it so much easier to train, and those long runs have been a good way to catch up and de-stress from the rigors of medical school. Running has been such a huge part of my life for so many years, and despite starting residency in July, I hope to keep it that way!”

Filiberto will begin her general surgery residency training at the University of Florida College of Medicine-Shands Hospital this summer. Giunta is headed to the state of Washington where she’ll train in family medicine at Swedish Medical Center.

By Erin Lucero

19
2016

MacGyver medicine: Medical school team wins wilderness medicine event

Stabilizing a patient with spinal cord injury. Emergency tracheotomy. Intubation. It’s all in a day’s work.

Except now imagine doing these procedures while mountain biking, canoeing, running through the woods with map and compass, and carrying all your supplies on your back.

The Class of 2016’s Phil Griffith, Chris Woleben, M’97, H’01, and the Class of 2017’s Jenika Ferretti-Gallon prevailed in the Mid-Atlantic MedWAR that combines wilderness medicine and adventure racing.

Sounds almost impossible, but the medical school’s Lactated Ringers team prevailed at the Mid-Atlantic MedWAR (Medical Wilderness Adventure Race) competition on March 19.

MedWAR events pit three-person teams of wilderness medicine enthusiasts against each other for a day-long event that challenges their medical knowledge, orienteering skills and stamina. The competition, held in several locations throughout the U.S., was created in 2000 by two emergency medicine physicians with a passion for adventure racing. MedWAR events have no route markers, water stations or cheering spectators; instead they simulate backcountry rescue situations so participants can test and improve their skills.

The Class of 2016’s Phil Griffith heard about the event last year and decided it was the perfect venue for his love of the outdoors and career plans as an emergency physician. “Emergency medicine fits with wilderness medicine,” he noted. Except in the outdoors, “You’re practicing with fewer resources, higher evacuation times and the same principles of stabilize and improvise.”

He participated in the event for the first time last year with Chris Woleben, M’97, H’01, on a team dubbed the Lactated Ringers. This year, the Class of 2017’s Jenika Ferretti-Gallon joined them.

An associate professor in the Division of Pediatric Emergency Medicine, Woleben is also associate dean for student affairs in the medical school. Though he’s far more experienced in medicine, Woleben calls the students “the masterminds to our team’s success.”

The competition, held in Newport News, includes three loops (four for more advanced competitors) consisting of questions and hands-on scenarios. Each team must navigate to checkpoints where they will encounter physical challenges or wilderness medicine simulations, which they must successfully complete before moving forward.

The team takes its name from Ringer’s lactate solution that’s often used for fluid resuscitation after blood loss due to trauma, surgery or other injury.

During the race, which the Lactated Ringers completed in under seven hours by mountain bike, canoe and foot, they performed a cricothyrotomy on a pig trachea and removed a fish hook from someone’s skin (using a pig’s foot as a stand-in). One memorable scenario involved stabilizing a skydiver who had landed in a tree and sustained spinal cord injury.

The trio capitalized on the lessons learned from the experiences of the 2015 team.

“The reason for our success was that we planned in advance,” said Ferretti-Gallon. “We practiced orienteering the weekend before the race at a Boy Scout camp.”

The group also knew what to carry in their pack, smaller than last year’s but still a hefty 20 pounds of wilderness supplies. “The most important thing you can have is gloves,” said Griffith. “And a knife is always useful.” The group also hauled water purification equipment, shelter, epinephrine for anaphylactic shock, gauze and a CPR mask. A skin stapler came in handy, too, for making quick repairs on their simulated victims so the team could get back on the course.

With few penalties for wrong answers and some bonus points for their knot-tying skills, the team was named winner of the Intermediate division. In addition to bragging rights, the team won a copy of “Improvised Medicine,” a book Griffith dubs MacGyver medicine. “Actually, I’ve had my eye on that for a while,” he said.

It also gave them confidence. “MedWAR can change the way you think about practicing medicine,” Ferretti-Gallon said. “It gives you skills to apply in the field. It’s encouraging and it’s empowering.”

She’ll hold down the fort next year at MedWAR, as Griffith moves to Ohio for residency.

However, he remains prepared for anything he encounters. “I always try to keep my medical bag with me. And my keychain is just exploding now with a bag of gloves, a pocket knife and other supplies.”

By Lisa Crutchfield

18
2016

M3 student Nehal Naik shares his experiences on national surgery blog

M17 Naik,Nehal _MG_3615 (3)
The Class of 2017’s Nehal Naik

A Friday evening in Ecuador gave the Class of 2017’s Nehal Naik a first-hand view on how a break down in emergency communications can impact patient care.

As an M1 observer, he was slated to spend time that evening in the city of Cuenca’s 911 call center as well as at Hospital Vincente Corral Moscoso, the region’s only trauma center. So he was on hand when the call came for an ambulance in the aftermath of a motor vehicle collision.

“En route, the patient was determined to be a critical trauma patient,” Naik recounted in a first-person essay published by The Academic Surgeon, the official blog of the Association for Academic Surgery.

“Little communication had been made to either the dispatchers or the receiving hospital, so the trauma team I was working with found themselves with a critical head trauma and no prior preparation. Despite the best efforts of the trauma surgeons at HVCM, the patient died from the traumatic head injuries. Many on the trauma team felt that if the patient had arrived earlier, with adequate preparation she may have been saved.”

Naik’s road to Ecuador began nearly three years ago when he joined the International Trauma System Development Program as a first-year student in the VCU School of Medicine. That opened an opportunity to visit Ecuador and study the South American country’s emergency response system.

His unforgettable Friday evening as an M1 observer was just the first day of his summer experience, and it laid a foundation for a quality assessment and improvement project on trauma communication between Cuenca’s pre-hospital and hospital providers.

Working with him on the project was the Class of 2016’s Michael Rains and four medical students from Liga Académica de Trauma y Emergencias. The work began with a close look at the Richmond Ambulance Authority, a model EMS system in Richmond, Va.

But, Naik points out, “Like many global development projects, it was imperative to have local leaders guide the mission of new projects.” So he and his collaborators also met with Ecuadorian EMS and 911 teams as well as hospital staff to better understand the problems they faced.

While Naik initially struggled with professional level of medical Spanish spoken by his peers and mentors, their patience, local language classes and the Latin-rooted medical jargon he knew from medical school filled the gaps in his proficiency.

His team’s partnership reached beyond the research they performed. “We shared on-call nights in the emergency department learning basic emergency care. During down time, we had impromptu lessons from our trauma surgery mentors.”

Naik also joined his teammates at events where they taught basic first aid and trauma care to non-medical students, churchgoers and even driving school participants.

M17 Naik,Nehal LATE first aid

While in Ecuador, Naik worked with students from the Liga Académica de Trauma y Emergencias to teach basic first aid and trauma care to non-medical students, churchgoers and even driving school participants.

The Ecuadorian student group’s commitment to service and teaching have inspired Naik to emulate their programs on the MCV Campus. Students involved with VCU’s International Trauma System Development Program are modeling offerings after what Naik saw in Ecuador, with programs like a hands-only CPR class for locals.

Naik reconnected with his teammates last August at the Panamerican Trauma Society 2015 Congress in Bolivia where they presented their findings. They also discussed continuing the project and what opportunities there might be for further collaboration.

The experience has convinced Naik how valuable international experiences are for networking with likeminded student leaders in other countries. “Future physicians in nations that face a growing burden of disease from trauma and other surgical diseases can benefit from a global network for exchange and collaboration.”

Naik is chair of the student subcommittee of the Panamerican Trauma Society. He hopes to pursue a career in emergency medicine and continue working in global health, focusing on sustainable development of emergency health infrastructure, especially in low- and middle-income countries.

By Erin Lucero

02
2016

Building rapport: Medical Spanish class helps students connect with patients

Unlike many young children, the Class of 2016’s Arhanti Sadanand looked forward to going to the doctor.

“I loved my pediatrician,” she said. “I felt like there was always someone there to help me feel better. My doctors were always my role models, and that stuck with me.”

Once she entered VCU’s School of Medicine, she made it her mission to establish a similar rapport with her patients. One major tool she had at her disposal was her ability to speak Spanish.

There’s a big difference between avergonzado – embarrassed – and embarazada — pregnant. M4 Arhanti Sadanand leads her classmates through an OB patient case.

“I’m lucky enough to have a background in Spanish,” said Sadanand, who minored in Spanish at New York University. “But many doctors don’t. Part of our responsibility is to communicate with all our patients as best we can so that we can build rapport.”

To help other medical students on the MCV Campus form a closer relationship with Spanish-speaking patients, she is teaching a Medical Spanish elective. The four-week class, offered twice this year, has an emphasis on listening comprehension and oral fluency in realistic healthcare scenarios.

“This is critical for medical students,” she said. “The class has a focus on clinical dialogue they will use every day in the exam room.”

Sadanand is teaching common phrases and medical terms in a fun way. Participants often role play or compete in Spanish Jeopardy, bingo and other games to bring some fun to the classroom.

“I wanted to make it more interactive,” Sadanand said. “Still, I don’t want anyone overestimating their abilities when they leave the class. They won’t be fluent, but it’s a great start.”

The class is Sadanand’s community-based capstone project, a requirement of the school’s International/Inner City/Rural Preceptorship (I2CRP) Program. I2CRP is a four-year program that fosters the knowledge, skills and values needed by doctors to provide quality and compassionate care in medically underserved communities.

“This class helps bring our students much closer to making that all-important connection with patients,” said Mark Ryan, M’00, H’03, medical director of I2CRP.

Each session addresses specific topics: physicals, abdominal pain, respiratory infections, diabetes, hypertension, pregnancy, musculoskeletal complaints and pediatrics. At the end of the four weeks, Sadanand will assess Spanish proficiency with the help of a fluent Spanish speaker acting as the patient in a mock medical encounter.

“I’m lucky enough to have a background in Spanish,” said the Class of 2016’s Arhanti Sadanand. “But many doctors don’t. Part of our responsibility is to communicate with all our patients as best we can so that we can build rapport.”

Sadanand will also compare improvement of and confidence in Spanish proficiency by using standardized pre-tests, post-tests and student surveys. She will present the results to the school’s curriculum council with hopes the class will be added to the School of Medicine’s catalogue.

“The vision and the drive she has brought to this project has been extraordinary,” said Mary Lee Magee, M.S., who serves as educational director of I2CRP. “There are limited resources available for our medical students in this area, and the need is so great.”

The class, however, does not replace a medical student’s obligation to use certified Spanish interpreters. Healthcare providers can call on live interpreters to visit patients and translate for them or use technology assisted interpretation that are phone or web based.

But, “There’s nothing like the personal touch,” Sadanand said. “When I put myself in the patients’ shoes, it must be terrifying. Imagine not being able to communicate with your doctor.”

Sadanand’s class builds upon the work of two previous I2CRP students, Irving Phillips, M’15, and Patrick Lam, M’15. Their research showed the Teaching Proficiency through Reading and Storytelling method is an effective alternative to Rosetta Stone, which is more general. Sadanand’s fellow I2CRP student Deborah Me sees so much value in the approach that she volunteered to help out with teaching duties when Sadanand was busy with her fourth-year rotation in pediatric hematology-oncology.

Shanti Nambiar, M’16, is one of about 20 students enrolled in the class this year. “This has been extremely helpful,” she said. “It’s giving me the tools to get through a clinic visit.”

During her third year, when Sadanand completed her clinical rotations, she met at least one Spanish-speaking patient every day, she said. She is confident that number will only rise. According to the U.S. Census and other government sources, the United States is home to more than 41 million native Spanish speakers.

“What’s so important is building that trust with your patients,” said Sadanand, who is pursuing a pediatrics residency. “When you establish that link, when you bring your patients that comfort, everyone wins.”

By Janet Showalter