The Last Summer for Medical Students

12 01 2012

The summer between first year and second year of medical school is sometimes referred to as the “last summer” since it is the last time students can travel or take off before they start the journey towards USMLE Step 1 and then their third year clerkships.  With the angst building, first year medical students are actively deciding in the dead of winter what they will do over the summer.  One popular decision is to do research – this is not uncommon since residency programs are increasingly competitive and look for students who have a commitment to scholarly work.  However, there are a plethora of other things students could do as well.    As tonight is our “Intro to our Summer Research Program” for Pritzker medical students, I thought I would share some of the most common questions I get about the “Last Summer”:

  • Should I do research in a competitive field?   The answer here is to do substantive research that you are interested in with a “CAPE” mentor (Capable, Available, Project interests you, Easy to get along with).   As my premed advisor once told me, “Mickey Mouse” research is not going to look good to anyone (no offense Mickey).   The key is to find something you are passionate about – after all you have to tell this story on your interview trail of why you choose to do this and the answer “because I wanted to go into ortho” is not really that captivating to anyone (even to an orthopedic surgeon).   Instead, if you do something you are passionate about, like community health work, you can always tie it back to your chosen field.  Most residency program directors don’t expect you arrived in medical school with laser like focus towards their field anyway and expect to hear some type of journey or a-ha moment that drew you to their field.  Because competitive specialties are often reimbursed for clinical work and tend to be smaller departments, they depth of research opportunities may be more limited.  But, don’t forget that neuroscience research is relevant to neurosurgery – and oncology research on head and neck cancer is still relevant for ENT and so forth.  The best research is often interdisciplinary and crosses department boundaries so you should not be afraid to either.  It’s also important to remember that as a first year student, it’s hard to even know if you will be competitive for radiation oncology or associated competitive specialties.  You will need killer board scores, and great clinical grades.  So, while you may think securing the research with the Dept Chair will give you an extra ‘edge’, nothing and no one can make up for a poor performance on high stakes exams or clinical rotations.  So, don’t forget to study!
  • I want to go to country X?  How can I get a global health rotation there?  Well, certainly the urge to travel is strong in anyone (including me).  But, you need to separate your travel bug from a genuine interest in global health.  Most global health rotations are not a vacation – and may not be what you think of as “tourist” destination (despite the short-lived popularity of Off the Map).   Maybe your stars are aligned and your school or a nearby affiliate you know has a program near your hot spot of interest.  Usually, however, it is not that easy and you should consider how strong your affinity is for a specific country or location versus your interest in getting the best global health experience possible.  Global health programs that fund medical students are not easy to come by.  So, if you are genuinely interested in global health, it is always better to go with an established program and mentor to get the most substantive experience even if it’s not in the exact country you are interested in.  The other thing to remember is while this may be your last summer for a while; it is not your last vacation!  You will have time to plan a vacation to your designated hot spot if you can’t work it in this summer.
  • Do I have to do anything?  The answer here is easy – no, you don’t have to do anything per se with your ‘time off’.  Many students find themselves on the hamster wheel of endless extracurricular activities.  The real question is what is your goal? If it is to go home and see family and friends, there is nothing wrong with that!  The key is to ensure that you are doing something with your time off that will make you feel ready to face the second year of medical school.   It is easy to forget that there is a lot of time to participate in extracurricular activities at various other points in your medical school career.   The key is that if you will regret not spending time with your friends or family this summer, then you need to make time to do that.
  • What if I want to do everything because I don’t want to close any doors?  This is not an uncommon feeling for medical students. However, its important to remember that your summer work is not choosing a specialty! There is essentially nothing you can do over the summer that will ‘close a door’ – there may be some things that allow you to put your foot further into the doorway but that does not mean another door will close.   The only doors you close are the ones in your mind.   Most students decide on their specialty after their third year rotations and will often fine-tune their experiences in research in that area in the fourth year.   Another thing to consider is to do research in a cross-cutting area like ethics that could apply to everything.  Sometimes the angst you may be feeling is about making a choice that is wrong for you.  However, the truth is that as long as you are genuinely interested in the opportunity, you cannot make a wrong choice since it will be an easy story to tell no matter what you do.  Since everyone is different, it is always good to get individualized advice from a faculty advisor at your school who can comment on your specific career and research goals.

Finally, no matter what you do with your last summer, don’t forget to make sure you enjoy it!

Vineet Arora MD





Rising Above the Sea of MacBooks: “Edu-tainment” and Other Tips

12 09 2011

Although Steve Jobs has stepped down as CEO of Apple, his legacy for physicians-in-training is very palpable. Or should that be visual – As I looked into the auditorium of eager and bright incoming medical students this Summer, I saw a bunch of Apple’s staring back at me – sleek, silver and unmistakably MacBooks.  This is the millennial generation so why would I be surprised?  Maybe because it is more ever-present than before this year.  Could it be that the entering class of 2015 had more millenials?  Actually, another hypothesis has also been put forth that is equally if not more plausible…our medical school auditoriums were installed with new desks and chairs.  While these were well received, the desks served as an inviting surface just beckoning for the MacBooks to be placed there.    As a result, you’re never sure if you’re competing with Facebook, the worldwide internet, or even email messages that appear more interesting than your class.   Since lecture capture technology has made it possible for people to view lectures from home, it’s important to make attending lecture in person worthwhile.  Well, here are some tips for medical educators who ‘lecture’ in this new age.

1.  Engage in “edu-tainment” – As Scott Litin at Mayo refers to it, “edu-tainment” is the goal – entertainment via education.  How does one incorporate entertainment into lecture style?  Well, the easiest way is through humor.  This is difficult since not everyone is funny by nature so it may be that you have to inject humor in odd ways.

2. Play games – Games are inherently fun and interactive can stimulate a lot of learning and discussion.  While you may be thinking about computer games, easy games can often stimulate learning.  One of our research ethics faculty played 20 questions with the group of students to teach about landmark research ethics cases.

3. Turn into a talk show – There is nothing more boring than watching the same person for an hour give a talk.  It is much more interesting to watch a panel of people tell a story about themselves – whether it be a patient, another physician, or another student.  I still remember medical school lectures with invited guests that had this talk show appeal due to the lack of power point and focus on the story.  While I’m not suggesting a Jerry Springer approach, who doesn’t love Oprah – at least Chicago has several role models to choose from.

4. Showcase video – Video is one of my favorite teaching tricks.  One well made video can communicate a thousand research articles.  In our week of Scholarship and Discovery, our faculty used videos from Xtranormal (no it was not the famous orthopedics vs anesthesia) but a similar one.  One faculty who could not attend taped a welcome introduction, and another used a clip from “Off the Map” which is now off the air but is still an effective reminder of how NOT to perceive global health.

5. Use audience response – Use of Turning Point clickers can result in instant feedback and engagement with students as they see the results of their poll immediately. It also tells you how many people who up to class!  The only problem is that passing out the clickers and collecting them can be rather time consuming.  So, another possibility is to issue them at the start of class which is done in some colleges and used as a way to count attendance (until a brilliant undergrad brings in a bunch of clickers to class to vote for their lazier friends!).  Here Steve Jobs can help again – Turning Point has audience response systems for iPhones and iPads that can be used and automatically identify people- but it would require that everyone have a smartphone and purchase a license to the software.

6. Refer to the internet– Given that students are on the computer, you can take advantage of it and ask them to visit internet resources in class by showing them urls or web pages that are of use.  Sometimes you may actually refer to your own course website like we do.

7. Provide fancy color handouts – While handouts may sound like they have gone by the waste side, there is nothing like a fancy color brochure or handout to create a “buzz”.  It’s almost like a souvenir of their hard journey to class that day.  If you ever want to provide someone with a ‘leave behind’ that looks important, lamination is key.  A color laminated leave-behind is even better.  Pocket cards are some of my favorites.

Is there any guarantee these tips will work?  Of course not.  But, what’s the harm in trying?  While some professional schools have gone so far as to block wireless in lecture halls, the truth is that current medicine is augmented with the help of computers and online resources- so we should figure out how medical education can be too.

–Vineet Arora, MD





Can We Trust Medical Trainees with Social Media and Other Digital Dilemmas

18 04 2011

Last weekend, I was on a panel for internal medicine residents at the American College of Physicians Council of Associates forum in San Diego.  I was invited by Erin Dunnigan and Baligh Yehia, the Co-Chairs of the Council, a position that I have also held earlier in my career.  The topic – was about the debate on social media use among medical trainees and whether it was professional.  Fortunately, I was lucky enough to do it with my rock star colleague Darilyn Moyer, the program director at Temple, who also moderated last years panel on Mean Girls in Medicine with me.

The Temple chief resident, Brooke Worster, started us off by asking the much debated anathema in medical education – what is professionalism – and if it is in the digital domain, it’s even harder to describe.  Then she proceeded to show some videos of medical students that you could say exercise some creativity – from the harmlessly funny to incredibly poor taste and ranging from schools such as UT Southwestern to my own alma mater Washington University in St. Louis.

The questions from the residents were spot on and here were some of the Q&A that followed:

Medical trainees are people too – shouldn’t they able to express themselves in ways  using colorful medical humor either in a show or their profile?

The objection is not for class shows and parodies – those have existed since the very first class medical show that took place at the University of Michigan and called the Galen’s Smoker (this year’s name- “Spleen Girls”).  The issue is more complicated with public consumption of materials never meant to be seen by a public audience.  Then, when a video is seen by a patient, an employer, or another interested stakeholder, alumni, philanthropists, those that donate their body to science (to name a few), the meaning of the video is not clear and those individuals often lose faith in the medical system.  There have been cases where patients have refused care by a residency trainee after seeing their Facebook profile with images that don’t seem suitable for their doctor.  So, while medical trainees deserve the right to blow off some steam and exercise creativity, it should not compromise their ability to see patients or work in the future.

Shouldn’t we just trust students and residents to police themselves on social media?

The answer here is that while most students are capable of policing themselves, a breach of professionalism on the internet is like a NEVER event – especially if it relates to patient information or trainee information that could result in harm.  So, opting for a putting out fires approach will not be effective and it’s important for medical educators to teach students and residents about responsible use of social media.  The good news is that the more one uses social media, the more likely they are to be able to draw that line in the sand.  Our research shows that superusers, or more frequent users, are more likely to oppose regulation but are also more likely to believe that they are responsible for portraying a professional image.  So, by teaching people to use it appropriately, we may actually prevent violations and breaches.

Should schools screen social media as part of its application process?

Interestingly, some students and faculty in the audience advocated for ‘second chances’ and redemption if a student had a inappropriate picture posted since Facebook privacy settings are initially confusing and a student could be misguided initially. But, let’s face it… screening applications for admission to medical school or residency is hard and takes time.  People are looking for ANY red flag to set downgrade your application compared to others.  Don’t give them a reason.  Medicine is not unlike any other industry in which candidates are interviewed to see if they can get the job done and also represent that organization appropriately.  If a video is posted that showcases a student in a tasteless parody with your school logo or name in the background, a hospital or residency is not going to want to take that risk with you.

What can medical schools do to protect themselves?

Well, for starters, schools can have a social media policy that highlight that do’s and don’ts in this area.  Unfortunately, in a recent study by @kind4kids and @MotherinMedicine, most schools do not so we have room for improvement.   The second thing is that schools can also deliver education, not only on the negatives – or how NOT to use social media, but they can also encourage and role model proper use of social media through disseminating course materials, student press, recruitment and admissions, or communicating with their students.  A recent post on a new student blog actually has a Poll this week asking students if they would want to receive information via social media and the majority say yes.

What can students do to ensure that their digital image is safe?

This question actually came from a student that has the same problem as me – a person with another name who happens to be garnering attention for the wrong reasons – in my case, it’s someone with my same name who is an ophthalmologist and has been accused of blinding patients and has many negative patient testimonials.  So, what can I do – well I initially started on LinkedIn to try to distinguish myself from this person and I also took control of my own digital footprint using a Google Profile to highlight who I am and the links on the web that I want people to see.  (You’ll notice my Facebook profile is NOT on my Google Profile).

The same old adage about Vegas applies here- whatever happens on social media stays on social media.  Therefore, just like the national dialogue on health information technology, its important for medical educators and trainees to engage in a constructive dialogue and establish policies that both set standards and teach others how to meaningfully use social media.

–Vineet Arora, MD








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