April 2015

The New Curriculum and What It Means
By Anand Jayanti, M1

Medical education took a turn in 1910 when a man named Dr. Abraham Flexner wrote a report about a system in disorder. Before this "Burn Book," called the Flexner Report, medical schools were all different in quality, length, and material. Over half of them offered sub-standard apprenticeships with no formal courses or scientific education. His report cut the ribbon for the modern age of medical education: two years of basic medical science, two years of clinical science, residency, and board certifications. 

Today we sit in a situation similar to Dr. Flexner's: Our institutions aren't preparing new physicians to meet the needs and demands of the society around us. It’s impossible for students to learn all that’s required to practice during a 4-year period, yet we find even then, that not all of what we’re taught is clinically relevant and is moreover briskly forgotten. One wonders idly if only we could reallocate this effort and intellectual capital, whether we might ultimately join lawyers, politicians, biomedical engineers, and patients in having a say about our profession these days.

Industries like medicine and blacksmithing are similar in a few ways; there's the biology, or the metallurgy, and then there are the calluses on your hands that help you better grip the tools and not flinch over the vagrant spark that lands on your skin. Medicine needs time to settle into not only our minds, but also our hands.

But we have to learn the brachial plexus and the signs of organophosphate poisoning, don't we? The new, shorter preclinical curriculum will encompass this certainly, but Dean Ogden alluded in my conversation with him to even further compaction of the first two years of material. This vision takes root in the hypothesis that we learn better when the material is of immediate relevance to us. "Becoming a Physician" gains meaning (and therefore retention) the closer we are to actually bearing that title. Learning the brachial plexus matters more (and sticks better) when there's a young patient named Alice in the waiting room who broke her humerus during Little League this afternoon.

A&M's decision to shorten the preclinical curriculum from next year onward should be one that we are proud of. Its content will aim to teach students not just the basic sciences but how to keep up with changing sciences throughout one's career, and the shortening of the schedule will effectively bring that career a little closer. We are one of only a handful of schools making this all-but-obvious change, and it's clear that this will distinguish us as an institution, not only in the state but nationally, as pioneers and game-changers.

As students, let's not only celebrate this decision with our juniors next year but help our faculty evolve it further. Let’s give them constructive feedback from our place in the trenches--in our debt, in our a.m. hours, in our families--so that future medical students’ education might be made to feel more meaningful and well-spent toward the achievement of a healthy world.

Spotlight on Cadaver Ball
An interview with Mariel Swinney, M1

On April 10, the Bryan/College Station campus hosted its annual Cadaver Ball, an end-of-year formal thrown by the M1s for the M2s. The entire project was spearheaded by BCS Vice President Mariel Swinney. The Synapse’s Ann Dyer sat down and talked with Mariel about the planning process.

Ann: There was just so much to do for Cadaver Ball. How did you even begin the process of planning?
Mariel: It was really such an exciting project to tackle! The first, and most important, task was rallying the troops!  The Cadaver Ball Committee was a group of M1s who wanted to help out with this project. We started meeting in November, and everyone broke up into sub-committee groups based on their interests: Logistics, Promotions, Decorations, Entertainment, Awards, and Desserts. From there, we met every other week to make plans and work on Cadaver Ball projects. At some point, the Decorations Committee started meeting at my house to do craft projects. It turned into a biweekly social! We decided on a theme during the first few meetings, and then the creative juices started flowing. I loved the theme, Le Cirque Des Reves, because it was unique, elegant, and mysterious. We tried to incorporate the theme in all of the elements in the party, from the decor, to the photo booth, the candy bar, the entertainers, and the dresses. I was so pleased that so many peopled dressed to fit the theme! It will take me a long time to not gravitate toward black and white stripes when I'm shopping!

Ann: Everyone in the class was so impressed with how flawlessly everything went. Can you tell us a bit about how you managed to balance school, life, and this giant project so well?
Mariel: Again, I could not have done it without the Cadaver Ball Committee! Everyone shared the weight of this project, and I am so thankful I got to work with such a dedicated group of peers. I made it through Cadaver Ball with a lot of lists. Lists, lists, lists. At each committee meeting, we would have "Action Items" for each sub-committee to accomplish that day. We made slow, steady progress at each meeting and in between meetings, and after a while, all of the items on my lists were checked off! The Logistics sub-committee was essential in making sure that we didn't have any "Watershed Areas" in our planning, and that everything got finished.  Also, I made sure to go to yoga a few times a week! Namaste.  

Ann: Could you pick a most fun and most challenging part of planning Cadaver Ball?
Mariel: The most challenging was probably deciding what entertainment to use. We weren't really sure what would be a hit. But the Entertainment Committee was so creative, and they found such cool entertainers! Magicians, a caricature artist, a fortune teller, and the card tables really made it feel like a "Night Circus." And I think based on the lines at all of these spots, they were a success!  The most fun part was definitely the biweekly decorations meetings at my apartment. We would open up a bottle of wine and start crafting all sorts of projects. Menus, wine bottle centerpieces, bows, signs ... so many projects!  But it was truly fun working on it with friends, and it was so rewarding to see all of our projects come together at Cadaver Ball!  

Ann: Have you had your spa day yet?
Mariel: My spa day is scheduled for right after NBME! I cannot wait! Thank you to the Cadaver Ball Committee for the sweet gift. And many thanks to the BCS M1 and M2s for making Cadaver Ball such a memorable and fun event!  

Early Detection of Alzheimer's Disease
By Kimberly DeAtley, M1

An issue of women’s health that is of particular importance to me, and I believe, to future physicians everywhere, has to do with the increasing occurrence of Alzheimer’s disease (AD) and its faster progression in women than men. Having cared for my mother, who was diagnosed with AD only four years ago, I saw how fast the disease progressed in such a short amount of time. What was even more devastating is that she showed signs of cognitive impairment years before an official diagnosis was made, despite having seen multiple physicians for health-related issues during that time span.  

Although much research is being done on Alzheimer’s disease, there still is no commercially available diagnostic method for early detection, nor is there anything to help halt or slow its progression. This, along with an aging baby boomer population, makes it more important for physicians to be hyper-vigilant of AD’s increasing prevalence, especially among postmenopausal women, and screen for signs of cognitive impairment during routine visits. By doing so, physicians can potentially improve their patients’ quality of life and relieve caregiver burden. Earlier detection can perhaps lead to better responses to drug therapies and allow patients and their families to take appropriate measures to prepare for the inevitable. 

For my parents, early detection would have afforded more time to financially prepare for future medical or care-related costs. It would have provided my mother, a breast-cancer survivor, the opportunity to make decisions concerning the quality and duration of her own healthcare. And for me, it would have given me a chance to ask my mom about things which only moms can answer.  

This is a winning essay for the 2015 Magnolia Tea Scholarship.

Death's Heartbeat
By Marcus Zaayman, M2

The yellow-orange tinge of the familiar sunrise seemed to creep peacefully across the sandy landscape, slowly reaching out to illuminate the smoldering towns below. The shade of this stretching grasp seemed to change fervently as it proceeded to flow and dance across the land, scorching the countryside in a fiery brightness. All seemed well as the cool morning breeze blew gently, breaking the silence of night. Faint, wispy clouds cast strange, daunting shadows that moved and danced aimlessly overhead, unburdened by the sun as it burned life into the plagued earth.

The light seemed to toil to penetrate the darkness of the murky smoke, swirling menacingly above a small town. Wraith-like, the smoke appeared to crouch ominously, straining to conceal the shadowy torment within. Faint rays siphoned through the darkness, sneaking their way through the murky depths to briefly dance on the scarred earth below. Thin lines of dancing light could be traced to the ground and seemed to emit a pacifying presence. 

Suddenly the silence is broken and yells of pain and fear fill the streets, ringing out maliciously, time stands still. Gunfire erupts from everywhere--splintering, gashing, shredding. Dust and shrapnel casts everything in a haze. A hapless scene of destruction; people scramble, run and fall. Grenades, mines and bombs explode, leaving stone crippled and broken. Houses loom like haunted shadows, scarred, blackened, ghosts of what they once were. Like a living carpet, smoke and dust cover the scene, billowing, flowing, masquerading death’s heartbeat.

The hazy dust slowly settles, lifting the terrible mask to reveal one of the few horrible truths of life, death. Bodies lay strewn--mangled, bruised, torn, unrecognizable remnants of the departed. Stone, brick and metal twisted, crumbling to the cratered, ashen ground. Crimson stains glisten in the sunlight–a trail to the horror. Lifeless eyes gazed skyward, looks of fear and rage mingled with blood, sweat and ash. Chickens, goats, pigs, mixed among man, share their lifeless looks as they lie, pieces strewn. Men, women, children stripped of limbs lay praying for help as the crimson gleams expand.

Unflinching gazes survey the scene, detached from emotion; they take in what they had wrought. The soft sounds of a baby’s cries and the sudden stifled sounds of a woman whispering break the loud looming silence. Muffled footsteps from leather-booted feet imprint their way, parting patches of dirt toward the source of unrest. The feet stop before a crippled building; splinters and pieces of wood from the devastated door lay scattered in the abandoned street. Faint light siphons through the darkness of the cold, soot-stained building to illuminate an unclear shadowy figure. The feet shift closer; a dull, battle-worn barrel is raised pointing toward the unwelcome silhouette. Once in the doorway, the scene inside becomes clear. Near the center of the room is a woman kneeling, her face and arms stained with an ash-mingled sweat, in her arms is a small bundle quietly sucking on the end of a tiny ashen arm. She does not look up as the intruders enter; she simply stares deep into her baby’s eyes. A single tear escapes her, cutting a smooth white line through the dark ash.

Clicking, a sudden flash, the photo speaks a thousand words. The barrel is once again on the two shapes, its dull form blending with the darkness. Three thunderous waves ring, two more shadows to lie motionless, destined to fade and decay in the sand. Flashes of death, images of pain, strewn across the history of our plagued earth. The beat of a broken planet–death’s heartbeat–stretches across the ages etching its mark. Immune to the stifling of time, the drum will never falter.

Albert's Lesson
By Krystha Canthu, M2

“Decline” is a word
tucked neatly onto powerpoint slides
It vanishes and appears like a furtive
symptom to alarm you
relinquish control

To decline is to lose power
We stop. We tried.
The drugs in combination or alone
a pharmacological thrust that fell short
for death had already begun
to nestle itself in the bed
Decline is not acute
but slow and insidious
and then I saw it, tangible
on his face
Frozen in awe or confusion
the flip flops
stretchy Nike pants with elastic to ease
the burden of the downward spiral
to make room for the sense of self decay…

The walker he refused to use in public
as shame jousted with him
in his geriatric state
We conversed in the third person
as if he weren’t there
as if he were absent
A protracted life excused him from the formalities of doctor appointments

But in his eyes I could trace the lingering
sense of knowing that pervades in your veins
and I carried it with me for days
like a crumbled candy wrapper dissolving
in my pocket

Albert was 84 but he smiled
and he said he was pretty
and he was
He really was
He talked about how stubborn his daughter was
and she tightened her grip on his arthritic hand

Then I knew that decline was a state of mind
that he swatted away
and his thick bed of neatly-­slicked chalk-­white hair
and his crystalline sea foam eyes
and the manly oakmoss smell of his Aqua Velva
were testaments to how his beauty
did not yet allow death to peeve him

Don't Give Up!
By Brian Nguyen, M1

I hope that this message finds you well,
I heard you’re having a hard time.
I don’t have many answers for you, as you can tell,
But I hope you can relax, it’s not a crime.

Maybe this was not a good time to reach you, but
I hope that this message finds you well.
I know you’re caught up in all the hullabaloo
Of trying your best, persevering, giving them hell.

You being where you are is a sign you can excel
So please believe in yourself and stay strong.
I hope that this message finds you well
And know you are right where you belong.

Have faith in your abilities, have faith that you tried,
Keep the lessons you learned when you fell.
Be brave, be bold, be an exemplar of pride.
I hope that this message finds you well.

Research Studies Lack Female Subjects
By Cullen Soares, M1

There is a saying among men that women are another species. While that phrase may refer to the inability of men to understand women on a psychosocial level, it highlights how different men and women are from each other. Indeed, the physiology of men and women are very different. The most obvious examples are exterior features: Men are often taller and more muscular and have broader shoulders; women are usually shorter and less muscular and have wider hips. Beneath the skin are differences that are not as visible, such sex hormones that alter numerous biochemical pathways. Despite the differences, we assume that diseases progress the same way in each sex. But is this necessarily true? Take the example of a heart attack: The classic symptoms are chest pain, with numbness radiating down the arm. However, research shows us that women do not possess these “classic” symptoms. Instead, they experience pain radiating into the jaw or the neck. Why might this be? A heart is a heart, no matter if it is from a man or a woman, right? Perhaps this is not the case. This is just one example of how men and women manifest the same disease differently. 

There is currently a problem in the research community where studies do not include adequate numbers of females--in both basic and clinical research. Tomorrow’s physician leaders will need to properly address this issue. It is important to me because I want to ensure that my mother and sister, as well as my female patients, will receive the best care using evidence-based medicine. I do not want to treat female patients while relying on evidence verified only in males.

Last year, a New York Times article exposed this problem, which begins in animal studies at the most basic levels of medical research. Researchers used only males in order to avoid any complications with hormone cycling in female animals. In the realm of clinical research, the article states that women have only recently begun to make up 50% of participants in NIH-funded studies. However, this number is lower for research funded by private institutions, such as pharmaceutical companies and medical device manufacturers. In addition, many drugs on the market today were tested in the past, when the male bias was even more prevalent. As a result, changes still need to be made. For example, the FDA intervened two years ago to reduce the women’s dosing guideline for the sleep aid Ambien by 50%, since women metabolize the drug more slowly than men. It is improper to establish a principle in males and assume that it also applies to females, without replicating the research on actual female subjects. 

Men and women have fundamental biochemical and physiological differences. As a result, it is imperative that researchers should investigate the effects produced by both sexes, since interventions of any sort may have different outcomes due to these differences. Research should not operate under the premise of unverified assumptions.

This is a winning essay for the 2015 Magnolia Tea Scholarship.

Slowing Down
By Eric Ruff, M1

Breast Cancer. Despite awareness campaigns, novel research, and a shift toward individualized therapies, breast cancer remains the most common cancer in women worldwide. For nearly 300,000 women in the United States this year, breast cancer will become their reality. While these women rely on tomorrow’s physicians and researchers to discover new treatments, they will also rely on them for guidance and education as they endure what will undoubtedly be one of the most difficult challenges of their lives. Are the future healthcare leaders ready for this role?

With rapidly advancing research and a myriad of revolutionary treatments, even the most seasoned physicians can have a difficult time deciding which route is best for their patient. Trying to decipher publication after publication, trying to consult colleagues, and trying to keep numerous patients informed as to the next step in their care is certainly a tall order. As future physicians, we must remain cognizant of the fact that the stress and uncertainty we face when devising a treatment plan pales in comparison to the challenges our patients face.

Five years ago I received a call from my mother that put my life on hold. She told me that her annual mammogram had revealed an abnormality and that the doctors were concerned it might be cancer. I can still remember her voice as she tried desperately to hold back the tears and reassure me everything was going to be fine. My initial fear was soon replaced with frustration and a desire to find answers. After every doctor visit my mom seemed to be more and more confused. It seemed as if no one was on the same page, and this only served to escalate the anxiety she was feeling.

In today’s fast-paced world of medicine, emphasis is too often placed on volume rather than value. Physicians feel pressured to see more patients, order more tests, and write more prescriptions rather than focusing on what the patients want. I remember my mom saying that she just wished one of her doctors would have sat down with her and explained what everyone’s role was. I believe that the multidisciplinary management of breast cancer is essential, and it has come a long way when one considers that only 150 years ago breast cancer was considered a death sentence. However, leaders in the medical community must come together in order to make this approach one that best serves the needs of patients. This starts with slowing down and organizing a team that the patient feels a part of.

I am thankful for everyone who had a role in caring for my mother during that difficult time. Without all of the researchers, surgeons, oncologists, radiologists, nurses, and other disciplines involved, my mom would not be cancer free today. As tomorrow’s physician leaders continue to improve breast cancer treatment, I urge them to think of their own mothers and how they would want them to be treated if faced with this disease that continues to claim the lives of women around the world.

This is a winning essay for the 2015 Magnolia Tea Scholarship.

VA Falls Short in Services for Female Vets
By Kent-Andrew Boucher, M1

A current issue in women’s health that future physicians will have to face is the lack of proper tools or training to care for female veterans. Most Veterans Affairs (VA) hospitals are not equipped to provide the proper services to their female veterans, such as access to on-staff gynecologists, which requires many to be sent to outside facilities far away. Female veterans also lack access to timely mammogram screenings and results due to the lack of proper screening test equipment or staff in VA hospitals or in community clinics.

Many females are now starting to take on combat role positions, which means their need for proper care will become even more of a necessity than it already is. This is especially true for treating their mental health, since they are more likely to be victims of sexual assault and suffer from post-traumatic stress syndrome. Earlier in our Becoming a Physician class this year, we discussed the fact that many physicians currently are not properly trained and or do not feel confident in handling and discussing domestic abuse or sexual abuse with patients. This is due to time constraints, personal attitudes that violence is not common or not occurring with their patients, and lack of experience in dealing with violence. Thus, future physicians need to be prepared and ready to tackle these issues for our female veterans and female patients in general.

Many current VA physicians are also not properly trained to treat our female veterans. Many veterans are of child-bearing age and need physicians who have knowledge of which medications are safe for pregnancy or breast feeding. Unfortunately, many of the VA physicians are still not used to giving advice on birth control, pregnancy, or menopause, since they are used to treating male veterans from the Vietnam War, the Korean War, or World War II. These issues are important to me because I am currently a student in the Health Professions Scholarship Program for the Air Force. I will personally be serving as a military physician in my career and will have female patients who are on active duty or dependents of active duty service members, regardless of the specialty I choose to enter. It is ridiculous and unfair that fellow veterans who put their lives on the line and sacrifice for their country, just like their male counterparts, do not receive equal care due to outdated facilities and inexperienced physicians. The fact is that the number of female veterans keeps increasing and will continue to increase, which means that these issues need to be addressed.

This is a winning essay for the 2015 Magnolia Tea Scholarship.

THANK YOU

To our amazing faculty mentors:
Mary Elizabeth Herring, Karen Wakefield, AJ Stramaski, Gül Russell, & Barbara Gastel