Claudia and Riley

By Samantha Carver

It was a beautiful July day in 2008 when cousins Riley Jane Lawrence, 4, and Claudia Faye Wadlington, 5, were crossing the street in Louisville to go to swimming lessons. In moments though, their young lives were cut horribly short when they were hit by a 27-year-old man who was running from Louisville police.

After the girl’s deaths, their families wanted to do something to honor their memories and help others. The Riley Jane Lawrence and Claudia Faye Wadlington Fund was created.

To honor Riley’s mother, Sarah Lawrence, who is an administrator for the Student Doctor Network Web site, SDN members raised money for the fund to help the families with expenses and other organizations in memory of the girls. The money raised was donated to several local groups and the rest is part of a permanent memorial fund at the Community Foundation of Louisville.

This three-part series of articles focuses on the work of each of those groups that has received donations thus far, and why they were chosen by the girls’ families.

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With more than 15,000 animals through their doors each year, the Louisville Metro Animal Services office works to reunite families with their lost members, find homes for those without families, provide medical care for those who need it and at times, be with them until their last breath.

A fostered kitten at Metro Animal Services

“We chose to make this donation because Riley did love animals so very much,” said Sarah Lawrence. “We used to take her to the Metro Animal Services to see the dogs and cats. She especially liked the kitten room. She picked out our poodle, Moe, there. Since it was a place that she enjoyed so much, I though of them for a donation.”

According to Jackie Gulbe, assistant director for community relations, a donation of more than $1,200 was made to the animal care fund of the Metro Animal Services.

“That fund helps us to spay and neuter animals as well as pay for medical care needed for incoming animals,” Gulbe said. “We see a lot of animals that are in need of medical attention. Our resources are limited and without donations, they would be even more limited. We offer a low-cost spay and neuter program to help the community.”

Lawrence said the choice of animal medical care was something that was in keeping with the mission of www.studentdoctor.net as well as something that could provide a gift that would go a long way at the shelter.

“Medical services are one of the greatest expenses of any animal care organization,” Lawrence said. “We wanted to help provide necessary services that were in keeping with the mission of the Student Doctor Network which is an organization for those in the medical field or in training for the medical professions, including veterinary medicine.”

Besides providing medical care, the office handles animal care, education and community relations, administration and animal control.

There is a 17-person staff to care for the animals including a veterinary clinic coordinator, a staff veterinarian, a veterinarian technician, two veterinary assistants, eight animal care specialists, three adoption coordinators and an animal care manager. The Animal Care Center is staffed 24 hours a day, seven days a week. Incoming animals are accepted between 7 a.m. to 11 p.m.

“We take in more than 15,000 animals here every year,” Gulbe said. “We make every effort to get them adopted or work with rescue groups to get them placed. We return as many as we can to their owners.”

Metro Animal Services provides a Web site to show adoptable animals to the public or has adoption hours at the Animal Care Center throughout the week. They also take many adoptable animals to different locations throughout the city for adoption days.

“We also have a new adoption facility that will be open in March,” Gulbe said. “We have a 10,000 square foot adoption-only facility on Newburgh Road. It is really like what the rest of the facility should look like.”

The 18 animal control officers investigate more than 24,000 complaints each year and bring in thousands of animals. There are also many animals brought in by owners who can no longer care for them. Those officers drive more than 225,000 miles a year when covering Louisville Metro’s 386 square miles. They are on duty from 7 a.m. to 11 p.m., seven days a week, 365 days a year.

The donation to help with animal medical care is not the only one the Lawrences have helped facilitate.

“My husband and I continue to make donations to the shelter periodically,” Lawrence said. “The shelter has placed a plaque in the kitten room in honor of Riley.”

One of the dogs helped by Metro Animal Services

Gulbe said that the Lawrence family made a donation last year around Riley’s birthday.

“They wanted to do something, and we were doing a bed drive,” she said. “I was getting kind of worried because my goal was to get all of our beds by January 1, and we were short 21 beds. Sarah called to see what she could do for us, and the next morning I came in and was notified that we had received our last 21 beds. It was a wonderful thing to do in Riley’s memory. That was so awesome!”

Gulbe said there are two plaques in the room in memory of Riley.

“One is more like something for a little girl with a sleeping cat, and it says in memory of Riley Jane Lawrence, and then below that is one that talks about how she like to come and spend time in the cat room with the kittens,” she said.

The facility is open to families who would like to visit with and help with the animals through education.

Educational programs are provided with the only classroom humane education program in animal welfare in the region. The programs range from classroom visits to interactive core-content related lessons. Students can visit the shelter for a tour or be visited by a certified assistant animal.

Adult education programs are available once a month though volunteer orientation sessions.

Lawrence said the chance to help the shelter is one she appreciates.

“I know that the shelter needs the money and that it will go to good use,” she said. “I hope our gift inspires others to give as well. There are many worthy organizations, and the need is great.”

Claudia and Riley

By Samantha Carver

It was a beautiful July day in 2008 when cousins Riley Jane Lawrence, 4, and Claudia Faye Wadlington, 5, were crossing the street in Louisville to go to swimming lessons. In moments though, their young lives were cut horribly short when they were hit by a 27-year-old man who was running from Louisville police.

After the girl’s deaths, their families wanted to do something to honor their memories and help others. The Riley Jane Lawrence and Claudia Faye Wadlington Fund was created.

To honor Riley’s mother, Sarah Lawrence, who is an administrator for the Student Doctor Network Web site, SDN members raised money for the fund to help the families with expenses and other organizations in memory of the girls. The money raised was donated to several local groups and the rest is part of a permanent memorial fund at the Community Foundation of Louisville.

This three-part series of articles focuses on the work of each of those groups that has received donations thus far, and why they were chosen by the girls’ families.

—

When the Riley Jane Lawrence and Claudia Faye Wadlington Fund chose to donate $3,000 to Shoulder to Shoulder Ecuador, it was a decision made from previous knowledge of the group.

“I learned about them through a former classmate at the University of Kentucky College of Pharmacy,” said Sarah Lawrence, Riley‘s mother. “I was interested because pharmacy students like myself were involved, and it seemed like a worthy project.”

The $3,000 donation was given from the fund through the Community Foundation of Louisville.

“That is the cost of medication for one trip to Ecuador,” Lawrence, an SDN administrator, said.

Dr. Thomas Young of Shoulder to Shoulder Ecuador said that donations like this one make it possible for the medical brigades that travel to Ecuador to treat around 1,000 patients with each trip.

Medical brigade member treating a child

“We usually have at least two medical brigades each year with about 40 team members on those,” he said. “We have doctors, medical residents, dentists and a fair number of students from any of the health colleges. The pharmacy department has been involved in each of our trips, and we take all of the medications with us. This money has allowed us to purchase those medications for one of our trips.”

The core values of Shoulder to Shoulder Ecuador include service to the poor, working in conjunction with other community leaders, providing a sustainable community impact, reporting to supporters, safety and being a light, not a judge, to the community in need.

The organization exists to serve the needs of the poor and improve their health situations. The goal is to help a community that will ultimately be responsible in assuming control of all of the projects.

While short-term medical trips are made to areas by many organizations, Shoulder to Shoulder Kentucky plans long-term relationships to open sustainable possibilities such as disease prevention and continuity of care. It allows aid to be provided in health education, economic and educational development and public health issues.

Medical team in front of Centro Medico Hombro a Hombro clinic in Ecuador

Community leaders in Santo Domingo identified the shantytown of Carlos Ruiz Burneo as a community in extreme need. With limited access to medical care and extreme poverty, the community of 20,000 was the recipient of Centro Medico Hombro a Hombro in May 2007. The health center includes a physician, nurse, receptionist, coordinator and part time dentist. The center also has outreach programs to provide immunizations and community based prevention projects.

“We operate that full-service clinic through donations,” Young said. “We raise money to fund all the staffing that takes place because it operates on about a $100,000 a year budget. That amount of money goes a long way in that community. We would not even be able to afford a doctor for that budget in the United States.”

The staff for the clinic is all from the community that is being served.

“People there really can’t afford the medications that they need,” Young said. “We also provide a number of vaccines that these people would not be able to get otherwise. It was nice to have Sarah’s support for helping us with those medications.”

Because of the long-term relationship with the community, Young said Shoulder to Shoulder Ecuador is able to do regular follow-ups with patients.

“There is a 15-year-old girl there with multiple sclerosis who is at a point that she can’t walk anymore,” he said. “We were able to take her a walker last time, and get her fitted to it. She was all smiles!”

The safety of volunteers is paramount, but is ultimately the responsibility of the volunteer. It is also their responsibility to submit trip reports to team leader. This helps keep sponsors involved in what is happening with their donations.

Volunteers are also encouraged to be a model, but not a critic, to the communities in which they serve. They are to avoid condemning lifestyles, religious affiliations and other methods of relief.

“We have trips coming up in May and August of this year,” Young said. “There is also a small physical therapy group going down in March.”

Landscape near the clinic site

Young said work in the area is very agricultural and heavy, but finding access to physical therapy is a challenge.

“It is very limited there,” he said. “We are the only health care facility in that community of 20,000. They could have access to the public health system, but it is a long distance away, and they run out of supplies quickly.”

Young said that Shoulder to Shoulder Ecuador is considering replicating their services and possibly building other clinics in other countries.

“We would like to open a clinic in India, but of course that is all dependent on funding,” Young said. “No matter how much further our money can go in these foreign countries, we still have to raise the money to begin the projects.”

Although she has not planned to at this time, Lawrence would consider a trip to Ecuador.

“If life allows, I might participate in one of their future trips,” she said. “I hope that people receive medical care and medication that improves their lives. I like the thought of children thousands of miles away being cared for in Riley and Claudia’s memory. I hope that our participation encourages others to support this project as well.”

To participate in an upcoming medical brigade, apply on the organization’s Web site at www.shouldertoshoulderky.org.

University of Kentucky students should contact Morgan McKenzie, president of the Shoulder to Shoulder Ecuador Student Association, at morgan.mckenzie@uky.edu.

The Student Doctor Network would like to thank our many members who donated to The Riley Jane Lawrence and Claudia Faye Wadlington Fund through SDN.  Look for two more stories on the organizations aided by the donations received.

Premedical students are, understandably, focused on getting into medical school. They shadow physicians and have an idea of what being a physician is like.  However, many don’t have an understanding of what life at medical school is like.

Medical school is a place in which you will grow as a person and as a professional. You will be challenged to study more than you thought possible and pick yourself up when you fall down.  The massive amounts of knowledge you need to learn in a short period of time makes medical school one of the most challenging professional schools out there.

I like to think of medical school as a roller coaster. Each medical student who enters is happy and even eager to study but as the months drag on, the studying gets old and you say to yourself, “I cannot wait until all this studying is over!“

As a new physician, I have experienced the sleeplessness, the long arduous hours of studying, the multiple stops at Starbucks and more.  Here’s my overview of the realities of attending medical school.

Types of Schools

Two types of medical schools exist: Allopathic Medical Schools and Osteopathic Medical Schools.  Allopathic medical schools confer an M.D. degree and Osteopathic medical schools confer a D.O. degree.  Both schools train its students to become fully licensed to practice medicine and prescribe medications. Both doctors see patients and become investigators of the body as they try to find out why their patients are sick.

What’s the difference? Osteopathic Physicians learn osteopathic manipulative treatment, using their hands to help diagnose and treat different diseases.

Class Structure

The typical medical school focuses on a combination of lectures and problem-based learning modules. Imagine sitting in class, listening to lectures, taking notes and then taking Scantron or even computerized tests. This is the standard way in which medical school builds and tests your knowledge. In fact, medical school literally feeds your brain with first, basic sciences and then, clinical knowledge.

The problem-based learning method consists of a group of med students working together to solve a patient case. For example, you are presented with a hypothetical 45 year old man with a history of heart disease and high cholesterol. He travels from New York to California on a business trip. Upon landing he experiences excruciating right leg pain. Problem-based learning focuses on exploring this case and diagnosing this patient. A physician-moderator typically sits in to guide and create the dynamic of the group.

Schools may have a traditional or system-based curriculum.  A systems-based curriculum means that all your classes are divided up by body system. For example: Month one may be about the cardiovascular system, month two may be about the gastrointestinal system and month three may be about the reproductive system and so on.

Classes

YEAR 1
Your MS-1 (Medical Student 1) year will be your most difficult year of med school.  Year one of medical school consists of mostly basic sciences courses, which means LOTS of memorization. I detail the major classes below, but medical school also consists of medical ethics courses, OSCEs in which you learn the physical exam and more. OSCEs refer to Objective Structured Clinical Exams in which you are presented with various hypothetical patient scenarios. An actor portrays a patient with a certain clinical disease and you are expected to obtain a thorough medical history and physical examination in the allotted time period.

GROSS ANATOMY
In year one, you are presented with one of the most challenging medical school classes known to humankind: gross anatomy. For many of you, gross anatomy conjures up images of cadavers and the smell of formaldehyde. Gross anatomy has two components: lecture and lab. Lecture is typically lasts for an hour while lab is typically about four to five hours long.

Different medical schools structure their gross anatomy courses differently: Some medical schools have gross anatomy every day while other medical schools opt to hold the course three times a week. The course itself can last three months to one year.

Here, you will learn the wonders of the human body from the cranial nerves, brachial plexus and mediastinum to the femur, humerus and orbicularis oculi muscle in your eye. I’m not gonna lie, gross anatomy is a tough class. You have to keep up with the reading or else you will be behind. Study in groups if you like learning with a group of people.

HISTOLOGY
Histology is the study of cells in the human body. This, too, consists of a lecture and lab component. Oftentimes, you will take histology and gross anatomy together, especially if your medical school is systems-based.  Lab consists of looking at slides in the microscope. I loved histology but didn’t appreciate gross anatomy until I was done with it!

PATHOLOGY
Ever watch Dr. G Medical Examiner? Pathology class in medical school is similar to pathology seen on Dr. G Medical Examiner. You look at histology slides of, for example, an infarcted heart (heart attack) and know by inspection that it is a damaged heart. This, like histology and gross anatomy, consists of lecture and lab.

BIOCHEMISTRY
Biochemistry is similar to organic chemistry but better. Don’t panic, you don’t have to distill any liquids in lab or draw any funny structures as this class is primarily lecture-based. You may have to memorize the Kreb’s cycle and glycolysis cycle.

YEAR 2
Year two of medical school is typically clinical-based. Here you will learn a handful of the diseases you will encounter in the hospital, such as:

• Myocardial infarction (heart attack)
• Pulmonary embolism (blood clot in the lungs)
• DVT (deep vein thrombosis )–blood clot in the leg
• Rheumatoid arthritis
• Congestive heart failure

and the list goes on (and on and on…).

This is when medical school turns to real medicine.

YEAR 3
Year three consists of clinical rotations. Here you will become part of the medical team. A medical team typically consists of an attending (senior doctor), residents (doctors-in-training) and interns (first year residents). As a medical student, you are at the bottom of the totem pole. Some doctors will make that well-known while others are very nice.

You will rotate through the many clinical specialties of medicine, such as Internal Medicine (adult medicine), pediatrics, ob/gyn, psychiatry, etc. Here, you will get a taste of what kind of doctor you will become.

Your team will grade you on your performance during your rotation. As with any work environment, this can be a bit biased. However, national tests are administered at the end of your rotations. Some medical schools require you to pass this exam to receive a grade at the end of your clinical rotations. Sometimes, the percentage grade is even factored into your final rotation grades.

YEAR 4
Year four of medical school is much like year three but a bit more specialized. You can delve into the specialties of medicine even more. For example, if you liked internal medicine, you can elect to do a gastroenterology, cardiology or rheumatology rotation. Grading is the same as in year three.

So this piece hopefully gave you a good overview of the nuts and bolts of medical school. Congratulations on your recent admission – or good luck with your applications – and best wishes for your future plans!

Dr. Lisabetta Divita is a physician, medical writer/editor and premedical student mentor.  Her company blog, MedicalInk911, can be found at LisabettaDivita.weebly.com.

Some pitfalls of the medical school interview are obvious: Don’t ramble, don’t say “um” too much, don’t be rude to people, don’t chew gum and don’t greet your interviewer like this: “Hey Dave. It is great to meet you. I read everything I could find about you on the internet.” But what pitfalls might not be so obvious?

Not being prepared
You studied for the MCAT. You composed multiple drafts of your personal statement. So, why is it that you think walking in cold to your first medical school interview is acceptable? I find that many outstanding medical school applicants who have an impressive list of accomplishments are often not able to clearly articulate their motivations and paths to pursue a career in medicine. All great performances require practice, and speaking about yourself and essentially marketing your candidacy is not easy. So, practice, practice, practice. Most undergraduate career centers offer mock interviews. Or you can grab a friend, teacher, parent or relative who has more experience than you do in this arena. Practicing also builds confidence, which helps your performance.

Overpracticing
On the opposite side of the coin, practicing too much can also hurt you. Why? First of all, you don’t want your answers to sound rehearsed or canned. Ideally, you want your medical school interview to be conversational so if you are fixated on what you have rehearsed, a conversation pattern for which you didn’t prepare can make you overly anxious. In the same way, over-rehearsed applicants often stumble when they receive a question they weren’t anticipating.  This is also an issue for the fortunate applicant who has multiple interviewers. Try to keep your answers fresh, which can be challenging after being asked “Why do you want to be a doctor” for the 17^th time.

Getting psyched out before the interview
“Everyone there already had at least 5 acceptances.” “I was the only one at the interview from a non-Ivy League school. I have no chance.” Sometimes the interactions between candidates as they wait for their interviewer or a presentation about the school can be harmful. Obviously, you don’t want to seem like a social outcast and sit alone in a corner of the conference room while the other applicants are chatting. But at the same time, you don’t want these casual conversations to cause you unnecessary anxiety before you enter your interviewer’s office.  Though it’s tough, try to stay away from, “So, where else have you interviewed/been accepted” type of topics. And, if such questions do arise, answer vaguely or change the topic without being rude. If you were invited for an interview, you are just as qualified as everyone else sitting in that room with you, and each interview is an opportunity for acceptance.

Adhering to strict rules
“I heard I should speak only for a maximum of three minutes per answer.” “I heard that I need to ask my interviewer at least three questions to seem interested in the school.” Many myths are out there about what you “must do” or “not do” on interviews. Remember that your interviewers are not robots; they are individuals. The vast majority of interviews are not scripted so the rhythm and flow of an interview will depend on many factors, including your interviewer’s style, level of experience and even his or her mood that day. It is important to enter each interview with an open mind as to how the interview might progress. For example, some less-experienced interviewers may feel uncomfortable having a fluid conversation whereas the more experienced medical educator might purposefully get off topic and start a conversation about something in your background that you didn’t expect.

Telling them what they want to hear
It is important to research your school before your interview so you have a clear idea of its mission and values. You also want to try and tailor your answers so you fit these ideals as best you can. But the applicant who says something that is not sincere or that is inconsistent with her background has fallen right into a major pitfall. For example, the school that values community service is seeking students who have a demonstrated commitment in this area but also wants students who have other interests. When an applicant who has no background in community service says that she hopes to become involved in helping the underserved during medical school, her assertion seems patently false. Be true to yourself and make sure that everything you say is consistent with your background and experiences.

Trying too hard to “stand out” or “be distinctive.”
Applicants are always concerned about standing out from the crowd. “What can I say that will make me different than everyone else?” “What can I do that will be unique?” First of all, you cannot change who you are on your medical school interview day. Most interviews are somewhat biographical so your experiences are what they are. I find that when applicants try too hard to be “different,” they often undermine their own success.  Medical schools are not evaluating you on your distinctiveness, per se; they are trying to assess your motivation for a career in medicine, intelligence, communication skills and level of compassion, among other qualities. Sure, candidates who have accomplished something truly unusual are evaluated differently, but these candidates are the exception. Ironically, applicants who exude confidence, enthusiasm and authenticity and who are “comfortable in their own skin” are often the individuals who stand out. So, be yourself. A seasoned interviewer can sniff out insincerity. Trying to be someone or something that you are not will inevitably negatively impact your performance and your interviewer’s evaluation.

Ultimately, every interview dynamic is affected by the rapport between the interviewer and applicant, the interviewer’s approach and the applicant’s comfort level in speaking about himself, his motivations and his ideals. Be aware of the common pitfalls and be able to express who you are, why you want to pursue a career in medicine and how you got there.

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits, a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog and The Medical School Interview: From Preparation to Thank You Notes.

Exhibition categories are:

• Application and Admissions Resources
• Board Review for Medical Specialties
• COMVEX
• DAT
• GMAT
• GRE
• MCAT
• NAPLEX
• NBDE
• OAT
• PCAT
• SPEX
• Textbooks, Reference Materials, and Study Resources
• USMLE/COMLEX

Exhibitors will include:

• The Apprentice Doctor
• Boards Boot Camp
• CE Webinar
• Colen Publishing
• COMBANK
• COMLEXpert
• COMQUEST Osteopathic Specialists
• DATtoGO
• Dental Board Busters
• DoctorsInTraining.com
• Elsevier
• Examkrackers
• Gold Standard MCAT & Gold Standard DAT
• GraduateTestPrep.com
• Kaplan Medical & Kaplan Test Prep
• McGraw-Hill
• MedEdits
• Modality, Inc.
• OnlineMCATprep.com
• Orgoman.com
• The Osler Institute
• Pearson
• Premier Review
• The Princeton Review
• Scratch Sheet
• The Study Barn, DAT Professor, OAT Professor, Medical School Professor, & PCAT Professor
• Thieme Medical Publishers
• USMLERx
• USMLEWorld
• Youel’s Prep, Inc.

And, more!  Visit the SDN forums at http://forums.studentdoctor.net for more information and to enter drawings.

The School Reviews database allows current and former medical students to provide feedback on what it is like to be a student at their institution.  By completing a survey, students can paint a picture of life at their school, including their classroom and clinical education, the local area, social environment, and success of graduates.  Pre-medical students can review the results of the surveys to help them choose the medical schools they want to target for application.

“We are very excited to be launching the School Reviews functionality for our users,” said Dr. Lee Burnett, SDN Executive Director.  “This application, along with the updated Interview Feedback database, will enable prospective students to better understand what it is like to attend a school from the real experts – current and former students.  We are launching the school review application for allopathic and osteopathic medical schools and will soon be expanding it to other health professional schools.”

In addition to the new School Reviews database, SDN is launching an updated version of the Interview Feedback database.  The Interview Feedback database allows students who are applying to a health professional program to describe their interview experiences and view what other applicants have said about their interview experiences.  Thousands of SDN members have completed Interview Feedback surveys, providing a rich source of information for pre-health professional students.

“The power of SDN is in the way our members help each other,” continued Dr. Burnett.  “We are indebted to our current students for the information they have provided on their interview experiences.  This new functionality will make it easier for our members to share information about their perceptions of life at medical school.  The School Review and Interview Feedback databases support the mission of SDN, which is to provide free and unbiased information to students in their efforts to become health professionals.”

Students who complete a School Review or Interview Feedback survey in the month of January may be randomly selected to receive one of 50 SDN “Dress the Doc” magnets.

Most residency applicants have not found themselves in the interviewee seat since they applied to medical school. Well, the residency interview is somewhat different from the medical school interview. Because you have now nearly graduated from medical school (for the traditional applicant), no one is trying to assess your commitment to medicine; rather, they are specifically evaluating your commitment to the specialty to which you are applying. They also are evaluating your ability to perform well as a resident and if you will be a good fit for their program. This article will provide some tips to help you succeed, whether you are applying to residency this interview season or in the future.

Clearly articulate your interest in the specialty to which you are applying.
Residency program directors must be convinced that you have a genuine interest in the specialty and a clear understanding of what it means to practice in that specialty. They also want to know that you are motivated and that you will work hard to become an outstanding clinician. The question “why THIS specialty” will undoubtedly come up at every interview, and your answer to this question must be clear and well thought out.  Don’t just say the obvious, but try for a response that will set you apart from other applicants. For example, as the associate program director in emergency medicine (EM), when I asked the question, “why EM,” I heard this response more times than I can count: “Well, I liked everything in medical school and I enjoy caring for high acuity patients so EM was an easy choice.” A more memorable response was, “I have been interested in EM ever since I was a patient in the ED during my second year of medical school. As I watched what was going on during that roughly six hour visit, I realized that the emergency physician who cared for me represented the type of doctor I hoped to become: someone who could manage anything that came through the door, was kind and compassionate and cared for a diverse group of patients. My time in the ED as a patient really made it clear that EM was the ideal specialty for me.” You should also try to substantiate your answer by using examples from your rotations in that specialty to illustrate what you like about it.

Be personable, energetic and communicative.
A large part of your residency interview will focus on the evaluation of your interpersonal skills, including not only how well you communicate but your demeanor, enthusiasm, compassion and general attitude. These skills are important not only because any physician, regardless of specialty, must be an effective communicator, but also because program directors are seeking applicants who will be pleasant to have in their program. You will be spending three to five intensive years in this program so interviewers try to match with people who will be a joy to train. To assess an applicant’s ability to communicate, many program directors ask them to describe an interesting case. International medical graduates (IMGs) who are not US citizens are most likely to be asked this question.

Have a clear idea of what you want to convey during your interview.
Why is this important? Many residency interviewers have little interviewing experience and simply do not know the best questions to ask or what information they should obtain. Your interviewer is your advocate on the residency admissions committee, but he or she can present the committee only the information you provide. If interviewers fail to ask you pertinent questions because of a lack of experience, their presentations in support of your candidacy may be weak. So, it is your job as a residency applicant to be proactive; tell them specifically why you are interested in the specialty, what you have done to explore this interest and what makes you a unique applicant.

Be sure to bring up “red flags.”
These red flags include board failures or major gaps in time. Even if such topics do not come up during your interview, they will likely be discussed in behind-the-scenes discussions, and you are sunk if your interviewer does not have a defense for you because the issues were not addressed.

Project a good image.
No, you won’t be evaluated on your attire, but you must appear to be mature, professional and well-balanced. This means you should have good posture, make eye contact with everyone whom you meet, speak clearly and articulately and convey confidence but without any hint of arrogance. Your interviewers are also trying to rule out any underlying psychopathology; a program’s worst nightmare is to have a resident who might have a personality disorder, a hidden substance abuse problem or a tendency to cause trouble.

Have a sense of why you will be a good fit for the program.
It is important to have as much information about the program before you interview. Sometimes this information is easy to find on websites but, if not, you can also learn about programs at dinners or events the night before the interview day (if offered) and at presentations during the interview day itself. While it is important to be authentic during your interview day (most seasoned interviewers can sense if someone is misrepresenting himself or herself), you can tailor your responses to become a better “fit” for the program. If a program is largely community based, for example, you don’t want to emphasize that you hope to become a physician scientist in the future. In contrast, for the large academic program that boasts residents’ scholarly pursuits, you would want to highlight your past academic achievements and mention that you might consider an academic career.

Be friendly and respectful towards the residency coordinator and residents.
Residency coordinators and the residents you meet have tremendous influence in this process. The residency coordinator who has a negative impression of someone often will mention this to the program director. By the same token, residents’ opinions of applicants are also taken in to consideration, especially when they are extremely positive or negative.

Be prepared for specific questions if you are an IMG.
The IMG who is a United States citizen likely will be asked about his decision to go abroad for medical school. When I do mock interviews with residency applicants, I find that most clients initially give this type of answer: “I wanted a different experience and to learn about a new culture.” When I ask for the “real” reason, they reveal the truth: “I couldn’t get into a US school because…. After doing research, I realized I could do well by going to XXX medical school.” I encourage applicants to always tell the whole truth. The IMG who is not a US citizen should be able to discuss why he decided to pursue residency training in the US and his path to residency. As discussed above, most non-US citizen IMGs will be asked to talk about an interesting case.

In summary, remember that most residency interviews are directed and conversational. In my work with clients I find that some interviews are becoming shockingly brief – some clients tell me that interviews last only 10 to 15 minutes. Depending on the program and the specialty, you will have at least two interviews but may have up to five or six. Usually, the more interviews you have, the shorter each individual interview will be.  On average, though, an interview will last 20 minutes. This brevity makes it important to have a clear idea of what you would like to talk about on interview day. Also be prepared to talk about the same topics repeatedly since most interviewers are trying to ascertain the same general information.

Here are some topics that you should be prepared to discuss at your residency interview:

• Tell me about yourself.
• Why XXX specialty?
• Where do you see yourself in the future?
• Why do you want to come to this program?
• Tell me about an interesting case.
• Tell me about your rotations in XXX specialty.
• Tell me about your greatest strength and weakness.
• What are some issues in health care today and how will they impact this specialty?
• What are the negative aspects of practicing this specialty?

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

by Deirdre Mills and Laura Turner

On college and medical school campuses nationwide, it isn’t uncommon to see students hurrying around campus with an iPhone or iPod Touch in hand. These devices allow you listen to music, access your email, and get on Facebook with the flick of a finger.

You’ve probably downloaded some fun apps to play with – Tetris, Scrabble, ESPN, Frogger and Facebook, of course. Maybe you’ve even tried “I Am T-Pain” to channel with your inner rapper. There are tens of thousands of entertaining apps available to help kill time and de-stress. But did you know that you can get hundreds of medical study aids on your iPod and iPod Touch as well?

In the Apple App Store, the “Medical” section currently holds more than 1,000 applications, with more added every day. Many of these apps provide instant access to flash cards, question banks, study guides, medical tools, and clinical reference materials. Whether you are an undergraduate studying for the MCAT, a first year med student looking to review gross anatomy, or a family physician needing to quickly calculate a patient’s BMI, the App Store has something to satisfy your needs.

Learning and Reference Applications

As a student, most of your life outside of the lab and the classroom consists of studying for exams, reviewing different procedures, or perfecting surgical techniques. Flash cards and review books are helpful to have on-hand for an impromptu study session; however, these study tools are difficult and heavy to carry around 24/7.

There are a plethora of learning and reference applications available for purchase through iTunes, designed with the same content as the hard-copy versions, but offering additional interactive features. Time spent waiting for the bus, in line at Starbucks, or while waiting for class to start can be turned into a study opportunity with these digital learning and reference applications.

Instant ECG: An Electrocardiogram Rhythms Interpretation Guide (iAnesthesia, LLC) – $0.99
A comprehensive ECG app that includes 90 high-resolution ECG examples and 30 full-screen movies (without audio) of common arrhythmias.  You can also test your interpretation knowledge with 140 exam questions.

Kaplan MCAT Comprehensive Flashcards (gWhiz, LLC) – $34.99
Kaplan Publishing presents this app, which includes 700 comprehensive flashcards and five instructional videos.  The key concepts highlighted in the videos are Colligative Properties, Effective Nuclear Charge, Enzymes, Bernoulli’s Equation, and Resistance.  The flashcards address terms, definitions, and concepts in physics, general chemistry, biology, and organic chemistry.  The app includes the ability to take quizzes and mark cards for future review.

Lange Flash Cards (Modality, Inc.) – $34.99 each
Lange Flash Cards (available for Biochemistry & Genetics, Microbiology & Infectious Diseases, Pathology, and Pharmacology) give comprehensive, customizable course review and USMLE Step 1 prep. These apps allow you to create a personalized study regimen based on your needs using two distinct modes: index mode for key information about each card, and the flash card mode.

Procedures Consult: Internal Medicine (Modality, Inc.) – $39.99 each
Two apps are available in the Procedures Consult series so far—General Internal Medicine and Musculoskeletal —each featuring a blend of high-quality video, illustrations, animations and text for common medical procedures encountered in a clinical setting. These apps include a fully searchable index, ability to bookmark procedures, and locally stored content on your device.

Medical Tools

You are doing daily rotations in the hospital and are asked to calculate a patient’s BMI, or you are shadowing a doctor and are asked to reference the CDC for child immunizations. There are numerous formulas for varying medical indicators, many of which you may need to reference, or will be unable to calculate in your head.

AHRQ ePSS (U.S. Department of Health & Human Services) – Free
The ePSS app is published by the Agency for Healthcare Research and Quality to identify the screening, counseling, and preventive medicine services that are appropriate for a patient based on age, sex, and behavioral risk factors.  The ePSS information is based on the current recommendations of the U.S. Preventitive Medicine Task Force.

MedCalc (Mathias Tschopp & Pascal Pfiffner) – Free
This is a free medical calculator, providing you instant access to numerous medical formulas, scores and classifications. MedCalc allows you to make a list of your most-used equations, search for formulas by name or keywords, and obtain detailed information about each formula.

Clinical Support

Streamlining workflow on the wards is a constant battle. You may serve a sizable non-English speaking community and your high school Spanish class is a distant memory. Or, you are an obstetrician whose patient arrived at the hospital in labor while you’re delayed at an airport hundreds of miles away. Even keeping up with drug formularies is a herculean task. Get some point-of-care support from your iPhone by using these apps:

AirStrip OB (AirStrip Technologies, LLC) – Free
This app provides obstetricians instant access to critical data from the Labor and Delivery unit. Users can access nursing notes, vital signs, labor status, physical exam and maternal/fetal waveform data, even patient historical data.

Epocrates (Epocrates) – Free
This free app provides you access to information about thousands of drugs, including dosing, adverse reactions, formularies, pricing and pill photos. You can identify pills by their physical characteristics and imprint code and check for up to 30 drug interactions at a time with this app.

Pedi STAT (QxMD Medical Software) – $2.99
This app provides quick reference to critical data when caring for pediatric patients in the emergency and critical care environment.  Features include rapid results for airway interventions, cardiac resuscitation data, and age- and weight-specific pediatric equipment.

Pocket Medical Spanish with Audio (Modality, Inc.) – $4.99
This app allows healthcare providers to communicate with, diagnose, and treat Spanish-speaking patients with over 400 phrases. Visual text and audio pronunciations of key questions allow for faster, more effective communication at the point of care. Also available in French.

While PDAs and smartphones have been a part of medical education for years, Apple’s App Store is rapidly changing the way students and professionals are using mobile technology. Leave a comment about your favorite apps below to help others in search of the best study aids in the App Store.

Emil Chuck

by Emil Chuck
Health Professions Advisor & Term Assistant Professor of Biology, George Mason University

Have you ever noticed that many schools note that they want a letter of recommendation from a “pre-health advisor or committee if available to the student”?  In this article, I’d like to give you the basics of what a pre-health advisor is from my perspective and why they can be your ally in the application process.

Who are the pre-health advisors on your campus?

For up to 40 years, some undergraduate institutions have emulated the health professional school “dean’s evaluation” process for residency placement by providing a similar evaluation letter for applicants to health professional programs.  The structures of these offices vary by the number of advisees and advisors, the institutional resources, the organizational structure, the level of involvement advisors have with pre-professional and application programming, and the scope of professional schools that value such letters.

At first, pre-health/premedical advisors were tenured faculty members who volunteered part of their time to advising students on the application process.  Currently, one can find advisors who are trained professionals in career placement or academic advising offices, retired faculty, retired clinicians, part-time practitioners, tenure-track faculty, and non-tenured full-time administrative faculty (such as myself).

For the most part, each institution spells out the resources it offers and the contact for the chief health professions advisor to pre-health students in their course bulletins and dedicated websites.  At some institutions, their services are limited to just undergraduate students.  Other schools allow postbacs taking science courses at their institution or alumni to receive services as well.

How can pre-health advisors help you?

The type of assistance that pre-health advisors give varies on where the advisor is based in university organization.  Often advisors are responsible for advising on a variety of areas beyond their primary area of expertise.  Others prefer to refer advisees to other advisors with more expertise.  I do both, depending on the situation.

Here are some of the ways pre-health advisors can help you (with examples from my own system):

• Developing a self-assessment for your appropriate fit to your desired health professional career path.
• Answering questions about fitting prerequisite and upper-level coursework within plans to pursue a specific major or fit in internship or study abroad experiences.
• Informing freshmen, sophomores, community college students, transfers, upperclassmen, and postbacs of volunteering or shadowing opportunities through on-campus programs and presentations.
• Organizing on-campus admissions visits, off-campus open houses, and online admissions recruiting seminars with admissions recruiters, directors, and sometimes alumni.
• Writing letters of recommendation for freshmen, sophomores, and other students interested in pursuing an undergraduate summer research or academic enrichment program (especially those which I promote to my students).
• Coordinating seminars or workshops on personal statements, interviewing skills, resume writing, standardized test-taking skills, and other parts of “the application process.”
• Informing students of health professional career options, and career options outside of the doctoral-level clinical professions.
• Establishing the formal timeline and process for generating an institutional committee evaluation letter for all applicants (including alumni) and decide on exceptions for eligibility on a case-by-case basis.
• Advising pre-health student clubs and supporting leadership development among these organizations.
• Encouraging students to take advantage of programming that is designed to support and mentor disadvantaged potential applicants, including securing fee reduction or disability documentation for test registration or applications.
• Developing online resources to help students remain informed of programming, deadlines, and news that will help them keep focused on their future careers.  I have a website, institutional listserv, Facebook fan page, and an iTunesU site.
• Reporting on past statistics to note the qualities that promote successful applications.

Procedurally, pre-health advisors can prevent applicants from experiencing extreme angst with their recommendation letter packets.  Pre-health advisors often can quickly send your evaluation letter packet to schools much more efficiently than five individual references can.  Additionally, pre-health advisors can compare applicants in a given pool against historical candidates, so they have an understanding of the qualities a particular health professional school seeks.

When should I see an advisor?

While most advisees usually seek pre-health advisors when they are about to consider an application to a health professional program, very serious applicants work with their institution’s pre-health advisors as early as freshman year and take advantage of programming to develop a long-term application strategy.  This is particularly important for a competitive application to MD/PhD programs.  Many freshmen who meet with me to craft competitive applications to summer enrichment programs return as prospective applicants to finalize very attractive profiles for applications and for the institutional committee letter.  The additional time spent becoming competitive for those programs or other undergraduate scholarships is extremely valuable for anyone aspiring to put in a competitive professional school application.

What is the “Committee Letter”?

While grades and entrance exams are very important to pass the initial screening process in the pool of applicants, admissions committees are looking for additional personal and professional characteristics from the applicant’s references and statements.  A well-crafted committee letter provides a holistic description of the applicant’s professional development and preparation and his or her perspectives or experiences from which his or her peers and faculty can learn.

While it is expected that regular solicited letters of recommendation frame the applicant as an exceptional candidate – as I put it, “has superhero powers” – committee evaluations are written at a higher standard of honest evaluation, including a realistic assessment of an applicant’s deficiencies and strengths in comparison to successful professionals.  Finally, the pre-health evaluation committee letter often discusses other qualities of an applicant that are not often emphasized or brought up in typical reference letters. Sometimes a committee’s evaluation process includes submission of written essays or mock interviews, so a committee can address communication, interpersonal, and professional skills and qualities in much greater depth than the professor who saw you sitting in the front row of a class asking questions.  This is why committee evaluations are often preferred over standard letters of recommendation.

Types of committee letters

The pre-health evaluation letter comes in different forms that reflect how the pre-health advising structure is set up at an undergraduate institution.  Admissions committees that have a history of working with an undergraduate institution will understand the variations, so it doesn’t matter which type your school offers.

The most common types of letters are:

• Composite committee letter based on solicited letters of recommendation and interview: Often a member of the committee will write a “composite letter” that consists of the committee evaluation of the applicant’s academic performance, resume, and other solicited information from the applicant.  Often letters of recommendation are solicited by the applicant and sent to the committee.  Excerpts from these letters are incorporated into and referenced in the “composite letter”, and at least one member of the committee signs the document.
• Committee letter packet: Admissions committees like to view the original solicited letters when available.  The evaluation committee can thus write a cover letter that evaluates a student and append the solicited letters of recommendation.  Some advisors may select the “best” letters while others opt to include all letters regardless of “quality” or “recommendation.”
• Letter packet: Some institutions will receive solicited letters of recommendation and be a clearinghouse to deliver these letters as a bundle to the applicant’s schools.  In this case, the cover letter does not include a recommendation about an applicant, but may include other information that verifies the applicant’s interest in a professional career.

Sending out committee letters

Committee letters can be sent in paper or electronic copies.  In the past two years, AMCAS and OptomCAS have joined AADSAS and PharmCAS (and other health professional application services) in accepting letters of recommendation electronically through their own system, though not every system is friendly to letter packets.  The pre-health advisor can deliver your letters to these services by mail, electronic upload, or through an electronic service like VirtualEvals or Interfolio.

VirtualEvals is a service that allows pre-health advisors to digitally transmit your letters to nearly all MD and DO schools, as well as some podiatry and optometry schools.  If your advisor uses VirtualEvals, he/she can track when your letters were accessed by the schools that do not use the AMCAS letter system and when your letters were downloaded by AMCAS for those schools that use the system.  It is your responsibility to check the application websites for each school to make sure each step of the application process – including the receipt of your evaluation letters – is completed in a timely fashion.

Why do I want to get a pre-health “Committee Letter”?

Often a school’s secondary application will ask an applicant whether you took advantage of the pre-health resources at your institution, and – if there is a pre-health committee present — why you did not get an evaluation letter, if applicable.  In addition, admissions deans or current professional students who were alumni at your institution who have worked closely with pre-health advisors will ask potential applicants on interview day about their advisors.  The answers you give to these questions make a huge difference on the perception of your application, especially if they call your pre-health advisor to verify your responses.

How can I work best with my pre-health advisor or committee?

From the perspective of a pre-health advisor, here are my tips for a productive relationship:

• Meet your advisors early if you are seriously considering a future career in the health professions.  As soon as you find out the structure and role your pre-health advisors on campus have, make sure that you respect their time and expertise.  It doesn’t matter if you received top scores on standardized admission tests like the MCAT/DAT; if you don’t address the pre-health advisors, committee members, or the staff with respect, you can seriously damage the impact of your application if you try to force the committee to evaluate you.
• Treat your pre-health advisor and staff like an admissions director and staff at your dream school.  You would never ask an admissions director questions about the school whose answers are easily found on their official website.  The same thing applies for your pre-health advisors.  Do your research and ask questions that clearly show you have a secure grasp on the fundamental timeline and criteria for desirable applicants.  When meeting with your pre-health advisor, have an agenda and series of questions (see above point) that you would like your advisor to address.
• Release your test score and application to your pre-health advisors.  It’s unfair to ask the advisor what GPA or test score looks competitive to applicants from your school if you are not yourself willing to give your advisors access to this information for future pre-health students.  The more pre-health advisees at an institution do this, the more helpful the answers the advisors can give you about your own application.  Obviously the advisors won’t release your test score information in a way that breaches confidentiality.
• Always keep your pre-health advisor informed of progress in your application attempt.  This person has helped you as an advocate to admissions committees to consider you, so keep them aware when you receive an interview invitation, an offer, a waitlist, or a rejection.  This advisor will be key to any reapplication attempt you may have to take and could also play an important role in helping you consider your postbac options.
• If you lose interest in allopathic medicine, make sure you talk with your pre-health advisor.  Often he or she has information about other career options you could consider.  Usually anyone who identifies himself or herself as interested in one or more of these alternate career paths gets placed near the top of my priority list for an appointment.
• Because the Federal Education Records Privacy Act (FERPA) limits the type of information that can be shared with parents or guardians regarding your academic progress or your career decisions, sharing your career advising with your family may make things more complicated.  Find out what your pre-health advising structure expects from you and your parents/family involvement when making your future career plans.  That said, advisors generally recognize that support from your family and friends needs to allow you to grow and mature personally and professionally both in your preparation for and your education in and beyond medical school.

Is your advisor too “negative” about your chances?

Sometimes you may think that your advisor is being too discouraging about your chances.  While there may be advisors who automatically discourage applicants from applying because they fail to achieve a certain GPA or test score profile, many times advisors do know what they are talking about when evaluating your profile.  Often the feedback is not driven by your GPA or standardized exam scores.  Really pay attention to the advice they give you about your communications skills, clinical experiences, penchant for serving others including underserved populations, and so on.  The advisors understand what makes a more desirable applicant.

National Association of Advisors for the Health Professions

Most pre-health advisors are members of NAAHP.  Members receive information that gives them insight into changes in the application process and about new programs that might help them work with applicants with varying profiles.  Often advisors get a chance to act as a mock admissions review panel for applicants in various career paths to get a sense of how the decision-making process can work based on an applicant’s profile.  The most anticipated event of these meetings is the networking session with admissions directors, deans, and recruiters.  Outside of meetings, many of these advisors continue to contact each other about questions that advisees ask that sometimes stump a less-experienced advisor.

Emil Chuck, Ph.D., is the chief health professions advisor at George Mason University and a member of the National Association for Advisors of the Health Professions.  He has experience working with Kaplan as an instructor, student advisor, and admissions consultant.  He has served as a career advisor for the AAAS Science Careers Forum, and is a former diversity committee co-chair with the National Postdoctoral Association.  His past graduate and postdoctoral research focused on electrophysiological changes in cardiac embryological development.  His current advocacy interests include competency-based holistic evaluations of pre-health students and the promotion of research-intensive career pathways for future health professionals.

Acknowledgements
Kay Singer, Anne Wells, and Gina Moses for initial feedback to the article.

By Glenn Laffel, MD, PhD
Senior Vice President, Clinical Affairs
Practice Fusion

Not too long ago, it seemed safe and reasonable to define health information technology (HIT) narrowly as the management of health information and its secure exchange between patients, providers, and insurers.[1]

For many, the definition effectively compartmentalized HIT. It was for someone else, not me.

That began to change when quality initiatives started forcing physicians to deal with performance data and patients began showing up with reprints of journal articles they hadn’t read themselves.

But nothing could have prepared physicians to handle the flood of HIT that inundates them today, a flood that threatens to sweep away established codes of professional conduct and disrupt the very processes by which care is rendered and doctors communicate with patients.

Consider these examples:

1) Dr. Jain, a medical intern[2] receives a friend request on Facebook from Erica Baxter. As a medical student, Jain helped deliver Baxter’s baby. Is Baxter simply a grateful patient interested in sharing news about her child, or does she have other motives? Jain clicks “confirm,” granting Baxter access to his network of friends, his personal photographs and blog, and the scrawls of others on his wall.

2) Dr. Margolis, a middle-aged pulmonologist, receives 120 emails per day. The assortment reflects her busy life. There’s one from her child who needs a lift at 6:30. Her dentist has an opening for her prophylaxis, and her secretary just added a patient to her afternoon schedule.

And then there are emails from her patients, some of which require immediate attention.

Problem is, Dr. Margolis can’t read all her emails. She has a thousand unread messages in her inbox. She worries that some contain time-sensitive information from patients.

3) Dr. Tapscott, nearing the end of his career in family practice, is convinced by office personnel to adopt an electronic health record (EHR).

But the implementation goes poorly. He can’t get the hang of it and believes it puts a barrier between himself and his patients. Five months and $20,000 later, he ditches the system.

Physicians have faced emerging ethical challenges before. Their struggle to develop professional identities is as old as the profession itself. And this isn’t the first time they’ve have had to incorporate new innovations, but the HIT Deluge multiplies these challenges several fold, and creates myriad new ones, many of which remain vexing even to deep thinkers in the field.

The Impact of EHRs on Medical Education

EHRs are a prime example of this. They have begun an inevitable march into the lives of all physicians, stimulated by the American Recovery and Reinvestment Act, which allocated $21 billion to encourage “meaningful use” of such systems[3].

The Fed’s largesse is based on the premise that EHRs will improve quality and reduce the costs of care, but the move will impact the health care system in other ways as well. One such area is medical education.

What kind of impact can we expect? In some ways, EHRs appear to enhance medical education, but in others, the impact appears to be negative.

Benefits
Two studies suggest that EHRs improve documentation[4] by medical students. In the first, Morrow and Dobbie found that first-year students who used an EHR to document a history recorded more features of pain [5]than those using paper charts.

In another survey of third-year students, Rouf and Chumley showed that 72% reported asking more history questions when prompted by an EHR.

These authors also assert that EHRs make it easier for faculty to give feedback to students[6], track the procedures they perform and store records of interesting cases for future use.

Beyond this, EHR speeds access to the medical literature which should facilitate learning and encourage students to rely on medical evidence.

Risks
EHRs have some negative impact as well, particularly relating to the learning environment and patient-physician communication.

EHRs can disrupt the learning environment by creating shortcuts that threaten the time-honored process by which trainees synthesize patient’s symptoms, signs, and lab results into a coherent story and present them to senior clinicians for feedback and discussion.

One example of this is the process by which trainees copy and paste chart notes and other information created by others, and send them to supervisors for feedback. This discourages critical thinking by the trainee[7].

The potential negative impact of EHRs on physician-patient communication is particularly acute for medical students who are just finding their voices as professionals. Inserting a terminal into the middle of a student’s session with a patient adds complexity to the interaction, might reduce eye contact and stilt the conversation, and prevent her from seeing how her words and body language affect her patients.

Tweaking Medical Education to Leverage EHR Benefits

As these issues show, the quality-improving, cost-reducing benefits of EHRs can only be realized by aligning multiple systems and user-based factors. Educators can begin the alignment in three ways:

Begin EHR Education Early
The process should begin in Year 1. Non-science oriented courses like “Introduction to the Patient,” present ideal opportunities to introduce the medium.

If students master EHR skills before their clinical rotations, they can focus the latter time on traditional learning exercises, such as clinical reasoning, diagnosis and so on.

What to Teach
Students should be taught how to use basic EHR functions like order entry, lab look-up, messaging and charting. This exposure should occur away from patients so students can focus on the EHR itself.

They should also be exposed to the nuances of physician–patient communication in the presence of an EHR. Specific communication techniques include:

-        adjusting the spacing between patient, physician and computer so the patient can see what the physician is doing on the computer,

-        encouraging the physician to walk-through data on the screen with patients,

-        spending no more than 30 seconds at a time typing into the computer,

-        making eye contact with the patient; assessing the patient’s emotional status and understanding of the information provided

Don’t Forget Faculty
Most medical school faculty have received no EHR training, yet until they become facile, they can’t be good role models for students. This topic is beyond the scope of this article.

Social Media: Disruptive Force in Medicine

In medicine, social media including Facebook, Twitter, YouTube, blogs and virtual physician communities has grown explosively.

Enterprising providers have deployed sophisticated social media strategies to extend their brand around the world. The Mayo Clinic, for example, maintains several blogs[8], a Facebook fan page[9] (which has 8,800 fans), a library of YouTube videos and a Twitter stream[10] (7,120 followers)[11].

Many physicians also leverage social media to help patients access support networks, a heretofore difficult undertaking for homebound or geographically isolated patients, or those with rare diseases.[12]

But social media also creates challenges for physicians.

In some ways, the challenges are most acute for the youngest physicians, who grew up with Facebook. Unlike their counterparts, they are familiar with social media, but some have become ensnared by it.

Thousands of young physicians have created personal social histories and exposed them on Facebook. Their challenge is to manage this archive while forging identities as professionals.

A study by Thompson and colleagues the University of Florida sheds light on the challenge. They found that of the 44% of students at the UF Medical School who maintained Facebook profiles, only 37% made their entries private. More than half shared information regarding their sexual orientation, while 58% shared their relationship status and half shared political opinions.

A closer inspection of the profiles of 10 randomly-selected medical students revealed that 7 included photos showing them drinking alcohol. Five of these implied excessive drinking. Three students had joined groups that were flagrantly sexist (“Physicians looking for trophy wives in training”) or racially charged (“I should have gone to a blacker college”).[13]

The boundary-blurring effects of social media extend in every direction since medical students, nurses, housestaff, fellows and faculty are linked[14], and the chain is only as strong as its weakest link.

What has been done to mitigate risks associated with social media?

Many have issued warnings. “Caution is recommended,” wrote Jules Dienstag in an email to Harvard medical students. The Dean for Medical Education explained that when “using social networking sites such as Facebook…items that represent unprofessional behavior that are posted by you reflect poorly on you and the medical profession. Such items may become public and could subject you to unintended consequences.”

Similarly, Drexel University College of Medicine warned students that information on social-networking sites can impact decision making regarding their applications to residency programs[15].

Warnings like these are analogous to a “Dangerous Rip-Currents” sign at the beach. By the time people read it, they have arrived in wet suits, having driven an hour to get there.

Some believe the challenges posed by social media are large enough to warrant promulgation of guidelines for its use in health care, modeled after AMIA’s “Guidelines for the Use of Electronic Mail with Patients” which were published just as providers began relying on that medium.[16]

Such an approach begs questions like who has the authority to issue such guidelines, or whether they could impact behavior without an associated means for enforcement. And since no one believes that social media utilization in healthcare should be regulated, the alternative is to modify medical school curricula and beef-up CME.

With social media, the genie is out of the bottle.

Innovations That Make a Difference

Even though EHRs and social media have had a large impact on medicine, it does not necessarily follow that medical education should be modified to account for them.

After all, thousands of technologies have disseminated into the mainstream; medicine accommodates them organically.

To some extent, this is happening with social media. In the Florida study of Facebook utilization for example[17], 64% of medical students were found to have fully public Facebook accounts, whereas only 12% of residents did.

It’s also true that finding space to teach HIT in a packed medical school curriculum means subtracting time from something else.

Still, we argue that the HIT Deluge presents unprecedented challenges to patient-physician communication and while blurring social boundaries in ways that generate ethical challenges and legal risks that cannot be ignored.

Medical schools including Harvard, Stanford, Vanderbilt and UCSF approach the conundrum by offering elective courses in HIT, often in conjunction with other graduate schools.

HST.921, “Information Technology in the Health Care System of the Future,”[18] is an example. The course is open to all graduate students at Harvard and MIT, including those at Harvard Medical School.

In it, students learn how HIT improves health care quality and provides new options for patient education and self-care.

Florida State University College of Medicine, one of the nation’s newest medical schools, has taken a more aggressive approach. Bypassing the above-mentioned incremental approach, its  Internet-age curriculum has HIT woven into its fabric.

FSU students receive laptops upon arrival. Their textbooks are on line. During orientation and first semester, they learn to access library resources on line and gain exposure to decision support tools.

In the second semester, they receive PDAs and learn how to carry out literature reviews and manage bibliographies on line.

In their fourth semester, FSU students learn to use SOAPware, a laptop-supportable EHR. During their third year, they use SOAPWare during supervised patient encounters and receive feedback from supervising physicians.

And what about all the physicians who graduated medical school years ago and have had no HIT education whatsoever? That’s where Russ Cucina, an associate medical director of IT at UCSF plays a vital role. Cucina, you see, teaches a CME class called, “Blogs, Tweets, and Facebook: What the Hospital and Medical Administrator Needs to Know.”

We hear it’s filling up fast.

[2] http://content.nejm.org/cgi/content/full/361/7/649?ijkey=Tarf0DE9052Gc&keytype=ref&siteid=nejm

[3] http://www.ehrbloggers.com/2009/07/meaningful-use-take-ii.html

[4] http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000069

[5] http://www.stfm.org/fmhub/fm2008/July/Heidi462.pdf

[6] http://www.biomedcentral.com/bmcmededuc/

[7] http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000069

[8] http://www.mayoclinic.org/blogs/index.html

[9] http://www.facebook.com/pages/Mayo-Clinic/7673082516

[10] http://twitter.com/mayoclinic

[11] http://www.informationweek.com/news/healthcare/patient/showArticle.jhtml?articleID=219200127

[12] http://www.nytimes.com/2009/06/11/health/11chen.html?_r=1

[13] http://news.ufl.edu/2008/07/10/facebook/

[14] http://content.nejm.org/cgi/content/full/361/7/649?ijkey=Tarf0DE9052Gc&keytype=ref&siteid=nejm

[15] ibid

[16] http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=9452989

[17] http://news.ufl.edu/2008/07/10/facebook/

[18] http://www.hst921.org/home/

Glenn Laffel is Senior Vice President of Clinical Affairs for Practice Fusion.  Practice Fusion addresses the complexities and critical needs of today’s healthcare environment by providing a free, web-based Electronic Health Record (EHR) application to physicians.