Friday, April 9, 2010

From second look to CVPR

Right around this time last year, I was visiting for "second look" weekend. I had already been accepted, and the school was now trying to convince me to come here. (It worked.) I ended up staying with a guy in the class ahead of me, which gave me the chance to pick his brain about his experiences in medical school.

"What classes are you taking?" I asked him. CVPR. C-V-P-what? Cardiovascular-pulmonary-renal, he explained, and he talked about what kind of material they were learning. It all seemed way above me, I remember, like there were so many steps between second look weekend and CVPR that I couldn't fathom getting from here to there.

A year later, I've done it. We're in the middle of the CV part of CVPR, learning such bedrocks of medicine as interpreting electrocardiograms (EKG) and heart murmurs. This block is decidedly more clinical than either Blood and Lymph or Disease and Defense, a shift that has taken me a bit by surprise. It's a welcome change, though: a much more analytical approach to learning material that emphasizes the process of diagnosis based on clinical presentation (history and physical).

For a sneak peak into some of what we've been learning, here's the EKG Dance youtube video that explains different types of arrhythmias (when the heart doesn't beat in its usual coordinated manner): http://www.youtube.com/watch?v=asR2-sb27Vw

(Explanation: The heart has four chambers. Two ventricles pump blood to the lungs and the rest of the body, and two atria serve as filling chambers that help the ventricles do their job. Imagine the ventricles as this guy's legs and the atria as his arms.)

Thursday, April 8, 2010

Mentored scholarly activity: Figuring things out

One of the graduation requirements is completion of a mentored scholarly activity (MSA). Such a research requirement is becoming more and more popular in medical education as competition for residency programs increases. The types of projects that fulfill this requirement can range from basic science research to clinical research to community health and epidemiological studies, or really anything that poses some sort of academic question related to the medical field. The requirements are quite lax. I see the MSA is a chance to explore my interests, gain some (more) research experience, and possibly publish a paper or two.

Global health: Uganda

Given my recent experiences in Honduras, I very much wanted to put together a Global Health project. I had several potential projects on the table, including one that would take me back to Honduras, one to Peru, and a third to Uganda.

The prospect of working and gaining clinical experience in any of those countries was intoxicating. Honduras fell through at the end of last semester because it would have been nearly impossible to put together a project from scratch in the limited amount of time available to me. I decided not to follow up on the Peru option mostly because I wasn't excited enough about the existing study. A group of students in the class of 2012 started this project and put a lot of time and hard work into it, which is why I felt like I wouldn't own it.

I did follow up on the Uganda option. A few weeks ago, I interviewed with the doctor who would be my mentor and was eventually offered a position that included a stipend award to cover travel costs. I would be working at a hospital in southern Uganda throughout this coming Summer. There isn't any pre-defined project, and I would be expected to develop one while I was over there then return sometime during my fourth year of medical school to wrap it up. I was very excited, especially because my older sister has already done a lot of work Uganda.

Clinical research: Deep brain stimulation in Parkinson's disease

At the same time as I was looking into international options for my MSA, I also wanted to explore other more traditional research options - "traditional" relative to my experience in clinical research. The reason for this was my concern (whether justified or not) that doing a more community based global health project might make me less competitive should I choose to apply to a more specialized residency program. In fact, I talked with Dr. Michaels (one of my professors) who in so many words recommended that, if I have a more "hard science" research option, I go that route and instead do an international rotation during my fourth year.

She asked me what kind of research I would do if I could do anything, and without even a pause I responded, "deep brain stimulation in Parkinson's disease." Then I should pursue that, she suggested, and she gave me the name of a neurosurgeon who I could contact. I followed up with this lead, and to make a long story less long, found a mentor who had a stagnant research project just waiting for someone like me to take the reins and move it forward.

Decision time: Global health or clinical research

With both offers on the table, Uganda and the DBS in Parkinson's disease project, I took a few days to think it over and weigh my options. What it came down to, though, is that I've been wanting to do exactly this kind of research ever since high school when I came to understand what it meant that my Grandpa Don had Parkinson's disease. Even back then, when I first read up on Parkinson's disease, I was fascinated by deep brain stimulation and its almost miraculous relief of motor symptoms. Uganda will always be there, as will the rest of the world. I have a feeling that I will have many opportunities to travel the world throughout my medical career, if I look for them. Until then, I'm very excited to be working on this study!

The title of my project:

"The burden of cerebral diffuse ischemic white matter disease, measured quantitatively on MRI, as a possible predictive factor of cognitive outcomes after subthalamic nucleus (STN) deep brain stimulation (DBS) surgery for Parkinson disease"

More details in a later post.