Super Star Blogs!

Nicaragua: A Cultural Immersion That Turned Into A Life-Changing Experience

The perceived notion that cultures other than your own exist is often an arduous concept for us to comprehend. We get caught up in our ideals of what culture should consist of that we either forget or choose to neglect the cultures others embrace. That being said, culture is not defined by one thing in particular. Culture ranges in a variety of aspects, from the sports team you play for, to the country from which you were born. The precise definition of culture presents with much ambiguity; however, a commonly accepted explanation is that culture consists of common beliefs, values, rules and behaviors shared by a given society or group (Bonder and Martin 2013). Over the past several weeks, I was offered the unique opportunity to explore a culture far different from my own through a cross-cultural course taught at Eastern Mennonite University.

The purpose of this cross-cultural course was to provide me with a sense of respect for cultural diversity and ultimately, to gain cultural competence. Cultural competence, which is an on-going process that in order to be successful, requires one to be fully immersed in varying cultures with an open mind and the desire to learn (Bonder and Martin 2013). Nicaragua, the country I had the pleasure of visiting, was full of rich culture, allowing me to learn not only about the people, but also about the geography, sociology, and health care system.

Nicaragua is a remarkable country located in Central America, directly south of Honduras, with a population of approximately six million and growing (Sequeira et al. 2011). In fact, it is the largest, yet most sparsely populated country in Central America. The dominant language spoken in Nicaragua is Spanish, and the primary ethnic group is the Mestizos; however, other languages and ethnicities exist. The health care system of Nicaragua is operated financially based on general taxes (Sequeira et al. 2011). MINSA, which stands for Ministerio de Salud (Ministry of Health), is the primary health care provider to Nicaraguans, providing up to approximately 70% of the population (Sequeira et al. 2011). MINSA’s mission is to provide Nicaraguan citizens with free, universal health services, as well as encourage preventative measures, to promote healthier lifestyles. There are three administrative levels in the public health system known as the central level, SILAIS level, and municipal level. The health services provided at the central and SILAIS level include national reference hospitals and departmental hospitals, while the health services provided at the municipal level include health centers, health posts and community-based clinics (Sequeira et al. 2011). There are roughly 32 hospitals, 28 health centers with beds, 144 health centers without beds, and 855 health posts, all of which are supported and financed through a community-based network. During our time in Nicaragua, we were able to observe first hand, how volunteer health posts function and how it benefits smaller communities within the country (Sequeira et al. 2011). In fact, for the duration of our trip, we participated in house visits, followed by clinics for treatment of patients.

 

During our initial house visits, we collected personal and medical history information from residents in the San Isidro Community, while paying close attention to specific living conditions to assess whether these conditions may potentially contribute to disease. Based on initial observations, the way people live in this area differs drastically from what I am accustomed to in many circumstances. For instance, the majority of the houses are built with basic materials such as wood, metal, and plastic. These materials, compared to more urbanized, wealthier locations in Nicaragua, appear less sturdy and enclosed. Also, the majority of these houses do not have material floors. The floors are the dirt/ground. According to the providers we were working with, the home is considered clean if the floor has been swept and is clear of debris/leaves. Laundry is washed by hand and hung to dry on a line connected to trees. Many people cook their food over burning wood. Overall, the concept of living is similar in that we cook food, we wash our clothes with water and soap, and we insist on living in a sheltered area for sleeping; however, the way we go about these things is different. Perhaps these differences contribute to health conditions prevalent in the area. Visiting the homes of San Isidro opened my eyes to how people can live so differently from what I am used to. Also, the house visits reminded me of the city of Lima in Mountains Beyond Mountains. Lima was a city, where the poor lived, that was described by dirt paths, convenience stores, metal tin roofs, and unstable housing, surrounded by disease and filth (Kidder 2013). Being a poorer community, it also actually made me wonder how accessible quality healthcare was for these people. The majority of them did not have cars, with most modes of transportation being a motorcycle taxi or by a horse. With San Isidro being about 20-30 minutes from town, and with transportation being limited, I would assume gaining regular access to healthcare would be difficult. This lack of access may also be contributed to the prevalence of disease in this area.

 

The clinics for San Isidro were held at the local church of San Isidro for three days. The organization of the clinics was two groups, each with three volunteers, a translator, a physician and a patient. We averaged approximately twenty patients per day and the patients we treated ranged in age from infants to the elderly. One of the most severe cases we saw on the first day of clinics was a 62-year old woman. She complained of pain in her leg, pain in her stomach/chest and fatigue. She told us she had her uterus taken out several years ago due to uterine cancer. During her physical examination, we noticed several abnormalities. First, her blood pressure was 160/90. Second, and perhaps most importantly, I palpated a large mass (probably the size of a grapefruit), in her pelvic region. Since her uterus had already been removed, we concluded that she most likely had metastatic reoccurring cancer. This could explain her symptoms of pain in the stomach/pelvic region as well as her fatigue. We recommended she go to the hospital for further treatment; however, she said she was not going to go for reasons unknown. This was hard to accept knowing the patient was in critical condition and we were unable to make a meaningful difference. Unfortunately, she was not the only patient experiencing life-threatening conditions.

 

Our next patient was a 34-year old female. She presented with pain in her chest, right breast, and right axillary region. She was aware of her history of gastritis, which most likely explained the chest pain. During her physical examination, I palpated a tender mass (probably the size of a grape) in the patient’s right breast. I also palpated swollen, tender lymph nodes in the right axillary region. We recommended the patient get further testing at the hospital, such as a mammogram and biopsy, but the patient said she could not go. It was upsetting to see so many people with complex medical issues that required further medical attention beyond our capabilities, knowing access to that medical attention was very limited. Fortunately, many of the patients we encountered were suffering from illnesses/diseases that are relatively easy to treat with the over-the-counter medications we had in stock. Some of the most common illnesses/diseases we found included asthma, fungal skin infections, parasites, and dry cough. Despite being able to give these medications, many of these individuals require these medications long term and therefore would need access to obtaining them. As mentioned previously, access is most likely limited due to not only transportation but also finances. Other factors, such as cooking with wood and lack of personal hygiene, may also be contributing factors to the persistence of illnesses/diseases.

Every patient we encountered seemed to have something new to offer to my expanding knowledge of the Nicaraguan culture.

 

Despite initially having automatic ethnocentric thoughts, I made a conscious effort to acknowledge, “my way is not the only way.” Cultural brokers also referred to as cultural translators, cultural clinicians, or cultural navigators depending on their precise role, aided us in our immersion by helping us adjust to the different culture to be able to provide quality health services (Bonder and Martin 2013). Another thing that I had the opportunity to pay attention to during my immersion is that people of our culture often consider people of poorer/sicker countries to not care about their health. In contradiction, however, I noticed quite the opposite. The patients we treated seemed to care about their health and just wanted to feel better. The problem appeared to be a lack of resources, such as transportation, money, and education. While MINSA visits these communities approximately once a month, it is not enough to sustain a healthy community given the conditions. The majority of these visits include preventative methods and house treatments for mosquitos. Aside from that, these communities only get occasional visits from volunteer associations, such as ISL. Many of the people in these communities do not have insurance and do not have adequate access to healthcare. There are public hospitals that give free treatment; however, they are overcrowded, not necessarily easy to get to, and do not appear to be the best of quality.

 

After three days of clinics in the community of San Isidro, we migrated to another community San Sebastian. In comparison to the previous community, San Isidro, it seemed as though the people were not quite as poor and the housing was improved in many ways. For instance, the materials used to build the homes appeared to be more permanent and sturdy, including the use of concrete cinder blocks. Most of the houses also had toilets, which was a significant upgrade compared to the latrines of the other community. Our clinic was held in a school.

One thing that I noticed during clinic was the language barrier between the physician and us, which in my opinion was a downfall to our experience. Not to say this is her fault by any means, especially since we are guests in her country; however, the doctor did not speak very good English, and we are not very fluent in Spanish. This made clear communication with the physician complicated, resulting in a less ideal learning opportunity from the physician. Don’t get me wrong; I believe she knows what she is doing and makes for an excellent physician; however, the language barrier appeared to make her easily influenced by our opinions of what the treatment options should be. This could be considered a type 1 or type 2 storti incident depending on how you look at it because it was somewhat expected for us to be able to communicate via language (Storti 2001). Having experienced difficulty understanding their language, I can now better understand how those who do not speak English may feel when seeking treatment in the United States.

 

Following clinics, we were able to visit the public hospital. It was extremely eye opening to see how incredibly lucky we are to have what we have in the United States. The hospital was extremely overcrowded, and the majority of the hospital did not have air conditioning, making for fairly miserable conditions. The bathrooms were disgusting and unsanitary. I asked the physician who was giving us a tour if we could see the operating room and he agreed to show us. Since I am a surgical technician in the United States, it was very intriguing to see the differences. First off, the equipment was outdated and scarce. Also, the operating rooms were not near as clean as they are where I work. The sterile technique, from what I could tell, was not nearly as sterile as what I am accustomed to in the United States. I asked the doctor what the infection rate was and much to my surprise, he said it was 3-5%, which is much lower than I thought it would be given the conditions. The emergency room was packed with hundreds of patients, and the space available was inadequate for the volume of patients. The amount of time people wait to be seen is unreal, especially given the conditions of where they are waiting. The patients are seen based on severity, as in the United States; however, most emergency rooms in the United States are blessed with air conditioning and adequate space for patients to wait comfortably. Visiting the hospital, along with house visits and clinics, was an invaluable learning experience.

 

During my experience in Nicaragua, I not only learned about a different culture but also about myself as a person and future professional. In personal reflection, I noticed an innate tendency to be somewhat close-minded about how medicine should be practiced. For instance, when a patient presented with insomnia, the physician prescribed Benadryl. I automatically disagreed with this decision because Benadryl, in my opinion, is not meant for helping people sleep but rather it is meant for people having an allergic reaction. I found myself so caught up in disagreement that it took me some reflection time to realize the reasoning behind why the physician prescribed Benadryl. It was the only medication available that she could prescribe the patient to relieve the patient’s symptoms; therefore, the physician made due with what was available. In the United States, we are privileged enough to have an abundance of medications available to us, whereas, in the areas we were serving, there was a very limited supply. As a future healthcare provider, I would hope that I can be more open-minded to things that may not be ideal to me and find ways to be frugal and make use of what I am blessed to have.

 

Aside from learning to have an open-mind, I learned several personal strengths that will make me not only a compassionate health care provider but also an overall, well-rounded person. For instance, my ability to recognize that patients with a different culture than my own may appear as though they do not care about their health, but in reality, are struggling to overcome barriers that prevent them from having adequate access to the services necessary. I would say another strength is my passion to understand the background of my patients and what they believe is important. It is important to me to make sure that my patients feel comfortable and can count on me to have their best interest in mind. In addition to cultural competence, I found myself able to easily solve medical problems by asking the right questions and observing the symptoms/vitals a patient had. I did not realize how much I have learned over the past several years through my education and work experience.

 

Some key takeaways from this experience that I would like to put into practice in the future are that cultural competence is an ongoing process, requiring much time, effort and persistence. The ability to adapt and accommodate when exposed to various cultures is an essential quality that every health care provider should have to provide the best care possible for their patients. Carefully respecting the views, beliefs, and lifestyles of every patient are imperative into determining what treatment will work best for that patient. It was an experience that forever changed my life and how I now view the world. Unfortunately, as mentioned in Mountains Beyond Mountains, once one problem is solved, another arises. No matter what we accomplish, there will always be another issue. There is no end. So, I guess the solution is to do the best we can and continue to push for a better world. The Millennium Development Goals (MDGS) are the efforts being enforced to solve global poverty, hunger, disease, etc. Kidder, in Mountains Beyond Mountains, discusses these goals and how Farmer was completely committed to accomplishing these goals (Kidder 2013). Our agency, although not quite as extravagant as Farmer’s efforts, was able to help in some ways by providing advice and some medications. Even though the trip was short and the idea of short medical trips is often scrutinized, we did everything we could to help in the best way we knew we could (Decamp 2007). We are such a small piece of a much bigger plan. I am so grateful to the communities we were able to serve in Nicaragua, and I cannot wait to be able to do it again since there is still so much for me to experience and learn. I was confident in my decision to become a medical health provider before the trip, and now after the trip, I am even more confident in that decision. My passion is helping people in any way that I can. I am so thankful to have been blessed with this experience.

 

References

1. Bonder, Bette and Laura Martin. 2013. Culture In Clinical Care. 2nd ed. New Jersey: SLACK Incorporated.

2. Decamp, Matthew. 2007. Scrutinizing Global Short-Term Medical Outreach. Hastings Center Report 37(6): 21-23.

3. Kidder, Tracy. 2013. Mountains Beyond Mountains. New York: The Random House Publishing Group.

4. Sequeira M, Espinoza H, Amador JJ, Domingo G, Quintanilla M, and de los Santos T. 2011. The Nicaraguan Health System. Seattle, Washington: PATH.

5. Storti, Craig. 2001. The Art of Crossing Cultures. Intercultural Press.

Chunking Down the App Process – One step at a time

For those of you applying this cycle congratulations on making it to this point. Being ready to apply is a huge accomplishment in its own right, and something you should celebrate. The medical school application process is a daunting roller coaster fueled with excitement, doubt, fear, stress, worry, and hopefully triumph. I advise a systematic approach to the overall process, and counsel students to take it one step at a time. At this point, all of your energy should be focused on the primary application. Completing the primary app takes a lot of work, and chunking it down into sections will help you progress through it. Keep in mind that this is your pitch to medical schools on why they should want you as part of their incoming class. Use the AAMC Core Competencies for Entering Medical Students as a framework for crafting an application that clearly communicates your strengths as a successful future physician. Here is a brief list of things to keep in mind during the primary app process:

-Order and submit your transcripts now to AMCAS.

-Contact your letter writers and check in about their readiness to submit letters on your behalf, they should do this asap. If one of your writers can speak strongly about how your work demonstrates a core competency mentioned in the AAMC guide ask them to write about it in your LOR, and send them the link describing the core competencies.

-Get feedback and edit your personal statement, do not discount the importance of this essay. Your essay should do two things effectively: provide the reader with a sense of who you are as a person, and clearly communicate why you want to be a physician (with special consideration to your core values).

-For the activities section choose experiences that speak to the core competencies mentioned above, and think about what you learned from your participation in each one.

-Use the MSAR to refine your school list, and apply as broadly as possible based on your budget. Apply for a fee waiver to increase the number of schools you can afford to apply to.

-Two of the most common reasons applicants need to reapply is that they apply too late or they don’t apply to enough programs, so do your best to apply as early and as broadly as possible without sacrificing the quality of your application.

I’ll continue to post in more detail on these topics, as well as secondary application tips, interviewing advice, non-traditional student topics, and general comments on navigating the premed process. Please feel free to send me a direct message if you have specific questions, want feedback on your essay, or post a question below.

Top 5 Things to Know About Medical School Rankings

Do medical school rankings really matter? Do you have to go to a top medical school in order to accomplish your dreams?  Premedical students ask these questions often.  It’s really a subset of the larger question which is “How do I choose which medical schools to apply to?”   But back to the rankings.  In the internet age, information is ubiquitous and there’s always a new med school rank list being published by some authority. These rankings in turn make pre-medical students nervous and question whether or not they need to go to a top medical school.  Certainly, if you have the opportunity to attend a top medical school then hey, if you can afford it why not take it?  The real challenge comes when you have that acceptance letter from a top program but you have an acceptance letter and a nice financial package from a lower ranked program.   Here are a few things you should know before worrying too much.

1) Anybody Can Make a Rank List. This is very important to keep in mind when researching medical schools. If you are going to rely on a rank list, make sure it’s a credible one. Always review their ranking methodology. There are certain respected and reputable organizations that put a great deal of effort into their ranking systems, and these should be taking at greater face value. Still that is not to say that their systems are perfect, but if you are going to consider school ranks, make sure to choose a respected organization.

2) Not all rank lists rank the same things. Rank lists tend to focus on research, primary care, or opinion surveys. Depending on what is most important to you, be sure you are looking at a list that reflects that. For example, if you don’t care about research, you might not place so much weight on the research ranks. I do caution however that because premedical students usually are not certain about what specific field they will pursue, be open to research when starting medical school as something might pique your interest.

3) Patients don’t really care how your medical school ranked. It’s great to go to a top ranked place and that has MANY bonuses. But when it comes to direct patient interactions, your patients won’t really care where you went. To confirm this, I asked several people where their doctor went to medical school, and a whopping 0% knew the answer. I know, you’re reading this and saying well my doctor went to [Insert School Name]. Okay, you’re the exception, and you’re obviously more interested in medical schools because you are reading this blog. For the most part, your patients will only care that you know what you are doing and that you treat them well. Doctors don’t build their clientele by advertising where they got their MD, they do so by being excellent in their practice.

4) Doctors don’t really care how your medical school ranked. As a practicing physician now, I can tell you that doctors don’t ask each other where they went to medical school. As a matter of fact, the question that is typically asked is “Where did you do your training?” And by training we are referring to residency and fellowship, not medical school. Here’s what’s most important for premeds to understand. You get your MD or DO in medical school, BUT you become a doctor in residency. Nobody will let a fresh medical school graduate take care of them because in reality they don’t know how to practice medicine yet. Residency is where you get your clinical training and fellowship is a further specialization. When choosing a medical school, put more value on what residency programs can this help you get into, rather than how the medical school ranks. Then when it is time to choose a residency, you should pay a little more attention to the ranking systems then because that truly affects how strong of a clinician you will be.

5) The top medical schools are on top for a reason. Taking into consideration everything I have said above, there is some great value to be gained from using reliable rank lists.  Medical schools that consistently rank at the top of these list do so for a reason. There’s no denying that the top 10 are special in their own ways.  Their ability to repeatedly rank is in part a reflection of their culture to achieve excellence. Now, this matters!  Along my journey to become a board certified physician, I was able to train at a top program and that desire to be the best was very evident. In my personal opinion, you should always take ranking systems with a grain of salt. Your success is based more on you than the medical school you attend. However, you want to be at a place that has a culture which demonstrates they can help you to succeed. A medical school does not have to be on the top of the list to do that. I went to a school that wasn’t ranked too high, but I chose it because the students performed excellent, got among the best board scores in the country, and matched for residency very well.

Here’s my take home message, rankings can be helpful to a certain degree, but make sure you take more than that into consideration.  Perhaps most important is finding a school that matches students into their top residency choices. If you can find a reliable medical school rankings list based on that statistic, use that list!

So, to close this article, I’ll ask you a question and look forward to your answers.  Which factors do you take into consideration when you rank medical schools?  What are the things most important to you?

Social Determinants of Medical Education

When considering the barriers to medical education for minorities and low-income groups, it is quickly apparent that there is great overlap between these social determinants and the social determinants of health. Indeed, much discussion has centered on the role of social and economic factors in the context of healthcare (Marmot & Allen, 2014). Similarly, the externally-derived barriers that limit access to medical education have been heavily explored from this perspective, and there is value to considering other categorical divisions for these issues, as new insights may be gained. There are some splitting of hairs necessary to discuss socioeconomic status as separate from social networks, but perhaps a different method of categorizing will minimize such entanglements.

From a broad perspective, where categories can be simplified, the following categories should be considered. The first is the availability of means, commonly thought of in terms of currency, as being the simplest way to assess the availability of means to pursue opportunities. The second category is social connections. This includes family members, friends, teachers, mentors, employers, etc. Of course, it cannot be forgotten that there is a relationship between the community that one belongs to and the availability of means, and this relationship can become exquisitely complicated in individual circumstances.

Availability of means

The cost of tuition for medical education in the United States is extraordinarily high. This high cost is even more notable when compared to other developed nations, where the cost of education is borne by the taxpayer base, rather than by the individual student. Here, in the United States, the cost of tuition for medical school ranges from approximately $16,000 per year to approximately $60,000 per year. This is the cost of the tuition alone, and does not include expenses for the cost of living. Cost of living expenses also vary widely, depending on the city where the medical school is located. For example, the estimated cost of living for medical students at the University of Arkansas for Medical Sciences is $20,780, whereas the estimated cost of living for medical students at the University of California at San Francisco is $31,656. Additional factors can also play a role, such as whether or not a student has in-state status at publically supported medical schools.

There have been some efforts to reduce the barrier imposed by the cost of attendance. The availability of federal student loans, for example, ensure that United States citizens who are accepted into medical school in the United States can generally have access to the funds to pay for it. However, these loans are administered at interest rates that are relatively high, although lower than the loan rates available through most consumer loan mechanisms. There is some controversy over the effectiveness of loan programs in improving minority access to education (Long & Riley, 2007). Beyond loans, many medical schools are part of larger, state-sponsored university systems. These medical schools typically offer residents of the state to attend the school at a significant reduction in tuition. For public medical schools, the difference in tuition for in-state students as compared to out-of-state students can be nearly two-fold. However, even with this subsidization of medical education, in-state tuition can cost tens of thousands of dollars per year.

However, looking only at the direct cost of medical school, one fails to capture the larger barriers imposed by the limited availability of means. Acceptance into medical school requires a number of academic and experiential qualifications to be met. Beginning with the academic requirements, it is worth keeping in mind that there are great disparities in the United States regarding high school graduation rates amongst minority and low-income groups (Heckman & Lafontaine, 2010). In general, families of similar financial means live in the same neighborhoods, and subsequently, their children attend the same schools. In many areas, school funds are related to property taxes. As a result, regions where the majority of the population is wealthier have more funding, compared to areas where the majority of the population is low-income. This creates a fundamental differential in what resources are considered standard. For example, at present, there are school districts that provide an iPad to every student, while there are also school districts struggling to maintain an adequate supply of classroom textbooks. Of course, education is about far more than the cost of the provided resources, and the value of an educator cannot be understated. However, teacher salaries also vary significantly across school districts. This, in turn, leads to a differential in educators as well. This is not to say that there are not many exemplary educators in low-income school districts, but it warrants acknowledgment that even a subtle differential can lead to significant consequences on a larger scale.

Therefore, before yet considering the impact of social connections, it is important to highlight that there are broad, system-level barriers affecting minority groups and those raised in low-income households.

The impact of social connections

It would be exceedingly difficult to overstate the importance of social connections, and the impact that they have on medical school matriculation rates. Children begin developing dreams and aspirations from a very young age. Indeed, it seems that perhaps the only limit to a child’s imagination is the breadth of their experience; therein lies the problem. Children that are exposed to professionals outside of a professional context (that is, a child that knows a doctor as a family friend, and not merely as the scary person with a white coat) have the concept that this profession is a real and viable option for them to pursue. This may not be the case for children who only meet the doctor in the doctor’s office.

There is also much to be said for the importance of family support. Familial networks that are fundamentally supportive in nature will encourage children to work towards dreams and aspirations, even if those aspirations are difficult to achieve. Alternatively, if the family environment is one in which such goals are scoffed at, a child will quickly become discouraged and choose to pursue more socially acceptable goals.

The process of pursuing post-secondary education can be overwhelming. The cost of applications alone can dissuade students. While there are fee waivers available, they require additional paperwork that is yet another barrier. Students who are surrounded by others going through this process have the benefit of peer support, which can also influence academic performance (Zimmerman, 2003). However, students who do not have peers or role models assisting them often drop out of the educational training pipeline at this juncture. Many schools employ counselors exclusively for the task of guiding students, but the utilization and quality of these resources vary greatly from school to school.

For students who overcome the aforementioned aspirational barriers, experiential barriers may still remain. Acceptance into college, and especially acceptance into medical school, require applicants to have pursued a certain set of baseline experiences, most often emphasizing community service. Students who have a rich social network are aware of this and can prepare accordingly. However, students lacking informal information resources may not realize that these non-curricular requirements exist, and may struggle to prepare a competitive application as a result.

Finally, the importance of developing social connections with mentors is essential. These mentors not only advise students but also endorse them through letters of recommendation. Depending on the social norms that a child is raised in, developing any type of personal rapport with an instructor may seem odd or even disrespectful. Yet this, once again, could serve as a barrier. A strong letter of recommendation can explain and even supersede a lack of experience or lapses in academic performance. But a recommendation letter of this sort would rely on there being a connection between the student and the mentor that exceeds the standard relationship.

The intersection of means and social connections

While the main focus here is on the consideration of broad categories of barriers with less overlap than those typically considered, it is important to still address the intersection of financial means and social connections. For this, two scenarios will be presented.

First, there are the students who overcome all aspirational and support barriers, yet social responsibilities are forced to take priority. For example, there are many students who must work full-time, even at the cost of ceasing their academic pursuits, in order to take care of their families. In this case, the financial resource systems designed to aid in the accessibility of medical education are insufficient. As discussed, the financial resources available involve loans and reducing the cost of tuition. However, neither of these mechanisms would help the student to fulfill their family obligations.

The second scenario is systemic in nature and related to the differential in opportunities provided by various school districts and education systems. As discussed above, there are a number of non-curricular, experiential requirements for post-secondary education as well as medical education. School districts with a greater availability of resources often organize opportunities for their students that meet these requirements. For example, volunteering opportunities around the community, and supplemental training that is outside of the formal coursework. Students from school districts with fewer resources likely need this assistance more to reduce barriers, but in the absence of sufficient resources, the point is simply unfeasible.

Using availability of means and social connections to reduce barriers to medical education

While it is clearly impossible to truly generate categories of barriers that are independent of one another, this perspective of the barriers to medical education is helpful from the perspective of implementation. To begin, a stronger education system nationwide is needed, but of equal importance are mechanisms needed to equalize the opportunities provided through education. Particularly when considering public education, resource re-allocation (though controversial) can significantly offset many of the opportunity barriers discussed here. There are many organizations and institutions that strive to help students through career and academic planning. Many of these resources are very good, however, they exist independently from one another. Some efforts have been made to aggregate these resources, but it is often still unintuitive and difficult to navigate without assistance. Improved promotion of and user interfaces for these resources would make them far more effective.

The fundamental cost of higher education, including medical education, must also be addressed. College tuition rates are ever increasing as the demand for non-curricular opportunities puts pressure on colleges and universities to spend increasing amounts of money on non-academic topics. Therefore, the cost of these additional programs must first be addressed. Additionally, the financial responsibilities of higher education should be considered separately from the perspective of social benefit. Increasing the educational level of a population also increases the quality of life in that population. While specific estimates on the ultimate size of the economic benefits from socially funding higher education are controversial, it is broadly accepted that this effect exists. In regards to medical education specifically, both the social value of a strong healthcare system and the economic benefits of a healthier population are great.

There is evidence that indicates that the diversity of healthcare providers has an effect on the extent to which patient populations pursue care (Komaromy et al., 1996). Therefore, as an increasing portion of the United States population is comprised of minority groups, the health of our overall population relies upon improving the diversity of our healthcare providers. Reducing barriers to medical education not only reduces barriers to education as a whole but also improves the health of the population. The need for these solutions are both social and economic in nature and therefore warrant broad support.

References

1. Heckman, J. J., & Lafontaine, P. A. (2010). The American high school graduation rate: trends and levels. Rev Econ Stat, 92(2), 244–262. http://doi.org/10.1162/rest.2010.12366.THE

2. Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., & Bindman, A. B. (1996). The role of black and Hispanic physicians in providing health care for underserved populations. The New England Journal of Medicine, 334(20), 1305–10. http://doi.org/10.1056/NEJM199605163342006

3. Long, B. T., & Riley, E. (2007). Financial Aid: A Broken Bridge to College Access? Harvard Educational Review, 77(1), 39–63. http://doi.org/10.17763/haer.77.1.765h8777686r7357

4. Marmot, M., & Allen, J. J. (2014). Social determinants of health equity. American Journal of Public Health, 104(SUPPL. 4), 517–519. http://doi.org/10.2105/AJPH.2014.302200

5. Zimmerman, D. J. (2003). Peer Effects in Academic Outcomes: Evidence from a Natural Experiment. Review of Economics and Statistics, 85(1), 9–23. http://doi.org/10.1162/003465303762687677 

 

How PreMed StAR Can Work for You

There is no better time to be a premedical student! In this information age, there are a lot of amazing tools out there to assist in the premed journey. As premed students roughly a decade ago (wow, time flies!?), we had very few resources available to us. I was very grateful to have wonderful, knowledgeable friends and a great premedical advising program that made sure I stayed on track. For the past decade, I have been honored to mentor hundreds of premedical students and hear awesome stories from students all across the world. One of the biggest joys I get in life is to watch the MD/DO dream come to reality. However, the biggest heartbreak always comes when I hear stories of rejection or giving up on medical pursuits due to finances, lack of resources, misinformation and other hardships. It is true that some students weren’t in it for the right reasons but for the many students who without a doubt would have been excellent doctors, I have literally spent nights crying with them. My profession has missed out on a number of amazing people.  With this in mind, we struggled for years to find an innovative solution to give these worthy students a better shot at bringing their dreams to fruition.

So, in comes PreMed StAR! This has been an amazing journey for us over the past few years putting together something completely designed with premeds in mind. A platform that allows premedical students to shine and network while at the same time providing medical schools with the opportunity to find premeds who they would have never had the opportunity to connect with. PreMed StAR continues to grow rapidly with amazing premeds, excellent post bacs, and some of the worlds best medical schools. We listen very carefully to the students and understand that many of you are still figuring out how to best use PreMed StAR (there are a LOT of great things here) and how to maximize your chances of getting into medical school.  Our team is fortunate to have years of experience in technology focused on premedical students.  This experience has given us the opportunity to acquire unique perspectives and feedback which in turn have allowed us to develop a platform you have told us you want and need. We appreciate your feedback and are here for you.  This article is to ensure you are getting the most out of PreMed StAR.  So, here is how PreMed StAR can work for you:

Network, Network, Network:  Remember, we are all in this together. It is important to share your stories with others across the country going through the same journey. We can make each other better and stronger doctors to be. It brings me joy to see members of the PreMed StAR community at national conferences.   So many new friendships have formed online and I love to see them in person at these conferences and summer programs. PreMed StAR is a great tool to stay connected with new friends you meet at fairs and in summer programs. Also, using tools like NoteShare gives you the opportunity to share and modify each other’s notes.

Keep You from Going Broke  PreMed StAR is FREE. After paying for premedical fairs/conferences, MCAT class, MCAT registration, application fees, transcript fees, secondary fees, interviews, and acceptance deposit you can easily be in the debt $5-10K…BEFORE starting medical school. Hey, we were premeds too and know what you’re going through.  Because of that, we are doing our best to provide resources that can help you save money.  Financial strain was a huge factor behind why so many of my mentees did not apply to as many schools as they should have or did not have an opportunity to attend national conferences or premed fairs to give them a fighting chance. Applying to medical school is expensive! As we continue to grow, PreMed StAR serves as a free online recruitment fair to meet schools from across the country.  Major organizations have partnered with us because they understand our social mission and goal. With their support, we are able to provide you with awesome discounted and free resources such as MCAT courses. And stay tuned, many more wonderful deals are coming your way!

Track Your Progress  Many premeds have made the very same mistake I did many years ago; losing track of activities, awards, and times from 2 or 3 years ago. It is important to provide data as accurate as possible on your medical school application. Make sure to track these things in the PreMed StAR Portfolio. The CV generator is also a useful tool. This allows you the opportunity to always have access to this data! No need to carry a jump drive with your data on it anymore. When application season comes around you will be grateful for this.

Learn about and Communicate with Schools  We are very excited that more and more schools understand the vision and are using PreMed StAR. As we grow, more and more med schools and post-bac programs will be excited about sharing info about their programs with you and answering your questions. Schools are provided with rotating list of students that fit what they are looking for so it is important that you keep your profile accurate and up to date. The schools are watching. They have the opportunity to see you grow over the years on the site. Becoming the student of the week will give you a great opportunity to share your story and passion for medicine with the schools and the rest of the PreMed StAR community. This is also a nice addition to your resume. Schools are also impressed with those bold students who share pics of their mission trips, volunteer experiences and poster presentations. I understand this may be uncomfortable at first, but for many premeds without a perfect MCAT and GPA these experiences are the things schools are looking for. Besides, this is a lot more interesting than posts of what we ate for lunch we sometimes put up on other websites. These are the things that will make you unique and a good fit for some schools. This way, you are no longer simply a number. Here is your chance to show your personality and why medicine is for you.

Have Fun PreMed StAR is more than simply assisting you in applying to med school. It is a place to journey with one another. The path to becoming a physician does not have to be entirely stressful. Sharing fun pictures with one another, surfing through your friend’s profiles and joining in on the premed games and discussions allows you to take a study break and not feel so guilty doing so. We’ve got great feedback on popular resources like MChAT. There is a lot to come so stay tuned as our community continues to grow. We are honored to be a part in this premed journey with you and hope you can use PreMed StAR to shine.

 

 

Written by Dr. Daniel

Communication and Healthcare

Patients often complain that they are unable to spend an adequate amount of time with their healthcare provider during a medical visit; these complaints are not unfounded. According to the Medscape Physician Compensation Report 2016, most physicians spend an average of 13-16 minutes with a patient during a single visit (Peckham, 2016). Healthcare providers take an oath to care for the well-being of all patients, and I believe that this begins with each visit. It is imperative that healthcare providers offer patients respect, empathy, and attention during each visit. In my own experience, I have witnessed patients complain that their physician does not pay attention, or even provide eye contact, when speaking to them, and they feel rushed and unwelcome during their visit. Physicians may type away on their computers and direct questions at the patient in a robot-like manner. Such behaviors leave patients feeling unsatisfied.

Patients feel more comfortable when the doctor provides them with undivided attention. Open and adequate communication supports shared decision-making and feelings of respect and dignity in the patient (Paddison, et al., 2015). An adequate amount of time for communication between physician and patient allows the physician to ask more in-depth questions regarding the patient’s symptoms and conditions and to formulate a more accurate diagnosis.

I recently had the opportunity to learn first-hand the value of physician-patient communication. I attended a patient panel last month, consisting of critically ill patients classified as survivors of their conditions. The two patients included a five-year old girl, who survived a rare form of leukemia, and a traumatic-brain-injury survivor. Both patients received excellent clinical care at the University of Virginia and Duke medical systems. The mother of the leukemia survivor stated that she believes the physicians, who are fully invested in the health and well-being of their patients, are what separates great medical centers from average ones. These physicians give their undivided attention to patients at each visit. The traumatic-brain-injury patient concurred, stating that all of his doctors went the extra mile by calling to check on him and his family, as well as answering insurance questions typically answered by the administrative staff. Elite medical centers staffed with physicians, such as these, not only care for the patient but also for the family and friends, which ensures that the doctors meet the needs for information, support, and care.

Effective communication between the physician and the patient, as well as interdisciplinary collaboration, can lead to positive outcomes. Physicians, who are effective communicators, positively influence the emotional and physical health of the patient, leading to the improvement of symptom resolution, more effective pain control, functional status, and patient satisfaction (McAlinden, 2014). Interdisciplinary collaboration is another key element of effective healthcare. Just as with effective communication, the collaboration of multiple care providers in determining an appropriate treatment plan for a patient is associated with improved quality of care and safety (Ponte, et al., 2010).

Clinicians are human, just like everyone else, but the ability to remain upbeat, positive, and genuinely care for patients, and their families, sets them apart as true professionals. Communication and the willingness to devote time to the patient are essential components of effective and emphatic care. This sense of caring can make a world of difference in the life of a patient.

References

McAlinden, C. (2014). The importance of doctor-patient communication. British Journal of Hospital Medicine, 75(2), 64-65.

Paddison, C.A., Abel, G.A., Roland, M.O., Elliot, M.N., Lyratzopoulous, G., & Campbell, J.L. (2015). Drivers of overall satisfaction with primary care: Evidence from the English General Practice Patient Survey. Health Expectations, 18(5), 1081-92.

Peckham, C. (2016). Medscape physicians compensation report 2016. Retrieved from http://www.medscape.com/ features/slideshow/ compensation/2016/public/ overview#page=26.

Ponte, P.R., Gross, A.H., Milliman-Richard, Y.J., & Lacey, K. (2010). Interdisciplinary teamwork and collaboration: An essential element of a positive practice environment. Annual Review of Nursing Research, 28, 159-89.

Congratulations to Holly! Premed of the Week!

Hello. My name is Holly and I am a native New Yorker predominantly raised in the tropical paradise of Puerto Rico. Currently, I am a Medical Laboratory Scientist professionally certified by the American Society for Clinical Pathology, MLS(ASCP), working for the Johns Hopkins Hospital as a Clinical Laboratory Scientist II in Special Chemistry. I hold a Bachelor of Science degree in Microbiology and a minor in Chemistry from the InterAmerican University of Puerto Rico (UIPR). I am also a Master of Public Health candidate at George Washington University’s Milken Institute School of Public Health.

When I was in high school I swam competitively and volunteered as a cadet in the Civil Air Patrol, the auxiliary of the US Air Force. During my time as a cadet, I attended many special activities, including civic leadership academy, where I lobbied my Congressional representative for CAP funding, Hawk Mountain Ranger School and the National Flight Academy. I have approximately 30 logged flights in a glider and pre-solo wings.

As an undergraduate student, my favorite teacher was my general microbiology professor. Her love of teaching and of all things microbiology inspired me to become a professional who is passionate about her career. I chose chemistry as my minor because it was a subject that I initially struggled with. Overcoming a challenge is something I take innate pride in so it was quite rewarding to finally grasp and attain a solid understanding and foundation of the subject. Although I am an avid cat aficionado, having five fur babies of my own, my favorite undergraduate experience was dissecting a cat during anatomy lab.

When I originally enrolled in the medical technology program at UIPR, my intent was to acquire a profession that would subsidize my graduate studies through to completion and provide me the necessary skills to strengthen future applications to biomedical research institutions. It has since evolved into a passion to not only gain research experience in the biomedical sciences but for studying medicine as well. It was at that time that I realized that I wanted to know the exact biological mechanisms and pathogenesis of diseases. My research interests encompass the following: elucidating the pathogenesis of diseases that haven’t been fully characterized, such as neuroborreliosis; exploring the myriad immune mechanisms designed to ward off specific diseases; delving into the biochemical, cellular and histological changes induced by pathogens during infection; and evaluating the mechanisms employed by pathogens to evade the immune system, remain latent in tissues and organs, and avert detection by conventional diagnostic methods. Notwithstanding my evident passion for infectious disease pathology, my medical interest includes neurosurgery and/or neurology.

Aside from my passion for biomedical science, I am a voracious bibliophile and enjoy all things water sports/activities. Ironically, my favorite book is Rubin’s Pathology Clinicopathologic Foundations of Medicine. I am also a gamer with a particular affinity for the Resident Evil franchise and I strongly advocate for and support various civic and humanitarian causes such as autism inclusion, disaster relief, disability and civil rights. To alleviate stress, I enjoy taking long, leisurely walks by the harbor, singing my heart out and expanding my culinary palate by dining at cultural/ethnic restaurants.

Cross Culture: ISL Nicaragua Trip

I recently had the privilege of helping people in need by participating in a medical mission trip to Nicaragua with International Service Learning. In response to the shortage of healthcare professionals in developing countries like Nicaragua, our team of six Americans, including two physicians and one dentist-provided healthcare services to two communities. This rich learning experience provided me with insights into cultural values that differ from my own. It enabled me to not only witness, but participate in, the creation of a healing environment.

Healthcare Needs of the People of Nicaragua

Although Nicaragua is the largest of the Central American countries, it is also one of the poorest in the Western Hemisphere. Almost one-half of its residents live below the poverty line. The average per capita income is equivalent to $2,720. Up to 40% of the population has little to no access to health services, and 78% of the individuals who are employed lack health insurance (Sequeira, et al., 2011). It was not surprising to read these statistics after visiting the country, as the families we served in San Isidro and San Sebastian lived modestly, with limited healthcare access.

Residents of Nicaragua experience a number of health issues due in part to their poverty. Child malnutrition is not uncommon, as one in five children suffers from this condition. Acute respiratory illnesses, mental illness, and infectious disease are also widespread, (Sequiera, et al., 2011), as well as chronic conditions of hypertension, diabetes, and arthritis (Emmerick, et al., 2015). As a medical missionary to the country, I observed residents who suffered from respiratory illnesses, rashes, parasites, and hypertension. Given that the majority of people in the two communities I visited had virtually no access to healthcare, my trip provided me with the ability to facilitate a healing environment for those who desperately needed it.

Home Visits

Our first team assignment was to knock on the doors of residents living in the small, rural community of San Isidro and offer a free medical examination. The people of the community were kind and respectful, yet some were initially hesitant to accept our offer. Others took advantage of the opportunity, recognizing that most healthcare providers were remote and inaccessible, and that few residents possessed means of transportation. In fact, given the dates on the prescriptions bottles that people had from previous visits, it was evident that they were unable to obtain refills for medications used to treat chronic conditions.

Our team provided basic medical care to community residents, which included vital signs, triage, and prescriptions. I observed a number of common health issues in San Isidro, including respiratory illnesses, rashes, hypertension, obesity, and the occasional colicky baby. As previously mentioned, most residents were unable to fill prescriptions due to lack of access to pharmacies and healthcare providers. This was disconcerting, as many of the prescriptions I viewed were written to treat chronic conditions and needed to be taken on a consistent basis. I realized that without traveling clinics like ours, many of these people would not receive life-sustaining medications. While it was rewarding to be able to provide them with the medication, I knew that after we left, access would once again vanish for a time.

In addition to medications and medical examinations, culture is an essential aspect to a healing environment. Culture encompasses the beliefs, values, and behaviors of a people group. No one can operate outside of culture. Thus, culture has a significant impact on healthcare. In the case of this Nicaraguan community, it was evident that cultural beliefs affected their approach to health. Nicaragua is a Christian country, with a majority of its citizens active in the Catholic Church. Prayer is emphasized as a central part of life. I observed prayer in the home as part of the healing process. People would frequently offer thanks to God for receiving medications from us, or a family member would pray aloud for healing. Another cultural aspect of health is home remedies. Many homes contain jars, resting on the floor or on shelves, filled with liquids and plants. One of the physicians on our team who had previously traveled to Nicaragua explained that herbal remedies for illnesses were common and valued. I realized that it was important to respect this prevalent cultural belief, even though I had never encountered it before.

Clinics

After traveling to individual homes in San Isidro, our team temporarily settled in a small building in the town and provided a health clinic for several days. Just as with the home visits, the people who greeted us were warm and kind. They had faced much adversity in recent years. Several years back, a devastating flood leveled the town, and most residents lost all of their belongings. Not only did the flood take their material possessions, but it took away their sense of security and safety. A healing environment comprises more than just assistance for physical problems; it is important to address emotional and psychological needs as well. As the town’s residents received medical care and prescriptions, they simultaneously gained a sense of hope. Sometimes lending someone your ear, empathizing with their problems, and being truly present in the moment can promote healing.

After leaving San Isidro, we traveled to San Sebastian. At first glance, this town stood in stark contrast with the previous town in that it was a newly-built, middle class community. However, despite the appearance, the people faced health issues very similar to those in San Isidro. They had limited access to healthcare, as all clinics and healthcare providers were very far away. Over the course of three days, our team served over 60 individuals. Many suffered from respiratory illness, hypertension, and most notably, obesity. I observed that cultural issues once again played a role in our visit. For example, according to one of our physicians, the residents placed great value on receiving something–anything–when visiting a healthcare provider. If they do not receive a tangible good, they tend to believe that their care is inadequate. In the past, this issue has prevented some residents from seeking medical care at the free clinics offered by missionaries. Out of respect for this cultural belief, our team provided medications when necessary, and handed out vitamins if medication was not warranted.

In addition to medications and vitamins, education is a key element for holistic healthcare. Since obesity was a prevalent concern in both communities, education that stressed the need for a healthy diet and adequate physical activity was important. I realized very quickly that my knowledge about the types of foods preferred by Nicaraguans was deficient, and that I couldn’t effectively counsel them on how to prepare a healthy diet. Fortunately, both physicians on our team were familiar with local foods, and were able to offer insight into this issue.

One troubling issue with our ability to facilitate a healing environment was the lack of possible follow-up care. Although I believe we contributed to the health and wellness of the individuals we served, our time there was temporary. I knew that when we left, these people would again be in need of healthcare. Many town residents only receive healthcare when a traveling clinic comes to their town. This is particularly problematic for those with chronic health conditions that need regular monitoring and medication, such as those with hypertension. A healing environment is an ongoing endeavor, not one that ends when the client leaves the care provider’s presence. In order to best facilitate a continued healing environment for the people of these small Nicaraguan towns, clinics like ours must return on a regular basis.

Conclusions

My medical mission trip to Nicaragua gave me an opportunity to facilitate a healing environment within communities suffering from poverty and loss. In addition to serving these residents by providing medical examinations and prescriptions, our team offered a listening ear, a sincere heart, and a willingness to respect their cultural beliefs and practices. A healing environment is holistic, addressing physical, psychological, emotional, and spiritual needs. It was truly a privilege to create this type of environment among the people of San Isidro and San Sebastian, and one that I look forward to again.

Research: Creating Your Own Experimental Design

I am a graduate of Eastern Mennonite University’s M.A. in Biomedicine program. A part of the curriculum requires that a student design their own research project using the fundamentals of the scientific process. I have included my entire design along with a snapshot for each of the outcomes. This is something I am passionate about and plan to pursue as a future practitioner. Clinical research is extremely relevant and leads to better patient outcomes. Let me know if any of you have questions or please post a comment!

Background:

When patients experience trauma in the field, pre-hospital rapid sequence intubation (RSI) is often the course of action. Despite the fact that RSI is associated with favorable outcomes it also carries the risk of increased hypotension and bradycardia. Ketamine is a very attractive anesthetic for RSI because it does not impair breathing and is thought to increase catecholamine levels, ultimately increasing heart rate and blood pressure. Thus, if a patient demonstrates bradycardia and hypotension as a result of intubation, ketamine may be able to the raise heart rate and blood pressure closer to normal levels. But the research literature regarding the effects of ketamine on patients with varying baseline hemodynamic measurements is variable and somewhat unclear. Some studies showed the use of ketamine raises both HR and BP, while others showed the opposite. As a result, it may be difficult for first responders, ER personnel and trauma surgeons to determine who will benefit from ketamine’s hypertensive and tachycardic effects versus those who will develop hypotension and/or bradycardia. Therefore, we sought to clarify the determinants of the ketamine response in patients undergoing rapid sequence induction of anesthesia. 3 post-ketamine primary outcomes / or responses were examined: 1) development of bradycardia; 2) development of hypotension 3) development of hypertension. The predictors / risk factors for the ketamine response that we tested included: Subject age, category (trauma vs. medical), and pre-ketamine vital signs (HR, SBP, DBP, MAP, and SI). We also studied the effect of ketamine dose on the response.

We hypothesized the following:

Hypothesis 1: Vital signs prior to administration of ketamine (i.e. BP and HR) predict the development of hypotension and/or bradycardia in patients undergoing RSI;

Hypothesis 2: The relationship between baseline vital signs and the development of hypotension, hypertension, and bradycardia is moderated by the dose of ketamine given.

Methods:

Data was obtained from PHI Air medical group (a Helicopter emergency medical service that safely transfers trauma and emergency patients across the nation). A total of 1516 subjects were enrolled, out of which 730 were medical patients and 786 were trauma patients. Study subjects received ketamine doses that were categorized into four dose groups: < 100 mg/ml, 101-150 mg/ml, 151-200 mg/ml, and >200 mg/ml. Data regarding subject demographics, patient category (medical vs. trauma), drug doses and hemodynamic measures were obtained and used in the analysis.

Results:

1) Predictors of bradycardia:

• Older age was a predictor of post-ketamine bradycardia (Patients who developed bradycardia were on average 13 years older than those who didn’t).

• Medical patients were more likely to develop bradycardia than trauma patients.

• Patients who developed bradycardia had lower baseline pre-ketamine vitals signs (SBP, DBP, MAP, HR) and higher Baseline SIs.

• Higher doses of ketamine were also associated with bradycardia.

2) Predictors of hypotension:

• Older age was a predictor of post-ketamine hypotension (those who developed hypotension were on average 10 years older than those who didn’t)

• Patients who developed hypotension were more likely to be medical patients.

• Lower pre-ketamine (baseline) SBP, DBP, MAP, and SI were associated with development of hypotension, while higher HRs at baseline were associated with the development of hypotension.

3) Predictors of hypertension:

• Younger age was associated with development of hypertension. (were on average 4 years younger)

• Trauma patients were more likely to develop hypertension than medical patients.

• Higher baseline SBP, DBP, MAP, and shock indices were associated with the development of post-ketamine hypertension.

Note: Higher doses of ketamine were significantly associated with bradycardia and hypertension.

Conclusion:

We found that older age, lower baseline vitals, and being a medical patient vs. a trauma patient is more likely to predict the development of bradycardia and/ or hypotension following the administration of ketamine during RSI. On the other hand, younger subjects, higher baseline vitals and trauma patients were more likely to develop hypertension following ketamine administration. It also seemed that higher doses of ketamine were associated with developing bradycardia and hypotension / or hypertension. Knowing how baseline subject characteristics including vitals signs effect the response to ketamine administration will help first responders and trauma/ emergency care personnel better identify who may benefit from the administration of ketamine versus those who may potentially develop adverse events such as hypotension and bradycardia. This will enable healthcare professionals to improve upon current mortality and morbidity rates associated with RSI.

Post-Bac Journey: Success through the lens of a non-traditional student

  Success in the future is attainable, no matter what your academic past may look like. I am a second year graduate student at Eastern Mennonite University (EMU) in the Master of Arts (MA) in Biomedicine program. Despite my own academic highs and lows, my passion for pursuing a career in medicine and global health has not faded. It has kept me grounded through times of uncertainty. When trying to prove yourself beyond your academic history, it can be difficult to find a program that fosters personal growth in work and study habits, as well as academic achievement. I am fortunate to have found the “right fit” with EMU’s MA in Biomedicine program. Regardless of a student’s background, I believe that those who have the desire to excel and the tenacity to pursue their goals will benefit from the small, collaborative environment found within this program.

While many post-bac programs in the biomedical sciences exist nationwide, it is vital to choose a program that works with you, as a student, to help achieve your academic goals; a program that holds students to high academic standards while also providing opportunities to flourish in the basic sciences through the support of faculty and staff. At EMU, I have been able to tailor my curriculum to incorporate my own specific interests and needs. Additionally, faculty and staff welcome student feedback about the program, which greatly enhances the quality of instruction and education that my peers and I receive. Excellent instruction demands academic excellence from the students as well. However, the faculty and staff provide the necessary support in order for students to meet, and even exceed, those expectations.

In addition to academic rigor and faculty/staff support, there are other important qualities to consider when choosing a post-bac medical program. Things to look for are a small student-to-faculty ratio, a program that emphasizes collaborative approaches to teaching/learning, passionate professors who give priority to teaching, and a program with a thesis/research component. While it may be rare to find all of these qualities in a single program, I am fortunate to have found them within EMU’s MA in Biomedicine program.

A multidisciplinary approach to healthcare focuses on the mind, body, and soul. I have had the opportunity to apply this integrated perspective to health in a variety of leadership roles, including serving as an ambassador for a healthcare organization, shadowing and engaging with patients through my practicum experience, and performing research for my thesis. The program also incorporates a cross-cultural component, which enables students to gain exposure to international health and volunteer opportunities abroad. I chose to participate in ISL’s Global Health program in Nicaragua, allowing me to volunteer and serve medically underserved populations. All of these opportunities have enriched my academic experience, teaching me things that cannot be learned in a classroom.

As you consider your own academic future, I leave you with one final consideration: if you have the will and the desire to succeed, don’t sell yourself short! It does not matter how old you are or what circumstances you face. “You can’t go back and make a new start, but you can start right now and make a brand new ending” (Sherman, 1982, p.45). EMU can help shape your new future by instilling the confidence that is necessary to excel and attain your goals.

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