Question about research

I've been getting some really good questions over email. I'll post questions here in the future if I think they may be helpful to others. Naturally, everything is anonymous...

Q: I have applied for summer research and I will have an interview with Scripps Translational Science Institute this Thursday. I wonder what your experiences in research? Have you done research on genomics and bioinformatics. I would be appreciative if you can give me some insights and suggestions on how to better prepare for the interview.


A: It's very difficult to answer your question without knowing more details. "Bioinformatics" and "genomics" encompasses a huge field. It's new and fun, and very diverse an area. I would say a good place to start is to contact the person you'd be working for/with and ask them for some reading in preparation for your interview. Comb through a few recent PubMed reviews and find one or two cool things to talk about. The absolute WORST thing would be if you mention something without understanding it. Always assume the other person is the world expert on whatever you're talking about. In most cases it is most important to appear intelligent, interested and hard-working. Good luck!

SpacedEd: Love This Resource

http://www.spaceded.com/

I discovered SpacedEd in physiology: our course instructor suggested we use it to keep up with the course. But it offers so much more! I'm signed up for Chest Radiology I/II, Cardiology, Endocrinology, Neurology and many others. Chest Radiology courses are really great. Every day I get 5-10 case-based questions to answer. It takes me only 10-15 minutes, but the cases are so much fun! There is a handy edition for the iPhone, which is available for free (no software download is required).

I'm Learning Real Medicine!!!

Wow...

This week's NEJM issue features two clinical cases that I can actually say I understood!
When we were learning systemic and portal circulation, we had a clinical study case that
was just like this one. We had to identify at least 4 porto-systemic anastomoses, and predict
what would happen to these blood vessels should pressure go up in the portal circulation
due to liver cirrhosis. I knew what they were showing on the picture, too! This is so cool --
"Anatomy is Power" as my professors used to say every so often.


Bleeding Esophageal Varices
http://content.nejm.org/cgi/content/full/362/5/e13

By coincidence, I've been learning pulmonary physiology this week -- and so this article jumped
out at me (I've just spent the past 9 hours predicting lung volumes and guessing at the flow rates
for tomorrow's quiz). When I look at this article now, it amazes me I actually know what I'm
looking at. I know what a CT is, I've learned some basics of how to read them, and I have an
appreciation for what should be on that CT and roughly in what sizes. My physiology class uses
lots of clinical cases like this one to practice solving "problems". So yes, I've just spent many hours
in solitude with my TI-84 and heaps of my meticulously numbered and dated papers. But it's a
trade worth anything and everything -- because I get to experience at least some of what this case
really looked like to the physician who treated it.

Under Pressure
http://content.nejm.org/cgi/content/full/362/5/449

Well, that makes me feel much better.
But I'm going to sleep --

I have class in 3hrs...

State of the Union: Keeping it Together Through Physiology

I'll finish this post when I wake up.

Hopefully I'll still be able to remember all the witty things I was going to say.

Quick survey of today's damage: 

- two finals this morning: done with January block!

- responded to email for 5hrs: how many calories does one spend per hour of typing?

- worked on my research proposal: two deadlines on Monday, many more coming up

- noticed but chose to ignore the Leaning Tower of mail on my desk

- failed to write this post in a non-bullet-point form... brain feels mushy

- slept less than 4hrs/day this week

- ate my classmate's cookies without sharing

Zzzzz...

Kicking off 2010 with Medical Statistics :-)

A brief winter recess ended on Monday. My classmates and I returned to Harvard to begin our next class block: clinical epidemiology and population health. I’m going to go ahead and challenge the conventional wisdom that January is a take-it-easy month at Harvard. We are in the middle of the Boston winter, which is completely manageable if you follow one key rule and DON’T GO OUTSIDE. Too bad for me because my condo is a lengthy commute away from the Medical School, so getting here quickly while avoiding the cold is the first of the two problems I have to solve almost every morning. Number two is staying awake through an hour of statistics in the morning. In college I took statistical thermodynamics which threw me into such despair with Fermi and quasi-Fermi energies that I couldn’t sleep at all. I cursed the day semiconductors were invented, while my professors surely cursed the day I signed up for their class. For five months we suffered together and I ended up alright. But at Harvard it is me against the means and the medians, and the normal distribution at 8:00AM, and they are clearly winning...

But the course work is much lighter than the blazing hoops of Human Anatomy or Biochemistry because February 1st is an important deadline for submission of the student research proposals. Harvard has the luxury of being able to fund all proposals that successfully pass the rigorous review by the research committee. Two electives are offered this month aimed at increasing the quality of student proposals. Students who are planning to do basic or clinical research are offered to take Scholarship in Medicine (SIM). Physician in Community (PIC) is the equivalent course for social science projects. A lot of us are grudgingly taking one of these classes, while the MD/MBA students get to savor two extra free afternoons a week: they will be doing a summer internship which doesn’t require funding applications.

Such was the first week of the 2010. Four weeks to go until physiology begins (allegedly the hardest class this year), and three months to the next break. But these days I measure life in much shorter intervals: Cowboys and Eagles are playing in two minutes, Vietnamese delivery is arriving in thirty, and I don’t have to worry about a test for another eighteen hours :)

Dixie Cup and a Sand Truck

My first class at Harvard Medical School is over. This Friday my class took a three-hour final exam in Molecular and Cellular Basis of Medicine (MCM), results pending until next week… It was one of the best classes I’ve ever had, well-organized and well-narrated. On the first day of class I discovered a six-inch-thick stack of printed PowerPoint lecture slides in my mail box – “Welcome to MCM!” read the first page. I flipped through the slides. Double-sided, of course. Was there any possibility I would be able to learn all this in five short weeks? I had my doubts.

My biochemistry day started at 8:30am, usually with a small group study or “tutorial”. Eight of us spent 1.5hrs working on assigned problems and discussing questions, guided by a tutor. It took a little while to get used to the format, but by the end of the course our group was very efficient and collaborative. After tutorial sessions we had 3hrs of lecture, interrupted by 15 minute break. All lectures were recorded and posted online that afternoon. For twenty bucks you could purchase a nifty RealPlayer plugin to watch those lectures in 2x speed. A few times we had a “Clinic” – a special 2-hr lecture that awarded us an opportunity to get clinical insights about diseases we studied. By early afternoon I was done with biochemistry classes and had to find a way to cram everything I learned that day into my head.

My college studying strategy was immediately out of the window: no time to make color-coded study notes, too little time to read full chapters, no time for office hours. “Efficiency” became my one and only study slogan. I used any study tool I could, from book to YouTube, whichever gave me a clear picture of what was going on in the shortest amount of time. Two weeks into the course I had the weirdest biochemistry dream: I was rocking myself to sleep on a ribosome, peacefully sliding along a convoluted mRNA molecule. I woke up feeling really weird.

Three weeks went by and I started wondering if my childhood memories are being forced out of my brain by the invading squall of cell biology. The best phrase to characterize this experience was offered by one of my lecturers, Dr. Chien. He compared his experience taking biochemistry at HMS to “Standing underneath a dump truck full of sand with a Dixie cup and trying to catch it. Over the years the amount of sand has gone up, but the Dixie cup is no bigger than it was when we first started.” Over the past three weeks my appreciation for Dr. Chien’s words has grown exponentially as the pace of the course picked up towards the end. But at the end it all came together: I earned a new appreciation for the elegance of biochemistry, especially metabolism!

Metabolism was covered in the last two weeks of lectures and it was the perfect culmination for the MCM course. Our class was working together to overcome the challenges of last week: notes, schemes, summaries and helpful links circulated the class mailing list. I charted pathways over and again to remember the fates of metabolites and the names of the key enzymes. Everything I could learn about carbs, fats and proteins my memory crafted into series of lines and arrows that combined at odd angles and trajectories to produce “Metabolism”. I was as amazed to see it all work as was Jodie Foster’s character in the movie Contact when the bald guy on the plane shows her how to crack the Alien code.

And so it is done. On Monday I’m starting a new course block “The Human Body”, which combines anatomy, embryology, and histology. I’m very excited, but I will surely miss biochemistry! It left its mark on me. Maybe it was like driving through a bunch of flies with a Lincoln, trying to hit as many of them as possible.

Four weeks later...

I just can't believe how busy it is... I haven't had a time to write at all. I'm taking a final exam in biochemistry in a week, and then I'm starting Human Anatomy. Weeks go by so quickly and the work load is intense, but I love it! Two days ago I performed my first ever injection on a person - I attended a flu vaccination training and the nurses let us practice with saline on each other.

My First Patient

“Doctor, I can’t breathe!”

I stared at our patient: his heaving chest, cerulean eyes, and his pink plastic hair locks. I could hear his eyelids open and close with a loud “click!” His face permanently assumed an expression of astonishment. His soft plastic skin felt disturbingly real. I grabbed his arm and felt his throbbing racing pulse. I looked over to the monitor where I could read his heart rate, blood pressure, oxygen saturation, and body temperature. I leaned closer and stared at his face intensely, as if this was going to rescue him from peril. The room was electric!

“Is it okay if I put an oxygen mask over your face?” my teammate asked gingerly.

“I guess so…”

I was, of course, in a simulation lab. Our patient was a mannequin – a young male with a perfect athletic body, currently posing as a seventeen year-old female with an asthma attack. While simulators like this one can be found in many medical schools around the country, Harvard integrates simulator training into their curriculum starting as early as first year. It was my first ever interaction with a patient.

It was an amazing and novel experience for me. I really liked working with my teammates. We scrambled together to come up with possible solutions for our patient. We asked questions about our patient’s history, their medications, their allergies and whatever else we could think to ask but in no particular order. For instance, we completely forgot to ask their name! Being in a simulated Harvard Emergency room, we could request to perform any test and administer any medication.

“My chest really hurts! It’s hard to breathe!”

“Give us an albuterol inhaler, please!” we asked.

My teammate sprayed two clicks of albuterol into our patient’s wide-open mouth. We looked over at the vital signs on the screen, waiting for a change. And there it was: oxygen saturation went up, signifying to us that our actions helped the patient. We smiled at each other, but our mannequin still complained.

“My chest really hurts!”

My happy feeling was gone. “What’s wrong with her heart rate? Why is it so high?” I wondered. I was really hoping for her to be happy and relieved. We ordered a chest X-ray. It came up on a huge flat screen, looking very pretty in high-res. I was staring at it, hoping to see the solution to this poor young woman’s problem. “Why does her chest hurt? What can I do for her?” I felt so bad. It felt so amazingly real! My heart was racing.

We found nothing obvious on the X-ray, but the consensus was reached that this woman was having an asthma attack. What to do now? We brainstormed a list of medications, but none of us was certain enough of how they were supposed to be administered.

“Let’s call her primary care physician” somebody suggested.

“Yes, let’s do that.”

“What’s their name?” We all looked at each other, puzzled by this basic piece of information.

It was our good fortune that we were able to obtain the name from our patient. We got her primary care physician on the phone and asked about her asthma history. We were told that she keeps it in check pretty well with steroids.

“Ah, steroids! Yes, let’s give her some steroids!”

The steroids brought our patient the desired relief. We successfully admitted her into the hospital and the case was over. Our instructor came out from behind the curtain, smiling. She was incredibly supportive, and discussed the case with us in great detail. She reviewed our performance and made suggestions how we could improve. We were supposed to notice that our patient’s chest was overinflated on the X-ray, but none of us noticed that. The white specs in the center of the film that I thought could have been some foreign body or dust were in fact normal blood vessels and airways. Her heart rate was elevated due to albuterol which we administered early on. It all finally made sense!

I was mentally drained, but thought the whole experience was incredible. My meager performance gave me a boost of enthusiasm, actually. I wanted to go to the library immediately to learn about asthma and the treatments for it. Next time I will know what to do!

On my way home I was reflecting on the events of the day. Absentmindedly I looked around the train car. It was crowded with people returning from work; wary faces, reading newspapers, listening to iPods, swaying to the rhythm of the train. “What if all of them suddenly had an asthma attack,” I suddenly thought with penetrating terror. I turned my head and saw a pregnant woman standing by the door. “What if she had an asthma attack? What on Earth would I do if that happened?”

But the sim lab did not give me lasting nightmares. Rather I had a new awareness that emergencies do happen and that I need to learn to be ready for them. It motivated me.

My First Day As a Harvard Medical School Student

08/17/2009

Fist Day

This morning I had a number of introductions, most notably by Dr. Nancy Oriol – the Dean of Students at HMS. She has a wonderfully charming personality and generously shared her advice about what’s in store for us. “If you’re a male”, she said, “Being a Harvard Medical School student is an aphrodisiac. Showing up at the bar and informing men in there that you’re a medical student at Harvard is death for a female”.

We shared our excitement and worries with each other (just a few hours earlier a lengthy session on mental health hazards and treatment was conducted). On a large blackboard Dr. Katharine Treadway, our instructor for Introduction to Profession class, neatly listed our points of excitement. Her writings were encoded in a language that I might one day be able to read and understand comfortably. She used single letter abbreviations for “with” (looked like marriage of e and a coma) and “without” (an s with a bar?) which I have never seen in my life. Also “b” for “be?” and other symbols. Her “E” looks like a dollar sign missing one bar.

Among things people were excited about:

- Being somebody’s hero

- Becoming an agent of social change

- Being a Harvard student

- Reaching catharsis when it all begins to make sense

- Classmates

Solid, positive stuff. Upbeat. Then we started filling out another half of the board with our worries and concerns. Things like DEATH and DEBT appeared in caps and the mood changed.

- Harming people inadvertently

- Disappointing myself and my community

- Cynicism

- Workload

- Classmates

Interestingly, “Classmates” appeared as both, an excitement point and something to worry about. One student’s exhilaration “My classmates are all geniuses and very incredible people!” became another’s fear “Are they all going to be like geniuses and all, how am I ever going to make it here?” Yet another student wondered – anonymously – if adcom has made a mistake with their decision to let them in. Yes, we were all worried and anxious, but still excitement prevailed.

After getting my ID, I walked up to the main entrance to the Gordon Hall building. Its heavy doors seemed impassable. I remembered the day I came to interview. I thought these doors would never open for me (there was also a helpful sign that said “No Access Without ID” here). So now I held in my hand the magic laminated key to these doors. I swiped the card. The yellow light flickered but remained unaltered. “Hem-hem,” I thought, “Perhaps I’m not all the way a student yet? This does say a temp ID…” But that moment I looked over at my new friend and my confidence returned. This is my first day as a medical student at Harvard. I met amazing people today. I received a heartfelt welcome from so many distinguished students and faculty. I have a new mailbox and a new home, my society home. With a confident “SWOOSH!” I swiped the card again. This time the light turned green and the door clicked, and Harvard Medical School door opened and let me in.

Interviewing at Dartmouth Medical School

I interviewed at Dartmouth in the fall. The day was October 16th. I took the Dartmouth Coach bus from downtown Boston where I live to Hanover, NH. I got off the bus on a drizzly afternoon to find myself in the middle of a quaint rural neighborhood which was clearly NOT Dartmouth… There was not a sign to indicate where I was nor was I anywhere near my presumed hotel location. I walked into a different hotel lobby and asked how to get to Dartmouth. I was told I have to take a $60 cab ride to White River Junction, VT -- so much for cheap travel to NH -- but hey, at least I knew where I was! Finding a cab in New Hampshire is not possible. In Boston there are frequent cab stands, but in New Hampshire if you want a cab you have to call in and wait. It took another hour of plowing through rush hour traffic to get to White River Junction. My hotel was a shabby brick building in the middle of a parking lot, but there was a big Wendy’s banner in the middle of it -- so I was happy. You can never be too far from civilization if there’s Wendy’s!

Next morning I had to take a cab to the admissions building, but this time it was only $15. I was greeted by the most incredible, friendly admissions staff! Interviewees were shown into a large antique room with high ceilings and bay windows. We all had a chance to hang out and chat, and have coffee. The official part started at 9am. We met with the dean, and the financial aid director. All struck me as the friendliest people. The atmosphere was incredibly casual and relaxed. Both of my interviews were at the Dartmouth-Hitchcock Medical Center (DHMC) and both were with medical faculty. To get to DHMC I had to take a free campus shuttle. It took roughly 30 minutes to get to the complex. A student-guided tour was offered, and a lunch at the hospital cafeteria (it really was not bad). To get back to the admissions building was trickier. A number of shuttle buses run from the DHMC and only one takes you back to school. I had to wait for that one for 45 minutes in the rain. I left Dartmouth around 4pm that day on the bus back to Boston. Overall I had the most positive impression of the school!

What did I like about Dartmouth?
I was most impressed by the atmosphere inside the Dartmouth-Hitchcock Medical Center. It’s a brand new construction and is rather enormous, but inside is designed like a shopping mall. They told us the architect designed the building in a way that would feel friendly and familiar to patients, and I really think they did it right. In the middle of the main hall there was a big concert piano. Doctors would come over and play calming music on it all day long.

I read New England Journal of Medicine and I frequently see articles on public health published by MDs and MD/PhDs from Dartmouth. The school offers a variety of research opportunities to its students in both clinical and basic sciences. There are lots of funding options available to graduate students, although I could not find a similar comprehensive resource for medical students.

Dartmouth-Hitchcock Medical Center serves New Hampshire, Vermont and parts of Maine. Students have the opportunity to see cases from all three states. Dartmouth is the only medical school of this strength and size in the area, so most difficult cases go to DHMC. When I was waiting for a bus to get back to the admissions office I met a young man with a huge surgical scar on his forehead. He was injured by a bomb in Iraq and was treated at DHMC for injury-related epilepsy.

After I was accepted I received the most personal treatment from the financial aid office. They were helpful, responsive, and very efficient. It was easy to reach a person and get help with filling out forms and supporting documentation. Dartmouth offers generous financial aid and no-interest student loans.

What did I not like about Dartmouth?
The medical center is quite far from the school and even further from residential areas. While free shuttle service is available, it is not efficient enough for a fast-paced life style of a medical student. You really do need to have a car.

New Hampshire is a very rural area – it’s only two hours away from Boston, but it is much less densely populated. You have to drive everywhere to get to a supermarket, go out for dinner, movies, and get coffee in the morning. On the other hand, it’s at the heart of traditional New England recreational activities like hiking, skiing, and snowboarding. In the fall it looks gorgeous.

I was concerned about the conservativism of DMS curriculum. It is heavily lecture-based with little research focus and problem-based learning. While certain aspects of it were attractive – community-based patient interaction programs, mentoring programs – it was not the best fit for my research interests in medicine.

Fun facts about Dartmouth
Dartmouth is a historic place. It was the fourth medical school in the US – way before John’s Hopkins was built as a large medical school. William Osler, Harvey Cushing, and other huge names in medicine all came here to give lectures and seminars.