Friday, February 24, 2017

Week Three

Hi everyone!

Hopefully, all of you had a wonderful week. As for me, I finally got to set foot on the University of Arizona College of Medicine campus and familiarize myself with the involvement of the Narrative Medicine department!

On Wednesday morning, I had the opportunity to shadow Dr. Hartmark-Hill in her "Visiting Professorship" meaning with Dr. Beyda, the head of UofA's Bioethics and Medical Humanism department. 
The meeting started off with scheduling of various narrative medicine events as a way to continue promoting patient stories in the local medical community, and this segwayed into discussion of narrative medicine at an international level. It was pretty cool to see that a physician all the way in Venezuela chose University of Arizona to get professional medical training because of its focus of humanities in medicine and value of patient stories.

After the meeting, Dr. Hartmark-Hill gave me a tour of the campus, and I was truly mesmerized by the medicinal and anatomical canvas paintings hung up on the walls. Although the campus isn't dedicated to narrative medicine, there is definitely a strong influence of the simplae presence of medical humanities and narrative medicine programs in the building.


We later attended a medical humanities writer's group, which was hosted by two authors who used creative writing as an emotional outlet for their experiences in the medical world. The collaboration was called "True Stories: Exercises to Pull Meaning from Memories, Part I", and the authors Amy Silverman and Paul Rubin set up a workshop followed by a telling of their own story. Listening to their development as writers through the power of medicine was really inspiring; Ms. Silverman wrote on the story of science and love in coping with her daughter's down syndrome and Mr. Rubin writes through the interaction and bonds formed when a diversity of people share an equally diverse set of stories.


The following day, I was able to sit in on my first medical student lecture! I actually wasn't aware this was a big deal, but I was told that first graduate-level lectures are a milestone, so there's that. My first lecture was on cardiomyopathy, and this covered the different forms of cardiac diseases and their corresponding treatments and prognoses. One thing that stood out to me was that each disease and patient was treated as almost a two-dimensional object, and the options for treatment were simply categorized in "drugs", "devices", or "cardiac transplant". Although the medical student curriculum was offering professional education on the heart, I felt that there was a lack of depth and realization that each patient has differing symptoms based on their story as a person. However, the second lecture was called "Heart Sounds with Harvey", and right from the title I could guess that this would be interactive and offer characterization to each patient. This lecture was a case-study, so each patient was treated as a unique case, and each heart rhythm was associated with a patient story regarding their racial background or age. Here, the medical student education was certainly integrating the humanistic approach to medicine, and I noticed that the students were a lot more interested and were able to better apply their knowledge towards becoming a physician. 

I'm really glad that I was able to be a part of a medical community that views medicine in social and emotional context because, it's hard to describe objectively, but there really is a difference in their attitudes towards clinical practices and the overlap between professionalism and humanism. Thank you for reading such a long post!

I will be taking next week off for my Spring Break, but I look forward to sharing my experiences with you the Friday after next! 


Anivarya

Friday, February 17, 2017

Week Two

Welcome back! 

I hope these past few days have treated you well! This week, I've been working on completing a very lengthy Institutional Review Board (IRB) Application. First lesson I learned: When they say the IRB is not for people younger than graduate students, they're undoubtedly right. Although paperwork for the IRB was unlike any other set of forms I've seen, it was a remarkable learning experience for me. 

The particular form that I needed to complete was the F200: Application for Human Research. When a study uses human subjects as a part of their research, the Institutional Review Board is required to approve the study to ensure the protection of each human subjects' health and privacy rights. It's fascinating to see that something as simple as conducting a survey comes with so much liability. 


To better understand what the F200 entails, here's a quick run through of the application. The first section was the background, which mirrored my Introductory Post in this blog in explaining what narrative medicine is and its significance. Within the second section of purpose, I discussed the two direct purposes, two specific aims, two objectives, and the primary and secondary endpoints of the research. The following series of sections focused on compiling key words and adequate questions for the Likert scale survey. Once approved, I'll release my official survey questions on this blog!


Along with this survey, I was required to create two consent forms as well. One was a general consent form and the other was a consent to participate in research; both addressed potential concerns of the subjects (which, in this study are the medical students). Each consent form requires the human subject to read and then sign their rights to privacy and voluntary action, potential costs and risks, and potential benefits of the study. 

After "briefly describing" (with a not-so-brief 650 word minimum!) the study population, subject recruitment process, research procedures, settings, costs and risks, benefits, and provisional protection and confidentiality of data, I was required to explain the research investigation in "lay summary". Funny thing is, this was by far the most difficult part of the entire application. According to research investigators, the guideline for being specified as "lay" is 10th grade reading level, but since this includes 10th graders of all backgrounds, it's surprising to see how much the writing style has to change to meet that. If I'm honest, I spent a solid 2.5 hours on making my lay summary from "15th grade" (I didn't even know that was a thing) to 10th grade level. 


Although there were a lot of tedious applications and forms to fill out, I was personally fascinated by this process. I mean, who would've thought that a 2 minute survey would take over 15 hours of paperwork?! There are so many minute details that are often overlooked when it comes to dealing with human subjects, and as someone who plans on pursuing research at university and medicine in the future, this has been an amazing learning opportunity for me. 


As always, thanks for reading and please check in next week! 


Anivarya 

Friday, February 10, 2017

Week One

Hi guys! 

I hope everyone had a great week! Over the course of the last few days, I have been working on (surprise, surprise) passing yet another string of tests and quizzes to become certified for conducting clinical surveys. But in all honesty, it's been pretty fun!
In order to interact with patients and physicians in a clinical setting, I've been taking training courses and assessments for CITI, HIPAA, and SHOW. 

Before I begin detailing my experience with each, I just wanted to give a quick side note about my research question. Turns out being in high school (in combination with being under 18) results in complications with directly surveying patients, so my study has evolved to a slightly different approach to narrative medicine. As such, my new research question is: How does storytelling impact a clinician's experience in patient care? In hindsight, this is actually a wonderful opportunity for me because there already exists some research on the effects of storytelling on patient health and relationships; however, almost no investigations study the effect that storytelling has on clinicians in their ability to diagnose and improve treatments for their patients. 

In continuation with the certification trainings, I would like to discuss the types of questions in and significance of each. 

Collaborative Institutional Training Initiative (CITI): The goal of CITI is to ensure public trust, integrity, and quality in research. Under the University of Arizona College of Medicine branch, I was able to take the Social and Behavioral Research Investigators (HSR) course which covered lessons in healthcare ethics, federal research regulations, risk of assessment, human subjects in research, and privacy or confidentiality protections. I was particularly interested by the modules "Research with Children", "Research with Prisoners", and "Research with International Minorities" because it's so fascinating to see that in healthcare, each individual is valued for their unique contribution to the patient world. 

Health Insurance Portability and Accountability (HIPAA) Training: The purpose of HIPAA is to secure privacy while maintaining efficiency in portability of patient information. HIPAA training is meant for higher-degree physicians running a private practice and graduate students practicing for medicine, so admittedly this was a bit more challenging to comprehend. Essentially, I was able to learn what PHI (individually identifiable health information) is and the uses and disclosure procedures of it. I personally really liked the "special circumstances" section which included medical scenarios in law enforcement, decedent and familial records, and military and national intelligence activities because this showed how complex the interdisciplinary nature of practicing medicine truly is. 

Student Health Outreach for Wellness (SHOW) Clinical Orientation: The SHOW training was relatively simplistic and the goal is to take a holistic approach in providing a safe environment to patients experiencing homelessness in the community. I was introduced to SHOW-specific clinic flow and the different codes which are universal in hospital and clinical settings: code red for fire, code yellow for a bomb threat, code blue for cardiac arrest, code gray for security alert, and code orange for hazardous material incident. (Definitely realized the colors of the rainbow aren't so peaceful anymore)

Overall, taking these orientations and assessments (fun fact: I got straight A's) was an unforgettable experience. I'm so glad to already feel like I'm a part of the medical community that I strive to be in as a physician. Now that I'm officially certified to interact with patients, doctors, and medical students, I'm looking forward to beginning my interview and survey process soon! 

Thank you so much for reading! Please check in next Friday for my weekly update! 

Anivarya