Improving Medical Genetics

Alright, time for Point 2 on my Blurbs: My issue with the genetics course and my recommendations to the faculty.

So this course was to introduce us to medical genetics. I was on the M1 liaison committee for this course and it was honestly somewhat frustrating hearing the excuses made by the faculty (valid excuses though they were). Most of their arguments boiled down to "We didn't have enough time. We had to cut something and we decided to cut that." -_- In its current iteration, this course doesn't really help us as future clinicians recognize and diagnose genetic illnesses, nor really help us track them through family history. Some diseases and important points were highlighted, but certainly not enough to be useful. Apparently there's a lot of "turf war" going on between classes and allotting time. Ugh, inter-department politics (not to mention inner-department politics). Fact is, there are things they could've done to improve the quality of this course given it's very short class-time.

My recommendations on the eval were as follows:

- Simplify and combine the lectures on transcription and translation into a single lecture.
- Simplify the cyclin/CDK material and combine the lectures on mitosis and meiosis into a single lecture.
- Have a lecture on Mendelian genetics and non-Mendelian genetics.
- Have a lecture on epigenetics.
- Have a lecture on creating pedigrees and emphasize their importance in medicine (or make this a short online tutorial).
- Have a lecture on genetic counseling: who are genetic counselors, what they do, when to refer, etc (or make this a short online tutorial).
- Have a lecture on the ethics of genetics and genetics research (or make this a short online tutorial).
- Have 1-2 lectures on cancer genetics. The first can focus on the genetics of cancer (e.g. Knudson's two-hit hypothesis, transformation from normal cells to hyperplasia to malignancy, a little bit of pathology), and the second lecture can focus on specific genetic cancers (e.g. BRCA1/2 and breast cancer, APC and familial adenomatous polyposis, p53 and Li-Fraumeni).
- Reorganize the lecture on Huntington's corea, Duchenne's muscular dystrophy, and cystic fibrosis to highly other genetic diseases (specifically Huntington's corea, Prader-Willi, Angelman's, and sickle-cell anemia). DMD and cystic fibrosis have been repeatedly covered again and again in other lectures.
- Simplify the development section of this course. Combine weeks 1 and 2 into a single lecture, and weeks 3 and 4 into a single lecture.
- Enforce greater communication between faculty lecturers so that the same topic isn't lectured on over and over again (i.e. telomerase, DMD, and cystic fibrosis).

If they even did 1/3 of the recommendations above I believe this course would've been greatly improved next year. But it's not like it matters much in the long run, as in 2-3 years there's going to be a massive shift in the curriculum into something entirely new and unrecognizable, and the current classes we now take will be abolished for a new system. That could be interesting . . .

Life's Hand and Death's Mask

I know it's 9-11, but many others are covering the significance of this day so I won't belabor it here . . .

So yesterday was a LONG day. I saw my apartment for a total of about 45 minutes between 8am and 9:30pm.

For lunch I went out with some other M1s to this Mexican restaurant/bar. It was in a pretty shady part of town (thank God we went in the middle of the bright day). It was my first time having mole and it was delicious! Though I think I may have burnt my lips and tongue a little, grrr.

After classes were done, I had a meeting because I was a member of the M1 genetics liaison committee, a group of students who met with the genetics course director and gave our feedback to them. I won't discuss this here as that can be a post in it of itself.

After that I went to the Saturday free clinic mandatory meeting. I had signed up to be a volunteer but I was accidentally left out of the schedule. After a few pokes via email I was assigned to volunteer two Saturdays this semester. I'm sure practically every med school has a free clinic run by med students for the uninsured and under-served population. Here, each M1 is paired with an M2 and we take the patient history together. Then an M3 or M4 conducts the physical and, with the M1 and M2, makes a preliminary suggestion as to treatment. The volunteering doctor then either approves or modifies our decision. Interestingly, we have pseudo-prescribing powers as med students at this free clinic (though we use a very limited formulary for dispensing drugs, as we're not allowed to prescribe brand-name drugs because the patients would never be able to afford them, even if they worked better than a generic). I say "pseudo-" because we can write the prescriptions, but the volunteering doctor(s) there must sign off and okay it. Same thing goes with referring powers.

Practically every med student volunteering for this free clinic is super-excited because this is the first instance where we'll have real clinical experience and have real patients. This is what we went to med school for (well, hopefully most of us).
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Life's Hand

After the Saturday free clinic mandatory meeting, I met up with an M2 and went to the APAMSA (Asian Pacific American Medical Student Association) dinner at a faculty's apartment. He lives in a very nice apartment right on the riverfront and he's incidentally the founder of APAMSA, so it was quite an honor. He's a pediatric gastroenterologist (they call him the baby vomit doctor) and it seems like an interesting field . . . I may ask to shadow him in the clinic and during procedures.

It was a lot of fun and great getting to know other M1s, M2s, and even some M3s and M4s. I met the M4 who's "assigned" to my anatomy table to help us out. She's a really pretty half-Asian who's going into neurology. Gah, why're all the M4s so hot!!

This one M2 guy brought his wife and 14-month-old son to the APAMSA dinner. He's the first Asian Mormon I've ever met! And his son was soooo cute, and shy; he wouldn't let anyone but his mom and dad touch him. The mom sat near me with her son for a good portion of the dinner. After a few minutes the son got comfortable enough with me to cautiously lay his little hand on my leg a few times (he was still avoiding everyone else but his mom and dad). A few minutes later he was pointing at something and looking at me to follow his gaze (he avoided eye contact with all the other strangers). And then he put his little hand in mine and just rested it there for a minute or two. It was definitely an "awww" moment. If we had a bit more time to interact I think we would've become friends. ^_^

This impressed the people around. I can generally establish rapport with (most) babies and kids within half an hour, somehow. I'm not sure how. But it's really cool that they just feel comfortable around me. I really like kids of almost all ages and I have my ways of connecting with them (usually). As a fellow M1 said, it's almost as if I was "destined" to be a pediatrician, lol. Babies!!
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Death's Mask

Today we started the 2nd block of anatomy - the head and neck. Omg, there are sooo many bones, muscles, nerves, arteries, and veins in the head. I think I saw more names flash on the screen today in just 2 hours than in all of the last block combined. Not cool. -_-

Then in lab we had to finally uncover the face of our cadaver. Now, cutting into our cadaver's arms was disturbing, especially since we had to sometimes tie them up so there was a rather grosteque Christ-like appearance with arm parts splayed out. But we got used to this easily enough, and certainly during the lab practical exam there were arms sticking up at random angles, almost as if to wave or grasp at the air. And now we do the face, one of the most personal and "human" parts of the body next to the hands.

His eyelids were slightly open, his glazed eyes staring blankly and deathly at us. We cut into his face and began to peel back the skin. We initially cut too deep and stripped the muscles and everything from the top of the skull. A professor took such pity on our mutilation that he spent more than half an hour dissecting the skin off half the face for us to show us just how superficial we had to cut, as well as pointing out structures we surely would've destroyed without knowing.

Staring at our cadaver's face as it was being stripped of flesh was an . . . interesting experience. He died with this expression that I couldn't quite place - a rather quizzical death mask. From one angle he looked sad, almost with regret. From another angle he looked quite peaceful. And from yet another angle he appeared almost arrogant and proud (even as flesh was slowly being sliced away from his right cheek). The professor remarked that our cadaver had nice facial muscles and that perhaps he was a particularly expressive person in life.

The other cadavers around us each had their own unique death masks etched upon their faces. The old lady beside us had this creepy almost-grin, and as the group stripped her skin off it reminded me of a horror movie. Another group further down had progressed even further and the skin hung by the sides near the ears - it wasn't really recognizable as human anymore.

To be honest, I'm very surprised that no one fainted or vomited. It seemed like the normal thing to do in this situation. Perhaps we've become comfortable with death . . . As my friend said, "You can't pay me enough to do what you do." And my response, "Ironically, we're paying a lot to be able to do what we do."

Blurbs

Okay, it's late and I need to sleep. But there's so much swimming around in my head that I want to address in several posts. So need to jot down these blurbs to serve as my reminders. In the next several upcoming posts you can expect topics such as:

- My day (being 9/10/09, and maybe 9/11/09 depending)
- My issue with the genetics course and my recommendations to the faculty
- The reason why genetics is so near & dear to my heart (not sure if I've specifically blogged about this before)
- My thoughts on health care reforms (maybe . . . I may not touch on this)

Operation: Survive Block 1 - Success

Hehe, that title's way more dramatic than reality. Oh well. I'm back! Miss me?

This morning I finished the last of 3 exams (a genetics final, an anatomy lab practical exam, and an anatomy written exam). I believe they call these "block" exams because all our exams are crammed into a single week, so we learn in "blocks" and take all our exams at the end of each block.

Honestly, it wasn't that bad. I don't know who keeps saying it's so horrible - oh yeah, the "gunners" - the people who HAVE to get nigh-100% on everything (and in that light, everything's difficult). In some respects, these exams were somewhat easier and less stressful than some of my undergrad exams. It's interesting to see half my class freak out and yet I wasn't, strangely.

Honestly, I think my mentality has changed from undergrad/grad school to now. In undergrad/grad school grades mattered a lot and everyone strove for that "A." Here, where's it's more or less pass/fail (but with gradations of pass from Honors, High Pass, Pass, and Low Pass), it feels less stressful. I know I'll pass, and anything above that is just gravy. Of course I want to do as well as possible, after all I'll need (at least some of) this knowledge later when I see patients. And I actually did really well - Honors in genetics (92.12%), and High Pass so far in anatomy (88.75%). The year's off to a good start grade-wise. :-)
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After the exam this morning, 5 of us went out for sushi for lunch. It was relatively good and inexpensive sushi, I was impressed. More interesting was a good portion of our conversation.

We're med students. So of course we discuss topics relating to our classes and medicine. And I thought it rather odd and amusing how we kept returning to anatomy and dissecting cadavers (our next block is on the head and neck - definitely NOT looking forward to that). Anyway, as we wait for our meal we comment on the dreadful smell of the lab and how we have to wash our hands multiple times to neutralize the smell on our hands (though now we don't notice it as much, not sure if that's a good thing or not). I commented how if I cut up garlic for cooking, the smell of garlic on my fingers overpowers the smell of death so all you smell is the garlic. Hmmm, maybe that's why garlic is used against vampires . . . Garlic trumps death, good to know.

When I came home for the afternoon I didn't know what to do with myself and all this free time. o_O So I read this blog that someone emailed me: A Sailor Boy's Blog. Wow, some hot and steamy stuff in there! It's an interesting read, so go check it out!!

Then I went out with my roommate and a friend to a bar/restaurant that I kept hearing other med students talk about. It was pretty good and I finally tried this one appetizer that my friend from grad school (who's originally from the state I'm currently in) told me about. It was good, I liked it. And we tried the $0.99 drink of the month - peach sangria. That was good too (maybe because it was only $0.99).

I watched the Obama speech on health care when we got back. It was good . . . but there wasn't anything substantive in there for me. No real details of how things might work, no ideas how to implement things, no mention how this will help doctors with our myriad issues - ridiculous med school debt, the primary care vs. specialty imbalance, nationalized electronic medical records, malpractice caps, etc. Maybe in time, maybe never. The public ethos is against doctors anyway and people tend to think all doctors are really well off. Not necessarily true (especially primary care docs with $200K in med school loans + interest) but whatever, that discussion is for another day.

---TANGENT---
Alright fellow bloggers who don't update much, if I can do it while being busy with med school, I'm sure you can do so as well. I'm talking to you, authors of:

Amazing Corey
A Popular Dude's Secret Life
A story of a boy and the universe
Gay+Teen+Syndey
Gentleman's Romance
I Gotta Story To Tell
Where I Stand

If you're reading this, please say something to let us know you're alive and doing well! Thanks!!
---END TANGENT---

The Sensitive Soul

I took this "What type of med student are you?" quiz on Facebook. My result: "the sensitive soul." In an odd way I'd say that's accurate though I would've never pegged myself as such a few years ago. The source of the quiz comes from this comic below (please click on it to enlarge and absorb the full hilarity):
My roommate got: "the questionable admission." I'm sorry to say but sometimes I feel that's an accurate description for him - not that he can't do the work (he definitely can) but that he doesn't care about medicine as much.

Another hilarious comic is the "12 Medical Specialties Stereotypes." I particularly like the ones for dermatology, ob/gyn, and radiation oncology. See here below (again click to enlarge):

Both of the comics above come from scutmonkey, who's also the author of the blog the underwear drawer.

Anyway, studying is going along alright. I had a mock anatomy lab practical exam last night. Nothing like spending an hour with about 100 of your peers staring at dead bodies in the night. I kid. I got 43/50 right, which isn't bad. I'm having trouble distinguishing arteries from nerves in some parts of the body (shut up, they all look the same in a cadaver - white and stringy - that probably sounded bad). It kind of sucks that we're not allowed to touch the bodies during the exam, as that's how many of us can definitively distinguish some things from others. Ah well, spending more time in the lab today with my group to get that sorted out (hopefully). People are beginning to freak out, maybe I should study more . . .

Oh, M4 Guy will no longer be helping us in anatomy lab. He's now doing his next rotation in I don't know what. Le sigh. :-(

Randy Sighting

So Randy IM'd me briefly on MSN tonight. He's given me permission to divulge his current location because he's moving on to his next destination tomorrow or the next day. He's currently been sighted in Ontario, Canada. Where exactly in that massive province I'm not sure (I'm not sure he's entirely sure either).

That's pretty much it. This was a pretty short and random post.

Oh, I discovered that 2 of my professors are apparently pretty hardcore creationists. Ugh, as long as they don't let that influence what they teach . . . Med school just gets weirder with all these strange egos.

Lastly, check out Ben & Jerry's support of gay marriage in Vermont by introducing a new flavor called Hubby Hubby. That seems really nifty. :D

Alright, sleep time.

Love & Hate

To refresh, M1 Guy and M4 Guy are from this post. Cute Girl is from this post. I haven't decided if I'm going to "codify" them (I suspect they'll be recurrent characters here) or just leave them with the designation M1 Guy, M4 Guy, and Cute Girl. For the purposes of this post I will though.

A refresher: M1 Guy is slightly taller than me, blond, blue eyes, cute smile, nice body, really nice persona, and wears glasses that makes him adorable in a slightly dorky kind of way. Apparently he's living with his girlfriend. Dang.

M4 Guy is (again) slightly taller than me, short curly black hair, beautiful blue-hazel eyes, wears glasses, a really cute smile, a deep voice that I can listen to all day, and is really really helpful and nice in anatomy lab. The following below will mostly focus on M4 Guy.

Cute Girl is shorter than me by a few inches, long wavy brunette, tan skin, and has a really cute and bubbly persona.
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Love

So it seems that all 3 girls in my lab group have a major crush on M4 Guy. He came over to see what we were doing today and he helped us identify structures (mostly muscles) of the forearm and tendons of the wrist. He stood next to me and I must say, he smelled soooo good in the formaldehyde-infused air. I was covertly breathing deeply next to him. All the girls broke into smile and lit up at his presence (I don't blame them).

This other girl from another group had come by to see what was going on. She kept putting her hands in our cadaver's arm to help identify/find structures, and Cute Girl had to resist the temptation to swat her away so that only M4 Guy may probe the muscles. When M4 Guy left, all the girls pronounced their crush on him, especially Cute Girl - she gets all giddy. One of the girls has a boyfriend, and she tells him about M4 Guy all the time.

I admit, I do have a man-crush on M4 Guy. Like the girls (though more secretly) I scan the room occasionally to see if he's around. He emailed us his notes from when he took anatomy 3 years ago, and he linked us to a site with demonstrations of live dissections (not to be confused with vivisection) where the anatomists explain how to dissect and point out important things along the way. How nice is that?!
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Hate

Okay, I think I hate my genetics course now. It transitioned from biochem pretending to be genetics, to "real" genetics (which, although grossly oversimplified, was much appreciated), to now embryology. That's not "really" genetics again, ugh. Why is this class even called genetics?!

Whatever, more annoying, we had a genetics quiz this morning and there is a particular question that many of us felt had two correct answers and/or was a bad question to begin with, because it required knowledge of material outside the lecture notes. I emailed the lecturer who wrote the question to challenge its validity. His email reply was very curt and didn't acknowledge my efforts. I don't appreciate that - he could have at least acknowledge that I had a point (and I knew my explanations were fairly solid, I had researched things briefly to make sure I wasn't completely off base). His reply basically boiled down to "because I said so." Ugh.

Must not make enemies with the faculty . . . I mean, I did fine on the quiz so I guess I shouldn't complain much. I only got 2 (out of 18) wrong, and one of them was a stupid error on my part. But this other question - it's going to draw the ire of many students I think.