I'm still here
I've been holed up in my home office in the past few months, willing the winter to disappear but also getting massive cabin fever. All this isolation makes me an awkward human being. (See The Oatmeal on what it's like to work at home.)
The good news is that I'm getting stuff done.
In February, I had a piece in Nature Medicine (subscription required) on experimental vaccines to help treat addiction. These vaccines work by triggering your immune system to detect and sequester drugs -- nicotine or cocaine, for example -- before they reach the brain and tap into its reward circuits. Nicotine vaccines are in late-stage clinical trials, and will probably be the first to get approved.
Cancer vaccines are also hot right now, and I wrote about the career opportunities in this area for NatureJobs. The first cancer treatment vaccine, called Provenge and manufactured by Seattle-based biotech Dendreon, is marketed for the treatment of late-stage prostate cancer. The treatment is expensive ($93,000), but it looks like Medicare plans to cover it. Perhaps for Dendreon, and the many scientists plugging away on their own cancer vaccines, the jobs are here to stay.
For this month's issue of The Scientist, I talked to researchers who are finding new--and sometimes unconventional-- biological indicators of disease. Like analyzing the breath of children to see whether it's possible to pick up early signs of asthma. Or scanning the brains of former athletes for metabolites that signal damaged tissue. Check it out.
At Medscape Medical Students, I have been recruiting physicians and medical students to write and have been doing some writing of my own. In particular, I'm writing for a new series called "Students Are Talking About" which allows me to lurk in the Medscape student discussion forums. (I'm not creepy, I promise!) The latest result of my lurkery is a piece on depression in medical school. (You have to have a subscription to access the article, but signing up is free and easy.) It's not big news that many medical students are depressed or burnt out, as I mention in one of my previous posts, but researchers have really started getting a grasp on how having poor emotional health can affect the education of future doctors.
Addiction, cancer, depression. I just realized that I've been working on some super heavy stuff. Perhaps I need to take on a lighter topic?
The study of medical students
I recently signed on as a freelance clinical editor with Medscape Medical Students and have been busy learning the ropes. As part of the adjustment process in my exciting new role, I have been learning more about what medical school is like. Rifling through studies, blogs and tweets has allowed me to get inside the heads of medical students. (And as a result, I may never go see a doctor again.)
During my immersion into the world of medical education, I have been assaulted by acronyms such as OSCEs, MSREs and USMLE. What the heck are shelf exams? When do rotations happen, and what's the residency match process like? These are the basics that I need to absorb, pronto.
I was digging around on PubMed the other day when I noticed the plethora of data on medical students, on everything from their mental health to study habits. As an outsider, the fact that there's so much data is somewhat surprising. Medical training seems so steeped in tradition. How has studying it helped bring about change for the better? Maybe it is changing. At least there seems to be open dialog about medical education's unfortunate side effects -- however difficult those are to remedy. Here's what I've found so far:
There's a lot of talk about burnout and depression. About 53 percent of med students have burnout -- which includes emotional exhaustion and feelings of professional inadequacy -- according to a survey of about 2500 students from 7 US medical schools. Perhaps not surprisingly, the burnt bunch was more likely to report having done something dishonest, like cheat. Another recent study from JAMA found that 14 percent of medical students (at the University of Michigan) report symptoms of moderate to severe depression. What's more, roughly 5 percent of the 505 students surveyed reveal that they've had suicidal thoughts at some point during training. Although these reports acknowledge the stigma attached to depression, it's easy enough to find future doctors having an honest conversation about it, in blog posts like this one.
Medical educators seem to be increasingly concerned with teaching empathy -- or could it be that I'm new to this topic? Studies show that empathy erodes during medical training (although some researchers say that finding is exaggerated). Still, it's hard not to notice anecdotes coming straight from the exhausted trainee. In a poignant blog post on Medscape, for example, psychiatry resident Kendra Campbell explains how not getting her basic needs met -- namely, sleep and food -- made her resent her patients during an 18-hour shift. Her essay appears to have brought all sorts of medical-trainee-internet-lurkers out of the woodwork, many saying that they can relate.
Some schools are making empathy part of their curricula. Robert Wood Johnson Medical School in New Jersey has a "Humanism and Professionalism" component to third-year rotations that includes blogging about clerkship experiences and debriefing after significant events, among other things. The University of Massachusetts Medical School tested a "human factors" day-long course that includes efforts to improve empathic communication in medical students, with some positive results.
In any case, it seems there is still room for improvement at the bedside. Physicians tend to miss most opportunities to respond to their patients' emotions with empathic statements. Perhaps just being reminded of this problem will help student doctors fight it.