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Medical Student Syndrome

By Sujata Ojha, MS – III

This article was originally published in the July/August 2022 issue of the Tarrant County Physician.

As medical students, we have an incredible opportunity to discover a vast amount of medical knowledge, learn about the normal and the pathological, and to immerse ourselves in clinical settings where we witness the complexity of diseases. In the process of learning about life-threatening diseases, the risk of nosophobia, or illness anxiety disorder, can develop. More commonly termed “Medical Student Syndrome,” it is a concept that medical trainees are well acquainted with. 

What is Medical Student Syndrome? It is the phenomenon that causes fear of contracting or experiencing symptoms of the disease that the students are studying or are exposed to.  

Medical students learn the pathophysiology, the diagnosis, the treatment, the prognosis, the best-case scenario, and the worst-case scenario of diseases. We learn about teenagers diagnosed with melanoma and hear stories about patients in their early 20s diagnosed with breast or cervical cancer. The worst-case scenario tends to grab our attention. This reinforces us to not ignore a patient or symptom that doesn’t follow the general pattern of the disease, allowing us to widen our baseline scope of clinical suspicion when it comes to debilitating pathologies. The constant medical stimulation and limited clinical experience earlier on in our education can cause students to become preoccupied with symptoms and construct connections between what we are experiencing with the worse-case scenarios we learn about. 

“I booked an appointment with the dermatologist because I thought I had a melanoma,” said one classmate after we shortly finished our dermatology unit. After undergoing a biopsy, the classmate discovered that the melanoma in question was a benign nevus. During the cardiopulmonary block, another medical student said he went to the ER after experiencing mild epigastric pain and tachycardia, thinking he was experiencing symptoms of atypical myocardial infarction. He had recently encountered a patient in his late 30s with a history of MI who presented with similar symptoms, further reinforcing the “worst-case scenario” in this trainee’s mind. After hours spent in the ER, he was diagnosed with gastritis and sent home with a prescription for a proton-pump inhibitor. 

Throughout my medical training, I have heard countless stories resembling these. This is not an uncommon phenomenon that trainees experience. It is a topic that everyone in medicine is familiar with, whether through personal anecdotes or through stories discussed with classmates, mentors, and acquaintances. Understanding the complexity of medicine takes more than four years of medical school. Medicine is a field that requires life-long learning and an internal motivation to be updated with evidence-based practice. Expertise comes with clinical experience and after encountering numerous successes and failures. I believe that these experiences can help future physicians connect with their patients more effectively. If we as medical trainees can fall victim to an overwhelming fear of vague symptoms, how can we expect our patients with limited medical knowledge to be immune to this? With Dr. Google, a benign tension headache can be escalated to look like brain cancer. Understanding these fears and reflecting on the days when we experienced these uncertainties can bridge the gap in patient-physician encounters. It allows us to effectively address the patient’s fears without judgement, urging us to educate our patients about their symptoms instead of dismissing or minimizing them. 

Medicine on the Road

by Sebastian Meza, OMS-I

This article was originally published in the July/August 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Texas is suffering a healthcare crisis from a lack of practicing physicians. This fact is even graver in rural communities, where the nearest hospital might be a couple of hours away. It is time that we take medical care closer to these vulnerable patients, and that is where mobile healthcare clinics can offer an efficient solution.

As a first-year medical student at the Texas College of Osteopathic medicine, I was fortunate enough to serve with the Pediatric Mobile Clinic at the Health Science Center. To picture this mobile clinic, you must imagine a bus or RV that has been transformed into a fully functional pediatric clinic. It might seem like there would not be much space in the mobile unit, but it is fully equipped to perform many medical services. The unit carries out vaccination drives, full screen wellness check-ups, sports physicals, and much more. It is a small glimpse into the future of medicine.

Looking back at my very first day serving as a student doctor, I did not know the extent of what the pediatric mobile clinic could do. My first patient came in and presented with learning difficulties, café au lait spots, and some vision problems. It was an enormous surprise to find myself examining a possible case of neurofibromatosis, a rare disease that we had covered just a few days prior. I left that day thinking about how this child would not have been able to receive care or be referred to a specialist if the Pediatric Mobile Clinic had not shown up at his school. I felt grateful and fortunate to have been there to serve the children of our Fort Worth community.

It was not until I had a chance to serve in this mobile unit that I realized that this concept was a great solution for Texas’ rural communities. Mobile clinics bring medical services to areas that are hours away from major cities with large medical centers. These clinics are easily adaptable and can be transformed to house many different kinds of practices. They operate much like a regular clinic; patients can look up when the mobile clinic will be near them and then schedule appointments online. Primary care practices can take full advantage of transforming and adapting the mobile units to serve a specific patient population. 

For example, mobile clinics can directly help many underserved communities by being closer to patients, which saves time and transportation costs that can often be barriers to seeking treatment. Mobile health clinics do require an initial capital expense for institutions and hospitals. However, they bring in enough revenue to cover their own costs, they draw patients into the sphere of the base clinic or the hospital, and they help keep our community healthier. 

I did not expect to feel so strongly about the concept of mobile healthcare clinics when I first set foot onto that crowded bus, but it is impossible not to recognize how efficient it is to have mobile clinics at our major schools and hospital institutions, as well as in rural communities. These mobile clinics should be part of our vision for the future of healthcare. It is time to advocate for more mobile clinics on our Fort Worth roads!

Behavioral Health to Combat Physician Burnout

By Sofia Olsson, MS-I, and Anand Singh, MS-I

This article was originally published in the July/August 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Burnout is not a new term for physicians. In fact, prior to the pandemic, an online survey conducted by the American Medical Association in January 2020 found that there was an overall physician burnout rate of 46 percent.1 Unfortunately, the pandemic has exacerbated burnout for physicians due to a multitude of unprecedented factors. Burnout can be defined by three main symptoms: exhaustion, depersonalization, and lack of efficacy.2 Physicians may exhibit harmful behaviors as coping methods in response to burnout, so it is important to acknowledge behavioral health as it addresses how individuals’ daily habits and actions impact their mental and physical health. As two medical students, we founded Behaviors Supporting Mental Health (BSMH) to raise awareness surrounding behavioral health for all individuals. For our current campaign, we are focusing on physicians’ response to burnout. Through BSMH, we hope to provide resources for physicians to address their behavioral health and reduce or prevent burnout.

Continuous refinement of our daily habits, actions, and behaviors leads to better
mental and physical health. 

First, though, we want to acknowledge the prevalence of burnout and what factors are contributing to this phenomenon. According to research conducted by the Agency for Healthcare Research and Quality, the cause of physician burnout is multifactorial.3 The study found that some of the main causes of physician burnout are tied to physicians having to balance family responsibilities, work under time pressure, deal with a chaotic work environment, have a low control of pace, and implement electronic health records.3 Unfortunately, physician burnout has been linked to consequences such as lower quality of patient satisfaction and care, physician alcohol and drug abuse, and even physician suicide.2 Therefore, addressing physician burnout and combatting unhealthy behaviors are critical for physicians themselves as well as for the patients they serve.

The activities physicians partake in can impact their risk for burnout, so assessment of one’s behavioral health is important regardless of current mental health. Several coping strategies, such as making an action plan, taking a time out, or having discussions with colleagues, have been correlated with a lower frequency of emotional exhaustion in physicians.4 On the other hand, keeping stress to oneself has been associated with a greater frequency of emotional exhaustion.4 After making note of behaviors and identifying their purpose, one can decide whether these actions should be eliminated, continued, or supplemented.5 Changing behaviors, however, is easier said than done. Since useful coping skills are not “one size fits all,” BSMH aims to provide resources that help physicians build a toolkit of ways to improve their behavioral health. For example, the app Provider Resilience, designed by the Defense Health Agency, functions as a method to keep physicians motivated and hold them accountable in their behavioral health.6 The QR code shown is a link to the BSMH website (https://tinyurl.com/bsmhproject), which includes further resources tailored to prevent or relieve burnout in physicians. Our contact information can also be found here for anyone with questions or a desire to collaborate.

Continuous refinement of our daily habits, actions, and behaviors leads to better mental and physical health. Regardless of the extent of a physician’s burnout, addressing behavioral health is always a necessity. Intentional actions impact one’s identity as a physician and any other role they have outside the clinic. Transitioning one’s behavioral health from passive to intentional can improve one’s ability to balance familial responsibilities, work under pressure, and deal with a chaotic work environment.2 This puts physicians in control of their behaviors and decreases their risk for substance abuse and suicide while improving the quality of patient care.7,8 Meaningful reflection and continuous behavioral health improvement creates a healthier mindset that allows physicians to better care for their patients and themselves.  

References

1. Berg S. Physician burnout: Which medical specialties feel the most stress. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-which-medical-specialties-feel-most-stress. Published January 21, 2020. Accessed May 18, 2022. 

2. Drummond D. Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Fam Pract Manag. 2015;22(5):42-47.

3. Physician Burnout. Content last reviewed July 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html      

4. Lemaire JB, Wallace JE. Not all coping strategies are created equal: a mixed methods study exploring physicians’ self reported coping strategies. BMC Health Serv Res. 2010;10:208. Published 2010 Jul 14. doi:10.1186/1472-6963-10-208

5. Hem, Marit Helene, et al. “The Significance of Ethics Reflection Groups in Mental Health Care: A FOCUS Group Study among Health Care Professionals.” BMC Medical Ethics, vol. 19, no. 1, 2018, https://doi.org/10.1186/s12910-018-0297-y. 

6. Provider Resilience. Version 2.0.1. National Center for Telehealth & Technology. 2021.

7. Harvey, Samuel B, et al. “Mental Illness and Suicide among Physicians.” The Lancet, vol. 398, no. 10303, 2021, pp. 920–930., https://doi.org/10.1016/s0140-6736(21)01596-8. 

8. Panagioti M, Geraghty K, Johnson J, et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Intern Med. 2018;178(10):1317–1331. doi:10.1001/jamainternmed.2018.3713

Medicine Has No Borders

by Aiyana Ponce, OMS-I

This article was originally published in the May/June 2022 issue of the Tarrant County Physician. You can read find the full magazine here.


As a high schooler attending a medical magnet school, my first patient interaction came early, but the lesson I learned that day has influenced the type of physician I hope to become. Nervously, I greeted my first patient, Laura, and informed her that I would be assisting the nurse that day. I helped with her bath and brushed her hair with care, just as I brushed my own mother’s hair when she was hospitalized. Laura was blind and her tracheostomy tube prevented her from speaking, but despite that initial disconnected feeling, I was told, “The goal should be to take care of the patient as if she were your own family member.” That goal was to serve with compassion and empathy. These words have remained with me each time I have interacted with a patient. I took lessons such as this one with me after graduating and made it my mission to maximize my impact on others while serving my community.

Over spring break this year, I participated in a medical mission trip to Guatemala with 35 of my peers. Over the course of five days, we traveled by air, sea, and land to visit Santa Maria de Jesus, Magdalena Milpas Atlas, Monterrico, and San Juan, where we saw over 600 patients. Upon arrival at the pop-up clinic locations that were normally schools or church community rooms, there was often an impressively long line that formed before doors opened. Patients waited hours to be seen each day, and that was a humbling sight. 

As a first-generation American raised in the U.S.-Mexico border region and a native Spanish speaker, I served as a link between patients, physicians, and medical students. My responsibilities were to initially take patient’s vital signs and blood glucose readings and then discuss their medical history and chief complaints so I could give the information to the attending physicians volunteering with us. Other days, I had the opportunity to work with a student partner and conduct full patient interviews. We would present our differential diagnoses to one of the attending physicians and work alongside the patient to create the best plan of care. On one of these days, I noticed that a patient came in particular distress. Upon my initial analysis, I noticed that he had what I call “working hands.” Large, dry, and calloused, they resembled the hands of my construction laborer father. As soon as I introduced myself by saying, “Buenos días, mi nombre es Aiyana,” his demeanor changed entirely. One moment he was shyly nodding and following the motions, and the next he looked up, seemingly comforted by familiar words. He, like many others, opened up and provided critical information necessary for his recovery. This change in demeanor occurred patient after patient, and I began realizing how incredible it was to contribute to the enhancement of patient care that would otherwise be limited by communication barriers. I am proud of my work as a translator, but I learned that there is far more that goes into quality of care than a shared language. Though some physicians and students were limited by language, I witnessed spectacular uses of eye contact, hand motions, diagrams, and body language – all of which portrayed a genuine desire to connect with and educate patients. Everyone seemed to have an impeccable awareness of their patients’ needs and feelings, despite their differences.

 As soon as I introduced myself by saying, “Buenos días, mi nombre es Aiyana,” his demeanor changed entirely. One moment he was shyly nodding and following the motions, and the next he looked up, seemingly comforted by familiar words.

It is a privilege to be entrusted to care for the life of another human being and I do not plan on taking such a responsibility lightly. It is important to acknowledge that one does not need to travel to faraway lands to serve those in need, as many underserved individuals are likely residing minutes away from us right now. In the future, I will continue to participate in mission trips abroad in addition to serving the local community, wherever I go! 

The Delicate Dance of Disseminating Information

By Siri Tummala, MS-II

This article was originally published in the May/June 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

“Cranial nerves two through twelve intact. Sensation is absent to light touch in right C5 and C6. Strength five out of five in bilateral upper and lower extremities. Bilateral hyperreflexia noted in patellar reflexes. No gait abnormalities,” I recite to my neurology preceptor. I quickly tap my right foot in nervous anticipation of disseminating the physical examination findings and their implications to the patient. 

Context is everything. One year ago, abnormal neurological findings on an Objective Structured Clinical Examination (OSCE) would excite me. It was a free space to explore various pathologies in depth without fear of harming the patient. But this is not an OSCE. Gone are the days when hired actors pretended to be patients with medical cases. This is the real world with patients experiencing debilitating symptoms presenting to clinics. Now, abnormalities are not just an opportunity to see topics I learned in class or in a textbook last year come to life. Rather, abnormal physical exam findings in the real world can have devastating effects on individuals’ lives and on their overall wellbeing. 

Informing patients about abnormal findings that warrant further imaging is not an easy task. I take a deep breath and knock on the door. I calmly deliver the news that his neck pain, hyperreflexia, as well as his numbness and pain in the middle and pinky fingers necessitates an MRI of the cervical spine for evaluation of possible cervical degenerative disc disease. 

“So, I won’t know if I have that disease until I get the MRI?” asks the patient.

“Yes, that’s correct. Imaging is a tool we can use to confirm our clinical findings,” I reply. 

The patient’s body starts to reflect the stress he feels from this information. Sweat beads form on his forehead. His brows furrow. His lips quiver. 

“But it won’t be until a couple of weeks that I can get the MRI and have the results back,” he worriedly says. 

I sense his uncertainty, and I spend twenty extra minutes with him. I calmly explain that it is normal to feel anxious about the unknown. I further explain that imaging is a helpful tool we can use to confirm our clinical findings. I reassure him that physical exam findings and imaging results together will allow us to formulate an efficacious treatment plan to fulfill his goal of improving his symptoms. 

Our job as healthcare professionals transcends purely applying medical knowledge to real-life settings. The quality of the medical information we give patients is valuable only if it is delivered in an understandable manner that takes into consideration how that information affects their daily lives. If the pathology is prioritized over the patient, medical care will not suffer, but the patient will. Given that our primary duty is to ensure the wellbeing of patients, patient encounters are more fruitful when extra time is spent explaining the importance and relevance of the information. It takes years to fully master medical topics for medical students who spend all day studying and are constantly immersed in the material. It is not a fair expectation to assume that patients will recognize the significance of and be able to apply health recommendations without a clear and thorough explanation by the caregiver. Patients are real people, and this recent encounter reminded me that entering medical settings is a vulnerable situation that requires physicians to acknowledge their experiences with care and compassion.

TCU Medical Student Publishes Two Children’s Books

By Prescotte Stokes III

You can find the original article here.

During a short break from medical school during Summer 2021, Sereena Jivraj, a second-year medical student at the TCU School of Medicine, had a burning desire to create something.

She combined her love for science, medicine and children for something special. She made the most of her time by writing two children’s books entitled, “Connor and His Composting Adventures” and “Ella and Her Vaccine Soldiers.”

“I’ve had these ideas in the back of my mind for some time,” Jivraj said. “I’ve spent so much time around children whether that was tutoring or babysitting and I’ve always been reading children’s books for years and it just felt like I’ve been so involved with kids in the past that it would be cool to keep it going in the future.”

Sereena Jivraj, a second-year medical student at the TCU School of Medicine, holds her newly published children’s books entitled “Connor and His Composting Adventures” and “Ella and Her Vaccine Soldiers.”

In “Connor and His Composting Adventures,” Connor learns what the difference is between compost and regular trash. Throughout the course of the story Connor learns what everyday items can be composted and how to prevent trash from ending up in a landfill.

“The point is just to educate kids and even parents on what composting is,” Jivraj said. “A lot of people when you speak to them about it they’ve never heard of it. What I really wanted to do is be able to instill that knowledge from a young age. Hopefully that will make it easier to make changes in our society one day in the future.”

Her second children’s book called  “Ella and Her Vaccine Soldiers” is about young Ella’s visit to her doctor. Ella learns how important vaccines are and how they can turn into “mini soldiers” to help her body fight viruses and diseases.

“With COVID-19 around last few years and previously with flu shots, I can remember everyone being afraid to go to the doctor just because they knew a shot was coming,” Jivraj said. “I want kids’ fears to be diminished so they can have a healthy relationship with their doctors and not fear them because you’re really brave when you get these vaccinations. I don’t want this fear of vaccines to prevent you getting the help that you need.”

Writing the books was a process that helped Jivraj tackle some of her own issues with long form writing. She reached out to the medical school’s Compassionate Practice® team after she did some volunteer work gathering donations for homeless individuals in Fort Worth and felt compelled to pen a poem about her experience.

“I used it as a way to get out my emotions and help me decompress,” Jivraj said. “I went to the Compassionate Practice® team and that kind of gave me the confidence to do this because I always felt like writing was my weakness.”

She also talked to Samir Nangia, M.D., a Physician Development Coach at the medical school, about the idea of penning the children’s books. During their chats, Dr. Naniga said that her urged Jivraj not to put her ideas off and take some time during her break to pursue them.

“In some instances, through coaching we can help students become more efficient with their time management and help them discover what resources they need to make their dreams a reality,” Dr. Nangia said.  “However, in some instances all it takes is that motivation and emotional support.  Both of which were true in Sereena’s case.”

In addition to embracing her creativity, Jivraj said that she chose to author children’s books so the information would be easy to understand and accessible to all people.

“This is a book that you can read to your child in your belly or read to your newborn,” Jivraj said. “Because just exposing them to the vocabulary and to the words it helps create those processes in their brains so when they are exposed to it later on, they are not completely confused about it.”

Both books “Connor and His Composting Adventures” and “Ella and Her Vaccine Soldiers” are available in the Amazon Store as a download or paperback version. They are also available to download on Kindle.

Booked Up Together

A Tarrant County Physician Student Article

by Brittany Shah, OMS-II

This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.


Deciding to become a doctor meant comparing myself to numbers my whole academic career. In high school, I put my self-worth in my class rank and SAT score. In college, my sense of self relied heavily on my GPA, MCAT score, and volunteer hours. Getting anything less than an A (which happened more often than I would like to admit) sent me into a spiral of anxiety. I found myself scouring through online forums such as Reddit and Student Doctor Network to see where I stacked up to my peers. I would compare my GPA and MCAT score to the acceptance data provided by schools to determine if I was truly worthy of applying to that school. The uncertainty and stress of being a pre-medical student caused me to value numbers over relationships, but I told myself that one day, it would be worth it.

The sad reality was that in an effort to succeed, I had isolated myself emotionally and physically. These numbers I was chasing had come at a cost – I had become so single-minded that I had conditioned myself to study alone. I found class, study groups, and review sessions pointless because, in my mind, I was counting the hours down to when I could be alone at my desk, studying how I thought was best. 

I started medical school in 2020 during the height of the pandemic. I had a positive mindset going in, but the first semester was one of the hardest times of my medical career. The forced social isolation stripped me of any sense of drive. I started missing class, my mental health declined, and my grades reflected my inner turmoil. The propensity for self-imposed seclusion that I had developed came back with a vengeance and worsened my cycle of apathy and misery. I struggled silently. 

Things did not get much better during my second semester, so when I saw a classmate post about forming a study group called “Booked Up Together” over Zoom, I figured it was at least worth trying. As dramatic as this sounds, there was a little voice in my head telling me that I needed to admit that my way was not working, and I had to try something different. Let me tell you – I am so glad that I listened to that side of myself. Time that would have normally been spent alone in my room was now filled with friends quizzing each other and breaking down lecture material in a way that was easier to understand. Joining Booked Up Together was hands-down the best decision I have made since starting medical school. I started going to class, my mental health improved, and my grades got better. I became friends with warm and genuine people who helped me see the importance of not going through school alone. Study group became a safe space – I knew even on my bad days, there were people who understood and related to the pressure and stress. 

Healthcare is multifaceted. As physicians, we will work together with different specialties and healthcare workers to ensure our patients receive the best care possible. While we are told that medicine is collaborative, the journey through medicine often feels solitary. I suppose it seems obvious now, but it is vital to protect our humanity while going through medical education not only for ourselves but for our future patients. For me, studying with my classmates reminded me that medicine at its root is a collective field, and while it is easy to get swayed by numbers and resume building, it is also important to remember why we decided to become physicians in the first place. What worked for me might not necessarily work for someone else, but I believe finding an avenue to collaborate is a beneficial way to stay connected with that part of yourself. Medical school is hard but going about it alone is even harder. 

Navigating Blindly

Kristian Falcon, OMS-III

This article was originally published in the November/December issue of the Tarrant County Physician. You can read find the full magazine here.

“Si se puede!” (Yes, you can). . .

. . . is what I have been told throughout my life by my parents and by my entire familia. Being the first ever in my family to go into the medical field is a commonality that many Hispanic students share. My father emigrated from Mexico at the age of 18 and had to delay attending university to first learn English. My mother immigrated here at the age of 26, after already holding a teaching license and an equivalent master’s degree in Mexico. She had to redo her education after first learning English to regain her teaching license in the U.S. 

Learning English at the same time as my mother was no easy feat. She taught me my vowels and how to read while we taught her proper syntax and English grammar. When it came time to apply to college, how was I supposed to ask my parents to revise my application essays since when growing up, I was the one who edited and revised their emails and text messages?

When I began college, my father asked me, “What are you going to do with a degree in biology?” to which I responded, “Be a scientist.” He wasn’t asking because he didn’t believe in me; he was asking because he truly didn’t know what I could do with such a degree, and to be 100 percent honest, I didn’t either. Becoming a doctor was not a thought I had before; I fell into this path through getting involved with my passion to serve others and my interest in science. Once I realized that I pictured my future self as being a physician, my family grew concerned about the difficult path I would face. They suggested alternative careers, knowing that no one from our family had ever gone down this path before and that many who try, fail. 

Maybe I was naïve and didn’t do the proper research on what a career as a physician entailed, but without any guidance, I faced only my short-term goals, one at a time. What I didn’t realize was that becoming a doctor involved much more than just meeting specific checkboxes. It required immense dedication, time, and sacrifice. 

At times, I questioned if I even belonged in medical school. During my application process I was told, “You only interviewed there because you’re Hispanic and speak Spanish,” or “You’re lucky you’re underrepresented in medicine; you’ll get accepted anywhere.” I was continually discredited of my merits and accomplishments because of my ethnicity, even though I had years of volunteering, research, and experiences in the medical field as an EMT, and had not only a bachelor’s but also a master’s degree. Upon entering medical school there were less than 20 Hispanic medical students in my class of 220. Hispanic students make up only 15 percent of the student population of all the health professional colleges combined in the health science center I attend, while in Texas, the Hispanic population comprises roughly 40 percent of the state’s population. 

Lacking representation and not having mentors who had faced similar paths, I struggled to fit in and find my place. While many of my colleagues had family and friends that were doctors, I grew up not knowing a single person in this field besides my own doctor. I faced obstacles because I had to find resources on my own to help me accomplish my goals. Every medical experience, preceptorship, or shadowing opportunity was one I went out and found on my own; I didn’t have the luxury of growing up with those opportunities around me. I carved my own path.  

Within the first month of my third year, I was reminded of the importance of having Hispanic representation in the medical field. I attended to many patients who were Hispanic and spoke only Spanish. While medical translators are vital and do an amazing job of communicating adequately with a patient when there is a language barrier, being able to communicate directly and relate to a patient forms a bond unlike another. Conversations with a translator can sometimes be procedural and very formal; being able to communicate freely in one’s own language allows for a more human interaction and a better understanding between a provider and a patient. 

It is the moment when I see a patient become more animated and more comfortable that I remember why I chose this career and that I bring more representation to this field. I remember why I chose to be the first in my family to carve this path, and why I choose to be involved in leadership and advocacy so that many others like me can take this path a little less blindly. While I still have over a year left until I graduate and become a physician, my message to those who seek this path is, “Si se puede!”

A Love Letter to the Community

by Rachel Marie G. Felix, OMS-II

This article was originally published in the September/October issue of the Tarrant County Physician. You can read find the full magazine here.

by Rachel Marie G. Felix, OMS-II

If everything I’ve learned in medical school thus far, my favorite realization has been that I love people. Given the fact that we live in a society rooted in individualism, becoming aware of this fundamental truth of mine was not as straightforward as it sounds. Especially when being part of the medical field, where there is constant pressure to compete, accomplish extremely taxing feats, and be the best all-around people we can possibly be at all times. From a young age, those who pursue medicine are conditioned to hyper focus on their individual accomplishments. However, through guidance from my extraordinary mom, support from my childhood loved ones, and interactions with my incredible classmates, I’ve come to truly understand my “why,” and it’s all for the community.

With a jam-packed schedule and overflowing course material, during the first few weeks of medical school I knew I had to take time to contemplate who I was and what I wanted from life, or else I would risk losing myself to the grind. And from deep reflection and unlearning during the Black Lives Matter movement, I realized that I thrive when I am able to contribute to the joy and wellbeing of those around me.

What came from living daily in this truth was life altering. I found myself soaking in every conversation shared with my mom and truly learning the depth of her selflessness. I challenged myself to go on a medical mission trip to help those with limited access to healthcare and was overwhelmed by both the support from my family and friends and the gratitude from those we were able to serve. I would even go to campus completely open to meeting new people and end up having such enjoyable conversations. This would lead to sessions of vulnerability and genuine connection, leaving me feeling enriched by the opportunity to appreciate the different sides of each classmate-turned-friend.

As I made a point to cherish each interpersonal opportunity, I realized just how fulfilling every day can be when we immerse ourselves in community. Yes, we can say we show appreciation for our communities through volunteering or even through our careers, but intentionally showing how much we care for one another as a regular practice is a lifestyle that I highly recommend. While there are many outside influences that can cause us to get caught up in our own worlds and participate in a zero-sum game, the truth is, there is abundance in the shared human experience. We are each beautifully complex and different beings with something unique to contribute to one another. So when one of us wins, we all win.

Conversely, we all hurt when one of us hurts. As made obvious by the pandemic, a flourishing community depends on the health of its people. So dear reader, I hope you are able to appreciate the unparalleled opportunity we have to positively impact those around us as healthcare professionals. Moreover, I hope you see how valuable both you and your patients are in creating a thriving community and allow every interaction—inside and outside of the clinic—to reflect that.

Am I Really Cut Out for This?

Imposter syndrome and how the little monster brings us down.

by Ashley Brodrick, OMS-III

This article was originally published in the July/August issue of the Tarrant County Physician. You can read find the full magazine here.

“Am I really cut out for this?” A question most medical students have asked themselves time and time again. Imposter syndrome is this little monster in the back of our minds that tells us we are inadequate; it grows every week, with every test, and with every medical encounter. It tells us we are destined to fail. It tells us we are never going to make it, we are never going to learn, and we are never going to be good doctors. This little monster puts doubts into our minds about our ability to be successful physicians. If you are lucky enough never to have been visited by this little monster, I applaud you.

Medical school is this arduous four-year journey that tests us mentally, physically, emotionally, and sometimes even brings us to our breaking point. Why is medical training so taxing on our emotions, leaving us feeling empty, drained, and questioning if we are made for this career? Medical school is competitive by nature, with a national acceptance rate of 43 percent. This means you must be the “best of the best,” graduating with extraordinarily high GPAs, and performing well on the MCAT. Don’t get me wrong, being a doctor is no easy task. You are responsible for another person’s life, something that I consider to be a tremendous honor. However, at what point do we start to take a step back and reconsider this competitive atmosphere that we have fostered for so long and look at applicants on a holistic level and not just a statistic on a sheet of paper. I can tell you I would rather have a doctor that understands my concerns and listens to me than one who scored in the 99th percentile on their standardized exams but never questions their diagnosis. I would rather have a doctor that IS questioning their diagnostic and treatment decisions for me—not because they don’t know the proper protocols, but because they care about getting my treatment right for me as an individual. M

I am no stranger to imposter syndrome; however, this little monster did not visit me until my second year. My first year of medical school was the year I thrived, leading me to believe that maybe I could make it through without letting that little monster get the best of me. My grades were above average, I was making friends, and I was becoming more confident in my ability to talk to patients (even if it was standardized and following a script). The real challenge for me came during my second year, when my self-doubt started setting in. I was having difficulty connecting the dots and putting everything together. My classmates seemed to be following the right path, understanding how the different diseases connect across organ systems, whereas I felt like I was stumbling every step of the way. Each block presented a new challenge and fed that little monster even more. While I could understand the information and explain it flawlessly to my friends, it was just not coming together on the tests. This inability to perform well on exams did a number on my mental health. You don’t realize how deep into a hole you are until you turn around and realize you can no longer see any light, making it impossible to escape. Each day I would wake up with my heart racing, but you know what I did? I told myself this was normal; this is what medical school is supposed to be like. Stressful, hard, and exhausting, it takes everything out of you along the way, while proving to everyone that you are the “best of the best,” having the highest level of education, being in the top 0.29 percent of the population. The one thing I did not tell myself was that medical school did not have to be this way.

Medical school puts you in a bubble, one that is hard to escape. You are surrounded by medicine 24/7, and during my first two years I found it difficult to talk about anything other than medicine when I was with my friends and family. Every time I went home it was always, “How is school going? Any recent tests? What are you learning now? Making good grades still?” It was never, “How are you handling everything? Is there anything you need help with?” I knew they were trying to show an interest in my education, and genuinely wanted to know what I was learning, but I did not have the energy to go into detail. So, I found myself falling into the same routine of saying, “School is going well, just the same every day. I spend 10 hours in the library and when I get home I take Sadie on a walk, then sit on my couch and watch TV until I do it all over again.” This wasn’t always the case. I was hanging out with my friends, going to dinners, TV show watch parties, doing normal adult things, but whenever I would tell people about this, I would be hit with, “Shouldn’t you be studying? How do you have time for all of that?” I decided it was not worth it to try to please everyone and explain myself, so I shut down and didn’t tell anyone outside of medicine what was going on in my life. To some degree I felt this fed that little monster even more, because I was not sharing all the extraordinary things I was learning. I was not sharing how I was learning to properly perform a physical exam on patients. I was not sharing the complex pathology behind diseases and how to treat them. I was not sharing how I was developing my communication skills with our standardized practice patients. I was not sharing how I was constantly being uplifted and supported by not only my classmates and friends, but also my professors and faculty advisors. Looking back, I think the main reason I decided to suppress and not discuss was because of my imposter syndrome. I felt that if I started to talk about a subject and got one thing wrong, then my months of learning proved nothing, showing that I didn’t belong in this field.

I had this grand idea in my mind of what my clinical years in school would be like, but the pandemic added hurdles and setbacks, which further contributed to my imposter syndrome. I’ve spent most of my third-year rotations online— 60 percent, to be exact—which has left me questioning if I really am ready to begin my residency. I’ve never witnessed a code, never rounded on in-patient care, my note writing skills are lacking, and frankly, I just have not had the experience I feel is necessary to graduate medical school. Thus, imposter syndrome is in full effect for me right now. I made it halfway through my third year when I realized I was just getting to my first full in-person rotation. Thankfully it was OB-GYN, the field I have fallen in love with and will be applying for in the 2022 residency match. I felt comfortable taking a gynecologic history, performing PAP smears, delivering placentas, assisting in the OR, and even having the incredible opportunity of catching a baby. Now, as I am nearing the end of my third year, I realized I had the expectation that I would know so much; however, I feel like I know so little and find myself looking forward to the day when it will all come together. When I look around at my other classmates, I realize I am surrounded by people who were at the top of their class, and while I am one of those people, I still find myself feeling inadequate. I still find myself wondering how they can connect the dots on their rotations and see the big picture. I still find myself wondering how they know what questions to ask. I still find myself wondering simply how they make it look so easy. The one benefit of spending most of my clinical time online is it has allowed me to have time for self-reflection. This year has allowed me to foster relationships with my friends in ways that would not have been possible with a full work schedule. This year has allowed me to make myself and my mental health a priority. Most of all, this year has shown me the amazing support system I have cheering me on every step of the way, especially during the hard times.

So, while I try my best to contain this little monster, there are days when it breaks free from the room it is kept in, and I sometimes am still unable to contain my feelings of being inadequate. When these days come, I’ve learned how to work through them. I remind myself of how far I’ve come to get here. I remind myself of the years of education and knowledge I have gained on this journey. I remind myself of the countless individuals who have supported me, encouraged me, and helped me on this path. I remind myself of what lies ahead, and while it is a long and arduous road, it is one I am happy to be on. Sacrificing the best years of my life to being confined to the library, where I am studying and absorbing an overwhelming amount of information, has been worth it to me. Some might ask why, and the only answer I can give is that whenever I am asked what I would do if I wasn’t in medicine, I honestly do not have an answer. So, this is how I lure the monster back into its room—by reminding myself of my worth, my perseverance, my triumphs, and my successes throughout this journey.

Part of me is curious if it is the competitive culture of medicine that contributes to imposter syndrome, or if it is the self-doubt we carry in ourselves because of how difficult the road is to becoming a doctor. My biggest question going into my fourth year is how do we combat this? How do we tell medical trainees that it is okay to have these doubts; that they are normal, and that you are still learning and absorbing everything around you? How do we tell them that medical school is hard, but you don’t have to endure it alone? I think the answer to these questions is acknowledging that everyone experiences imposter syndrome at least once, and it is okay to have these doubts. It is okay to take a step back and say, “Wait a minute, was that the right call? Was that the right diagnosis? Should I have treated my patient’s condition in a different way?” Acknowledging this monster allows us to not become complacent in our careers, ensuring we are doing the best job that we can. This is a big part of the reason I chose to pursue medicine—the constant educational and learning opportunities, the inability to ever become complacent in your job. My time in medical school has opened my eyes to the type of physician I want to be. I want to encourage and reassure the medical students I will one day work with that it is okay to not know the answer to everything. It is okay to ask questions out of curiosity, even if the answer is something that I view as common knowledge. It is okay to be nervous, it is okay to be scared, it is okay to simply not know things. Medical students are exactly what they are called: students. Here to learn, here to observe, and here to take in everything around them. They should be able to do this without fear of humiliation or being deemed incompetent. I want to be the type of resident that shows my students that I too suffer from imposter syndrome right there with them, and that with the right tools and strategies, it is possible to cage the monster.

My challenge to this generation of physicians is to look back on your time in medical school and think of a resident or preceptor that showed an interest in your education and made you feel like you belonged. Do you think you could have survived that rotation without their help? If you find yourself answering “yes,” I give my applause to you, but if you find yourself answering “no,” hold on to that thought, remembering it for when you have students of your own.

We don’t have to be alone on this journey. We should work together to normalize the conversation around the mental exhaustion medical school creates in individuals. We should work together to lift and encourage our peers. We should work together to ultimately say it is okay to have imposter syndrome, but here is how we can deal with it before it becomes something greater than we can contain.