As the population of elderly people in our country grows, and as air travel becomes more accessible, medical professionals will be increasingly faced with emergencies in the air. During medical school, students are given some preparation for these situations should they arise: for example on my third-year ob/gyn rotation, we received a lecture on how to deliver a baby on an airplane, and during our fourth year, a lecture on handling medical emergencies in the air. However, as I learned when recently confronted with a medical emergency during a flight, it is really the ability to think quickly and adapt to the resources at hand that allows you to best deal with such situations. As providers, it is sometimes easy to forget to take a step back and appreciate medicine as a profession founded on the basic principle of helping those in need, and these situations often serve as reminders of this concept.

plane flying over the sunsetI had never felt less prepared to talk to a patient in my life. I was running on two hours of sleep and had been out of my clinical rotations for almost 10 months; however, when someone called out for a doctor and no one moved, I stood up, knowing that a little knowledge and experience are better than none. When I reached the patient, he was completely unresponsive to the screams of his terrified wife. His head was tilted back, his jaw was slack and his eyes were rolled back into his head. Almost thirty seconds after I reached him, his eyes re-focused, and he regained consciousness, with no memory of the event. His wife explained that he had done the same thing two minutes before, which had prompted her initial cries for help.

Completely on my own to care for the patient, I performed a quick exam, took a history, managed to collect his vital signs and calmed down his terrified family and the panicked flight attendants. The flight attendants kept asking me whether they should land the plane, an enormous decision to make as a medical student, but thankfully one I did not have to make alone, due to the arrival of a family practice physician who had been at the front of the plane and had not heard what was happening. Together, we tended to the family for nearly an hour, and for the remainder of the flight, everyone from passengers to the captain thanked me, ending the flight by clapping for “the medical student.”

quote: The most important piece of any clinical interaction is the doctor-patient relationship ... speaking with the family and keeping them involved was the most valuable asset I was able to provide.

This experience brought me back to the basics of medicine. In a situation with very limited resources, I revisited what patients really expect from their medical provider. The most important piece of any clinical interaction is the doctor-patient relationship, and on this flight, speaking with the family and keeping them involved was the most valuable asset I was able to provide. By maintaining a calm presence, and simply being there for the patient and his family, I was able to offer them some peace of mind until the flight touched the ground. This experience was one that truly humbled me, because it was yet another reminder of how fulfilling medicine can be. In the face of difficulty, you can offer people a shred of hope as a provider, and in the face of fear, you can offer them a soothing smile, a calm voice and the presence of someone who is there in a time of need.


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Rabia Karani

Rabia Karani just completed her M.P.H., and is now finishing up her last year of medical school. She is passionate about any topic regarding patient care and public health. An anthropologist at heart, she is an avid reader, a Harry Potter enthusiast, and she hopes to use her love for writing to inspire understanding between different groups of people.

As an undergraduate, I frequently shadowed physicians and remember vividly many moments and anecdotes from those experiences, many of which would go on to shape my future career aspirations. One of my close mentors, a veteran vascular surgeon at the end of his career, once reminisced about his surgical training at The Johns Hopkins Hospital in the early 1960s, telling me half-jokingly, “During my intern year, I walked into the hospital on the morning of the First of July and didn’t leave its doors for the next year.” He went on to say, “They called us House Staff for a reason. When you’re a resident, the hospital is home.”

Of course, a lot has changed since then. Resident work hours are now regulated by the Accreditation Council for Graduate Medical Education (ACGME), which first instituted work hour restrictions in 2003 after a series of lawsuits, research studies and reports revealed how sleep deprivation and long hours can lead to breaches in patient safety, preventable mistakes, and trainee depression.

Since 2003, these regulations have been critically examined and periodically modified, the subject of an interminable and fervent debate among medical trainees, doctors, politicians and the general public. In 2011, the ACGME revised duty restrictions, banning 30-hour shifts and placing a 16-hour cap on shifts worked by first-year residents. On March 10th, the ACGME Task Force released another revised set of work hour restrictions, which will go into effect on July 1. The new rules increase the maximum shift that interns can work from 16 to 24 hours, plus four hours to ensure safe patient handoffs and allow residents to participate in non-direct patient care educational activities, while maintaining the 80-hour work week limit. Importantly, second- and third-year residents can already work a maximum of 24 hours per shift under the previous rules.

The 2015 Medscape survey results reflect the highest burnout rates among critical care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons reporting burnout.

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In its announcement of the change, the ACGME noted that “the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized … and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole.”

Learning Effective Leadership vs. Resident Burnout

Proponents of the change argue that the longer shifts reduce handoffs between physicians, a key source of medical errors); maintain continuity of care in critical situations, such as during a surgery or immediately following a new admission; and give residents and educators more flexibility to optimize their training. The change also gives interns more opportunity to observe and follow patients throughout the natural course of an illness, especially on the night of admission.

When asked about the goals of the revisions, Dr. Jessica Bienstock, Johns Hopkins Associate Dean for Graduate Medical Education and member of the ACGME Task Force, stated “The Common Program Requirements encourage training programs to teach new physicians how they can be effective participants and leaders of team-based patient care that is the standard of healthcare today … and allow residents to benefit from the personal and professional satisfaction and sense of accomplishment, indeed the meaning and joy, that comes with professional commitment to one’s patients when you care for them in a longitudinal manner.”

Opponents of the change, including Public Citizen consumer group and the American Medical Student Association, argue that sleep-deprived residents are at greater risk of car accidents, needle-stick injuries and depression, and that the vast majority of patients oppose loosening of duty hour restrictions. With increasing awareness of the high rate of burnout, depression and suicide in the medical profession, this rule change has some worried that wellness among medical trainees is still not a top priority.

There is no simple answer. Optimizing duty hour restrictions depends on many competing factors, and it is clearly hard to reach a consensus about what is best for patients and residents. The relationship between duty hours and burnout is a complicated one, as burnout is a multifaceted and complex problem. Research has not always demonstrated a clear correlation between duty hours and burnout. Despite the contentious nature and strong emotions that often overshadow work hour regulations, in the end. patients, residents and medical educators are all united by the same priorities: a desire for high quality and safe medical care, effective and efficient training, and happy, healthy medical trainees.


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Benjamin Ostrander

Benjamin Ostrander is a third-year medical student who strives to keep life infinitely interesting through creativity with words, food, music, medicine and more.

Diet—what and how people eat—is becoming a powerful potential intervention for a variety of debilitating neurological diseases. The ketogenic diet, in particular, has been a well-established treatment for epilepsy for the past century. Yet, even now, physician-scientists are discovering new indications for the ketogenic diet.

Ketogenic diet as a promising treatment for severe intractable epilepsy

The Atkins diet was all the rage in the early 2000s. Now, a diet with a low-carbohydrate emphasis similar to that of the Atkins diet has proven beneficial to an unexpected group of people—patients with intractable epilepsy.

The ketogenic diet is based on a low-carbohydrate, high-fat and adequate-protein composition. Through this diet, the body is forced to burn fats as fuel instead of carbohydrates. The liver converts fats into fatty acids and ketone bodies, which travel to the brain to be used as an energy resource and through the bloodstream, inducing a state called ketosis. Ketosis has been shown to contribute to a reduction in the frequency of seizures.

Ketogenic diet consists of 75% healthy fats, like avocado, 20% proteins and 5% carbs. The CDC recommends the diet as a treatment for epilepsy.

Since the 1920s, the ketogenic diet has been a mainstay in the treatment of pediatric epilepsy, but Johns Hopkins researchers have found that the diet can also be helpful in treating the rare, super-refractory status epilepticus (SRSE). SRSE is a very severe form of epilepsy, characterized by lengthy periods of seizure that necessitate medically induced coma as intervention. There are currently no set practice guidelines for what medications physicians should administer after 24 hours of SRSE.

According to Dr. Mackenzie Cevenka of the Adult Epilepsy Diet Center at The Johns Hopkins Hospital, “ … the ketogenic diet is effective in [treating] one-third of adults with epilepsy who are resistant to traditional anti-seizure drugs.” In a study of fifteen patients hospitalized with SRSE, doctors started the ketogenic diet over the course of 72 hours while patients remained in medically induced comas (1). If patients awoke and had improved conditions, they could eventually change to a modified Atkins diet, which is easier to follow, as a long-term treatment option. Overall, eleven patients (79 percent) were successfully treated with the ketogenic diet, with eight recovering within a week after the onset of SRSE.

Variations of the ketogenic diet exist for patients with epilepsy. The other common nutrition plan, the modified Atkins diet, has been administered to mostly adult patients since its inception at Johns Hopkins in 2002. The modified Atkins diet results in lower rates of seizures in half of patients within a few months of starting the diet.

Overall, diet therapy for various forms of epilepsy for patients of all ages is safe and efficacious. Careful supervision by a neurologist and dietitian, who are well-versed in the implementation and adjustment of the ketogenic diet, is necessary for good patient care, especially for those suffering from severe forms of epilepsy.

References

  1. Ketogenic Diet Shown Safe and Effective Option For Some with Rare and Severest Form of Epilepsy

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Visit the Adult Epilepsy Diet Center at Johns Hopkins Medicine to learn more about how we're using the ketogenic diet as a treatment regime in children with epilepsy.

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Adela Wu

Adela Wu is passionate about making connections between ideas and people, and seeing how her interests in literature, creative writing and medicine play out in that theme. In addition, she also enjoys river and sea kayaking, having recently whitewater kayaked the Shenandoah River rapids.

As a fourth-year medical student at Johns Hopkins, I have had the privilege of working with attending physicians in a number of outpatient clinics. My roles in the clinic have varied. In most clinics, I see the patient independently, take a history, and perform a physical exam. I then describe the course of the illness, medical history and physical exam to the attending physician, as well as share my assessment and plan for the patient. The attending and I then go and see the patient together. Other times, I am less involved in the clinic, perhaps only taking the history independently or shadowing. There are opportunities to write patient notes, ask questions and receive feedback, but the amount and quality of teaching vary between clinics.

students in an ongoing discussion with a professorIn 2015, a group of Johns Hopkins medical students began investigating the factors that contribute to a successful outpatient educational experience for students in the neurology clerkship. They presented their findings at the American Academy of Neurology meeting last year. In collaboration with the neurology clerkship directors, they surveyed 67 students who took the neurology clerkship between 2014 and 2015. They found that students were significantly more likely to perceive a clinic session as an “effective educational experience” for each additional patient they interviewed, presented, and documented. In other words, students felt that they learn more when they are actively involved and have greater responsibilities.

In addition, the group also explored how students impact the clinical productivity of the attending physicians. This information is critical because of the widespread perception that medical students hinder clinical productivity, as attendings must juggle supervisory and teaching roles with patient care. Therefore, the group catalogued relative value units (RVUs), a metric for assigning value to clinical activities and a measure of clinical productivity, per clinic session with and without a student for 43 attending physicians.

study findings: Surprisingly, the majority of physicians (74 percent; n=32) had 42 percent more RVUs per clinic session when a medical student was in clinic, compared to the same clinic without a medical student. Surprisingly, the majority of physicians (74 percent; n=32) had 42 percent more RVUs per clinic session when a medical student was in clinic, compared to the same clinic without a medical student. This increase is most likely because in the time that the student sees the patient, attending physicians can simultaneously see a second patient or finish patient notes. Furthermore, the RVUs per clinic session significantly increased as the number of patients that students interviewed, presented and documented increased.

This study suggests that medical students can be actively incorporated in outpatient clinics in a way that is mutually beneficial for both the student and the attending physician. Students feel that they receive a greater educational experience when they are actively involved, and they can also increase the productivity of the preceptor.

One limitation in this study is that only neurology clinics at Johns Hopkins Hospital were surveyed. This work is still under review, but the next phase is to examine the generalizability of the conclusions across medical specialties and institutions. Currently, I am working together with Stephanie Zuo, another Biomedical Odyssey blogger, to extend this study to the pediatrics and women’s health clerkships at Johns Hopkins. Our hope is that this project can improve the outpatient educational experience for future medical students, as well as encourage attending physicians to participate in medical education.

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Alisa Mo

Alisa Mo is an M.D./Ph.D. student who's passionate about the intersection of neuroscience, genomic medicine and society. She’s also a pianist and enjoys cooking.

Seven medical students shuffle through the narrow doorway. One of my classmates steps forward and addresses the patient. “Hello, Mr. M. How are you doing this morning?”
Mr. M. does not respond.
“Mr. M.? Mr. M.?” The student shakes the patient’s shoulder vigorously. The student feels for a pulse. “I have a pulse, and I see chest rise.” We all release half a breath: The patient is not in cardiac arrest. But why can’t Mr. M. respond?

Patient and doctors in the emergency roomFortunately, Mr. M. is not in any danger because Mr. M. is a mannequin. But this is no mere plastic simulacrum. Mr. M. really does have a pulse. He has lungs that inflate to lift his chest. He can be shocked, intubated and examined for neurological deficits. Mr. M. is a $100,000 machine built for simulating emergency medicine. And he is also a forgiving instructor to green second-year medical students just learning to translate textbook medicine to the hospital bedside.

Medical school is traditionally divided between two years of classroom-based instruction in physiology and the mechanism of disease, and two years of hospital-based training. On the wards, medical students rotate through each of the core specialties for several weeks at a time: internal medicine, surgery, pediatrics, obstetrics/gynecology, neurology and psychiatry. The transition between these two phases of medical education is, unsurprisingly, associated with significant intellectual and emotional shock. Students are no longer full-time learners solely responsible for expanding their own knowledge. In the hospital, they become active participants on the medical care team, accountable to patients and professional colleagues as well as to their own learning.

quote: At this stage of education, it’s all about introducing and drilling in the basics. Mnemonics are (literally) lifesaving tools used to bridge the gap between learning a medical principle and internalizing it. To better prepare soon-to-be third-year students for the rigors of hospital medicine, the Johns Hopkins faculty developed the Transition to Wards course. The three-week class concentrates its efforts on common early stumbling blocks faced by medical students. Students review the interpretation of frequently used diagnostic tests, revisit the principles of biomedical ethics, train in basic procedural skills and learn the steps for initial management of an acutely ill patient.

At this stage of education, it’s all about introducing and drilling in the basics. Mnemonics are (literally) lifesaving tools used to bridge the gap between learning a medical principle and internalizing it. One classic for acute care: “When a patient is sick, say ‘OMI!’—oxygen, monitoring and IV access.” The transition course provides room for mistakes without human consequence during the steepest part of the learning curve.

Why can’t Mr. M. respond? Oxygen and monitors are hooked up, and the IV is open. He is not in cardiac arrest. Heart rate, respiratory rate and blood oxygenation look good, but his blood pressure is concerning at 144/80. Two years of pathophysiology kicks in. My teammates call out potential causes for unconsciousness, and side conversations instantly spring up, each pair or trio debating a different diagnosis. Another classmate, silent until now, suggests in a clear, crisp voice that we check a finger stick blood glucose.

I want to high-five her for her insight: Low blood sugar is one of the most common causes of nonresponsiveness — obvious in retrospect, but it’s astonishing how few concepts are obvious to a medical student struggling to diagnose an active problem. We check the blood sugar; it’s a third of what it should be. We give glucose, and slowly, Mr. M. comes to.
A small victory, perhaps. Hypoglycemia is not a difficult or complex diagnosis. But a team of my classmates examined, diagnosed and treated a simulated patient for a potentially lethal condition. My classmates saved a life. That’s enough to put a spring in my step.


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Carson Woodbury

Carson Woodbury relishes a good detective story. Drawing early inspiration from Scooby-Doo’s Mystery gang, he fell in love with the natural world and all its enigmas — from Herodotus to developmental genetics. He is a second-year medical student, an aspiring mountaineer and an avid reader of The Baltimore Sun. His dream job is chief medical officer of a starship.

The concept of bloodless medicine first arose in the 1970s, when Denton Cooley, the legendary Johns Hopkins University School of Medicine alumnus and cardiac surgeon, performed operations on a group of patients that most other doctors turned away: Jehovah’s Witnesses. According to their doctrine, Jehovah’s Witnesses are not permitted to receive blood transfusions, largely due to the organization’s interpretation of specific verses of the Old and New Testament. In particular, the religion cites Genesis 9:4, Leviticus 17:10, Deuteronomy 12:23, and Acts 15:28 and 29 as clearly commanding of abstinence from blood. However, Jehovah’s Witnesses do receive and encourage all other forms of medical care, which brings about a complex situation: How does one conduct surgery or other operations without the supplementation of outside blood to restore blood volume, maintain hemoglobin levels required for oxygen transport and replenish other important coagulation factors?

This is a question that the Center for Bloodless Medicine and Surgery answers every day. Steven Frank, director of the center, describes the mechanism of providing bloodless care to patients: “The way we do this is to conserve blood by reducing or eliminating bleeding by stimulating the body to make its own blood cells at an accelerated rate, and by recycling blood that patients lose during surgery and giving them back their own blood.”

The Center for Bloodless Medicine has a variety of techniques to provide quality care for those whose religious traditions forbid the use of blood transfusions.

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Creating the Right Blend
Blood is a mixture of a variety of different components, including red blood cells, white blood cells, platelets, plasma proteins and clotting factors. Although Jehovah’s Witnesses do not allow the transfusion of whole blood, most do permit the transfusion of certain components of blood, such as albumin and individual clotting factors. By taking advantage of this, the center can provide alternative routes of care.

One such example includes giving patients erythropoietin, a hormone responsible for creating red blood cells, before and after surgery to stimulate the production of blood in anticipation of blood loss. Patients may also receive other vitamins, such as vitamin K, that are critical for the formation of blood components. Blood loss can be further minimized by the use of advanced tools, such as the harmonic scalpel, a type of scalpel that cuts and cauterizes at the same time. Additionally, technologies such as the intraoperative blood salvage system can actually recover lost blood from the operating table by washing the red blood cells with saline solution and returning the whole blood to the patient after the impurities and waste components have been removed.

Finally, although still in the development phase, some research labs are investigating the efficacy of artificial hemoglobin synthesized from various chemical compounds called hemoglobin-based oxygen carriers that mimic naturally occurring human hemoglobin, which can then be used for transfusion. These are just a few of the techniques that the center uses to ensure that patients who refuse or cannot take blood transfusions still have successful outcomes. The Center for Bloodless Medicine and Surgery at Johns Hopkins is one of the few centers across the country fostering innovation in the field of blood management. Aligning with Johns Hopkins’ commitment to outstanding medicine, the center applies cutting-edge technology to allow patients of all backgrounds to receive world-class care.

References


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Pranjal Gupta

Pranjal Bodh Gupta is a first-year medical student who arrived at Johns Hopkins from Vanderbilt University where, over the course of four years, he danced in numerous cultural showcases. Throughout these shows, he learned various routines, including a Japanese fisherman dance (“Soran Bushi”), Indian Bollywood dance, Korean pop, Japanese drumming dance (taiko) and Indian Bhangra. As a side hobby, Pranjal made short films and majored in chemical engineering. His latest adventure includes learning medicine and trying to gain social media fame.

This year’s St. Patrick’s Day was celebrated across the country by medical students and residency programs as the eagerly anticipated Match Day. After long months of assembling an application, nervously waiting for interview invites, and flying across the country to visit programs in cities both familiar and foreign, March 17 marked the day on which excited and nervous students learned where they would spend the next several years of their lives training to become independent physicians. Unlike a typical job, where an employer makes you an offer that you can then choose to accept or decline, the National Resident Matching Program uses a statistical algorithm where medical students rank residency programs, residency programs rank medical students, and the algorithm integrates this information to best accommodate the wishes of students and programs alike. Once students and programs participate in the match, the results are binding.

Congratulations Class of 2017!

Image courtesy Ruchi Doshi

While schools have many different types of Match Day ceremonies, Johns Hopkins has a short, simple event. Taking place in the medical education building, students, families and invited faculty members gathered for a brief brunch and to take photos at a St. Patrick’s Day-themed photo booth. Per tradition, first-year students were invited to watch from above, giving them a view of the newly matched fourth-year students in the atrium below and a glimpse into their own futures. A few chosen faculty members and students spoke, reflecting on the journey through medical school and giving advice to get through the first year of residency, otherwise known as intern year, before playing the Match Day video. Put together by the matching class, the video is a tradition that combines the humor, inside jokes and quirky personalities of the matching class. Shortly after the video, students gathered their envelopes, counted down the seconds till noon and simultaneously opened their cards to see where they would be going for residency.

The Big Reveal

Just after noon, the medical education building erupted into a cacophony of screams, cheers and tears. Students celebrated matching at their top-choice institutions, excitedly taking photos of themselves, their envelopes and their friends to share with loved ones who couldn’t attend the event. For some individuals, their match meant making history. For others, matching was a personal milestone, the end of an era spent in Baltimore. While some individuals are continuing their training at Johns Hopkins, many are making their way to a new adventure in a different city — or even a different coast! I was surprised and delighted to discover that I was moving on to my next adventure: Duke University Hospital, to train in internal medicine-pediatrics. Simultaneously, I felt a little sad, realizing that soon, I would be leaving both Johns Hopkins and Baltimore — my homes for the last five years.

Ruchi Doshi and her family at this year's Match Day celebration.

Ruchi Doshi and her family at this year's Match Day celebration.
Image courtesy Ruchi Doshi

I think those feelings sum up Match Day in a lot of ways. There’s excitement, surprise and delight, tinged with sense of poignancy. After four or more years of hard work, it becomes real and strange to know that no matter where you plan to go for residency, whether at Johns Hopkins or elsewhere, many things will soon change — the most important of which is your peers, whom you learned and grew with over the last four years. Soon, medical school will become a part of memories rather than a part of the present. While you keep your friends and mentors — and, for some people, your apartment — little else will stay constant over the next few months.

March 17 was an exciting day, but now the major milestone is graduation, looming in the near future in May. Or is it late June to early July, when most of us start our residency programs? Either way, congratulations to the Johns Hopkins University School of Medicine Class of 2017, and good luck on the adventures ahead!


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Ruchi Doshi

Ruchi Doshi is a third-year medical student pursuing her M.P.H. She is also an avid cook and baker who loves everything Bollywood.

Spurred by the most recent women’s march in Washington, D.C., it is easy to think that the best way to get involved and rally for women’s rights is by donning a pink cap and waving signs. While that is one way to fight for women’s rights, another is to highlight health care disparities specifically affecting women and find ways to change them. This was the topic of a recent symposium at Johns Hopkins on Friday, March 10, during which Robert Bristow, the former division director of gynecologic oncology at The Johns Hopkins Hospital and current chair of the University of California, Irvine’s Department of Obstetrics and Gynecology, was celebrated and honored.

The symposium celebrated a fellowship fund created by Bristow and Diane O’Day, the former fellowship coordinator of the program and current budget analyst of the department, and also highlighted the great gynecologic oncology fellowship program at Johns Hopkins. Bristow, a former graduate of the gynecology and obstetrics residency at Johns Hopkins, took attendees on a journey through his early career, speaking about his fellowship at Cedars-Sinai/UCLA and his subsequent return to The Johns Hopkins Hospital, where he went on to work with the late Frederick Montz. It was during his time working with Montz that he focused his research on ovarian cancer. While Bristow has authored countless textbooks and written over 200 peer-reviewed publications, the research he chose to highlight at this symposium specifically focused on disparities in ovarian cancer care.

Unequal Treatment of a Cancer Diagnosis

The conclusions he presented were eye opening. Through his research, Bristow found that in the U.S., not all women are treated equally in terms of care following an ovarian cancer diagnosis. Using the guidelines in cancer care established by the National Comprehensive Cancer Network, he found that when comparing long-term outcomes across different races for patients diagnosed with the same stage and type of ovarian cancer, black women were more likely to die of ovarian cancer than their white counterparts. The factors related to this included lower socioeconomic status, being less likely to seek care at high-volume centers, less access to surgery or care with high-volume providers, and differences in type of insurance (i.e., private insurance versus Medicare). He was able to extrapolate this data in another study on geospatial mapping and determined that to some extent, these differences in access to care and patient outcomes were related to where the women lived.

quote: by bringing these disparities to light and increasing access to care, we can work to make sure that a patient's treatment outcome it not determined by his or her geographic location and move toward a future in which all patients have the necessary tools to best fight a cancer diagnosis, regardless of the neighborhood they live in or socioeconomic status.Expanding Access to Quality Care

One way of bridging the divide created by geography between patients and hospitals that care for them is ensuring that the barriers are eliminated so that patients have access to the centers that can best care for them. Many hospitals have tried to emulate this model, and if you drive around Baltimore, you may notice that Johns Hopkins has as well, via the Hopkins Access Line, a program that helps streamline the process of referring patients from other health care providers to The Johns Hopkins Hospital for care. Bristow brought to light a problem that tends to be easier to recognize than it is to remedy.

Realizing that major metropolitan centers tend to harbor the cancer centers that ultimately provide the best care for cancer patients is the first step, but his presentation also emphasized how important it is for providers to strive to bring gold-standard cancer care to all populations and work to increase access to better care. By bringing these disparities to light and increasing access to care, we can work to make sure that a patient’s treatment outcome is not determined by his or her geographic location and move toward a future in which all patients have the necessary tools to best fight a cancer diagnosis, regardless of the neighborhood they live in or socioeconomic status.

Realizing that major metropolitan centers tend to harbor the cancer centers that ultimately provide the best care for cancer patients is the first step, but his presentation also emphasized how important it is for providers to strive to bring gold-standard cancer care to all populations and work to increase access to better care. By bringing these disparities to light and increasing access to care, we can work to make sure that a patient’s treatment outcome is not determined by his or her geographic location and move toward a future in which all patients have the necessary tools to best fight a cancer diagnosis, regardless of the neighborhood they live in or socioeconomic status.


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Diana Cholakian

Diana Cholakian is a fourth-year gynecology and obstetrics resident at Johns Hopkins. When she’s not in the OR, she enjoys biking, hiking, and running around the city.

As any graduate or medical student will well-understand, choosing a career direction to pursue after graduation can be a daunting task. What is your dream job? Where would you like to be located? Where do you see yourself in five years? These decisions require careful reflection and research, and importantly, mentorship and advice from professionals and the institution.

pair of feet standing on a tarmac road with color arrowsIn the past 10 years, there has been a paradigm shift throughout the graduate programs at Johns Hopkins. Previously, Ph.D. students were encouraged only to pursue academic jobs, with most following the traditional postgraduate school path that had been taken by nearly all of their advisers — several years spent as a postdoctoral fellow before going on to start a lab and become a principal investigator. However, the percentage of students with steady, tenure-track positions in their field after graduation has been steadily dropping since the 1970s, and currently only 8 percent of doctoral graduates in life sciences will hold a professorship within five years of completing their Ph.D.

Obviously, it’s untenable for graduate programs to prepare students solely for the academic life, only to have fewer than 10 percent able to find jobs in their field. But the pressure to promote academia is deeply ingrained in the scientific culture. Investigators are often measured by the success of their students, and it can be challenging for professors to advise students on how to best follow a path they themselves have not taken. Debra Silver received her Ph.D. from Johns Hopkins in 1997 and reflected that at the time, “alternative careers were still considered dirty words.”

Now, due to necessity, that perception has shifted. An uncertain funding climate combined with a drastic scarcity of faculty positions has left training institutions with a need to educate and encourage their students to pursue a variety of “alternative positions.” Although a big ship turns slowly, Johns Hopkins graduate programs should be commended for the work they have accomplished to this end in the past 10 years. The Professional Development and Career Office has more than doubled in size and offers a number of services to students throughout their time here.

Specifically, it regularly hosts panel discussions with professionals from a wide variety of career styles to discuss the pros and cons of their professions, as well as the best approaches for students interested in following each path. Professors throughout Johns Hopkins have also begun to recognize the reality of the changing academic climate and have made a concerted effort to help students find the career that will suit them best, whether academic or otherwise. Silver, now a principal investigator at Duke University, has two of her own students going through this process, and she lauds the changes to no longer tout academia over other options while encouraging students to search for careers that will enable them to find their own happiness.

As you approach the end of your time in graduate school and begin to look at the ever-widening world of career options, take the time to think about the right direction for you personally. Don’t be afraid of change — a majority of Ph.D. students find their desired career has shifted during graduate school. There are many advising services available, and professors across the hospital and medical campus have become far more willing to encourage and assist in finding positions outside the traditional academic track. There is a right career for everyone, and the tools to find and join yours are finally here.


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Benjamin Bell

Benjamin Bell studies sleep and circadian rhythms in mice and flies, and is fortunate the mice understand his semi-nocturnal work schedule. When not actively in the lab, you can find him thinking about research and science-writing on his motorcycle, on the hiking trails, or at any local concert venue.

We Americans are privileged to live in a country that boasts the top scientific research in the world being conducted in our laboratories, research institutions and government establishments, like the National Institutes of Health (NIH). The United States is currently considered the leader in biomedical research, but what most Americans don’t realize is that our place at the top is shaky at best. With other countries, including China and Germany, increasing science funding and surpassing the number of U.S. college graduates in STEM fields, the distance between the top and second place is narrowing at a quick pace.

The recently proposed federal budget further threatens to bring the U.S. toppling from its precarious position as the world leader in scientific research by slashing the NIH budget by a staggering 18 percent, eliminating of funding. As a graduate student at Johns Hopkins, it’s easy to believe that the rest of the population shares my sentiments that this is a detrimental and misguided proposal from the new president and his staff. But when I talk to people outside the biomedical sciences, I’m often confronted with the unfortunate truth — many people don’t understand science funding, how it works, why it matters or why their tax dollars should be spent on it.

NIH budget cuts could hit Johns Hopkins' research budget, but the extent is still unclear.

Investing in scientific research and being a world leader has many unrecognized benefits. America attracts top science students and professors from other countries, who come to our institutions to learn and conduct research — with foreign-born individuals representing 23 percent of scientists working in the United States in 2006. Falling from our top position means that fewer talented scientists will choose to leave their countries to work here, which will also decrease the caliber of research. Furthermore, when scientists from other countries compete with the U.S., there can be economic consequences. A recent example centers on concerns that a French company, Sanofi, will be given an exclusive license to patents for the Zika vaccine, which would allow the company to set a very steep price for Americans hoping to obtain it.

Unfortunately, making the case for science funding can become inherently difficult when it comes to cut-and-dried decisions like setting the federal budget. Although the 1950s saw a surge in support for science funding, much of which was specifically allocated to “basic science” — scientific research that does not have immediately apparent medical applications — the new millennium and the exponential growth within the tech industry have resulted in a shift in public attitude toward one of impatience, accompanied by a desire for swifter returns and an increased pressure from funding sources to pursue scientific questions with clear clinical relevance. It can be frustrating from the public’s perspective to look at the seemingly immense NIH budget and feel that the money invested isn’t giving tangible, obvious results, but this is because science requires time, thought and planning, with significant advances often occurring at an incremental pace as new discoveries are made.

quote: "Falling from our top position means that fewer talented scientists will choose to leave their countries to work here, which will correspondingly decrease the caliber of research "For researchers, this emerging impatience with science can be equally frustrating, but it is important to remember that the scientific process is largely obscured from those not directly involved in it. Researchers and clinicians must find a way to convey that although the benefits of science funding are rarely concrete, this does not negate their importance and often leads to outcomes that are greater than could have been imagined at the start. Indeed, as Fareed Zakaria’s highlights in his 2009 Newsweek article, federal funding has led to “to the development of the internet, lasers, global positioning satellites, magnetic resonance imaging, DNA sequencing and hundreds of other technologies, an accomplishment that should be touted by researchers and better communicated to those outside of the research community.

Therefore, although making the case for science requires convincing the taxpayer to invest in the future, it also requires the researcher to be more vocal about the value of this investment, especially during a time in which instant gratification is becoming increasingly valuable. Researchers must recognize that asking taxpayers to support science funding asks them for altruism, faith and respect for the scientific process, requests that may be met with more acceptance if they include demystifying scientific research. Convincing politicians and the general public that science has inherent value has to come from the people who best understand the intricacies of the process and must include better communication from the scientific community.

quote: Louis Pasteur once said, “Science knows no country because it is the light that illuminates the world,” and it is now the responsibility of all modern scientists to work fervently to make sure that that light cannot be extinguishedResearchers, clinicians and science students can no longer be content to simply mingle with like-minded people within our field and need to strive to make a conscious effort to talk with people outside of science or medicine, while underscoring the importance of research and investing in the scientific process. Louis Pasteur once said, “Science knows no country because it is the light that illuminates the world,” and it is now the responsibility of all modern scientists to work fervently to make sure that that light cannot be extinguished.

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About the Author

Emily Fray

Emily is a second-year Ph.D. student in the Biochemistry, Cellular and Molecular Biology Graduate Program. She is passionate about reading and writing about science, learning about infectious diseases, consuming large quantities of caffeine, and studying her personal role model, Louis Pasteur. She hopes to someday combine her loves of English and science to work as an editor for a major journal or textbook company.