Episode 028: What Cultural Competency Really Means

You've practiced how to extract from a patient their chief complaint.  You've memorized lists (and lists and lists) of drugs, treatment modalities, and other interventions.  You've learned all the physical exam skills on the test, and you've got every organ system down pat.  You even remember the Kreb's cycle.

Now, your patient has walked into the exam room looking for help with her headache (although she turns out to have none), doesn't appreciate your blank stare when she says her soul is lost, and is very confused about why you're treating her clearly 'hot' illness with a 'hot' medicine.  Time for a psych consult?

Nope.  Time to delve into the patient's cultural beliefs about illness, treatment, and doctors, and reach some sort of understanding between you and your patient that allows for a good outcome.  That's what cultural psychiatrist Hendry Ton, the Medical Director of the Transcultural Wellness Center and Director of Education at UC Davis School of Medicine Center for Reducing Health Disparities, advised UI student Lisa Wehr to do when she encounters a patient whose beliefs just don't line up with those taught by Western medicine.

Recommended:
National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care

Listen to Episode 028: What Cultural Competency Really Means.

Episode 027 - A real life Dr. House: Gurpreet Dhaliwal

All our listeners are familiar with the archetype of the master diagnostician, probably best represented in pop culture by Dr. Greg House, the irascible, pill-popping doctor of the eponymous television series.  Every week, House put together the clues and discarded the red herrings to come up with a diagnosis that only he could have thought of.  It’s a great trick, and there are people out there who can really do it.  Some even do it for their peers, at grand rounds that are akin to displays of medical prestidigitation.

But it’s about more than tricks.  For instance, in April of this year, a Hopkins review of 25 years of malpractice claim payouts found that diagnostic errors—not surgical mistakes or medication errors—made up the largest fraction of claims, the greatest harm to patients, and the highest total payouts: almost $39 billion during that time.  All this despite the common practice of defensive testing, in which tens of billions are spent each year on unnecessary tests in the hope of protecting doctors from the possibility of lawsuits.

Our guest on this episode is Dr. Gurpreet Dhaliwal, Associate Professor of Clinical Medicine at the University of California San Francisco School of Medicine.  Among Dr. Dhaliwal’s professional interests are clinical reasoning, diagnosis and diagnostic errors, and how physicians can improve in those areas.  He is also much less angry, and students Eric Wilson, Dwiju Kumar, and Alison Pletch found him a lot more fun to talk to, than Greg House.

Listen to Episode 027 - A real life Dr. House: Gurpreet Dhaliwal.

Episode 026 - 'Fake Patients' and Students: a Meeting of the Minds

Few students like exams.  That probably wasn't close-to-mind when, in 1999, the Liaison Committee on Medical Education, which accredits medical colleges, decreed that the Carver College of Medicine would incorporate clinical skills assessment into the curriculum.  Then, in 2004, the National Board of Medical Examiners began using the Step II Clinical Skills test as part of the United States Medical Licensing Examination.  This Step, one of the three that seeks to ensure students are becoming competent doctors, required students to demonstrate their clinical skills on live actors.  These actors played standardized roles so that the examination results would be meaningful.

So it was that the University of Iowa Carver College of Medicine, and MD programs across the country, created the Performance-Based Assessment Program.  The PBA program was charged with preparing third-year students for this new exam. They did this the exact same way the NBME did it: by hiring actors to portray patients with various complaints to test what third- and fourth-year students had learned about interviewing such patients.

Since then the program has grown tremendously.  Now they don’t just test medical students, but they teach them as well.  Things like general physical exam skills, PE skills specific to male and female patients, communication skills, and a lot more.

On this episode, students Cole Cheney, Senuri Jayatilleka, Michael Zhang, and Keenan Laraway joined simulated patients JC Luxton and Mary Nell Jackson meet for a little debate and an exchange of views on their roles as students and 'fake patients.' 

Listen to Episode 026 - Who Are These People, Anyway? Simulated Patients and Students.

Episode 025: Henrietta Lacks vs. HeLa, and the People Behind the Specimens

The efficacy of any biomedical researcher is based on his or her foundation of scientific knowledge.  Few would have any problem grasping that idea.  What's less well understood, by both researchers and laypeople alike, are the stories of the biological materials they work with.  Often these materials are cell cultures, tissue samples, human DNA.

From left to right: Dave Etler, Eboni Jones, Victoria Baptiste, David Lacks, Alison Pletch, and Greg Pelc.

Unlike the chemicals, reagents, test tubes, and machinery used in research, these materials often come from people.  That's easily forgotten when they can be ordered from catalogs and websites in the way of other commodities. But those people, who may no longer live among us, have stories.  In the case of Henrietta Lacks, an African American woman who passed away in the early 1950s of cervical cancer, the cells taken from her without her or her families' knowledge touched off a revolution in biomedical science. 

Henrietta and Day Lacks (From
"The Immortal Life of Henrietta Lacks,"
R. Skloot, 2009)

They've contributed to the vaccine for polio, were the first cells to be cloned, and have been used in a number of cancer, virus, and pharmacological studies all over the world. Rebecca Skloot's 2009 book "The Immortal Life of Henrietta Lacks" noted that Mrs. Lacks' cells have been used in more than 60,000 studies, and 300 more are being added each month.  They are of huge importance to science because they were the first so-called immortal cell line--unlike most cells, they divide and reproduce essentially without limit.  But though no-one in Henrietta Lacks' family knew of their existence at first, the cells ultimately became of huge importance to her descendants.  In this episode, Alison Pletch, Eboni Jones, Greg Pelc, and I were honored to be able to welcome two members of the Lacks family to the show.  David Lacks is Mrs. Lacks' grandson, and Victoria Baptiste is her great granddaughter, and they spoke with us about their ancestor, informed consent, and their work with the National Institutes of Health on HeLa cell research guidelines.

Listen now to Episode 025: Henrietta Lacks vs. HeLa, and the People Behind the Specimens

Episode 024: John Lawrence, Doctors Without Borders, and Syria

Syria is in the midst of a civil war.  As a measure of the seriousness of the situation, a Reuters report out recently says that the war has claimed the lives of 115,000 people.  And with 5000 of those deaths in September alone, it seems as though international pressure to eliminate Syria's chemical weapons hasn't slowed the war down at all.  The UN reports that only twelve international aid organizations are approved by Syrian officials to work in country. One of those is Doctors Without Borders, or Medecins Sans Frontieres.  This time on The Short Coat Podcast, we welcome back Dr. John Lawrence, pediatric surgeon and associate professor of Surgery at the University of Vermont College of Medicine. and formerly of the University of Iowa Carver College of Medicine.  Dr. Lawrence has performed six surgical missions working with MSF, and he's come to Iowa to talk about Syria, from which he's recently returned.  Not long ago, medical students Jessica Gaulter, Katherine Ryken, and Ethan Forsgren sat down to talk with him about his experiences with MSF and in Syria.

Listen now--Episode 024: John Lawrence, Doctors Without  Borders, and Syria

Local coverage: Opportunities for third year students in Des Moines

This episode introduces students to the Des Moines Area Medical Education Consortium's group of hospitals,  and the unique opportunities available to third-year students at the Carver College of Medicine who can take advantage of a year-long rotation in Iowa's capital city.  Dr. Steven Craig, the executive director of the DM Consortium, talks with Natalie Ramirez about what the benefits and opportunities exist for M3s in our state's capital city.

Listen now: Opportunities for Third-Year Students in Des Moines.

Episode 023: Relationships and Medical School.

About three weeks ago our guests, Lisa Wehr and Matt Maves, Jacob and Rachel Evans, and Jessica Kincheloe, were plunged into another year of medical education at the UI Carver College of Medicine.  Since some, notably first-year medical students, find that it is an icy plunge, indeed,  we got together to discuss relationships in medical school: how our guests maintain them, how to allow them to flourish, and how to prevent them from being crushed by the pressure of medical school.

Okay, so it's not that bad...but everyone could use a few tips, amiright?

Listen to Episode 023: Relationships and Medical School

Episode 022: Marilynne Robinson and Gilead

Here at the Carver College of Medicine, on the campus of the University of Iowa which is famous for its legacy of writing and writers, we are lucky enough to receive occasional visits from some pretty outstanding authors.  Recently, during the annual CCOM Reads contest, medical students were encouraged to read author and Iowa Writers' Workshop Professor Marilynne Robinson's Gilead, a novel for which she won the 2005 Pulitzer Prize for fiction.  It's an account of the memories of John Ames of his father and grandfather, all of whom are Congregationalist ministers in Gilead, Iowa.  After the contest was over, we asked Ms. Robinson to visit with the students to talk about her writing of the novel.

Listen: Episode 022 - Marilynne Robinson and Gilead

Episode 021: Match Day!

The Haugsdals compare their match results.

This week, we talk about Match Day, the big day when medical students find out what they'll be doing for the next few years after graduation.  It's a big deal, and to help us make sense of it, CCOM Registrar Damien Ihrig and fourth-years Jaclyn and Michael Haugsdal and Natalie Ramirez sit down to hash it out.  It's both magical and stressful, but at the end you have a job that you love...hopefully.

Listen now to Episode 021: Match Day!

Episode 020: Positive Exposure with Rick Guidotti

Photos by Rick Guidotti

Rick Guidotti is a fashion photographer working in New York, Milan, Paris, and London for everyone from Elle to Yves Saint Laurent. In 1997, he and physician Diane McLean founded Positive Exposure, a non-profit organization dedicated to using the visual arts to highlight the beauty of genetic diversity and challenging the stigmas associated with differences in appearance. Positive Exposure presents diversity workshops, educational and human rights programs, and multimedia exhibitions for physicians, nurses, genetic counselors, health care professionals-in-training, universities, elementary and secondary schools, legislators, and the general public.  Rick sat down with Iowa medical students Kurt Wall and Miriam Wiener to talk about his work with Positive Exposure, and about what families who live with genetic, physical, and intellectual differences want: to have their stories heard.

While you listen, be sure to visit http://positiveexposure.org/, and look at the galleries at the bottom of the page to meet the families and people that Positive Exposure works with.

Listen to Episode 020: Positive Exposure with Rick Guidotti.