Whitney Palmer

Healthcare. Politics. Family.

Dr. Brenda Armstrong, Dean of Admissions, Duke University School of Medicine

Published in the May 2015 Durham Magazine

By Whitney L.J. Howell

As a student in a segregated Rocky Mount, N.C., high school, Brenda Armstrong, M.D., knew she wanted to be a scientist of some sort. But, she didn’t know far her determination and the support of her family and friends would take her.

But, now, Armstrong points to events and people in her life that positioned her to use her gifts to help others.

“My life, and whatever roles I’ve been fortunate enough to find, has been about giving back,” she said. “I have wonderful gifts that no dollar amount could bring.”

Today, Armstrong, 66, has been the Duke University School of Medicine Dean of Admissions for nearly 20 years. (She’s also an associated dean for medical education, a professor of pediatrics, and a pediatric cardiologist for children, adolescents, and adults with congenital heart disease — a woman who wears many hats!) She’s changed the School’s demographic make-up to better reflect the Durham community, more than doubling the number of black applicants in her first few years and continuing to enhance diversity.

It’s an accomplishment close to her heart. While at St. Louis University School of Medicine, Armstrong was the only black woman student for three out of her four years of training. She recruited the second black woman who joined her for her final year.

Her road to steering medical school admissions was a winding one, though. It was a teaching job right out of Duke undergraduate that revealed Armstrong’s future career.

For four years, she taught science and math to the same students as they progressed through school. With her, the students rose from “C” and “D” achievers to the honor roll. That experience prompted her to pursue medical school so she could heal and teach others about their well-being.

She even had the opportunity to hone her teaching skills in medical school – this time with a support network. The custodial staff frequently asked her about her work as she studied late at night.

“When I studied by myself, the folks cleaning up would ask me what I was doing,” she said. “It was great to have someone who looked like me care about my work. They were my study aids, and they knew it.”

Because the community bolstered her, she works to give back. For more than 30 years, she’s served as the physician for the Durham Striders, a local youth track association.

“Being of the community and in the community makes me a better person,” she said. “The community has kept me grounded, has given me values, and has allowed me to use whatever gifts I have to make my community better.”

To read the profile at its original location: http://issuu.com/shannonmedia/docs/binderdmmay?e=13657385/12589504 pg. 38

June 28, 2015 Posted by | Profiles | , | Leave a comment

Duke University team discovers a gene mutation tied to severe myopia

Published in the June 16, 2013 Raleigh News & Observer and Charlotte Observer

By Whitney L.J. Howell

When it comes to reading, teachers re-tell the same stories year after year. One student holds a book inches from his face and requests to sit in the front row. His sister seems perfectly content in a desk toward the back of class and can easily read papers at arm’s length.

It’s not uncommon for children to have varying degrees of eyesight. But is such a big difference normal among siblings?

The reasons why one child inherits a parent’s nearsightedness while another offspring has perfect vision have long been fuzzy. Now, new research out of Duke University is bringing some clarity to this puzzle.

Known clinically as myopia – and frequently blamed on significant time spent reading – nearsightedness is the most common eye disease affecting humans. Nearly 30 percent of American adults have myopia, according to the American Optometric Association. The condition occurs when the

A scene as it would appear to a person with myopia (nearsightedness). ( National Eye Institute/ National Institutes of Health) NATIONAL EYE INSTITUTE / NATIONAL INSTITUTES OF HEALTH

A scene as it would appear to a person with myopia (nearsightedness). ( National Eye Institute/ National Institutes of Health)
NATIONAL EYE INSTITUTE / NATIONAL INSTITUTES OF HEALTH

eye is either oval-shaped (rather than round) or the cornea – the transparent covering over the front of the eye – is too curved. In either case, the eye is unable to properly focus the light coming through the pupil.

The result is blurry vision, meaning a nearsighted person must stand closer to an object that a normal-sighted person in order to see it clearly. For example, a nearsighted person must stand 20 feet away from a street sign to see it as well as a normal-sighted person can at 40 feet.

But, according to research published in the American Journal of Human Genetics, the genetic cause behind myopia could now be a little clearer. Duke researchers found that a newly-identified genetic mutation that affects copper metabolism and oxygen regulation in eye tissue is a culprit in cases of severe myopia.

High-grade myopia is inherited and occurs most commonly in Asian cultures. But it also affects nearly 2 percent of nearsighted Americans, increasing their risks for additional eye problems, such as detached retinas, cataracts and glaucoma.

Several myopia-associated genes have already been discovered, but this one – SCO2 – is particularly important in the study of high-grade disease, said Terri Young, M.D., an ophthalmology, pediatrics, and medicine professor at Duke. When functioning properly, SCO2 helps metabolize copper, an element vital to controlling oxygen levels in eye tissue. A malfunctioning gene can allow oxygen levels to rise too high, increasing stress on the tissue. These high levels can, ultimately, alter the eye’s development and function, she said.

“This is the first time a gene mutation like this has been discovered,” she said. “It’s one found in cases of inherited severe myopia among Caucasians where only one parent carries the gene for the condition and where the nearsightedness isn’t associated with any other health conditions.”

Finding the mutation

To find genetic mutations common among individuals with high-grade myopia, Young and her colleagues within Duke’s Eye Center, Center for Human Genetics, and graduate medical school in Singapore analyzed DNA extracted from the blood and saliva of four individuals all from the same 11-member American family of European ancestry.

Her team used a new sequencing method – next-generation sequencing (NGS) – to produce large, more precise quantities of data. NGS enables researchers to sequence larger numbers of DNA pairs faster than when using the more traditional method, electrophoresis.

“Using next-generation sequencing, we were able to obtain more than 50 times the number of DNA copies than we would have through traditional sequencing,” she said. “It was because we had more copies that we knew what we were seeing with the mutation was real. That’s how we found the gene and discovered that the mutation was only present in people with myopia.”

The team also found three additional SCO2 genes mutations in an additional 140 people.

After identifying the SCO2 gene mutation in human eye tissue, researchers explored the gene’s expression in mice to further confirm their findings. They induced nearsightedness in otherwise normal-sighted, newborn mice by putting a translucent contact lens over one eye in each animal. After six weeks, they analyzed the eye tissue to see where SCO2 was most expressed, and in this case, mutated. By attaching a stain to the gene, they found these genes were most expressed in the retina – the tissue where the eye actually sees images – and the white, protective part of the eye called the sclera.

Combining the results from both human and mouse eye tissue analysis highlights the existing connection between low levels of copper in the body and eye disease, she said.

“What we’ve found – and what’s in pre-existing research – suggests that copper deficiencies could set people up to become nearsighted,” Young said. “We didn’t specifically test diets, but it’s possible that mineral- and vitamin-deficient diets could play a role.”

If that’s the case, she said, taking copper supplements could conceivably slow down or stop myopia’s development.

What’s next?

Even though malfunctioning SCO2 has a significant, negative impact on eyesight, it is likely a very rare mutation, Young said. So, rather than test for it alone, her group plans to add it to a panel of studies known myopia-associated genes.

Additional work is also ongoing, exploring the impact an SCO2 mutation could have outside of eye disease. According to Dennis J. Thiele, Ph.D., a pharmacology and cancer biology professor at Duke who wasn’t part of Young’s team, one of the SCO2 mutations is pivotal in a deadly form of cardiomyopathy, a condition that causes the heart muscle to weaken and eventually leads to heart failure.

Because this gene mutation can affect multiple body systems, it’s important for investigators to continue their explorations, said Gary Heiting, a practicing ophthalmologist in Minnesota, as well as the editor of All About Vision, an online eye-education publication. Knowing more about SCO2 will help scientists and doctors better understand how much of eye health is inherited and how much is cause by day-to-day activities.

“This new research is an important step in understanding what causes myopia to develop in some children and not others. But, it is just one step,” Heiting said. “Further research, including research in the areas of genetics, nutrition, reading behaviors, time spent indoors versus outdoors during childhood, and other factors, is needed before we will fully understand what causes myopia and what we can do to effectively reduce the incidence and prevalence of nearsightedness in the future.”

To read the story at its original News & Observer location:  http://www.newsobserver.com/2013/06/16/2959250/duke-university-team-discovers.html#storylink=cpy
To read the story at its Charlotte Observer location: http://www.charlotteobserver.com/2013/06/16/4102306/duke-university-team-discovers.html

 

June 19, 2013 Posted by | Family, Healthcare, Science | , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

More Medical Schools Offer Instruction in Complementary and Alternative Therapies

Published in the February 2012 AAMC Reporter

By Whitney L.J. Howell

At first glance, Megan Wolf believed the man in front of her had been mortally wounded. She was horrified, until he looked up and laughed.

“I gasped, but he giggled at my reaction,” said the third-year student at the University of Pittsburgh School of Medicine. “He said it didn’t hurt at all and that he never felt better than after one of those treatments.”

What Wolf, who is the chair of the American Medical Student Association’s (AMSA’s) Wellness and Student Life Committee, saw—and what the man experienced—was a high-velocity, low-amplitude spinal adjustment. In essence, the chiropractor cracked his neck.

Witnessing this episode was part of Wolf’s introduction to complementary and alternative medicine, or CAM. Also known as integrative or mind-body medicine, these therapies are becoming more common in U.S. medical education.

The push to bring CAM into medical training began in 1999 when the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, launched the CAM Education Project.

Initially, the center awarded 14 grants of $1 million to $1.5 million to medical schools, teaching hospitals, and AMSA for research projects, such as training pediatric residents on the benefits of CAM in treating childhood diseases or teaching students to communicate effectively about it with patients. Today, a group of more than 50 U.S. and Canadian medical schools and teaching hospitals, called the Consortium of Academic Health Centers for Integrative Medicine, includes CAM in its curricula.

Although opinions about CAM are heated, there is no question that patients use it. According to 2008 data from the Centers for Disease Control and Prevention, nearly 40 percent of adults and 12 percent of children use at least one therapy, and many are reticent when it comes to telling their doctors. The substantial size of this group makes it vital that medical students understand how nontraditional therapies or supplements interact with standard medical care, said Aviad Haramati, Ph.D., a Georgetown University School of Medicine physiologist, who pioneered CAM education at Georgetown in 2000.

“We aren’t educating CAM practitioners,” he said. “But we are giving medical students knowledge so they can talk with their patients in an open-minded way from informed positions, and educate them on the potential risks of mixing complementary techniques or herbal supplements with prescription medications.”

The growing body of evidence-based research supporting CAM in peer-reviewed journals, such as the Annual Review of Medicine and the Journal of the American Medical Association, means academic medicine cannot ignore these modalities, Haramati added.

Opposition to CAM in Curricula

But not everyone in academic medicine agrees that medical students should learn about CAM. Steven Salzberg, Ph.D., medicine and biostatistics professor at Johns Hopkins University School of Medicine, openly opposes integrating CAM into medical education curricula, asserting that alternative modalities are ineffective.

“Whatever term is used—alternative medicine or integrative medicine—this isn’t medicine. At best, these are hypotheses,” Salzberg said. “Over 20 years, NCCAM has spent more than $1 billion, and [there is] no strong evidence that these activities work.”

He also criticized the propensity in academic medicine to group meditation and yoga with acupuncture, chiropractic, and homeopathic treatments. Clear evidence exists to support the efficacy of meditation and yoga, he said, and equating them to other modalities is erroneous.

Despite his objections to including CAM in curricula, Salzberg agreed it could be useful to train physicians proactively about treatments patients might seek on their own.

Challenges to Teaching CAM

Salzberg’s objections have not slowed the integration of CAM into education, but that does not mean getting buy-in for course additions has been easy. There are three main questions about this fusion, said Victor Sierpina, M.D., a professor in the integrative medicine program at the University of Texas Medical Branch in Galveston.

“The biggest concern is people’s unfamiliarity with the evidence behind CAM,” he said. “Once they become aware of peer-reviewed research, the resistance to including these topics drops. The same is true for administrators, faculty, and students.”

Many institutional leaders want details about how faculty will teach CAM from the evidence-based perspective, he said, and they want to know how this knowledge will augment training and turn students into lifelong learners.

Even with these questions satisfied, CAM remains divisive, said Michelle Bailey, M.D., a Duke University School of Medicine pediatric integrative medicine physician. She is also the director of medical education for Duke Integrative Medicine.

“Increasing CAM in allopathic medical training can still be considered controversial,” she said. “But there are many in the consortium who are looking for best practices, as well as the best ways to translate it to medical students.”

Current Course Curricula

Many medical schools and teaching hospitals have elaborate programs featuring CAM. For example, Haramati said, Georgetown launched a five-year program in 2005 for students to earn a master’s in CAM before pursuing their medical degree. The first degree program of its kind includes, among other topics, nutrition, mind-body skills, and CAM use in oncology.

“We brought acupuncture into anatomy and neuroscience, biofeedback into physiology, and the science of stress reduction into endocrinology,” Haramati said. “We want students to experience the mind-body connection firsthand and understand more about themselves.”

At Texas, students receive an orientation to the library that includes case-based information about herbal supplements as well as other CAM strategies, Sierpina said. Second-year students discuss chiropractic and massage in musculoskeletal classes, and others participate in grand rounds about the interaction between over-the-counter supplements and anesthesia. CAM is quickly becoming a fluid part of the curriculum, he said.

“It’s mostly invisible. It’s seamless,” Sierpina said. “We use problem-based learning to train students, and we want them to evaluate all possibilities. When treating a patient, CAM might not be the solution, but we want them to consider all options.”

But medical education is cramped, and many worry adding CAM-focused courses could overwhelm students.

To overcome this barrier, many institutions follow Texas’ example, infusing CAM theories into existing classes. For example, Duke offers two-week elective courses that give second-year students a solid foundation in CAM, Bailey said.

In addition to attending lectures, students meet CAM providers, such as acupuncturists, massage therapists, or health psychologists, and shadow these providers at the Duke Integrative Medicine building.

“It’s important for students to learn the credible information around integrative medicine so they can point patients to reliable sources,” Bailey said. “If, as patient advocates, we are to first do no harm, then we must be armed with information to educate patients and keep them safe.”

Duke students also learn about CAM during their required fourth-year capstone course. As part of this class, the school holds a four-hour integrative medicine health fair bringing in nearly 40 CAM providers from the community. Students visit booths, asking questions and gathering information. A lecture series several days before the fair also presents basic CAM details.

Student Reaction

Medical students know patients benefit when their providers understand CAM, but students also see value for it in their own lives, said AMSA’s Wolf.

“AMSA participants focus on their wellness,” she said. “Our members look at natural things like yoga to handle the stress and pressures of medicine. These things help us take better care of ourselves so we can be better physicians.”

David Darrow, a fourth-year Texas student, agreed that studying CAM gives him empathy for how patients choose to approach their health.

“It’s ironic. As medical students, we approach our education as scientists who make decisions on evidence and fact,” he said. “But learning about CAM has really led me back to the humanistic part of medicine.”

To read the article at its original location: https://www.aamc.org/newsroom/reporter/feb2012/273812/therapies.html

February 24, 2012 Posted by | Education, Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Teaching Community-Based Participatory Research

Published in the June 2011 AAMC Reporter

By Whitney L.J. Howell

As she watched the teenagers discuss their new health information database, Tirza Cannon realized why getting communities engaged in their own health care is so important.

The teenagers were unveiling HealthShack.info, a Web site that gives marginalized and homeless young people a safe place to compile and access their medical information. For Cannon, a third-year student at the University of California Davis (UC Davis) School of Medicine, the Web site illustrated how to make the community a true partner in medical research.

“These young people talked eloquently to more than 100 people about how they helped design and implement a system to house medical information,” Cannon said. “That really drove home for me that physicians must be aware of the social, economic, political, and cultural factors influencing their patients.”

HealthShack is an example of a new kind of research that has gained ground over the past decade: community-based participatory research. This method unites investigators with communities to identify health problems, the best ways to study those issues, and how to design health behavior changes that the community is most likely to adopt.

Now, a growing number of medical schools like UC Davis are introducing this research method to their students. The National Institutes of Health and the Centers for Disease Control and Prevention sparked interest in this fledgling field in 2008 when they issued a call for grant proposals in community-based research. Since then, some schools have incorporated community-based research instruction into their curricula through individual studies or full classes.

Still, the method remains a relatively new concept, and finding the right way to teach it has been difficult. In fact, a 2009 study published in Academic Medicine reported that some medical schools and teaching hospitals may be reluctant to accept or encourage community-based research because their investigators have proven success with other methods.

Being familiar with this technique, however, will benefit students as medicine continues to shift its focus to prevention, said Elizabeth Miller, M.D., UC Davis assistant professor of pediatrics and adolescent medicine.

“The amount of didactic instruction that students have received on community-based participatory research has been variable at best,” said Miller, a faculty leader for the HealthShack project. “There’s been very little room in medical education to do this type of thing, but including it is vital because it teaches students early on how to really connect with the people they will serve.”

According to Miller, UC Davis will launch a community-based prevention program in July, in which first-year medical students spend a month tackling child and family wellness issues with community partners.

Jen Kauper-Brown, M.P.H., a director in Northwestern University’s Community-Engaged Research Center, echoed Miller, stressing that community-based research lectures alone are not as effective as real-world training.

“Community-based research is hard to learn in the classroom,” she said. “We have to provide experiential learning models that fuse faculty instruction with days spent working in the community.”

In 2012, Northwestern University Feinberg School of Medicine will introduce a community engagement course series that will place students in a research project, provide on-the-ground training for community-based research skills, and offer students ongoing feedback and support from faculty and peers.

Duke University School of Medicine teaches these concepts to incoming medical students through an interprofessional course in which they learn alongside physician assistant and physical and occupational therapy students, said Mary Anne McDonald, Dr.P.H., assistant professor at Duke’s Center for Community Research.

Students also work in prenatal health and telemedicine programs through the Arizona Cancer Center at the University of Arizona College of Medicine. To help students understand how community-based research is similar to clinical skills, Ana Maria Lopez, M.D., Arizona medicine and pathology professor and telemedicine director, often draws a parallel to a basic medical activity.

“I tell students that working with community partners is a lot like getting the vital signs for an individual patient,” Lopez said. “In order for this research method to work, we have to go talk to them, see what’s working, and change course if we need to based on what they tell us.”

With the growing popularity of community-based research, it is still challenging to ignite medical student interest and make participation feasible, said McDonald. The rigors of medical school and the short length of rotations make it difficult for students to cultivate the long-term relationships that are needed to succeed.

For now, that problem has no clear solution. Getting students excited about the idea that community-based research is the next wave of medical research will depend very much on the faculty role models involved in these projects, said Kauper-Brown.

Even though there is an ongoing debate about what types of research projects can correctly claim that they truly engage the community as partners, exposing medical students to research that immerses them in the community will only have a positive impact, said Doug Brugge, Ph.D., public health and community medicine professor at Tufts University School of Medicine.

“There is no substitute for real-world experience,” said Brugge, who also directs the Tufts Community Research Center and has conducted collaborations with several neighborhoods around Boston. “You can talk or read about working with communities, but you’ll never understand how complex some community’s issues are or how difficult implementing changes can be until you ask questions and listen. Some students are shocked to see that, and it’s an important thing for them to learn.”

June 20, 2011 Posted by | Education, Healthcare | , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Change Agents: Training Doctors as Change Agents for Community and Primary Care

Published in the Summer 2011 Duke Med Alumni News

By Whitney L.J. Howell

When Tracey Spencer enrolled in Duke University School of Medicine’s Class of 2013, supporting a patient’s leg in the delivery room was not the first clinical care image that popped to mind. But earlier this year, that is where she found herself, and she says it is one of the greatest parts of her medical training so far.

“I held my patient’s leg for an hour while she pushed. I never really thought about deliveries taking that long, but 30 minutes into it, her leg started to feel really heavy,” says Spencer, MSIII. “It was my first time seeing a baby delivered, and when I needed to take a break to avoid passing out, they waited on me. The patient was so comfortable with me and really considered me to be a big part of her care team.”

Spencer’s experience is unique among her peers because she is part of a new program for second-year Duke medical students called the Primary Care Leadership Track (PCLT). This academic path is an effort to answer the Association of American Medical Colleges’ recent call for medical schools to  produce more primary care physicians.

As with many aspects of medicine, however, Duke is putting its own twist on things. Rather than  follow the traditional second-year curriculum focusing on inpatient training in the hospital, the PCLT places students mostly in outpatient settings, such as primary care, community, and obstetrics-gynecology clinics. The change gives them first-hand experience in the predominant primary
care settings.

Forming the Program

The past five years have been a time of growing pains for Duke’s primary care and family medicine programs. Since shuttering the family medicine residency in 2006, the school revamped the program, and administrators redoubled their commitment to primary care training. The same enthusiasm arose when faculty began discussing the PCLT, says Edward Buckley, MD, vice dean for medical education.

“Duke’s fundamental educational mission is different from other schools,” he says. “While we do train physicians focused solely on patient care, we also have a commitment to train clinical leaders and scientists who can be change agents for health care at the community and primary care levels.”

In fact, says Barbara Sheline, MD, MPH, PCLT program co-director and assistant dean for primary care, getting buy-in from school administrators and lead faculty took less effort than program coordinators anticipated.

“After we presented our thoughts and plans for the program, the overriding consensus was that this is the way we should’ve been teaching primary care all along,” she says.

Finding five faculty preceptors for each PCLT student was the first step to successfully launching this part of the curriculum. Every student must have a preceptor from each core area— family medicine, internal medicine, psychiatry, pediatrics, and obstetrics-gynecology— so Duke provides faculty development to physicians who do not regularly teach.

Students spend nine months in outpatient clinic training, and they also have the unprecedented  opportunity to rotate through the emergency department. Inpatient training comes by spending nearly three months working in the hospital. Throughout the year, they meet with Sheline every Thursday for instruction and discussion.

Although the PCLT opened with three students enrolled, nearly 200 applicants applied for the six slots available next year, Sheline says. Interest was so great that within 48 hours of posting program information online, coordinators received 96 inquiries. Faculty select students based on a written essay and a separate interview in which program leaders look for applicants with demonstrated or potential leadership skills.

Accepted students receive a $10,000 scholarship to offset the cost associated with pursuing the often lower-paid primary care positions. If students decide to enter a different specialty, the scholarship reverts to a loan.

How It Works

While PCLT students begin the same curriculum as their classmates, taking basic science courses during their first year, they also discuss patient cases with other health care professions students. They branch away further as second year students by learning in different environments. Instead of spending the majority of their time with hospital inpatients, these second-year students rotate through outpatient clinics.

Each week, they spend half-days shadowing their preceptors, taking patient histories, and learning to hone their diagnostic skills. Time spent in the clinics gives students the benefit of one-on-one time with faculty, says Bruce Peyser, MD, PCLT co-director from internal medicine.

“Second-year students naturally need more time and supervision than fourth years, and in many cases they’re starting from square one. They can’t find a lymph node or aren’t skilled enough to hear a heart murmur,” Peyser says. “But working alone with a doctor means they get more time to make sure they’re doing things correctly and we, as faculty, can take time to really show them things and make sure they understand or can ask questions.”

In addition to observing patients with their preceptors, PCLT students also get their first taste of being a “real doctor.” They are required to compile their own panel of patients—a group of individuals whom students follow through the health care system as they need and receive services. For instance, if a primary care provider refers a patient to a specialist, the student would accompany the patient to the appointment as a patient advocate and to provide an extra continuity of care layer.

Having an individual panel of patients gives PCLT students a first-hand glimpse into the life and  responsibilities of a practicing provider far earlier than any of their peers.

“I don’t think even fourth years or residents get the same continuity with their patients,” says  Christopher Danford, MSIII, who chose Duke over other medical schools specifically for the PCLT program. “All three of us have had a patient we’ve been close to die or get a new diagnosis of cancer. And on the other end, we’ve been able to deliver babies. That’s a very emotionally charged experience.”

The Centering Program through Lincoln Community Health Center offers PCLT students the opportunity to follow pregnant patients through their health care experience. Together with a nurse midwife, the students work with a group of women throughout their pregnancies, providing prenatal care and leading Program discussions. The students are present for the births— many delivering the babies—and they follow mother and baby to postnatal care.

“It’s wonderful for the women to get to know the students and have them at their births,” says Trish Payne, a certified nurse midwife who serves as a PCLT preceptor. “These women walk into the hospital to have their baby and instead of seeing a stranger, they see their medical student.”

The program is too new to provide longitudinal data on the benefits of having medical students involved in prenatal care, but Payne says she anticipates the Centering Program women will not only be more likely to listen to and follow the students’ advice, but they will also be at a lower risk for a C-section because they will be less frightened in the delivery room.

The Program ’s Next Steps

Real-world primary care training continues for PCLT students in the third and fourth years of medical  school. During the third year, according to program co-director Sheline, students must complete a research project in collaboration with the Duke Center for Community Research that focuses on a community or population health issue facing Durham residents, such as diabetes in the African- American population.

“This is the year where students will really see the health care system through the patient’s eyes,”   Sheline says. “They will work with groups already looking at health issues Durham cares about while receiving training in community and population clinical leadership.”

The PCLT fourth year will be similar to the traditional fourth-year curriculum. Students will choose a variety of electives designed to increase their primary care proficiency, including a sub-internship and a critical care elective. Additionally, PCLT students must complete a four-week long capstone course that will better prepare them to work in a patient-centered medical home.

Another View of Health Care

Even though they have only finished the program’s second year, the three PCLT students have already achieved one of Duke’s goals—they are far more aware of what it means to be a patient in today’s health care system.

“It’s been most interesting to see the transition of care as a patient goes from different practice to  practice. I’ve realized that many patients have trouble getting to and from appointments because of transportation issues, and I’ve seen them struggle to make their co-pays,” says Cassandra Kisby, MSIII. “I know our classmates don’t see that because they’re transferring from service to service rather than rotating with the patient.”

The effect so far—on student and patient—has been positive, says co-director Peyser. The need for strong leaders in primary care is especially great as the health care system faces a time of substantial transition. The continuity of having students in the clinic is also comforting to patients.

“Without fail,” Peyser says,” the patients who agreed to have Chris [Danford] as part of their care ask for him and want him in their appointments.”

June 13, 2011 Posted by | Education, Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Achieving Balance: Medicine & The Arts

Published in the Winter 2011 Duke Med Alumni News Magazine

By Whitney L.J. Howell

By day, they study anatomy, absorb the latest research on combating acute disease, and learn best practices for managing chronic conditions. But by night and on weekends, they play instruments, dance, sing, sculpt, and act. They are Duke University School of Medicine students—and they are artists.

Although keeping up with the rigors of medical school is their number one priority, these students unanimously agree that they cannot imagine abandoning their artistic activity. It does not matter that they cannot devote the same level of time and intensity they once did. Most consider their art an integral part of their lives—and key to handling the stress of medical education.

A study presented at a 2009 Association of American Medical Colleges regional meeting found that exposure to art can improve a doctor’s clinical skills. These artistic Duke physicians-in-training agree. For them, art and medicine go hand-in-hand.

“The best doctors are people who are balanced and find enjoyment in something other than medicine,” says Brian Schwab, MSIII. “For me, if music keeps me balanced and happy, then that will be good for my patients. Staying active with music will help me express myself better and share my professional enjoyment with patients rather than thinking only about health, drugs, and surgery.”

EXPRESSING THEMSELVES

For Schwab, the current Davison Council president, and JenniferVogel , MS II, artistic expression comes as their fingers fly across piano or organ keyboards. Although neither considered music as a career, they both carve out time weekly to play for themselves and others.

Schwab, who self-published two improvisational albums in high school and college, cut his musical teeth the way many young students do. He picked up the clarinet in the 6th grade and played in his school band. A year later, he switched to classical piano, but soon found he had a passion for jazz and rock music. In fact, the high school rock band for which he played keyboard—Ninjas of the Kremlin—placed among the top three in a Battle of the Bands competition in his hometown of Portland, Ore.

His love of music followed him through his undergraduate career at Rice University, where he performed both as a solo artist and with a large church group. He found it impossible to escape the desire to create melodies, even while on a medical Spanish immersion trip to Mexico before his senior year. When the salsa band at his hotel took a break, he took the stage and ended up playing with the band that night.

At Duke, Schwab has continued playing church music at Mt. Moriah Baptist Church in Durham. He also has integrated into the medical school’s vibrant music scene. As a first-year student, he joined two bands—Sorry Charlie, a Duke-University of North Carolina at Chapel hill group, and the Duke-only Bill Roth & The Histones.

With plans to become a surgeon, Schwab says staying active in music will help him continue to improve his performance when he is a practicing physician. He also plays guitar and recently picked up the harmonica.

“I enjoy being able to express myself through music,” he says. “Continuing to play and practice will help me develop a higher level of skills.”

Like Schwab, Vogel is a pianist. But unlike him, she pursued classical music and eventually, with encouragement from her music teacher and influence from her older brother, turned her attention to the organ during her early teen-age years. A devout student of the three B’s of classical music—Bach, Brahms, and Beethoven—she admits that the organ is an unusual instrument for a young person.

“As a middle-schooler, I saw my brother play the organ, and I got jealous because it looked like it was really fun to play,” says Vogel, who currently works part-time as an organist for a Durham church. “It’s a really cool instrument, and it opened up opportunities for me to perform competitively, as well as to watch many great musicians play.”

One such experience set the trajectory of her college years. As a rising high school senior, she attended the prestigious Aspen Music Festival and School in Colorado. During those eight weeks, she studied with other talented musicians and had free access to concerts given by international artists. The two months were inspiring, and they led her to major in music at Stanford University. Once there, she earned the trust of the music faculty and received a set of keys to the campus chapel to practice on the organ at her convenience.

But she bypassed a musical career in favor of one in health care. However, she says her years as a performer did prepare her well for medical school.

“The four to six hours I spent every day practicing and playing were great training for the long hours of being a medical student,” she says. “I knew I wanted to concentrate on the enriching aspects of music—the business of music is very different than simply making music that you enjoy and love.”

And, it is exactly those inspirational aspects of music that she hopes will positively impact how she practices medicine and relates to her patients. It is incumbent upon physicians to communicate health information effectively, and being well versed in expressing emotion through music will be a benefit to patient relations, she says, especially as she is considering a career in pediatrics.

FINDING DISCIPLINE AND RELEASE

The double-helix structure of DNA does not often come to mind in discussions of art. A steel sculpture now outside the Bryan Center on campus proves it can be an excellent model.

Although he usually draws pulp fiction comic art, Kwadwo “Kojo” Owusu-Akyaw, T’10, MSI, deviated from his norm to create a more than 8-foot-tall structure of DNA in the midst of the process of replication. He built the sculpture in early 2010 during the last semester of his senior year at Duke University. It was placed at the front of the student center at the request of Vice Provost for the Arts Scott Lindroth and Vice President for Student Affairs Larry Moneta.

“The structure of DNA has a very big visual appeal,” Owusu-Akyaw says, adding he only began sculpting a year ago. “I wanted to produce something that demonstrated that biology and its components can be beautiful.”

Owusu-Akyaw used conventional tools to construct the sculpture, but his long-standing artistic tool is his saxophone. He picked up the instrument as a 5th-grade student and took classical music lessons. As a high school student, he played in several All-Region Bands, as well as a classical quartet that competed at the state level.

Today, he plays in the Durham-based quartet Straight Up Jazz. He joined the group this past August, and they often perform at Broad Street Café near East Campus. The other band members might be significantly older than he is, but Owusu-Akyaw, who admires Miles Davis but emulates saxophonist Sonny Rollins, says he thoroughly enjoys being part of the group.

“With jazz music, there’s lots of room for improvisation and expressing yourself,” he says. “You can say what you want to say. Once you know the basic rules of music, you can open up a whole new world.”

Having music as a stress-relief outlet will make him a better doctor, he says, because he often finds an inner peace when he plays. Picking up his saxophone at the end of a hard day helps him process the day’s anxieties and will likely enhance his ability to help others.

For Matthew Kan, MSIII, his art—the violin he has played since age 4—has prepared him to be a strong leader. After two years of private lessons, Kan joined the San Francisco Symphony Youth Orchestra and became a concert master by the end of high school. During his tenure with the orchestra, the group performed in Mexico, Cuba, Russia, Lithuania, and Ireland. One of the concerts they performed was Peter and the Wolf, featuring narrators Danny Glover and Sharon Stone.

Working with famous actors was an incredible opportunity, he says, but it also required him to accept a level of responsibility unusual for someone his age.

“The orchestra is a very professional environment, and its pressures require more maturity than is often expected from a high school student,” says Kan, who has a clinical interest in pediatric allergy and immunology. “So, I learned leadership skills that have proven helpful as I’ve gone through the MD/PhD program, such as how to compromise and work well together, as well as how to delegate tasks.”

Kan’s love of chamber music remained with him after high school. Like Vogel, Kan, who also has an affinity for Brahms and Bach, spent two months at the Aspen Music Festival and School. In addition, he was part of the first season of Music@Menlo, an internationally acclaimed chamber music festival and institute in San Francisco, and he played with Stanford University’s Emerson Quartet.

As a Harvard University undergraduate, he played in the Harvard-Radcliffe orchestra throughout college. His musical involvement at Duke, however, has been less constant—he was unable to play during the demanding second year. Currently, he plays in the Duke Medical Orchestra, a group composed of approximately 50 Duke health care professionals, and takes private lessons from Eric Pritchard, a violinist and professor of practice in Duke University’s Department of Music.

LIFTING SPIRITS

Many physicians and artists would agree there is a clear connection between the medical study of the human body and using the entire body to produce artistic expression. Singing, dancing, and acting often require total body involvement, and several Duke medical students engage in these activities frequently.

From the moment Matthew MacCarthy, MSIII, tried out for a role in The Music Man as an 8th-grade student, he has loved musical theater. His turn as first tenor in the barbershop quartet showed him the joys of acting out stories on stage with words and song. His participation in such a physically demanding art form is unique, however, because MacCarthy lives with cerebral palsy.

Rather than join a theater group as a University of Denver undergraduate, he became involved in the Physically Handicapped Actors & Musical Artists League (PHAMALY), a community theater that provides performance opportunities for individuals living with disabilities. As a group member, MacCarthy participated in several productions, including Oklahoma!, Les Miserables, and The Wiz.

“The first time I saw a PHAMALY production in high school, I thought it was amazing because the shows were tweaked to accommodate and play off of the disabilities of people in the cast,” MacCarthy says. “It’s always been very inspiring to me to see people overcome their daily challenges. It takes guts to get on stage just for the love of art.”

MacCarthy says he participates in the annual Duke Medical Student-Faculty show, but his main artistic activity now is Duke’s oldest undergraduate a capella group, Pitchforks. Currently, the all-male group takes up the largest chunk of his time outside of academics, with roughly four hours of practice weekly.

Being involved with Pitchforks dovetails nicely with his plan to enter pediatrics, he says. Ultimately, he wants to employ music therapy, such as singing solo for children or in groups, to enhance the medical treatment they receive. MacCarthy also sings with the medical school a capella group, Major Groove, which rounds the hospital, singing for patients who want to listen. According to MacCarthy, the effects are evident.

“Music is a special tool in the art of healing,” he says. “You can physically see people’s spirits lift. When we sang Deck the Halls this past holiday season, one woman in the hospital for cancer treatment, who had been relatively nonresponsive, opened her eyes wide, sat up, and was the first one to clap when we finished.”

Cecelia Ong, MSII, also was part of that serenade. During her first year of medical school, Ong founded Major Groove, which is named for the major and minor grooves in DNA. In the beginning, the group, which is part of the Health Arts Network at Duke, was composed only of first-year medical students. Now, 16 to 18 students from all four years and the MD/PhD program participate.

During the holiday caroling, Ong had a similar experience to MacCarthy’s. In between songs, a patient spoke up about the desire to have a doctor who sings.

“He stopped us and said, ‘I want you to be my doctor. I want a doctor who can sing to bring my spirits up,’” she says.

Ong’s music career blossomed when she walked up to a piano in a store unprompted and started picking out notes unassisted—her parents took it as a sign that their daughter needed an instrument. Throughout her youth, she played for her high school theater group and took up the string bass to be part of the school orchestra.

“Piano is a solo focus, but the string bass provides the foundation for sound. You really hear the sounds of the foundations of the chords,” she says. “As a soprano singer, I’m very fond of hearing the ranges of melodies these instruments provide.”

Her vocal training began at age 8 in a Vietnamese youth choir under the leadership of a Vietnamese medical oncologist. It was an enlightening experience, not only because it introduced Ong to the intricacies of music, but also because it highlighted a Vietnamese musical culture previously unknown to her.

Since then, the voice and how it works has fascinated her. She is not ready to say she will be an otolaryngologist, but she does want to learn more about how vocal chords are used.

Perhaps the most physical form of art is dance. Stephanie Sheikh, MSII, first studied ballet, tap, and jazz as a 4-yearold, and she competed and traveled nationally in middle school. While in high school, Sheikh participated in national competitions in New York that offered opportunities to study under the current leading dancers from the American Ballet Theatre. She also continued her art as a neurosciences, behavioral biology, and dance undergraduate at Emory University.

After being accepted to study dance in New York, Sheikh deferred medical school for a year. During that time, she learned more about how the body moves naturally and what dancers should do to expand their current abilities. She now continues her training in modern dance at Ninth Street Dance in Durham. Each class is a step along the path toward her ultimate career goal and the seamless fusion of art and medicine.

“I’ve wanted to be a neurologist for a long time to work with patients living with Alzheimer’s and dementia,” Sheikh says. “I also have an interest in working with patients who have movement disorders, because being unable to move is devastating.”

For Sheikh and her classmates, no matter the art form, they firmly believe including art in their lives will not only affect them today, but it will also influence them—and their patients—for years to come.

To read the story online: http://medalum.mc.duke.edu/wysiwyg/downloads/Winter2011DMAN.pdf

The story begins on pg. 11

 

February 8, 2011 Posted by | Education, Healthcare, Profiles | , , , , , , , , , , , , , , , , , | 1 Comment

   

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