Science Education – Scientists Talk Funny

New approach effectively relieves chronic low back pain

Anyone with an aching back knows just how debilitating that pain can be. Now, Stanford Medicine researchers may have good news for the 500 million people worldwide experiencing low back pain.

Stanford pain psychologist Beth Darnall, PhD, has developed a single-session, two-hour class called Empowered Relief, which aims to rapidly equip patients with pain management skills. The first randomized, controlled clinical trial suggests this new method may be as effective at reducing chronic low back pain as weeks of traditional therapies, a paper in JAMA Network Open recently reported.

Empowered Relief stems from a traditional therapy called cognitive behavioral therapy, which relies on the interconnection between thoughts, feelings, physical sensations and actions. Both treatments can help patients identify and change thoughts and behaviors that increase their pain, as well as learn coping skills to better control pain response and improve quality of life.

“The problem is CBT isn’t broadly accessible,” said Darnall. “There are only a small number of behavioral specialists, and yet millions of Americans live with ongoing pain. And many under-served communities in the U.S. don’t know how to find a trained therapist.”

Another major barrier, said Darnall, is time commitment — cognitive behavioral therapy patients attend a two-hour group session each week for two to three months.

To address this problem, Darnall combined what she believed were the most critical skills from cognitive behavioral therapy, such as identifying unhelpful and stressful thought patterns, with information about the science of pain, mindfulness principles, and the relaxation response. With the help of an instructor, patients then translate their new skills and knowledge into a personalized plan to manage their pain at home.

“The goal is to align our treatments with what’s feasible for patients and make it broadly accessible,” Darnall said. It’s possible, she said, to teach 85 people in a one-and-done Empowered Relief class. And if taught weekly, 680 patients could be treated in eight weeks, compared with 10-15 who could be treated during that time with cognitive behavioral therapy.

Pain treatment with lasting effects

Darnall conducted the clinical study with Sean Mackey, MD, PhD, professor of anesthesiology, perioperative and pain medicine at Stanford. In it, 263 adults with chronic low back pain — most of whom had this pain for more than five years and almost half of whom had additional chronic pain conditions — were randomly assigned to eight cognitive behavioral therapy sessions, one Empowered Relief session or one traditional health education session, which acted as a control. (In health education, participants learned basic information, such as the definition and warning signs of back pain, but not actionable skills or the neurobiology of pain.)

For three months after the treatment, the participants reported information about their pain, such as its intensity and whether it disturbed their sleep. According to patient reporting, Darnall’s course relieved pain as effectively as cognitive behavioral therapy and better than the health education session.

“I was pleasantly surprised that people’s back pain improved as well as their sleep, depression and anxiety symptoms,” said Mackey. “I can easily see this integrating with standard medical care to provide benefits for many patients.”

The results are promising, but the study will need to be replicated in a larger and more diverse population, said Darnall.

The success of the course doesn’t mean cognitive behavioral therapy will be eliminated, Darnall said. Instead, the researchers want to determine how to match individual patients with treatment options that work best for them. That, she said, could inform pain treatment protocols, resource allocations and other medical decision-making.

Now, Darnall’s team is expanding access to the Empowered Relief program to help address existing disparities in pain care. The class is already available in five languages and seven countries to treat chronic pain — and the team has certified 300 healthcare clinicians around the world as Empowered Relief instructors.

“I hope expanded, online access to the course will provide more equitable access to evidence-based pain care for people living in rural areas, prisons and other settings that lack trained pain professionals,” she said.

Photo by Sasun Bughdaryan

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

How to talk with someone about COVID-19 vaccine hesitancy

With less than half of the United States fully vaccinated, you’ve probably wondered, “How should I talk to hesitant friends or family members about getting their COVID-19 shot?” Now, Stanford Medicine researchers specializing in health education have developed guidelines to help facilitate those awkward conversations.

“We’re trying to find common ground between different audiences to create guidelines that catalyze conversation about vaccination, not stifle it,” said Rachelle Mirkin, MPH, administrative director of health education, engagement and promotion at Stanford Health Care, who led the effort.

Moreover, these conversations either aren’t happening or they’re often ineffectively divisive, said Emilie Wagner, a healthcare strategy consultant who teaches at Stanford and who helped Mirkin and Nicole Altamirano, program manager for digital experience strategy, conduct the research. “There’s so much tension that people don’t want to risk a relationship. Yet, if it goes unaddressed, the tension just naturally mounts.”

The team wanted to understand why some people are reluctant to adopt COVID-19 prevention measures — including wearing a mask, social distancing and being vaccinated — and wanted to learn how to facilitate better communication with vaccine-hesitant individuals.

So far, they’ve discovered that traditional messages — such as the need to protect yourself and others or the enticement of getting kids back to school — don’t move the needle when it comes to persuading hesitant people to get a vaccine. Having a personal, empathetic conversation with people works better than presenting statistics and facts at them.

Needing a new approach

Mirkin and her team conducted an extensive literature review of vaccine hesitancy, using the information to create a list of 25 talking points they thought might sway those who are vaccine hesitant.

They then interviewed health care providers, hospital administrators and a small group of older white adults who were vaccine hesitant, but only regarding COVID-19. Somewhat surprisingly, these participants weren’t generally against vaccines, said Mirkin. Some had already received a two-part shingles vaccines, which can have significant side effects including fatigue, muscle pain and fever.

But when it came to COVID-19 shots, the traditional messaging did not resonate with the target group, said Wagner.

“They had a response for everything,” she said. “They thought the vaccine wasn’t a means for returning to normal. It wasn’t their responsibility to keep others safe. And they believed the risk of the vaccine outweighed the risk of COVID.”

So, the team switched from drawing on knowledge to drawing on empathy. Instead of focusing primarily on facts, they suggest having open-ended conversations that validate feelings and personalize the vaccine experience. And they recommend talking about how everyday life is easier once you’re vaccinated.

According to Wagner, they found that the appeal of hassle-free travel can motivate this group to get vaccinated. Visiting with grandkids can also nudge older adults into getting their shots. But generally, it takes a combination of incentives. The researchers also realized that many short conversations over time are needed. “It takes persistence, so talking with friends and family members can be more effective than a single conversation with a provider,” Wagner said.

To share their approach more broadly, the researchers translated their new strategy into two practical guides — one for health care providers and one for friends and family — and are now disseminating them.

“We need to make space for these discussions,” Mirkin explained. “The more non-judgmental conversations you have with an individual, the more likely they are to protect themselves and others from COVID.”

Encouraging vaccine acceptance, one group at a time

Mirkin’s team is also trying to understand the drivers of vaccine acceptance in two other groups: Latino Spanish speakers and Pacific Islanders. They are working with community partners to create social media campaigns, including Facebook ads, Twitter and Instagram posts, as well as public service announcements. So far, the Latino public service announcements have been picked up by Telemundo, a Spanish-language television network, and the Facebook ads have more than 3 million hits.

Based on initial data, the main issue for Latinos and Pacific Islanders is access to personal protective equipment — such as masks — COVID-19 testing and vaccines, Mirkin said. “In general, the concerns are very logistics-based, whereas the Caucasian hesitant group is philosophically- and identity-based,” she said.

Vaccine acceptance is often complicated by a larger erosion of trust of science and health care systems that have failed many people, especially those of color, said Mirkin. “As an academic medical center, we have to understand what’s going on to begin to reshape the conditions to help rebuild trust.”

This is a reposting of my Scope blog story courtesy of Stanford School of Medicine.

Photo by Mattia Ascenzo

Physicians re-evaluate use of lead aprons during X-rays

When you get routine X-rays of your teeth at the dentist’s office or a chest X-ray to determine if you have pneumonia, you expect the technologist to drape your pelvis in a heavy radioprotective apron. But that may not happen the next time you get X-rays.

There is growing evidence that shielding reproductive organs has negligible benefit; and because a protective cover can move out of place, using it can result in an increased radiation dose to the patient or impaired quality of diagnostic images.

Shielding testes and ovaries during X-ray imaging has been standard practice since the 1950s due to a fear of hereditary risks — namely, that the radiation would mutate germ cells and these mutations would be passed on to future generations. This concern was prompted by the genetic effects observed in studies of irradiated fruit flies. However, such hereditary effects have not been observed in humans.

“We now understand that the radiosensitivity of ovaries and testes is extremely low. In fact, they are some of the lower radiation-sensitive organs — much lower than the colon, stomach, bone marrow and breast tissue,” said Donald Frush, MD, a professor of pediatric radiology at Lucile Packard Children’s Hospital Stanford.

In addition, he explained, technology improvements have dramatically reduced the radiation dose that a patient receives during standard X-ray films, computerized tomography scans and other radiographic procedures. For example, a review paper finds that the radiation dose to ovaries and testes dropped by 96% from 1959 to 2012 for equivalent X-ray exams of the pelvis without shielding.

But even if the radioprotective shielding may have minimal — or no — benefit, why not use it just to be safe?

The main problem is that so-called lead aprons — which aren’t made of lead anymore — are difficult to position accurately, Frush said. Even following shielding guidelines, the position of the ovaries is so variable that they may not be completely covered. Also, the protective shield can obscure the target anatomy. This forces doctors to live with poor-quality diagnostic information or to repeat the X-ray scan, thus increasing the radiation dose given to the patient, he said.

Positioning radioprotective aprons is particularly troublesome for small children.

“Kids kick their legs up and the shield moves while the technologists are stepping out of the room to take the exposure and can’t see them. So the X-rays have to be retaken, which means additional dose to the kids,” Frush said.

Another issue derives from something called automatic exposure control, a technology that optimizes image quality by adjusting the X-ray machine’s radiation output based on what is in the imaging field. Overall, automatic exposure control greatly improves the quality of the X-ray images and enables a lower dose to be used.

However, if positioning errors cause the radioprotective apron to enter the imaging field, the radiographic system increases the magnitude and length of its output, in order to penetrate the shield.

“Automatic exposure control is a great tool, but it needs to be used appropriately. It’s not recommended for small children, particularly in combination with radioprotective shielding,” said Frush.

With these concerns in mind, many technologists, medical physicists and radiologists are now recommending to discontinue the routine practice of shielding reproductive organs during X-ray imaging. However, they support giving technologists discretion to provide shielding in certain circumstances, such as on parental request. This position is supported by several groups, including the American Association of Physicists in Medicine, National Council on Radiation Protection and Measurements and American College of Radiology.

These new guidelines are also supported by the Image Gently Alliance, a coalition of heath care organizations dedicated to promoting safe pediatric imaging, which is chaired by Frush. And they are being adopted by Stanford hospitals.

“Lucile Packard Children’s revised policy on gonadal shielding has been formalized by the department,” he said. “There is still some work to do with education, including training providers and medical students to have a dialogue with patients and caregivers. But so far, pushback by patients has been much less than expected.”

Looking beyond the issue of shielding, Frush advised parents to be open to lifesaving medical imaging for their children, while also advocating for its best use. He said:

“Ask the doctor who is referring the test: Is it the right study? Is it the right thing to do now, or can it wait? Ask the imaging facility: Are you taking into account the age and size of my child to keep the radiation dose reasonable?”

Photo by Shutterstock / pang-oasis

This is a reposting of my Scope story, courtesy of Stanford School of Medicine.

SLAC summer programs encourage students to explore STEM careers

Proving that science can be fun, middle school students at the lab’s CORE Science Institute made giant soap bubbles to learn about thin film interference, which happens when light reflects off the two thin layers of soap film that form a bubble. (Jacqueline Orrell/SLAC National Accelerator Laboratory)

The Department of Energy’s SLAC National Accelerator Laboratory welcomed more than 300 science enthusiasts this summer – from middle schoolers to physics graduate students – for camps, institutes and internships aimed at encouraging them to become part of the science, technology, engineering and mathematics (STEM) community.

The youngest group – 18 students from Ile Omode, an African-centered middle school in Oakland – attended a week-long summer camp hosted by the Committee for Outreach, Recruitment & Engagement (CORE) Science Institute. The students learned about thin film interference from bubbles, coding and electronics from programming Arduino kits, electricity from a Van de Graaf generator and Newton’s laws of motion from playing basketball. They also learned the difference between science and engineering by taking apart old cell phones, and enjoyed the tasty results of a chemistry demonstration on how to make ice cream with liquid nitrogen.

CORE Science Institute students also worked in pairs to prepare and present a poster on one of these activities to a large cross section of SLAC employees. Camp organizer Margaux Lopez said she considers this poster session and the presentation skills it hones the most valuable part of the week.

The second annual SLAC Accelerating Girl’s Engagement in STEM (SAGE-S) summer program introduced high school girls to the work and lifestyles of scientists and engineers at SLAC. The 40 participants came from 30 public high schools, traveling from as far away as Santa Rosa, Sacramento and Gilroy.

Over the course of a week, the students heard talks by scientists and engineers, worked on team science projects and shadowed SLAC professionals as they went about their work. The girls also attended a professional growth program to develop critical skills like effective communication, under the guidance of organizers Diana Gamzina and Giulia Lanza. This year, the SAGE-S executive committee added a “leadership styles” exercise that emphasized the need for diverse approaches to leadership.

But the SAGE-S camp wasn’t all work. The students also enjoyed evening activities like building spaghetti-marshmallow towers and duct tape wallets at their Stanford dorms and stargazing at the Stanford and Foothill observatories. These relaxed activities allowed participants to make friends with other students and with the SLAC scientists and engineers who joined in.

More than 120 undergraduate students got a deeper immersion in the SLAC research community as summer interns through five internship programs. They were guided by organizers Enrique Cuellar and Alan Fry and mentored by SLAC scientists, engineers and other professionals. Interns participating in the two programs that were funded by DOE also wrote papers and gave presentations on their research at the end of the summer. This year, about a third of all the interns were women.

Many of these undergraduates participated in the Science Undergraduate Laboratory Internship (SULI) program, a DOE Office of Science-funded program that provides STEM research opportunities for students from both four-year and community colleges at 17 participating DOE laboratories and facilities. SLAC’s SULI interns also experienced life at Stanford by living in the dorms.

Another popular summer program, the Linac Coherent Light Source (LCLS) Internship program for undergraduates and graduate students, is funded by the LCLS Directorate at SLAC. These interns focused on hands-on laboratory, programming and data analysis projects for the LCLS and LCLS-II programs. They came from 26 colleges and universities, and many were from historically black colleges.

For community college students, the DOE Office of Science-funded Community College Internship (CCI) program provided housing on the Stanford campus and real-world technology experience at SLAC. Meanwhile, the STEM Core Community College program offered students from two local community colleges valuable experience as technicians and technologists at SLAC; the program was funded by Alameda County Workforce Development Corporation and facilitated by Growth Sector.

But what about those who dream of becoming STEM teachers rather than researchers? SLAC had that covered, too, with the STEM Teacher and Researcher (STAR) program, which is funded by Cal Poly, San Luis Obispo for students and alumni of California state universities and the National Science Foundation’s Robert Noyce Teacher Scholarship Program.

Based on past experience, you may meet some of these interns as long-term SLAC employees in the future.

Finally, as the summer nears its end, 120 physics graduate students and early-career scientists from all over the world just attended the SLAC Summer Institute (SSI). This year’s theme was the flavor physics associated with quarks, charged leptons and neutrinos. SSI participants attended lectures, topical conference talks and discussion sessions, did group projects and took tours. According to organizer Thomas Rizzo, the most requested team project used machine learning algorithms to identify electron and muon neutrino events in a liquid argon time projection chamber.

Participants also competed in a “wittiest answer to the question” contest, a highly competitive and long-standing tradition of SSI. This year the question was, “A discovery in the area of the Physics of Flavor could lead to the first clear signal of Beyond the Stanford Model physics. What will it be and how will it impact future developments in HEP?” The winning answer by Innes Bigaran predicted a detection of neutrinoless double beta decay that confirms the Majorana nature of neutrino mass and causes Ettore Majorana, who disappeared under mysterious circumstances in 1938, to reappear to accept a Nobel Prize.

You can find more information about SLAC’s educational and internship programs at https://careers.slac.stanford.edu/node/128

For questions or comments, contact the SLAC Office of Communications at communications@slac.stanford.edu.

This is a reposting of my news feature, courtesy of Department of Energy’s SLAC National Accelerator Center.

Explaining neuroscience in ongoing Instagram video series: A Q&A

At the beginning of the year, Stanford neuroscientist Andrew Huberman, PhD, pledged to post on Instagram one-minute educational videos about neuroscience for an entire year. Since a third of his regular followers come from Spanish-speaking countries, he posts them in both English and Spanish. We spoke soon after he launched the project. And now that half the year is over, I checked in with him about his New Year’s resolution.

How is your Instagram project going?

“It’s going great. I haven’t kept up with the frequency of posts that I initially set out to do, but it’s been relatively steady. The account has grown to about 13,500 followers and there is a lot of engagement. They ask great questions and the vast majority of comments indicate to me that people understand and appreciate the content. I’m really grateful for my followers. Everyone’s time is valuable and the fact that they comment and seem to enjoy the content is gratifying.”

What have you learned?

“The feedback informed me that 60 seconds of information is a lot for some people, especially if the topic requires new terms. That was surprising. So I have opted to do shorter 45-second videos and those get double or more views and reposts. I also have started posting images and videos of brains and such with ‘voice over’ content. It’s more work to produce, but people seem to like that more than the ‘professor talking’ videos.

I still get the ‘you need to blink more!’ comments, but fortunately that has tapered off. My Spanish is also getting better but I’m still not fluent. Neural plasticity takes time but I’ll get there.”

What is your favorite video so far?

“People naturally like the videos that provide something actionable for their health and well-being. The brief series on light and circadian rhythms was especially popular, as well as the one on how looking at the blue light from your cell phone in the middle of the night can potentially alter sleep and mood. I particularly enjoyed making that post since it combined vision science and mental health, which is one of my lab’s main focuses.”

What are you planning for the rest of the year?

“I’m kicking off some longer content through the Instagram TV format, which will allow people who want more in-depth information to get that. I’m also helping The Society for Neuroscience get their message out about their annual meeting. Other than that, I’m just going to keep grinding away at delivering what I think is interesting neuroscience to people that would otherwise not hear about it.”

Is it fun or an obligation at this point?

“There are days where other things take priority of course — research, teaching and caring for my bulldog Costello — but I have to do it anyway since I promised I’d post. However, it’s always fun once I get started. If only I could get Costello to fill in for me when I get busy…”

This is a reposting of my Scope story, courtesy of Stanford School of Medicine.

“The brain is just so amazing:” New Instagram video series explains neuroscience

Many people make New Year’s resolutions to exercise more or eat healthier. Not Stanford neurobiology professor Andrew Huberman, PhD. This year he set out to educate the public about exciting discoveries in neuroscience using Instagram.

Huberman’s sights are high: he pledged to post on Instagram one-minute educational videos about neuroscience an average of five times per week for an entire year. I recently spoke with him to see how he’s doing on his resolution.

Why did you start the Instagram video series?

“Although I’m running a lab where we’re focused on making discoveries, I’ve also been communicating science to the general public for a while. I’ve found that there’s just immense interest in the brain — about diseases, what’s going on in neuroscience now, and how these discoveries might impact the audience. The brain is just so amazing, so the interest makes sense to me.

I don’t spend much time on social media, but Instagram seemed like an interesting venue for science communication because it’s mostly visual. My lab already had an Instagram account that we successfully used to recruit human subjects for our studies. So at the end of last year, I was talking with a friend about public service. I told him I was thinking about creating short, daily educational videos about neuroscience — a free, open resource that anyone can view and learn from. He and some other friends said they’d totally watch that. So I committed to it in a video post to 5000 people, and then there was no backing down.”

What topics do you cover?

“I cover a lot of topics. But I feel there are two neuroscience topics that will potentially impact the general public in many positive ways if they can understand the underlying biology: neuroplasticity — the brain’s ability to change— and stress regulation. My primary interest is in vision science, so I like to highlight how the visual system interacts with other systems.

I discuss the literature, dispel myths, touch on some of the interesting mysteries and describe some of the emerging tools and technologies. I talk a bit about my work but mostly about work from other labs. And I’m always careful not to promote any specific tools or practices.”

How popular are your videos?

“We have grown to about 8,000 followers in the last six weeks and it’s getting more viewers worldwide. According to the stats from Instagram, about a third of my regular listeners are in Spanish-speaking countries. Some of these Spanish-speaking followers started requesting that I make the videos in Spanish so they could share them. Last week I started posting the videos in both English and Spanish and there’s been a great response. My Spanish is weak but it’s getting better, so I’m also out to prove neural plasticity is possible in adulthood. By the end of the year I plan to be fluent in Spanish.

I’ve also had requests to do it in French, German, Chinese and Dutch but I’m not planning to expand to additional languages yet. I think my pronunciation of those languages would be so bad that it would be painful for everybody.

Currently, my most popular video series is about the effects of light on wakefulness and sleep — such as how exposure to blue light from looking at your phone in the middle of the night might trigger a depression-like circuit. But my most popular videos include Julian, a high school kid that I mentor. People have started commenting #teamjulianscience, which is pretty amusing.”

What have you learned?

“It’s turned out to be a lot harder to explain things in 60 seconds than I initially thought. I have to really distill down ideas to their core elements. Many professors are notorious for going on and on about what they do, saying it in language that nobody can understand. My goal is to not be THAT professor.

I’ve also learned that I don’t blink. Sixty seconds goes by fast so I just dive in and rattle it off. After a couple of weeks, people started posting “you never blink!” — so now I insert blinks to get them to stop saying that.

I’ve also found the viewer comments and questions to be really interesting. They cue to me what the general public is confused about. But I’ve also found that many people have a really nuanced and deep curiosity about brain science. It’s been a real pleasure to see that.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Virtual reality helps train emergency physicians

Imagine you are an emergency medicine resident, trying to focus on your patient with abdominal pain — asking about his medical history and symptoms as you give him a physical — but you keep getting interrupted. A technician stops by to hand you another patient’s EKG. A staff member asks about an order for pain medication for a different patient. And then you are called to see a psychiatric patient who is agitated. You return ready to focus and then an attending physician breaks in to redirect your attention to a new patient with a high heart rate.

All told, you’re interrupted 12 times during the patient exam. How can you possibly maintain your train of thought? How can you build trust with the patient, when all these disruptions are stressing him out?

The above narrative was inspired by the script of a new training simulation, which was filmed at Stanford’s emergency department as a virtual reality video.

This is a typical scenario faced by emergency physicians, who are interrupted on average every six minutes. These interruptions increase the likelihood of errors, so it is critical for emergency doctors to practice how to multitask in this fast-paced, high-risk and disruptive environment.

The script was written by Henry Curtis, MD, a Stanford clinical instructor in emergency medicine, and Cameron Mozayan, MD, a Stanford emergency medicine resident.

“A problem with many current learning modalities is that they don’t engage modern participants in an active, immersive learning environment, so it’s difficult to sustain their attention,” Curtis said. “Virtual reality-based education presents an innovative solution to address this problem. Distractions are minimized as the learner excitedly engages in the VR world. The perception of the experience also triggers strong memories, which connect them to the educational content. So participants allot their full attention as they contemplate important medical decisions.”

Over 30 health care educators and providers at the 2018 International Health Humanities Consortium Conference at Stanford tried the training simulation recently. While viewing, the participants were asked to choose which interruptions were more important than the patient-physician consultation. The participants then viewed the video again with expert pro and con discussions — interactively testing to see if the others’ viewpoints swayed their opinions on the importance of the interruptions.

“Training is more powerful if the participants are seeing it in 360 virtual reality and they are being engaged in an interactive experience,” Curtis told me.

Participants said the VR training realistically conveyed what it was like to work in an emergency department. One health care worker declared, “This experience makes me feel like I’m in the emergency department. I feel like I’ve seen all of these things happen at work.” Another said, “Sometimes emergency medicine feels like a warzone.” A third participant added, “I was feeling so tense in there with all of the interruptions.”

The users also provided insights. For instance, one person was struck by how often technology caused the interruptions.

Curtis worked with Jason Lowe, MD, and Anne Merritt, MD, members of Stanford’s medical humanities team and with Stanford’s Education Technology team to create the first video. Now, they are analyzing the data from the conference, and are planning a series of VR training simulations.

For his next project, Curtis is also working with Aussama Nassar, MD, to film a trauma simulation with an agitated patient who deteriorates into neurogenic shock after a bicycle accident.

Curtis said he hopes the virtual reality series will enhance the quality of the lessons learned during the training simulations, in addition to extending their reach to a larger audience. He added:

“VR education can be transported globally to allow learners across the world to immerse themselves in the intricacies of innumerable clinical encounters, as well as receive structured debriefing in the virtual world by renowned experts from Stanford University and the like.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

On writing about female physicians and the Grand Canyon: A Q&A

As a voracious reader, I particularly enjoy mystery novels featuring a female detective or medical examiner. And as physicians know so well, medical mysteries can be just as gripping, and surprising, as crimes. So I was eager to read the novel, Only Rock is Real, about a female doctor with a family practice at the Grand Canyon. I spoke recently with the book’s author, Sandra Miller, MD, who is a writer and retired family physician.

What motivated you to write novels?

I have always written poetry and essays, but crafting a novel pushes my writing to another level. The process of weaving a plot — while creating compelling and authentic characters, developing their growth and showing their stumbles — is riveting to me. The greatest compliment is when readers tell me they feel like they know my characters personally and care about them.

I’m also on a mission to promote family medicine and women physicians through fiction. I really want to encourage physicians to write, and especially to write fiction. There is little medical fiction being written currently, with the exception of the crime scene/thriller genre. I would love to see more fiction about everyday physicians and their trials and joys. And I welcome with any medical writers who want to brainstorm, share or seek feedback about their work.

How did you develop the main character, Dr. Abby Wilmore?

Like most fictional characters, Abby is partly a conglomerate of people I have known and partly made up. Every physician wants to be highly competent and strives for excellence, but there are many potholes along that path. Perfectionism and anxiety are common in doctors; finding your peace with an ever changing and critical career like medicine is no small task. I wanted to show how her confidence builds and then derails — the ups and downs of successes and errors, real or perceived, in both her professional and personal life. I wanted to show how very human physicians are.

How did you select which patient cases to include?

I tried to use a mix of cases representing a typical day: some common and some less common, some routine prevention and occasionally a very difficult case. I also wanted to include a mix of physical and mental health issues. I guess the teacher in me is always lurking, because I also selected cases where readers can learn about topics like diabetes, the morning after pill and contraception, heat injury and flu vaccines.

I keep them as realistic as I can. Sometimes you know the diagnosis immediately and other times it takes detective work. Sometimes you’re wrong because people aren’t textbooks and they don’t always follow the rules. I’ve put much effort into making all the science — medicine, geology and astronomy — as accurate as I can.

Why did you set your books in national parks?

For the last thirty years of my career in academic medicine, I helped train family medicine residents who often did a rotation at the Grand Canyon clinic. And I have friends who worked there for years. I know their stories, the human dynamics in such unusual places. Only a few national parks actually support a physician.

In addition, I have always felt a deep connection to the natural world. We’re all constructed of the same molecules; all follow the same rules of development and decay. The wonders around us are simply stunning and worth celebrating.

How do you describe your books?

I’m calling my books ‘evidence-based medical adventures.’ There is romance and a bit of a thriller plot, but the books are also filled with tons of real medicine, science and the quandaries physicians face every day. And the poetry of the night sky and the rock under our feet, not to mention the value of humor.

Are there similarities between writing and being a family physician?

I think it helps for both to know you can never know everything. And that much of life comes at us in tones of gray. Being a family physician certainly gives you a broad view of the world and the vagaries of the human mind. You need to know as much as you possibly can and you need to know what you don’t know. You keep trying your best. I think this experience helped me as a writer.

Photo by DomCarver

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

New course highlights how surgeons can serve their communities

Stanford medical students Jecca Steinberg and Paloma Marin-Nevarez want to spread the word that service-minded medical students can care for underserved communities by specializing in surgery. With the help of their mentor James Lau, MD, they have created an upcoming seminar series for medical students called “Service Through Surgery,” which showcases how surgeons can address health inequities.

Beginning in January, the new 10-week course will expose Stanford medical students to a diverse group of surgical leaders who are passionate about improving health equity through surgery. I connected with Steinberg, shown on the left in the photo, and Marin-Nevarez to learn more.

What inspired you to create the Service through Surgery seminar course?

Marin-Nevarez: “I emigrated from Mexico when I was 10 and settled in a low-income community in south Los Angeles. I never really considered myself disadvantaged until I went to college and experienced firsthand the shortcomings of my education system. Ever since, I knew I would make my life’s work to serve the underserved in communities like my own.

In my second year of medical school, I fell in love with surgery. However, when I thought about being a ‘community physician,’ I didn’t see how surgery would fit into that picture. The speakers in this course will show students with the same internal struggle as mine that they don’t need to compromise their values in order to pursue their dreams.”

What role can diversity play in overcoming health inequities?

Steinberg: “Low-income, minority communities continue to receive inadequate surgical services and bear unconscionable health burdens. Research has demonstrated that increasing diversity among physicians improves healthcare access and outcomes for traditionally disenfranchised communities, but surgery continues to trail behind other medical specialties in racial, socioeconomic and gender diversity. So the surgical workforce represents an underutilized resource for decreasing health inequities and improving the health of our communities.”

Marin-Nevarez: “A more diverse workforce leads to better outcomes for the underserved because minority patients are more likely to seek care from and be more comfortable with physicians from diverse backgrounds. And physicians from diverse backgrounds are more likely to treat patients of color in underserved communities.”

What causes surgery to be less diverse than other medical specialties?

Marin-Nevarez: “Because of unequal opportunities — especially for communities of color — surgeons are not as diverse as they should be. Because of this lack of diversity, there is a lack of mentorship that then perpetuates the cycle.

Mentorship can make a huge difference in recruiting people into a field. For example, James Lau, MD, is an amazing mentor — he was the first person to make me believe that being the first surgeon in my family may be an attainable goal. Those who ‘make it’ without mentorship most likely had access to extra resources or had to work much harder than their counterparts, or both.”

How will your seminar course inspire change?

Steinberg: “Our seminar course will create an opportunity for Stanford medical students to meet and form relationships with accomplished physicians who have combined their passions for diminishing inequities and surgery. It will show the incredible impact surgeons can make on their community. For example, Matias Bruzoni, MD, will talk about a Spanish clinic he created from scratch to improve the surgical experiences and outcomes of Spanish speaking patients. And Sherry Wren, MD, will provide her perspective on serving veterans domestically and populations around the world, exploring the adversity she faced in dedicating her career to social service.

When students connect with role models like these with a similar background and passions, they are more likely to follow in the trajectory of that role model and consider careers that might have previously seemed unattainable. We hope this seminar will provide that initial connection.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Educating the next generation of surgeons: A Q&A

Research shows that many medical students view surgeons as intimidating, competitive and predominantly male workaholics — and these stereotypes can deter students from a surgical career. As a result, there has been a relative drop in applications for surgical residencies.

James Lau, MD, a clinical professor of surgery and the director of the Goodman Surgical Educational Center at Stanford, is working to combat this trend by spearheading educational initiatives. I caught up with him recently.

Why is there a declining interest in surgical careers?

“Medical students are becoming more sophisticated in choosing specialties, and a lot likely has to do with life style issues. I think there’s a misconception that surgeons work all the time and can’t have a work-life balance.

Medical schools are also getting shorter — some are even going to three years and some schools are emphasizing primary care — so students aren’t exposed early on to surgery. So we’ve built a mentorship component into our SURG 205 surgical training course to give first- and second-year medical students at Stanford the opportunity to go into the operating room and learn what surgery is like. And it sparks the flame and shows them more accurately the collegiality and dedication of those in surgery.”

What do your students learn in SURG 205?

“Previously the students would have to find a mentor and negotiate the system on their own to get the training to be allowed in the operating room. This course brings it all together —training them on technical skills, facilitating finding them a mentor, experiencing one or two operations and hopefully building an ongoing mentor relationship with an attending surgeon.

We want them to participate in the OR, so we train them on technical skills — from the simple skills like knot-tying and basic suturing to performing a full case on a cadaver. As we explained in a recent paper, we also teach them nontechnical skills, such as coaching them on how to get along with the operating team, so they feel more comfortable when they go to the OR.”

What other educational efforts are underway?

“Surgery residents and surgeons have to know more than technical skills to do operations. They also have to work well together in teams in different settings. They have to be able to interact well with patients and make clinical decisions. And the techniques are changing all the time. So we provide a skills and simulation center with a curriculum — to help teach and mentor these skills.

We also must train inter-professionally in surgery. The nurses, anesthesiologists and surgeons all work together but traditionally train separately, which makes no sense. In a new program, we’re having monthly simulations in the operating room with surgeons, surgery residents, anesthesiologists, anesthesiology residents, OR assistants, scrub technicians, circulating nurses, and anyone else that would normally be in the operating room. We want people to understand that everyone has a role and should speak up in crisis. We’re trying to change the culture by training together.

We also have a resident as educator program, because our residents are automatically teachers and mentors to the medical students. To be a good teacher, you have to be a constant learner and create a safe learning environment. A good teacher is a good communicator and their learners include the patients.”

Why did you recently get a Master’s Degree in Health Professions Education?

“I oversee a two-year surgical education fellowship that has surgery residents teach, create curricula and evaluate the work that they do in the clerkships and residency education programs here at Stanford. Our goal is to prepare them to be thoughtful program directors, helping to make them the next generation’s education leaders in surgery. As part of the program, we encourage them to complete a master’s degree in education. To be a mentor for them, I decided to ‘walk the walk’ and get a masters degree in education. After a decade in education, I wanted to inform myself in the formal discipline of education to become more effective in the programs that we create for learners here at Stanford.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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