Tag Archives: medicine

Dr Patrick O’Donnell is a Clinical Fellow in Social Inclusion at the , a pilot project of the the University of Limerick’s Graduate Entry Medical School in Ireland

It was a one of those endless days in the medical library in my third year of studies that I had an epiphany. I had become pretty disillusioned with my life as a medical student and I was starting to doubt my reasons for choosing this path. I remember leafing through a fairly dull journal when I came across a series of reports on student electives to far-flung impoverished parts of the world. My attention was immediately seized and I quickly set about finding out how I could become part of the wave of idealistic students who go abroad every summer to help people less fortunate than themselves. To be able to marry my passion for travel with an interesting medical experience seemed like an incredible opportunity.

This was the start of a journey that led me to India, the Solomon Islands, Haiti and Nepal to take part in IHEs (international health electives) over the next four summers. They were all very different experiences, but I returned with the same positive feeling; “I have helped in a meaningful way”. These were experiences I could not have gotten at home, I felt. These were making me a better person and hopefully a better doctor in the future. The feelings they created in me and the reactions of those I told about my experiences on my return made me feel like I was definitely making good use of my knowledge and skills.

Looking back, I doubt I made a difference at all, as a recent CMAJ editor’s blog suggested. I was ill prepared and very naive. Language was a barrier to being any way useful in all four of the countries I visited. Often a member of staff (usually a qualified nurse or doctor) was assigned to translate for me as I chatted to patient in the clinics. This ‘baby-sitting’ was a waste of skilled professional time in services that were often overstretched to begin with. I didn’t know very much about the common conditions in these far-flung parts of the world, and often the little I did know related to advanced tests and expensive treatments unavailable in the countries I visited. I brought with me some old textbooks, antibiotics and some surgical supplies to donate to clinics. I had done a little general research on each country I visited, but still managed to encounter civil unrest in both the Solomon Islands and Haiti. I had no plan B, no formal emergency contacts and my medical school did not know anything about my exploits.

Don’t get me wrong, I had the time of my life, and the experiences I had and the people I met have moulded me as a person and a doctor.

That medical student worldwide are attracted to IHEs electives is not surprising. A on the attitudes of university students to global development reported that 83% of those surveyed felt it was important to do something to improve the world in which we live and 81% felt that traveling abroad to volunteer is the most effective action to take.

It is not surprising then that bright, enthusiastic medical students act on these impulses. I know I certainly felt as a medical student I had much more to offer on a developing country elective than my colleagues studying arts or business. I also know, however, that as a medical student I was less inclined to examine my reasons for travelling, my activities while away and the effects of my trip with a critical eye. I had never been to a homeless shelter or an addiction service in my own country, yet I was delighted to fly half way around the world to meet similarly marginalised patients in distant places.

I now have the benefit of age, experience and a higher qualification in global health and yet I am still conflicted on the issue. Do IHEs serve a purpose? What do students actually gain from them? Do they cause harm? Are they safe? Who is ultimately responsible for the students and their welfare while on IHE? These are some of the many difficult questions generated by the phenomena that are IHEs.

One area that is beginning to be looked at is the ‘host’ experience of these IHEs and their effects on health services in the developing countries visited. The studies that have so far been published do show despite all the expected problems with IHEs; such as cultural incompetence and language difficulties, there are benefits (Bozinoff et al. 2014, Kraeker and Chandler 2013). Most of the positive gains reported relate to improved partnerships between developed and developing country academic institutions and that concept of reciprocity that is often mentioned, but very hard to achieve in this context.

There are now a huge variety of resources for students to encourage practical preparation and that provide thought provoking scenarios that focus on the inevitable dilemmas faced on IHE. Many medical schools now have modules on global health and cultural competencies. Post-exposure prophylaxis kits for HIV exposure are much more widely available. Students are a lot better informed on world news and issues in foreign parts. Communication with home and emergency contacts are easier. All of these factors should make for better informed, safer and more knowledgeable IHE students.

Whether IHEs are truly successful as a life changing learning experience, however, rests with the attitude of the students themselves.

In addition to those mentioned , some international resources include:

• project from UBC, Canada

• Ethical scenarios on the website

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is Digital Content Editor at CMAJ (she is also a trained medical illustrator)

Perhaps you’re familiar with the profession, but many are not. Medical illustrators are educated in human anatomy and life sciences and have the skills and technical training to communicate scientific concepts in a visual way. They create animations, illustrations, 3D medical models, virtual simulations, medical games, interactive educational modules, and more. There is one accredited program in Canada, , at the University of Toronto (my alma mater).

Last week, I attended the 69th annual in Rochester, MN, home of the world-famous Mayo Clinic. Rochester is a tiny town but it boasts an impressive variety of leaders and experts in diverse fields. Our group of 400+ attendees got to hear from some of them, as well as other awe-inspiring speakers from around the globe.

There were so many great talks and I wish I could address them all but, alas, here’s a quick flyby:

, pediatric surgeon at Mayo Clinic, gave a poignant and emotional talk about the successful separation of conjoined twins Abbigail and Isabelle Carlsen, which took place back in 2006. He explained that multiple imaging techniques ultimately still fell short in detailing the intricacies of the girls’ anatomical abnormalities (such as a common duodenum, and a messy network of bile ducts) in a way that was clear enough for the surgical team to feel confident with performing the operation. Medical illustrator was asked to step in and worked closely with pediatric radiologist to provide a series of extremely accurate illustrations of the twins’ anatomy (see one sample below). These provided a crucial surgical planning tool for the team of 70+ people who separated the twins. The poster-sized print-outs were then used as reference on the day of the surgery. “Medical illustrators saved the lives of two girls”, said Dr. Moir.

Mayo Clinic conjoined twins' illustration

Again on the theme of medical planning tools, Mayo Clinic pediatric neurosurgeon, , explained a new approach used for surgical treatment of craniosynostosis (the abnormal fusion of one or more bones of the skull in infancy). A medical 3D animator (whose name I unfortunately did not catch), uses CT scan information from a child’s malformed skull, recreates it in 3D software, and essentially provides a virtual platform in which surgeons can break down the top portion of the skull into pieces - think puzzle pieces - and reconfigure the skull into a more natural shape. They then map out the new skull pieces with lettered codes on the child's skull and perform the operation. Their research on the technique has found it yields a better shape result with a single, shorter operation. Win, win. More details .

, Director of Social Media for Mayo Clinic, shared his insights on the importance of being out there (here?) in the world of #socialmedia. He said the networking that happens on social platforms is what drove Mayo to the top, despite it being in a small city. And with its relatively minimal cost, the return on investment for being involved in social networking has the potential to be quite large.

In their talks, MK Czerwiec (aka ) and Johns Hopkins medical illustrator and instructor , shared with us the power of comics in medicine. Although they have been in the field for a long time, graphic novels and comics are now being recognized as an important and effective modality for knowledge transmission, especially for taboo or touchy subjects (e.g. ), the younger crowd (e.g. asthma education, ), or even for global topics such as a , published by the CDC. Comic Nurse MK Czerwiec, who is in fact a nurse, now does workshops with medical students to unleash their inner graphic art talent. For more on graphics in medicine, check out .

Avid Twitter user , Art Director of Information Graphics at Scientific American, shared her insights on the difficulties of visualizing complex scientific information for both an educated lay audience and an expert audience within the same graphic. Not an easy task but she always finds beautiful solutions. She also challenged us to , an organ that may be better understood as a functional map rather than an anatomical one. See the for more information.

There is a fascinating community of science+art lovers on the Internet. Some of the insiders helped us explore this world. There was , social media guru, talented artist, and blogger for the Scientific American blog , a lovely fellow with an under-appreciated sense of humour. There was also , founder and editor-in-chief of online magazine , who seems to know everything about science-based art. Follow , on Twitter and check out for more.

A handful of fine artists shared with us how they have discovered a love for anatomy and medicine and garnered attention along the way. There was , of the Tissue Series fame, who recreates anatomical cross sections entirely out of rolled-up narrow strips of paper (a technique called quilling). Artist uses liquid latex and markers to dissect with a paintbrush directly on human subjects, giving us a dramatic peek inside (see below).

Then, if all that wasn't enough, our minds were blown by a couple of speakers who have worked with the likes of National Geographic, BBC, Discovery Channel and, oh ya, George Lucas. The first was , paleo-artist, who, as he put it best, "likes to make heads". In his small NY City home studio, he creates anatomically correct forensic reconstructions of fossil hominids, both in sculpture and as paintings or murals. This video pretty much sums up the greatness that is Viktor Deak.

The second mind-blowing presenter was , who gave a few talks and workshops. Andrew started out as a working with the greats in California and while doing so he became obsessed with sculpting human anatomy. He eventually left Hollywood (!) in order to dedicate himself to teaching and his anatomical modelling company. His Sculpting for Surgeons class teaches cosmetic and plastic surgeons to pay attention to the aesthetics and proportions of anatomy as well as its function. "Be addicted to the human form," he said, "in order to recreate its beauty."

, MD, PhD, is Assistant Professor of General Practice at University of São Paulo, and the Former President of the Brazilian Society of Family and Community Medicine

 

“Soccer is the most important thing of unimportant things” is a common expression in Brazil. It is attributed to Arrigo Sachi, an Italian coach and to Nelson Rodrigues, a Brazilian writer. Brazil will not be the same country after July 8th 2014 when the national soccer team was almost destroyed by the Germans. During the preparation for World Cup the most frequently discussed aspect was the “the legacy”. But this was not what we expected. Many patients I saw this week were very upset- just as if they had suffered a major personal trauma. Brazil has never really been at World War. The feeling is not of anger against the Germans. Not at all. Everybody is in shock, or what “specialists” might call “post-traumatic stress disorder -population based”. All my consultations this week began by asking patients about the game. The most common words used were “shame” and “pathetic”. Many of them told me they dreamed that it was not true.

The first responses on social networks were the jokes even before the game finished. It is one of the ways Brazilians deal with trauma. But now everybody in trying to understand what happened. Planning beat improvisation is the most common theory. But isn’t soccer an art? It is as important to train the basics as in ballet or in painting but surely talent is the most important part? It seems that this day is over.

Soccer is now more a business than an art - just as medicine. Medicine chose the evidence based path. Improvisation is linked more to communication, especially of risks and benefits, in supporting a shared decision. One might say that “medicine was art for centuries, then become a science for decades, and now it is business”.   Maybe that is unfair and there is still a vestige of art and science, at least in some doctors. In São Paulo it is not easy to find them. The main goal for good students at the University of São Paulo, with some exceptions, is to open a nice private office as soon as possible and charge R$ 1000,00 reais (US$ 400,00) for each consultation that may last from 30 to 90 minutes - like the famous professors.

People feel one reason for this tragedy is the organization of soccer and its shady relations with sponsors and television. There is too much corruption in the Brazilian Soccer Federation (the last president left the country and lives in Miami). It seems that in Brazil the soccer stakeholders use methods that are decades surpassed. The coach, Felipão is totally outdated. The German team planned well. Their current coach, Joachim Löw, was the assistant of the former coach and was not sacked even though he lost two World Cups (2006 as assistant and 2010 as coach). For this World Cup they built a quiet hotel close to an isolated and beautiful beach and now intend to sell it.

In conclusion, the lesson for now is that improvisation is not, or should not be, the most important player in modern world. It is true for medicine, for soccer, and for any “value chain” that attracts billions of dollars. For medicine as in soccer, the big question is to know the right place for art and improvisation. It still remains behind the medical consultation even in the current business model.

And, now we need all our professional skill and evidence based medicine to deal with the national post-traumatic stress disorder. Or not.