Perhaps the biggest challenge I will face this summer is going to be scheduling. The residents have a very busy schedule every day, attending different meetings, doctor's appointments, and groups, which frequently interfere with coming to my class. Nearly one-third of the residents were absent for last Tuesday's class, so I met individually with the residents who were absent to tutor them in what we had learned and have them do their make-up assignments. This just doesn't seem like a sustainable system for the summer, however.
We came to another bump in the road on Thursday, which was Staff Appreciation Day. My supervisor invited me to come even though I had only been working at PSI for a week. Since the entire rest of the staff was going, I felt like it would be rude and anti-social to stay behind. To be brutally honest, the celebration was at Orchard Beach and they were having a make-your-own-sundae station, so I was pretty much sold from the get-go. The only problem was I'd have to postpone my Health Literacy class until Friday. Luckily there seemed to be an open slot in the schedule that I could move my class to on Friday at 11:00 AM. Unfortunately, Friday at 10:45 AM my supervisor came into my office to tell me there was a mandatory meeting for all residents at 11, and I would have to cancel my class. I was pretty upset. Especially when I actually attended the mandatory 11:00 meeting, and saw that it was basically just a forum for the residents to ask individual questions to staff members.
To make matters even worse, I'm taking a very poorly-timed vacation this week. So basically we had two Health Literacy classes, then stopped the classes for the next week and a half. I'm wondering how many residents will even bother showing up to class the rest of the summer, now that I have proven to be unreliable and inconsistent. One of the residents even said to me, "They always do this to us! We're finally taking a class we like, and then they take it away from us!" I tried to explain to her that this would merely be a pause in classes, and they would take place regularly every Tuesday and Thursday for the rest of the summer. She seemed doubtful.
I have some problem-solving to do. How can I make sure that mandatory meetings don't pop up throughout the rest of the summer? How can I prevent doctor's appointments and the like from being scheduled at the same time as my class? How can I gain back the residents' trust?
Monday, June 28, 2010
Wednesday, June 23, 2010
So, This Is Hard
After my first day of actual teaching yesterday, I realized there will definitely be some unique challenges to working with the population at PSI. I want to start out by saying that I absolutely love working with them. The best part of my job is having the privilege of interacting with the patients here. They're a fun and rowdy bunch, which can definitely be a positive thing since it leads to thought provoking discussion and insightful questions about their disease. We will be facing our fair share of obstacles, however.
Two of the residents I teach have mild mental retardation. One has such poor vision that she cannot see the letters on the worksheet. One doesn't read a word of English, and can barely speak it. One decided five minutes in that she wasn't going to participate, but she didn't want to leave the room either and instead walked around loudly bothering the other residents. One proclaimed in class yesterday "I hate reading," to which I responded, "Well... this is a literacy class, so we're going to be doing a lot of reading."
Unlike teaching high school, I can't threaten the residents with consequences like detention or a deduction in their participation grade. The residents attend my class completely by their own free will, which is amazing. Also unlike teaching high school, about 10 minutes before class was done there was a large group of people waiting to cross through the area where I teach to go outside and take a cigarette break. Needless to say, this caused quite the distraction when they walked through my classroom, right as the residents were working on their quiz for the day. This 3:00 smoke break will happen at the end of every one of my classes.
Our objective for the day was to be able to read and answer questions about a paragraph on HIV/AIDS drugs. The average reading comprehension score on their diagnostic was a 65%. Amazingly, the average quiz score was an 86%, meaning they grew 21 percentage points in just one class! (If I discount the scores of the 2 residents with severe disabilities, the average jumps to a 93%). I'm so incredibly proud of each of my students. Hopefully their reading skills will continue to grow as the summer progresses.
Two of the residents I teach have mild mental retardation. One has such poor vision that she cannot see the letters on the worksheet. One doesn't read a word of English, and can barely speak it. One decided five minutes in that she wasn't going to participate, but she didn't want to leave the room either and instead walked around loudly bothering the other residents. One proclaimed in class yesterday "I hate reading," to which I responded, "Well... this is a literacy class, so we're going to be doing a lot of reading."
Unlike teaching high school, I can't threaten the residents with consequences like detention or a deduction in their participation grade. The residents attend my class completely by their own free will, which is amazing. Also unlike teaching high school, about 10 minutes before class was done there was a large group of people waiting to cross through the area where I teach to go outside and take a cigarette break. Needless to say, this caused quite the distraction when they walked through my classroom, right as the residents were working on their quiz for the day. This 3:00 smoke break will happen at the end of every one of my classes.
Our objective for the day was to be able to read and answer questions about a paragraph on HIV/AIDS drugs. The average reading comprehension score on their diagnostic was a 65%. Amazingly, the average quiz score was an 86%, meaning they grew 21 percentage points in just one class! (If I discount the scores of the 2 residents with severe disabilities, the average jumps to a 93%). I'm so incredibly proud of each of my students. Hopefully their reading skills will continue to grow as the summer progresses.
Saturday, June 19, 2010
My First Class
I put a sign up sheet on the door to my office, made an announcement to all of the PSI residents about my class, and crossed my fingers that people would sign up. As I was sitting in the office planning the final details of my first class, I could hear a group of them congregating outside my door.
"What's this sign up sheet for again?"
"It's the class that white girl was talkin' about!"
"Oh yeah! We get a certificate at the end!"
I couldn't help but laugh to myself. The residents I'll be teaching already remind me a lot of my students in Houston. For one, being known as "that white person." And secondly, how excited the residents got about receiving a certificate for my class. No matter your age, external rewards seem to be a good motivator. Hopefully in time they will start to value what they're learning in my class to become internally motivated. As it turns out, there may be a legitimate reason the residents (most of whom are middle-aged) remind me of my teenage high school students. Another member of the education staff of PSI told me that when addicts stop using drugs, they remain "stuck" at the same developmental level they were at when they started using. For many of the residents of PSI, this was when they were in high school.
I ended up getting over 20 people to sign up for my class this past Thursday, which I viewed as a huge success. The first item on the agenda was introductions. I reminded them of my name (I haven't been referred to as 'that white girl' since, I believe) and defined 'Health Literacy' as the ability to read and understand health information. Then I gave them their pre-test for the medication unit. I thought there was a possibility some would walk out when I announced I was giving a quiz, but they all went along with it! Afterwards, I had them sign a contract saying that they would attend class and work their hardest. I also had them write their first journal assignment, in which they described what they wanted to learn from my class, their goals, and anything else I should know about them. All of the residents gave very thoughtful responses and to my delight, want to learn about some of the topics I was already planning on covering.
To wrap up class, I told the residents they could ask me anything they wanted. One woman asked me if there were any differences between women's and men's health, besides the obvious anatomical differences. I told her that in fact, many diseases have different symptoms, prevalence, and course in women and men. Next, a transwoman raised her hand and asked, "How does this affect me, since I have male chromosomes, but women's hormones?" I was so impressed by this intelligent and insightful question, and told her the truth - that I didn't know, because there was not much research done on trans health. This led to a great discussion of the biases that transpeople and people living with AIDS face, and how society did not respond to the AIDS epidemic until upper-class and straight people were diagnosed. The residents got so fired up by the discussion, and I really want to include some reading assignments on social justice later on in the curriculum.
Overall, great first class!
"What's this sign up sheet for again?"
"It's the class that white girl was talkin' about!"
"Oh yeah! We get a certificate at the end!"
I couldn't help but laugh to myself. The residents I'll be teaching already remind me a lot of my students in Houston. For one, being known as "that white person." And secondly, how excited the residents got about receiving a certificate for my class. No matter your age, external rewards seem to be a good motivator. Hopefully in time they will start to value what they're learning in my class to become internally motivated. As it turns out, there may be a legitimate reason the residents (most of whom are middle-aged) remind me of my teenage high school students. Another member of the education staff of PSI told me that when addicts stop using drugs, they remain "stuck" at the same developmental level they were at when they started using. For many of the residents of PSI, this was when they were in high school.
I ended up getting over 20 people to sign up for my class this past Thursday, which I viewed as a huge success. The first item on the agenda was introductions. I reminded them of my name (I haven't been referred to as 'that white girl' since, I believe) and defined 'Health Literacy' as the ability to read and understand health information. Then I gave them their pre-test for the medication unit. I thought there was a possibility some would walk out when I announced I was giving a quiz, but they all went along with it! Afterwards, I had them sign a contract saying that they would attend class and work their hardest. I also had them write their first journal assignment, in which they described what they wanted to learn from my class, their goals, and anything else I should know about them. All of the residents gave very thoughtful responses and to my delight, want to learn about some of the topics I was already planning on covering.
To wrap up class, I told the residents they could ask me anything they wanted. One woman asked me if there were any differences between women's and men's health, besides the obvious anatomical differences. I told her that in fact, many diseases have different symptoms, prevalence, and course in women and men. Next, a transwoman raised her hand and asked, "How does this affect me, since I have male chromosomes, but women's hormones?" I was so impressed by this intelligent and insightful question, and told her the truth - that I didn't know, because there was not much research done on trans health. This led to a great discussion of the biases that transpeople and people living with AIDS face, and how society did not respond to the AIDS epidemic until upper-class and straight people were diagnosed. The residents got so fired up by the discussion, and I really want to include some reading assignments on social justice later on in the curriculum.
Overall, great first class!
Thursday, June 17, 2010
Here Goes Nothing
Today is the big day - I'm teaching my first Health Literacy class. I spent all day yesterday at PSI getting ready and outlining my plan for the summer. I decided the class will be broken down into four units - Medication, Adherence, Wellness, and Understanding Your Disease. For today's class, I'm going to be giving them a diagnostic quiz for the Medication unit (I'll give them the same quiz after I teach the unit so I can directly measure my impact). We're also going to have a discussion about what to expect from my class, and we're going to set up our folders. Should be a fun day, as long as they don't mind taking the quiz.
Last night I was introduced to all 66 of the residents of PSI at their nightly meeting. They gave me such a warm welcome, complete with applause! I can't wait to get to know each and every one of them. I'll let you know how it goes today.
By the way, here's a picture of the front of PSI, if you were curious what the place looks like!
Tuesday, June 15, 2010
5 Things I Learned My 1st Year of Med School
I'm taking a break from discussing my summer project, because I feel the need to reflect on this huge thing that happened yesterday - I finished my first year of med school. I heard somewhere that a first year med student learns 10,000 new facts, which seems about right. Somewhere in between all of the cadaver dissections, lectures, shadowing, and labs, I learned some lessons that can't be found in any medical textbooks.
1. People will get naked in front of you. I mean this both figuratively and literally. I was shadowing a doctor during one of the first weeks of school, and the doctor was about to give a physical exam. The elderly female patient simply started removing all of her clothing, and I had this urge to look away before I realized that I was supposed to look. In addition, during practice patient interviews for my courses, patients revealed things about their personal, psychiatric, or sexual history that they may not even tell their spouses or their best friends. When you are wearing your white coat, patients will automatically trust you and have faith that you know what you are doing. Who am I to have earned this privilege to hear and see the most intimate details of people's lives?
2. Medicine is messy. As a wise doctor once said to me, "Med students choose their specialty based on which body fluid they least hate to put their hands in." When I was shadowing a Cesarean section, the doctor let me hold the suction tube to suck up the excess blood (similar to what you'd see at a dentist's office to suck up excess drool). I was doing a great job as she was masterfully slicing through the layers of skin, fat, and muscle to get to the uterus. Then, the intern turned to me and said, "Get ready to suck." A half second later, the doctor nicked the amniotic sac, and it was suddenly like trying to suck up a waterfall with an eyedropper. After moments of futile trying, the doctor hastily grabbed the suction away from me and did it herself. The intern was right - I did suck.
3. To the patient, this is a big deal. No matter how many appendixes you have removed, or how many times you've had to break the news that the fetus has Down Syndrome, the patient is experiencing one of the most significant events in their lives. I have heard enough patient stories now to know that some doctors forget this fact. When I was facing some health problems of my own this year, I was having a simple procedure done that I knew (from a med student's perspective) was not a big deal. However, as a patient, I was scared out of my mind. I realized to be a good doctor is to be able to see things from the patient's perspective.
4. Ignore the gunners. For those of you not in med school, a gunner is a med student who is an obnoxious overachiever. They probably said they wanted to be an orthopedic surgeon or dermatologist on the first day of med school. They probably started studying for their MCAT as freshmen in college. They look at you with disdain when you tell them you don't like to read the textbook or didn't study last Saturday night. Although difficult, I had to learn to ignore these people to preserve my sanity. I had to get over the fact that it is truly impossible to learn all of the material presented. There are 3 more years of med school for a reason - we're not expected to have everything memorized the first time around. It was much more worth my time to maintain good relationships with friends and family and to relax on the weekends than it was to study. Balance is essential.
5. I am in the right place. This past year has been the most fulfilling and rewarding year of my life. I have had so many moments where I have just known that this is where I am supposed to be. For the first time in my life, I don't feel like the goal of what I'm doing is to get to someplace else. I'm already here.
1. People will get naked in front of you. I mean this both figuratively and literally. I was shadowing a doctor during one of the first weeks of school, and the doctor was about to give a physical exam. The elderly female patient simply started removing all of her clothing, and I had this urge to look away before I realized that I was supposed to look. In addition, during practice patient interviews for my courses, patients revealed things about their personal, psychiatric, or sexual history that they may not even tell their spouses or their best friends. When you are wearing your white coat, patients will automatically trust you and have faith that you know what you are doing. Who am I to have earned this privilege to hear and see the most intimate details of people's lives?
2. Medicine is messy. As a wise doctor once said to me, "Med students choose their specialty based on which body fluid they least hate to put their hands in." When I was shadowing a Cesarean section, the doctor let me hold the suction tube to suck up the excess blood (similar to what you'd see at a dentist's office to suck up excess drool). I was doing a great job as she was masterfully slicing through the layers of skin, fat, and muscle to get to the uterus. Then, the intern turned to me and said, "Get ready to suck." A half second later, the doctor nicked the amniotic sac, and it was suddenly like trying to suck up a waterfall with an eyedropper. After moments of futile trying, the doctor hastily grabbed the suction away from me and did it herself. The intern was right - I did suck.
3. To the patient, this is a big deal. No matter how many appendixes you have removed, or how many times you've had to break the news that the fetus has Down Syndrome, the patient is experiencing one of the most significant events in their lives. I have heard enough patient stories now to know that some doctors forget this fact. When I was facing some health problems of my own this year, I was having a simple procedure done that I knew (from a med student's perspective) was not a big deal. However, as a patient, I was scared out of my mind. I realized to be a good doctor is to be able to see things from the patient's perspective.
4. Ignore the gunners. For those of you not in med school, a gunner is a med student who is an obnoxious overachiever. They probably said they wanted to be an orthopedic surgeon or dermatologist on the first day of med school. They probably started studying for their MCAT as freshmen in college. They look at you with disdain when you tell them you don't like to read the textbook or didn't study last Saturday night. Although difficult, I had to learn to ignore these people to preserve my sanity. I had to get over the fact that it is truly impossible to learn all of the material presented. There are 3 more years of med school for a reason - we're not expected to have everything memorized the first time around. It was much more worth my time to maintain good relationships with friends and family and to relax on the weekends than it was to study. Balance is essential.
5. I am in the right place. This past year has been the most fulfilling and rewarding year of my life. I have had so many moments where I have just known that this is where I am supposed to be. For the first time in my life, I don't feel like the goal of what I'm doing is to get to someplace else. I'm already here.
Friday, June 11, 2010
Why Health Literacy?
I thought I'd share with you how I became interested in the topic of Health Literacy. For those unfamiliar with the term, health literacy is the ability to understand and interpret health care-related information and services in order to make good decisions and adhere to treatment. Better health literacy is known to be correlated with more positive health outcomes in patients living with AIDS, like the residents of Project Samaritan. In fact, one study found that the number one determining factor in AIDS outcomes is the level of health literacy! (AIDS outcomes meaning the amount of virus particles in your body, survival time after diagnosis, etc.) I very strongly believe that health care is a right, and it is abhorrent that one's education level should determine one's quality of health.
This brings me to the reason I became interested in health literacy in the first place. Before I enrolled in med school last fall, I was a high school teacher for 2 years with Teach For America (http://www.teachforamerica.org/). TFA is an organization that recruits recent college graduates to teach in low-income schools for two years, with the goal of closing the achievement gap. Learning that only 1 in 10 children growing up in poverty will graduate from college, or that the average student in a low-income community performs as well as an eighth grader coming from a higher income area, made my blood boil.
After graduating from college, I moved to Houston, Texas where I taught ninth grade science at Jefferson Davis High School (see the picture of me in action in my classroom). About 90% of the students at Davis qualify for free or reduced lunch. Many of my students were several grade levels behind in math and reading. I also began noticing that my 15 year old students had health problems that I had thought were predominantly disease of older people - high blood pressure, cancer, type 2 diabetes. It was then that I started making the connection between poverty, education, and health, which put me on the path to medical school.
As a Teach For America alum and a medical student, I have a particular interest in the intersection between health care and education. Teaching my Health Literacy class this summer is bound to be an incredible experience. I can only hope that my students will learn as much from me as I know I will learn from them.
Wednesday, June 9, 2010
Baby steps
It's official, I will be teaching a Health Literacy class this summer. I met with the brilliant education team at Project Samaritan this afternoon, and after a THREE HOUR long meeting, we established that my class will likely exist on some level. Not a huge amount of progress, but still, hooray!
I am truly looking forward to working with the patients this summer. When I stepped into the elevator on my way to the meeting, I was greeted with a big smile from one of the residents who wanted to know all about who I was and why I was there. The residents aren't used to seeing unfamiliar faces around the building, since there are only 66 of them and about 20 or so staff members. When I explained my class to her, she said she would love to sign up - my first future student! I also happened to run into one of the residents whom I had met in the fall, when I was shadowing. I met him on the day he was admitted to Project Samaritan, when he was dying from AIDS, addicted to heroin, and sentenced by a judge to enroll in the program (or else go to prison). He looked so much healthier than I remember him, and he told me proudly that he was entering his last phase of treatment and would be graduating from the program soon. As you can see, Project Samaritan is amazingly successful at getting patients who have hit rock-bottom to be healthy and prepared to re-enter society.
Next step: start planning my curriculum. I'm going in on Tuesday to introduce myself to the residents and try and recruit students for my class. Any thoughts on how to make Health Literacy sound downright fascinating?
I am truly looking forward to working with the patients this summer. When I stepped into the elevator on my way to the meeting, I was greeted with a big smile from one of the residents who wanted to know all about who I was and why I was there. The residents aren't used to seeing unfamiliar faces around the building, since there are only 66 of them and about 20 or so staff members. When I explained my class to her, she said she would love to sign up - my first future student! I also happened to run into one of the residents whom I had met in the fall, when I was shadowing. I met him on the day he was admitted to Project Samaritan, when he was dying from AIDS, addicted to heroin, and sentenced by a judge to enroll in the program (or else go to prison). He looked so much healthier than I remember him, and he told me proudly that he was entering his last phase of treatment and would be graduating from the program soon. As you can see, Project Samaritan is amazingly successful at getting patients who have hit rock-bottom to be healthy and prepared to re-enter society.
Next step: start planning my curriculum. I'm going in on Tuesday to introduce myself to the residents and try and recruit students for my class. Any thoughts on how to make Health Literacy sound downright fascinating?
Tuesday, June 8, 2010
Welcome!
I am so incredibly excited to begin writing my first-ever blog. Full disclosure: I have zero writing experience. In fact, I am totally a left-brained kind of person. Right now, I'm just finishing up my first year of medical school at Columbia University College of Physicians & Surgeons. So why, might you ask, am I blogging?
This summer is the so-called "last summer" for us med students, since from the fall on I will have school and work straight through for the next, oh, 60 years of my life. Being at an academia-focused medical center like CUMC (Columbia University Medical Center), the majority of students decided to spend their precious last summer months doing research. To be candid, our med school completely pushed us in this direction. I, however, couldn't stand the thought of being cooped up in a lab all summer, when I don't even know what area of medicine I'm interested in yet. I decided to apply for a fellowship through the Arnold P. Gold Foundation for Humanism in Medicine. For reasons I'll save for a future post, I have an intense passion for education and social justice, and I designed a project where I will be teaching health literacy at Project Samaritan in the Bronx. Project Samaritan is a residential treatment center in the Bronx, where people living with AIDS and substance addictions live and rehabilitate. They offer a holistic treatment program, including health care, substance abuse treatment, and educational classes. I had shadowed there for one of my med school classes this past year, and I knew I wanted to somehow get involved there during the summer.
By some miracle, I was awarded a Gold Fellowship, and I landed my dream summer job! Part of the requirement for my fellowship is that I write a blog about my experience. I was looking for an excuse to start a blog, so I was thrilled to hear about this. I can't wait to share my journey through this summer, and beyond, with you. I have a meeting with the folks at Project Samaritan tomorrow to plan how my health literacy class will be structured. I'll keep you updated!
This summer is the so-called "last summer" for us med students, since from the fall on I will have school and work straight through for the next, oh, 60 years of my life. Being at an academia-focused medical center like CUMC (Columbia University Medical Center), the majority of students decided to spend their precious last summer months doing research. To be candid, our med school completely pushed us in this direction. I, however, couldn't stand the thought of being cooped up in a lab all summer, when I don't even know what area of medicine I'm interested in yet. I decided to apply for a fellowship through the Arnold P. Gold Foundation for Humanism in Medicine. For reasons I'll save for a future post, I have an intense passion for education and social justice, and I designed a project where I will be teaching health literacy at Project Samaritan in the Bronx. Project Samaritan is a residential treatment center in the Bronx, where people living with AIDS and substance addictions live and rehabilitate. They offer a holistic treatment program, including health care, substance abuse treatment, and educational classes. I had shadowed there for one of my med school classes this past year, and I knew I wanted to somehow get involved there during the summer.
By some miracle, I was awarded a Gold Fellowship, and I landed my dream summer job! Part of the requirement for my fellowship is that I write a blog about my experience. I was looking for an excuse to start a blog, so I was thrilled to hear about this. I can't wait to share my journey through this summer, and beyond, with you. I have a meeting with the folks at Project Samaritan tomorrow to plan how my health literacy class will be structured. I'll keep you updated!
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