Author: Ankur Narain

Ankur is a medical student at the Johns Hopkins University School of Medicine, Class of 2017. Ankur graduated from U.C. Berkeley (2011) with a degree in Molecular and Cellular Biology. He did his undergraduate thesis in the laboratory of Dr. Jay Hollick, where he studied epigenetic effects on the inheritance of plant color in corn. After college, Ankur worked for two years in the laboratory of Dr. Keiko Ozato at the National Institutes of Health. Ankur studied the role of histone H3.3 in activation of the innate immune response in macrophages.

Outside of school, Ankur enjoys sports and movies. He is a die-hard San Francisco 49ers, San Francisco Giants, and Golden State Warriors fan. His favorite movie is The Usual Suspects, with Infernal Affairs coming a close second.

A Guide to the Operating Room for Medical Students Or How I Learned to Stop Worrying and Love the Sterile Field

Post author By Ankur Narain
Post date April 9, 2015
No Comments on A Guide to the Operating Room for Medical Students Or How I Learned to Stop Worrying and Love the Sterile Field

The summer between MS1 and MS2 I did a research project with an orthopedic surgeon at my school. Part of the project had me observing in the operating room (OR) a few days a week, watching procedures and helping with any tasks that came up. This experience was actually my first time being in an OR, and I was pretty nervous leading up to it. I had heard horror stories about students breaking sterility, knocking over solution bottles, and generally making fools of themselves in front of important people. While I tried my best not to do anything foolish or embarrassing, it was oftentimes very hard to avoid. Slowly, I become more confident in the OR, and the blunders came further and further apart. As a service to all the pre-meds and un-initiated med students, I now present a short list of important things to know before your first OR experience.

Figure out the rules. Surgeons love rules, and at times it seems as if they have a weird fascination with them. If you don’t ask then the rules are never really explained to you, and you will be in big trouble when you break one. Consequently, I think it’s prudent to ask someone what the rules are. Considering your fear of talking to the surgeon, he or she isn’t the best option. The resident or intern is probably too sleep-deprived and hopped-up on caffeine to notice you. Your best bet is to ask one of the circulating nurses or other students who have been on the service for a while. Believe me, it will save you a lot of trouble later on.
Make sure you’re dressed appropriately. Make sure everything you’re supposed to wear is on correctly. Make a mental note of scrubs, cap, mask, and boots. Aside from actually wearing the right attire, please make sure you are wearing it correctly. You’re going to feel really stupid when someone points out that your cap is on crooked, or that you forgot to tie half of your mask. You will also be the butt of many jokes over the next few days when you aren’t there. In addition to knowing what to wear, it is also important to know what not to wear. Don’t wear shoes that you actually like, unless you think it’s cool to have fecal matter on your $100 Sperry’s. Also, leave the personal items and accessories at home. While that puka shell necklace you made in 10th grade art class may be “totally rad, bro,” it is definitely a sterility hazard and you definitely shouldn’t bring it into the OR. Also, if you’re still wearing puka shell necklaces in your mid-20s you should probably re-evaluate your life choices.
Know where the sterile field is and how to avoid it. This rule only applies if you’re not scrubbed in, and the decision of whether or not you get to scrub should have decided before you show up. Anyway, just remember that the sterile field should be avoided like the plague. Any blue towel or covering should send off warning signals in your head. Don’t get close to it, don’t breathe on it, and don’t even really look at it if you don’t have to. Don’t try to be cute either and inch your way as close as possible, because the scrub nurse will call you out and you will be embarrassed.
Try to look interested even when you’re not. After the 5th time seeing the same surgery, it’s only human nature to get a little disinterested. There are only so many times you can be mystified by a hernia repair, and you’ve probably passed that threshold long ago. It is imperative, however, that you look interested at all times. Surgeons have an innate ability, almost like boredom-radar, to tell when you are dozing off or doing something else. These situations usually end up in you getting pimped mercilessly in front of everyone. To make matters worse, you don’t come off looking like a shining star when your response to the first question is “Huh?” You can typically avoid these situations by employing certain maneuvers that indicate “interest.” My go-to method was switching sides of the OR every 20 minutes to get a new “viewing-angle.” Another tried and tested one is intently looking at the monitors or camera. Find what method works for you, and stick to it.
If you’re not scrubbed in, find yourself a role. Surgeons dislike idle people. There’s nothing worse you can do than to just stand in the same place in the OR doing nothing. Find a job you can do, and be amazing at it. Like to record information? Write down the incision and closing times. Like to clean? Become the best darn disinfectant wipe user ever. Like to retrieve things? Be the person who looks up and prints all the obscure research papers the surgeon even tangentially mentions during the procedure. Note: If you choose the last one, be prepared for incessant pimping later. Remember folks, nothing is without consequence, so choose your punishment wisely.
Prepare yourself for the spectacle that is a patient waking-up post-op. This is the part that you never hear about or even see on those dramatized TV shows about surgery. A patient waking up from anesthesia is most definitely not pleasant. Prepare yourselves for all sorts of near disasters. Patients will try to pull out breathing tubes, or roll over onto joints that have just been operated on. Some will even try to get out of the bed, as they don’t realize where they are for the first few minutes. People will often kick out their arms and legs, and if they aren’t stabilized someone on the team is bound to get a black eye. The best thing you can do is to be aware of the possibilities, and find out how the team handles such situations.
Find a place to store food for post-op consumption. We have finally reached the pinnacle, the crown jewel of my OR guide. Don’t pay attention to the fact that this rule actually doesn’t correspond to anything taking place in the OR. After spending countless hours in the OR, the first thing on your mind will be food. No matter how mundane or exciting the procedure was, human need for nutritional sustenance will take over. Make sure you have a safe storage spot for food, whether it is in the clinical workroom or in the students’ lounge. Also, considering that everyone you will be working with (read: vultures) will also be voraciously hungry and will have no problem eating anything lying around, make sure you keep your food in a place only you can find it. Invest in a locker and a lock if your facilities have them. You’ll thank me for this advice later. You’re welcome, by the way.

Featured image:
CPMC Surgery by Artur Bergman

Tags guide, Operating room, surgery

General

The Chasm Between Pre-Clinical and Clinical Medical Education

Post author By Ankur Narain
Post date February 12, 2015
No Comments on The Chasm Between Pre-Clinical and Clinical Medical Education

Depending upon which school you attend, the first one to two years of medical school are predominantly classroom-based learning. As medical students, we spend countless hours memorizing facts about disorders and diseases. We pore over diagnostic criteria, look for the minutiae in radiographs, and stress about the side effects of antibiotics and other medications. While all of this information is useful and important, the reality of medical education soon changes when students start spending time in the hospital and in various clinics.

In transitioning from pre-clinical to clinical education, it soon becomes clear to medical students that what you learn in class and what you actually see in patients is quite different. Furthermore, even when presentations are clear it is still not trivial to determine what an actual patient’s diagnosis may be.

One poignant example, which I remember well, occurred while I was shadowing a local pain management Physician as part of the early clinical exposure course at our school. The patient whom we saw had a textbook case of C-7 radiculopathy with associated shoulder pain and loss of sensation. We had learned about radiculopathy in medical school, and I had a working knowledge of the diagnosis. After I had spent some time interviewing the patient, my preceptor asks me what I thought the diagnosis was. I had some idea that the patient had a radiculopathy, but in my nervousness and uncertainty all I could muster up were a few whispers and murmurs. My preceptor turns to me and basically says that this was a very clear case of C-7 radiculopathy. After hearing the diagnosis, I distinctly remember thinking that I had known the disorder and had seen the symptoms in the patient, but had been unable to connect the dots.

The ability to connect the dots and turn pre-clinical knowledge into data that is useful in a clinical setting is a difficult skill to acquire. You have to deal with patients that have varying presentations and many associated comorbidities, both situations that are not emphasized in much of the book and lecture-based learning of the pre-clinical years. The only real method to attain proficiency in a clinical setting is hands-on experience.

Noting this need for hands-on experience, medical school curricula has changed substantially over the last decade. More medical schools now offer early clinical skills and patient experiences in their curricula, hoping to bridge the chasm between pre-clinical and clinical education. At the school that I attend, we start to see real patients in the second week of our first year. In the second semester of our first year, we embark on a year-long experience in local clinics where we work with practitioners to learn the ins-and-outs of clinical medicine and practice. Most other schools have implemented similar programs. Furthermore, the trend towards shortening pre-clinical education to one to two years is a direct response to student need for early clinical experience.

While early clinical exposure is important in medical education, it must occur with a solid foundation of preclinical knowledge. Balancing knowledge acquisition with practicing clinical skills is a juggling match every medical student must deal with. Luckily, we don’t have to learn all of it during medical school, as medicine is a lifelong learning experience.

Featured image:
stethoscope by Dr.Farouk

Tags clinical, curriculum, medical student, pre-clinical

General Lifestyle

A Medical Student’s New Year’s Resolutions

Post author By Ankur Narain
Post date January 22, 2015
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With the end of 2014 and almost the whole of 2015 upon us, there is no better time to sit and reflect on the past year and to mentally anticipate the year to come. In this free time, I’ve thought a lot about New Year’s resolutions. Now, I’m not referring to resolutions like losing weight, exercising more, or eating healthier meals. I’m referring to resolutions that are specific to the medical student. We, as medical students, live unique lives that require a different set of resolutions than what are typical of most other people.

Here are my top 5 medical student New Year’s Resolutions:

Resolution #1: Get on a sleep schedule that resembles normal circadian cycling
Medical school really screws up your sleep schedule. Late nights studying coupled with mornings filled with lectures leads to afternoon naps, which leads to sleeping later at night due to the fact that you aren’t tired. This vicious cycle continues throughout medical school, and your suprachiasmatic nucleus is all out of whack. Therefore, the first resolution I propose is to try to sleep at normal hours. Let’s face it, those hours of studying after 11 PM aren’t really that productive anyway. You’re probably better off going to sleep so that you’re rested for the next day’s study marathon.

Resolution #2: Preview material before the lecture
I feel as if this resolution is something everyone has already tried. Personally, I tell myself that I will preview material before every new block. I am even successful for a little while, usually keeping up the trend for the first few days of the course. However, like all things that are too good to be true, this habit usually falls by the wayside after “life” (read: laziness) catches up to me. Therefore, the second resolution is to make a conce rted effort to preview material before the lecture. The chances that this is successful throughout the entirety of the next semester are low, but you should humor yourself for a little while at least.

Resolution #3: Do more outside of school
We know medical school takes most of our time. We come into medical school all but expecting as much. However, that does not mean you shouldn’t do other things outside of school, for both your physical and mental health. I’m talking about things you do for yourself that have no direct affect on your professional life. If you enjoy cooking, you should cook more. If you enjoy sports, you should play or watch more. If you enjoy any other hobby imaginable, pursue that as well. Pursuing such endeavors may decrease your studying and professional development time, but it will also prevent burnout and increase happiness.

Resolution #4: Get out into the community
Ok, this one is kind of a continuation of the last one. But, I felt this recommendation was too important to not have its own category. One thing I think many medical students feel is that while they live in a certain place during medical school, they never really come to know that place because they are always studying or at the hospital. We, as students, need to get more in touch with the communities we serve in a non-medical way. Volunteer at local shelters, kitchens, or churches. Talk to the people that live around you. Explore the city’s historic landmarks. Eat at some of the city’s best restaurants. You may not recognize it now, but there is great value in really knowing and appreciating the nuances of where you live.

Resolution #5: Get Better Every Day
Medical school is an interesting and challenging time in a person’s life. While at times it can be overwhelming, it is important to realize that medical school is a marathon and not a sprint. As such, it is important to focus on getting a little bit better every day. If you get a little better at something every day, you will reach proficiency sooner. This resolution extends not only to your medical life, but to other aspects as well. As long as you get a little bit better every day, no day is wasted.

Featured image:
365-001 time flies by Robert Couse-Baker

Tags New Year, Resolutions

Law Opinion

Medicolegal Issues: Physician Involvement in Litigation

Post author By Ankur Narain
Post date November 6, 2014
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The medical and legal landscapes are intertwined much more so than ever before. With the advent of this close relationship between the medical and legal fields, physicians have become involved in a multitude of legal proceedings. Physician involvement ranges from consultation on legal matters to testifying in open court to contesting malpractice lawsuits. In part 2 of our review of medicolegal issues, we are going to look at a few different types of legal cases that physicians are involved in, and what their roles are in those proceedings.

Social Security or Supplemental Security Disability Hearings

One of the major case types in which physicians are involved is for determination of an individual’s eligibility for Social Security or Supplemental Security Income Disability. Both of these programs provide financial assistance for those with disabilities. Social Security Income Disability pays benefits to people who are “insured”, meaning those who have worked for a certain number of years and have paid Social Security taxes. Supplemental Security Income does not have those restrictions, and pays benefits based on the financial requirements of the applicant.

Cases involving income disability center around a hearing, where citizens can appeal decisions made by the Social Security Administration (SSA) involving eligibility or specific monetary payouts. In these types of cases, physicians often testify for both the claimant and SSA. When physicians testify for the claimant, their purpose is usually to summarize key information about the claimant’s medical history and to provide the judge with evidence justifying the awarding of income disability. When physicians testify for the SSA, the purpose of their testimony remains to summarize key information about the claimant’s medical history. However, physicians are often called by the SSA to help support SSA decisions and prevent the case from being remanded or appealed again. Irrespective of which party the physician testifies for, they are also exposed to questioning by the other side involved in the hearing.

Criminal Trials

Another key case type that physicians testify in, and probably the one most notable to the public, is criminal trials. In criminal trials there are two notable roles that physicians may play. Physicians in the field of forensic pathology fill the first notable role. Forensic pathology is a sub-specialty of pathology and requires an additional year of fellowship training after completion of a pathology residency program. The role of forensic pathologists is multiple, with their primary objective being to analyze biological evidence. This analysis can include such things as performing autopsies on postmortem specimens to determine cause of death, examining wounds for possible etiology, inspecting histological slides to identify a disease process, or interpreting toxicology screens to determine drug exposure or impairment. Forensic pathologists are often called upon as expert witnesses to provide their testimony in open court, and they are subject to questioning by both parties involved in a case.

Forensic psychiatrists fill the second notable role for physicians in criminal trials. Forensic psychiatry is a sub-specialty of psychiatry, with an additional year of fellowship training after completing a psychiatry residency program. The responsibilities of a forensic psychiatrist include determining a person’s ability to stand trial in the context of mental competence. Further responsibilities include giving an opinion to the court about the mental state of a person during the commission of a crime. If a forensic psychiatrist determines that the party in question has some mental defect or illness, the party may be found “not guilty by reason of insanity.” The validity of these judgments are controversial, as many are suspicious of attorneys using “insanity defenses” when they are not typically warranted. Like forensic pathologists, forensic psychiatrists are subject to questioning by both parties involved in any legal case in which they testify.

Malpractice Cases

Medical malpractice is defined as professional negligence by a health care provider where the treatment provided falls below, or deviates from, accepted standards of care. The specific course of action taken by the health care provider results in injury or death of the patient. In these types of cases physicians are the defendants, and they often employ legal advisors to aid in their defense. In order to further protect themselves from malpractice suits, physicians and hospital systems spend significant sums of money on malpractice insurance.

The statistics behind medical malpractice are both interesting and striking. In 2012, malpractice payouts totaled $3.6 billion from 12,142 claims. Cases involving death (31%) and significant permanent injuries (19%) encompassed 50% of all payouts. 5 states (New York, Pennsylvania, California, New Jersey, and Florida) had total payouts exceeding $200 million. The significant monetary burden of malpractice claims has created a controversy surrounding tort reform. Malpractice tort reform will be the topic of the next installment of the series, so stay tuned!

Sources

Featured image:
Cast Aluminium Nurse with Stethoscope (Ne Kensington, PA) by takomabibelot

Tags criminal trials, disability, malpractice, medical malpractice payouts, medical school, medicolegal, physician involvement in legislation, physician legislation, supplemental security diability hearings

Law Opinion

Medicolegal Issues – Medical Personnel as Expert Witnesses

Post author By Ankur Narain
Post date October 16, 2014
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The role of physicians and scientists within the legal system is ever expanding. Medical and scientific personnel are frequently called upon to analyze evidence in a wide variety of legal cases, ranging from worker’s compensation claims to felony trials. The expertise of physicians and scientists is often so valuable that the result of cases hinge on their professional opinions. While the importance of medical involvement in the legal field is implicit, certain ethical issues do arise. This is especially true when physicians are on retainer or are compensated by certain parties in a legal dispute. The importance and intricacies of medical involvement in the legal process has inspired curiosity in me. What is the history of the use of expert witnesses in common law? Where do scientific and medical expert witnesses fit into our legal code? Most importantly, how are these witnesses used in current court proceedings, and what are the prospects for the future?

The Origin of Expert Witnesses

The origin of expert witnesses is in England. According to English law, the first expert witness was used in a 1782 case involving the silting up of Wells Harbor in Norfolk. In that case, renowned civil engineer John Smeaton testified, signifying the first use of an expert witness’ opinion in common law. In the United States, expert witnesses were codified into US law in 1975, under the Federal Rule of Evidence (FRE) 702. The FREs represented general rules passed by congress governing how evidence is presented in both civil and criminal cases.

Scientific and medical witnesses have greatly helped to shape the rules governing expert witnesses. Prior to FRE 702, rules for admissibility of scientific evidence were established in Frye v. United States (1923). In Frye, the question at hand concerned whether scientific evidence in the form of a systolic blood pressure deception test was admissible in court. The Frye ruling indicated that such evidence was admissible as long as the test or theory was “generally accepted” among a meaningful portion of the scientific community. To prove that something was “generally accepted,” parties often put a number of scientific experts on the stand to verify certain tests or theories. This rule for establishing the admissibility of scientific evidence is colloquially known as the Frye Test.

After the adoption of the FREs in 1975, they, along with the Frye Test, remained the seminal rules governing scientific expert witnesses. However, in 1993 a new case would open those rules up to interpretation and eventual amendment. In Daubert v. Merrell Dow Pharmaceuticals (1993), two citizens born with birth defects sued Merrell Dow Pharmaceuticals claiming that Dow’s drug Bendectin caused their conditions. Both opposing parties relied upon scientific expert witnesses to prove their claims. A district court ruled that the testimony from the citizens’ expert was inadmissible because the evidence came from methodologies, such as in vitro and in vivo studies, that were not “generally accepted” at the time.

After the Ninth Circuit Court upheld this decision, the citizens’ took their claim to the Supreme Court. The citizens’ reasoned that the Frye Test was no longer the governing standard for admissibility of scientific evidence as soon as FRE 702 was passed. The court agreed, reasoning that, since FRE 702 made no mention of “general acceptance,” the Frye Test was not to be applied in discerning the validity of scientific evidence.

The implications of the Daubert ruling were significant in amending the rules for the admissibility of scientific evidence given by experts. No longer was evidence only judged on its “general acceptance” among the scientific community. Under Daubert, scientific evidence can be admissible if it is “relevant to the task at hand” and “rest(s) on a reliable foundation.” In determining what makes up a “reliable foundation,” conclusions made from evidence must be based on sound scientific methodology. Sound scientific methodology rests in using proper scientific method, including empirical testing of evidence, peer review, proper controls, and determination of potential error rates. In order to prevent the presentation of “pseudoscience,” judges are given the power to be the final arbiter of any submitted scientific evidence. These guidelines outlined in the Daubert ruling were eventually added as amendments to FRE 702.

Understanding the history of expert witnesses allows us to determine how science and medicine shaped one aspect of the US legal code. In the next part of this series, I will provide an overview of current medical and scientific involvement in court proceedings. I will examine not only common case-types in which physicians testify, but also case types in which physicians are directly involved in. Check back soon!

References
1. http://www.law.cornell.edu/rules/fre/rule_702
2. http://www.casebriefs.com/blog/law/torts/torts-keyed-to-prosser/causation-in-fact/daubert-v-merrell-dow-pharmaceuticals-inc-4/

Featured image:
Cast Aluminium Doctor with Stethoscope (Ne Kensington, PA) by takomabibelot

Tags expert witness, law, medicine

Innovation Opinion Technology

Medical Technology: Implementation Without Cause?

Post author By Ankur Narain
Post date September 25, 2014
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A trip through my apartment is a serious lesson in buyer’s remorse. My iPad? What I thought would be a useful note taking and studying tool is more of a $500 YouTube and Netflix consumption machine. My spiffy dual monitor setup that I thought would amp up my productivity? Most of the time I forget to plug in my other monitor and spend my computing sessions staring at my 13” MacBook screen. In fact, that exact situation is occurring right now as I write this. My fancy Bluetooth speaker that I thought would be useful for jamming out when I had friends over? I’ve used it a handful of times, lost the charging cable so the thing won’t even turn on, and have absolutely no desire or intention to either find or buy a new cable.

You may be asking yourself what the point of that rant was, and I don’t blame you. What unifies all those examples is that they are situations when I either purchased or was given a new tech toy that I thought would be life changing, but instead turned out to be unnecessary or obsolete. What I’ve learned from years of accumulating new technology is that while everything comes with copious advertising and monstrous hype, few devices actually deliver as promised.

The medical field is no stranger to this. Hospital administrators and clinical program directors are people too, and they enjoy new toys just as much as the rest of us. Hospitals and universities try to justify their actions by citing journal articles and claiming that having “X” item allows them to remain “on the leading edge of Y specialty.” Let’s be honest, no one is being fooled here. Those new collections of surgical mallets aren’t any better at impacting components than the ones made 20 years ago.

One of the most sought-after technologies is robot-assisted surgical systems, such as the da Vinci^©. Are these systems, while definitely innovative and interesting, akin to my iPad? Are they just shiny new toys that don’t justify their cost? Well, let’s find out.

What exactly is this technology?

Robot-assisted surgical systems are surgical workstations, containing robotic arms with cameras and tools, which can be controlled and manipulated by physicians. The most prominent and successful robotic system is the da Vinci^©, manufactured by Intuitive Surgical of Sunnyvale, California. The features of this system include four robotic arms that can control surgical tools, a magnified 3D high-definition visual system, and wristed instruments that can produce a range of motion beyond that of the human wrist.¹ The claimed benefit of this system is that surgery can be performed with smaller incisions, thus decreasing the pain and recovery time that is usually associated with open surgery.¹ These and other systems are currently in use in many different fields such as cardiac, colorectal, gynecological, thoracic, and urological surgery.¹ These systems are not cheap however, running upwards of $1 million plus large maintenance and service contracts that can reach into hundreds of thousands of dollars per year.²

What does the literature say about these systems?

There has been much study about these surgical systems, with the number of peer-reviewed articles reaching into the thousands. However, there have been a few recently published studies that have shed some concern about the use of robotic surgical systems. In a letter to the New England Journal of Medicine, physicians from Sloan-Kettering Memorial Cancer Center found little to no advantage when using the da Vinci^© system for radical cystectomy.³ They found robotic and open surgery to have similar rates of perioperative complications. They also found that while the patients who underwent robotic surgery had lower blood loss, they also had longer mean length of stay after surgery.³ The longer mean length of stay invariably led to greater costs when using the robotic system.

The American Congress of Obstetricians and Gynecologists, in a March 2013 statement issued by President James T. Breeden, denounced the use of robotic surgical systems.⁴ Dr. Breeden claims, “There is not good data proving that robotic hysterectomy is even as good as – let alone better – than existing, and far less costly, minimally invasive procedures.”⁴ This speech came after studies published by researchers at Columbia University cast doubts about the perceived advantages of robotic surgical systems.²

These two examples only represent a few of the many opinions divulged about the topic of robotic surgical systems. The literature is rife with both positive and negative opinions, and it is up to hospital administrators and faculty to gauge the worth of these systems.

Why do so many hospital centers have this technology?

Implementation of these robotic surgical systems has occurred in major surgical centers in the US, France, Italy, Germany, Spain and many other places. If the literature is conflicting on the efficacy of these systems, why is implementation so widespread? I believe the answer is marketing. Top medical centers have a need to “keep up with the Jones’.” If one renowned medical center acquires certain technology, all of the other medical centers instinctively implement that technology as well to avoid a perception of inferiority. There is also a marketing aspect in terms of patient recruitment, as new technology and the promises of a “superior” surgical experience may lure prospective patients away from competing hospital systems. Whether or not the added income from patient recruitment offsets the initial and recurring costs of these systems is, to my knowledge, yet unknown.

My conclusion on this topic is that these surgical systems are akin to my iPad. They are good in theory, but their cost and relative utility make them a bad investment at the moment. However, this is not to say that these systems will never find justifiable use. With new innovation these systems may find a niche that makes them both efficacious and profitable. Just as a new app may breathe more life into my iPad, new research and better training with the robotic surgical systems may lead to advancements that will justify their implementation.

References
1.http://www.intuitivesurgical.com/
2.http://online.wsj.com/news/articles/SB10001424127887323764804578314182573530720
3.Bochner, B. H., Sjoberg, D. D., & Laudone, V. P. (2014). A randomized trial of robot-assisted laparoscopic radical cystectomy. N Engl J Med, 371(4),389-390.
4.http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Statement-on-Robotic-Surgery

Featured image:
Da Vinci Surgical Robot by Ars Electronica

Tags Da Vinci, Medical technology

Clinical General Innovation Lifestyle Opinion

Medical Technology: Google Glass and the Future of Medical Education and Practice

Post author By Ankur Narain
Post date July 12, 2014
4 Comments on Medical Technology: Google Glass and the Future of Medical Education and Practice

Medicine is often a field at the forefront of technology. The importance of the field itself combined with the lucrative payouts seen for successful medical devices attracts many entrepreneurs and companies to the field. One of the most intriguing new technological advances is Google Glass – the augmented-reality glasses developed by tech powerhouse Google. There has been much speculation about the use of Google Glass in medicine. The possible implementation of Google Glass within the medical field raises important questions about how Google Glass may change medical education and practice.

What is Google Glass?

Google Glass is an augmented-reality system developed by Google. It is a voice-controlled, hands-free computing system that is housed in a “glasses” interface that users can wear much like spectacles. It contains an HD capable screen, 5 megapixel camera, and is Bluetooth, WiFi, and GPS enabled. The interface can sync with both Android and iOS phones for integration of information across platforms. Google Glass is currently in its “Explorer” beta phase, with a retail price of $1500. Speculation is that the upcoming retail version will be greatly reduced in cost.

What are the uses for Google Glass in Medicine?

The combination of features present in the Glass package makes it an enticing future medical tool. The main hypothesized role for Glass is in information sharing and transfer. Glass may prove useful in allowing physicians access to patient medical records, imaging studies, and pharmaceutical information in real time via the integrated HD screen. Glass may also be useful for physicians on home-call, as information about patient’s vitals and status can be relayed while the physician is en-route to the care facility. In the surgical field, Glass may help with surgical procedures by providing instant access to reference materials and real-time consults in the operating room. Finally, Glass may provide a more integrated and unique experience for medical students. Students will be able to view patient interactions and procedures with the same point of view (POV) as the physician, providing an unparalleled immersive educational experience. Furthermore, use of Glass by patients will allow students to view patient encounters from the patient’s POV, providing a perspective that many students may never have otherwise experienced.

Photo courtesy of Ted Eytan

How is Google Glass Currently Being Used?

While Google Glass is still in its infant stages, there has been some limited implementation in the medical field. Dr. Christopher Kaeding, an orthopedic surgeon at the Ohio State University, was the first physician to use Glass during a surgical procedure. The procedure was broadcast via Glass to both medical students and faculty at the university.

In terms of education, the University of California – Irvine Medical School has implemented Glass in its innovative iMedEd program. Established in 2010, iMedEd provides medical students at UC Irvine with specialized technological access and training. It started with school-issued iPads for every medical student, and later expanded to point-of-care ultrasound training and use. In 2014, the iMedEd program began utilizing 10 pairs of Glass to be distributed amongst the 3rd and 4th year medical students on the wards. It will be an interesting development to see how Glass is received amongst the students, and how they rate its effectiveness at enriching their educational experience.

What needs to happen for Glass to have widespread adoption in the medical field?

While Glass does have intriguing possibilities, it is by no means a proven entity in the medical field. I believe that for Glass to become an influential medical product two things have to happen. The first thing that must happen is that Glass must be utilized extensively in the consumer market. Many of the questions about Glass revolve around public uncertainty about privacy issues. If Glass gains a large foothold in the consumer marker, patients will become accustomed to interacting with Glass users and will feel less hesitant in a Glass-using setting. The second thing that must happen is that app developers must create useful medical apps for Glass. These apps must both provide utility to physicians and be compliant with HIPAA regulations. Much like EPIC was to electronic medical records, Glass needs companies who are willing to take on the intense regulatory scrutiny of the medical field in app development.

Sources:

Featured image:
Google Glass Dr. Guillen

General

5 things you learn as an MS1

Post author By Ankur Narain
Post date April 16, 2014
No Comments on 5 things you learn as an MS1

Entering the first year of medical school, MS1’s believe that they have some idea of what they are beginning. We are inundated with information about medical school starting in our pre-med or post-baccalaureate years, and the application process heaps even more onto our plates. Along with this, we have stories passed down by older friends and relatives who have already started or gone through the medical school experience. When we finally get to school, we think nothing will surprise us.

Needless to say, this naiveté is quickly shed after the first week of classes. We soon realize that we have much to learn, and very little time to learn it in. Some of these lessons occur in the classroom, while others remain more personal. After having gone through most of my first year, I have some surprising lessons.

Here’s my Top 5:

1. The amount of material you learn in a short period of time is amazing.

I was an immunology major in college. I took two semesters of lecture and one semester of lab to qualify for this major, on top of all of the other pre-med requirements. My immunology course in medical school was three weeks long. The medical school course covered more material than my core undergraduate major classes in 27 fewer weeks.

You learn so much in medical school so quickly that it is at times mind-boggling. While you do adjust somewhat to the coursework, you will still be amazed at how much you are expected to know from every day of class. Some people deal with this by studying all day, while others procrastinate and spend the days leading up to the exam stress eating pounds of chocolate. Either way, you get through it and come out more knowledgeable (and slightly heavier) than before.

2. Medicine has its own language, and it makes no sense at all.

Nothing, absolutely nothing, is put into layman’s terms. You can’t say “elevated heart rate”, you must say “tachycardia.” You can’t say “shortness of breath”, you must say “dyspnea.” You can’t say “low platelets,” you must say “thrombocytopenia.” That last one is my personal favorite. The ridiculous nature of this system is apparent to everyone, but since it’s been entrenched in the medical community for so long, it continues onwards. Have fun, future medical students.

3. You become desensitized to gross masses/fluids/images.

Menstrual fluid? No big deal. Oozing pus from a skin lesion? Not interesting. Penile sischarge? Just another Tuesday in the infectious disease/STD clinic. Teratoma? Well, that one is still rough. If you haven’t seen a teratoma, I’d suggest you google it (not at work, definitely NSFW).

4. Everyone is smarter than you.

I’m amazed every day by all of my classmates. They are all so accomplished and humble. One of my classmates is a published author (of a real book, not a research publication). One is a pilot. Another, an investment banker before beginning medical school. My college days of playing too much Xbox Live, while impressive for sheer immaturity, pale in comparison.

What I’ve really come to realize, however, is that you can learn a lot from viewing how others reach success. I’ve picked up many good habits and behaviors by just observing how my accomplished classmates go about their lives. As they say, imitation is the sincerest form of flattery.

5. Medical school is truly life changing.

For how much everyone complains about medical school, no one can deny that it is life changing. You learn so many interesting things, and all of them are relevant in positively affecting the lives of others. You meet so many interesting classmates and mentors, forming a motivating and comforting community. Most importantly, medical school teaches you about yourself. You learn that you are capable of so much more than you previously thought, and that you can deal with any challenge. All of these lessons and experiences are, quite literally, worth the price of admission.