Artifacts – Website

According to Google, and artifact is:

an object made by a human being, typically an item of cultural or historical interest

In this case, artifacts on my website have been projects that I find interesting, and are of historical interest to me, as they highlight my growth in projects.

In this inaugural edition of adding artifacts, I’d like to link to my previous websites in an effort to show the evolution of this website over the last 10+ years.

2006 – my first ePortfolio, built from HTML through Dreamweaver.  Hit the “Home” button up in the top right corner to enter the website.  Many of the links are broken, and the website requires flash to work properly.  Should you be using a browser that does not have FLASH installed, you will just see “missing plug-in” everywhere.

 

2008 – In all my experience from the first ePortfolio, I redesigned the entire website for a more modern look.  FLASH plug-ins are still required, but the website has a more refined look, and is an interesting snapshot of my life at this time just before medical school.

 

As I entered medical school, I was officially not a technology fellow any more.  So I had to decide, do I let the ePortfolio die, or do I continue it myself.  I felt that I couldn’t let my website die and stay behind with my undergraduate years.  I officially bought the domain “shawnvuong.com” and started building my third version of the website.  At this point, flash was no longer the standard of the internet.  CSS now becoming the norm.  This was a pivotal time for the website, going from a mandatory portion of my fellowship, to a professional marketing tool for my online persona.

First attempt – did not like the layout, and it was difficult to incorporate the photos.  I ultimately decided I wanted a layout with cleaner lines.

Second attempt – I liked this layout a lot better, but felt that there were too many boxes to fill.

Third time is a charm.  This ultimately became ShawnVuong.com in 2012.

 

Since I had the server space and the ability, I offered my services to others.

At one point my mother thought she was going to open a home-made soap business.  I drafted this as her potential website.  However, her business never came to fruition.

I also ran some websites while I was in medical school.  One was a philanthropy website for an AMA 5K organized by the medical school students.  Unfortunately, I was not able to continue upkeep for this website, and its been at a standstill since 2013.

Unfortunately there are a few other website projects that have been lost in the chaos of life, whether that be old failed hard drives or just lost in the pathway of life.

As I look through these websites, its cool to see the evolution of this site through the years, and hope to keep these available for the future by documenting them here as one of my first artifacts of the new website upgrade.

Update to ShawnVuong.com

Well the time has come to update ShawnVuong [dot] com.  I have been in residency for 4 years now, and have not had any time to update or write on the blog, but I have now entered my PGY-5 year and the time is now.  At the University of Cincinnati neurosurgery residency, the PGY-5 year is currently our “professional development” year.  This year I am working in the Mangano Lab at CCHMC.  I am very excited to be working out genetic mechanisms of congenital hydrocephalus.  As a result of being in the lab, I have significantly less clinical duties, which allows me to have time to update this site.

The overall look of the site has obviously changed drastically, but so has the actual build of the website.  All of my previous e-portfolio and website projects were created using Dreamweaver software, which required me to learn HTML, CSS, and PHP.  This is time consuming and can be onerous to update and format.  There were times when I was making the previous versions of the website that I found myself spending whole weekends trying to code an object to position itself in the browser, where I wanted it to be.  Given the amazing rate of increased technology and improved ease of website building over the last 4-5 years, I have come to appreciate the customization of WordPress.  As a result, this entire website rebuild only took a couple weeks with the help of WordPress.  I chose this platform because of my previous familiarity with the software, but also due to the ease of setup, the ability to quickly change an entire website’s look but updating a theme, and simplicity of adding posts and pages to keep the website updated.

I hope to post on the blog more often now, and hope you enjoy the new website!

Trust in the White Coat

Medical culture is a weird yet powerful force that bonds together those who practice medicine.  From the SOB in bed 2 to the frequent-flyer out in the waiting room, the connection that we get by speaking our medical lingo brings out a special bond  of the medical culture.  Its a large, sub-culture, and like many sub-cultures we have our different rules and lingo.  I would even argue that within our large medical sub-culture we have many many different smaller ones inside that.  Nurses, techs, doctors, etc.  And even among the doctors their tends to be this imaginary dividing line between specialties.

As a new resident, I’ve found it odd that the same day I’ve earned my long white coat, was also the same day the culture around me changed to the point where it was considered a “newbie” move to wear the long white coat around.  I was quickly made fun of for wanting to flaunt around the fact that now I was actually an MD.  It was a very odd feeling.

However, I have stood my ground, and continued to wear the long white coat despite what my fellow residents say.  While I admit, a large part of wearing the coat is for the extra pockets, I do enjoy the fact that it took me many years to earn it, and I do see it as a sense of pride.  But more-so, it turns out in the literature that the long white coat is actually a non-verbal way of instilling confidence, trust, empathy, and establishing a good doctor patient relationship. For proof please see the references below.

References:

http://www.ncbi.nlm.nih.gov/pubmed/22445730

http://www.ncbi.nlm.nih.gov/pubmed/16546951

http://www.ncbi.nlm.nih.gov/pubmed/18286342

http://www.ncbi.nlm.nih.gov/pubmed/16271913

http://www.ncbi.nlm.nih.gov/pubmed/20095290

http://www.ncbi.nlm.nih.gov/pubmed/2016013

 

Patient Decisions

In my short 3 weeks as a resident, I have seen some incredibly tough decisions that have needed to be made.  Some of the toughest being, whether or not to operate on a patient, and watching families decide whether or not it’s the right time to stop trying to save their loved one and provide them with a comfortable death. It’s widely known and aggressively taught (at least at my medical school) that three ethical principles are important when speaking with patients, autonomy, beneficence, and non-maleficence.

 

Autonomy, the principle that recognizes that patients should make their own decisions.  This is the most ethical thing to do according to our teachings. But is it the correct thing?  Two Ted talks I have seen question the current practice of autonomy as it is in current medical practice.  Should patients be required to make every single medical decision?  Or should they be given the option to let the medical team make some of the decisions?

 

Reference:

1. Baba Shiv: Sometimes it’s good to give up the driver’s seat

2. Sheena Lyengar: The art of choosing

 

First Day of My Third Year

Today was my first day of the third year.  To be fair it wasn’t a true first day, so much as an orientation day.  This post is going to be a couple random thoughts about the day.

First off, I hate orientation days.  Being the kind of person who likes to jump right in and get my hands dirty – a learn as I go kind of guy – orientation days seem to drag on and are extremely boring from my perspective.  The “need to know” things in an orientation day can usually be summed up in maybe an hour.  They could just tack this to the beginning of the first day and call it good.

Another thing I hate about orientation days are the ice breaker and get-to-know-you games.  Today we had at least four different speakers have us go around the room, introduce ourselves, tell them where we were from, and a little about ourselves.  Doing it once is more than enough.  By the fourth time you feel like strangling a puppy.

Next random thought, I have my own business cards.  The program gives them to us to distribute.  How cool does that make me?  Admittedly, probably not very cool.  But I feel a ton cooler.  Also, I have a pager now.  I guess I’m important enough to page and give out business cards.  Whoa.  Moving on up the ladder.

Yankton, SD has over 65 practicing physicians.  Yankton county only has a population of 21,000.  I was unable to find out the size of the catchment area of the hospital.  But that seems like an impressive number of physicians for a community this size.  Also, while talking to the physician recruiter, she said that they are currently looking for family practice doctors, internal medicine physicians, endocrinologists, urologists, general surgeons, and 3 invasive cardiologists.  I asked if the Yankton community even had the resources to support three interventional cardiologists, and she stated that they had all the infrastructure in place, they could hire and support all three tomorrow.  I was shocked.  Not only does Yankton have 65 practicing physicians, but also it could support many more.  Crazy.

Talking about physicians, a neurologist has just started practicing with the large multispecialty group in the last two months.  I was excited to hear this, with my interest in the neurosciences.  Also, the hospital plans on upgrading their MRI to a 3 Tesla with fMRI capability, in conjunction with research funding.  So, fMRI research will be taking place right where I’m studying.  That is exciting.

We will be getting a TON of hands on experience.  Just recently a student interested in surgery who has been going his third year in Yankton, was allowed to do the left side of a hysterectomy under close supervision of an attending surgeon.  In what other medical school could a person get that kind of hands on experience as a medical student?  No where.

We will be required to do 42 history and physicals with a problem list – over dictation (with our own dedicated transcriptionist) over the course of the 3rd year.  We will be required to assit with twenty vaginal deliveries, assist with five c-sections, do twenty new born exams, and twenty-five well child exams.  There are medical students in the United States who finish their third year having never assisted in a vaginal delivery.  And here at SSOM, 20 deliveries is just the bare minimum requirement, some students log way more.  I wonder how many babies the Ivy league medical students deliver?

While orientation day was boring, the information I received over the course of the day made me super excited to get this year started.  It has a LOT of potential.

Sanford School of Medicine – Match Statistics

One thing that I learned sometime during my Pre-Med days was to look at match statistics of schools to determine how well they do at training their students.  I thought that was good advice.  Obviously, how well a school does training their students should correlate to a better match rate.  I mean it’s exactly like looking at how well certain colleges place their students into careers.

So, I took that to heart.  Now, I’ll be the first to admit, I wasn’t exactly afforded a large choice between medical schools.  What I mean to say is, I didn’t get into a ton of medical schools.  But hey, that doesn’t matter now does it?

So, before I even started medical school, I took an interest in the matching statistics of the schools I was applying to.  And after I was accepted at the Sanford School of Medicine (SSOM), I really concentrated on their matching stats, and to be honest we do pretty well.

I have compiled the matching statistics from SSOM since the year 2000 in a spread sheet, and I have found some interesting trends.

Match Stats


Since the year 2000 (including the 2010 match) – we have graduated and matched 545 students from SSOM with 93 going into Family practice which is 17.1% .   Compared to the US match rate of 7.4% matching into Family Practice (and only a 3% behind the leader), I would say that SSOM is doing pretty well meeting it’s mission.  And out of all the students who graduated since 2000 almost 45% of them have entered a primary care specialty (which would include Family Practice, Internal Medicine, Pediatrics, and Psychiatry).

Our medical school has also done a great job matching students into very competitive specialties as well. Dermatology has long been known as one of the most difficult specialties to match into.  Yet, three students from a class of 50, matched in both the 2007 and 2008 match.  Or to put it another way, 6% of our class those two consecutive years matched into a specialty in with only 1.8% of medical students are able to match (according to the 2009 match statistics).

While most of our students match in the midwest, some have matched into some of the most well known universities in the country including Baylor, Cleveland Clinic, Dartmouth, Emory, Massachusetts General, Mayo, UCSF, Rochester, Vanderbilt, Yale, and others.

So, if you’re a Pre-Med student, don’t worry if you don’t get into the Ivy league schools.  State schools, even little South Dakota, can help their students match into competitive specialties in well known programs.

——————
Top Ten SSOM Specialty Choices

  1. Family Practice
  2. Internal Medicine
  3. OB/GYN
  4. Anesthesia
  5. Pediatrics
  6. Psychiatry
  7. Emergency Medicine
  8. Radiology (Diagnostic)
  9. Pathology
  10. Orthopedic Surgery

Top Ten SSOM Match Locations

  1. South Dakota
  2. Minnesota
  3. Iowa
  4. Nebraska
  5. Wisconsin
  6. Kansas
  7. Michigan
  8. Missouri
  9. Texas
  10. Illinois 

Sanford School Of Medicine – Early Clinical Exposure

One reason I chose to come to the Sanford School of Medicine here in South Dakota, is because of the early exposure to real clinical medicine.  Sanford SOM is known (by those in the area) for it’s amazing clinical experience especially in the MS3 and MS4 years.  The medical students at this school work almost exclusively one-on-one with attending physicians.  Usually there is no senior student, intern, junior resident, senior resident, chief resident, or fellow blocking the third year medical student’s view of the action.

But little is known about the early clinical exposure in the MS2 year.  Here at the Sanford SOM, the second year classroom schedule ends at the end of March.  A transition to the clinical world takes place over the end of March and early April, and then the real fun begins.  Each MS2 gets paired with a rural family practice physician somewhere in the state of South Dakota, and we spend an entire month with them.

Almost all of us were exposed to serious trauma, OB/GYN, geriatrics, pediatrics, general medicine, emergency medicine, and some even were scrubbing into surgeries.  I personally was rounding on hospital patients, putting in stitches, doing history and physicals, seeing clinic patients, seeing nursing home patients, and assisting with surgery.

To give you an idea of how much exposure we had, I personally logged in over 200 patient encounters.  Some of these include:

  • Ear aches
  • Multiple Myloma (Cancer)
  • Well Child Visits
  • Physicals
  • Abdominal pain
  • Pneumonia
  • Allergies
  • Head trauma
  • Broken ankle/foot
  • Knee injury
  • Elderly falls
  • Vertigo and Dizziness
  • Constipation
  • Hypothyroid
  • Stroke
  • Heart Attack
  • Congestive Heart Failure
  • Flu
  • Breast Lump
  • Headaches
  • Low Back Pain
  • Smoking cessation
  • Pregnancy
  • Diabetes
  • Warts
  • Depression
  • Bipolar Disorder
  • Hypertension
  • Syncope
  • Hemorrhoids
  • Strep Throat
  • Hernia
  • Seizures
  • Cough
  • Acid Reflux
  • ADHD

I was also lucky enough to get to do some cool procedures too!

  • Interpret X-Rays, CT scans, and MRIs
  • Assist with ultrasound of the bladder, cartoid arteries, and pregnancy
  • Put in stitches
  • And scrub in and first assist on 8 surgeries including open appendectomies, laproscopic cholecystectomies, C-sections, and a hysterectomy.  
So, here’s a taste of the clinical exposure we get at this medical school.  If you’re interested to read more about what I have to say about the Sanford SOM, read my medical school review Part 1 and Part 2.  It was an awesome first clinical experience, and I cannot wait to get started with the 3rd year!

Medical Students Have To Learn Sometime

[The dude in this picture is just a random guy I googled, not the real patient talked about in this post]

Another medical student and I were hanging around the emergency room at a small town hospital the other day.  The weather had been particularly nice that day and a man decided to fix some of the gutters and siding on his home.  So he climbed up his ladder and started working, but his guardian angel must have taken a coffee break and his ladder broke.  The man fell 15 or so feet down to the concrete, and was transported by ambulance to the ER.

Unfortunately this man had a large laceration across his forehead, and another long his arm.  Lucky for us medical students, this man had two large lacerations that required stitches.  For story completeness – this guy was completely stable and had absolutely no life-threatening injuries.  The lacerations were the only injuries he sustained as a result of his fall.

The doctor working in the ER with us decided this was a great opportunity for us to practice our suturing skills, and so the doctor told the other medical student and I to come over “and assist him with stitching up.”  The man’s wife did not like the sound of that at all, and she asked if the students would be allowed to put in the actual stitches.  The doctor told her that we would, under his close supervision.  The wife wasn’t convinced that this would be ok.  So she asked if there was ANY way that the doctor could call in another physician to help “assist” with the stitches.  He said that the other doctors were too busy to be called in for this, and the medical students were available and have had plenty of training in this type of procedure.  The man’s wife told the doctor that she really didn’t want students practicing on her husband, and the doctor reassured her that we have had lots of training and that medical students can do this.

It felt weird to be in the middle of that disagreement.  On the one hand, I completely understand the wife’s concern of having medical students essentially “practice” on her husband.  Yes we’ve had 6 years of post high school training, but in all honesty probably less than 5 hours of suture only training at this point.  But on the other hand, us medical students need to practice on someone.  If you only had the most experienced people do the job every time, then how would you train the next generation?  Also, if I completely mess up and a suture falls out, then we can always put another in or just let it heal without the missing stitch.  It won’t make a big difference.  I also understand that the wife may not have known that this was a fairly low risk procedure on the grand scale of things, and so I can understand where she’s coming from.

Yes we have to learn sometime.  If everyone says no to medical students, then there will never be an experienced group of physicians.

Handbook of Neurosurgery by Greenberg

Those in the neurosurgery circles are pretty excited about Dr. Mark Greenberg’s new edition of the Handbook of Neurosurgery hitting shelves soon.

Dr. Greenberg, a neurosurgeon and director of neurosurgery in Florida, is most widely known for his work producing this book.  This book has been considered by many in the neurosurgery world as the “bible” of neurosurgery.  Every student who is interested in neurosurgery is advised to get one, every neurosurgery resident has one close, and every neurosurgery attending has at least a couple sitting on his bookshelf.

Just today, Dr. Greenberg on his blog posted a contest with the prize being a free copy of his newest edition.  I threw my name in the hat and I won!

I never won a contest before.  I feel awesome!