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By Emily C. Wong
On my first day in the hospital as a medical student, I saw a man falter in the hospital lobby and get rushed into the Emergency Room. He had been picking up his wife from work at the Zuckerberg San Francisco General Hospital when he felt a sudden tightness in his chest. Within minutes, the medical team mounted an impressive response, orchestrating a quick and coordinated effort to get him the care he needed—first, a firestorm of providers buzzing purposefully around him in the Emergency Room, and then a team of four working quietly to restore blood flow through his blocked coronary artery.
As a first-year student in the inaugural year of the Bridges Curriculum at University of California, San Francisco, I witnessed these events through the lens of systems improvement. It was a Thursday afternoon in September, and I was observing the clinical environment in which I would be implementing a quality improvement project through the Clinical Microsystems Clerkship (CMC). As I debriefed my observations from the day with my medical school coach, Dr. Andrea Marmor, I felt energized knowing that this system, complete with effective protocols and good communication, had served its purpose that day: saving a man’s life.
In the months since, I have learned many things through the Bridges Curriculum that give context to what I saw that day. Through our Foundational Sciences curriculum, I learned how ST-Segment Elevation Myocardial Infarctions (STEMIs, or heart attacks) are diagnosed, which medications were likely given to this patient upon his arrival, and the name of the artery that was blocked. Through my CMC systems improvement work, I discovered that those seamless protocols I witnessed did not come into place overnight; and that effective communication between team members and departments requires sustained effort. In the Health and the Individual and Health and Society curricular blocks, we discussed structural determinants of health, and I learned to recognize the forces outside of the man’s acute diagnosis—including personal identity, politics, language, and wealth—that played instrumental roles in shaping his access to and interactions with health care. And through the Coaching Program, in which a physician coach spends one day per week with five to six medical students working on clinical skills, I gained an appreciation for the open communication and compassion that the medical team showed the patient’s wife in the Emergency Room as she looked on nervously from a corner of the room.
Still, I have at times felt overwhelmed by the magnitude of things we encounter in medicine. I was overcome with grief after scrubbing in on an organ procurement operation, in which the organ donor was exactly my age, with a family that delayed the procedure by a few hours because they were having a hard time saying good-bye. And I was infuriated by Congressional attempts to repeal the Affordable Care Act, knowing that access to routine preventive care was a major reason that a patient with chronic pancreatitis and diabetes was able to stay out of the hospital. Through our curriculum, I have learned about the process for placing individuals on the organ transplant list, engaged in conversations with classmates about the interplay between policy and medicine, and even attended classes dedicated to critiquing and writing op-eds to advocate for our patients. But I’m still figuring out how to bring what I’ve learned into practice; how to make sense of these broad concepts in the context of real-world patients, hospitals, and clinical settings.
Luckily, I have a wonderful partner in this journey—my coach, Dr. Marmor. Our coaches serve dual roles as instructors and mentors throughout medical school, and Dr. Marmor has enthusiastically cheered alongside me after small successes while being a generous listener when I’ve needed to process more difficult days. Having a coach with whom to debrief difficult clinical encounters, discuss my academic progress, and develop a plan to get me from first year to residency has been a major highlight of the Bridges Curriculum.
As I continue to grapple with the practical and emotional challenges that come with being a clinical care provider in the context of an immensely complex social environment, I take comfort in knowing that the Bridges curriculum has given me exposure to some of these things already—and that my coach will be there to help guide me through the rest.
Emily C. Wong is a second-year medical student at UCSF. She is the advocacy chair of UCSF’s Students for Organized Medicine, a student group dedicated to promoting activism through policy, advocacy, and service.
This story was originally published in the July/August 2017 issue of San Francisco Marin Medicine, reposted by permission.