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Curriculum

Saba Student Looks at Why Canada Lacks Doctors

Forty years ago, Canada enjoyed one of the best physician-to-population ratios among developed countries. That's not the case today.
Among the 34 countries that are part of the Organisation for Economic Co-operation and Development, Canada now ranks 28th.

What happened? Andrei V. Malko, a student at Saba University School of Medicine, decided to find out. He made the shortage of doctors in Canada the focus for the research paper that is required of all Saba students.

And now Andrei has joined the select group of Saba students who have had their papers published—his paper, Physician Shortage in Canada: A Review of Contributing Factors, appears in the Global Journal of Health Science, Published by the Canadian Center of Science and Education.

 “Assessing medical data is a critical skill for any physician today,” said Jim Bruzik, Associate Dean for Medical Education at Saba.  ”Since we made the research module part of the Saba curriculum, students tell us it gives them a real point of differentiation in their residency interviews. This is especially the case for students like Andrei and others who have had their papers published.”

Andrei looked at a wide range of underlying factors impacting Canada’s physician shortage from government policies and population demographics to medical student career preferences and the decline in physician productivity. Understanding the wide range of underlying causes is critical because, he notes, “decisions that are made today will take at least a decade to reveal their full effect.”

To see Andrei’s’ published paper, click here.  To learn more about the student research program at Saba, including video interviews with Dean Bruzik and other Saba graduates who have had their papers published, go here on the Saba website

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The ‘Darkest Time’ in Med School—Prepping for Your Third Year Clinical Rotations

 

Just a few years ago, you could sum up a medical education quite simply as two years in the classroom (i.e., learning the basic sciences) and two years making rounds (i.e., your clinical clerkships.)

But now leading medical schools, including Saba University School of Medicine, have overhauled their curriculums to better integrate the clinical side much earlier.

There are many reasons for this change, but one often overlooked aspect is the realization that making such a stark transition from classroom to clinicals in the third year wasn’t healthy for anyone—not the students themselves and not their patients.

According to Danielle Ofri, a medical school professor and author of the book What Doctors Feel: How Emotions Affect the Practice of Medicine, the “ice-water plunge” into primal clinical experiences produces a welter of emotions, not all of them positive. Coming to grips with the messy realities of disease and death, observing egos and medical hierarchies, witnessing fear, anger, grief, humiliation in patients and doctors alike—and going through all of this for six-weeks, before being whisked off to start over again in other rotation—these are all reasons why the third year is often referred to as the “darkest” year of med school.

Ofri points to studies that document the decline of empathy and moral reasoning in medical trainees during the third year—emotions that can profoundly affect what kind of doctors these students become and the quality of medical care they can give to their patients.

On a positive note, she points to the growing recognition of this challenge as schools such as Saba reorient their clinical curriculums, introducing greater clinical exposure well before the third year and implementing more hands-on mentorship.

For more about Dr. Ofri’s observations, see her article The Darkest Year of Medical School.

For more about Saba’s clinical program, including interviews with deans and students, go to http://www.saba.edu/academics/clinical-education

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Mistakes to Avoid While Studying for the USMLE

The USMLE is a rite of passage for every medical school student. Here are some tips from Brian Radvansky, a USMLE Tutor, on mistakes to avoid while studying for USMLE Step 1 & 2 CK:

·         On test day, you will need to be focused and present for about 8 straight hours.  Start building that stamina now. Avoid giving yourself those “mini-rewards” for just completing a question block. Keep going.

·         Avoid doing too great a proportion of your practice blocks in Timed Tutor mode and getting overly used to expecting a green check or red X after every question. That obviously won’t happen on the exam.

·         Try as much as possible to physically emulate the actual test conditions, i.e., working at a desk vs. lounging with your iPad on the couch.

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Doctors, Skilled Workers and Protocols

It’s a never-ending debate, made more intense in this era of cost-control and evidence-based medicine: What kind of latitude should doctors have in treating patients? Should doctors be looked upon as “skilled workers” performing highly complex work, but following strict protocols or should they be seen as professionals, working independently and applying their knowledge to an unending stream of unique situations.

Consider just a few examples:

  • A 57- year old man slips on the ice, breaks his hip and goes to his local hospital where a general surgeon pins the shattered bones back together—well, almost. When the hip failed to heal correctly the patient sought out an orthopedic surgeon specializing in trauma conditions at a large urban hospital who said simply, “I can see the problem right away. They followed the protocol, but in your case it wasn’t enough.”
  •   A resident being "trained" by an attending doctor was about to administer a drug using the protocol developed by that hospital's clinical department. The attending doctor interrupted and said, "Don't do it that way. I've been a doing this for over 20 years, and that way is stupid."
  • An ob/gyn practicing in an extremely rural environment—the nearest other ob-gyn is more than an hour’s drive away—says that “the only thing keeping my patients and me safe is well established and tested protocol and procedure.”

Here at Saba University School of Medicine, our students wrestle with questions like these every day—in the clinical training that starts from virtually the moment they step on campus, in classes on medical ethics, and in the research program on medical literature all students are required to complete by the end of their fifth semester. Learn more about Saba’s Curriculum

Of course, there are no simple answers. Today’s protocols are in many cases based on extensive clinical research that far exceeds the independent experience of any one physician. At the same time, no protocol can be right 100% of the time and there are numerous examples in the history of medicine of practitioners who bucked the prevailing consensus and were proved right.

For interesting discussions of these questions see Doctors are more than just skilled workers. Here’s why. And "Protocols are for nurses."

 

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Wearing a White Coat—Who, What, When, Where and Why

 

At Saba University School of Medicine, all first semester students undergo the rite of passage known as the White Coat Ceremony—you don a short white coat, a symbol of your status as a full-fledged medical student. Upon graduation from Saba, that short coat will be replaced by a long one, a sign of your status as a full-fledged physician. End of story? Not by a long shot.

 For starters, a lot of professionals in the medical world now wear long white coats. To an anonymous, young, female physician blogging on KevinMD, this is troubling: “As a female physician I often will enter a room and introduce myself as Dr. (last name), and I cannot tell you how many times the patient or family member will remark to another person in the room or on the phone, and say “Oh, the nurse is here.”

 This physician isn’t putting down non-physician colleagues—simply wondering if there isn’t a way that other medical practitioners can acquire a distinctive, professional attire, symbolizing the dedication and skill they bring to healthcare, without it being the long white coat traditionally worn by physicians.

 For Shivam Joshi, MD, the issue is not who wears the white coats, but where. Writing in his blog AFTERNOONROUNDS, he reports being aghast at running into a fellow physician wearing his white coat at the grocery store.

 Dr. Joshi cites studies showing how much bacteria has been found on white coats and notes that Britain’s National Health Service now bans doctors from wearing white coats in the hospital and the United Arab Emirates’ Ministry of Health bans them outside the hospital.

 The Society for Healthcare Epidemiology in America (SHEA) recently recommended that healthcare providers should possess two or more white coats, launder them regularly and have access to hooks where the white coat (or other long-sleeved outerwear) could be placed prior to patient contact.

 So, that first-semester White Coat ceremony? It’s a rite of passage into the world of healthcare in more ways than you might have realized.

Photo: White Coats at Saba

 

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Going to Med School—Yesterday and Today

Genomics. Statins. Targeted Biopharmaceuticals. PET (Positron Emission Tomography). The world of medical treatments never stands still—and the same is true for going to medical school.

As What Medical Schools Are Doing Now That They Weren’t 20 Years Ago notes, a physician who graduated years ago might be surprised at the curriculum of today’s med student in which classes on medical ethics carry equal weight with those on anatomy and pharmacology.

Yes, today’s med students are trained in interpreting the various symptoms of disease, but they are just as likely to get trained in biostatics and evidence-based medicine. And while they are tested on their ability to assimilate vast quantities of information, today’s med students are also evaluated on their progress in developing an effective bedside manner.  All of that is a big difference from what medical school was like in the past.

Finally, a physician trained years ago might be surprised by the experiences of today’s medical residents: Instead of being on call almost around the clock, regulations now limit a resident’s weekly workload to 80 hours.

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Saba Curriculum: Organ Systems-based and Interactive

Students at medical schools in the U.S. and Canada have traditionally followed a curriculum that involves two years of classroom learning followed by two years of clinical exposure. It’s a curriculum based on a legendary 1910 study known as The Flexner Report.

Now, for the first time in over a century, that curriculum is undergoing a major overhaul. A wide range of medical schools, including Saba, have changed their learning strategies to better prepare students for a medical world that is more patient-centered and focused on achieving measureable outcomes.

According to Dr. James Bruzik, Associate Dean for Medical Education who spearheaded the curriculum update at Saba, the new approaches are taking place on several levels:                                                                                                                                                                                 

Organ, systems-based approach: At Saba, basic sciences and clinical studies are now being taught in an integrated, organ-systems-based approach. That means (for example) when you’re learning about a developmental abnormality in a specific organ you also study the anatomy, genetic background and pharmacological approaches to treating it—all in one, integrated learning module.

Early exposure to clinical experiences: Students are exposed to clinical experiences from the very start. In the first week of classes at Saba, you may be learning about the basics of the cell and then attending a class where you’re doing role-play exercises or taking an oral assessment on how well you’re able to communicate with patients and medical colleagues. 

Active learning: There is a great emphasis on active learning and classroom interaction. Saba has “flipped classrooms” designed for small group interactive learning and also incorporates much more in terms of ongoing formative assessment: in an ungraded format, students get the opportunity to take tests and see where they stand. 

Research: Because so much of medical practice today requires the ability to evaluate medical literature and advise patients on the latest developments, students at Saba complete a research project involving an in-depth review of medical literature on a specific topic. For many students, this research became a key asset in getting selected for a top residency. Several Saba students have had their research papers published in medical journals.

Medical education is changing. As a leader in international medical education, Saba is committed to being at the forefront of these changes. Learn more about the Saba curriculum, including an interview with Saba administrators and deans, at http://saba.edu/academics    

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Just Getting to Know Saba—Here Are 5 Fast Facts

 

  1. A Leading International School: Saba has been educating physicians for more than 20 years and is one of the most established and experienced international medical schools in the world.
  2. 99% USMLE Pass Rate: Saba students have a 99% first-time pass rate on the USMLE.  Based on data compiled by U.S. News and World Report, that not only exceeds any other Caribbean school, it’s better than most U.S. schools.
  3. Residencies: Saba graduates earn residencies at a rate consistent with U.S. medical schools, including appointments in 2016 at Boston University, Hershey Medical Center/Penn State, McMaster and Queen’s Universities (Ontario) and Yale.  Many Saba graduates become family doctors, addressing the critical need for primary care in the US and Canada.
  4. Approvals: Saba has received all approvals needed to enable our students to practice anywhere in the US and Canada. Saba was approved for participation in the Title IV U.S. Federal Direct Student Loan Program after the U.S. Dept. of Education determined that Saba’s academic program was comparable to that of U.S. medical schools. Because Saba, the island, is actually part of the Netherlands, Saba University has undergone a rigorous accreditation to meet European standards.  In effect, Saba is a European medical school that happens to be on a Caribbean island. 
  5. Tuition: In addition to Title IV loan availability, Saba aggressively manages tuition, keeping it 30-50% less than other international schools with comparable ranking.

 

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Saba—‘The European Medical School in the Caribbean’

Many people know that Saba has received ALL of the approvals needed to enable our students to practice anywhere in the US and Canada. Also, Saba has been approved for participation in the Title IV U.S. Federal Direct Student Loan Program based on the U.S. Dept. of Education’s determination that Saba’s academic program is comparable to that of U.S. medical schools.

What you may not know is that because Saba (the island) is actually part of the Netherlands, Saba University has also undergone a rigorous accreditation to meet European standards.   Saba University School of Medicine has been accredited by the NVAO (in Dutch: Nederlands-Vlaamse Accreditatieorganisatie), the Accreditation Organization of the Netherlands and Flanders. This organization was established by international treaty and ensures the utmost quality of higher education in the Netherlands and Flanders. So when it comes to international medical schools, Saba really is quite unique:  a medical school with European accreditation that happens to be located in the Caribbean.

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Saba Students Undertake a Wide Range of Clinical Rotations

One of the top questions we hear from prospective students is “Where will I do my clinical rotations?” It’s a very important question because where you do your clinical rotations—particularly your elective rotations—has a big impact on where you do your residency.

Saba students complete clinical rotations at medical centers across the US and Canada. Here is a snapshot of Saba graduates since 2000.

 

 

18,000+ Rotations: While Saba is a relatively small school—our class sizes are just a fraction of what you will see at some of the other medical schools located in the Caribbean—Saba students have completed more than 18,000 elective rotations across the US and Canada.

Every Specialty Represented: The American Medical Association groups physicians into 26 specialty groups, from Allergy/Immunology and Anesthesiology to Surgery and Urology. Saba students pursued electives in every one of those 26 specialties, as well as other “ungrouped” specialties such as Hospitalist and Wilderness Medicine.

Top Specialties for Electives: The top areas for Saba students to pursue elective rotations were Internal Medicine, Surgery, Psychiatry, Pediatrics, Obstetrics/Gynecology, Family/General Practice, Cardiology, Emergency Medicine and Radiology.

Numerous Subspecialties: Saba students pursued elective rotations in numerous subspecialties. For example, Saba students completed electives in surgical subspecialties including Burn Surgery, Cardiovascular, Colon & Rectal, Craniofacial, Endovascular Surgical Neuroradiology, Pediatric Cardiothoracic, Critical Care ICU, Transplantation, Trauma and Wound Care.

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