Annie Li Yang Student Essay Contest 2021
April 14, 2021
A key component of the Shared Discovery Curriculum is the integration of early meaningful clinical experiences with clinical, basic and social sciences. The 2021 Annie Li Yang Student Essay Contest asked students to reflect on the connections between their clinic and classroom experiences and how that impacted their growth as a medical student and physician-in-training.
IN MEMORY
The contest is named in honor of Annie Li Yang (1995-2019), one of the inaugural essay winners. Annie was a first-year medical student at the Michigan State University College of Human Medicine. She held a BA from Princeton and would have received her MD in 2022.
In her winning 2019 Inaugural Student Essay Contest entry titled “Patiently Gazing into Patients’ Lives,” Annie candidly delved into her fear of and journey to overcome reductive thinking, stressing the importance of always keeping sight of the individuality of patients and their lives outside of the hospital or clinic. In her words, “what it truly means to become a physician [is] to see the patient as someone much like myself, a member of a wider community and family.”
First Prize Winner
Becoming A Doctor
By Emily Brereton
“Our patient’s labs are back - can you go review them with her?”
I smile, “No problem, then I’ll call her husband with an update.”
Striding purposefully back to the work room, down a corridor brightened by the sun reflected on snow, this work feels natural. Then a rare moment of reflection slows my step. An attending trusts me to interpret and share test results. I feel responsibility and ownership of my patients. I’m becoming a doctor.
A rite of passage for every first year student at MSU CHM is viewing their very first, painfully awkward patient interview - recorded and played back for themselves, their classmates, and preceptors. After receiving our brand new white coats, on the precipice of starting our early clinical experience, it is fitting that we were immediately humbled by this simple exercise. I imagine I’m not the only one who left thinking, Why would any patient ever want to talk to me, albeit listen to anything I have to say?
The concept of sending students into clinical experiences in the infancy of their medical education depends on the radical notion that we have more to offer our patients than medical knowledge. I routinely took vital signs, listened to concerns, recited a comprehensive review of systems, and performed standard physical examinations with the variety of family medicine patients I had the privilege of learning from. However, when I reported to my supervising physician, I was more capable of describing a patient’s recent vacation or beloved grandchildren than offering an intelligible assessment or plan.
My first meaningful contribution to a patient’s care was not catching a subtle murmur or realizing an overlooked detail that led to diagnosis. ‘Fatigue’ was noted in her chart, but with gentle encouragement she shared that she worked full time and also cared for her aging and mentally ill mother, whose behavior had become more unpredictable and often disrupted her sleep. The physician said she was aware of these concerns, but I couldn’t shake the feeling that the situation was getting worse. I asked, then suggested, then insisted that she would benefit from social work intervention. Connecting that patient with the services she needed and had never been offered before was the first time I felt my presence had served, not just my own learning, but another person.
Meanwhile in problem-based learning, my scholar group came together to apply fresh knowledge of physiology, pathology, and pharmacology to integrated patient cases. “An 83 year old male presents with a complaint of dizziness upon standing up…draw the pathophysiology of orthostatic hypotension” - cue collective groan, then the distribution of multi-colored dry erase markers. While we could have made these diagrams individually, collaborating forced us to practice the art of sharing knowledge, accepting limitations, and respectfully challenging one another.
Our preceptors set the expectation that we would learn rather than perform, and encouraged us to communicate our ideas,
“You don’t have to know the entire answer, just get us started,” a phrase I learned when I became a small group facilitator, was a favorite of our leader. Hearing how my classmates approached problems helped me identify the gaps in my thought process, and being able to admit “I understand this part...here’s where I need some help” gave others a chance to share and solidify their knowledge. One of the greatest gifts of solving problems with a trusted group of peers was learning to tactfully challenge or correct one another and receive feedback graciously. The habits formed: looking up information from credible sources, clarifying its meaning, and reconciling different interpretations have been invaluable in navigating clerkships, ever changing clinical guidelines, and varying provider preferences.
I believe the most unique and rewarding aspect of my integrated clinical experience was the opportunity to rotate with allied health professionals. Before resolving to pursue medicine, I considered careers in music therapy, social work, physical therapy, counseling, and occupational therapy. While the physician role best fit my interests and strengths, I found great value in approaching patient wellbeing and treatment through these different lenses. Rotating with different disciplines within the healthcare team early in training primed me to look for learning opportunities beyond my residents and attendings on medical clerkships.
When my OBGYN preceptor was swamped with charting and I’d done all I could to help, I reached out to the nurse I’d been checking in with all night and asked if she could observe my cervical exam and Leopold’s maneuvers? She coached me through these skills and I assisted her in repositioning and attending to our patient’s comfort. When we returned to the nurse’s station, she found a cervical exam board and asked me to estimate how dilated our patient was. Her colleagues noticed that I was eager to learn, and joined her in quizzing, correcting, and teaching me about obstetrics practices. In these informal education sessions, they also shared how they were impacted by physician attitudes and actions, and advised me on how to be a better teammate to my nursing partners when I become a resident.
Now in the core clerkships of my Late Clinical Experience, I appreciate how my attitudes, practices, and identity as a medical student have been shaped by these academic and clinical foundations. The realization that stopped me in my tracks, I am becoming a physician, remains an awesome and daunting task; a task I can approach will the skills and clarity of purpose to become a holistic provider, an effective communicator, and a team player.
Second Prize Winner
Seeing People
By Eunice Im
The first time I met Annie was at the University of Michigan for a conference where she was presenting her research that she did at Papua New Guinea. I could be wrong about that. Basically, she did research at a cool place outside of the United States and I was immediately fixated on her. I monitored her because I wanted to see what I could glean from her genius. I wanted to incorporate something and anything into my below-average-NBME-scoring-medical-student existence.
Cynthia and I approached her before she put up her poster on her assigned board. One of us asked her about her research; it was likely Cynthia. I waited for Annie’s first word. She said something along the lines of, “Oh, it’s nothing.” I did not take this statement seriously, because Asian Americans often downplay their achievements. So, I probed further. She repeated the same message of self-reproach. Then, it occurred to me that she genuinely thought that her research did not mean much. I realized that she was commiserating with us about how, even though you try with all your might, you do not always achieve all that you wanted when you started. I eased into our conversation after I realized that we were relating to each other. We were part of the collective struggle, in which medical students strive to claim as many academic achievements as possible; so that we can, one day, be worthy to serve as physicians. She saw me, and I saw her.
This practice of seeing each other is repeated at any and every opportunity at the College. My unconscious biases have been exposed and some have started to lose their grip. To my surprise, even as a Southern-California-bred-Korean-American, I am not immune to the self-serving heuristics that the human mind harbors deep inside.
I recall an incident during orientation, where one of my small group mates took the risk of talking about the challenges that some white Americans face in America. He presented the hypothetical Buddhist white man, who has to deal with the assumption from people that he is privileged, when, in reality, he is alienated from his own community because of divergent personal beliefs. This caused an uproar from the entire class, and sparked a conversation within my small group; we are still continuing it today. We have had endless discussions about racism - all passionate, fiery, angry, and honest. We discussed and debated, over and over again, issues surrounding sexuality, poverty, and body image as well. I suspect that our faculty fellows have post-traumatic-stress-disorder after trying to modulate the emotions that we threw across the room and the thoughts that we placed on the table. After these sessions, somehow, we managed to go to the local pub to grab burgers or to the Starbucks at Spectrum to get our beloved caffeinated beverages. We brought our fire, then quickly extinguished those flames with love.
While at a local outpatient community as a first year student, I met a young woman who was dealing with withdrawal symptoms from alcohol misuse disorder. I can assure you, if I met this woman before my white coat ceremony, I would avoid her. I never liked “alcoholics” and their odd behaviors, but the College did something to me. More specifically, Dr. Cara Poland did something to me. When I saw this patient, I saw myself in her. She was the same age as me; and I could not escape from the thought that, if I was her, living within the same circumstances with the same limitations, I would make the same choices, and I would need compassionate and competent medical care, too. I could not sleep well after meeting her. I still see her face in my mind.
I knew that the College got under my skin after I observed my response to recent events. With the Black Lives Matter movement, the COVID-19 pandemic and the resulting civil unrest, I fell into a mental and spiritual haze that I have never experienced before. These men and women - protesting throughout the country, expressing their outrage against an unjust world, dying from a virus that travels across nations - were not strangers to me. I could see my friends in the crowd. I saw Arrionna Dryden; I saw Eric Poole; I saw Cory Wilson; I saw Njeru Muragami; I saw Ajah Chandler; I saw Brittany Herron; I saw Kenechukwu Isi; I saw Austin Novarra; I saw Onome and Osose Oboh; I saw Dr. Lisa Lowery; I saw Dr. Wanda Lipscomb; and I cried.
The College does not let us sit in our emotions. Dr. Wagner and Dr. Demuth, in their wisdom and administrative savvy, coax us to continue the steady march through the curriculum, which has sufficient and strategically placed opportunities to untangle garbled thoughts on these issues during weekly scholar group meetings and simulation lab; and my classmates - my wonderful classmates - are generous to listen to me and help me think through these issues. Through video chat, GroupMe texts, and voice memos, I continue the work of undoing biases that I have dearly held onto my entire life: African-American men are threatening and scary; all men take advantage of women; and LGBTQIA folks are confused. There are other biases that I have yet to uncover and let go.
I will be forever indebted to Addams 3: to our beloved boo mama, genius Hong Kong dinosaur, underground sage and lover of all living things, gentle giant who was a Corgi in a previous life, firecracker who wants to adventure through California’s mountain ranges, baseball lover who was mistaken by the entire class for being a divorced man with a son, and cheeky royal jokester. Walking through the SDC was worth every single penny of my out-of-state tuition. In Annie’s memory, I vow to become a physician who sees people for who they are; when I struggle to do so, when I sense that I am missing something, or feel the chains of my self-designed prejudices, I’ll text you, Addams 3.
Third Prize Winner
The Art and Science of Medicine
By Karren Wong
Prior to medical school, I imagined medicine to be a precise science at the forefront of innovation. The media made it feel as though medicine was on the cusp of finding the panacea to humanity’s ailments. There was always a newer and better drug on the market. Always one step closer to a cure for cancer or Alzheimer’s disease. Fast forward to medical school, where my romantic ideas of medicine quickly evaporated. Much to my chagrin, I spent countless nights looking up concepts with the end result being a “black box”. And despite never figuring out acetaminophen’s mechanism of action, I somehow managed to progress to LCE.
Completing two years of medical school and overcoming STEP 1 felt like significant progress. But on the wards, I had regressed back to being a kindergartener. I didn’t know the language of medicine and I stumbled during my patient presentations. I was also full of questions. The most common ones were “Why?”, “Can I eat now?”, and “May I go use the restroom?”. And without the Pavlovian school bell, I wasn’t sure if I could go home unless multiple residents shooed me away.
Suffice it to say, being in the real world keeps the ego in check. A surgeon once asked me to identify the vascular structures in the operating field. That was humbling. The anatomy was nothing like the clean ink lines found in Grey’s Anatomy, it looked more like spaghetti to me. In an attempt to compensate for my mental constipation, I word-vomited names of anatomical structures and luckily the shotgun approach worked that time. As I stood there retracting for hours, I tried to stay engaged by asking questions. More often than not, the response went along the lines of “Great question, but that’s for an internist to answer.”.
So, when I was assigned to work at the Hurley Outpatient Clinic in Flint, I was excited about the prospects of finding “my people”. One of my first patient encounters was a middle-aged woman with knee pain, whom I’ll call Ms. M. Before I entered the exam room, I thought it would be an easy case of osteoarthritis. I asked her about what had been going on and she burst into tears. Ms. M was pushed down by her son a month prior. But she hadn’t taken care of the knee pain because she was busy with being the primary care giver for her elderly mother. No amount of studying could have prepared me for the rawness of her pain. I was flustered. I ran to my senior resident and asked if there were any analgesics for Ms. M.
Then in walks Dr. Towfiq, a jovial internist that has been practicing medicine for longer than I’ve been alive. The N95 covered most of his face, but thick glasses magnified his eyes and revealed the windows to a wealth of knowledge. He proceeded to ask Ms. M what happened. It was difficult to make out what she was saying through her tears. Dr. Towfiq gently acknowledged her pain, but firmly asked for her help in focusing so that he could get to the bottom of it. Almost like magic, Ms. M calmed down enough to follow Dr. Towfiq’s instructions for the physical exam. He asked her to kick her foot against his own foot and to point to the location of the pain. She said, “My knee hurts.” while pointing to her left quad. He palpated the quads, looked over his shoulder and said, “Quadriceps rupture”. Now Ms. M had tears of joy because she finally had an answer to the cause of her pain.
The speed and accuracy of Dr. Towfiq’s diagnosis was impressive, but his forthright acknowledgement of the patient’s suffering was the most astonishing aspect of the encounter. In that moment, the phrase “medicine is an art and science” finally clicked. The seasoned physician seemed less fascinated by the pathology, but more so by the patient’s interpretation of the pathology. Understanding what the patient is trying to communicate requires trust and knowledge. This case served as a reminder that humanism is the core of our profession. As medical students, we sometimes put humanism in the backseat of our minds as we try to drink from the firehose of information that we’re supposed to learn. We chuckle when we’re told to treat our patients with compassion because the advice is so obvious. But the ability to balance empathy while trying to pinpoint the diagnosis is an art that comes with time and mindful experiences. According to Dr. Towfiq, a physician’s greatest power comes from knowledge and the connection to patients. Patients will tell you exactly what is wrong so long as you listen. The problem is that many people listen to respond rather than to understand.