I look back...
Week 1: Oncology
Day 1: Internal medicine meeting, out patient clinic, in-patient rounds
Day 2: Internal medicine meeting, out patient clinic, colorectal cancer presentation, target therapy presentation
Day 3: Internal medicine meeting, TIHTC orientation, introduction to pathology equipments and protocol, patient interview
Day 4: Internal medicine meeting, Pathology review of Colon Cancer section, Acupuncture for Chemo-induced nausea and vomiting, Neurology case conference
Week 2: Cardiology/ Cardiovascular surgery
Day 1: Internal medicine meeting, outpatient clinic, inpatient rounds, EKG, pacemaker removal operation/ infected wound cleaning
Day 2: Surgical department meeting, echocardiography, abdominal ultrasound, exercise stress test protocol, EKG, evening outpatient clinic
Day 3: Double lead pacemaker placement, dialysis AV shunt balloon angioplasty, AV graft thrombectomy
Day 4: Introduction to extra-corporeal membranous oxgenator, surgical department conference, Out patient clinic, in-patient rounds
Day 5: Observe stent placement to repair abdominal aortic aneurysm
Week 3: Neurosurgery
Day 1: Finalize group colorectal cancer case presentation with Dr. Chen, visit ICU, introduction to intracranial shunts and ICP monitoring
Day 2: Surgical department meeting, observe C4/C5 disc herniation, disc removal, spinal nerve decompression and prosthetic disc insertion, brain CT discussion Tentorial subdural hemorrhage: differential diagnosis and complications, evening outpatient Clinic with Dr. Chen
Day 3: Tracheo tube removal, discussion of emergent decompressive craniotomy to remove the hematoma, patient chart review, continuous ICP monitoring, lunch time documentary on Herceptin, observe L3/L4 decompression surgery
Day 4: Introduction to trauma neurology: diagnosis, signs, symptoms, and treatment protocol, goals
Day 5: Introduction to cervical ultrasound, intracranial circulation, and economics of private neurosurgery
Week 4: Nephrology
Day 1: Pediatrics meeting, introduction to hemodialysis and protocol, inpatient rounds, interpret imaging studies and lab values (chemistry panel)
Day 2: Internal medicine meeting, out patient clinic, inpatient rounds
Day 3: Internal medicine meeting, admission H&P for recurrent pyelonephritis patient
Day 4: Visit Shenkeng Public Health Center
Day 5: Observe consult with vegetative patient’s family on ventilator removal, epidemiology research data collection, inpatient rounds, observe femoral double shunt placement for emergent dialysis
I remember...
1. Dr. Chin Yi Chen was the preceptor for 3 of us during the first week. He taught us many things in the short 4 days we had. In addition to outpatient clinic and inpatient ward rounds, he presented powerpoint on numerous topics including target therapy, colorectal cancer, case studies, Chinese medicine, and individualized genetic cancer treatment. He also encouraged us to interview patients and learn about their disease and treatment course. Dr. Chen was extremely good at patient education—he was able to tell the patient a story of his/her illness in such a way that patient understand and comply with the medical recommendation he made. Many of his patients emphasized that he was the best doctor in their personal experiences. For the following 3 weeks, Dr. Chen also allowed us to shadow him in his Tuesday evening outpatient clinic. His assistance and guidance went way beyond his duty as our preceptor; he even spent an entire morning to help us re-structure, collect data, and refine our case study presentation on colorectal cancer.
2. I attended various morning departmental meetings: internal medicine, surgery, and pediatrics. These were fantastic ways to start a day. During one hour, one to 15 or 20 cases were presented and discussed. I enjoyed the fast pace and interactive discussion, very conducive to knowledge expansion and application. The pediatric chief and Dr. Wu from internal medicine were especially encouraging and accommodating. They would often emphasize differential diagnosis and pathophysiology principles.
3. Cardiology and cardiovascular surgery worked seamlessly together. Learning from both specialties in one week was an incredibly exciting and productive experience. Dr. Kuei-Feng Chen showed us the breadth and depth of cardiology; he also exemplified high standards for patient care and professionalism. As the director of Cardiology, he led an outstanding team of dedicated physicians such as Dr. Yu (young attending) and Dr. Fong. As I observed (in lead suits myself) Dr. Yu place a double lead pacemaker in a 90-year-old patient, I realized that cardiology is not for the faint of heart. The CV surgeon was also enthusiastic about teaching, welcoming Sandy and I to observe numerous operations (AAA stent repair, AV shunt thrombectomy) even though he was Nicole’s preceptor.
4. I appreciate the multi-faceted learning experience our preceptors/ TIHTC staff structured for us. I was able to observe and learn from numerous surgeries, patient/ family consultation, outpatient clinic, inpatient ward rounds, departmental meetings, case conferences, imagining studies and interpretation, and develop my own research project. I can hardly imagine a more fruitful and meaningful experience than these 4 weeks.
5. Dr. Yi Gian Chen (Chief nephrologist) and Dr. Shui are amazing teachers. Not only do they teach me a lot about chronic renal diseases and hemodialysis, they also support and guide my intellectual quests in every possible way. I discuss my idea of doing epidemiologic research on end stage renal disease patients with Dr. Chen. He listens to my proposal patiently and helps me collect as much data as possible. He generously shares his experience and knowledge of current research and trends, assisting me to refine my research goals and methods. He even mentioned the opportunity to collaborate with 3rd year resident on future research!
6. Dr. Ding, one of the neurosurgeons at Taipei hospital, gave me the opportunity to assist in spinal surgeries as the first assistant. This was an eye-opening experience and great honor. He also guided us through a complex and interesting discussion of cerebral hemorrhage. He shared about his current pursuit of PhD in Healthcare Queue Management. He explained one project he was working on: how to maximize the utility of emergency beds a hospital maintain. I thoroughly enjoy the richness and multi-dimensions of medicine, from concrete intricate surgeries to abstract mathematic modeling.
7. I really liked Dr. Liao’s powerpoint presentation on trauma neurology. I learned a lot of information; the actual cases he shared were very helpful in solidifying major patho-physiologic principles and treatment protocol.
I would have done this again because TIHTC
1. Solidify and expand the knowledge I have obtained from my first year of pre-clinical studies at Touro University.
2. Rotations such as neuro-surgery served as good preview of selected topics in my second year studies.
3. Prepare me for 3rd and 4th year clinical rotations.
4. Show me ways to improve health care in US. Real time electronic medical records optimize healthcare delivery efficiency and streamline information flow among departments.
5. Taiwanese doctors see their patients as whole persons, not discrete organs of interest or disease states. I witness that even highly specialized physicians such as oncologists, nephrologists, and cardiologists share a holistic approach to patients. This resonates deeply with The Principles of Osteopathy.
6. One of the most meaningful and productive ways to spend the only summer vacation I have in the years to come. My passion for medicine was renewed; my mind challenged and my heart inspired.
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