The Front Line
As Dell Medical School’s first class begins training in hospitals and clinics, students learn what it means to work with real people — with real problems.
Ten-hour shifts. Stale coffee and hospital food. Long rounds and longer notes. Patient problems without textbook answers — or answers at all. Wrap up one rotation in a clinical specialty, then on to the next. Rinse, and repeat.
Clinical clerkships are a defining part of the medical school experience. Students with long-held dreams of helping and healing are finally at the front line, connected with real patients with real problems. They’re also confronted with the difficult realities of the job. Through rotations in six specialties during the course of a year, students observe and learn from seasoned physicians — slowly forming their own professional identities and developing goals for the future.
The first class of students at Dell Medical School at The University of Texas at Austin entered its second year and began clerkships in hospitals and clinics around Austin in mid-July. That’s one year earlier than students at most medical schools due to a condensed and intensive first year — 12 months of preparatory classroom work.
We shadowed four second-year students in the surgery and psychiatry/neurology clerkships at Seton Healthcare Family’s teaching hospitals, where Dell Med students and residents train. What follows is a behind-the-scenes look at what students are learning in the wards — and how the experience is shaping them into the next generation of physician leaders.
Mastering Doc Speak — & Patient Translation
Aphasia. Brachycephaly. Angiograms. CT scans, MRIs and EKGs. Health care professionals speak a different language.
During clerkships, medical school students learn how to talk to other doctors — and how to translate diagnoses and treatment plans to patients and their families. For Aydin Zahedivash, a second-year Dell Med student, that’s the best part of the experience.
“It’s amazing how explaining something well can comfort someone,” he says. “Our body is ours — we know what it feels like and what’s going on. But we don’t always know how it works, and that creates anxiety. And when we have illness, that compounds it.”
After completing his morning visits with patients who have had strokes, Zahedivash returns to the neurology team room at Dell Seton Medical Center at The University of Texas, where medical residents (graduates of medical school still in training), students and attending (read: supervising) doctors gather to discuss patient cases before rounds. Part real-life case study and part lecture, the team goes through films and discusses each patient’s condition, analyzing the students’ findings. But the conversation often comes back to doctor/patient communication — and the power of optimism.
“I’m a bit of a cheerleader for patients and their families,” says Steven Warach, M.D., a professor of neurology and an attending physician at Dell Seton. “The amount of neurologic recovery after stroke or brain injury is highly variable from person to person. The most accurate prognosis we can share in the acute stage is a range of possible outcomes, from worst to best. The size and location of the damage shown by scans do not tell the whole story. People’s emotional and motivational states have effects on recovery in ways we don’t understand — some people seem to get better because of sheer force of will. It doesn’t hurt for their physician to be optimistic as well as comforting. But it can hurt if we aren’t.”
The clerkship experience is a rapid-fire exchange of information. Attendings don’t miss an opportunity for instruction — or a pop quiz.
“How much fluid do you give a patient who is profoundly septic?” asks Jayson Aydelotte, M.D., the attending on the surgical ICU service at Dell Seton. Guesses from students and residents fall short. “It takes 15 liters of fluid to give the body back what it needs,” he explains. “I know you think there’s no way it could be that much. You’ll have to see for yourself, but it’s true.”
On the floor of the surgical ICU, the team moves from patient room to patient room as a group, an impenetrable bubble of constant discussion. Woody Green, another second-year student, prepares to present his first patient. He’s been practicing and is, justifiably, a little nervous.
In a calm, clear voice, he gives an update on the woman’s condition and progress. Aydelotte listens, processes and then moves on to another question, without comment — a success for Green.
During long shifts at the hospital, students perform patient exams; observe and assist with procedures; learn diagnostic tests and complicated treatment plans; and digest interprofessional processes between doctors and nurses, social workers and pharmacists. When they leave the hospital, every free moment is spent reading about the patients they are caring for and studying for the exams that will take place during the last week of the clerkship.
Green, who worked as a paramedic before beginning medical school, says there is a lot to learn, despite his previous health care experience.
“It’s the same medicine, but it’s much more complex,” he says. “It’s been interesting to see what happens with patients after EMTs bring them to the hospital. I now know that many of the cases I saw at the beginning had a lot more going on than I realized.”
What You Bring to the Table
Medical school attracts students with many skills and experiences. Each day, the students reveal how their backgrounds will shape care teams.
During morning rounds on the vascular surgery service at Dell Seton, no one on the team speaks Spanish — except for Emily Niewiarowski, another second-year student. Standing outside a patient’s room, the lead resident describes the case. A man in his late 60s has a clot in his leg, a bad heart and a lung cancer diagnosis. He has been struggling to walk and experiencing pain in his legs, so the team will check blood flow and decide if further intervention is needed.
After performing an ultrasound on the patient’s legs to assess blood flow, Niewiarowski stands between the resident and the patient’s wife and mother. She effortlessly translates as the resident explains the situation. His cancer will need to be treated before his weak heart can be fixed. They don’t have answers for how chemotherapy treatments will proceed, or if they will be covered by Medicare. For that, they’ll need to visit the cancer clinic.
Niewiarowski fields questions and comforts the family for more than 15 minutes, reassuring them that the cancer doctor, or oncologist, will soon be in touch.
“I’m really happy that I get to use my Spanish skills in the clinical setting,” she says. “I studied it for many years, so being able to use this skill as a way of connecting with and better understanding patients has been infinitely rewarding. It’s a small act, but I hope it makes a difference for the team and the patients.”
Beth Nelson, M.D., associate dean for undergraduate medical education, says that practicing physicians are already seeing the value Dell Med students bring to the clinic.
“We’re trying to create an environment within the clerkships where students are members of the team,” says Nelson, an architect of the clerkship experience. “Because of their diverse backgrounds and unique training, our students have ideas and abilities that many other students don’t. Clinical teams are taking notice and leveraging those skills to the benefit of patients.”
Students enter the wards excited to finally begin applying their skills and knowledge to helping patients. But they soon discover the limits — of the hospital system, of their abilities and even of proven treatments.
At Dell Children’s Medical Center of Central Texas, student Cierra Grubbs interviews a young boy who recently had multiple brain tumors removed. He has since struggled with speaking and understanding speech. He’s also been hallucinating — seeing a friend from school in his room who hasn’t actually come to visit. Grubbs’ and her team’s regular check-ins assess the boy’s confusion, but treatment options are limited. It will simply take time for his brain to heal.
“The good news is that he’s getting better,” she says. “But it’s difficult. You want to do more, to see that you’re making a difference in a child’s life, but that’s not always possible in the short time you have. It will be a challenge for me, moving forward, to help patients as much as I can and then let go emotionally.”
Grubbs, who earned her undergraduate degree in psychology, is co-president of the Psychiatry Student Interest Group at Dell Med. She’s passionate about working with patients and families to destigmatize mental illness. That doesn’t mean she’s without anxiety about making the leap from the classroom to the care room.
“No med student ever feels truly prepared to enter the wards,” Grubbs says. “Everyone is always nervous when dealing with real patients.”
But it’s time. And, after a grueling first year of study, Grubbs is ready for the next step in her medical training. So she gets back to work.