Adventures as a Medical Simulation Specialist – Part 3

Here’s Part 1 & Part 2

Namaste and Happy Friday everyone!

I ended my previous post with my adventures as a medical mission volunteer in India and working in critical care research!

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Along with my research position, I also worked as a medical simulation specialist for about two years! This was pretty exciting because I was involved in:

  • medical education
  • writing patient scenarios (easy, medium or hard)
  • networking with various healthcare professionals
  • running medical simulation sessions using high-fidelity manikins
  • coordinated all the major (& minor) education events in the simulation lab

What is a medical simulator you ask?

They are high-tech manikins that have heart beats, pupils that dilate and constrict to light, eyelids that blink, imitate breathing by moving its chest up and down, speak, bleed or sweat and even have seizures! These manikins have vital signs that can be changed according to what patient scenario is to be run! You can intubate them, perform surgeries, deliver babies, perform CPR and even shock them!

Health care professionals use these manikins to practice their knowledge and skills on. Better to make mistakes and perfect skills on manikins that have a restart button!

Our sim centre had several adult manikins, baby manikins, pediatric manikins and even a BIRTHING manikin – this was pretty cool! We also had an ultrasound simulator to practice ultrasound skills & learn to read the images.

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I’m seen here with my friend who was the medical simulation specialist before I joined. She matched into family medicine residency and is a practicing doc now! 🙂

I would control these manikins from behind a one-way mirror using a laptop that was wirelessly connected to the manikin! So I would be able to see the participants but they would not see me and what I will do next. I also had a mic that would allow me to pretend to be the patient and answer relevant questions – it was a lot of fun 🙂 I can make the scenario as hard as I want it to be or go easy on them 🙂

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Most memorable days?

I LOVED coordinating and running education days! Queens University family medicine was affiliated with our hospital, so a major chunk of their education session was in our sim lab. Emergency department would hold ED education days in the sim lab. Pediatric Advanced Life Support courses (PALS). Advanced Cardiac Life Support courses (ACLS)…and the list goes on.

Here are some pictures from a few education days: https://www.lakeridgehealth.on.ca/en/trainingandresearch/Events.asp

These education days consisted of planning and coordination that starts MONTHS in advance. I, the education department head and all the team members would have frequent meetings discussing:

  • what scenarios we were going to run (and work on those scenarios)
  • what skills stations are we running
  • what props/simulators are needed
  • if there was not a prop or simulator already in the sim lab that could meet the expectation of the educator, I would have to create one! I’ve made some pretty cool ones – pericardiocentesis models, chest tube insertion models, central line insertion models etc.
  • I would ensure all the rooms are booked, all equipment is ready to go, all people have been informed etc.

ON the day of – I would show up extra early make sure everything is PERFECT, and so far all of our education days have run pretty smoothly, if I can say so myself 🙂 There have been a couple of glitches with our simulators of course…can not expect technology to be perfect…but after some thinking it would be up and working again.

The adrenaline rush I would have at the beginning of the day…and by the end of the day when I see everyone’s smiling faces, knowing they had a wonderful experience I know I did my job well 🙂

After about two years though, I loved what I was doing but I was getting too comfortable. My GOAL was to match into a residency program and I needed to get back to clinical medicine. The knowledge and experience from clinical research & medical simulation education traveled with me as I left Ontario and moved to British Columbia!

It was 7 months ago, I took a deep breath, prayed I was making the right decision, booked a one-way ticket and left my family and friends in Toronto, my Hubby in Pittsburgh…and it was hello Vancouver! 

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Till next time! 🙂 Hope you enjoyed this post!

 

 

Friday randoms

Namaste & Welcome to my Friday randoms…. ❤

  • It’s about 10:30 pm for me here in Vancouver and I am missing Hubby. He is fast asleep in Pittsburgh as it is 1:30 am for him. I am bored.

 

  • I look forward to starting up my new position as a clinical research assistant on a University-affiliated women’s health study that we’ll be running out of the family medicine clinic. I will be using an ultrasound-type probe to detect any lumps, masses, cysts in a subject’s breast(s) etc. The hope/purpose of this project is to test whether this ultrasound device can help detect and diagnose breast cancer easier and be less invasive than other methods. -> http://www.cbc.ca/news/canada/british-columbia/sfu-breast-cancer-detection-1.4059666

 

  • I’ve been really into smoothies these days. It’s fresh berry & fruit season in B.C.! There are several generous patients who drop by and show their thanks to the physicians in our clinic by dropping off crates of blueberries, cherries, peaches, strawberries, and nectarines! I don’t hesitate to help myself to some before I leave the office. Nom nom 😀

If world leaders could take some time to chill out and share a smoothie together, I  believe it would solve a lot of problems!

 

  • This video —>

 

  • I am looking for a professional looking vegan/pleather bag to take to the office that will fit my stethoscope, notebook, cell, wallet, lunch etc. I find them to be expensive though. Here are some that I liked, easy to sanitize and wipe outside.

Matt & Natt, Nicora

–> http://corporette.com/stylish-vegan-professional/

–> https://unicorngoods.com/collections/vegan-briefcases-and-professional-bags-for-women

 

  •  I love this –> 19510099_1077414549026499_8943403872213451791_n

 

Peace, love and happiness everyone. Have a wonderful weekend! Grab yourself a smoothie 🙂 ❤

 

 

 

Three-ingredient frozen chocolate dessert!

I didn’t think that this frozen concoction of mine would be so popular! 🙂 So here is a short and to the point post on how to make this frozen chocolate dessert!

  1. Ingredients:
  • 1 cup dairy-free chocolate chips
  • 1/4 cup almond milk
  • 1/3 cup shredded coconut OR chopped peanuts OR hey, why not both 🙂

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2) In a bowl -> chocolate chips and the almond milk

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3) Zap this in the microwave for 1 minute, stir in between. Take out of microwave and throw in the mix-ins (coconut, peanuts or both!). Stir! Resist the urge to eat the whole bowl of ooey gooey yumminess 🙂

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Ummm where was I? Oh yea…..

4) Use two spoons to make little blobs on a tray lined with foil. Freeze for 30 to 45 mins and you can devour! 🙂

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Here is my pic from the frozen chocolate peanut bark. I flattened it and then froze it —>

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You’re welcome 🙂

 

Sweet & Sour Okra curry

Happy Friday everyone!

It has been quite a light week for me as my attending physician is on vacation! I had time to cook, do some painting, update my blog several times, Instagram, go to the gym, watch lots of movies etc. I should also be studying shouldn’t I? 😛

I just finished watching the movie Arrival! I LOVED it! I am into extraterrestrial, SciFi type movies anyway but this blew my mind. It had a very bitter sweet ending and got me teary-eyed.

I also started watching How I Met Your Mother, how have I not watched this until now?? It is hilarious, although Ted’s character annoys me a bit with his dating problems. 😛

Tonight on the menu for dinner is veggie burgers made from kidney beans and a whole bunch of other veggies I have in the fridge (onion, spinach, sweet and hot peppers etc.) I get bored with my meals easily so I try to keep my meals colourful, tasty and different without eating out several times a week. Here are some pics of some of my meals & snacks over the past week or so…

 

This okra dish is also made at home by Mom dearest. I love the sweet and sour aspect of this dish. Usually made in Kerala and Tamil Nadu (South India) by many vegetarian families! No onion or garlic and very little oil!

Sweet & Sour Okra Curry (vegan, no onion, no garlic)

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Ingredients (ignore the lemon juice in the pic)

  • 1 frozen okra bag
  • 3-4 tablespoons shredded coconut
  • 1 tomato chopped small
  • 2 thai green chilli (more if you want it more spicy)
  • 1 tablespoon tamarind paste (I had seeds in mine)
  • 1-2 tablespoons jaggery or sugar
  • salt to taste
  • 0.5 teaspoon mustard seeds
  • 0.5 teaspoon jeera/cumin seeds
  • o.25 teaspoon turmeric powder
  • 1 tablespoon olive or vegetable oil
  • 2-3 cups water

Soak tamarind in 2-3 cups warm water for about 5-10 mins. You are going to use this tamarind water as the “sour” part of the gravy. Take out any of the seeds from the tamarind paste and throw seeds away.

Put the tamarind water into a pot turn stove on medium-high. Mix in the frozen okra, jaggery/sugar, turmeric and some salt. Let it boil.

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While it is boiling, grind the coconut and green chillis with some water. Add this to the pot. Cut tomato and add to the pot. Continue boiling for a couple more minutes. Taste the mixture and see whether it is the right amount of sweet, salty and spicy. If it’s too sour, add some salt, that should help. If it’s not sweet enough add some more jaggery/sugar. If it’s too thick add some more water.

After you have turned off the stove. Heat the oil in a separate pot, add the mustard seeds. These will pop, once they are done dancing around, add the jeera to the same pot. Jeera is ready when it’s a brown and releases a pleasant aroma. Don’t let it burn as it will be bitter.

Carefully add this to the okra curry as it will splutter.

Enjoy with rice or roti!!

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Simple curry to make! Enjoy!!

 

Medical mission volunteer & critical care research experience – Part 2

I backtrack a little bit before I continue from my Part 1: previous post….

Before I joined the research position in 2013, in December 2012 I went to India to volunteer my time with Amar Seva Sangam. The organization is located in Tamil Nadu, India and provides food, housing, education, physiotherapy and medical care to children and adults with disabilities. I was extremely happy to be involved on so many levels! I volunteered my time for several months teaching English, math, learning various methods of physiotherapy and also assisting the physician in providing medical care to the children, adults, and families from nearby villages!

In addition to this, I met some occupational therapy students from Quebec and we became extremely good friends! To this date, we continue to keep in touch! One of them even came to India to attend my wedding! ❤

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Gotta have coconut water when in the South!

All the kids seen above are probably all grown up now! It was an unforgettable experience that touched me so deeply. Once I am an independently practicing physician, I will go to India for a few months every year and volunteer my time serving under privileged communities.

Fast forward to Sept 2013….continuing from Part 1: previous post….

I traveled 170 km total to volunteer at the allergy clinic 5 days a week. This went on for several months and I was starting to become physically and financially drained. I came back after work and spent hours looking for research positions closer to my home. I sent out another hundred or so emails and finally…FINALLY, in March 2014 I received an unexpected response from the head of research at a hospital about a ten-minute drive away from home!

I met with the head of critical care Dr.W who told me that he was looking for a clinical research coordinator for his sepsis study as his previous study coordinator matched into family medicine at the University of British Columbia. In addition to this, Dr. W took me on a tour of the medical simulation lab in the hospital and asked me whether I was interested in volunteering as a medical simulation specialist! At this point, my eyeballs almost popped out of my head and I said YES! I had never worked with simulators before and it excited me!

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Let’s talk about the research study. It was called EUPHRATES: Evaluating the Use of Polymyxin B Hemoperfusion in a Randomized controlled trial of Adults Treated for Endotoxemia and Septic Shock. To explain it simply,  first, we found adult patients who were septic. (Septic patients are those who have an infection that had spread through their blood to the whole body to shut down major organs like the kidney, heart, brain etc.) If the infection was severe and the doctors were unable to control it with their initial ways of handling it (fluids, antibiotics, pressors to increase BP etc.) this study was an option. We were researching whether the antibiotic Polymyxin B would help these very sick patients.

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I would be in charge of roaming the CrCU floor, communicating with the critical care doctors and nurses to find and enroll severely septic patients into the research study. It was difficult because:

1) very few patients got that sick because the staff were so well trained at managing septic patients, so they got better even before I got to review their chart for the study

2) if I did find a patient they would have to fit into some pretty strict inclusion and exclusion criteria to be a part of the study

3) If they met ALL criteria then I would have an OMG moment and then a holy SH*T moment because now the clock starts ticking. I get 28 hours from the time they started their vasopressors to the first dose of antibiotic (abx)….so all of the following had to be done within this span of time! I had to review the pt’s information, calculate their MODS (multiple organ dysfunction syndrome) score, inform my PI (Dr. W) and give a heads up to the nephrologists (you will see why in point 4), track down the patient’s family members (because the patient is usually intubated and sedated because they are really sick), explain the study to the family,  they need time to think about it, read like a 50-page consent, get their signatures, draw the patient’s blood, test it myself in the lab for the level of endotoxin in their blood….if it was high enough then another holy SH*T moment happens because that means the patient can actually start receiving the abx.

4) I won’t go into too much of the nitty gritty details but the antibiotic is not an abx that we give by iv. I would need nephrologists for this because the abx is a cartridge that we stick into the dialysis machine. So a line has to be started on the patient to receive the abx via the dialysis machine…

Oh goodness gracious. It was difficult enrolling a patient for various reasons….I have to find the patient in time, the patient could have been admitted in the middle of the night and already started their vasopressors so many hours could have passed by, the family does not agree to the study because it sounded too dangerous, the endotoxin level in the blood was not high enough…and the list goes on 🙂

It definitely made my adrenaline pump on many occasions, but it FELT GOOD to be around physicians, nurses, critical care, in a hospital working on a really cool study!

I just didn’t like the amount of paper work that came with being a clinical research coordinator 😉

Will continue with part 3 next…

If you are interested in volunteering with Amar Seva Sangam: https://www.amarseva.org/get-involved/volunteer

Upcoming Residency Match Season and my new-found confidence – Part 1

Happy Monday folks!

Medical School Graduation with my Family!
Medical School Graduation with my Family! I had no clue what I was going to face in the next few years….

It’s been a while since I posted anything medicine related. So I thought I would write a bit about my journey right after graduation and how I feel now about residency applications this upcoming match season. A word of warning, Part 1 is a little depressing but it works its way up to a more positive Part 2. 🙂

Try, try and try again until you succeed!

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I have attempted matching into residency for several years now since medical school graduation. In addition to the thousands of dollars we pay for medical school and medical exams, we also invest thousands of dollars towards applications to CaRMS (Canadian residency program service) and ERAS (US residency program service).

I will clarify what MATCH is. We graduate from medical school and then we need to be formally trained in a specialty (i.e. family medicine/pediatrics/internal medicine/obstetrics gynecology/psychiatry/surgery etc.). The formal training can be two – ten years (depending on the specialty and whether you want to further sub-specialize). After the training (and more exams), we can practice independently. The Match process takes place when we send out our applications (much like a job application) and programs call us for interviews. If we like them and they like us – it is a match! The problem is, there are many more applicants than there are residency positions. So many of us go unmatched with no spot to start our training. Oh, those rejection emails.

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Every year I looked at my application and thought, what did I lack this year? What could I do better next time? There obviously must have been something because I did not match after attending interviews! (Funny video below 😉 Enjoy!)

  • USMLE Step 1, 2, 3 ✔
  • Canadian MCCEE, NAC-OSCE ✔
  • Rotations and a SubI in FM in the United States ✔
  • Volunteer positions ✔
  • Observerships after graduation ✔
  • Letters of recommendation (LORS) ✔
  • CV and personal statement ✔
  • Professional interview preparation sessions ✔
  • bloody TOEFL exam to prove that I knew how to speak, read and write English because I attended medical school abroad (grrrrr) ✔

My scores and rotations performance cannot change. Year after year, what CAN change? Observerships/traineeships, LORs, CV, personal statement, interview prep….what else? What made me unique, what sets me apart from other applicants?  

You are You
Umm yea, that was not enough.

After graduation when I didn’t match, I grew depressed. I do not use this word lightly. I did not want to get out of bed. I would break into tears very randomly. I would go to the temple and sit in a corner and cry, asking God why am I in this position? I did not socialize and avoided all get-togethers for the fear of being asked by some Uncle and Aunty “so what are you doing with your life now? You’ve graduated from medicine and you still don’t have a job?” Did they not realize how these words were kicking my (already very little) confidence into a black hole. 

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Then, more dangerous (irrational) thoughts – what a disappointment I am to my family. My family must think they wasted so much money on my education. I don’t deserve to have loving family and friends around me. I should quit medicine and find a job at Tim Hortons or McDonald’s to help pay the bills – but what experience do I have to work there?? Would they even hire me?

With the help of my family and friends….one day I had enough of my moping. I felt physically sick by my thoughts. I spent hours in front of the laptop and on the phone, sending out many many emails and made many phone calls to residency programs, research programs, Professors, hospitals, YOU NAME IT. I needed to get out of this rut. I was faced with many emails that turned me down or well, no replies whatsoever. They could probably hear my lack of confidence over the phone and read it in my emails.

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Then in August 2013, a friend pulled some strings to find me a volunteer research job at an allergy clinic. I took it! I drove 85 km in the morning to work and 85 km back home, five days a week, unpaid just so that I can keep in touch with medicine, socialize with medical people, do something fun and interesting with my life. This got the ball rolling. I used this job experience to help me find the next one that was much closer to home and so much cooler. It was in a wonderful hospital where I held two positions.

More on the next post as a Critical Care Research Coordinator and Medical Simulation Specialist!

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Molagootal – Chayote squash gravy

Happy Saturday everyone!

When my Mom makes this at home, I devour it! It is a simple delicious (vegan, no onion, no garlic) gravy made by many vegetarian families from Kerala, India. It is usually made with freshly grated coconut but I used coconut milk instead. It may also be made with ghee for garnish but I used vegetable oil so it is totally vegan! This molagootal can be eaten with rice or roti!

The main vegetable in this dish is chayote squash. I found 6 of these for a $1 in Walmart’s discounted food section. Use a pressure cooker and these get cooked very quickly!

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Excuse the mismatched plates, bowls, and other items 🙂 I still live like a college student!

Molagootal – Chayote squash gravy (vegan, no onion or garlic)

Ingredients

  • 3 chayote squash, peel, take out seed, cut into small cubes
  • 1 cup yellow daal/moong daal
  • 1 cup coconut milk (1.5 cups will make this more creamy)
  • 1 tablespoon jeera/cumin seeds
  • 2 small thai green chilli (red chilli can be used as well)
  • 1/4 teaspoon turmeric powder
  • salt to taste
  • 1 tablespoon vegetable oil (for garnish)
  • 1/2 teaspoon mustard seeds (garnish)
  • 1/2 teaspoon urad dal (garnish)
  • water as needed

Use the pressure cooker to cook the chayote squash and daal together. I usually turn the stove off after three whistles. Leave it closed until you have prepared everything else.

Grind the coconut milk, jeera, thai green chilli and 1/4 teaspoon of salt. Make sure it is ground well.

Open the pressure cooker and drain the excess water from squash and daal. Add turmeric and ground coconut milk/jeera/chilli to the squash and daal. If the gravy looks too thick at this point, add some water. Add more salt if needed. Simmer on medium heat for a few minutes and turn off.

The garnish will require you to heat up the vegetable oil in a separate pot. When this is hot add the mustard seeds, these will sputter and jump around. Next, after the mustard seeds have sputtered add the urad daal to the mustard seeds. Make sure to stir so the urad daal does not burn, it should be a light brown colour. Add this to the gravy and you are done! The garnish adds a bit of crunch! ❤

Hope you love this as much as I do… 🙂