Interview: Dr. Charles Putnam, M.D.-Ph.D, University of Arizona

There are many pre-med students that engage in research during their undergraduate careers. Some even go on to continue research in medical school, and a few even get a Ph.D. after or during medical school. I have found that there are many students interested in a dual degree, M.D.-Ph.D option. Because of this, I recently decided to interview a M.D.-Ph.D., Dr. Charles Putnam, to get some perspective. He is a former surgeon and is currently a molecular and cellular biology lecturer and researcher at the University of Arizona.

• Why M.D.?
  

Dr. Putnam's interest in medicine originated from an interest in biology. During his undergraduate career, he was torn between medicine and graduate school. He worked in a surgical research lab, and therefore, got close contact with many physicians. It was from this experience that he realized he could continue research as a doctor.

• Why Ph.D.?
  

Dr. Putnam cites the fact that there is a big difference in the methodology of medicine and research education. Medicine is evidence based (step by step). In medicine, one must learn the "ABC's" of diagnosing a patient. With research and graduate education, one must take an unconventional approach, and not react in a stereotypical fashion to reach the answer. This is what Dr. Putnam liked about the Ph.D.

• Pros and cons of an M.D.
  

Pros

First, the satisfaction of dealing with people and challenging problems was a pro for Dr. Putnam. Also, the fact that medicine is a constantly evolving field is a big up. Dr. Putnam gives an example of this with orthopedics and the invention of artificial joints, along with miniature cameras.

Cons

The intrusion of outside agencies like lawyers and insurance companies is down to medicine. Also, the resistance to long hours has diminished the relationship between doctors and patients.

• Pros and cons of a Ph.D.
  

Pros

The excitement of science and discovery and finding novel ways around a problem were two ups for Dr. Putnam.

Cons

For Dr. Putnam, the uncertainty of making a discovery and gaining funding were the biggest cons for being a researcher.

• What will be the biggest issue or breakthrough in medicine in the next ten or more years?
  

Dr. Putnam believes that the biggest breakthrough in the future will be practicing medicine on a genomic basis. He also believes that the method of drug discovery will change as it will be based more on basic science, and a specific target in the body, than on fortuitous discoveries.

• Advice for pre-med students
  

His biggest advice is to not get overly consumed and absorbed with just getting in, but to look beyond entry into medical school. This can obviously be difficult at times; but thinking ahead gives someone the ability to not only have a plan but also make sure that medicine is the right field for oneself.

• Do you recommend a multidisciplinary approach for all students?
  

The main thing Dr. Putnam tried to get across to me was that, at a practical level, it makes sense to get experience in many fields. The big example he gives is the field of bioinformatics. Getting a degree in computer science, for example, would clearly be beneficial for anyone who wanted to get involved in bioinformatics. Trying other fields like law and public health could always lead to something special so he says trying something different never hurts.

An SMDEP Experience

I would like to introduce a new contributer to PreM.D. Heang Chi. This summer he participated in the AAMC's Summer Medical and Dental Education Program. He approached me about sharing his experience and I thought it was a terrific idea. His experience can be read below...

Hello, let me first introduce myself as Heang Chi. I am a sophomore at Pima Community College. I expect to transfer into the University of Arizona system by Spring or Fall 2007. My current major is Molecular and Cellular Biology.

This past summer I had the opportunity to attend the Summer Medical and Dental Education Program (SMDEP) at Case Western Reserve University (CWRU). Many past students may recognize the program as the Minority Medical Education Program (MMEP) or the Summer Medical Education Program (SMEP). This is the first year the program will implement both educational and clinical experiences in dentistry at their sites. According to the AAMC, “SMDEP is a free (full tuition, housing, and meals) six-week summer medical and dental school preparatory program that offers eligible students intensive and personalized medical and dental school preparation.”

Here is an outline of my experiences in the program:

• Spotlights
  

• Presentations made by guest speakers who specialize in medicine, dentistry, admissions, and study/learning techniques.

• There were at least two spotlights presented each week. The dean of admissions from the medical and the dental school spoke to us on what they expect and look for in applications.

• Presentations

• There were several presentations provided to introduce the schools and hospitals located in Cleveland. They also highlighted the application process and what you should focus on.

• One presentation I found interesting was a two day presentation provided by Dr. Hy Doyle, who teaches learning strategies at UCLA and visits a few SMDEP programs throughout the summer. Dr. Doyle helped us identify what our weaknesses and strengths in the test-taking process. Along with this presentations he highlighted some great note-taking techniques and study habits that some of should focus on.

• Clinical Experiences

• One of my favorite clinical experiences was the Den Sum Simulator. It uses some of the latest technologies in dentistry and it is helpful for first year students before practicing on real patients. The simulator works as a teaching aid where you can program what kind of case you are working on. The sensors in the mannequin detect if you performing it correctly. It is also used for exams. I had the opportunity to perform two fillings. After working at a dental office for a few months, I thought I knew what I was doing, but I had a horrible score on my first attempt! My second attempt was a little better, a score of 72.

• If you plan on attending programs like this, I strongly recommend that you make friends with the person in charge of assigning surgeries and also be able to negotiate your own surgeries around the program with fellow classmates or find surgeons on your free time. Clinical experiences are given out randomly. I was able to get more than 8 opportunities.

• Introduction to the medical and dental programs at CWRU

• Included a brief introduction to their new degree program, M.D/D.M.D, which allows students to receive both a medical and dental education in a very intense and competitive program. This is something I was very interested in.

• Admissions Interview

• I was fortunate to get both a medical and dental admissions interview. You attend it like an actual interview. The whole interview process was great. Each interviewer gave me both positive and negative feedback that has been really helpful. They have your transcripts and application so they can point out what your weak points are.
  

• Classes

• Four days a week from 8:00 am to 12:00 pm by CWRU professors. Each class was an hour long and there were four different sections: Math, Biology, Chemistry, Physics. The four sections were also divided into sub-categories of those classes. You could either choose classes to prepare for upcoming classes or review for a class you really didn’t understand.

• Math: Pre-Calculus, Calculus, Concepts beyond Calculus.
• Biology: Only one class, but covered many topics. These topics included: DNA and Replication, RNA Transcription, Gene Regulation, Protein Translation, Metabolism, Virology, Pharmacology, and Public Health.
• Chemistry: Chemistry, Organic Chemistry, and Neuroscience.
• Physics: No option. All students present.

The program was one of the best experiences I have ever had. A few weeks before the program began we were sent a book that we had to be read before arriving, and once we arrived we were given another novel to read in a few weeks. The novels were used in a reading group discussions. The program director loves to read, and believes that reading at least an hour a day will increase your MCAT score. There was an optional course available to half of the students to help with writing their personal statement for admissions. In addition to the classes, we were also required to work in groups and develop a public policy. Presentations were made the last week. Yes, the workload did seem like too much at times, but overall I would say it was worth it. I had tons of fun.

Feel free to contact me with any questions about the program or applying to it.

Heang Chi

kinggasdelimart@yahoo.com

The Teleshrink Has Arrived

Earlier, I had posted on a CNET article about telemedicine and its breakthroughs in England. Over here in America, telemedicine has begun to slowly spread, especially in rural areas. The New York Times has recently highlighted one of American telemedicine’s shining stars, psychiatry. Psychiatry is one medical field that can very easily be done from a distance because of the lack of physical contact needed to administer treatment. According to the Times, the need for telepsychiatry in rural communities is immense. For example, one doctor, Sara Gibson, works in a county where psychiatrists are scarce, but badly needed.

Her territory is Apache County, which is about the size of Massachusetts and Connecticut combined, but which lacks even a single psychiatrist on the ground for its 69,000 residents despite widespread problems of poverty, drug use, child abuse and a suicide rate that is twice the national average.

The article also noted that, in some ways, the act of receiving psychiatric care from a distance was beneficial and preferred by some patients.

Dr. Gibson said the lack of smelling and touching, at least when it comes to psychiatry, has proved to be a good thing. Being physically in the presence of another human being, she said, can be overwhelming, with an avalanche of sensory data that can distract patient and doctor alike without either being aware of it.

"Initially we all said, 'Well, of course it would be better to be there in person,' " she said. "But some people with trauma, or who have been abused, are actually more comfortable. I'm less intimidating at a distance."

I myself have seen a telemedical facility at the University of Arizona’s Medical Center. It was pointed out to me that while doing psychiatric sessions there, video that was slightly fuzzy was preferred by patients over crystal clear video. For some patients, being at a distance from the doctor must create comfort and safety. Perhaps the fuzzy video adds to this distant effect.

The impact on future medical students, especially those that are interested in psychiatry, is enormous. More future doctors, like Dr. Gibson in the article, could practice solely through telemedicine. This could create a boom in care given to underserved areas, and rural areas. It is now up to medical schools to provide opportunities for students to get hands on telemedicine experience. The technology is here; it is now up to us to embrace it.

TV Screen, Not Couch, Is Required for This Session [NY Times]

Book Review: Organic Chemistry as a Second Language: Translating the Basic Concepts

To supplement the guide I have provided below, I am also doing a book review on an organic chemistry book I found a while back. If you find yourself still in a jam after using the study guide’s tips below, then this book might help you reinforce some key concepts.

The book, titled Organic Chemistry as a Second Language: Translating the Basic Concepts, is by Dr. David R. Klein of Johns Hopkins University. Who I am assuming is an organic chemistry professor. It starts of very slowly with a simple how to study guide that is similar, but not as in-depth, as the one I posted earlier. The rest of the book deals with learning key concepts in organic chemistry. The first chapter is a simple one on just bond-line drawing. There are several practice problems scattered throughout the entire chapter and solutions to them in the back of the book. The book then goes into some arrow pushing and resonance. It continues with everything from orbitals and chair structures to elimination and substitution reactions. There is also a fabulous section that offers tips to better master the drawing of mechanisms, something I find people have trouble with. In chapter eight, there is something that I think is really outstanding, a template for writing down reactions. It is essentially a sheet that allows you to write down the name of the reaction, what type it is, the stereochemistry, and the regiochemistry. Below these categories is room to fill in the mechanism of the reaction and some examples. It looks like an excellent way to organize your studying of reactions. And, it will make you do something that really aids the learning process, writing the reactions. Finally, the last section deals with tips for synthesis problems which are something else that people seem to have trouble with in organic. I can guarantee that you will see them first semester and throughout second semester because they are, more than anything, the true test of your organic knowledge.

I must note that just looking at this book will not give you an “A” in organic chemistry. The author even points this out:

This book cannot replace your textbook, your lectures, or other forms of studying. This book is not the Cliff Notes to Organic Chemistry. It focuses on the basic concepts that will empower you to do well if you go to the lectures and study in addition to using this book.

The problems you see in class will be of a higher difficulty, but this book will reinforce the basics. Also, this book will help for first semester organic, but does not deal with the majority of second semester topics. This is probably due to the fact that most of the concepts seen in first semester come back for the second, just more complicated. If you can master these fundamentals, you can do fine second semester, when the real chemistry begins.

Overall, the book is first-rate. I feel it roughly follows the order in which you will cover topics in class, and is a good compliment to the book you will have for class. There is something in it that everyone can use, from the reaction sheets to the boat loads of practice problems. If you happen to find yourself drowning, scoop up this book to help you get back on track.

Grade: A

Organic Chemistry as a Second Language: Translating the Basic Concepts

Organic Chemistry Tips

I’m sure that many of you, this summer or in the fall, will be taking one of the most dreaded required classes for medical school, organic chemistry. No doubt, it is a rough class, but that does not mean that someone cannot do extremely well in it. In fact, plenty of people do every year. The key, in my opinion, is recognizing how to study. This class will teach you how to study for harder classes that you will take later in life, including in medical school. It requires time, patience, and diligence. More importantly, the class will test your ability to apply constructive effort. What I mean by this is that you have to put in the effort, but in the correct manner. Otherwise, you’ll study for hours and get absolutely no where. Thankfully, I have been able to get a terrific former organic professor of mine, Dr. David Spurgeon from the University of Arizona, to supply me with a study guide. It is a wonderful guide that hits on all the points I made above and more. If you follow this guide, and put in the correct effort, you will conquer organic.

Here is the link to the guide: Study Guide

Feel free to print it out or save it to refer back to.

Thanks again to Dr. Spurgeon for this generous contribution.

Art is Good for Doctors? No way

The New York Times has done an interesting article related to the humanities and doctors. Apparently, many medical schools are adding, or are thinking of adding, a humanities component to their curriculum. This is because it has been shown that exposure to the humanities makes better doctors. The article gives the example of how an AMA study found that looking at paintings or sculptures improves observational skills. The art instructor at Mount Sinai School of Medicine, Rebecca Hirschwerk, also believes that art can give a doctor something special.

I can't think of many places outside art where you can be in a moment, and just look, for as long as you can take it. Think about what it would be like if you were with a patient and could freeze the moment to really pay attention to everything that patient was trying to tell you. It's hard to do when you have only 15 minutes with patients, 20 times a day.

I think that in addition to the actual “skills” one can obtain from the humanities, they simply make someone a better person. The entire objective of the humanities is to make a person more humane. That is certainly a quality every patient wants in their doctor. Plus, if your entire life is just science 24 hours a day, it must be pretty dull, even if you are a doctor or pre-med student.

One of the medical students at Sinai, Komal Kapoor-Katari, summed it up best:

It sort of reminds me of life before medical school, back when you were still a regular person.

Remembering to be a “regular person” is what, I think, makes the best doctor sometimes.

At Some Medical Schools, Humanities Join the Curriculum
[NY Times]

Writers Wanted

The blog has now reached the stage where it would be nice if other writers could contribute. It is a nice way to have an influence on the pre-medical community around you. People can contribute as much or as little as they would like. If you are interested, leave your email in the comments section and I will contact you.

Positive Visualization Strategies for MCAT Preparation

This article comes from my very own pre-med advisor, Nancy Stiller, at the University of Arizona. The MCAT is coming up in just a few days and I think this is something everyone should read. With all the studying that pre-med students do, it is easy to forget that is takes more than knowledge of facts to do well. The visualization strategies in this article are really terrific, and will help to supplement all the ridiculous amounts of studying everyone has been doing. Thanks Nancy!

Positive Visualization Strategies for MCAT Preparation

By:
Nancy J. Stiller, Ph.D
Assistant Director, University College and Coordinator,
Pre-Health Professions Advising Center
The University of Arizona

The MCAT is fast approaching. During these past months, you spent long hours reviewing processes, pathways, and principles. You took practice tests and unlocked some of the mystery surrounding test question design. You are prepared for the intellectual challenge, but are you prepared for the mental challenge? “Positive visualization” can help you answer in the affirmative. Here’s the story about how I learned about this strategy.

I started my career in the 1970’s as a high school teacher and girls’ basketball coach in Massachusetts. There were some terrific athletes on my teams and we were lucky enough to win two consecutive New England Prep School Basketball tournaments. Some players went on to play college basketball while I became very interested in the psychology behind the success. I learned about a process called, “positive visualization” and wondered if it could help my players with their one weakness -- free throw shooting. Although those players were regional champions, they weren’t very good free throw shooters. During practices, I assessed shooting technique, made corrections, and tried to simulate a “game-like” atmosphere so they could learn to shoot under pressure, but nothing worked. Our foul shooting statistics remained unimpressive and I feared that, someday, because of this weakness, we would be on the losing end of a close game.

One afternoon, I was helping a player work on her foul shooting technique. She stood at the foul line, bounced the ball three times, took a deep breath, and mumbled, “I’m a lousy free throw shooter.” A light bulb went off in my head and I realized that her shooting technique was fine, but she, quite simply, was carrying out her “self fulfilling prophesy.” I called the team to the sideline and gave them “homework.” Every night, before nodding off to sleep, they were to spend five minutes visualizing themselves at the foul line. They were to think about and visualize themselves in uniform with people cheering in the stands. The game is tied with no time remaining and they are at the line. As I said these words, they collectively groaned and someone said, “… no time remaining!” “That’s the problem,” I said. “You tell yourself that you can’t do it. Your thoughts are negative. I want you to replace that negative thinking with positive self-talk.” Their puzzled looks told me that they were wondering whether or not the stress was getting to me, but I asked them to try it. The next day, I began practice with another team meeting. I asked them if they had done the “homework.” Many had dutifully complied with my request, but they were clearly not convinced of visualization’s benefits. The foul shooting part of practice seemed to go a little better, that day, and … yes … our foul shooting percentage in games began to rise. They all became believers!

My own career interests turned in the direction of counseling and advising college students and, in the years to come, I continued to use visualization strategies to help students deal with challenges such as final exams and standardized tests. So, give visualization a try. Here are some steps to take:

• Get in a comfortable place such as your couch, a favorite chair, or bed.

• Close your eyes and take some deep breaths. Concentrate on your breathing until you feel relaxed.

• Now, create a picture in your mind. It’s the morning of the MCAT. You wake up before your alarm goes off. Picture yourself in your usual morning routine … what do you decide to wear? What game-day meal will you eat? You look in the mirror and tell yourself that you have prepared well for this day. You tell yourself that you’re ready. Picture yourself arriving at the test site. You find your seat and follow the test administrator’s directions. You take a deep breath and tell yourself that you will read each question carefully. You will successfully use the strategies you learned in your preparation.Wait!You hit a snag … a tricky question. You close your eyes for a second, take a breath, and recall the positive visualization you created every evening during the time leading up to the test. You open your eyes and tackle the problem. You feel confident.

• Repeat this positive visualization, each evening.

Mental preparation is important. Positive visualization will not remove all of the stress of taking the MCAT, but it will help you relax and do your best. You can do it!

Computerized MCAT

If you haven’t already heard, the MCAT is switching to a computerized form in 2007. The August 2006 administration of the MCAT will be the last opportunity to take the MCAT the old school way (paper and pencil). Most of the other graduate school tests like the DAT and the GRE switched to a computerized format a long time ago.

There will undoubtedly be pluses and minuses to taking the new format. I think the biggest disadvantage is that most preparatory programs will not be equipped to prepare students on the new format. Programs like Kaplan and Princeton Review have thoroughly figured out how to master the paper form, but it will take time to figure out the proper strategies for the computer form. Also, how would Kaplan administer a practice test? By arranging a room with 100 computers with the exact same setup and specifications of the real MCAT? I would imagine it would also be harder to take the test on the computer because reading from a computer screen for an extremely long time can hinder concentration.

There are also plenty of pluses to the new MCAT form. The biggest advantage is that it is shorter. The test day will be shorter because if you finish a section early you can move forward in the test instead of waiting for the entire time allotted to the section. Also, the actual test is shorter, too. This is really great because many people have a great difficulty keeping stamina for an eight hour test day. The test will also be offered 22 times a year compared to the twice a year scheme (August and April) currently offered. Now, if you’ve got a big research paper due the same week of the MCAT you can just take it at later date instead of having to wait an enormous amount of time. Finally, the new MCAT will not implement CAT. CAT, short for computer adaptive testing, increases question difficulty based on real time performance in the test. The MCAT will not be doing that. I’m sure this will be a relief to all the pre-med students out there. You can read more about the new MCAT at the link below.

Computerized MCAT Frequently Asked Questions [AAMC]

Tips For Metabolic Biochemistry

I promised when I started this blog, that I would post tips from professors on how to do well in common pre-medical classes. The first set of tips is for metabolic biochemistry. Although it is not a prerequisite for medical school, an upper level biochemistry course is highly recommended for all pre-medical students by most schools. Dr. Canfield, of the Department of Biochemistry at the University of Arizona, has provided me with the following “information sorter” to be used when studying a metabolic pathway. She has told me how well it worked for so many students in the past. I can also attest to that because I myself have used the “information sorter.” It helped me quite a bit. This is a modification of an earlier version by Dr. Marc Tischler, also a professor in the Department of Biochemistry at the University of Arizona.

Information Sorter for Metabolic Pathways

1. Purpose of the pathway.
2. How the pathway connects to other pathways.
3. How (conditions) the pathway is stimulated or inhibited.
4. Names of molecules entering and leaving the pathway.
5. Identify the control points – (regulatory steps)
6. Identify regulatory molecules and the direction in which they push the pathway.
7. Names of reactants and products for each regulated enzyme and each enzyme making or using ATP equivalents (e.g., NADH, GTP, FADH2).
8. Essential vitamins and cofactors involved in the pathway
9. Specific molecules that inhibit or activate specific enzymes.
10. Consequences of enzyme defects discussed during lecture.