Editor's Note: The second quarter of Penicillin For Your Thoughts continues to explore the transition from pre-med to medical student to practicing doctor, not only in terms of schooling and physical obstacles, but also how ones identity and relationship with their passion is constantly being redefined.

The third and fourth years of medical school are not some Greys Anatomy prequel, the race to residency. Yes, you have dramatic things like surgery, impressing attendings, and 24-hour shifts, but this time, there are real people going through it. For those who have never spoken to medical students (me before sophomore year), you cant help that fiction dictates your reality, and thats okay. Just listen up.

Third and fourth years move the student out of the classroom into clinical rotations through the various specialties. The School of Medicine holds clerkship rotations in all five WWAMI states, sending its students all around the region to study under professionals. Sometimes, youre the only one in your rural Idaho town, stripped of the support of school.

Third year was jarring, and youre not really prepared for it until you do it, fourth-year student Liz Reed said. When your time is limited, you have to figure out how to soak up all that knowledge when you dont get the chance to see it over and over again.

The vast majority of students are accustomed to textbooks and lectures, to sitting down and having time to process. Labs and field experience have always been an elective. Once you get to rotations, though, youre learning from your hands.

You have those moments, Oh shoot I didnt ask that question, I didn't think of that, Reed said. I struggled a lot. I hated being wrong and I was wrong a lot.

The physical demands of rotations are about as crazy as youd expect. Reed commented that she got an average of three hours of sleep during her internal medicine rotation, which was apparently pretty good.

Youre adjusting to a new sleep schedule every six weeks, Reed said. My first was OB-GYN. The first two weeks was getting up at 4:30 to get to the hospital, then I had nights, then a regular 9-5 schedule I dont know if you ever get used to it, its just something you do.

Its always in retrospect that you realize you werent prepared for a big life adjustment. Reed advises not to beat yourself up and be gentle.

Fourth years been a huge relief, Reed said. Being able to talk to your classmates, your mentors, your partner, your friends [it is] that little piece of solidarity of We know, were there too.

For all the ways it grinds your soul to bits, rotations give you the first opportunity to see the same patient over and over again. During her internal medicine rotation, Reed got to tell a woman she had been moved to number one on the priority list for liver transplants. Saying goodbye to this patient after six weeks was one of the moments that validated Reeds decision to do medicine.

When I got up there, she was having a rough day, Reed said. When she realized it was me, she let me into the room and kind of broke down. Im feeling overwhelmed, all these doctors, I need a break. Shed kicked out every doctor, resident, person, but she let me in. It was really special.

What we can get out of medical school rotations as pre-meds is the attitude to just take things as they come without being bitter. If people can emerge from rotations with a positive attitude and a reinvigorated love for their passion, its probably the course to take.

What makes all the studying worth it, all that hard work worth it, is those relationships with patients, Reed said. Its been my absolute favorite part of school.

Reach columnist Theresa Li at science@dailyuw.com. Twitter: @lithere_sa

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Medical school rotations: What to expect from the hardest years of medical school - Dailyuw

The figure was revealed by Department of Health Finance Director Neelia Lloyd at the Stormont Health Committee.

She confirmed the expenditure was included in the additional 169m the Health Minister Robin Swann has said he needs to fulfil the ambitions of the New Decade, New Approach deal.

Ms. Lloyd was asked about the medical school by Sinn Fin MLA Colm Gildernew.

I noticed the Minister said that an additional 169m is required to deliver the NDNA commitments. Does that figure include the money for the development of the north-west medical school, and how much of it is within the 169m? she asked.

Ms. Lloyd replied: There is a resource element to it...yes, it does include revenue funding within the 169m. It is a very small amount for 2020/21, but, notwithstanding that, it is likely to have a lifespan of something like I think it ramps up to 25m by year 10 in terms of a resource requirement, but for 2020/21, the figure is very, very small.

Brigitte Worth, DoH Director of the Investment Directorate, said the cost of building the facility would be met by other departments.

On the capital side, because it is a further education project, we expect the capital spend to be factored in by the Department for the Economy on the further education side. There is no capital factored into the figures for that, she said.

Continued here:
Video: Department of Health finance director Neelia Lloyd confirms Derry medical school will cost 25m a year to run - Derry Journal

The best hospitals in the world must deal with a plethora of challenges facing the health care field today, including tight regulations, rapid advancements in medical science, new health risks and ever-rising costs. And they must do so while also delivering on what must be a medical facility's No. 1 priority: providing top-notch patient care.

What is critical for health care consumers to figure out: Where can you find these industry leaders todaythe ones that meet the economic, political and medical challenges they face with speed and skill, while also providing the very best health care to the people they treat?

To help answer that question, Newsweek partnered with Statista Inc., a global market research and consumer data company, to develop a groundbreaking ranking of the world's best hospitals. The result is our second annual ranking of the best hospitals in the world, the top 10 of which you'll find here.

You find the full ranking, which includes separate lists of top hospitals from 21 countries including the U.S., as well as exceptional specialty hospitals in cardiology, oncology, orthopedics and pediatrics, here.

The largestand originalMayo Clinic has been in Rochester, Minnesota, since 1889. Every year, approximately 1.3 million people from 138 countries come to the Mayo Clinic's 19 hospitals in five states for their specialized team approach. With over 4,800 staff physicians and scientists and over 4,000 full-time research personnel, it is committed to finding answers to the toughest medical cases. Always on the cutting edge, the clinic recently announced several new cancer initiatives. In a counterintuitive move, researchers in Rochester found that by encouraging cancers to mutate, the cancers can be targeted by immunotherapy, and clinical trials for pediatric patients with brain tumors will put this into practice shortly. It also recently announced an agreement to build the first carbon ion therapy treatment center in North America to treat challenging cancers at its Jacksonville, Florida, campus. Patients who seek out the Mayo Clinic appreciate the convenience of its rapid, same-day test results and free concierge services to assist with logistics and travel advice. MayoClinic.org

Cleveland Clinic has always made patient care its centerpiece, and it takes to heart its motto: "Care for the patient as if they are your own family." Historically, Cleveland has also been known for medical breakthroughs and organ transplants, including the first face transplant in the United States. In 2019, it broke its own organ transplant records897, up 3 percent from the year beforeincluding the world's first single-port robotic kidney transplant, which allows for a single small incision and limits the need for postoperative opioids for pain relief. Cleveland's health system encompasses 18 full-service locations systemwide. In 2018, there were 7.9 million outpatient visits, from 185 countries, across all of its campuses. My.ClevelandClinic.org

Over 200 years old and the original and largest teaching hospital of Harvard Medical School, Massachusetts General Hospital is known for its cutting-edge research. Mass General doctors put the insights they gather from that research to good use when diagnosing and treating the nearly 1.6 million patients who walk through its doors annually. With an annual budget of more than $850 million for research and more than 1,200 clinical trials taking place at any time, it is no wonder that Mass General publishes more research articles in prestigious medical journals and receives more federal funding than any other independent hospital in the country. Its researchers' findings range from linking sleep timing and teen obesity to tagging cells using laser particles so as to better understand the growth ofand treattumors. MassGeneral.org

Since 1819, Toronto General Hospital has been a leader in cardiac care, organ transplants and the treatment of complex patient needs. TGH has focused on novel therapies to treat endocrine and autoimmune disorders ever since insulin was developed, and its first clinical use in the treatment of diabetes at the hospital was in 1922. This past year, TGH doctors performed the first robot-assisted brain surgery on a live patient, which they hope will bridge even more frontiers and eventually allow patients in remote communities to get this kind of life-saving care. Its five-year strategic plan focuses on patient well-being and provides regular, transparent performance reviews of health outcomes and patient experience. Uhn.ca

Given that Charit was founded in 1710 when bubonic plague threatened Berlin, it is fitting that, in what is now one of the largest university hospitals in Europe, Charit researchers are taking the lead on identifying and treating infectious diseases such as Zika, SARS and MERS. Charit researchers developed the first diagnostic test to identify the COVID-19 coronavirus, which originated in Wuhan, China. More than half of all German Nobel Prize winners in physiology or medicine can be claimed by Charit as one of its own, and the hospital is internationally renowned for its excellence in teaching and training. In a new partnership announced in July 2019, Charit is integrating the Berlin Institute of Health under its umbrella; according to a statement from the BIH, it "is to becomealongside patient care and the medical facultythe third pillar of Charit." Charite.de

The Johns Hopkins Hospital, founded in 1889 in Baltimore, is not only a leading teaching and research hospital, but it is also central to the history and development of American medical education. William Osler, one of the hospital's founding physicians, invented the idea of medical residency, taking students out of the lecture halls and onto the wards to examine patients. Today Johns Hopkins has 1,162 beds and more than 2,400 full-time attending physicians. Among other firsts, Johns Hopkins was the first hospital in the U.S. to perform male-to-female sex-reassignment surgery. HopkinsMedicine.org

The lineage of this hospital, the first in Zurich, dates back to 1204. It is one of five university hospitals in Switzerland. Currently, it has 43 departments and institutes, ranging from a center on aging and mobility to a department of surgery and transplantation. The hospital has 980 beds, and 1,500 physicians and scientists. It treats over 42,000 inpatients and has over 500,000 outpatient visits every year. In 1977, a physician here successfully restored normal blood flow to constricted coronary arteries using a balloon catheter. Today, the procedure is widely used all over the world. En.Usz.ch

The oldest and largest hospital in this city-state, Singapore General Hospital, a teaching hospital, was founded 1821. Now, it employs more than 10,000 people and sees more than 1 million patients every year. It is home to Southeast Asia's only full multidisciplinary center for cancer and is an acute tertiary referral hospital with over 40 clinical disciplines. In 2010, it was the first hospital in Asia to receive the Magnet designation for nursing excellence from the American Nurses Credentialing Center. Sgh.com.sg

The Sheba Medical Center at Tel Hashomer, near Tel Aviv, serves as Israel's national research and university-affiliated training hospital. It was founded in 1948 as the country's first military hospital. Today, it collaborates with biotech and pharmaceutical companies around the world to develop new drugs and treatments. Serving more than 1.6 million patients a year, its facilities include an acute care hospital, a rehabilitation hospital, a women's hospital, a children's hospital, an eating disorders clinic, a post-traumatic stress disorder clinic forsoldiers and an outpatient clinic. Its research specialties include cardiology, cancer, brain diseases, obstetrics and gynecology, genetics and medical education. https://eng.sheba.co.il/

This hospital, with about 15,000 employees and 1,340 beds, is affiliated with the Karolinska Institute, which was founded in 1810 by King Karl XIII as a school for military surgeons, given the alarm about death rates in army field hospitals. Today it is one of the largest and most prestigious medical schools in the world. The facility incorporates two children's hospitals and is known for its specialties in reproductive medicine, fetal medicine, surgery, urology and neurosurgery. It is a member of 18 referral networks across Europe concentrating on rare diseases. Karolinska.se

Visit http://www.newsweek.com/best-hospitals-2020 for the remaining Top Best Hospitals in the World.

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The Top 10 Hospitals In the World - Newsweek

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Discovery promises to aid production of protein-based drugs, vaccines, other biomaterials

Tubes of green fluorescent protein glow more brightly when they contain more of the protein. Researchers at Washington University School of Medicine have found a way to increase protein production up to a thousandfold, a discovery that could aid production of proteins used in the medical, food, agriculture, chemical and other industries.

Medicines such as insulin for diabetes and clotting factors for hemophilia are hard to synthesize in the lab. Such drugs are based on therapeutic proteins, so scientists have engineered bacteria into tiny protein-making factories. But even with the help of bacteria or other cells, the process of producing proteins for medical or commercial applications is laborious and costly.

Now, researchers at Washington University School of Medicine in St. Louis have discovered a way to supercharge protein production up to a thousandfold. The findings, published Dec. 18 in Nature Communications, could help increase production and drive down costs of making certain protein-based drugs, vaccines and diagnostics, as well as proteins used in the food, agriculture, biomaterials, bioenergy and chemical industries.

The process of producing proteins for medical or commercial applications can be complex, expensive and time-consuming, said Sergej Djuranovic, PhD, an associate professor of cell biology and physiology and the studys senior author. If you can make each bacterium produce 10 times as much protein, you only need one-tenth the volume of bacteria to get the job done, which would cut costs tremendously. This technique works with all kinds of proteins because its a basic feature of the universal protein-synthesizing machinery.

Proteins are built from chains of amino acids hundreds of links long. Djuranovic and first author Manasvi Verma, an undergraduate researcher in Djuranovics lab, stumbled on the importance of the first few amino acids when an experiment for a different study failed to work as expected. The researchers were looking for ways to control the amount of protein produced from a specific gene.

We changed the sequence of the first few amino acids, and we thought it would have no effect on protein expression, but instead, it increased protein expression by 300%, Djuranovic said. So then we started digging in to why that happened.

The researchers turned to green fluorescent protein, a tool used in biomedical research to estimate the amount of protein in a sample by measuring the amount of fluorescent light produced. Djuranovic and colleagues randomly changed the sequence of the first few amino acids in green fluorescent protein, generating 9,261 distinct versions, identical except for the very beginning.

The brilliance of the different versions of green fluorescent protein varied a thousandfold from the dimmest to the brightest, the researchers found, indicating a thousandfold difference in the amount of protein produced. With careful analysis and further experiments, Djuranovic, Verma and their collaborators from Washington University and Stanford University identified certain combinations of amino acids at the third, fourth and fifth positions in the protein chain that gave rise to sky-high amounts of protein.

Moreover, the same amino-acid triplets not only ramped up production of green fluorescent protein, which originally comes from jellyfish, but also production of proteins from distantly related species like coral and humans.

The findings could help increase production of proteins not only for medical applications, but in food, agriculture, chemical and other industries.

There are so many ways we could benefit from ramping up protein production, Djuranovic said. In the biomedical space, there are many proteins used in drugs, vaccines, diagnostics and biomaterials for medical devices that might become less expensive if we could improve production. And thats not to mention proteins produced for use in the food industry theres one called chymosin that is very important in cheese-making, for example the chemical industry, bioenergy, scientific research and others. Optimizing protein production could have a broad range of commercial benefits.

Verma M, Choi J, Cottrell KA, Lavagnino Z, Thomas EN, Pavlovic-Djuranovic S, Szczesny P, Piston DW, Zaher HS, Puglisi JD, Djuranovic S. A short translational ramp determines the efficiency of protein synthesis. Nature Communications. Dec. 18, 2019. DOI: 10.1038/s41467-019-13810-1

This work is supported by the National Institutes of Health (NIH), grant numbers R01 R01GM112824, R01GM51266, R01GM113078, R01DK115972 and T32GM007067; the Skandalaris Center LEAP Award; JDRF, award number 3-APF-2018-573-A-N; and Stanford University Bio-X Fellowship.

SD holds US Provisional Patent #62/540,897 Methods to modulate protein translation efficiency. This patent is owned by Washington University and managed by the Washington University Office of Technology Management (reference numberT061889)

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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Scientists find way to supercharge protein production - Washington University School of Medicine in St. Louis

PHILADELPHIA The proportion of high school students who identify as a sexual minority lesbian, gay, bisexual or questioning doubled in the past several years, according to a new study published Monday.

Yet those greater numbers have not necessarily meant they have found greater acceptance or peace. The study, based on data from a federal survey, found that those teens attempted suicide at a rate nearly four times higher than their heterosexual peers.

The research, published in the journal Pediatrics, was based on data from the Youth Risk Behavioral Surveillance Survey from 2009 to 2017. The findings were based on survey information from Delaware, Illinois, Massachusetts, Maine, North Dakota, and Rhode Island, the only six states that continuously collected sexual orientation data for all those years.

These new findings, particularly the disproportionate rate of suicide attempts, dramatically point out the need for increased efforts to assist and support these young people, according to the researchers.

Large disparities in suicide attempts persisted even as the percent of students identifying as LGBQ increased. In 2017, more than 20% of LGBQ teens reported attempting suicide in the past year, said lead study author Julia Raifman, an assistant professor with Boston Universitys School of Public Health.

Its critical that health and educational institutions have policies and programs in place to protect and improve LGBQ health, such as medical school curricula and high school health curricula that are inclusive of sexual minority health, Raifman said.

According to the study, 14.3% of U.S. teens identified as a sexual minority in 2017, compared with 7.3% in 2009. Adolescent girls in 2017 were twice as likely as boys to identify as a sexual minority.

The research also found that many more high schoolers are engaging in or at least experimenting with same-sex sexual contact. Their numbers increased from 7.7% of teens in 2009 to a little over 13% in 2017.

The sexual contact numbers were based on data from Delaware, Connecticut, Illinois and Rhode Island, the four states that continuously collected that information from 2009 to 2017.

As troubling as the high rate of suicide attempts for sexual minority teenagers compared to heterosexual kids is, the rate at the beginning of the study period was even worse.

In 2017, a little over 20% of the high schoolers who identified as sexual minorities reported attempting suicide, compared to 26.7% in 2009. The reported suicide attempt rate for heterosexual kids was about 6% for both those years.

Our paper indicates that an increasing number of teenagers are identifying as LGBQ and will be affected by anti-LGBQ policies that may elevate these already very high rates of suicide attempts, Raifman said.

Raifman said previous research she was involved in show a correlation between public policies and LGBQ suicide attempts and mental health.

In one 2017 study, Raifman and colleagues found a 7% reduction in suicide attempts in high school students, particularly those identified as sexual minorities, in states that allowed same-sex marriage. A 2018 study led by Raifman found increased mental health distress among sexual minority individuals in states where there had been publicized cases of anti-gay discrimination.

Suicide is the second leading cause of death for young people ages 10 to 24.

In addition to Boston University, the study authors include researchers from Boston Childrens Hospital, Harvard Medical School and the School of Public Health, Johns Hopkins School of Medicine, Brown Universitys School of Public Health and medical school, along with other hospitals.

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More high school students than ever are coming out, but their despair remains acute - TribLIVE

If you are looking to enter the U.S. physician workforce as an international medical graduate (IMG), following residency or fellowship, you are likely examining pros and cons of each potential practice setting.

One option that may offer some appeal is working in academic medicine.

Academic institutions offer opportunities for research and being at the cutting edge of knowledge and skills, including taking on the patients who are toughest to diagnose and treat. You also can work to shape the future of medicine by teaching the next generation of students and residents.

Based on insight from an IMG who has excelled in the field, there is a path for IMGs to land faculty positions and succeed in academic medicine. These four tips can help IMG residents make a smooth transition to the academic setting.

Learn more with the AMA about what to consider before you choose a practice setting.

Sabesan Saby Karuppiah, MD, MPH

Having completed medical school in India and residency in the U.K., Sabesan Saby Karuppiah, MD, MPH, was frustrated when he moved to the U.S. and had to go through residency training a second time.

By the time I was doing my second residency, I was kind of bored, said Dr. Karuppiah, division vice president of graduate medical education at HCA MidAmerica in Overland Park, Kansas. I was looking at other things I could get myself interested in. I took on leadership roles and tracks and became a chief resident.

Because I had so much time, I began to teach more, and I began to understand that I liked teaching.

Dr. Karuppiah, an AMA member, went on to do a post-residency fellowship in the field of faculty development. The experience gave him the tools to succeed as an academic physician.

Success in academic medicine is largely based on ones clinical and teaching ability, but the third pillar to the field is research.

In this arena, IMGs may have a leg up in that they tend to come into residency with extensive publishing experience.

According to the National Resident Matching Program, the average non-U.S. citizen IMG who matched in 2018 had 5.9 abstracts, presentations and publications as part of their application. Thats higher than the 5.7 figure for allopathic medical school seniors who matched in 2018.

If you are an IMG now and get into residency, you need to be top notch, you have to have [test] great scores and research papers, Dr. Karuppiah said. So, what that means is IMGs have more research which puts them in a good spot to be a faculty. They have already been looking at research and grants even prior to residency.

As residents, IMGs may find challenges in transitioning to the U.S. system of training. They also may need additional guidance in getting into the academic track and help networking.

If you want to get more involved in a field, you might need mentorship from people who were already in the position, Dr. Karuppiah said.

Communication is the key. Sometimes IMGs can be shy or their confidence might be lacking. You need to let your guard down and seek out mentors. That will help you go a long way.

Read about five AMA member IMGs who speak up for patients and fellow doctors.

Dr. Karuppiah credits his involvement in organized medicine and the AMA as a big part of his ability to advance in academic medicine. He is a member of the AMA-IMG Section governing council, which gives voice to and advocates for issues that affect IMG physicians.

You need many tools to be faculty, he said. You need basic teaching skills, communication skills, feedback, evaluation, those are the skills you have to have as a faculty. Those skills might be what IMGs are lacking.

I got that training personally from being involved in organized medicine, going to meetings, writing resolutions. You get to work with people and be on conference calls. It boosts your confidence, develops your communications skills.

Read the rest here:
IMGs: Heed these 4 tips to pursue academic medicine career - American Medical Association

UMass Medical School and GE Healthcare Life Sciences have announced the companies plan to establish a new large-scale viral vector manufacturing facility that will be housed on the Worcester campus of the medical school.

The facility will be able to provide large quantities of high-quality recombinant adeno-associated virus vectors for preclinical research, according to a news release from the medical school.

The potential of gene therapy to treat human disease has finally become a reality, said Terence R. Flotte, the Celia and Isaac Haidak Professor of Medical Education, executive deputy chancellor, provost and dean of the School of Medicine and professor of pediatrics. However, the ability to move the field forward to treat additional serious diseases remains limited by the efficiency and flexibility of producing gene therapy vectors suitable for testing in new disease models."

A lack of large-scale vector manufacturing facilities has limited preclinical research capabilities, according to the news release.

Researchers often wait 12 to 24 months to secure enough vector for their research. With this facility, researchers will have access to GE Healthcares processing equipment, helping get research to the clinic faster, the medical school said.

Accelerating research that brings novel cell and gene therapies to patients is the mission of our business, said Catarina Flyborg, the general manager of cell and gene therapy at GE Healthcare Life Sciences. By partnering with UMass Medical School to create this large scale AAV manufacturing facility, we will provide researchers with the tools and AAV needed for pre-clinical research that will advance the cell and gene therapy industry and get therapies to patients faster.

The facility will be 3,220 square feet and will be fully operational in 2020. Four to six professional staff members will manage day-to-day operations, with Sylvain Cecchini, an associate professor of microbiology and physiological systems, as the core director, the statement said.

Continued here:
UMass Medical School and GE Healthcare establishing manufacturing facility in Worcester - MassLive.com

I spent the first two days of my winter break thinking about what I wanted to write in this post. I'm at this pausing point, five months into rotations in my third year of medical school, and it feels like I should have something to say in the way of a summary, some idea or lesson to cap off this first chunk of clerkships. But honestly, I'm at a loss to write about any singular topic. I have too many scenes, dynamics and ideas rolling around in my head to sit down and produce one digestible post.

Instead, since this is the time of year for recaps, I thought I'd provide one of my own.

These are my clinical experiences of 2019:

At this point, I've finished my clerkships in OB/GYN, emergency medicine, ambulatory medicine, and most recently, in surgery. During ambulatory, I worked in the clinics of oncologists, cardiologists, hypertension and urgent care physicians. On surgery, I rotated through plastics, endocrine and colorectal surgery specialties.

I'm starting to get the hang of doing medical student tasks. I write notes, give presentations, call consults and suggest (tentative) care plans.

I've gotten my hands dirty to say the least. On OB/GYN, I delivered babies. In the ED, I used a big needle to draw fluid from a man's belly and sharp knives to incise and drain abscesses. On ambulatory, I listened to the lungs of a patient who proceeded to sneeze on my face. On surgery, I cut through skin and fascia, then sutured it back together. I'll spare you the nitty gritty details from my month with the colorectal service.

I've managed my time in new ways. I've worked weekends, overnights, woken up at 3:30 a.m., and crashed just minutes after getting home from a long day. I've learned to squeeze studying into the quiet minutes between seeing patients or while eating dinner at night.

I've seen a lot already. A lot of diseases. A lot of different patients -- across all ages, and from many different backgrounds. I've witnessed care plans that worked, and others that fell short. I've seen new life and dealt with a couple of difficult deaths.

I've learned more than I can put into words -- about specific diseases and illnesses, about techniques and skills, but also about communication, generosity, compassion and trust. I've worked with many different team members at all levels of training, and have gathered little lessons from each one -- I pick and choose from their mannerisms, expressions, explanations and perspectives, taking those that I want to carry forward myself.

I'll adopt one intern's foresight to sit with a "difficult" patient in the evening, answering the patient's questions. This assuaged her anxiety, while also ensuring that the team wouldn't stall in her room during 5:30 a.m. rounds the next morning when we had 20 other patients to visit.

I'll practice giving off the warmth one resident exuded when talking to patients or team members, and work to accept criticism -- even when delivered brusquely -- with the same genuine appreciation he felt.

I'll aspire to mirror one attending's sense of humor, which always put her patients at ease, and aim to deliver bad news with the unflinching and honest expression of another.

In review, it's been a lot --and there's a whole lot more to come in 2020. But before the next wave begins, I plan to relax, rejuvenate and process the past few months.

On New Year's Eve, I'll be thinking about a woman I met on my surgery rotation. She told me her goal was to recover from her operation in time to throw confetti from the rooftops in Times Square as the ball drops. I looked into it and learned that revelers toss 3,000 pounds of confetti -- large chunks of multicolored paper -- several seconds before the ball descends. Many of them write messages on individual pieces of paper, recording their hopes and wishes for the year.

I have many hopes for the new year, and one of them is that my patient will be there, in the heart of Times Square as the clock strikes midnight, throwing handfuls of confetti over her shoulders, hugging her family and friends.

Wishing everyone a happy and healthy New Year.

Stanford MedicineUnplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unpluggedcategory.

Orly Farber is an undifferentiated third-year medical student from the East Coast. She loves reading and writing about medicine. Her written work has been featured online inSTAT NewsandThe Intima,as well as in print inThe Boston Globe.In between hospital shifts, you can find Orly running The Dish or making a mess of dishes in her kitchen.

Photo by Dave Hunt

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Year in review: Reflections on my first four medical clerkships - Scope

With the start of a new decade, a brain cancer patient discovers what may be the most courageous way to move forward in his life.

Jeremy Pivor is a graduate student in the UC Berkeley-UC San Francisco Joint Medical Program. He was diagnosed with a brain tumor at the age of twelve, had a recurrence when he was 23, and is now undergoing experimental treatments for another life-limiting recurrence. In addition to being passionate about climate justice and ocean conservation, Jeremy advocates for the brain tumor and young adult cancer communities through writing, speaking, fundraising, and lobbying with groups like the National Brain Tumor Society, Dana Farber, UCSF and others. You can follow his journey at jeremys-journey.com or on Twitter @JeremyPivor.

When living with serious illness, what is considered courageous?

"Don't let cancer define you," is one of the most common expressions among the cancer community. Throughout my journey living with brain cancer since the age of 12, I have felt pressured to prevent cancer from changing the direction of my life. I thought that persevering in spite of my diagnosis was a courageous act.

As the new decade begins, I've reflected more on the meaning of courage as I embark on an enormous transition in my life. For the past two and a half years, I have been living in California while studying in a joint medical and master's degree program at UC Berkeley and UC San Francisco. My goal coming into this program was to become a physician to work at the intersection of human and environmental health. However, my path took a turn when I was diagnosed with a second recurrence of brain cancer in March 2018, just nine months into my studies. Two months later, I had an awake brain surgery.

Since learning of my diagnosis that spring, I have contemplated whether to continue with my medical degree. I finished my first year as if everything was normal, but after surgery and receiving the news that the remaining parts of the tumor were more aggressive than previously thought, I decided to transition to school part-time. While I still wanted to move forward in my studies, I needed to focus on my recovery and maintain a decent quality of life. This meant putting my medical degree aside while I focused on my masters. Still, I had every intention though to return to my medical studies.

When my first treatment following surgery proved unsuccessful, I questioned my decision to remain in medical school, but ultimately felt I should keep pushing forward with my plans, or at least keep that door open. Countless times I would receive comments such as, "You're going to be such a great doctor" or, "It's so courageous you're continuing with medical school while being a patient." I internalized these opinions, which made me feel like I had a duty to stay in medical school. I had two identities, patient and medical student, that could help shape me into a thoughtful physician.

While I originally planned to write my Master's thesis on the mental health impacts of forest fires on California youth, my medical experiences and exploration of the illness narrative genre drawing upon inspirations such as Julie Yip-Williams' The Unwinding of the Miracle,inspired me to pivot, turning my thesis into a book-length narrative about my journey with illness in medical school. Writing and reflecting on living with terminal illness strengthened my understanding of my values. I wanted, first and foremost, to prioritize my relationships with my family and my partner. Second, I wanted to use my experiences and privilege to help others.

As I neared completion of my Master's thesis, I came to a decision point of whether to continue with medical school. Over the past year, I had come to see that when living with life-limiting illness, it is not courageous to push forward blindly. Increasingly, I saw that I needed to recognize how my illness had helped to shape my values and, in turn, my path forward.

My values have guided me to put medical school aside and move back to the East Coast where my family and partner live. As a medical student, graduate student, and patient living in the Bay Area, I connected with colleagues, advocates, patients, and communities who taught me an important lesson: I do not need to be a physician to form deep, holistic connections with other people. I can do that through my own writing, advocacy, and experiences.

Every person living with a serious illness will respond uniquely to their diagnoses. The trope, "Don't let cancer define you," potentially prevents individuals from discovering new parts of themselves: aspects of their identity that could help them evolve to become someone they never thought was possible.

On New Year's Eve, when the clock struck midnight to start the new decade, I made a resolution to listen and respond to my values. While I have no idea where that will lead me, moving forward in this manner may be the most courageous act I can do for myself.

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When Living With Serious Illness, What is Considered Courageous? - Curetoday.com

The AMA does not define the term in its press release on the announcement, but it said schools should include information on fee-for-service, managed care and other payment structures.

The policy was adopted by the AMAs House of Delegates at its meeting in mid-November. The AMA says it has spent several years trying to integrate health systems science into the curriculum and it should be a third pillar in addition to basic and clinical science.

Medical students and residents with a deeper understanding of cost, financing, and medical economics will be better equipped to provide more cost-effective care that will have a positive impact for patients and the health care system as a whole, stated Barbara McAneny, M.D., spokesperson and past president of the AMA.

Concerned About Bias

Teaching medical students about the highly regulated profession they are about to enter can be a positive step, says Beth Haynes, M.D., a board member of the Benjamin Rush Institute, a nonprofit organization that helps students learn more about free-market medicine.

My concern is that medical schools will fail to be balanced in their presentation of economic theories, said Haynes. Schools may emphasize [the late economist John Maynard] Keynes and other supporters of significant government intervention while ignoring free-market, limited-government theories like [those of Milton] Friedman and [Ludwig] von Mises.

Economics can be a touchy subject in medical school, says Chad Savage, M.D., owner of the Michigan-based direct primary care practice YourChoice Direct Care and a policy advisor to The Heartland Institute, which publishesHealth Care News.

There is an implicit understanding in medical schools that it is for some reason taboo that physicians should discuss or have any expectation of compensation, said Savage. It is somehow unseemly to expect compensation, and this engenders the belief that the only way to partake of medical care is via governmental transaction.

Hoping for Balance

The AMA says it has published a study tool and developed several teaching models so medical educators can provide a better understanding of health care economics.

The AMAs announcement is welcome news to third-year medical student Anthony Fappiano.

I happen to love economics, so this is a topic I would have loved to learn about more, especially in school, said Fappiano, who attends the University of New England College of Osteopathic Medicine.

Fappiano says he hopes the presentation will be balanced, but a recent conference he attended was not encouraging.

It was a panel with a lobbyist for some single-payer company and two physicians who supported single-payer systems, said Fappiano. Not exactly a broad set of opinions.

Calls for Consumer Emphasis

Fappiano says he would like to learn more about consumer-driven care models.

I think it would be important to emphasize the ways that we as upcoming doctors can lower costs for patients more effectively, said Fappiano. We need to stress the importance of inexpensive treatments like lifestyle changes, hands-on medicine like physical therapy and osteopathic manipulation, and generic drugs, rather than jumping to topline drugs or surgery. This is rarely emphasized in medical school, and the board exams reinforce the idea that expensive tests are a necessity, when that is not always the case.

Fappiano says he learned about direct primary care from a faculty member who had such a practice, which does not accept insurance or government payments.

It gives the patient more flexibility and unlimited access to their physician, said Fappiano. It is lower-cost than most insurance, and the quality of care is the same or better.

The AMA has a strong influence on the nations medical schools, and policy announcements can be an indication of where the organization stands on political issues. In June 2019, the AMA announced it wants medical schools to introduce climate change into the curriculum, and an amendment to stop formally opposing single-payer health care was defeated by three votes.

AnneMarie Schieber(amschieber@heartland.org)is managing editor ofHealth Care News.

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AMA Calls for Health Economics Classes in Medical Schools - The Heartland Institute

DETROIT, MI Armed with care packages, clothes, and clinical supplies, medical students in Detroit are learning outside the classroom. They are bringing their knowledge to the streets, providing free health care to the citys homeless.

Each week, students under the supervision of a registered physician or nurse practitioner get on their bikes and look for those in need.

One of the first experiences I had in the world of street medicine was with a young man who had gotten into an accident and broken his arm, said Ellie Small, a second-year medical student at Michigan State University and president of Detroit Street Care. He was put into a cast the day before, though nobody had seen to the road-rash that covered half of his forehead and the side of one of his legs.

Small and a group of volunteers went to work removing the dirt, stones and debris from the grateful patients wounds.

Its a job that Small describes as making invisible people visible.

The medical students treat wounds, check vital signs and provide patients with blood pressure medicine, insulin and antibiotics. Perhaps more importantly, they connect with people experiencing homelessness on a personal level.

Youre seeing them in their home, whatever that home might look like. We teach all our volunteers to be eye level with patients. If your patient is sitting on the ground, you need to sit on the ground. It goes a long way for their comfort, Small said. We need to realize whats most important medically might not be the most important thing in their life at that current time. Thats unique to this population. We always ask about someones housing status.

Programs such as Michigan State Universitys Detroit Street Care, Wayne State Universitys Street Medicine Detroit, and the University of Michigans Wolverine Street Medicine work together to treat as many of the citys homeless as possible.

According to the Homeless Action Network of Detroit, there were over 10,000 people experiencing homelessness in the city in 2018.

Members of the programs compare notes on patients and map out routes to ensure all pockets of the city are covered. They also host clinics at shelters and work with organizations to place people in housing whenever they are ready.

Jamie Wojahn, Director of Homeless Recovery Services at the Neighborhood Service Organization, said programs like these are crucial to the homeless population.

If it wasnt for all these schools and all these volunteers, there would be so many more people dying, Wojahn said. They are giving vaccines on the streets to people who havent had vaccines in several years. They give a lot of basic medical needs to people who have diabetes and hypertension that have been unaddressed for years.

Jedidiah Bell, a fourth-year med student at Wayne State University and president of Street Medicine Detroit, said seeing issues from lack of health care access in his home country of Zimbabwe made him want to participate.

When I moved to the states for university and medical school, I saw the similar things [lack of access] with the homeless population, Bell said. When I saw street medicine, I appreciated the model of how can we take medical care to the street and build up trust to bridge the gap between the homeless and the medical world.

While the programs provide a vital service to the community, Bell said the real-world experience teaches students things classrooms and clinics cant.

It teaches medical students to hone-in on, not just medical conditions of patients, but to be able to sit down and form relationships and discuss other things that might be contributing to [patients] health but might not come up during a traditional medical encounter, he said.

Bell said theres a widespread belief that students take away more from people on the streets than they take away from us.

Anneliese Petersen, a second-year medical student at Wayne State University and volunteer with Street Medicine Detroit, said the experience also shows upcoming medical professionals another side of health the social determinants.

Things that are not strictly medical-based but have a strong impact on health and well-being. Income, access to health care, access to medication, being able to eat well, sleep well, to be able to relax and not be under chronic stress, she said.

Learning to see how patients live outside a doctors office could help the students provide better treatment once they begin working inside one. But the main goal for the students remains with those on the streets.

If we can improve the situation for the person sitting in front of us and even just make their day or afternoon a little bit easier, were serving our purpose, Small said.

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Medical students take to the streets to give free care to Detroits homeless - WGNO New Orleans

I met Mr. AR for the first time in September of my intern year. He was a 70-year-old gentleman admitted to the hospital with nausea, vomiting, and abdominal pain. CT scans revealed an obstructing mass in the head of his pancreas. The rest of the workup yielded a frightening diagnosis of pancreatic cancer, prompting his primary medical team to consult usthe surgical oncology service. Although another resident had already seen him the day before, the patients daughter had only just arrived today, having traveled over 300 miles to be with her father. Mr. AR knew only that he needed to have surgery, so his daughter asked the nurse to page the surgery team, asking for someone to explain the proposed procedure.

I felt my heart pounding as I listened to the nurse relaying the request. I was barely three months out from graduating medical school, but my senior residents were operating (and so was the attending physician), so there was no one but me to walk to the north wing of the hospital, frantically studying diagrams on my phone as I made my way over. I made silent promises to myself that it would be okay to say, I dont know, because I truly didnt know. How long would he have to stay postoperatively? When could he eat normal food? What activity could he do afterward? Would he be cured? Would he still need chemotherapy? These were questions Id ask if I were the patient, and yet I had none of the answers.

Up until that day, I had decided that I hated surgical oncology. The patients were ill to begin with, having spent some time fighting a malignancy prior to presentation, then some of them would be weakened by neoadjuvant chemotherapy, sustaining neither nourishment nor exercise, and then we would throw them into the gauntlet of a major surgical resection. Much of a surgical interns time is spent on the inpatient floor following postoperative patients, and I felt a crushing gloom entering the ward every day looking in on how sickly the patients seemed to be. Watching them die was even worse. The promise of more time to live, however long, didnt seem worth it, and I struggled to care about these patients when everything seemed so futile to me.

Despondent, I knocked gently and pushed the door open, peering in. Mr. AR and his daughter looked up from their conversation, smiling brightly and asking if I was the surgery person. I stumbled over my greeting, taken aback by the sunny atmosphere. They were so glad that someone had come. He looked nothing like my patients: no temporal wasting, no ribs showing through his side, no exhaustion in his eyes. I drew pictures of the anatomy that would be altered during the procedure in order to remove the cancer. I apologized where I had no answer and reassured them that the attending surgeon would be by to fill in the gaps.

I also found out that he and his daughter came from my hometown, and by the time we were done chatting about more than just his diagnosis, an hour of my afternoon had drifted by. They thanked me for the information that I could give, and as I left the room, I couldnt hide my own smile at having shared a positive connection with another human being.

The next time I saw him, Mr. AR had undergone his surgery and relocated to our surgical postoperative floor. His recovery was not without complications. He endured a prolonged course of ileus, a string of electrolyte derangements, fluid collections requiring percutaneous drains, and an infection requiring antibiotics. Despite that, he greeted me cheerily every morning, even if I came to bother him at five or six oclock. When I caught him pushing a rolling walker in the halls, he wanted to show off his dance moves, weak as he was. The optimistic attitude he and his daughter shared was contagious, and it motivated me to continue working hard to get him better after every setback. By the time he left the hospital, he looked more like the cancer patients I was used to seeing, frail and thin, but he didnt stop smiling.

Months later, a stranger tapped me on the shoulder. I almost didnt recognize him. He was a far cry from the last Id seen him: normal clothing, filled out cheekbones, standing on his own. Apparently he was there following up with his oncologist and was doing very well on his adjuvant chemotherapy. He thanked me for the care he had received and expressed that I must continue doing so for others. I left that encounter with a renewed sense of purpose: the care I was providing no longer seemed futile.

Though progress was slow, I began to see how Mr. AR had changed me. As an intern, I had focused on the nitty-gritty details: the diagnosis, the pathophysiology, the workup, the treatment, the answers to difficult questions from the attending, the right orders to input into the computer. As a second-year resident, I found that the knowledge and workflow were now second nature, and I began to really see the patients for who they were. I saw new patients, anxious about their symptoms, fearful of the c word.

I saw survivors, racking up years free of cancer, eating well and living normal lives. I saw beyond the details of the treatments and began realizing the principles and patterns guiding the care of cancer patients. I assisted in surgeries big and small, where some patients were cured with a small excision and others like Mr. AR had to face the gauntlet. For these latter patients, I could now picture where they would be a few months following their surgery, strolling down to the hospital cafeteria for a snack after their infusion.

But they wouldnt get there on their own. Motivated by their stories, I challenged myself to take ownership of their care, to read as much as I could, to be able to answer their questions where I couldnt answer before. I presented patients I had seen at the multidisciplinary tumor board. I took notes on my clinic patients the night before so that I could spend more time with them in person and less with the computer. I stayed past shift changes to struggle through difficult cases with my attending. So imagine the surprise when third year rolled around, and I said with certainty, I want to go into surgical oncology.

Mr. AR is still alive today, and the lesson I learned from our shared experience is still with me as well. He showed me a different perspective of caring for cancer patients. Where I had once viewed it as a process of dying and merely delaying the inevitable, now I view it through his lens, as a process of living for the hope of living better, no matter what length of time we can give them. He had the strength to face every day with joy and positivity, and now I can do the same for my patients who dont have that strength themselves. This is what has helped me become a better doctor.

Continued here:
2019 Physician Writing Contest: The hope of living better - Medical Economics

VERMILLION Mary Nettleman, M.D., dean of the University of South Dakotas Sanford School of Medicine and vice-president of USDs Division of Health Affairs, has been named the 2019-2020 recipient of the Elizabeth and Emily Blackwell Award for Outstanding Contributions to Advancing the Careers of Women in Medicine, presented by the American College of Physicians.

Nettlemans own career as a clinician, researcher, academic and as a medical school leader has demonstrated an ongoing commitment to womens health issues and to promoting women in health and medical careers. Prior to her duties as dean of USDs medical school that began in 2012, Nettleman was a professor of medicine and chair of the department of medicine at Michigan State University. There, and at other institutions including the University of Iowa and Indiana University, she distinguished herself in the field of health services research, particularly regarding diseases and conditions related to women.

Under Nettleman, USDs medical school has initiated concerted efforts to encourage South Dakota high school and college students to pursue education and training in medicine and health sciences. Increasing the number of women serving as physicians in South Dakota is a central objective.

Nettleman has pursued this objective not by creating preferential treatment, but by identifying and removing barriers that disproportionately hinder women. Nationally, she was the first person to identify gendered language in letters of recommendation written by medical schools for their students applying for residencies, and she led efforts to eliminate such bias. Nettleman has also led efforts at the school of medicine to implement policies recognizing the needs of women who are both mothers and medical students. At USD she has recruited women into faculty positions and administrative roles at the medical school. Nearly half of the schools leadership is now female.

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Dean Of USD Medical School Honored For Advancing Careers Of Women in Medicine - Yankton Daily Press

28 October 2019

The four-storey 8,100 square metre building, including a roof terrace, is situated on the island of Gozo in Malta, next to Gozo General Hospital. It includes:

The building also hosts a library, student support facilities, a large canteen and social space, and offices.

Professor Anthony Warrens, Dean for Education at Barts and The London School of Medicine and Dentistry, Queen Mary University of London, said: This marks a significant new chapter in Queen Marys presence in Malta. This state-of-the-art facility will be a boon for students and staff alike, creating an excellent teaching and learning environment while also providing additional areas for students to study and relax.

The new building adds to Queen Marys Malta campus which includes an Anatomy Centre, which opened in December 2018 and features a dedicated area for teaching anatomy through dissection. It is equipped with facilities for clinical imaging, as well as office accommodation for academic, technical and administrative staff.

Queen Mary launched a five-year Bachelor of Medicine, Bachelor of Surgery (MBBS) programme taught on the Mediterranean islands of the Maltese Republic two years ago. It has now accepted its third cohort of students for the 2019/20 academic year.

The MBBS is taught by Barts and The London School of Medicine and Dentistry at Queen Mary and has been designed to provide students with the medical knowledge, clinical skills and professional attitudes that are required to become a competent Foundation Year (FY1) Doctor.

The programme is taught in English, using the same curriculum as the MBBS in London, and results in the award of a Medicine MBBS from Queen Mary University of London. Arrangements have also been made to make junior doctor (Foundation Year 1 and 2) positions in Malta available to our graduates.

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SMD - Queen Mary opens the doors on a new medical school building in Malta - QMUL

Medical Billing and Coding Jobs in South Carolina

Three significant employers of medical billing and coding professionals in South Carolina are:

Open since 1950, ACH currently has 200 employees on staff. The hospital specializes in cardiology, emergency, family practice, internal medicine, pathology, podiatry, and radiology. Their John E. Harter Nursing Center employs approximately 155 full time employees. The perks at ACH include tuition assistance, disability insurance, a 403b with employer match, and vision, health and dental coverage.

Opened in 1975, Trident Medical Center is a 313-bed major medical care facility. Its services include heart and vascular care, a nursery, senior health, a burn clinic, and womens and childrens health services. Benefits at Trident include dental, health, vision and life coverage, disability, a 401(k) plan, a day care flexible spending account, and other perks.

BCHNC employs 22 physicians among its staff, servicing an area of 4,000 residents. Some of the services they provide include emergency medicine, anesthesia services, and a variety of inpatient services such as family medicine, obstetrics, and more. The benefits package at BCHNC includes dental, health, vision and life insurance, supplemental life and disability, a pension plan, retirement packages with employer match, and tuition reimbursement.

According to the U.S. Bureau of Labor Statistics (BLS), South Carolinas unemployment rate was at 3.9% inSeptember 2016, down from 4.5% the year before. During that same period, employment in the education and health services sector increased by around 2.5%.

Overall, the employment of medical records and health information technicians is expected to increase by 15% in the U.S., according to the BLS. This demand is anticipated due to the nations aging population, which tends to require more medical tests, treatments, and procedures to be performed. For a sense of how medical billers and coders currently fare in South Carolina, please refer to the most recent city stats below.

More than 83,000 healthcare professionals around the country are certified in medical coding by the AAPC. According to the BLS, most employers prefer to hire credentialed medical coders. To become certified, candidates must pass a credentialing exam. An online program in medical billing and coding can help prepare students to take this exam, and some may even allow students to take it during the program.

Listed below, compiled with information from the BLS, are the top cities for medical billing and coding employment in South Carolina.

There are approximately 710 medical billers and coders in the Charleston-North Charleston metropolitan area, according to theBLS. The average hourly wage is $19.15, and the average yearly wage is $39,830.

Columbia is home to 490 medical billers and coders, according to the BLS. The average worker makes the most money here: $20.04 hourly and $41,670 annually.

The Greenville-Anderson-Mauldin metropolitan area employs3 70 medical billers and coders, according to theBLS. The average wage is $17.28 hourly and $35,950 annually.

In Spartanburg there are approximately 220 medical billers and coders who make an hourly mean wage of $16.57 and an annual mean wage of $34,460, according to theBLS.

In Florence, there are approximately 150 medical billers and coders, according to theBLS. On average, they make $19.20 per hour and $39,940 per year.

The Myrtle Beach-Conway-North Myrtle Beach metropolitan area has about 110 medical billers and coders, according to theBLS. They make an hourly mean wage of $15.13. The annual mean wage is $31,480.

TheHilton Head Island-Bluffton-Beaufortmetropolitan area has about 60 medical billers and coders, and they make an hourly mean wage of $19.60 and a yearly mean wage of $40,760, according to the BLS.

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Medical Billing & Coding Schools in South Carolina

Part 4 in a series.

Many liberal arts colleges in a demographic and financial trap have sought escape by seeking applicants elsewhere traveling the country, accepting more international students or adjusting their programming or their pitch.

But Regis College, based in Weston, has thrived over the past 15 years, in part by becoming more than a college.

"One has to be smart, not beat your head against the wall to try to continue to grow undergraduate education right now," says Antoinette Hays, the college's president since 2011.

Instead, over the course of the past decade, Regis has become a university with a diversified base of students roughly equal parts undergraduate, graduate and online with the overall majority focused on nursing or public health.

You can see Regis's growth is not on its main campus in Weston, but 35 miles north. Since 2013, Regis staff and students have shared space with Northern Essex Community College (NECC) in the center of Lawrence, and in 2017 theyrenovated that space.

Big parts of the building are given over to hospital-like rooms: a mock intake desk and beds full of high-tech medical mannequins. Some appear to breathe; at least one can "give birth."

Part of educating nurses is getting them habituated to interacting with real people from placing catheters, taking EKGs, to responding to a heart attack. Brenda Lormil, on the "Regis North" faculty, says the mannequins which are owned by the community college are an excellent teaching tool toward that end, even if they are a little unsettling. ("I never stay here past six," Lormil laughs.)

One of Regis's biggest programs at its Lawrence campus is an accelerated, 16-month program to earn a bachelor's degree in nursing. The program, for students who've received a prior bachelor's degree, is intense. But it allows working people to shift quickly into a career that pays well and many students say speaks to the soul.

Lormil understands the deep attraction of nursing; the profession pulled her in despite herself. As a teenager, Lormil says,"I wanted to be an international business woman" so she enrolled at Johnson and Wales University.

Freshman year, Lormil was assigned to a group project. As they presented, it became pretty clear she had done all the work. Her professor wasn't impressed.

"He told me that business is not for me," Lormil remembers. "Because, 'it's a dog-eat-dog world, and your character doesn't fit.' "

Lormil, then 18, was crushed. But she dropped out and applied to Regis College to study the same trade as her mother and her aunt."I detoured, purposefully. I was trying to be ... the different person.But it was always nursing."

Today, Lormil obviously loves her work. She's a nurse practitioner at an oncology ward at Massachusetts General Hospital, and she teaches the subject at her alma mater.

Still, Lormil says she's been impressed by the drive of the students she sees at Regis North. These are students going to college for a second time: "Their why is much deeper. Theres a lot more on the line.

Regis itself has gone through a similar process. In the early 2000s, the college then small, still single-sex was struggling. Given demographic and social trends, they could only expect things to get worse.

"Being a focused liberal arts institution became challenging," says Hays, who was in charge of the school's small nursing program at the time."People were starting to look at, 'what are the job prospects?' And we didn't have many professional programs."

So in 2007 the same year Lormil came to campus as a student-- Regis went co-ed. And they also doubled down on a bet: expanding graduate education and opening a standalone nursing school, of which Hays was the first dean. Nurses can receive a range of credentials, from associates up to doctoral degrees. Regis has conferred nearly 7,000 nursing degrees in the past 33 years, with 592 of them coming this past year.

Teddy Richards who's enrolled in the accelerated program is aiming to get his bachelor's next spring. Richards grew up in Liberia and Ghana, always with one particular dream: "to go to medical school to be a doctor. That was my thing."

But after he came to the United States at 18, Richards sayshe balked at the time and expense between him and doctoring. Now nearly 30 and with several years of work as an EMT, he's adjusted his dream. He now wants to become a nurse practitioner as soon as possible.

Walking through campus, Richards is glad the accelerated program in Lawrence sets him up to do that,without what he sees asneedless detours in the name of liberal arts.

"Colleges should be very focused," Richards says. He looks backon his time studying biology at UMass Lowell: "Kids [are] doing all these other classes that they're not really interested in. It's like, 'Why I am doing this if I'm not gonna end up using that in my work?' "

Twelve years on, Regis's bet on nursing has apparently paid off.

The college's annual revenue from tuition has doubled, while undergrads still pay relatively little to attend. Graduate and online students now make up two-thirds of Regis's enrollment, and many pay their own way. Regis is now a college in name only.

But they're not alone in this corner of the market. Other small schools, like Curry College, and much larger ones including Northeastern University and UMass Boston offer their own accelerated nursing programs.

It's not clear how much longer this boom can go on. Judith Par, head of nursing at the Massachusetts Nurses Association, the state's largest nurses' union, says thatwhile there may still be a national shortage of workers in her field, this stateis becoming an exception.

Par saysshe cautions her own students: "If you want to stay working in the Commonwealth, you may need to apply on average to 60 or 70 positions before you will find an opening."

But at least for now, Regis is growing, with health careers leading the way.Hays, the president, is determined to keep it that way. With the worst financial moment behind it, Hays has pushed expansion not just to Regis North, but alsothe acquisition of Mount Ida College's former dental-hygiene program,complete with 13 faculty and staff and nearly 80 students.

Hays is restrained, but ambitious. She frequently invokes a mission statement inherited from the Sisters of St. Joseph,who founded the college: to "care for the dear neighbor without distinction."Hayspitches both expansions in that spirit: the dental-hygiene program is now set up to give low-cost dental care at a new facility in Waltham that opened earlier this month. And Regis Northwill give a career-ready option to the underserved, and predominantly Latino, community around it with courses on medical Spanish planned for the year ahead.

At the same time, Hays and her team keep their eye always on the ever-changing world of hospitals and companies outside.

"We're very industry-driven," she says, "and we want to be sure that when our students graduate that they have employment."

Hays is confident in where Regis is now, and that it can continue to turn out hundreds of work-ready nurses each year in close cooperation with Greater Boston's medical establishment.

Do you have questions about small private colleges in Massachusetts? Fill out the form below:

Illustration by Chris Cerrato for WBUR.

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A College Specializes In Medicine And Health And Finds Itself Revived - WBUR

On Oct. 24 Roseman University of Health Sciences sponsored a special symposium on the Future of Medicine featuring some of the best and brightest thinkers in healthcare and education. The event is part of Roseman Universitys 20th anniversary celebration as a comprehensive health science university. Roseman will open a state-of-the-art private medical school in 2023.

Paul Umbach, a nationally recognized moderator and community health pioneer introduced distinguished speakers who shared their vision and passion regarding the transformation of population health, technology, policy, and practice in medical schools. Leaders in the Las Vegas community from all sectors of the economy in attendance participated in an open dialog about the transformation of medicine in southern Nevada. With two new medical schools in the Las Vegas in various stages in development (UNLV opened its doors in 2018 and Roseman University anticipates welcoming its first class in 2023), this program was especially timely and important to the health and well-being of the region.

According to Paul Umbach, founder of Tripp Umbach, who was instrumental in the development of more than 15 new medical schools over the past 20 years, medicine is undergoing its greatest evolution in centuries moving from a focus on sickness and disease to health and wellness.

Keynote speaker Dr. Pedro Greer, shared share lessons learned from starting a new medical school in Miami and from a career as a national and internationally recognized speaker and medical education visionary. Author of Waking Up in America, an autobiographical account about his experiences, from providing care to homeless persons under bridges to advising U.S. Presidents George Bush Sr. and Bill Clinton, Joe challenged the audience to think differently about the role of the new Roseman University College of Medicine in transforming the Las Vegas community.

Roberto Vargas Vice Dean of the Charles R. Drew University of Medicine and Science, a nationally recognized expert in addressing Population Health shared his research underway in underserved South Los Angeles, where a new minority serving private medical school in under development. Dr. Doug Miller, who has served as Dean of medical schools in New York, Georgia, and Canada explored the intersection of medicine, advanced technology, and artificial intelligence.

The program was as a springboard for Roseman Universitys plans to bring a private MD-granting medical school to Las Vegas and the beginning of Rosmans celebration of 20 years.

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Roseman University of Health Sciences Driving the Future of Medicine - Nevada Business Magazine

Not all enrollment trends at the University of Missouri-Columbia are down the medical school has increased its class size by one-third this year.

The expansion, to a class of 128 from 96, is aimed at addressing a looming physician shortage created by an aging population. Most of Missouri is considered to have a shortage of health professionals, particularly rural parts of the state. The state needs an additional 367 doctors to accommodate its population, according to Kaiser Family Foundation data.

In 2006, the Association of American Medical Colleges recommended medical schools increase their enrollments by 30 percent in the following decade. The same year, St. Louis University increased the number of first-year students to 175 from 150, making it the largest medical school in the state.

Washington Universitys medical school enrollment has stayed between 120 and 124 students per class. There are no plans to increase the size of the class, which is partly influenced by the number of faculty and available space, according to the dean of admissions.

Mizzou started looking at expanding its class size soon after the 2006 recommendations, said Weldon Webb, an associate dean.

Were the No. 1 provider of practicing physicians in Missouri, so if somebody was going to increase, it should probably be Columbia, he said.

The expansion of the medical school includes a new $42.5 million classroom and laboratory building on the Columbia campus. A clinical campus opened last year in Springfield where some third- and fourth-year students train, aided by a partnership with CoxHealth and Mercy hospitals. About 44 percent of the medical schools students stay in Missouri after graduation, Webb said.

The growth of the medical school contrasts with undergraduate enrollment in Columbia, which dropped by about 14 percent this fall. The incoming class of about 4,000 freshmen is the smallest in nearly 20 years.

Reports of racism and a lack of diversity at Mizzou contributed to the drop in undergraduate enrollment and have also caused troubles for the medical school.

The medical schools credentials are at risk if it doesnt train more minority doctors, according to a 2016 report from the Liaison Committee on Medical Education, the accrediting organization for U.S. medical schools. The committee previously cited the school for its lack of diversity in 2001 and 2008.

The committees most recent recommendations give the school until 2018 to increase the number of black, Hispanic and Native American medical students, among other requirements.

Last year, less than 4 percent of Mizzous medical students belonged to one of the three underrepresented minority groups, according to national data. In the incoming class, 9 percent of students identify as black, Hispanic or Native American, school officials said.

The increased diversity of the incoming class tops St. Louis University, where 7 percent of medical students are in the three minority groups. The accrediting body placed SLUs medical school on a two-year probation in February in part for its problems recruiting and retaining low-income and first-generation students.

Washington Universitys rate of underrepresented minority medical students is 9 percent. University of Missouri-Kansas City has the states most diverse medical student body, with 12 percent.

Ebony Page of St. Louis joined Mizzous class of 2021 because of the medical schools growth and the opportunities to work in underserved communities after graduation, she said.

For me, growing up in the inner city and knowing the health disparities, a lot of it has to do with access to care, said Page, 27. To see the shortage firsthand made it important to go to an institution where it was important to them.

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Mizzou medical school will produce more doctors to address shortage - STLtoday.com

UT Southwestern Medical School is one of four medical schools in the University of Texas System and one of the nations top medical schools. UT Southwestern admits approximately 230 students each year, and admission is highly competitive. Were looking for the best and the brightest, the most intellectually curious, and the most caring and compassionate future physicians.

Since our founding in 1943, weve graduated more than 11,000 physicians. This year alone, the Medical School will train about 950 medical students and 1,300 clinical residents.

Our graduates have distinguished themselves at top medical facilities around the world, advancing the cause of medicine, furthering their careers, and adding luster to a UTSouthwestern degree. In fact, one Medical School graduate won a Nobel Prize.

The Medical School is located in the 387-acre Southwestern Medical District, just minutes from downtown Dallas. The medical district is home to two UTSouthwestern University Hospitals, William P. Clements Jr. University Hospitaland Zale Lipshy University Hospital; as well as Parkland Hospital one of the nations top public hospitals and Children's Medical Center, a national leader in pediatric care. All are used to train Medical School students.

Along with educating the physicians of tomorrow to care for future generations of patients, UT Southwestern is a leading research facility ($427.3 million in annual funding). We are home to some of the countrys foremost medical minds. UTSouthwestern's faculty includes more members of the prestigiousNational Academy of Sciencesthan all other academic medical centers in Texas combined.

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About the School: Medical School UT Southwestern, Dallas, TX

University of Washington President Ana Marie Cauce, left, shows off her Gonzaga pen while she and Gonzaga University President Thayne McCulloh, right, sign the formal agreement after the announcement that Gonzaga University would host UW medical students on campus, starting in the fall of 2016. The announcement was Wednesday, Feb. 24, 2016 at Gonzaga University. (Jesse Tinsley / The Spokesman-Review)

For now, at least, the University of Washingtons medical school in Spokane will have classes of just 60 students.

Through a partnership with Gonzaga University, UW welcomed 60 first-year and 40 second-year medical students in Spokane last fall. Earlier this year it asked the Legislature for $9.3 million to add 20 students per graduating class.

But lawmakers were juggling other expensive obligations, including a court order to invest more in K-12 education, so UW received just $5 million for the biennium, enough to support two more classes of 60 medical students.

Our long-term goal is to get to 80 students, said Ian Goodhew, UWs government affairs director. Thats what weve been working on for several years.

Washington State University, which received $10 million for its fledgling medical school in Spokane, also is authorized to serve classes of 60. UWs medical school served significantly fewer students at WSU Spokane before that partnership splintered several years ago.

Goodhew said UW is satisfied with the amount it received. He said lawmakers recognized that the partnership with Gonzaga is off to a pretty great start.

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UW medical school in Spokane won't get bigger classes - The Spokesman-Review