Campbell’s charter class of medical students is already making an impact on their first round of rotations
ERICA BROTZMAN
9:15 AM Erica Brotzman’s morning has finally slowed down a little. She and Dr. Connie Mulroy have left the fast pace of the hospital for Mulroy’s OB/GYN clinic, about a five-minute drive away when you factor in traffic and a few red lights.
This clinic — an office with assistants, secretaries, a waiting room and regular appointments — this is what Brotzman hopes her future looks like. It also feels a lot like her past.
Her mother is a rheumatologist, a physician who specializes in autoimmune conditions affecting the joints, muscles and bones. Brotzman spent a lot of time in her office growing up, often given little tasks around the pharmacy or in the mail room.
“I grew up around medicine,” she says. “My mom is my biggest role model, so I decided pretty early that this is what I wanted to do with my life.”
Brotzman earned her bachelor’s degree at the University of Richmond and took part in a post-baccalaureate program at Virginia Commonwealth. Three years later, she was accepted to and had already paid her deposit at a nursing school when she learned she was also accepted into the charter class of Campbell’s new osteopathic medical school. She instantly fell in love with Campbell and its program.
“I remember getting this little pamphlet with all the osteopathic medical schools in the country, and there was this little addendum about three new schools,” she recalls. “I remember seeing Campbell and thinking, ‘Buies Creek, North Carolina? I don’t know where that is, but I want to go there.’ I’m a Southern-kinda girl, and I wanted to stay in the South, and the more research I did on Campbell, the more amazing it sounded.”
She says her first interview “felt like a big bear hug,” and the campus reminded her of Richmond. The three-year wait for med school was worth it, she says. “Everybody was so welcoming and so family-oriented.”
You can sense why these qualities are so important to Brotzman in the way she approaches Dr. Mulroy’s second appointment on this day — a 68-year-old woman in for a routine check-up. The doc steps aside and allows her to ask her questions about her medical history. Campbell students have spent countless hours in mock exam rooms that look exactly like this one and have practiced patient interaction ad nauseum. Still, it’s different with a real patient with a real history. Brotzman applies a little Southern charm and comes off as having done this for years. She performs her first Pap smear and pelvic exam, and her patient is happy to be her first.
“How will you learn if you’re not trying it on someone,” she assures Brotzman. “May as well be me.”
It’s as she’s writing her first real SOAP [Subjectives, Objectives, Assessment and Plan] note when Brotzman’s one hour of relative calm is turned on its head. Dr. Mulroy has received a call from the hospital that she’s needed for a possible emergency C-section on a young woman in just the 29th week of her pregnancy. The two begin gathering their things and walk hurriedly (almost jogging) to the parking lot.
“This could be nothing,” Mulroy tells her student. “Or it could be much worse.”
RAJBIR SINGH
10:00 AM Rajbir Singh and Albie Simeone stand at the foot of the bed of a frail elderly woman who’s lying on her side fast asleep and clearly benefiting from the pain-killing IV drip at her side. Sitting next to her bed is her son, who hands Simeone his cell phone so the physician assistant can speak to the woman’s daughter.
The conversation isn’t easy.
Simeone must convince the daughter that her ailing mother needs her leg amputated. The procedure — a BKA (below-the-knee amputation) — is far too common in Robeson County, where the death rate linked to diabetes is more than double the state average. But these phone calls are anything but routine for Simeone, who spends more than 15 minutes explaining the procedure and explaining that if it’s not done now, it could be much more difficult (and more of the limb might need to go) if the family waits. Simeone avoids the medical jargon in their talk, and after he hands the flip phone back to the woman’s son, he gives Singh a knowing nod that the conversation was a success.
“You can be the best surgeon or the best clinician in the world, but if you don’t know how to communicate with your patients, they’re not going to trust you, and they’re not going to want you to see them,” Simeone later says. “It doesn’t come off well if someone thinks a doctor, PA or med student is talking down to them or using terms they don’t understand. One of the big differences between PAs and MDs or DOs is we have to log 1,500 patient-care hours before we go to school. We’ve had that experience of talking to patients. One of the biggest compliments PAs get is that we communicate well.”
Singh says these learning moments are just as important as the ones in surgery. It reminds him of why he wanted to become a doctor in the first place — a revelation that hit him when he was 17 and visiting India for the first time since his family moved to Miami when he was 4. During that trip, he met the doctor for his family’s village — a man who worked for very little money, yet had a tremendous impact on the community.
“I asked why he basically worked for free, and he told me, ‘This is where I’m from. If I don’t take care of my people, who will?’” Singh recalls. “I even got sick at some point during that trip, and my grandfather took me to his house in the middle of the night for meds. It wasn’t life threatening or anything, but I could have been much worse. I saw first-hand how important a doctor can be. It’s hard to understand that need if you haven’t felt that need yourself.”
The first in his family to graduate college, Singh earned a degree in biology pre-med from the University of South Florida and spent two years shadowing physicians and working on the application process for medical school. During that process, he discovered Campbell — a school he’d never heard of before then —and liked the idea of being in a charter class.
“It was out in the middle of nowhere, and at first I was taken aback, coming from Miami,” he says. “But it reminded me a little of India. Quiet, calm, surrounded by farmland. I liked it. I wanted to get away from the craziness anyway.”
Simeone wakes his patient up moments after his phone call ends to inform her of the decision. With Singh at his side, Simeone tells her that her left leg will be amputated.
WHAT’S A ROTATION?
The terms “rotation” and “residency” might sound similar to those of us outside of the medical field, but they’re two very different parts of a doctor’s education.
While a resident is an MD or a DO with a degree (yet not a fully licensed physician), rotations are viewed much like internships, and for students at the Jerry M. Wallace School of Osteopathic Medicine, they make up the third and fourth years of their four-year med school education. As with most schools, Campbell students spend the first two years in the classroom, and rotations give them a more hands-on education in a hospital setting.
Third-year students at Campbell are required to complete 10 clinical rotations, each about a month long. All students must complete the core rotations — which include internal medicine, family medicine, general surgery, OB/GYN, pediatrics and psychiatry — plus several elective rotations.
“We train physicians in many of the medical specialties to ensure they have a well- rounded education that will prepare them to be safe and effective physicians and ready for residency programs in whatever specialty they choose,” says Dr. Robert Hasty, associate dean for postgraduate affairs at Campbell and vice president of medical education at Southeastern Health.
Tom Soker
10:14 AM “There he is, going to save lives.”
Tom Soker nods and smiles to the classmate who says this as they pass each other in the maze of hallways that make up Southeastern Regional Medical Center. Soker doesn’t have time for much more than the nod, however, as he’s trying to keep up with his preceptor, Dr. Sydney Short, a cardiologist of over 30 years. The two meet up with resident Dr. Danielle Eagan, a graduate of the Edward Via School of Osteopathic Medicine and Campbell internal medicine resident.
This is an elective rotation for Soker, a soft-spoken graduate of UNC-Chapel Hill who’s seriously considering going the cardiology route in his career. Without a doubt, he’s chosen the right hospital in the right region to learn.
Robeson County has one of the highest rates of heart disease and stroke not only in the state, but in the nation. Heart disease has been the No. 1 killer in the U.S. for over 90 years, and in Robeson, it kills about 300 people each year, according to the Society of Public Health Education. A big reason for that is the region is home to the Lumbee Indian tribe, the second largest Native American tribe east of the Mississippi River. Lumbees, according to Duke University research, are significantly more vulnerable to heart disease, and with more than 50,000 living in and around Robeson County, the need for more physicians and surgeons is great.
Short, Soker and Eagan’s next patient on this morning’s rounds isn’t Lumbee, but his is a fascinating case. He’s a young man who a day prior collapsed with no warning while working a morning shift as a convenience store clerk. As Short checks his heart and begins asking questions about the incident, the patient offers something better than his story.
“I have video,” he says, handing the doctor his iPhone.
The three gather around the phone standing bedside and watch it all unfold via the store’s surveillance footage. A few seconds in, their faces reveal the moment he passed out.
“Wow, you sure did. That’s pretty impressive,” Short jokes.
Now the learning begins for Soker, and Short begins going over several possibilities of what could have caused the patient’s blackout. They discuss his drinking three to five cups of coffee every morning instead of eating breakfast. They discuss a potential drop in his blood pressure. He also doesn’t rule out a rare condition called Brugada Syndrome, a potentially life-threatening heart rhythm disorder.
“His heart is functioning normally now, so we’re going to send him home,” the doctor tells Soker and Eagan. “It’s rare for someone to come in with footage like that. Sometimes we’ll get pictures. This guy is a good case study though. There will definitely be follow-ups.”
It’s been an eventful first few days for Soker, who began his rotation earlier in the week by watching doctors insert a pacemaker into a heart patient. He’s settling in to this new chapter in his life, and calls this part of his medical education both “exciting and scary.”
“I’ll admit, I’m a little nervous about this rotation,” he says, “but I’m excited, too. It’s not a core rotation, so I don’t have to stress over a big test coming up. I’m just soaking everything in and learning as much as I can.”
SADIA MOBEEN
10:25 AM There’s a chip in the table in the psych ward’s interview room, a half an arm’s length away from where the patient usually sits when he or she is answering questions from Dr. Hosseini or a nurse practitioner — “Do you see things?” “Do you hear voices?” “Do you feel hopeless or worthless at times?” “Do you have severe mood swings?”
That chip in the table becomes the focus for many of these patients — digging it deeper and deeper with their finger, or rubbing it with their thumb to avoid giving their full attention to the moment at hand. It’s easier to chip away at a table than accept the reality of the moment … or to answer questions they’ve likely heard before.
Sadia Mobeen has joined one other med student, Dr. Sid Hosseini and a nurse practitioner in the locked room to interview a new patient. The young woman’s Southern accent is thick and grammar is elementary school-level, and Mobeen — a native New Yorker — is finding it difficult to understand much of what the patient is saying.
Following the interview, Mobeen is asked to perform a routine physical exam on the patient. Minutes into it, the woman asks her to stop and politely requests the nurse practitioner finish the exam. Mobeen accepts the patient’s demand, also politely, but when she steps out of the room, she’s frustrated.
“We’ve been trained to do physical exams, and we’ve done countless exams since our first year,” she says. “It wasn’t that I was doing it wrong; she was just uncomfortable that somebody new or somebody without a degree was doing it. I respected her wishes, but it’s frustrating when you know you’re capable. I’m a student, and doing it is the only way I’m going to learn.”
Part of the frustration stems from Mobeen’s genuine desire to help people like this patient. In her two years between undergrad and med school, she worked for AmeriCorps, helping homeless and less fortunate patients after their ER visits get medications, find shelter and find follow-up care.
“It might sound corny, but I really like helping people. Making a difference,” she says. “I want to do something good for society, and I like the role of a doctor in doing that. Patients believe in them, and if a doctor really does care, that goes a long way. That’s why I wanted to go into medicine.”
BETTER DOCTORS
Lumberton family physician Dr. James McLeod admits having Campbell students following him around keeps him on his toes.
“When you know some smart person who’s reading, studying and learning with the latest and greatest stuff is looking over your shoulder while you practice medicine, you tend to think things out more than if no one was around,” he says. “It forces you to be as good a doctor as you can be.”
Bringing medical education into the hospital makes a hospital better, says Dr. Robert Hasty, associate dean for postgraduate affairs at Campbell and vice president of medical education at Southeastern Health (soon to be the founding dean of Montana’s first medical school on the campus of Montana State University). Joann Anderson, CEO and president of SeHealth, agrees, and she’s seeing the results first-hand in just a few short months since cutting the ribbon on the hospital’s new Medical Education Center.
“I believe this has changed our organization,” she says. “You walk down the hallways, and you feel it. The energy level has been turned up. The discussions you hear at a nurse’s station or around the classrooms — they’re exciting. I ran into a physical therapist at the cafeteria here, and asked him how things were going. He said, ‘It’s great. This thing with the students … it’s just wonderful.’ I’ve known this guy for years, and for him to say this was truly significant to me. He sees that partnering with Campbell has changed our world in a positive way.”
CHERIE DICKSON
11:02 AM Dr. McLeod’s next patient on a busy morning at the Dr. A.J. Robinson Medical Clinic is a woman in her 60s who suffers from plantar fasciitis, causing great pain in her foot when she walks. During a discussion with her doctor and Cherie Dickson about lotions and stretches that might help, the woman talks about her husband, whom she lost just weeks prior.
The man she met when she was 15 and shared an up-and-down marriage with for 40 years was gone, and the void he left in her life was too much to bear, she says.
“God I miss him,” she says, tears welling in her eyes. “It’s hard … but God’s given me strength day by day. Life goes on … but it’s just so hard.”
A few seconds of silence is broken by Dickson, who takes a step toward the sitting patient and offers another form of healing.
Prayer.
“Would it be helpful if I prayed with you?” she asks.
She kneels in front of the woman, and the two hold hands as Dickson begins to pray aloud.
“Be a constant reminder that she’s not alone,” Dickson says, eyes closed. “That you’re with her, Lord.”
The minute-long moment ends with a whispered “Praise Jesus,” from the woman. It’s not the first time prayers have been shared in Dr. McLeod’s office, and it’s not the first time Dickson has prayed with the people she’s been called to help. She describes herself as a strong Christian who believes God has led her to medicine, and she believes spiritual care is important in overall health.
“Last summer, I was in a spiritual care program in California with the Loma Linda University School of Medicine, where you learn to integrate your faith into your practice,” she says. “I learned a lot there, like what’s OK to talk about with your patient and whether it’s OK to talk about God.”
“As a provider, you’re granted a high level of respect from your patients, so if you ask them, ‘Can I pray with you?’ there might be pressure on them to do it whether they want to or not because you’re in a position of authority. Asking if it would be ‘helpful’ to pray, however, lessens that pressure. If faith is important in their daily life, then why not help them use it to heal?”
TOM SOKER
11:30 AM A little over an hour after watching cell phone video of a man pass out at work, Tom Soker, Dr. Danielle Eagan and their preceptor, Dr. Sydney Short, are gathered around another patient’s bed, this time joined by a room full of health care professionals.
Three registered nurses and an echocardiographer are there to help Short perform a transesophageal echocardiogram (or TEE) procedure, where they will guide an ultrasound transducer down the patient’s throat as he’s sleeping to get a close-up look at the heart’s valves and chambers without interference from the ribs or lungs.
The patient came in after an atrial fibrillation (or afib) flutter, which can cause the heart to contract irregularly and less efficiently than normal. Short is checking this particular heart for clots, and if he finds one, he won’t be able to follow up with an electrical cardioversion procedure (a brief “shock” to the heart), because such a procedure can cause a clot to come loose and cause a stroke.
The patient, a slightly overweight man in his late 40s or early 50s, is given something to swallow to help “lube” his throat for the procedure. The man consumes the bitter-tasting liquid before he lies down to let the anesthesia do its work. Minutes later, he’s snoring, and Short goes to work.
As Short guides the ultrasound carefully, his resident and student stand behind watching both his hands and the monitor as 2D images of his heart begin to appear.
Soker’s eyes light up as he focuses on the images, trying to find the clots his preceptor is looking for. He was a junior in high school when he first decided he might want to go into medicine. A former YMCA camp counselor who loved working with kids, Soker was dead set on being a pediatrician before med school. His plans were put on hold when his applications were denied his first year after college.
He responded by getting his Certified Nursing Assistant license, doing research at Wake Forest University and shadowing a neurosurgeon in Greensboro over the next two years. He also worked as a patient transporter just to get his foot in the door and get some experience and build his pre-med school resume. It was upon entering his third application cycle when he discovered Campbell University and its yet-to-be-built School of Osteopathic Medicine. Upon reading more about the school, he introduced himself to osteopathic medicine and liked that Campbell and a DO education aligned with his own personal health care values.
In 2013, he learned he would become part of the 160-member charter class of the school that fall.
“My first reaction was joy, then relief that I wouldn’t have to go through the tedious application process again,” says Soker, who never swayed in his dream of med school despite the rejections. “I have plenty of friends who had been rejected once or twice. I also have a great support system at home telling me I’d be a great doctor one day. I also have faith in myself — so the encouragement was there. I didn’t see a reason to stop. This is what I wanted to do.”
On the monitor, a small clot appears in the patient’s heart. He will not receive a shock, Short tells his team as he reels in the tube.
“Cardiology’s never boring,” he tells Soker and Eagan.