During Immersion Phase, we’re required to take at least one Integrated Science Course (ISC), which combines clinical work with aspects of our preclinical years. The ISC I chose focused on obesity and its impact on adults, children, healthcare, and society. We rotated through several clinical sites throughout the month and also had lectures and completed assignments on the pathophysiology of obesity, medical and surgical management, public health and cultural considerations, and other aspects of the topic.
This course was probably the most important one that I could have taken this year. Given the fact that over a third of adults in the U.S. are classified as obese (by BMI), any medical professional will encounter patients who are dealing with obesity or some of the medical conditions related to it–diabetes, heart disease, sleep apnea, and arthritis, to name a few. However, as I learned over the past month, many healthcare providers are more comfortable with treating the effects of the underlying problem than they are with approaching the problem itself. To many, counseling a patient about weight loss consists of reciting some form of the “eat less, exercise more” mantra at the end of the clinic visit, or running through a list of reasons why being obese is bad for the health. However, these tactics are rarely effective, as they largely don’t consider the patient’s opinions and goals. A patient may know all of the oft-quoted facts but not be motivated to lose weight for any number of other reasons; by contrast, he or she may have tried and failed to lose weight alone countless times and need some guidance or accountability. It is important for physicians to talk with patients instead of at them in order to get a better idea of their thoughts and their needs where their weight (really, any number of issues involving behavior change) is concerned; these are the underlying goals of a technique called motivational interviewing.
The Obesity ISC was also one of the most rewarding courses I’ve taken in a while, for a number of reasons. For one, I appreciated the breadth of the experience. I worked with internal medicine physicians, pediatricians, surgeons, nurse practitioners, dietitians, psychologists, and exercise physiologists at clinic sites specializing in bariatric surgery, hypertension, sleep, and more; I was also able to see how patients are served by the interdisciplinary teams at certain locations. Another rewarding aspect of the rotation was the level of continuity that I witnessed over several mornings at the adult weight loss clinic. By being present several types of patient visit–initial consultation, nutrition and exercise evaluation, follow ups for medical weight management, education sessions and required psychological evaluations before bariatric surgery, post-operative visits–I got a good understanding of the longitudinal care that a patient might receive. And, of course, it was a treat to meet patients for whom bariatric surgery had been a life-changing success. I talked with a man who had lost almost 200 pounds over the year following his surgery–he legitimately did not look like the same person compared to “before” pictures in his chart; he also reported more energy and no need to use his CPAP machine at night.
For this rotation, we also worked on several projects in order to synthesize what we’d been learning over the month. One project that someone chose to do required him to modify a recipe to make it healthier; he brought in a version of chicken Parmesan that he made in a slow cooker, which was very tasty. We also created individual concept maps to capture the complexity of obesity and its various causes and effects. Another project that we all had to do involved choosing a question that interested us regarding management of obesity and creating a presentation, handout, or other modality to educate our chosen audience. For mine, I chose to look at mindfulness apps that physicians might recommend to patients who struggle with emotional eating.
Of course, that’s only a snapshot of what I experienced this past month. Despite the relative ease of fourth year compared to everything before it, medical school has been keeping me on my toes.
Now I’m out of class for roughly two months in order to travel for residency interviews. The process and progress of the interview season can be a bit of a sensitive topic, so I won’t openly talk about it here. But if anyone has questions, I’m open to answering them!