Penn State College of Medicine completes record-setting year
Thursday, June 21, 2007

With a record number of student applications, the largest graduating class in its history and its highest-ever residency match rate, Penn State College of Medicine further cemented its role as a medical school of choice over the past year.

Harold L. Paz, senior vice president for health affairs, dean of Penn State College of Medicine and Medical Center chief executive officer, today announced the College of Medicine experienced a 14 percent increase in medical school applications this year with more than 6,800 applicants for the 145 available openings for the college’s class of 2011. In the previous year, the College received nearly 6,000 applicants for the same number of available seats. Nationally, one in six applicants to medical school applies to Penn State College of Medicine.

“The continued and growing interest of aspiring doctors in our College of Medicine is tremendous, but it is only part of the story,” said Paz. “Our ability to see an increase in applicants, while maintaining excellence in the overall applicant pool, speaks volumes about the quality of our programs and quality of the students we are attracting.”

The standard grade point average (GPA) for Penn State College of Medicine applicants in 2006 was 3.66, while the GPA for applicants this year was 3.68. The average score for the Medical College Applicant Test (MCAT), the medical school entrance exam, for 2006 applicants to the College of Medicine was 28.81. This year, the average MCAT score was 30.07.

In May, the College of Medicine graduated its largest-ever class of students. The college awarded 127 doctor of medicine (M.D.) degrees. Another 43 students earned master of science (M.S.) and doctor of philosophy (Ph.D.) degrees, bringing the total number of graduates to 170. The class included Hoda Bostani, a 21-year-old M.D. recipient who became the youngest graduate in the college’s history.

In March, the college’s fourth-year medical students participated in the National Residency Match Program, a private, not-for-profit corporation established in 1952, to coordinate the “matching” of graduating medical school students with accredited residency programs. Approximately 16,000 U.S. medical school students participated in the residency match this year, with an average of 90 percent of students matching into residencies. The organization’s match rate, 96 percent, was higher than the national average and was the highest match rate in the organization’s history. The Medical Center also enjoyed success in retaining aspiring doctors. More than one-third (35 percent) of College of Medicine medical graduates chose to stay in Pennsylvania to complete their residencies, while 20 percent matched into residency programs at Penn State Hershey Medical Center.

“It is rewarding to see that many of our graduates chose to stay in Pennsylvania, because it means we are helping to meet a growing need,” said Paz. “As Pennsylvania’s population continues to grow older, many of our current doctors are approaching retirement age. To meet the future health care needs of our Commonwealth, we must ensure that we are producing a new generation of doctors to fill the void. At Penn State, it is clear we are fulfilling that obligation through our increased class size, the continued quality of our students and our success in retaining aspiring physicians.”

Paz points out, however, that student debt is an ongoing challenge for many medical students, with 63 percent of all medical school graduates facing individual student debt of $150,000 or more. The average debt for Penn State College of Medicine graduates is more than $140,000.

“We must do all we can to prevent medical school from becoming an option for only the wealthiest of students,” said Paz. “If we are to meet future health-care needs, we also cannot risk having students choose more lucrative specialties over areas of need such as family medicine simply because of a need to pay off substantial student loans.”

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For couples struggling to conceive a child, news of becoming pregnant with multiples following infertility treatment is often cause for celebration. Some even wish for it.

“I hear that frequently: ‘I want twins. I don’t want to pay for this again.’ The two-birds-with-one-stone thing,” says Dr. Robert Stillman, medical director of Shady Grove Fertility Center in Washington, D.C., and a clinical professor of obstetrics and gynecology at Georgetown University School of Medicine. “They see twins in a stroller at Starbucks and think, ‘I’ve been at this for four years. Why not just do this two at a time?’”

But the truth is that having multiples — even twins — comes with significant health risks, and the cost of their care can be staggering.

“For the mother, there’s an increased chance of gestational diabetes, which increases risk for diabetes later in life too,” explains Stillman. “And there are risks for hypertension, stroke and preeclampsia,” a potentially life-threatening condition in which blood pressure spikes in pregnancy.

Then there are all the many risks to developing fetuses — ones that can have lifelong consequences. “The biggest one is prematurity,” Stillman says. From that, a number of devastating problems can follow: cerebral palsy, blindness, bowel problems, learning disabilities, even malnutrition from sharing resources in utero.

All of these risks grow tremendously when a woman is having triplets or more: Where the preterm birth rate in twins is 50 percent, it’s 90 percent with triplets, most of whom will face complications requiring stays in a neonatal intensive care unit. Some may not make it: A twin is seven times as likely — and a triplet is more than 20 times as likely — as a singleton baby to die in the first month of life, according to the American Society for Reproductive Medicine (ASRM).

Recent reports of sextuplets in Arizona and Minnesota make poignantly clear just how great the risks can be: Jenny Masche, who delivered three boys and three girls earlier this month in Phoenix, experienced heart failure shortly after delivering, though she is now stable. Brianna Morrison of Minnesota delivered four boys and two girls at 22 weeks’ gestation, but three of the boys have died and the remaining three babies are in critical condition.

Fertility experts are so concerned about these health threats that they’re taking new steps to reduce the risk for multiples, especially for couples opting for in vitro fertilization (IVF). As recently as the mid-’90s, doctors were commonly transferring three or four embryos from the lab into a woman’s uterus in the hopes that at least one would grow into a healthy pregnancy. But as assisted reproductive technology (ART) has improved, the number of embryos that implant into the uterus and become a fetus has climbed — resulting in more multiples.

So last October, the still-worrying numbers of twin, triplet and higher pregnancies led the ASRM to recommend that doctors set tighter limits: put just one to two embryos in a patient under age 35; two to three in a woman ages 35 to 37; two to four in a woman 38 to 40; and three to five in a woman over 40.

A single shot at conception?
Not surprisingly, though, this approach isn’t without controversy. When a doctor puts fewer embryos into a woman’s uterus she’ll obviously have fewer babies — and be more likely to have just one. But it can also mean that she won’t conceive at all.
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Waves and sharks aren’t the only dangers at the beach. More than two dozen young people have been killed over the last decade when sand holes collapsed on them.

That’s according to a report by father-and-son doctors who have made warning of the risk their personal campaign.

According to a letter from the doctors published in this week’s issue of The New England Journal of Medicine at least 20 children and young adults in the United States have died in beach or backyard sand submersions since 1985. And at least eight others died in Australia, New Zealand and the United Kingdom.

The report’s lead author Dr. Bradley Maron of Harvard Medical School says sand hole collapses occur horrifyingly fast.

People naturally worry about splashier threats, such as shark attacks. However, the Marons’ research found there were 16 sand hole or tunnel deaths in the U-S from 1990-though-2006 compared with 12 fatal shark for the same period.
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Most patients want a personal relationship with their doctor, evidenced through simple actions such as shaking hands and having the doctor greet them by their first name, a new study finds.

“The first few moments of a medical encounter are critical to establishing a rapport, making the patient feel comfortable and setting the tone of the interview,” wrote a team at Northwestern University Feinberg School of Medicine in Chicago.

They surveyed 415 adults about their expectations and preferences for being greeted by doctors and found:

* Just over 78 percent wanted doctors to shake their hands, while about 18 percent did not.
* More than half (50.4 percent) wanted their first names used during greetings, about 17 percent preferred their last name was used, and nearly a quarter (23.6 percent) wanted doctors to use both their first and last names.
* Just over 56 percent of patients wanted doctors to introduce themselves using first and last names, 32.5 percent wanted doctors to use their last name, and about 7 percent wanted doctors to use their first name.

The researchers also videotaped 123 new patient visits with 19 different doctors. They found that:

* Doctors and patients shook hands about 83 percent of the time.
* In 50.4 percent of visits, doctors did not mention patients’ names at all.
* Doctors used their first and last names when introducing themselves in 58.5 percent of the meetings, and did not introduce themselves at all in about 11 percent of the visits.

“Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior,” the study authors wrote. “Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patient’s first and last names and introduce themselves using their own first and last names.”

The study is published in the June 11 issue of the journal Archives of Internal Medicine.

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Hospital’s ’scribes’ help them focus more on patients, less on paperwork

Doctors struggling to keep pace with the growing volume of patients who pass through Tri-City Medical Center’s emergency room are getting help from an unlikely source: college students.

Emergency room scribe Jackie McDonald (right) took notes and recorded orders for Dr. Neil Joebchen as he examined Christine Greathouse at Tri-City Medical Center in Oceanside. The hospital employs 28 scribes.
The Oceanside hospital has hired undergraduate pre-med students and recent graduates as “scribes” to document physician notes and orders in the emergency room – work that doctors usually do themselves.

That change gives doctors at one of the busiest emergency rooms in San Diego County more time to spend with their patients and provides the students with real-world medical experience they normally wouldn’t get until later in medical school.

“It helps doctors stay on task and on track,” said Dr. Cary Mells, chairman of Tri-City’s emergency medicine department.

Lauren Davie, a University of California San Diego graduate who plans to start medical school in the fall, jumped at the chance to work as a scribe at Tri-City. The 23-year-old Oceanside native had previously worked as a volunteer in emergency rooms, but most of her time was spent helping nurses shuffle papers.

As a scribe, Davie works side by side with doctors as they examine patients, review laboratory results and decide on a course of treatment.

“This is so much hands-on,” she said. “You get to know the doctors on a personal level. You get a feel for what it’s like being a physician. It’s a great way to figure out if this is really what you want to do.”

Some hospitals have been using scribes in emergency rooms for years, but Tri-City became the first to employ them in San Diego County when the North County hospital launched the program in late February.

While figures weren’t available on how many of the nation’s 4,000 emergency rooms currently use scribes, Dr. Brian Keaton, who heads the American College of Emergency Physicians, said the number is small. “I know of only a handful of people using scribes across the country,” he said.

Keaton likes the idea of using pre-med students to do the work.

“It’s something that contributes to patient care and . . . to (the scribe’s) education. Anything we can do that allows me to be more effective as a clinician, those are good things,” he said.

Scribing, an ancient profession, dates back at least 4,000 years to the age of Egyptian pharaohs, hieroglyphics and papyrus scrolls. Scribes have been used by kings, merchants, churches and cities to record historic events, business transactions and judicial decisions.

Over time, scribes morphed into accountants, historians, journalists and lawyers. But the vocation also has endured in its more basic form in jobs such as court reporting.

The 28 scribes who work at Tri-City are employed through ScribeAmerica, a medical labor service based in Lancaster. Before they start work, each scribe completes a two-week training course to learn medical terminology, become familiar with emergency room computers and practice taking physician notes, said Sarah Esquibel, chief operating officer of ScribeAmerica.

The scribes work shifts of eight to nine hours – about the same as doctors – and their pay starts at $10 an hour, Esquibel said.

That’s in line with the $9 to $13 average hourly wage that inexperienced nursing aides, orderlies and attendants earn in the county, according to the San Diego Workforce Partnership’s 2007 Occupational Outlook Report.

Scribes shadow doctors wherever they go in the emergency room, using wireless tablet computers to record information spoken by the physicians. The tablets are part of the hospital’s electronic medical records system that lets doctors and nurses access many patient records on computers anywhere in the hospital at the click of a mouse.

Scribes can record information by tapping the tablet’s touch-sensitive screen, by writing longhand with a light pen or by plugging the pad into a portable keyboard.

The scribes also help doctors keep track of patients as they move through the hospital, letting them know when laboratory tests have been completed or X-rays arrive.

It helps for scribes to have aggressive personalities and thick skin, especially when it comes to dealing with doctors with big egos and demanding personalities, Esquibel said.
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