PHAROS of ALPHA OMEGA ALPHA HONOR MEDICAL SOCIETY Winter 2009 the PHAROS of Alpha Omega Alpha Honor Medical Society Winter 2009
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THE PHAROS OF ALPHA OMEGA ALPHA HONOR MEDICAL SOCIETY Winter 2009 THE PHAROS of Alpha Omega Alpha honor medical society Winter 2009 ´"YJP7XKFMF ´ ˆJOUPV7` BMHP´ VOUB7ˆ Alpha Omega Alpha Honor Medical Society “Worthy to Serve the Suffering” Founded by William W. Root in 1902 Officers and Directors at Large Editor: Edward D. Harris, Jr., MD Rae-Ellen W. Kavey, MD Editor Emeritus: Robert J. Glaser, MD President Associate Editor and Managing Editor Bethesda, Maryland (in memoriam) Edward D. Harris, Jr., MD Helen H. Glaser, MD Executive Secretary Menlo Park, California Managing Editor Art Director and Illustrator Donald E. Wilson, MD Debra M. Lancaster Jim M’Guinness Vice President Baltimore, Maryland Administrator Designer Ann Hill Erica Aitken C. Bruce Alexander, MD Secretary-Treasurer Birmingham, Alabama Robert G. Atnip, MD Editorial Board Hersey, Pennsylvania N. Joseph Espat, MD Jeremiah A. Barondess, MD Lawrence L. Faltz, MD Eric Pfeiffer, MD Providence, Rhode Island New York, New York Sleepy Hollow, New York Tampa, Florida David A. Bennahum, MD Faith T. Fitzgerald, MD Richard C. Reynolds, MD Ruth-Marie Fincher, MD Albuquerque, New Mexico Sacramento, California Gainesville, Florida Augusta, Georgia John A. Benson, Jr., MD Daniel Foster, MD William M. Rogoway, MD Douglas S. Paauw, MD Omaha, Nebraska Stanford, California Dallas, Texas Seattle, Washington Gert H. Brieger, MD James G. Gamble, MD, PhD Shaun V. Ruddy, MD Baltimore, Maryland Stanford, California Richmond, Virginia Don W. Powell, MD Richard Bronson, MD Dean G. Gianakos, MD Bonnie Salomon, MD Galveston, Texas Stony Brook, New York Lynchburg, Virginia Deerfield, Illinois John C.M. Brust, MD Jean D. Gray, MD John S. Sergent, MD Joseph W. Stubbs, MD New York, New York Halifax, Nova Scotia Nashville, Tennessee Albany, Georgia Audrey Shafer, MD Charles S. Bryan, MD David B. Hellmann, MD Medical Organization Director Columbia, South Carolina Baltimore, MD Stanford, California Marjorie S. Sirridge, MD Robert A. Chase, MD Pascal James Imperato, MD John Tooker, MD, MBA Kansas City, Missouri Stanford, California, and Brooklyn, New York American College of Physicians Jaffrey, New Hampshire Clement B. Sledge, MD Elizabeth B. Lamont, MD Marblehead, Massachussetts Henry M. Claman, MD Chicago, Illinois Councilor Directors Denver, Colorado Jan van Eys, Ph.D., MD Kenneth M. Ludmerer, MD Nashville, Tennessee Eric P. Gall, MD, MACP, MACR Fredric L. Coe, MD St. Louis, Missouri Chicago, Illinois Abraham Verghese, MD, DSc Chicago Medical School at Rosalind James B.D. Mark, MD (Hon.) Franklin University of Medicine Jack Coulehan, MD Stanford, California Stanford, California and Science Stony Brook, New York J.Joseph Marr , MD Steven A. Wartman, MD, PhD Chicago, Illinois Ralph Crawshaw, MD Broomfield, Colorado Washington, DC Portland, Oregon Stephen J. McPhee, MD Gerald Weissmann, MD Amy Goldberg, MD Peter E. Dans, MD San Francisco, California New York, New York Temple University School of Medicine Baltimore, Maryland Robert H. Moser, MD David Watts, MD Philadelphia, Pennsylvania Scott K. Epstein, MD Madera Reserve, Arizona Mill Valley, California Boston, Massachussetts Edmund D. Pellegrino, MD Anne Mancino, MD Washington, DC University of Arkansas School of Medicine Little Rock, Arkansas Student Directors Natalia Berry Dartmouth Medical School Manuscripts being prepared for The Pharos should be typed double-spaced, submitted in triplicate, and conform to the format outlined in the manuscript submission guidelines appearing on our website: www.alphaomegaalpha.org. They are also available Kara Maria Cavuoto from The Pharos office. Editorial material should be sent to Edward D. Harris, Jr., MD, Editor, The Pharos, 525 Middlefield Road, University of Miami Suite 130, Menlo Park, California 94025. Cason Pierce Requests for reprints of individual articles should be forwarded directly to the authors. University of Texas Southwestern Medical The Pharos of Alpha Omega Alpha Honor Medical Society (ISSN 0031-7179) is published quarterly by Alpha Omega Alpha Honor School Medical Society, 525 Middlefield Road, Suite 130, Menlo Park, California 94025, and printed by The Ovid Bell Press, Inc., Fulton, Missouri 65251. Periodicals postage paid at the post office at Menlo Park, California, and at additional mailing offices. Copyright Administrative Office © 2009, by Alpha Omega Alpha Honor Medical Society. The contents of The Pharos can only be reproduced with the written 525 Middlefield Road, Suite 130 permission of the editor. (ISSN 0031-7179) Menlo Park, California 94025 Circulation information: The Pharos is sent to all dues-paying members of Alpha Omega Alpha at no additional cost. All correspondence Telephone: (650) 329-0291 relating to circulation should be directed to Ms. Mara Celebi, Webmaster, 525 Middlefield Road, Suite 130, Menlo Park, California 94025. E-mail: Fax: (650) 329-1618 [email protected] E-mail: [email protected] POSTMASTER: Change service requested: Alpha Omega Alpha Honor Medical Society, Post Office Box 2147, Menlo Park, CA 94026. www.alphaomegaalpha.org Editorial The dreaded burnout David P. Hill Edward D. Harris, Jr., MD Two words: poverty and depression. They are personal What causes the despair that can lead to full depression disasters. Poverty is easier to recognize and treat than is de- and suicidal ideation or suicide among medical students? One pression. Recall the agonizing account of George Hurstwood study published in the Annals of Internal Medicine in in Theodore Dreiser’s novel, Sister Carrie, whose descent by Liselotte Dyrbe and her colleagues attempts to relate the from manager to tramp defines poverty with incisive detail. prevalence of suicidal ideation in medical students and its re- Alleviating poverty usually entails providing resources, such lationship to burnout, demographic characteristics, and qual- as money. Depression, in contrast, is a black hole separating ity of life.2 Using the evidence that suicidal ideation is a direct one from life. John le Carré, in A Most Wanted Man, describes precursor of a suicide attempt, they found a direct relationship the feelings of a man standing in the Ernst Barlach museum, between suicidality and burnout, and a strong dose-response viewing sculptures of mythic figures not easy to view: “each relationship between burnout and suicidal ideation during the figure was as alone as he was, and . each was communicat- subsequent year. ing something; but nobody was listening, each was searching But what is “burnout”? The investigators defined the do- for a solace that was not available.” That is depression. mains of burnout as: Do you remember your years as a medical student? Oh sure, t FNPUJPOBMFYIBVTUJPO there was stress—the oral exam in biochemistry, falling asleep t EFQFSTPOBMJ[BUJPO trying to really understand renal clearance, suffering the arro- t MPXTFOTFPGQFSTPOBMBDDPNQMJTINFOU gance of residents. But balancing and trumping those traumatic Within the group of students meeting the criteria for times were the camaraderie of your classmates, the pizza and burnout, twenty-seven percent were no longer burned out at beer that appeared late Friday afternoons, and the glimmering one year follow-up. They had recovered! This group of “recov- crescendo of certainty that when these trials were behind you, ereds” were less likely than students with “chronic burnout” a career in the most respected of professions would be yours. to report suicidal ideation in the subsequent year (. versus There was idealism, too, although cynicism eroded away much .). Burnout among medical students, then, can be revers- of what you had brought to medical school. ible! The authors make logical recommendations: Is it not confounding and perplexing, then, to read that . Require medical schools to have systems in place to among medical students, depression occurs in fifteen to thirty identify currently suicidal students percent, three times higher than the rate of depression in ei- . Identify students with burnout—those at high risk for ther the general population or in age-matched peers? What is suicidal ideation medical education doing wrong? Or does this imply a link of a . Implement “student support and wellness programs [to] depressive trait to aptitude for science and a caring nature? optimize the learning environment, the organization of clini- Heather Finlay-Morreale was, as you were, in a bedeviled cal rotations, and the diversity of clinical experiences.” 2p340 but balanced and accepting state of mind before her classmate, Could AΩA chapters help with these interventions? On Mike, in the first year of medical school, committed suicide. one hand, our students are not equipped to help with therapy This was not an impulsive act on his part in the midst of a self- of students with suicidal ideation, nor can we expect AΩA to limited crisis. He chose to die by carbon monoxide inhalation, have a significant impact upon curricular reform. What AΩA a method that requires step-by-step planning. Ms. Finlay- can do is to organize mentoring programs for fellow students. Morreale wrote about the impact of his death upon her in Mentoring is contact of one to another that is not teaching, her essay, “And then there were eight,” for which she received not therapy, not role modeling. It is taking the hand of and second prize in the AΩA Helen H. Glaser Student Essay guiding someone through the treacherous waters that the Competition. Her essay was published in the Winter mentor has already navigated successfully. AΩA is the national issue (pp.