Blog 24: Last Presentation Reflection

(1) Positive Statement

What are you most proud of in your block presentation and/or your senior project? Why?


My activity went by really well. I'm very happy that the audience was very much into the activity I had created and I'm so thankful that Mr. Pang said that it was one of the best he's seen in a long time. I was honestly surprised at how much fun everyone seemed to be having throughout the game.


(2) Questions to Consider

a.     What assessment would you give yourself on your block presentation?  Use the component contract to defend that assessment.

I think I should get an AE for this presentation because I made sure to include what's required for the presentation and I also had a plethora of props and tools that directly correlate to my topic. I made sure to reference sources and my mentorship throughout my presentation and show where I got my information from. I had a lot of fun presenting and I'm thankful that my audience was very responsive (aka laughed at my jokes). I warmed up as the presentation went along and there was a lot of information I had to run through, so I'm so glad it turned out well in the end.

b.     What assessment would you give yourself on your overall senior project? Use the component contract to defend that assessment.

I think I should get an AE for the project this year. I've done all my assignments and I put a lot of work into making sure my other presentations throughout the year were the best I could produce. I spent a lot of time going out and talking to experts in the field of anesthesiology. I wanted to gain insight from several different angles of the topic, so I interviewed several people, shadowed at different hospitals, and looked at other sources (books, articles, journals, videos, documentaries, etc.)

(3) What worked for you in your senior project?

What worked for me was my access to experts in anesthesiology. I was lucky enough to find a mentor that let me see such a wide view of what the job entails and I'm so thankful for that experience. I was able to even talk to patients and see the entire process for each procedure in a day. My mentorship was definitely a key factor that helped me narrow down my project.

(4) (What didn't work) If you had a time machine, what would you have done differently to improve your senior project?

Even though I was lucky enough to have access to experts like my mentor, I was held back by the fact that I have to be 18 years old to legally shadow under some doctors that I wanted to follow throughout the day. I wanted to follow a couple doctors in the hospitals that they worked in, but because I'm not of legal age yet, I had to pass the opportunity. 

Another problem I came across was HIPAA laws, so basically the doctor-patient confidentiality laws.With each patient, I had to ask if I could be present for their procedure and I had to ask if I could take pictures during their procedure. I was lucky enough to be allowed to do so, but it was still something I always had to keep in mind whenever I went to mentorship.

(5) Finding Value

How has the senior project been helpful to you in your future endeavors?   Be specific and use examples.

I had always been influenced by my parents' jobs as doctors throughout my life. I had been thinking about pursuing a career in medicine but I was very unsure. This senior project gave me that little push to put myself out there and learn from the experts. This really motivated me to pursue medicine (at least for now) and I had such a fun experience gaining more and more information. Whenever I would go to mentorship, I looked forward to watching cases and seeing how each procedure differed from the last. I found a lot of enjoyment (as morbid as this probably sounds) in seeing the surgeon cut open the patient and being able to see the patient still breathing (their chests would move up and down as they took breaths). The best part is being able to share these stories with others because it's an exciting feeling. I'm mostly thankful for the amazing experiences that I had throughout the year and I feel it was a sort of "leg up" for what I want to do in the future. 

Exit Interview

(1) What is your essential question, and what are your answers?  What is your best answer and why?

EQ: How can an anesthesiologist best ensure a patient's safety and comfort for surgery?

Answer 1: An anesthesiologist can best ensure a patient's safety and comfort for surgery by being well-versed on the drugs used for surgery to maintain body functions.

Answer 2: An anesthesiologist can best ensure a patient's safety and comfort for surgery by monitoring a patient's vital body functions through use and full knowledge of anesthesia machines.

Answer 3: An anesthesiologist can best ensure a patient's safety and comfort by reviewing the patient's history and background.

My best answer is my Answer 1, because drugs are a major part of an anesthesiologist's job. They can interpret readings from their machines and look through patient charts to plan for their anesthesia care, but without having drugs and knowing how to use them, they can't proceed with their task. They can determine if the patient is having trouble breathing or if the patient is uncomfortable with the help of monitors, but could do nothing to help that if they don't have the tools to help them.

(2) What process did you take to arrive at this answer?

Once I had narrowed down my 3 answers, I started asking the medical professionals that I interviewed what they thought. The response that stood out to me most was that of Dr. Imelda Murillo. She said that you can't call yourself an anesthesiologist if you don't know how to handle the drugs. There are so many drugs to understand and so many methods to use them depending on the individual patient. With other research, too, I have found that drugs are the key to anesthesia. A patient cannot be rendered unconscious without medication and cannot feel less pain without the aid of medication. Monitors are to show the effects of the drugs and the condition of the patient throughout, but the patient cannot be helped if not given a mixture of medications.

(3) What problems did you face?  How did you resolve them?

I had trouble narrowing down 3 answers, let alone a best answer. There are so many layers to the job of an anesthesiologist that summarizing them to concise wording proved difficult. However, what helped me the most were my mentorship experiences and interviews. This is why I decided to do extra mentorship hours for my IC 1 and shadowed under different anesthesiologists from other hospitals for my IC 2. I wanted to get a better idea of what anesthesiologists do. Just by watching them and talking to them I gained more insight than just reading articles that have the basics or generalize the job that they really do.

(4) What are the two most significant sources you used to answer your essential question and why?

My interview and shadowing experience with Dr. Zhuang T. Fang from UCLA was a major contributor to my findings. I was exposed to so much more than I had imagined and I was lucky enough to have help from someone that not only is an experienced anesthesiologist, but also a professor that teaches doctors how to specialize in anesthesiology. He helped me understand the more complex concepts and it definitely enhanced my project.

Other major resources I used were 2 books: Anesthesiology and Anesthesia Crash Course. Though simply titled, they both put seemingly confusing and overwhelming concepts into layman's terms. This helped me understand at least the basics as to the tools, machines, medications, and duties of an anesthesiologist and how they do it. In fact, Anesthesiology included a chapter that talked about Mallampati Classification, which I had used for my hook activity.

Blog 22: Independent Component 2

LITERAL
(a)“I,  Julianne General, affirm that I completed my independent component which represents 30 hours of work.”
(b) Cite your source regarding who or what article or book helped you complete the independent component.

For this independent component, I shadowed under 3 different anesthesiologists to gain more insight into how other anesthesiologists work aside from my mentor. I followed Dr. Zhuang T. Fang (from UCLA Stein Eye Center), Dr. Park (another doctor from Desert Valley Medical Center), and Dr. Lorna Wood (from Montclair Medical Center).

(c) Update your Independent Component 2 Log (which should be under your Senior Project Hours link)

(d) Explain what you completed.   

For each of the 3 doctors, I shadowed for at least 10 hours over the course of different days. And each doctor specialized in different aspects. For example, Dr. Zhuang T. Fang from UCLA is an attending for anesthesia residents and he specializes in anesthesia for eye surgeries. When I was with Dr. Park, I got to see a lot of urological surgeries (most patients have kidney stones). And when I was with Dr. Lorna Wood, I got to see a lot of OB cases, so they were epidural placements and deliveries.
 
(e) Defend your work and explain the component's significance and how it demonstrates 30 hours of work.   Provide evidence (photos, transcript, art work, videos, etc) of the 30 hours of work.   

Because my essential question asks about how an anesthesiologist is able to ensure the safety and comfort of their patients, I didn't want to just see how one person does their job. My mentor is very experienced and has helped me so much along the way, but people do a lot of things differently. I thought that by exploring other areas that anesthesiologists are also involved in, it could help better support the answers I could come up with for my EQ. So, I spent days with 3 different anesthesiologists to see different aspects of the job.

Here are some photos I've taken:

UCLA Stein Eye Center (I was with Dr. Zhuang T. Fang)

(This is the fancy sign at the front of the building)

(This is the entrance to the beautiful new building. It was so fancy!!)

(This is the observation room adjacent to OR 1. I had to go down a crazy flight of stairs from the main entrance to get here and they had a fancy machine that gives you scrubs.)

(This was my view of the operating room before one of the surgeries started.)

(Unfortunately, due to HIPAA laws, I was not allowed to take photos of the patients having surgery, but I was able to sneak some photos while the lights were off. You can sort of see the screen of a person's eye while getting cataract surgery.)

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Montclair Medical Center (I was with Dr. Lorna Wood)

(This is one of the hallways in the OR dept.)

(This is one of the supply rooms stocked with a bunch of medical supplies.)

(This is Dr. Lorna Wood showing a breathing mask.)

(Dr. Wood is checking the schedule for the day's surgeries.)

(These are more supplies that stock the OR. There was a lot of stuff there.)

(This is me standing next to a baby warmer/incubator for c-sections.)

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Desert Valley Medical Center (I was with Dr. Park)

(This is one of the operating rooms with a Da Vinci machine on the left.)

(I got to help set up the operating table for one of the cases that day.)

(This is me while we waited for the patient to be brought down from the patient floors.)

(This is known as a glidescope. It's a fancy version of a regular laryngoscope blade because it has a camera and light.)

(This is a propofol infusion pump.)

(This is me in the waiting room after a long day.)

(f)How did the component help you answer your EQ? Please include specific examples to illustrate how it helped. 

This component helped me see the different sides of anesthesia that I had not known much about. Because my mentor works mostly on "bread and butter" surgeries. I wanted to experience how the principles that my mentor had taught me applied to other aspects of the job of an anesthesiologist. And in watching these 3 other doctors, I had such a great experience learning from them and getting to see how the job is done.

For example, one thing that Dr. Park said to me that has stuck to me was about how he thinks of putting a patient under anesthesia. He said it's sort of like flying a plane. You start out by putting them under anesthesia slowly until they're completely out and you keep them at that "altitude" throughout surgery. Once you know surgery is about to be done (in his analogy, once you're arriving at your destination), you can start to slowly wake up the patient. It's funny because I remember that as he was telling me this, as if his timing was so perfect, the patient started responding and waking up from a surgery that had just finished.

Another example is my experience going to UCLA. Being that Dr. Fang is a professor, he was very knowledgeable and explained whatever he was doing throughout the day. He allowed me to follow him as he checked on his patients before surgery and there were a lot of anesthesia residents roaming around the facility as well. Dr. Fang even gave me some of his published works regarding anesthesia that I was able to use as resources. One of those that I found very fascinating was his mixture of drugs that he uses when he puts his patients under Monitored Anesthesia Care (MAC). I guess I hadn't thought much about putting the drugs all in one large syringe, as I had only seen drugs laid out individually in small syringes prior to visiting. It was this experience that really helped me form my answer 1 because I saw him use this mixture on many of his patients. I saw how it affected them and to see their satisfaction in the end seemed very rewarding for Dr. Fang. I could tell that he really cared about his doctor-patient relationship. He even told me that he still keeps in great contact with a few of his patients and he would email them to see how they're doing.

Dr. Lorna Wood also talked about this aspect with me a lot. She explained to me why she loves doing what she's doing (and also warned me not to go into medicine if you just want the good pay). She told me about her struggle of coming to America from the Philippines and having to retake tests to certify that she can practice in the United States. She said that it's very important to care about your patients because you won't enjoy your job otherwise. And despite the hard work she has to do every day, she told me it's all worth it in the end if she can help bring someone into the world or save someone's life. When I asked her my essential question and her thoughts on it, she ensured that I also mention the importance of the doctor-patient bond and trust that has to be developed in the minutes that anesthesiologists have before a surgery. Ensuring a patient's safety and comfort can't come if the doctor doesn't first care about their patients. And this brought about a different perspective to my project that I hadn't really thought about before, so for that I'm very grateful that Dr. Wood was able to share that with me.

Blog 17 - Interview 4 Reflection

Interview Audio

1. What is the most important thing I learned from the interview? 

This interview helped me focus on what my best answer is for my Essential Question. It helped me fully define what my best answer will be for my final presentation. I made sure to ask questions that related to my 3 answers and this interview provided support for the answer I was leaning towards before the interview.

2.  How will what I learned affect my final lesson?

As stated, this interview gave me further support for what I had been thinking of to be my best answer to my Essential Question. I had narrowed it down to 3 topics and of the three, Dr. Murillo helped me focus on the aspect of the drugs used during surgery. There are a number of quotes from this interview that I will definitely consider using for my presentation.

Fourth Interview Questions

1.  Who do you plan to interview?  What is this person's area of expertise?

I plan to interview my mom, who is an anesthesiologist with over 20 years of experience, or Dr. Edgar Guerero, who has also been an anesthesiologist for 20+ years.

2.  Post 20 open-ended questions you want to ask an expert in the field concerning your senior project. Your focus should be finding answers to your EQ.

1. What do you enjoy most about your job?
2. What do you dislike about your job?
3. What are the most common surgeries you help with?
4. How often would you say complications arise while working?
5. What are typically the most difficult patients to care for? Why?
6. What has been the most difficult aspect of anesthesia to learn?
7. What drugs do you use most often?
8. How often do new drugs replace older ones?
9. How important would you say the medications in a procedure are?
10. What are the main monitors you use? What are they for?
11. To you, what are the most important monitors?
12. What key factors do you pay attention to when creating your plan for anesthesia for each patient?
13. On average, how do patients with an alcoholic history react to anesthesia? drug users? smokers?
14. How important is it to know about the patient's history and background?
15. How do you go about not knowing a patient's full history and background in the state of emergency?
16. What are a few memorable patients that you can recall?
17. Being that anesthesiologist do not get to spend as much time with patients as other doctors, how do you establish a great doctor-patient relationship within the short span of time before surgery?
18. What do you believe is the main duty of an anesthesiologist?
19. Which of these three do you believe is the best way an anesthesiologist can ensure a patient's safety and comfort for surgery: knowing your drugs, monitoring the patient, or knowing patient history and background? Why?
20. What advice would you give someone, like myself, who is considering becoming an anesthesiologist in the future?

Blog 19: Third Answer

• EQ 
• How can an anesthesiologist best ensure a patient's safety and comfort for surgery?
• Answer #3 (Write in a complete sentence like a thesis statement)*
• An anesthesiologist can best ensure a patient's safety and comfort by reviewing the patient's history and background.
• 3 details to support the answer
• Knowing if the patient is a drug addict, smoker, or alcoholic is crucial to the anesthetic procedure because they need special care.
• Knowing if the patient has had previous surgeries can give the anesthesiologist an idea of how the patient reacts to certain drugs.
• Being well-informed of the patient's allergies before surgery is important.
• Receiving a detailed list of all medications the patient takes regularly is important.
• The research source(s) to support your details and answer
• *Best Source* 52a) Newhouse, Beverly J., MD. Anesthesia Perioperative Evaluation Syllabus. 2005. WHAT IS THE PURPOSE OF THE ANESTHESIA PR WHAT IS THE PURPOSE OF THE ANESTHESIA PREOPERATIVE EVALUATIONEOPERATIVE EVALUATION. University of California, San Diego, San Diego. <http://anesthesia.ucsd.edu/som/anesthesia/education/residency-program/curriculum/Documents/Preopsyllabus.pdf>
• 3a) Glidden, Randall S. "Perioperative Anesthetic Management." Anesthesiology. Pages 9-26. Baltimore: Lippincott Williams & Wilkins, 2003. Print.
• 30) Novak, MD, Richard. "WHY DOES ANYONE DECIDE THEY WANT TO BECOME AN ANESTHESIOLOGIST?" Wordpress. Wordpress.com, 11 Sept. 2013. Web. 30 Oct. 2015. <http://theanesthesiaconsultant.com/2013/09/11/why-does-anyone-decide-they-want-to-become-an-anesthesilogist/>.
• 39) "Anesthesia Options, Risks, and Side Effects." Johns Hopkins Medicine. Johns Hopkins. Web. 22 Jan. 2016. <http://www.hopkinsmedicine.org/howard_county_general_hospital/services/surgery/anesthesiology.html/anesthesia_options_risks_and_side_effects.html>
• 45) Mayo Clinic Staff. "General Anesthesia: What You Can Expect." Mayo Clinic. Mayo Clinic. Web. 11 Feb. 2016. <http://www.mayoclinic.org/tests-procedures/anesthesia/details/what-you-can-expect/rec-20163594>.
• Concluding Sentence
• It is crucial for an anesthesiologist to know a patient's history and background, because some patient require special care, such as more drugs during surgery in order to keep the patient safe.

Blog 18: Answer 2

1.  What is your EQ?

How does an anesthesiologist best ensure a patient's safety and comfort for surgery?

2.  What is your first answer? (In complete thesis statement format)

An anesthesiologist can best ensure a patient's safety and comfort for surgery by being well-versed on the drugs used for surgery to maintain body functions.

3.  What is your second answer? (In complete thesis statement format)

An anesthesiologist can best ensure a patient's safety and comfort for surgery by monitoring a patient's vital body functions through use and full knowledge of anesthesia machines.

4.  List three reasons your answer is true with a real-world application for each.

Answer 1:

• Knowing the drugs and what they do
• Anesthesiologists have to be experts in pharmacology. There are a wide range of drugs that anesthesiologists use to maintain a patient's body functions. For example, in order to render a patient unconscious, they use a sedative, like Propofol. To paralyze the muscles, they use a muscle relaxant, and a reversal drug as well. They use a large selection of narcotics to rid of pain before, during, and after surgery. Additionally, these medications have side effects, such as raising and lowering blood pressure. There are drugs to combat this as well.
• Making a patient comfortable through use of drugs
• Throughout the process of undergoing surgery, patients are often experience anxiety or fear. With the aid of drugs, anesthesiologists can ensure that patients will be relaxed before even entering the operating room. For example, Midazolam is a drug that is given before surgery to calm a patient. It also causes temporary amnesia, making the patient not remember anything that happens in the operating room.
• Labeling of syringes
• Anesthesiologists are sure to label their syringes for sake of patient safety. There have been studies showing that the labeling of syringes has greatly improved patient care, as it is less likely for there to be a faulty drug given to the patient. Most medications are clear fluids, so labeling them is a key factor to patient safety. Drugs are categorized by type, like narcotics are colored a light blue, hypnotic drugs are yellow, muscle relaxants are bright red, etc.

Answer 2:

• Wide array of machines
• There is a wide array of machinery that is used during surgery for monitoring the main body functions of a patient. For example, heart rate, blood pressure, oxygen level, CO2 level, other gas levels, and even brain waves are all monitored. Each monitor gives readings that cannot be observed otherwise. Additionally, new and improved technologies are produced every year with more technologically advanced machinery. In fact, my mentor has told me that anesthesiology is one of the fastest improving medical field in patient safety.
• Provides a warning before things go wrong
• In turn, with advanced machinery screening a patient throughout a surgery, this increases a patient's safety. Simply having all the equipment is not enough. Anesthesiologists have to be diligent and pay attention to the monitor readings. By watching the monitors, anesthesiologists can tell beforehand if a muscle relaxant is starting to wear off or if a patient is having trouble breathing.
• Recording monitor readings throughout surgery
• Every surgery I've observed, I have seen the anesthesiologist record important monitor readings at certain time intervals throughout procedures. This is not only to show that the anesthesiologist was paying attention to monitors during surgery, but also to show that the patient was comfortable. The monitors would show if the patient was not able to breath or was in an unstable condition. Thus, keeping record of how the patient was doing as the procedure progresses can have an effect on safety and overall comfort.

5.  What printed source best supports your answer?

Sources located in Working Bibliography

Answer 1: Sources 37b

Horton, Charles. "Better Living Through Chemistry." Chapter. Anesthesia Crash Course. New York: Oxford UP, 2009. 27-45. Print.

Answer 2: Sources 21

Subrahmanyam, M., and S. Mohan. "Safety Features in Anaesthesia Machine." Indian Journal of Anaesthesia. Medknow Publications & Media Pvt Ltd, 1 Oct. 2013. Web. 21 Oct. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821264/>

6.  What other source supports your answer?

Sources located in Working Bibliography

Answer 1: Sources 3b, 8, 15, 33, 36, 37b, 42
Answer 2: Sources 1, 21, 24, 37a, 46

7.  Tie this together with a  concluding thought.

With anesthesiology being one of the fastest improving medical fields, safety and comfort are the main focus. Every year, there are better, more advanced machines and techniques that are discovered. But the main ways in which anesthesiologists ensure that their patients are safe and comfortable are through monitoring of machines and being well-versed in the medications used in surgery. I have seen these methods used many times while at mentorship. Implementing these factors plays a role in possibly saving a person's life.