One typically thinks of a high school science project as something involving frog dissection or baking soda and volcanoes. Less often do you see high school students presenting posters on communication between medical residents and patients who leave the hospital against medical advice. But the Training Early Achievers for Careers in Health Program, or TEACH, prepares students for a future in medicine and research with the real, undiluted deal, a summer studying an important aspect of hospital operations.
Since 2004, more than 70 students from the University of Chicago Collegiate Scholars Program have willingly traded a significant portion of their summer break to assist on a TEACH project. Groups of high school students are connected with an UChicago undergraduate, a student from the Pritzker School of Medicine, and a faculty advisor to tackle a research topic. At the end of the summer, those research projects are presented by the high schoolers in a poster session attended by physicians and social scientists.
This year’s session, held in early August, grouped the students into four research “teams”: Team Sleep, Team ESM Pain, Team AMA, and Team Handoffs. But this was no summer camp three-legged race; their posters covered topics that appear frequently in the highest-profile medical journals and conferences.
Tenika Walker, working with undergraduate student Arshiya Fazal, presented on the effects of hospital sleep – or lack thereof – on the blood pressure of inpatients. With the noisy overnight environment of the hospital ward and occasional late-night and early-morning tests, patients in the hospital slept an average of 2 hours less each night compared to at home. The sleep loss led to more than just baggy eyes, as the study found that 10 percent less sleep raised blood pressure by an average of roughly 3 mm/Hg.
“The hospital is supposed to be a place of healing, but unfortunately sometimes it’s not,” Walker said. “In the future, we hope to inspire hospitals to consider patient’s sleep.”
Where patients may benefit from fewer interruptions during the night, another poster focused on the frequency of contact with physicians, nurses, and other staff members during the daytime. To do so, they used an “experience sampling method,” a method of measuring a patient’s experience in the hospital. Throughout the day, researchers William Bernstein, Zikra Mohideen, Andres Nicodemus, and Ethalle Thompson would stop by patients’ rooms and ask who was with them. They found that the most frequent visitors were family members, with nurses close behind and physicians a rare sighting (though the students suggested the timing of their sample may have missed early-morning doctor rounds).
Physician-to-physician communication is just as important as physician-to-patient communication, and another poster focused on the errors that can occur in the first dialogue. The effectiveness of patient hand-offs – the exchange of information between physicians going off and on a shift – were tracked with a worksheet that tallied the number of interruptions experienced during this important process, producing data analyzed by three students. They found that interruptions (side conversations, pages, people entering the room) were rampant: at least one occurred in every hand-off observed. The worksheet could serve as both a tool for further research and a self-assessment for physicians to see just how often their hand-offs are disrupted, the researchers said.
“If it became more widespread, it could be used in other handoffs to see how listening behaviors are turning out,” said Carina Oceguera, who presented the poster with Kashif Osmani and Roman Tamas.
The fourth poster studied AMA – not the American Medical Association, but Against Medical Advice, when a patient decides to leave the hospital against a physician’s wishes. Often, doctors will warn such patients that their insurance company will not pay for their visit if they leave AMA. But researchers Pooja Agarwal, Paul Calhoun, and Audrey Rowe reviewed the records of hundreds of patients between 2001 and 2009 and found that none of them were charged by their insurance companies for leaving AMA, despite widespread belief among physicians.
“68 percent of residents believe that this happens, when it actually never has happened in the past decade,” Rowe said.
The high school students came out of their projects with undiminished interest in medical research and education, albeit with a long path still ahead of them. One of their undergraduate mentors, Jose Jimenez, could offer some perspective, as a TEACH alumnus who is now a UChicago pre-med student. Inspired by his father’s heart transplant, Jimenez said he is interested in eventually practicing cardiology, though he recognizes that a lot of work lay between now and then. Still, he said the TEACH program had given – and, in his new role as advisor, was still providing him – with important experience.
“At first, it was weird being an advisor, because it was like looking at me three years ago,” Jimenez said. “But the students look up to us, and we build special bonds.”
Photos by David Christopher