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Zhuoran Yang, Shanghai Medical College Fudan University (China)

MEDI 465 – AI in Ward Medicine

MEDI 413 – Nephrology

Tell us about your elective rotation experience in MEDI 465 (AI in Ward Medicine)

This is the best rotation I have ever had. First of all, we take care of the patient by ourselves. You are accepting the patient in the Emergency Department, then write the History and Physical, then follow up and write their progress note every day. I think the most exciting part is talking to the patients and families on our bedside rounds. For an international medical student, I think the biggest challenge is conversation. On one hand you talk to your colleagues and on the other hand, you have to talk to your patient and their families. You have to think of how to use words and terms that they will understand. It’s important to interpret their reactions because of cultural differences. At first this was really a challenge for me. On my first and second day, I wasn’t familiar with the patient’s history and our plans. But I needed to update the plans, I felt confused and needed to explain to them why, that is the most difficult thing.

My attending Dr. Marucci and the senior Jared and two residents Brian and Dan are all very helpful. They are so supportive, so I don’t need to be stressed or nervous because they are very supportive. If I forget something, they will just complement what I didn’t add. I think the people here is another very fascinating thing about UNC. Everyone is so nice and so helpful. For my previous two electives, it was more you step back and watch what they are doing. For this one, I can have my own thoughts and plans and discuss with the team. So, I feel more involved with patient care.

I’m usually busy in the morning and the afternoons are another fascinating thing. Dr. Marucci will take one or two hours to teach myself and a UNC medical student. Every day we have a different topic to discuss. Dr. Marucci has a lot of things to share with us, usually it’s professional, medical, or about ethics. We also present a lecture every Thursday by ourselves. He will give us give us a topic and then we have 10 minutes to present. Medical students are very focused in this too. Everyone likes to share knowledge with us and likes to teach us. This is very good teaching atmosphere.

What were the differences in your two electives?

On the floor service, you have to take care of your patient. You take care of every problem, every system, and you get the big picture. Sometimes you just ask for help from the consult team so you don’t get to dig deep into those specific problem. However, on consult service, you have plenty of time to dig into one problem. For example, we were consulted for a hypernatremic patient after surgery. Generally speaking, we just treat it by letting the patient drink water. But Dr. Clay Block, who is a perfect teacher, asked us a question about the parental nutrition – how much protein they supplied the patient and how will these proteins transfer to the BUN and how will this increase the osmolality of the serum and how much will be excreted in the urine as the urea. These are examples of very detailed questions and you can look at the literature yourself. We had a lot of time to discuss those details. I’m quite interested in nephrology so I loved all this.

What was your favorite part about nephrology?

I think the kidney is a very interesting organ because every system can have an impact on it. It has a lot of interconnection with different systems. You feel like when you get consulted, you are not only a kidney doctor, you are also a physician who will take care of all of the systems and provide guidance on something else. I’m also interested in cardiology and the kidneys and cardio are connected to each other. For example, how to monitor the volume, to adjust your diuretics used, also most important when to start dialysis. We also have a lot experience in urine spin. It is a very direct way to see what is going on in the kidney. I think Kaavya and I became some kind of “expert” seeing the urine sediment. We got to go to the lab and spin urine by ourselves, this is something I would not do at home. There, the lab technicians do this so I have actually never seen the sediments before until I came here. Another thing is the biopsies, the pathology is very interesting. We had a pathology conference every Friday. This helped me understand what was going on in the native and transplant kidneys. I think transplant is something I seldom come into in China, we don’t have many transplanted patients.

Another interesting part is we have several consults from OBGYN. In my hospital in China, we don’t have an OBGYN department, they are an independent hospital. So we have no exposure to those hypertension or nephrology symptoms in the setting of pregnancy. The history collecting and physical examinations were very interesting. It almost feels like I did a small rotation in OBGYN.
The personalities of the nephrology fellows was very nice! They are super helpful and easy going, they are willing to tell you all they know. For the AI, you improve more in the history collecting and presenting on rounds because it’s your own patient. For consult, most of the history has already been collected by the primary care team. Now most of the job you have to do is to dig into the kidney problems and analyze those things that contribute to kidney dysfunction.