Tough (But Important) Conversations

What is it to Attend Johns Hopkins University School of Medicine?

Tough (But Important) Conversations | Johns Hopkins Medicine

The tutors behind Varsity Tutors come from a variety of impressive backgrounds and experiences—including medical school! In this inaugural installment of our new Medical School Experience Q&A series, Rachel, a Maryland tutor, shares her experience at Johns Hopkins University School of Medicine. 

Rachel is a second-year medical student who specializes in biology tutoring, MCAT Physical Sciences tutoring, SAT tutoring, and several other subjects. See what she had to say about Johns Hopkins University School of Medicine: 

Why did you decide to attend Johns Hopkins?

Rachel: I decided to attend the Johns Hopkins University School of Medicine for several reasons. It was located in an urban setting that would expose me to extraordinary patient diversity, it had premiere research facilities that would allow me to explore all of my interests, its curriculum included early clinical and patient exposure… the list goes on and on.

However, the main factor was the general environment and the atmosphere around the students.

Johns Hopkins University School of Medicine uses a pass/fail grading system for the first two years, which really eliminates any competitive tensions in the air.

My class is wonderfully collegial and collaborative—not to mention the diversity of personalities, experiences, and expertise that we have in one student body.

This is not to say that other schools do not have this.

I also considered Icahn School of Medicine at Mount Sinai, Northwestern University’s Feinberg School of Medicine, University of Michigan Medical School, Weill Cornell Medicine, and others.

They were all wonderful institutions that had many, if not all, of the things I listed above. In the end, Johns Hopkins University School of Medicine just felt right. 

Describe the application process

Rachel: The interviews were generally similar to one another. None of them particularly stood out as extremely difficult or strange. It depends more on who your individual interviewer is. Some you will click with, some you will not.

Either way is fine—the interview is designed to help admissions officers get to know you better in a more personal, multi-faceted way that your paper application does not necessarily express.

Multiple mini interviews (MMIs) might take some getting used to, but they really were not so difficult and not worth being intimidated over. In fact, my first interview was a MMI, and it went fine. 

I remember Duke University had some odd, very deep essay topics. Vanderbilt University had one of the longest, more ambiguous essays (a 1,200-word personal autobiography). Other than that, the essays for all schools were pretty similar, I would say.

I took the MCAT at the end of the summer between my sophomore and junior years. I did a month of intensive studying.

What medical specialty are you pursuing? What medical specialities is this school known for?

Rachel: I am uncertain about which specialty I am pursuing—I have only just completed my first year. I am leaning toward surgical specialties though.

My school is quite strong in most specialties, really. The one area that it might not be as strong in is primary care.

How would you describe your first two years of instruction? What research or hands-on experience did you gain?

Rachel: I have only finished one year so far. In regard to that year, however, I would say that it is an exercise in time management and balance.

It becomes really easy to get sucked into just studying, or just organizing your extracurricular activities. But you want to remember to take breaks and to take time for just you.

Mindfulness and wellness are more important than you initially realize.

At Johns Hopkins University School of Medicine, you begin learning clinical skills in the first week.

You learn how to conduct an interview, take a complete history, and conduct a complete physical exam for all systems in the first semester.

Starting second semester, you are assigned a practice/clinic (usually primary care) where you go once a week. There, you get hands-on, independent experience with patients.

Students usually complete a research project during their first (and only) summer. That is what I am currently doing. These projects do not necessarily have to be basic or even clinical. Some students do history of medicine or arts in medicine.

What are the instructors, laboratories, and libraries ?

Rachel: Our medical school building is newly constructed and very modern, open, and airy. Our anatomy labs are on the top floor, with plenty of windows and natural light, thus lacking the dungeon- feeling.

We also have “virtual labs”—rooms filled with new Mac computers with large monitors for viewing histology and pathology slides.

We also have a general computer room with similar technology, and a quiet study area with plenty of desks, windows, and lamps.

Library-wise, the libraries are physically located in other buildings. But our online library has practically everything you would ever need, and if there is anything in paper that you need, you can request to have it delivered to the medical school building.

Our instructors are all very available and committed to students. All lecturers are volunteers— they are not paid to give us lectures. Instead, there is an expectation and commitment to our education that is genuinely felt by the students. 

What support services does this school offer? Is there assistance for USMLE Steps I and II, as well as for residency matching?

Rachel: There is a Student Wellness Initiative group within the medical student body. For Johns Hopkins University students in general, JHSAP (Johns Hopkins Student Assistance Program) provides various counseling and support services for free. They will also refer to long-term mental health services (also for free).

The peer advising organization matches every first-year student to a second year. That peer advisor is a great resource for any struggles that you may experience. 

The Colleges Advisory Program assigns you to a faculty advisor from day one, as well as to a “molecule” of your peers.

You meet with your advisor individually on a regular basis, and he or she provides a lot of guidance regarding academics, social life, residencies, etc.

You also meet as an advising group (with your molecule) often, typically to learn new, potentially sensitive topics in medicine. 

Describe the work-life balance at Johns Hopkins

Rachel: Work-life balance is heavily emphasized at Johns Hopkins University School of Medicine, but it is up to you to execute it. The school gives you ample opportunity for it, from making lectures optional and giving you at least two afternoons off a week, to having a wealth of various wellness- or activities-based groups (i.e. sports, rock climbing, art, etc). 

However, I think work-life balance is ultimately decided individually. You have to make it a priority. As long as you do, maintaining it is easier.

What is the surrounding town ?

Rachel: Baltimore is a city with a reputation. Honestly, growing up in Maryland, I cannot really speak to what people outside of the area think of Baltimore.

For me, personally, Baltimore is pretty much what I expected. It is a city of neighborhoods. There are some great, unique, beautiful and fun areas, and there are some not-so-safe areas. Just all cities, you need to exercise common sense and appropriate vigilance when you are out and about. I do not feel that I am living any differently than other people living in other cities. 

In general, a majority of first years live in an apartment complex very close to class. Starting in second year, however, more people live in row homes nearby, or in other neighborhoods. It is pretty easy to find housing and roommates. There are also a lot of tools that the school offers to help with that. 

We tend to relax in young neighborhoods Fells Point and Mount Vernon, or Inner Harbor and Federal Hill. We will take the occasional trip to Washington, D.C. or New York City.

What is one piece of advice you would give to a student who is currently applying to Johns Hopkins? Perhaps one strategy that served you well, or one thing you wish you had known then

Rachel: One thing I would advise is to take the decision seriously. Medical school is amazing, but it is also difficult. If you are not going for the right reasons, or for external motivations—if you are not going for you—it is even more difficult. 

I said in other answers, remember work-life balance, even now. Remember that your own wellness should be one of your top priorities. It is not being selfish—you cannot be expected to take care of patients when you cannot take care of yourself.

It is a little hard to think about now, but speaking as someone who just completed her first year, medical school takes a lot of adjusting and adapting. It requires some settling in. You are losing a lot of the support system and routine you had in college, or at your previous job, and while you are also gaining new ones, it takes some time to adapt. 

Basically, I am saying to be ready for your boat to be rocked. Once you get your sea legs, though, medical school is an absolutely amazing experience.

Check out Rachel’s tutoring profile.

The views expressed in this article do not necessarily represent the views of Varsity Tutors.


Tough (But Important) Conversations

Tough (But Important) Conversations | Johns Hopkins Medicine

Linkedin Pinterest Aging Well Caregiving for a Senior Senior Centers and Assisted Living Aging and Relationships

Two thirds of Americans don’t have a living will or advance directiveoutlining their wishes for end-of-life care. Ninety percent of olderAmericans hope to stay in their own home as they age—yet one in fouralready has difficulty with everyday needs bathing, dressing andgetting around the house.

“Helping older relatives plan for the future means having important, yetsometimes difficult, talks,” says Johns Hopkins geriatric medicine expertAlicia Arbaje, M.D., M.P.H.“It’s not easy to talk about topics aging and illness and even dying,but having these conversations can give everyone peace of mind.” 

These steps can help you approach tough topics with older loved ones andstart a productive conversation.

Start early

“It’s easier to talk about issues advance directives or moving fromyour own home into a retirement community, assisted living or a nursinghome when you’re not in the middle of a crisis,” Arbaje says. “You’ll havemore options and more time to think, and be able to come to a betterdecision.”

Do your research

Learn about the subject before you bring it up. “If you’re going to discussadvance directives, check the organizationAging with Dignity’s Five Wishes websiteand material .

This program will help your loved one name a person to makehealth care decisions for them when they cannot and help them discuss theirwishes for medical treatment,” Arbaje says.

“Another good resource is theAmerican Geriatric Society’s website, which has a section on making end-of-life wishes known.”

Check into local housing options by talking with your county’s Office onAging.

One of the challenges faced by those who have been called to care is taking good care of themselves. Learn how to manage caregiver stress and take better care of yourself.

“Sitting your parent or another loved one down for the ‘big talk’ canbackfire. He or she may feel cornered or as if you’re telling them what todo,” Arbaje says. Instead, bring it up casually—and talk about how youfeel.

“You might talk about a neighbor who’s moved to a retirementcommunity or mention a news story about a living will,” she suggests. “Youmight say, ‘Mrs. Jones really s being around other people.’ Or ‘I justread an article about end-of-life care.

It sounds a good idea to tellpeople what you want.’” Invite your loved one to share thoughts andfeelings too.

Find out what matters to your loved one

“The older person needs to feel they’re in control—that they’re making thedecisions,” Arbaje says. “If you’re discussing a housing change, find outwhat’s important—is it saving money, staying near friends, bringing the catalong, being able to cook Sunday dinner? Knowing what matters will help youpresent options your loved one’s goals and values. This is truefor advance directives too.”

Try It

Another tough conversation many families face is whether an older loved oneshould continue to drive. “Driving is independence for many people, butsafety comes first,” says Johns Hopkins geriatric medicine expert AliciaArbaje, M.D., M.P.H. “You can ask your loved one’s doctor to help bybringing it up.”

We recognized the importance of family caregivers, as well as the physical and emotional stresses that can accompany caregiving. Hear how Johns Hopkins Bayview prepares and supports those caring for loved ones with health-related needs or limitations. 


Johns Hopkins Magazine

Tough (But Important) Conversations | Johns Hopkins Medicine

To fill this gap, the Berman Institute of Bioethics established the Program on Ethics in Clinical Practice. The teaching faculty — Joe Carrese, Maggie Moon, and Mark Hughes — offer the residents practical tools to resolve the ethical dilemmas that can arise when doctors and patients interact.

“You can actually use logical analysis to help sort out an ethics case in the same way that you use logical analysis to sort out a diagnosis,” explains Moon, an assistant professor of pediatrics.

“I think we encounter ethical issues on some level almost every day,” says Laura Landgraf, a first-year resident in pediatrics.

Often the issue is a conflict between the patient's wishes and the doctor's medical advice. On occasion, physicians are torn between respecting a patient's confidentiality and protecting someone else's health.

Earlier this year, for example, the pediatric residents worked with an HIV-positive teenager who admitted to keeping his status a secret. “There was a person visiting him who the residents felt convinced was his sexual partner,” says Moon. They felt a “moral obligation” to this woman, she says.

The rulebooks can sometimes provide answers, but in this case the law was ambiguous: The doctors were allowed to break confidentiality, but not obligated. These gray areas, says Landgraf, are where their ethics training comes into play.

Without formal training, Moon says, residents tend to avoid the tough conversations. “If there's no teaching, then they're left to some sort of default position.

” Residents tend to pick up attitudes about ethics from attending doctors.

Though some faculty have substantial ethics training and do a good job of transferring that knowledge, others lack expertise or “imply that it's not worth addressing,” says Moon.

“It's a teaching moment that gets lost,” Carrese adds.

Currently, the clinical ethics program is only available to residents in pediatrics and surgery, but the institute plans to expand the program this fall to include the residents in medicine at Johns Hopkins Hospital and Hopkins Bayview.

Moon hopes the clinical ethics program will influence the way ethics is taught not only at Hopkins, but at other hospitals as well, as Hopkins-trained doctors move into leadership positions at other institutions.

The Berman Institute will be celebrating its 10-year anniversary this spring. In honor of the occasion, President William R. Brody has declared the week of April 16 Bioethics Week at Johns Hopkins. The institute will hold several lectures, conferences, and meetings at a variety of campus locations. — CW

History: Peace via all-out war

The first figure a reader meets in David Bell's acclaimed new book, The First Total War (Houghton Mifflin, 2007), is the rakish and effeminate Armand-Louis de Gontaut, the Duc de Lauzun.

Early in his military career, the “fair-skinned, red-lipped, and beautiful” Lauzun had already garnered a reputation as a philanderer of epic proportions — a reputation he both earned and flaunted. He even led a battle on horseback, dressed handsomely, with a mistress riding shotgun. (Fans of Dangerous Liaisons will recognize Lauzun in the character Valmont.

The book's author, Choderlos de Laclos, was a friend of Lauzun's.) Lauzun's victories were not limited to the boudoir. He ably commanded regiments abroad, most notably during the American Revolution.

Bell, a Johns Hopkins history professor and a renowned expert on French history, chooses Lauzun to open his book, his first written for a general audience, because the Frenchman was the quintessential military commander of his times: an aristocrat who had as much flair in battle as he had at the royal court.

He — and Napoleon Bonaparte, whom we meet later on — came of age during a time when wars were comparatively limited, restrained, and honorable, Bell writes. The 18th century was a time of sword duels, peasant soldiery, battlefield discourse between enemies, and splendidly costumed commanders who took time off to write novels and avoided fighting during winter months.

In general, they spared civilians, at least compared with other periods.

The First Total War in large part tells the story of the changing philosophy of war that took place during Napoleon's time. The Age of Enlightenment hatched the theory that total peace was an achievable human goal — and that the means to that end was a final — or total — war.

To achieve this ideal, however, meant eradicating the old regime who felt war was a part of life — an upheaval realized in the French Revolution. Out went the old armies and in came the new, made up of civilian volunteers and conscripts who were swept up by a spirit of nationalism and the pursuit of final peace.

Bell defines “total war” as one of grand scope involving mass casualties, guerrilla warfare, and a blurring of lines between combatants and noncombatants.

Bell writes: “What marked the conflicts that began in 1792 was not simply their radical new scope and intensity, but also the political dynamic that drove the participants relentlessly toward a condition of total engagement and the abandonment of restraints.”

Between 1792 and 1815, warfare on an unprecedented scale ripped apart Europe. The fighting caused perhaps as many as 5 million deaths and affected every state on the continent.

Before 1790, only a few battles involved more than 100,000 combatants, Bell writes, as compared to the Battle of Leipzig in 1813, for example, which drew 500,000, a third of whom were killed or wounded.

No longer was war about securing a strategic location or pitting royal house against royal house. Entire nations were now at war, and hell-bent on slaughter for the sake of an everlasting peace.

A contributing editor for The New Republic and co-editor of The Tocqueville Review, Bell previously authored The Cult of the Nation in France: Inventing Nationalism, 1680-1800 (Harvard University Press, 2001), for which he won the Leo Gershoy Prize from the American Historical Association. With Total War, he set out to illustrate the apocalyptic horrors of such conflicts and how the meaning and fear of this type of warfare lives with us today.

Bell also uses the book to re-appraise Napoleon's role in history.

“I think [readers] will be surprised by the extent to which I show Napoleon having been shaped by the literary culture of the day, and the extent to which I take seriously his own early literary ambitions,” says Bell, remarking on the general's impressively bad foray into writing. “More fundamentally, perhaps, they will be surprised by the way I present him as someone in large part created by the phenomenon of total war, rather than creating it himself.”

Critics say that Bell puts too great an emphasis on the Napoleonic wars, arguing that total wars of another sort existed before this time.

“There were obviously examples of [unrestrained war] going back as far as you want,” Bell responds, “but the idea that an entire society can be politically mobilized for the sole purpose of the enemy's destruction is a distinctly modern one that is born in this period.”
— Greg Rienzi

Medicine: Catching, and releasing, a cold

Stuffy head, runny nose, sore throat — chances are, you're infected with one of the 200 or so viruses that cause the common cold.

The symptoms that make you feel so bad are the work of specialized white blood cells responding to a virus by ramping up the immune system.

New research Johns Hopkins suggests that your eventual return to health will be caused in part by a protein called Carabin, which your body uses to shut down that response.

The study found that Carabin inhibits two proteins that would otherwise prompt white blood cells to produce immune- activating chemicals. As the amount of Carabin increases, the cell gradually releases fewer and fewer of the chemicals needed to sustain the fight against infection. These findings appeared in the January 25 issue of Nature.

One of the authors, Jun Liu of the School of Medicine's Pharmacology Department, says the most interesting part is that a viral infection triggers white blood cells to produce chemicals that induce an immune response, and simultaneously to produce Carabin.

“It's as if you're stepping on the gas but also hitting the brake,” says Liu. But the brake works gradually, leaving a window during which white blood cells and other anti-viral agents can wipe out the infection.

Individual differences in Carabin production may be one reason some people have a cold for just a day or two while others suffer for weeks.

What would happen if the body didn't produce Carabin? Liu and his colleagues compared normal white blood cells to those from which Carabin had been removed.

Those without the protein generated three to five times the amount of chemicals used to switch on the immune system. A stronger immune response could lead to more acute symptoms.

“Imagine if someone had a fever that was three times as severe,” says Liu. “It could be extremely detrimental.”

The proteins that Carabin inhibits are involved in many other processes, and Liu hopes to explore how Carabin functions in other cells. “We think that this brake system is not only confined to the immune system,” he says.
— CW

Interfaith Center: Chaplain departs for Yale

During her 14 years as Johns Hopkins' university chaplain, Sharon Kugler built a strong interfaith community representing students of more than 25 religious groups, created a new campus interfaith center, and guided the university community through crises big and small. She's also won raves for her chili — a spicy concoction dished out to resident advisers and Interfaith Council members at dinners where the décor includes strings of lights shaped hot peppers.

Now she's taking her talents (and her chili pepper lights) to New Haven, Connecticut. In February, Kugler became the first woman, first lay person, and first Roman Catholic to be named chaplain of Yale University. She starts July 1.

Source: Health Member Meeting 9

Tough (But Important) Conversations | Johns Hopkins Medicine

37 Hospitals Attended This Meeting: Adventist HealthCare, Avera Health, Boston Children’s Hospital, Boston Medical Center, Carilion Clinic, Children’s Hospital of Pittsburgh, Children’s National Health System, Cooper University Health Care, Dartmouth-Hitchcock, Dignity Health, Encompass Health, Forrest Health, Henry Ford Health System, Holy Name Medical Center, Houston Methodist, Johns Hopkins Medicine, LifeBridge Health, Mary Washington Healthcare, Mayo Clinic, MedStar Health, Mercy, Methodist Le Bonheur Healthcare, Michigan Medicine, Northwestern Medicine, NYU Langone Health, Oregon Health & Sciences University, Penn Medicine, Penn State Health, Prisma Health, Providence Health, Rush, St. Jude Children’s Research Hospital, Temple University Health System, UCLA Health System, University of Maryland Medical System, UPMC Pinnacle, and UT Southwestern Medical Center.

You’ll talk about the critical issues you can’t talk about anywhere else, because everything is 100% confidential and you choose the topics. Meetings are exclusively for social media leaders (no vendors, no selling), so everyone in the room understands your challenges and has answers.

Leave inspired, energized, and better prepared to lead your social media program.

1. Conversations that Matter

We’ll talk about the important issues that you’re facing as a social media leader. Bring the tough problems you’re trying to solve and the questions you can’t ask anywhere else.

2. Confidential, Off-the-Record, and Members-Only

No vendors, no agencies, and no sponsors. Every conversation is completely confidential (no recording, blogging, etc.), and every participant is a social media leader at a major hospital.

3. It’s Not a Conference, It’s a Discussion

Member Meetings are designed for high-value conversations that will help you be a better social media leader. There are no panels, keynotes, sponsors, or other distractions.

Member-chosen, member-led peer-to-peer discussions on the hottest issues of the moment.

Show & Tells
Members share what they’re working on in casual, behind-the-scenes talks.

Member-Led Discussions
Deep-dive conversations on pre-selected topics from your fellow members.

Meal Discussions
Meals aren’t just breaks — they’re formal parts of the program where some of the best conversations happen.

1. Registration is Not Open to the Public

This meeting is private, off-the-record, and exclusively for social media leaders at major hospitals. All registrations are reviewed, and everyone will have signed a confidentiality agreement.

2. Monday is Members and Invited Guests Only

The first day is off the record, but some prospective members will be joining us. They’ll leave when our private member dinner starts that evening.

3. Tuesday is Members Only

Everyone in the room will be a Health member. Members, if you’re hoping to send someone that isn’t on your roster yet, they need to be approved at least two weeks before the meeting. Your friendly Community Manager can help.