Taking It to the Floors

Nursing students experience more direct care

A collaboration between the Health System and the School of Nursing is testing improved approaches to educating student nurses by providing them more direct clinical experience. During the 2008 fall semester, a group of junior nursing students participated in the pilot program designed to immerse students more intensely and meaningfully in the day-to-day life of the hospital and the work of nurses, and to acclimate them early on to a team-based model of health care.

Involvement in patient care has been a critical aspect of nursing education for decades. But this new initiative, known as Phase I of the Initiative for Excellence in Clinical Education, Practice, and Scholarship — and the brainchild of School of Nursing Dean Kathleen Potempa, D.N.Sc., and Health System Chief of Nursing Services Margaret Calarco, Ph.D. — takes it several steps further.

In the traditional model, Potempa says, students and faculty entered the unit as “guests,” often for just a day at a time. Assigned to one or two patients, they were relatively segregated from other unit activities, leaving their experience largely devoid of context. “This new model puts education in the framework of faculty-driven practice and research,” says Potempa.

Students received an intensive refresher course in clinical skills after the summer break, attended additional lectures in patient safety and trained in team dynamics. “We wanted them to hit the ground running,” says Potempa. Then, in addition to the semester’s traditional coursework, students and faculty together took to the floors of the hospital, becoming embedded in a specific unit for days at a time.

Students in the pilot program have the chance to get to know the patients they care for and observe the outcome of their care over several days. Not only do they get to witness the intricate teamwork of nurses, nursing supervisors, physicians, assistive staff, surgical technicians and others involved in patient care — they get to be a part of it.

Overseeing students at all times are a staff nurse clinical mentor and clinical faculty member who are aware of the students’ strengths and weaknesses. “The faculty member might say to a student, ‘I’d like to spend a little more time with you today,’ ” explains Marilyn Svejda, Ph.D., an associate professor of nursing and the project’s director. “ ‘This patient needs care that you haven’t performed before. Then we’ll talk about how this fits in with total care.’ ”

The inaugural semester came after a full year of planning that was a team effort all its own. In spring 2007 at a two-day meeting, faculty, staff nurses, students and clinical leaders in the School of Nursing and the Health System discussed ways to improve nursing education at the University. Says Potempa, “What was dramatic was that so many people, from so many different sectors, could come up with a pretty consistent view of what was needed.”
—WHITLEY HILL

Bradford Selected as Otolaryngology Chair

The Medical School has selected one of its own — Carol R. Bradford (M.D. 1986, Residency 1992) — to chair its Department of Otolaryngology, pending approval by the U-M Regents.

Bradford is a professor of otolaryngology with long-term ties to the U-M. She earned her undergraduate, masters and medical degrees from the U-M, and has been a faculty member since 1992.

Previously, Bradford was director of the U-M Head and Neck Surgery Division, co-director of the Head and Neck Oncology Program, and associate chair for clinical programs and education. Bradford specializes in head and neck cancers, including the removal of skin cancer and reconstructive surgery. Her research focuses on identifying and evaluating biomarkers that can predict outcomes in head and neck cancer patients, and developing therapies to combat certain types of head and neck cancer.
—SP

For an expanded version of the story

El-Sayed Named Rhodes Scholar

He heard the chair of the selection committee call his name, but until he saw it written on the official list, Abdulrahman (Abdul) El-Sayed didn’t believe it was true. The 24-year-old University of Michigan M.D./Ph.D. student had just won a Rhodes Scholarship. In September 2009, he would be moving to England to spend two or three years studying at the University of Oxford with all expenses paid.

“The first thing I did was I texted my wife and then I texted the rest of my family and my advisors here,” says El-Sayed. “They [the selection committee] took us into a back room and told us what we had to do in the next two weeks to apply to Oxford. You’re in this euphoric state and suddenly you have to take in all this information that will be important for the next two years of your life. It was a surreal experience.”

El-Sayed had made it through a long and competitive application process. Of 769 American students recommended by their colleges or universities for a Rhodes Scholarship, he was one of just 32 — and the only one from U-M — chosen to receive one.

But in spite of everything, El-Sayed still doesn’t see himself as Rhodes Scholar material.

“When I think of a Rhodes Scholar, I think of this strappy, tall, slender New Englander who likes rowing and water polo,” says El-Sayed — a short, muscular second-generation Arab-American from Bloomfield Hills, Michigan who played on U-M’s varsity lacrosse team and was active in the Muslim Students’ Association.

El-Sayed came to Ann Arbor in 2003 with plans to graduate from U-M, go to medical school and become a neurosurgeon. By the end of his junior year, El-Sayed had already been accepted to the Medical School with a Dean’s Merit Scholarship to cover his tuition. He was married to a beautiful U-M sophomore named Sarah, and everything seemed to be going just like he planned.

But then, during the second semester of his senior year, he discovered research.

It began when he read a study about Arab-American infants in California who were born in the months after the Sept. 11, 2001 attack on New York’s World Trade Center. According to the study, these babies had lower birth weights and were more likely to be born prematurely than Arab-American infants born before 9/11. The University of Chicago researcher who led the study suggested that higher stress levels in Arab-American mothers after 9/11 might be responsible for the difference.

El-Sayed was fascinated by the implications of the study. Could discrimination and stress increase the risk of adverse birth outcomes in certain populations more than others? Do social and cultural factors unique to specific ethnic groups make them more vulnerable to disease?

Working with his undergraduate advisor — Sandro Galea, M.D., Ph.D., a professor of epidemiology in the U-M School of Public Health —El-Sayed decided to repeat the study using Michigan data. He spent weeks analyzing Michigan Department of Community Health data about birth weights of Arab-American infants born just before and after Sept. 11, 2001. Galea and El-Sayed published the results of their research in a journal called Ethnicity & Disease.

“We found no birth weight effect in Michigan,” says El-Sayed. “Our hypothesis was that there was something about living in the large, concentrated Michigan Arab-American community that protected mothers against stress.”

By the time he graduated from U-M in 2007, El-Sayed was hooked on research. He applied to the Medical Scientist Training Program during his first year in Medical School, and started work on a joint M.D./Ph.D. degree in medicine and public health. Since then, his research has broadened to include the relationship between high birth weight and risk of future obesity in children of Arab-American immigrants. The plan to become a neurosurgeon has been replaced by plans to specialize in pediatrics or some aspect of global health.

“Research is what I love to do most in the world after being with my family and making sure I’m the best person I can be,” he says.

While at Oxford, El-Sayed plans to complete a master’s degree in global health science, and continue his Ph.D. research on the impact of socio-cultural factors on the health of minority populations. Then it’s back to Michigan to finish his last two years of Medical School and write his Ph.D. dissertation.

Ten years from now, El-Sayed sees himself working at an academic medical school somewhere in the United States with a dual appointment in medicine and epidemiology. “I’ll be running a successful research group and seeing patients one or two days a week,” he says.

He realizes that most of the jobs he’ll want will be located at universities on either the east or west coast, but says he’d love to stay in Michigan. “I can’t enumerate everything I owe to this school,” he says. “Wherever I end up, Michigan will be my home.”
— SP