January-February 2022

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Meet the Authors

Remy Arnot

Remy Arnot is a third-year medical student at Pacific North West University of Health Sciences College of Osteopathic Medicine. She is a proud Montanan with a strong conviction to work with underserved communities, always giving back whenever possible. She is a strong advocate for equal and fair distribution of food, water, and other resources, particularly in areas of the US where such resources are limited. As a future physician, she is committed to bridging the gap between affordable healthcare and affordable housing.

Oscar Cazares

Oscar Cazares is a post-baccalaureate student at the University of Texas Rio Grande Valley (UTRGV). He is currently the programming coordinator of the American Medical Student Association's Wellness & Student Life Action Committee. Cazares wishes to obtain certain graduate credentials before applying to medical school. His ultimate goal is to take on leadership roles in charitable international organizations where he wishes to provide free medical services to the underserved. Through this work, he hopes to improve public health systems and enact health policy change.

John Madden, M.D.

Dr. John Madden is an associate dean of students at St. George's University, director of the Office of Career Guidance and Student Development, and a professor of emergency medicine. In addition, Dr. Madden was formerly a clinical assistant professor at Jefferson Medical College, a professor at Drexel University and the Arcadia University Physician Assistant Program, where he is the former medical director and teaches emergency medicine.

G. Richard Olds, M.D.

Dr. G. Richard Olds has served as the president of St. George's University since August 2015. Dr. Olds is dedicated to the advancement of the University and its students, and collectively, hopes to help address the shortage and maldistribution of physicians in the United States and around the world. Prior to joining SGU, Dr. Olds was the vice chancellor for health affairs and founding dean of the School of Medicine at the University of California, Riverside. In 2010, he joined UCR to lead the creation of a new school of medicine—the first LCME-accredited medical school in California in more than four decades.

Stormy Orlin

Stormy Orlin is a second-year non-traditional medical student at the Mercer University School of Medicine. She has previous career experience in building and launching software in the financial technology space. She aims to return to her community to serve her neighbors in the form of practicing compassionate healing and health guidance.

Leana Pande

Leana Pande is a first-year medical student at the Touro College of Osteopathic Medicine. She is a self-taught artist in watercolor, acrylic paint, oil paint, gouache, pen, and more. Her work has previously been published by the American Medical Women’s Association and the Geisinger Commonwealth School of Medicine. She paints realistic and stylistic medical anatomy, as well as other natural landscapes and animals.

Angely Wilmary Catano Reyes

Angely Wilmary Catano Reyes is a fourth-year medical student at O&M Medical School. She is passionate about making a positive impact in her community and in the medical field. She has neurology/neurosurgery aspirations with an interest in research and the development of new treatment technologies. Beyond her medical aspirations, Angely enjoys spending time with family and friends, dancing, reading, working with non-profit organizations, and playing tennis.

Kyla Swain

Kyla Swain is a third-year medical student at Trinity Medical Sciences University. She is passionate about reproductive justice advocacy and serves as her school’s Medical Students for Choice chapter president and the AMSA Reproductive Health Scholars Program course director. She aspires to be an OB/GYN and abortion provider in the future while continuing to advocate for the rights of her patients. In her free time, Kyla enjoys playing the french horn, hiking, and spending time with her family.

Twitter: @kylaeswain

Lawren Wooten

Lawren Wooten, is a fourth-year medical student at Georgetown University School of Medicine applying into pediatrics. She is the current president of the American Medical Women’s Association student division and a Clinical Case Co-Chair for the American Academy of Pediatrics. She received her BS from Cornell University College of Human Ecology and an MS from the George Washington University School of Medicine and Health Sciences.

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Storytelling is one of the most powerful tools in the fight for reproductive justice. While statistics are unlikely to sway opinions built on emotion, the experiences of real people help put issues into perspective and build empathy for those experiencing them. In this way, storytelling promotes empathy between diverse groups of people (5). Just as people coming out to their families helped drastically sway public opinion surrounding marriage equality in the last few decades, people sharing their experiences of having an abortion is helping break down the taboo. Additionally, sharing stories can make those with similar experiences feel less alone and more supported. Storytelling can be accomplished in many ways, from individual conversations between loved ones to publications and speeches for the world to hear. While these real stories hold immense value, the impact of fictional stories cannot be understated. These often reflect real experiences, and when one is immersed in the experience of reading a book or watching a film they can feel just as real. For some, this may even be their only exposure to a realistic story about abortion care.

References and further reading

Vestron Pictures. (1987). Dirty dancing. United States.
University of California San Francisco. (2021, December 19). Abortion onscreen database. ANSIRH. Retrieved January 5, 2022, from https://www.ansirh.org/research/abortion/pop-culture
University of California San Francisco. (2021, December 14). Abortion on TV and film. ANSIRH. Retrieved January 5, 2022, from https://www.ansirh.org/abortion/abortion-tv-and-film
University of California San Francisco. (n.d.). Abortion onscreen in 2021. ANSIRH. Retrieved January 5, 2022, from https://www.ansirh.org/research/research/abortion-onscreen-2021
Abortion storytelling. Reclaim Project. (n.d.). Retrieved January 5, 2022, from https://reclaimproject.org/abortion-storytelling/

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Atomic Habits

My Journey Toward Wellness

by Angely Wilmary Catano Reyes

All my life I have been stressed. During high school, stress was a part of my personality. Despite this, I graduated from high school, applied to medical school, and got accepted. I was expecting medical school to be hard and stressful, but since I was already used to working under pressure, I considered this to be normal; I had essentially normalized the level of stress that ruled my life.

Medical school started and it was as challenging as I expected. Soon, however, the stress I normally managed increased exponentially. I kept ignoring its presence in my live and accepted it as normal since I was doing well in school. Eventually, I began to realize there was an inverse relationship between school life and my own life: the latter went downhill until I reached rock-bottom.

By the end of 2019, my health was declining. I began to have multiple health issues from all the stress I was experiencing. I kept going despite being burnt out. I pushed myself through the end of 2019 but in the end, I realized that I was not myself anymore.
After that realization, I decided to quit putting myself last and avoid making academics the only priority in my life; after all, self-care is health care, is it not? Despite everything, I truly loved school and my journey through medical school. The problem was I was no longer loving myself and began to wonder if the academic success was worth my identity. Here is where this story begins.

In September 2019, I started my journey of self-care. A journey to become me again. A journey that we often forget to take part of during our medical training. As medical students, we over-prioritize academic achievement and excellence and instead begin to normalize things that should not be normalized.
I have since tried journaling, yoga, cycling, running, meditation, dietary changes, different time management and organization tools, and have read several books on these topics. One of the books that impacted me the most and encompassed all these aspects of wellness was Atomic Habits by James Clear. This book entered my life at the perfect time and has allowed me to combine all the things I felt were important in my self-care journey.
I believe that as medical students, we could all benefit from this book. It brilliantly outlines strategies for achieving any goal, big or small. “Tiny changes, remarkable results”, as the book time and time again exclaims, was exactly the motto that I needed. Medical school is a hectic time. We need to learn to take things slow and never forget that there’s time for everything if there’s proper systems and personal awareness.

In the book, author James Clear explores how to build good habits and break bad ones through four laws of habit formation: (1) make a habit obvious, (2) make a habit attractive, (3) make a habit easy, and (4) make a habit satisfying. Clear further explores how small actions can be introduced gradually into our lives.

Atomic Habits taught me how to best utilize all the things I learned about self-care for almost two years. I went from learning about yoga and meditation to consistently practicing these relaxation techniques for my well-being. After exploring different forms of exercise beyond the gym, as the book suggests, I ended up finding various sports that are now hobbies. These two changes alone have made me feel significantly better, both physically and mentally.

Other aspects of my life Atomic habits impacted included better planning of daily activities and achieving goals. As medical students, organization is a big part of our lives. Having a list of priorities, scheduling study hours and wellness hours, and following the rules of habit formation has allowed me to become a more productive yet relaxed person.

A crucial exercise promoted by the book is that or listing current and desired habits and then prioritizing these habits. This exercise allowed me to identify and analyze my current habits, discover bad habits that I should work on, and add new ones that were going to help in my personal development.

After months of learning, growing, and being kind to myself, I can say it was all worth it. I used to say I didn’t have time for anything other than studying, but that could not be further from the truth. I am now able to achieve things I thought impossible. I owe much of this change to Atomic Habits, but I also owe this change to believing in myself and being patient, consistent, and self-aware. There’s no magic key that will just make it happen. If you want to start reinventing yourself and your life, the time is now.

I truly want all medical students, my future colleagues, to be able to accomplish their life aspirations while also having healthy and nurturing lives. Remember to take time for yourself, explore, and learn. If feasible, involve family, friends, and colleagues in the process. And of course, do not forget to enjoy the medical training journey. In the end, we all want healthy, strong, present, empathetic, physicians.

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Dear International Medical Students:

Do Not Worry About Changes to the Step 1 Exam

by John F. Madden, M.D.

Dr. John Madden is associate dean of students at St. George's University.

Starting January 26, medical school students who take Step 1 of the U.S. Medical Licensing Examination will no longer receive a numerical score. Instead, they'll receive a grade of "pass" or "fail". The Federation of State Medical Boards and the National Board of Medical Examiners—the administrators of the USMLE—believe the change will reduce some of the stress medical students feel while preparing for the exam.

That's reasonable. The Step 1 exam, which students typically take after their second year of medical school, is rigorous. To prepare, students study for hours on end and go over thousands of review questions. Some even skip class to study for the test. So, it's surely a relief for many med students that the USMLE is going pass/fail. But plenty of others—especially those at international medical schools—are concerned about how this change will affect their careers in medicine.

The Step 1 score has always been a key consideration for residency program directors. In 2020, 90 percent of residency programs cited the USMLE Step 1 score as a factor in determining which applicants to interview. That was the highest percentage of any factor they took into account. What will happen when that score is taken out of the evaluative process?

For years, many of my students at St. George's University in Grenada have counted on earning a top-notch Step 1 score as a means of boosting their chances of admission to their first-choice residency program. What can they do now to stand out? International medical students need not worry. Doctors educated at international medical schools are a crucial part of the U.S. physician workforce. Residency directors know that they are skilled—and they know that the United States needs them.

In the 2021 Match cycle, over 7,500 international medical graduates started residencies across the United States. More than 1,000 of our students at St. George's were among them. They joined 230,000 international medical graduates who are already practicing in the United States. They account for one-quarter of the country's physicians workforce.
IMGs tend to practice in communities where care is most desperately needed—like low-income, majority-minority, and rural areas. Residency directors also know that IMGs provide top-notch care. According to a recent study published in The BMJ, patients treated by international medical graduates had lower mortality rates than those treated by doctors educated at U.S. schools. IMGs also often care for patients with more complex healthcare needs, according to a report from researchers at Massachusetts General Hospital.
Demand for physicians has never been higher. The United States is staring down a significant physician shortage. The country will need up to 124,000 additional doctors by 2034, according to projections from the Association of American Medical Colleges. That includes up to 48,000 primary care physicians.

Thankfully, the number of residency positions has been increasing every year. So there are more and more opportunities for IMGs to pursue exciting careers. The 2021 match cycle was the largest in history. The number of open residencies has increased by roughly 50 percent over the past decade.

Finally, it is worth remembering that all students will receive a pass/fail outcome — not just international medical students. Therefore, the change to Step 1 will fundamentally shift how residency directors assess each student, not just those educated abroad. For that reason, the change could actually give international medical students a leg up. Here's why.

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