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THE WHITECOATS ARE COMING

2017 �Թϱ��� COM WHITE COAT CEREMONY

White Coats. Blue Lobsters. Peripheral Brains. These are some of the words that describe this year’s White Coat Ceremony. One may venture to believe that once you have attended one of these events, you have seen them all, yet nothing could be further from the truth.

First, let’s paint the scene. The ceremony opened at Merrill Auditorium in Portland on the morning of Saturday, September 23. The sun shone brightly on the shiny silver buckles of obsidian-colored belts and dress shoes; silver earrings sparkled, and the slick chrome parts of the arriving cars glistened ceremoniously. The second-year students arrived early, picking up the white coats for the students they were to escort to the stage; the first-years looked nervously around the room for their escorts, anxious whether or not their second years were present to “give them away” as if it were a wedding ceremony. The seemingly spacious rehearsal hall got smaller and smaller as more than 300 students congregated together, chatting about their families, eating donuts, and loading up on coffee before the start of the event. A few die-hards even found a quiet nook to study.

Inside the auditorium, families searched for the best vantage point to see their students walk across the stage. Peering up from where the students were to sit in the orchestra section, the deceptively large space was filled almost to capacity with friends and families. In an auditorium that showcases hundreds of artists — singers, actors, and comedians alike — one could imagine that any number of professional events was about to begin given the enthusiasm of the massive crowd.

It was the first time the White Coat Ceremony for �Թϱ��� COM was held at Merrill Auditorium. For most students and their families, it was probably the first time they had stepped foot into the majestic theater. Hopefully, in just a few more years, they will return to the same venue for their own student’s graduation.

The ceremony officially began as the students processed into their seats. Dean Jane Carreiro, D.O. welcomed everyone to the event with her usual charm and wit. �Թϱ���’s President, James Herbert, Ph.D., took to the podium afterwards, welcoming the students to medical school and speaking to the challenging (and rewarding) years to come. The President of the Maine Osteopathic Association, Meridith Norris, D.O., made the crowd laugh with her own story-telling and anecdotes. Dr. Norris works in Southern Maine and specializes in family medicine, treating substance abuse, obesity, and pain management.

One of the very first 36 graduates of �Թϱ��� COM, Craig Boisvert, D.O. ‘82, was the keynote speaker. He is currently the vice president for Academic Affairs and dean of the West Virginia School of Osteopathic Medicine. Dr. Boisvert reminisced about the days he was in school. At that time, medical students carried little black books, which they called their “peripheral brains,” and stashed them in their newly acquired white coats. Nowadays, students’ peripheral brains have been replaced by their smartphones, which they use to assist them with drug calculations, studying, as a medical reference, and to transfer money to one another through Venmo for student fundraising. To recognize Dr. Boisvert’s contribution to �Թϱ��� COM and osteopathic medicine in general, he was awarded a blue lobster, a hand-blown, glass figurine that represents the frequency of spotting one in nature, about one in 2–3 million.

The first-year students were escorted to the stage, and their names announced by COM faculty member, Marilyn Gugliucci, Ph.D. As the students crossed the stage, coated by their physician, the crowd clapped loudly and cheered. The students’ faces beamed, excited to be a part of the �Թϱ��� COM tradition, and earning their “stripes.” Once the students uttered the last of the Oath of Honor, “I will confront all ethical misconduct which could violate the trust that our institution holds dear,” the ceremony was over, and students met their proud families outside on the steps of city hall for the reception. Maybe it was the sunny weather, but more than likely it was the notable occasion that stuck perma-grins on their faces as they shared this proud moment with the people they love most.

Spotlight Story

The Intersections of �Թϱ��� COM and Medicine in Today's Changing World 

TRANSFORMING PRIMARY CARE

About the Author
Marlana Solebello, MEd works in the COM Office of Recruitment, Student & Alumni Services

In his presentation, Dr. Bettencourt spoke to the team approach that his office embraces. It isn’t solely a one-on-one relationship between doctor and patient, but a team of people that includes a nurse, patient advocate, behavioral health specialist, case manager, and available support groups to meet the needs of their transgender patients.4 This is one model that pulls together various resources in order to best care for their transgender population. It goes without saying that rural areas don’t have the resources that a city such as Boston, or even Portland, have more readily available. Because of this, Dr. Bettencourt consults with other primary care physicians who want to give their transgender patients the care they need, wherever they are in their process and geographically.5

Echoed in Dr. Bettencourt’s presentation was the idea that transgender medicine is not specialty medicine, but falls under primary care.4 However, there is a definite need for education on transgender health in order to provide physicians with the knowledge necessary to feel competent in their ability to treat members of the community. Practicing physicians are already required to earn continuing education credits for licensing in order to ensure they are on the cutting edge of medical treatments and interventions. For example, since more physicians have seen an increase in patients addicted to opioids, some states such as Massachusetts require opioid education for physician licensing.6 Similarly, the first step to the advancement of transgender medicine is within the scope and ability of primary care. Physicians have access to the tools necessary to treat their transgender patients, but what is missing is the knowledge of where to seek out those resources, and the impetus to do so.

Isabel Lowell, M.D., a professor at Emory University School of Medicine, Department of Family and Preventative Care, believes that “Making [transgender care] primary care just means that any transgender patients anywhere in the country can go to their own doctor.”3 Similarly, Dr. Bettencourt quotes A.T. Stills in his presentation: “To find health should be the object of the doctor. Anyone can find disease.”4 The osteopathic principles instruct D.O.s to treat the mind, body and spirit. In his lecture, Dr. Bettencourt states that his treatment goal is to lessen the gender dysphoria in his transgender patients, or, in short, to unite mind, body, and spirit. In terms of treatment, he states, “I treat the patient, not the numbers.” Despite what resulting labs or other diagnostic tools tell him, listening to his patients is key to understanding what direction or what avenue he will inevitably choose to pursue.4 The 2007 Virginia Trans Health Initiative Survey found that 60% of transwomen and 23% of transmen have at one time or another taken self-prescribed hormones, therefore, the role of the primary care provider is to regulate and monitor their patients’ levels in a controlled environment.4
 
Healthcare will continue to ebb and flow as medicine tries to catch up with societal shifts and changes. The inclusion of gender pronouns has started to find their way into electronic medical records so that physicians can use preferred language with their transgender patients. On the other hand, the data that has been collected on transgender health will see another drop as gender identity questions have been removed from the 2020 census. We have yet to see what impact this will have on healthcare, and, more specifically, transgender health.

�Թϱ��� COM has taken the first step in creating a safe space for the transgender community by providing gender-neutral restrooms in Stella Maris, the site of the College of Osteopathic Medicine when it first took shape in 1978. According to the Fenway Institute, using gender-neutral language supplies the foundation for advocacy within the walls of both healthcare and higher education.7 Colleges in general have slowly been implementing ways of supporting their transgender populations. The video,  is a resource created to help professors understand what their students need to feel safe in the classroom.8 One conclusion is the importance of language in creating safe spaces and encouraging open dialogue. Likewise, if physicians start by using gender inclusive and gender-affirming language, and by acknowledging the existence of transgender with signage and reading materials that are not gender-specific, then that would be a beginning in opening lines of communication and creating a safe environment for their patients to seek treatment.9

There is a need for more education on transgender medicine, and the physicians who attended �Թϱ��� COM’s CME Weekend this October recognized this, and took advantage of the resource they were given. The many holes and divots within healthcare for transgender patients can slowly be filled and re-graded by continuing medical education. It starts with the willingness in current physicians, medical students, teachers, and administrators to have the desire and willingness to promote inclusivity on campus, in the classroom, on rotations, and within healthcare, to treat all people with dignity, regardless of how they identify, and for them to look at the current structures in place and challenge them to do better — to be better.
 
In the immortal words of Michael Jackson, “If you care enough for the living, make a little space, make a better place.”10

References:

1. Hill, Mel Reiff, and Jay Maya. 2011. The Gender Book.

2. McPhail, D., Rountree-James, M., and Whetter, I.. Addressing gaps in physician knowledge regarding transgender health and healthcare through medical education. Can Med Educ J. 2016 Oct 18;7(2):e70-e78. eCollection 2016 Oct. https://www.ncbi.nlm.nih.gov/pubmed/28344694

3. Landman, K. Making Primary Care Trans-Friendly. The Atlantic. 2017 April. https://www.theatlantic.com/health/archive/2017/04/trans-medicine/523731/

4. Bettencourt, D.O. John-Paul. Transgender Medicine in Primary Care. 2017. http://tinyurl.com/2017�Թϱ���COM

5. Fenway Health. 2017. http://fenwayhealth.org/care/medical/transgender-health/

6. Massachusetts Medical Society. 2017. http://www.massmed.org/Continuing-Education-and-Events/Continuing-Medical-Education-Requirements-for-Physician-License-Renewal-in-Massachusetts/#.Wa76TLKGOpo

7. Transgender Health. American Medical Student Association. 2017. http://www.amsa.org/advocacy/action-committees/gender-sexuality/transgender-health/

8. 'Ask Me': What LGBTQ Students Want Their Professors to Know. The Chronicle of Higher Education. Sept 2015. https://www.youtube.com/watch?v=rnbnF8QAnsY

9. McNamara, M., and Ng, H.. Best Practices in LGBT Care: A Guide for Primary Care Physicians. Cleveland Clinic Journal of Medicine. 2016 July;83(7):531-541http://www.mdedge.com/ccjm/article/109822/adolescent-medicine/best-practices-lgbt-care-guide-primary-care-physicians/page/0/2

10. Michael Jackson, Heal the World, in Dangerous, Epic, 1992.

In Good COMpany

The Who's Who in �Թϱ��� COM

RUN COM, RUN! THE MAINE MARATHON

Race participants and volunteers gathered at Baxter Boulevard on October 1 in Portland, Maine. The sun was bright as racers warmed up before the big event. The Maine Marathon has been a tradition since 1979 and draws competitive runners from across the U.S. Due to the vast size of the event, services such as bathrooms, water stops, and medical services were spread out among the 26.2-mile course. Along with professional medical organizations, 28 first and second-year �Թϱ��� COM students, and three Pre-Doctoral Teaching Fellows, provided Osteopathic Manual Medicine to more than 90 athletes competing in the race.

Community service is a huge part of the �Թϱ��� COM experience. It is one way for students to apply the skills they are learning in the classroom, and gives them the opportunity to give back and be of service for a community that has taken them in. Such exposure also helps develop the empathy and compassion that arguably is a necessary companion to clinical skills, and the mark of a great physician. One second-year student, Sarae Sager, OMS II, said of the event, “It was a wonderful opportunity to gain experience within our community, developing our OMM and patient-focused communication skills, while teaching the community [about] Osteopathic Medicine.”

Two �Թϱ��� COM faculty members, Dr. Bonnie Sendzicki and Dr. Nicholas Phillips, were the physician preceptors for the event, and provided supervision and instruction as needed. Both physicians have been instrumental in teaching the students the necessary skills to make an impact in their local community.

For additional photos visit our  page. Read more

OF MICE AND MEN: THE 17TH ANNUAL RESEARCH FORUM

This is the 17th year that the Research Forum has taken place at the �Թϱ��� College of Osteopathic Medicine. With the amount of time and dedication that goes into these presentations, it is no wonder that the event is always a great success. Between the faculty judges, the first and second-year medical student presenters, the keynote speaker, and the various spectators, there were more than 50 people who participated in the event.

Ron Korstanje, Ph.D., FAHA, was the keynote speaker whose talk, “The Genetics of Aging: Worms, Mice, and Humans,” was more than a throwback to John Steinbeck. Dr. Korstanje is an assistant professor at The Jackson Laboratory, one of five Nathan Shock Centers of Excellence in the U.S.; he is also the co-director in the Basic Biology of Aging.

After all was said and done, awards were bestowed upon the top three student clinical research projects and the top three student basic science projects.

The winners included:

THE MUSLIM STUDENT ASSOCIATION JOINS THE FRAY

One beautiful thing about UNE COM is the diversity of its students. Medicine has no boundary, and medical students from all around the world come to �Թϱ��� COM to learn how to be the best physicians for their patients. When Omar Shawaf, OMS I, and Sharmeen Jaffry, OMS I, started their freshman year over the summer, they took note of the Jewish Medical Student Association (JMSA) and the Christian Medical and Dental Association (CMDA) that were already present on campus. Student Doctor Omar Shawaf, recalls, “having come from big universities from Canada and all across the U.S., we were always used to having an MSA [Muslin Student Association] to represent us on campus and hold events that helped keep our faith strong and provided us with events and resources to continue to practice our faith, even when we were away from home.” Given the number of Muslims in the first-year class alone and their undergraduate experiences at larger institutions, they decided to see if there would be enough interest here at UNE COM. The idea was presented to the Student Government Association (SGA) the first week of October 2017 as a route to help foster and increase cultural sensitivity in medicine and to bridge the gap between Muslim and non-Muslim students. At the meeting in October, the MSA was officially recognized and welcomed as a �Թϱ��� COM organization.

Their first meeting was held on Friday, October 13, where they discussed board positions and started brainstorming about future events. One such idea, an interfaith seminar, is a collaboration with the JMSA and the CMDSA to bring physicians from various religious backgrounds to talk about some of the challenges they face in treating patients who are culturally diverse.

While the mission of the MSA involves mediating faith and medicine, it is also tasked with the deconstruction of harmful myths. Student Doctor Shawaf states:

"The MSA works to uphold the Osteopathic principle of promoting a holistic approach to health and medicine through holding cultural sensitivity workshops with fellow faith groups on campus to facilitate dialogue, awareness and understanding. Additionally, the MSA will combat the media narrative about Islam and educate those interested regarding the true teachings of our religion through interfaith discussions. The MSA will also ensure the facilities and services can adequately accommodate religious obligations, such as having places for prayer and providing halal food on campus."

In less than a month after the group’s induction into the COM Clubs and Orgs, the food provider on campus, Sodexo, started providing halal food for its Muslim population. Whether or not the MSA had a hand in this shift or not, it is clear that its very presence will continue to advocate and represent the needs of Muslim students at UNE and especially here at UNE COM.

As Shawaf attests, “the Muslim Student Association (MSA) is very excited and grateful for the opportunity to be officially recognized by �Թϱ���.” Conversely, �Թϱ��� COM appreciates the richness the MSA brings to campus through their contributions to the diverse tapestry we will continue to weave in the belief that the field of medicine, as well as the world we practice in, will not merely recognize the ways in which we are similar, but sincerely value the ways we are different.

This year, �Թϱ��� remembered our veterans with a Veteran’s Day Celebration on November 11 in the Campus Center. More than 80 students, faculty, and staff attended the event to honor those who have served and continue to serve in the armed forces of the United States. �Թϱ��� President James Herbert, Ph.D. was among the guest speakers to thank our veterans for their service. A �Թϱ��� alumnus, Chris Keller, who served multiple tours overseas, recognized his fellow classmates in his opening speech.

Associate Professor Amy Keirstead offered final remarks by educating the masses on the differences of how Canada and the U.S. celebrate their veterans. In Canada, November 11 is known as Remembrance Day, where an extravagant service is held at the Tomb of the Unknown Soldier in the capital city of Ottawa; the sound of bugles can be heard in the air, and the royal anthem, “God Save the Queen,” is sung by a choir. Unlike Veteran’s Day, the occasion is more of a somber event. Poppies are worn to honor those who have lost their lives in the call of duty. The tradition of the poppy was inspired by a poem, “In Flanders Fields,” written by Lieutenant Colonel John McCrae during World War I.

WORKING ON THEIR FITNESS: BENEFITS OF GROUP EXERCISE

Anyone familiar with Osteopathic medicine understands the necessity of wellness for body, mind, and spirit. The rigor of medical school can be defeating, and the enticement of late night snacks and stress attacks can take their toll. A recent graduate of �Թϱ��� COM, Dayna Yorks, D.O. ’17, recognized the importance of exercise for her own mental health and implemented fitness classes while in school. An experienced fitness instructor, Yorks implemented a fitness program at UNE COM. Her passion for fitness didn’t stop there. Discussing the importance of exercise with Associate Professor of Anatomy Mark Schuenke, Ph.D., they started to formulate a research topic on the subject of fitness. Eliciting the help of Professor and Director of Geriatric Education Marilyn Gugluicci, Ph.D., and Professor and Interim Chair of the Osteopathic Manipulative Medicine Department Christopher Frothingham, D.O. '01, the team embarked on a research project that tracked the health of 69 first and second-year medical students over a 12-week period.1

The study divided the subjects into 3 categories: those who exercised in groups; students who exercised alone or with up to two people; and those who did not exercise regularly. The study was published in the Journal of the American Osteopathic Association and had two major discoveries. First, that exercising on a regular basis improved overall mental and physical health. Second, that there is more health benefit associated with exercising in groups.

"Those who participated in group exercise had a 12 to 26 percent improvement in mental, physical, and emotional quality of life," said Dayna Yorks, D.O. ’17.2

References:

1. The Benefits of Group Exercise: �Թϱ��� Student Research Project Receives International Attention. �Թϱ��� News. 2017 Nov. 17. http://www.une.edu/news/2017/benefits-group-exercise-une-student-research-project-receives-international-attention

2. Study: Bigger Benefits from Group Workouts. CBS. 2018 Jan 1. http://www.wcax.com/content/news/Study-Bigger-benefits-from-group-workouts-467555023.html

Below is a visual representation of �Թϱ��� COM News for Summer 2017

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Alumni Notes