January 24, 2017

Ryan Howard: Driving the change

Student input is invaluable in developing a curriculum that will make a difference for future learners and patients

Ryan Howard, MD
Ryan Howard and classmates
Ryan and his classmates have some fun showing off their stylish side!

The University of Michigan Medical School is in the middle of a curriculum transformation that was launched in 2013 when the AMA awarded our program a $1.1 million grant to change medical education. Since then, more than 250 members of our community have come together to better align our educational goals with the health care needs of society. Our med students are not only actively involved as partners on various curriculum committees, but also volunteer to participate in pilot courses and programs.

M4 Ryan is one of these volunteers. He is currently piloting the IMPACT program, a new feature of the Branches curriculum that gives students the opportunity to make an impact on a pressing health care issue. Ryan’s project centers on reducing the amount of excess opioid medication that enters our communities after surgery. Here he answers nine questions about his project, and how being a part of this process has impacted him and his career goals.

Why did you choose to reduce the amount of excess opioid medication that enters our communities after surgery as your IMPACT project?

Leftover painkillers are a huge contributor to the current opioid epidemic, and when we started asking patients how much medication they actually needed after surgery, we found that the vast majority were not using the entire prescription. For instance, after gallbladder surgery, patients were usually prescribed around 50 pills, but rarely took more than 10. All those extra pills sit in medicine cabinets for years and may eventually get misused by friends or family members. This led us to develop smarter prescribing guidelines, which we rolled out last fall. Since then, these guidelines have kept thousands of pills out of the community while still adequately treating postoperative pain. Now we’re working on building a toolkit so that hospitals around the state can make a similar impact on the opioid epidemic.

What interested you in taking part in a pilot course?

My participation is due largely to the incredible mentorship available here at Michigan Medical School. I’m passionate about patient safety and quality improvement in surgery – I have one of those minds that's always asking, “I wonder if there’s a better way to do this?” One of my mentors knew this and essentially said, “Ryan, opioids are a huge problem. What do you think you can do about it?” And what he was challenging me with was precisely that: to actually do something. The prospect that I could change clinical practice and make a difference in patient safety was also irresistible.

What do you think you’ve contributed to developing this course for future students?

The most valuable lesson I’ve taken away from this experience is that anyone – even a student! – can make a difference. Not only have I helped make a difference here at U-M, but along the way I’ve developed so many skills that simply cannot be taught in a classroom: How do you build consensus across departments? How do you develop a successful health message for patients? How do you create policy at the state level based on a project at the hospital level? I hope that by recognizing all of these valuable benefits to this course, future students will be granted flexibility in pursuing a wide variety of projects large and small!

Why do you think it is important to include students as part of the curriculum development process?

Students are often the most important and most accurate source of feedback for any new part of the curriculum. Since we see new initiatives firsthand, we can speak to what works and what doesn’t. This kind of feedback is integral to developing an innovative curriculum that not only fulfills a broader vision, but that actually works for students. By including students in the conversation, I think UMMS has done an incredible job of providing students with the highest-yield experiences. This also allows students to work on the projects they are most passionate about!

What would you say future med students can look forward to in terms of inclusion of students in this process?

The administration here at the University of Michigan Medical School goes out of its way to help each student achieve their fullest potential and will actively work with students to make that happen. In my own case, I’ve been given time and resources to attack the opioid epidemic during my final year of medical school. A classmate of mine was given similar flexibility so that she could write a book. Another was allowed to intern at a venture capital firm. It’s truly amazing how much the administration values its students’ passions and goals, and ultimately I think this serves to greatly strengthen our medical education.

How do you find time for everything you do?

Sometimes I ask myself this question as well! Lots of coffee? I think that part of “making it work” comes from pursuing projects that you’re truly passionate about. There are so many possibilities in what kinds of extracurriculars students can pursue, so everyone really has the opportunity to pick something that resonates with them. With my opioid work, I feel so motivated to put in the time because I’m actually seeing the project make a measurable difference. Beyond staying passionate, I’ve certainly had to develop my time management skills exponentially – this is pretty much a natural result of medical school, so don’t worry, it will come!

What specific courses/activities influenced your decision to choose general surgery as your specialty?

I chose to go into general surgery because I love connecting with patients and solving problems in a hands-on way. What’s more, so much goes into ensuring the best outcome for the patient: from the moment they call to schedule their appointment, to their final follow-up visit. I really enjoy working within that larger system to find ways we can improve quality and safety to deliver the best care possible.

The first experience that really got me thinking about surgery was spending the summer after M1 year working in a laboratory that studies extracorporeal life support. The lab works on things like developing an artificial lung, an artificial placenta, keeping organs alive for long periods of time outside of the body, and even liquid ventilation. To me, this stuff was like science fiction. I thought it was so cool!

During my time there, I helped with many surgical procedures on animals to study the devices we were developing, and started to fall in love with the hands-on nature of surgery. I also found myself blown away at the difference we made. We could take an animal with almost no lung function, surgically implant a device, and the next day it was walking around!

That was my first step, but what truly “sealed the deal” for me was the incredible mentorship the department provided. Once I expressed my interest in surgery, the faculty did so much to help me gain experience and further develop my passion for the field. This is what’s incredible about medical education here at Michigan: regardless of the field you’re interested in, you can be pretty sure that there are world-famous faculty working in that field, and if you’re excited about what they do, they’ll go out of their way to involve you.

What are some of the insights you have gained so far as you prepare to be a physician?
  1. Just get started (I think Nike says something similar…). It’s so easy to put things off because you feel like there’s more preparation and planning to do. I’ve learned that most of the time, the second you start working on something, you learn a hundred new things that make the plan irrelevant anyway. So you might as well just get started
  2. Don’t take it personally – many of your patients are probably having the worst day of their lives.
  3. Hobbies are important – keep them up!
  4. You can change things! You’re going to see inefficiency everywhere – guess what? You can do something about that!
  5. You don’t have to be an expert to be a leader. Don’t be deterred from taking charge because you feel like you don’t know enough.
  6. Never leave home without a granola bar in your white coat pocket.
  7. And my last, totally cheesy piece of advice – attitude matters! So much! It’s easy to get caught up in all the information we have to learn in our training, but a positive attitude and a smile can make a world of difference for your patients and your peers.
What would you say to a prospective student who is considering the University of Michigan Medical School?

Michigan does an incredible job working with its students to develop their unique interests and talents. From what I’ve seen, the academic experiences of a student interested in medical history might be vastly different from those of a student who wants to invent a biomedical device. At the end of the day, it’s really up to the student to bring their vision and to think big! Ask yourself what type of things you dream of accomplishing while in medical school, and chances are the faculty will find a way to make it work. As long as you’re willing to put in the time and energy, there’s really no limit to what you can accomplish.