Practicing Medicine as a Global Citizen

Roundtable Discussion

Juan: Welcome to the Baylor College of Medicine Resonance Podcast. I’m one of your hosts, Juan Carlos Ramirez, and the writer for today's episode is joining me, Eileen. 

Eileen: Hi! As Juan said, I'm Eileen. I’m one of the writers and sound engineers here at Resonance, and today for our episode we'll be talking to Dr. Alshaikh, who is currently a fellow here at Baylor College of Medicine, where she also completed her residency after graduating from medical school in Saudi Arabia where she grew up. We wanted to talk to her a little bit about the difference in medical practice in the US versus in Saudi Arabia and what her experience has been like straddling both of those worlds and her plans moving forward. She is an emergency room physician, so we actually had planned this conversation several months ago not realizing that we would be in the midst of a pandemic. So if you will please excuse the audio quality, it's not quite up to our usual standards, but that is a function of doing a zoom interview. So we also wanted to take the chance to ask her about some of the stuff that's going on in the world right now.

Juan: Yeah, it's a dire time for all of us and we just kind of have to make due with what we have, but I think it'll be a great episode. So can we go into some details, like what are we gonna get?

Eileen: Yes, we're also going to talk a little bit about the role that international medical graduates play in our medical system, which has been growing bigger and bigger and bigger. It's interesting, because if you want to be a resident here and you're applying from a school outside of the United States, it's actually significantly harder to match. So in 2019, the match rate for PGY1 for US seniors was 93.9%, but if you're looking at international medical graduates, it falls to 58.8%. So it's essentially twice as hard to match if you're coming from outside the country. Not to mention the fact that you're having to travel for interviews and try and figure out potentially culture differences, and you also have to take all of the same exams, all of the same step exams, which can be a challenge to do if you haven't done it yet. So for example, if you don't realize that you're going to be applying as an international medical graduate, which is the case with Dr. Alshaikh, she had to take Step One after she had already graduated medical school. For those of you who don't know, Step One is much more focused on the basic sciences and pre-clinical curriculum, so to have to take it after a couple years in clinics would be a big challenge. But despite all of the hurdles, the number of international medical graduates has actually been growing. The number has grown by almost 30,000 in the last 10 years, which is a 15% rise and we're disproportionately seeing more doctors who are coming from medical school abroad. We're really lucky to have them here. 98% of international medical graduates speak two or more languages fluently, and so it can be a huge help in patients who have a language barrier or a culture barrier, who feel they might otherwise be intimidated to seek care, to know that they're going to be able to talk to someone or meet with someone who's more familiar with their home culture.

Juan: Yeah, so I guess, does this reflect--like even given all this, you know I hate to kind of even bring it up, but you know political backlash about, you know, having international travelers come to the US Does that--does that really affect it? Do you think that's affected it in any way?

Eileen: I don't know that we have specific data on the difference in numbers between IMGs who have come in, say, the last four years as opposed to the time before that. I can't imagine that it's been especially welcoming, but I think that we are still seeing a significant rise. And it's also interesting to see where those students end up. So for example, about a third of IMGs end up in the South and about a third end up in the Northeast, but only 20% end up in the Midwest, 17% in the West, and then 3% in territories or military bases. I wonder if there is more of a sense of welcoming or comfort to being in the South or the Northeast, or if that's just the way that the residency programs end up shaking out.

Juan: Interesting, may be interesting to see that data. Just kind of how it's changing over time. I mean, those areas kind of makes sense, right? But I think it'll be interesting to get Dr. Alshaikh's viewpoint and her personal opinions and her story.

Eileen: Yeah, it would be really great to talk to her about her own experience and how her perspective coming from Saudi Arabia has shaped what she thinks not only of the American medical system in general, but also the global nature of the pandemic that we're all living through right now. So without further ado, I will go ahead and start our interview with Dr. Alshaikh. I'm going to start off by asking her where she's from and she's going to give us just a little bit of background and then we'll jump into it.

Interview

Dr. Alshaikh: So I was born and raised in Saudi Arabia. I did medical school there and was planning on doing residency back home before there was like a huge detour in my path. I had, we had, an opportunity (my husband and I) of continuing him doing a master's actually in the States and so I saw this as a great opportunity to start the process of applying for residency here. And so I had to do all the requirements, including all the exams and everything, after I completed my medical school. When I came to the US, I completed all the requirements and then did a master's of public health in Oklahoma before going back home for one year and then starting residency in 2016 here at Baylor. It’s been a long long path, but very worth it.

Eileen: What have you noticed some of the major differences between medical school in Saudi Arabia versus being a resident or a fellow here versus the time that you spent living in Oklahoma?

Dr. Alshaikh: Very different experiences honestly. So starting with med school. In Saudi Arabia, they follow the old system where you do a year of general science and then do six years of medical school that includes a year of internship or general training/clinical exposure. Whereas in the US, you guys follow the newer system of doing like the organ-based like rotations and doing all the basic science as well as the clinical rotations pertaining to that specific system. In here, you do--you graduate from high school, you go into undergrad, and then go to medical school, whereas it's straightforward to like medical school if that's what you want to do. With regards to Oklahoma, so it was my first experience in the US. It wasn't much of a cultural shock because honestly a lot of people around the world are exposed to the American culture one way or the other, like watching movies, shows, news, and that sort of thing. But being away from, you know, your comfort zone, being away from your family is actually stressful, but I feel like it prepared me--a good exposure before residency. 

Eileen: What was your husband studying?

Dr. Alshaikh: He did radiation therapy and then did a master's in dosimetry in Oklahoma, and now he's doing a master's in bioinformatics here in Houston. So I followed him to Oklahoma and he followed me to Houston. 

Eileen: Well it all works out, I guess! Did you always know that you wanted to go into medicine? I personally, when I started my undergrad, I did not know that I wanted to do medicine so I always admire people who know right out the gate like that.

Dr. Alshaikh: Yeah, no. It wasn't it wasn't the case with me until I was in my ninth grade actually. Before that, I never thought of medicine. I wasn't one of those who grew up dressing like doctors or aspiring to be doctors honestly, and I'm the first doctor in my family. My dad is a chemical engineer and my mom is a stay-at-home mom, and so it's very far away from our family (the medical field in general). But I started thinking about it after losing some close people to me and I thought it was empowering in a way, you know, to know what you're dealing with and be able to help people. 

Eileen: So then you went to medical school and then came and did a master's in public health and then went back to Saudi Arabia and then came back to the US.

Dr. Alshaikh: Yeah, back and forth.

Eileen: So you are working in emergency medicine and obviously this has been a pretty crazy time for everyone, but I would think especially emergency medicine. We scheduled this interview I think back in February, but we've been planning it since October, so we didn't know that it was going to be a Zoom interview. But I'm just wondering what your experience has been with all of the craziness with COVID working in the ER?

Dr. Alshaikh: So it's definitely a very stressful time for everyone, especially people in the medical field... and people working in the hospital in general, from different services, like all collaborating in providing the service. The emergency medicine clinicians in general and providers are on the front lines, and so it's more stressful to some people… especially those who have, you know, kids at home or elderly. The situation is not easy on anyone, because nobody knows about this virus and it's like, I'm sure, that first experience of pandemic for everyone except those who are like a hundred year old were there during the Spanish flu. And so there is definitely some stress and anxiety going on, on all levels. For me personally, during this time I'm actually having some credentialing with TMB issues, with the fellowship program itself needing renewal. So I'm not working clinically, but I have been working doing things related to ultrasound... so doing scanning shifts and then also involved with the COVID task force for the emergency. And so we've been planning, scheduling daily meetings going over, you know, what things we could do, with the things we could improve, and working with the different teams in order to prepare our ER to face this pandemic. We just recently, like the past week, moved to every other day meeting. But it's been a very heavy work and I'm actually proud of my colleagues, my senior faculty, who have been working hard to prepare us for this. And actually, our ER was one of the first ERs to prepare for the pandemic in the area. Thankfully we weren't hit hard, but we're still being very cautious because we haven't--most of us think we haven't seen our peak yet--but places in New York, Italy and Spain, you see just a horrific scene and the reports we hear from our colleagues there are honestly frightening. Recently, I don't know if you guys had heard the news, but one of our colleagues--emergency physicians--has lost her life due to this pandemic. A lot of people, you know, can work to a certain… extent extent under stress, but eventually it gets to you.

Eileen: So are you planning to stay at Baylor or are you thinking about going elsewhere?

Dr. Alshaikh: I'm staying at Baylor. I'm doing an additional year doing global health and industrial medicine at the same program so it's a combined ultrasound-disaster medicine with global health mission. 

Eileen: Do you know what you want to do after that?

Dr. Alshaikh: After I finished my fellowship, I'm planning on going back. So I'm going back to Saudi. I'll be working at the tertiary center, a cancer center back home, for about three years and then planning on going back to the academic emergency medicine setting. So to a university or educational facility and hopefully incorporating the additional training I got in ultrasound, disaster medicine, and global health, and doing medical missions worldwide in underserved areas. That's the long-term goal, I would say. 

Juan: So you would agree that this crazy time is kind of preparing you for more challenges down the road? 

Dr. Alshaikh: For sure! Yeah, yeah, for sure. I mean it's preparing everyone. Like I don't think the world is going to be the same after COVID honestly. I feel like it has humbled everyone in a way. 

Juan: So, I mean, it's obviously a very challenging time. You said that this time definitely has prepared and it's going to change medicine for the better. What ways do you see personally from your experiences that this is going to prepare us in the future, or maybe just make a better physician or better public health awareness?

Dr. Alshaikh: It shows how it's important to educate the public and use the available media channels in a way to do so. As I said, a lot of people are having some very stressful times, having anxiety and depression, and some people even--like there are people committing suicide because of all of this. And so it just shows how important this part of medicine is, and how it is vital to incorporate the into patient care and the community actually programs in general. 

Juan: And it's gonna be a little frustrating in some sense to, you know, to understand from the point of view of medicine and being in medicine as a practitioner or as a medical student and then to see the public kind of deny the seriousness of these problems. It's just very frustrating, right?

Dr. Alshaikh: Yeah, absolutely, and that's because they're getting conflicting information. So you see, people from the medical field getting the correct information, but then you see some other people who are not specialized in this part of, you know, this aspect of science or knowledge and then they just give advice or share their information as if facts. And we should--we need to differentiate and take the information from those who are specialized rather than, you know, just listening to everyone's input with regards to this. I feel like public health officials in general need to point out this, and also hold those people who spread those kind of, you know, misinformation accountable in a way to stop it from spreading. 

Eileen: Do you think that your degree and your time spent studying public health has affected how you're looking at this epidemic? 

Dr. Alshaikh: It's always important to be proactive, so I feel like sometimes it's too late to implement measures. And what I loved about our program is that they addressed this even before it got to Houston. You know, they started early on, and that's what I feel helped flatten the curve in a way and made us more comfortable, you know, handling a potential, you know, surge if it occurs at some point, we know all the specific details from the very minor to the major details, and so addressing the problem and dealing with the problem early on is manageable, as opposed to addressing it when it's it's too late--like secondary or tertiary prevention prevention. Like we deal with, for example, cancer--breast cancer for example,--or lung cancer. It's super easy to tell someone, you know, to stop or modify the modifiable risk factors--like, for example, tobacco smoking--as opposed to, you know, address the lung cancer when it's stage four. Same thing goes with the pandemic in general and everything in life generally--if you address it early on, it's much easier for you to control it. 

Juan: I guess that's assuming that we have an open mind and listen, right? And that people understand what they're hearing?

Dr. Alshaikh: True. Unfortunately, everybody now has a way of, you know, having their input out in the world and so there's a lot of people talking and much less people listening honestly. And that's why it's not effective with certain groups of the public. And so, I feel like again you have to take the information from those who are specialized, rather than just, you know, from everyone. Because it's just going to confuse you and and you'll get lost. Ironically, today is the first day of their plan of reopening Texas in general and so a lot of us are very concerned about this. It's good that they're doing a gradual reopening process. It's better than, you know, just moving from shutting down to fully open. But we're still--we still think we haven't reached our peak yet. Very important to follow the public health measures implemented in the beginning, which is social listening distancing--minimizing, you know, gatherings as much as possible and maintaining that six feet distance from everyone. And honestly people who are eager to go to, you know, restaurants, salons, movie theaters, malls--I feel like I understand the economical part--aspect of this all, but we're dealing with a bigger problem honestly. It's your life, as well as the lives of everyone else. You might be fit and healthy. You could have someone elderly at home who might be susceptible and may have complications because of this. As you know, a lot of people can have the infection and wouldn't show any symptoms, and so you could easily transmit this infection to others. And that's why we ask people not just to, you know, keep those who are prone to get the complications or die from the from the infection like locked out, rather have the whole community contribute to this--because of the asymptomatic carriers that could transmit the infection to everyone else. And then there were reports of people having significant morbidity and mortality, despite them not having any risk factors. And so don't… I wouldn't ask… wouldn't tell anyone to take it lightly. Even if you think you're young and healthy, you be should be very cautious until we know more about this virus and hopefully develop a vaccine for it. This case fatality rate thankfully is, is less in the US compared to, for example, Italy. I think it--it's around 3, 3.5%. In Italy, it was at some point around 9%, which is very high. And a lot of people are recovering from the virus, but again this overwhelms our health system and  if the cases start increasing significantly... we could be in the same situation as other parts of the world. But thankfully, currently, it seems like we're doing a good job.

Eileen: Is there anything that you've been doing just personally to kind of keep yourself sane? 

Dr. Alshaikh: So the best thing, honestly, that happened to me is that I had--I got a dog a year ago. Not a year even, nine months ago! And she's turned one year old like two days ago. 

Eileen: Happy birthday!

Dr. Alshaikh: Thank you. And it's been honestly very helpful at keeping me sane. I feel like this, as well as maintaining that communication and connection with family and friends via phone/texting does help. I'm an introvert of sorts, so I don't mind, like, staying home if I need to. It's okay. But I know that it must be difficult for some other people who rely much more than us on, you know, on being outside, being outdoors, and engaging more... can be very stressful. But I feel like--just think of the alternatives. Exercising--you could just try to do that inside the house in a way. A lot of programs out there are providing free workouts and there's also some counseling going on through Baylor and other services. And there's the meditation apps, websites. So there's a lot of options and I feel like the community came together in a way to help provide that support. 

Juan: And I think there are other aspects of all of this, right? We were just focused on the virus, of not getting sick, that we didn't really think of social factors, right? And human factors? And I think a while ago, as this started to increase in severity, I would think of the back end, right? I would think of who would be getting the best care. And it was kind of interesting that the CDC released the numbers from New York… those from disadvantaged backgrounds getting less care and I was wondering if--what your thoughts are on that here, and if you think anything similar is maybe happening here? 

Dr. Alshaikh: You bring up a very good point. Health disparities exist, and it's a real thing, and has been researched. In terms of our experience with this specific pandemic, honestly don't have any data to back this up or personal experiences, honestly, just to support that. But I feel like, giving that we're practicing in a county hospital has been a good thing for us, a fortunate thing, honestly. We really don't close our doors in the face of anyone. We accept everyone and treat everyone, thankfully. ERs in general are governed by EMTALA in general, and so they don't really use anyone who seeks care. They have to stabilize before they transfer, if the transfer is needed. But other services, I can imagine this could be potentially stressful if the physicians host war, you know, to provide care for those who need it... go against the hospitals they work for because the patient doesn't have, you know, what it takes to pay for the care required, or they come from an unfortunate background, or are being judged because, for example, they have some certain aspects to their prior visits. And so they have--people have those preconceived notions that this patient, “Oh he's probably just an alcohol consumer” or “He's done that” or “He did drugs.” And so we don't really provide that same of care because we don't believe him in a way, but I feel that's probably not that common, at least in the--our county hospital. And I feel like a lot I work alongs alongside great physicians, honestly, who try their their best to pay attention to those kind of things. And one of our physicians actually brought up this as a research topic: of looking at racial disparities with regards to COVID. But because we don't have big patient population yet, difficult to look at this at this research topic in particular. But yeah, they do exist unfortunately. 

Eileen: I'm afraid that I don't know terribly much about it, but could you talk a little bit about how the health system works in Saudi Arabia and how it might be similar or different to how we approach health here?

Dr. Alshaikh: Yeah, in Saudi Arabia it's a universal health care system and so everybody has the option of seeking the governmental hospitals and have their care for free, actually, which is a good thing for a lot of people. But the only disadvantage is that because everybody is going through that channel, it could slow things a bit, and so people could have appointments in life six months or a year, and the wait times are longer than than other parts of the world, especially the US. But the--there's a private sector as well, so those who can afford it could potentially go through that. And that's the major difference. With regards to the US, when I first came in here, the biggest shocking factor was the high cost of healthcare in the US compared to the Middle East, and the world in general. Like for example, I'm talking about a medication that I--not a medication, a CT actually. I've had a friend who had a CT scan here in the US in an ER. It cost, if I remember correctly, close to fifteen hundred dollars. And my sister required a CT back home and it costs about 250 dollars. And so it's like six times the price. And then there was my--I had a medication that I needed here in the US, and it had to prescribe… to be prescribed. And it costs around like 190 dollars. Back home, it would cost around 12. So there was a significant, significant difference in terms of the cost in general, and I feel that may have led to this disparity seen as well. The other thing was… given that the US is not a universal health care system, those who can't afford care unfortunately won't get it unless they go through like a county hospital or a charity, and it's been frustrating to hear about this and see that. And I feel like the US is great in many ways and could potentially address this, giving that they are leaders in the medical field in many ways--in research, technology, innovation. This is a big problem and I feel like could potentially be solved and hopefully would be in the future.

Eileen: And how do you think that affects your work in a county hospital, in the emergency department in particular? As you mentioned, if someone comes into the emergency department and they're not stable, you can't just send them home. You have to treat everyone. So do you think that you end up seeing people, like you were saying before, who haven't gotten the preventative care and so they end up in a much worse position than they would have been otherwise?

Dr. Alshaikh: Yeah, so it was honestly frustrating to see like a patient that you treated, for example, weeks ago when you told them, you know, you need to get your medications, you need to see your primary care doctor, and then they come back not doing any of the things you told them. And, you know, me being a junior and not very familiar with the health system, I was like, “This patient is not compliant.” But when I talk to them, it turns out they can't afford the medication, or they don't have a primary care doctor, or they don't have transportation to take them to their doctor. And so it's straining in a way on providers, you know. We swore an oath we want to provide care. We want to help our patients, but our hands are tied. There is a certain limit of help you could provide and at some point you feel like--I mean, engaging social workers could help and our social workers are actually excellent at doing so, but again they too can't help with every aspect of the patient's care and their social issues and barriers. And yeah, it does create that frustration. We do our best, at least when we're prescribing medication, to look at the cost and so we try to find the cheapest option with the equivalent effect of medication but on the cheaper side, to take that into account. And as well, we try not to order or over order things that we don't need. And not just to, you know, minimize cost, but also to limit risk associated, for example, with radiation and unnecessary testing. But yeah, it makes us very very keen on thinking of the economical factors in the ER setting, giving that we're dealing with underserved population. But like I said, with the EMTALA, which is the Emergency Medical Treatment and Active Labor Act, it's a good thing for us in the ER setting, because we really don't shut our doors in the face of anyone. And so everybody is welcome to come to the ER, at least get their medical screening exam done. And so I feel like it's a bit less stressful compared to other services who can't provide that, governed by their institutional life guidelines.

Eileen: And how did you end up specifically in emergency medicine? 

Dr. Alshaikh: When I first got into med school, before even, I was interested in GI and endocrinology. 

Eileen: That’s pretty different.

Dr. Alshaikh: Yeah very very different, but because my late grandma--she died due to complications of cirrhosis and diabetes, and so those were the areas that I was interested in. But as I was getting, going through the years and started getting that clinical exposure, did my ENT rotation first and just fell in love with it, with the surgical aspect of it, and was thinking of even doing a subspecialty in allergy and immunology. And then did an ER rotation, I was like “Wow, this is even more fascinating!” I could still keep that wide large knowledge base and still do interventional procedures and intervene on critical patients and save lives, and still could do things related to ENT, in a way. Like I could still, you know, manage critical ENT situations and keep that connection with every other specialty. And so I decided to go with ER due to that specific fact. If I could do two specialties, those would be my two specialties but that would be impossible of course and just crazy hours, like to study for 20 years or so!

Eileen: As a first year medical student who is very interested in emergency medicine, would you recommend going into emergency medicine?

Dr. Alshaikh: Oh for sure. I mean, this pandemic is the biggest example of how important this field is. At the very basic description of it, you're saving lives on a daily basis. You're seeing a very wide range of cases--from very stable bread and butter, like primary care even cases, all the way to critically ill dying patients and everything in between. You see pediatric patient population, you see geriatric patients, you see female--pregnant females, you see other specialties--like surgical and medical specialties. And you deal with those cases, and so I feel like it's keeping that connection with every other specialty. And so, if you are leaning more towards a generalized specialty, emergency medicine is the most generalized specialty, in my point of view. And you could still do procedures, intervene in a way. If you’re like a person who loves to do some kind of surgical or procedural things, then emergency medicine provides that. But it's very rewarding, I would say, if you're a person who loves to see quick results. If you want to do meaningful things and see quick results immediately, then that is provided in an emergency setting. It can be very stressful and very humbling, especially early on in your training, but it's definitely very rewarding and worth it. I think it's one of the most fascinating specialties out there and I never regretted going into it.

Eileen: Do you have any favorite moments working in the ER, either a moment with a patient or with a colleague?

Dr. Alshaikh: I have so many great moments honestly, but in general it’s when--my favorite moments are when I do a procedure and see a significant and a quick result in a way: like significant or sudden pain relief, a change in the critical situation in a better way, or significant improvement. And then I love those shifts when it's very busy and there's a lot of things that you could do that is 180 degrees transforming the patient's condition. Like for example, when in one of our community side, it was a busy shift and we--in addition to the regular cases we're seeing. And one day I had two intubations, placed two central lines in on those patients, had a patient with altered mental status, had to do an LP in addition to the full workup, had an unconscious patient that we had to resuscitate until patient gained consciousness, had a patient with an overdose we had to give narcan, and then put him on a drip and have to intubate him. And then on top of that, we had a patient with an ankle fracture that we had to splint and reduce. And then just the cherry on top, we had a pregnant lady who was in labor. But we didn't deliver her; thankfully, she was stable to go to the labor ward, but it's just the wide range of things that you see. And you're having to be very efficient and flipping from one room and one case to another. And just change that mentality completely and be able to help and contribute in a way. It's just--just very rewarding. Although it's exhausting, but very rewarding. 

Eileen: I don't think there's any other specialty where you get to see all of that in, you know, one one shift. 

Dr. Alshaikh: Basically all specialties of medicine are incorporated into one.

Juan: Sounds like an Oscar-winning drama series.

Dr. Alshaikh: Yeah, it can be crazy. It can be crazy, but there are days where it's like
slow and different--completely different. The whole situation is unpredictable honestly. In the ER, you don't--you never know. And there's always that subtle anxiety deep down inside in every one of us, because we know it could just transform in a matter of seconds. And so we never say
it's too quiet, because it will jinx it. 

Eileen: I worked in an ER for a couple of years and then we called the keyword quiet--you did not say that.

Dr. Alshaikh: Exactly. It does do something, in a way. Maybe I'm superstitious, but I've seen it. Like early on, during my first medical school, going “Oh my gosh it's super quiet.” And then hell just broke and since then I was like, “Oh I learned my lesson.” 

Eileen: Yeah, one thing that was interesting for me working in the ER is I noticed a pattern that a lot of the younger physicians were a lot quicker to pull out the ultrasound machine and to use it for many more things. So I'm wondering if you can tell us a little bit from the perspective of someone who's doing a fellowship in ultrasound, how do you see that changing medicine and emergency medicine moving forward?

Dr. Alshaikh: So ultrasound is great for patient care in general honestly, because it provides a safe and a quick tool, you know, in order to help determine disposition, as well as a safe procedural guidance. For example, for central lines, people used to do them blindly and so they would stick a needle in the neck of a patient or the groin of a patient and hoping that they get into the vein. Of course, knowing the underlying anatomy helps, but there are some patients who have difficult surface anatomy to tell where the vein is. And so bleeding, puncturing the lung… using ultrasound--Juan is just terrified. Don't worry Juan, we're using ultrasound now! It's much safer.

Juan: Just thinking of someone just turning those arteries into swiss cheese. It's just... poking around.

Dr. Alshaikh: It can be--it can be definitely scary, especially if it's like a junior person who's just learning, you know, the skill. But thankfully, with ultrasound, you don't have this problem or it's significantly minimized. You still do honestly, but it's significantly minimized because you could tell what you're going through. You could tell how deep is your needle and what's--how far is it from the pleura or the lung covering and then how far is it from the artery. Because when you’re doing this procedure, you want to go through a vein. You don't want to be puncturing an artery, leading to hemorrhage and hematoma and whatnot. And so you could potentially control this and minimize any complications with this, with these procedures. And then the other thing that I like about ultrasound is that it just gives you--it's affordable, cheap, useful, and safe modality. And so what I mean by that, it doesn't--it doesn't really use any kind of radiation. And so when I'm--I could easily just pull my ultrasound with me and go look at the heart, looking for any fluid around the heart that could be drained. Is the heart pumping or not? I could scan the lung and look for any fluid around the lung, any air around the lungs or any signs of pneumonia, and then I could move down and look at the belly looking for the aorta and any complications related to that. We could also evaluate the pregnancy, ruptured ectopic pregnancy. We could look for any bleeding within that intra-abdominal space or intraperitoneal space. And then we could also look for DVT, or deep venus thrombosis. So these are just things that you could--it could potentially cause the patient to have shock or hypertension--you could easily screen for within a matter of 10 minutes maximum if you're an experienced scanner. And get your answer then and there. Because a lot of patients who are unstable should not be taken to the CT scan. They could decompensate. And ultrasound could provide answers at bedside. It's safe. Like we said, we don't have to scan the patient multiple times every visit for, for example, aortic pathologies. You could do it do an ultrasound and look for that without exposing to exposing them to that extra radiation. And so that's what I like about it. It's the other new thing that we've been trying to practice more with regards to ultrasound, is regional blocks. So that's like a technique that's used by anesthesiologist, but now we're trying to incorporate that into our practice to minimize the use of anesthetics and opioids. And so it's slowly gaining more popularity and being done in the ER setting as well, under ultrasound guidance. 

Juan: What is the advantage of employing the ultrasound for regional blocks?

Dr. Alshaikh: It's the same thing with other procedures. So you’re actually looking through what the needle is puncturing and what you're going through. You don't want to be developing complications like puncturing the nerve. You want to be around that nerve, inject anesthetic around the nerve, and then also making sure that you're doing it in the correct location in order to increase your success rate as well. 

Eileen: So as ultrasound continues to get cheaper and more portable, do you see that playing a role more in global health and disaster medicine, as you're going in to study next year?

Dr. Alshaikh: For sure. Actually, I went to Belize in a medical mission back in--last year, in April actually, and we did an ultrasound training program. We're still working on that. Like a group of us would go every few months in order to help train and reiterate whatever has been taught. And making sure that we cover all different locations of ultrasound. And it's amazing, because in a lot of sites that we've been to, CT scans are not available, period. They have to transfer them one hour away. So imagine having a trauma patient who's unstable and you really don't know what's going on intra-abdominally, and ultrasound provides that in a matter of seconds and minutes. And so it's definitely very applicable, very useful in limited-resource settings. 

Eileen: Yeah, I think it's incredible the number of things that we can do with ultrasound. It's also a little intimidating when you're first starting to learn how to read an ultrasound, because a lot of it looks like grainy, black and white… 

Dr. Alshaikh: The same?

Eileen: Yep!

Dr. Alshaikh: I know. I've been there, but I promise you it will make more sense if you get exposed. So you're welcome, as well as other medical students, you know, to rotate with us. I think it's provided as an elective. And it will make more sense, I promise you. There is some science to that grainy, unclear, black and white picture. But yeah, and you love it once you see how amazing it is and different applications. For example--like the medical students get excited when we do the ocular ultrasound. They're like “I didn't know that we could use it for the eye.” And they actually see the pupil, you know, constricting and dilating and the eye moving and the different parts, even the optic nerve, back like deep behind the eye. So it's fascinating. It's like that--what is it--the vision? The infrared? I forgot the English term. It's like the through and through vision.

Eileen: X-ray vision, like?

Dr. Alshaikh: Maybe. So it provides that. Because for example, I love radiology and I appreciate the ultrasound because you know it showed me that behind the scenes look. Incorrect description, but yeah. Just shows how fascinated I am with this modality.

Eileen: Could you talk a little bit about the teaching that you've done at Baylor, and how that's been part of your medical career?

Dr. Alshaikh: Every shift is an opportunity for you to teach someone, it’s either your juniors, your medical students--whether that's case-based, whether that's ultrasound-related, whether it’s procedural, or critical care management. With regards to ultrasound, we do scanning shifts. So we have been doing those for the past year and we rotate with residents as well as students and other rotators (PAs) and teach them all the core applications of ultrasound in the ER setting. In addition to that, we do have the journal club and video review weekly meeting. We try to do QI where we review our trainees’ ultrasound scans and send them feedback. The medical mission we've done in Belize also was part of the educational aspect. We also look in, you know, at possible opportunities elsewhere, outside of the hospital. I know prior classes had--had taught EMS and other specialties, as well, pediatrics, people from medicine, I believe. And so it's a good opportunity to teach this modality to everyone who is interested. And we consider every opportunity. We were supposed to actually, in April, participate in TCEP to teach at conference, at a conference in Dallas--Fort Worth, I mean. And then we also taught at ACEP, and there was also a surgical conference back at the beginning of the academic year. My colleagues and I, we did ultrasound teaching to groups of those--groups of interested people. So there's a lot of teaching you could do with ultrasound and we look forward to any opportunity provided.

Eileen: This has been such an interesting conversation, and you've answered most of my questions. I think the last thing that I just wanted to ask you about briefly was how you see the role of international medical graduates becoming more common in the US in residency? And what that was like? You mentioned you had to sort of go back and do all of the US requirements after you had already graduated from medical school, and what that process is...

Dr. Alshaikh: It's a big decision to make, honestly. And a lot of IMGs take risks by coming to the US. The process should, in the most ideal situation, should begin early on, like during your first two years of med school in order to try to incorporate your Step One after you do the basic science. And then do the remaining tests after you're done with your clinical rotations. With regards to--you asked about their contribution, is that correct, or their role? So I feel like it depends; it differs. Like certain IMGs plan on staying in the US, and they do contribute great things to the US system and they embrace the American dream. And there are some other IMGs who want to improve their healthcare work--the health system back in their home countries. And I'm in that group. I want to--I want to go back, I want to teach. I want to help improve the system, as well as the med school there in terms of ultrasound and disaster medicine in general. But I still want to have that connection with the US, as well as the rest of the world in global health so yeah...

Eileen: We're very lucky to have you, even just for a few years.

Dr. Alshaikh: Oh thank you so much. I'm lucky to be here. I'm very fortunate. I love Houston, by the way. It feels like my second home. It's hot and humid, like back home, and crowded. And it's just like home.

Eileen: Do you have any advice for either students who are applying to get into medical school or first-year medical students who are kind of at the beginning of their career?

Dr. Alshaikh: Yeah, I do have advice to those who are beginning residency and those who haven't really decided on what specialty they want to do. For those who didn't decide yet, I would advise you to have all the possible exposure you could get--even specialties that you didn't consider at the beginning. Try to get that exposure. You could be surprised. Your true calling might be something very different from what you've got into medicine thinking you're going to be doing, like in my case. So find that and commit to it. And it's definitely a path worth taking. With regards to those who are starting their residency, I'm gonna be realistic. It might be a very stressful time for you guys. And so it's very important to take care of yourselves: your diet, your health--mental and physical health--and maintain that connection with your loved ones. Maintain that support system, even if it's like talking to your parent or your sister or your friend for like just a couple of minutes every few days. It might be difficult, especially in the beginning, but just remember that everybody is going through a stressful time at the beginning of their training during internship year. Everybody--regardless of what they seem or do. Just some people are better at hiding it and some people seem more anxious than others. So know that you're not in this alone, and make sure that you invest in your health. It's very easy to get into a habit of eating fast food, or you know just the snacks or bars or whatnot, but make sure you know you take some kind of supplemental like diet or multivitamin. Fruits, veggies: smoothies are super easy to do. So invest in a smoothie maker or blender. And then the emotional or the emotional aspect of your health is very very important. It's okay to cry. It's okay to feel like you're lost. It's okay to feel that you're going through a lot. I mean personally, I felt like “Oh my gosh, I can't do this; it's just gonna--I'm just gonna fail.” You know, it's a turmoil. There are some ups and downs. We all go through this. Just reach out to those who can help (your mentors) and remember that it's gonna get easier as you go. You either get more resilient or things truly get easier. And just work on your education and knowledge base slowly but surely. Never stop. There was like a nice sign that I saw all over Belize: “Be slow, but keep moving.” So I feel that's good advice, you know. And it also helps sometimes when you--on your day off, to completely disconnect, even for a few hours and just like go for a run, a yoga class, or you know with your pets if you have a pet, or with your loved ones. You know, just try to disconnect completely from the hospital atmosphere. And I promise you it's worth it at the end. But if you feel like--if the stress is just too big of a burden, there are ways of, you know, getting help. And I know that through Baylor they have this mental health support which is very confidential, and there's a lot of you know channels for which you could get help. So just seek those and ask about them if it's not very clear, but don't ignore that aspect of your health.

Eileen: Great, great advice and very inspiring. Well, we're kind of coming up on the hour and I don't want to keep you any longer. Is there anything else that you wanted to say, or pretty much ready to go hang out with your dog?

Dr. Alshaikh: Well thank you so much, guys, for having me. This has been fun. It actually passed very quickly. I didn't feel like we already reached an hour. So thank you so much for having me.

Eileen: Well thank you so much for talking to us. I really enjoyed the conversation a lot.

Juan: Yeah, thank you. Time flies by when you're sharing an inspirational story and motivating others to do better and to stick through these tough times. And we really appreciate you--having you on. And I wish you all the best in the COVID battles, and just know that you have our full support and that you guys are our heroes and we appreciate everything you do.

Dr. Alshaikh: You too, guys. Thank you so much. And I know the medical students have been very active, actually, in procuring PPE for us. So big shout out to you guys. You've been awesome and always ready to help; so we couldn't do this without you. We're all in this together, so… it's gonna pass.