UMHS graduate Dr. Amrita Amanda Lakraj (June 2013) is currently a Neurology Resident at Froedtert Hospital, part of the Medical College of Wisconsin in Milwaukee. While still a medical student, Dr. Lakraj did neuromuscular research at Yale and published a case report. In addition, as a postdoctoral research associate at Yale, she observed patients and published manuscripts about movement disorders. Dr. Lakraj also contributed to a chapter for a textbook. We spoke to this busy and accomplished young doctor about how she became interested in neurology, her research experiences, and how her medical education at UMHS prepared her for such a challenging, lifesaving area of medicine.
What made you want to become a neurologist?
Growing up and entering medical school, I always wanted to be a pediatrician. My inspiration for becoming a neurologist actually stems from my experience in the neuroscience course at UMHS. Neurology as a field is known to be complex, and this was confirmed by many of the upperclassmen who I witnessed to be struggling and spending an immense amount of time studying the material. Eventually, it was my turn to take the course and I decided I would work extra hard in fear of failing. However, to my surprise, I was delighted to find that I was enjoying what I was learning and actually wanted to spend more time studying. The gross anatomy of the brain intrigued me, the puzzles of spinal cord lesions challenged me, and the different neurologic pathologies kept me wondering, “How and what if?” With that being said, I cannot overlook the influences of the two professors who taught the course (Dr. Alan Ernst and Dr. Michael Doherty) who guided my learning in every way, answered every dumb question I had, and supported my interest in the subject matter. I truly owe the seeds of my success to them and their teaching. Ultimately, I ended up doing well in the class and had the opportunity to be the neuroscience teaching assistant for the class to follow. After starting my clinical clerkships and experiencing a sense of intrigue over neurologic cases early on, I knew that neurology would become the epitome of my career goals in conjunction with my journey to residency and becoming a physician. I was incredibly lucky to Neurology Sub-Is and research at great hospitals and really enjoyed every minute of these experiences, further confirming my career aspirations.
What is the most intriguing aspect of neurology?
I believe that the most intriguing aspect of neurology is the variety in presentation. Two patients with the same lesion or disruption in anatomy may not present the same way, and the same symptom can be caused by several different sources. Basically, this means that every patient needs to be considered separately and may need a different plan of treatment. There is no set schematic or flowchart to follow. For example, not every patient who comes in with a stroke will get TPA; and for those who will, the decision needs to be made in a certain timeframe. The need for critically thinking through the differential diagnosis, work up, and treatment in neurology is a true art requiring a skilled mind,which can be quite the challenge but is exciting and oftentimes rewarding.
What are some of the challenges that neurologists currently face?
Challenges faced by neurologist mostly surround treatment. Though there are many medications available to help with neurologic symptoms, there are no definitive treatments. Many people report that this is what turns them away from neurology. The most common example used is stroke. The situation I am most familiar with is Parkinson’s Disease for which there is no treatment. However, it must be taken into account that neurology is a very young field and every day steps are taken to bring us closer to treatments. Not to mention, the so-called “Band-Aids” available today to help symptoms are much more improved. For example, we can now use botulinum toxin [Botox] to help with disability in stroke victims, and deep brain stimulation for Parkinson’s patients.
Tell us about the research you did at Yale.
As a medical student, the research I did was neuromuscular based under the leadership of Dr. Daniel DiCapua where I worked on a project which studied the correlation of abnormal electromyography (EMG) reports and abnormal cerebrospinal fluid results within a day of each other in patients presenting with Guillain–Barrésyndrome. During this time I also observed many interesting patients with neuromuscular illness and published a case report on one child with Myotonia congenita: http://www.ncbi.nlm.nih.gov/pubmed/23483815
The research I did as a postdoctoral research associate at Yale once I graduated was through the division of Movement Disorders under the mentorship of the department chair, Dr. Bahman Jabbari. The movement disorders division is largely made up of Parkinson’s Disease patients and patient’s with Parkinson’s-like illnesses such as Progressive Supranuclear Palsy (PSP), but also other movement disorders and dystonias in general. As a researcher I worked on various clinical trials which mostly focused on the use of botulinum toxin for things like restless leg syndrome, post-cancer surgical pain, and Parkinson’s Disease tremor. I also observed patients in the clinic and was given the opportunity to publish manuscripts on different subjects in movement disorders:
You worked on a textbook. What was that experience like?
Working on a textbook was a very arduous [process]. However, I learned a lot. One morning my mentor called me to his office and said that we were asked to contribute a chapter to a textbook and that he wanted me to do it. He gave me some instructions to read about the material and familiarize myself a couple days before writing, but that was it. The best part was that we had less than two months to complete it. It was pretty much trial and error. I would write large parts, page after page, section by section, and send it to my mentor for review. There were times where he would delete pages of my writing because a certain area needed less information and then ask me to write more pages if a certain area needed more information. I can remember being frustrated and being locked in the office on the ninth floor for hours, but with the support of my mentor, the chapter was completed and it is currently in press.I am very, very excited to see it come out later this year or early next year.
How did you first hear about UMHS and what made you decide to attend the University?
I first heard about UMHS as a member of American Medical Women’s Association (AMWA) at my undergrad institution, University of South Florida. A representative (can’t remember which one now) came to speak to our group and gave us some information about the school. I was intrigued by the state-of-the-art equipment, new anatomy lab, reputable professors; and, of course, the fact that it was founded by the Ross family gave it credibility. I decided to apply in December and two weeks later, was headed to the island for a January start date!
What about your medical education at UMHS gave you a unique edge to prepare for becoming a doctor?
Doing medical school on an island alone of course gives an edge. Every student compromises the closeness of family and friends to go to a place which is completely out of their comfort zone and lacking in the amenities which they are accustomed to in effort to pursue their education. The fact that our classes are smaller gives everyone an equal chance to get the attention and help they need. The professors, for the most part, come from established medical backgrounds in the USA and know what they should be teaching. And finally seeing health care in a less-fortunate place like St. Kitts, where there is no air conditioning in every hospital room, the equipment is not up to date, people are not educated enough about their health, and tons of people are suffering from diabetes and concomitant infections gives each student another perspective of medical healthcare and makes them more well rounded.
How would you compare your preparedness during clinical rotations to that of U.S. medical students?
I would say that my preparedness during clinical rotations was equivalent to US students, especially with our built-in semester in Maine that helps with clinical skills. My first rotation was pediatrics at St. Barnabas Hospital in Bronx, NY, where I rotated with Albert Einstein students. According to the feedback from my preceptors, my clinical performance was good and I felt that it was comparable to the other medical students who were at the same stage in rotations as myself. I would also like to take the opportunity to say that I did away rotations at Yale and definitely still felt comparable to those medical students. When questions were asked at rounds, I sometimes would be the only one to answer, and this has nothing to do with me as a person, but instead is directly attributed to the training I got on the island (I really do believe this). Finally, I would like to mention that thanks to the clinical semester in Maine, I actually took my CS portion of Step 2 after only two rotations as a medical student.
What is the most important thing you learned during clinical rotations?
The most important thing I learned during rotating is the fact that you as a student will play a big role in deciphering what kind of experience you will have and what you will learn. It is up to you as the student to take responsibility of your own patient, which includes following everything that goes on with them, all results from tests and labs, and spending time explaining to the patient what is going on with them. Not only does this help you learn by teaching the patient but in keeping both the patient and your resident updated on all changes and results, you as a student feel a sense of responsibility, the patient is happier because they feel informed and involved in their care, and your resident can tell that you are putting in effort, even if this means giving them an update which they had known beforehand because they are the resident, and it is their job to be the first to know whatever new information is available for their patient.
What advice would you give to current UMHS students preparing for the residency match?
In preparing for residency, I would advise students to start early. The worst thing you can do is be in a rush to complete your application in the end and submit it with typos or [have it be] deficient of important information. Ask for letters of recommendation early and from people with whom you have established a good connection. Even if it is way ahead of the time you will apply, ask them to write the letter and keep it on file with their secretary; that way when they are writing the letter, you are fresh in their mind. Finally, always look for [an] opportunity to help with research projects which your resident/interns are working on, or try to become involved in activities which you know will be beneficial to strengthening your CV, such as a volunteer activity, which does not take up too much time but serves the community.
Is there anything else that you would like to add?
The bottom line is that this school will give you the tools you need to be successful in the clinical world. However, as with all medical students, including American grads, it is up to you to build on what you know and seek opportunities to excel. The worst mistake you can make is thinking something is not possible because you are a Caribbean medical student. Though our school may be young and we have all faced our struggles from a technical side (scheduling something, getting a grade in or a particular fee), it is up to us as students and alumni to showcase our knowledge and clinical skills not only to open doors for ourselves, but for UMHS students to follow, which will allow our school to be well known and on top.