Community and Humanity for Med Students—Online

By Ajay Major and Aleena Paul

On the first evening of the AAMC 2013 Annual Meeting in Philadelphia, actors from The Center for the Application and Scholarship of Theater in Medicine showcased “Milestones,” a production chronicling the journey of Dr. J. Smith from her first day of medical school to her third year of residency. The audience watched as Dr. Smith transformed from a blissfully optimistic but naive medical student to an overwhelmed physician, unable to cope with the stressors in her life and acting unprofessionally towards her colleagues. The circumstances behind this transformation were all too familiar to the medical students in the audience: the overwhelming volume of knowledge to be gained, the family members who don’t understand long nights spent at the hospital, and the constant, biting fear of inadequacy. In the discussion following the play, it was heartening to hear faculty stressing the importance of the humanities in maintaining compassion and empathy as medical students tread the arduous path to becoming physicians.

This is not a new concept. Medical educators have long agreed that patient-centered values of self-reflection, communication, collaboration, and empathy should be inculcated in students early in their education to advance quality across the health care system. Adequate training in clinical empathy for students improves patient outcomes, decreases costs, and avoids provider burnout. Unfortunately, research suggests that the socialized hierarchy and “hidden curriculum” of medical education are structural barriers that impede training in the humanism of medicine and may even sap medical students of their compassion and optimism for the profession. It is apparent that there is a disconnect between what medical students need to become compassionate physicians and what is actually available for them during their medical training.

To be frank, these dimensions were not on our minds when we launched in-Training, the online magazine for medical students, in April 2012. Arriving at medical school with a background in news reporting, we sought—and did not find—a forum to continue our own passion for journalism as a force for patient advocacy and collaboration among medical professionals. We founded in-Training to learn more about the community and culture we were about to enter, to participate in the shared experience of being a physician-in-training, and to learn from the wisdom of our peers.

However, when our initial call for submissions garnered over 150 inquiries from medical students across the country in merely two weeks, we came to the startling conclusion that we had stumbled upon an unfilled niche in medical education. Over the past 17 months, in-Training has met this pressing need for a communal gathering place for the medical student body. With over 210 articles authored by 101 medical students at 50 institutions across the United States, Canada, India, and even the Dutch Antilles, in-Training has become a forum for medical students to showcase their literary and artistic endeavors and share their thoughts on arts, politics, science, and literature with their peers around the globe.

The majority of pieces we have published are self-reflections. Medical students finally have a place to call their own where, through reading or writing, they can take a moment in their hectic schedules to reflect on the profound transformation they are undergoing as physicians-in-training. They address diverse topics, including developing patient–physician relationships, maintaining compassion, improving medical education, addressing health disparities, and refining the health care system. The pieces on in-Training are stories of the everyday moments that define today’s medical students and tomorrow’s physicians.

Since we launched, we have learned that the medical student voice is organic, evolving with the changing tides of medicine and health care. To preserve this living, breathing nature, we refined in-Training’s mission this past summer to encourage self-reflection, communication, and collaboration among our medical student audience. We now recognize that our original mission of encouraging the use of media as a vehicle for patient advocacy is only possible once we physicians-in-training have a place to care for our own wellbeing and to navigate our own transformation from blissfully optimistic but naive medical students into compassionate and collaborative physicians.

Major and PaulAjay Major, MBA and Aleena Paul, MBA, are founders and editors-in-chief of in-Training: the online magazine for medical students. @InTrainingDoc

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3 Responses to Community and Humanity for Med Students—Online

  1. Adr Born says:

    Dangerous words, empathy and compassion.
    In the commmunity, compassion would be to ease the pain of an arthritic patient and make life easier for them. The compassion of a doctor is to kick their butts, not accept excuses and get them remobilised to live a longer and more fulfilling life. Societal compassion would put them in a wheelchair.
    Empathy understands why an obese patient is obese in theoretical terms, learning attitudes, tastes, lack of exercise and stress coping strategies in childhood and proactively combating them for the sake of the patient’s health. Sympathy would be to accept those excuses, how the patient feels and how hard it is. The belief that the obese should love their body and love themselves as a right is sympathy when reality is that they obviously do not. They do not care for themselves.
    A sympathetic medical student will already be offended by that last statement. They will easily get trapped in dependent relationships with patients with a transference of power from the patient. The patient is disempowered. The sick role is encouraged.
    Sympathy is to share another’s emotions and be pulled into their point of view in order to be popular. Empathy is to maintain an emotional distance and effectiveness for the sake of the patient’s health. And empathy requires knowledge and experience, a knowledge of the world and experience of what patients are going through with their condition and life. It requires fundamental knowledge of how the mind works, basic psychology.
    And here is the rub. Sympathy does not lead to empathy. They are opposites. Clinging to sympathy prevents the development of empathy. Paradoxically, the path to empathy is to become first the cold, uncaring scientist and academic in order to erase sympathy and learn a culture of objectivity and live it fully to indoctrinate the subconscious mind. That then forms the basis for the knowledge and experience to change to empathy.
    Medical education is a cultural process and much as we would all love to believe that there are short cuts, they do not work. In terms of psychological development, medical school is accelerated aging through the life stages to reach the mental age of the wise traditional matriarch or patriarch stereotype who is assured and confidence enough to be objective and solve problems rather than pander to popularity and blame others. At least two life stages, total reversals of character take place in that process, similar to the reversal between baby and child or child and adolescent. It is the depth of change that new parents often describe.
    These are complete changes in personality, worldview and morality. The med student arrives sympathetic. They change to cold and academic. Then they become empathic. They have become a great doctor.
    These are the major internal changes that prepare the doctor for the stress of their future and to carry such great responsibility. It is sympathy that makes the new doctor powerless, lacking in confidence and overwhelmed becasue they are subjected to a constant tug of war with the patient’s emotions.

    • Vera says:

      Sympathy means acknowledging another person’s emotional hardships and providing comfort and assurance. Empathy goes a step further and means to understand what others are feeling because you have experienced it yourself or can put yourself in their shoes. So while not all doctors can empathize, every great doctor should be able to sympathize

  2. Pingback: A Medical Student's Point of View - The Academic Surgeon

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