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John Harvard's Journal

Doctoring 101

September-October 2006

What does it mean to be a physician? How do I work as part of a team? Which career options lie ahead? What’s it like to watch a patient die? For first-year students at Harvard Medical School (HMS), these are natural questions. Faculty members teaching in the new “Introduction to the Profession” course that began in August are charged with suggesting answers.

The two-week course replaces the old three-day orientation that focused more on practical tips about HMS resources. The expanded program’s aim is to help students grasp the magnitude and responsibilities of their prospective career. “Our goal is to get them to understand they are no longer students; they are physicians-in-training,” says course director Katharine Treadway, assistant professor of medicine. “Not only are they obligated, for the welfare of their patients, to learn basic science, but their emotional and professional development is also tremendously important. This is not about getting an ‘A’ on a test; it’s about somebody’s life.”

Katharine Treadway
Photograph by Stu Rosner

“Introduction to the Profession,” which grew out of many discussions as part of HMS’s curricular reform,exposes the students to small-group learning, hospital rounds, and self-care. It includes training in vital signs and basic life support, such as cardiopulmonary resuscitation.

In tutorials, classmates work together to explore the impact of diseases such as AIDS on patients, families, physicians, researchers, and society. They also tap their team skills when using a simulator mannequin to carry out procedures. “To get here, these students have been intensely competitive,” Treadway notes, “and now we’re asking them to turn 180 degrees and share information with each other.”

Looking ahead to their clinical training, first-years in the introductory class spend time observing on a hospital ward. According to Jules Dienstag, HMS dean for medical education, “They’re asked to focus not so much on the technology but on the interactions among physicians, the team, and the patients, almost like a Martian coming in from outer space.”

Emotional stress is also on the agenda. “We discuss how important it is to talk with one another—and that detachment is not the goal,” says Treadway, a primary-care physician at Massachusetts General Hospital who has co-led a course on the doctor-patient relationship for the past 15 years. “There are times you have to be detached; if somebody drops dead in front of you, you can’t stand there saying, ‘Oh, that’s horrible, what should I do?’ You have to think in your doctor mode. But afterward, you have to allow yourself to react to what just happened.

“Over my 28 years as a practicing physician,” she adds, “I have come to believe that medicine is a complex and extraordinary profession. It demands both the accumulation of scientific information and an emotional commitment. Being a doctor truly is a calling. In allowing yourself to care deeply about your patients, it is an incredibly soul-nourishing endeavor.”