Introduction to the Profession: Entering Students Take the Plunge

Photo by Graham Ramsay Katharine Treadway directs a new introductory course for incoming students.

“Most people go through their lives never seeing someone die,” said Katharine Treadway, HMS assistant professor of medicine at Massachusetts General Hospital. Doctors do see it, and they must absorb the emotional impact. Or they may treat a 16-year-old who was made a quadriplegic by a diving accident. “What is that like?”

Starting in August, it will be Treadway’s job to show entering students what it is like and to clue them in to other essentials of the physician’s life, as director of a new two-week course, Introduction to the Profession. “When they enter medical school, they need to make a transfer in thinking from that of being a student to that of being a physician-in-training,” she said. Introduction to the Profession is meant to be a two-week dress rehearsal for the next four years of medical school: getting students to appreciate that the cornerstones of a doctor’s life are intellectual development, emotional development, and professional development. All of these are essential to becoming an effective clinician.

The new students will go on rounds two years ahead of the current schedule. Plunged head first into all that medical terminology, they “will understand absolutely nothing,” Treadway conceded. But rounds teach that saving lives demands knowledge of basic science—something that some entering students have less background in than others. The doctors-to-be also will be told to observe interactions: between house officers and attendings, nurses and doctors, family members and patients, patients and doctors. Treadway said they will be instructed to note their feelings because such gut checks are “an absolutely critical skill for a physician.” Then they’ll come together in groups of about a dozen to discuss what they have seen, and they will interview a patient about his or her experience. They will also learn basic life-saving techniques like the Heimlich maneuver and CPR.

Over two days, students will be assigned a case, probably involving HIV, that will run very much as tutorials do now. After watching a video of a doctor and patient together, the students will discuss the case to learn how to get worthwhile patient information. Basic science lectures will be part of the case. “HIV is particularly useful because … the basic biologic processes are very well understood, and so you can link basic science to how you design a drug to provide effective treatment,” Treadway explained. “It also affords an opportunity to talk about some of the ethical issues that arose in the beginning … when there were doctors who refused to treat people who were HIV-positive. There’s a whole social context of disease and emotional context of disease.” At the end of the two days, the students will meet the real patient and doctor in their video case and talk with them.

The variety of careers in medicine, self-reflection, teamwork, and communication—students will see all of these. The HIV case, as well as another exercise of using mannequins to rehearse a crisis as a team, will address what Treadway calls a critical but overlooked need in educating doctors: “All of these students have come out of highly competitive environments to get here, and we’re going to tell them to do a 180 and suddenly cooperate with each other to learn.”

—Rich Barlow

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