Emotional Education in PBS's 'Rx: Doctors of Tomorrow'

Alexa Mieses

Disclosures

March 31, 2015

Editor's Note: A PBS two-part documentary, Rx: The Quiet Revolution, will air beginning on April 2 (Check local listings). Reflecting on his physician father's practice and the move away from hands-on care in contemporary medicine, the documentary's award-winning director, David Grubin, highlights a range of innovative practice models from Maine to Alaska. Medscape asked a number of our experts to preview the film and offer us their reactions and opinions about how the documentary depicts the healthcare system as they know it and live it.

In this commentary, Alexa Mieses, a medical student at the Icahn School of Medicine at Mount Sinai and blogger for Medscape's Medical Student blog, The Differential, offers her perspective.

The upcoming PBS documentary Rx: Doctors of Tomorrow shows first-year medical students at Hofstra-North Shore Long Island Jewish School of Medicine (Hofstra-LIJ) as they undergo their first foray into medicine. The program reminded me of my first day in the anatomy lab. I had imagined that day many times over. Anatomy lab is a rite of passage for medical students, so I had mixed emotions of excitement and fear. The experience marked the official start of my medical education but also my first encounter with a dead person—my first patient.

Watching the Hofstra-LIJ students took me back to my initial assignment: to dissect the muscles of the back. The logic was that we become desensitized to our cadaver over time, saving the more intimate parts (eg, face) for last. It wasn't dissecting the face or genitals that generated anxiety within me...it was the hands. Hands tell you a lot about a person. Nail polish, calluses, and scars offer a glimpse into the soul that once filled the body. My cadaver's hands reemphasized that the body in front of me was once a person. I thought about her hand intertwined with that of a lover or brushing tears away from a child's face. I will never forget the curvature of her thumb.

The documentary does an excellent job capturing the emotions associated with the initial medical experience. Although not all patient interactions are as intense as anatomy lab can be, most are easily just as intimate. Physicians (and medical students) are allowed into strangers' lives and personal space at a time when they are most vulnerable and in search of healing. If physicians are lucky, they earn patients' trust and form a bond unlike any other. For this reason, the practice of medicine is more than scientific papers and clinical practice logarithms. This is why documentaries like the PBS one are valuable—because they remind us of things that can't be learned simply from textbooks. The practice of medicine is an art form and a privilege.

Watching the Hofstra-LIJ students served as a reminder that medical education is diverse in nature and encompasses things not often considered. I recently heard a doctor recollect that, when he was in medical school, the saying was, "Do you want to be a nice physician or a good physician?" This of course implied that connecting with patients and being an astute clinician are mutually exclusive. Now more than ever before, this saying could not be any more false. Thankfully, Rx: Doctors of Tomorrow is proof that at least one medical school is training soon-to-be-physicians to be humanistic and curious, from the day their education begins.

Hofstra-LIJ's approach is very interesting. First-year students begin EMT training on day one. The logic is that by training and working as an EMT, students see their patients within the context of home and community. As Lawrence Smith, MD, dean of the Hofstra medical school said, "We want them [medical students] seeing patients as people in need of healing, not people who are just diseases presenting to their office." In fact, training students to be EMTs is not the only way that Hofstra-LIJ is training compassionate physicians.

The film documents the students' first day of anatomy. And it begins with the cadaver lying face up. The students' reactions echo the anxiety about death shared by medical students past. One of them, Edom Yoelum, insightfully remarks, "It is hard balancing your emotions and everything that comes with working with the human body...conscience of the things going on in the patient and the changes that are occurring in you." Part of the curriculum includes a time to reflect and share thoughts in small groups.

As I watched the students speak and take intermittent pauses to hold back their tears, I too became tearful. Emotions stemming from my own experience with a cadaver came flooding back. The Hofstra-LIJ students also wondered about their donor's life and loved ones. Medicine reminds us of our own mortality every day; for many medical students, anatomy lab is the first time we receive that reminder. The documentary captures this emotional and personal moment in the students' lives. Their professor so accurately remarks, "[Students struggle to be] engaged with [the donor] but detached. It is a dichotomy they will have to face for the rest of their lives."

Rx: Doctors of Tomorrow goes on to portray other aspects of the Hofstra-LIJ curriculum. Small-group learning activities and clinical preceptor sessions focus on the patient rather than the disease process and emphasize a team-based approach to patient care. It is difficult to teach a physician to genuinely connect with patients, yet, if ever there was a way, perhaps Hofstra-LIJ has nailed it. Ingraining a culture of humanism, professionalism, and a sense of humility early on in medical students' training can help them blossom into compassionate and empathetic physicians; medical students can transform into healers.

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