Kanter, Steven L. MD
At many medical schools around the world, the months of August and September mark the time when students complete the rite of passage from applicant to medical student. These rites most often include orientation sessions, social activities, and greetings from school officials.
One topic that permeates these sessions is professionalism. Through implicit themes and explicit messages, deans and faculty begin to educate new students on the very first day of medical school about the principles of professionalism, including excellence, humanism, accountability, and altruism.1
Over the years, I have heard many presentations and read many articles about these principles and other aspects of professionalism, but rarely, if ever, have I heard or read a compelling discussion about when someone actually becomes a member of the profession of medicine. That is to say, at what point during the continuum of medical education and practice does an individual make the transition from being a lay person to being a member of the medical profession? It is in this spirit that I write the following letter to all those who have the privilege to matriculate as medical students.
Dear New Medical Student,
I know that you have worked extremely hard for many years to gain acceptance to medical school. I also know that your medical school has worked equally hard to screen and interview many applicants, each of whom wanted to occupy the place you now hold. So, congratulations and welcome!
Now that medical school has begun, I am sure that the deans and faculty of your school are talking to you about the unique privileges and critical responsibilities that accompany being a medical student – and ultimately being a physician. As you listen to them, and as you begin to reflect on what it means to be in medicine, I invite you to consider the following question: When will you become a member of the profession of medicine?
Each year, during the first week of class at my medical school, I go before the new first-year students and pose this question to them. Some students respond that it occurs when one becomes a practicing physician. Some say it happens when one receives a license to practice medicine. Others contend that it takes place when one enters a residency program, and still others call out that it happens when one officially receives his or her MD degree.
So then I ask my students whether they think that something magical happens at some point during medical training, such that an individual suddenly merits membership in the profession. For example, could this happen with the granting of a license or degree? What about the first time you touch a patient? Or, perhaps, the first time you save a life?
We always come to the same conclusion: that there is no better time to begin the transition from lay person to professional than the very first day of medical school. It is so important to start, as soon as possible, to incorporate attitudes and values of professionalism, to integrate in your own mind ways to think and act in a professional manner, and to develop an underlying identity of yourself as a member of a profession. That's right—it is critical that you begin this process now. And, as soon as you do, I believe that you have become a member of the profession of medicine!
Considering yourself a member of the profession of medicine, starting right now, will begin an important process of socialization and acculturation. It will help you begin to think about yourself and to conduct yourself in new ways and to mature intellectually and professionally as you develop an identity as a student-doctor, and eventually as a doctor.
This is important for many reasons—let's consider three. First, it is very likely that sometime in the next few weeks, one of your professors will bring a patient before the class. As a student, you may see it as the order of the day that a patient is brought in to help you learn. But, if you consider yourself a member of the medical profession, you will begin to sense a larger perspective, and you likely will reflect on your own responsibilities in such a setting.
You may decide that it is important to present a professional appearance to the patient, and so you may wear your white coat that day. You may think about how the patient views you (not just how you view the patient). A patient once commented to me that he saw medical students not only as members of the medical profession but also as representing the very future of the profession. Because patients will often see you as a member of the profession (even though you are not yet a licensed physician), they will share with you the most intimate details of their lives. This is truly a privilege and important to your learning.
As you extend your thinking along these lines, you will begin to think more about the patient in the context of his or her own life. For example, the patient may not be confident in his or her decision to appear before a class of medical students, but was swayed by the desire to please his or her doctor (who also is your professor). Recognizing this as a possibility may help you include some comforting words as you thank the patient for contributing to your education. For instance, you might decide to say something like, “I realize how much courage and effort it takes to appear at an event like this, and I just want you to know how much it adds to our understanding of other people who have an illness like yours and who work so hard to deal with it.”
When you conduct yourself in a professional manner with patients who consent to come before a medical school class, it validates their feelings that they are contributing to the education of health professionals and thus helping others who have the same disease or syndrome that they do.
Second, considering yourself a member of the medical profession is also important to your basic coursework. Soon, you will begin to study the gross anatomy of the human body and, in most medical schools, you will have the privilege of dissecting a cadaver. If you think of yourself as a professional person, it will enhance your ability to understand the relationship between you and your cadaver and it will help you as you think about how to regard a body willed for anatomic dissection.
And third, if you are walking down a road and you see someone get hit by a car, and you believe that you are a member of the medical profession, then you have no choice but to go to that person's side and do what you can to help. A lay person may do that – perhaps should do that – but is not obligated to do that. You are. I realize that you may not feel qualified at this stage to do much, and it is certainly important to do no harm. However, I believe that there are many things you could do to help in a situation such as this. For example, even as a new first-year student, you could call for help, make observations about what transpires that could be useful to qualified personnel who subsequently arrive on the scene, and comfort the individual.
So, congratulations again on securing a seat in your entering class. You will hear a lot about professionalism—its definition, its principles, and how your school will measure it—but please consider what it means for you to be a member of the medical profession, beginning right now. It will influence how you think about yourself, how you approach the task ahead of you, and how you interact with patients, colleagues, and others.
Remember that nothing magical happens at the time a degree is awarded or a license is issued or a ceremony is held. These are milestones that mark achievement, but they will not suddenly and miraculously convert you from a lay person to a member of a profession. It is up to you to begin a process of reflection as your underlying identity evolves from undergraduate student to medical student, from lay person to professional person, from learner to health professional.
Thinking about yourself in this way is hard work and takes time and will continue throughout your professional life. But the rewards of being a member of the medical profession are some of the greatest a human being can know. Welcome to the profession of medicine!
Steven L. Kanter, MD