To the Editor:
We support Lown and Manning's1 advocacy of the Schwartz Center Rounds (SCR) as a means for achieving positive changes in the culture of medical institutions. However, would offering SCR to third-year students—when the professional enculturation process is still in its early stages—contribute in unique ways to medical culture and communities?
To pursue this question, our medical school has offered SCR for third-year students since 2007. As might be expected, we find that there are many commonalities between the ways that medical students and their more senior colleagues respond to SCR. For example, both groups enjoy having a forum for discussion that is not didactic but dialogic, allowing all attendees to share their perspectives.
What is substantially different, however, is the focus. In SCR, dialogue typically focuses on patients and the complex matters of caring for patients as whole persons. With third-year students, the focus is on the students as whole persons, so much so that, in this version of SCR, it can fairly be said that the students are the cases. This is not to say that students lack empathy for or interest in patients: hardly so. But what we are coming more and more to appreciate is that the stresses of the identity formation process in which these students find themselves—coupled with the often profound loneliness of serving brief, six-week clerkships in hospitals around the world—require strong compassionate attention both from us as faculty members and from each student to his or her fellows.
As Lown and Manning suggest, compassion is itself a kind of medicine, one that benefits both providers and patients. It would seem that medical students need compassion, too, and perhaps much more than we've been in the habit of providing them. And, if our hunch is right, showing compassion to them in their third year may do much to keep them emotionally healthy and safe, to abate the rise in cynicism that typically occurs at this juncture in their training, and to encourage the formation of a professional identity in which compassion is a central and enduring feature.
Naturally, we welcome comments and challenges from our colleagues.
Peter (Pano) T. Rodis, PhD
Lecturer, Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire.
Joseph F. O'Donnell, MD
Senior advising dean and professor of medicine and psychiatry, Dartmouth Medical School, Hanover, New Hampshire; firstname.lastname@example.org.
William E. Boyle, Jr., MD
Advising dean and professor of pediatrics and community and family medicine, Dartmouth Medical School, Hanover, New Hampshire.
James R. Bell, MD
Advising dean and associate professor of medicine, Dartmouth Medical School, Hanover, New Hampshire.