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The Impact of Premedical Clinical Experience

Orringer, Matthew J.

doi: 10.1097/ACM.0000000000002232
Teaching and Learning Moments
AM Rounds Blog Post

M.J. Orringer is a fourth-year student, Brown University, Providence, Rhode Island; e-mail:

An Academic Medicine Podcast episode featuring this article is available through iTunes.

Author’s Note: The names and identifying information in this essay have been changed to protect the identity of the individuals described.

My parents met as medical students at Harvard, and there are generations of physicians in my family. Growing up, dinners were filled with talk of transhiatal esophagectomy, a procedure my grandfather conceived, my father’s laser treatments for vascular lesions, and my mother’s care for migrant farmworkers’ children. When teachers asked what I wanted to be when I grew up, I reflexively responded with “a doctor.”

As I began my college studies, almost without thinking, I registered for the classic premedical courses. Then one day, while attending a dry lecture on photosynthesis, I began to question what my classes had to do with becoming a doctor. The following summer, I worked in a lab, extracting DNA from tumors and becoming proficient with PCR technology. Still I wondered how learning microbiology techniques was preparing me for life as a physician. Organic chemistry and physics as a sophomore did little to recommend medicine to me. Yet I continued my skeptical quest toward medical school.

During the summer after my sophomore year, I shadowed a pediatric cardiologist, Dr. R, and joined his clinical research group. In clinic, I met Noah, a boy born with a single ventricle. I’d heard from my family that the sacred personal relationship between a doctor and a patient may be just as important as their medical relationship. Seeing Noah embrace Dr. R dramatically underscored this for me. The bond between Dr. R and “his families” was palpable. Through my involvement in such interactions, I began to see medicine as a career I wanted to pursue, not just because of my family’s professional pedigree but because of my desire to connect with people and improve their lives as Dr. R was doing.

From observing in the ICU, I learned about the medical problems that pediatric cardiology patients may experience and the treatments that improve their survival and quality of life. On rounds, I listened as physicians analyzed vital signs and lab results. I was struck by how deeply the doctors and nurses cared for each patient, and I related to their sense of teamwork because of my own experiences in athletics. Immersed in the sights and sounds of clinical medicine, I came to understand the satisfaction and impact of practicing medicine and the tremendous honor it is to care for patients.

I also recruited patients for Dr. R’s study identifying the genetic markers that may explain why some kids with congenital heart disease recover quickly after surgery while others are prone to complications. I loved interacting with the patients and their families and felt proud to play a small role in potentially improving their lives.

Understanding the study’s vast potential helped me draw a direct line between my science courses and real-life clinical care. No longer were genetic and molecular pathways just information to memorize but, rather, they served as the critical basis for treatments that were intended to save lives. For example, when Dr. R explained the molecular mechanism of ACE inhibitors, I recalled learning the renin-angiotensin-aldosterone system in my physiology course. I began to understand that it is basic science discovery that has led to new therapeutic options that help people every day. Seeing the fruits of such work applied in clinical practice made clear the true value of learning basic biology. Making these connections between what I had read in my textbooks and the many patients I met made my future career path certain.

Moving forward, I want to learn more about the functioning of the body, and I will never forget that, for every tumor suppressor gene or phosphorylation reaction waiting to be understood, there is a patient who might benefit from this knowledge. If not for these rich and varied clinical experiences, I might still be wondering if pursuing a medical career is truly the right path for me. I can now passionately answer the age-old question of what I want to be when I grow up.

A doctor.

Copyright © 2017 by the Association of American Medical Colleges