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Teaching and Learning Moments

Morning Report

Torchia, Michael T.

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doi: 10.1097/ACM.0000000000000202
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“I saw Charcot-Marie-Tooth disease yesterday. Wish I could have recalled the details of that disease in front of my attending,” said my classmate as he sat down next to me, settling in for yet another eight hours of lecture.

“At least you didn’t get pimped on the vascular distribution of the MCA,” I countered, simultaneously racking my brain for any memory of a PowerPoint slide on Charcot-Marie-Tooth disease while explaining the stroke code I had witnessed in the emergency room the previous night.

“Did they give tPA?” interjected another classmate, with a hint of self-satisfaction in her ability to identify the presumed next step in the management of my patient.

“Don’t know … I went to check the patient in the next room with an occlusion of the RCA who was headed to the cath lab for a PCI,” I stuttered, trying to seem confident in pronouncing the cardiac alphabet soup that was crowding out my already-faint memories of the Charcot-Marie-Tooth disease slide.

While the Department of Medicine held their weekly morbidity and mortality conference one room down from our second-year medical school classroom, four of my fellow classmates and I knew that the real clinical conference of the week occurred here, from 7:54 AM to 7:59 AM every Tuesday morning.

All of us were enrolled in the Process of Clinical Care course, a longitudinal experience that spanned our preclinical years and intentionally immersed us in three care settings (inpatient, outpatient, and acute care/long-term care) for one day per week, usually Mondays. My classmates and I then spent Tuesday mornings sharing the best of what we each saw the previous afternoon in the “real world” of hospitals, clinics, and nursing homes.

Of course, we would be the first to admit that the pathophysiology, natural history, treatment, and management of the disease processes we saw were quite foreign at that point in our medical education. Yet, we also understood that these experiences were far more valuable and had far greater ramifications than simply providing us with a better understanding of how to integrate preclinical education with clinical experiences. Gradually, we came to realize that our weekly de facto “conference” served a much larger purpose—we formed a template for how we will practice medicine in the future. That is, we learned the value in presenting a case crisply without useless details, developed a sincere desire for feedback, and sought our peers to provide guidance and support. Medical educators would call this forming our professional identities. We just thought it was fun to pimp each other.

Perhaps most importantly, however, we realized that it was fun. It was a blast to think about pathophysiology, pharmacology, decision making, and the privilege of practicing medicine; to realize that, oh yeah, I really am passionate about clinical medicine and that’s why I’m here. For at least a few minutes each week, we got a break from the arrhythmia-inducing phrases that dominate a second-year medical student’s life—exams, grades, EBM, FA, AOA, USMLE. We were able to fully embrace our lack of knowledge and not worry about impressing an attending or, worse, looking like the sophomoric second years that we were. Without these high-pressure circumstances, we experienced more clearly the joy in practicing medicine.

Every day I’m saturated with articles about what the medical profession lacks—funding, time, organization, simplicity, new therapies, compassion, innovation. But I have yet to hear someone write about the lack of joy. Perhaps the answer to so many of our supposedly intractable problems is to rediscover the joy that comes from the privilege of practicing medicine. Critics might say that a second-year medical student knows nothing of clinical medicine, let alone anything about the physical, mental, and emotional toll that it exerts on a physician. They would be correct. Yet I do know that anything that allows us to discover and rediscover our original passion for medicine, for healing, is surely not a bad thing. While the specific circumstances that prompt each of us to rediscover our passion for the art of medicine will be different, perhaps we should spend some time figuring out what those circumstance are. For now, though, I have to prepare for a Tuesday morning conference.

Michael T. Torchia

Mr. Torchia is a third-year medical student,

University of Minnesota Medical School,

Minneapolis, Minnesota; e-mail:

© 2014 by the Association of American Medical Colleges