Being a Student at Harvard Medical School
Enrolling at Harvard Medical School is much more than beginning just another educational experience or preparing for just another job. Entering HMS is the first step in assuming a way of life that will stimulate and challenge you for the rest of your days and that will shape your view of the world and your relationships with others — not only your patients, but your colleagues, your friends, and your loved ones. As you are acquiring new knowledge, attitudes, and skills, you will also be developing as a person who can take responsibility for the care of other human beings in the most important moments of their lives — often when they are the most vulnerable. You will be preparing yourself for a life of service, making responsible use of the special privileges granted by society to those who assume the healing role.
The many rewards of being a physician are proportional to the seriousness with which you undertake this role. Learning to be a doctor is not trivial or simple; it is challenging intellectually, physically, emotionally, and personally. The role of Harvard Medical School is not to dilute or diminish these challenges, but rather to help you to grow as a person and a professional by confronting them. The following are the dimensions of the growth that will accompany your transition to becoming a physician.
Intellectual growth is the traditional core of medical education, preparing you for lifelong learning, for proper approaches to clinical reasoning, for critical analysis of the sources of scientific knowledge, for the development of new knowledge, and for the applications of that knowledge in the care of patients. Being a good doctor requires a substantial fund of knowledge; acquiring and applying that knowledge demands intensive work. Perhaps most crucial, you must always be aware of what you do not know and have the confidence to seek assistance to fill in gaps and further your knowledge.
The multiplicity of careers now open to physicians expands the scope of knowledge to be grasped in medical school. The upshot is that the standard courses, tutorials, and clinical and laboratory experiences remain the heart of medical education and cannot be taken lightly. This is true whether your career is focused on research, teaching, clinical care, some balance among this classic triad, or an altogether novel, nontraditional path.
Medicine is by its very nature imprecise and will require you to live with and tolerate uncertainty and ambiguity every day. You will learn to make the best possible judgments, based on your knowledge of empirical findings, personal experience, professional values, and the wishes of your patients — all requiring critical self-reflection and ongoing self-assessment. You will learn to acknowledge and learn from the inevitable mistakes we all make in the course of our professional lives. Vital to intellectual growth is a commitment to excellence, honesty, and integrity, whether at the bedside, in the clinic, in the classroom, or in the laboratory. Your intellectual development requires constructive channeling of competitive urges, alertness to conflicts of interest, and sharing, together with other members of the profession, the responsibility for the maintenance of intellectual and ethical standards by others.
The practice of medicine at the highest level, which is in most cases physically demanding, calls for close and continuing attention to personal health and physical well being. Students have a responsibility to themselves, their families, and their patients to maintain good health and, to the extent possible, to practice the health measures they recommend to others. Maintenance of health includes paying attention to your sleep, relaxation, exercise, and diet; believe it or not, HMS students are not super people, immune to the physical limitations set by nature. Studying and practicing medicine also calls for you to maintain a professional relationship with your own primary care physician and seek appropriate consultation for your physical and emotional needs.
Self-care particularly involves judicious use of alcohol and keen awareness of the dangers of other substances of abuse. An important and often ignored fact cannot be stressed strongly enough – physicians and other health workers are at high risk for disabling substance abuse because of stressful work habits, the emotional demands of clinical practice, and easy access to drugs. These risks begin at the student level and continue throughout your career and into old age.
The physician is privileged to participate in life's most intimate, personal, and agonizing moments. These are often the most rewarding when they are most stressful emotionally. Medical education at Harvard offers experiences in a variety of settings involving these emotionally demanding situations. Immersion in such situations is enriched for students by the wisdom and experience of clinical faculty and other colleagues who can offer understanding, empathy, and support.
Your development as an effective physician in caring for patients requires establishing collaborative relationships in which you are attuned to patients' physical, emotional, and spiritual needs. You will learn to facilitate these deep connections based on active listening, mutual respect, and dialogue resulting in empathic connections with your patients.
Learning about the emotional impact of illness in others should involve attention not just to patients and their families, but also to the emotions of your fellow students and mature practitioners as well. Participation in these experiences as a student is an opportunity to begin the complicated but crucial process of managing your own emotions as a physician. The goal is to maintain enough distance and perspective to function effectively and responsibly in your caring role without shutting yourself off emotionally. Finally, your very world view is unlikely to escape modification during your transition to becoming a physician.
The practice of medicine is a social activity that occupies protected space in society. The physician is granted exceptional privileges by society in return for which s/he assumes obligations of duty, service, accountability, confidentiality, and the maintenance of standards of quality. These public obligations, such as concern about the costs of care,
cannot be set aside lightly or overridden by obligations to individual patients. Instead, the physician must seek a balance between the two demands of society and individual patients. Doing so is not an easy task, as the possibilities for the care of one patient may intrude on the availability of care for other patients. Your education at Harvard will afford you the opportunity to begin the struggle with, and mature in managing, these difficult issues.
The practice of medicine is no longer a solo activity. Driven by the demands of technological complexity, medical care requires that physicians interact with other professionals and a variety of social institutions whose realities and prerogatives must be understood, respected, accommodated, and occasionally challenged. Harvard medical education emphasizes the reality of team-based practice to prepare students for participation in modern medical care. Physicians must be both leaders and followers, and both roles call for a nuanced approach to medical autonomy and primary responsibility.
Your role as a physician requires you to be aware of the world of the patient and develop a deep understanding of the meaning of the patient's gender, ethnicity, race, sexual orientation, spiritual beliefs, family structure, and personal understanding of health and illness. Your increasing cultural competence will ensure optimal communication and provision of care. Beyond your knowledge of a patient's culture and individual values, you must be aware of the social and community context within which health care is delivered. The role of poverty, literacy, social stigma of illness, and access to health care will become increasingly important to you as a physician.
A traditional component of medicine is altruism — that the care of patients is separate from financial rewards. In an earlier era, that concept meant that physicians were expected to donate their services when patients could not afford medical care. That tradition is rendered more complicated by the technological complexity of medical practice, by changes in financing and payment for services, and by the fact that most modern care must be delivered in organized settings by a large contingent of providers of whom the physician is only one of many. The new dimensions of altruism include concern for the realities of the social context. Primary responsibility for the care of individuals must be expanded to include the broader dimensions of community, nation, and world. The most common condition associated with poor health is poverty, whose roots lie in history, culture, economics, and politics. You will have the opportunity to learn about the broader dimensions of advocacy for patients at the community, national, and international levels.
Moral "true north" for physicians has traditionally been the commitment to place the interests and welfare of patients above other considerations. In the increasingly complex world of modern health care, focusing on the patient's interest is not sufficient. In the actual practice of medicine, a great many situations arise in which conflicts of values cannot be resolved simply by placing the patient's interests first without regard for complicating factors. Technology creates a "patient care village" in which the good of all may be affected by the good of one. You will be introduced early to the complexity of deciding the right thing to do in the absence of simple answers. Doing the right thing based upon that moral judgment will be a constant demand and struggle.
Being a physician, a member of a learned and humane profession, imposes highly personal demands on time, intellectual commitment, integrity, and responsibility. Each physician owes all others a standard of behavior that reflects well on the entire profession. This kind of commitment is true "24/7." Wherever and whenever you act, not only in the clinic, hospital, and laboratory, you represent all physicians and the higher standard to which they are held. Conversely, difficult as it may be, each physician must contribute to the self-regulation and group discipline that is one of the defining principles of medicine as a profession. Your student years are not too early to begin to shoulder that responsibility. Contributing personally to a culture in which ethical problems and lapses of professional behavior are confronted and discussed is an important and challenging obligation of your life as a student.
The HMS faculty consists of individuals who are highly skilled at what they do and yet demonstrate both the nobility and the frailties that make them human beings. High accomplishment may at times be accompanied by personal immaturity or other missteps, and everyone, no matter how talented, has some bad days along with the good ones. Learning from bad role models is just as valuable as learning from admirable ones, and the importance to HMS students of appreciating the difference between the good and the bad role models and learning from each cannot be overemphasized. Concern about faculty conduct should be shared with trusted individuals, particularly Society Masters or mentors; such feedback ensures that the student's point of view contributes to the professional culture to which we all aspire at HMS.
Success at Harvard Medical School
Harvard medical students are high achievers, distinguished by their accomplishments in a considerable range of fields; accolades for you and your fellow students are not new. Being congratulated for accomplishment as a fledgling physician will happen and will be gratifying but is not an experience that will add substance to your future as a physician.
Much more important than praise will be critical comments that identify areas in need of improvement, which may come from faculty, from patients, from other health care workers, or from classmates. Painful as criticism may be in the short run, such feedback is the key to improvement and should be sought and welcomed.
Constructive criticism is hard to come by. Candor is at least as painful to the provider as to the recipient. Surprisingly, faculty members hate to criticize students; they dislike confrontation and feel uncomfortable inflicting pain even in a good cause like a student's improvement. Asking faculty members to tell you what can be improved may be the only way to learn the most important lessons for your future as a physician. Short-term pain is the key to long-term gain, and seeking to improve through self-scrutiny and reflection must become a lifelong habit.
Failure at Harvard Medical School
The educational program at HMS is organized around the principle that each student is a precious investment in the future of service to the public — an investment that must be treasured and preserved. As a result, for a student to fail at HMS is very difficult.
The first line of defense against failure is the relationship with your Society Master and Associate Masters. Their job is to know each student personally and academically, which permits them to understand any problems in a personal context. Learning in medical school, particularly learning in the complex clinical environment, requires skills different from those needed in the premedical or basic science environment. In addition to the Academic Societies, the Office of Advising Resources (OAR), which is staffed by learning specialists, offers help with study skills for the Boards, exams, and clinical medicine and provides assistance in identifying learning difficulties. Evaluation of psychological or medical problems is readily available at University Health Services in Vanderbilt Hall or at Holyoke Center in Cambridge. The Promotion and Review Board monitors the educational progress of all students and has available a number of measures to assure that Harvard Medical School graduates are safe and effective practitioners, a credit to the school and their colleagues, and capable of serving society.
Failure at Harvard Medical School is defined only as the inability or unwillingness to make use of the rich resources available to help.
You are fortunate to be entering medicine at this time. Advances in the treatment and cure of disease and alleviation of suffering are vast and continue to expand each year. The personal and moral dilemmas with which you will struggle are a measure of that growth and are to be welcomed rather than resented or ignored. Similarly, the gratification of participating in a life of service grows with the advance of knowledge. In your professional lifetimes, a great many changes in the role and functioning of physicians will take place. You must prepare yourselves to contribute constructively to those changes to ensure that the tradition of service remains at the heart of our profession. Be assured that the finest medical faculty in the world is eager to work with you to assure your success.
Now that we have told you what we hold as the highest ideal for our students, we will tell you about Harvard Medical School, beginning with its history.