During his first year at Harvard Medical School, Rohan Minocha felt an urgency “in his own head” to decide on a clinical specialty and area of research. He was particularly stressed, he said, because he was interested in both pediatric ophthalmology and cardiology.
Minocha, now a second-year student in the Pathways MD program, was not alone in feeling pressure about career choices and related challenges. This past spring, HMS launched a talk series, Thriving in Medicine, to help students manage the stress around these uncertainties.
In these sessions, individual HMS faculty members share stories about their career paths with small groups of students to help them understand what they can do during their first year to thrive throughout medical school and beyond.
By hearing stories of success despite obstacles or changes in direction, students hear how others have faced similar challenges and that it’s possible to hit a bump in the road and still do well in their careers.
“Students put their faculty on a pedestal, thinking they’ve had a perfect path from college directly to med school, graduated with honors, and then were top residents,” said Harpreet Singh, HMS assistant director of student affairs, who co-directs the series.
In reality, many faculty members’ paths have been winding, even rocky, Singh said. Some have doubted that they had what it takes to become a doctor, questioned their choice of specialty, struggled with work-life balance, or wondered how to be true to themselves while still belonging among their peers.
Minocha, who attended three of the sessions, valued hearing from faculty members in their own words about how they didn’t know exactly what type of clinician they wanted to be when they entered medical school and how they made decisions when they experienced conflict between their career and personal lives.
“The faculty were candid about not just their career, but their lives, their values, and how they got to where they are,” he said.
Voicing unspoken norms and values
Four sessions were held over dinner last spring, a setting meant to encourage open, honest discussions of medical school’s unspoken norms and values, often called the hidden curriculum.
Hidden curricula can support or undercut the values the formal curriculum teaches, according to a position paper co-authored by Lisa S. Lehmann, HMS associate professor of medicine, part-time, at Brigham and Women’s Hospital, and published in the Annals of Internal Medicine in 2018.
One of medical education’s primary objectives is to cultivate empathetic doctors, say the authors, yet empathy has been shown to decline during medical school and residency. Thriving in Medicine is one answer to the authors’ call for explicit conversations about challenges to medical student wellness.
The talks support students in becoming the best version of themselves so they can become excellent doctors, said series co-director Andrea Reid, associate dean for students at HMS and HMS assistant professor of medicine at Massachusetts General Hospital.
Two of the speakers centered the importance of finding community. Jennifer Potter, HMS dean for students and HMS professor of medicine at Beth Israel Deaconess Medical Center, and Michael Dougan, HMS associate professor of medicine at Dana-Farber Cancer Institute, each described cultivating relationships that helped them thrive in medical school, in their careers, and in their personal lives.
Guided by a North Star
Potter, who spoke to students on April 28, sought stability and belonging from an early age, she said, because one parent had alcohol use issues, the other had significant mental health challenges, and the family moved often, within the United States and in Europe.
Her path to medicine followed an unconventional course. She skipped two grades in high school when her family moved to Miami from the U.K. She took a gap year, recognizing that she was too young for college. Then, at Swarthmore, college “felt very small,” so she left after two years. For the next three years, she worked as a mental health worker and research assistant while taking classes on nights and weekends to earn a bachelor of science degree.
Resettling as a medical student at HMS brought the next set of challenges. It was the mid-1980s, and she was out as a queer woman. “It was a different era where people were not so much out,” she said. She joined what she says was the first LGBT group at HMS, which provided a microcosm of belonging inside a wider community that felt less accepting. But the group met off campus because members did not feel comfortable meeting on School grounds.
“It wasn’t their fault, but it was lonely for me because I was willing to go there and other people weren’t,” she said.
Potter found a greater sense of belonging in Boston itself. She worked with a dentist who was a gay man and had a gay clientele. In that clinic, and later during medical school clinical rotations, she saw large numbers of young men getting sick and dying from an unknown cause that turned out to be AIDS.
Those experiences, she said, inspired her to take care of members of her community.
She tells students that finding a North Star is important in defining a career. Hers began with women’s and lesbian health, but it grew into something broader: a career devoted to making medicine more equitable for everyone overlooked by traditional care models. She founded the Women’s Health Center at Beth Israel Deaconess and later became co-chair of the Fenway Institute, work that extended her focus from women’s health into LGBTQ health more broadly and ultimately into questions of health equity, access, and representation in medicine as a whole.
Potter’s path opened possibilities she might never otherwise have imagined, not in spite of but because of its circuitousness, she said.
Supported by allies
Dougan, who spoke on May 12, followed an unexpected route in his career journey. He had always wanted to care for patients and had not seen himself becoming a scientist, yet he kept finding himself in the laboratory during college. He was good at it, made good money, and enjoyed the environment.
Recognizing that he needed to think through this self-discovery, he took a gap year. His mentors helped him weigh whether to be a clinician or a basic scientist — a decision that, he said, “felt big to me.”
Then he discovered immunology, which he thought was more medically relevant than many other basic sciences. He decided to become a physician-scientist, which would allow him to do scientific research in immunology while becoming the physician he had always envisioned.
“You have to know those things about yourself, and you don’t want to deny them,” he said.
Dougan had young children while in medical school at HMS in the early 2000s at a time when it was rare for students to have kids, and he said it caused friction with classmates.
During his surgery rotation, he arranged to work extra weekends and holidays in exchange for time off when his first child was born. His classmates complained that he was gaining an advantage by working with surgical residents seven days a week. He found support among established women attending doctors.
“It was hard to be a woman in medicine then, and they told me they were not treated well because they had children,” he said. “Because they hadn’t had mentors, they said they wanted to be there for me.”
But Dougan thinks there were other reasons for the resentment. When course directors asked about students’ goals for the surgery rotation, he was confident enough to say that he didn’t want to be a surgeon and planned to go into internal medicine. His goals were to learn when a patient needs to see a surgeon, how to call a surgical consult, and what to communicate to surgeons.
His straightforwardness got him placed in clinic more often than his classmates, where he got to work directly with attendings.
“The surgical rotation was the most tailored experience I had at HMS, because I was honest about what I actually wanted to learn,” he said.
Optimal growing conditions
Reid likened the Thriving in Medicine series to gardening: The School is the soil, and programs like these are different types of caretaking that enable every individual to flourish.
Hearing from some of the “most accomplished, busiest people in the field” that there is time for family, dinner at home, and hobbies is motivating, said Minocha, who is student council vice president of mental health and wellness.
“We are planting the seeds and nurturing all different types to give them the individualized fertilizer, light, greenhouses, watering, and support that they need to be maximally productive to their own definition of success,” Reid said.
More talks are being planned, and Reid and Singh are reaching out to students so they can guide the program as it expands.
“We want our students not just to survive, but to thrive and become who they want to be without losing themselves along the way,” Reid said.
