For many of the 200 members of the incoming Harvard Medical School and Harvard School of Dental Medicine Class of 2022, the start of their journeys as physicians and dentists is the culmination of a lifetime of hard work and dreams.
As they received their white coats during their first week Introduction to the Profession classes, however, they were cautioned that while they will learn a great deal during the next four years, they will also confront uncertainty and failure, and these experiences will inform their futures as physicians.
“You must learn to be comfortable with not knowing everything,” HMS Dean George Q. Daley, the Caroline Shields Walker Professor of Medicine, told the incoming students. “You must learn to tolerate uncertainty while being inspired and empowered by everything that you do and learn here. If you bring earnestness, compassion and sensitivity to all that you do, there is one certainty, and that is you will serve your patients well.”
Edward Hundert, dean for medical education and the Daniel D. Federman, M.D. Professor in Residence of Global Health and Social Medicine and Medical Education, echoed that theme, telling the students that because medicine changes so rapidly, one of the most important things they will learn in medical school will be how to learn—a skill they will need to hone for the remainder of their careers.
“You are going to learn so much more medicine in the 40 or so years after medical school,” Hundert said. “You’re going to learn the most from your patients.”
Social determinants of health
The new class wasted no time before beginning to learn about future patients and the impact of geography on every individual’s health.
Following a tradition begun in 2017, the students spent part of a day visiting Boston-area communities. They traveled to nearly 20 different neighborhoods, many in under-resourced areas, and called at clinics such as the Whittier Street Health Center in Roxbury, Boston Health Care for the Homeless Program and the Healthy Chelsea Coalition.
“It’s important for the students to have this exposure because, while they’re going to learn to be the best doctors and dentists they can be within a clinical setting, they’re going to learn that’s only a piece of a person’s total health and well-being,” said Jennifer Kasper, assistant professor of global health and social medicine at HMS and HMS assistant professor of pediatrics at Massachusetts General Hospital.
The idea is to give the students an up close and personal exposure to the social determinants of health, Kasper said.
Before they embarked on their tours, fourth-year student Sanjay Kishore spoke to the new students about why understanding where a patient comes from and what their life is like is so vitally important to being a successful physician.
“You will hear over and over again that the secret to medicine is actually just listening—and that’s what you begin today, as soon as you step out those doors,” Kishore said. “This is a sacred act. You start listening to the communities you actually aim to serve.”
The students later returned to HMS to debrief and discuss their impressions. Some noted the sometimes vast income disparities of adjoining neighborhoods in Cambridge. Others remarked on the impact a federal building is having on a community of immigrants in Chelsea. Others described the seemingly insurmountable obstacles to adequate health care that geography and economics create for significant numbers of people.
“I think it was really important that we saw [community disparities] ourselves, not just talking about it in the classroom,” said Stacy Cho, whose group visited the Southern Jamaica Plain Health Center.
“I think a lot of times the [medical] curriculum is very heavy on the technical details … and it becomes a little difficult to zoom out and get perspective,” said Anamika Veeramani. “This is a commitment to always realizing the patient is a person with a family, a community and a future.”
"The faculty facilitators were all struck by how the experiences of the day really brought out critical lessons about our local communities; their challenges and their assets; and the impact of community on the health our students’ future patients," said Nancy Oriol, faculty associate dean for community engagement in medical education and associate professor of anaesthesia at Beth Israel Deaconess Medical Center.
"This is why the day was so important - physicians and dentists must understand the context of their patients’ lives if they are going to know how to support their health during all the rest of their life when our patients are not in our offices," she said.
The 165 medical students entering this year were chosen from a pool of close to 7,000 candidates, according to Robert Mayer, faculty associate dean for admissions.
Fewer than 900 of those candidates were invited for interviews and 3.4 percent were offered places in the new class, with 72 percent accepting. The students come from 61 different undergraduate schools, 32 U.S. states and eight other countries.
Twenty-four percent of the class is from groups underrepresented in medicine; 32 percent are Asian and 18 percent self-reported as LGBTQ. Seventy of the new students are male and 95 are female.
HSDM received more than 1,000 applications and invited 92 candidates for interviews, admitting 36. There are 16 women in the class and 20 men. Eleven percent are from groups underrepresented in medicine. The HSDM class hails from 16 U.S. states and 28 different undergraduate schools.
The dental students will spend the first year of their studies with medical students enrolled in the Pathways curriculum.
“We are committed to excellence in dental education, to innovation in charting the future course of dental medicine, to the pursuit and advancement of scientific discovery and to the application of new knowledge to improve patient care,” HSDM Dean R. Bruce Donoff, the Walter C. Guralnick Distinguished Professor of Oral and Maxillofacial Surgery, told the new students.
“These lofty goals and core purpose are well-served by our belief and practice that dentistry is a branch of medicine, dental disease is part of medical disease, and care of any part of human disease demands an understanding, knowledge and appreciation of the whole patient,” Donoff said.
Midweek, all of the students attended their first patient clinic at Brigham and Women’s Hospital after a get-to-know you lunch within their individual societies, where they also received their white coats. Even as they were set to embark on a long path of learning how to care for others, they were all reminded that wellness—their patients’ and their own—begins at home.
“With medicine, it’s a balancing act and you’re always trying to figure out how you can juggle everything you have to do,” said Alden Landry, faculty assistant director of diversity inclusion and community partnership, advisor and associate director of the Castle Society, and HMS assistant professor of emergency medicine at Beth Israel Deaconess Medical Center. “It’s important to remember to have fun and keep it all in balance.”