More About HST
As I've mentioned before, I am in the Health Sciences and Technology curriculum at Harvard Medical School. This is a joint venture between Harvard and MIT, and I thought I'd explain more about it here.
The primary goal of the program is to train physician-scientists. Ideally, the graduates will both manage their own laboratories while seeing patients, although some graduates tend to go entirely into medical practice or research. A large component of what we learn is therefore cutting-edge research in the field. Each week in all our classes we will probably have at least four scientists in the field explaining their work and the state of the field.
This means that what we learn is not directly relevant for medical practice or for our medical licensing exam, but the point is instead to train a system of thinking about medical science.
Within the rest of the medical school, the HST student is stereotyped as being nerdy, less attractive, and bookish. But this is OK, as we have fun stereotypes for the other programs as well.
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End of ITP & Thoughts on Learning Styles
Today marks the end of our two-week Introduction to the Profession (ITP) and the beginning of regular classes. The two programs, New Pathway and HST, will separate here and reunite only in third year when we begin working in the clinic.
I wanted to take this chance to reflect on case-based learning, the mainstay of New Pathway and most other medical schools in the country. A patient's clinical case is presented, usually with uncertainty about the underlying disease. Uncertain parts of the case - test results, symptoms, X-ray readings, family history - are split among students to research, and upon reconvening each student shares his research with everyone else. Gradually the case is clarified with help from a supervising group leader, usually a doctor.
For me, this system was inefficient for learning. An entire two-hour session could be distilled into a single sheet of paper that could be read in fifteen minutes. Our group would also often branch into unrelated tangents on minor details, bringing up interesting facts that were irrelevant to the case.
I am not suggesting that the problem-based learning model is without merit. The benefits of this system are clear - it resembles real clinical practice in that the patient's condition is often unknown and requires gradual steps to figure out. Furthermore,it encourages collaboration between students, building the type of collaborative spirit central to medical teams in hospitals.
Ultimately the question is whether medical school is about learning the facts or learning the skills of becoming a doctor. Of course, it should be about both. But in these cases, the only skills we practiced were researching a narrow part of the overall case and presenting information to other students, both of which you either already have or can develop quickly. Once these skills are developed, future cases become inefficient in the learning you do per amount of time.
I would rather first build a solid foundation of knowledge through efficient learning, then progress to case work when I am not as clueless.
Medical students - how do you feel about case based learning?
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Two Doctors Walk Along a River
Today Katherine Treadway, one of the teachers at Introduction to the Profession, told a nice parable about two doctors walking along the Charles River, Boston's main body of water.
They're walking along chatting about their work when all of a sudden a man drifts by in the middle of the river, screaming for help. The doctors immediately spring into action, one doctor standing by the bank for support while the other dives into the river. He pulls the man, swims to shore, and they both climb out soaking wet.
The two doctors continue their stroll when a woman drifts by in the river again, just screaming for dear life. The doctors rush again, and they save the woman from drowning.
They walk further down the river until another man comes down the streaming river, at risk of drowning. One doctor immediately dives in, but this time the other doctor runs away up the river, inexplicably. The swimming doctor manages to save the man, and he waits by the side of the river for his friend to return.
When he does, the wet doctor asks, "Why in the world did you run away when I was trying to save him?"
The other doctor says, "I went upstream trying to see why so many people were falling in the river!"
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This is a cute story, but it also illustrates the multiple roles physicians can have in society. They can serve on the frontlines treating patients with what we currently know, or they can research the unknown about why diseases happen. Both are absolutely essential roles in medicine.
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The Inaugural Post
In the face of uncontrolled medical costs and unprecedented technology, where does a doctor's responsibilities lie? Is it solely to the patient or also to society at large? A doctor can provide the best (and expensive) treatment for the patient with minimal chance of efficacy, but if all doctors subscribe to this practice, medical practice nationwide is weakened.
In this inaugural post, I want to describe an experience that motivated me to create this blog to chronicle my medical education.
In our summer MDPhD course, William Hahn, a cancer biologist and oncologist at Dana Farber, discussed a paper for the drug cetuximab, an antibody therapy for colon cancer. Cetuximab was shown to be more likely to be effective in patients without a certain mutation in their cancer cells. This is an expensive therapy, costing about $30,000 for an 8-week course. Furthermore, they show only a modest increase in stopping the disease, roughly two months, during which quality of life suffers from side effects and intravenous administration.
It therefore seems wise to screen patients for the lack of this mutation to determine if the treatment is likely to be successful, and indeed this is standard practice. It's not so simple, though. A low percentage of patients with the mutation also respond to treatment. In this case, it was one patient (1.2% of those without the mutation).
A patient nearing the end of life and the supporting family will often do anything to extend that lifetime. I certainly would try for myself and anyone I cared about. Even if there was just a 1.2% or a .01% chance that the treatment might give a few months of extra life, I would take that chance, even though the science overwhelmingly discourages it. After all, that patient could just be that lucky one out of a thousand.
And so the dilemma surfaces. As a doctor, I want to do everything I can to help the patient, even in the most unlikely of scenarios. I would expect the same of my own doctor. Yet if all doctors felt this way and supported treatments that were very unlikely to work, healthcare costs rise uncontrollably, and the medical institution as a whole suffers.
So with whom do our responsibilities lie?
I don't know the answers to these questions, but I aim to figure them out for myself over many years in the future.
My mission in this blog is to discuss questions like these. I want to describe my medical education, to be frank about my fears and hesitations, and to share the lighter parts of becoming a doctor. I hope that it reveals insight into how your doctors become who they are and what issues we constantly grapple with while we practice.
It's going to be an exciting ride.
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