Fri May 10, 2013
Future Docs 10: Good Luck, Sarah and Peter
Throughout the school year, we’ve been documenting the experiences of two Brown University medical students. They’ve begun their careers at a time when health care is changing dramatically – from where we get care to who provides it and how we pay for it. But our Future Docs Sarah and Peter are ready to dive in. They’re about to begin their third year in medical school, leaving behind the familiarity of the classroom for the new world of the hospital wards.
Second year medical student Peter Kaminski is attempting his first stitches on a small, pink pig’s foot. For him and about 30 of his classmates, it’s suturing 101.
“Fortunately not much harm can come to an already separated pig’s foot, so it’s good to practice on this first.”Kaminski practices in a classroom full of other second year students at the Warren Alpert Medical School of Brown University. At each student’s place is a tray stocked with a foot, a packet of sutures threaded through a curved needle, and what look like a pair of scissors and some tweezers. Students watched a 10 minute video, listened to an even briefer lecture, and then got stitching right away. Fourth year medical students circulate to answer questions and guide them:
“So now you’re going to tie your knot. The first throw is called the surgeon’s knot.”
“So, do I release?”
Kaminski is getting ready to start his third year of medical school. And it’s a monumental transition from the second. Goodbye to classrooms like this one, and hello to two years of rotations in the hospital – a few weeks here, a few weeks there in different specialties. He’ll be expected to work with patients, learn how to do a range of procedures, and work under the guidance of residents and attending physicians. It’s a new level of responsibility, an even more hectic schedule. But Kaminski is sanguine.
“At this point, it’s less apprehension and more excitement, simply because we’ve been cooped up in the classroom so long and it’s about time we actually start doing what we came to medical school in the first place. Learn how to actually practice medicine and heal.
And with that, he ties off his last surgeon’s knot.
The pig’s foot looks good as new, although Kaminski thinks his technique could use some work.
“Oh god, I’ll cringe in a couple years from now!”
Peter Kaminski and fellow second year med student Sarah Rapoport have just wrapped up another day of hands-on workshops like the one on suturing when they meet up in an empty classroom in the med school building to check in. All week long they’ve been practicing actual procedures, sometimes on each other. Rapoport is buzzing – and not at all freaked out at being a guinea pig.
“We got to practice stitches and suturing, we got to practice drawing blood from each other… it was really exciting," says Rap0port.
“So basically it’s boot camp for preparing us to go on to the wards," Kaminski chimes in. "So we’ve been learning the theory behind medicine, but a lot of logistics goes into how a hospital is run, in terms of interacting with medical records, doing procedures in order to get lab tests done, and all those things that can really hamstring a med student when they first go into this completely foreign environment.”
Not completely foreign. Kaminski and Rapoport have both shadowed a mentor on rounds in the hospital. They’ve gotten a taste of what it’s like to work an overnight shift in the ER. They’ve taken a real patient’s medical history. But this is the first time they’ll have actual responsibilities in the hospital. Rapoport starts with obstetrics and gynecology—or OB.
“It’s still unclear to me, what does a med student do when you’re on the wards," says Rapoport. "OB is my first rotation, and I know that at the end of OB, we’re supposed to be able to demonstrate that we can deliver a baby, on a mannequin.”
Granted, Rapoport says, a mannequin birth is pretty far from the real thing. But still, it’s just a few weeks of on-the-job training before she’s expected to know the ropes. Kaminski says that’s typical.
“And as scary as it is, there’s a certain, something encouraging about the amount of confidence that’s placed in knowing our true capabilities. And the fact that this is the way medicine has been taught for ages simply because there’s so much to learn that you just have to keep up with the pace.”
Rapoport nods in agreement.
“What I do know is that it’ll be a lot of learning, being on my toes, and not really sure what I’ll encounter each day, but I think that sounds exciting.”
Especially after having been mostly in the classroom for two years.
“I feel like this is what we all dreamed of when we thought of medical school.”
Not to worry if you think you’ll be thrust into an inexperienced medical student’s hands if you end up in the hospital. They’ll be under constant supervision. And they’ll already have practiced many of the more common procedures you’re likely to need. Kaminski says he isn’t worried about patients refusing a med student’s care, or even about keeping up with the new fast pace.
"I’m just worried about understanding where all the different gauge needles are and familiarizing myself with that environment," says Kaminski. "Because until I feel comfy cozy and know where everything is, I don’t feel like I’m running at my top capacity.”
And while the same worries about first-day-on-the-job stuff are also on Rapoport’s mind, she’s more obsessed than ever with figuring out what to specialize in:
“How do you know? And when do you know? And how do you figure it out? And it isn’t something anyone can do for you and it is different for everyone. And I don’t know, it’s a whole mystery, so.
“Sarah’s particularly cursed because she’ll be talented at everything," Kaminski says.
“Please don’t broadcast that!" says Rapoport, laughing, although she reconsiders.
Then she explains why she’s so keen on figuring out what to specialize in.
“I think it will allow me to channel my energies toward what I know makes me happy, and I want to be good at whatever that is.”
Kaminski is closer to knowing where his path will lead – probably surgery, emergency medicine, or pediatrics, or a combination. And Rapoport says she’ll be there to cheer him on, too.
“I’m excited to find out what you choose. Graduation day will be an exciting time.”
Exciting for our Future Docs Sarah Rapoport and Peter Kaminski, and exciting for anyone who’s watched them grow into talented, compassionate physicians.
Note: Listen to more stories from our Future Docs series right here.