Future Docs: a new series about becoming a doctor

PROVIDENCE, RI – From health reform to our changing population, health care as we know it could look a lot different in the future. Doctors in training today will help shape that future. Introducing a new series from Rhode Island Public Radio called Future Docs. We're following the stories of medical students and residents to find out what it takes to become a doctor. And we'll hear from experts about how that's changing and why.

We start the series with this story of two young med students at the beginning of a long, tough journey.

Peter Kaminski is a 2nd year student at The Warren Alpert Medical School of Brown University in Providence. He's wanted to be a doctor ever since he can remember.

"I was that kid who around 6 or 5 years of age was given a Fisher Price doctor kit with the little plastic stethoscope, which is surprisingly functional if memory serves."

Kaminski grew up in Acton, Massachusetts with parents who fled Poland in the 80s as intellectual dissidents. In college at the University of Massachusetts at Amherst, he gathered up as much medical experience as he could. "My freshman year I took an EMT course. And it was probably the best $600 dollar investment I made in my life."

Soon he was helping teach that course to budding emergency medical technicians and working with an ambulance crew in South Boston. Over the next few years he interned in a community health clinic and with the international NGO Partners in Health. He even started his masters in public health. All before starting med school.

But none of those experiences prepared him for his first time cutting open a cadaver, which Brown students do their very first semester. "I remember just thinking, you know, am I going to faint? Am I going to make a fool of myself? And very soon thereafter, you're just thinking, Who is this person going to be?'"

Walking into the anatomy lab, donning the gloves and lab coat, smelling the pungent odor of formaldehyde used to preserve bodies it's a major milestone for many medical students, an experience they don't take lightly. Kaminski says the donor's body is gift, and he really had to think about how to honor the person while still maintaining enough scientific distance to get the job done.

"Making that first incision, and I still remember making the first incision for my group - and you work in a team of four, and I think that's a crucial aspect, because you can't go through the experience without the support of your fellow medical students - making that first incision was simply a statement of, you know, this is something we're going to have to learn how to do, and there might as well be no better time to start than now."

The first two years of medical school is about absorbing mountains of information--learning about the body and its intricate structures, how they work when everything's going right, and what can go wrong. As his second year gets underway, Kaminski is delving even deeper into the body's systems and how to treat disease. We've asked him to keep an audio diary of his experiences, and this was his first entry, the night before a big cardiology exam.

"I've spent the past 12 hours studying for an exam, 12 hours before that, and pretty much 12 hours on Friday as well. I can't another thing about myocardial infarction before I'll want to have one of my own."

He didn't have a heart attack, that is. In fact, Kaminski has figured out some unique ways to manage the intense workload. When most students are in class listening to lectures in real time, he's in a caf , listening to yesterday's lectures . at twice the speed. Kaminski has fired up his laptop and plays a recent lecture on the kidneys to demonstrate. Yep, he's listening at twice the speed and he swears he gets what he needs this way to understand the material.

"Yeah, you can get a lot out of it!"

He says he uses the time it saves to blow off steam. But with 50 to 60 hours or more of studying a week, there's not that much extra time. Like a lot of his classmates, he's involved in community service, and has even organized a series of discussions about the country's changing health care system.

Those discussions should be lively. Kaminski has entered medical school at a time when the health care system is undergoing some of the most dramatic changes in decades. The Affordable Care Act is reshaping who gets covered and how. There's a greater emphasis on primary care a specialty with serious doctor shortages. And a showdown is looming on Capitol Hill over who pays for doctor training. An aging population will further test the system. And then there's the sheer pace of scientific discovery, adding to the complexity every day. It's going to take some of our best minds to navigate this new terrain. And that's why we're following these doctors of the future, allowing their stories to help fill in the bigger picture.

Here's another future doc. "I'm Sarah Rapoport. I'm 24 years old. And I'm currently a second year medical student at Brown university medical school."

Rapoport attended Brown as an undergrad, already accepted into its medical school through the competitive Program in Liberal Medical Education. Get to know her and you begin to understand why she made the cut at a medical school that accepts just over three percent of applicants. In high school she made stellar grades, captain of her fencing team. She also began her scientific career in earnest.

"I was the only 17 year old who was a finalist in the Intel science fair."

for which she researched how embryonic cells distinguish left and right during development. Medicine might have seemed inevitable for her. She grew up in manhattan in a family of doctors father, brother, cousins, uncles. But she chose the path herself when she found her father's old otoscope what you use to peer inside a patient's ear on the kitchen counter. He wrapped it up in a big red bow for her 8th birthday.

"And I forget what holiday was around the corner, but I basically went around the entire barbecue asking all my relatives if I could look in their ears and look up their noses."

Since then, Rapoport has been working in medicine in some capacity at home and abroad. On a trip to Honduras, she helped teach pregnant women how nutrition can prevent spina bifida. In Israel, she worked with African refugee women. And now at the start of her second year in med school, Rapoport is focused on soaking up as much knowledge as she can. To do it, she manages her time meticulously.

"Every moment feels important. Every detail feels important. And so you don't want to let any single detail out of your grasp. There is no way to know everything. And yet you have to try."

She's already seen how the right detail, recalled, can make a difference in a patient's life. Second year students at Brown must also shadow a mentor on a regular shift in a hospital. Here's Sarah's first entry in her audio diary.

"This is Sarah calling. It's a few minutes after midnight and I'm returning home after a shift in the ER. I am a flurry of endorphins and feeling heavy with exhaustion. I am feeling alive."

It's early experiences like this that are starting to shape Rapoport and Peter Kaminski's ideas about where to specialize. A long road still lies ahead, and both say they're still interested in being exposed to as much as possible. But what they eventually choose whether pediatrics or emergency medicine, where they find a residency slot, and who pays for it, are pressing questions right now for health care reformers, hospital administrators, patients, and lawmakers. We'll be exploring those questions and following Sarah and Peter's experiences in the next Future Docs.

Health care reporter Kristin Gourlay will be checking in with Peter, Sarah, and other Future Docs throughout the year. Learn more about these students and follow other Future Docs on our web site, RIPR.org. Just look for the "Future Docs" link on our home page.

Do you have insight or expertise on this topic? Please email us, we'd like to hear from you. news@ripr.org