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Whenever possible, I try to elicit feedback from my patients.
Sometimes the opportunities arise as I pre-round in early morning
hours. Other times they don't present themselves until the
afternoon lulls after I've finished my floor work for the day. But
whenever those moments open up in front of me, I try to cherish and
linger in them - partly because they beautifully offset the
often-hectic pace of patient care; partly because they remind me I
didn't choose medicine mainly for the science, pharmacology, or
treatment plans, but the people that make those things matter;
partly because after eighteen months on clinical rotations, I have
learned that there is perhaps no truer, more penetrating, or more
instructive perspective on my growth as a student than the one my
patients provide. So I'm mindful of the fact that almost all of
their answers to my most important question - which quality, above
all others, they value most in their doctors - consistently center
As obvious as this might sound, altruism is not just an
attribute patients expect out of their physicians. Locally,
altruism - as evidenced by service and community work - has long
been an important consideration medical schools use in selecting
applicants. Nationally, it is a quality the American Association of
Medical Colleges found important enough to focus educational
efforts on and include in the four core attributes emphasized in
its Medical Schools Objectives Project. Individually, and most
importantly, it is the trait most of us expected out of ourselves
when we first donned our white coats and repeated our oaths, the
one frequently easier to recognize than define, the one behind our
deepest desires to help people and make a difference.
As our profession has continued to understand the importance of
cultivating altruism among trainees, two instructive questions have
arisen: first, whether focusing on altruism through service work
derives benefit outside of deepening individual character, and if
so, how to best promote this during undergraduate medical training.
In regards to the first, it is clear from recent work studying the
"outcomes" related to altruism that service work during medical
school is associated with overall academic performance and
residency performance, and in some cases, career choice. In other
words, it is tied to academic and vocational, as well as personal,
development. The second - about how medical schools can best foster
habits of service among trainees - has been somewhat less clear.
Most institutions have traditionally offered completely voluntary
service opportunities. But several have begun offering formal,
curriculum-based opportunities, with the belief that structured
learning environments allow for more thorough preparation and
reflection. An example of the latter is the Medical University of
South Carolina (MUSC), which created a dedicated community service
office to support a voluntary, but structured, service program.
Students are encouraged to participate in service work and are
provided opportunities and information by the service office. They
are also asked to record their hours with the office, with annual
recognition of the students with the most service hours.
My home institution, Baylor College of Medicine (BCM), has
supported similar goals in a different way. By hosting one of the
thirteen national sites for the Albert Schweitzer U.S. Fellowship
Program, BCM allows its students - along with graduate healthcare
professions students at surrounding institutions - to partner with
community-based organizations in identifying unmet health needs,
create rigorous, 200-hour projects around those needs, and carry
the projects from idea to completion. Having just completed my
fellowship year addressing HIV linkage and follow-up care, I feel
that the Schweitzer fellowship provided a particularly powerful
structure for cultivating service. First, it required that the
students themselves identify unmet needs and craft project
proposals, ensuring that we identified issues we personally
encountered and then thought critically about to address them.
Secondly, the work was done over twelve months concurrently with
our academic/clinical responsibilities, allowing us to experience
the time, energy, and resources required to serve our communities
both as service workers and healthcare professionals. Thirdly, the
multi-disciplinary, multi-institutional nature of the program
allowed for a unique blend of encouragement, brainstorming, and
growth. As a MD candidate, I brought certain clinical, patient-care
perspectives that helped inform others' work, but I also learned a
great deal about myself and my project from the other fellows who
were studying public health and social work. Fourthly, the
fellowship emphasized regular feedback, introspection, and
planning, aspects that I found particularly helpful when I had to
re-assess the direction of my project or face setbacks. All in all,
the Schweitzer fellowship was as complete a service opportunity as
I've ever experienced in medical school because it allowed me take
ownership of my work while having access to ready support,
persevere through tough periods while brainstorming creative
alternatives with others, and realize that lifetimes of service
begin with a few initial steps, ones I don't have to - and perhaps
shouldn't - take alone.
Appropriately, service work is a broad area, and altruism should
be fostered in a number of voluntary, diverse ways. But in light of
work showing beneficial associations between structured service
work and other trainee outcomes, students and institutions could
benefit greatly from development of more formalized community
service programs. And whether they choose to set up a program like
that at MUSC, invest time like BCM to host a Schweitzer
fellowship-like program, or forge a new, innovative path, it seems
to me that the ultimate visions are the same: that undergraduate
medical resources be leveraged to support better health through the
cultivation of more empathic, selfless healthcare providers; that
in identifying these issues, we do our best to support what we and
our patients have long known to be true. Altruism matters.
For more information:
Joshua Liao, MS VI
Baylor College of Medicine
August 2011 Issue of IMpact
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