DEAR DOCTOR K:
You often mention your colleagues at Harvard Medical School. I’m curious, what does it take to become a doctor at Harvard?
Believe it or not, this is the first time I’ve been asked that question. Here’s how things are organized. We have several hundred medical students. They spend four to five years learning to become doctors. Then they get an M.D. after their names.
The next step is residency and fellowship. This is a multiyear process when a newly minted M.D. gets additional training and certification in one of the medical specialties, such as internal medicine or surgery. Then, for many, comes further training in narrower subspecialties within each specialty. For example, internal medicine is divided into subspecialties such as cardiology, endocrinology or general internal medicine (primary care). The process of going through residency and fellowship can take three to eight years.
In this brief column, I can give you only a taste of the process. For a comprehensive look, I recommend a short and inexpensive new e-book called “The Making of a Surgeon,” written by my Harvard Medical School colleague Dr. Stan Ashley, with John Hanc. You can find this book on Amazon.com.
The book describes the intense and grueling pace for both the trainees and their teachers. The workday begins between 5 a.m. and 6 a.m. But while there is an organized work schedule for every day, surgical emergencies can pull the surgical teams from the hospital floors to the operating rooms at any time, 24/7.
For a surgical trainee, the process of becoming an independent surgeon is a gradual one. At first, the trainee is just watching and learning. There’s always lots of book learning — textbooks and surgical research journals. And there are even computerized simulations to help learn manual skills.
When the teachers are confident the trainees have the necessary knowledge and skill, they begin to do some parts of the surgery under the watchful eye of the teacher. By the time they have reached the end of their training, the trainees are quite independent.
At Harvard, surgical residents must learn 139 essential surgical procedures by the time they’ve completed their training. They start by learning the basics: tying knots, suturing, general operating room procedure.
As soon as they’re ready, the residents enter the operating room. There, they work next to attending surgeons on appropriate cases for every level of their training. And they begin the long process of working their way through those 139 essential surgeries.
There are lots of skills taught during medical school and residency. For surgeons, the manual procedures of doing surgery obviously must be mastered. But that’s not enough: The trainees need to learn coolness under fire and how to think clearly when things are not going “by the book.” Above all, they need to learn how to be members of a team — because surgery requires a team — and how to listen to, comfort and explain things to patients.