ONE STUDENT WROTE ABOUT her encounter with a dying patient and husband who lived in a pea-green trailer with piles of pizza and donut boxes and orange prescription pill containers inside.
Another learned the value of being an empathetic listener and the therapeutic power of spending time with a woman who presented with an upper respiratory infection but had much deeper pain.
A third student found that she learned the most from the oldest patients, who also filled a void in her left by grandparents who died before she was born or lived on the other side of the world.
The students were third-year P&S students on their primary care rotations at Mary Imogene Bassett Hospital when they wrote about their experiences there. The writings were published in Let Me Listen to your Heart: Writings by Medical Students. Their writings resulted from one of the more unique requirements of the Bassett rotation. In 1996, Dr. Alan Kozak, associate clinical professor of medicine and course director for the medical students at Bassett, drew on his own undergraduate background in literature as well as his medical training at the University of Rochester, where he was influenced by teachers such as Dr. George Engel, to initiate a requirement that every student on rotation at Bassett write a personal essay about an emotional experience while working at the hospital.
The topics are left to each student. At the end of the rotation, the students meet and read their essays out loud. We learned so much from this, says Dr. Kozak. It gives students a venue for dealing with issues not dealt with in other educational arenas. We werent sure how the students would feel about this requirement, but it has been met with interest and enthusiasm. The writings have been extraordinary.
The goal of this is to allow each student to express their feelings and to share some of their insights, says Dr. David Svahn, an attending physician at Bassett and P&S associate clinical professor of medicine. What we hope will come out of the assignment is that they will realize the insecurities that are attendant with learning medicine are not unique to them.
What also came out of the assignment was a collection of essays, many of them extraordinarily powerful. People have tended to really let it all hang out when they write these papers, says Dr. Svahn. They are sharing their innermost feelings and insecurities in a way that didnt usually show up in formal rounds.
Dr. Svahn and Dr. Kozak, co-editors of the book, collected 41 of the essays into Let Me Listen to Your Heart, a project that took three years to complete. The stories cover a wide range of topics, including doctor-patient relationships, the fear of making a potentially fatal mistake, the role of listening to the patient, and the vagaries of working in a field that isnt always clear-cut.
Dr. Svahn praises the assignment as a way for medical students, who are often focused on the clinical aspects of medicine, to get more in touch with the emotional aspect of their workand with each other. It is healthy for these students to realize they are not alone.
The book closes with a poem titled A Lasting Impression: What I Learned in Cooperstown by Ann Salerno99, now a pediatric nephrology fellow at Childrens Hospital in Philadelphia. The poem details Bassetts impact on her, from the first line, I learned what primary doctors do, through the last line: I learned that behind each exam room door, there sits a new experiencea person to learn from, a person to teach, a person who has the opportunity to leave a lasting impression.
The book, published with support from the Arnold P. Gold Foundation and Bassetts Medical Education Endowment Fund, is available at the medical center bookstore, from the Office of Medical Education at Bassett (firstname.lastname@example.org), and from amazon.com.