In the Company of Excellence

In some ways, I am living a semi-charmed life, with both very lucky opportunities and also many an unlucky happenstance. I have previously written about the gratitude I have toward particular individuals who have had the most significant impacts on my education and development as a person. Now, I would like to comment briefly on a few of the institutions to which I owe and perhaps will owe a great deal of thanks and respect:

1. The New England Journal of Medicine

Having spent a summer working in the NEJM Editorial Offices as a summer student and two years working in collaboration with the editors of the NEJM on The Next Generation, I feel that I have a much stronger understanding of medicine and clinical research journals than most students at my level of training (and perhaps beyond). I don’t necessarily know more, but I do have a broader and more acute perspective. I owe this to the NEJM editors who took time to help me develop a balanced, critical perspective and better analytical skills. Though I have never had to formally pledge allegiance to this journal, the editors and staff have certainly done more than earn my respect and admiration. In few institutions have I witnessed such a high degree of intelligence, clear-headedness, and most importantly, integrity. This, perhaps, is the key difference I see in the NEJM leadership and organization as a whole as compared to the vast majority of purveyors of medical and health care information, including the popular media and medical bloggers: these people have demonstrable integrity that is integrated into the structure of the organization, while it is easy to see that many other writers and news sources have easy-to-uncover agendas. This is not to say that the NEJM editors and writers do not take stances on issues: it all depends on how one does so, and whether one has previously conducted one’s activities worthy of earning the trust of one’s colleagues and the public.

I would expect similar high levels of integrity to be encouraged at and structurally integrated into the organizations of other highly influential clinical research journals. I do not expect as much from popular news sources or medical bloggers. Many writers may individually have substantial credibility and integrity, but the infrastructure of the medium does not encourage or have any visible guarantees of these values. People pay more attention to messages they believe (i.e. confirmation bias), and blogging is a powerful tool for catharsis. Whether reading the writing of individual bloggers or perusing link-collection blogs, I believe it is important to be critical and vigilant in one’s analysis of the motives of these writers: there is no significant system in place to keep them trustworthy.

Information is power, but there are only a few people who prove themselves worthy of wielding it. I believe that many medical journals, if they take after the example of the NEJM, have earned the public’s trust over the past hundred or so years, and will continue to do so in the face of a continuously degrading popular media. I only hope that there is a change in the popular media toward better reporting and greater integrity, because the popular media can be a powerful force for good. So can medical bloggers, if we conduct ourselves honorably and with integrity that is often currently lacking.

2. Tulane University School of Medicine

Anyone who bothers to read my résumé will note that I attend Tulane’s medical school. I have no intentions of hiding my identity, and I hope that this practice not only encourages my only frankness and sincerity but also encourages others who read this blog to be honest in their conduct as readers. I don’t use this blog to complain; write snide notes about my classmates, patients and teachers; or write mud-raking exposés about the institutions at which I work and/or receive my education. I do, however, reflect on my experiences and interactions with people, classmates and patients included, and hope to do so in a manner that preserves the anonymity of these people. If ever you are worried that I have made reference to you in a manner that is identifiable, please contact me and I will make changes or omit that section of my post!

I am quite happy for the education I have received so far, and I am quite proud at this point to be a Tulane medical student. Though not the highest (or lowest) ranked of medical schools, Tulane has consistently provided its students with a very friendly and approachable medical education with a strong emphasis on hands-on learning. As a first year medical student, I had the opportunity to put in an IV, bag/ventilate/intubate a patient before surgery, take several histories, perform as many physical examinations, ride in an ambulance truck, and much more. (My experiences are relatively tame compared to some of the experiences my classmates have had in Emergency Departments and on their required ambulance rides.) Having these early clinical experiences have certainly boosted my confidence and reinforced my motivations for entering medicine in the first place (i.e. reminded me during my many hours of studying why it’s worth it for me to study). Perhaps compensating for the loss of Charity Hospital as a training center, the Tulane physicians and residents really go out of the way to present the medical students with clinical opportunities in the hospital and in free clinics. This, perhaps, also reflects the grace and generosity of many New Orleanian patients who see academic physicians: the majority I have seen are quite happy to have a medical student participate in their care. This is one of the things I love about people from New Orleans, rich or poor, of whatever race: even when they are in a time of need and when they are afraid, people here often still conduct themselves with a grace and generosity found in few other places (even in normal circumstances).

One thing I value about the physician-instructors at Tulane is that they have confidence in the ability of the students to learn: the anesthesiologist who showed me how to prepare a patient for an operation provided me with one-on-one instruction and insisted that I (and not the residents) perform every step at least once (even though I wasn’t graded on my performance or participation, and the experience was entirely voluntary). I don’t think physicians at many other institutions place as much confidence in their students, which bothers me: medical students should be given the chance to be gung-ho about their education and their clinical skill development. In the free clinic in which I worked, the attendings expected me to present patients and use the knowledge I had available so far to make a differential diagnosis (i.e. even if I didn’t know the specifics of the diseases, I was expected to take several deductive steps in the right direction). The clinician I followed in a community hospital, though friendly and approachable, did not expect me to know nearly as much as I did.

3. The National Institutes of Health

I have just started my summer research fellowship at the NIH, and I’m very excited. The campus is enormous, and my project will likely give me exposure to basic, clinical, and translational research (with my research project being primarily “bench-to-bedside” translational). Not to mention all the talks and other events! The team I am working with seem very friendly, approachable, intelligent, and very capable. I am looking forward to learning more about the NIH as an institution as well as how research is conducted here.

So, by the end of the summer, I will have worked at two of the most influential and well-respected academic institutions and will be continuing my medical training at a medical school of underestimated value. I wonder where this will take me? I suppose I should figure out what discipline I want to work in first.

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