Pulse
First Days
School begins on different days and in different ways at the three campuses in Minnesota where you can start a medical education.
All Joe Mayerle remembers about his first day of medical school at the University of Minnesota Medical School, Twin Cities campus, last August was that “it was kind of a mess.”
Mayerle had planned to check in at 9 a.m. sharp. So he planned carefully. “I was thinking, I’ll park in this garage right by where I need to go,” says Mayerle, who had scoped out the area ahead of time. “It will be perfect.” But on the morning of orientation, the garage was full and Mayerle, who grew up in Bloomington but was new to the campus, faced one of the great challenges of academic life in a large city—parking.
“I ended up blocks away. I was totally lost,” he says. Mayerle arrived at the orientation late, harried, and frustrated. From that point, his memory of the day is foggy. “There were a couple of orientation talks,” he says, “but honestly, I don’t remember what they were about because I was so flustered.”
So much for the carefully orchestrated entrance Mayerle had hoped make. And so much for the carefully crafted orientation the medical school had planned for him.
Every year, medical educators in Minnesota finesse the fine points of the first days of their programs, hoping that their students won’t have a start like Mayerle’s. Recognizing that first impressions set a tone for what’s to come both in the classroom and in the clinic, they take the task seriously, thinking through the messages they want to emphasize and the values they want to instill.
The result is that the start of Mayo Medical School’s and the University of Minnesota Medical School’s programs in the Twin Cities and Duluth are all quite different.
Here’s a glimpse of what happens during those first days and the ways they reflect the different missions of these
programs.
University of Minnesota Medical School, Twin Cities Campus
What Kathleen Watson, M.D., associate dean for students and student learning at the University of Minnesota, Twin Cities campus, had hoped Mayerle and the other 164 students in his class would experience last August 9 was that they not only begin to feel at home on campus but that they begin to shift their thinking about their reason for being there.
Watson says students used to studying in order to get an “A” need to see that everything they do in medical school is in service of another purpose—patients. So during their first days of orientation, students not only learn such essentials as where to park but also hear from patients.
Last year, family physicians Jon Hallberg, M.D., and John Song, M.D., brought in two to talk with students. This year, in order to help students understand how soon they’ll be working with patients themselves, the plan is to have third- and fourth-year students and their patients talk about their relationships. “In medical school, there’s this constant sense of postponement of reality, of making a contribution, of doing the real work,” Watson says, adding, “the real work of listening to patients begins Day 1.”
One of the challenges in planning the orientation, she says, is that there’s usually a mild conflict between the “99 things” administrators want students to learn and what the students want—that is, to get to know each other.
One of the ways students get acquainted is when groups of 15 or so meet with a faculty member called a “master tutor” throughout the year to discuss ethical and professional issues raised in two of the first-year courses, Physician and Society and Physician and Patient. Mayerle, who has been in a group led by internist David Satin, M.D., says the experience has been “phenomenal.” He explains that the issues raised in the courses don’t lend themselves to lectures and reading articles. “You kind of need to process it and discuss it,” he says.
That’s exactly what Watson hopes to foster with the courses and the small-group discussions. “Most people think medical school is all this curricular content, and you just kind of have to suck it in and remember it,” Watson says. “We’re trying to change that. What people learn is around the edges—it’s applying their own experiences and rethinking and listening to each other.”
One of the things that has not changed on the Twin Cities campus is anatomy starting the first week of school, immediately after orientation. “Sometimes we think, is this a terrible way to introduce students to medicine, starting with dead people?” But Watson says both research and student experience shows that taking anatomy is a transformative experience.
Mayerle, who had a history of getting weak at the knees during his own visits to the doctor, was concerned how he’d handle the cadaver lab. He did find it shocking, he says. But not in the way he expected. Anatomy confirmed what people had told him about medical school—that it was a lot more work, but worth it. “I think anatomy class was the moment where it all came together,” he says.
University of Minnesota Medical School, Duluth Campus
When the 55 first-year medical students gather in the student lounge at 8 a.m. on the University of Minnesota, Duluth campus, on August 29, they’ll be nervous and eager to start the day. But they won’t be strangers.
That’s because most of the entering class will already have met in June. They will have had orientation, and they will already know the names of some second-year students, whom they may have e-mailed over the summer with questions about life in the port city.
“You’d maybe expect to walk into this room, and everyone’s quiet. It’s quite the opposite,” says Lil Repesh, Ph.D., associate dean for student affairs and admissions.
Dressed in everything from jeans to work attire (but “no suits,” according to Repesh), they arrive ahead of the 8 a.m. start time to mingle until the formal welcomes begin at 8:30.
“Right away, that first day, you can tell that this is a really close community,” says Daniel Bowman, a first-year student from Esko, Minnesota, a town of 4,000 near Duluth.
And right away, the students can tell that Duluth is serious about its mission to produce the state’s next crop of rural physicians. The first class, which begins on Day 2, is Introduction to Rural Primary Care Medicine.
By Thursday of that first week, the students are loaded on buses and sent to nearby towns, where they visit local businesses, schools, and members of the health care community. For example, students have visited the prison in Moose Lake, the paper plant in Grand Rapids, and the mine in Hibbing as well as hospitals, pharmacies, and clinics. When they return, the students do group presentations about the places they visited, the health care needs in those places, and the available resources.
The goal is to show the advantages of living and working in a rural community, says course director Ruth Westra, D.O., who admits, “sometimes we’re preaching to the choir.”
Such was the case for Bowman, who says going to Hibbing was a chance to see a rural site that was actually bigger than his hometown. Like most students in the Duluth program, he already knew he wanted to practice in a small town.
So for Bowman, the field trip was one more chance to develop relationships with his classmates. Westra says this year pharmacy students will join the medical students on the trip, providing an opportunity for interdisciplinary interactions as well.
Such experiences have been invaluable, Bowman says, and the relationships have continued. “Our class is not a competitive group at all. It stems back to that first week and the atmosphere presented by the faculty,” he says. “Right away that first week, we had a class full of friends, not strangers.”
Mayo Medical School
Thomas Parisi hadn’t planned to return to his hometown to attend medical school.
But then, the Rochester native also hadn’t planned on spending months in hospitals during his senior year of high school because of ulcerative colitis. In 1999, when Parisi was at Mayo Clinic for a full colectomy, he began to rethink attending Mayo Medical School one day. “It made me realize how great a place Mayo is,” he says, recalling how his doctor phoned him from his vacation in Hawaii to check on him. “It’s hard to top Mayo for wonderful care,” Parisi says.
Such a high level of commitment to the patient is exactly what Patricia Barrier, M.D., associate dean for student affairs, hopes Mayo students will strive for. That’s why on Day 1 of medical school every year, in addition to hearing about the nuts and bolts of the program, the 42 first-year students hear from Hugh Butt, M.D., one of the last living people to work with Will Mayo, about the values of the clinic’s founders.
The talk by Butt, now 97, is one of the few things about this year’s start on July 24 that will be the same as last year’s, however. “We’ve radically changed what we’re going to do in our first week,” Barrier says.
Instead of having a week of orientation, the school is planning a three-week block on leadership. The first week will include a session on personal effectiveness and a career counseling workshop, shadowing of physician-mentors in the clinic, an exercise on teamwork and conflict resolution led by a faculty member from the University of Minnesota’s Carlson School of Business, and a session on wellness, with information on nutrition, exercise, and mental health. “We think our students need to know how to take care of themselves in order to take good care of other people,” Barrier says.
Such thinking is at the heart of changes in the medical school’s curriculum that are being implemented this year. The brainchild of the school’s dean, Keith Lindor, M.D., the redesign is an attempt to provide students with a more humane medical school experience. Lindor was influenced by a 2005 study published in the Mayo Clinic Proceedings that showed medical students had significantly poorer mental health than their peers in other graduate programs, Barrier explains.
“We hope that by emphasizing these aspects of leadership, mentoring, career reflection, teamwork, and wellness in the first week, the students will see that this is valuable,” Barrier says. “This isn’t something extra.”
The hope is also that the first-year students will bond with one another and with upper classmen. To foster that, Mayo has several events planned for the fall, including a cruise on the Mississippi River the first day, a dinner and dance, a family weekend, and even a “prom,” which Barrier says is a huge event replete with fancy dresses.
Parisi credits the deans for making his transition into medical school a smooth one and notes that one early message in particular has stuck with him—that he belonged there, even if he struggled academically. “They understand that it is going to be hard,” he says. “But that doesn’t mean you’re not cut out to be a doctor.”
—Carmen Peota