I no longer feel alone the way that I did the first few weeks of dissections, because now I recognize that my peers were sectioned off at their tables also worried that they were losing their sensitivity, that they weren’t good enough to belong, and they didn’t know how to cut into a person. I wish that I had known what my classmates were thinking and feeling during the anatomy course.
To understand the issue surrounding assessments, we must understand that it has become increasingly challenging to train physicians suited to face contemporary changes. To future physicians who have access to a repository of ever-expanding information on their smartphones, being tested on ‘high-yield’ minutia serves little purpose. Being able to think critically (and perhaps even imaginatively) in order to make sense of that information for patient care is what counts. And thus, no matter how standardized an examination is, lack of contextual reference renders it futile.
In this episode we interview Dr. Ijeoma Nnodim Opara. Dr. Opara received her medical degree from Wayne State University School of Medicine (WSUSOM) and completed a Med-Peds Residency at the Detroit Medical Center where she served as Chief Medical Resident. Currently, she is a double-board certified and an Assistant Professor of Internal Medicine and Pediatrics.
Why would someone choose to donate their body to medical education? We have a dishonorable history in medicine of illicitly sourcing cadavers for dissection: robbing corpses from graves, murdering people for their bodies and salvaging the unclaimed dead from city hospitals and morgues. Today, we call the bodies we learn from “donors” instead of “cadavers” to honor their autonomy and personhood, their choice to be in the room.
It is the day before the first anatomy lab for the first-year medical students, and a single professor walks alone, up and down rows of tables laden with twenty-six naked, embalmed bodies. He silently shares a few minutes with the donors, a private thank-you. Soon the donors will be covered in white sheets, and the students will tentatively spill through the locked wooden doors of the labs, a rush of anticipation, teamwork, questions and learning. But right now, no one makes a sound. There is no buzzing of saws, whirring of the suction machine, or gentle clinking of hemostats and Metzenbaum scissors against the metal tables, no nervous laughter, exclamations of discovery or confused mumblings.
Another day passed as I approached the deadline of my latest assignment. Our professor asked students rotating in the ICU to reflect and write up a patient encounter that influenced them deeply. In an effort to encourage a more humane and nuanced understanding of medicine, this was part of a series of reflective assignments being introduced in medical schools. While the budding writer in me was delighted at this prospect, the medical student, ironically, was …
I believe these inadequate approaches circumvent the answer the interviewer is actually trying to provoke: are you self-aware enough to know your faults?
Every one of us is imperfect, fallible, and vulnerable to making mistakes. Being a strong physician requires self-reflection and awareness, and interviewers want to know if you are willing to be honest with yourself and others. I can’t tell you how to answer this question, but I can tell you how I did.
In the golden glow of a fall day, one hundred four first-year medical students parade
out of the medical center carrying boxes of bones to aide our anatomy lab studies. The crates
look suspiciously like instrument cases, perhaps the size of an alto saxophone, and it feels absurd
to march back to our houses a la The Music Man, knowing all the while that we are bringing real
live (well, dead) human skeletons into our living rooms, kitchens and coat closets. Mine resides
propped against a bookshelf in my bedroom. I only open it during daylight hours, and only when
absolutely necessary. For the next four months, as we visit classmates in their homes and
encounter the subtle black or brown cases they’ve tucked into the corners of their lives, the bone
boxes will serve as a reminder of the secret club that we all have newly joined.
In 2018, a patient filed a complaint against a medical student for wearing a “Black Lives Matter” pin on her white coat. When the student reached out to her school’s administration, she received this response: “It is best to not raise barriers in the way we present ourselves…Some of your political pins may offend some people, and it is probably best not to wear them on your white coat or while you are working in a professional role.”
Over the next four weeks, I will share a series of essays with you in which I tell some of those stories. This writing results from the work of a summer, supported by a Summer Research Fellowship in Medical Humanities & Bioethics at the University of Rochester School of Medicine and Dentistry, in which I interviewed nine first-year medical students, two third-year medical students, eight anatomy and medical humanities professors, two Anatomical Gift Program staff, three palliative care clinicians, two preregistered donors and one donor’s family member. Out of respect for their privacy, none of the people interviewed are named, and identifying characteristics have been removed.
The notion that a person’s health is only impacted by the clinical care they receive is not a reasonable one. Currently, as a first-year medical student, I have had the privilege to learn from a variety of professionals that have once again reminded me why I am on this path and why I want to serve underserved populations.
Regardless, with this data in mind, it is important for students in medical education to understand that we are entering the profession at a time where the reputation that precedes us is not ideal. This also means that the capacity to alter this perception is dependent on the way we practice upon entering the workforce.