Medical School: Then and Now

A Conversation Between Alexandra Rabin, University of Massachusetts Medical School Class of 2022, and:

Rebecca Kowaloff, DO Touro New York College of Osteopathic Medicine Class of 2011

Harvey Kowaloff, MD Northwestern University Feinberg School of Medicine Class of 1975

Joel Popkin, MD SUNY Downstate Medical Center College of Medicine Class of 1974

Lynn Eckhert, MD SUNY Buffalo School of Medicine Class of 1970

Peter Schneider, MD Harvard Medical School Class of 1959

Certain core tenets of medical training have held true through the generations: the weight of basic science and physiology, the integration of medical students in the clinical system, and the fostering of professional identity. Medical education does not exist in a vacuum, however, and is shaped with the entire educational system by major world events, social and educational movements, and new technologies. Among many examples, our limitless access to the internet and the subsequent ease of conducting research, searching for therapies such as medication doseses, and understanding disease pathology are relatively new privileges for medical students compared to earlier generations. This is just one of countless advances that have reshaped medical education. I spoke with several Worcester-area physicians who graduated medical school between 1959 and 2011 to learn about their medical school experiences and understand the trends that shaped them.

Alexandra Rabin: While medical students may sometimes feel we operate in a closed system of studying and clinical work, our education has certainly not existed in a bubble. What was the zeitgeist of your time in medical school?

Harvey Kowaloff (’75): Entering medical school in 1971, my class was at the beginning of a transition in American medicine. We saw the first significant increase in women entering medical school and we were one of the first classes to enter medical school who had come of age during the Vietnam and civil rights eras. As a result, there was more social and political consciousness among my classmates than in most medical school classes in the preceding decades. Lynn Eckhert (’70): The Vietnam War had a major impact on us all. In the evenings, night after night, we saw the carnage of war and we took to the streets and marched in protest. I recall leaving the medical school library to find the campus full of tear gas as police tried to quell an uprising. The male medical students were granted military deferments as a result of their studies and some were conscientious objectors. Female physicians did not have to serve. However, it impacted all of us. As a spouse of a physician assigned to the Indian Health Service, my GME years were spent at three different institutions as he was reassigned.

Peter Schneider (’59): I was in medical school 65 years ago, so I may have forgotten much of the zeitgeist. It was a relatively placid period but, importantly, it was the dawning of the space age with the launching of the Russian Sputnik I in 1957. However, my career path was not shaped by external events but by my own long-term interest in science. Perhaps, and somewhat unusual at the time, was that one-third of my class went into psychiatry.

Rebecca Kowaloff (’11): I was in the first class of a new osteopathic school opening in Harlem with a mission to increase the number of underserved groups in the medical profession. The fact that we were a new school was a blessing. There was ample room for us to step into leadership roles and establish clubs and such. For instance, I was a student government president in my second year, something not normally in my nature. Being the inaugural class was a curse, however, in that we often felt we had to advocate more than we should have for the support and resources we felt we needed.

Alexandra Rabin (’22): It has been a strange and exciting experience to attend medical school in the COVID-19 era. While we are privileged to experience medicine in an unprecedented age, with new innovations like the mRNA vaccine and the treatment of COVID-19 pneumonia, we have also suffered tremendous losses on the personal and global scale. Beyond COVID-19, movements like Black Lives Matter have also contributed to forming a more conscious group of students who are thoughtful about our role in reducing disparities and racism in health care.

AR: Did you have any particularly memorable interactions between yourself and a medical school attending?

Joel Popkin (’74): I still remember the day as a third-year clerk. We were to meet the chief of medi-

cine for teaching rounds. He was an intimidating figure and presenting a case to him seemed to be best avoided. But, he turned out to be every bit the wonderful teacher he was renowned to be and conducted rounds in a relaxed atmosphere, conducive to taking home some of the teaching points I actually remember today. But, things went less well if he found out a medical student was contemplating marriage or – heaven forbid – had actually done the deed. He felt very strongly that a career in medicine excluded marriage and any other significant distractions. I would almost invariably see him eating dinner alone in our cafeteria and, knowing no better, could only feel sorry for him.

Lynn Eckhert (’70): The most remarkable interaction I recall was with an attending who served as a supervising physician for me during a clinical rotation in Liberia. Dr. Franklin Keller was a remarkable physician and surgeon, a highly skilled and caring individual who devoted his life to caring for a vulnerable population in upcountry Liberia. Often, as the only physician in a 70-bed hospital, he was capable and comfortable in the full breadth of medicine and common surgeries. A highly principled man, he sought to bring out the best in his patients, his colleagues, his students and himself. He was a patient teacher who moved each of us to build on our talents and perform at the highest levels. From Dr. Keller, long before the social determinants of health were well defined, I learned how education, socioeconomic status, culture, and the environment impacted the health of individuals and families.

AR: What is the most salient difference between your medical school experience and that of current students?

Joel Popkin (’74): In our class of 205, five students were women. Horrifying to think of today, but standard in the early 1970s.

Lynn Eckhert (’70): Women were uncommon in medical school with the percentage in the single digits. Often we were referred to as “hen meds.” My senior resident on a medicine rotation during my third year of medicine announced, “I do not like women in medicine,” an inauspicious way to begin a six-week stint on his service. However, I had no such incidents from my classmates who felt we were all in this together.

Harvey Kowaloff (’75): We were in clinical training before limits were placed on residents’ hours. Consequently, a part of the medical student’s education was to experience the long hours that would be an integral feature of their training and practice lives.

Peter Schneider (’59): It’s almost obvious that the greatest change in medical school is the explosion of information and the means to access it. We all felt there was too much to learn. That feeling is probably even greater now. However, the second part of the information explosion is the computer which remembers almost everything for us. To look something up, we went to the library and its shelves of the “Index Medicus.” That was a huge, printed resource, updated yearly, which covered most of the world’s medical publications. To find something, we would look up as many pertinent keywords as we could think of, find references, and search the library stacks for relevant articles. It was very time consuming, but it did demand a certain discipline to determine the best search strategies. Lynn Eckhert (’70): For better and worse, medical school was different. Simulations were upfront and personal as we practiced drawing blood, taking blood pressures and passing nasogastric tubes on our classmates. In the clinical settings during our third year, we were immersed in the care of our patients. Among our responsibilities, we carried out what is often referred to as “scut work.” This taught us much about clinical medicine and about the best use of the ancillary services of the hospital. If we needed to take our patient to radiology for a film, we did, and while there we learned how the department functioned. Long before hospital accreditation required higher standards in laboratory techniques, we students, while on night duty, spun our patients’ hematocrits, stained and examined smears for red and white cell morphology, determined the specific gravity of urine, and checked for glucosuria. We performed lumbar punctures and trotted off to the lab to perform the cell counts in suspected cases of meningitis. Students were central to uncovering the diagnosis. What a pure joy it was to detect malaria parasite in the Giemsa stain slides I had prepared.

Joel Popkin (’74): Third- and fourth-year students had relatively little supervision compared to now. Getting data back then was incredibly more difficult, both in medical records and medical literature. But, we often provided the primary care for our patients and therefore learned the value and need for ownership. And, as crazy as the hours were, we devoted everything to learning and patient care, being very little bogged down by some of today’s needless documentation exercises. I believe this is the reason that the term “burnout” had not even been described until the year after my graduation. Perhaps from the few in my generation still hanging around training programs, where burnout has been rightly described as occurring in epidemic proportions, our perspectives might be of some relevance.

In speaking with these physicians, I perceive several important trends. Demographics have shifted; the concept of “hen meds,” as Dr. Eckhert writes, is now foreign, as medical school enrollment is evenly distributed between men and women. Second, global events like the Vietnam war and the COVID-19 pandemic drastically affected students’ social and political consciousness and showed that our experience is understandably susceptible to outside forces. And last, the responsibilities of medical students have evolved markedly since Drs. Schneider, Eckhert and Popkin were third-year clerks, though medical students continue to be highly engaged in patient care. The extent of change in medical education over the last half century is remarkable. But the common themes – a passion for constant learning and an excitement about science and clinical medicine – still define who and what we are. + Alexandra Rabin is a fourth-year medical student at UMass Medical School.