A new year, 106 new careers

Eclectic view of medicine unites first-year class

When Dagan Coppock came to the School of Medicine as an applicant, he knew he would like it here. His interviewers seemed interested not just in his GPA or what science courses he had taken, but in the poetry he enjoys writing. “I knew they were going to be supportive of other interests,” said Coppock, who took time off after his graduation from the University of Tennessee to study traditional healing in Nigeria.

Encouragement of other activities, the independence offered by the Yale System and the collegial atmosphere were among the reasons first-year students gave for deciding to study medicine at Yale. “I can concentrate on whatever I want,” said Aaron Berger, a graduate of the University of Pennsylvania from Lexington, Ky. “Laboratory research, volunteer work, you can go ahead and do it.” The school’s strong commitment to basic science research was another draw, he said.

Richard A. Silverman, director of admissions, noted that applications, available electronically through the American Medical College Application Service last year for the first time, were up 43 percent at a time when fewer students nationally are applying to medical school. The increase, Silverman said, was higher than the admissions office had projected. He attributed the increase in part to the new application system and in part to the attraction of Yale.

Because of the increased applicant pool, the rate of acceptances dropped from about 8 percent to 6 percent. “That’s a big difference,” he said, “for a school that’s already selective. I think the change is reflected in the quality of the class in ways that would be very hard to quantify.

“It’s not enough to be smart, to be well-grounded in the sciences, to be a good classroom student,” Silverman said. “When we look at applicants, we look for qualities in them that are going to make them good doctors, not just good students.” Among those qualities, he said, are interests and experiences outside medicine.

The 106 members of the Class of 2004 include a former ski instructor, a figure skater, a ballroom dancer with a black belt in karate, and a researcher who spent two years studying HIV at the University of California at San Francisco. Kavita Mariwalla, a 1998 Yale College graduate, decided to leave her job as a Manhattan investment banker for something more fulfilling than enriching other people’s portfolios. “In medicine,” she said, “you can say you did something to help others.”

Coeurlida Louis worked her way through Wellesley as a registered nurse before coming to Yale. Since her childhood in Haiti, she knew medicine would be her calling. She recalled going to see the country doctor who tended to his patients under a huge tent. “There was the doctor looming over everyone in a white coat,” she said. “I wanted to be like that. He was making a difference in a lot of people’s lives.”

This year’s incoming class includes 56 men and 50 women, 11 African-Americans, eight Latinos and 24 Asian-Americans. Six students come with master’s degrees and one has a Ph.D. Almost a quarter of the class, 23 students, were Yale undergraduates. Another 11 came from Harvard and six came from Stanford.

The promise of the white coat
The first year began, as it has for several years, in a tent on Harkness Lawn where faculty helped the students don the white coats that symbolize their promise as physicians. “What is it about this simple white coat that provides the lifeline between the patient and the physician?” asked Herbert S. Chase Jr., M.D., in his first address as deputy dean for education. “We are promising to our patients that we will be caring, that we will be kind, that we will comfort them, that we will respect their culture, that we will be completely committed to them and responsible for them.”

“When you wear that white coat,” said Dean David A. Kessler, M.D., “people will allow you into their lives. They will tell you things about their lives they will tell no one else. You are going to have to grow into that white coat.”

On the first day, an appreciation of other cultures
The first day of class began in Room 110 of the Hope Building with an unusual exercise. On colored slips of paper, students used a word or two to describe themselves in each of five categories. On pink slips they wrote their religion. Ethnicity went on violet paper. Green was for sexual orientation. Orange was for race and bright pink was reserved for socioeconomic class.

The papers were collected, sorted by color, then taped to the walls of the auditorium. Some answers were to the point—“middle class,” “heterosexual,” “Latino.” Others displayed some humor—“boy crazy,” “broke,” “rags to riches,” “part-time Sikh” and “Roman Catholic, at least my mother is.”

The point of the exercise was to highlight the class’s diversity and stimulate a discussion of culture and tolerance. A few moments later, the class divided into groups of seven or eight students to discuss the doctor-patient relationship as described in The Spirit Catches You and You Fall Down, by Anne Fadiman. Fadiman spent eight years documenting a tragic clash of cultures between a Hmong family from Southeast Asia and their doctors in California. While doctors looked to science to treat their infant daughter’s epilepsy, the Lee family sought answers in spirituality.

After lunch at the Lawn Club, Fadiman gave a keynote speech about her experiences writing the book and the lessons she believes it provides for doctors (See On Campus). “What lay between the doctors and the family was not only a linguistic, but a cultural gulf,” said Fadiman. Her own first visit with the Lees demonstrated that gap, she said. “I had been told the Lees were stupid and stubborn and crazy and hated Americans. I immediately met this smart and witty and warm and friendly family. I perceived them differently than the doctors did because they perceived me differently.” She urged students and physicians to acknowledge their patients’ cultures and beliefs and try to understand illness from the patients’ points of view.

Following Fadiman’s talk, students saw the dry language of a medical history translated into a flesh-and-blood human story. While a case history was projected on a screen, fifth-year student LaLisa Anderson read from oral histories she has collected in the South. Using the words of the people she interviewed, Anderson took on their characters, telling the stories. One, which paralleled a case history on the screen, was that of a young man who found his life turned upside down by the war in Vietnam. He came home addicted to drugs and alcohol, eventually to find redemption in faith. The message throughout the day was that the culture, language and beliefs held by patients will influence the way they interact with their doctors.

“Why are we talking about the doctor-patient relationship on the first day of school?” asked Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs. “Now is as good a time as ever to start thinking about these relationships, before acquiring any of the notions of how to behave that you are likely to pick up over the next four years.”

Public health program welcomes 114 master’s students
The entering class at the School of Public Health includes an unusually high number of women, who make up 76 percent of the 114 new master’s students. Usually, says Anne Pistell, M.A., M.B.A., associate dean for student affairs, women make up about two-thirds of the class. The students range in age from 21 to 52, with an average age of 25. The group also includes 14 physicians taking an abbreviated course of studies, one veterinarian, one lawyer and a college professor with a doctorate in the history of medicine. The incoming class represents 76 undergraduate schools and 35 majors, the most popular being biological sciences. Pistell added that the program can accommodate students with a very wide range of interests, whether it’s doing community work in Thailand, making policy in Washington or managing an HMO.

“Don’t Throw Me the Knife” and other survival skills for the clinic

In years past, third-year medical students entered the wards armed only with whatever clinical exposure they’d gleaned in their basic science years and at a daylong orientation consisting largely of lectures. The preparation sometimes left students ill equipped for their first days of clinical studies. “I remember someone saying ‘Go get the EKG machine,’ and not knowing what the EKG looked like, let alone how to attach it to a patient,” said Nancy R. Angoff, M.P.H.. ’81, M.D. ’90, HS ’93, associate dean for student affairs.

To help students through the transition from basic to clinical science, Angoff’s Office of Student Affairs expanded its clinical orientation program this year with a two-day Survival Fair held on June 22 and 23. In addition to lectures from chief residents, hospital staff and others, students received lessons in how to conduct a pediatric ear exam, draw blood and take blood pressure. A session called “Don’t Throw Me the Knife” offered tips on operating room do’s and don’ts.

The Survival Fair was the brainchild of Angoff, Cynthia Andrien, M.S., assistant dean for student affairs, and Gisella Weissbach-Licht, director of the Office of Education. “You’re going to feel unprepared no matter what,” said Angoff. “We came up with this idea to try to relieve the anxiety of starting on the wards by introducing students to some simple, hands-on skills they didn’t get in great detail before.”