Gameiro, Gustavo Rosa

Silva, Henrique Branzani da

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Cadernos Espinosanos (E-Journal)

Breaking Paradigms: Students in PerspectiveGustavo Rosa Gameiro,* Henrique Branzani da SilvaGraduation in Medicine, Faculty of Medicine FMUSP, University of Sao Paulo, Sao Paulo, SP, BR.*Corresponding author. Email: gustavo.gameiro@fm.usp.brOn Wednesday at 2:30 pm, after attending all of my morn-ing classes and having lunch, I intended to rest. However, onmy way home, as I climbed the stairs of the college, I ran intothe dean, Professor Auler, in a lab coat, who was comingdown the stairs and heading for the intensive care unit (ICU)to visit some patients. To my total surprise, he invited me tofollow him.In a few minutes, I found myself in a circle of approxi-mately 10 professionals, including doctors, nurses and physio-therapists, discussing the bedside management of each patient,including enigmatic cases and apparently less complex ones.The discussion was filled with acronyms, ideas and citations ofstudies recently published in respected scientific journals.As I contemplated so many professionals working for thehealth of one individual, I was beginning to grasp a truedance of knowledge; I felt a little pang of angst, for it lookedas if I added very little to the discussion. It seemed to me thatas a student, I was only disturbing them with my questionsand doubts. At the end of the visit that day, I took home notonly the new knowledge and some doubts but also a certainfeeling of discomfort: what is the role of students in healthservices?During a student’s very first contact with the hospital atthe basic health unit or the outpatient clinic, we realize howasymmetric our relationship with these institutions will be.On one hand, there are freshmen who are unable to recognizean obvious heart murmur or even a classic sign of massiveascites. On the other hand, hospitals are large organizationswith hundreds of patients, multidisciplinary teams and aninfrastructure that sometimes includes a kitchen, pharmacy,laundry facility, waste collection center and more.At first, it is difficult to find our place, as we do not havethe experience to discuss medical conduct based on the latestupdate published in a reputed journal. We have difficultytalking to patients about their illnesses, it takes us longer tocarry out anamnesis and physical examinations, and ourmedical visits are longer due to elementary questions.During one of my weekend rotations in the infectiousdisease ward, for example, I was supposed to see patientsquickly and discuss them briefly with the attending physician.Something that was supposed to take a few hours ended upstretching for a whole day, since the attending physician wasinterested in answering all my questions. It was the longestvisit I ever attended and by far the most didactic one.Contrary to what one may expect, although students needmore time to talk and perform physical examinations, patientsdo not seem to think that longer examinations are boring ortiresome; they actually recognize how humane and intense alonger consultation may be, which is something that could gounnoticed in a quicker anamnesis but is more likely to benoticed by a student.The health system continues to function despite the pres-ence of the student, and I have already caught myself wonder-ing if it would be more efficient if we were not there.It is undoubtedly inside the various health facilities wherewe grow academically: we begin to understand the mainsyndromes, we learn to treat the most common clinical condi-tions and we learn how to behave in emergency situations.We also understand that the hierarchy present in the healthsystem is not as simple as it seems. Personally, we build relation-ships with patients and their families and with our friends,coworkers, mentors and superiors. Emotionally, we experiencehuman suffering so closely and sometimes we feel helplessagainst the disease, which cannot be compared to the worstsentimental deception that we may have had. Our humility isput to the test, and we are faced with our limits (1,2).We also learn to value our time and to address the dif-ficulties that we have in practicing the profession; we learnhow difficult the task of giving bad news is, we make mis-takes, and we lose our first patient. We find that sometimeswe cannot offer the state-of-the-art treatment because it is notavailable in the public health system, especially in develop-ing countries, but we can always do our best.The health equipment in a university context is designedto train students and turn them into good doctors who willbe responsible for taking care of the next generations. In thisscenario, it is necessary to highlight the important role playedby active agents in the propagation of knowledge, namely,our professors, masters and tutors.The interpersonal relationship between students and traineddoctors can take several forms, namely, medical visits with adidactic purpose, scientific orientation, lectures or even tutor-ing. Regardless of the form of interaction, it is imperative thatthe academic knowledge and personal experiences of eachphysician be passed on to younger generations, where theywill find fertile, virgin ground to take root, develop and bearnew fruits (whether scientific, human, social, etc.) for latergenerations.I repeat, no matter how important and indispensable to thestudent medical books and fictitious clinical cases may be,DOI: 10.6061/clinics/2018/e434Copyright & 2018 CLINICS – This is an Open Access article distributed under theterms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in anymedium or format, provided the original work is properly cited.No potential conflict of interest was reported.Received for publication on November 13, 2017. Accepted forpublication on April 10, 20181EDITORIALthey are insufficient to fully convey the biological, human, andsocial conceptions of the process of sickness and recovery.Throughout history, the medical student has never played anexclusively passive role in relation to the patient and themedicine (3).An example worthy of note is the biography of AugustaDéjerine-Klumpke (1859-1927), an exponent of neuroscience.A brief glimpse into the history of her life is enough to proveher activism for women’s rights in medicine, an exclusivelymale profession in Paris during her time. Her struggle forsocial inclusion echoes to this day, with more and morestudents discussing issues such as ethnoracial quotas forstudents in medical schools, for example.Like Dr. Déjerine-Klumpke, students are the ones whobreak most paradigms. She was known not only for heractivism in favor of women in the medical profession but alsofor her remarkable her prominence in the field of neuro-anatomy throughout her academic life, which culminated inthe description of lesions of the lower brachial plexus, latercalled "Paralysis of Klumpke".A lot can be be said about many other students who havebeen involved in important scientific discoveries for medi-cine, which is certainly the case for Dr. Thomas J. Fogartyand the invention of the catheter bearing his name, forDr. Auguste-Maurice Raynaud and the description of theRaynaud phenomenon, an important manifestation of rheu-matological diseases, and for Charles Herbert Best (1899-1978) and Frederick Grant Banting (1891-1941) and thediscovery of insulin (3), to name just a few.It is remarkable how some of the great technical-scientificadvances of medicine have come about through the handsof the then less-experienced but very creative students.Drawing a parallel with the theory of the Nobel laureateDr. Daniel Kahneman, these young people have much moremedical practice related to System II than to System I (4),unlike hospital seniors, for whom everything is more auto-matic, more fast-paced and more efficient but less innovative.Such individuals were not afraid to dare to take a steptoward the unknown, to defy valid ideas, and even to makemistakes. This same innovative spirit remains alive withinstudents’ hearts and can be stimulated and directed accordingto the action of experienced physicians and professors.Therefore, yes, perhaps the health system exists "in spiteof" the students, but it is their exposure to different environ-ments, in essence, that hold the major responsibility for thetraining of a physician as a whole and, in turn, for the naivebut attentive and creative look of the students that leadsto the rupture of paradigms to achieve the more humaneapproach and perhaps to develop great scientific innova-tions. Let us not be afraid to participate actively, students!Professors, we expect to see you in the next case dis-cussions, whether in the basic health unit or in the ICU.’ REFERENCES1. Bradley L. Non-maleficence: perspective of a medical student. Br J GenPract. 2017;67(659):252, http://dx.doi.org/10.3399/bjgp17X691001.2. Ganguli I. The case for primary care — a medical student’s perspective.N Engl J Med. 2010;363(3):207-9, http://dx.doi.org/10.1056/NEJMp0912843.3. Stringer MD, Ahmadi O. Famous discoveries by medical students.ANZ J Surg. 2009;79(12):901-8, http://dx.doi.org/10.1111/j.1445-2197.2009.05142.x.4. Kahneman D. Thinking, fast and slow. New York: Farrar, Straus andGiroux; 2015.Figure 1 - Gustavo Rosa Gameiro, Professor Jose´ Otavio Costa Auler Jr and Henrique Branzani da Silva ready for the next visit.2Medical Students in PerspectiveGameiro GR and da Silva HBCLINICS 2018;73:e434

Breaking Paradigms: Students in Perspective

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Breaking Paradigms: Students in Perspective

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