Coaching pre-medical students towards professionalism: A multi-year approach
Kate Karacay and Emily Brunner
2013

Students entering college with declared pre-medical majors often feel a sense of commitment to their chosen profession (Shaffer and Zalewski, 2011), but they may not fully know the importance of professionalism and preparation in achieving their goal.  Students may not understand the amount of science classes required to successfully apply to medical school. Likewise they may not understand the importance of community service or the strong communication skills needed to become a physician.  Academic advisors can guide pre-health science students throughout their college careers by helping them develop and refine the academic, affective, and communication skills that are important in medical school. 

In this article, we define professionalism as “A process of socialization where students acquire not only the knowledge and skills, but also the values, attitudes and beliefs, in essence the culture of the profession of medicine” (Goldie, 2008).  While it is not an advisor’s position to professionalize a student into the career of medicine, advisors can help students better understand their desire to become physicians. Professionalism is highly valued in medical school and numerous studies exist on how assess professional skills in medical education (Arnold, 2002). Strong academic and communication skills are crucial for successful matriculation into medical school and beyond. 

Working with first-year students: Self-knowledge and establishing expectations 
A significant hurdle for many first-year students is making the adjustment to college-level academics and  a new environment (Lu, 1994).   Pre-medical students, seeking admission to competitive programs with high GPA requirements, must quickly adjust to college-level academics.  Many students come to college relying on study skills that worked well in high school but fall short for college; they may not understand that they need to develop study schedules and their own study materials.  First-year students may be too intimidated to consult with faculty during office hours even when they do not understand a concept. New students may not realize the value of campus tutoring opportunities or the wisdom of completing the extra practice problems in the back of textbooks.  

Advisors help their pre-health students by asking when, how often, and where they are studying, along with what tools and techniques they are using to study. Advisors can ask students about their note-taking, where they sit in class, how often they review their notes, and how they handle concepts they may not understand in class. These questions allow advisors to coach good study habits and strategies, as well as help link students to campus resources (e.g., tutoring labs and faculty office hours).  

One effective advising strategy is the use of group advising with new pre-medical students.  Working with a group of students allows advisors to convey the importance of study skills, grades and work habits to large audiences in a way that does not single out individual students.  Another effective advising strategy is to meet with individual advisees after their first exams to examine what worked and what didn’t.  Sometimes students may be surprised that extra effort and more refined study techniques are required to master college-level courses and achieve high grades.  Advisors can help students determine workloads and teach strategies required to be a successful pre-medical student.  

Additionally advisors can help students better understand their desires to be a physician.  Students vary in levels of personal awareness and in how much they understand what the medical profession entails.  It is important that advisors have intentional conversations with students about how they use leisure time, how they can get involved in volunteering and research, and what sacrifices needed in time and leisure to achieve their career goals.  Some students may not be fully aware of the years of schooling needed or the residency requirements to become a doctor. Nor do they always understand the level of debt students incur in medical school.  Medicine requires a high degree of scientific acumen.  Students drawn to medicine for the helping aspects of the profession should also be aware of the extended schooling and high levels of scientific knowledge required to succeed.  

Developing Communication Skills 
To prepare themselves to be effective physicians, students must learn to communicate skillfully with patients and co-workers.  Students must intentionally explore their own beliefs, experiences and communication styles; they must learn to interact with people whose backgrounds and worldviews are different from their own.  Advisors can help pre-health students seek out experiences that will hone their communication skills and expand their horizons. 

One important way students can develop communication skills is through volunteering or working in a healthcare setting.  Students are often anxious to obtain healthcare experience, but typically need some prompting to understand what they should be learning from these experiences.  Aspiring doctors often focus on observing procedures and learning about diseases and treatments; advisors can urge them also to attend to the more human side of healthcare.  Students should consider their own interactions with patients, peers, and healthcare professionals, reflecting on times when they communicated effectively and instances when communication was challenging.  They should observe how doctors and other healthcare providers interact with patients and each other and seek out role models who demonstrate effective teamwork and communication skills.  In both their healthcare experiences and extracurricular activities, students should consider how they work in teams and examine their leadership styles.   Advisors can encourage pre-health students to focus on communication issues by asking probing questions and by encouraging students to keep a journal in which they reflect on their volunteer and work experiences.  

Today’s students will work in diverse settings, and they will need to communicate with patients and co-workers who are different from them (Rosen et al. 2004).  To communicate effectively across differences, students must first understand how their own experiences and backgrounds shape their beliefs and assumptions (Kai, 2005). Many institutions offer classes that ask students to examine their position in class, race, gender and other power hierarchies and to consider how their social positioning influences their worldview.  For example, anthropology classes can help students understand the impact of culture on their own and other people’s decision making.  

Understanding the profession’s role in society 
Students come to college with varying degrees of commitment and understanding of their chosen careers and majors; students may decide on a medical career without much thought to what that means (Albright, Martel and Webster, 2012).  For students wishing to become medical doctors, their impressions may come from family members, friends, media, and a strong desire to be in a helping profession.  Many students, especially those who are first-generation or from disadvantaged backgrounds, may have very limited exposure to medicine and may be unaware of the schooling needed, financial outlay required, or the demands of medical school, residency, and a medical practice.  

Advisors ask new students what they know about the profession.  Exploring students’ thoughts on the high visibility and responsibilities of doctors can help students think about how they project themselves in their volunteer opportunities and community work. Thought-provoking questions help students explore their own feelings about having a career with high community expectations.  Advisor should talk with students about their comfort levels with making life or death decisions, communicating difficult or bad news, working with people from different backgrounds, dealing with ambiguity in diagnosing and therapeutics, and working in high-stress conditions. These conversations can help students think about their own talents, values, and their desire to be a physician.  

Advisors should help students process experiences in research and volunteering.  For example, the student who reports that her research project was a failure because her experiments did not work opens the door for a fruitful conversation on dealing with failure and frustration when diagnosing and treating patients.  A student who comments on his hesitation to take a class with an instructor with an accent can initiate a good conversation on the need to develop excellent communication skills with a wide variety of people.  Talking with students on how they conduct themselves in volunteer situations, how they communicate with faculty, and how they present a professional profile prepares students for admissions interviews and for the profession’s high visibility.  Advisors can play a significant role in helping students connect their beliefs, experiences, and coursework to the realities of medicine, and thus help ensure that students have a good sense of their abilities and desire to be a doctor. 

Making the Connections 
Students sometimes feel too busy and overwhelmed during the school year to put very much time into reflecting on their experiences.  Advisors can, therefore, encourage them to spend time during summer break thinking critically about their emerging professional identities.  One method to encourage this sort of introspection is to send out an email at the end of the school year assigning students summer “homework.”  Possible homework assignments include brainstorming topics that students might want to discuss in the personal statements required for medical school applications, shadowing a doctor, volunteering in a novel healthcare setting, or reading books and essays about the practice of medicine.  

When advisors talk to students about their extracurricular experiences, one powerful technique is to refuse to answer questions about what “looks good.”  Students often ask whether a particular class, volunteer opportunity, or major “looks good” to admissions committees.  This question reflects an attitude that the purpose of pre-medical preparation is to impress others or to check off items on an unspoken list of requirements.  Advisors can reframe the question to encourage students to think about how their coursework and experiences will prepare them to be more skilled, compassionate, and effective physicians.  When a student says “does this look good?” an advisor can reply “I don’t know.  How do you think it will make you a better doctor?”  Advisors certainly need to communicate to students that admissions committees expect to see certain prerequisite classes and activities, but even in those conversations it is important to emphasize why medical schools believe those things to be so vital. In conversations with students, advisors can convey the expectation that students  view their goal not as accumulating achievements, but as developing the skills and knowledge needed for their chosen profession.  

Conclusion 
Advisors play a key role in helping pre-medical students synthesize their academics and experiences into the bigger picture.  Through meaningful discussions on study skills, research and volunteer experiences, and students’ perceptions of their chosen careers, advisors can help students better understand why they want to be a doctor and how the undergraduate experience can prepare them for the challenges they will face as they achieve their career goal. 

Kate Karacay
Academic Advisor
University of Iowa

Emily Brunner
Academic Advisor
University of Iowa
 

References 

Albright, Janis, Karen Martel & Brenda Webster. (2012) No more missed opportunities: using the foreclosure model to advise nursing and pre-nursing students. Academic Advising Today, 35(4). Retrieved from: http://www.nacada.ksu.edu/Resources/Academic-Advising-Today/View-Articles/No-More-Missed-Opportunities-Using-the-Foreclosure-Model-to-Advise-Pre-Nursing-and-Nursing-Students.aspx 

Goldie, John. (2008). Integrating professionalism reaching into undergraduate medical education in the UK setting.  Medical Teacher, p. 513-527. 

Kai, Joe. (2005) Cross-cultural communication.  Medicine, 33(2), 31-34, Retrieved from: http://www.sciencedirect.com/science/article/pii/S1357303906001745

Lu, Luo. (1994). University transition: Major and minor life stressors, personality characteristics and mental health.  Psychological Medicine, 24, 81–87. 

Rosen, Joel, Erica Spatz, Annelise M.J. Gaaserud, Henry Abramovitch, Baruch Weinreb, Neil S. Wenger & Carmi Z. Margolis. (2004). A new approach to developing cross-cultural communication skills.  Medical Teaching, 26(2), 126-132. 

Shaffer, L., and Zalewski, J. (2011). It’s what I have always wanted to do. Advising the foreclosure student. The NACADA Journal, 31 (2), 62-77.