"I spoke with the most amazing patient today — three chronic diseases, but still defines herself as 'well.'"
"It's like we need to redefine what 'illness' is."
"Just because I say we should figure out the genetic basis of intelligence, that doesn't make me a eugenicist!"
"Oh, no? Do you know the stats for Down syndrome abortions?"
"I've been hopelessly overwhelmed with this clinic work in Malawi. I just feel like I can't get anything real done."
"Been there. For the last seven years. Let me tell you what I figured out about what really matters."
These are the kinds of conversations that take place among students in the vaunted hallways of Harvard Medical School, but have had no dedicated outlet to the broader public — until now.
This week, Harvard Med students delivered a baby of the literary sort: A new, student-run journal titled the Harvard Medical Student Review. It aims to offer an online, more permanent venue for those hallway-type conversations and much more, from personal essays to policy positions.
I spoke with its four co-founders, online and by phone. Our conversation, edited:
The introduction to your first issue cites the first American medical journal, launched in 1797 New York during a Yellow Fever epidemic. But why this and why now?
One of the most common comments we received when we pitched this idea to friends and advisors was, "Oh of course! Why doesn't this exist already?!" Medicine, and healthcare more broadly, are in such flux today and today's health students - medical and otherwise - are training right through these dynamic changes - in curriculum reform, reimbursement reform, delivery redesign and otherwise.
Also, as the majority of students have not yet worked as qualified health professionals, they have a uniquely fresh perspective. Fresh, of course, because we have yet to work in the trenches for a living. Unique in the sense that these students have a highly vested interest in shaping the future of health and medicine - their careers and lives depend on it! They bring their youth, energy, and creativity.
Plus, we think medical journalism and publishing and medical humanities from the student perspective are a rising force. After we began we working on this, we noticed a couple other medical schools have blog-style student journalism sites that have received positive reception. We're trying to take this a step forward by introducing the first medical student online, peer-reviewed journal.
What topics do you most hope your writers will cover? What are the most burning issues?
Moving forward, we'd like to see the reach and breadth of the journal expand. One particular area of interest is quality improvement (QI). The work done by the Institute for Healthcare Improvement is a clear example of the excellence in care delivered, costs saved, and lives improved that can be achieved by focusing on improvement as a process level - from a system-design perspective. They also focus strongly on students. Highlighting QI projects and their tangible impact is one of several potential areas for growth that we would like to see.
One of our advisors, Dr. Sachin Jain, mentioned that it makes most sense for students to weigh in on what they know. One of the things we have unique expertise in is what we spend every day on - education. It would be particularly interesting to see medical students reflect on and dissect this constantly evolving beast. Schools across the country are updating and adapting their curriculums in innovative ways - changing both the structural model and the content.
As the US continues to make philosophical decisions on healthcare and coverage and reimbursement models and incentive drivers, we will need to look sharply and cautiously at what our students are being trained to do - what professional values we are instilling, what we are teaching them is important, how to interact with patients and other healthcare workers, and what bigger picture we are conveying of how all the professions fit together.
It is important to us also that HMSReview can be used to advocate for those who are living in extreme poverty, and who depend upon compassionate and inclusive global health policies. We are very excited to see global health pieces written, not only for the sake of advocacy, but also to educate the public on what it’s like to live in extreme poverty and what can be done to address these multidisciplinary issues.
Many of our students engage in basic science research by taking a year off or pursuing MD/PhDs. Medical schools have trained many successful and famous scientists, giving students an interesting take on what's up and coming in the world of research. Because science and medicine are intimately linked (as particularly evident in the field of cancer), we would like to see more science perspective articles and even primary research articles as we grow.
We also have students who like to creatively express themselves in non-medical ways. We have many classmates - both here and in schools across the country - who are artists and poets who have been able to apply their creative sides to medicine - and we have been able to include some such examples in our first issue. Medical schools have an underappreciated wealth of talent in art and the humanities, and we want to help promote it.
What if someone wants to write something that's essentially oppositional, against the Harvard administration?
One of our advisers, Dean of Students Nancy Oriol, said this is actually 'a great venue for you guys to really speak your mind, free of any censorship.' So if someone wanted to say anything that went against a faculty or staff member at Harvard or elsewhere, as long as that person is fair-minded and fact-based, and not doing it just for the sake of being inflammatory, that would be fine as long as it’s vetted and checks out.
Do you see your audience as beyond med students? Who else?
Definitely. Our team itself includes dental and public health students. While medical students may constitute a majority by default, we want to reach students across the health professions: (medicine, dental, public health), nursing, pharmacy, health administration, and the allied health professions — as well as anyone who is interested in knowing what students think, both in and out of the medical community. One of the roles we hope this journal could play is to bring students of these different but professions together. Indeed, we have already begun to reach out to those groups directly.
Could you point to a couple-three pieces in the first issue that are emblematic of what you hope to do?
Hard to pick just a few. We really enjoyed the humanistic focus shared by "Essence to Essence" by Scharff and "Redefining Suffering and Illness" by Beckwith, and would mention Schapira's "Letter to the Editor: How We Heal."
Scharff weaves a compelling narrative, while Beckwith brings scholarly weight to a common theme: the essential humanity of one-on-one physician patient interactions. This is a phenomenon that students are seeing for the first time and can reflect on with fresh eyes - through a lens that you could imagine is particularly relatable to the average reader, student, professional, or someone even outside of healthcare. Finding and sharing those types of unique insights that you don't find in other journals is something we're definitely all about.
Your advisory panel includes some really major figures in the Harvard and health care world, from Dr. Paul Farmer of Partners in Health fame to the head of Massachusetts General Hospital and the scientist George Church. Seriously, how did you get that star-studded advisory panel?
Haha, the answer is nothing more elaborate than: we asked them. We thought to ourselves, if we want this journal to provide meaningful substance and value to its readership, having experienced mentors at the forefront of their respective fields could only help. And then we just dreamed big.
Many of them we had met or had as advisors or guest lecturers in one capacity or another. Some we emailed, one we ran into on the bus and just approached cold. We were extremely lucky that they all said yes. I think their endorsement speaks to the strength of the concept - and their faith in students. We are incredibly grateful for their support and guidance.
Are there any topics you aim to avoid?
I don't think so. Most importantly, we want to emphasize fair and fact-based discussion, analysis, and research, and provide a platform and space for academically rigorous student expression and critique.
Any other point you'd like to emphasize?
While this is a journal by students for students, we welcome submissions from any school and even anyone (including non-students). The management team of the journal must be students. Given our warm and supportive reception - both at home by the Harvard Medical School administration and community, and on our social networks - we know that people care about the thoughts of students and how they think healthcare and medicine can be changed for the better. After all, we are going to inherit and be the future caretakers of health and medicine in this country - and world.
How often will the HMSReview come out?
We'd love it to be once every semester, so we imagine the next one will be sometime in the early fall — but if the content is overwhelming, we might publish more.
Readers, suggestions for the next issue?