Weill Cornell Medical Center, New York, NY
An unpaid internship in New York City: talk about the ASIP Grant coming in clutch! This summer, I worked in the Research Associate Program at NewYork–Presbyterian/Weill Cornell Medical Center, and I am wholly thankful for the experience. I was gifted with a wonderful learning opportunity, and its existence was truly borne from the generosity and kindness shown by the Williams College ’68 Center for Career Exploration and the Class of 1972.
Broadly, our role as Research Associates (RAs) was to help various researchers conduct various clinical studies in the hospital’s Emergency Department (ED). Specifically, we performed many of the studies’ hands-on and time-sensitive aspects, e.g., recruiting patients for participation, walking patients through informed consent protocols, conducting interviews, collecting blood samples, recording study data. We were employing between five and seven studies at any given time, and their investigational content included sepsis diagnostics, concussion treatment, elder abuse, telemedicine, PTSD, and many other lines of research. (The range of content, as well as having multiple studies, allowed for an especially broad education in clinical research.) All the while, we constantly interacted with—at times, worked alongside—nurses, social workers, physicians, and all those involved with patient care in the ED.
A day in the life of an RA went a bit like this: 1) Clock in. This was a shift-based job with coverage from 8:30 a.m. – 8:30 p.m. every day of the week. So, with only four summer RAs (note: all of us from Williams!), you could be clocking in any day, nearly any time. 2) Snuggle up in room M-112, our cozy little closet/locker room/office. Surrounding M-112 were four connected physicians’ offices, and the room itself was shared by RAs, ED scribes, and a handful of physician-assistants. It was not spacious. But, perhaps counterintuitively, I think the tight quarters incidentally became a great part of the job! By working in the same space, we got to know so many of the people mentioned—some of whom became unexpectedly close friends. (Summer friendships are, as many of us sadly know, often ephemeral. I hope we stay connected over the years, something I want to improve upon in my own life.)
3) If you were on the early shift, report to the morning “huddle.” Here, nearly everyone related to the ED workflow (nurses, physicians, social workers, IT workers, patient navigators, RAs, etc.) meets in a literal huddle, introduces themselves by name and role, and announces any messages to the group. The RA announcements typically concerned study protocols. Personally, I found the whole process—the act of introducing yourself as part of the team, as someone with something to contribute—empowering. I imagine I was not alone in that feeling. I can see how such a practice may help employees feel valuable, promote communication amidst various roles and power dynamics, and ultimately contribute to better patient care. (I think Atul Gawande advocates for these types of huddles in The Checklist Manifesto.)
4) Get to work! The rest of the day involved checking “the board” (i.e. the secure online portal that hosts real-time medical information of all patients in the ED) and performing our necessary duties for the various studies we were assigned to. As mentioned earlier, most of these duties involved talking with patients. For me, these were the highlight of the job. Administering the studies was often interesting, but even better were the long conversations after the studies were over. When the questions had all been asked, boxes checked, pen and clipboard put down, and we had the privilege of talking with patients about both of our lives. It felt like a special space to have those types of conversations—sometimes about nothing, sometimes about everything, with the patient’s future wellbeing often uncertain. I was fortunate to experience many beautiful moments in these spaces.
From a bird’s-eye view, that was the job of an RA as it appeared to me. I enjoyed the work, I felt close to those I worked with, and I learned a lot about a field in which I hope to spend a lot of my life. A great job.
Aside from clinical research, I learned much about the life of an emergency physician. I have plenty of time before I must decide my medical specialty, so there’s no rush. However, I can’t help but try to weigh some of the pros and cons of the various specialties I observe. For emergency medicine, here are some things I found appealing: 1) Variability. I’ve talked with some physicians, in non-emergency fields, who find that their work can become a bit repetitive. Treating the same ailments and performing the same procedures every day could understandably become tedious. Emergency physicians, however, see everything. They must know how to treat the urgent and life-threating conditions that affect every organ system. That is, their expertise has crossover with nearly every other medical specialty—something that could be appealing, as a way of preventing job monotony.
2) Schedule flexibility. Emergency physicians work on a shift-based schedule, and thus often have flexibility to plan their work around the rest of their lives. With this, we met many physicians who had active pursuits outside medicine, e.g., time with their families, travelling, research, filmmaking, photography, gardening, teaching, and writing. As someone with a wide range of interests, I find this especially appealing.
3) Patient population. Emergency physicians not only treat everything, but also everyone. With fewer barriers than some other specialties (though certainly not barrier-free), emergency medicine has the opportunity to care for those who are so often denied it. It was beautiful and sad. Of course, as most of us have become aware of, many people came to our ED because it was the only care they could access. And they deserve better, more accessible primary care. The system needs reform, in addition to greater immediate care. Emergency physicians provide the immediate care, but may also have a window to promote larger, more systemic change. American medicine seems both internally confused and institutionally stifled in trying to create a better medical reality; to me, caring for those who are traditionally undeserved may help me better learn what those patients want and need out of medicine. This learning could almost certainly inform better policy.
My RA job inspired ideas that, I hope, will foster further investigations into these broad and complex issues. I want to learn, I want to involve myself, I want to help. Right now, my understanding of the American medical system and its innumerable manifestations feels peripheral and somewhat nebulous. Thus, I hope to focus my near future (and, eventually, my entire career) on listening to those who need change. As of now, I hope to teach, volunteer, or otherwise provide service to underserved communities following graduation. From there, I plan on attending medical school, becoming a physician, and using my knowledge and various opportunities therein to work for medical reform. It’s certainly an unspecific plan, but I hope each step will better inform the next.
As one step on that plan, the RA job gave me wonderful opportunities for learning and productive questioning. I feel grateful for the privileges granted by Weill Cornell, the RA program, the Williams College ’68 Center for Career Exploration, and especially the Class of 1972. I hope my knowledge and experience gained from this summer will eventually contribute to better care and better systems for patients who need it.