She rode along to an apartment complex, where she witnessed, firsthand, a woman about her own age having a grand mal seizure and lapsing into a state of unconsciousness. During her hospital admission, it was discovered that this previously healthy young woman had seized because of rapidly developing renal failure.
What caused her kidneys to quit? Lupus nephritis. The dean was effusive in his praise of this student who tenaciously followed this patient in the hospital, at all her clinic visits and at her home, as her illness evolved over the course of the next 18 months. Through a stroke of serendipity, the clinical mentor assigned to her before the start of medical school happened to be an internationally prominent rheumatologist with a devotion to the study of lupus.
These are the types of experiences that may serve as game changers in our quest to capture the hearts and minds of medical students and residents. Right now, we are performing rather poorly, with over 99% of students choosing those other forks in the road, the ones leading them away from rheumatology.
As part of a curriculum redesign team at Harvard, we are about to put this theory to the test. Rheumatology, which used to be crammed into a 15-hour course held over four consecutive half-days, has been given ample breathing space. We have allied with our friends in dermatology, allergy and immunopathology to create a teaching adventure that will generously span six weeks. Out with the large lecture halls, and in with concept videos and flipped classrooms (see Rheuminations: Has Technology Depersonalized the Art of Medical Teaching? February 2015).
Can we, as rheumatologists, captivate the mind of the millennial medical student? If they want to learn dermatology, how about helping them explore the countless ways that lupus damages the skin? If they have a yen for orthopedics, they can learn how to manage various musculoskeletal ailments using a needle and syringe. And if they want to engage in long-term and highly rewarding relationships with their patients, putting all that knowledge they learned to excel in the new MCAT, they need look no further than rheumatology.
We may want to entice our millennial audience by playing some television clips featuring the eponymous Dr. House, that irascible, sharp-witted curmudgeon and brilliant physician. A modern-day Osler, this medical detective is idolized by the retinue of devoted trainees who hover over him on rounds as he hobbles down the hallways in search of answers for his patients, who have defied diagnosis. Perhaps House’s most famous line over the hundreds of episodes, uttered countless times with varying degrees of anger and frustration was, “It’s not lupus!”7,8 Sometimes though, it really is.
