Published: Wednesday, April 21, 2004

A Higher Calling
Two first-year Stanford medical students learn to be healers, not just physicians

by Dana Green
Photographs by Norbert von der Groeben

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Dora Castaneda remembers the exact moment she wanted to become a doctor.

First-year Stanford medical students Erik Cabral and Dora Castañeda work on a cadaver during a November lab session

The doctors' compassion lit a spark in her. "I remember thinking, I could do this," Castaneda recalled.

First-year Stanford medical students Erik Cabral and Dora Castañeda use textbooks to guide them through a cadaver during a November lab session.

Fourteen years later, Dora and her fiancé, Erik Cabral, are both first-year medical students at Stanford University's School of Medicine. They and their 84 classmates are part of something new: An experimental curriculum at the school designed to create well-rounded physicians with skills in empathy and compassion, not just book smarts.

"Stanford is not simply about training physicians," said medical school dean Philip Pizzo, MD in a press release announcing the new curriculum. "We want to equip our students...to become leaders who will help to shape the medicine of the future."

Stanford medical students (l-r) Sepideh Gholami, Eric Cabral, Dora Castañeda and Lorie Diaz huddle during a November study group session.

Eight hours a week they study Practice of Medicine -- which covers health management issues, ethics, empathy and cultural diversity, among other topics.

The new curriculum also emphasizes patient care: first-year students start to apply their course material immediately in the clinic. Before, students would wade through two years of class work before seeing the inside of the hospital.

Dora Castañeda is deep in thought during a study group.

"You just left anatomy behind," Dora said.

Seeing patients for the first time was a bit nerve-wracking - at first, the students "practice" on actors simulating injured patients. Afterwards, instructors questioned them about their technique, analyzing their bedside manner using videos.

"I shook a patient's hand and I learned later he had a hand injury," Dora said. "You learn to pay attention to the little things."

Dr. Jasminka Criley prepares to take Cabral and Castañeda on their first patient visits in January.

Last quarter, when Dora and Erik learned in class how to perform a neurological exam, they were able to apply the knowledge almost instantly on a patient. They discovered a motor-neuron injury had occurred by testing his foot reflexes. "We used a clinical tool we just learned," Erik said.

After months of clinic work, both of them are getting used to putting on white coats and a stethoscope and building a rapport with patients.

On their first hospital rounds, first-year Stanford medical students Erik Cabral and Dora Castañeda examine patient Mike Ollivier of Hanford, CA.

"By this quarter, I felt a lot more comfortable," Dora said.

In another change under the new system, first-year students also study whole organ groups -- for Dora and Erik, last quarter was head and neck, this quarter is heart and lungs. But it means working with cadavers: not everyone's cup of tea.

First-year Stanford medical students Erik Cabral and Dora Castañeda share a laugh with patient Mike Olliver .

Erik argues that working with cadavers, instead of isolated organs, gives aspiring doctors a sense of the whole system that they wouldn't have otherwise.

"I have a mental picture of where the heart is relative to the stomach," Erik said, "That's great to have."

New curriculum or no, medical school is tough. Last quarter, the couple averaged five to six hours of class work each day, anatomy lab or clinic work in the afternoons, and four hours of studying just to stay afloat.

"You (put off) the four hours, but then you're stuck doing 16-hour days to catch up," Erik said.

Teacher aid Ellen Morrow show Castañeda, Yingbing Wang and Ronnie Sebro a section of a human brian.

But they both are managing the sheer volume of material, with help from each other and their classmates. The first-year students share information, resources and notes by listserv and develop informal study groups.

"Stanford's one of the only campuses that doesn't rank their students," Erik said. "I think that fosters a sense of collaboration."

The new program also gives the students one day off per week - Wednesdays are class-free. The day off allows the two to catch up on bills, exercise and recharge for the rest of the week. "Wednesdays are sacred!" Dora laughed. Erik agreed: "It allows you to have a life."

After a grueling week, Castañeda and Cabral relax by watching a movie on a Friday night.

The couple's path to medical school was not without its bumps and detours.

Nobody in Dora's family had dreamed of going to high school, much less college. Her parents left rural life in Chihuahua Mexico behind, crossing the border into the U.S. as teenagers. Though they had grown up together on a farm, it was not until they met again years later at a family member's house in southern California that they became interested in each other.

Both parents worked hard to provide for their children: Her father commuted two hours each way to work as a janitor at a dye engraving company -- a company he now manages. Her mother started a day care center so she could stay at home with Dora and her sister.

Stethoscopes hang side by side with car keys and Mardi Gras beads at the campus apartment Cabral and Castañeda share.

It was her parents' work ethic that motivated Dora to fulfill her dream of being a doctor. "They've sacrificed so much to give me opportunities," Dora said. "That was always a push to do better."

Dora graduated at the top of her high school class, but her first quarter at college was rough -- from straight A's to straight C's. "I started to doubt myself," Dora said.

She credits the campus program for minorities in the sciences for getting her back on track, providing one-on-one tutoring and helping her hone her studying skills. After a year, her grades were back up.

When Dora participated in a summer research program at Stanford, she knew she had found her calling: neuroscience. She had also found where she wanted to go to medical school.

Erik Cabral and Dora Castañeda study for finals in otherwise empty classroom in April.

"I fell in love with the campus," she said.

Erik also was helped on his way to medicine through an innovative outreach program: As a high school student in San Jose, he was accepted into the Stanford Medical Youth Science Program, a five-week course that exposes youth to the field of medicine.

The opportunity led him to later attend Stanford as an undergraduate -- and dream of going to medical school there. Eventually, Erik came back as a teacher for the program. "It was a key experience for me," he recalled.

Erik Cabral and Dora Castañeda walk from the classroom to an afternoon lab. .

The couple met in 1998 at a conference for minorities in science where Erik was presenting and Dora was an observer. It wasn't until Erik ran into a friend of Dora's at a conference months later that he asked for her contact information.

"He started e-mailing," Dora said. "We've been together ever since."

Although the pressure and work that comes with a medical degree are immense, neither of them can imagine a different path.

"My interest in helping people, my mom said it's been there since I was young. She would buy medical toys for me," Dora said, smiling. "I know it's a cliché."