[August 2004 journal entry]
Bonhoeffer’s December 1942 After Ten Years essay ends, in its published form, with ‘The View from Below’ section that begins – “It remains an experience of unparalleled value that we have learned to see for once the great events of world history from below . . .” (my translation). His assessment offers one answer to the question I have found at the core of the experience of medical students whose medical school education and residency training -- contrary to most chosen professions -- require them to see ‘from below’ once they move from the classroom into their clinical rotations and their specializations. They cannot avoid the question -- “What value, if any, am I placing and will I place on this exposure to the extremities of the human experience?” They cannot avoid the exposure required by their clinical rotations and, therefore, cannot avoid assigning a value somewhere on a spectrum from ‘no value’ to ‘unparalleled (incomparable) value’. Since the 1980s in my various roles within the medical education and practice settings, I have attempted to identify and interpret the decisions/approaches students in medical school and subsequent years in their professional careers take on this ‘no value’ to ‘unparalleled value’ spectrum – e.g., (1) How free, independent, responsible are they in the value they assign? (2) How is their choice of specialty affected? (3) How is their choice of a residency program affected? (4) How is their choice of a practice affected? (5) How are their efforts to teach affected?