Youthful Critics

To the Editor: According to political philosopher Michael Walzer,1 youth are powerful reformers with a unique critical lens. Not yet full members of their society, their liminal position allows them to reflect on whether the society they are about to enter fully reflects the values and principles it espouses. In the national conversation about U.S. health care reform initiatives, medical students are Walzer’s youthful critics—committed and interested, but not full members of the profession. With a unique and powerful voice, they can reflect on their training with the credibility of insiders while still applying external values and retaining a sense of idealism about what the profession should strive to achieve. Medical students are poised to speak not only about the need for reform but also about whether or not their training is preparing them to meet these challenges. Despite this potential, the medical student voice in conversations about health care reform remains largely unheard. Typically, medical students engage in this conversation through traditional channels such as representation on curriculum committees or local and national professional societies. These are essential activities, but they isolate the student perspective in a forum only few can access. Few physicians, and even fewer members of the public, understand students’ perspectives on reform. Harnessing their power as Walzerian critics will require medical students to do more than advocate for change within the system. To be more effective agents for improvement and reform, medical students must reposition their criticism outward and recast it in the public eye. Instead of speaking only with faculty about the need for curricular reform, they can write op-eds, perspective pieces, and blog posts in order to reach a larger professional and lay audience. Rather than simply forming interest groups and holding conferences about topics like global health and quality improvement, they can engage in activism, lobbying representatives, health systems, or professional societies for more attention to these issues. Here, too, writing can take a powerful role, as medical students can leverage their unique ability to unearth system defects in the public space. Embracing the role of critic will be jarring. Medical students spend nearly a decade focusing on gaining entry into the field. But the transition into the role of medical student is one of shifting priorities—from working to gain acceptance to embracing an identity as a future member of the profession. With this shift comes a responsibility to promote the success of our health care system and secure the fate of the profession. Brian W. Powers MD candidate, Harvard Medical School, Boston, Massachusetts; [email protected] Sachin H. Jain, MD, MBA Instructor in health care policy, Harvard Medical School, Boston, Massachusetts.