The vulnerability of the medical student: posthumous presentation of L.L. Stephens' ideas.

L.L. Stephens described several critical issues in medical professionalization. The encounter with morbidity and mortality heightens the student's feelings of vulnerability. If he over-identifies with patients, he may suffer more and be unable to provide rational medical care. If he protects himself by dehumanizing patients, humane treatment suffers. Students have surreal perceptions of their responsibility for patients. Recognition of unconscious motivation may be troubling to students. Finally, there are emotional barriers to the recognition of psychosocial elements in disease. To optimize students' personal and professional functioning, medical training should deal with these concerns. Support can be provided by small continuing learning groups for students and clinical faculty, in which these issues, illustrated by videotapes of patient-student encounters and other clinical examples, are discussed in the context of providing comprehensive medical care. Support should continue during internship.