A day in the life of a student

6:50 a.m.Jonathan Hanna’s iPhone alarm plays its preprogrammed “Uplift” alarm tune at 6:45. If we’re honest, he usually hits “snooze” at least once.7:00 a.m.He is up and takes Apollos, our 7-month-old puppy, out to the yard, then feeds him breakfast.7:10 a.m.Hanna starts the coffee, brushes his teeth, shaves, and puts a quick dab of gel in his hair. He dresses in slacks, a button-down shirt, and navy tie, and downs a steaming-hot cup of coffee. He takes the puppy out once more, then returns to wake me for work.

7:30 a.m.The Yale shuttle app says the bus is 3 minutes from the stop, four blocks from our Cottage Street apartment. He grabs his briefcase and runs.

8:00 a.m.Instead of going to class, Hanna sets up his laptop, mouse, and mouse pad at a work station in the library. “I absorb material much more efficiently and effectively by chugging through textbooks instead of listening to lectures,” he says. “It’s really whatever works for you; lots of people would not be able to read for hours on end, and for them listening to a lecture and taking notes is more effective. … The beauty of Yale Med is it gives you the freedom to choose which method you want to use.”Hanna’s preferred method includes online textbooks. “I use a million different sources. I usually have some kind of basic science text … and some pathology/pathophysiology text to understand the disease process. Then I have a clinically oriented text that describes clinical management of disease. My text of choice, which I love dearly, is called Current Medical Diagnosis & Treatment.”Hanna also uses such supplementary sources as review books for breaking down dense concepts. He loosely aligns his studying with the class schedule, which covers one topic at a time. “I often go off track because there are certain things I like to learn more in depth. Like today, one of the topics is chronic kidney disease, and I’ll study that more in depth on my own.

9:50 a.m.With a takeout breakfast from the hospital cafeteria, he makes it to Hope 309 in time for a workshop, led today by Francis Perry Wilson, M.D., M.S., a nephrologist, and Sudhir Perincheri, M.D., Ph.D., a pathologist. Two faculty members lead each workshop, helping to conceptualize and expand upon the information studied independently or taught in lecture.Hanna chooses a seat at the end of the 8-foot table, which fills most of the space in the classroom. About 10 students open up their laptops. Hanna eats his breakfast—bacon, eggs, corned beef hash, and a blueberry muffin—while the class discusses kidney disease. The students look at pathology slides of kidney specimens, make diagnoses, and plan treatment for three cases. The session ends at noon.

12:00 p.m.Hanna heads for the gym in the basement of Harkness dormitory for a workout that is meticulously timed (with his iPhone) and executed—a circuit of weighted squats, lunges, and crunches. The gym is small, so he does 10 sprints in the hallway. “I do cardio and weights together so I don’t waste time.” Panting, he changes back to his slacks, shirt, and tie.

12:30 p.m.It’s a sunny day, so Hanna chats with classmates in the Harkness courtyard before a clinical skills class at 1:00. Today, they are interviewing standardized patients. Hanna reviews the interview questions on his iPhone. “I’m good at the interview process, but I don’t have it memorized. I’ll memorize it when I understand why I’m asking the questions I’m asking, but I feel comfortable with patient interviewing in general.”

1:00 p.m.Hanna and three classmates join Auguste H. Fortin VI, M.D., M.P.H., associate professor of medicine, in a practice exam room filled to the brim with purple chairs and examination tables. It is frigid with the air conditioning on high and the door to the tiny room closed. Fortin explains how the session will work. Four standardized patients (actors who role-play different medical situations) come in one by one to be interviewed by a student. The others, along with Fortin, give constructive feedback.“Remember, these are actors, not real patients,” Fortin says. “You can’t hurt them and you can call a time-out.”Hanna goes first. To simulate a real doctor-patient encounter, he goes into the hallway and knocks on the door after the actor has walked in.“Hi, Mr. Micella,” he says. “I’m Jonathan. I’m a Yale medical student, and I’m going to be part of your care team. What brings you in to see us today?”The patient describes sharp recurrent chest pain that began this morning at work.After ensuring that the patient is not having a heart attack, Hanna guides the patient into a discussion of his past medical, social, and family history. He summarizes what Micella says to make sure he understands what is going on and to reassure the patient that he is being heard. He pauses to check the order of his questions on his phone, then finishes the interview.Fortin tells Hanna that he likes the way he approached Micella—he did not interrupt or talk over him, allowing the patient to elaborate on the situation. Fortin opens up the discussion to comments from the other students in the room. Classmates praise Hanna for his laid-back but professional conversational style. They like that he validated what the patient was saying. Last, they say that Hanna should have used less jargon with the patient, avoiding words like hypertension and family history.Hanna nods to his peers in thanks. They then ask Fortin to help them make a diagnosis. Turns out the actor probably had angina, secondary to coronary artery disease.“Practicing patient interviewing in a one-on-one setting with Dr. Fortin was a really great learning opportunity, as he is an expert in patient-centered interviewing,” Hanna says, “and it gave me a stronger sense of how to make the patient feel comfortable while also efficiently obtaining necessary information.”

3:45 p.m.Hanna grabs a snack from a food truck on Cedar Street. Then it’s time to meet with Daniel Coman, Ph.D., an associate research scientist in radiology and biomedical imaging, to discuss a research project Hanna is working on this summer. They walk across the street to the computer labs in the basement of the Boardman Building. To their disappointment, they do not have the login information they need, so they plan to meet at another time. The warm spring weather makes Hanna change his plans for the afternoon. “Usually, I’d go to the library and study again for a few hours, but it’s so nice, and I’m pretty caught up, so I think I’m just going to go home and relax.”4:30 p.m.He takes the shuttle back to East Rock and takes Apollos to the backyard to play. After many tries, we teach the pup to catch a Frisbee in midair. It is a joyous occasion. Hanna goes back inside, and I heat up some leftovers for dinner.7:30 p.m.After dinner we head out to Hamden for Bible study and prayer with about a dozen friends. Rob Dunlop leads the group at his house, and we are just finishing up the Epistles of John. We leave at 10:00. Hanna drives us home, takes the dog outside one last time, and falls into bed about 11:00. “Got a lot to do tomorrow,” he says.

First-year medical student Jonathan Hanna greets a standardized patient while his classmates and Auguste Fortin observe. After the encounter, they will offer praise and critiques of his approach to the interview.