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WOLFE: Yes, the first time you see a medical student, introduce yourself. "Here is my card, my phone number; here is my pager number; let me know if you have any questions while we're on service together." That sets the tone for residents. It would be nice if physicians would remember to call students and give them follow-up about patients whom the students were caring for. Students learn outcomes this way, but it's also a way for a faculty member to say, "I really want to teach you."

CROSS: Do attendings really have time to do this?

WOLFE: Well, it doesn't take a lot of time and it doesn't need to be done for every patient. But in relevant cases, it can make a significant difference - in knowing a final diagnosis or understanding an outcome. It can all be done via e-mail.

Q: Do all of your students become practicing physicians or medical researchers?

WOLFE: About 5 percent of students go into nontraditional careers - for example, health management consulting, medical device companies. A few have started their own companies.

Q: Do you provide opportunities for nontraditional careers?

MURPHY: Not too long ago we had a career and lifestyles panel that included Tom Fogarty, a faculty vascular surgeon who is perhaps best known for medical device development. On the panel we also had Jeff Bird, a Stanford medical school alumnus, who has never practiced medicine but chose instead to work in private industry.

Q: How do you orient new students?

MURPHY: I help students with a lot of the logistic arrangements, part of orientation is giving them a mailbox, an e-mail account, a locker. The formal program includes standard health, safety and curriculum and logistic briefings, but we also have some eloquent faculty members who truly offer motivation and insights. One innovative program is the SWEAT trip [Stanford Wilderness Experience Active Orientation Trips], which is planned by returning students for new students. It's a bonding experience. Most new students do participate and it's usually held at Lake Tahoe. Students perform skits; they tell each other why they came here; they hike and camp in the wilderness. When they return, the orientation continues, and some aspects are symbolic. For example, each student receives two white coats with his or her name on them.

Q: White coats mean a lot?

MURPHY: Yes, I think they really do. And having their names on the coats means that hospital linen service recognizes and accepts their laundry - symbolically the students are being accepted as members of the health care community.

WOLFE: Details, even seemingly trivial ones, can be vitally important at accomplishing our objectives to help students feel they are a valued part of the community. It's socialization and education. Presenting arriving students with a stethoscope at a formal ceremony at the Faculty Club is another example. We've been doing this for six years.

Q: Is housing a serious problem for students - as it is for many people in Silicon Valley?

MURPHY: Some students may not come here because of housing (although I'm not personally aware of such a situation). But I do think once they arrive, the situation is survivable. About 80 percent of students live on campus their first year. Students with families have a particularly hard time. Single students have a very good network for finding roommates, and all students - not just families - are guaranteed housing their first year if they accept admission in a timely fashion. The students use e-mail as a communication tool for many aspects of their lives, and networking for housing is no exception. Also, students receiving financial aid receive partial coverage of housing as part of their package.

CROSS: I do hear serious concerns about housing. Many women don't have cars and need to live quite far from campus. This can become a safety issue. And one social difficulty is that we are talking about adults, some of whom have had other careers, who are now coming back to school and are funneled into a communal living situation.

MURPHY: Yes, most no longer want to live like undergraduates. Some situations are particularly difficult - single parents have to find child care, especially during their clinical years. Residents may often try to match where they have family nearby.

WOLFE:One impression I have is that more medical students are interested in having families. Many remember when it was almost forbidden to be married, let alone begin families. People who did get married kept it a secret. It was perceived as interfering with education.

MURPHY: We have come a long way. Recently I was asked to find a room for lactating mothers.

Q: Are there other areas where you work to improve the personal lives of students?

MURPHY: We hear a lot of stories about students who come out of other medical schools. The experience at Stanford is not as it has been described to me at many schools as being cutthroat. Students leave absolutely hating the medical school; they have no interest in having anything to do with it, at least in part because it wasn't a very friendly or nurturing place. At Stanford we go out of our way to be nurturing and to provide opportunities for them to have a balanced life while they are here. A real cornerstone of their support network are the 40 or so special-interest student organizations. Many of these are affiliated with national organizations, others are local. The discussion about family issues brings to mind one organization, POSUMS, which stands for Partners of Stanford University Medical Students. The partners can get together to discuss the issues arising from being a partner of a medical student.

CROSS: The curriculum as a pass/fail system should in some ways reduce competition and encourage cooperation. In past years I think we really fostered maturity by taking highly competitive achievers from the premed environment and giving them freedom to take charge of their education.

Q: Is Stanford fairly typical in terms of medical schools about how it treats students?

WOLFE: We avoid some formal protocols. For example, some housestaff arrive at Stanford and are surprised because there isn't a hierarchy based on the length of the white coat- longer coats for professors, shorter coats for others.

Q: Well, don't faculty leaders sometimes take the position that they had to work exceptionally hard in medical school, that's all part of the program, so the students should also learn to suffer?

CROSS: I think some faculty members might say that - but after they get to know the students well, I think that they would have a different perspective. These students are working incredibly hard. They're outstanding. It's a question of helping them channel their efforts effectively.

Q: Anything else you'd like to say to practicing physicians?

CROSS: I'd like to make a pitch for every clinical doctor who possibly can to involve just one medical student in some way in your activities. We have money to support med scholars for research; we have community service. Faculty members could contact either myself, Zera or Elliott, and we can find a match that would be mutually enriching - and certainly helpful to the student. I have a research bias, so I would say to faculty physicians, help a student write a proposal for a research project that is of interest to both. And all practicing doctors can provide inspiration by taking a student on rounds.

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Q: Are practicing physicians important to medical students?

CROSS: Clinicians are one of the main resources for medical students from the day they arrive. We're trying to increase the interaction of clinicians and students. Sometimes that interaction is noticeably missing.

MURPHY: Yes, especially during the preclinical years.

Q: Do you have any formal programs to foster interaction?

CROSS: For a long time we've had the Medical Scholars Program, which pairs faculty members with medical students who prepare a research proposal in the context of faculty members' work. More than 70 percent of research projects are undertaken with faculty in clinical departments. Students can work with faculty for one quarter full time to one year full time and be financially and administratively supported. Most students participate in our Basic and Clinical Science Scholars program. However, three new scholars programs have been approved by the Faculty Senate: the Community Partnership Medical Scholars, led by neurology chair Bill Mobley and Tim Stanton, a senior lecturer in education and student services; the Arts and Humanities Medical Scholars, led by faculty anesthesiologist and published poet Audrey Shafer; and the Biomedical Technology Innovation Medical Scholars program, led by cardiologist and medical device innovator Paul Yock and Josh Makower, who is a consulting associate professor of medicine and an entrepreneur.

WOLFE: The emphasis is on scholarship.

MURPHY: Approximately 90 percent of the students participate.

CROSS: The Medical Students Scholars Program is unusual among medical schools. A particular bonus to both student and mentor, by the way, is that many of the projects result in publication.

Q: Is there a cost to faculty?

CROSS: No financial cost, but a willingness to share their time and expertise with the student. One of the reasons for the success of the program is the commitment many faculty make to interact with medical students in this one-to-one educational setting. Working with the faculty member students write a "mini grant" proposal which is submitted for review by the scholars committee. Research progress and results are often presented at the annual Medical Student Research Symposium here. Typically benefits for both faculty and student far exceed cost.

Q: What's in it for the doctor? Is a student who doesn't know very much yet going to be helpful?

WOLFE: Not every project ends up with exceptional results, but many of them do.

CROSS: Typically, students bring energy and new ideas into a faculty member's group. The intellectual exchange that is encouraged can lead to a satisfying potential partnership.

Q: Is this available to nonfaculty physicians?

CROSS: Not directly, but medical staff members can collaborate with faculty and become involved in that way.

Q: How can nonfaculty medical staff members become involved with students?

WOLFE: One incredibly meaningful way is by volunteering at the Arbor Free Clinic, which provides "no questions asked" free services to uninsured patients. It's held weekly at the Menlo Park VA facility, primarily for residents of East Palo Alto, Belle Haven and portions of Redwood City. It's completely student run with a faculty advisory board and physician mentoring. The voluntary clinical faculty play a crucial role. I'm currently chair of the advisory board.

Q: What else do you have for students that could involve faculty?

WOLFE: We have a course called "Physicians and Patients," which is taught in the first year. Many of the teachers in that course are voluntary clinical faculty who enjoy teaching new physicians at the earliest phase. It introduces students to the medical interview and the physical examination. Getting students into clinical activities in the first rather than at the end of the second year enhances their learning of the basic sciences, and the course is always being revised and questioned internally by teachers to fine-tune the approach. In the clinical years students can work with a mentor one half-day a week in her or his office or clinic and follow a group of patients for nine months.

Q: What else are you doing to bring students into contact with clinical care at an earlier opportunity?

WOLFE: Preclinical students may enroll in "Early Clinical Experiences" in any specialty.

Q: Any other examples of ways the students become immersed in the clinical experience?

MURPHY: For the past two years, medical students have been given an access code to the hospital's patient database. They check labs and patient progress and even dictate to files. The code follows them through their lives - if they become a resident or come back later as an attending physician, they have continuity.

Q: This hasn't caused security issues?

MURPHY: We haven't heard about any security breaches here. Keep in mind that the students have trackable numbers. If a student checks a lab result, there is a record of the query.

WOLFE: And students learn the ethic of using medical information - don't look at a record unless you're involved with the patient's care. This is clearly a good way to make students a part of the hospital community.

Q: Isn't there another side - students should have some basic knowledge before they work with patients?

WOLFE: They do receive basic knowledge. But early contact with patients is a great motivator for understanding basic science. It's a powerful educational tool for students to see patients' clinical problems at the same time they are learning the physiology, anatomy or cell structure of the problem. It's a great ego boost, quite frankly, for clinicians to be involved in promoting someone's professional development at an early stage. And as with all teachers, when you teach, you learn more.

MURPHY: Students who have good teaching models become effective teachers. For example, just the other day I was talking with a recently graduated medical student now a resident here, who told me, "Guess what? I'm teaching medical students." She told her new students to ask her anything, "because I won't be evaluating you. A week ago I was sitting where you are."

Q: Is Stanford primarily interested in training students for academic careers?

CROSS: A very high percentage (about 30 percent) of our graduates go into academic medicine and, yes, that is a major goal. Essentially, however, we are interested in supporting the talented students that come here in their goal to become scholars in a broad range of medical fields.

Q: What advice do you have for attending physicians to improve teaching?

WOLFE: Make sure that medical students are completely integrated into the service so that the residents perceive and welcome them as members of the team. Some of this is quite simple - be polite, use social amenities.

CROSS: Set up a good learning environment.