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Walking the Shoreline: Erosion, Regrowth, and Professional Formation.

I’ve grown up walking shorelines. Each summer the beach reveals new contours. In one place, the span from dunes to the edge of the water has narrowed; farther down the beach, a vast expanse of flat sand stretches into the ocean. A sandbar appears just off shore, reachable at low tide through a gully brimming with life: minnows, crabs, starfish. While the core of my island stays constant, its shores are ever changing, shaped and reshaped by wind and water, tides, storms. Reflecting on this cycle of erosion and regrowth, I’ve come to see the process of professional formation in a new way. We’ve all heard of “ethical erosion,” a loss of empathy reported to occur during the process of medical education.1 It’s troubling to think that empathy would diminish precisely during the years when it is most needed.2-4 Do we need to fear that development of clinical skills inevitably results in numbing and emotional detachment? My own recent experience leads me to a new view of “erosion.” Five years ago, after two decades practicing health care epidemiology and infectious diseases, I became a trainee again as a hospice and palliative medicine fellow. I plunged into a new world, answering a call to give