In 1768, the University of Pennsylvania School of Medicine held its first commencement, granting bachelor’s degrees to 10 medical students, and in 1771, four of those students were granted the first medical degrees at the school.
Now known as the Perelman School of Medicine (PSOM), the school has come a long way, now having 168 graduates in the Class of 2022 and ranking among the nation’s best medical schools.
Medicine has changed immensely throughout the school’s more than 250 years of history, and so has the process of becoming a doctor. Read on for stories about one of the school’s first medical trainees and two current PSOM students.
The First Resident
Jacob Ehrenzeller, an apprentice in the 1700s. Courtesy of the Pennsylvania Hospital Historic Collections.
Today, an aspiring physician could apply to one of the more than 140 medical schools in the country following their undergraduate career. In the 1700s, finding a school in the nation wasn’t even an option, until 1765 when Penn’s School of Medicine was founded — the first and only medical school in the 13 colonies.
Prior to its establishment, aspiring physicians had two options: wealthy individuals could travel to Europe and go to Edinburgh, Paris, or London — big cities with medical schools — or, a more common route was to become an apprentice to a local physician for an average of five years.
“There would be a contract drawn up and you would essentially work and do whatever the physician asked you to do as part of your training to understand medicine yourself,” said Stacey Peeples, lead archivist for Pennsylvania Hospital (PAH), which was the nation’s first hospital, founded in 1751. “This was fulltime training; they were not given much free or personal time. If you were an apprentice, that would be what you would live and breathe.”
The idea of modern medical residency grew from these apprenticeships. Jacob Ehrenzeller, an apprentice in the 1770s, would participate in both hands-on and lecture-based learning experiences. Although he was not officially enrolled in the School of Medicine, Ehrenzeller attended classes taught by the physicians he followed as part of his apprenticeship, making him PAH’s first resident.
Jacob Ehrenzeller's indenture. Courtesy of the Pennsylvania Hospital Historic Collections.
Inscribed on parchment in 1773, a list of policies was established for Ehrenzeller. First, as an apprentice, he had to faithfully serve and obey the commands of the doctor, being readily available both day and night for tasks unless they provided proper notification of absence.
“They would follow around the physician and have lots of notetaking, getting as much information as they could,” Peeples said. “They’d take lecture notes, and some even had the skill for doing illustrations to remember things.”
However, these rules also dictated how an apprentice would live their life outside of their studies, prohibiting them from playing cards, dice, “or any other unlawful game … nor haunt ale-houses, taverns, or playhouses,” or “contract Matrimony within the said Term,” according to the contract.
“The indenture not only outlines Ehrenzeller’s medical training, but also outlines what the hospital thought created a good moral character,” said Peeples. “It was in keeping with their Quaker beliefs of engaging in modest and virtuous activities.”
In addition to the rules established in the indenture, medical students were required to have three years of previous education, with coursework in anatomy, surgery, midwifery, chemistry, institutes and clinical medicine, practice of physics, and natural and experimental philosophy. In their final year at the School of Medicine, students completed exams and concluded their degree by writing a thesis, paying for its printing, and defending the thesis at the May commencement.
PSOM in the Present
Michaela Hitchner and Rahael Borchers
Fast forward more than two centuries later. The image of a medical school student and doctor have drastically changed. When third-year PSOM student Michaela Hitchner was a child, she was fascinated by her pediatrician’s fun energy, having a roller-skating hobby and offering popsicles to calm a sore throat, which inspired her to pursue a career in medicine. A New Jersey native, Hitchner didn’t have to travel far for her studies at PSOM.
Across the country in California, Rahael Borchers pivoted towards medicine after finding her passion for patient care. Originally a political science major working in the non-profit sector, she became interested in medicine through an internship at San Francisco General Hospital. She completed a post-baccalaureate program and applied to PSOM, excited to gain skills to help patients improve their lives. Now a fourth-year student, Borchers leads student involvement at the Refugee Clinic at the Penn Center for Primary Care, is a clinical volunteer at Puentes de Salud, and volunteers with the Hebrew Immigrant Aid Society (HIAS), a refugee resettlement organization.
“I always knew I wanted to be involved in service, and explored different ways to do that,” Borchers said. “Medicine combines direct service with the kind of intellectual challenge that excites me the most. It’s such a privilege and joy to be a part of patients’ lives, and there is always so much more to learn and discover in medicine.”
Balancing Lessons and Leisure
Michaela Hitchner in an anatomy course in her first year at PSOM.
Much like Jacob Ehrenzeller’s apprenticeship of observation and lectures, Hitchner and Borchers first attended classes to delve into the world of medicine, learning about the various organ systems before applying that knowledge in hands-on clerkships. PSOM students rotate through different departments, such as Neurology and Family Medicine, getting firsthand experience working with a diverse patient population.
While PSOM’s first class was required to present a thesis to graduate, current students must similarly have a scholarly pursuit, such as an independent research project or a dual degree, like through Penn’s Master of Public Health program or the MD/MBA dual degree in partnership with the Wharton School at the University of Pennsylvania.
Unlike Ehrenzeller, who had to pause any interests or hobbies to fully dedicate his time to the hospital, PSOM students are encouraged to pursue other interests outside of medicine and collaborate with peers.
Rahael Borchers and her classmate starting their day at the hospital.
“The faculty is really understanding that students need to be human and have passions outside of medical school. When we’re not in classes, we could go home and be with family and friends, or we could be involved in hobbies and other organizations with our classmates,” Hitchner said.
Hitchner has found that the support structures PSOM has developed has played a beneficial part of her medical school experience. She is a student leader in Penn Medicine’s First Generation and/or Low-Income group in addition to a member of the Elizabeth Blackwell Society, a mentorship organization for women in medicine.
“My mentor and I have had dinner or will get coffee every once in a while to talk about things I’m going through or to introduce me to anyone she may know in the field I’m interested in,” Hitchner said.
Borchers also finds the support to be integral to her education. Spending time with her classmates has been helpful for relieving any stress that comes with medical school.
“Clinical rotations have been amazing overall, but there are also heavy experiences at the hospital that can be emotionally challenging, especially for the first time,” said Borchers. “It’s so important to see classmates and reflect and recharge together, and also to have fun and just enjoy each other’s company. We love to dance, hike, potluck, picnic, and explore Philly. Even during winter of the pandemic, we would hang out socially-distanced in parks, definitely cold but happy to be together.”
Moving Forward in Medicine
Despite being centuries apart, the first and current graduating classes have been readily prepared to take on medical endeavors beyond PSOM’s walls.
Ehrenzeller was awarded a certificate of medical competency after serving five years in Pennsylvania Hospital, becoming an assistant surgeon for the American Army and a village physician.
Hitchner would like to pursue her Master’s in Public Health, having the ultimate goal of becoming a plastic surgeon. She also hopes to leave a legacy for future students by providing a guide on navigating medical school as a first-generation and/or low-income student. She currently has a podcast, “Med Legs,” that offers resources on the topic.
Borchers will start her residency in internal medicine at the Hospital of the University of Pennsylvania. She hopes to become an advocate for all patients, and to combine clinical medicine with community partnerships to help reduce health inequities and improve patients’ lives.