Leaders in Medical Education

An Interview With Dr. Gabriel Aranalde, A Man of Science and Arts

Greta Bensi
Published on Jul 24, 2020. Updated on Sep 15, 2020.

Do you have a favorite instructor at your school? Consider interviewing them for the Osmosis blog! Today, Osmosis Medical Education Fellow Greta Bensi shares her interview with Dr. Gabriel Aranalde, a popular teacher at the National University of Rosario in Argentina. Together, they reflect on health and medical education in their home country.

Hi! I’m Greta Bensi, a third-year medical student in Argentina. Before I get into the interview, I wanted to provide a little background on Dr. Aranalde.

Dr. Gabriel Ignacio Aranalde was born in Rosario, Santa Fe, Argentina in 1968. He is a well-known professional with four different specialties: Internal Medicine, Nephrology, Emergency/Disaster Medicine and High Blood Pressure. Gabriel also teaches different subjects— mainly physiology—in the Faculty of Medical Sciences at the National University of Rosario (UNR).

Dr. Aranalde is the author of several books, and holds both Doctoral and Postdoctoral degrees. In 2014, he received, in recognition for his outstanding personal and professional career and for his contributions to society, the “Distinguished Medical Doctor Award” from Rosario City Council, and became the youngest professional to be bestowed with that honor. 

A lifelong learner, Dr. Aranalde does not only excel in Science, but in Arts as well! He loves Music and Literature. His musical career started long before his years at medical school. Today he sings chamber music as a member of Santa Fe’s opera choir, which has recorded studio and live performances that have been sold nationally and internationally. 

When he’s not in the clinic or at choir, you can find Dr. Aranalde in the kitchen—he’s also a master of the culinary arts!

Dr. Aranalde is truly a Renaissance Man, and I’m so honored to get to spotlight him as a Leader in Medical Education today. Now, let’s get into the interview!
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GRETA BENSI: What led you to pursue a Medical career? Did you always know you wanted to be a Doctor?

DR. GABRIEL ARANALDE: Since I was a boy, I had the intention of being a doctor. The idea was always there. I also wanted to make music. At one point I strongly visualized myself pursuing that career, but ultimately, I decided on medicine, which is what really motivates me the most. I am convinced that the driving force behind this decision was the altruism inherent to it: I’m a person who is always trying to help whoever I can, whenever it’s needed, through whatever means. This is my main motivation, and it is the reason why I practice medicine and teach today.

I started teaching at the Department of Physiology before I graduated—I’ve been here for almost 30 years now. Here, being useful to others plays a fundamental part: a purely altruistic objective.

GRETA BENSI: Could you name the 3 career related achievements you are proudest of? 

DR. GABRIEL ARANALDE: What a difficult question! 

 First, I would say I’m proud of everyone with whom I’ve had the opportunity to share my knowledge—both patients and students, from whom I receive great gratification, which increases every day. Your curiosity is what sustains me in my career.

I have said this on many occasions: I have nothing more to ask for regarding my personal goals, because I get to achieve them every day. Being able to help my patients get better and feel that appreciation is a gift. So is hearing from my students, who, after they graduate or pass an exam (even when I am no longer their teacher!), call or text me saying “I made it! Thank you so much!” 
What can I say? I get goosebumps. It is amazing. What else can I ask for? That is the main goal.

Another goal is to have pleased my parents, who are no longer around unfortunately. They were always there for me and supported me financially. Because of their support I was able to completely focus on my studies, without worrying about my university expenses. I am proud of them and my family, and I know they are proud of me, too.

Finally, I would name some other personal achievements like having been a featured speaker at the International Conference on Disease Biomarkers and Precision Medicine in Houston, Texas two years ago, or having several articles published in foreign journals, despite the lack of support from the institutions I belong to. 

Osmosis illustration indicating the importance of being humble as a health professional.

GRETA BENSI: What is your top piece of advice for someone about to enter your health profession and specialty?

DR. GABRIEL ARANALDE: My first specialty was Internal Medicine, which I continue to practice. 

First (and this is obvious), you have to like this field. Internal Medicine is one of the most comprehensive specialties, from an academic point of view. It involves a lot of knowledge, a lot of deduction, and a lot of inference; all are necessary for a good diagnosis and correct treatment. 

My main advice is to be responsible while studying. Know that your goal should always be to improve your patient's care and quality of life. To do that, you have to keep in mind that Internal Medicine is an extremely broad-reaching specialty. It is impossible to know everything—no one knows everything in Internal Medicine. You have to be humble. Know what your limitations are, because recognizing them is how you get better. If you rest on your laurels thinking you know everything, you will stay stuck there. Arrogance is a roadblock on the highway of wisdom.

Also, be respectful to the people you will interact with in your day-to-day. This applies not only to coworkers, but to patients as well. The fundamental thing, both in residence and life, is respect—regardless of who the person in front of you is.

So: dedication, respect and, fundamentally, responsibility, are the three things I advise to have in mind when pursuing Internal Medicine. Of course, this also applies to any other specialty!



GRETA BENSI: What is your top advice for any medical student or aspiring medical students worldwide?

DR. GABRIEL ARANALDE: I will comment based on our University’s experience. 

We experience an exponential decay of students over time. Every year, we take in thousands and thousands of new students, and we end up with a very small percentage of them graduating. 

I believe this happens for many reasons—enough for a whole other interview. But one of the main reasons is the fact that students have no idea the amount of information they are required to learn in medical school. And the knowledge you need to know expands more and more every day with the exponential growth that comes from new technologies, emerging diseases, a proliferation of resources, and so on. Any aspiring medical student should be prepared to become a life-long learner.

Besides knowing that there is a lot to learn, you also have to understand that medicine is a very competitive career. And, fundamentally, you should have a clear understanding of the reason why you decided to become a doctor. 

You do not study medicine for yourself: you study for others. That should be the ultimate goal. If you really understand that all you learn is for the sake of others, you’ll find the burden of always having to learn is greatly reduced.

Clearly, there are other things you should think of, like enjoying science (especially biological studies). Be interested in how our amazing bodies work, how complex diseases are, and how resilient people are in being able to adapt to changes.

Finally, there is also a strong emotional component that comes with being a doctor. As health professionals, we are duty-bound to not get personally involved with patients or family members when it comes to medical matters, but it is impossible to detach from our human nature. There will be extremely challenging moments. 

I have had patients with whom I became friends, who later passed away. These are truly traumatic situations, so it is important to separate professional from personal. For those who are not that sensitive, it might be easier. For those like me, it can get tricky, but we must make it work. 

Personal involvement with a case often interferes with a correct diagnosis and adequate treatment—which means we’ve failed in our role.

Osmosis illustration of a stressed-out doctor.

GRETA BENSI: This question is about something you did not know in your 20’s while studying medicine…. something you would have liked to know? What would you tell yourself to influence the choices you made or change or the way you saw medicine? If you could change something, what would it be?

DR. GABRIEL ARANALDE (laughing): I'm laughing because it's a brilliant question—one we could discuss for days. But I will try to be as brief as possible.

Something I would change? To have studied more! I have always been a bookworm, but I have always felt like there was something else to learn—never satisfied. But you see, this feeling collides with an undeniable reality: it is impossible to learn absolutely everything.

Maybe I would have liked to dedicate myself to research a bit more during my residency. My program did not offer many research opportunities, so that is something I feel I should have pursued more. Apart from that, I would not change anything. To myself and everyone: the struggles, along with good and bad experiences, are part of life. 

I had a superior, Dr. Lazaro Gidekel, who passed away recently. He was an unconditional support for me from an academic and affective point of view. I feel so extremely thankful and lucky to have been his student. He wouldn't see a patient without including us: “Let’s assess this patient—what do you think?” 

Once I had a problem, an overwhelming situation that led me to almost quit my medical training; , I was a third year resident, with only months left. Because of Lazaro, I did not quit. 

He came to me and said, “No, no, Gabriel: you are not making any decisions right now. Tonight, we will have dinner together!” And he took me to dinner. We had a conversation, and he talked me out of it. 

I believe 99% of where I am today is because of him. Somehow, he’ll always be around in a way.  


GRETA BENSI: Are there any changes you would like to see in Argentina's current medical educational system?

 DR. GABRIEL ARANALDE: Yes, especially in Argentina’s residency programs. 

It is extremely important that we avoid programs that are exclusively focused on providing healthcare. While contact with patients is fundamental to our training, I believe the research aspect has been very neglected. By this, I don’t mean we necessarily need a proportional distribution; it just needs to be reasonable and coherent.

Research and management are things that, along with healthcare, foster medical excellence. We must respect this combination. This is key to comprehensive training. 

I also think that we should reconsider the number of hours residents have to work, taking into account not only their physical health, but their mental health as well. With such long shifts, the chances of experiencing burnout are high. We are humans, and we have limits.
Osmosis illustration of a medical student experiencing burnout.

Another aspect, which I think is already changing, is the extreme hierarchy present in our residency programs. Although structure is necessary in order not to fall into anarchy, there are specialties in which first-year residents are subjected to truly medieval situations. 
All this said, there we find some differences between Argentina’s training system and the one in North America or Europe. Their programs are more integrated and dynamic considering the constituent elements of medical training I mentioned before. There is greater availability of medical equipment, among other things. 

GRETA BENSI: How would you describe healthcare in Argentina? 

DR. GABRIEL ARANALDE: Generally speaking, Argentina has a very good health system that provides medical care for free, for everyone. Whether you are a native or a foreigner, you are not required to pay. 

We have health policies that back up and allow the redistribution of state funds, allocating them to public health. It is something fundamental in our country. This is not peculiar to any particular political party; this had its origin many decades ago. Obviously this system has its flaws too.

It is usual for us to receive “medical tourists,” which are basically groups of people from countries like Paraguay or Bolivia who come here to receive treatment for free. And this is all financed by our taxes. I want to clarify I do not say this with any xenophobic or racist connotation at all. 

From an abstract point of view, I believe that it is very good to have free public health for those who cannot afford it. I will always stand by this, as long as it is well-administered, and here comes the issue: people who, despite having the means to pay for private healthcare, come and use this resource provided by the state. “Why should I pay? I pay my taxes; this is my right too!” 
Argentina’s economy is not stable. There are good and bad times that come and go. You never know when. At any sign of complications, people start saving money by stopping paying for private healthcare. They switch to charge-free public health; after all, it is their right, written in the Constitution. This results in saturated hospitals, which ends up diminishing the quality of the service provided for everyone.

Regulatory measures should be taken to address this. I personally think that, if someone has the means to pay for their treatment, they should do so, and leave the free options for those who are not so lucky. To achieve this, we first need a change in our citizens’ mindset. This will take years. But it is what we have, and we must work hard to make it better. I know we can.

Osmosis illustration of two hands holding a heart in front of a map of Argentina.

GRETA BENSI: You previously mentioned how saturated our medical school is with thousands and thousands of people starting every year. This clearly compromises the quality of the education we receive since resources are scarce and cannot cover everyone. Solutions are constantly discussed, from building more classrooms to restricting the number of admitted students. In your opinion, what should be done?

DR. GABRIEL ARANALDE: Greta, you saved the hardest question for the end!

In my opinion, the solution is crystal clear. But first I want to tell you briefly about my own experience as a medical student... 
When I began my studies, admission tests had already been eliminated. Everyone who applied got in automatically—about 1,200 students. Less than 200 graduated. There is obviously something that creates this high number of dropouts, observed primarily during the first two years. Nowadays, we admit approximately 5,000 new students per year. The problem is, we do not consider the infrastructure required to accommodate this insane influx of students.

We have a problem. It is there, and it is undeniable. We cannot hide it. There are issues to be discussed.

Is it convenient to have all 5,000 admitted? If so, do we have the resources needed to provide a good medical education? We must not forget that after they graduate, these people will be responsible for their patients’ health. This is a serious matter, and should not be taken lightly. 

And here comes another alarming aspect. Every faculty member will agree on this one. 

In my first year I had my physiology final exam. We had random topics assigned, and we were asked several questions related to each topic—and they were difficult. If I asked my students to answer questions with that same level of difficulty today, none of them would pass. None. The fact that we had to decrease our demands worries me tremendously. I see it during examinations. This week, out of 70 students, 67 failed. 
Osmosis illustration of a student studying with coursework.

So, why does this happen? Well, students come into the program with (and sometimes even without) rudimentary knowledge—things they should have learned in High School. I had to stop examinations to explain the rule of three: basic math, to university students! Of course, we have many outstanding students as well, but unfortunately they are the exception, not the rule. 
Teachers’ responsibility should also be taken into account. It’s easy to forget that we need to keep exploring learning methods to provide the best experiences for our students.

So, what should be done? Personally, I wouldn’t set a limit on admissions. I believe that every person who really wants to study something should have the opportunity... But there must be an admissions test. Those who pass, get admitted. This would result in students actually experiencing a bit of the program and finding out if they like it or not. Make them study a lot before they actually get in. Make them study anatomy, chemistry, physiology, before they start the program— that would certainly limit the crazy amount of people starting every year. 

This is just an opinion. I think it would work, but it will take some time.

When I think of instant solutions, Osmosis jumps into my head. During my first medical years I could have only dreamed of a platform like this. It’s so great that students have these resources. I celebrate this with great joy. My student here showed me Osmosis, and I was just amazed!

GRTEA BENSI: Do you think Osmosis responds, in terms of content, to our student’s needs?

DR. GABRIEL ARANALDE: I would say it does more than that. I thought I would come across elementary to intermediate content complexity, but what I found exceeded my expectations. And I encourage students to use it!

Everyone who knows me, knows I am constantly reading and keeping myself updated with the latest when it comes to internal medicine and nephrology. So I had an amazing surprise finding content that’s so high quality and so clear.  

You can certainly tell, by looking at the platform, the hard work and dedication behind it. I really want to congratulate the Osmosis team. 

GRETA BENSI: Do you have any final thoughts regarding the medical profession as a whole?

DR. GABRIEL ARANALDE: Pursuing a career in medicine, truly, is one of the most wonderful things a person can do with their life. It is a profession that will give you so much satisfaction while making people’s lives better.

GRETA BENSI: Thank you for speaking with me today, Dr. Aranalde!

DR. GABRIEL ARANALDE: Always a pleasure, Greta.

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About Greta
Greta Bensi is a third-year medical student at National University of Rosario, Argentina. She plays field hockey for the UNR’s team. Her hobbies include acting and writing.

 

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