Monday, August 9, 2010

To Sir, With Love

One aspect of medicine which is so pervasive, yet infrequently discussed, is the role of teaching. By this, I mean the day to day, person to person teaching that happens on every rotation that one goes through as a student or resident. I've always enjoyed this part, because it makes me feel like learning is a tangible discussion, rather than a formal and stiff lesson. There's something thrilling about walking away from a lively spontaneous discussion on sickle cell anemia or primary amenorrhea, that makes you feel like you gained so much just by staying tuned in for an extra five minutes.

What's not so easy, I'm discovering, is leading that teaching process. I've always loved sharing information with others, and reinforcing what I think I know with a group of people who inevitably remember better than I do. As medical students, we are continuously expected to teach and help each other, as well as to give more formal talks on disease processes and case presentation. But I'm realizing now that this type of teaching, which is simply informational, is the easy part. What's not so easy is to teach someone how to be a medical student, how to get through doing physical exams and admissions and learning to formally present a patient at rounds. I remember helping third year students with this last year, and I never found it as difficult, perhaps because the responsibility ultimately didn't fall with me.

But perhaps I was also lucky, and didn't have too many encounters with that Thorn In Your Side, the lazy medical student. Most medical students I knew, often my friends, were incredibly smart but also terribly hard working. They didn't mind coming a little earlier or staying a little late to get things done, especially if it meant learning how to do something new that would later be an expected responsibility, like drawing blood or placing IV lines. I myself enjoyed staying late to learn how to do central lines or surgery consults, because I wanted to be sure that I at least had an idea of how they were done before I was expected to do them regularly. This is, of course, most likely a ridiculously rosy picture of myself, and I know that on many occasions I have been an inadequate or incompetent student. But I can say with 100% certainty that I always tried hard.

Somehow, it never occurred to me that there are some people who make it past the first two years of school and are still trying to make it through with as little work as humanly possible. These are the people who don't want to see the complicated cases, even if they are classically tested on the board exams. These are the people who don't want to learn how to properly present a case, and refuse to recognize the value in an efficient exchange of patient information between colleagues. These are the people who consistently disappear to the cafeteria or library if you don't keep your eyes on them, and always have a complaint about something or another. Every conversation is about which specialty gets you the most money for the least work, and every assignment is met with a complaint (and even talking-back). And, of course, these are the people who are most persistent in asking about how to game the system and get the best recommendation letters.

A lot of residents I know are of the mentality that if a person wants to screw him or herself over, let it happen. We are all adults, this isn't daycare, if someone doesn't want to learn how to work hard, that's their problem. I wish I had more of a hands-off attitude like that sometimes, because I feel like I am letting myself get more stressed about this type of situation than I need to be. But I feel that if all doctors are also teachers, we have a responsibility to help our students find the motivation to work hard, and form good habits. I also feel that I have a responsibility to all the students who do work very hard on rotations, even if it isn't a specialty they want, and it isn't fair that other students slack off and there are no consequences. I know that I had a lot of bad habits as a student, many of which I still struggle with, and it's only with the consistent help of people who cared that I've been able to make any improvement at all in my SOAP note writing or patient presentation. So, I don't want to give up.

I wonder how my parents did it.


  1. Thanks for the link to your blog! I've just started reading it but finding it really interesting already. I too am the med student who gets in early and stays back late (and learn an awful lot from doing so), but often have to badger others simply to turn up to our classes on time (I can't fathom leaving our tutors - who are doctors - waiting around for first year students when they could be seeing patients!).

    As far as motivation goes, I'm sure you know that you can't *give* them motivation - but by sharing your experiences, and being open for them to talk to if they're struggling with stuff, you may just inspire them to find that motivation for themselves. Those who want to make the most of this opportunity will learn from you - as for the others, well, as the saying goes, you can lead a horse to water...

  2. Nice blog! I know what you mean about teaching in general, and teaching compassion in particular... Being on the other side of the fence is so much harder than I thought - teaching is not natural to almost all of us, it's easy to give tips to someone who is almost there but I have house officers who are really not coping and have almost become outcasts - people whom everyone wants to avoid being on call with, because it means so much more work and frustration.

    Like compassion with patients, it's a lot harder to be compassionate with your co-workers when it's 3am, with 5 cases to clerk, a parent who's angry after a miscommunication and 2 nurses who are hassling you to do what your house officer was supposed to do 30 minutes ago.

    Do keep writing - it's great to have someone express articulately what makes this job so worth it and so difficult.
    I was encouraged by your sentence in a previous entry : "I'm not incapable, just inexperienced." Need to tell myself that after the next ICU call when a kid dies and you walk out feeling totally drained of hope, energy and competence.