Mile 7166: Teaching the Ropes

Above: A well deserved 7000 mile car wash.

I LOVE IT WHEN
THE TABLES ARE TURNED.

At points in the last four weeks, I've felt like I've become the intern at times.

Traditionally, every four weeks during our twelve-week rotation, we switch interns and teams to give us an idea of how rotating in a residency program feels. However, for the first switch after my first four weeks, we didn't switch teams. If we had, it might have been a mortal mistake.

Why? The caveat was that the timing of the switch matched to the time my hospital injected new interns into the 4-week rotation last month. When I say new, I mean "Just-Out-of-Match-2010" new.

Many of the interns at the hospital I am at had just simply survived a week of orientation at the hospital, and were all of a sudden thrown into the "real world." I have heard many of my friends who have gone through residency talk about the adjustment into residency and how hard it is, but here I was, along with six other medical students to see it first hand. I haven't seen as many blood shot and baggy eyes at any other point in my life than these four weeks! Some of them started to even question what they got themselves into (that was part of what I termed the post on-call syndrome.)

In some ways we knew more than the new interns.

Working four weeks at the hospital was actually four weeks more than some of the interns. Over the first four weeks, our rhythm on the wards was finally taking shape, we knew how the different rounds were scheduled, we knew where to grab the empty forms when needed, and we even knew the secret places in the hospital to get coffee. However, the most important thing that I saw during the intern switch up was how well we knew the patients on our teams; had we done the traditional team switch, that continuity of information may have been lost.

But over the last few weeks, it was odd to be teaching interns the "ropes" of the hospital. I mean, the interns knew a lot more about medicine (they finished school!), but I guess the working mindset is what we needed to teach them. The hospital world is now theirs, but now it it is time for them to make it their own. Each one of us medical students made sure that we gave the interns a framework to build on to make sure that their time at the hospital was successful. It was an odd way of learning for us students, as the last few weeks was a great lesson in learning how to teach.

Well, four weeks have passed. My intern has not only survived, but has changed since the first few days at the program; he's more comfortable with the ropes and is starting to get his rhythm with working the floors. But it's time for a new intern, and because not all the new interns for the residency IM program here have been on the floors, it's time to teach again for a second time around. It felt awesome to have been a part of my interns first four weeks in residency, and it felt awesome to be an intrinsic part of a medical team.

And here begins my last four weeks of internal medicine. I'll admit, its getting rather bittersweet.

Mile 3374: As If "Yes" Wasn't Enough

Above: I-95's southernmost exit that leads Key Biscayne. After this exit, I-95 ends and merges onto the busy U.S. 1, Dixie Hwy.

If there's one lesson that I'm going to have to walk away from Miami with, it would be,

A RECIPROCATED QUESTION IS A GOOD THING.
(MOST OF THE TIME)

And how exactly did I come up with this conclusion? I thought of it as I was observing several of my preceptor's teaching styles.

Case 1: One of my doctors at my previous mini-rotation looked me in the eye after I asked him, "Is the diagnostic glucose level for Diabetes at >125 mg/dL?" He then said, "Is it?" I nervously replied (with more confidence put into the last word than the first), "I think it is." He nodded and then said, "You are right." I sighed a breath of relief.

Case 2: This week, a patient with rheumatoid arthritis walks in, and I noticed the patient had a neck injury in the past that caused lower body paralysis. In a rather naive tone, I ask the doctor, "Is that caused by atlantoataxial subluxation?" As he was entering patient data into the computer, he asks me, "What do you think?" I just ended up throwing a Hail mary by shooting out a "Yes" from my lips. He nodded with me as I began to feel the sweat near my forehead and said jokingly, "That's right... Why do you ask questions to which you already know the answer?" This was a rather deep point that simply brought a smile to my face. At that point in time, I just didn't know why.

I'll admit that getting a reciprocated question always makes me second guess, but I found that my preceptors are trying to see how confident I am in my answering. However, a reciprocated question has other uses than to say "you're correct." I've seen myself and other students get reciprocated questions, and the question is designed to develop the student's case for diagnosis & management of the patient. I've been through times where I'll explain my case completely, and the doctor will then tell me otherwise, with the consolation of acknowledging my train of thought made sense, but probably wasn't practical.

Making a strong case is of the valuable qualities of being a doctor I'm still trying to work on, as it is important to defend what I think is best for my patients. I'm glad Miami got me started to work on it.

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After writing underneath my pen nickname "TENergy" for the last year, I've decided to put my real name down just so my adventure can have a real face to it. Thanks for reading!

Mile 768: The Learning-Teaching Pairing

Above: The Chicago skyline on the NB U.S. 41 Lake Shore Drive to SB Interstate 55 flyover. I love flyovers!

"SEE ONE, DO ONE,
TEACH ONE."

2007. I recall one of our professors in the anatomy lab at the campus in Dominica was talking to us about how things "roll" in the anatomy lab. After our class was split into three groups, one of the groups each day would go on in to the lab and dissect a part of the body. For the people who weren't dissecting on a given day, they had to come in and watch the group that was currently dissecting give a demo on what they found out on that day. And for the next day, we'd rotate a group, and the process was repeated over and over again throughout the semester.

Dr. Martin said this was his philosophy, to see one, do one, and teach one.

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There's truth to that statement, and I'm seeing how it works firsthand in the wards. For instance, this past week, our attending doctor had demonstrated to us how to perform a neonatal physical (see). As a group, we then spent time everyday to perform the physical exam (do). Finally, when a new group came in to work in the ward with us, we spent the time to teach them the procedure if the doctor wasn't available (teach).

And through doing all three, I would have gone through either a procedure or a nugget of information, three times (and the procedure amazingly stuck!). Most would agree that in order to teach one has to learn. However, for me (but not for everybody), to learn one has to teach. It is commonly said that becoming a physician is a career of lifelong learning.

Right now, at this stage as a medical student, this is how I see it:

Throughout our careers, we have to keep up with the continuous research that goes on, filter out what's appropriate, and pass that information to improve the care of our patients. When we teach them what we learned (one way is through a doctor visit), I think that we have to pay attention to our patients, such as if we are communicating our ideas effectively to the patient or how well the treatments we plan are working. If something's wrong with that, we have to go back to the drawing board and start learning about that issue from square one again.

So after all that, I'll have to say that teaching and learning go hand in hand, and for me, one can't go without the other. For me, being enthusiastic about medicine (or just about anything) can make the processes of learning and teaching exponentially addictive.