: • Canadian Family Physician • Le Médecin de famille canadien
ollèg olleg
“Please … put the pens down!”
Sharon K. Bal, MD
I
t is undeniable that our past experiences and encounters shape our opinions about medicine as a profession. Much of our exposure to medical dogma and culture begins through an initiation of sorts, organized by a community of “elders” (senior medical residents) on clinical rotations. roughout clerkship, I really enjoyed my encounters with resi- dents who provided good-quality teaching, advice, and clinical pearls. ink back: a sleepless night on call in the hospi- tal, your attending physician at home in her cushy bed, time spent talking with your senior resident.
is person became for many of us a role model, a mentor, off ering advice and guidance on an experi- ence with which they were more recently familiar than our medical school preceptors.
e “senior resident”: this term still inspires a sense of admiration and respect in me, along with a certain degree of envy and frustration. Perhaps best personifi ed by “the Fat Man” in e House of God, that eminent ode to the horrors and challenges of internship, the mythic fi gure of colleague-teacher has stood the test of time.
The delivery of information through a never-ending hierarchy of colleague-teachers is central to the study of medicine. “See one. Do one.
Teach one.” How many times has each of us heard these words during our medical training? This idea of teaching as a necessity is impressed upon us early in our careers. In fact, specialty residents are largely responsible for training house staff in most teaching hospitals. eir proximity to medi- cal students allows them a valued say in determin- ing delivery of clinical education. Interestingly enough, these residents are receiving their own
education in the process: they are being prepared for future academic careers.
Is all this applicable to family medicine? We cer- tainly do not have a team system in which a group of students and residents is responsible for a lim- ited set of inpatients, especially not in community settings. Is it possible in a 2-year residency to aff ect the lives of students in the same way? Is it even important?
Absolutely.
I began teaching in earnest this past year. It has been a very humbling and meaningful expe- rience. I still look back with dread at the first time I was asked a difficult clinical question. I paused to collect my thoughts, cleared my throat, and looked up to respond—only to find to my horror seven eager-faced students, poised with paper and pen to permanently record my ram- bling thoughts into irrefutable text. For Heavens’
sake … put the pens down!
Looking back, in spite of my dread at being recorded, there was a great deal of learning dur- ing those fi rst few sessions … at least on my part!
I learned to think before I spoke. I also learned to use certain phrases, such as “ at’s a really inter- esting question: does anyone have any ideas?”
“Yes—good thought,” and my personal favourite, “I don’t know. But I’ll look it up for you.” I guess it is only appropriate that after teaching clinical clerks problem-based family medicine, I went on to teach fi rst-year students about history taking. After all, by that time I was an expert in the pregnant pause, summary, and artful use of refl ection!
One theme kept repeating itself this past year (besides my constant fear I would deliver some
Residents’ Pag
Canadian Family Physician • Le Médecin de famille canadien : •
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inaccurate medical fact): specifically, students seemed keenly interested in my perspectives on residency. ey asked me what it was really like, how I managed a personal life during internship, and what made me choose family medicine. ey occasionally seemed surprised that I had read a particular study or that family physicians managed very complicated, diverse cases. I appreciated the opportunity to answer their questions frankly and to reminisce about my own decisions.
e idea of responsibility is important in clini- cal teaching. Medical accuracy, however, is only one facet of the educational challenge we face: it is far more important to be aware of the influence a mentor can have on students. Having said this, access to medical students and even junior resi- dents allows senior residents a unique opportunity to be ambassadors for their medical specialty.
It has often been said that to truly know if you understand a concept, simply try to explain it to someone else. Truer words were never spoken. I learned more about my feelings for my career and chosen field during my encounters with students than I ever had on my own. Perhaps therein lies the lure of an academic career: less in the teach- ing of medicine, and far more in the discovery of enthusiastic critique and challenge of yourself. e next time a junior resident asks which medication I prescribe for illness X, I will pause and ask myself about my answer. Is it up-to-date? Is it evidence based? In other words, I will teach myself first, and be a better physician for it.
Family medicine has declined in popularity in recent years. Multifaceted as the etiology of this problem undoubtedly is, residents, I believe, have an important role in its solution.
Education in hospital-based specialties relies on senior residents to open doors to the inner workings and inherent opportunities of their discipline. A much shorter, largely community- based program (such as family medicine) is automatically disadvantaged in the current sys- tem. Students considering family medicine as a career, however, deserve the same advantage as those considering other disciplines: the abil- ity to discuss one-on-one with a resident “what it’s really like” in our chosen field. Mentoring is critical in recruitment and, perhaps more importantly, in cultivating an accurate image of family medicine among students destined for other specialties.
So, is it possible in a 2-year residency to affect the lives of students in a meaningful way? Is it even important? I believe the answer is yes. In fact, it is a necessary part of our training. As residents, we must actively seek teaching opportunities. Before starting, however, remember the golden rule of teaching a medical student: first, thou must confis- cate any recording devices.
Or do as I do … simply cry until they put their pens down.
Dr Bal is a second-year resident in family medicine at the University of Ottawa in Ontario.
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