Ágoston Kecskés
992868991
January 18, 2012
The
tradition of teaching is alive and well in internal medicine. Each year, new
third-year clinical clerks join the ranks of the clinical teaching units while
keen fourth-year clinical clerks rotate through during electives. Both groups
are taught by the first- and second-year residents situated above them in the
hierarchy of the clinical teaching unit. From higher still, the attending
physicians dispense pearls of wisdom to all. That’s how we become physicians.
But how do we become teachers? How do we learn and perfect our teaching
scripts? How do we teach others to teach? Certainly, leading by example is a
popular method of teaching in internal medicine. The dictum of “see one, do
one, teach one” often holds true to some extent. And leading by example is very
powerful indeed. All too often we learn this lesson the hard way when we
develop poor habits by mirroring those of others.
But
it doesn’t seem that a good example is sufficient. Despite how finely honed the
internist’s skills of observation are, observation is rarely a sufficient
condition for good teaching. We need something more. We need a structured
approach to passing on teaching skills to clerks in internal medicine.[1] Some
might argue that this already exists: attending physicians, for example,
routinely assign to clerks relevant topics to be researched and presented to
the team. The problem is that clerks are so concerned about presenting
accurately and comprehensively that the art of teaching is lost. The problem is
compounded by the time crunch on medicine teams, which often leads to members
of the team filing in and out throughout the presentation. The presentation
falls apart completely if the senior resident or attending physician interrupts
the clerk for clarifications or corrections, thereby undermining the clerk’s
confidence and flow. One way around this would be to have the clerk present to
the senior resident prior to the large-group session, thereby vetting any
errors. Subsequently, the focus could fall on the art of teaching instead of
the art of saving face in front of your preceptor.
[1] S. Hartley, D. Gill, F. Carter, K.
Walters, and P. Bryant, “Being an effective clinical teacher,” Teaching in the
Clinical Setting, http://fds.oup.com/www.oup.co.uk/pdf/0-19-851072-1.pdf;
accessed 17 January 2012.
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