Saturday, March 7, 2015

Selective reflections

I wasn’t sure what to expect coming into this selective. Would I learn how to be a teacher? Would I improve my ambulatory clinical skills? Or maybe I would be doing an extensive literature review on a certain topic in medical education. Now, three weeks later at the end of the selective, I’m surprised, partially at how fast it went by (because of how much fun I had, obviously!) but more-so surprised at how many areas I had an opportunity to explore. Let me recount some of my adventures here…

The simulation training program here is quite remarkable, and I felt extremely lucky to have received excellent teaching from several staff members, each with their own approach to identifying murmurs and bedside exams. Some of these sessions were very personalized to the learning objectives of me and my colleague, which made the sessions even more adaptive and interactive. Internal medicine was something both of us were interested in pursuing, and being able to receive simulation training for bedside procedures, such as detection for ascites and paracentensis, which were tailored to the required skills of internal medicine residents was a great way to help us develop a basic level of confidence to attempt these procedures on real patients in the future. Simulation training is something that will be very prominent during our next years of residency; I'm glad to have initiated this training process in such a safe learning environment.

Dr. HPK's clinic was also a fascinating experience - you could never predict what he's about to quiz you on... medical knowledge, geography, bizarre pieces of trivia... He created an interesting environment where learning about patients' conditions was integrated with the art of examineship, conversation and relationship-building. He also introduced us to the “grey zone of medicine”, an area I’ve never heard of where physicians and patients must learn to recognize and appreciate the fact that sometimes, things in medicine can neither be proven nor disproven, and depend largely on the patient’s preferences and available options. Being able to accept this fact is difficult, especially in an advancing technological age where it can be easy to believe we have found the definitive truth to most things. Many of Dr. HPK’s patients sit within the grey zone; being able to help these patients navigate their frustrations on their conditions is something that he seems to have become extremely proficient in. His holistic view on health is an important quality I will take away from this experience. His clinics also introduced me to many rare conditions I've never seen before including Gitelman syndrome, dermatomyositis, malignant exophthalmos, post-herpetic neuralgia, reflex sympathetic dystrophy and scleroderma. The opportunity to learn about these complex conditions from real patients is uncommon and certainly helped me appreciate the art of diagnosis in medicine.

My primary research area was formal mentorship programs in the medical curriculum and this led me into debates on whether it is effective or not. Interestingly after reading through several studies, my initial perception of mentorship being a great addition to any medical school was quickly altered by understanding the practical challenges in implementing such a program. As I go forward in my training, I’m certain my interest in mentorship will continue to grow and I hope I may use some of the knowledge I gained in my readings during encounters with medical learners in the future. My colleague and I also did some minor research into teaching strategies that can be employed in the ambulatory setting. We came across the concept of SNAPPS and One-Minute Preceptor, both evidence-based teaching models that have been shown to be effective in improving student clinical performance. We were able to teach these strategies to our fellow selective colleagues at the end of the selective. I felt it was a great opportunity for us to connect with our peers and discuss medical teaching in general, as well as learn how to formally develop a teaching session by going through the steps of creating learning objectives, choosing content, choosing a method of delivery, and finally, receiving feedback.

Overall, this selective was an extremely positive experience. I felt that there was a good balance of ambulatory clinics, teaching sessions, and dedicated time for research, reading and blog reflections. I was particularly fond of how open the requirements were for independent research. Apart from being provided a helpful list of resources to search from, the research topics were completely decided upon by us with minimal guidance on narrowing the research question along the way. My colleague and I chose this rotation because of our interest in medical education and curriculum development. I would definitely recommend this selective to any student who has similar interests and wishes to gain new insights on the art of medicine.

-JJ

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