Thinking Outside the Box

I arrived on Monday morning to begin my new Selective with CEEP in Ambulatory Internal Medicine and Medical Education...having really no idea what I was getting myself into. I discovered (to my happy surprise) that I would be spending a large part of my time with Dr HPK in his clinic and learning from his unique teaching style.

My first day was wonderful. It felt like my brain was executing constant mental acrobatics and forming all sorts of new connections. This kind of lateral thinking has always been similar to the way I think and it felt like coming home. Today, in Medical Grand Rounds, Dr Silver treated us to a set of Rebus Puzzles before beginning his talk. These again reminded me of my childhood adventures in lateral thinking exercises, and so I've chosen to reflect on that today.

I was "diagnosed" with being gifted at a young age. All I knew at that time was that it meant I thought differently than many other children and learned maybe a little bit faster. I also knew that it was the reason I got to skip a grade and why I got bored pretty easily at school. When I started attending the Program for Gifted Learners (PGL) in Grade 4, my scholastic life got decidedly more interesting.

At PGL we started every day with a "Problem of the Day" which was written up on the chalkboard and we were left to sit and figure out the solution for as long as it took us. These problems could be number-based, logic puzzles, or sometimes as simple as a play-on-words. Sometimes when we finished early, we got sheets of the Rebus puzzles (linked above) to let our brain exercise even more. The rest of the day was spent on various projects: from learning to write HTML, build websites, and use Corel Draw to working on fundraising campaigns banning Landmine usage in developing countries (in which I learned to use a button-making machine. How useful.) The day finished with more discussion-based group problem solving: sometimes we were given a Sherlock Holmes-like crime and were allowed to ask yes or no questions to get to the answer. Needless to say, I loved my time spent with the other students in this classroom, but I don't think I truly appreciated what it was teaching me until years later.

Fast-forward fifteen years and terms like 'Thinking Outside the Box' and 'Lateral Thinking' are common buzz words that you hear all the time. Quick googling has taught me these terms are relatively recent: Lateral thinking was first coined by psychologist and inventor Edward de Bono in 1967 and, interestingly, the term Thinking Outside the Box seems to have come a bit later- the first published references are in the 1970s. "The box" that is referenced in this term actually comes from the famous Nine Dots puzzle which was published in Sam Loyd's Cyclopedia of 5000 Puzzles, Tricks, and Conundrums (With Answers) in 1914. In this puzzle, one is asked to connect all 9 dots placed in a 3x3 grid using only 4 straight lines. The solution can only be acheived by drawing lines beyond the borders of the box, thus 'thinking outside the box'.

So what does this have to do with Medicine?

Much of what I value about medicine are the diagnostic challenges and puzzle solving that we face with patients on a daily basis. Certainly in Dr HPK's clinic, we see some of the most varied and intricate diagnostic challenges that can exist in medicine and are reminded to think beyond the obvious diagnosis. More than that however, I have been left feeling in the last couple days that Dr HPK's tendency to use clues and word association to teach and help problem-solve is very much in line with how I process information and harkens back to the lateral thinking I was taught at a very young age in PGL. I never realized how useful those brain exercises were and how much it has become second nature for me to think outside of the box, using every bit of knowledge I have learned (medical or otherwise) and in circles rather than a straight line.

And so, I've realized that this selective is perfect for me. I can't imagine a better way to spend the last month of medical school than reinforcing my knowledge by learning from a legend in the field of medicine and 'exercising the tiny grey cells', as Hercule Poirot would say. I'm looking forward to chronicling my journey down the rabbit hole of medical education and thinking about how we think, learn, and remember, especially in the context of medical knowledge.

~LG