Learn, then apply

What I love most about being a medical trainee is the abundance of learning opportunities. Enthusiastic preceptors are always passionate about creating the ideal learning environment to suit a learner’s specific interests. Even our patients are keen to teach us about their own battles with illness and will go out of their way to facilitate our training as future doctors. At times, all these experiences can be overwhelming. Today, I think I found the perfect tactic to combat this issue.

During this morning’s team huddle, our discussion centered on a patient who had developed bacteremia from recurrent UTI’s. The team had been treating her for several days using a first-line empiric agent but her symptoms were not improving. Unfortunately, the official culture and sensitivities were still pending. While the fellows and senior residents brainstormed potential differentials, my preceptor asked whether the team had examined our patient’s previous cultures. Unfortunately, we had not. Upon doing so, we quickly ascertained that urine from her previous admission grew an organism resistant to her current therapy. We immediately adjusted the patient’s antibiotic regimen.

Shortly after morning rounds, one of the residents and I were paged to see an ER consult. The patient was an elderly gentleman presenting with a presumed diagnosis of recurrent pneumonia. He was not doing well with an O2 sat of 70% on room air and a respiratory rate of 44. The patient had just been admitted 2 weeks ago for pneumonia and was sent home with a 10-day course of antibiotics. After finishing his therapy yesterday, he returned with deterioration in his clinical status. Clearly, something didn’t add up. The resident and I quickly applied the teaching point we learned during this morning’s rounds and looked up the patient’s microbiology reports during his last admission. His sputum culture had grown an organism resistant to his discharge therapy. We quickly selected an empiric antibiotic that covered this organism and started his first IV dose.

Today, one patient’s treatment failure taught us to be thorough in formulating treatment plans. This resulted in extra diligence in assessing our next patient. Applying new knowledge and skills on the go helps facilitate consolidation for medical trainees. This iterative process helps learners benefit from every learning opportunity. 
- AX