Archive for October, 2008


October 1, 2008

One of the integral components of medical culture is the pervasiveness of teaching.  In medicine, everyone is a teacher, and everyone is a student.  Even at the very top and bottom rungs of the ladder, first year medical students play teacher to each other, and the attendings learn from grand rounds.  Everyone teaches, and everyone is taught; forgive me if I’m wrong, but if that doesn’t ring of self-betterment, humanism and (to some degree) egalitarianism, I don’t know what does.

Now that I am several months into my second year (and no longer at the extreme bottom of the proverbial pyramid), I am starting to get acquainted with the concept of teaching as an integral part of my membership in the medical institution.  I am a co-director of one of the student run clinics at my school, and in addition to administering to the clerical needs of the clinic and seeing patients, there is the expectation that I teach something to the new first years.  And while I might know very little clinical medicine, they know even less, and part of my job is to impart some of my meager knowledge to them.

It is a strange and somewhat intimidating thought, that I am in some way contributing to the education of a future doctor; I worry about whether I learned it correctly the first time, so that I am passing on the right information to my juniors.  But that said, it’s a neat feeling when you realize that despite how much you really don’t know, you do know SOMEthing, and have a chance to teach that something to other people.

For example, I am no expert at blood draws.  I’ve had a fair amount of practice, but I’ve certainly done fewer than 15 or 20.  But at clinic, one is expected to do blood draws, and if the first year doesn’t know how, why, it is our prerogative to teach them.  Indeed, my first blood draw as a first year was from a brave second year who patiently coached me through inserting a pointy object into his arm.  And in the best traditions of the institution, it is now my turn to be that second year.  I actually happen to have particularly big and easily visible veins, and so I offer myself up as a phlebotomy guinea-pig on a pretty regular basis.  While occasionally a painful experience (no, the needle doesn’t go THERE) it’s really something to see how excited they are when they pull it off.  For whatever reason, I think your first blood draw is kinda a bench-mark (an early one, but one all the same) in your path to becoming a physician, and it is really gratifying to me to be able to teach people how to do it.  The same feeling goes for teaching people where to listen with their stethoscope or how to take a blood pressure.  It’s just a neat feeling.

That said, I am (much more frequently) on the opposite side of the equation, where some kindly third or fourth year, or junior physician takes time out of their hectic lives to teach me something of value.  I spent a night following around a junior resident taking care of the cardiac ICU, and despite all the stuff she had to take care of, she was able to take some time to explain to me what was happening, and teach me a little something on the side.  While punching in orders for the last patient, she could simply have just let me sit and stare at the wall, but instead she pulled up the next patient we were to see on the computer, and told me to read up on him and present him to her when she was done.  She involved me in what she was doing, and at some expense and inconvenience to herself (as a second year, my presentation skills suck, and she could find probably have learn what she needed to know in 20 seconds rather than listen to two minutes of my stammering).

Teaching is a big deal in medicine, and I think it is part of what makes this profession appeal to me so much.  One never stops learning and teaching, and if you asked me, I think that’s pretty cool