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Saturday, February 16, 2008

Live and lea-

Med school (seemingly) is all about learning in what seems to be the least efficient way possible. For instance, the first two years, you spend most of your time in the classroom* learning from PhD's who want you to learn what they enjoy. Then you spend 2-3 months fearfully cramming into your brain all the information that the writers of the USMLE want you to know (which may or may not be what the PhD's want you to know.) Then you get out on the wards and it's a whole new ballgame, son.

No one teaches you how to actually be a member of a medical team and that's a damn shame. I can tell you that for some people, sphingomyelin is very important. I can tell you that if the boards show a picture of a funny-looking guy with his hands held beside his face, it's probably a growth hormone-oma of the pituitary. But I'm having a hard time telling you how to actually take care of another human being. It just isn't taught.

I think there are two reasons for that. The first of which is, there just isn't time. They tell us the first day that there is too much information to learn in the four years we are given and we can't do it if we try, but we're expected to try. They can't teach you about the hospital because you don't yet know what sphingomyelin is. The second reason is, there's no possible way to do that. Every service in the hospital operates differently. And among services with the same aim, every hospital is different. There just ain't no way.

Which is why I kind of shrug when my intern's eyes bug out as I say "I only went to pediatric traumas last night." I'm rotating through peds surgery right now, so I think, when I'm on call I go to the peds stuff - right? Wrong. When I'm on call during my peds rotation, I go to pediatric AND adult traumas. For some reason my intern thinks this should be self-evident. I don't much mind. I had a real, real quiet night and I got a ton of reading done. Maybe next time.

Live and learn, you know? Except not really. An attending was talking to me about just that, learning theory. There's a method to learning medicine called "See one, do one, teach one." And it's as simple as that. See a procedure, do it yourself, teach it to someone else. My attending says to me, that's a system designed to propagate errors. The real way to do it is see it, do it, see it again, do it again, etc. That way you see it, then you do it (realizing what you are actually doing,) and then you see it again with eyes open. But that doesn't really work in an environment in which your role changes constantly. And that's the difficulty here - knowing one's role.

Surgery can be pretty good for that. For instance, in the OR I have a very simple role as a helper. I help retract during surgery (if needed,) I bring in the bed when the surgery is over, and I write the operative note at the end. Ultimately that's all that is required to be a good medical student. Anything after that is up to me... but what role am I to take? I feel like I know just enough to cover a dime if it isn't windy.

So I don't feel too bad about going to the lone pediatric trauma last night, and reading instead. If I'm going to feel comfortable taking a hand, I've got to be more confident in what I know. If the efficient way to do that is just to sit down and do it, I'm doing it.

And it was kind of fun to sit up and read, read, read. Haven't done that in a long time. Unfortunately, I had to drink so much caffeine that by the time the morning came around, I was literally nauseous. Yet another example of med school's pervading themes: learn about being a healthy person, but don't immediately apply much of that knowledge to yourself.

*Others did. I spent most of my time out of class, in my room. With my books.

1 comment:

Abby said...

A team is a group of people who have learned how to work together. You teach each other that. It happens after you have been working together for a while, and when your success depends on each other. There stages all teams go through.