Teach Me

This month, I am taking an Advanced Clinical Teaching course taught by our Internal Medicine Program Director, Chief of the Charity Hospital system, and one of the best teachers I have ever had: Jeff Wiese, MD. He describes the course as an “Inside the Actor’s Studio” approach to clinical coaching, not teaching, as he asserts that medicine is a performance sport. The ultimate goal is to help us evolve from the earlier phases of teaching (where the motivation is self-reaffirmation of extent of knowledge and external validation though commendation and teaching awards) to the last phase of teaching (where teaching is only about helping your learner develop the skills and understanding to become a better clinician for his or her patients).

His first axiom of teaching is “Understanding is more important than truth.” This, for me and a great number of clinicians and scientists, is difficult to reconcile with the innate compulsion to strive for perfection in knowledge and practice (that theoretically is a selection criteria for medical school, at least until medical students start believing “P=MD”). However, I believe it is the essential foil to the most common, paralyzing mistakes in teaching medicine: the temptation to fill lectures with every nuanced detail and exception, and the inability to empower students. Knowledge is not empowering. Trying to convey large amounts of knowledge can, in fact, be very disempowering as it reminds learners how much they do not know. Understanding and developing methods of understanding are empowering. Without fully recognizing it, this is exactly what I sought to accomplish with the Doctors Ought to Care school health education program I co-led as a second year medical student: we were reshaping lesson plans to give young people the tools with which to better their health, stay motivated, and learn more.

Reflecting on this past week and the weeks ahead, I am thrilled by this month’s potential: I am going to be a much better teacher and a much better clinician than I otherwise would be. If nothing else, this month is giving me the time to build a repertoire of lesson plans, talks, and methods (including “advanced organizers”) to address areas of Neurology as well as the areas in Internal Medicine I find most important to my future practice. A few months ago, I was tempted by delusional hopes of being able to read all of Adam and Victor’s Principles of Neurology or Harrison’s Principles of Internal Medicine before starting my intern year. This is a result of the ways I have been taught previously: that there is so much knowledge out there and that I simply do not know enough. Even if I had the time for that, though, most of that knowledge would have been stored in short-term memory and would have disappeared by the time I started my Neurology residency. Now, as I develop methods and “canned talks”, I am learning, retaining, and understanding more than I otherwise could. I have already developed talks on the differential diagnoses of headaches and spinal cord disorders (one subject I have never previously had a good grasp on). I am hoping to cover the major topics in Neurology by the end of the month and to have somewhere between twenty and thirty prepared talks (spanning Neurology and Internal Medicine) by the time I start my intern year. I have not felt this motivated to learn in a long time.

1 comment
  1. pgayed said:

    Sounds like an interesting course, Apollo. Medicine and medical school has changed for me too — and not always in ways that I am proud of. Sometimes I am surprised by how discouraged I can feel about learning, something that I have always felt passionate and motivated to do. Medicine is such an amazing, wide-ranging corpus that, dare I say, no one can master. I think what I’ve learned this year — now a little more than halfway through with my third-year — is that the best students, and ultimately the best physicians, can exist comfortably in uncertainty, in the massive darkness that medicine can sometimes feel like. It’s essential, I think, to learn how to function well (and feel motivated) in the absence of mastery. Mastery, if it ever occurs, takes such a long time to develop. So we have to learn to react and treat and think without it.

    I too have been tempted by this idea that the more reading I do, the better clinician I will be. If I could just finish Plum and Posner’s Coma during my neurology clerkship, I will be set, I will be well-versed for the neuro-related problems I will see in the future. But things just don’t seem to work that way, I’ve found. Patients rarely present in ways that can be neatly boxed up, even when such topics are written about by the best authors and clinicians. There is almost always something that’s “just not right” or “just doesn’t make sense,” and this is exactly when that magical substrate they call clinical experience comes into play. In medicine, things can be known, I’ve come to conclude, only after we’ve read and experienced and discussed them with others.

    Nevertheless, this canned-talk method sounds interesting, and I wonder if you plan to post your finished products in some form. It may be a very good model to begin the process of understanding medicine.

    Keep up the great work, Lester. Looking forward to following your posts and thoughts.

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