Stand and Deliver

Today, my team of fourth year medical student instructors completed a series of talks for the second year medical students aimed at preparing them for their transition from the preclinical years to the clinical years, from the books to the wards. My team’s talk, “How to see a patient,” is designed to provide the second year medical students with an approach to excelling at their first role as data collectors. Third year medical students begin their training as scouts: they have to get the lay of the land with respect to the patient’s history, the patient’s chief complaint, and the current status of that patient. However, it is possible for third year medical students and ideal for them to graduate from the role of data collector to a junior interpreter and manager of patient care. Some attending physicians and educators use the “RIME” mnemonic to illustrate this evolution: students must evolve from Reporter to Interpreter to Manager to finally Educator (not only care for the individual patient but also contribute to improving the skills of the team and the institution).

However, this evolution is not straightforward, and we sometimes lose sight of our roles. As noted by one of my friends and classmates, even as fourth year medical students we sometimes still feel the same way we did on that first day: we feel like a burden to our teams, we feel like we’re getting in the way of our residents and attendings who are the ones who are really taking care of the patients. One of the essential ingredients missing in the individual transitions from medical student to resident physician is the balance of confidence and humility. Take, for example, the relationship of medical students to nurses: sometimes this relationship is highly antagonistic. From a potential nurse perspective, medical students are below them on the totem pole of authority, and they have little experience and are just going to interrupt their work. From a potential medical student perspective, nurses are simply shift workers who care little about their jobs and are more likely to give medical students attitude then give them useful information. Some medical students worsen this potential antagonism by being arrogant and attempting to don some mantle of authority over the nurses. Some medical students never get beyond their perceived inferior role by being too humble and self-deprecating in their perception of their level of knowledge, experience, and utility.

However, contrary to what one might believe, confidence and humility are not mutually exclusive. For me, having worked in a variety of hospitals and wards and having dealt with all sorts of personalities in the workplace, I have managed to have 90% of my interactions with nurses be very helpful and collaborative if not friendly and congenial. In those crucial skill-building months of the third year of medical school, medical students need to learn to stand and deliver: they need to establish their role and space, demonstrate their beliefs and attitudes, and make alliances based around common goals and the collaborative delivery of a single service. In other words, students need to learn to how to stand their ground (don’t fight back) when facing frustration and impatience and deliver this message: “This is who I am, I am here because like you I care about this patient, I’m not here to give you more work but to work with you to help this patient get better and make things run smoother.”

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