Tuesday, June 20, 2006

Those Who Can...Do,
Those who Can't...Teach

The saying above is one we used throughout med school, internship, residency and fellowship. It was aimed at our professors who were, in our view, often pontifical and arrogant. You see, medicine has had, for decades, one traditional and didactic way of teaching. Unlike other graduate students who were treated as junior colleagues, med students enjoyed the rights of pond scum. During classes or on hospital rounds, profs often used a method of teaching we referred to as pimping (not the kind you see on COPS).

This method went something like this: The prof (in his long, flowing white clinic coat) would lead a bunch of us lepers onto the wards where one of us would present a patient's case to the group. The prof would then ask that poor bastard (the student or intern, not the patient) a question Einstien couldn't have answered. After saying we didn't know, the question would be endlessly repeated in different forms until the presentor was properly...and traditionally...devestated. This was tried on me during the first week of my residency.

I was asked, by the chief of renal (kidney) services a question about one of my patients. It was a good question, and I said I didn't know. He asked me another way, and I thought that it was a good teaching technique since it made me think. But, I still didn't know and said as much. He then began to ask again with a smirk on his face that alerted me to the start of a pimping session.

What I haven't told you so far is that I, unlike the other residents, had not just come out of my internship. I had, in fact, been away to Aerospace Medical School and then to Thailand where I did a year as a combat flight surgeon in F 105 fighters. Those were my people you may have heard about on the news ("captured...Hanoi Hilton"). Point is, I had been out in the world, was 2 years older than the other junior residents and had seen a slice of life I don't want to see again. The fear of being kicked out of a residency program seemed hardly threatening after scraping bodies off runways.

So, in my diplomatic way, I told the prof that I appreciated him making teaching rounds with us and that he could ask me that question until the cows came home. "Or," as I explained, "you could teach me the answer." (Which is why I was there in the first place).

The 2 students and the intern (under me) held their collective breaths, certain they were about to witness my summary execution. Instead, the prof, after staring at me for a while and seeing no fear in my eyes, launched into an excellent lecture for which I thanked him. No prof ever messed with me for the rest of my training.

Interesting, you say, but how does all this fit into the magic aura of this blog? I will tell you how.

In the sports I have done and do...kayaking, judo..., those who teach do so because they can do. And, there are no generals or "pimps". Students and teachers are colleagues and, other than certifications, no one "ranks" above another. There is no pimping, just collaborative teaching and sharing of knowledge.

When new students would come to our dojo to learn judo it was made clear that everyone, teachers and students, would show respect for one another. The Senseis (teachers), it was explained, wore black belts to indicate only that we were students just a little farther along because we had been at it longer. What a great atmosphere in which to nurture learning.

Before leaving you, I realize that today's ramblings may have infused you with fear over the competency and intent of doctors who have suffered such a learning experience and who, now in a position of power, might take it out on you. Well, in addition to the quote at the top of this piece, there is another saying you might want to know about.

The next time, as you are being rolled into the operating room and wondering if your surgeon is capapble, you will want to know how he learned to do the operation he is about to do all over you. The secret to learning an operation?

See one. Do one. Teach one.

Paddle safe...and sleep with one eye open.


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