What to make of teaching on clinical rotations, and how to get taught
As a relatively recent medical graduate, the odd limbo of medical student clinical rotations are still fresh in my mind. Many great teachers – consultants, registrars, interns and patients – stand out in my memories. Nonetheless, I also remember swathes of time spent waiting around, watching the umpteenth laparoscopic cholecystectomy, or feeling a little mentally bludgeoned after an interrogation on the radiological differences between acute and chronic pancreatitis. How do you make sense of the piecemeal teaching you are getting, and how do you squeeze out a little more teaching from your team?
Some of the common teaching techniques employed in medicine may seem like you as the student are either being targeted or neglected. Why do doctors teach in this way?
Here are some of the usual suspects:
You’ll notice that, as questions are asked on a ward round, you’ll often be the first target of questions. These questions may be well beyond what you know, or are expected to know – they may be even more at a registrar level. Unfair to ask you? There are a few reasons that you usually get first bite of the cherry.
a) Opportunity to shine: believe it or not, at times you’ll be sharper on some of the theory than the junior medical staff – if for no other reason than that you may have visited the subject more recently. Use it as an opportunity to show you’re engaged. Even if you don’t know the answer, showing some structured approach to an answer goes a long way.
b) Team dynamics: as the student you’re often not actually expected to know a great deal (though you do) and whatever you get right is a bonus. If you get a hard question wrong and the registrar knows the answer – no worries. If the registrar gets shown up by a student, some registrars may feel like they are being undermined (particularly if they themselves are not very confident). Having the question go to the student, then the intern, then the registrar means that no one is shown up.
c) When you get taught, everyone gets taught: while the teaching/quizzing may be directed at the student, you are not necessarily the sole target audience. One way for the senior to tell their juniors how they would like a problem approached is to talk through it with the most junior member of the team – often the student – and explaining their own approach from first principles. If the senior were to talk through the basics with their junior, the latter may feel like they are being told how to suck eggs. With the student as a proxy, the whole team can explore a problem from first principles without any ruffled feathers.
One common technique used in medical teaching is to ‘grill’ a student on a particular topic. You’ll be asked a question, then pushed on it until you don’t know the answer, and then get pushed a little more until you feel pretty sheepish. Why are they picking on you?
First, the teacher needs to find where the limits of your knowledge are to be able to teach you something new. The teacher wants to find something they can contribute, rather than wasting your time with things you already know. But why make it so stressful?
The best justification for this technique is that people learn and remember better when they are under a degree of stress. You’ll see all doctors have stories of similar ‘grillings’, and it doesn’t take long to realize that being grilled can aide recall, even decades down the track.
While being an effective technique, achieving adequate stress without overstepping the mark is a tough balance. Moreover, the forum for said grilling needs to be carefully chosen – the goal is mild stress, not public humiliation. Occasionally the would-be teacher overdoes the stress component or chooses an inappropriate forum – this can leave the grillee feeling dejected and incompetent, feeling more like they are being bullied than taught. If you’re ever on the receiving end of a lesson that leaves you feeling like this, try to take the experience for what it usually is: a bungled lesson rather than a reflection on your competence.
Grilling is a powerful technique, but as the mighty Spiderman said, “With great power comes great responsibility”. Grillings need to be delivered carefully to be effective – it is not a method to be emulated without serious consideration of how the grillee is taking the grilling. If a griller has a pattern that you believe to be one of degradation and humiliation, this isn’t teaching – and it is not ok. Talk to your supervisor or clinical school.
While this may feel like a cop-out on the teacher’s part, this can be an effective method, particularly if teacher and student follow up on it. There are some good reasons to have a student read up on a topic rather than simply start talking:
a) Sometimes this is an opportunity to be pushed to explore an area that hasn’t come up clinically, then discuss it with a senior in a way that will help consolidate knowledge.
b) At times the teacher is thinking, “I once knew this, I know it is important, but it is now way too rusty for me to be able to give you a decent structured lesson on it…if you read up on it then tell me about it then we’ll both know”. If you as the student are forced to teach someone else about it, then you’ll really have to get your head around it. Talking about it with a senior can help you sort it out in your head as well as give it some clinical context.
c) Some subjects don’t lend themselves to a chat, you simply have to sit down and learn them – for example, anatomy that is completely unfamiliar to the student. If the pterygopalatine fossa came up, and the student had no idea what or where this was, any conversation on this front is going close to or exactly nowhere. Better off reading about it and looking at pictures, then discussing it with your teacher the following day.
Understanding why people teach in the way that they do can not only stop you beating yourself up when you don’t know the answer to a question, it can help you get the most out of the teaching you are getting. Teaching, like medicine, is both an art and a science. Throughout your career you will encounter some exceptional teachers who will make complex problems simple and intuitive – these are the teachers who inspire you.
Next in Teaching medical students – Part 2: Making the most of your clinical rotation.