I do a lot of teaching. Truth be told, it is what drew me to stay in academic medicine. As a subspecialist, I am fortunate enough to have multiple opportunities to lecture, train, and educate in a number of venues. The word “doctor” is actually derived from the Latin word “docere” which means “teach”. I truly enjoy the privilege, and it is just one of the reasons that I have started this blog as well.
Teaching moments can come at times that are completely unexpected, even outside of the classroom or away from the clinical setting. Sometimes, the teacher can learn from the teaching moment as well. In a rare situation, a teaching moment affects some of the learners so greatly that the impact is felt immediately and the teacher gets the amazing satisfaction of learning how important the moment was. This was one of those occasions…
A few years back I became the Course Director for the MS2 (“second year med student”) GI course. As part of the class we decided to invite a patient with ulcerative colitis to come speak to the class about her disease. This particular patient is very memorable for the students because she is a candid, engaging young lady, around the age of many of the medical students themselves, who has actually published several articles about her disease, and how it has affected her, in a major newspaper.
The session lasts for about an hour and is the last large group teaching session (aka lecture) of the course. As part of the preparation for the session, I post her articles for the students to read. During the session, one of my colleagues spends a few minutes asking her about how she presented, how she was treated, etc. Then they discuss some issues about how both her disease and the treatment affected her and how she dealt with it. They also go into various issues relating to her interactions with several of the doctors she encountered–some good, some not so good. Finally the students have the opportunity to ask her questions, and some of these questions tend to be quite probing–moreso than they will probably ever ask many of their future patients.
Traditionally the first 2 years of medical school have been dedicated to the so-called “basic sciences,” whereas the second 2 years have been based around the “clinical sciences.” That is to say, the first 2 years are traditionally based on biochemistry, pharmacology, physiology, anatomy, and so forth, with students getting involved in patient care when they matriculate to their third year. Of course, this paradigm has shifted over the last decade or two, and clinical medicine is being introduced earlier and earlier in the curriculum.
So in a course like this that teaches the very basic concepts underlying gastroenterology, what could the students possibly get out of such a session? Even at this level, the medical licensure board expects students to have an understanding of how medical illnesses affect patients, and how patient factors (gender, ethnicity, etc) can play a role in medicine.
The assessment of a student’s comprehension and competency in such areas poses a particular problem on multiple choice tests, which (unfortunately) our tests must be. Because the final exam for the course has to be completed before this session occurs, I choose to take a very simple approach to assessment by asking the students a single question about the themes of the articles she wrote. This makes sure that the material on the exam was definitively covered in some manner even if it weren’t discussed in the presentation.
I asked one question on the exam…out of 60. Worth one percentage point on their final grade. That’s it. Even though it might have been the most important hour overall they spent in the course…hearing about how a patient reacted to her disease, to the therapy, and to the doctors… Everything else is in the medical textbooks, but in that one hour, they heard about topics that are completely overlooked throughout most of medical school. Topics like how she had to deal with telling her new boyfriend about her disease and how she reacted mentally to gaining weight when she was taking steroids to treat her UC. These are issues that most doctors rarely hear or inquire about.
She is such an engaging, enthusiastic woman that the students virtually all love that session. You would think that the time spent there was invaluable since the students for the most part came to medical school with the intent of taking care of patients… Unfortunately there are always a few rotten apples in the bunch…
After each course is over, a few students form a “focus group” to meet with the various Course Directors and review the course…what worked, what didn’t, how to make it better, etc. It was at that meeting this year, just a few days after the final, that I heard a comment that seemed to emanate more out of a high school student’s mind than a future doctor’s. The anonymous comment went something like this:
The hour we spent listening to the patient talk about her disease what not worth my time because all we had to know for the test was what she wrote. I could have spent that hour trying to read more about the actual diseases.
After I heard this comment, I decided to send the class a short note at the tail end of another email that discussed some changes to their test scores. The subject line of the email said: “Test scoring changes and a piece of advice”. Here is what I told them:
Lastly, one final piece of career and life advice…and this is geared toward responding to some of the post-exam concerns specifically…For those of you who are mad that the hour you spent listening to the patient discuss how her disease affects was “not worth” your time because all you had to do “for the test” was read the articles, then you need to re-evaluate your priorities.
You are in medical school to help patients, not to get a good grade on a test, which in 2 years won’t mean more to anyone than the scratch paper you used to work through the questions. If you don’t start to see that now, you might be unhappy in your career selection as a physician. Stop asking what you “need to know” and start trying to learn what being a doctor is about. Keep a record of all the times you complain about hearing about material that “won’t be on the test” (or how often you hear others do it). If you keep track, when you get into residency you will eventually look back and laugh at how silly it sounds to you at that point.
I didn’t think much about that email after I sent it. I certainly didn’t expect any responses. Boy was I wrong!
The next day, student after student sent me apologies. Not for themselves, but BECAUSE OF THEIR CLASSMATES! They were actually embarrassed that their classmates would behave and complain in such a way. I was touched. But it wasn’t until a month later that I got the final compliment: the email had somehow made its way to a colleague, the Course Director for another class, who told me that my message to the students should be “printed and framed in the lobby” of the medical school building.
Even though the note was directed at just a few students, it became clear that the message hit home to many, even me. The students seemed to realize that their teachers actually do have their futures in mind. For those who took it to heart, these students will have great careers in medicine.
As for me, I saw the impact of what it means to be a medical educator. In our best of times and in our worst of times, we can truly shape the future physicians. Not only do we teach the science but we are also role models. Usually we never know how much of an impact we maked…but sometimes the impact is more than we can imagine.