Posts tagged learning

There is no possibility for teaching without learning. As well as there is no possibility of learning without teaching.
Paulo Freire

Jeopardy / Millionaire

If you find yourself wanting to do a group study session but want to bring some excitement and competition to the table, why not set up a game night for your friends?

For academic medical students, try a hand at adapting Jeopardy. It takes some time to build up enough cards and factoids to make a late night session worthwhile. Do it in teams or fly solo. Can you answer fast enough?

For clinical medical students, adapt a game of Who Wants To Be A Millionaire? Put yourself in the hot seat in the audience of your friends and try to rank up in a certain topic. Find help with the 50/50 option, poll your audience, or call a friend (e.g. a dermatology resident for a skin lesion question). Rewards can range from free meals to switching prized call shifts to just good old fashion prestige. 

Have you ever played a study game? Share your ideas below.

Phases of the Bipolar Spectrum.
Our mood is always in a constant state of flux. In patients with bipolar disorder, the mood can swing quite dramatically into the highs and lows. They can be pleasantly but intensely perked up one visit or severely and suicidally depressed the next.
This diagram, adapted from the citation above, hopes to illustrate this.

Phases of the Bipolar Spectrum.

Our mood is always in a constant state of flux. In patients with bipolar disorder, the mood can swing quite dramatically into the highs and lows. They can be pleasantly but intensely perked up one visit or severely and suicidally depressed the next.

This diagram, adapted from the citation above, hopes to illustrate this.

Neil deGrasse Tyson speaks about learning mathematics from the Great Debate: the Storytelling of Science.

I watched this last night and I think it is advice that applies to many of the readers who have asked through the years what to do about their struggles with math, chemistry, physics etc. Certainly, I feel that it applies to those who question if medicine is too hard for their passion to stay alive.

With practice, you can become better at your craft, no matter what discipline you pursue. It takes time, it takes work, and it takes practice. But you do eventually get there.

Watch the full Q & A session linked above for other responses by Dr. Lawrence Krauss and Bill Nye to this question.

I remember when we first worked together at the beginning of the year. You were so shy and so nervous. Yet, look at you now: you look and sound confident - and rightly so. Your histories and physicals are impeccable and you are formulating sound management plans on your own. I could not be any happier with your progress this year. Just stellar work today.
One of my internal medicine preceptors and role models comments on my development this year.
More than a year ago, I took my first steps into clinical training by starting my summer medicine rotation. It had begun a new chapter in my development and left a profound impression on me. It was during that brief one-month window that I first started to hone my skills out in the field under the tutelage of not only my preceptors but also the residents.
Now, I find myself on the opposite end of that spectrum; I had an opportunity to meet an up-and-coming third year medical student, a graduated second year clerk in his summer medicine rotation. For a morning, I was tasked to work alongside him and offer some support as I helped him with his patients. 
When we are in the thick of things, it is easy to lose perspective of how far we have come. With only a year separating us, it was surprising to me how far I had grown.
The man was bright and had a very academic mannerism of speaking, the hallmark of two years of lectures. Despite a formidable understanding of theory, there lacked experience and comfort with the practicalities of medicine. This was the great divide between us. I could see his unease at handling a presentation, at coming up with an approach and a differential. It was the same unease I had felt so many months ago, and one that I still feel often, albeit not as often or as strongly as I had before. 
But still, what a difference a year has made! Being able to see him, to work with him, and help him in this moment of his journey enabled me to appreciate and to put my own learning in perspective: there has been progress; there will be progress.

More than a year ago, I took my first steps into clinical training by starting my summer medicine rotation. It had begun a new chapter in my development and left a profound impression on me. It was during that brief one-month window that I first started to hone my skills out in the field under the tutelage of not only my preceptors but also the residents.

Now, I find myself on the opposite end of that spectrum; I had an opportunity to meet an up-and-coming third year medical student, a graduated second year clerk in his summer medicine rotation. For a morning, I was tasked to work alongside him and offer some support as I helped him with his patients. 

When we are in the thick of things, it is easy to lose perspective of how far we have come. With only a year separating us, it was surprising to me how far I had grown.

The man was bright and had a very academic mannerism of speaking, the hallmark of two years of lectures. Despite a formidable understanding of theory, there lacked experience and comfort with the practicalities of medicine. This was the great divide between us. I could see his unease at handling a presentation, at coming up with an approach and a differential. It was the same unease I had felt so many months ago, and one that I still feel often, albeit not as often or as strongly as I had before. 

But still, what a difference a year has made! Being able to see him, to work with him, and help him in this moment of his journey enabled me to appreciate and to put my own learning in perspective: there has been progress; there will be progress.

A Rookie Cut

Over the past year, I have noticed a young man attending the barbershop I frequent. A tall and well-dressed adolescent who bared some resemblance to my barber, he initially started off with the scut work: sweeping the floor, greeting the customers, and watching. Always watching intently as my barber trimmed my hair.

Slowly, over time, he had begun to learn the tools of the trade - the different scissors and the brushes; the straight razor and the strop - and began to practice on the dummy heads.

Today, I went to the barbershop to find him cutting what must be his first set of heads full of hair. All the while, he was receiving pointers and tips from my barber, his father.

His eyes were focused, his body was tense, as he trimmed the weight from the man’s temple. Snip. Snip. As the locks fell to the floor, he re-examined his work. Was it too little? Was it too much?

“Remember to angle your brush up. It’ll give you more room to work with,” his father would say, and he would oblige and try again, with more angling of his left wrist. In the end, the older man seemed satisfied with the young man’s work. A sizeable tip came the trainee’s way, to which he hurriedly returned to the man.

“The cut is free. I’m still practicing.”

“You’re always going to be practicing. Besides, you’ve earned it. Keep the change.” The customer gathered himself and took his cane as he thanked the barber in training yet again. The young man was pleased.

“Next?” Of all the people waiting in the barbershop, no one took a second glance.

“Does your son know what he’s doing? I mean it’s a rookie cut,” came one snappy customer. No one moved. They wanted the expert, the experienced barber, the man who knew every bump under every patch of hair on their heads. They wanted his father. The brilliance of the man’s eyes that a moment ago seemed so alive, dulled. He put down the gown and reached for the broom.

“Sure, I’ll go,” I said, taking up his offer. He gave me a smile and motioned me to the chair. “Have a seat.”

I understood his plight. We were all in the same boat together. As learners, we depend on the good will of the people we see for us to gain experience, to be better, to become professionals. The process must start somewhere. It was time I returned this favour to another student.

“Caesar trim. Sides short. Front long,” his father called out.

“Hey.”

“Hello.”

“Thanks for giving me the opportunity.”

“No problem. We all have to start somewhere.”

The Zebra

“Tom, come take a look at this,” the attending beckons excitedly. I get up from the charting station and walk over to his computer.

A CT scan fills his screen with a very large, obvious abnormality. “This is one of the biggest I have seen in my career,” he says. The patient had developed not only a large mass but a rare one, causing all sorts of systemic anomalies. Given the extent, it would be inoperable.

As we proceed to the patient’s room, the doctor explains the clinical presentation of mass effect on the body. His eyes are wide and flicker with a fiery excitement. He can barely control the rate of his words as he gushes about the various pieces of the unique clinical puzzle in front of him.

“Are you excited?” he asks after he finishes. I reply that it is “interesting,” much to his displeasure. “How could you not be excited? You might not see this ever again in your life.”

But all I could think about was how this mass, this zebra on a CT scan would soon bring our patient to their untimely death.

Within, I watched the attending as he spoke to the patient and their family about the situation. He explained things with such professionalism, clarity and assurance that I could see no better way it could have gone.

Yet it continued to disturb me, his excitement in it all.

Joseph Addison, a poet said: “Everything that is new or uncommon raises a pleasure in the imagination, because it fills the soul with an agreeable surprise, gratifies its curiosity, and gives it an idea of which it was not before possessed.”

For my attending, who may have seen thousands upon thousands of patients with very similar presentations, this zebra case must have stirred up a renewed sense of adventure, a break from an otherwise regular routine of patients.

Perhaps, it is that hot flush of novelty, that infectious high of our peers that perpetuate our own behaviour.

Too often our fascinations show outwardly as our primary intent. In the process, we forget that the patient has a name, has a right to be treated with dignity, has an illness that still needs to be treated. In the process, we forget that the condition does not define the patient any more than he defines the condition.

It is a strange situation we find ourselves in, to be excited and captivated by our morbid curiosity; on some level, we must in order to learn and improve as clinicians; at the end of the day however, it must come at the expense of someone else’s health. For that, I must always consider the fine line that separates respectful and disrespectful learning.

“Pretty neat findings, eh?” He nudges me. I take a look back at the patient’s room. I watch as the family huddle in an emotional embrace as they come to terms with our news.

“Yeah. It is really interesting,” I mutter bleakly.

I remember one of the first students I was training here. He was a journalist. Was a journalist for nearly thirty years. He well could have been my father at his age!

But he was still learning.

This is a profession where even the old dogs learn new tricks, where the learning does not stop until the day you stop working.

A physician recounts a revelation about continuing education.

The Only Correct Way...

  • Dr. A: This is the way you should do this procedure for your final assessment. It is how it is written in your notes.
  • Dr. B: Do not go by what is in your book. That is the classic method. There are better ways to do it.
  • Dr. C: Why are you doing it that way? This is the best way to do it according to studies.
  • Dr. D: I see you picked up some bad habits. And by "bad habits" I mean "not the way I do it." While you are with me do it this way.
  • Dr. E: I ran into trouble before with the way you are doing it so I do not do that anymore.
  • Dr. F: Do it however you like.
  • Me: Brain cannot compute.