Forward Thinking

“Learn from the past, prepare for the future, live in the present.”

Thomas Monson

My pediatric cardiology block sadly came to a close this week. I learned so much and it felt great being back in the children’s hospital. Hugs from patients and working with supportive preceptors who took time to teach me and encourage my interests left my cup overflowing. There’s something about being around my peds or medicine people that leaves me feeling like I’ve come home. I hadn’t previously considered cardiology something I was particularly “good” at, but I left the rotation more confident in my ability to recognize murmurs, read EKGs and think about patient management. I also got to exercise my teaching muscles with my clinical skills groups, helping them navigate the patient interview and practice clinical reasoning. Yet again, I find myself amazed by how much I’ve learned and how far I’ve come and excited about my future as a physician and educator.

This week, I attended the first workshop of our academic clinician educator course. We had a wonderful discussion surrounding using social-emotional intelligence concepts to foster a supportive learning environment. Now that I’m in my last year of medical school, I’ve seen leadership done so many ways. Some have been effective. Others, less so. On rotations, setting expectations from day one sets the team up for success. My inpatient psychiatry rotation was one place that was done beautifully. Our residents sat us down as a group and walked through their expectations for us as well as the workflow in the psychiatry unit. They then modeled what their expectations looked like as we watched them conduct patient interviews. After that, they gave us space and trusted us to take ownership of our own patients. On other rotations, we were left to discover these expectations as the rotation progressed. Joining teams of residents who were at times overwhelmed, we often were expected to jump right in and get to work. Though this did help me work through my nerves starting a new rotation, I’d be lying if I said it wasn’t disorienting.

Another topic we discussed was different teaching styles. As a learner, I appreciate any opportunity where residents or attendings take time to go over important concepts . Sometimes this takes the form of lectures, others involve walking through cases or questions utilizing the Socratic method. Though different from one another, each serve a different purpose and are only effective if learners feel safe participating. The Socratic method commonly gets a bad reputation because it puts learners on the spot and increases the stress of an already uncomfortable situation. I absolutely have felt this, particularly when not given adequate time to think and respond. On the other hand, some of my favorite preceptors use this method, with one important caveat. They set the expectation that their questions were not to trip me up, but to see how I think through concepts and what I already know. Then they could adjust their teaching accordingly. I never once felt I was being punished by these individuals. I enjoyed the challenge of learning to think through hard problems, often found I knew more than I thought I did, and clarification where I went astray helped me understand topics better.

Finally, we discussed feedback. Firstly, the setting is key. Conversations I’ve had were we sat down in a quiet area that was private and in a “neutral” area were more comfortable than those where I felt cornered or took place in front of classmates. I’ve often been given feedback that is essentially “You’re doing great”. While nice to hear, it’s less than helpful. Specific feedback like “Please include more detail when discussing pertinent physical exam findings” or “Start considering discharge criteria and what needs to happen before patients can return home safely” is much more helpful when paired with examples of how to do so. When I have a team in the future, I plan to make a point of setting aside time before the beginning of each rotation to sit down and discuss expectations. I will make time for teaching, ensuring I take into account each individual’s interests and learning styles. Though I still have time before teaching will be expected of me, I look forward to submitting my residency application and discovering programs who will help me grow into the type of physician I dream for myself.