The least capable medical students and residents used to be the least satisfying to work with.
A situation I used to call “The Double Punishment.” An essay. 1/
The Double Punishment goes like this:
Your student/resident lacks motivation/ability.
So you spend extra time on everything.
The results are poor.
Mistakes are made, patients, nurses and colleagues are mad.
Days are long. That’s the first part. 2/
The second punishment is in writing the evaluation. It’s no fun. You have to think a lot. You have to try to figure out how they can get better. You know you can’t sell this broken glass as a gemstone.
Then you get feedback on your feedback. Not gentle enough, etc. etc. 3/
Double Punishment. It sucks to work together. It sucks to try to write a good evaluation afterward.
Extra work, less satisfaction. Double Punishment. 4/
The key for me is to stop taking learners personally. They aren’t my children. They don’t improve or damage my reputation.
I had to figure out how to make the “worst” learners improve my reputation. The answer is to get good at working with them! 5/
The first punishment never changes. You can’t hand off responsibility to a student or resident that lacks competence.
You just have to step in and do more, yourself. That one doesn’t change. 6/
As for the extra time, I am very clear. If the team can’t put together the diagnosis and plan on their own, we will do it together.
It’s gotta get done. 7/
I have learned to save time by being very clear. Here’s where I find you. We all need to improve. Here’s what we can reasonably get better at in a week or two. 8/
I used to try to teach learners everything they were missing. This is a huge mistake.
Just figure out the next thing they need to learn and teach that. Fast. 9/
Struggling learners need more time but not more time with you yacking at them.
They need more time to work on THE NEXT THING. That’s all. 10/
I have found stuffing learners appreciate being found where they are.
They usually know they are not at the top and don’t need to hear it again. 11/
What they need to hear is:
1. You believe they can be a great doctor. 2. You can see what they need to do next to get there. 3. You are their supporter, coach, and fan. Not another critic. 12/
This removes the second punishment.
Instead of “this resident was substandard in the following realms” you say “I found this resident needing help getting organized and structured in history taking” 13/
Instead of “below the average level for a student at this point in 3rd year” you can say “this student has not yet been taught to develop a differential diagnosis and they improved greatly during our time together.” 14/
There is plenty of room for thoroughly average doctors in the world. 15/
In an emergency, a mediocre doctor in front of you is worth 1000X an expert specialist asleep in their bed. 16/
In my experience, struggling learners remember this for a lifetime. They remember being found, being honest, and having someone help them get where they want to go. 17/
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Let’s discuss 3 facts: 1. You and your parents before you have been managing and balancing RISK v. DOING STUFF your whole life. 2. Over time your risk of dying of COVID will shrink beneath other risks. 3. We’ve been happily killing each other with infectious diseases forever. 1/
Like it or not (and style notwithstanding), this is the debate people like @VPrasadMDMPH and @drjohnm are trying to have right now.
I’m 45-54. You could easily reduce some of my TOP 10 risks of death by:
- outlawing cars: unintentional injury
- outlawing firearms: homicide, suicide
- outlawing tobacco and alcohol: liver/lung dz
There are 5 realms you will master if you want to be a good doctor. 5 bodies of knowledge about which we teach 3 in medical school. 1/
1. Diseases. You must learn their traits and character. Their prey and weaknesses. Their mimics and behavior. In some fields there are hundreds. In internal medicine we have tens of thousands. 2/
2. Bacteria and other infections beings. If you are an orthopod you will become an expert in staph aureus. OBs know Group B strep. Ophthos know that pseudomonas.
It’s weird to get to know some microorganism better than you know your neighbor on your block but you should. 3/
I spent lunch on Google Scholar reading ivermectin in COVID papers (of which there are a lot more than I thought).
Tons of bias. Zero RCTs. I wouldn’t be surprised if it helps a little. I also wouldn’t be surprised if it does absolutely nothing or causes harm.
That being said, I wouldn’t take it if I got sick.
More “promising” meds end up failing than succeeding. Every year we kill some people trying to test and find new medicines that end up being harmful.
Vaccination, masks, and social distancing have worked for me and the doctors I know who have spent countless hours in high risk close proximity to hundreds of patients sick and dying with COVID.
Only ~4% of my group has gotten sick in 18 months.
Unpopular opinion: rote memorization is the foundation of true understanding in many subjects. @efunkEM
I agree with this. Without training your brain to organize and recall the facts, you will not be able to think on the fly or spot rare diseases when they are sitting right in front of you.
You are not a chip. You have to be the whole computer. Storage, display, everything.
I have worked with residents who won’t bother to memorize the 3-20 item DDX for all the common things: anemia, fever, elevated WBC, delirium, AGMA, etc.