The hidden curriculum is trying to turn us all into the same robot interviewer. It's brutal watching interviews in small group sometimes - as long as everyone does their job, you literally watch the same interview three times in a row. Here's a sample:
--
Hi my name is __ and I'm a first year med student working with your doctor today, if it's ok with you I'm going to ask you a few questions.
Shake hands.
 |
| tell me more about that |
So what you brought you in today?
Tell me more about that.
OLDCARTS
PMH
FHx
I'm sorry to hear that.
SHx
Any other questions you have for me today?
Shake hands.
Leave.
--
 |
| tell me more about that |
Katie's been complaining to me recently because I had been talking weird. Whenever she says something - I'll respond in a weird monotone "pretty cool." My best pretend empathetic tone. And I'll follow up af her comments with, "Tell me more about that." Until Sudeep saw me in action, and commented on my empathetic comments to Katie, it never even occurred to me that this was happening. I was genuinely trying to be compassionate and empathetic, but my compassion and empathy neuronal pathways had been rewired.
That's fucked up.
One of my favorite authors is Abraham Verghese (Cutting for Stone, Tennis Partner). Both great, great reads. He doubles as an internist at Stanford, where he's a huge advocate for the physical exam. He believes a good physical exam can establish a strong patient-doctor relationship, and also provide higher quality care. He's developed his skills to the point that he gives patients a physical exam, but while he's giving the exam he goes through the patient interview. This way he can still fit in a thorough physical exam within the short patient visit time limits. Impressive. I imagine in an efficiency oriented world, he's not the only doctor that's mastered this skill.
I hope I can get to that level of patient interviewing. In the meantime, guess I should stick to my checklists. Thanks Step 2.
see you on the other side,
from ken
enjoy sidenote in 140 characters or less @kensidenotelife.
To say it's ruining our relationship is a little extreme. Plus, you've improved!
ReplyDeletegood writing = hyperbole/lying
DeleteCoach Knight at Indiana would drill his players to death on his motion offense. He was notorious for throwing kids out of practice even when they were executing a drill to physical perfection. If he decided a kid's heart wasn't driving the movement, the kid was done for the day.
ReplyDeleteKen, I would argue the purpose of repetition of physical exams (and for that matter the endless biochemical pathways you complain about) is not to turn you into a robot. I haven't seen a convincing reason why "they" would want you turn out that way. In my opinion, the purpose of repetition is for the mundane practical details to become second-nature so that you can dedicate your focus and energy onto the hard stuff, the empathy.
If you constantly have your attention directed towards what you need to check next, how can you really listen to what a patient is saying? How can you concentrate on the words even as you move your hands along the routine unless they possess the muscle memory you built up over hard work and time?
With regards to the academic foundations you dislike, you're right that you may not always explicitly remember the mountains of details you have shoveled into your brain. But the implicit schematic framework remains. Your neurons have reoriented. It's well and good for schools to teach problem-solving skills, and they may seem ultimately more important when rote details can so easily be referenced on a computer, but I really believe that unless you have wrestled with the details on a personal basis in the past, you will not be able to usefully build on and assimilate them in the future.
In short, I don't think your school forcing you to undergo repetition is indicative of a faulty process. If you find that your execution becomes more and more robotic over time, I don't think it's a failure of the system, I think it's a sign you need to renew your focus on the details that separate the artist from the technical craftsman: love, compassion, hope, and dogged dedication.
P.S. When I inevitably complain about studying and workloads in the future, feel free to throw this comment back in my face.
Yeah, you're right the OSCE is good for some things. It is good to learn what you need to do to give a clinical exam. And you're right that the point of learning biochemical pathways is not to turn us into soulless robots. But the point of the hidden curriculum is that things like losing empathy for patients are a real documented phenomenon, and things like learning biochemical pathways or learning to give clinical exams can contribute to loss of humanness if they are taught in certain ways. If we taught them differently, maybe we could help medical students maintain their compassion before they reach the clinic.
DeleteAlso, I'll be interested to hear your thoughts in two years.
Delete