What Do You Do With a Med Student?

One of the most exciting things for me about making the transition from student to resident is that I am now formally in a teaching role. Interns have more contact with medical students than any other member of the health care team, which means we're responsible for making sure they learn what they need to learn, as well as trying to model "good doctor" behaviors.

When I think about the interns I really enjoyed working with, they gave me leeway to actually do stuff on my own patients, tried to involve me in formulating the plan for a patient, gave me credit for work I did, and occasionally gave me knowledge that was useful for the upcoming exams. Now that I'm on the other side of the interaction and trying to behave the same way, I've made a perhaps-unsurprising discovery -- teaching well is hard.

As a student, I assumed my interns were fountains of medical knowledge. After all, I knew X, Y, and Z from my lectures and my nightly readings, so they must already have the same things memorized. I was wrong. Medical students, please take note: particularly in the summer, your intern does not know jack. Students have time and motivation to read in detail and memorize diagnostic criteria, subtle points of pharmacology, and so forth, and they have weekly lectures to cover these same topics. I use that same time to fill out paperwork and plan my wedding. Moreover, the older I get, the less appealing I find the idea of spending an evening memorizing lists. Hence, on most topics, the medical student actually knows the correct answer, whereas the intern does not. (I presume I, as an obsessive reader, must have driven my interns mildly nuts.) As a result, the med student can actually be profoundly threatening to one's ego. After you've been shown up two or three times a day by someone who's really just average for his/her class, there's certainly an urge to divert the pesky little twerp onto a many-hours-long paperwork or telephone task. Or, in some of the less gently specialties, to provide a few cutting remarks that make clear students should be seen and not heard.

Neither of those options being entirely palatable, I've had to find a new approach: teach primarily on things that aren't psychiatry. See, they may have all those lectures and do all that reading, but 99% of them focus it on the specialty at hand, since that's what the end-of-rotation test covers. It turns out there's a reason we still have MD/DO psychiatrists and haven't abandoned the field to PhDs -- there is a lot of general medical knowledge needed to competently diagnose patients and use these drugs, especially in the inpatient setting. Maybe I don't always know the side effects of every antipsychotic, but I can recognize common abnormalities on EKGs, I know how to interpret serum electrolytes, and I know a little bit about drug-drug interactions. Plus, I can try to teach that elusive skill of "efficiency", which separates the resident who sees his/her family from the one who truly does live in the hospital. Of course "efficiency" does often mean "OK, I'll write the note and the orders that I'm legally required to do, you do the phone calls and fax this prescription", i.e. a whole lot of scut.

I'll be really interested to see how the evaluations come back for these first few months -- I'm trying to give them responsibility and help them mature from students into doctors, but that also involves assigning them a lot of work and introducing them to the high-speed pace of modern medicine. Either I'm being a good mentor, or a slave driver, and I'm not sure which.