By Jane Zhao, MD, MS
It’s July, which means that around the country, it’s the beginning of the academic year for medical students and surgical residents. My brand new third year medical student finally became comfortable enough to confide in me, “I chose to rotate through surgery first to get it out of the way, and I’m enjoying this experience far more than I realized. I think I want to do surgery.”
I will not lie. It’s a point of personal pride every time I have a student rotate through surgery with me and successfully convince him/her to legitimately consider pursuing surgery as a career. I sincerely believe that part of being excited about surgery is being involved. Part of being involved is being invited to participate. My favorite rotations as a medical student were the ones where I was included in the resident text thread or where I held the resident ascom. I may have been bone-weary on those service-heavy rotations but I was part of the team. My responsibilities ranged from following up on the lab value for Patient A to performing the rectal irrigations for Patient B. My involvement impacted the patient’s well-being.
Now as a senior resident, I try to emulate this experience for my own medical students. I am a huge fan of how, in 2018, the Centers for Medicare and Medicaid Services changed reimbursement policies to permit teaching faculty to verify medical student documentation–as opposed to having to re-document everything–to have the student note count in the medical chart. In fact, my co-residents have laughingly teased me about how championing the right for medical students to document under their own names and to receive credit in the medical chart for their hard work has become my soapbox over the past year. Truthfully, it’s critically important to include medical students as part of the medical team, more so than birddogging cases when they roll into the operating room or being able to answer pimp questions correctly. We as a medical establishment have a responsibility to prepare our students to become doctors, and that includes having them be ready on day one of being an intern: to be able to document appropriately and efficiently, perform simple procedures, start and end a conversation about something sensitive when time is short, and know how to be silent in a healing and respectful way.
To be a good teacher is to do more than simply pile tasks onto students. It means that I have to follow through when I say I will do something and that I have to sacrifice time and energy that I could have used elsewhere. After I ask students to see, write up, and present their consults, I take the time to review their notes, perform edits, and then update them with the changes I made and provide reasons for why I made the changes that I did. I give feedback about what aspects of their presentation should have been bumped up in the first few seconds and which can be kept in reserve until asked. I ask my students to follow one to two patients daily and to write their notes. I edit them before I send them to the attending. When performing procedures like incisions and drainages in the emergency department, I go with them to gather supplies, hand them the scalpel, and then I talk them through the procedure. I try to remember to give positive reinforcement, but I am not above calling out individuals when expectations are not met. I try to tailor my teaching based on personality, and I find I have a lot of success with individuals on the quieter or shier end of the spectrum. Lastly, when the work is done, and all I have left is to tie up some loose ends, I show them that I respect their time to study for their shelf exam, and I send them home. I still remember how horrible waiting around and doing nothing feels like.
Taking time to teach has eaten away a number of hours I could have used for sleep–especially during my rotations on q3day trauma call. However, it’s ultimately worth it when I think about how I am doing my part to shape better doctors for tomorrow and maybe even convert a handful here or there into pursuing surgery.
Everyone has a different teaching style. Some are more Socratic. Some are more coach-like; others are more authoritative. I am heavily influenced by those who were great teachers to me. At the end of the day, I encourage everyone now and for the remainder of the academic year to be a little more patient, a little bit more optimistic, and remember that we all have much we can teach, whether it’s through our words or through our actions. To all my fellow residents, I implore you: reach into your own experiences, recall what it was like when you were trying to learn as a medical student, how your residents effectively taught you, and try to pay it forward as a resident-teacher by modeling that same behavior.
Jane Zhao, MD, MS is a general surgery resident with board eligibility in clinical informatics at the University at Buffalo, State University of New York. She received her medical degree from McGovern Medical School, the University of Texas Health Science Center at Houston and her bachelor’s degree from Vanderbilt University. She was the founder and chair of the AWS Blog Subcommittee from 2013 to 2014 and a founding member of the AWS Social Media Subcommittee in 2013. She currently serves as the Resident and Associate Society Liaison for the American College of Surgeons Health Information Technology Committee. She has been recognized locally and nationally for her leadership, innovation, humanism, and role as an educator. She can be followed on Twitter @zhaomd.
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