Bioethics Discussion Blog: Teaching Medical Students to Become Physicians (1)

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Wednesday, October 12, 2005

Teaching Medical Students to Become Physicians (1)

As with all teaching, I think there is an art in teaching medical students. As with many other skills, the art is developed over time with experience along with some education. The art is not related to teaching these students how to study. The techniques of study have been worked out by the students themselves over the many previous years of their academic schooling. The art is to effectively facilitate their medical learning process and help them not act like a doctor but instead be a doctor.

Learning the science of medicine doesn’t require much didactic teaching since many resources beyond the professors are readily available to the students and coming to class to listen is becoming less common. What the students need is direction toward the content of what is necessary to learn and they need proctoring and mentoring as they develop their physical and intellectual/behavioral skills. But there is also the need for psychologic and emotional counseling.

In the first two years, the exposure to real patients with real illnesses is not always easy for a student to handle emotionally. Students are faced with issues relating to personal identification with patients or personal identification with their illnesses. In these years, the students are beginning to develop skills for taking intimate history from the patient and physically touching the patient in the physical exam. These activities involve degrees of student hesitation or embarrassment. Boundaries of history taking, self-disclosure and physical contact have to be set.

In the 3rd and 4th years, as they work on the wards in their clinical clerkships, the students are then faced with multiple pressures, uncertainties particularly related to their increasing patient responsibilities, fatigue and at times difficult relationships developing between themselves and their superiors. In addition, the students’ private lives are beginning to be disrupted by their clerkship responsibilities. Further, there is also the increasing student concerns about the issue of selecting specialties and post-graduate training competition. The students also need to think at this time further into the future about how their professional and private lives are going to be managed.

Becoming a professional physician is definitely not easy and may be handicapped by institutional systems that carry along educational and behavioral baggage, repeated over the years, which is neither beneficent nor helpful for the development of a physician. More on teaching medical students later. ..Maurice.

2 Comments:

At Wednesday, October 31, 2007 5:58:00 AM, Blogger Kehinde said...

I am a surgeon who also train medial students in a medical school in Nigeria. Your comments addressed some issues that I had been trying to crystallize within myself for some time now. I have always told my students that medicine is a apprenticeship where the non-verbal aspect of teaching is quite important. Students at word rounds/clinics observe and internallize the ways their teachers. Little by little, guided by the teacher's comments and advice, they learn and become more confident.

 
At Wednesday, October 31, 2007 7:36:00 AM, Blogger Maurice Bernstein, M.D. said...

Kehinde, thanks for your comment representing another land and certainly another culture than is found here in the United States or in my community of Southern California. As I have written about more on other threads, there is the problem of the "hidden curriculum" where beyond the first two years, the medical students, interns and early residents may pick up wrong ethical behaviors along with the correct essential technical skills from superiors who
by their power over the students instill into them these wrong behaviors toward patients.

Do you have a similar situation in Nigeria? ..Maurice.

 

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