I posed a question about learning climate a couple of weeks ago. The comments addressed several issues; today I will give some of my thoughts.

In considering learning climate, I use the following principle. The students are paying for this education, so I owe them their money’s worth. They really are not students, rather they are colleagues in training! My job (yes I am paid to do this) is to help them grow into excellent physicians. While the interns and residents do not pay me as directly as the students do, I believe that I have the same responsibility to help them grow.

I have several routines that I will use today as I start a new 2 week block of ward attending. First, I will make clear my expectations. These include our starting and finishing time each day. Since I teach in a Socratic style, I will explain why I ask so many questions. I frame my questioning as a technique to find the necessary teaching level. I expect that I can find questions that they do not know. That is my job!

We will play “autobiography” today. I want the learners to know who I am and I want to know them as individuals. Too often I hear students complain that their attendings had no interest in them as persons.

I will use the technique that I have called question and rescue. When a student (or intern) obviously is confused by the question, I move quickly to the next person. The resident always goes last, unless it is a resident only question.

Rounds have 2 purposes. First, we must deliver excellent care to our patients. Second, everyone on the team must understand why we are making decisions and how we develop our “game plan.” Delivering excellent care is not enough for ward attendings. I can care for patients quite well without students and residents, but that is not my job. I am paid to teach while we care.

I must strive to manage without micromanaging. Let me illustrate the difference.

The manager asks the resident what IV fluids she plans to give the patient. If he disagrees, he challenges her plan with questions, and finally negotiates an adjustment.

The micromanager never asks the resident or intern what they want to do, he just tells people what to do. The manager achieves the same outcome, but the team feels involved. I will try to practice what I preach.

Finally, I will show my love of patients and medicine. I am happiest when making ward rounds. I like the patients and the teaching. As an extrovert I show my emotions easily. Many students and residents seem attract to my obvious enthusiasm. Showing enthusiasm has positive impact to the team’s mood.

Well off to the VA. I hope that I help create a positive learning climate.

Related posts:

1. On learning climate
2. The importance of patient volume for learning
3. Work hours – medical student perspective
4. Can a 3rd year student influence his attending? @autolycos
5. Picking a specialty – “what is the next hot field”

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