On learning medicine – the value of volume

1 Jul
2008

 

As the academic starts, I have the opportunity to work with new 3rd year students.  I love 3rd year students.  They are so excited to escape the virtual prison of the first two years.

They have generally not learned how to think, but are excited that we actually ask them how to think.

As I have oriented students, I remind them that patient volume is the key factor to becoming a better physician.  The more patients you see; the more patient problems you research; the more patient case discussions you participate in; the better you become as a physician.

Even celebrating 30 years since I finished my residency, I believe that I continue to become a better internist.  Seeing and discussing patients always provides insights and texture that I had not previously considered.  Examining patients and interviewing patients improves with practice and experience.

I have heard of unpublished data that suggest that shelf exam scores are best correlated with patient volume.  I believe this report to be true.

I worry about work hour requirements and what that means for patient volume, and therefore education.

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3 Responses to On learning medicine – the value of volume

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The Happy Hospitalist

July 1st, 2008 at 6:14 pm

100% true

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kevinh76

July 2nd, 2008 at 12:27 pm

When I was a resident, I always hoped for a quiet day (because they were so rare) and a busy month. When I had a busy month, I learned a ton. One can not learn medicine from only the lectures and textbooks. You need to see lots of patients too. Third year medical school was the most fun I had in my entire training. I wish I had kept a diary of all the great patients and cases I saw.

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rtb

July 2nd, 2008 at 4:48 pm

In an earlier century, I left New York for a residency without work hour limitations in order to become the best clinician possible. I admitted and managed far more patients than my residents do today (personal record: admitting 23 kids to the Oncology unit in one night). The experience taught me many practical lessons about medicine, interpersonal communication and healthcare systems. However my clinical skills were often based on instinct and tradition instead of grounded knowledge or evidence.

After residency, I sat down to systematically study for the Boards and also took some time to reflect upon my training experiences. The process noticably improved my diagnostic and theraputic acumen. It also gave me a wealth of self-knowledge.

I would support Bob’s view that the more patients we see, the more opportunities we have to learn. But I also encourage students to also take time to reflect on their clinical experiences and to think about their patients’ conditions in a systematic manner. Since every patient is unique, the patients they see on the wards today will only partially resemble the patients they see tomorrow. Taking time to place their patients in context will help them recognize when the next patient has a different diagnosis or requires different care.

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