Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
====
"I hear and I forget. I see and I remember. I do and I understand." - Confucius
====
"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
====
" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
====
"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
====
"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
====
"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
====
"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
====
"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
====
"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
====
"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
====
"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
====
"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
====
"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
====
"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
====
"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
====
"There are no facts, only interpretations." - Nietzsche
====
"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
====
"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 7
Mar -
The importance of patient volume for learning
1 Jul2009
He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all – Sir William Osler
I believe most educators have known this since Osler’s time. As I reconstruct my career, I strongly believe that I have continued to improve as I have cared for more patients.
I have known of this study for some time, as several of the authors are friends. I have referred to the principles of this study often in this blog. Internal Medicine Clerkship Characteristics Associated With Enhanced Student Examination Performance
Results: In school-level analyses (using a reduced four-variable model), independent variables associated with higher NBME subject examination score were more small-group hours/week and use of community-based preceptors. Greater score increase from USMLE 1 to 2 was associated with students caring for more patients/day. Several variables were associated with enhanced student examination performance at the student level. The most consistent finding was that more patients cared for per day was associated with higher examination performance. More structured learning activities were associated with higher examination scores for students with lower baseline USMLE 1 achievement.
We should take these findings into appropriate context. If you are a learner, you want to train at places with sufficient patient volume.
Some have advocated “competency based training.” I reject that philosophy. Medicine is never learned. We all should grow each day. How can we establish arbitrary goals in learning medicine when learning medicine will always remain a process not an achievable endpoint?
I encourage students and residents to seek out patient care opportunities. Each patient brings valuable teaching.
I am encouraged that small group teaching also does make a difference, since I love small group teaching. However, I am cognizant that teaching is best when it builds on actual patients.
Several years ago we had our residents rate teaching sessions in the Department of Medicine. Morning report was the clear winner and Grand Rounds was the clear loser! The reasons seem obvious. Medicine is best learned when given a patient context. Morning report, when done best, explores the intellectual process of diagnosis and management. When linked to the patient presentation, most residents learn important texture, even when they know much about the disease or symptom.
So my advice to students persists. Do not choose “easy residencies.” Choose residencies with the appropriate volume to allow you to grow as a physician.
Related posts:
- In which at least 2 commenters miss my point
- Reflections on 30 years of ward attending
- Duty hours, the ACGME and the surgeons
- Focus on pimping
- An old post – focus on basics
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants
4 Responses to The importance of patient volume for learning
Twitted by medrants
July 1st, 2009 at 7:16 am
[...] This post was Twitted by medrants [...]
Web Media Daily – July 1, 2009 | Reinventing Yourself...
July 1st, 2009 at 7:56 am
[...] The importance of patient volume for learning …DB’s Medical Rants [...]
Matt S.
July 1st, 2009 at 8:36 am
One of my attendings at UAB (I think it was Dr. Eloubeidi in GI) that told me to give as many prepared presentations in front of groups as I could.
He said you retain a small amount of what you hear, and a little bit more of what you do. But if you can take one of your cases, go over the material, and distill it into a lecture, that learning will stick with you a lot longer.
Guest
July 11th, 2009 at 7:28 pm
I went to a medical school without its own academic medical center. Instead, we spent third year at mostly community hospitals. Many had residency training programs, but most of the attendings were private attendings. As a 3rd year student I was asked to see about 12 patients a day and do about 4 admissions a day. Those are intern-like numbers, and many more than most of my colleagues at academic medical centers. I know because I did electives at academic medical centers.
When studying for the USMLE Step 2, I found studying to be very easy. When I took my first practice test, my initial score was over 240. With 3 weeks of studying a great deal, my final score went from a 249 Step 1 to a 270 on my Step 2 (a 21 point jump). If you ask me, my increase was do to the volume of patients that I saw. At the time (and maybe even in retrospect) I was asked to see too many patients as a third year student, but somehow seeing all of those patients really prepared me (1) for my examination and (2) for my Sub-I’s at major academic medical centers the following year.
“The student begins with the patient, continues with the patient, and ends with the patient, using books and lectures as tools, as a means to an end”
Sir William Osler