I wrote this 2 years ago. Recently I have given much thought to clinical teaching. This post is reflective of a major lack in some teaching, and especially the first 2 years of most medical schools.
Back to Basics
I have spent much of my career considering the role of clinical teaching. During this pursuit, I often wonder what attributes excellent clinical teachers should have. Excellent teaching while multi-faceted, depends on both a positive teaching atmosphere and appropriate conveyance of knowledge. As I talk with students and residents, I am becoming increasingly convinced that too many teachers skip the basics.
Too often I work with very good residents who do not have a full appreciation of the basics of internal medicine. Often they know much esoterica and have great depth of knowledge in some areas, but they are lacking in Internal Medicine 101. I blame our educators. Too many of my colleagues assume that students and residents know the basic stuff. They immediately take the discussions to Internal Medicine 301 or 401.
We as educators must master Medicine 101 and make certain that our learners do the same. Only when everyone is comfortable with the basics can we afford to start working on the more obscure. The great teachers take each patient, apply the basics, and then build on those basics. They remember the lesson from algebra – show your work, go through the basic steps on paper, even when they seem simple. Often I have seen diagnoses made because the student, resident or attending dotted all the I's and crossed all the T's.
Medicine requires discipline, and I fear that we do not always do our best job in teaching that discipline with enthusiasm. So for those who teach, never assume that your learners know the basics. Question them and ascertain their knowledge. Sometimes you will find a great educational opportunity.
