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扫描下载二维码331 SharesAs I finished my 24-hour call recently, I was reminded of a
revealing a
transition from
their mostly-didactic second year to third year, which is essentially an
apprenticeship in the hospital with lecture as an afterthought.
began my third year with what most would argue is the most difficult
rotation, surgery, and my experiences over the past 5 weeks have sparked
introspection on the things that cause medical students to burn out and
wall themselves off during the clinical years.
Numerous factors make the
difficult –
learning the layout and flow of the hospital, adapting time management
skills, the overwhelming volume of knowledge to acquire, and the
emotionally-draining experience of moving from 4-5 hours of lecture
daily to 14 hours of patient contact in the context of impatient
hospital staff are just a few.
However, I noticed that the experiences
that are the real body shots to our self esteem can be traced back to
our mentors.
Lack of mentor continuity. Being exposed to clinicians at different levels of training and with
varied style and substance is paramount to good clinical education.
However, rotating through teams too quickly can leave us feeling lost
and disoriented.
Likewise, residents are less inclined to teach when
they know they’ll never see us again – they just want to finish the task
at hand and steal away for a meal or a nap.
Lack of clinical continuity. It’s hard enough to learn how to manage hospital inpatients, but when
doctors start making up their own rules, it gets even harder.
surgeons prefer different antibiotics to be given before an operation,
and that’s fine, but here is an example of when fussiness becomes
detrimental:
my first resident said he never wanted to hear the term
“low-grade fever” – the patient was afebrile if their temperature was
below 100.4° F.
That same day, our chief resident described a patient
as having a low-grade fever.
This week, I presented to my new chief
resident a patient who had spiked a 100.9° F several times since his
operation and I was told that nothing below 101° F should be reported.
What will it be next time?
Hostile attitudes. To each other, to the team, and to other teams – this is perhaps the
most discouraging practice to witness.
Undermining your colleagues is a
terrible way to role model, and demeaning your apprentices does not
build character, but rather breeds resentment and affects the quality of
work your team accomplishes.
The lack of professionalism I’ve
witnessed at times was more than just thoughtlessness or off-color humor
– it was downright inappropriate.
Lack of feedback. I’m not sure how, but some new doctors who were in our shoes just a
year or two ago to forget how lost they felt as third & fourth year
medical students.
We often lack direction, and what we need to improve
upon is not always clear to us.
Doctors at teaching institutions must
be reminded that feedback is the most important responsibility of a
mentor, lest the relationship become a one-way street and we regress to
the passive nature of the second year.
Lack of forgiveness. Especially true for the technical specialties, like surgery, it’s
nearly impossible to get certain things right on your first attempt –
I’ve had instruments literally ripped from my hands while trying to
Likewise, I can’t know everything about a concentration a
specialist has been practicing for years – I was being pimped on breast surgery during a modified radical mastectomy (the first one I’d seen), and when I got a question wrong my resident
would roll her eyes and shake her head in disgust.
Experiences like
that don’t really make me excited to come to work the next day.
Avoiding hands-on training. This is a continuation of my earlier point about residents just wanting
to finish and move on – it’s difficult to bounce back and forth between
doctors who won’t slow down, teach, and let you do and others who expect you to be proficient and are bewildered when you
sheepishly admit this is your first time doing something.
Scapegoating. This is the worst – as a third year medical student, you learn early on not to explain yourself when you’re being scalded (it just results in
prolonging the agony).
I was recently working the balloon on a Swan-Ganz catheter,
an act that requires close cooperation with the person advancing the
catheter to avoid damaging vessels.
I faithfully inflated &
deflated the balloon as the resident navigated through through the heart
and pulmonary arteries – just as the attending walked into the room,
the resident realized he was retracting the catheter with the balloon
still inflated and told me “Don’t ever inflate the balloon without being
I just stood there & nodded – to correct him in front of
the attending physician wouldn’t have been worth it.
I could post one of the numerous papers on depression & burnout in medical school, but instead I’d encourage you to skim this thread on “” from a leading internet forum for medical students.
It speaks volumes
more than any abstract or numbers I could share with you.
I’m not trying to shift the blame for anyone’s poor performance, but I
know I’m a hard worker with the best intentions and I shouldn’t be made
to feel lousy so often.
My colleagues and I shouldn’t have to shoulder
these concerns during this especially demanding period of our education
– many of us have already begun to dread our future residencies and entered a kind of “survival mode,” but it doesn’t have to be this way.
When we work with thoughtful, professional and understanding
physicians, all of these worries dissipate, we perform exponentially
better, and with the compassion we swore to display when we first donned
our white coats.
James Haddad is a medical student who blogs at .
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