A tale of two sports, a 7-year-old, and how we train doctors

Post Thumbnail

By Michelle Gibson, MD, MEd, CCFP

Director, Year 1
Director, Student Assessment

Fall is a time of transition in many ways. In the land of Undergraduate Medical Education, our 4th year students are facing up to the joys and pains of the CaRMS process, our 3rd year students are anxiously and excitedly contemplating starting clerkship, our 2nd year students are returning to class as experienced students, and we have a whole new crop of 1st year students arriving to engage our curriculum.

In my main job (co-parent to a 7-year-old), it’s the time of year when soccer finishes, and skating starts up (and, of course, the fun and perils of Grade 2 must be addressed).

In the land of 7-year-old sport, as skating is about to start, there is a certain dread that I once again have to bundle up on a beautiful fall day to stand in a cold arena listening to (at times) dreadful music that we know will be played over and over all year long.   The 7-year-old adores skating, though, and looks forward to each new ribbon or badge, and a report card outlining the skills he has acquired over the year. These are proudly displayed in his room. He jumps at every opportunity to skate, including in the middle of a heat wave in August.

While the outdoor soccer venue is generally much nicer for parents (except when we get to encounter Kingston’s weather extremes), it is, for me, fraught with frustration about how my child is supposed to learn soccer, which is a universe away from the approach in skating.

This year, I vowed I would try to be analytical about the differences (versus getting frustrated and emotional, which is the natural parenting reaction), so as to help my kiddo, who really, really likes soccer, but who gets upset because he can’t play as well as he would like, and can’t figure out why.  kids' soccer

In soccer, the theory seems to be that if you find someone who knows how to play soccer, and they volunteer to show kids how to play, kids will learn—even if the much-appreciated volunteer has been given no guidance about how to teach the eager young Padawan. In practical terms, in our experience, this has meant having the kids do drills for 30 minutes, and then having the kids play a game. Somewhere in there, they are supposed to learn soccer. The skills are simple, right? You just run, and kick the ball. How hard can that be?

I have been to about 90% of the practices & games, and I have only rarely seen the kids being shown how to do something. My child has never been taught how to approach a game, even at a very basic level, except that he knows the point is to get goals. He knows that he should pass the ball and he generally understands why this is a good idea, but since he can’t quite figure out how to get the ball passed to him, this is not very helpful at present.

The boy can kick a ball, of course, and he improves a bit yearly, but no one has shown him how to control the ball at soccer practice. Fortunately for us, he loves soccer, and despite all of this, he plays with enthusiasm but not much skill. Other kids have real skills—possibly because their parents were actually taught how to play soccer, so they teach them, or, because they had different coaches over the years.  As the boy ages, he gets more and more aware of the skills differential, and doubt is starting to creep in.

Contrast this to skating. From the first day of his first skating class (with the same child:coach ratio), he was taught HOW to skate, by a certified coach. There was a nice clear list of skills he needed to master before moving up a level. In pre-skate, one key skill is getting up from the ice. (I like that one in particular.) Having moved up to the “real” skating lessons, he works on different skills at three different stations at each lesson. As he masters the skills in any one station, he will get a ribbon, and move up a level.

My child responds to this, and so, having also been born with reasonably good balance, he has moved up the levels quickly, often skating with older kids. Some skating Lessons2skill sets are harder for him, so he might be working on level 5 in ‘agility’ but only level 3 in ‘control’. Anytime he struggles with a skill and he can’t work it out himself, a coach will spend a few minutes watching him and then working with him on the skill. Each group has a teenaged program assistant who also helps show the kids how to do the skills. The report card we get each term has this all laid out for us, and we as parents can help him to know what skills he should work on (spirals, anyone?) to complete his current level.

The parallels to medical education are obvious to me. My medical education, and my clerkship in particular, was much very similar to the soccer approach: here’s some basic info, now go out there with practicing physicians, who have likely never learned how to teach, and, well, absorb it all and figure it out.  If you found a resident, or other clerk, or a nurse who could show you how to do something, or who would explain why something was being done, it was a golden day.  I don’t think this was very different than what most clerks of my era experienced.

Now, I will admit I learned a lot, and, I dare say, I was a good clerk—most of the time. My friends and I banded together, and taught one another. We passed on tips as one of us exited a rotation and the other one started. I definitely remember those days of not knowing what to do, being told to do it, and then not knowing why or how to do it. It wasn’t pretty. Some rotations were worse than others.

Skating lessons are much more in line with competency-based education. Our medical students crave clear directions, and clear instructions. The expectations are high but achievable, if they are clear, and feedback is provided. For some students, it’s easier (but never easy), and they are fortunate, and still deserve good teaching, assessment and feedback so they can improve. Other students really benefit from more explicit descriptions of what is expected, and feedback about what they need to do to meet these expectations. In my experience, most students welcome clear, high, but achievable expectations, in a supported environment. Learning medicine will never be easy, but we should not make things harder by just dropping them into an environment and hoping they figure out how to get the clerkship ball, so to speak.  A few minutes of direct observation can help me determine where a student is struggling, and I can provide feedback—something I am (mostly) comfortable with, having benefited from many hours of faculty development and good mentors.

As we enter fall, the boy’s soccer medal has joined his collection, and he is anxiously awaiting the beginning of skating in a few weeks. I am not looking forward to the hours in the cold rink, but I know my frustration level will be significantly decreased. I’ll be ready and happily working with all the students in our curriculum, but I’ll work hard to ensure that our new clerks, in particular, do not feel like a somewhat lost soccer player in the middle of a field, knowing they want to be there, but not actually knowing where the ball has gone.

Welcome to clerkship, #QMed2017. I look forward to seeing you on the wards, and remember to have fun!

2 Responses to A tale of two sports, a 7-year-old, and how we train doctors

  1. Onofre Moran says:

    Hi Michelle,

    I, like you, find the “teaching” system of soccer for kids IN CANADA rather frustrating. The problem is that it is volunteers that teach soccer to our kids at school and in parks in Canada (having said this, thanks to volunteers our kids have some soccer activities!).
    I grew up playing soccer and being coached since a young age by people who -even were not professional soccer players-, had learned the “trade” by experienced soccer players and (professional) Phys Ed teachers, resembling the “old school of learning medicine as an apprenticeship”.
    Kids who really are interested in soccer in countries where soccer is “big”, learn the theory and practice of soccer directly from professional soccer players and/or in professional soccer clubs who select to young soccer players who have excelled and are considered the best players in their local teams/areas, to give them the opportunity to become professional soccer players. Much like medical students are selected amongst thousands of students, to be trained professionally to become Doctors.

    Akin those professional soccer clubs that do their best to train the future professional soccer players to be the best players they can be, -we at Queen’s-, do the same for our medical students, so that they have the knowledge, skills and attitude to be competitive in national and international “soccer championships” and maybe one day in the “world cup”.

  2. Hi Onofre! I just found your reply. I too am grateful to the volunteers, and I know a number of parents who volunteer ,and it’s frustrating for them too. I hope that came through. Interestingly, the most frustrated parent volunteers are from outside of North America, and they agree with you 100%.

    It just struck me as to the similarities with the old-style clerkship … just jump in there and figure it out. So much time was spent figuring out where to find a form, which form to fill out, how to fill it out, that it really slowed down the whole “learning to think like a doctor” business. Gifted clinicians may or may not be skilled as teachers, just as I’m sure some super-star soccer players may never make good coaches. Learning how to coach or teach likely helps, regardless of one’s baseline skill level.

    I think we’re doing better, and I have hope for soccer. My boy still enjoys it, despite being somewhat lost, and we’ll try again next year… after a well-deserved break.

    Thanks for your reply.

Leave a Reply

Post Timeline

Curriculum Committee Information – September 28, 2017
Published Wed, November 15, 2017

Faculty and staff interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules. A meeting of the Curriculum Committee was held on September 28, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda. Faculty interested in reviewing the minutes of the September … Continue reading

Grade Inflation – the “dirty little secret” of academia
Published Mon, November 13, 2017

“Would any of us have gotten into medical school today?” This was the tongue-in-cheek question I posed to my classmates at our medical school reunion last year. They were rather amused by it and, being very much aware of the high academic standards required by our current admissions processes, believed the answer was an obvious “no”. I tried to raise … Continue reading

Facebook thinks I’m a doctor…
Published Mon, November 6, 2017

  And other unusual things that happen when you’re an educational developer at a medical school It’s a unique and interesting thing being one of the non-medically-trained employees who work (mostly behind the scenes) to help run the undergraduate medical education program at Queen’s. On the one hand, friends and family can sometimes think I’ve magically completed medical school in … Continue reading

Nominations open for next Exceptional Healer Award
Published Mon, October 30, 2017

Instilling the values of patient-centered care is one of our goals in the UGME program. It’s also what the Kingston Health Sciences Centre Exceptional Healer Award recognizes in physicians from both the Hotel Dieu and KGH sites. Launched earlier this year, the Exceptional Healer Award is sponsored by the KHSC Patient & Family Advisory Council. It honours a physician who … Continue reading

Students striving to make a difference in our community
Published Mon, October 23, 2017

One of the attributes that our Admissions Committee works very hard to identify in applicants is a commitment to service. This has multiple dimensions, involving service to both individual patients and communities. It’s therefore always very gratifying to learn of efforts such as that described below in todays guest article provided by students Lauren Wilson, Katherine Rabicki and Melissa Lorenzo. … Continue reading