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!