The following note was sent by one of our fourth year students to her community preceptor at the end of her Integrated Community Clerkship. Both parties have graciously agreed to allow me to share it with you.
Dear Dr. McLean
- Teaching me Medicine
- Trusting me with your patients
- Introducing me to Perth
- Letting me be wrong
- Helping me get to the right answer
- Asking my opinion
- Demonstrating to me how to make patients feel heard
- Having office hours that work for patients (the 7am start makes so much sense)
- Encouraging me to be curious about patients’ personal histories
- Stashing Fudgeo’s
- Asking me hard questions
- Not making me feel silly when I didn’t know the answer
- But expecting that I know it next time
- Being patient as I learn procedural skills
- Filling out the paperwork while I finish the fun jobs
- Showing me that people are the most interesting part of medical practice
- Helping the office get through an entire Costco bag of Swiss chocolate…in a week.
- Demonstrating the type of discipline you keep teaching me to foster
- Taking me to the family medicine update conference
- Letting me draft on the bike and in the office!
- Building me up in front of patients
- Laughing with me at the occasional absurdities of family practice
- Teaching me to look
- To always look
- Introducing me to DQ milkshakes
- Telling me something isn’t right with a simple glance during procedures
- And feedbacking a quiet “better” once I corrected
- Magically knowing when I was prepared enough for you to disappear behind the curtain
- Giving me generations of social history in one or two sentences
- Helping me process hard-to-process patients
- Teaching me to dictate after every patient
- Showing me that the chart can be your friend…
- …it lets you go on holiday
- …and remind you of things you forget
- Patching up the first-year medical student
- Saying “I don’t know” with patients
- Saying “I don’t know” to me
- Showing me that we have a responsibility to advocate aggressively but politely for our patients
- Not using much technology but having an awesome EMR
- Teaching me to look for the why
- Reminding me why I do not want to be a rhythmologist
- Post-clinic Buster Bars
- Teaching me to punt when appropriate, better too soon than too late
- Stressing the importance of good documentation
- Making me remember the type of doctor I wanted to be as a kid
- Walking down to radiology.
- Talking to me about my future
- And making me think twice about what it might hold
- Deliberately debriefing the patient who coded
- Reminding me that I cannot solve all of a patient’s problems but can stand by her as she chooses to make her life better, or not
- Organizing similar experiences for so many other medical students
- So proudly showing me Lanark Lodge
- Teaching me an approach to explain the “needs further testing” imaging results with patients
- Challenging me to make a real difference for patients, not just correct their serum sodium concentration
- Auto-bolusing the syncopal wedding guest
- Taking off early one afternoon to go biking
- Reminding me to read around patients
- Teaching me that if to make a clinical decision you need more information, then go get that information
- To help me in my first “teaching role” during community week
- Letting me check all the well babies
- Including me in the joys and sorrows of rural family practice
- Helping me to find even more fulfillment in Medicine
- And…inspiring me to dream big while rooting my future in discipline, curiosity, wonder, humility and purpose.
Despite the complexity of modern pedagogical theory, expectations of multiple “shareholders” and increasing demands of accrediting agencies, the essence of medical education remains constant since the pre-Flexner apprenticeship days. Fundamentally, the overriding objective of any program hoping to graduate competent physicians is to identify motivated, receptive learners, and put them into contact with capable, inspiring physicians in a setting that allows the interchange to flourish. That’s basically what any medical school struggles to accomplish. And when those three elements come together….well, the effect is just magical and wonderful to behold.
Motivated learners aren’t hard to come by. As we’re all aware, there are many more highly motivated young people pursuing medical education than positions available. The considerable challenge, as we’ve discussed in previous blogs, is identifying those with the right motivations.
Medical School Admissions: Striving for fairness despite “ill designed” tools http://meds.queensu.ca/blog/undergraduate/?p=363
Medical School Admissions: Unintended Consequences http://meds.queensu.ca/blog/undergraduate/?p=407
Effective educational settings are essential and include appropriately structured and resourced classrooms, clinical learning centres, simulation laboratories, libraries and a continually evolving variety of learning facilities. However, medical education must necessarily extend to clinical settings where students can engage “real” patients in “real” venues. Our Integrated Community Clerkships, which have been in operation in Perth, Picton, Brockville and Prescott for the past four years, are true immersion experiences for our students. They spend 18 weeks living in those communities, working with local physicians, seeing patients in offices, emergency departments, hospital wards, nursing facilities, their homes, or wherever the circumstances require. In addition to learning a great deal about a variety of clinical problems, they become part of those communities and learn about how physicians manage their professional and personal lives. Importantly, they develop a more complete sense of themselves as independent physicians. These rotations have proven remarkably successful, as measured by student satisfaction and academic success. Although many educational leaders and affiliated community faculty have contributed to this success, the two most responsible have been Richard VanWylick, who took on and still provides administrative leadership for the program, and Ross McLean, who not only participates so effectively in the teaching, but has provided steadfast and highly effective support for the program through his role as leader of the Eastern Ontario Regional Medical Education Program (ERMEP).
Which brings us to the most important and valuable of our three key ingredients: the capable, inspiring physician-teachers. At Queen’s, we’re blessed with many such people, none more dedicated or effective than Dr. McLean. Although he’d never describe himself as an “educator”, he is an instinctive teacher with an abiding drive to pass on his 40+ years of experience and wisdom to the next generation of learners (I can assure you he’s not in this for the monetary awards). The qualities of responsible advocacy, sensitivity, professional commitment and diligence that make him such an effective physician, translate naturally to his role as a teacher. His dedication to the profession and to his community are legendary and have been recognized by his having been presented with the Glenn Sawyer Award honouring “a distinguished career of service” in 2011. I understand there is a lively debate in Perth as to how many physicians will be required to replace him when he retires. Estimates range from three to five.
Eve Purdy’s letter captures more effectively than any treatise on educational theory or compendium of accreditation standards, the elements of an effective learner-teacher interaction. I can’t really add to it, except to join her in saying…Thank you Dr. McLean.