Mother Hen

I've just finished tutoring three rotations of med. students.  As their tutor, I had to decide on the content of the rotation, the schedule, make sure they had scrubs, lockers, food, basically worry about everything except wipe their noses. I felt more like a mother hen than a clinical instructor.  The first and last group were good. The second group made me depressed.  They seemed completely uninterested.  Whenever I asked a question (my style of teaching is very interactive) I was answered with silence and the glassy-eyed gaze of a newborn calf. I asked one of the students, based on her family name if she was related to the CEO of one of the health funds.  She replied that she was his daughter. I thought to myself, "Now I understand how she was accepted into med school."

During their rotations, I'm not assigned any particular schedule, so I help out whenever necessary and do emergency cases. One morning, I heard a call for help on the PA, when the call was repeated I went to that room. I asked the anesthesiologist was was wrong, she said asystole - cardiac arrest.  For some reason, she was drawing up meds and had not started closed heart massage.   I immediately started heart massage, other anesthesiologists came into the room and the incident quickly became a "mass caregiver event" (as opposed to a mass casualty event - which is much easier to manage.) After atropine and adrenaline the patient's pulse returned. And I left the room.

Reflecting on the case, I recalled what I learned in the ACLS instructors course: Recall of course content is very poor, hence requiring recertification at regular intervals. This was certainly true of this case, since the anesthesiologist did not immediately begin heart massage after calling for help.

My suggestion that I give a couple of refresher lectures to the department was accepted by the boss.

P.S. - The patient recovered completely with no neurological or cardiac sequelae.

Students

Students season is officially open!

I've been put in charge of the medical students who are rotating through anesthesia. They arrive in three rotations of two weeks each (actually 10 working days). In this short time, we must teach them the fundamentals of anesthesia, intensive care and chronic pain treatment. It is a Sisyphean task and in essence, we are only able to give them a taste of what it means to be an anesthesiologist.

My job is to be the mother hen: Create the daily schedule which includes daily assignments to the OR, make sure that the students have scrubs, know where to go and when. Remind the lecturers when they have to give a lecture etc...

My philosophy of androgogy (adult education) is that I don't spoon feed anyone. I'm more than happy to teach, or rather guide someone who is motivated to learn. I won't force any student to learn. Of course, one must constantly find ways to be interesting and engaging. Less lecturing and a more interactive approach has served me well. The idea is to ask many questions within the background of a clinical conundrum.

I also like to correct bad habits. One of the most annoying of these is that total lack of ability to present a case in an efficient manner. Differentiating between the wheat and the chaff in the sea of information about a particular patient is one of the most difficult things to learn.

With this in mind I include case presentations as an integral part of the rotation. The students themselves choose a patient to present. Even the most seemingly banal and routine case can be fodder for an in depth discussion about developing the anesthetic plan and anticipating the possible complications.

This first group is particularly sharp. They are interested, ask good questions and seem eager to learn. It is really a joy to guide such students. After the students presented a case to the chief of the department, she called me to say that she was very impressed with this group of students. I agreed, (obviously, one must always agree with the boss) and jokingly added that they were so good because they have such a wonderful teacher. "Exactly," she said, "that's why I called, to compliment you on doing a good job with them."

Of course it always helps to impress the boss. But the truth is, that all the credit goes to the students themselves, because they have the motivation to learn. I recall the very first year that I taught. I was given three students to guide. At the end of the rotation was the obligatory oral exam. One student earned a grade of 100, the second 85 and the third 65 (passing by the skin of his nose). Assuming that I treated each equally, the only explanation for such disparate grades is the ability and drive of each one.

But hey, if the boss wants to think that I'm responsible for their stellar performance, who am I to disagree?