Learners are junior colleagues | Considerations

When I begin an orientation session with new medical learners, I frame our working relationship with this thought: they are my junior colleagues.

I remember how I felt when I first heard this from a preceptor: it set the vibe not only for that rotation, but also for my practice. I tell all my patients that someone taught me how to be a doctor, and now I get to show others how to be a doctor.

And so, I encourage my learners to practice their skills and receive feedback. Pointing out areas for improvement isn't meant to bring shame, but rather to sharpen their clinical reasoning. Because in a few years, they will be a fellow family physician or a specialist colleague, and they'll likely be doing the same for me.

The CaRMS match is a major transition point for medical students as it sets them on their path for their specialty, and receiving the news from my students this past week has been a thrill! Glad to have been part of their medical training and looking forward to crossing paths with these colleagues again.

Know where you want to go, and also go with the flow | Considerations

"What's your approach to medical condition]?" is a common question that preceptors will ask their learners. We are checking on how they approach a problem and break it down into manageable steps.

Medical learners, especially early in their training, spend extra time taking a history because they feel they have to collect every single piece of information. My tip for them is to center their questions around their differential diagnosis, that is, the potential causes for the presenting complaint.

Yet, they have to hold those possibilities in their minds while being in conversation with an actual human being. In those moments, they are no longer working from a textbook (or a computer screen!) - they have to respond to the questions and intonations and pauses of their patients.

Perhaps the above phrasing is a bit cheesy (I prefer poetic!), but these threads come together during each teaching session. Move with intention and also be personable.

That error could have happened to me | Considerations

This week I had a case that ended with a poor outcome. I reviewed the case with a colleague, and they reminded me that the error could have happened to them.

Physicians train to make accurate clinical judgements. That drive towards improving our acumen is an explanation why doctors like to "talk shop" - here's what I saw, here's what I thought, here's what I did. Oh good catch, we'd say. Good thinking, we'd applaud.

What happens less often is sharing what we missed or when we made the wrong decision.

Everyone has their reasons for holding that information back, but one contributing factor that I'm learning about is shame. From Brené Brown, shame is "the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging." We want to hide where we looked less than stellar as shame threatens our professional identity.

My conversation with this colleague reminded me of advice during residency from Dr. Sasha Cormier's project about medical errors and emotional support, where she found that in addition to talking and listening, peers can provide "professional reaffirmation by telling the colleague that they are good at their job and…it was an error that others could have/would have made."

I have no illusions that I'll go through my career error-free, so it's having support like this that renews my spirit . And as long as I make time to own mistakes rather than run away from them, I'll do better next time.