Daniel Egan, MD

Disclosures

August 06, 2007

Question

I just finished medical school and am now an intern. How can I already be expected to teach medical students?

Response From Expert

 

Daniel Egan, MD
Attending Physician, Emergency Medicine Department, St. Vincent's Hospital, New York Medical College, New York, NY

It seems crazy, right? But as an intern, you are "responsible" for the education of medical students. I am sure you can remember talking to other medical students about which residents and interns were good teachers. Now you are thrown into the role of being the teacher. I have always found it interesting that, although we are expected to be lifelong teachers of students, patients, interns, residents, and fellows, we infrequently receive formal training in how to teach.

But back to the question: What it is like to work with a medical student as an intern? I can remember the first time I had a medical student working with me. I recall the struggle I had internally about making sure that I gave the student independence to feel like she was a part of the team, while at the same time staying actively involved in the patient's care. I still struggle with that dilemma, as I hate to be labeled a "micro-manager" by residents. In using that label, they imply that I am too hands-on and do not give them the freedom to make their own clinical decisions. As you will see, though, it is difficult to relinquish control of something that is critical to a patient's outcome as well as to your own medical license.

I think the first thing to remember when you have a medical student working with you is that they are there to learn. We can all think of times as a student when we worked with a resident who took the time to teach us something worthwhile, whether it was telling a quick vignette on rounds or teaching the intricate details of a procedure (even a nasogastric tube is exciting as a student). My first piece of advice is to find the teachable moment. Almost every patient encounter can provide a small topic for teaching. Although students are close to you in their training, there is a substantial learning curve that takes place through the clinical years and then during your intern year. You actually do know more than them at this point (maybe not about the pathophysiology of the Krebs cycle, but definitely about clinical medicine). Students love to learn. They will respond well to your taking the time to talk about a topic or procedure with them.

Second, give the student independence. This does not mean neglecting your patients, but try to find some part of the patient's care for which the student can feel responsible. Perhaps this means a blood draw if your nurses don't draw bloods. Perhaps it means obtaining the reading from the radiologist. Perhaps it means spending time at the bedside to update the patient and/or family on what is going on. Although we all have suffered through the scut of being a student, giving them a task that is directly beneficial to the patient as well as something that will help them in the long run is highly worthwhile. Empowering a student with something lets them know that you value their membership on your team and are relying on them for some portion of your patient's care.

Third, remind yourself that this is your patient. Students are students. They are learning and figuring out how to practice medicine. You will see as you go through your training that it becomes easier and easier not to reexamine someone if you are told the lungs are clear. Or, perhaps, you are told that the labs are normal but have not verified them yourself. There are some tasks that are appropriate to give to a student rather than doing them yourself (such as submitting a requisition for a test). However, in all examples directly related to your patient and their well-being, you need to check and double-check your student's work. Yes, this creates more work for you, but it is part of the deal when working in a teaching setting. Remind yourself that someone once did this for you, and now it is your turn to do the same.

As a busy intern, you will resent everything that gives you more work. But try to avoid letting this additional work cause any bad feelings toward your student. He or she is part of your team, and as you know, they will do practically anything you ask of them. They can be a huge asset. In addition, you will learn from teaching. The more we move away from the "see one, do one, teach one" mentality and embrace our teaching responsibilities, the stronger we will become as clinicians and the better training we will provide to future interns and residents.

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