Blog | Thursday, March 27, 2014

Residents and students want 'old school'


Recently I gave my rounding team individual feedback. After I give them feedback, I always ask them to comment on ways that I can improve as an attending. This group had verbalized, first as a group, then individually, that what they liked about my rounds as that I was “old school”.

What is old school and should we train all attending physicians in the old school ways?

They defined old school in 3 parts:

1) talking to the patient, taking a careful history and explaining what we are doing in understandable terms,

2) conducting relevant physical examination and demonstrating physical findings to the learners; and

3) using that information plus laboratory data and imaging studies to develop a differential diagnosis, with a clear explication of the thought process.

While I love receiving compliments, describing this process as “old school” saddens me. What about this description has become out of date? How else should one make internal medicine rounds?

What has gone wrong in medical education if this process is considered notable?

If we have many attending physicians who do not follow this process, then we need radical educational reform. We need to encourage attending physicians to honor traditional internal medicine.

Residents, students and recent graduates, please answer: Has old school become the exception? Do you want “old school”?

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.