Blog | Thursday, November 17, 2016

Tips for attendings: Learning is more difficult than teaching

As a newly minted journal faculty member rounding on the wards, I had great internal pride in my teaching ability. Like many residents and junior faculty I assumed that my teaching would result in the learners growing dramatically (especially since I had delivered the messages so brilliantly {please read that phrase with true sarcasm}).

During my growth as an educator I learned that teaching can help, but not as dramatically as I would have liked.

Try this yourself. Teach something to your learning group. Wait a week or two and then quiz them. At first you will be despondent, but then take time to reflect. How long did it take you to learn things?

About 15 years ago, the housestaff helped care for an unfortunate young woman with Wilson's disease. One resident presented the story at morning report, and I missed the diagnosis. I had never seen Wilson's disease, and really did not know much about how patients with Wilson's disease presented.

Approximately 2 weeks later, a different resident presented her story at a different morning report. I missed the diagnosis again.

The third time (yes this patient's story was recycled for a variety of presentations), I did remember the story. I now know the big clue is the very low alkaline phosphatase in a young patient with new liver disease.

Learning is complex. We learn better with repetition. We learn better with the use of different sensory inputs.

What should this mean for our teaching?

First, never apologize for repetition. Just yesterday I quizzed my team on something I had taught the previous week. One of four remembered the concept. So we repeated the key teaching points.

Second, encourage your learners to read about what they learn each day. I recommend that learners keep a small notebook (or enter notes into their smart phones). Each day they should pick 2 topics to reinforce. Spend 10 to 15 minutes on the topic. Reading about something that you just heard helps solidify the memory.

Understanding the difficulty of learning medicine should inform educators. Our job is to help our learners grow. This growth requires repetition. We owe our learners a great deal. Understanding and repetition are a good start.

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.