Doctors learn through mistakes during medical school

In most other professions, once you’re halfway through your education, you begin to develop confidence; slowly, but surely, fitting into shoes that once seemed too big for your petite, newbie feet. Not so in medicine.

Three years into it, and I still feel unsure – unsure of the answer to a rather simple question asked by an attending and unsure of whether I’m fit to be doing this in the first place. However, in those quiet moments of much needed soul-searching, a small voice inside me says yes, you are capable. Many of you will recognize the all-too-familiar faltering of conviction when asked a question that you think you know the answer to – you’re pretty sure, but not a 100% sure; it just seems like an instinctual regurgitation. Most of the time, self-doubt wins the battle and you keep quiet, avoiding eye contact with the attending, only to experience the even more familiar sensation of your heart falling all the way down to your feet (please excuse the medically inaccurate, nay, medically impossible, metaphor), thinking I knew that. What’s harder is trying, in the hope of applying a band-aid on the bleeding ego, to convince your peers that you actually did know the answer.

I have often wondered what it is that makes usually confident people act so meekly, and it eventually struck me – it’s medicine itself. In no other profession are you so directly and immediately responsible for your actions, your reactions and your mistakes. A mistake here doesn’t lead to disappointment; it leads, in the direst cases, to death. Although it is necessary to know the impact and the consequences of your actions, it is also necessary to not let yourself be paralyzed by the fear that accompanies this responsibility.

And where do you learn how to do that? Right here in medical school. A mistake here, at worst, means a dirty look from your attending and a round of ragging from your peers. Now who wouldn’t take that over the loss of someone’s life? Make all the mistakes you can while there is someone willing to correct them, because that’s how you learn. Nothing teaches like an attending’s rant about your ineptitude, usually right in front of the patient you were hoping to impress with your knowledge. And that is how you will gain the confidence to give the correct answer, not to your attending, but to the question in your own mind, about the best treatment modality for Patient X, when there is no one else to shoulder your responsibility and no room for mistakes.

Yes, those shoes still seem too big, and your feet still seem too small. But you’ll grow into them. And give those wings a try. If you fall, it’ll be into a safety net, and if you don’t, you’ll learn how to fly.

Irma Faruqi is a medical student. 

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  • Irma Faruqi

    “Our doubts are traitors, and make us lose the good we oft might win by fearing to attempt” – William Shakespeare

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Good judgement comes from experience.

    Experience comes from bad judgement.

    • http://www.twitter.com/alicearobertson Alice Robertson

      I like that. Okay…did you learn more via trial and error… or textbooks? Not an either/or question. I read about education a lot and like the European apprenticeship model that I feel offers so much more hands on type of education (we know even in preschool and elementary the retention rate when hands on is used, and the senses involved, is phenomenally higher)….just curious. After reading Dr. Gawande….wow….you wanted to throw yourself over your child when those residents came in the room….you smile…you chat….all the while praying they get their experience somewhere else…

      • Irma Faruqi

        I learned more through textbooks, but I retained more information from what I learned in a clinical setting. However, that’s an unreliable and inaccurate yardstick considering that I spent 95% of the last three years in a classroom and only 5% in the hospital. One reason for the extra retention could be that you see the outcome of your knowledge right away – you see the nod from the supervising doctor, the brightening up of the patient’s face and the (possible) look of awe on your colleagues’ faces, leading to positive reinforcement.
        I don’t think I blame you for not wanting someone still ‘in-training’ to come near a loved one, but I do know people who aren’t averse to it for the very simple reason, “How else will they learn?” Nonetheless, I think it’s always important to remember that they are under supervision, and this person might one day, unsupervised, be responsible for your health/life and wouldn’t you want them to be appropriately trained/experienced in case that situation arises?

        • http://www.twitter.com/alicearobertson Alice Robertson

          Sigh….um….I am not so altruistic that I want your first stab at delivering a child, or putting a breathing tube in, or messing up my child’s neck drain (I had to watch in horror on that one…resident was in such a hurry she snatched it out five days after the neck dissection with no morphine….wait until you watch your child turn chalk white and try to vomit because an untrained resident screwed up).

          Doctors are rarely guinea pigs….that’s an ideology for the vulnerable….just a fallacy they make us think they understand while protecting their own families….sigh…

          • Irma Faruqi

            All right, no one insists that you let an “untrained resident” (who are, btw, medical graduates and doctors; they’re just specializing in their chosen fields) perform procedures on you or your family. You are allowed to insist that you only want a specialist, but one must keep in mind that there are fewer of them and thus may not be available at all times.
            Secondly, do you have a doctor in your family? If you do, you’d know that families usually face the worst – aches and pains are ignored, procedures are often performed without anesthesia, because oftentimes these aren’t necessary. With a patient, you have to be empathetic, but the poor family members’ complaints are often overlooked.
            Finally, remember, that the doctor working on you/your family was once in training once. You better wish that enough people allowed him/her near them to give him sufficient experience to practice (pun unintended) on you!

          • http://www.twitter.com/alicearobertson Alice Robertson

            Do you have a doctor in the family?>>>>

            Um….specialists, internists galore.  I have a child with cancer and a child who had cancer…etc. more dealings with doctors than I want to admit.  It is not as cut and dry as you say.  And aren’t patients paying for a specialist….are we supposed to go to med school to be a patient…or are we required to exemplify the “trust” factor doctors like brain wash us with? :)  My specialist up and went sailing (actually, I think he went sailing and applied for a lucrative job) saying he was only a phone call away….the nurse claimed we were VIP’s (and on one level we were…the ENT said he would have used morphine…it’s an excruciating procedure….but the resident said she was rushed because the specialist was shocked they had not let us go home and she wanted to get us out of there before he called back…the specialist said everyone was warned the mother likes to email and he would hear about it….tis’ true….we had a warm relationship…we miss him terribly…he took that job as head of a department of a university hospital).   How in the world was I supposed to know morphine is required and know that it would cause pain on a level like that?  Should I interview residents at the next neck dissection to find out their skill level?  I know I will only let the specialist remove a tube again.  Experience is vital…….and my experience says bugger off to unskilled residents when it is my child:) 

            Before the last surgery I emailed the surgeon and requested no residents.  He pleaded the case for residents…I acquiesced….said I know when to surrender… but then he brought in a dream team….when I walked in they asked me who I was and how did I get this and that….I was all chuffed and a bag a chips!  Who doesn’t want the best for their child?  I do not have the “trust” factor in residents.  They can get their experience on someone who doesn’t mind pain, suffering and mess ups.  I don’t mind when they examine my child….they are actually better….I think they can catch an error because they are book smart….but the experience on painful procedures will not be done again….yes, experience is a cruel taskmaster…but we do learn.

            I would bet dollars to donuts Dr. Atul Gawande (author of Complications) is absolutely correct that doctors rarely let new residents mess with their own families, and if they do the residents know a mess up will be costly to themselves. 

          • Irma Faruqi

            I’m sorry to hear about your children, and I hope and pray that they get well soon and that you and your family have the strength and support to deal with such a trial. I can understand that you have had bad experiences, but people have had bad experiences with specialists as well, and one can’t stop going to doctors altogether.
            Nonetheless, I asked about a doctor in the family, because then one knows that they are not always given the best treatment – I know parents who have removed painful sutures in their children without anesthesia, parents who have preferred to sleep after a long shift instead of waking up and administering an intramuscular painkiller and a husband who failed to diagnose his wife’s condition because he didn’t pay enough attention.
            Anyway, we digress here. I was talking about med school and not residency. A resident is a doctor and is held responsible for his/her mistakes, while a med student who has yet to obtain a degree is always supervised, needs a senior’s approval before any procedures/prescriptions and is, in a broad sense of the term, guiltless.
            Once again, my sympathies. May you and your family always be blessed with health.

  • Anonymous

    I also read “Complications” by Atul Gawande about his medical training at Johns Hopkins.   What an eye opener about how patients are used in teaching hospitals.
     
    He told of the ways medical trainees are taught to “steal” their learning from patients, the easiest using the secrecy of the OR. Then to the outpatient setting where he said “elision” (deliberate withholding of the truth as to their experience) is tolerated.
     
    But when he had to bring his own sick young son into the hospital to be treated for some health condition,  he insisted on the expertise of the department head, dismissing the offer of a Fellow who was specializing in his son’s condition. To his credit, he did acknowledge the double standard and “perks” that hospital workers get with direct access to experienced caregivers when they or their families get sick,  offering the understandable explanation that as a parent he only wanted the “very best for his son”.

    • Irma Faruqi

      I’m not arguing with reality, but I challenge anyone to find an alternative teaching method. Medicine is both a science and an art – and while one can memorize and calculate all the ‘science’ there is in it, art can only be learned as an apprentice. As many students discover, being booksmart gets you nowhere in the hospital.
      Furthermore, why shouldn’t a doctor use his/her contacts/resources for his/her family? Wouldn’t a lawyer recommend the best in his profession to a loved one? Wouldn’t a hairdresser go to the best? Wouldn’t you, as a layperson, go to the most highly recommended doctor? No doctor is stopping his/her patients from going to whomever they think is best, so why should the doctors not do the same?
      With all due respect, this article was directed towards medical students (NOT residents), and did not aim to start a book club discussion on “Complications – A Surgeon’s Notes on an Imperfect Science”!

      • http://www.twitter.com/alicearobertson Alice Robertson

        I guess the dark side of medicine is only a place for patients…not doctors to be recipients only deliverers? Now tell us again why you are a medical student and how you worded your entry level writing about all the patients you were going to heal…sigh…

        • Irma Faruqi

          Ha ha… I’d never put my name to a cliched essay like that!

          • http://www.twitter.com/alicearobertson Alice Robertson

            That’s fine….with my experience with doctors and teaching literature….I am grateful that you are not practicing medicine……your posts have shown a lack maturity and are devoid of what it takes to be a good doctor…or writer.

          • Irma Faruqi

            Hmm… I have a lot to say to that, but I don’t want to dignify your cyber equivalent of pinching and eye-gouging with a response.
            I would like to point out, however, that this essay would be considered ‘language’, not ‘literature’, and I assume you mean lack OF maturity. Hope you’ve taught your students better!

          • http://www.twitter.com/alicearobertson Alice Robertson

            By golly….you accomplished something….your career choice should be in discovering typos….that missing word changes everything…the whole intent of the writer is illuminated in your expose. Whew….thank you….the audience thanks you….Encore! LOL. On one level your theatrics are amusing….if you were not considering medicine as your career choice…with such a lack of empathy…..hopefully, that will be picked up on by a teacher who will see this thread and try to help guide you to a better career choice…..which I imagine
            would be in the Drama Club:). Just sayin’!

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