In the 70s when I trained, we had no add-on curricula; we had no milestones; we had little interference from governing bodies. What we did have were role models.
In the current century, when I talk with students and residents (and I do that very often) they talk about what they see or do not see from their attending physicians and fellow residents. The carefully constructed curricula result from excellent intentions, but role models defeat those curricula every time.
If we want our learners to show respect for diverse patients; if we want our learners to understand the struggle that many patients have with drug costs; if we want our learners to make decisions based on patient preferences, then we must have clinician educators who embody those attributes.
A few months ago, we had an elderly patient who had spent six days in the ICU. She had a complex medical history. She and the family wanted her to go home. She wanted to go home to die, because she wanted to die at home. She wanted to go to church one more time. She and the family were unanimous on her end of life decision making. So we discharged her with hospice immediately.
The residents told me that they had not seen such a conversation previously. We listened and reacted in her best interest. We resisted suggestions that she go to rehab or a nursing home, because the family wanted to have her for end of life. The family members were remarkable. They were sad that she was dying, but respected her feeling that her time had come. She had had a great life, and now she wanted to be reunited with her husband.
Our learners need to learn from what we do. Talking the talk never achieves much. Walking the walk speaks louder than words.
Medical education needs investment in these role models. At each medical school, you know who they are. We must give them time to show our learners how to be a physician. What we do at the bedside matters. We influence our learners every day. Unfortunately, the learners tell us too many stories of negative role models.
So we can write curricula, develop milestones, but if we do not nurture and support our role models, we will never achieve our goals.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
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