Being an attending means being a teacher. Take that job seriously.

“Sometimes a simple, almost insignificant gesture on the part of a teacher can have a profound formative effect on the life of a student.”
– Paulo Freire

Think back to a moment when a teacher or “authority” figure gave you a compliment. We all have them, from kindergarten to high school to college and sometimes graduate school and work. The reason why many of you can recall such moments is that unlike compliments from friends, loved ones, or even parents, receiving a compliment from an instructor can hold a lot of weight in improving your self-esteem and motivating you. It can forge a bond of trust that motivates the student to work ever harder.

In college, in 2009, I took a philosophy of education class and grew to really come to appreciate the lessons that my professor, Dr. Pajares, taught and practiced himself. What I noticed was that he always valued all of his students and made us feel proud of any work we submitted to him. This wasn’t to say his class was easy. On the contrary, he graded harder than any teacher I had ever had. He never failed to miss a misused comma or citation because he felt it was his duty to improve the writing of his students down to every last detail. Since I felt like he invested so much time reading and editing my work I worked harder than I ever had before to improve my writing.

I was told by Dr. Pajares regularly, “You are good, but you have the potential to be so much more” which always pushed me to go the extra mile. Why get comfortable with my style of writing when I could be meticulously examining it for errors and make it better? His feedback made me feel capable and with that motivation I pushed myself ever harder to work.  After college, while working for one year in an underperforming school, I remembered his lessons. I always threw in a simple compliment to my students (especially the ones who would curse me off) and before I knew it, some of them were staying late after school to work on their math skills with me. As both student and teacher, I have seen this “motivational” effect in practice, and it can have wonderful outcomes.

Of course, how does this apply to clinical medicine? While I have a plethora of wonderful memories and experiences from my third year of medical school, unfortunately from what I have experienced, read, and discussed with fellow friends  across the country, this type of positive style teaching often isn’t practiced by some physicians who are meant to be “teachers.” I think many people do forget (I know I never will) the fear and hesitation that came with beginning the third year. I know many of us felt like we were teleported from this safe very well known world  of “study hard and take an exam” to a new land when suddenly there was constant stress from taking care of patients. In a manner similar to being the “new kid” at a new school, it was taxing to find a place within a new team every few weeks.  I think this adjustment related anxiety places students in particularly vulnerable circumstances.

In this sense, the effort to teach and encourage M3s to perform better becomes ever more important for attending clinical professors. Unfortunately many academic attendings do not seem to realize that many times they hold the spirit of their young third medical students. Often, the way the attendings treat the students determines how happy or miserable the students will be for the rest of the rotation and even more so if they will even join that specialty. The compassion that had led attendings desire to help heal and do good to patients, seems sometimes to get lost when it comes to interacting with students as they may not realize that a few simple words can make or break the spirit of their young future colleagues.

I felt like the physicians who made me feel most capable were kind and patient with me as I worked through translating the knowledge in my head into clinical patient care. Similar to Dr. Pajares this by no means implies the physicians who were best were the ones who “coddled” me, rather it was the ones who recognized I was an eager, bright-eyed student excited to learn about clinical medicine. In fact, one of my favorite attending physicians told me while referring to an H and P assignment  I turned in, “Your work is mediocre to below par. But I have seen you verbalize differentials, and you are smart enough to write a stronger assignment.”

Just like Dr. Pajares, she lifted my spirit by encouraging me to work harder to be best at what I do. Even while rounding with her she sometimes laughed at my differentials but also cared to let me defend my words and often times acknowledged that she loved having me on the team because once in a while through my efforts to learn I managed to teach her something new which is what her younger colleagues were for. I contrast that feeling of being part of a team with instances when I introduced myself to some of my, “teachers” and was ignored from the onset. Or times when I yelled at for seemingly insignificant errors, or humiliated once on the first day of a clerkship for not knowing a specialty related fact in front of others. I know others have many more experiences like this. Even though this type of negative teaching isn’t practiced as often as it is rumored to have been in the past, every attending should still strive to be compassionate and empathetic towards their students which most likely will best motivate them to be as capable as they can be which is the ultimate goal in education.

As a whole, my negative experiences were few, and I loved my clerkship year. But I see some gaping holes that at times hurt me and from what I have seen/heard have really hurt other colleagues. I acknowledge that many times medicine is too hectic and stressful for attendings to interact with or find time to teach students, but this is not always the case, as I have witnessed some of the busiest surgeons carve out even small pieces to show the students they are interested in them. Students have the right to be valued for their role and the right to be treated with respect. Most importantly they have the right to have their attending physicians teach them about the area they are rotating in.

Being a clinical professor at an academic medical center includes being a good teacher who can shape the minds and hearts of future physicians. This responsibility is a huge, and I can only hope in some way that all academic teachers reflect and value its importance.

Neil B. Newman is a medical student.

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