Transition from the hospital to the classroom

So this being my first blog entry, I figured it'd be a good opportunity to give a little background info about myself, as well as the purpose of the blog before I got into the hospital to classroom transition.

I'm currently, as of this past week, a graduate student at Penn's GSE.  I'm in the Teaching Learning and Leadership Division, in the masters program.  Before this week, I was a medical student at Penn (though now, technically I guess I'm supposed to call it the Perelman School of Medicine at the University of Pennsylvania...amazing what a quarter of a billion dollar donation will do).  I just finished my third year of medical school and now I'm taking the year to get my masters in education before finishing up my last year of medical school next year and applying to a pediatrics residency.  I want to do pediatric emergency medicine after residency.  While I will be a practicing clinician, I am also very interested in how medicine is taught both in medical school and in residency (hence the MSEd).  As far as my educational background, went to Yale for my undergraduate degree (I was a history major), initially studied foreign policy with the intent for that to become my career, but had a quarter-life crisis (or as my Dad likes to call it, my $250,000 epiphany) after an internship at the State Department the summer after my junior year.  After much angst and deliberation, I settled on a career in medicine.  Consequently after spending a year in Boston working as a waiter and an EMT, I applied to a post-bacc program at Bryn Mawr to complete the pre-med requirements (Physics, Bio, Gen Chem and Organic Chemistry plus their associated labs as well as the MCAT in 12 months).  I applied to Penn for medical school and have now just completed my third year.

I'm one of the students who works in the admissions office (hence the blog), so the purpose of this blog from the admissions office perspective is to give prospective students some insight into student life here at Penn (which I think is an awesome resource that gives you as my readers a more realistic understanding of student life).  They have told us to be honest in these blogs, which I will try to do.  I'll be posting weekly about my life at GSE. 

I'm sure I'll talk more in future blogs about why I chose to get a masters in education and how that fits into my future plans, but in short, I decided that I was interested in how medical education was taught, appalled at how little formal educational training our teachers (attending physicians and residents)  received and shocked at the paucity of evidence there was out there for what is actually effective as far as teaching medical students.  In the era of rising health care costs, decreasing reimbursement rates and increasing tuition for medical school, it struck me that while our health care system probably needed an overhaul (we'll leave that politically charged discussion for later), so too did our medical education system.

So now that you know a little bit about me, I guess I can get to the topic of today's post, the transition from the hospital to the classroom.   It's been an interesting transition, I'm coming off of two of the most intense rotations in medical school, my Sub-internships (sub-i).  Basically medical school is divided into three parts, the preclinical (or classroom) portion in which you sit in lectures and small group discussions for the first 18 months learning initially about the basic sciences and gross anatomy and then about the pathophysiology of disease; the core clerkships come next, they are the year of required clinical rotations (internal medicine, family medicine, surgery, emergency medicine, neurology, pediatrics and obstetrics/gynecology); and finally electives/sub-i's.  On the sub-i, you replace an intern (first year resident) on the team and consequently function as such, working the 80+ hour week, etc.  I just recently finished my Emergency Medicine sub-i (in July) and my Pediatrics sub-i (in August).  During August in particular, I was pretty much living at the hospital, super busy, but loving it.

While it has only been one week, the differences are pretty striking.  In the hospital so much of your grade is subjective, i.e what your residents think of you, so you have to be "on" all the time, constantly positive, cheerful and interactive. You are supposed to strike the balance between actively learning while not creating more work for your residents.  In a lot of ways to be a successful medical student you have to check your personality at the door, as while your learning is important, patient care comes first (as it should), and your learning should in no way negatively impact someone's health.  The learning you are doing is entirely patient centered, if your patient is having trouble breathing, you are going to learn all about the different things that can cause respiratory distress, in order to cure/stabilize them.  You learn about how to examine the patient to give you clues to what is wrong with them.  You research what tests are appropriate to aid in diagnosing the patient, and you learn about the evidence that supports or contraindicates each treatment.  It's fascinating, and tremendously effective, but it also leaves little time/energy for thinking about global issues (one of the reasons I think our health care system is broken is that doctors are not a part of the lobbying groups because they simply don't have time, so solutions are generally proposed without their input). It, in many ways, is exactly what you would expect from a professional school.

Contrast that with this past week.  During the initial portions of the week I constantly found myself tuning out of "low yield" discussions.  To me, "low yield" meant things that did not directly impact the tasks I had for the week (it's a very medical school approach).  But as the week progressed, I realized that this was part of the richer learning environment of graduate school, having the freedom to interact with my readings, wrestle with larger concepts and focus on the bigger picture.  I'm supposed to be learning for learning's sake, not because it will impact patient care.  Sure some of the more pie in the sky conversations are still striking me as overly idealistic and not practical as compared to the decision over whether or not antiobiotics are indicated in a patient with a fever with no source, but I think that's to be expected in graduate school, because where else are those thoughts to be explored and fleshed out.  That's not to say that I've abandoned my medical school ways entirely, I'm still in the Emergency Room every morning collecting data for the research study I'm working on, but it's nice to return to the type of rich discussions, readings and paper writing that comprised much of my collegiate experience as a history major.  There's less frenetic energy at GSE compared to the hospital, there's more room for personality and individuality.  There's much more independent study (I'm allowed to have a bad day and not have to pretend to love every minute of it), and independent learning.  The team collaborative element is not as hierarchical and is less formal, though just as prevalent.

I thought about calling this blog some play on words of the medical mantra surrounding how procedures are taught in the hospital "See One, Do One, Teach One," like "See One Do One, (take a year to learn how to effectively) Teach One"  or "See One, Do One, How the heck am I qualified to teach one?" but a) am not that creative and b) am hoping that this year is much more than that, and begins a lifelong journey of learning how to better teach medicine to future generations...