Medical Education

Neurosurgery and pediatrics are two very different rotations, especially when it comes to teaching. At Children’s Memorial Hospital, there are two hours (8am and 12pm) reserved every day for resident teaching. There are signs at every nursing station that remind them not to page during those hours unless it is absolutely urgent. The sessions are set up for case discussions and they focus on the important, relevant points of diagnosis and management. It was set up so that I could contribute and not feel stupid (even though I never did).

On neurosurgery, there are four conferences each week that students are required to attend. Two of them are for residents only, with presentations given by either attendings or fellow students. The topics themselves can be fascinating, but they often cover very specific details that are irrelevant for students rotating through. The latest conference I attended was nothing more than an overzealous attending and a 90-minute pimping session. Even if I knew an answer, there was no way I would offer it up, because the resident who didn’t know would probably feel insulted and proceed to make the rest of my rotation miserable. The other two meetings essentially consist solely of attendings arguing over the minutiae of rare and complicated cases and their surgical plans while the residents answer pages or stare at their phones for the entire duration.

On pediatrics, this constant learning mentality extends into the resident-student interactions as well. The residents took the time out to give us lectures, review cases, and quiz us. If anything, they were afraid that they were spending too much time teaching us. The first day on my inpatient infectious diseases service, the chief resident took me and my teammate aside, told us how the computers worked and where to find important information, printed out flow sheets for us to use, gave us advice on how to present, explained the team dynamics and roles, and made us feel welcome.

On my neurosurgery block, I blundered around my first day feeling ignored. No one seemed to care that I was there until I got in their way. After following them around on rounds not really knowing what was going on, I found a friendly face to scrub in with. By the end of the day, I had no idea what my roles or responsibilities were, how I could help out, or what kind of information I was supposed to learn from my rotation. It wasn’t until the end of my first week that I started feeling comfortable and part of the team.

It’s no mystery that I feel like pediatrics got it right and neurosurgery got it wrong. There is an inherent problem with how “teaching” occurs in neurosurgery. Everyone is always expected to know everything about neurosurgery before the rotation begins or even before their residency begins (except maybe the finer details of management, which you can argue about once you’re an attending). If you don’t know the answer, you feel embarrassed and study furiously after you get home from working for 14 hours. There really is no teaching; there are only unrealistically high expectations. As I was watching the train wreck that was one resident’s attempt at a logical answer to a question, I couldn’t help but think to myself how much more effective it would have been if they had just taught it first.

The Religion of Medicine

Spirituality is a nebulous term and I’m not sure I think of it the same way everybody else does. If it’s the same as faith, how does it differ from religion? If it’s just a set of values or a belief system, how does it differ from culture? Like religion, I think of medicine as a faith system instead of a factbook. Every time we prescribe a medication or send a slide to pathology we are secretly hoping and praying that we are in the 95% confidence interval. We use p-values and percentages to reassure ourselves that we know what we’re doing despite the inherent uncertainty of the scientific method. And if all else fails we can always seek comfort in describing a presentation as atypical.

But our patients often expect us to have the answers. We live in a world that highly values the tenets of science and technology; we live in a world that places empiric data and experimental reproducibility on a pedestal. Patients want the definitive diagnosis. We search for the pathognomonic feature believing that if we find it, we cannot be wrong. It didn’t surprise me to find a mother throwing stimulant drugs at her 4-year-old misbehaving son for a criteria-based diagnosis of ADHD, but it was quite a shock to find a patient who accepted the response, “We just don’t know.” But we practice medicine with the faith that we are doing our best, and there are times when our beliefs butts heads with other religions.

I come from a Christian household and a Chinese heritage. I think it is Asian culture that has convinced my mom that herbs are good and synthetic medications are bad. She views the body as a tumultuous entity constantly fighting to balance positive and negative chi. Disease occurs when one side wins out. She believes that, instead of restoring that balance, most drugs disrupt it further and cause side effects. But I think it is religion that has convinced her that, if she were diagnosed with a terminal disease, she would refuse life-prolonging non-curative therapy. She feels she has led a full and complete life, and she will be ready to die if and when God makes it clear that it is her time to go. Unfortunately, hypothetical situations can only reveal how we think, not how we act. I tried to take it out of the theoretical realm to find out what she would really do. Would she really refuse chemotherapy to prolong a prognosis from 1 year to 10 years so that she could see her son graduate medical school, get married, and have children? She didn’t answer, but her silence was a far more illuminating response. She didn’t know.

As far as religion goes, I have yet to encounter one of the “classic” confrontations between religion and medicine on my rotations. I haven’t seen any Jehovah’s Witnesses hemorrhage out and refuse blood. I haven’t seen any devout Christian family refuse to take a permanently unconscious family member off life support. What I have seen is a great many people confused about the role of medicine, searching for its place in their lives. I am always humbled when our patients realize that medicine is as much a faith as their religion is, but even more so when they believe in its power to help as strongly as I do.