I love each of these points! Dr Cifu seems to point out that attendings will no longer be as likely to ask these detailed questions, ie "grill" residents, as it seems the current teaching environment is trying to limit this approach. he's encouraging trainees to take this approach for themselves. I agree with all his suggestions, but wonder how likely it is that each resident, in the thick of the daily stress and grind, would have these mindsets and attitudes. It does seem to be the role of attendings to teach in this fashion - and really, the whole point of training!. It would be in residency where one would learn to ask these questions. Sad if it is not what is happening today. I've heard many academic attendings now refer to interns and residents as "learners" - this seems to infantilize these very capable adult members of the healthcare team.
In medical education, as in everything, it's generally not helpful to be in an extreme - neither extremely harsh, nor extremely soft. this list encourages that middle ground of most effective teaching techniques and the most logical and effective attitude to have as a practicing physician ongoing.
This is a great list to give each intern, resident, AND each attending at the start of each academic year to remind every one of the entire point of their endeavors.
Internship year is not the time for making major life altering personal decisions. Marriage, divorce, home buying and the like are best avoided during internship.
Continued excellent advice! My favorite is: "Learn by doing." It is like any other skill. The more we golf, the better we get at it. The more we work out, and eat healthily, the better health we will get. Same with clinical practice: the more patients we see, the more work we do, the better physicians we will be. It never ceases to amaze me that the same trainees who will happily spend hours on end in the gym may balk at spending 15 more minutes after their shift to care for a sick patient.
During my internship an attending told us about a technique he frequently employed when giving a presentation in a conference. If your presentation includes x-rays or scans, always hang one upside down or backwards. There is always someone in the audience who is dying to make a comment and/or criticism. By getting that out of the way at the beginning one can often satisfy that need and allow you to complete the presentation without further interruption.
I did IM residency over 15 years ago at a respected California program known to be collegial and not malignant. Even then, Dr. Cifu’s wonderful principles, all which reflect a growth mindset, were not systemic. I have not been in academic medicine since, so I am curious if today’s programs reflect these principles?
Looking back I realize only a handful of the best attendings indirectly promoted them. The rest, their teaching styles highlighted those who had the most esoteric book smarts and embarrassed those who were (rightfully) struggling during the most challenging years of their lives. Dr. Prasad’s criticisms of current medical education seem to favor this style, concerned that today’s doctors are “weaker” and not learning critical thinking skills in a “woke” environment. I can’t see how this is true if principles similar to Dr. Cifu’s form the foundation of today’s programs.
My fear is they do not, and remain hidden, only to be experienced by chance when residents are assigned their teams.
If true, I’d argue THAT is the failure of medical education, not Dr. Prasad’s overweighted concerns about vaccine mandates and masking 2 year-olds.
I love each of these points! Dr Cifu seems to point out that attendings will no longer be as likely to ask these detailed questions, ie "grill" residents, as it seems the current teaching environment is trying to limit this approach. he's encouraging trainees to take this approach for themselves. I agree with all his suggestions, but wonder how likely it is that each resident, in the thick of the daily stress and grind, would have these mindsets and attitudes. It does seem to be the role of attendings to teach in this fashion - and really, the whole point of training!. It would be in residency where one would learn to ask these questions. Sad if it is not what is happening today. I've heard many academic attendings now refer to interns and residents as "learners" - this seems to infantilize these very capable adult members of the healthcare team.
In medical education, as in everything, it's generally not helpful to be in an extreme - neither extremely harsh, nor extremely soft. this list encourages that middle ground of most effective teaching techniques and the most logical and effective attitude to have as a practicing physician ongoing.
This is a great list to give each intern, resident, AND each attending at the start of each academic year to remind every one of the entire point of their endeavors.
Internship year is not the time for making major life altering personal decisions. Marriage, divorce, home buying and the like are best avoided during internship.
Continued excellent advice! My favorite is: "Learn by doing." It is like any other skill. The more we golf, the better we get at it. The more we work out, and eat healthily, the better health we will get. Same with clinical practice: the more patients we see, the more work we do, the better physicians we will be. It never ceases to amaze me that the same trainees who will happily spend hours on end in the gym may balk at spending 15 more minutes after their shift to care for a sick patient.
I would say that these are a good reminder also for attendings (or consultants as we call them in Aus).
Agree 1000%
During my internship an attending told us about a technique he frequently employed when giving a presentation in a conference. If your presentation includes x-rays or scans, always hang one upside down or backwards. There is always someone in the audience who is dying to make a comment and/or criticism. By getting that out of the way at the beginning one can often satisfy that need and allow you to complete the presentation without further interruption.
I love that!
I did IM residency over 15 years ago at a respected California program known to be collegial and not malignant. Even then, Dr. Cifu’s wonderful principles, all which reflect a growth mindset, were not systemic. I have not been in academic medicine since, so I am curious if today’s programs reflect these principles?
Looking back I realize only a handful of the best attendings indirectly promoted them. The rest, their teaching styles highlighted those who had the most esoteric book smarts and embarrassed those who were (rightfully) struggling during the most challenging years of their lives. Dr. Prasad’s criticisms of current medical education seem to favor this style, concerned that today’s doctors are “weaker” and not learning critical thinking skills in a “woke” environment. I can’t see how this is true if principles similar to Dr. Cifu’s form the foundation of today’s programs.
My fear is they do not, and remain hidden, only to be experienced by chance when residents are assigned their teams.
If true, I’d argue THAT is the failure of medical education, not Dr. Prasad’s overweighted concerns about vaccine mandates and masking 2 year-olds.