(no subject)
my first week of seeing patients has taught me a lot. mostly, though, it's taught me that harvard students are expected to work FREAKING HARD. for every patient they see, they are expected to read up textbooks, uptodate, journal articles etc until they know every detail of the physiology, pathogenesis, investigations, and management options for their patient. and i don't mean generally. i mean in fine detail. i had a thyroid patient and i got asked how thyroid function tests are done (as in, the laboratory process), what was a TSH, T4, T3 and T3 uptake and what did they tell you. i had a patient with glucocorticoid induced osteoporosis and was asked by what mechanisms did glucocorticoids cause osteoporosis at an intracellular signalling level. this is detail that would NEVER be expected of us at UWA. ever. they expect more detail than we got TAUGHT in physiology and pathology and pharmacology. and the bummer is you have to basically find out ALL of that for your patient BY THE NEXT MORNING when you round with the attending (consultant).
but the upside is: you learn a DAMN LOT. also, harvard medical students, having done 4 years undergrad already (even in unrelated fields) don't necessarily get didactic teaching like we do here. they don't get lectures and have PBLs and tutorials (which is what i spend most of my learning time on). so every patient they see they must learn in detail because that might be the only teaching they get for that condition. and in order to increase the number of conditions they know about, for each patient they see with comorbidities, they may be expected to read up on those comorbidities as well.
it's superhardcore, and it turns out students who know a heck of a lot and also get used to sleeping ~4hrs a night (the average night for my fellows). the emphasis on physiology and pathogenesis is not necessarily helpful to clinical practice, however. one attending that i met recently suggested that harvard students know a lot when they graduate but make absolutely terrible clinicians because they knew nothing practical. i overheard some students complaining that they were practicing phlebotomy on each other and kept on failing. in contrast i remember that most of us at our first try at phlebotomy managed it with relative ease. i will probably end up doing a little bit more of this reading up when i get back to perth, particularly since there is even less didactic teaching in 6th year. but i will never go to the extent that they do it here. everything in moderation. that's the key.
one of the other differences i've noticed here is the absolute lack of cynicism amongst drs at all levels. for instance, all the attendings i've met manage to maintain wide-eyed interest when being told about a funky new procedure (eg draining CSF through the optic nerve sheath to alleviate raised ICP) or when listening to lectures that i fall asleep in ('thanks for that talk, it was really good, i have this really complicated question to ask!' 'wow, that's a really good question i'm so glad you asked it, here is my answer!') continue to be actively sympathetic to patients whom we would dismiss as non-compliant, and treat the patients who google their conditions as intelligent and well-informed.
to be perfectly honest, i think part of this lack of cynicism is due to the private health system. everyday the attendings fill out their little white cards with the patients theyve seen, and then submit them in order to get paid. they have a vested interest in the wellbeing of their patients, in much the same way private patients here see a consultant first before an intern. but i also think part of it is due to the hard work they put in. we all remember how amazing the human body seemed when we were learning about it in our preclinical years. the way their teaching is structured here, with the constant reading, must serve as a continual reminder of that wonder they first felt as students. a huge contributor to developing cynicism is thought to be burn-out, but here they work more intensely and in greater quantities than we do in perth and yet manage to maintain the naivete and idealism of first year students.
i'm not advocating working so hard. medicine literally ends up taking up their whole lives. also, i do NOT believe that attendings here are any more knowledgeable or competent than consultants in australia - so the catch up does happen. but i can certainly see the benefits of the style of their education, and will no doubt be applying some of that to my practice back in perth.
but the upside is: you learn a DAMN LOT. also, harvard medical students, having done 4 years undergrad already (even in unrelated fields) don't necessarily get didactic teaching like we do here. they don't get lectures and have PBLs and tutorials (which is what i spend most of my learning time on). so every patient they see they must learn in detail because that might be the only teaching they get for that condition. and in order to increase the number of conditions they know about, for each patient they see with comorbidities, they may be expected to read up on those comorbidities as well.
it's superhardcore, and it turns out students who know a heck of a lot and also get used to sleeping ~4hrs a night (the average night for my fellows). the emphasis on physiology and pathogenesis is not necessarily helpful to clinical practice, however. one attending that i met recently suggested that harvard students know a lot when they graduate but make absolutely terrible clinicians because they knew nothing practical. i overheard some students complaining that they were practicing phlebotomy on each other and kept on failing. in contrast i remember that most of us at our first try at phlebotomy managed it with relative ease. i will probably end up doing a little bit more of this reading up when i get back to perth, particularly since there is even less didactic teaching in 6th year. but i will never go to the extent that they do it here. everything in moderation. that's the key.
one of the other differences i've noticed here is the absolute lack of cynicism amongst drs at all levels. for instance, all the attendings i've met manage to maintain wide-eyed interest when being told about a funky new procedure (eg draining CSF through the optic nerve sheath to alleviate raised ICP) or when listening to lectures that i fall asleep in ('thanks for that talk, it was really good, i have this really complicated question to ask!' 'wow, that's a really good question i'm so glad you asked it, here is my answer!') continue to be actively sympathetic to patients whom we would dismiss as non-compliant, and treat the patients who google their conditions as intelligent and well-informed.
to be perfectly honest, i think part of this lack of cynicism is due to the private health system. everyday the attendings fill out their little white cards with the patients theyve seen, and then submit them in order to get paid. they have a vested interest in the wellbeing of their patients, in much the same way private patients here see a consultant first before an intern. but i also think part of it is due to the hard work they put in. we all remember how amazing the human body seemed when we were learning about it in our preclinical years. the way their teaching is structured here, with the constant reading, must serve as a continual reminder of that wonder they first felt as students. a huge contributor to developing cynicism is thought to be burn-out, but here they work more intensely and in greater quantities than we do in perth and yet manage to maintain the naivete and idealism of first year students.
i'm not advocating working so hard. medicine literally ends up taking up their whole lives. also, i do NOT believe that attendings here are any more knowledgeable or competent than consultants in australia - so the catch up does happen. but i can certainly see the benefits of the style of their education, and will no doubt be applying some of that to my practice back in perth.