The Cornerstone of Medical Education and Practice? Listening.

  • /Reviewed by: Amy Rontal, MD
  • Whether we are aware of it, or just letting it happen in the background, everyday we are teachers, and we are learners. In the realm of academic medicine, the roles and relationships are obvious. Attendings teach residents, residents teach medical students. Medical students teach each other, and to a great degree, must teach themselves. Regardless of our chosen field of medicine, our patients depend on us daily for coaching and education – everything from how to manage blood sugar and insulin regimens to quelling fears about an upcoming surgical procedure. Why is it then, with education being central to so much that we do in medicine, that the majority of us lack formal instruction on how to teach?

    The logistics are, indeed, difficult. We devote most of our brainpower and nearly all of our time to patient care. Outside of our ambitious brethren who seek formalized advanced degrees in education, clinical duties leave precious little time for figuring out just how to teach.

    We also tell ourselves that teaching is absolutely natural, and that there is no need to learn how to do it. The act of teaching and learning is engrained into our very being — as lifelong learners from infancy throughout our lives — because we know how to learn, so we must know how to teach.

    The act of formalized teaching in medical education is uncannily analogous to the way that we approach patient care. From day one of medical school, we are told, and thereafter endlessly reminded of, the lynchpin of the art of medicine. It is the foundation of both the humanistic facets of practice, as well as the practical approach to diagnosis: Listen to your patient.

    Our corollary is simple. The foundation of the art of teaching: Listen to your student.

    Whether we are medical tutors, residents, or attendings, we work with every type of student. There’s struggling student A who is not even managing to scrape by, and after two years of a haphazardly assembled curriculum at a fly-by-night medical school, s/he is totally unprepared for Step 1. There is student B who has built a more than satisfactory fund of knowledge, but who suffers from crippling test anxiety. It would be foolish to apply the same approach to either of these students that we would use for the high-achieving student C, looking to bring their score from the 85th to 95th percentile.

    Student A needs an intensive crash course in all parts of the basic science curriculum. This is too much for a clinical supervisor to be responsible for, and the weight of such preparation falls on the shoulders of a dedicated tutor. Student B will likely benefit from professional counseling, and must be informed that this is not abnormal, nor a sign of weakness. Their pride shouldn’t stand in their way of addressing the one identifiable issue standing between them and academic mastery. Student C’s improvement comes from all members of the team — the attending and residents who push them farther in keeping up with the literature, giving presentations (both on rounds and educational seminars), and bolstering their own knowledge by teaching fellow medical students. A tutor can identify their few weak points, hone their testing strategy, and help them to reach the upper echelons of performance.

    When it comes to medical education, especially in the realm of standardized test preparation, individualization is key. Just as every student comes forth with a different set of circumstances, skills, goals, and work ethic, so too must every teaching plan be created with these tenets in mind. Only when you listen deeply and try to understand your student will you hear them assert, “This is how you should teach me.”

    Let this be your actionable plan. Next time a student approaches you and beseeches you to impart some of your knowledge unto them, don’t revert to your canned lecture of “Approach to AKI” or “Pathophysiology of Heart Failure.” Think about your student, listen to them, and understand where they are coming from. Tailor your approach to a methodology that will be of greatest service to them. It is not the easiest path, but it is the one with the greatest value. Not only will it help him or her excel as a student, but it will unequivocally transform you into a better teacher.