Teaching as an Intern

We had a lecture on teaching as an intern from one of our master teachers at the VA. For pretty much all of us, teaching on the wards will be a new role next year. What do we do with the freshly minted third year medical student when we really don't feel that far removed from their shoes? How do we manage to role-model good behaviors and pass along words of wisdom while we're tired, overworked, stressed, and sleep-deprived?

I really want to be a good teaching intern next year. I love teaching, I value my own education, I learn the most when I teach, and I think it's an important responsibility. But it's pretty much impossible (and inefficient) for an intern to sit down and give a mini-lecture or chalk talk. What I learned is that intern teaching happens throughout the day in bits and spurts, recognizing that most moments are teachable moments and that most of them are less than 5 minutes long. Part of medical school is that hidden curriculum, learning the culture of inpatient medicine. Whether this culture is laudable or not, medical students must learn how to present a patient, write orders, call a consult, and sign-out; teaching how to do this is as important as teaching facts. Furthermore, this "hidden curriculum" is taught through modeling; the good intern is the one that models admirable behaviors and attitudes, thinks aloud, and explains what he does as he does it. The good teacher does this without imposing himself on the student; he facilitates that interaction between student and content rather than teacher and student, or worse, teacher and content.

From the last 20 years as a student, I've realized asking the right questions is really hard. When lecturers pose a question to a large group, silence occurs if the question is too hard or too easy. The effective lecturers pose the right question to their audience: challenging but not impossible, thought-provoking but not esoteric, general but not too general, specific but not too specific. The good questions stimulate the learner to solve things critically rather than dig around their memory banks for factoids. The good questions make the student feel good about himself yet also uncover things the student didn't know before.

Anyway, teaching is very important to me and it was a fantastic lecture to have to remind us that teaching is a skill we must prepare and practice, and that though we may be doctors, that does not automatically imply that we know how to pass our knowledge on.