Content With Utility
Teaching the oppressive details about a disease beyond what the student learns from textbooks probably does not have the same utility for them as learning the fundamental principles of how to diagnose, treat, and prognosticate a disease, says Dr. Wiese.
Although most hospitalists train in internal medicine, with a lesser number training in pediatrics or family practice, all hospitalist instructors are still responsible for all students—including those who may be headed for radiology or orthopedics, for instance.
“I can teach the medical content that is of utility to that student’s performance,” Dr. Wiese says, “and I still share responsibility for their performance as an orthopedic surgeon, particularly with respect to how they manage medical disease.” The important lesson is that utility is defined by the learner. “If my student has chosen a future career in orthopedics, the content of the lectures will shift away from high-end internal medicine topics and toward what I think the future orthopedist before me needs to know.”
“Should we have to motivate students to be great physicians both professionally and in terms of patient care and knowledge competence?” asks Dr. Wiese. “At the end of the day, the answer should be no; everyone has responsibility for motivating themselves. But, like a great coach, it is still the coach’s responsibly to ensure that when the players are tired, when they’re hungry, when they’ve got other things on their mind, they will stay motivated to want to learn the skill—even before we begin to teach the skill.
“A big portion of that motivation comes from figuring out what their career goals are and helping to link the medical knowledge or the skill that you’re teaching to those hooks, those things that are going to be of interest to them.”
There are four key components to motivation, says Dr. Wiese.
“First, remember the student’s name and use it often,” he says. “Remember that they will not care what you know, until they know that you care. Second, be physical. Reach out with the handshake or pat on the shoulder when things get done correctly. Third, stay focused on their hooks: Couch all content in terms of how they will use it in their future careers, and focus your analogies on their personal interests. For example, if a student likes music, my teaching of heart murmurs is going to use analogies of the song writer and performer.”
“The medical knowledge is analogous to the play that the team will run or the skill of throwing the ball, but [there are a lot of other factors that influence what’s needed for] the game-time scenario,” Dr. Wiese says. “It’s how you interact with the clock for the game, how you interact with the referees, how you interact with your team mates, how you interact against the defense.”
To teach in order to prepare your “players” for the realities of the challenge—or the challenges of reality, as the case may be—teachers need to do more than unwittingly repeat the methods used when they were students.
“A student who is learning about a disease from Harrison’s or Cecil’s [textbooks] can focus on all the details and knowledge they need to know,” says Dr. Wiese. “But the thing that they can’t get out of the book and that they really need from the hospitalist coach is all that game-time instruction.”
In other words, hospitalists must consider with their students how to integrate their knowledge into their interactions with the hospital system.
In this era of PDAs, wireless networking, and access to the Internet, hospitalists are way past the point of having to keep all their acquired information in their heads, Dr. Wiese says. “The issue now is how do you ask the right questions and then access that knowledge—and then more importantly, how do you take that knowledge and put it into the ‘play’ that is the patient?” And that is what a student can’t get out of a book, he says—and what they need to get from their coach.