Insights on Residency Training

Kashif Shaikh, MD, is the 2016-17 Chief Resident in Internal Medicine at the University of Central Florida College of Medicine.

We all start with medical school

I still remember the day I got the welcome letter from my medical school. I was super excited and proud. My dreams of becoming a physician were now a reality. So, I pushed myself during my two basic science years and awaited my clinical years.

I bought my first stethoscope and white coat in anticipation of my third year. (By the way, I still have the stethoscope that I bought almost 15 years ago, and it is the only stethoscope I still use.) I started my first rotation in community health sciences and family medicine. I was thrilled! But, the first patient I saw described his chief complaint in a most interesting way. My patient said, “I have a gas that starts in my stomach and goes into my head.” Even though I have been practicing history-taking for some time, it took me a moment to collect myself and to complete that medical history. Anyway, things got better with time. Nothing beats being a third year senior medical student in a white coat with a stethoscope hanging around your neck.

Johannes Jansson/norden.org [CC BY 2.5 dk] via Wikimedia Commons

 I began my medicine clerkship. By that time, I could take a comprehensive history and physical without losing a beat. I started interacting more with residents and attendings. I wanted to be a teacher, and I started identifying role models.

During medical school, I knew what kind of resident I wanted to be. I wanted to develop the same virtues that I admired in my role models: Kindness, passion, and dedication to teaching, and supportive and encouraging when the medical education process became very stressful. I wanted to be my students’ biggest support in a nurturing environment. I wanted to make learning fun, easy, and enjoyable. And I wanted to guide them through all phases of learning, from the medicine wards to residency applications.

By U.S. Navy photo by Mass Communication Specialist 2nd Class Gary Granger Jr. [Public domain], via Wikimedia Commons

A plan for teaching medical students

As an attending and a chief resident, I have been applying some of the key concepts about teaching medical students that I learned at the APDIM chief resident meeting.

• 1. I start orienting medical students on day 1. I discuss learning objectives, expectations, and how they can get the most out of their internal medicine rotations. I explain the residency match process in detail. I guide them on how to get LORs and write personal statements.

• 2. We do 1-hour teaching sessions, three times weekly. Each student gives a 10-minute presentation (2 students per session) to learn how to present and to become teachers — as residents and attendings, I hope they will carry on this tradition. They receive feedback  and some clinical pearls, and we work on board questions with explanations and test-taking skills and strategies.
• 3. To help develop clinical reasoning, we have a student-style morning report session. We simulate an actual patient scenario. I ask them to take a history and to tell me what they would do on the physical exam to come up with a differential diagnosis. Then I ask them to narrow it down, based on labs and imaging they would order.
• 4. I assign new patients to a medical student and an intern. The patient sees the student first, followed by the intern. We all sit down and critique the student’s presentation of the case. Then I round with them to do bedside teaching. Our team comes up with a consolidated plan for the next day’s rounds. With this teaching method, students begin to master clinical reasoning.

By HBS1908 (Own work) [CC BY-SA 3.0], via Wikimedia Commons

The best part of being an educator

I hear a lot of people complain about medical students. Do teachers and educators take responsibility for orienting them and teaching them? Patient care can be time-consuming, but students need direction. What’s the point of being on a rotation if no one is teaching? We have all been students. Engaging students more, and emphasizing how important they are as team members, makes a huge difference.

By DariaRomanova (Own work) [CC BY-SA 3.0], via Wikimedia Commons

I am amazed by medical students’ learning potential. They just need a little motivation to get things moving. I ask these students to be the future educators and be role models for their future students. Students learn best when they are given constructive and objective feedback through examples.

I am very proud of my medical students. They are my responsibility when they are rotating with us, and they should get maximum education out of the rotation. I dedicate this blog to all the medical students who are our future educators and physicians. Make us proud. Work hard, and don’t let anyone discourage you. There is a reason why you were selected for medical school. Best wishes and good luck to everyone in their future goals.

By Willow Brugh (education innovation) [CC BY-SA 2.0], via Wikimedia Commons

• “What the caterpillar calls the end of the world, the Master calls a butterfly.” – Richard Bach