This week I'm precepting a physician's assistant student at the hospital. Although the student is going to be working in outpatient settings, her program requires her to complete a month of inpatient medicine in order to get a feeling for complications of common diseases.
Since moving to Rural, CA. I haven't had many opportunities to teach clinical medicine. There have been a few physician's assistant students who have rotated through our clinic, and recently a family practice resident spent several weeks working with us in the hospital on an elective rotation. The hospital also has nursing students from two local school who do their clinicals with us, and so does the local paramedic training program. I even had a paramedic intern deliver a baby with me--his first.
I did a lot of teaching during residency. Second-year Night Float residents were expected to present 10-minute blurbs on topics related to cases they'd seen during the week. We always had UCSF medical students rotating with us on Family Practice or OB; we were really popular for OB because the students got a lot of deliveries with us, which was not the case for most of the other rotation sites.
Depending on a resident's motivation, you could teach some, a lot, or none at all, but I liked to teach. That's one of the reasons I got talked into being Chief Resident during my third year. As part of that job, I had to prepare formal talks and I was expected to work with residents on any weak areas of their performance. This was the hardest part of being Chief--I had to pull aside residents who weren't pulling their weight and put them right about professional responsibility. If a resident was weak in Internal Medicine, I had to go over all their orders with them and make sure they knew what they were doing. If they were having trouble with efficiency, I had to be a mother hen and make to-do lists and set time limits for doing H&Ps, evaluating labor patients, etc.
By the end of residency, I'd had enough of teaching. I was offered a faculty position with my program but decided to turn it down; I needed a break from whipping interns into shape. When I got up to Rural, I got completely immersed in being a "real" doctor. I distinctly remember the day I realized I was truly on my own. I was rounding on a big hospitalist service, discharging patients, ordering studies, starting/stopping antibiotics/TPN, advancing diets, etc. In the middle of the afternoon I sat back and asked myself, "Isn't anyone going to check on my orders? Who's going to tell me when I screw up?" It was one of those uncomfortable aha! moments, and it made me miss the gruff give-and-take of residency life.
Gradually, I've resumed sporadic teaching as I described above. It's been a lot of fun but undeniably a lot of extra work. Every time I have a new preceptee I have to factor in the time it takes to hold back and not lead the new learner too much. It also takes time to repeat the interview and exam of each patient, which of course is a requirement to be able to bill for student progress notes. So teaching is not a revenue-smart service to provide, but it yields other rewards, such as a kick in my own behind to keep up with standards of care and also the hope that we'll attract and retain new trainees.
Most of all, I've discovered I enjoy teaching again. I like going over cases and explaining what test results mean, looking up disease monographs, and poring over ECGs with a learner. It's nice to be back in the teacher's role again, even if the class size is limited to one.
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