Teaching is not about me 

Teaching is not about me 

Something has occurred to me recently, something that should have occurred to me years ago, and it’s that the teaching sessions I deliver are not about me. It may sound terribly self absorbed (it’s a flaw of mine) but for the last near 20 years I’ve been worrying about what I was going to say and how I was going to say it. Wrong! God what a vain and stupid cow I am. It’s about what they are going to learn and how they are going to learn it. 

Recently I’ve learnt the basics of how to teach and I can’t stop proselytising away about learning objectives and types of learners. It culminated in a session this afternoon (impromtu) in endoscopy when the nurses said at the end “that was great, what a brilliant teaching session, I’ve learned a lot too and how you did it was so clever”. I could not have been happier. 

I had one student and then an hour later I had two. I had decided the learning objectives for student 1 when he came in and we were making progress through the three objectives and then  when student 2 came I made student 1 teach student 2 what he’d learned; thus consolidating 1’s learning and freeing me up to do the paperwork.  Rather than me getting in a pickle about the pharmacology of buscopan, a distant and vague memory, we focused on just a few things and we did it well and when we finished they had learned something. It’s genius, and of course very obvious to people who know how. I’ve recently been criticised for my affection for the University’s “Teachometer” (not it’s actual name), as time spent teaching is not an measure of quality. I’m now on a one woman mission to make my teaching time quality time. 

Freeing myself from the terrible sense of fear that I might not know enough about the subject and therefore not be worthy of delivering teaching has been a long time coming. We filmed some of  a course we delivered locally and part of it involved me delivering a small group session. I have realised several things; I have a weird teacher voice, much quieter and softer than my usual speaking voice, I am not as fat as I think I am and nobody knew when I got the order wrong. 

In my perfectionist mind I had planned on saying things in a particular order but on the day, I didn’t, and despite my heart rate rising to 180 and feeling distraught at my failure, it was not at all apparent and didn’t seem like it was a disaster at all. This has helped me considerably to relax and enjoy my teaching because nobody but me knows what I am going to say and when. 

The observation that I get a gentler voice is not because teaching is anything like parenting, Mummy Me these days is a harassed and often shouting individual with little patience. I think it’s because I feel nervous and unsure, although fortuitously this is not how I come across and if I can project a bit more and change the tone back to my normal then it will seem more genuine. 

Anyway, now that I know that it isn’t about me I’m much less likely to get myself in a state mid lecture thinking I’ve ruined everything if I cock up my running order. Having the focus on them rather than me, so simple and so obvious, maybe that’s why nobody told me? 

I have lots of teaching to do this week and now that I am combining enthusiasm with some knowledge, theory and skills it might just be good quality. Can’t wait for the feedback/happyforms…but are they the right measure? Probably not but I’m excited nonetheless! 

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All the errors and mistakes 

All the errors and mistakes 

How many mistakes have I made? How many people have I harmed? Hopefully not as many as I have helped, at the end of one’s career the thank you cards should outnumber the complaints. 

I have undoubtedly caused harm, I can think of some of them now and those are just the ones I remember. What about all the people I’ve harmed and not known about? 

The woman who I sent for a CT scan in error, entering the patient details from the preceding patient. The operations that I did that would have been done better by someone more experienced. The pelvic abscess from a bad lap washout.  The massive incisional hernia that resulted from an abdomen I made a shambles of closing…shit there’s loads of them. 

There are probably plenty I don’t know about, the wound infections, hernias, anastomotic leaks even deaths. (Jeremy Hunt take note, junior doctor bodge ups that would not have happened if a consultant did them, maybe. I hope you do read this you lanky shit) 

The question that interests me now is how the hell do you start letting trainees do the operating and decision making and not freak out? I cannot imagine it, walking out of theatre and leaving a trainee to do the anastomosis! 

I need to become a good trainer;  having been obsessed with being a good trainee I now need to figure out how to teach people. Knowing how to do something doesn’t mean that you can teach it. I have had the benefit of some amazing trainers and emulating them is undoubtedly the way forward. 

I’m sure I will manage to train someone and trust them and feel happy to leave them to do the operation, but will I be happy to deal with the complication?  I remember seeing a consultant blame his trainee for a bilateral hernia that recurred on one side “that’s the one my registrar did” he told the patient. The patient looked at him like he was a twat, as did I. 

Letting someone do it in your name means taking the blame when it goes wrong. How do you cope with that? I can barely cope when something goes wrong that I have done never mind taking the rap for my trainee. It looks like I am going to be a terrible boss, who senior trainees will hate because I don’t let them do anything. 

Where are we meant to learn this? The GMC that licence my practice insist that the care of my patients my first concern, which of course it is. Nowhere in the Duties of a Doctor am I obliged  to teach or train: but I am really and if I don’t I won’t get a registrar and I can’t easily do the operation without skilled assistance. 

How do I face a patient with a complication that I didn’t directly cause but was done in my name?  Apologising is obviously in order and I do this without hesitation or reservation and so far haven’t been sued for admitting that a mistake has been made. People are very understanding, famously the family of a massive error have never sued as the surgeon was so open from the outset; I take my lead from him and haemorrhage regret and apologies for every ileus and leak that I come across. Sorry doesn’t mean you’re guilty or negligent. 

How do I face my registrar and be kind and pleasant when they have fucked something up? I have caused my fair share of problems and  I have been on the receiving end of some spectacular bollockings but overall mostly lovely bosses who have soothed my troubled conscience. I will try and be good and fair and take the pain. I’ve plenty of practice of doing this sort of thing as a parent, but I love my children more than my future trainees. 

There are so many things to worry about above and beyond the actual operating and none of it is in any book or written down anywhere. 

Teaching season again..

  I’m not an official academic, I have an honorary contract with the University of Bighospital that means I get an extra badge and a ridiculously grand sounding extra title of “honorary lecturer” when in fact all it means is that I give lectures and teaching for free. 

I do a lot of teaching as I enjoy it and I like talking to young and enthusiastic students. What gets me down is the few who don’t give a shit and think that they are funny and clever because of it. 

I was lecturing last week, a whole year group, sitting in the very lecture theatre where I too was a student. Ninety percent of them were listening I think, hard to tell when all you see is 180 glowing apple symbols from the back of their MacBooks. (I know, students nowadays, they have no idea. I got the bus and used a pen and a notepad). 

There were a few visibily bored, tired and yawning and a few who were determined to talk and disrupt their neighbours. I had spent many hours on this talk and I had come in on a day off to give it. I had tried to make it interesting and intermittently funny. It is not my job to do this, I volunteered because the university are so desperate for lecturers and I like it and of course it looks good on my cv. 

The talking students really annoyed me, in fact they made me feel small and silly. When I was a student I was constantly chatting to my friends and if mobile phones had been around I probably would have been messing about on snapshagger or whatever they are on. 

They have no idea that I am an unpaid lecturer, no idea I have spent  hours preparing this in my own free time and they also don’t care. I wish I wasn’t so upset by their disregard but I am. Maybe I will get used to it, I’ll have to as my teaching schedule is ridiculously heavy this year. 

All they have succeeded in doing is turning me into a reserved and disinterested lecturer who no longer will try and make my talks engaging  or fun, because rejecting the dry facts and talking through that doesn’t hurt me at all. 

It’s going to be a long year…

Medical students: how to survive a surgical attachment

Right, you little munchkins, I’ve had enough of your disinterested and sullen faces slumped over coffee at tutorials, my clinic, theatre exit rooms, etc. If you want to get anything out of general surgery, by which I mean get anything out of us, you have to engage our interest.

I can’t say this to you in the hospital as I would be done for bullying or some other crap (like my colleague in ortho, accused of being a chauvinist for some minor joke in a lecture) so I’m not going to hold back here.

The first thing we will ask you is if you want to be a surgeon, now, we know you don’t, if you did you would have already told us. Surgical med students are practically jizzing in their pants to speak to us and come to theatre.

When we ask you though, don’t say “I hate surgery”, “anything but surgery”, “I can’t tie my shoe laces and am very clumsy”. Even if you want to be a palliative care physician or a telemedicine community psychiatrist somehow or other put a spin on why surgery is interesting and relevant to you. The fact that the university is going to give you 2 degrees, one of which is a bachelor of surgery seems lost on you all and I think you should just be given an MB not MBChB.. Sorry I am off on a pet rant of mine.

Somehow or other fake some enthusiasm for surgery. At some point in your life you may be required to lance an abscess or amputate a limb to save a life. Who knows how or what or why, but you have the letters after and the title before to suggest that you have some basic competence at this sort of thing.

Pre theatre dinner.

You must, must, must have a pre theatre dinner. By which I mean get your tea in early and then open some books. Anatomy textbook, followed by surgical text books (note plural), followed by YouTube or websurg to watch a heavily edited operation. Then if you are genuinely interested you can look at some guidelines for management.

Anatomy obsessives

We are crazy about anatomy. DO NOT say to me that you can’t remember any anatomy because it was a long time ago. It was not a long time ago, 20 years ago is a long time, 2012 was very recently. You don’t remember it because it was badly taught, you weren’t interested, it meant nothing to you at the time and you didn’t bother learning it.

The anaesthetist

The anaesthetists are not better teachers, they don’t like you more than me, they are so bored that they teach you. They have done their bit, now they’re cruising at 32000ft and want a distraction, meanwhile I’m in an abdomen which has been unzipped for the fifth time, dealing with adhesions from hell and an unexpected amount of bleeding..I’m not talking to you because I am busy. So don’t put it in your feedback form that we didn’t speak to you much during operations!

We are predictable creatures

I ask the same stuff over and over and much like the professor of infectious diseases asks you all what bugs cause pneumonia and where the likely sources of E. coli bacteraemia are, my colleagues and I are similarly predictable.

Causes of pancreatitis, symptoms of colonic and rectal cancer, gall stone disease, causes of jaundice, small bowel obstruction, stomas… All of which is very standard general surgical fare, we aren’t looking for anything weird in the differential diagnosis of a profusely vomiting patient, I want the common stuff.

Little black book

In the olden days, before Tinder and mobile phones and Facebook, people kept their friends contact details in an address book. “A little black book” usually contained numbers of members of the opposite sex and was closely guarded. You need to get a little book, not a bit of paper, and you are going to write down all the things you encounter in a day that you don’t know. Take an ERCP- today on the round we spoke to a patient who was going for one- then we moved on to the next patient. I asked the four students what an ERCP was as we left the bay, none of them knew. Nobody had asked or written it down to ask later. You must do this, write it in your book and consolidate your learning at home with a textbook afterwards. This is the whole point of these (stupid) self directed teaching methods that they are so keen on these days. It doesn’t work if you are not paying attention to what is going on.

Try and enjoy your time with us, if you give it some effort we will too. Read the books, some students last year told me that they don’t have a surgical textbook as they don’t need one; you do. You must have one and you need to read it throughout the attachment.

We love having motivated and interested students around. Ask lots of questions, ask to scrub in as much as you can, follow the people that seem to like teaching you and are good at it. Stay away from those who ignore you or are mean. If you are able and keen, do a night shift or a weekend shift, you will get one to one teaching and get to do a lot more in theatre as we need the extra pair of hands.