To Hell with Books – Bring on the Bodies

“Tell me and I forget, teach me and I may remember, involve me and I learn.”
-Benjamin Franklin

I never learned well reading a textbook. Words on a page never had the juice that involved me in what I had to learn.

While studying in Mexico I employed the method of education that most of the other gringos used. I would sit on a rickety wood chair at a small desk with a single bulbed desk lamp and pore over two books. One of the books would be an English textbook of (for example) Physiology. I’d try to learn high concepts such as the Kreb’s Cycle or osmosis. I would try to piece together how these concepts would apply to my future aspirations of lifesaver. Would I even shout out dramatically, “Nurse, where is that Kreb’s cycle” or “that Kreb’s cycle is going flat! Get ready to apply osmosis STAT Dammit!”  Even at that point I didn’t think most of these concepts of physiological process would be ever used again in clinical practice. Maybe if I had had a clinical mentor during my first two years of education, I might have had a better appreciation of the theory behind the concept. By the way, that second book on the desk I mentioned? It was the same textbook, one edition older and in Español. You know some of the medical words are different in Spanish. The concepts remain the same… Even with the salsa added in.

Education is a complicated process and it’s rarely done well alone. By that I mean that there’s the “dry,” or the facts that are learned and the “wet,” or the real application of those facts. As much as some people can store ga’zillions of facts in their brains, most can’t and have to pick and choose what they need to be successful at whatever they set out to learn.

I am a terrible book learner. Thank God I picked the profession I’m in. Medicine is best practiced clinically by those that see, smell, taste, and touch a concept (tasting can be dangerous, proceed with caution). By this process the concept is forever bonded to the brain, always being a point of reference in a similar case.

So, who makes the better clinician, the book learned or the doctor practiced in exams? Obviously, the doctor who has prodded a million bellies, performed a zillion stellar rectals, and listened to trillions of chests. We have seven senses for a reason. Using only one of them makes no sense.

Medical education is a partnership between three parties, the student, the teacher, and the patient.

The student is the tabula rasa, the blank slate. He or she comes to the clinical setting waiting to be filled with the teachings of countless generations of doctors before them. It’s the teacher’s job to obviously fill this slate with information at the minimum. The good teacher will amaze, entertain and encourage wonder and a lifetime commitment of learning in a student. If the teacher is great, a talent for teaching is also transferred.

The teacher is the showman. “Laaadies and germs! Come feel the diseased thyroid and the bearded lady. See the plaques of cholesterol under the eyes and imagine myocardial infarctions in the making. See the man with the B-cup breasts and wonder of the estrogen-like effects of digitalis. Feel fear of the young lady with the pelvic pain, positive pregnancy test and tachycardia with a normal blood pressure and be scared… very scared.” A good teacher should try to earn an Oscar everyday and every student he interacts with. The future of clinical medicine depends on it.