Medical education is phenomenon unto itself. It is filled with nuances that make it distinctive in character and personality, as if it were possible to humanize an inert force. It’s the personalities in medicine and medical education that originate the methods by which a student assesses his own knowledge while challenging the intellectual depth of one’s classmates.
One such challenge is “one upsmanship” or the ability to know, or at least show you know, a fact, detail, or statistic before everyone else in your class or those with whom you compete. For example, when a group of students is discussing some topic mentioned in today’s lecture, it is you who knows a detail about that topic that no one else in the group knows. It was only you who knew that amiodarone has a half life of 55 days and can cause thyroiditis. You “one-upped” everyone else by knowing that fact.
This “technique” is used all the time by those who thrive on seeming to be the smartest guy in the room or who simply have to know more than everyone else or they’re a failure. Some students do it tactfully, as if to inform the “uneducated”, while others do it arrogantly making others feel, or look, stupid. After several doses of this form of intimidation, you avoid these people and seek colleagues who sincerely want to share what they know.
A second medical educational quirk is the “curbside consultation.” In this circumstance, one student puts another on the spot by asking him to expound upon a diagnosis without being aware in advance a question was going to be asked. As much as anything, it’s asking a student, or another doctor, to tell you what’s wrong with a patient you’re having trouble diagnosing yourself. The individual called upon is known to be knowledgeable in their field and is being asked to diagnose and talk about a case he is just now learning about. “Curbside consultations” prepare you to be able to handle your elderly patient’s family’s probing questions in a professional and knowledgeable manner.
Thirdly, medical educational is rife with quirks called “clinical pearls.” These are the hidden secrets of the universe that help a physician find his way in the murky waters of making a diagnosis. A “pearl” is a fact about a disease or disorder that clarifies the problem at hand and leads the doctor to the correct diagnosis. One example I cite is when diagnosing a generalized, pale, fine scaly rash located mainly on the chest and back, you know it’s Pityriasis rosea if the rash was preceded by a similar, single, larger rash called “the herald patch.” The herald patch appears a few days to a week or more before the rest of the rash appears. The “clinical pearl” that makes the diagnosis is the earlier appearance of the patch. With that history, you now know exactly what rash the patient has.
The final, and most complex, medical educational challenge is the clinicopathologic conference, or CPC. Here a professor, chief resident, or visiting expert is presented with extensive details of a case, and from these details, the challengee is supposed to make a diagnosis and provide specifics of the disease’s extent. The doctor’s suppositions are then correlated with the pathologist’s findings at autopsy. The audience members each have all the case details and are asked to make their own diagnosis. When the autopsy details are shared, and the challengee is evaluated, a detailed discussion then follows. This educational tool I always found very challenging until you have learned what all these lab tests and other data and findings on CT or MRI mean. By the time you’re a resident, the complexities and detail of a CPC are evident to you, and your education has prepared you for diagnostic challenges.
Some of these educational “techniques” are fun. Some are pure intimidation and challenge your composure. Others broaden your knowledge. Exposure and repetition are good teachers. Once you’ve seen a case of pityriasis rosea with its herald patch, you’ll never forget it. Once you’ve heard the “honk” made by mitral valve prolapse, you’ll never forget it. The challenge then becomes remembering all those little things that aren’t so memorable. If you can remember those “little” things, you will be fine.
