From unsplash, By Florian Klauer
Cognitive apprenticeship doesn’t mean cloning yourself.
Clones. You know, the goat that’s identical and then dies in a few months, because you’ve forgotten some essential detail. Having a student is more like being a farmer, than being a molecular biologist, or a genetic scientist. In case you’ve forgotten, cloning is tough business. You end up with an identical organism (minus a few jigsaw pieces) that was developed for the last generation. Even if we were successful, and didn’t have any gaping maws in our jigsaw puzzle, soon that organism would be a genetic anachronism.
We need to develop students that can form themselves, assimilate new information, adapt, and grow towards the sun. Making a copy of ourselves just won’t work.
Except of course for my students.
Are you keeping an exemption for your own students? Are you acutely aware of the shortcomings of your fellow colleague/ teachers, and unaware of your own? Unfortunately, that can be fairly common amongst us MDs.
How do you feel when your student challenges you? I don’t know about you, but I graduated over 25 years ago. Medical information has changed. I know you try to read, just like all of us. But don’t you think your fresh student may have some new ideas, or approaches?
One of the hardest things to do, in the cognitive apprenticeship model, is to refrain from cloning. Cloning yourself is the easiest path. Just demand that the student does it your way. Demand to see every patient before they’re discharged: don’t give your resident that power to prescribe, and line up follow up. If they’re a senior resident, demand that verbal corridor review before you give them the illusion of independence.
The cognitive apprenticeship model works the best when the learner physician does all the steps: greets the patient, takes them to the room, establishes a relationship, collects the data and examines appropriately, synthesizes the data, and provides options for treatment to the patient. That whole last negotiation is so important.
Then there’s the cliff dive: letting the patient go without reviewing the case first.
Let me tell you. Those are the contacts where learning really happens. The resident has had to pull in resources from several different mental areas, and cobble them together. As you realize, we all harbour a bit of doubt when we embark on a treatment path. Was the diagnosis correct? Did we ask enough questions? Were there adequate investigations done? Were all the nasty possible diagnoses covered? Did the patient understand? Was the treatment easy enough to follow that compliance won’t be an issue?
So many issues. And to the learner, it’s all worse. It’s all in screaming fluorescent colour. The patient has just walked down the hall, holding their script, and it’s all on the learners head. Or neck.
They can just feel that guillotine above them, imagine that edge, and hope it’s sharp enough. Don’t you think they’ll be at home, reading about each and every case? That’s self directed, problem oriented, real learning.
Do them a favour. Especially when confidence is shaky.
If their treatment plan is adequate, if no harm will come, if it’s something you can catch at the three month follow up and tweak to the way you’d really like it to go, then for heaven’s sake, let it go. Tell them how you would normally run it, but also clearly tell your learner that the treatment path they’ve cobbled together is adequate, and acceptable, and that you stand behind it, and her.
Know what? In your effort to accept an alternate viewpoint and treatment, in your staunch refusal to clone yourself, you just may learn something. Maybe their path is actually better.
Remember, medicine is a team. These aren’t just your students, but your future, and present colleagues.
If we continue to clone ourselves, we, our medical profession, won’t grow towards the light. The world will change around us, and our unfortunate clones.
Clone yourself and see your students wither and die. Be a farmer. Spread the seed, fertilize, and make sure you know that it’s actually a weed you’re yanking up….