Thursday, January 7, 2010

"Real world" shortcuts

One of my favorite articles to cite in response to the student who says, "... but my resident is showing me shortcuts for the real world!"

Am Surg 1996 Oct; 62(10):840-5

Clinical breast evaluation skills of house officers and students

Chalabian J, Garman K, Wallace P, Dunnington G

Current health care reform is placing primary care physicians in an increasingly significant role as the front-line providers of women's health care. It is critical that primary care physicians as well as surgeons develop the knowledge base, physical examination skills, and interpersonal skills necessary to care for patients with breast cancer. This study uses a standardized patient breast case in an Objective Structured Clinical Examination (OSCE) format to objectively assess clinical breast evaluation skill performance by house officers and medical students. Performance of USC medical students, exposed to a uniform clinical breast evaluation curriculum, were compared with MSIVs from four other medical schools, and postgraduate year I and II categorical surgical residents. USC medical students were found to maintain performance between an initial surgical OSCE breast station and a delayed clinical practice exam (CPX) reexam as MSIVs (breast exam, P = 0.21; patient-physician interaction, P = 0.67). USC MSIVs had statistically significantly higher performance on the CPX breast station when compared with other MSIVs (T = 11.701, two-tailed test, P = 0.0001). House officers demonstrated significantly poorer skills than medical students (P = 0.03) (My own emphasis added- GJB). An incoming housestaff group showed improvement with clinical breast evaluation checklists and orientation as part of their intern orientation program and ongoing curriculum.

My concluding thoughts: The 'real world' is not wholly divorced from the classroom. The 'real world' is a relentless, practical final exam to which you must bring every resource your instructor has given you, every day of your career.

Tuesday, July 7, 2009

Assisting the Great Physician

For more than two decades as a physician assistant, I have felt great reward in responding to a vocation to “assist”. My chosen work is a manifestation of true diakonia. I have heard that vital word translated as “ministry” or “service”. It is the source of the word “deacon”. One spiritual advisor who knew my career path chose to define diakonia for me as “assistant”, one who does work that benefits someone else. That slightly non-traditional definition of a single Greek word has been a source of strength for me throughout my career.

The reward is felt not merely in my role as an assistant to any one specific medical doctor but, in a broader sense, in assisting wherever I can to increase and maintain the health of others. On one occasion, I recall reading my business card silently to myself. I smiled at seeing the two phrases “Physician Assistant” and “Assistant Professor” in such close proximity to each other. At that time, in my two chosen professions of medicine and academia, I seemed to be twice removed from the seat of ultimate authority. I was comfortable in the knowledge that, in the end, there is only one such seat to be had, and it will never be mine, nor any other person’s. One day, I may hear a voice say “Friend, move up to a better place”, as the humble dinner guest was eventually exalted in Luke’s gospel (Lk 14:10-11). That will be the closest that any of us gets to the seat of ultimate authority, despite what some of my more self-aggrandizing supervising physicians have believed.

There is a combination of humility and a deep sense of purpose in pursuing a career with the modifier “assistant” placed so prominently in your title. Physician assistants by definition possess a sense of humility in that we strive to do our very best work each day largely for the greater glory of another – our employer, our supervising physician, and for many, our God. Recently, physicians have been known to say that the prestige and financial rewards of practicing medicine are not what they once were. Physician assistants can expect even fewer of these perks than doctors expect. Even some physicians admit that, if they had to do it all over again, they would seriously consider a career as a physician assistant: all of the healing, with significantly fewer tension headaches. Yet PAs that I have known and have educated show great career satisfaction, with an unmatched sense of purpose in studying and practicing medicine simply to know, to help, and to heal. That is diakonia in every sense of the word.

- adapted from the esssay An Assistant to the Great Physician (in press).