Practice Makes Perfect: The Hidden Curriculum of Learning Medicine

Maria Powell imageMaria Powell
Memorial University Faculty of Medicine
Class of 2017

Why do you want to be a doctor? The age-old question asked in the medical school interview. I remember when my interviewers asked me this question; I pretended I was thirsty and took a sip of water to try and buy some time to think. I was fairly nervous that day, so I don’t remember exactly what I said, but I know it was something along the lines of wanting to help people through my love of medicine.

The first time I felt like I really had the chance to “help” a patient in medical school also happened to be the first time I had the opportunity to perform a medical procedure. Before this day, I had imagined the rewarding feeling that would come with performing CPR, stitching up a wound, or putting in an IV line. This is why I pursued medicine― to acquire the skills I need to help people. But when I stood there, holding the needle in my hand, with the patient looking at me in disbelief as I said, “this won’t hurt a bit,” everything changed. All I could think was:  “I do not know how to do this procedure. I am a student. I should not be practicing on real patients!”

With that, I handed the needle back to the doctor and said, “Maybe next time. Right now, I prefer to watch.” The doctor then proceeded to give the patient a B12 injection. Yes, a B12 injection. This is easily the simplest procedure I could have done. It is an intramuscular injection usually given into the deltoid or the glute. To put it in perspective, patients can administer B12 injections to themselves at home!

Why did I decide not to give the injection? Truthfully, I was afraid I would hurt the patient. I wanted to delay attempting this procedure until I was skilled enough to execute it perfectly. But this is unrealistic. It is impossible to get better at anything by postponing opportunities to try new procedures because I am awaiting perfection. Excellence is never obtained without some degree of error; in order to improve, one must seek out new challenges that demand concentration and effort. How do you get better at something? You practise. The downside of medicine is that medical students have to practise on people. This is difficult for all parties involved. Likely, the most obvious struggle is for patients who ―like anyone― would prefer to have experienced hands performing their medical procedures. However, one should not overlook the plight of medical students, who may struggle knowing that in order to gain confidence and skill, they may have to hurt patients. This is challenging, especially given that those entering medical school are often selected for their compassion and empathy. One could expect them to be hypersensitive to any discomfort a patient may be experiencing. The reality is that, to master their craft, medical students must practise on patients. During this process, students may inflict additional, potentially unnecessary, pain. Although this contradicts the way many people think about medicine, a field centered on caring for patients, the best way for medical students to learn how to help people is to practise on them.

After giving myself a little pep talk I was convinced that I should not refuse the opportunity to try a medical procedure again. When I was asked if I would like to try and get IV access, I agreed. This time, instead of thinking about all the ways I could hurt the patient, I repeated to myself: “this is an opportunity to learn, and I must take it.” However, my first try proved to be much more difficult than I expected. I moved the needle in and out, back and forth, in search of a vein. I continued to poke and prod unsuccessfully for what felt like an hour, while the patient winced in pain. I was doing exactly what the doctor had told me to do, but it was not working. I thought to myself, should I stop trying? If I keep poking, will I eventually hit a vein? Should I stop here for the benefit of the patient, or keep going for the benefit of my own learning?

One thing we are not taught in medical school is how to deal with this dissonance. How far do we go for our own learning experiences? How many pokes are okay? At some point, medical students must formulate their own personal guidelines for defining how much patient distress is acceptable. To do this, medical students must learn to differentiate between pain that is normal for the procedure, and pain that is due to the inexperience of the performer. This will help student learners decide when it is appropriate to take advantage of opportunities to learn and practise medical procedures and when it is not. Medicine is an evolving field; it is constantly changing. Each year there are new instruments, techniques, and procedures that medical professionals must learn. Therefore, being able to determine how far to go for our learning experiences is essential. Although some patient discomfort is acceptable, it is important to understand the limits of our abilities. Patients are willing to put their trust in the hands of medical professionals; therefore, the onus is on us to know when learning is beneficial and when it is futile.

As the saying goes, “practise makes perfect.” Medical students must practise procedures in order to learn the skills they need to help people. We just have to keep in mind that it is our patients we are practising on.

7 thoughts on “Practice Makes Perfect: The Hidden Curriculum of Learning Medicine

  1. Allison

    I love this! One idea that may help is to us some sort of local anesthetic first so that you may practice without this factor. Saves the patient – and the student – unnecessary pain. I tell ya. There would be no way you would do it to me with my fear of needles! 🙂

    Reply
  2. Mary

    Congratulations, very insightful article! You are on your way to becoming a skilled and empathetic doctor-the best kind of doctor!

    Reply
  3. aggie

    Awesome article! Our everyday learning can sometimes be so product driven, it is easy to forget to care. A good reminder how inspiring it is to ponder and explore the human side of acquiring any skill. Thanks for sharing. Great food for thought.

    Reply
    1. Mercedes Aquilina

      Congratulations, Maria. you are a smart cookie and I bet you will be inserting those IV lines with your eyes closed in no time at all!

      Aunt Cedi

      Reply
  4. George H Powell

    This is a wonderful article by a dedicated medical student. Maria will make a very caring physician. We wish her well.

    Reply
  5. Edward Powell

    Thank you Maria for being transparent about your learning experience and for sharing your thoughts and feelings. You are setting an example for other health care professionals.

    Reply

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