Endocrinologist Offers Concrete Guidance on Mentoring Clinical Trainees

Clinician instructors are tasked with helping medical students refine their critical thinking, empowering them to ask relevant questions, and encouraging further inquiries.
Clinician instructors are tasked with helping medical students refine their critical thinking, empowering them to ask relevant questions, and encouraging further inquiries.

“When one teaches, two learn.” –Robert Half

Just before 1 PM on Friday afternoons, I take on an additional role. I work with a third-year medical student from the University of California, San Diego School of Medicine in my clinic — one of the many facets of my work that I find profoundly fulfilling.

We all teach. Whether we're explaining to a patient why diabetes increases the risk of coronary artery disease, asking a medical student questions after presenting a patient, or giving a talk to our colleagues, we're helping to convey knowledge and exchange concepts. It's one of the privileges of being a physician. But isn't teaching about more than what and how much you know?

If you're like me, you're constantly seeking ways to improve. Teaching should be no exception. I wanted to offer a few key points that may be helpful in your quest to continually refine your skills.

This brief list is by no means the final word, or provided to suggest that I have all the answers, or that any of this is easy. In that humble spirit, here's a brief distillation of what trainees have told me, and what I've personally observed.

1. Give guidance on your objectives from the beginning.

One of my colleagues, Dr. Tuan Dang, shared this particular pearl with me. He provides a written set of goals or objectives to each third-year medical student he teaches in his outpatient clinic before the first day of the rotation. Setting expectations not only provides clarity, a road map, but also stokes enthusiasm. It's like a preview of coming attractions. Some of my expectations include helping students cultivate an appreciation for and encouraging them to use evidence-based literature.

On the first day, the student and I also discuss expectations on housekeeping items. One of mine is that if a student sees a patient, they should expect to write a note (I believe in fully immersing trainees). Students will often ask questions such as: “Is there a particular note template you prefer that I use?”; or “How much time should I spend with each patient?”

2. Offer options.

I offer the student working with me every month a choice: complete the entire history and physical, with no particular time limit, and present the patient; or have me in the room with them while they're with the patient, as a silent fly on the wall, ready to help if the student gets stuck and wants to call a “time-out.” Keep in mind that some afternoons, due to logistics, this may not be feasible.

3. Provide — and ask for feedback.

I never let the sun set on a clinic session without debriefing it, so when the student is finished writing the notes — usually on 2 patients — I make it a point to discuss topics such as:

  • What went well?
  • What do you think could be improved?
  • What have you new you learned that's new, or what do you want to delve into further?

This time for reflection is integral for a student's continual growth, and point #3 can serve as a springboard for looking up a question, and be the basis for discussion as a mini-presentation the following week. Students have consistently commented on how much they enjoy these informal sessions.

However, feedback is a 2-way street. I also reflect on the interaction and ask the student at the close of each session for his or her thoughts on what I can do to improve the experience. As I remind them, my goal is to have this be the best possible learning experience.

4. Aim for balance.

Teaching in a busy clinic is a challenge, even with time carved out for it — on my Friday afternoons 2 patients are scheduled at 1 PM, 1 at 2 PM, and 2 at 3 PM. I must strike a balance between the student's learning experience and being reasonably efficient myself, so that we respect our patients' time. Students don't want to feel like they're hampering the latter, yet they also don't want to be merely shadowing me. I also want to balance when not to speak — by allowing the student time to think about a question, or to travel down what might be the wrong path for a bit (albeit in a safe way) — and knowing when to step in and ask a question.

5. Take a bit of time.

I also try to spend some time talking with students, not only about their aspirations, or questions about life in medicine, but also a bit about themselves — where they're from, what their hobbies are, and such. Does finding out a little about your patients as individuals sound familiar?

These tips that I've picked up over the last few years can apply, in perhaps a slightly modified fashion, to working with your colleagues, staff, or even your patients.

We're here to impart content as well as skills. Just as important, we're helping learners refine their critical thinking and empowering them to ask questions, and to continue to ask them. In the process, we may both push medicine forward and facilitate an enjoyable learning journey for both the student and the educator.

I invite you to please share any insights and tools you've found helpful for teaching.

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