Teaching and Learning Moments
Dr. MacKrell Gaglione is assistant professor and onsite clerkship director, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
One of my favorite aspects of the orientation of third-year students to the medicine rotation is relating a story of role modeling. Many students think that their most influential role models will be their attendings, but as most of us in medical education know, it is the interns and residents who are, for better or worse, the most crucial role models.
I was a novice third-year student on my medicine ward rotation when I first met Marie, a well-seasoned intern. She was smart, candid, and extremely practical. She never hesitated to ask questions, not asking with the familiar one-upmanship used by the other residents, but with a probing insightfulness that I have yet to encounter again. She deplored the antics of those who would only ask questions on rounds so they could quote their knowledge of a recent article. Her goal was pure understanding and she did not feel the need to impress anyone. Marie worked very hard and loved what she was doing; her enthusiasm was infectious.
We were at the VA hospital when we met TK. TK was a 29-year-old paraplegic man who had been injured in a motorcycle accident when he was 19 years old. He was admitted with bruising and fatigue and his CBC revealed acute leukemia. I vividly remember standing with Marie discussing the task before us of telling him about his illness. I was apprehensive because I had not yet experienced “delivering bad news.” As I listened to Marie talk to TK, my anxiety greatly increased. I was overwhelmed by how paternalistic Marie sounded when she told TK, “I know how it is to see a bunch of doctors gather around your bed.” I am sure that she described the disease and treatment but to be honest, I remember none of it. I was preoccupied with thinking that I had just witnessed the way not to give bad news.
As we stood outside the room, Marie said to me “Well, I think that went as best as it could.” I remember looking at her with an incredulous stare and asking how she could say she knows how it “feels to be in his shoes.” She said that she had never met a patient that she identified more with, and although she had never revealed that much of herself to a patient, she felt that it was important to do so in this instance. What I did not know was that Marie knew all too well what it was like to be a patient. She had had widely metastatic Wilms' tumor at four years of age and had received chemotherapy and radiation. During her second year of medical school, Marie had developed breast cancer and had undergone a bilateral mastectomy, chemotherapy, and radiation. She graduated from medical school on time and entered internship with her class. She said to me that sometimes we cannot help but be ourselves when we are relating to patients and we are whom our experiences make us. Although humbled by my own arrogance, I knew I would rarely learn such a profound lesson again.
I tell my students on orientation day that their best role models may be their fellow students, interns, residents, and hopefully, their patients. I encourage them to look for individuals who take risks to become more because of their experiences rather than less. Wouldn't it be great if we could all strive to be such a role model?