Learning to Teach

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Excerpt

To the Editor: A particularly revelatory moment occurred during my first subinternship, when I arrived for morning rounds to discover that one of our patients had passed away overnight: a patient whom the third-year student on our team, who had been on call, had been following. The student—bright, dedicated, and compassionate—came to me and told me that it was her first patient death. My first question was short: “Have you had a chance to talk to anyone?” Fortunately, she had called a faculty mentor. But, later that morning, the thought occurred to me that, even as a fourth-year student, I was partially responsible for the well-being and training of my junior colleague. I understood I should take the time to discuss with her the case and her experience, one so profound and unique to our profession.
I realized that the transition from a third- to a fourth-year student is a critical but overlooked change in the function and responsibility of the student doctor. The responsibilities of third-year medical students to their team are only upwards: to their superiors and to their patients. Fourth-year students take on the role of a teacher—specifically, a teacher of third-year students who are often disoriented and trying to anchor themselves in the tumultuous flow of hospital work. These students look to fourth-year medical students for support.
The opportunity for fourth-year students to grow and to provide mentorship to junior students seems to be completely deemphasized. The concerns of the fourth year seem focused on residency applications, letters of recommendation, and meetings with advisors and program directors; responsibilities to junior students can fall completely by the wayside. Yet as members of the senior class, fourth-year medical students must be exemplars of professionalism and act as a yardstick by which junior students can gauge their own development.
The evolution from junior to senior student is not particularly natural, and not all students experience effective mentorship. Some may believe that teaching junior students is simply someone else’s problem or that junior students must develop coping mechanisms on their own. Medical schools should provide students with tools to work with those junior to them; that is, medical schools should explicitly address the role that senior medical students play as teacher–mentors, a role so fundamental to medicine that it comes even before healing in the Hippocratic Oath. In less than a year, senior medical students will be interns, expected to be fully equipped to teach, to guide, and to mentor students, and they should be trained to excel in this—just as they are in any other area of medicine.
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