The other day I was in a tutorial and was asked by one of the cardio registrars to examine a patient and present my findings. My examination was average, and she highlighted a couple of things I could improve, and it was fine. Then she started quizzing me on the causes and presenting symptoms of a variety of heart murmurs. I had not looked at this information in two years, and I struggled.
Sadly, much like prey struggling against a crocodile, I just thrashed around and made my position worse. I was surgically (irony, she’s a medical reg! LOL) picked apart in front of six other medical students in the middle of a busy ward. It was humiliating, and it was brutal, and it was very, very useful.
Sure, I didn’t actually learn that much about the murmurs – I read up, of course, but there wasn’t that much extra to know after the reg had already painstakingly highlighted each detail I missed in turn. Instead, she inspired something that no amount of self-coercion or external encouragement has managed to awaken in years: ambition. I got home ashamed of my failure (the publicity thereof) and of failure (the possibility thereof). Now I have work lists for the week. I have written over 4000 words of notes in a week, over and above being in for placement every day. I am organising and revising and learning and I’ve set myself deadlines and not wasted time making a revision timetable or clearing my room or rearranging my desk or something like that. I am a new man!*
My question is this: is there so potent a driving force as shame? These days, teaching is all about reinforcing the positive, constructive criticism, doing one’s best. Teaching by humiliation has gone out of fashion, and is all but stamped out in the younger doctors. Nevertheless, none of the positive teaching I’ve had in the last five years has had so much of an impact as those ten minutes in the firing line. Hard truth is your best is only alright while you’re in school. Endless positivity just reinforces the fact that what you are doing currently is good enough, and that is not real life. It’s not what happens on my course. There is no grading in medical finals, no classifications, you either pass or you fail. You’re good enough, or you aren’t, and motivation doesn’t stem from being told you’re the former. Bring on the odd moment of humiliation, I say. As a constant teaching device I agree with the current model – it is demoralising and unhelpful. In small doses, though, administered as a short sharp shock…
I saw the cardio reg again today, and arranged a clinic with her for Thursday. I’ve read up on some cardio. Game on.
*to a point. Weekends are still the only time I get with Partner in Climb and I’m sure she’d be bored to hell with my constant banging on about coarctation of the aorta or similar.