Learning Philosophy in Pediatrics

Active Learning. Learning is always best accomplished by taking an active part. Passively watching others can increase your knowledge, but you will learn much more by taking responsibility. It is okay to step into the flow of things slowly at first, but if you wait too long you will miss too much of the clerkship.

Active learning on this rotation involves attempting to function as a primary physician for your patients. Do this by picking up patients (the more the better) and getting a history and doing a physical. You should then be able to put things together enough to present this information coherently. You may not know exactly what to do, but you should at least be able to ask the right kind of questions. For example, if you are stuck without knowing the patient's diagnosis you should tell your intern or resident, "Now I need to generate a differential diagnosis, but I am not sure what the differential for wheezing includes." This is preferable to staring blankly after you have presented the history and physical.

An active learning mindset may be enhanced by thinking of yourself as the primary caretaker of your patients. That means that you should consider it your responsibility that the patients get the best care. Do not assume that you are "just a medical student" and therefore it is not your place or responsibility to become intimately involved with all aspects of your patient's care. Read about each patient's problems and make sure he or she and the family understand what is going on. Find a way to build rapport and guide patients and families through stressful times. A good guideline is to think of the patients as if they were a niece or nephew -- close enough to care deeply about them yet distanced enough to keep some objectivity.

• Act as Primary Physician for Your Patients, NOT Just a Medical Student; Treat Patients like Nieces or Nephews

Altruism. Keeping the patient's interests first, above your own, is an important change from the pre-clinical years where, in general, learning activities centered on the needs of the students. Maybe it sounds obvious, but with the demands of day-to-day life as a third year student, you can easily forget the interests of others. Again, this does not mean you are "just a medical student;" rather, you are a student doctor with the dual responsibilities of caring for your patients and learning to become a doctor. Those two responsibilities are interlaced, creating a challenge: place the patient first with your learning a close second. Strive on this clerkship to develop an identity as a humanistic physician (there's more on this in the next section).

• Patient Needs Come Before Your Own Feedback.

Feedback about your performance enables you to develop as a professional. Be sure to push your colleagues to give you prompt, constructive feedback on how you are doing. That means push them to critique your write-ups, presentations and overall care for your patients immediately after you have done something. Retrospective feedback is generally vague and of less value than immediate and specific feedback.

Effective feedback must be specific, must describe changeable behavior, and must be based on direct observation. In order for you to receive effective feedback, you must place your self in situations where you are observed by house staff, attendings, mentors, etc. Many of us still need work on our feedback skills, so don't settle for "good job" or "that was a fine physical exam" or "your presentation was disorganized." Ask for specific details when given vague answers. Find out what exactly was good and what exactly wasn't. Again, you'll get the best results with an active behavior.

In addition, be aware of other barriers to eliciting feedback. Feedback differs from evaluation in that feedback is not primarily a judging or rating behavior; don't you (or the person you've asked for feedback) confuse the two. Some barriers can be internal. Feeling the need to be right or perfect can interfere with asking for and learning from feedback. Some may feel they are imposing by asking for feedback. During this clerkship we are committed to giving you effective feedback, so never be afraid to ask.

• Ask Regularly for Immediate Feedback; Feedback Describes Specific, Changeable Behavior; Beware of Barriers