One of the approaches used, in addition to a
discussion of teaching skills, is video-
taped role-play exercises. Each role-play is a
sort of skit that is designed to demonstrate
common, yet troublesome, scenarios in clinical
teaching. After the role-play is com-
pleted, participants review the tape and analyze
their performance.
Since the majority of physicians-in-training do
not yet have access to teaching skills
training, they are forced to learn how to teach
on their own. While this is difficult to
accomplish, they can seek help at the Office of
Medical Education at their hospital or
school. Also, information on clinical teaching
may be available in a medical library. The
best sources are the following short books: The
Physician as Teacher and Residents as
Teachers by T. L. Schweml and N. Whitman and
Teaching during Rounds: A Handbook
for Attending Physicians and Residents, by J.
Edwards and D. Weonholtz.
Finally, improvement in teaching skills can
even be obtained by so simple an
approach as identifying and listing the
attributes of the most skilled clinical teachers one
has been exposed to and trying to emulate them.
Similarly, the weaknesses of poor clini-
cal teachers can be identified so that those
deficiencies can be avoided.
CHALLENGES IN TRAINING
For many years the postgraduate training
interlude was looked upon as an initiation rite
into the exclusive world of medical practice.
Stress and a heavy workload have long
been accepted as part of this process.
Recently, a growing number of educators, as well
as many trainees, have emphasized the negative
aspects of this process.
A key problem is that most physicians,
including young attendings, consider the
troubling environment of postgraduate training
a "rite of passage," and they forget some
of the most traumatic interactions of their
careers. It is important not to block out one's
memories of the stress and trauma of the
apprenticeship years in order to avoid repeat-
ing inflicting the injustices on others further
down in the hierarchy. Unfortunately, it
appears that the abuse phenomenon may still be
perpetuated nationwide in the most
rigid training programs.
Already, competition, rather than team effort,
may be fostered in medical school. The
emphasis is strong on the science of medicine,
with the human aspects of medical care
often being neglected. In the residency, the
heavy workload and its associated responsibil-
ities overshadow educational goals. A further
impact of these conditions is the tendency
toward physician desensitivation, but reforms
over the past few years have improved both
the education and training systems.
Nevertheless, unhealthy demands are still being
placed upon prospective practitioners. It took
a fatal error in judgment by a sleep-starved
resident to bring about the 80-hour work week
for New York State residents, which has
also been adopted in other areas. Those outside
the system are still astounded by such
conditions, while some within the system regret
that changes have been made.
The dehumanization effect may be initiated in
medical school when patients are pre-
sented merely as abstract cases.
Standardization of patients to 150-pound white male
stereotypes makes it harder to think in terms
of patient differences.
The negative impact of stress and long work
hours was ignored for a long time. When
its effects in human terms became evident, such
as substance abuse or increased divorce
rate, more attention was given to the problem.
A number of approaches have been devel-
oped to cope with this problem, including
formation of support groups. The consensus is
that, while progress has been made, it will
take time to alter long-entrenched attitudes.
NEW TRENDS IN MEDICAL SPECIALTIES
Discoveries in research and changes in society
have resulted in changes within estab-
lished medical specialties, as well as the
evolution of new specialties. A brief overview
of several specialties that have taken new
directions follows.
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