Saturday, November 17, 2007
Valedictory
As a teacher in the RCS, I have a wide variety of roles. Foremost, I am the coordinator of the students’ learning, organizing their clinical attachments to the wards, clinics and remote sites and working to get them to the bedside as much as possible. But at various times I’m also a mentor, friend, colleague, preceptor, examiner, spirit guide and at times, a bit in loco parentis. Which means, either “in the place of the parent” or “in crazy parent mode”, I’m not sure which.
When people here have asked me about the differences between medical students in the U.S. and Australia, I have noted that the students here are very young. Most of the UWA RCS students begin medical school at age 17, right out of high school. Some have come back at older ages, but most have little life experience compared to a U.S. post-graduate. In fact, at the Jarlmadangah weekend last February, only 2 out of 17 students were able to well articulate “why they wanted to become a doctor” after 4+ years of study. Medical school in Australia is heavily subsidized. Compared to the rest of the world it is damn near free. (The low tuitions can be deferred to built-in interest-free loans, and graduates move on to full-salary post-graduate training placements, unlike the U.S. where Residents are paid at about 1/4 of usual salaries. In addition there are many scholarships and loan-forgiveness schemes as well.) Many of the students are eligible for Centrelink (welfare) subsidies while they are full-time students. In addition, RCS students receive free housing, transport of possessions and their own cars to remote sites, use of the RCS 4WD vehicle (free petrol included) “for educational purposes” and an additional stipend for the costs of rural living. They receive free airfare to and from their sites, and one free trip back to Perth for the Options study period mid-year. Student housing comes with free high speed internet, a complete library of medical books on site, as well as unlimited access to all University Library electronic books and journals. All their cases, lectures and slide talks are downloadable from the medical school web site. Student houses, generally some of the nicest in any remote town, are fully equipped, including TVs, stereos, DVD players, and modern kitchen and laundry appliances. The Port Hedland house even has a swimming pool. Gardening services are provided by the site—students don’t even have to mow the grass.
I spent this last week doing last minute tutorials with my RCS students, who have Final Exams this coming week. I’ve also welcomed my replacement coordinator, just arrived from the U.K., as well as supported our new Resident doctor who has been here one week. Last weekend the RCS students took us out for dinner, gave my assistant Jane, and me some lovely parting gifts, and came to a farewell reception we held for them at DAHS.
Finishing up my student teaching has led me to reflect quite a lot, because, after 20 years of having students in one form or another, I plan to take some time off from teaching for at least a year or two. In their individual exit interviews, the RCS students all expressed great appreciation for the year, and commented on how much they’d grown and improved as self-directed learners. All three of them commented in one way or another on Aboriginal health, the gist being that “before this year, they thought of Aboriginal people as being very different, but now they see they are just people with common human problems, complicated by different backgrounds”. Hearing this spontaneously from each of them has to have been one of the high points of the year.
While it is easy to teach shoulder examinations, the role of the folic acid cycle in Wiernicke’s encephalopathy, and stepped care plans for asthma, it is much harder to teach the personal and professional side of medicine. I can only do that by modeling, discussing cases, and providing environments where “transformational learning” might occur. At the end of the day, my goal as a teacher is not to produce “good-enough doctors”, but to nurture doctors who are good at what they do and good as people. I hope all the RCS students graduate with as much empathy, compassion and kindness as they possess smarts. Maybe more. One can always learn the smarts.
Without going into details, my students’ final leave-taking was not without its major bumps, causing a bit of consternation around here this week. Other concerning incidents have occurred this year across the RCS and also among the 6th-year students. For example, one 6th-year student's mother called the Medical School less than 10 hours after her arrival in Derby complaining that her 23 year old daughter’s hospital quarters were dirty and had cockroaches. This occurred in a community where many people live outside in the parks, or 15-20 people reside in one family house. In fairness, I have concerns about all medical students—not only in Australia, but in the U.S. as well. The stats show that more and more, the privileged are recruited into medicine, while fewer students with rural and social disadvantaged backgrounds become doctors every year. [be sure to read the "Response from Australia" on the link above]
So I have been wondering, do the students generally appreciate all the advantages they receive? Do they truly know how lucky they are to have this education, and all the material, not to mention personal and professional, support they enjoy?
Much of this week, my thoughts have gone back to the shy, teenaged Aboriginal girl from the desert beyond Hall’s Creek, who after 3 days on the Leeuwin trip in July, finally got up the courage to talk to Vicki, and shared her dreams of becoming an astronaut. She has been handicapped by birth and circumstance—such aspirations are forever out of her reach. How much would she give to trade places with any one of our medical students in the RCS?
Last January on the first day my students arrived in Derby, Vicki and I made supper for them and talked about the year ahead. Vicki talked about the importance of hygiene in the tropics—that kitchens and baths must be kept clean to prevent disease, that hygiene must be much more of a way of life here in the heat, due to risks of bugs, parasites, and skin infections. And I asked them, when on the wards or in the office, to wash their dishes. Because students and doctors are not special people, they should show humility, respect for co-workers and self-regulation by cleaning up after themselves, and not expecting to be waited upon. (And of course, behind my admonition is one of my favorite Zen koans: Student: “What is the way to enlightenment”? Master: “Go wash your rice bowl!”)
What do I want to see in the next generation of doctors—the people who will take care of me when I am old and sick and dying? Like everyone, I want a doctor who is kind and caring. A doctor who walks the talk, who takes care of herself with discipline and self-regulation, because she knows she herself is the tool that facilitates healing. I want a doctor who not only washes his own bowls and cups, but one who sees the wider problems, the big picture. So maybe, if I had to do it over again, I would assign, near the beginning of the year here in Derby, a reading and discussion of LeoTolstoy’s little treatise about poverty and morality, “What Then Must We Do?”
It is a hard question. It is what we must teach our children, the next generation, to whom we are leaving a world in trouble. How do we privileged doctors relate to our less privileged patients? How does the developed world fairly treat the undeveloped under Kyoto protocols? How do we as rich Westernized countries deal with poor, war-torn nations? It is a question of self-control, self-regulation, self-discipline and self-denial. Where do we draw the lines for acceptable and expected behavior? I don’t have all the answers.
But despite the bumps here at the end of the year, I leave teaching feel satisfied that at least I have asked the questions of my students. And I know that they have heard what I am saying.
When people here have asked me about the differences between medical students in the U.S. and Australia, I have noted that the students here are very young. Most of the UWA RCS students begin medical school at age 17, right out of high school. Some have come back at older ages, but most have little life experience compared to a U.S. post-graduate. In fact, at the Jarlmadangah weekend last February, only 2 out of 17 students were able to well articulate “why they wanted to become a doctor” after 4+ years of study. Medical school in Australia is heavily subsidized. Compared to the rest of the world it is damn near free. (The low tuitions can be deferred to built-in interest-free loans, and graduates move on to full-salary post-graduate training placements, unlike the U.S. where Residents are paid at about 1/4 of usual salaries. In addition there are many scholarships and loan-forgiveness schemes as well.) Many of the students are eligible for Centrelink (welfare) subsidies while they are full-time students. In addition, RCS students receive free housing, transport of possessions and their own cars to remote sites, use of the RCS 4WD vehicle (free petrol included) “for educational purposes” and an additional stipend for the costs of rural living. They receive free airfare to and from their sites, and one free trip back to Perth for the Options study period mid-year. Student housing comes with free high speed internet, a complete library of medical books on site, as well as unlimited access to all University Library electronic books and journals. All their cases, lectures and slide talks are downloadable from the medical school web site. Student houses, generally some of the nicest in any remote town, are fully equipped, including TVs, stereos, DVD players, and modern kitchen and laundry appliances. The Port Hedland house even has a swimming pool. Gardening services are provided by the site—students don’t even have to mow the grass.
I spent this last week doing last minute tutorials with my RCS students, who have Final Exams this coming week. I’ve also welcomed my replacement coordinator, just arrived from the U.K., as well as supported our new Resident doctor who has been here one week. Last weekend the RCS students took us out for dinner, gave my assistant Jane, and me some lovely parting gifts, and came to a farewell reception we held for them at DAHS.
Finishing up my student teaching has led me to reflect quite a lot, because, after 20 years of having students in one form or another, I plan to take some time off from teaching for at least a year or two. In their individual exit interviews, the RCS students all expressed great appreciation for the year, and commented on how much they’d grown and improved as self-directed learners. All three of them commented in one way or another on Aboriginal health, the gist being that “before this year, they thought of Aboriginal people as being very different, but now they see they are just people with common human problems, complicated by different backgrounds”. Hearing this spontaneously from each of them has to have been one of the high points of the year.
While it is easy to teach shoulder examinations, the role of the folic acid cycle in Wiernicke’s encephalopathy, and stepped care plans for asthma, it is much harder to teach the personal and professional side of medicine. I can only do that by modeling, discussing cases, and providing environments where “transformational learning” might occur. At the end of the day, my goal as a teacher is not to produce “good-enough doctors”, but to nurture doctors who are good at what they do and good as people. I hope all the RCS students graduate with as much empathy, compassion and kindness as they possess smarts. Maybe more. One can always learn the smarts.
Without going into details, my students’ final leave-taking was not without its major bumps, causing a bit of consternation around here this week. Other concerning incidents have occurred this year across the RCS and also among the 6th-year students. For example, one 6th-year student's mother called the Medical School less than 10 hours after her arrival in Derby complaining that her 23 year old daughter’s hospital quarters were dirty and had cockroaches. This occurred in a community where many people live outside in the parks, or 15-20 people reside in one family house. In fairness, I have concerns about all medical students—not only in Australia, but in the U.S. as well. The stats show that more and more, the privileged are recruited into medicine, while fewer students with rural and social disadvantaged backgrounds become doctors every year. [be sure to read the "Response from Australia" on the link above]
So I have been wondering, do the students generally appreciate all the advantages they receive? Do they truly know how lucky they are to have this education, and all the material, not to mention personal and professional, support they enjoy?
Much of this week, my thoughts have gone back to the shy, teenaged Aboriginal girl from the desert beyond Hall’s Creek, who after 3 days on the Leeuwin trip in July, finally got up the courage to talk to Vicki, and shared her dreams of becoming an astronaut. She has been handicapped by birth and circumstance—such aspirations are forever out of her reach. How much would she give to trade places with any one of our medical students in the RCS?
Last January on the first day my students arrived in Derby, Vicki and I made supper for them and talked about the year ahead. Vicki talked about the importance of hygiene in the tropics—that kitchens and baths must be kept clean to prevent disease, that hygiene must be much more of a way of life here in the heat, due to risks of bugs, parasites, and skin infections. And I asked them, when on the wards or in the office, to wash their dishes. Because students and doctors are not special people, they should show humility, respect for co-workers and self-regulation by cleaning up after themselves, and not expecting to be waited upon. (And of course, behind my admonition is one of my favorite Zen koans: Student: “What is the way to enlightenment”? Master: “Go wash your rice bowl!”)
What do I want to see in the next generation of doctors—the people who will take care of me when I am old and sick and dying? Like everyone, I want a doctor who is kind and caring. A doctor who walks the talk, who takes care of herself with discipline and self-regulation, because she knows she herself is the tool that facilitates healing. I want a doctor who not only washes his own bowls and cups, but one who sees the wider problems, the big picture. So maybe, if I had to do it over again, I would assign, near the beginning of the year here in Derby, a reading and discussion of LeoTolstoy’s little treatise about poverty and morality, “What Then Must We Do?”
It is a hard question. It is what we must teach our children, the next generation, to whom we are leaving a world in trouble. How do we privileged doctors relate to our less privileged patients? How does the developed world fairly treat the undeveloped under Kyoto protocols? How do we as rich Westernized countries deal with poor, war-torn nations? It is a question of self-control, self-regulation, self-discipline and self-denial. Where do we draw the lines for acceptable and expected behavior? I don’t have all the answers.
But despite the bumps here at the end of the year, I leave teaching feel satisfied that at least I have asked the questions of my students. And I know that they have heard what I am saying.
