This week’s JAMA has an outstanding commentary on the state of trainee teaching on the wards. The piece expresses what others and I have sensed for years, mainly, given technology use, changes in resident work hours, and the ascension of inpatient teachers, attending rounds of yesteryear are dead gone.
As I read it, “yes” boxes, all blackened, were awash in my brain. The piece articulated what I’ve experienced since completing residency, and particular passages identified qualities no hospitalist would mistake as anything but HM distinct. These same qualities set us apart from the teachers of yore and are our distinguishing mark:
[...] Because younger attendings came of age in the era of duty-hours restrictions and an emphasis on collaborative care, they are less conflicted about rolling up their sleeves to help expedite the work. They worry less about the erosion of house staff autonomy and are comfortable hanging out in the residents’ room; their presence is not seen as micromanaging but increasingly seen as the norm. When patients decompensate, these young attendings are often there and making decisions with, and sometimes for, the house staff.
The entire piece is important reading, if not for the content, but also the authors themselves: Bob Wachter and Abraham Verghese. Bob we all know, but Stanford’s Dr. Vergehese also has a national reputation as a writer, educator, and speaker. If you have ever uttered the term iPatient or viewed a TED talk—and this one is wonderful, you know him. I also commend the interview between the two of them and the editor in the linked podcast. The conversation expounds more deeply on the piece’s themes and the broadcast is terrific.
It was refreshing to read something so topical and on target. The essay sums up why the new system needs us as teachers (“new homeostasis”), and what traditions we might leave behind. You will cogitate on the anecdotes and the prose will compel you to think more deeply on your teaching approach. That is what great writing does.
UPDATE: The JAMA editor, Howard Bauchner, suggests to Bob and Abraham in the podcast, they should title their next piece, “Progress Notes in the Modern Era.” This stems from Dr. Verghese’s comments on how today’s notes lack the human flourishes of generations ago–unique identifiers that distinguished one attending from another, like fingerprints. I sense this absence too, and over time, learned to impart my own distinct tracks; partly out of fondness for the past, but also due to necessity. Notes need this character to relay substance and a human element. It is experience.