If a student or resident is struggling, our first inclination is to “teach more.”

This is often wrong. #tipsfornewattendings 1/

The right idea is often to teach less.

Pick one or a couple of main things and teach that. Over and over. The whole time. Until it sticks. 2/

A common problem new students and residents have at this time of year is: LACK OF STRUCTURE 3/

Most doctors end up sooner or later with a very structured way of doctoring. This saves you a) when you see something you’ve never seen before, b) when one patient has 20 problems and acts like 20 patients. 4/

The most basic structure is
A) H&P or bedside presentation.
CC
HPI
PMH/PSH
MEDS
ALLERG
SOC HX
FAM HX
ROS
PE: VS
Head to toe
LABS
XRAYS
A/P
1. Problem #1. DDX (3+ things)
- DIAGNOSTIC TESTS: you’d like to do to clarify then
- TEATMENT: meds, surgery, interventions 5/

And B) All medical decision making that falls into this paradigm in this order only:

Diagnose then Treat

(Which is why, above, you put the tests before the treatments in your plan). 6/

A struggling learner needs a “skeleton” to hang new knowledge on before you start handing them new knowledge. 7/

After that, sometimes you are faced with a learner who,is not good at remembering facts. Don’t keep throwing facts at them.

Instead, teach principles: 8/

- it’s more important to recognize that someone is dying than what they are dying from
- when scared, get help
- not all fevers are infectious but most are
- nobody ever got a Nobel prize for withholding antibiotics

- when lost, stay put and let help find you (don’t just do something, stand there)—holler if needed
- all good medicine requires good teams more than good brains
- it’s an open book test; you can look up answers
- your worst day is someone else’s best; run cases past colleagues

- if you need help with an X-ray go to radiology; EKG find a cardiologist, skin hail a derm or family medicine, OB/GYN can help you with a pregnant lady, most surgeons will check a belly for you and teach you something, etc. etc.

- most new problems in the hospital are from something you did
- most patients that can’t press a call button belong in the ICU
- if the next upward titration of therapy (eg O2) can’t be done in this room, move them to a higher level of care

Operating by principle saves time and mental space. It’s efficient and works pretty good most of the time. Later, you can attach the exception to the rule. This is how medical textbooks should be written. 9/

When the learner is struggling, don’t teach more.

Teach less but thoroughly and completely.

Teach STRUCTURE and PRINCIPLES that can be applied to many different situations. 10/