Tuesday, 7 October 2014


Block: Nephrology, week 2

Right, so I'm currently on a general medical block and attached to a renal firm and a cardiology firm. I'm not massively keen on renal medicine but I was very glad when I got this allocation because I felt my renal knowledge was severely lacking and during these 8 weeks I'd actually learn something. So thanks to this block I now know the difference between the nephrotic and nephritic syndromes (probably-maybe-hopefully).

There isn't any formal clinician led teaching as part of the renal block. Instead, each student has to run one teaching session during the course of the placement and make a presentation on a given aspect of renal medicine to the other students. This isn't a bad idea actually - teaching is an important part of the work of a doctor so why not start it early. A cynic might say that we're paying £9000 a year so that someone with more than 6 months experience of clinical medicine can do the teaching, but I am not a cynic. Grumpy, miserable sod perhaps, but not particularly cynical about the education I'm fortunate enough to be receiving.

So I spent this weekend making my presentation and reading around my topic - I would hesitantly venture to say that the presentation I wrote was, in my opinion, actually pretty okay (considering my stage and all that). Giving the presentation didn't go too badly either. But what always seems to happen is that I unravel a bit during the grilling afterwards. Is it nerves? I don't know, maybe, but whatever it is, that bit was shaky to say the least.

But that's not what pisses me off. Clearly I'm not meant to be an expert on renal medicine, and we're all here to learn anyway and that includes not knowing the answer to questions. Whatever. What pisses me off is when the clinician in charge of supervising the teaching session doesn't actually give you a complete appraisal of your presentation, but merely lists what was wrong or lacking with it. Including, at one point, telling me that I hadn't included something which I very clearly had.

I am not a precious flower. I don't need a pat on the back and a smiley face stamp on my report sheet to keep me going through medical school. What I do need however, is something other than criticism once in a while. I'm not asking for anything grand, just the merest acknowledgement that at least the bits of my presentation which weren't criticised were actually up to scratch. Because when all I hear is that I missed this bit out and I don't know about that other thing, I'm left with the impression that actually, I'm not meeting the standard expected for someone at my stage, my presentation wasn't very good, and that I might as well have spent the weekend getting loaded and re-discovering the meaning of life instead of sitting in the library.

Or am I supposed to assume that your silence means that you tacitly approved of the rest of my presentation? Or is "approved" perhaps too strong a word for you? How about "tolerated"?

Clearly the only way to learn is for someone with a great deal more knowledge and experience to point out where you're going wrong. But when all you hear day in and day out, whether it's in a teaching session, on the wards, in the clinical skills lab etc is that what you're doing is all wrong and lacking in this and that, it really begins to grate after a while. Fair enough, on the ward you don't have the time to give me proper feedback - but in a formal teaching session that's not really the case, is it?

Medical students are already way more prone to neuroticism, perfectionism and self-criticism than the average population - this sort of thing only serves to encourage it.