One Dozen Things
U.S. Graduate Medical Education
Scenario Analysis
This scenario demonstrates the typical dynamics and interaction of a group of residents and students with their attending physician in the clinical teaching setting. After the team has spoken directly with the patient, they appropriately and courteously thank the patient and inform him that they will be discussing his case and that his resident will return later to update him. The team then leaves the patient’s room and reassembles in a hospital corridor.
The attending physician initially asks the patient’s resident for her differential, but she eventually involves everyone in the discussion. Her questions are generally open-ended and are meant to encourage the students to think as they speak rather than to provide fixed answers. When one student is at a loss for an answer, the attending turns to another student but then comes back to the first student offering him an opportunity to answer a follow-up question. Although the attending physician is clearly in charge, her questions are not delivered in a demeaning or threatening manner. Instead, her questions are meant to encourage the unsure student.
This brief scenario demonstrates a fairly common pattern of give-and-take between the attending, residents, and students. This style of teaching is not meant to be a quiz or oral examination as much as an exercise in critical thinking and problem-solving. All participants are expected to contribute in a manner consistent with their level of medical knowledge and training. Although residents and students may not be expected to answer all questions about potential diagnoses, treatments, or tests, they are expected to be well-versed on the information specific to their patients. Because of this, always review your patients’ information before rounding with attendings or senior residents.
You should be willing to admit when you do not know something and should be willing to track down the information just as the attending recommends in this scenario. It is also acceptable to question or challenge the attending, although this should obviously be done tactfully, recognizing that some attendings may be more or less receptive.
The general tone of teaching rounds in U.S. medicine is more relaxed and less formal than the didactic style in some other medical cultures. The participation of all residents and students is not only encouraged but expected.
