Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Why I teach…

Introduction

I have been teaching (involved in academia) in some form since 1994 which means that I have “been around the block a few times”. Teaching has been my way of “paying it forward” since I was in graduate school in the 1990s. I use the term “paying it forward” because I was fortunate enough to have outstanding professors at every juncture of my education. Medical school just added patients to the list of persons that I teach which continues to make my practice interesting and fun. I use the word “fun” to describe teaching but it’s not lost on me that my teaching is a way to show how my teachers affected the way that I learned science and medicine which I attempt to pass along to my students and patients.

The first  influential professor

The first professor who had a profound influence on me was my undergraduate physics professor. A “renaissance”  man in every sense of that word, my physics professor would start the class off by playing a few minutes of a Beethoven symphony whereupon he would ask us to identify the work. I was usually the only person to do this as I had spent more than some quality time study the compositions of Beethoven, Chopin and Mozart in my harmony and ear training courses that I had taken when I studied music. My professor marveled at how I could “guess” the identity of the piece with little more than three or four bars. For me, Beethoven, Chopin and Mozart were so distinctive in their styles that my task was simple. If he wanted to “stump” me, J.S. Bach would do the job.

In addition to music, this professor was a prolific writer, photographer and collector of thousands of ideas. My favorite idea was when he spoke of walking though Einstein’s office at Princeton and breathing much of the same air as the famous physicist. My professor also had the gift of being able to explain extremely complex ideas and theorems in a language that added this knowledge to our fledgling knowledge bases. As he filled multiple chalk boards with derivations of quantum theory and mechanics, I learned how to approach a body of knowledge, immerse myself and convey my thoughts and findings within the language of those complex theorems. In short, my professor showed me how to look at the world from the standpoint of mathematics and precision. After one semester of university physics for scientists and engineers, I was transformed.

My mentor in analytical chemistry

My next influential professor was an analytical chemist from Hungary. His influence on me was teaching me to love electrochemistry from the standpoint of chemical analysis. Like my physics professor, my chemistry professor was able to teach the utilization of any and all “tools” in the craft of studying a body of work. My chemistry mentor taught me how to prepare a PowerPoint lecture of a complex subject for different audiences.  He always said that one needed to be able to explain their research, no matter how complex, to other scientists, to scientists in other disciplines, to potential investors and to the lay public. His great lessons have proven invaluable to me over the year of graduate school, medical school and practice. He has a thriving research group that is putting out some amazing experiments because of his ability to bring out the strengths of each member of his team and his ability to get everyone to work toward a common goal. His lessons were great. Like my physics professor, my chemistry mentor was a man of ideas.

My biochemistry/physiology mentor

My mentor in biochemistry was actually a physiologist and a woman. She had a fine analytical mind but was very vulnerable in many areas. My greatest lesson from her was to be able to see collaborative possibilities in a multitude of situations. She had thousands of ideas every day which was refreshing to be around. When she needed to focus on one path, she was unshakable but she always saw the larger implications of everyone’s work and contributions which never went unrecognized.  She admired my quest for knowledge and I admired her ability to cut to the “bottom-line” of any situation, scientific or political. Under her tutelage, I became exposed to the politics of academia and came to understand how to get what I needed to present my best to my students. From my studies with her and under her, I learned how to integrate basic science with clinical medicine. One cannot separate science from medicine as science drives medicine which is its practical application. I also came to realize that since she had been one of Sir Hans Krebs’ graduate students, I was by association, a student of Sir Hans Krebs. Yes, I know the citric acid cycle inside, outside and backwards. One of my favorite tasks in graduate school was to substitute nitrogen for carbon and rework the “Krebs” cycle. (Hint: follow the electrons because it’s oxidation and reduction that “fuels” life on earth).

My first clinical mentor

My first clinical mentor was another renaissance man whose broad interests and talents make him a character. He was a specialist in Internal Medicine who was fond of referring to surgeons as “Philistines” (Orthophilistines, Neurophilistines and others) in the sense that Philistines are ill-mannered and generally crude. Some of his favorite statements were, “Internists practice classical medicine while the Philistines practice common medicine”. To his delight and astonishment, I ended up choosing to enter the practice of “common” medicine and become one of the “Philistines”  for which he always teased me when I encountered him.

The greatest thing about my clinical mentor was that he always gave his patients 100% of his attention and ability. He was a voracious reader and writer who encouraged me to begin reading the New England Journal of Medicine from the day I received my acceptance letter for medical school. He said that I probably wouldn’t understand much of the journal but have a daily habit of spending at least 30 minutes reading a journal would be of great utility to sound practice and education. He suggested that I read the Case Reports from Mass General first thing in every issue and then turn my attention to the Original Articles. To this day, this is the manner in which I approach the New England Journal of Medicine ( I have added about 30 additional journals each week). Again, I see the utility of putting the basic science with the clinical science which cannot be separated.  I am a profound believer that medical students should make it a habit of reading Mayo Clinic Proceedings, Nature Medicine and The New England Journal of Medicine from day one.

My surgical mentor

My surgical mentor is a laparoscopic surgeon who was trained a Duke University. When I met him, I realized that he had the same approach as the rest of my mentors which meant that he is a man of broad interests and abilities. He is an avid distance runner for whom I suspect his running keeps his agile and always active mind on course. He is another mentor who is able to put a strong team together where everyone’s strengths are highlighted. From my surgical mentor, I learned to never give up on any patient for any reason. When that 30th hours is creeping up and one is fighting sleep and a wandering mind, my mentor taught me to find a “kernel of focus” and build upon it. He also taught me the utility of rounding alone late at night when one can see the patient with renewed perspective. His late night teachings were some of the best (yes, he was up at 4am too). He taught me to rely on my training and thinking rather than emotion though I suspect that his emotions are far deeper than he shows on the outside. Under his direction, I became fearless to a certain degree and confident in my skills as a surgeon. The most outstanding characteristic of my surgical mentor is that he loves to teach and thrives on the excellent training of those who are under his direction.

Common thread

The common characteristics of my mentors over the years is that they are people of diverse ideas and interests. Every year at the start of a new year, I strive to get back to the characteristic that I most admire in my mentors. At each year’s end, I take stock of what I have learned and appreciate in this journey of medical practice. I know that I am fortunate to have had an opportunity to have been taught by many outstanding professors who have left their profound influence. I also know that there are those who I hear “whispering” in my ear on a daily basis. No matter where you are in your training in medicine, you should stop and take a minute to thank the people who have taken the time to teach you something. It’s good to remember that not all lessons are learned in the classroom and that it’s a privilege to have a mind that allows one to learn from a good professor.

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31 December, 2011 - Posted by | academics, medical school, medicine, surgery |

4 Comments »

  1. Dear drnjbmd

    I am thrilled to find your blog. It is extremely helpful in many ways. I appreciate your effort in sharing your experiences and perspectives here. I am in my late 30s and just started application process. If I am lucky, I will graduate medical school when I am 42….it is my hope to become a physician in PM&R. I will certainly come to your blog to learn and get advice from you if that is okay. Would you consider writing some experience of how you balance work and life when in medical school and residency?

    Thank you so much~~ and thank you again for this great blog!!

    Comment by JC | 29 September, 2012 | Reply

  2. Hi Dr NJBMD, Really wanted youre valuable advice on my step 2 ck prep. I recently did NBME 2 & before than NBME 1 & scored a 250 ON nbme 2 which is not even a passing grade. On the breakdown, I saw that I have been consistently scoring below the mark in diagnosing disease. I am currently doing usmle world questions. I have trouble remembering my kaplan notes. Im really confused as to how I am supposed to proceed with my prep. Do I do the q bank subject wise or mixed. I realise when I finish one subject & move onto the next I forget the previous subject I have done. How did you keep information fresh in youre mind? Do you review a lot? thanks so much. Tina

    Comment by IHOM | 1 May, 2012 | Reply

    • To IHOM:
      If you are continuing to have diagnostic testing pointing towards a particular area deficient, then your knowledge base is your problem. If you have a poor knowledge base, review books won’t solve it. It looks as if you are continuing to do questions but your focus is not on why you are missing the particular question but on attempting to memorize answers to specific questions rather that shoring up your deficient knowledge base. Continuing to focus on questions isn’t going to get you over a knowledge base that is deficient in the first place. You likely need to go back to the textbooks for the particular subject areas that are weak. If everything is weak, which poor diagnostic achievement would indicate, then you need to stop going from subject to subject in terms of questioning and look to a more long-term method of getting your knowledge base adequate. Once you have an adequate knowledge base, a review would be more useful. You have to have learned the material in the first place before you can review. You can’t “review” what you haven’t learned. Good luck.

      Comment by drnjbmd | 1 May, 2012 | Reply

  3. Hey there,

    Just wanted to leave a note to thank you for your blog and say that I really enjoy your writing. I hope to attend med school one of these days, although for practical reasons I just can’t pull it off right now (I’m a geologist, a few years into my career, but interested in medicine since before I even graduated).

    I hope your new year is going well. Based on the content and nature of your blog, I’d say you’re doing well to honour your mentors and pass on their spirit of knowledge and nurture.

    Cheers,
    Tim

    Comment by K & T | 14 January, 2012 | Reply


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