Thursday, July 15, 2010

See One, Do One...Teach One?

One of the things I love about residency is that the learning curve is just so darn steep. Just when you’ve got one thing down pat, it’s time to learn about something else. The process of self-improvement just doesn’t end.

Example 1: The first half of my intern year was dedicated to learning how to get through the basic steps of a vaginal delivery or cesarean section. I was happy just to get through a delivery without fumbling the baby. If I finished a delivery and the baby wound up in a nice football hold, if I could cut and clamp the cord without dropping the instruments, I was glowing. Same goes for a c-section. If I could hide my intern tremor for the duration of the surgery, I was happy. If I could sew up the uterus and the attending didn’t need to throw in a ton of extra sutures afterwards, I considered it a job well done.

Example 2: The second half of my intern year was dedicated to finesse. It was about maintaining order in a labor room, creating a positive birth experience for my patients, catching a baby with grace, and knowing when and how to intervene if a baby dropped its heart rate or if mom had more bleeding than usual. It was about developing my own style and routine of baby catching. In the operating room, my focus was on doing the c-section start to finish, calling for instruments, delivering the baby without struggling, re-loading my needle driver without touching my needle. It was about a beautiful subcuticular stitch to close the skin. It was about dictating from memory before I walked out of the OR.

Now, a year later, the start of my second year is dedicated to a new learning objecting: teaching. I’m no longer standing at the perineum and coaching a soon-to-be mom with her pushing. I am not catching the baby and handing it off to its waiting mother. I am walking our new interns through it. I am helping with their delivery maneuvers, their laceration repairs, and everything in between. The good is that it’s been extremely rewarding. There is a certain pride you feel when your intern does a beautiful delivery or repair. And with every delivery, they get better and better. As if that weren’t reward enough, their excitement and enthusiasm for these new experiences is incredibly contagious.

The challenge for me in all of this is making the personal transition from the “do-er” to the “teacher”. Struggling with something, be it getting the baby into a good football hold or delivering the placenta, is an important part of the learning process.I know this. Watching it without jumping in, however, is harder. It’s like being the kid in class who actually knows the answer to the teacher’s question but not being able to answer it. It’s like waving your hand in the air saying “Pick me! Pick me!” knowing full well that it’s not your turn to talk. A couple days ago, I hip-checked my intern out of the way when we had a tight cord around the baby’s neck. Afterward, I realized that I had missed a great opportunity to teach my intern how to deal with this situation. What makes me feel even worse about the whole thing is that I remember being in this intern’s shoes. Just a year ago, I remember being so eager to do a delivery, by myself, start to finish. I remember being hip-checked myself and thinking, “Just give me a chance! I can do this!!!”

Reflecting on this experience, I realize that I had panicked in this week’s delivery because, as the next senior person in the room, I felt ultimately responsible for the outcomes of this mom and baby (which is true). Looking back, however, there was plenty of time to walk her through a nice somersault maneuver and still have a happy baby.

Intern year, for me, was about stepping into my role as a doctor. It was about stepping up to the plate and getting my hands dirty. As a second year on the labor floor, I’m learning that my job is to take a step back and teach. It’s to trust my intern with a straightforward delivery. It’s to trust myself that I know when to step in. Like I said earlier, there’s always something to work on in residency.

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