If I’m counting right, I had 14 teachers this week. Since we had a test Friday, that’s 14 people over 20 hours of class time. I’d hit 23 if I count the doctor I work with in clinic and the patients I saw — and, frankly, no one teaches me more.
This isn’t an unusual week. Medical school is remarkable for the enormous breadth of knowledge presented to us. In our first two years, we essentially go through the whole body, twice, learning how it works and breaks on levels ranging from individual atoms to societies. That breadth is probably the biggest challenges I have as a student. It’s a bigger challenge for the teachers, since they have to know more about all of this than we do, in order to explain it and field our questions, which range from minute scientific points (what is the role of enkephalins in the basal ganglia?) to broad curiosity (how long after you eat food will you poop it out?).
No one person can know enough to teach all of medical school, so we get masses of teachers. Each of our courses has one or several “directors,” who arrange the syllabus and give many lectures. But even the director seldom gives more than a dozen lectures in a couple-month course. Much of their effort goes to lining up a host of basic scientists, clinical faculty, community doctors, patients and others willing to come teach 120 total strangers for an hour or five.
A surprising variety of people are willing to share their time to teach us. A couple of weeks ago, Dr. John Kitzhaber, the governor (and an OHSU grad) came and spoke to our clinical class about Oregon’s efforts to create medical groups that offer better and better-coordinated care to state employees and people insured by Medicaid. This past week, the university president, ophthalmologist Dr. Joe Robertson, told us more about OHSU’s efforts to start these “Coordinated Care Organizations,” and discussed his hopes to make OHSU more of a statewide institution than a local one. His phrase: OHSU is not a “citadel on a hill” but an “amoeba with fingerlings” that spread throughout the state.
But they’re doctors, who may feel an obligation to teach us. More impressive to me is the number of patients willing to discuss how their illnesses and interactions with health care affect their lives. We’re studying neurology now, and we’ve had patients come in to talk to us about subjects from how their Parkinson’s drugs affected their marriage to their worry cops will arrest them for their staggering walk. We’ve had everyone from infants to retirees speak to us — even a TV star. This spring, people will even come to our clinical class and let us practice giving a pelvic exam on them. It’s an almost embarrassing amount that these people give to us, asking nothing in return except that we try to become good doctors. They offer so much insight into how medicine and disease function in real life, I don’t think we could be good doctors without them.
Teaching by the gaggle has a few drawbacks. From time to time, we face teachers who lecture at levels of complexity far over our heads, leaving us confused, or levels so simplistic we all quietly reach for our smart phones to play Words With Friends. Clearly, teaching well is a skill not everyone possesses. (Though people who work in public health do all seem to be good teachers.) Everyone presents information in different formats, from power-point slides to printed handouts to extemporaneous ramblings, which can make studying tricky. And different teachers sometimes offer conflicting information; our talks on prescribing opiates revealed more clashing viewpoints than a presidential debate. But even this may be a good thing. In medical information, as in medical school, I’ll get a glut of information: Patient stories, journal articles, test results, Internet printouts, drug ads. Some will be too complicated, some too simple, some unclear or conflicting, always coming from new people in new ways. Maybe all this team teaching is good practice for good practice.