Practice-Based and Lifelong Learning CEO 3.4: Identify one’s own strengths, weaknesses, and limits; a) seek performance feedback, b) maintain an appropriate balance of personal and professional commitments, and c) seek help and advice when needed.
As a naturally shy and quiet individual, I dread any form of public speaking. During my earlier years of education, no amount of practice could reliably prepare me for class presentations. I would always perform well enough to pass, but was always marveled by the ease with which my peers could get up in front of the class and speak.
After I decided upon a career in medicine, I remember being warned countless times about the intense workload or the difficult material. Never did anyone tell me that medicine was more than just learning and knowing how to care for patients. You also needed to be an effective communicator, both orally and in writing. Seventeen years of education and a degree in English had prepared me for the written communication, but I was still not ready for the oral portion. I had learned about and practiced how to give oral presentations during my pre-clinical years weekly Longitudinal Groups, but doing so on the wards is a completely different story.
My first third year clinical clerkship rotation was a three-week elective in Infectious Disease. On my first day, I was already apprehensive about my patient presentation. I was given only one patient to see. After my interview, I wrote down my entire presentation and practiced it a few times before rounding began. Nonetheless, when it was time to present to my attending, fellow, and resident, my nerves got the best of me and I ended up barely stumbling through what should have been a thoughtful and thorough presentation. It didn’t help that my attending and fellow would intermittently interrupt my presentation to briefly discuss the case before allowing me to continue.
Perhaps my team forgot that I was only at the very beginning of my third year clinical clerkships (after all, May is when most other medical schools are finishing the year, not beginning), even though I’d reminded them of this throughout my rotation. Today, more than a year later, these disruptions would not even phase me. But for the me who was only just starting out, they made me question what I was saying and forget my next steps. I tried to ask my fellow and resident for advice on how to improve my presentation, but they would either recommend that I practice giving my presentation or that I try to organize myself before I give the presentation. These were valid suggestions, but I found it difficult to prepare for a presentation that I didn’t know when I would be stopped.
As the rotation went on and I became more accustomed to my team’s workflow and to having to give presentations, I felt that I had improved my presentations to be at least satisfactory, even if they were far from excellent. At the end of my rotation, I asked to meet with my attending for feedback, and she specifically mentioned that she thought my presentations were significantly better than when I had first started, and that she was very pleased with the progress I had made. My fellow made a similar comment, that he felt my presentations had come a long way.
A few weeks later, I received my clinical evaluations from the rotation.
While the comments did not surprise me (my fellow had even emailed me his comments), I was shocked that most of my team still felt that my presentations “lacked clarity and organization, often incomplete or poorly prepared.” My impression from speaking with my team was that I had significantly improved and was doing much better, but I didn’t realize that “much better” did not translate to “good enough.” I began wondering if my performance on my subsequent rotations (2 weeks of Inpatient Psychiatry followed by 2 weeks of General Internal Medicine) was also subpar, and my team was just not telling me even though I frequently asked for feedback.
My fears were eased when I received my evaluations for those two rotations and they all listed my presentations as “usually clear, organized, concise, and chronological.” However, I did not want my case presentations to be this burden that I could tolerate. I wanted to overcome this obstacle that had held me back for so many years. Medicine is a field in which teamwork and thus communication is vital to providing optimal care for our patients. To excel in medicine, I needed to master all forms of verbal communication.
I began seeking out opportunities to practice oral communication. If a patient of mine needed a consult to another service, I volunteered to make the call and speak with the other team. If a patient or family member had a question for the team, I asked to be the one to speak with them. Outside of the hospital, I would strike up conversations with strangers at the coffee shop or grocery store. No opportunity was too insignificant for me to try. The more I spoke with others, the more comfortable I felt doing so.
By the time I reached my 2 week General Cardiology rotation, which was about 3 months into my clinical clerkships, my team members were actively commenting on the quality of my presentations.
This journey probably took me many more months than my classmates, but I am so proud of myself for not giving up and resigning myself to subpar performances on my rotations. Whether I was judged unfairly during my first rotation or not, I took that feedback graciously and used it to improve. Medicine has forced me to confront my fears so that I can grow as a clinician and as a person.