Probably the question that my students are most concerned with is that they cannot learn all these medical topics in just a couple of months they are spending in that specific clinical rotation.
And my answer always begins with the same thing: you are absolutely right. You’re not going to be able to do that. No one can. No one is supposed to.
You pass the nephrology course. You score a high grade on that exam. But it does not mean you are able to manage patients with problems related to nephrology. You probably get confused on the first case with hyponatremia.
It’s not your fault. They are not the same. I will talk about the Bloom’s taxonomy of learning some other time. But up to now, no medical exam can fully simulate the real clinical encounter. Most of them even do not come close to it.
Clinical wisdom is slow to build.
AND we should accept – at the very beginning of your clerkship or residency – that this part is painstakingly time-consuming and resource-intensive.
Becoming a clinician is not the same as getting a high grade.
As Joseph Sapira mentions in his great book (Art and Science of Bedside Diagnosis), clinical wisdom is like building the Alexandria library:
The mind grows slowly, one skill or fact at a time. Therefore, you are encouraged to read about each patient seen every day and to try to learn at least one new fact about that patient and his disease.
The greatest library known to the ancients, and possibly the greatest library of all time, was the one at Alexandria. It was built by requiring that no ship could dock in the harbor unless it brought payment of a book.
Thus, the library was built one book at a time. Unfortunately, the library at Alexandria was burnt in a tumult.
The one at Constantinople was also burnt, but only so that the manuscripts could be used to heat the water for the public baths. It is said to have taken weeks to consume that library.
The mark of degenerate societies is that they foolishly consume the accumulated wisdom of their predecessors.
So, too, is the accumulated wisdom of the clinician consumed by time and senility. Like the library at Constantinople, the only evidence of a former vigor may be the length of time it takes to burn out.
