Learning by doing: the realities of inexperience
An essential part of learning for every health professional student is the practical component of hands-on learning. Clinical training is a rite of passage that every aspiring doctor, nurse, or allied health professional must complete. Without it, it is impossible to transition from a student to a professional whom patients look to for guidance and expertise.
Every student has a moment where they realise the magnitude of the responsibility that has been thrust upon them. My moment occurred in my very first week of clinical training when I came across a 16-year-old girl named Amy (not her real name). Amy had a rare hip condition I had never heard of before. A quick Google search before the consultation yielded a small amount of information. Yet after that, I found myself alone in the room with her and her mother explaining how we would enable her to walk normally again.
Granted, I knew my supervisor was hovering just outside in case I needed backup, but in that moment, this young lady’s future lay in my hands.
This may sound a little melodramatic, but it is not necessarily too far from the truth. Consider a patient who has a fall because the student forgot the catheter bag attached to the bed, causing her to fracture her hip. Or a diabetic patient who did not receive adequate explanation of the importance of taking antibiotics for their infected foot, later needing a below-knee amputation.
The primary role of the healthcare system is to provide the best possible treatment for every patient. Secondary to this, the medical system is also required to train the next generation of health professionals. And herein lies our dilemma.
Every learner must have a first time. A first time taking a history, a first time drawing blood, and a first time cutting open a live human being with a razor sharp scalpel. Most first attempts are by no means perfect, and it is therefore no stretch of the imagination to say that this does not constitute best possible care.
An expert can provide a superior quality of care than a novice, and yet, to become an expert, practice is needed – 10,000 hours to be exact, according to Anders Ericsson.
The public generally appears to have accepted the need for students to gain experience, with studies finding 66%-95% of patients are willing to have students involved in their care (Marracino and Orr, 1998). However, as explored in Atul Gawande’s ‘Complications’, those with connections to people inside the medical profession are occasionally given preferential treatment in the medical system.
You may have experienced this first hand. A patient is admitted to hospital who happens to be the mother of one of that hospital’s directors. In such cases, it is not uncommon for a senior doctor to come down and personally handle this case from start to end – not exactly the kind of treatment everybody receives.
Perhaps many patients do not object to students being involved in their care simply because they do not know that they have a choice in the matter. Or perhaps they don’t realise that the student is not fully qualified.
Certainly, when I was a student, there was a manner with which approaching a patient would yield a greater likelihood of being allowed to participate in their care. For example, speeding over the ‘student’ part of your introduction (as to omit it completely would be blatantly unethical), walking into the room with arms full of equipment to show that you meant business, or perhaps using the phrase ‘in training’ rather than ‘student’ to appear more qualified.
It gets even more confusing to patients when confronted with doctors in training, who carry various designations including intern, resident, HMO, and registrar. Patients of higher socioeconomic status who are more likely to have greater education and health literacy, are subsequently more likely to understand the difference in knowledge levels between a student and a junior doctor. These patients may feel more confident exercising their autonomy in determining who administers their treatment.
In theory, the same public health services are available to all patients, and all patients are given the opportunity to reject student involvement. However, the system appears stacked in favour of those with who have knowledge of the system or the people in it, to whom options may be presented more candidly.
This is an inherent inequality which seemingly undermines the principles upon which our healthcare system is based.
Now don’t get me wrong. I am not saying that there is anything wrong with being a student, or being seen by a student. In fact, there are several benefits from having students involved in care.
The main issue is that the same healthcare options should be presented to all patients equally.
Of course, this is all well and good, until it is your father, your mother, your child – and then you will do everything in your power, pull every string you can, to get the best possible care available.
To quote George Orwell’s ‘Animal Farm’ – “All animals are equal, but some animals are more equal than others”.
To this, there is no simple solution. Without providing students an opportunity to learn, there will be no future health workforce. And yet, it is human nature to want the best for those we hold dear.
Simulation and virtual reality technologies are continuously developing, and in the future, may be able to provide students with ‘practical’ experience without compromising patient care. However, for now, perhaps all we can do is be cognisant of the different choices we present to patients every day, and be just that little bit more diligent in our quest to providing the best care possible.
The views and opinions expressed in this article are those of the author and do not necessarily represent those of the Doctus Project.