Deliberate Practice #1: The Medical Student

On my way back home today, I listened to a revealing and frankly, inspiring, episode of EMCrit about “deliberate practice.” We’ve all heard a little bit about it – “Practice perfect makes perfect.” That’s the simplest way to put it. So rather than rehash what I heard, I wanted to talk about The Med Student.

That may sound generic, but no one will replace her as The Med Student in my mind. She was there at the Procurement I went to as part of the Thoracic Surgery team. She stood at the head of the bed. And without asking or telling, she grabbed onto the bronchoscope and bronched the patient. Down she went, zipping and zooming down the Left Main stem and it’s tributaries. Out – out – out and down the right now. Flawless technique. Confident. Practiced.

I was too busy trying not to screw up my part of the abdominal transplant by helping the attending but I didn’t think much of it beyond admiring her skill. Because I thought she was a fellow. Or at least a resident. It didn’t cross my mind a medical student could be that good. So confident. So polished.

I wasn’t the only one. The cardiac surgeon asked her – “What year are you?”

“Uh, 4th year.”

“Oh, PGY-4.”

“No, um, med student. 4th year medical student.”

The cardiac surgeon was stunned and impressed. As was I, to say the least. Once I got over my pride and the transplant hit a lull point, I asked her the question that had been in my mind since my Thoracic Surgery service 5 months ago.

“How did you get so good at bronchoscopy? I have been struggling with that for a while.”

She smiled shyly. “I want to go into CT and I wanted to be really good at this. And I was really bad. So in my thoracic surgery month, I bronched every patient that I could. Even ones who didn’t need one necessarily. But I was the one to do it. And my fellow taught me how and helped me fix my technique.”

And I will never forget that. Because it wasn’t that I lack(ed) the drive (though I had hit a very rough patch recently). But I lacked the deliberateness. The focus to improve and the vision to define what improvement means and the humility and mentorship to actual achieve it.

Focus. Vision. Humility. Mentorship & Coaching. Not having one of those element makes it harder, but not impossible. If the Med Student can be that good at something resident struggle with, I have to believe I can at least try.

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