“Have any cases for us today, Professor?” Mariah asked me as I walked into the resident workroom. I was a PGY-3 neurosurgery resident and she was a fourth-year medical student on her sub-internship. She had started referring to me – somewhat tongue in cheek – as “Professor,” because I enjoyed conducting informal case presentation sessions with the medical students. On that particular day, we sat at the computer together scrolling through CT and MRI scans, while discussing a case of a pediatric patient with a posterior fossa mass. The teaching and learning that comes with these types of interactions turns out to be crucial for us both. From learning neuroanatomy to preparing for a career as an educator in academic neurosurgery, medical student teaching greatly enriches both experiences.
I remember being a medical student in Mariah’s shoes a few years ago. Similarly, I relished the opportunities to learn more from residents during these types of teaching sessions. I recall one such session where I was asked by a resident for a differential on the cause of a parenchymal hemorrhage in a middle-aged man. I mentioned dural arteriovenous fistula, but was not familiar with the classification system. My answer was met by the resident’s response, “Hey, good idea on a dural AV fistula. It’s less likely in this patient who presented so hypertensive, though. But let’s go through the classification system together.” He then did an internet search for the Cognard and Borden classification systems, and we discussed the details together. Even though he was familiar with the classification system, he was also using the discussion to recall the explicit details of each type. We both benefitted from the discussion; for me an introduction, for him a refresher.
These types of interactions were memorable to me because of both the neurosurgical knowledge gained and the appreciation for the constant continued learning required of residents. The residents were people that I identified with, given the proximity in age, yet I still looked up to them and their advanced knowledge. These types of sessions also helped me construct a vision of myself in three to four years at a time when people kept asking the daunting question – “Where do you see yourself in 15 years?” Additionally, it gives the student and resident the opportunity for more substantive interactions. When evaluating students and giving feedback to be included in recommendation letters, these teaching sessions provide specific experiences on which to comment.
As a resident, I have learned to appreciate how crucial teaching medical students is to my own development as well. I have amassed a series of example cases that I use with medical students. Going over these cases has helped crystalize my knowledge of the relevant anatomy, differential diagnoses and surgical approaches. Indeed, I encountered a similar question regarding surgical management of posterior fossa masses on my board exam after having discussed it with medical students. As I continue to add to my teaching cases, the depth of my knowledge continues to grow. I enjoy the challenge of not only understanding the more complex cases, but of also being able to simplify them to teach younger colleagues.
Teaching medical students has also taught me lessons translatable to other arenas. Early in residency, my teaching sessions were more didactic lecture rather than an interactive session. As I became more comfortable in my teaching, I transitioned to having the students take over the case, using the mouse to scroll through images, diagnosing and prescribing interventions. It is a much more effective method for adult learning. In addition, as I interact with junior residents, I can use this exchange as an opportunity to stress patient ownership, a basic tenet of neurosurgery. I encourage careful and thorough analysis before presentation to amore senior colleague. I have found that this leadership style is critical to maximizing people’s potential – I will utilize this strategy in the future.
As I look to future steps in my development as a neurosurgeon, I see the importance of education at all levels. Working with medical students has helped me hone a teaching style, solidify my knowledge base and develop my leadership style. As I envision being an attending tasked with teaching residents at all levels, the foundation that I am building in my residency is critical. Both developing an expansive knowledge base in neurosurgery and perfecting the craft of teaching are crucial skills that started with teaching medical students, like Mariah.
