Preparing resident for the practice: An opportunity.

What is a surgical pathology rotation for a resident?

No virtual reality or simulated setting can fully replicate the complex interactive learning that is available at a surgical pathology sign-out, or in some specialties, at the bedside [...] The relationship is professional but also intellectually and psychologically personal, as it requires extended and repeated series of queries, statements, challenges, affirmation or refutations, criticisms, and compliments.

What does a resident actually learn from us at sign-out?

Although a resident may learn diagnostic criteria, a vast array of other information is transmitted [...]:  that we possess much medical knowledge;  that our dogmatic views are not entirely shared by many other equally dogmatic attending pathologists; how we deal with ignorance and uncertainty; how we deal with errors  and  how we communicate with colleagues, secretaries, and students; and much about our behavior and attitudes.  

What attitudes are expressed at sign-out?

Making a diagnosis represents both science and art. [...] The resident who sees himself/herself as a learner; eager to absorb more knowledge; curious about diseases, their pathogenesis, and natural history; [He is] grateful for the opportunity to learn [...] and will extract information from almost any situation.

What behaviors are displayed at sign-out?

Irritability, impatience, interruption of speech, exasperation, disappointment, dissatisfaction, and frustration are too often expressed, when calmness, patience, good listening, acceptance, or acknowledgement of error could add to the educational experience.  We should express frustration with work that has been done carelessly, but it should be conveyed deliberately and with a full understanding of its effect on the resident. Our behavior is also revealed in ancillary interactions. How do we handle interruptions (phone, page, or personal)? What comments do we make about clinical colleagues? How do we react when we find a typographical error? Do we have a predictable, fixed time for sign-out? Do we demonstrate respect for colleagues, residents, secretaries, and technicians? As we model a behavior, it is more likely to be adopted by the residents with whom we work.

We have the opportunity and the responsibility to shape the professional lives of our colleagues in training by how we approach this simple surgical pathology sign-out.                We can influence not only how much is taught but what is learned and how it will be used.

Zaino RJ, Abendroth CS. Preparing residents for practice. An opportunity to teach professionalism and communication skills as well as diagnostic criteria. Hum Pathol. 2010 Jul;41(7):923-6.

"...Je dois apprendre aux curieux..." 

Expédition nocturne autour de ma chambre, 

Xavier de Maistre, 1794. (http://en.wikipedia.org/wiki/Xavier_de_Maistre)