How residents can create a positive clinical learning environment [PODCAST]

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“For me, the team room became a safe space filled with light, stories, laughter, and food. There, my residents helped me read CT scans, interpret CBCs, come up with the differential for bradycardia, and organize my oral presentations. My residents gifted me confidence, advice on the third year and specialty selection, and Dr. Pestana’s Surgery Notes. They took away from their time on the wards to go over my notes, and from their time with their loved ones at home to prepare me short and helpful whiteboard lectures.”

Reem Al Shabeeb is a medical student and can be reached on Twitter @reemalshabeeb.

She shares her story and discusses her KevinMD article, “The role of residents in teaching and creating a positive clinical learning environment.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Reem Al Shabeeb. She is a medical student, and she wrote the KevinMD article “The role of residents in teaching and creating a positive clinical learning environment.” Reem, welcome to the show.

Reem Al Shabeeb: Thank you, Kevin. It’s a pleasure to be here.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Reem Al Shabeeb: Sure. So my name is Reem Al Shabeeb. I’m a fourth-year medical student at the George Washington University in Washington, D.C. I’m calling from my family’s apartment in Silver Spring, Maryland. That’s about 45 minutes to GW, where I went for college and now medical school. In college, I had a really great experience. I really loved it. I double majored in biology and chemistry, and then I also got involved in a lot of teaching and research activities that I continued in medical school.

Now I’m a fourth-year medical student applying to internal medicine residency, and it’s really exciting. It’s a really fun time, Kevin, because in less than two months, I’ll find out where I match, and I’ll get to graduate soon after and become a doctor and become a resident. So I’m really excited about all of that.

Kevin Pho: Well, congratulations on being toward the end of your medical school journey. Now, we are speaking at the end of January, so tell me about the whole residency interview process during the pandemic.

Reem Al Shabeeb: Sure. So the residency interview process during the pandemic was all virtual for me, and it’s really interesting, because at the beginning we were a bit worried. It was like, “Are we going to be able to really assess programs?” But then I think that the programs did a great job and were really showing a lot of opportunities for the students to learn about the program. So that was really nice. We had breakout sessions about interviewing, when we had breakout sessions with the residents. And then it was really nice: They kind of tried to simulate their true experience of interviewing, but here they even had virtual tours. So that was really exciting and really fun.

Kevin Pho: What’s something that you have to do differently while interviewing virtually versus interviewing face-to-face with someone?

Reem Al Shabeeb: I feel like one of the things that I learned is to get a better camera and a better microphone, and a lot of my classmates did that. And then we also learned tips about lighting. So, for example, right now there’s a window in front of me, because that gives you the best lighting. And then we learned that we need a really good and strong internet connection. So it’s just these things that make the interview more natural. But other than that, I felt like virtual interviewing is like the one-on-one interviews that I had when I applied to medical school. I didn’t see a lot of difference, which was really nice.

Kevin Pho: So you talk about a microphone, a better camera, better lighting. Coincidentally, those are all the things you need to start a video podcast as well. So perhaps in the near future, after you finish your residency training, you’ll have everything you need to start a podcast as well.

Reem Al Shabeeb: Of course, thanks, Kevin. And when I had this amazing opportunity to be with you, I was like, “OK, well, I’m ready. I have my camera ready, I have my microphone ready, I’m ready to be on the podcast.”

Kevin Pho: So let’s transition now into your KevinMD article, “The role of residents in teaching and creating a positive clinical learning environment.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Reem Al Shabeeb: So the story I wrote, or the article I wrote, is about the role of residents in teaching and creating a positive learning environment. I started the article by saying how nervous I was on the first day of my internal medicine rotation, which was my first clerkship in third year, and then how I was surprised that most of my time was actually spent with the residents, and how they contributed to my wellness and my happiness through the creation of a positive learning environment.

In the article, I mentioned many examples of ways and things that I learned from the residents, not only in terms of medical education, but things like career advice and professional development. So I emphasized the role of residents in teaching and in the creation of a positive learning environment, and those are the residents that I want to be in a few months, when I graduate and become a resident myself.

And then, in terms of why I wrote it, just in general, I love reflective writing and I love journaling. Journaling and reflective writing are my hobbies. And the themes mentioned in this article, like gratitude, positivity, mentorship, teaching, these are things that I’m really passionate about, and I really love, and I love reading about, and I love learning about. So, as one example, in my room right now I have boxes of thank-you cards that I give to people to express my gratitude. And as another example, I had the privilege and the pleasure to help many premedical students and junior medical students through mentoring. So I just wanted to put more content out there related to these concepts.

Kevin Pho: So can you tell us a story of how an intern or resident helped you as you were going through these medical school clinical rotations?

Reem Al Shabeeb: Sure. So I mentioned many in the article. For example, I had a resident who would go over CT scans with me, to make sure that I’m not only just reading the impressions, but kind of opening the CT scan on the chart and then asking me, “OK, well, can you tell why the impression said that?” Or just making sure that I understand what’s going on with the test that we’re ordering with the patients.

In thinking about what qualities I want to have as a medical resident, since I’m graduating really soon, the two things that come to my mind: The first is just being proactive and helping others, because, especially early on in the clinical year, we may not know, as students, what we don’t know, or we may not know what we need help with, or we may not know in what capacity the resident can help the student, or we may just be shy to ask the resident for help. So just being proactive in asking the medical students, like, “Am I ready to present this to the attending, or do I want to practice presenting to the resident before the attending?” and things like that that my residents did, I felt, were really helpful. Or just when they had free time, when there was free time on the rotation, when we were able to just talk and learn and go over practice questions, that was very helpful.

And then the other thing that I really appreciated in my residents is how amazing they were in being transparent and just remembering what it was like to be a medical student. They would say things like, “Oh, when I was a medical student, I was also nervous on the first day.” And so things like that would lighten up the mood and just strengthen teamwork and strengthen our bond as one team.

So one of the studies that I mentioned in the article is about how, from the students’ perspective, it’s not really the resident’s medical knowledge that the students care about the most, but rather the resident’s ability to create a safe clinical learning environment. And that makes sense to me, because the things that medical students usually need help with are things like just practicing presentations and finding information on the chart. So these are the things that residents can easily do, and can contribute to the creation of a more positive and safe learning environment.

Kevin Pho: Now, like a lot of medical students, I’m sure that your experiences with interns or residents have not been universally positive. What are some of the things that residents or interns did that kind of struck you as particularly negative or unhelpful during your clinical rotations?

Reem Al Shabeeb: I would say that most of my experiences were positive. On the off chance, once in a blue moon, that there would be an experience that is not good, it would be just, going back, the opposite of the points that I mentioned: not being proactive in helping the medical students, or not remembering what it was like to be a medical student. And so things like that, I found, sometimes my classmate and I were a bit unhappy about, and we wished more work would be done on the residents’ part to make it more teamwork-based. So, for example, not asking us if we understand what’s going on on the rotation, or when we’re not sure what’s going on on a certain rotation.

And it’s not really a negative on the aspect of the person, because for every person who goes through medical school and matches, like now I’m in interview season, the process is not easy to apply and be selected as a resident. So the fact that they are there already means they are amazing people with great clinical skills and great interpersonal skills. And so these negative aspects, which are rare, are usually not intentional, but there are ways that, if the resident is more proactive in helping the student, would just make it better.

Kevin Pho: Now, is there any way for medical students to offer constructive criticism to help improve the clinical teaching aspects that the residents have?

Reem Al Shabeeb: So I was actually just doing residency interviews, and at most programs, they already have programs or lectures on how to give feedback, how to be a more effective teacher, and things along that line. And then, for the medical student, I think if everyone is transparent and just takes it from the perspective of, “You’re an amazing person, and this is just to help you become more amazing,” then it will all be on the same team. So I think with transparency, it would all be a good, or a better, environment.

And there was not a single point where I asked a resident, like, “Hi, can you walk me over this patient’s chart?” or, “I cannot understand the CT scan,” and, just from my experience, no resident really said no. So it’s just being more transparent in asking for help that gets you the help you want.

Kevin Pho: Was there any difference across specialties during your clinical rotations: medicine versus surgery versus OB versus psychiatry versus pediatrics?

Reem Al Shabeeb: I felt that across the board I had amazing residents. I had amazing residents in internal medicine, like I mentioned in the article, and then I had amazing residents in pediatrics. And then even in specialties that you would hear or read in the literature have high mistreatment rates, like surgery, I still had some of the most amazing residents, and I found friendship with so many of them. And so across the board, I felt that people were able to be themselves and be helpful to me and be great to me.

And just when I was reflecting back on the article I wrote, I wrote this article right after I finished my first rotation, of internal medicine, but there were still so many amazing examples that happened in every single rotation, and so many amazing residents that I met. So I felt that at the end of the day, anyone can really be a great resident and contribute to the creation of a safe and positive learning environment.

Kevin Pho: We’re talking to Reem Al Shabeeb. She is a medical student, and she wrote the KevinMD article “The role of residents in teaching and creating a positive clinical learning environment.” Reem, you’re now toward the end of your fourth year. Is there anything that you know now that you wish you knew back before you started your clinical rotations?

Reem Al Shabeeb: When I get this question, the main thing I say, the main advice I give to more junior medical students, is first and foremost to work hard and be a strong advocate for patients. After all, that’s why we’re in medical school, and so that’s always the first tip. And then afterward, just emphasizing teamwork, not just with the other students or the residents or the attendings, but also with the rest of the nurses and the pharmacists and the medical assistants and the premedical volunteers. Together we improve patient care as a team, and together it’s honestly more fun. It’s more fun to walk around the hospital and hear “hi” around every corner.

And in terms of evaluations, I would ask the attendings I had, or my supervisor, at the beginning of the rotation about their expectations, and then ask for feedback along the way to make sure that I’m progressing on the right path. And also, one more thing: If you know a peer who did this rotation, I would just ask them about any tips they have, or any advice, or any feedback that they received that I can now incorporate.

For example, midway through my clinical rotations, I started creating these notes about my experiences on the rotations and the feedback that I received, and I would give these notes to classmates for our own rotations. And what I noticed is that most of the time these notes were really helpful, and I really got great feedback from my classmates saying, “Oh, this really helped us with this and that.” So this is what I wish I knew earlier on, or what I would emphasize in my training.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Reem Al Shabeeb: Sure. My take-home message is that in many rotations, students spend most of the time with the residents, and the residents have an important role in teaching and creating a positive learning environment. So thank you to all the wonderful residents that I had throughout my medical school journey, and thank you, Kevin, for having me.

Kevin Pho: Best wishes on your residency journey that’s upcoming, and thanks again for being on the show.

Reem Al Shabeeb: Thank you so much. I really enjoyed this.

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