How does one become a doctor? What does it mean to become able to help preserve the health and sometimes the life of someone else?Even today, at a time when technology plays an essential role in all areas of medicine,
to become a fully-fledged doctor you have to do what was done several centuries ago, when those who wanted to learn a trade followed a master. This was also my case, having entered the medical-surgical profession a few years ago. I realised that even today, despite the fact that technology is increasingly accompanying medical practice, the human factor remains central, from start to finish.
Scholars of the learning mechanisms in the biomedical area differentiate formal learning (lectures) from informal learning, which occurs either by oral transmission or by simply being around reference mentors. As a doctor, I learned most of the theoretical knowledge from formal study, but all the technical and interpersonal skills I learned from the example and practice of a mentor. In my profession, as in the past, the figure of the mentor, who is a guide and example, remains central. It is no coincidence that in the Hippocratic oath the student undertakes to respect and assist his or her mentor until his or her death. In my field, which is predominantly surgical, there is no book to teach me certain skills, nor to correct my mistakes, but a mentor who assists me and watches me work.
But another essential part of the professional skills is knowing how to relate to patients, to colleagues and to other health professionals: you only learn this by observing your teacher. As it happens to me today too. In fact, there are skills that are learned by imitation, without almost noticing, a bit like young children do from their parents. So the teacher must know that every step he or she takes will be observed and imitated by those who follow him or her. This is extremely important for the student and implies extreme responsibility for the tutor!
I am currently working in close relationship with an older colleague, from whom I learn a lot on a practical and relational level. So I have to be ready to learn from those who are more experienced than I am, taking advantage of every moment and every situation. However, I have realised that from some other colleagues I may also assimilate attitudes that are wrong, or not fully correct in the ethical field, without realising it. Therefore, my daily effort is to always have the utmost attention in critically assessing the attitudes of those around me, without passively adapting to them.
In turn, I also find myself being a reference figure for students and young trainees, perhaps even more so than a professor would be, because I am closer to them in age. So it is important that I provide a positive example of the way I work at all times and that my behaviour is consistent with the principles I affirm. It has been shown that if the theoretical message differs from the behaviour of the tutor, confusion is generated in the pupil and, between the two messages, the example prevails over the theory.
Example is also fundamental in relational skills. The doctor-patient relationship – the subject of numerous studies and research – remains one of the most difficult components to master, as well as to learn and teach. The basic reason is that each one of us is unique in terms of character, personality and training (so the possible sums are infinite!). But in my opinion, it is a fundamental component of my work, because in relating to a patient, first of all there must be a meeting between two people and then a relationship between a health professional and his/her patient; then because the relationship heals, sometimes better than many medicines. Therefore, experience helps a lot, and learning from a teacher’s experience how to relate in a healthy and constructive way with patients – and, why not, also with relatives – provides a substantial starting point, especially in learning how to reach out to the other.
Another aspect that has changed my way of approaching my daily work was to understand that every occasion is a useful learning lesson for me, even when I witness conduct I do not agree with: in fact, in those cases I learn how I should not behave and should not act. Understanding this has been very important, even if I have to make the effort to separate within myself the author of a negative example from the action itself, learning to appreciate the good in everyone, even if mixed – as for all of us – with the inevitable limitations. Incidentally, in the light of this I am better able to accept my own limitations.
The last aspect to consider is that, in any case, a personal relationship is established between teacher and pupil, one to one, without intermediation. A deep friendship is not necessarily indispensable, but a direct and sincere relationship is certainly needed, between people firstly, rather than between colleagues.
But beware: what about the ones who are not doctors? Truly, all of us have or have had ‘teachers’ to refer to, or we can in turn become one. So keep your eyes open!
Michele Trevisan
