Orphanage Team Rounds

Standard

We have been going back to the orphanage weekly for the past 5-6 weeks now, and are gradually figuring out a system to maximize how we see the patients and do effective teaching.  In addition, we have several new residents in the program who are getting their feet wet.

This week the other pediatrician and I started doing “team rounds,” where we split up the  trainees into two teams and each of us reviewed the patients with that team’s residents.

Before, we had been a bit more haphazard about the patient presentation, with each resident individually talking to one of the attendings.

The dynamics of small group teaching were visible as my first resident Nan began her presentation.

She is pretty new and her English is still emerging, so J helped with the translation as needed.

Even as my Chinese gets better, one of the objectives of our training program is to help the residents improve their medical English, as that is a very marketable skill for them, so the patients are reviewed mostly in English.

As Nan described the patient, a six year old girl with hydrocephalus (fluid in the brain) and developmental delay, I asked some questions.

We found out that the child had surgery to place a shunt, which drains fluid out of the brain and into the abdomen, at age ~8 months.  I described the basics of the procedure and how it works.

I was really excited when Q, listening to the somewhat choppy, but sincere presentation, suddenly asked a question a few minutes later.

“So what happens when the child grows?”

The wheels were turning, and he was genuinely processing the information and thinking ahead on his own, anticipating potential problems and complications.

This is one of the skills we are hoping to cultivate in a group of doctors who come from a memorize-and-recite-back system where individual thinking is not usually emphasized or encouraged.

Yay!

It was truly a highlight of my day.

I said, (as attendings before me have said for millenia), “That is an excellent question.”

We went on to talk about how a baby’s body grows, and the tip of the shunt catheter over time is no longer draining into an open cavity, can get plugged easily and stop working, and other related topics.

We went back and looked at the growth chart again, examined the patient, and discussed some more as we developed a plan.

The child had open sores on the back of her scalp from lying on her back all the time, and an ear infection.

We talked about how to position her with a rolled up towel to put pressure off the wound, and treating pain as well as infection in children.

I reminded the resident to make sure and talk to the caregiver about the plan as well.

Even though the circumstances are very different than my suburban clinical pediatric practice in a former lifetime, some things don’t change.

Such as the mantra we heard throughout our training:  “See one, do one, teach one.”

Here residents are often relegated to the role of observer during their entire training period.

I have met several of our doctors who have never held a newborn until I brought my daughter in for a checkup.

We are hoping that the higher level residents can begin to teach those coming behind them as well.

We all owe so much of what we have learned as doctors, to those who have gone ahead of us, and I will never forgot certain mentors and how they pushed, prodded and encouraged me to constantly do better.

I will also never forgot those senior residents who took great pleasure in torturing me and ripping me to shreds during team rounds…

But good and bad, it all contributed to part of my lifetime of learning, and I am eager to participate in this new learning environment with my residents and patients here in China.

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3 responses »

  1. So… what does happen when the child grows up? Is it replaced or removed?

    What’s been your biggest challenge teaching so far?

    • The biggest thing is to let go of my assumptions about the residents and comparing it with a US training experience, having to take several steps back to gauge their knowledge and experience. The Chinese educational system is big on memorizing facts, but not so much on thinking outside the box about diagnoses, or on hands on training. Most medical students in the US have had a lot more experience examining patients than these docs.
      The kids as they age out? Some have permanent disabilities and stay in the “adults with disabilities” section. They are all entitled at least to regular high school education, and I imagine that some may get jobs etc. But without having specific details about China in hand, data from orphanages in general show that those kids are at much more risk of having mental health problems, becoming drug addicts, prisoners, prostitutes and homeless than the general population. In part due to cognitive delays from being in an institution, in part from the lack of nurturing and attachment that comes with being in a family setting. So these kids are at very high risk of problems, even those who survive the early years.

  2. Pingback: Learning, Learning « Chopstix for Six

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