See one. Do one. Teach one.

The first two years of medical school are all baby steps. There are no leaps, no bounds, no dramatic progressions in clinical acumen. We dream of expertise in the skills we learn but progression is slow. This is partly our fault and partly a structural feature of our medical education. We fail to train to the point that we cannot get it wrong, our study load fails to allow the time for practical task repetition.

I write today about learning on the job. Eyes forward to the clinical years. Although only nine weeks in it is clear that this is a very different set-up. The leaps, the bounds, the elusive progressions in clinical acumen are now available. At last, what we have been yearning for through years one and two. Let us become competent, let us strive for expertise.

Unfortunately, these things are not a given.

Although I confessed to writing about learning on the job, I suppose I am really writing about WANTING to learn on the job. About seeking opportunity, about doing scary things. I’m writing about the need to be willing to see one, then do one, then teach one.

I’m going to highlight the simple steps I think you should take to achieve the seeing and doing components successfully. Yes, I am writing from a medical student perspective but I expect there may be crossover to other realms of learning.

Step 1 – Have a grasp of the theory.

Ideally, you’ll be across the skill or procedure you are about to see. Perhaps you had warning that you would be seeing this and you dug around to find out some basic steps, some indications and contraindications. If this situation comes to be then please, take advantage of it. Learn, simulate, repeat.

Unfortunately, this will not always be the case. In many situations the steps, the indications and contraindications will have to be learnt after ‘seeing one’. That is ok. Not ideal, but ok. If that comes to be then accept and embrace the opportunity. Why? Because the next time you are in a room where this skill or procedure is being performed it will be with your hands.

Step 2 – Have your ears on the ground, then be honest.

If you are blessed with that supervising doctor that doesn’t happen to be busy (blue moon odds here) you will next be asked to perform the skill under supervision. Wonderful! Accept with honesty that you haven’t done it before but that you are enthusiastic and want to try. Perform your tactical breathing, listen to your positive self talk and grasp the opportunity. Easy.

Now for the remaining 98% of opportunities. They will present themselves in a subtle way. Perhaps you’ve seen the patient for a history, perhaps you brush past the conversation between doctors and nurses. Whichever way it happens, when you realise the procedure or skill is imminent, put your hand up and ask – “Can I please do the …” Again focus on honesty. Assure them that you’ve seen one, you’ve read and become theoretically aware, and you are keen to give it your best. The key component for you here is an acceptance that you must put yourself out there.

Step 3 – You must act confident before you will feel confident.

Confidence is key, both to trick yourself and assure the patient. There is no doubt you will have little confidence in the execution of the skill or procedure. So forget about that. Instead gain confidence from what you know; the theory, the patient, the need to learn, the safety nets around you in the form of doctors and nurses. Again, channel the positive self-talk while you breath to slow your racing heart. There is no shame in errors, only in holding yourself back. Stand tall, steady your hand, and smile.

Step 4 – Reflect, revise and remember.

The experience is one thing. Getting something out of it, particularly any form of competence or confidence, is another. You must reflect on what happened to stand a chance of this. Ask yourself three questions; What did you do well? What can you improve on? What did you learn? Aim for three dot points under each question. I say dot points because I do actually want you to write these things down. It aids the reflection and solidifies the learning points.

After your reflection, within 48 hours, revise the skill or procedure. Think again about which bits you did well and what you can do better next time, in addition to the specific components you learnt. I assure you that through this explicit refection and revision you will remember.

The clinical years do indeed offer the chance to accelerate your learning, to gain quick competence and begin the progression to expertise. But not without significant actions on your part. Be prepared, be honest, be confident. Be willing to see only one before putting your hand up to do one. From there complete the cycle through reflection, revision, and the ultimate assessment of your understanding, teaching those around you.

Good luck.

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