{"id":2029,"date":"2010-05-07T14:57:01","date_gmt":"2010-05-07T13:57:01","guid":{"rendered":"https:\/\/stg-blogs.bmj.com\/bmj\/?p=2029"},"modified":"2011-03-22T15:29:36","modified_gmt":"2011-03-22T14:29:36","slug":"andrew-burd-%e2%80%9care-you-sure%e2%80%9d","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2010\/05\/07\/andrew-burd-%e2%80%9care-you-sure%e2%80%9d\/","title":{"rendered":"Andrew Burd: \u201cAre you sure?\u201d"},"content":{"rendered":"

\"\"It is that time of year again.\u00a0May heralds the last few weeks of the medical curriculum, culminating in the final examinations.\u00a0Over the years at the Chinese University I have seen the examinations become increasingly sophisticated from the perspective of objective educational assessment.\u00a0It took a critical event – namely, SARS –\u00a0to cause a radical change in the format of the examinations<\/a>.<\/p>\n

The OSCE stations have become an opportunity to incorporate increasingly realistic clinical scenarios for the students.\u00a0To put some context in place I should mention that every fifth year medical student at CUHK spends a structured week of teaching in the division of plastic reconstructive and aesthetic surgery. Being the only surgical team involved in the gigantic integumentary system we have much to share but try to focus on what is practical and most useful for the generic doctor.\u00a0 To this end in addition to our structured clinical teaching each group of four students spends a day working with the nurses on the burn unit.\u00a0 The medical students are told this is as much a test of their initiative as it is a formal educational experience.\u00a0 They are told to offer to help the nurses perform wound dressings and to ask questions. I tell our students this because I know that our nurses are excellent but I do not want the medical students to be “spoon fed.”\u00a0 I tell our final year students that their quality of survival in their first year as professional doctors will depend far more on the relationship they have with their nursing colleagues than with their medical peers and seniors. The interns who do not do well are those who are arrogant or\u00a0lazy and do not genuinely care about patients.\u00a0 Such doctors can be sifted out by the nursing radar and in a host of subtle ways be subject to reprogramming techniques.\u00a0<\/p>\n

To instil inter-professional respect at the student stage is good.\u00a0So this year we thought to try something new.\u00a0We developed an OSCE station run by our nurses.\u00a0There was one experienced nurse specialist who acted as examiner and two student nurses, one was the surrogate patient with a wound; the other student nurse waited to receive instructions from the \u2018doctor\u2019 who was tasked with assessing the wound and deciding on the most appropriate dressing regime.\u00a0 To make the choice easy, four dressings were on display and the medical student was asked to choose one.\u00a0 In our final practice run as we set up the logistics of the OSCE we decided to add a question after the student had made their choice of dressing.\u00a0The specialist nurse, who was also the examiner, asked the student, \u201cAre you sure?\u201d\u00a0This is a simple station testing aseptic technique, doctor-patient and inter-professional communication, assessment of a wonderfully realistic “moulaged” wound and the management of that wound.\u00a0 But so far, without exception every student asked that question by the experienced nurse has changed their choice of dressing!\u00a0There has to be difference between arrogance and confidence, but also between guessing and knowledge.\u00a0We had anticipated this during our teaching; and repeatedly instructed the students, \u201cif you are not sure ask our experienced nurse what they would suggest.\u201d I will talk more about the concept of “face” in Chinese culture, but certainly in the practice of everyday medicine we must ensure that our new medical professionals can work with our nursing staff in a spirit of common concern for patient welfare.\u00a0Status or hierarchy cannot come in the way of appropriate care.\u00a0So if you are not sure; ask.\u00a0To be honest and humble is the sure way for the new doctor to gain the respect of the nursing colleagues.\u00a0Of\u00a0 that\u00a0I am sure.<\/p>\n

Andrew Burd<\/strong> is professor of plastic, reconstructive and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

It is that time of year again.\u00a0May heralds the last few weeks of the medical curriculum, culminating in the final examinations.\u00a0Over the years at the Chinese University I have seen the examinations become increasingly sophisticated from the perspective of objective educational assessment. […]<\/p>\n

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