On acquiring difficult skills

On Thursday, I told a standardized patient that her daughter is brain-dead secondary to a gunshot wound to the head.

The SPs cried and gnashed their teeth appropriately while I had to guide the conversation to a relative close. The mother wailed, “She might get better, you don’t know! You aren’t God!”And I sat there in false calm, allowing her to use me as the necessary emotional punching-bag, to bring her to the next stage of grief.

Of course, this experience barely encapsulates the true delivery of tragic news, but it serves at this point in our medical education to inoculate us, like a vaccine, against the emotional drain. SELECT is attempting to arm the next generation of physicians with the subtler skills of healing, before we arrive in the clinic. We have said the words once in a safe place, the next time may not be under the guidance of a preceptor.

How do you prepare for a difficult skill? You could dive right into the thicket, without an on-ramp to the highway. You could ease slowly over a long period of time, gaining speed and competency over the gradual acceleration. Or you could take the two steps forward, one step back approach a healthy mix of both.

Second year feels like that quick shift into a higher gear between SELECT, where we’ve talked about death and simulated poverty, and the coursework, where the associations and side effects we are expected to sling has frankly doubled. Due to Step One and the clinical clerkships looming ahead, this acceleration is necessary and understandable, but that does not make the increased volume easy to digest or less painful.

The dive-right-in seems to be the MO of medical school, despite their best efforts to increase our skill set step-wise. It’s also the boot camp approach. It works, but not terribly relaxing. Folks can get left behind in each big step.

The slow progression is how a child learns emotions, or an adult learns a language. If you have the luxury of time, this is a pretty awesome approach. There is a trade-off: the ease of acceleration creates fragility to the unexpected. You make the learning process comfortable, but become vulnerable to unforeseen outcomes  I learned basic Arabic over three semesters in college, but when I spent six weeks in Egypt I barely spoke because I couldn’t adjust to the strong dialect.

Two-steps forward, one-step back can seem to combine the worst of both: the slow progression of relaxed learning, and the stress of quantum leaps in expectations. Instead, this approach inoculates you from the stress of large jumps and allows for gradual acquisition of knowledge. Additionally, you get to feel like a boss because each step back reminds you of how much you’ve learned, like a deload week for progressive strength gains.

Since I can’t control the curriculum, nor would I want to, I’ve created a progression for myself. Between Jiu-Jitsu, medical school exams, these weekly reflections, releasing an interview On Death every Thursday, my partnership, slacklining, and the rest of life, I find myself uncomfortably advancing two-steps in one field while relaxing one-step back in another.

When taken together, I’m learning these difficult skills in a slow linear progression while accepting the discomfort of quantum advances. Perhaps the dichotomy I presented earlier is a false one: unless you are supremely focused on one singular aspect of your life, there will be a necessary rhythm and wobble.

Variety keeps things interesting. I’d get bored of that laser-beam focus, anyway.


Long Form Sundays

On Death Podcast

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