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A Piece of My Mind
December 24/31, 2014

Trust Worthy

Author Affiliations
  • 1Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;312(24):2621-2622. doi:10.1001/jama.2014.10438

It took me several years as a clinical skills course director before I realized that my students didn’t trust me. Looking back it makes sense: our time together was limited to lectures and logistics. But I didn’t understand why for a long time. When I described what I felt would be the most successful approach to mastering the physical examination, students were more likely to ask a peer. When I promised to fix a glitch—in the schedule or the manual or on the examination, their expressions often informed me it was too little, too late. When I suggested that studying from shadowy, student-generated answers that lurk in the hidden curriculum rather than reading their textbook would be cheating themselves, they responded that First Aid had it covered. And always, the concern about the grade, often out of proportion to the probability that it would not be favorable. Faculty has placed its trust in multiple-choice examinations, and for our students, those examinations and the resulting grades trump all. At some point, I figured it out; it occurred to me in a sudden rush of understanding, as these truths sometimes do. Rather than seeing me as someone with knowledge to impart and students’ best interests at heart, many students saw a potential adversary in control of their grade. A lot of behavior was easier to explain, but I had to wrestle with a new conceptual model for what it meant to be a teacher/administrator in a medical school.

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