The word “gestalt” is thrown around constantly during medical school, residency, and beyond. Although never specifically taught, we all develop an idea of what gestalt means — impression, clinical intuition, gut feeling, something we are meant to develop over time.
With just a few months left of residency, I’ve started to pay a lot more attention to what is going on around me. I’m realizing what a unique perspective we have as housestaff physicians. The best way for me to explain what I mean is with this story of one particularly busy shift in the ER.
At this stage in our training as residents, we are at high risk for making mistakes. These mistakes can vary in range and type. It is impossible to go through residency without making an error, no matter how big or small.
In medical school, competence was defined by studying the course pack, that stack of crucial lecture notes, and memorizing the details therein. Especially in the first two years, my classmates and I spent virtually all of our waking hours reading text books, attending lectures, highlighting and underlining every word of the course material because we were told that all of it, every word, was important. This understanding of competence reflected the clear but unspoken end game: to have the best score on the exam possible, or at least a better score than the other half of the class.
Some time ago, you walked across the stage and received your first white coat. More recently, you walked across another stage and became hooded into your profession as a physician. Congratulations. You are now the owner of a piece of thick paper that allows you to medically manage acutely ill patients and alter the course of a patient’s treatment.
Despite EBM’s role as an incredible advancement in the history of medical care and patient management, there remains many challenges that young clinicians must face when attempting to implement EBM into their respective practices.
A surgical resident writes: “Several recent studies suggest current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?”
It’s 2 a.m., and the patient’s blood pressure is beginning to rapidly decrease. Every IV line is occupied by an antibiotic or IV fluids, and we are in need of a vasoactive medication. The nurse comes to my computer and sternly states, “We can no longer avoid it. I think the patient needs a central line.” I quickly say “okay,” but I don’t move. I am momentarily frozen by my unease with the bedside procedure ahead.