Wednesday, December 19, 2012

Crash and burn

I teach the Evidence-Based Medicine curriculum at our residency program.  I'm passionate about this curriculum, as it teaches our residents how to be critical thinkers about the never-ending deluge of scientific data that can benefit our patients.

One of the tricky things about teaching EBM is that it involves numbers: calculating sensitivities, specificities, positive predictive values, etc.  Mixing these numbers up is not hard to do.  I create all of the materials used in this course, and I usually double and triple check my arithmetic - and then have someone else quadruple check it - before finalizing handouts and PowerPoint slides to present.

Something went terribly, terribly wrong yesterday.  The computer in the conference room was being buggy with 2010 PowerPoint, so, I opened my previously saved 97-2003 version.  As far as I could remember, it was pretty much the same.

Yeah, except that I had, in fact, actually tweaked all of the examples in between versions. The examples on the handouts that the residents had to work through. The examples on the handouts that had the wrong answers on every single PowerPoint slide.

My quadruple-checker was there, but unusually we had not been able to meet to confirm the quadruple check before-hand.  We've never had anything but a teeny tiny discrepancy before, I reassured myself.

Whoops.  Mass confusion quickly erupted as the residents started working through the problems and the wrong answers popped up on each slide.  The quadruple checker had the correct answers, thankfully, and we eventually salvaged the session by just working through the problems on a whiteboard.

I want so badly to teach that EBM doesn't have to be a scary avalanche of numbers and equations.  I want them to get the bigger picture, the concepts above the arithmetic that can enhance their patient care.  Unfortunately, today, all they got was an hour of group effort trying to puzzle through...a scary avalanche of numbers and equations.

More than teaching about EBM, though, I selfishly want my residents and colleagues to trust my knowledge and judgment.  Failing miserably in front of everyone exposed my imperfections, making me uncomfortably vulnerable.

I wish I was a perfect teacher and a perfect doctor, and being reminded that I'm far from perfect is hard to stomach.  Maybe, though, my public failure will make the people I work with a little less afraid to be imperfect around me.  Maybe this unpalatable dose of disgrace will break down any barriers I or others have about labels such as "teacher" and allow more genuine, unfettered working relationships.  That would almost make yesterday's debacle worth all of the humiliation.


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