Practice Perfect 672
Going from What to Why – The Making of the Smartest Doctors

As a residency director focused on my own program, it’s difficult to know what occurs at other programs. One often hears gossip about other programs, but who knows the truth? “This program has no academics.” “That program is so authoritarian that residents are afraid to ask questions.” “That program doesn’t allow residents to do the majority of procedures.” The hearsay goes on and on, and who knows the truth?

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I imagine the reality is somewhere in the middle, with some programs - for any number of reasons - providing strong didactic learning opportunities while others do not provide strong academic background. The one factor that seems true after speaking with many colleagues around the country is that many residents don’t feel entitled to ask that all important “why” question. This is the single most important question any resident could ask during their training. I try to push my own residents to question and challenge the information that’s presented to them and to ask why. I am also lucky enough to have some attending colleagues who also emphasize the importance of “the why.”

Many residents don’t feel entitled to ask that all important “WHY” question?

Residents should feel open and safe to ask those all important why questions, and trainers need to be open to receiving those questions. To that end, here are some recommendations for both residents and attendings to get the most out of their educational experiences. These 10 suggestions will create a safe space for residents to ask those why questions and learn better.

Understanding WHY they are instructed to take a certain action greatly deepens their understanding and facilitates them making better clinical decisions on their own.
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  1. Seek immediate, specific, and constructive feedback - from as many people and experiences as possible.
  2. Track the outcomes of cases with which you assist, even if that means doing extra work.
  3. Ask “why?” for everything you do. Why did we give that steroid injection for that plantar fasciitis patient? Why did you choose that surgical procedure? Why did you write that prescription? There’s a why question for almost everything in your training. However, be diplomatic when you ask that why question – don’t deliberately challenge your superiors in a way that is bound to upset them.
  4. Squeeze the maximum amount of education out of every experience. If you’re presenting a case at an academic session, research questions that you think will come up during the session. Look for research evidence to answer your own questions. What is the recurrence rate of tarsal tunnel syndrome after release of the flexor retinaculum? What is the best incisional approach for Achilles ruptures? What is the most stable fixation method for that ankle fusion? Milk your experiences for all they’re worth and incorporate that information into both your presentations and future thought processes.
  5. Grab on to those attending physicians and surgeons who are open to you asking why without becoming defensive. An attending that can’t answer the why question but is receptive to talking about and researching the answer is also educational gold to resident training. One mark of a great clinician is curiosity. No one knows enough to stop learning. As the Dos Equis Man says, “Stay hungry my friends”.
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  1. Make it explicitly clear that residents can ask and explore questions.
  2. Include case discussions in your academics.
  3. Teach all attendings to participate in a nonjudgmental manner.
  4. Don’t become defensive when your residents asks “WHY”. They are not always questioning your judgment or decisions. They are often trying to gain a deeper understanding. Remember, analyzing our own outcomes is an excellent way to improve.
  5. Push your residents to learn as much as they can from their experiences. Don’t let them be passive absorbers of the education presented to them but rather press them to be active participants in their own training.
Attendings should encourage Residents to be active participants in their own training

Best wishes on your next academic exploration.

Podiatric Residency Summit Midwest 2019

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor

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