What does medical education look like? Let me describe today.
I was up early for some reason, eyes open at 4:30 AM. I have been getting up early this week . . . but 4:30 is about an hour earlier than usual. So after showering and some reflective time and Bible reading, I started reviewing my notes for today’s lecture on shock and sepsis. This review was an ongoing process while waking up the kids multiple times until they are out of bed, and then seeing them off to school. I went into the hospital around 8:30 AM, quickly walked through the ER and the two step down ICU units, finally ending my walk in the ICU. I wanted to see who had been admitted overnight. Around 9:00 AM as I was reviewing my patient’s labs and x-rays while also updating our audit sheets, I was called by the ER doctor that he had just intubated a young woman in the ER and was sending her to the COVID ward. He wondered if I was covering COVID. I told him I was in ICU, but that I could help in the COVID ICU if needed. One of our medical officers is covering the COVID ward this week, and I am her back up for complicated patients. I decide to run down to the COVID ward to meet the patient on arrival. Unfortunately, the patient was not there yet, but I spent the opportunity to review antibiotics, ventilator settings, and plan of care with the care team in the ward. This was an unplanned teaching moment, but it was a typical educational opportunity at Kijabe. We teach at the moment of giving care or preparing to give care. Not all the interns or medical officers are comfortable with the ventilator, and reviewing the machine is a good chance to teach about how the lungs work, how the body balances acid and base levels, how circulation functions in different pressure scenarios, and how to think logically about the process.
While there, I got a call from the gynecological team for help with a patient. I was just across the courtyard, and so I ran over and gave a mini-lesson how to manage inpatient blood sugar levels and how to start insulin on a new diabetic patient. That was my second unplanned teaching moment of this still early day. Since the patient had still not arrived to the COVID ward, I ran upstairs to round with the ICU team. My trainees are muslim and Christian, and it is a good chance to try and model Christian medical ethics to all of them. This was my first scheduled teaching time. We had several new patients admitted overnight to meet and several previously admitted patients to review. With each patient there is a new topic to cover. Diabetic Ketoacidosis, tuberculosis, meningitis and renal failure in one bed. An epidural hematoma in the next. A hemothorax and multiple trauma injuries suffered by our next patient. The fourth bed is an HIV patient with a cheek tumor. Then we went on to the two HDU’s to discuss hyponatremia, seizure disorder, stomach hemorrhage, and stroke among many other things. After rounds, I ran down again to the COVID ward to discuss the new admission. We reviewed her chest x-ray, the possibilities diagnosis that she might have and how we were going to sort them out. Again I did a quick review of ventilators. This is another great chance to try and teach. I went back up to the ICU, and as I was reviewing some other patients I get a call that the woman in COVID ward is needing resuscitation. So we spent 40 minutes trying to save this patient, and through it all we are reviewing the rules of Advanced Cardiac Life Support and Basic Life Support. We got some labs back that show she is in complete renal failure, and so we spoke a bit about that. We teach while treating patients. Then I was tasked with informing her husband about her passing, and I did that with one of our interns. This is different, but it another form of education. It is a chance to model Christian compassion while breaking bad news.
I quickly ran home for some lunch, then, as there was a small break in the rain, I ran back to the hospital. Now it was a formal teaching time, and I reviewed for one hour sepsis and shock with the interns assigned to the ICU. Afterward, I received two calls from my medical officers, reviewing patients with them. More informal teaching. The afternoon exit rounds were spent reviewing a man who had been in a car accident in whom we found a diaphragmatic rupture on CT that we ordered in the morning. I spent another 30 minutes going over all of his x–rays and CTs trying to see if there was a way it could have been found earlier. That was a learning time for me, trying to get better. And I hope it models a certain humility and need to always try and get better to our interns.
That is how teaching works in a teaching hospital, and specifically at Kijabe Mission Hospital. Formal times mixed in with many random opportunities. I learn each day, and I try and pass on how I learn and what I learn to those interns who entrust their education to us.