Like women a year after childbirth who have fuzzy memories of the experience, preceptors don’t remember what it was like not to know X. Their fingers don’t remember the inability to tie knots and they are unable to list the steps in a procedure because it is performed automatically, both mentally and physically. Therefore guidelines seem too simplistic or obvious to experts. Even changes to guidelines are rapidly assimilated if they fit into the medical patterns that experts already have.
Medical Students Don’t Have Patterns
Medical students leave the university with vast chunks of information, but only practice in the real world forms those chunks into the patterns that denote medical expertise. Both their bodies and their minds are awkward participants in the new learning process that forms the clinical years.
Guidelines promote clinical learning for the following three reasons:
- memorizing steps is a familiar learning process for students, it’s concrete in an environment that may feel nebulous and unpredictable to recent graduates
- guidelines act as a bridge to pattern making, with increasing practice and confidence the student begins to understand the links to deeper knowledge and understanding
- guidelines are a concrete tool for feedback. Instead of the nebulous “great job”, preceptors can ask the clerk or resident how well they followed a particular guideline.
Just for fun, take a look at how one physician is encouraging the use of guidelines. How might you promote the use of guidelines?