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See One, Do One, Teach One

To learn medicine, they say you need to see it done once, do it yourself once and finally teach someone else how to do it.

This has always been the way it was taught. But despite being such a classic didactic model, I wonder if this is the best and right way to learn?

I remember the first time I heard about the hidden curriculum of medical school. It was the story of medical students performing pelvic exams on unconscious patients who had not given their consent. The argument was where else would students get the chance to practice, no patient would want a inexperienced student doing an unnecessary and invasive exam, all in the name of learning. And I’ve talked to some senior doctors about this, and even though they are very ethical and caring doctors, they shared their experience about going along and not questioning it, even when they knew it was wrong. I’m afraid I will be in similar situations in the future, and I am scared that I will not know what to do.

Today, I stumbled across a report on “Providing a strategic vision for improving patient safety” and came across the following quote.

“The old approach to teaching procedures—See one, Do one, Teach one—
is antithetical to safe, patient-centered care. Simulation provides the
opportunity for one to see as many as one would like, do as many as
are necessary to demonstrate procedural competence, and leave the
teaching to experts.”

In one sense, I agree completely that simulation can be a perfect way to hone your skills so you can be competent when you finally see your patients. On the other hand, I also think that you can’t learn and understand the complete practice of medicine in the classroom or simulation room in this case. You learn medicine by interacting with human beings, real patients with real diseases. You remember faces and emotions associated with diseases. You get the real deal, not just a fictitious rigid simulation. I don’t know what my complete thoughts are about medical school training, but I just want to leave you all with this quote by one of the greatest physicians of the 20th century.

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

- William Osler

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