The efficiency of kindness
by Guest Contributor
Monday mornings of my surgical rotation this year made me a little apprehensive. Each week we were assigned to a new team. We might be with doctors who were blessedly supportive and kind, doctors who frequently pointed out how stupid we were, or doctors who ignored us. Lucky dip, if you will.
I was once supervised by a surgeon who called me “phone girl” for a week in theatre because I was meant to be answering her mobile phone while she was scrubbed in. Apparently asking my name and then using it wasn’t a good use of her time or memory space. Her logic was a little flawed, however, given the five or so seconds it took me to register that “Aha, yes, that’s me!” whenever she shouted “PHONE GIRL!” across the theatre.
Personally, I appreciate when people have a direct communication style. When clinical teachers tell you what you did well and what needs improving with as little interpretation required as possible, it makes it easy for students to learn and become better at executing their skills. However, far too often bullying comes in the thinly veiled form of “directness.” I see doctors and students humiliated every day by their superiors in hospitals, and it’s frequently considered an acceptable mode of communication. “Our work is too important and we don’t have time for niceties” is seen as a reasonable attitude. However, we are not robots and cannot ignore the human element of interaction in teaching and feedback.
I genuinely believe that kindness in teaching makes learning more efficient. The cost is a small amount of care and consideration, and the reward is higher quality learning. I had one surgeon teach me how to place subcuticular sutures with a demonstration at lightning speed. He hurried me because theatre time was expensive (fair), and then proceeded to bark “No!” each time I tried to grasp the edge of the skin with the forceps (less fair), repeating the same instructions that clearly weren’t communicating the concept well. My hands were shaking rather violently and I proceeded to complete the slowest and most average two subcuticular sutures I’m sure that theatre has ever seen. I’ve still retained a wary dislike of subcuticular sutures and a belief I’m inherently “bad” at them. And honestly, it will probably be self-fulfilling with my current lack of desire to improve that particular skill.
I can contrast this experience with the loveliest plastic surgeon teaching me about simple interrupted sutures. The patient had a good scattering of lesions around his head and arm, and after their removal the surgeon completed the deep dermal sutures and then allowed me to finish the job by suturing the top edges of the wound. She asked if I was comfortable giving it a go, and slowly and carefully demonstrated how to tie the sutures. She clearly stated how far apart she wanted the sutures, how much tension to apply and how she wanted the strings cut. I was given an arm to suture while she worked on the patient’s scalp, with the instructions “Now just do your best, and I’m sure it will be great, but if we’re not happy with them we can always cut the sutures and I’ll redo them. You just take your time and I’ll be working over here!” I took a deep breath and picked up the skin edge with the forceps. The surgeon pops her head over the patient and says “You’re doing great!” and even though she’s wearing a face shield I can tell she’s smiling. I was determined to do the best damn suturing job I could, and after a few minutes showed the surgeon my neat little row on the arm. I was then permitted to suture the wound on the patient’s face since I’d demonstrated I wouldn’t do a terrible job, and I’ve never been so proud in my three years at medical school. And I remember every point for improvement that surgeon told me (tie closer to the surgical field, less tension on more superficial sutures and don’t drop your scissors on the floor). With the two minutes that it took for the surgeon to explain kindly and carefully how to do the work, I was able to be useful such that I didn’t cost theatre time to teach.
These stories are anecdotal, but certainly not isolated. I had a tough time choosing between the hundred odd clinical teaching interactions I’ve had this year to illustrate both ends of the spectrum, and sadly only a few have been as wonderful as my plastic surgeon teacher. And from discussing with other students, the experience is pretty near universal. I can only imagine how much more we would learn, and how much less anxiety we would have on Monday mornings if the norm were to teach students with kindness.