American College of Physicians: Internal Medicine — Doctors for Adults ®

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One teacher's secret: Use challenges, not humiliation

By Bryan Walpert

After 35 years of teaching medical students and residents, George A. Sarosi, FACP, knows a good student when he sees one. In addition to being recognized for teaching excellence 18 times throughout his career, Dr. Sarosi will receive the ACP-ASIM Distinguished Teaching Award at convocation tonight.

"Medicine is 95% attitude and 5% aptitude," said Dr. Sarosi, professor of medicine at Indiana University and chief of medical service at the Roudebush VA Medical Center in Indianapolis. "A student's attitude toward learning is readily apparent, usually the first day. Really good students have a degree of anticipation and excitement. They love to be challenged. They want to challenge back."

As an example, Dr. Sarosi recalled how a student recently investigated a patient case. Dr. Sarosi and his students were considering the possible causes of high calcium in an elderly woman. While breast cancer was an obvious choice--the patient had already survived the disease two years earlier--a third-year medical student took the initiative and examined the patient's peripheral blood smear.

An hour later, the student reported that the patient had circulating nucleated red cells. Based on that finding, a bone marrow test was ordered, and it was later confirmed that the patient had metastatic breast cancer.

While Dr. Sarosi said that his students would have reached the diagnosis eventually, the student's quick independent work saved several days of tests. "I consider it a triumph," he noted, "when someone goes out of his way."

While he sees such triumphs frequently, Dr. Sarosi said he sometimes wishes he witnessed them even more often. "I'd like to see more excitement about medicine in general," he explained. "I wish more students viewed learning as something to enjoy rather than endure."

He suspects that changes in modern medicine have helped produce a workaday attitude in some students and residents. "I think the approach toward medicine has changed," he explained. "It has become a little less of a calling and a little more of a job."

For Dr. Sarosi, who typically puts himself on the attending schedule 10 months a year, teaching remains not only a calling, but a source of pleasure. He enjoys contact with students and residents who, because they are young, "haven't become totally jaded," he said. "I just love being with young people, because older people bore me."

He said he enjoys today's students, who as a group are more diverse than in the past. That's a benefit, he said, for physicians who will treat a multicultural population.

"I learn from students all the time, not so much in patient care but in human interactions," he explained. "They are in many ways more well-rounded than my generation. They have many outside interests."

And he does his best to keep his students excited about medicine. He believes in active learning and constantly questions his students: Why would you do it this way?

Dr. Sarosi tries to get his students to debate, question and challenge, although he noted that it isn't always easy. "Especially in the Midwest," he explained, "students tend to be very reticent. They don't like in-your-face questioning. It's not part of the ethos."

He does his best, however, to encourage them. "I poke and prod and tell bad jokes," he said. "You can ask most people questions without humiliating them." He added that he recalls a few of his own attendings "not so fondly" because of their tendency to humiliate.

As much as Dr. Sarosi enjoys his calling as an educator, he occasionally experiences disappointments. Take the medical student who checked the elderly patient's blood smear.

"Unfortunately, he's interested in orthopedic surgery," Dr. Sarosi said with a laugh. "I tried to change his mind, but to no avail."

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