learning to walk

My babies were delivered the third week of June. They spent two weeks getting fed a variety of information, most of which they have probably already forgotten. Then, on Monday, July 2, they began their three-year journey toward becoming the world’s best pediatricians. I have spoken before about how I spend the majority of my clinical time (my time with patients) and the joys and frustrations I sometimes experience. Well, this past week I was “on service” with three of the “babies” plus a medical student and several more experienced (non-pediatric) residents, two nurse practitioners, and the whole gamut of other health care professionals. I have also explained how I tend to see everything around me in terms of developmental stages, and what I can say, is that what I saw happen between Monday and Friday of this past week was nothing short of a developmental miracle.

Have you ever watched a baby take his first steps?

How tentative as she lets go of the surrounding support; whether that is a parental hand, the wall, a piece of furniture. He looks around, stands there and takes a test step away from the security of that support. then what? Usually panic and PLOP! Down she goes. Maybe shedding a few tears, or maybe just getting up to try it again.  Once he sees how to put more than two steps together, he can choose a destination and move toward it. The first time she tries to walk from Mom to Dad, she doesn’t get there in one efficient line. But soon, it all comes together and he is off and running. Sometimes toward a goal; sometimes with Brownian motion. Eventually, the toddler is able to choose a landmark, plan a route, and walk or run in a relatively efficient, effective path. We cheer as parents and grandparents and aunts and uncles. It’s a miracle.

The miracle I saw unfold this week was not in any way less spectacular.

Timid and shy. Tentative and insecure. They were so cute on Monday. Should I actually awaken a sleeping child to examine him? How much do I need to tell the attending on morning rounds? What do you want to know, Dr. Ackerman? Where do I write this order? Why won’t my electronic prescription go to the pharmacy? They would take a step, falter and fall down. They got right back up, took two steps in a row. Every day, every hour, new skills were gained, new capabilities enhanced. There was an exponential growth in knowledge base and skills. There were some things they didn’t need to be taught. And for that I am so happy and so proud.

They didn’t need to be taught to CARE about their patients. They didn’t need to be taught how to speak in such a way as to let the parents know they were listening. They didn’t need to be told that some parents were frightened by their child’s illness. They didn’t need to be told that the patient and his needs came first, and the writing of notes was not the highest priority. We started the week with a relatively small “service” of 8 patients. It took us about three hours to see all 8 patients Monday morning, assess their needs and make a plan for the day. On Friday we had over 20 patients to see, and were able to do so in about the same amount of time. Everyone knew his or her patients. There was less reading from papers when talking to the parents. There was more use of lay terms instead of medical terms in the rooms. We were much more efficient. We were discharging patients ready to go home while we were rounding. Wow. Of course I was only able to see the progress in three of the six; those who were assigned to the inpatient ward this week. The others are assigned elsewhere. I have no doubt they are having the same kind of miraculous growth and development experience. I am so happy that I was there to witness this week.

What miracles did you witness this week? What questions do you have about how resident physicians are trained? Please leave your thoughts below.

About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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