Mentorship is one of the professional relationships that fascinates me the most. We’ve all had those people in our lives that help us advance our careers, gain more insight to our practice, guide us to a more work/life balance. Some might call these people mentors, while other call them coaches or guides. Even after completion of training or schooling, people make use of these coaches/mentors as is the case in sports or medicine. For example Atul Gawande writes how a mentor helped him improve his practice as a surgeon years after completing his training.

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“The worst thing about busy shifts is that I never learn anything.”
– anonymous resident

A junior resident and I were contemplating the many difficulties of residency, especially when working at a busy urban ED where patients are plenty, but teaching during shifts may be harder to come by. We discussed the importance of coming up with at least one learning point or clinical question during each shift, and making a point of following through and reading up on it after.  (That shift we both learned about fat emboli s/p extremity fracture.)

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Why do most of us dread patients who complain of dizziness in the ED? Because it is so vague, and the differential is so broad from elusive posterior cerebellar strokes to ear wax clogging up our ear canals. And this is one of those diagnoses where the differential really depends upon performing a thorough physical examination. 

Think really hard, when is the last time you focused upon getting a complete and accurate physical examination? In medical school, there are courses dedicated to the art. I always laugh when I think of my neurology attending who just loved to bang on different parts of the body with his reflex hammer to elicit cool reflexes.

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