17 March 2011

Perfect or Good Enough?

Yesterday - still cool, still winterish though sun filled, thank the Maker. Training for comprehensive clinical exams for third year medical students - very detailed and exacting - only the first of three training sessions. I generally enjoy these trainings, as they provide chances to ask questions and envision how the exam will intersect with our mission - to help make better doctors. Yesterday however I noticed a disconnect inside - something unsatisfying to me I couldn't identify.

Today - spring's arrival! - 75 degrees and breezy, even the trash blowing in the streets sparkling. A shorter training for comprehensive clinical exam for the second year students in the afternoon - and my balance is back. The connection between how we teach and how we test is made in me, and my comfort level returns to its usual state during the training.

OK - so what's the difference? I think it has to do with the difference in assumptions about students, even more, the difference in how individual faculty members see themselves. Doctors, I have learned (in part) through this work as a Standardized Patient, really aren't any different than the rest of us. Some of us are guided by an inner need to control, to strive toward "perfect." I know this driving need too well. Others of us have, or have developed, a belief in living and working within and through a reality that says "good enough" is really the best we can do.

When it comes to training future doctors these different ways of looking at the world and ourselves in it show up clearly, even harshly.

The training yesterday was conducted with an eye toward "perfect" - and from that viewpoint arises the assumption that we should not trust the examinees, nor should we conduct the exam with any forgiveness for nervousness or the pressure that students are under. Many would hold that view - that we are training them to hold the lives and health of people in their hands - that they should perform perfectly under pressure and in situations that push them to the edge physically and psychologically. Is this possible? Is this view consistent with how people learn? Even as I type these questions I hear a Gatekeeper hollering from way off - from out in the center of our society - "well it SHOULD be!"

Today's training arose from the idea that learning is process, that "good enough" at the given stage of learning really IS good enough, and that the examination of what has been taught is as much an examination of the teaching as an examination of the learning. Clearly, I resonate more with this view.

I'm sure that I feel more comfortable and capable of greater vulnerability (in asking questions and making suggestions) in the "good enough" view because I used to use the "perfect" yardstick both on and against myself. It still shows up, this idea that what I do and who I am has no value unless it is perfect. But nowadays I see it coming, and attend to its affect on my body, rather than jumping to obey its commands.

This surely was what happened during yesterday's training. The old familiar came to life in that room, where perfect beige was the color being painted in broad strokes over all of us, and over the students by extension. I couldn't meet the expectation of perfect - and couldn't as a result really focus either.

Today as we sat in that grey-on-grey auditorium, the breezes of mid-March spring wafted through the room, and even without a brush, the color of just-opening daffodils was visible in the corners and at the edges of our chairs. Maybe spring can help us see that we - like what we learn, like how we learn, how we take and do on exams, like what sort of people we become - are all, at best, good enough.

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