He reminded the graduates that the practice of medicine had changed markedly, and that increasingly, the best docs are members of teams.
Gawande pointed out that, “The doctors of former generations lament what medicine has become.”
I’m having my graduate-level teacher certification students read the address. On the copy I’m providing them, I’ve lined out “doctors” and “medicine” and written in “teachers” and “education”.
Here’s Gawande’s primary point:
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.
Today, isn’t it a workplace truism for nearly everyone that “. . . you can’t hold all the information in your head. . . and you can’t master all the skills”?
The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.
On my students’ copies, I’ve lined out “doctors” and “people” and substituted “teachers” and “students”.
Gawande acknowledges that medical education fails to teach docs to function like pit crews for patients. The same is true for teacher education.
Too often nursing, medical school, and teacher education faculty wrongly assume that novice nurses, docs, and teachers will naturally, through osmosis, form knowledgeable, skilled, interdependent work teams. Absent intentional team-building curricula, in which case studies would be an integral component, professional apprentices depend upon the modeling of their veteran colleagues, often out-of-step ones pining for old school independence and autonomy.
When in comes to intentionally teaching teamwork, what can and should professional preparation programs do to shift the balance from cowboys to pitcrews? More generally, what can employers do to teach teamwork?
They shouldn’t assume it’s something someone is either born with or not. Effective teamwork can be taught through case studies that illuminate what the best teams do and what commonly trips up most others. And by proactively providing pre-professional students positive examples of excellent teams during their fieldwork.