Overstepping one's bounds

An SP about to demonstrate her medical knowledge.
[Queen Victoria via wikimedia]

One of the things I keep reminding myself is that SPs are not medical professionals. For instance, no matter how many times we do a gall bladder case, we are not qualified to diagnose cholecystitis.

In fact, I think it's dangerous for SPs to give advice to medical students about anything beyond what they experienced in the encounter unless expressly directed to do so at the event. I cringe when I hear SPs discuss medical feedback they've given students because "I've had a lot of experience with nurses and I know how they do things" or because the SP has experience with the condition s/he is portraying.

This is especially true given our inconsistent training. But it is also in large part because during feedback the power differential is flipped: SPs become the authority, and our words carry a lot of weight, especially with students earlier in the program. But that balance is fragile. If what the SP says conflicts with what students are being taught, all SPs become untrustworthy. We are part of their education but rarely have any actual insight into what they are being taught beyond what we know about our case. Standards and procedures differ at each school, program, hospital, clinic, specialty, etc. And teaching changes all the time, so there is real risk of delivering outdated information.

I also think this attitude is disrespectful to students. Even though SPs should be respected and appreciated for what we have to offer medical students, it's ridiculous to think we are medical experts when the amount students have to learn -- and have already learned -- is so stupendous. Many first-year medical students probably know more about general medicine than most SPs, even those who work several cases a month. Medical students, by and large, are dedicated and bright. We need to make sure we are honoring their educational journey by refraining from the need to prove what we think we know. Of course, some SPs have been or are medical professionals. But I still feel just as strongly that they should not be speaking to students in that role for all the same reasons.

I feel the strength of SPs lies within our ability to focus our comments on the communication skills of the students, not the medical skills. With limited feedback time, I would hope SPs would choose to focus on the details of the interaction rather than medical feedback.

Setting the standard:
At the very least, SPs must identify when they are offering feedback based on their personal medical knowledge, never giving the impression they are speaking on behalf of the program.

Better schools ask SPs to refer students to their lead instructor if there is a conflict between the way the SP thinks a PE should be done or if an HPI question should be asked that isn't on our checklist.

The best schools reinforce this standard and review to make sure SPs are staying within good feedback guidelines.