Yesterday I was at the pool in my apartment complex. Many students live there, so it is common to see other Palmer people. I did not know the two girls I saw there yesterday. As the sun streamed onto the patio, I could hear their words wafting over me; I could tell they were in 3rd quarter. The gist of the conversation was that an upcoming test would be "straightforward." It suddenly occurred to me that I was once like that too. I once thought things were simple.
The 3rd Quarter Change
While in quarter three, it is easy to think that information is coming together. In reality, it is... but not in the way I once thought. In quarter three, I was at the stage where I was starting to know things--about anatomy, about physiology, about some chiropractic techniques, about physical exams. I synthesized this information and began to make some clinical prediction rules for myself. I thought I could give all sorts of advice. So did these girls. They were advising each other on various topics from sunburns to headaches, using the vocabulary that they had just made vernacular. It made me smile with the bittersweet nostalgia that a parent might feel--children becoming adults, students becoming doctors.
The problem with this change is that it isn't complete. Quarter 3 is the end of the first academic year. One year into the curriculum, students know enough to be dangerous and cocky. I did too. There are three more times this happens. After qtr 5 when all the chiro techniques have been learned, after qtr six when anatomy lab ends, and after the first part of boards when everyone is an "expert" on microbiology and pathology. At each of these times I felt like I ruled the world. Little did I know how much more there was to learn.
Now
Patients make all the difference. No one presents like a textbook, no one will comply with a treatment plan without patient education, and unfortunately, no one knows the things students take for granted. All of this is valuable information to know, but it also makes an interesting distinction: as I have reached the terminal end of my education, I know enough to know that I don't know much of anything.
A New Frontier
I love star trek. The thing I love most about it is the idea that we can explore new places and discover things for which we do not have even a concept. I feel like this experience is well paralleled by Palmer Florida. Before setting out into space, humans have no idea what is out there. We can't conceive of things we have never been exposed to. There is a certain amount of certainty to this position. We know a variety of things and we don't even have language for anything else. It isn't until we get into the upper quarters that we realize being in school means essentially nothing. Practice is a big galaxy full of things we have never even thought of. Luckily, as a student I learned all the information I am going to need eventually, but I will never again be arrogant enough to think that I "know" anything for certain.
The other day, I was talking to my mentor in the clinic, Dr. Beres. She made a very interesting point. One of the most interesting things about evidence based practice is that it changes all the time. Since new things are being discovered and proven through research and experience constantly, it is never wise to scoff at anything. Anyone who says he/she has "the way" to practice is misguided and conceited, because no one can know what is out there in the healthcare "galaxy" without a vehicle for traveling there. A student's best vehicle is openness to realize how little we actually "know."
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