A Different Kind of Rotation

Hey there 👋🏻

Every year, I have about two students who sign up to do a pain management rotation with my colleagues and me. I usually spend two days per week giving the student some shadowing experiences. And if they are performing at a resident level, I’ll assign them manageable cases to flex their brain muscles.

But this time, I did something completely different.

The student was interested in industry. After discussing career goals, I figured I wouldn’t bore them with opioid conversion or buprenorphine.

But soon I had to face this question:

“What am I going to teach?”

Is there something—whether a skill or knowledge—in pain management that is highly translational, something the student can apply in industry?

There is, and it’s communication.

Something often overlooked in pain management is communication. We love to focus so much on the therapeutics: how to convert opioids, how to dose methadone, how to switch someone from gabapentin to pregabalin. But if we cannot pitch our ideas to both patients and physicians, or if we cannot make patients feel heard, then none of the clinical knowledge really matters.

So I call this new learning experience Clinical Communication 101, and here’s how I structured the rotation.

Phase 1: Modeling and reflection

What I’ve learned from modeling for students over the years is that if you don’t provide specific things for them to observe, they’ll get lost and distracted. So here are a few things I always ask them to look for before we go into the room:

• What facial expressions do you see during the conversation?

• What is the tone you notice from the patient?

• How does the patient react when we discuss the risks and benefits of the medications?

• How do I acknowledge the patient’s concerns?

• How do I bring up sensitive topics?

And when you’re done modeling, you ask the same set of questions for reflection. This process helps the student identify patterns of effective communication. And when the student is ready for the next phase, it’s time to apply the skills.

Phase 2: Application and more reflection

Communication is like any other skill—you cannot master it without doing it yourself. When it’s time for application, it’s important to acknowledge that students may feel some degree of imposter syndrome. I always encourage them by saying:

“You can fail as hard as you want during this time. Just aim to be 1% better next time.”

I received very good feedback from the student with this learning experience. It would have been dull if I’d stuck with the pain stuff. So if you have a student with a different career goal than what your rotation usually offers,

Why not meet them where they are?

See you next time.

SP