When posed with the task of coordinating the medical student curriculum for neurosurgery as an Assistant Professor of Neurosurgery, Dr. Ravish Patwardhan was expected to accomplish a task: teach a medical student all the essentials he or she would need to know about neurosurgery, to help him or her in whatever medical speciality of choosing. The time the students would have would only be one week on the neurosurgery portion of the rotation.
Collaborating with similar clerkship coordinators from Neurology and Psychiatry, Dr. Ravish Patwardhan evaluated the best approach: case-based learning, didactic teaching of the “most commonly encountered or most dangerous concepts,” or a combination of those two. Of note, many medical schools (and even business schools and other schools, for that matter) had a renaissance by moving towards the case-based model. However, these programs almost never would do this within the span of a week – a key assumption of the case-based learning method is that enough cases would be encountered to convey the key topics of a subject. In the given week, this seemed inadequate.
After consultation and reflection upon his own practice, it became clear to Dr. Ravish Patwardhan that students would get the “case-based learning experience” by seeing patients in clinic, on the wards, or in the operating room during the week they participated. However, in order to learn the proper evaluation of headaches, for example, or back/neck pain, a didactic approach would be necessary. In addition, there was scope to involve other faculty members or residents. Hence, a three-pronged approach was implemented by Dr. Ravish Patwardhan: (1) a series of over 50 notecards he composed, full of key points in neurosurgery and scans, along with dress code/behavior code; (2) a series of lectures given by neurosurgery residents and/or faculty for the key topic approaches (e.g. including back pain, headache, bleeds, etc.); (3) a case-based presentation, where students would actually present patients they had seen on the wards, clinic, or operating room. The test, then, was based upon approaches form all three. At a time when LSU was implementing simulated patient learning as part of its medical school curriculum, surgical subspecialties also began to become interested in this modality.
After several years of implementing this program, the feedback eventually came, according to Dr. Ravish Patwardhan. Students he taught went into fields as varied as pediatrics, rural medicine, orthopedics, and others. Yet, there were the occasional students he would come across who had thought about, in an emergency room patient for example, needing to order a CT scan which would save someone’s life by an epidural hematoma being detected. Or there was a patient with “the worst headache of his life” who had a ruptured aneurysm detected. Medical students who knew what to order as residents made a difference in patient care. When asked about how many success stories of life-saving procedures would make all the years of curriculum development and teaching worthwhile, Dr. Ravish Patwardhan believed the answer was simple: One.
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