This will be a brief one: they didn’t teach public speaking in medical school.

I did toastmasters in high school and then after doing the college exams and losing all humility I thought I was OK at public speaking. The a couple of years ago I gave a talk at a conference I was all nerves – it was the International Liver Cancer Association Meeting and I think it was the first and only presentation from an Australian. The room was one of those in which you were blinded by lighting and couldn’t see the audience well. All of the ‘gods’ were either on the stage panel or got up to ask questions afterwards. For the first time in ages I got ‘nerves’.

Speaking in public is something I actually have to do all the time but it is not always straight forward.

Here are some tips – both practical an perhaps tongue-in-cheek:

Tips on Public Speaking

Perhaps the commonest complaint of my trainees when they are in the first year of their specialty (medical oncology) training is that they just don’t know where to start. In one respect this is understandable – the party-line is you need to know everything.

These are my tips:

(1) study stuff that will make your job easier. If you don’t know how to prescribe anti-emetics to prevent chemotherapy-induced nausea then read up on this.

(2) study stuff you see in clinic or on the wards that you didn’t know anything about. This entails keeping a list – get a notebook, send yourself an SMS or email, use Evernote or a similar app to remind yourself what you need to look up.

(3) do sweat on the small stuff. In this case the small stuff is the basic science behind treatments. By knowing this you will be able to do the higher level activities better.

(4) have a plan. Set yourself a goal about knowing about a particular topic by a certain time.

(5) have a template of questions. Really – it is not possible to go and learn about ‘colon cancer’ without a targeted plan. Think of questions that that apply across disciplines e.g. is systemic chemotherapy useful for metastatic colon cancer, in monotherapy better than polychemotherapy, what is the optimal duration of therapy, etc, etc???

(6) study stuff that interests you – the other stuff will fall into place naturally

(7) volunteer to present at meeting or to teach – then you will be forced to study

(8) pick something you think you already know and revise it – get up-to-date

(9) close your eyes and drop your finger on a contents page

Today in a discussion about what makes an excellent clinician a colleague suggested that he didn’t like the concept of ‘excellent’ because it implied aiming to be perfect – which obviously (perhaps) one can’t achieve.

I reject this assertion.

We need some assumptions. Yes – we can’t be perfect – but we can excel.

The dictionary definition(s) of excellence is:

n
1. the state or quality of excelling or being exceptionally good; extreme merit; superiority
2. an action, characteristic, feature, etc., in which a person excels

I’d like to propose a different definition of excellence that ignores perfection. Being excellent means always trying to be better and to do better. I believe this is the intent of pursuing excellence in healthcare. And yes – for some of the consumers this will be a perfect outcome.

So the RACP (Royal Australasian College of Physicians) has self-management as part of its’ Professional Qualities Curriculum. Well this wasn’t taught at medical school and it isn’t being taught or assessed by the college. Nor is it getting assessed for CPD/CME points.

Self-management includes stress management. This includes addressing work-life-balance.

My first comment is that the notion of ‘addressing work-life-balance’ is more likely-than-not written buy a bunch of middle-aged to elderly white males who have little concept of what outsiders to consider to be work-life balance. This is a homily. If somebody is happy working – let them do it. It is their source of balance.

But seriously. I’ve never really had a proper discussion with one of my trainees about stress management. At least in a serious sense. We’ve discussed ‘debriefing’ with one’s partner or colleagues but stress management can go beyond this.

Several lines of research are suggesting but haven’t definitively proven the role of mindfulness for managing patient symptoms and stress. This work might also provide guidance for physicians for managing stress.

Currently I’m testing the Headspace app for iPhone. In the old parlance this is meditation but mindfulness is a more approachable term for us folk who aren’t into alternative medicine. Interestingly I think I couldn’t have done this 5 or 10 years ago but now it is sitting nicely.

I don’t know if mindfulness training is going to improve my overall well-being but it seems mostly harmless and it is teachable to junior doctors who are having to deal with different stressors to me. There are flow on effects – if your doctor is better rested then he/she might manage your case better. If your doctor understands mindfulness-based therapy then he/she might recommend this app.

This will be short and sweet.

One thing they didn’t teach in medical school was how to teach. Maybe we weren’t taught this because we might start charging for all of the unpaid teaching time that we provide.

Teaching is obviously important because we need to teach the up-&-coming doctors how to be, well, doctors, but also because by teaching we get to explore for ourselves our own level of expertise and understanding. Good teachers usually know their stuff backwards and can expalin it simply.

Teaching can be hard and like everything needs to be tailored to the audience, the occasion and the context. I’ve certainly made heaps of mistakes along the way….apparently I’m scary.

Dr Fiona Lake and her colleagues have recognized this and come up with Teaching on the Run. Look up the website or check out the articles in the Medical Journal of Australia.