Next Generation is a BWH Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This month’s column is written by Owen Harris, MD, an Emergency Medicine Ultrasound fellow.
This past summer, I was one of five members of the Division of Emergency Ultrasound who travelled to Gallup, New Mexico to give a three-day teaching seminar on the use of ultrasound for patients in the emergency department and other critically ill patients. We went as part of the BWH Outreach Program with Indian Health Service, the centralized volunteer program for Brigham Health clinicians. Located in northwestern New Mexico near the Arizona border, Gallup carries the nickname “Indian Capital of the World” due to its proximity to multiple Native American reservations including the Navajo, Hopi, and Zuni tribes.
Our hosts at IHS were incredibly welcoming and appreciative of us. After a tour of their facility – a three-story building with a small ICU and an ED the size of the Brigham’s Au Bon Pain – they took us to see the Inter-Tribal Ceremonial. We were lucky enough to be in town for this annual event, showcasing the rich heritage of the local tribes. We experienced a number of tribal songs and dances, some original arrangements by modern artists, others passed down for hundreds of years. To see the intricate handmade costumes was breathtaking, and an amazing feeling of fellowship and togetherness reverberated throughout the entire event. It was easy to see what motivated the staff at IHS to travel from hundreds of miles away to serve this community.
As the BWH delegation’s most junior member, I prepared three half-hour lectures on different uses of ultrasound for diagnosis and management within the ED. I also assisted with hands-on demonstrations on volunteer medical students and family members of staff and on gel block practice models for placing peripheral IVs. My colleagues gave similar lectures, but also prepared more advanced discussions for the hospital’s monthly trauma grand rounds.
Throughout medical school and residency, I presented many topics to many audiences. Short, five-minute oral morning reports to fellow residents; half-hour literature reviews on subjects I knew little about to attendings with expert subject knowledge; morbidity and mortality cases to an audience of all levels, and grand rounds to the entire ED faculty. Every presentation I prepared was done so with two things in mind: I was trying to impress the audience, but I was still in training. There was always someone in the room with a more advanced understanding of the topic at hand. I couldn’t hope to surpass them but I could prove I was on my way to being considered their colleague. Being a trainee didn’t mean that expectations were low, but questions asked were often done with the purpose of testing the limits of my knowledge rather than advancing the collective knowledge of the room.
A few short months later, I had a new home and title but didn’t think I was a different doctor. I had a certificate stating I graduated residency, but I hadn’t even taken the boards yet. I was selected from a group of other qualified candidates to be a fellow at the prestigious Brigham and Women’s Hospital, but I hadn’t laid hands on a patient yet. I was standing in front of a room of attendings and other staff who had been in practice since I was in high school, and now I was the expert. No longer was the atmosphere one of trial, but rather one of training. Nobody was testing the depth of my knowledge; they were looking to me for reliable answers to improve their practice. Suddenly I was an expert, despite my subject matter knowledge being no different than it was at the end of residency. The anxiety of presenting for the first time as a fellow transformed into pressure to provide expert opinions for the sake of helping patients.
My trip was eye-opening from a cultural and professional standpoint. I arrived nervous and left with a new confidence in my skills. I also gained a new appreciation for a culture I knew little about. It was an uplifting way to start my post-residency education, where I will continue to learn and grow personally, but also will be looked to as an authority by not only students, but other practicing physicians as well.