Learning Hands-On Doctoring in a Virtual Age

October 1, 2007

At the end of her Guest Commentary, "The Virtual Patient" (CONSULTANT, July 2007), Dr Faith Fitzgerald asks: "How shall my students experience the things that cannot be taught but only learned through the sometimes inconvenient, potentially time-consuming, emotionally disquieting, and generally non-remunerative interactions with real patients?"

At the end of her Guest Commentary, "The Virtual Patient" (CONSULTANT, July 2007), Dr Faith Fitzgerald asks: "How shall my students experience the things that cannot be taught but only learned through the sometimes inconvenient, potentially time-consuming, emotionally disquieting, and generally non-remunerative interactions with real patients?"

As an internist and someone for whom being a physician is synonymous with being a teacher, my answer to her question is to teach by mentoring-one student or resident to one physician-and to have the student spend several weeks with his or her mentor, day in and day out. Now all we need are physicians who want to be physicians. In my view, they are a rare commodity.

---- Gloria Engel, MD
Rancho Mirage, Calif

I agree with Dr Engel; however, in my area at least, many students and residents cannot find such mentors. Clinicians in practice are too busy under group mandates that they "meet their quotas." Also, students and residents cannot find time to be mentored, given their increasingly mandated and detailed formal curriculum and an overwhelming work load in their home teaching hospitals and clinics in a time of concurrently constricted hours-of-work limitations. This is a great problem--but one that we must overcome.

---- Faith T. Fitzgerald, MD
Professor of Internal Medicine
Associate Dean of Humanities and Bioethics
University of California, Davis, School of Medicine