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/ 1 MEDICINE, SCIENCE, AND SOCIETY

Students and Their Teachers KEITH WRENN, M.D., Rochester, New York

H e had been my teacher, not so much of medical facts, but more importantly of an approach to

patients. As a student or intern, there was always a specter looking over my shoulder late at night while I fought sleep and wrote my lengthy work-ups. His presence made me go back to the bedside to listen for the forgotten bruit or do the overlooked rectal exam. At first the specter was fearsome; morning report would be miserable if these things were left undone. He had an uncanny knack for sensing a flaw in the work-up. Later, though, his presence was less frightening, partly because of fatigue and famil- iarity, but partly because I wanted to please him.

He had a sarcastic bent that was often enjoyable as long as I was not the subject of his ire. Even when I was the offender, there seemed a purpose to the ridicule, although usually in retrospect. He went too far on occasion but that was just part of his legend. You might not actually forgive him but you let it pass, like so much else that was unpleasant during those times.

He was easily imitated. I think he actually en- joyed being parodied. He had a larger-than-life role to play and he fostered his legend. He was like a bronze statue in the park of a stern Civil War gener- al, always there, always alone, surveying the com- ings and goings in his domain. He seemed omni- present and you could never really let your guard down or he would catch you.

I can’t say that I liked or knew him very well. I doubt anyone did. I was never comfortable around him. Every time I saw him, it would provoke an uneasiness accompanied by tachycardia and perspi- ration. Yet he could be very generous, especially when writing letters of recommendation. He also had an incredible memory for names and personal facts, often surprising me in later years with a refer- ence to some obscure or mundane piece of me like my birthplace or my father’s occupation.

I left training for private practice, at last free of anyone’s dominion, or so I thought. His presence, however, stayed with me, constantly fueling my

From the University of Rochester School of Medicine, Rochester, New

Requests for reprints should be addressed to Keith Wrenn, M.D., Uni-

Manuscript submitted June 4, 1991, and accepted in revised form

compulsive nature to the benefit of more than a few patients. I still would go back to the bedside late at night and awaken patients to ask one more question or do that one item on the physical exam I had forgotten. I developed more and more respect for the principles he taught me.

I had relatively few contacts with him over the next several years. Each time we would meet or even talk on the telephone, the same old feelings of dread I had experienced years before would surface. It is difficult to become a peer with someone who has had so much influence in your life, despite the use of first names.

After 8 years of private practice, I decided to return to an academic setting. I was an unlikely candidate for an academic position and it’s safe to say he was instrumental in my being hired at the institution where I had trained.

Although our relationship hadn’t changed much over the years, unbeknownst to both of us, I had changed. Whether or not he had changed is less clear to me. In any event, we began to have minor clashes over one thing or another. The clashes grew more strident and frequent. Harsh words on both sides were common. In retrospect, the issues were less important than the fact that mutual annoyance had taken the place of mutual respect.

I’ve moved on to a new job in a different city. The specter still looks over my shoulder, but the change in our relationship saddens me. If we meet again, I probably won’t get those old feelings of dread. I’ll miss them.

This scenario acts itself out in various settings all the time. On a basic level, as we grow up we grow away from our parents and assert our indepen- dence. The teacher-student relationship is much like the parent-child relationship but there are not the years and the same degree of love to protect teachers from their students. Relationships like this need to be nurtured and require more discipline, work, and understanding to maintain.

Teachers need to acknowledge at some point that students will catch up to or likely even surpass them in their fund of knowledge. This should not be dis- tressing but rather a source of pride. The transition from teacher to peer is a difficult one. If a teacher- student relationship is founded in mutual respect, the transition will be easier. When the respect seems to come from the student only, then eventu-

April 1992 The American Journal of Medicine Volume 92 427

ally there will be a conflict between one’s expecta- tions and another’s priorities. Disillusionment is of- ten the result.

Students also should be aware that as times change, circumstances and priorities change. Take full advantage of your teachers now. Don’t expect them to stay ahead of you forever. Forgive your teachers for their diminishing role in your life as you grow. Losing respect for a teacher whose fund of knowledge has diminished relative to your own is at least unfair. It may well be that a good teacher’s primary role lies less in the imparting of “facts” than in providing an ethical framework on which to model your behavior. In medicine, in particular, “facts” change with some regularity but “the right thing” does not. In academic medicine, roles change; political and administrative responsibili- ties assume greater importance. Younger faculty, residents, and students do not often have access to the “big picture” and may need to adopt an attitude based more on faith in the acquired wisdom of their mentors, rather than on the result of the latest jour-

nal article or their emotions. Be aware that you will also change. Although you will necessarily move from mentor to mentor as you grow, remember, treasure your prior mentors.

We are students all of us, and to some degree we are all teachers as well. We should all attend to this business of mentoring. Are there groups of students left out of close mentoring relationships by virtue of gender, race, age, class-standing, or choice of spe- cialty? Is a close relationship between one student and one teacher always fair, or healthy? Should such relationships be fostered? If we examine our own teaching styles, are we really promoting close teaching relationships with the students who need them most? Or are we drawn to the top 20% of the class, to those who seem most like ourselves?

I no longer have the man who spawned the spec- ter I carry to argue these issues with. My hope for you is that my experience will make you work hard to maintain these teaching relationships because even when the “teaching” stops, the relationship can be beneficial.

428 April 1992 The American Journal of Medicine Volume 92