Learning to Fly

Imagine you are learning to fly a very large, passenger plane. You aspire to be the captain and make the daily decisions to fly and (hopefully) land the plane. You start with smaller planes and work your way up over time. But imagine after getting your private pilot license in small 2 seat small planes, your instructor, who has never seen you actually fly the plane, hands you the keys to a 747 and says "have a nice day". He assumes you know everything there is to know about flying because you finished entry level pilot school. And assumption that will likely be fatal to you and everyone on board.

I don't want to be dramatic, but that is essentially what often happens in residency training programs where the instructors are as lost as I am. Professional medical educator often make assumptions and are so lazy they can't begin to solve the problems at hand and truly mentoring and training future medical professionals. Now I know they are all not like that. And I know many who are extremely good, but I am dismayed at the number of inferior faculty members in medicine today.

On several occasions I've been "handed the keys" without a word of education, mentoring, direction or anything resembling teaching and told to "start the engines". Nothing quite 747ish, but certainly in a class I've never flown before. Assumptions of my skills, knowledge, education, morals, ethics, decision making, memory of clinical practice guidelines (checklists to the pilot) etc have been largely "assumed" inaccurately and brushed off with a "well you went to medical (flight) school, didn't you?" I've been careful, I've plodded through each situation with care, but not without error and certainly not without trauma (to me especially). The system, at least my part of it, is very broke.

If other industries worked as ours does, the country would be in shambles. Planes would fall out of the skies as pilots, who never practiced on a simulator or in an otherwise safe environment, muddle their way through piloting encounters. Vehicle accidents, caused by police/fire/EMS driving fast to calls, would be common as drivers muddled their way through it without the benefit of an emergency driving course or similar. You get the idea. We gain expertise by mentored practice and infusion of knowledge working first in safe environments with simulators, training courses, etc. Not on people.

This is silly. This is dangerous. It was the best of time, it was the worst of times. And I have to go back to the planes tomorrow. I doubt I'll even be greeted by a hello, let alone meaningful teaching of any kind. But I'll do my best to park the 747 and not hurt anyone. Particularly me.