"What did I learn?" How I became my own coach and help others do the same.

In our training and growth as health care professionals, we look to our instructors and others as coaches, people who help us learn not only concrete skills but also ways to solve complex problems and form meaningful and productive relationships with patients and colleagues. In this article, I outline how I became my own coach by reflecting and building on my experience as student, teacher, and physician, and how I help others do the same. THE STORY I'll start with a story. At about 5 p.m. one aft ernoon during my internship year at Minneapolis General Hospital (now Hennepin County General Hospital) a long time ago, I rode the ambulance to the scene of a one-car accident. The policeman at the scene led me to the car, smashed head-on against a tree. The driver, conscious but behaving wildly and speaking incoherently, was seated in the car and handcuffed to the steering wheel. "When I arrived, Doc," the policeman told me, "he came out swinging, and so I had to subdue and 'cuff him." I was about to inject the man with a sedative so that we could transport him to the hospital, when one of my teachers, a physician who lived in the neighborhood, strolled by, surveyed the scene, and reflected aloud, "I wonder if he's having an insulin reaction." And so, instead of injecting the sedative, I substituted intravenous 50% glucose. In just a few moments, the man calmed down and spoke, making sense. Students worry all the time about doing well and not making a mistake. I tell them that one of the purposes of professional training is to lessen the likelihood of mistakes. Yet there are so many different situations, combinations of problems, patients' personalities and cultural backgrounds, and ways they tell their stories-what is said and what is left unsaid-that the opportunities to err are immense. The chance appearance of my teacher gave him the opportunity to coach me and teach me important lessons. But how many times will we have a teacher by our side to coach us as we confront a new problem? Ultimately we need to become our own coaches. WHAT DID I LEARN? My students and advisees know that my favorite question of them is "What did you learn?" What did you learn from today's class (readings, lessons, encounter with a patient or physician who was a class guest, etc.)? What did you learn from your experience in the lab (as a waitress, as a nursing home volunteer) that would be of use in your career as a physician (nurse, therapist, etc.)? In essence I am asking them to internalize the question, build on their own experience, and become their own coaches. I used this question every day, aft er every patient, to teach and coach myself. Here are some examples: * In caring for a patient with abdominal pain and weight loss, I learned the following: * Single problems can be multidetermined, and unless all the contributing causes are identified, the problem may be incompletely solved. * Patients may panic when their medical care is so divided among various professionals that no one seems to be in charge. One person needs to coordinate care and present a consistent message. * In caring for a combative patient with fever and diabetes, I learned the following: * Among the causes of fever are the common ones, like pneumonia and urinary tract infection, and those one might not first think of, like pulmonary embolus. * Beyond the technical tasks of managing each of this patient's illnesses, named and yet to be named, is recognizing that "combativeness" is itself a problem that needs to be more clearly defined. * In caring for a patient with congestive heart failure and a pelvic cancer, who had taken the nonsteroidal anti-inflammatory drug indomethacin, I learned the following: * Much illness is drug- or treatment-induced. When a new medicine or treatment is prescribed or stopped, we need to anticipate all the possible effects of the change. …