In a week or so, I will leave the ranks of being an Attending Physician and return to academia as a Fellow Physician – a doctor LEARNING a subspecialty of their field. As a locum tenens, I have been lucky enough to work with multiple learners of various stages throughout the country: from medical students, to resident doctors and, from time to time, to doctors in their fellowship. Aside from the daily mantra of science, the goal of inviting mentees deeper into the world of medicine and providing them with multiple avenues of education to hopefully produce the next generation of compassionate, intellectual and innovative physicians, there is a role I sometimes feel is undervalued or discussed less frequently: Equitable Educational Advocacy.

When I was in my third year of medical school, I will never forget when I was rotating through the OBGYN clinic and a middle eastern patient refused to allow me to take part in any of her visit. From gathering a simple history, to watching the routine ultrasound be performed, to even really talking to her. Now, I get it, I have had a few hundred patients at this point of various cultural and religious beliefs and ALWAYS try to respect them and this post is NOT about that; but, I will never forget how my Maternal Fetal Medicine Attending Dr. D handled this situation. She told the patient that she respected her requests but that we were a Teaching Institution and there were other practices she could go to if she wanted. She told her, and this will stick with me forever, “I will fire you from my practice if you are not ok with males and my medical student.” She explained that she could not control for who would be at the delivery of her baby and couldn’t promise only males being available for her care… Well not the point of this post but just to complete the story… She ended up having an umbilical cord prolapse, a life threatening emergency for the baby that required an emergency c-section. The Anesthesiologist? Male. The OBGYN on call? Male. The Resident holding the cord in from below hoping to save her baby? Male. The Pediatric/Neonatology team? Mostly Male. Now, this is not about cultural competence, but the fact that that Attending stood up for me, little ole medical student me, something she didn’t really have to do.

On a Psychiatry rotation later on, I remember rotating in Biloxi, Mississippi with a very peculiar Psychiatry Resident… And he would ALWAYS refer to me as the, “Junior Doctor.” To this day, when I round with my medical students, I have adopted and internalized his words and learned that it has led to a variation in how my patients interact with them. We aren’t in the 1940s anymore when Medical Students effectively learned by autonomous decisions and hoping they didn’t kill someone on the wards, and it is common that these learners have less respect than they might have a long time ago. I have heard many Nursing and Medical students often say to me, “I am JUST the *nursing/medical* student.””No, you are a *NURSING/MEDICAL* student!” It is fascinating but empowering how one’s role changes the way one views it, and likewise advocacy to realize the importance of one’s job, no matter what field, is important to teach self-esteem, self-respect and SELF-advocacy down the line.

And then, it happened one day when I found myself in the role of the Supervising Teaching Attending needing to defend/include my resident, and I will never forget it. In a small midwestern town I attended a late night urgent cesarean section. I walked into the room, expecting my resident to be my side and excited to walk through the steps of Neonatal Resuscitation with her, and she was nowhere to be found. I found out that the patient had refused any learners at any part of the delivery. I acknowledged her concerns but requested, respectfully but strongly, still that the Family Medicine Resident join my side for the baby, even if not part of the delivery itself. They agreed. Luckily, it was a straight forward resuscitation, but her being allowed to be present gave us some time to talk through situations she might often see and the rare cases she might not. I realized that night, as I put up a strong wall to the family to allow her to be by my side, that we are responsible for the generations that we train and the future of medicine – this starts with how we advocate for and treat our learners. It is my responsibility to ensure she leaves training with the preparedness to act when she is alone and I realize now that that’s what Dr. D did standing up for me as a medical student. As I return to a Fellowship a Senior Mentor advocated for me, telling me I needed to focus on my own wellness and balance. I hope I will always be able to work on my worldly advocacy for those that might look up to me (even if only metaphorically). To treat those that are learning from us as mentees with respect, conveys respect for the profession and acknowledges the professional interactions that should exist as we go further in our careers, at any stage.

Image Credit (From my Alma Mater, Tulane) – Me as a lowly brand new medical student… Using my stethoscope the wrong way… (https://news.tulane.edu/news/medical-students-receive-mantle-responsibility)