3 Embrace Uncertainty

By: Dr. Michelle Gibson

A few years ago, due to scheduling conflicts, my colleague Dr. Melissa Andrew and I had to completely redesign our teaching in geriatric psychiatry to second year medical students.  What was initially a frustrating annoyance ultimately evolved into an opportunity to teach students to embrace uncertainty in clinical practice, through changing the way we taught about common geriatric psychiatry presentations.

Instead of teaching directly about how dementia or depression can look in older adults, we started with a story of a patient who had a number of symptoms that were not specific to any one diagnosis- which is very common in our clinical practices.  We then had the case evolve in 3 different ways, in part by ‘rewinding’ at different times during session.  For example, in the first instance, our lovely older patient who was experiencing sadness and some mild cognitive changes after the death of her husband turned out to have a medical condition that was causing many of her concerns … but then we rewound the case (i.e.- imagine time travel backwards), and changed the results of the investigations to be completely normal, thus removing that possibility as the cause of her symptoms.  This then led down another path… and this time, it was an underlying dementia that was emerging.  We explored what that might look like for a while,  until we travelled back in time again, to get a slightly different story, and found that the main issue was depression.

We repeated this approach in another session as well- to highlight how various non-specific symptoms can in fact be due to many different diagnoses. Through this, we hope to help our students learn that our patients do not always arrive with a textbook version of a diagnosis, or even that not all diagnoses will be clear initially and that time, and patience, and detective work may be needed to help clarify the underlying issue.

We also aim to model for our students that it is totally normal to not always know immediately what the ‘answer’ is.  This is our reality in medicine, and in geriatrics in particular. We model the collaborative approach to clinical practice, in that Dr. Andrew and I are from different disciplines, so we try to teach the way we practice.  In this way, we highlight how we learn from one another and collaborate to provide patient-centered care.

Even in the era of Zoom teaching, this approach has significantly increased student engagement in our teaching, and we enjoy the interactions we have with our students even more.

Photo by Robert Ruggiero on Unsplash