I love self-study, but what I love even more is good doctors sharing their clinical pearls, their personal experience, their shortcuts and techniques. The latter is what makes a residency or fellowship better than others.
That's why I love Paul Marik's critical care books, for example. I don't need somebody to recite Uptodate for me, I want them to tell me about their own experience, even (or especially) if it contradicts the mainstream view. If they don't have enough experience to talk freely about a subject, they shouldn't be teaching it. That's why the best teachers can do it just with pen and paper anywhere; no need for fancy Powerpoint.
Most academic programs make lecturers out of their resume padders, the fancy-shmancy brown-nosers who write their papers while supposedly directing cases and teaching. Because that's what matters in academia, the amount of research crap one has unleashed on one's peers. Instead, they should use the clinical guys, the ones who also work solo, the ones with hundreds of hours of hands-on experience in the respective subject. Those are the ones I have learnt the most from, the kind of people who could run circles around their academic peers in a clinical setting. I learnt more from the clinical guys in my first year as an attending than from most of my academic teachers.
The problem with American graduate programs is that they are too research-centered, because they can afford the luxury to. In some parts of the world, if you don't teach well, nobody will waste 5-7 years slaving away for you. Teaching should be the number one mission of every academic program, because they make tens of thousands of dollars on the back of every trainee every year. A good program should have a good number of clinical guys, who couldn't give a crap about their resume, and a good number of emeritus level people, who are beyond giving a crap about it, but who are still passionate about their job and teaching. IMO, these are the guys with the pearls, who will teach the stuff one cannot read in a book; not the famous textbook writers, ASA meeting speakers or board examiners, no offense.
Btw, I went to the ASA meeting hoping to have my socks knocked off. I am still a fellow, so I am still growing (and will be, for the next 30 years). Except for 1-2 talks, it was an utter waste of my time and money. I heard stuff that I had read online months before in a much better digested form, with less fluff and more practical applications than the Powerpoint presentations by junior faculty at the ASA. These people and their academia are still living in the last century; they should look at stuff like FOAMEd or SMACC to see how real teaching in the 21st looks. Here are two great examples, from the world of emergency medicine (and from a great TEACHER, may he rest in peace):
Another example. Many lectures from the
University of Maryland CC project are excellent (their fellowship program too, most likely), just look at these two:
Thank God, critical care has some great doctors blogging and podcasting, both in the US and abroad, so I am spoiled with stuff like this every day. The day is not long enough to read and listen to quality materials, so all I want from my fellowship is to give me the time to be able to do so, when not learning from patient care and when not being taught useful clinical pearls or practical skills by good teachers.
In a good program, every of the 80 hours/week of training should be well accounted for.
My basic feeling is that the 1:1 clinical time with an attending is the bulk of the program's real opportunity to teach.
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