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Teaching cases presented as fables to learn the mentoring process in medical training. Part four: apprentice in the period of introspection and hope. Winter*

Review | DOI: https://doi.org/10.31579/2835-9291/30

Teaching cases presented as fables to learn the mentoring process in medical training. Part four: apprentice in the period of introspection and hope. Winter*

  • Jose Luis Turabian *

Specialist in Family and Community Medicine.

Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain

*Corresponding Author: Jose Luis Turabian, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.

Citation: Jose Luis Turabian, (2025), Teaching cases presented as fables to learn the mentoring process in medical training. Part four: apprentice in the period of introspection and hope. Winter., International Journal of Clinical Case Studies, 4(1); DOI: 10.31579/2835-9291/30

Copyright: 2025, Jose Luis Turabian. This is an open access article distributed under the creative commons’ attribution license,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 06 February 2025 | Accepted: 24 February 2025 | Published: 28 February 2025

Keywords: medical education; tutoring; mentoring; teaching; medical intern

Abstract

Fables allow us to understand something unknown in terms of familiarity. Therefore, they are frequently used in all sciences that adopt common terms to name complex realities. The mentoring process in medical training, is one of these complex realities, explained here through a fable: that of the virtuous and thoughtful mentor, the slow and parsimonious tortoise called Dr. Golden-Headed, who “discovers” a certain number of Scientific Laws of medical training, and his apprentice, whose name changes throughout the training and development process. Based on these short stories, the stages that medical trainees go through in training will be described, from their hesitant beginnings of preclinical training where basic sciences are studied (Spring), through clinical training, which involves practice in hospitals and health centers (Summer), and rotating internship, where practical experience is acquired in various specialties (Autumn), to their independent practice and specialization, which allows the doctor to focus on a specific area of medicine (Winter), and some keys to what the tutoring work should be shown. In this part four (apprentice in the period of introspection and hope. Winter) Dr. Golden-Headed “discovers” several laws: the law of the workshop, the law of the group effect, the law of tandem,  the law of lines of force, the law of lions learn to swim, the law of the lightsaber, the law of love for locked rooms. These “laws” explain cooperative learning, mutual learning, co-mentoring, autonomous learning, self-learning, significant learning, problem-oriented learning, metalearning, performance-based assessment and self-assessment.

Introduction

Winter

The cold, the snow, the wind, the ice... Dr. Golden-Headed observes the white landscape with her usual twinkle in her eyes. “Winter is order, the austerity of the essential. Night has come for the apprentice. Have you learned to warm yourself, dear apprentice?; Have you learned to hibernate? The treasure of Winter is learning to draw energy from your own well. Finding your strength”, Dr. Golden-Headed continues meditating”, thought Dr. Golden-Headed.

The Law of The Workshop

The apprentice, who at this moment seemed like a Frosted Snowflake, was reviewing his notes and books from the College. He thought he should prepare himself by rereading what he had learned at the School so as not to disappoint his future teachers...

Dr. Golden-Headed said to him:

-"Aha! Frosted Snowflake, I see you're brushing up on your knowledge from the Academy. Careful! Remember that an academy is usually a formal learning center with a focus on theory and general knowledge... But..."

-

"But what? Is that wrong?" Frosted Snowflake asked.

-

"But... That includes a lot of emptiness," Dr. Golden-Headed answered slowly and softly.

And Dr. Golden-Headed continued: “Today's painters hide from us the present emptiness of their art… They fill the rectangular canvas with circles and cubes… and then they say: 'Here is the painting.' The most modest Italian or Flemish painter of the 16th century would be ashamed to paint like the most famous painter of today…”

- “And why is that? Are there no academies?” Frosted Snowflake asked innocently.

- “It is precisely because there are academies,” Dr. Golden-Headed concluded. “It's because there are only academies. The traditions of the workshop, acquired empirically and passed down from masters to disciples, were lost over time. Until the day came when no one knew how to paint as before. Cézanne confessed to being a poor amateur, nothing more. And it's the truth. He was an amateur who, in Giorgione's studio, would have been sent to grind the colors.”

- “So, what to do?” Frosted Snowflake asked again innocently.

- “Well, you'll have to go grind the colors before putting a single brushstroke on the canvas” (1), Dr. Golden-Headed replied, smiling beatifically. And she added, “It's another law I discovered: THE LAW OF THE WORKSHOP.”

- “Both 'academy' and 'workshop' can refer to places of learning, but with different approaches. A workshop generally involves more practical instruction. Workshop also refers to a group of people working under the direction of a teacher,” Dr. Golden-Headed clarified.

- “In short, if you're looking for a place to learn how to actually do something, practically or with your hands, a workshop is the way to go,” Frosted Snowflake concluded.

- “Very well. Workshop promotes thinking in situations. It's an active methodology where participants learn by doing, through practical experience and interaction, integrating theory and practice, fostering teamwork, research, and skill development” (1-3).

Dr. Golden-Headed entered a meditative state again and thought: “It's ignorance not to know how to distinguish between what needs demonstration and what doesn't.”

And she wrote on the board: “It's not that it's difficult to understand foreign languages: it's difficult to understand any language.”

The Law of The Group Effect

The apprentice, who was now a ground squirrel, insisted to Dr. Golden-Headed that he wanted to continue his training in emergency medicine.

Dr. Golden-Headed attempted to do some emergency medicine in the office, which she didn't usually do.

However, during this teaching work with Common Squirrel, Dr. Golden-Headed, who was very observant, realized that she was often uncomfortable noticing that she didn't master or perform certain techniques that could be performed in emergency , either because these were not areas of particular interest to her personally or because she lacked the training or experience the apprentice had requested.

Dr. Golden-Headed realized that this wasn't a problem for her patient management, as she relied on consultations with specialists in the subspecialties of Anthropomedicine, but it could be a problem for Common Squirrel's training.

So she said to Common Squirrel:

-"I just discovered the LAW OF THE GROUP EFFECT!"

-"Okay," Common Squirrel replied, wagging his tail.

-"Group members, when working together, are more likely to solve problems—particularly those requiring a creative approach—than any individual member, even the most skilled," Dr. Golden-Headed began to explain.

And she continued: the combined training resources are much greater than those available to each individual teacher. And on the other hand, you can learn from other colleagues or peers. This is cooperative learning or co-tutoring: A set of educational methods in which students work together to complete a task.

Cooperative learning promotes individual knowledge, personal progress, interpersonal relationships, social support, and self-esteem more intensely than competitive or individual learning...” (4).

And she concluded: “In reality, a trainee, a resident, is a kind of ‘taker,’ a ‘vampire,’ who ‘takes’ everything he can from the senior residents and doctors in the hospital, but simultaneously a ‘giver,’ who gives everything he’s learned to the junior residents. Each year, the resident advances in the ranks, accumulating more and more knowledge, and his responsibilities expand. This is the basic principle of a resident’s maturation. The more one learns, the more responsibilities he has to the junior residents” (5-8).

-“Well, well, but... no insults… I’m a common squirrel, not a vampire,” Common Squirrel joked.

But Dr. Golden-Headed was already beginning to meditate with her head in her shell… and wrote on her blackboard: “If you project love into the group setting, love returns in an amplified form.”

The Law of Tandem

-“And how will I continue learning after I finish my training here?” asked Silent Night, the current apprentice, one cold Winter day.

-“How have you done so far?” asked Dr. Golden-Headed.

-“Well... talking together, you and I, dialoguing and discussing together... being listened to, and encouraged to reflect...?” replied Silent Night.

-“Perfect!” exclaimed Dr. Golden-Headed, “you have discovered the LAW OF TANDEM.”

-“Many large companies were created by individuals who worked ‘in pairs’ – as teams… of two. Bill Gates and Paul Allen at Microsoft, etc. Biology already tells us: evolution must be understood as a co-evolution of organisms and their respective environments, in which every organic change is both cause and effect of environmental changes. Can we call working in pairs or in tandem co-tutoring?” (9-14), asked Dr. Golden-Headed.

-“Of course… it would be co-mentoring” (15), Silent Night pointed out.

Dr. Golden-Headed probably didn't hear her... She had begun to meditate again: "If the teacher is at a lower level than the student, the student will degenerate." And he wrote on his blackboard: "You have to have teachers with a higher level than you."

The Law of Lines of Force

For several weeks, Dr. Golden-Headed and her apprentice—now a 5,000-year-old Antarctic sponge (yes, you know, the estimated lifespan of the Antarctic sponge is up to 15,000 years)—had been commenting on how quickly time had passed, leaving very little left for Antarctic Sponge to complete her training.

Dr. Golden-Headed asked Antarctic Sponge: “What do you think your lines of force are? It’s time to evaluate our past and future directions.”

-“Lines of force?” Antarctic Sponge repeated.

-“Yes, magnetic field lines are due to Michael Faraday (1791-1867), who called them lines of force.” But, they represent something more: the directions of our energy, where our inner energy takes us again and again,”explained Dr. Golden-Headed.

-"Can you complete a list of three guiding principles in your life related to the profession? Those things that frequently constitute both threats and opportunities for the development of your profession; those things that can explain your present and help predict your future, Antarctic Sponge," asked Dr. Golden-Headed.

And she continued: "It's about finding the 'guiding' or 'energetic' problem or forces around which the rest revolve or depend. An autonomous learner knows how to learn and can use this knowledge in any learning situation they encounter and at any time in their life” (16-19).

And Dr. Golden-Headed wrote on the blackboard: Eliminate the figurative and discover the composition."

The Law of Lions Learn to Swim

-“Despite everything… how will I learn on my own during my next training after leaving this center?” said Emperor Penguin, the current apprentice, who had a black head and back and a white belly with yellow trim around his neck. “I think I've gotten used to learning here, with you, Dr. Golden-Headed.”

-“How long will your training last in the future?” asked Dr. Golden-Headed.

-“Well… I don't know… Yes! a lifetime!” replied Emperor Penguin.

-“In that case, you must apply… THE LAW OF LIONS LEARN TO SWIM!” replied Dr. Golden—Headed immediately.

-“How so?” asked Emperor Penguin.

-“Big cats have been forced, in some areas of Africa, to develop skills contrary to their natural habits in order to catch prey that is less vulnerable in the water than on land…” explained Dr. Golden-Headed.

-“It’s about achieving self-learning. The process by which a person can learn on their own. In a sense, we are all autonomous in learning something. Each student has to learn for themselves. Teachers help their students but cannot learn for their students” (30. 21), continued Dr. Golden-Headed.

-“And how do I do that, Dr. Golden-Headed?” asked Emperor Penguin, wearing his elegant dinner jacket.

-“The shadow of the master freezes the smile of the disciple. Don't trust the experts. Experts are experts in what has been, but not in what might be. Experts are extraordinarily useful, but don't postpone a new idea because of an expert's judgment.”

And Dr. Golden-Headed continued: “Learning about learning is learning about the contexts in which we learn. It is when we are able to identify when and how we learn, and when and how we don't learn, and then seek adaptations accordingly. In this way, we build new learning strategies into our learning experience” (22, 23).

-“That is, we must be able to critically self-observe our interventions, becoming aware of their effects and their coherence. What do I do? Why do I do it? How do I do it? What resources would I need to improve what I do? What are my limits? What satisfaction does what I do give me? Etc.” (24, 25).

-“In self-learning and problem-based learning, there is a complete inversion of the traditional order of learning: here's a problem, learn from it, replacing the traditional: learn this and then you'll be able to solve problems” (26-28).

And she wrote on his blackboard: “Set the wings of a bird in gold, and it will never fly to heaven again.”

The Law of The Lightsaber

-“Dear Leafless Tree -that was the apprentice’s appearance now,” You are nearing the end of your training, and so I will leave you alone in the office for a certain period of time”, Dr. Golden-Headed said.

-“But by some special law?”joked ironically Leafless Tree.

-“Yes, of course, based on the LAW OF THE LIGHTSABER, which I discovered it,” replied Dr. Golden-Headed.

-“For 25,000 years, the Jedi Knights were the guardians of Peace and Justice throughout the Galaxy, their personal weapon, the lightsaber. The construction of the saber also represents the culmination of Jedi learning.”

-“When I see you have built a new lightsaber, your skills will be complete”, Dr. Golden-Headed explained to Leafless Tree.

-“Let me see if I understand: Do it myself without any help the work of consultation for a while is like building my lightsaber?” asked Leafless Tree. “It’s my final project,” she added, laughing (29-31).

-“I see you’re learning well,” replied Dr. Golden-Headed. “It’s the final evaluation, Leafless Tree.”

And Dr. Golden-Headed wrote on the board: “In the end, everyone loses their life’s battle. The greatest victory is the one you win over yourself.”

The Law of Love for Locked Rooms

-“The end of Winter is approaching… the end of Nature’s cycle… It is the final time of your training in this center…” Dr. Golden-Headed explained to Elegant Bright Yellow Late Winter Daffodil Flower.

-“Hmm… But then, have I passed or failed, Dr. Golden-Headed?” Elegant Bright Yellow Late Winter Daffodil Flower asked anxiously.

-“Well… I have no choice but to discover another important law: THE LAW OF LOVE FOR LOCKED ROOMS,” Dr. Golden-Headed replied.

-“Despite of this law, I'd like to know your evaluation, Dr. Golden-Headed,” insisted Elegant Bright Yellow Late Winter Daffodil Flower.

-“Are you asking if your level of competence and your results are good? You're asking me. Perhaps you've asked other colleagues before... You compare yourself to others and… I now ask you, Elegant Bright Yellow Daffodil Flower of Late Winter, to leave all of this. You look outward, and precisely this, at this moment, is not permissible for you. No one can evaluate you, advise you, or help you—no one. There is only one way. Go within yourself. Investigate the foundation of what you call pass or fail; dig within yourself for an answer that comes from deep within. Self-evaluation or self-analysis is already a criterion for success. From self-evaluation, one becomes more mature, autonomous, and responsible” (32-35).

-“You are so young that I would like to ask you to be patient with what is not yet resolved in your heart and to try to love the questions for themselves, like locked rooms or books written in a very strange language. Don't look for the answers now: they cannot be given to you. Live the questions now. Perhaps later, little by little, one day in the future, without realizing it, you will enter into the answer,” added Dr. Golden-Headed. And she wrote on her blackboard: "You are a pilgrim on your own personal path. What I taught you is comparable to these leaves I hold in my hand. What I didn't teach you is comparable to all the leaves in the forest.”

References

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