December 3, 2009
UW Medicine’s Dr. Erika Goldstein: teacher, mentor and friend
UW medical students in the Introduction to Clinical Medicine course are in class learning how to talk with patients. The professor, Dr. Erika Goldstein, turns on a tape of Click and Clack, hosts of the National Public Radio show Car Talk, hammering out some mechanical trouble. The students look puzzled.
Medical student Nigel Campbell later e-mailed Click and Clack. “We were hearing you two guys spending equal time asking the caller searching questions and laughing (as usual) at your own jokes.” As they listened, the students began to recognize a pattern: first, open-ended questions. Then, follow-up questions. Afterward, Click and Clack discussed what the car’s problem might be, and how they would check if they were right and fix what was wrong.
“I realized it was the magical art of the H & P [medical history and physical exam],” a student noted, “and if those guys could master it, so could I.” Campbell’s e-mail was read on the show segment, ‘Jiffy Lube Medical School.’”
Goldstein’s unorthodox method reminded students that connecting with patients is as important as acquiring medical skills and knowledge, and that good role models are found in unlikely places.
She is one of the few faculty members whom medical students call by first name. Their respect is far deeper than a formality. Medical student Daniel Benedetti observed that “Erika demonstrates an unparalleled dedication to helping us become the best physicians we can be. She appeals to the idealism that drove most of us into medicine.”
In November Goldstein was honored as one of the country’s best medical educators by the Association of American Medical Colleges. She received the 2009 Alpha Omega Alpha Robert J. Glaser Distinguished Teaching Award.
The award recognizes both her teaching of UW medical students and her innovative contributions to medical education nationwide. Goldstein was a leader in forming the UW medical school’s college system. Entering medical students are assigned to one of six colleges: Denali, Wind River, Big Sky, Rainier, Snake River, and Columbia River. Each college has students from all four years of medical school.
Every student is assigned to one physician mentor throughout medical school. During the second year of school, the mentor meets weekly with his or her students to teach them the fundamentals of patient care — history-taking, physical examination, diagnosis, clinical reasoning, and professionalism — and to supervise them closely as they work with patients. The mentors maintain regular contact with students during their clerkship years, assess their progress, and offer guidance.
The UW medical school’s college system is emulated by several other U.S. medical schools. The inspiration came from Goldstein’s experiences as a University of Rochester medical student. The program emphasized bedside training at a time when that approach was eroding at many other medical schools. One of her teachers was psychiatrist Dr. George Engel, who blurred the distinction between physical and psychological suffering with his biopsychosocial model of disease. From him she learned patient interviewing. Engel’s colleague, Dr. William Morgan, taught her physical examination and diagnostic skills.
“They gave me my assumptions on how medicine should be taught,” Goldstein said. She did her residency in internal medicine at the UW, and then helped create a clinic at Harborview Medical Center for Asian refugees. She continued her interest in cross-cultural medicine as a UW Robert Wood Johnson Clinical Scholar, and completed most of the work for a doctorate in anthropology.
After co-chairing, and later heading, the Introduction to Clinical Medicine course, she said she still felt something missing in her approach and in her ability to teach and mentor 200 students primarily on her own. The clinical skills and mentoring idea that led to the college system was, as she says, “born in my head.”
When asked how she earned the reputation as an outstanding mentor, friend, and advocate for medical students, she responded, “Perhaps it’s because mentoring takes the same interpersonal skills required of a doctor. You look at the experiences of your patients — or your students — from within their own world and listen with compassion, empathy and understanding.”
Goldstein also is known for holding high standards of competency.
“Being nice is not enough to make someone a good doctor,” she said. “Patient/physician relationship building is essential, but not sufficient. To become effective physicians, medical students need a solid base of medical knowledge and sound clinical reasoning, in order to comprehend a problem quickly and think of ways to solve it.”
According to M.D./Ph.D. student Muyiwa Awoniyi, Goldstein helps her students gain this competency through the clarity of her well-organized teaching style. She is always prepared for her classes, does a quick review of the previous topic to jog memories, has any slides ready weeks ahead, and peppers the discussion with witty comments.
She often quotes Sir William Osler, whose proposed changes in U.S. medical schools in the previous century improved the quality of medical education and physician care. One of medical student Gabriel Wallace’s favorites is: “… the education upon which one is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation.”
Goldstein realizes that medical students observe how she lives her life.
“They see that my family is of the utmost importance to me,” Goldstein said. “They notice that I set boundaries to protect my time with my husband and three daughters.” An influential national figure, she is still a humble, unpretentious family gal who likes knitting for her kids, often during faculty meetings while fully engaged in whatever discussion is going on.
What is the most difficult thing medical students have to face?
“They have to accept that they will be dealing with people at some of the most challenging times of their lives, and will be making life and death decisions,” Goldstein said. “The job can be emotionally trying because you’re wrapped up in people’s lives. It’s also gratifying for the same reason.”
As a teacher, Goldstein finds great satisfaction in watching young men and women with wonderful goals and values develop into skilled physicians, and leave with their optimism and concern for others intact.
“This is an amazing job. I’m lucky to have it,” she said.
In recognition of her championing of student concerns, the Medical Student Association recently created the annual Erika Goldstein Award for Dedication to Medical Education.
