One of the many topics of discussion from fellow TCM students is a general lack of confidence. This flaw appears once students get into a clinical setting and realize that, while they may have studied hard, their cases are rarely "simple" because of it.This quickly leads to students feeling lost and questioning why they did all that studying. Finally, their confidence level dips.
Before I started clinical training, I heard about this happening to students. I began to feel a bit worried because I didn't know what I was doing, just that I would be treating patients without any confidence. With TCM being such an energetic medicine, I seriously began to question my abilities.
I know many would think this is the point of clinic - to learn, study, etc. They are correct; that is a big part of clinic. However, the conflict that lies within all of us while training is the desire to heal but also fearing hurting another, even if we are just "practicing." I quickly found out I was not the only one to fear this.
In this article, I hope to give some ideas to raise students' confidence level. There are three main "tools" at a student's (or even a practitioner's) disposal that we can use to improve our clinical skills. The first is study; we all know memorizing is essential but applying the knowledge is entirely different. The second is practice; this includes practicing all day, every day (ideas on how to do this will be discussed later). Third is mentor/apprenticeship; this is by far one of the most effective methods in putting together all you have done (before actually being in clinic).
Studying. This is all too common a word on a student's tongue: "I am studying on weekends, nights, days ... in fact, all the time." This is an immense portion of our medicine - memorizing point locations, meridians, herbs and diagnoses. The list goes on and on, until you eventually feel you can't fit anymore in your head. To add to our dismay, we then hear the frequent way to weaken the spleen is by overthinking/studying. This, of course, leads us to the conclusion "Oh great! Not only am I behind in studying, but now I'm weakening my spleen. Not only am I weakening my spleen, but even as I think this, I'm studying!" It truly is a never-ending cycle, although it is a necessary one.
To me, studying generally is the first step of any task we set out to do. We learn about a subject by reading and researching. Of course, this always entails memorization (one of the most difficult aspects), as well as long hours. But studying is a necessary first step because it directly leads to the next step and ultimately builds our foundation for the future.
Practice. That's right, practice everything you've learned. Bring all that memorization from the back of your mind (or wherever you had to stuff it to get it all in) and begin to use it. It's important to point out here that, as students, it's against the law to practice needling on anyone outside the school. This is not necessarily the kind of practice I am talking about. (Though when you can needle under supervision, take every chance to do so!)
I am talking about daily practice by the hour and even by the minute. Many might think this is impossible. It sounds so; however, I want to share something my Master once told me:
"Many students say they cannot train for hours a day, every day. They try to set aside the time but rarely maintain practice this way. I then tell them to keep practicing. Of course, this gets them more frustrated, but then I point out: How many minutes are there in a day? How many minutes do you spend standing? Sitting? Watching TV? You don't need to practice for straight hours, but rather, practice whenever you can in these spaces of time. Soon, the amount you practice will far exceed setting aside time for practice."
I have tried the best I can to incorporate this idea into my own daily life. Some ways I do this is when I see people walking down the street; I do a quick "intake" and ask myself questions about this person. What is their facial color? Do they have shen in their eyes? How are they moving? Do they have a smell? (Of course, don't go take a sniff, but see if you can pick up on it as you walk by.) When you watch TV, look at the actors the same way; look at their tongues, their eyes etc.
By doing this, you are practicing - training yourself to do intakes just as the doctors of old did. Always seek to hone these skills, using your senses daily. If all else fails, you always can just keep going over ideas in your own head. Ask the simple question: Why?
Why does liver yang rise? Why are these symptoms of kidney qi deficiency? Why is a very powerful question that is invaluable to students. If you can't answer the question of "why" then look it up. If you still can't find it, this is where a mentor/teacher comes in.
Finding a mentor or instructor with whom you can train and study. This is extremely beneficial for all students. This is one of the best ways to put together everything you have been studying and practicing. You will get to see how someone else may put together treatment ideas, diagnoses, etc. before you get into clinic. My mentor, Ron Rosen, often said, "The real way to learn this medicine is in clinic." As a student, the closest thing you can get to clinic is mentoring.
Finding a mentor can be difficult. Although there are many ways to find a mentor, it's never quite as simple as you might think. So in hopes of making other students' efforts a bit easier, I will share my own experiences when finding a mentor. The two big areas that seem the most daunting are taking your time to find a mentor and finding a mentor who suits you.
Find a mentor who suits you. What I mean by this is it will be far easier on you both if you have similar thoughts about the medicine. It will be difficult for a student to try to practice with a mentor who focuses solely on herbs, when the student wants to only do acupuncture. Of course, finding the "perfect" mentor will never happen, but it's important to realize that if you don't enjoy spending time with your mentor, you won't gain much from the time spent.
For these reasons, it's important to take time to find your mentor. There is an old saying "When the student is ready, the teacher will appear." This adage has proven true with me, as it seems whenever I "forced" myself to find instructors/mentors, the relationships never lasted. However, when I found my mentors "out of the blue," we always ended up having a strong bond and I learned a lot from them.
As students, we feel time is of the essence and we have to rush through this process so as to "really practice medicine." I want to point out, however, that the day you stepped through the doors of your school, is the same day you will always be "practicing."
By realizing this and utilizing the tools I have pointed out, your confidence as a student will grow. You will have fewer fears about how to approach patients in the student clinic and you will begin to understand "why," rather than asking it. A big piece of what sets apart a student from a practitioner is asking why and understanding why. Of course, as a practitioner, you will have to continue to ask why to raise your skills, but that is further down the road.
Click here for previous articles by Joseph Wollen.