PREFACE

You’ve had the usual busy day. Just finished seeing and writing up the last of six patients admitted overnight to your service (including one who had to be transferred to the ICU with sepsis). Sent in an application to the medical center’s curriculum committee for a proposed new course, “The Golden Glove: Defining, Detecting, and Eradicating Medical Errors.” Late for a hospital committee meeting on the new quality initiative to improve care in postoperative patients.

When you return to your office, two of the 59 new e-mails in your inbox catch your eye. The first is from a third-year medical student who presents with the complaint that “I feel disoriented and confused only one day after starting my medical clerkship.” This note is not a request for a neurological consult but, rather, a distress signal from one of your mentees who has been touching base with you throughout her clinical years without any indication of prior problems.

The second e-mail, from a friend and colleague, says: “Work and teaching rounds took four hours today! How can we teach students and house officers to present more clearly and concisely and how to frame a differential diagnosis?”

This book is written for hyper-busy clinicians/teachers and their trainees who face these types of challenges related to apparent gaps between the world of the class and the world of the wards. Despite the best-intended efforts of courses with names such as “The Doctor–Patient Encounter,” students and their preceptors often express the sense that essential but hard-to-identify components are missing from our training efforts. These missing links contribute to the types of frustrations voiced above. We have adopted the term interstitial curriculum as a way of defining selected necessary concepts and practices that seem to fall between the disciplinary cracks of contemporary medical education programs.

Throughout the book, we highlight these concepts with mini-case examples. Most are drawn from internal medicine; further, a cardiovascular bias will unmask the specialty orientation of the authors, but hopefully will not prove limiting.

The complementary processes of constantly rethinking assumptions, researching information, and reformulating basic mechanisms are fundamental to practicing all types of medicine successfully. Such processes also help to avoid potentially lethal errors and help to rigorously and compassionately advance the inseparable sciences of prevention and healing. These deep and multidimensional challenges are central to the ongoing pursuit of becoming the consummate clinician.

ARY L. GOLDBERGER
ZACHARY D. GOLDBERGER