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I recently paid a visit to Brown University in Providence, Rhode Island. My aim was to exchange ideas about postgraduate training with the medical teachers there. Brown is one of America's leading universities, and I saw a great deal that challenged my preconceptions about medicine in the USA, and also made me question some of our working practices in the UK. Most of my time was spent observing my hosts as they carried out their own clinical and educational work. One of the events I observed was a ward round in a high dependency unit. I joined an attending physician, her chief resident, and the intern on the team—the equivalent of consultant, specialist registrar, and foundation year doctor. I watched and listened as they reviewed the patients they had admitted during the previous 24 h.
I was immediately struck by the courtesy that the team members showed for each other. No doubt Brown is an exceptional place, and perhaps this team was especially well matched, but I couldn't help remarking on the conspicuous lack of hierarchy or reserve in their conversation with each other. Setting aside the difference in their ages, it would have been easy to imagine that they were professional equals: a kind of levelling-up of power relations which I believe one still rarely sees in the UK.
Also, for whatever reason, their discussions seemed unhurried. Evidently they had set aside lots of time for case based teaching. At first, I thought they may have created special conditions because they knew I would be present as an observer. …