The walnut manoeuvre
====================

* Ronald Bayne

Probably most of us have encountered brutal or sneering teachers during our medical training. Usually we think of a rebuttal too late, or do not respond for fear of reprisal. Robert Patterson's "Fear and loathing in residency"1 reminds me of an encounter that a colleague described to me many years ago in which the student gained the upper hand.

During his education at Harvard Medical School, my colleague was taught clinical skills by a renowned clinician, physician to a president of the United States. This man was well known for his delight in picking out one student in each group for gruelling questioning until the student was reduced to jelly. He would ask sneeringly, "And just what do *you* know about *that?*"

In one clinical skills group was a student whom I shall call Collins. From the first session Collins realized he was to be favoured with this special attention. He prepared himself accordingly. When asked to examine a patient, he felt the inguinal nodes and casually remarked, "Yes, I feel a lump ... definitely a lump."

"Well, describe it."

"It is firm ... not mobile and ... about the size of an English walnut."

"So ... and just what do *you* know about English walnuts?"

Collins stood up, looked his teacher in the eye, and began. He described the tree, its height and breadth, its geographic location and climatic limits, its production of walnuts, their size, consistency, industrial uses and value to the economy, and so forth, continuing without pause until the end of the session. Collins was never troubled again.

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## Reference

1.  1. Patterson R. Fear and loathing in residency. CMAJ 1999;161(4):419.
    
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