I am working on outlines for 2 talks that I will give at November’s Academic Hospitalist Academy. One talk is on academic promotion; the other concerns didactic teaching. I plan to discuss several types of didactic teaching:
- "Chalk talks"
- Case presentations
- Classic 1 hour talks
Each of these separate types of didactic teaching have much in common. I believe that all didactic teaching benefits from an understanding of performance.
I will try to explore this idea, but I also want input, especially from students and residents. What are the characteristics of good didactic teaching?
Great teaching starts with enthusiasm. We all have heard very smart physicians give horribly boring talks. Great talks have modulation and pacing. The voice matters. Some lecturers have voices which sparkle. Think of a raconteur. A raconteur captures your attention with voice, pacing and then the story.
The second part of great teaching is the story. As I consider my best talks, and my less good talks, I know that my best talks tell stories. At a recent Grand Rounds presentation, 2 colleagues commented that my talk reminded them of a movie script. I took this as a great complement. I try to design talks that have a clear introduction (with an explication of my roadmap), and logical discussion of the issues, and then a summary which emphasizes the issues that I hopefully have taught.
The third part of great teaching is understanding how much learners can absorb. I see too many talks which are crammed full with so much information that I leave dizzy. The great teachers understand that if we learn a couple of useful points from each talk, then they have succeeded. Their job is to understand how to prioritize the message.
The fourth part of great medical teaching is to use patient stories. While this does not always work, when you can include case presentations, you will more likely grab your audience. Physician learners almost universally enjoy hearing case presentations. Our brains are wired to consider how new information will help us help patients. Providing patient context drives home our points more completely than abstract discussions.
The fifth (and last today) part of great teaching is appropriate use of visual aids (slides or writing on the board.) Making good slides is an art. Most beginners (and too many veterans) put too much information on each slide. All aspiring teachers should study the slides of the best talks, and try to understand the philosophy behind slide development. Remember that the slides are an aid, not the show. You are the show, the slides are really cue cards for your performance.
I may write more on this topic after I get your thoughts. Please react to my comments and suggest other aspects of great teachers. Your thoughts will definitely help me develop the right talk on didactic teaching.
{ 5 comments… read them below or add one }
I’m a PA student just finishing my didactic year, which has consisted of 40 hours per week of listening to lectures. I gotta say, most of my lecturers leave a lot to be desired. I’d say that for the most part, you’re pretty much spot-on, but I might re-order your list. Enthusiasm is of course still first, but I would put patient stories after that. Nothing holds my interest better than accounts of the lecturer’s patients who have had the conditions he’s discussing. It makes it real. It helps me care. He could be extremely disorganized and have slides that are very overcrowded and I’d still learn more from him than from someone who is meticulously organized but doesn’t bring any real-world examples into the lecture. Perhaps that’s just my learning style. Anyway, that being said, all of your points are valid and I can’t think of much to add.
As a recent med student, becoming a resident, I have found didactics that enable the student to gain confidence with concepts familiar to them early in the lecture and progressively dive deeper to probe understanding, expand thought processes and decision making allowed me to apply that information quicker and with more confidence.
Good rules: The old Preachers adage: tell them what you are going to tell them, then tell them, then tell them what you told them. If you seriously regard this method you only have to have fifteen minutes of content. It’s about the max for most folks, even well educated ones.
Rule: If you don’t care about learning, go ahead and lecture. Maybe 10% of the information will stick. One of my mentors, that I fondly recall the horrors of rounds with, used all the senses. There is nothing quite like the smell of gangrene to drive home a point about tissue infections.
And last: This citation is buried somewhere in a pile of paper, and is from 1967, a medical school faculty member, but it has stood me in good stead through a teaching career and with patients.
Paraphrase: “It is not possible to teach all there is to know about medicine. Half of what the student will need to know has not yet been discovered and half of what they will learn will be obsolete in a short time. What is most important is that we teach them to teach themselves so they can survive after they leave…”
I have found the most riveting educational experiences focus on how the teacher learned from the problem being discussed. The lectation method keeps the learner dependent and helpless.
My two p anyway.
Great teaching comes from great teachers who recognize the greatness imminent in the moment of each subject and the greatest needs of each student. Aristotle had it right in his Rhetoric.
Great teachers are leaders first, managers second – just like great doctors. (Isn’t the root of ‘doctor’ in fact ‘docere’, to teach?) So a great teacher proceeds from her Ethos (which gives her the moral right to be in that place at that time, and is not necessarily based on her medical school or degrees) through Logos shaped in a narrative: we learn “the pathophysiology of Mr Smith”: the specific instance of the general case. But that narrative of each human is what hooks us. First, we all use narratives as heuristic devices to make sense of the complexity of the world, so in fact we cannot do otherwise except learn Medicine one Mr Smith-narrative at a time. (C Miller Fisher taught us to learn neuroanatomy “one stroke at a time.”) Second, Logos by itself is not enough to move us to learn without our first being…well…touched. (This distinction comes from Carse’s “Finite and Infinite Games.”) It is Pathos which touches us. The individuality of the narrative, its humanity, provides the touch. It is the Chief Complaint that makes the History, Physical, and Decision-Making meaningful and, in fact, preternaturally necessary. Yes, even about Type IV RTA – though I am not a nephrologist: I was drawn into the narrative of that patient, his NSAID and the surprise everybody must have felt about the role of his ‘innocent’ meds, his predicament just when he thought things must have been ‘just right’.
Great teachers instill faith in…well…great students, and because of that faith, students perform. (And not every student is great for each subject.) Perhaps it should be “students who accept their greatness.” Your feelings about renal physiology and fluid dynamics are immaterial: that’s hardly why you immerse yourself in Kokko. Facts are quite undemocratic. Either you sit your butt down and learn the stuff because of your relationship with a great nephrologist, or just try pulmonology. You may reflect all you wish (e.g., Argyris or Schon), generate a “personal philosophy” about the subject, or form a study group, i.e., use all the techniques that employ various learning heuristics: nothing takes the place of assimilating facts and creating information from them. Somebody makes you want to learn the language. I do not doubt that sometimes, great students perform because of their INTERNAL relationships with teachers. This is the “I’ll show that SOB who can learn all the terminal branches of the external carotid” syndrome – only to find that you, yourself, are the one who is joyfully surprised while the teacher is simply amused. (OK: that’s how and why I learned them.)
This is why PowerPoint and other learning paraphernalia don’t cut it without the relationship with a great teacher. And that goes for the patient as well: our relationship with her, hers with us. Not only is “aequanimitas” impossible to maintain, it is a destructive presence in the medical classroom and the clinic. Teaching Medicine is a performing art, and practicing Medicine is a performing art, because as our Art, perfecting its techniques make us forever different from our kind and perfecting its techniques demand we be forever as human we can possibly be.
Yup, I’m afraid that the wonder of Medicine lies in the transformation of the Physician first, the care of the patient second. If we are artist enough, no one else ever knows.
David Block MD, PhD
4docsonly.com
Some disagreement here.
Medicine is not taught; it is learned. If the student/resident is not properly self-motivated, even the greatest teacher will have no lasting effect. At my university, there are numerous folks with PhDs in education, and they go around presenting seminars purporting to teach clinicians how to teach the “adult learner,” and such. Waste of time. If we as clinicians and teachers demonstrate a high level of enthusiasm for our craft, if we treat our patients with respect, if we demonstrate the importance of knowing what needs to be known to do our jobs adequately (one absolutely has to know the anatomy, physiology, pharmacology, etc.- you can’t just go look it up in the middle of an operation or rounds), our proteges will be adequately motivated to learn what needs to be learned so they can do what they want to do. Every student has his or her own learning style, and for us to presume that if we just teach right, they will all learn what we want them to learn, will lead to a career of frustration .
Some of us may be better showmen than others, and will have more enthusiastic attendance at our lectures, and get better evaluations from the audience, but that will not necessarily lead to learning. What has motivated me, at least, is fear/concern that I’ll be in the middle of a patient interaction (operation, clinic visit, or rounds), and I will not have the tools (i.e., knowledge) to do the job I’m there for. My students very likely roll thir eyes when I say it, but there is some stuff that you just gotta know, and you gotta learn it however best works for you.
My $.02.
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