Parents are a child’s first teachers, so as the child of public-school educators, I benefitted from their formal training in pedagogy during my formative years. They were adept at finding the “teachable moment” in everyday experiences and were able to guide my innate curiosity toward problem solving and self-sufficiency. From both of them, I learned physics and chemistry camouflaged as “life skills” such as driving and cooking, respectively. Frequently I was a “teacher’s aide”, frequently helping my father with grading test papers and helping my mother organize her classroom for her middle school biology classes. I am sure that the years of student insect and leaf collections taking residence in our home contributed to my affinity and aptitude for the biological sciences. As a seventh grade science teacher, my mother emphasized learning the scientific method grounded in observation and hypothesis testing. In addition to the informal education I received within the parent-child relationship, I also had the unique experience of being a pupil in my father’s fifth-grade classroom learning about the solar system and a star named Andromeda. It was interesting to see the patient, calm, and humorous disposition he had at home remained present in the classroom and thus created an ideal learning environment for my peers and myself—relaxed, engaging, and fun! Also, similar to his approach at home, he did not hesitate to offer constructive feedback whenever I was in error!
This background informs my approach to teaching in general, as well as for clinical and research education, and is anchored in principles of adult learning theory (androgogy). Androgogy emphasizes a problem-based, collaborative approach to learning for learners who draw from their life experiences and tend to be practical, goal-oriented, and internally motivated. This framework is particularly relevant for graduate level trainees in basic science and clinical research, public health, and medicine that generally have a long record of prior achievement and have already invested a significant amount of time and resources into learning and service. Furthermore, physicians and scientists have a predilection for learning by doing, which underlies the apprenticeship model of training that is pervasive in graduate and medical education.
With this in mind, my first obligation as an educator is to create an optimal environment for learning. My personal communication style is informal and collegial, yet respectful, in order to foster an interactive and constructive atmosphere for sharing diverse perspectives. For example, I prefer circular seating arrangements whenever possible to facilitate everyone being seen and heard. When first meeting students, I always incorporate an “ice-breaker” activity to learn more about the students’ prior personal and educational background and their goals and expectations not only for the course and for their careers and lives in general. I frequently share my own experiences–both trials and triumphs–to create a shared sense of purpose, to share my passion and enthusiasm for the subject matter, and to communicate empathy for the challenges of meeting both intrinsic and extrinsic demands for acquiring knowledge and achieving competency in desired skills.
I assess learner goals and gaps in knowledge in order to be sure my teaching meets the needs of and expectations of adult learners. Because learners come from different backgrounds with different levels of aptitude and competencies, I often conduct an initial evaluation or “pre-test” of knowledge, skills, and attitudes based on the course objectives. This may take the form of a formal survey in a classroom setting, or a more informal series of questions in a clinical setting. I utilize this data along with what I’ve learned about the student’s learning goals to customize the content and teaching approach. I typically begin with an orientation to the topic to be assured that all learners have the same base knowledge; any repetition of previously covered information further contributes to learning by strengthening associations and fact recall.
Content should be current and relevant to the learner’s intended application. This is particularly important in science and medicine, as breakthroughs and discoveries are made faster than textbooks can be printed. Therefore, course content is generally the result of review and synthesis of recent literature from current peer-reviewed resources. Furthermore, it is important to know what is already known in order to a) understand current standards of practice and b) identify areas needing further study and discovery.
Consistent with the principles of androgogy, I seek to engage learners in a process that mirrors the scientific method by emphasizing observation, investigation, and reflection. Observation is the active acquisition of information, frequently involving multiple senses often augmented by the use of tools and instruments such as a microscope, survey, or stethoscope. In both medicine and science, standardized approaches facilitate the systematic collection of information that may be applied to multiple topics and contexts. I frequently use mnemonics to help learners organize how they remember or obtain larger pieces of information (e.g., characteristics, steps, stages, parts, or phases). For example, the ETHNIC mnemonic (Explanation, Treatment, Healers, Negotiate, Intervention, Collaborate) helps trainees remember the steps for eliciting and negotiating cultural issues during healthcare encounters. The FINER criteria (Feasible, Interesting, Novel, Ethical, Relevant) guide researchers in selecting research questions.
I am keenly aware that students will also observe me, and therefore I must possess the knowledge and skills I seek to teach. I challenge myself to remain up to date on advances in science and medicine through reading journals and attending professional development seminars. I apply the processes, skills, and behaviors to my own research and practice. When teaching, I frequently share anecdotes or “think out loud,”, thus modeling how I approach a clinical situation or research problem in order to further illustrate specific principles or processes.
Investigation encompasses hypothesis development and testing. In clinical medicine, this may mean students create a list of differential diagnoses and make decisions about which physical exam procedures, biochemical assays, or imaging studies will help determine the cause of illness and potential treatment plans. In research, trainees select subjects or participants and lead the development and execution of a study protocol. In both cases, I use the Socratic method of focused questioning as an effective method to elicit critical thinking.
Reflection encompasses the synthesis and interpretation of observations and investigations. In addition, reflection is a particularly important component of metacognition, which refers to learners’ awareness of their own knowledge and their ability to understand, control, and manipulate their own cognitive processes. Metacognition is an essential skill to develop the problem-solving skills required of physicians and scientists. In classroom settings, reflection may take the form of a group discussion. In clinical settings, trainees summarize patient data and their decision-making process in the form of “SOAP” (subjective, objective, assessment, plan) notes or oral presentations to colleagues.
Although the content may vary depending on the learner and the context, all of my curricula have the common goals of increasing learner knowledge and competence, fostering independence, and ultimately encouraging the development of physicians and scientists who are sensitive and responsive to the cultural and social contexts of the individuals and communities they serve. Measures to evaluate knowledge and competence include recall of knowledge through written tests, demonstration of skills through observation such simulations with standardized patient, and active engagement and participation in the learning process as measured by class attendance and timely completion of assignments. In the long-term, learners should demonstrate integration of skills and knowledge into their practice and/or research as evidenced by scholarly work such as peer-reviewed research publications, and equity in health status for the patients they treat as measured by clinical outcomes and patient satisfaction surveys.
The façade of an abandoned high school near my medical school said “Enter to learn, leave to serve.” Ideally, the learning process will also ignite a sense of passion and enthusiasm for the subject matter that motivates lifelong learning. This sentiment is echoed in Cecil’s Textbook of Medicine (21st edition) that states, “…the learned professions are really ‘callings’ from which the members cannot separate their lives. There are no part-time professionals; having accepted such a calling, one is bound to live it or leave it.” The best evaluation of my effectiveness will be seeing my students continue to find fulfillment with a career in science and medicine, and effecting change in social and health systems through leadership and practice to achieve health equity.