The The Doctor as Teacher – Doctor as Teacher – The The Teacher as Teacher as Doctor Doctor DR. HAROLD C. LYON, JR. DR. HAROLD C. LYON, JR. Guest Guest Fulbright Fulbright Professor of Medical Professor of Medical Education Education Ludwig Maximilians University and TU Ludwig Maximilians University and TU Munich, Germany Munich, Germany Colloquium des Instituts und der Colloquium des Instituts und der Poliklinik f Poliklinik f ür Arbeits-, Sozial,-und ür Arbeits-, Sozial,-und Umweltmedizin Umweltmedizin January 17, 2008 January 17, 2008
Transcript
The The Doctor as Teacher – Doctor as Teacher – TheThe Teacher as Teacher as Doctor Doctor
DR. HAROLD C. LYON, JR.DR. HAROLD C. LYON, JR.Guest Guest Fulbright Fulbright Professor of Medical Professor of Medical
Education Education
Ludwig Maximilians University and TULudwig Maximilians University and TUMunich, GermanyMunich, Germany
Colloquium des Instituts und der Colloquium des Instituts und der Poliklinik fPoliklinik für Arbeits-, Sozial,-und ür Arbeits-, Sozial,-und
Umweltmedizin Umweltmedizin
January 17, 2008January 17, 2008
My Goals for this My Goals for this PresentationPresentation
With apologies for not speaking to you in With apologies for not speaking to you in GermanGerman
(Gift & “Hotel Garni”)(Gift & “Hotel Garni”)• What I would like you to learn:
Become familiar with effective teaching skills, research, and techniques
• What I would like you to feel: Committed to effective teaching
•What I hope you will do: Seek to improve your teaching.
Review Step How many of you speak English?
What teaching do you do? What training have you had for teaching? What experience?
~Experience is something you get, just after you need it. ~
German Medical Curricula in state of dramatic transformation!German Medical Curricula in state of dramatic transformation!Murrhardt KrisisMurrhardt KrisisBolognaBolognaCost containmentCost containmentStudentsStudents
OOverview Step of my verview Step of my Presentation Presentation
Origin of word “Doctor”: docere in Latin Origin of word “Doctor”: docere in Latin means “to teachmeans “to teach
Why is it important for you to Why is it important for you to be an effective teacher?be an effective teacher?Doctors spend 80% of their time teaching:
Teaching students (60-70% of teaching done by residents -- informal "modeling" in clinic)
Teaching other healthcare providers Teaching patients -- a very difficult challenge to teach someone to change her lifestyle!
OOverview Step of my verview Step of my Presentation Presentation
Teaching is the best way to learn: "to teach is to learn twice."
In process of organizing, preparing, and presenting to others, you learn a lot.
If you master main points made in this presentation, you could significantly improve your effectiveness as a teacher
4 levels of self-4 levels of self-understandingunderstanding• Unconsciously incompetent:
You don't know what you don't know.
• Unconsciously competent:You don’t know what you know.
• Consciously competent:You know what you know
~It ain’t so much the things we don’t know that get us in trouble.
It’s the things we know that ain’t so~
• Consciously incompetent:You know what you don’t know.
PPresentation Step resentation Step Good teachers are made, not bornGood teachers are made, not born
Adler: 94 pediatric interns showed significant decrease in appreciation of social & emotional factors in patient care plus bias against out-patients who they viewed as more troublesome.
Pasnau & Bayley and Bauer: 1st year psychiatric residents: 65% sought psychotherapy themselves; built defenses against helplessness and anxiety; need to control and fear of control; increase in depression, rigidity, self depreciation, hostility, and withdrawal.
M. Hojat, Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes (Springer: 2006)
Does physician training make good teachers?
Past research evidence is to the contrary:
PPresentationresentation
• Physician training can contribute to cynicism in students.
Warning: Physician training Warning: Physician training may be hazardous to your may be hazardous to your interpersonal skills!interpersonal skills!
Findings about physician training and Findings about physician training and teaching:teaching: • As students become increasingly proficient in analysis of pathophysiology, without formal training in interpersonal skills, their ability to relate to patients interpersonally declined.
An Effective An Effective Teacher --Teacher --
Both Useful & NovelBoth Useful & NovelA teacher who is novel but not useful is a charlatan.
A teacher who is useful but not novel is a pedantic bore.
A teacher who is both useful and novel is an inspirational teacher… and they are rare.
The LectureThe Lecture
15 years ago, 67% of the first 2 years of Dartmouth Medical School was passive lecture.
(Prof. Reincke: LMU reduced lectures in past 5 years from 70% to 30%)
But good question asking in a lecture can stimulate thinking
And good interactive case-based or E-Learning like CASUS can transform lectures
Lecture teaches mostly to memory instead of thinking
More About the LectureMore About the LectureB.F. Skinner in Walden Two (1948)B.F. Skinner in Walden Two (1948)
"The lecture is the most inefficient method of diffusing culture. It became obsolete with the invention of printing. It survives only in our universities and their lay imitators, and a few other backward institutions....Why don't you just hand printed lectures to your students?
Yes, I know. Because they won't read them. A fine institution it is that must solve that problem with platform chicanery."
Transmitting new material which does not appear in print
Synthesizing knowledge from many sources
Forums for introducing patient diagnostic problem-solving and E-Learning cases
“A weekday edition of the
New York Times contains more
information than the average
person was likely to come across in
a lifetime in 17th
century England.”-Information Anxiety -- Richard Saul Wurman
Problem-based and E-Learning can help
~Time is what keeps everything from happening at once~
Research Results on Research Results on Effective TeachingEffective Teaching
Based on 200,000 hours of classroom teaching at all
academic levels, over 25 years, in 32 states and 7 countries including Germany! (Aspy, Roebuck,
Rogers and Tausch)In the average classroom:In the average classroom:1. Teachers talk 80% of the time
2. Students talk 10% of the time
3. 10% is silence or confusion4. Virtually no responses to feelings
5. Only 1 minute of laughter out of every 12,000 hours of instruction!
More Research Results on More Research Results on Effective TeachingEffective Teaching
Based on 200,000 hours of classroom teaching at all
academic levels, over 25 years, in 42 states and 7 countries including Germany! (Aspy,
Roebuck and Rogers and Tausch)In the average classroom:In the average classroom:
6. 85% of students nonparticipating – just going along passing time
7. The average teacher used only 2 of the 15 steps found to be important for effective teaching8. Teachers with certain personality traits and skills tended to be significantly more effective
Outcomes of students who Outcomes of students who had teachers with THE had teachers with THE
certain traits:certain traits:1. Increased standardized achievement scores
2. Less absenteeism
3. Fewer discipline problems
4. Increased IQ scores
5. Increased self-concept scores
6. Improved attitudes toward school
7. Increased levels of cognitive functioning -- more thinking
More results of students More results of students who had teachers with THE who had teachers with THE
certain traits:certain traits:8. Increased creative (divergent thinking) responses
9. Much greater percentage of "student talk" than in the average classroom10. Increases in teacher's energy and satisfaction levels and correlation with physical fitness and humor in the classroom
What were the personality What were the personality traits found in the most traits found in the most
Can we train people to have Can we train people to have these traits?these traits?
PRIZING - caring about students - (Würdigung)
GENUINE or CONGRUENT - (Authentizität)(Not perfect, or God-like, but a person with
strengths and weaknesses)
And many used HUMOR in their classes… ~ shortest book in the world?~
Research Evidence on the Research Evidence on the Value of MentoringValue of Mentoring
White House Task Force on Gifted & Talented:
most effective intervention for education of gifted person =
mentorship -- a one to one human relationship with a person who possessed nurturing traits: empathy, prizing, genuiness.
Studies of highly successful Studies of highly successful people show that those who people show that those who had mentors gained more had mentors gained more “success” than those without “success” than those without mentors including the mentors including the following:following:
• Achieved a higher education at a younger age
• Were more likely to follow a career plan and, in turn sponsor more proteges than those who did not have mentors
• Published more works
• Made greater contributions to their career fields
• Earned more money
• Had greater career satisfaction
THE 15 STEP R-O-P-E-S THE 15 STEP R-O-P-E-S MATRIX for indelible MATRIX for indelible
teachingteachingDrs. Carkhuff, Aspy and Roebuck tested Drs. Carkhuff, Aspy and Roebuck tested these principles and built the steps these principles and built the steps to incorporate the principles of to incorporate the principles of
effective teaching effective teaching
3. Present the instruction using multi sensory methods (tell-show-do) & have students Exercise the methods)
5. Generate thinking and respond to it (question asking and problem-solving)
2. Insure motivation of students by relating content to their real world (Overview)
1. Diagnose the learners’ entry level skills before teaching (Review)
6. Facilitate skill development, transfer, and application (Summary)
4. Respond to student’s ideas
Tell, Show, and Do – add Tell, Show, and Do – add these to ROPES making a these to ROPES making a
15 cell matrix15 cell matrix TELLTELL the learners (in words) what skills to do and how to do them.
SHOWSHOW the learners (in pictures, audiovisual aids, or modeling) how to do the skills DO DO provide the learners a hands-on (kinesethetic) opportunity to do the skill Tell one
Show one Do one = Teach one
What does the research What does the research show when you teach using show when you teach using
the ROPES matrix?the ROPES matrix?
You actually transform a lecture into something quite different and far more effective. You increase student talking and thinking which makes it quite different from a lecture and significantly more indelible (dauerhaft) and transferable in terms of learning.
Comparison: Traditional Comparison: Traditional vrs ROPESvrs ROPESClassroomClassroom
Hal’s Life LessonsHal’s Life Lessonswith thanks to Steven Wrightwith thanks to Steven Wright
They told me I was gullible. And I believed them
I used to be indecisive. Now I'm not sure…
One nice thing about egotists: they don't talk
about other peopleDon’t just do something, stand there!Indecision is the key to flexibilityAs I said before, I never repeat myself.Each talk I give is better than the next.
More of Hal’s Life More of Hal’s Life LessonsLessons
Half the people you know are below average.
Ninety-nine percent of lawyers give the rest a bad name.
The early bird gets the worm, but the second mouse gets the cheese.
Support bacteria - they’re the only culture some people have.
Still More of Hal’s Life Still More of Hal’s Life LessonsLessons
Ambition is a poor excuse for not having enough sense to be lazy.
Only two things are infinite: the universe and human stupidity, and I’m not sure about the former. (Albert Einstein)
It’s better to be a good winner than a poor loser.
Times flies like an arrow. Fruit flies like a banana.
Tips from the Redneck Book Tips from the Redneck Book of Mannersof Manners Always identify people in your yard
before shooting at them. If you have to vacuum the bed, it is time to change the sheets.
DINING OUT Avoid throwing bones and food scraps on the floor as the restaurant may not have dogs.
ENTERTAINING IN YOUR HOME A centerpiece for the table should never be anything prepared by a taxidermist.
Do not allow the dog to eat at the table no matter how good his manners are.
PERSONAL HYGIENE
While ears need to be cleaned regularly, this is a job that should be done in private using one's OWN truck keys.
Proper use of toiletries can forestall bathing for several days. However, if you live alone..... deodorant is a waste of good money.DATING
Always offer to bait your date's hook, especially on the first date.
DRIVING ETIQUETTE
Dim your headlights for approaching vehicles; even if the gun is loaded, and the deer is in sight.
When sending your wife down the road with a gas can, it is impolite to ask her to bring back beer.
Never relieve yourself from a moving vehicle, especially when driving.
Viewpoints on learning Viewpoints on learning vrs. Teachingvrs. Teaching
Some believe if there was no learning, there was no teaching. Do you believe this?
Significance of this viewpoint is that we cannot say someone is a good teacher just because they seem to teach well.
What counts is whether learners learned.
Viewpoints on Learning Viewpoints on Learning vrs. Teachingvrs. Teaching
Another viewpoint: "Anything done by a teacher that intentionally promotes learning is teaching."
Value of this viewpoint is that it recognizes the reality that good teaching may occur under circumstances so adverse, ( like with the student asleep), that little learning takes place. When something is given, it may not be received. (And when received, it may not be used.) But the effort deserves to be acknowledged as teaching.
Teaching vrs. LearningTeaching vrs. LearningBalance of both views: Bottom line is whether, as a result of your teaching, there IS learning. So teaching and learning is a two way process, and students and teachers share the responsibility for it.
The “Dr. Fox Effect”The “Dr. Fox Effect”
Student ratings of instructor are affected by the personal style of the teacher rather than by the teacher's knowledge of instructional material
PresentationPresentation
Is this a true statement: "If the learner didn't learn then the teacher didn't teach.”
I tell you: “I taught my dog how to whistle.”You say,"I don't hear him whistling." I reply, "I said I taught him to
whistle. I didn't say he learned it."
What is the difference between teaching and learning?
An example:
The Value of MentorsThe Value of Mentors
There appears to be an interesting multiplier effect in mentorship. Those who have them tend to perpetuate the concept by becoming mentors themselves. Certainly, this has important implications for mentorships in all professional fields.
Women entering professional career fields need mentors even more. Studies of successful women (J. Walters, 1981) reveal that they often had several mentors (usually men) and that they, in turn, became mentors for several proteges (usually women).
The Functions of the The Functions of the MentorMentor
These traits of the successful mentor are an ideal model. In reality no one mentor practices or has them available all the time. We do the best in our unique manner with the gifts we have. Our genuineness is expressed in our human imperfection.
Teacher: to enhance the student's skills and professional development Sponsor: to facilitate the student's entry and advancement in the profession by opening doors through influence and by providing opportunities for exceptional experiences. Host and guide: to welcome the initiate into a new professional and social world and acquaint her with the values, customs, resources and cast of characters. Exemplar/role model: to model through your own virtues, achievements and way of living. Counselor: to provide moral & counseling support in times of stress & crisis. Parent analogue: to support and facilitate the realization of the "dream."
