It is often said that 50% of what we teach in medicine is wrong. The only question is, which 50%? In light of the fact that we have been wrong (at least) half the time over our combined 85 years of teaching medical students and residents, we appreciate the national teaching awards that have been conferred on us by our esteemed colleagues—the Association of Academic Psychiatry Annual Award for Teaching (1992, JFB; 1997, IDG) and APA’s Vestermark Award (1990, IDG; 1997, JFB). In these four contexts and elsewhere, we have been asked to present our reflections on the teaching-learning process in psychiatry (1, 2).
The field of psychiatry has changed drastically over the past four decades and, in an attempt to keep pace, the teaching process has also evolved and changed. Written lectures have given way to PowerPoint presentations, video clips, interactive computer programs, and other teaching devices. However, as two teachers who have used these devices to teach both pharmacology and psychotherapy courses to psychiatry residents and medical students, we believe that successful teaching continues to be based on the teacher-learner relationship. From our experiences in the school of “ego-dystonic hard knocks,” we will briefly present our thoughts on this relationship, distilled into 12 “teaching pearls” which we hope will be of value to the next generation of teachers of psychiatry.
1. Know and Engage Your Audience
Good teachers have a clear idea of what they want their students to learn, and a road map (called a lesson plan in other contexts) of how they will present materials so as to foster this learning. To be successful, it is vital that the teacher first assess who the learners are (e.g., residents or medical students), and “where” they are on this journey (e.g., what they have learned from previous didactic and clinical experiences), if one hopes to bring them along to the planned learning destination.
2. Students Learn in Different Ways
This seems obvious, yet as teachers we tend to forget to use formulas other than lectures, for example, case-based teaching, texts, etc. Learning is individualized. The “key” is to unlock each student’s creativity, understanding, and unique learning style.
3. Course Content Is “Necessary But Not Sufficient”
As a teacher of medicine, one has to present the best available data, but such data are not enough to enable students to learn. Students have to be “turned on” (i.e., stimulated) and helped to work through the questions posed by the content. Further questioning and continued learning are common results of energizing students’ interests.
4. Students’ Lives Do Not Revolve Around Our Teaching
This is a painful lesson for teachers to learn. A more realistic assumption is that we are lucky (given the demands of today’s clinical loads) if medical students or residents find the time for our teaching (and/or its associated reading). Students’ time is precious. It is our job to keep them interested—and to show them the relevance of what we teach, beyond the often-necessary detail.
5. Be Informative, Interesting, Entertaining
We try to make our lectures and seminars enjoyable. Needless to say, “the fun” is aimed at engaging and stimulating our students and increasing their learning. As David Robinson said, “If your students understand the humor, they understand the concept. If they are laughing, they are also learning” (3).
6. Be Succinct—Don’t “Pile It On”
For many teachers, learning may be inversely related to their need to spew out words. Learning is incremental; a pyramid of knowledge builds as one develops professionally. Trying to teach everything at one time often leads to an overwhelmed and frustrated student. Time and experience will help the students integrate concepts from earlier points in their education and training.
7. “Lay It Out on a Silver Platter”
You cannot be “too clear.” Life in a residency program in the new millennium is very busy. The more the teacher integrates and simplifies issues down to their essentials, the more understanding the student takes away.
8. Interact, Don’t Pontificate
Although we said the teacher should “lay it out on a silver platter,” good teaching balances this with engaging the students’ own thought processes. Questioning and discussion should be encouraged. As the poet Goethe said: “We derive great benefit from lively and frank associations from educated people. A nod, a word, a warning, encouragement, timely opposition, are often capable of changing a life” (4).
Do not just regurgitate the field. Rather than merely listing the main points of a particular topic, the better teaching technique is to help the students critique the ideas inherent in the topic. Again, learning is incremental, and the teacher should help expose the strengths and weaknesses of the data.
What they are paying us the “big bucks” for is to use our experience and knowledge to make sense of diverse ideas, data, etc. So, for example, pulling together a complicated case formulation is an excellent way to synthesize clinical data that may be very difficult for a medical student or junior resident.
11. Don’t Be Afraid To Say “I Don’t Know”
Some of our former teachers always had answers for everything (regardless of how little data were available or how poorly informed they were). If 50% of things are eventually proven wrong, we cannot profess to know everything. It takes a fair bit of effort, but professing ignorance and exposing areas of further exploration can be a useful way to get learners involved in finding answers, which increases learning.
12. Critics and Critiques Are Your Best Friends
If there is one thing crucial for a junior faculty teacher to understand, it is “don’t take it personally.” Actively solicit and use feedback to change and improve your teaching. Learning to teach is incremental, as is any other knowledge or skill area, and listening to feedback and modifying your teaching will improve it over time.
Vikram Seth, the Indian author, observes: “There are three kinds of teachers: those who are forgotten, those who are remembered and hated, and the third, the lucky ones, … those who are remembered and … forgiven” (5). We hope the pearls we have distilled from our years in the teaching trenches will be helpful to junior faculty as they approach the task of educating tomorrow’s medical students and residents about psychiatry, and help turn them into teachers who are both “remembered and forgiven.”