Educational Perspective
The Real Sources of Educational Excellence Peter R. Gunderman, AB, Richard B. Gunderman, MD, PhD Key Words: Education; teaching; educators; excellence. ªAUR, 2014
I
n medicine today, the superstars are widely known. They are the researchers who have garnered major prizes, great clinicians whose names have become household words, and personalities who grace nationally syndicated television programs such as The Doctors and Dr. Oz. But there is another group of physicians who tend to be unseen by most people, yet who play an absolutely crucial role in medicine’s future. We are referring to medical educators, the faculty members of the nation’s 141 medical schools who are teaching the next generation of physicians. There are 75,000 medical students and another 110,000 resident physicians in the United States, and the quality of their education and training is highly dependent on the medical educators from whom they learn their craft. Numbering 128,000 in total, the work of such faculty members tends to be largely invisible. There are good reasons that medical educators are largely unknown to all but the medical students and residents they teach. For one thing, medical schools tend to focus most of their attention on their principal revenue-generating activity, patient care. For another, they tend to appraise their progress and rank themselves based on the research grants they garner. By comparison, student tuition represents a relatively fixed source, constituting only about 5% of total revenue. Yet these institutions are known as medical schools, and their defining responsibility is neither patient care nor research but education. Moreover, the work of medical educators is powerfully shaping the future of medicine for generations to come. If we teach medical students and residents well, we stand to reap substantial benefits. On the other hand, if we neglect the educational mission and the people who carry it out on a daily basis, we all stand to suffer. We recently sat down with one of the legion of the nation’s medical school faculty members, who, although relatively unknown to all but learners, is breathing new life into medical education. He is not a radiologist. We focus on a nonradiologist not because radiology is devoid of such educators but
Acad Radiol 2014; 21:1218–1219 From the Indiana University School of Medicine, 702 North Barnhill, Rm 1053, Indianapolis, IN 46202. Received March 2, 2014; accepted March 12, 2014. Address correspondence to: R.B.G. e-mail: [email protected] ªAUR, 2014 http://dx.doi.org/10.1016/j.acra.2014.03.014
1218
because looking outside the bounds of one’s field sometimes makes it possible to see essential features of educational exemplars even more clearly. He is a pulmonology–critical care physician in his 30s. His name is Graham Carlos, and he is Assistant Professor of Clinical Medicine at the Indiana University School of Medicine. He has not earned advanced degrees in education or even done coursework in how to teach. He has not developed some new pedagogical theory or devised any new instructional methods. He has not won shelves of teaching awards. Yet his excellence as a teacher is making a difference everyday in the lives of learners. Teaching medical students and residents is not a particularly well-compensated line of work, generally does not provide a fast track to career advancement, and tends not to generate the same prestige as excellence in clinical care and research. Increasingly, faculty members at many institutions feel almost as though they are being penalized for their dedication to teaching. Sitting down with Dr. Carlos, we began our conversation by asking why he devotes so much time and effort to education. ‘‘It’s simple,’’ he answers. ‘‘You have to ask yourself a basic question: what represents your best chance to become an extraordinarily fulfilled physician? In my case, I learned early on that helping to teach future physicians makes me feel more alive than almost anything else I do. It may not pay as well, and many of us could make twice as much money out in community practice, but once you discover that teaching makes you tick, you almost have to do it.’’ In particular, Dr. Carlos does his best to share with students and residents not just the knowledge and skills they need to possess to call themselves physicians but also his own journey as a person. He endured rough patches during his own medical education and he knows what it is like to fear being on the wrong path. By sharing his own struggles with learners, he helps them understand that they are not just preparing for a future career but already leading a life. ‘‘When I think about the teachers I admired most as a medical student and resident, I am struck that they didn’t just formulate the clearest learning objectives, employ the latest educational technologies and instructional techniques, or grade students most fairly. They did something far more. They poured themselves out so that we could be filled up.
Academic Radiology, Vol 21, No 9, September 2014
They shared their stories with us, and that is exactly what I try to do with those I teach.’’ Before he goes into a lecture or on rounds, he asks himself a question: ‘‘Why am I here?’’ Specifically, ‘‘Why am I here in this profession? Why am I here caring for this patient? Why am I here teaching this student?’’ His answer is not that it pays the bills or preserves his job security. Instead he relishes the challenge of making each encounter meaningful for learners and leaving them with something worthy of further reflection and discussion. He is emphatic that education at its best cannot be about the teacher. Nor can learners become the physicians they should be if they think medicine is all about them. ‘‘So much of medicine is about putting the physician at center stage. Many aspects of medical school and residency only exacerbate this self-centeredness, which can border on narcissism. So one of the most important lessons I try to share with my students is to strive for something beyond self.’’ In an age that tends to glorify consumption and a profession that is placing increasing emphasis on each physician’s productivity and revenue generation, medical educators such as Dr. Carlos are attempting to instill in future physicians the realization that the true joy of medical practice comes ‘‘not from collecting your paycheck but from serving and sharing. My best moments are always the ones when I could really help a patient or a student. Real fulfillment comes from seeing them thrive.’’ He worries that students and residents–and for that matter practicing physicians and medical educators–sometimes get our priorities out of whack. ‘‘It is so easy to get caught up in the little things, to become preoccupied by concerns that don’t really matter and to become obsessed with things like grades and test scores. To counteract these tendencies, we need to encourage learners to think about what really comes first for them, to get their priorities in order.’’ One of the main causes of burnout among physicians at all stages of training is the inability to find balance in life. ‘‘While you are in medical school, they tell you to do as well as you can
REAL SOURCES OF EDUCATIONAL EXCELLENCE
on tests. In residency, they tell you to devote your whole attention to your clinical responsibilities. And once you get out into practice, they tell you to produce. Where do we learn to balance work and personal life, patients and family, students and friends? I press them to think seriously about this.’’ We asked Dr. Carlos to describe a practical way of sorting this out. ‘‘We are told that we are what we eat, or what we earn. But I have come to believe that we are what we read. Somehow, many of us lose the habit of reading, and even those of us who continue often end up reading fluff. I believe that we can be only as good as the books we read. If you look at my computer, you will always find a book lying open by its side. I am always recommending or giving books to students.’’ The real secret of Dr. Carlos’s excellence as an educator seems to lie less in his head than in his heart. ‘‘As the saying goes, people don’t care how much you know until they know how much you care. Each day I interact with learners I will never see again. Somehow we need to find a way to make those moments count. Some of those learners are hurting, scared, and feel as though their worlds have been turned upside down. We need to show them that we care, that we know what it’s like to feel scared.’’ Recently he was at the bedside of a patient, a relatively young man with terminal cancer. At the foot of the man’s bed was his young daughter. Dr. Carlos observed that the situation must be very difficult for him. Imagining what the future would be like for his family, the man broke down in tears. Such moments are defining for a physician, and Dr. Carlos showed his true mettle. Knowing that he had no medicine to make the cancer go away, he too shed tears. As we said, Dr. Carlos has not become famous as a medical educator. His walls are not lined with awards and plaques. He is not a department chair or a dean. Yet though he and countless other medical educators around the country labor in relative obscurity, they are making a difference–all the difference–in the future of medicine. They are helping young physicians to become not only competent physicians but above all thoughtful and caring human beings.
1219
The Real Sources of Educational Excellence Peter R. Gunderman, AB, Richard B. Gunderman, MD, PhD Key Words: Education; teaching; educators; excellence. ªAUR, 2014
I
n medicine today, the superstars are widely known. They are the researchers who have garnered major prizes, great clinicians whose names have become household words, and personalities who grace nationally syndicated television programs such as The Doctors and Dr. Oz. But there is another group of physicians who tend to be unseen by most people, yet who play an absolutely crucial role in medicine’s future. We are referring to medical educators, the faculty members of the nation’s 141 medical schools who are teaching the next generation of physicians. There are 75,000 medical students and another 110,000 resident physicians in the United States, and the quality of their education and training is highly dependent on the medical educators from whom they learn their craft. Numbering 128,000 in total, the work of such faculty members tends to be largely invisible. There are good reasons that medical educators are largely unknown to all but the medical students and residents they teach. For one thing, medical schools tend to focus most of their attention on their principal revenue-generating activity, patient care. For another, they tend to appraise their progress and rank themselves based on the research grants they garner. By comparison, student tuition represents a relatively fixed source, constituting only about 5% of total revenue. Yet these institutions are known as medical schools, and their defining responsibility is neither patient care nor research but education. Moreover, the work of medical educators is powerfully shaping the future of medicine for generations to come. If we teach medical students and residents well, we stand to reap substantial benefits. On the other hand, if we neglect the educational mission and the people who carry it out on a daily basis, we all stand to suffer. We recently sat down with one of the legion of the nation’s medical school faculty members, who, although relatively unknown to all but learners, is breathing new life into medical education. He is not a radiologist. We focus on a nonradiologist not because radiology is devoid of such educators but
Acad Radiol 2014; 21:1218–1219 From the Indiana University School of Medicine, 702 North Barnhill, Rm 1053, Indianapolis, IN 46202. Received March 2, 2014; accepted March 12, 2014. Address correspondence to: R.B.G. e-mail: [email protected] ªAUR, 2014 http://dx.doi.org/10.1016/j.acra.2014.03.014
1218
because looking outside the bounds of one’s field sometimes makes it possible to see essential features of educational exemplars even more clearly. He is a pulmonology–critical care physician in his 30s. His name is Graham Carlos, and he is Assistant Professor of Clinical Medicine at the Indiana University School of Medicine. He has not earned advanced degrees in education or even done coursework in how to teach. He has not developed some new pedagogical theory or devised any new instructional methods. He has not won shelves of teaching awards. Yet his excellence as a teacher is making a difference everyday in the lives of learners. Teaching medical students and residents is not a particularly well-compensated line of work, generally does not provide a fast track to career advancement, and tends not to generate the same prestige as excellence in clinical care and research. Increasingly, faculty members at many institutions feel almost as though they are being penalized for their dedication to teaching. Sitting down with Dr. Carlos, we began our conversation by asking why he devotes so much time and effort to education. ‘‘It’s simple,’’ he answers. ‘‘You have to ask yourself a basic question: what represents your best chance to become an extraordinarily fulfilled physician? In my case, I learned early on that helping to teach future physicians makes me feel more alive than almost anything else I do. It may not pay as well, and many of us could make twice as much money out in community practice, but once you discover that teaching makes you tick, you almost have to do it.’’ In particular, Dr. Carlos does his best to share with students and residents not just the knowledge and skills they need to possess to call themselves physicians but also his own journey as a person. He endured rough patches during his own medical education and he knows what it is like to fear being on the wrong path. By sharing his own struggles with learners, he helps them understand that they are not just preparing for a future career but already leading a life. ‘‘When I think about the teachers I admired most as a medical student and resident, I am struck that they didn’t just formulate the clearest learning objectives, employ the latest educational technologies and instructional techniques, or grade students most fairly. They did something far more. They poured themselves out so that we could be filled up.
Academic Radiology, Vol 21, No 9, September 2014
They shared their stories with us, and that is exactly what I try to do with those I teach.’’ Before he goes into a lecture or on rounds, he asks himself a question: ‘‘Why am I here?’’ Specifically, ‘‘Why am I here in this profession? Why am I here caring for this patient? Why am I here teaching this student?’’ His answer is not that it pays the bills or preserves his job security. Instead he relishes the challenge of making each encounter meaningful for learners and leaving them with something worthy of further reflection and discussion. He is emphatic that education at its best cannot be about the teacher. Nor can learners become the physicians they should be if they think medicine is all about them. ‘‘So much of medicine is about putting the physician at center stage. Many aspects of medical school and residency only exacerbate this self-centeredness, which can border on narcissism. So one of the most important lessons I try to share with my students is to strive for something beyond self.’’ In an age that tends to glorify consumption and a profession that is placing increasing emphasis on each physician’s productivity and revenue generation, medical educators such as Dr. Carlos are attempting to instill in future physicians the realization that the true joy of medical practice comes ‘‘not from collecting your paycheck but from serving and sharing. My best moments are always the ones when I could really help a patient or a student. Real fulfillment comes from seeing them thrive.’’ He worries that students and residents–and for that matter practicing physicians and medical educators–sometimes get our priorities out of whack. ‘‘It is so easy to get caught up in the little things, to become preoccupied by concerns that don’t really matter and to become obsessed with things like grades and test scores. To counteract these tendencies, we need to encourage learners to think about what really comes first for them, to get their priorities in order.’’ One of the main causes of burnout among physicians at all stages of training is the inability to find balance in life. ‘‘While you are in medical school, they tell you to do as well as you can
REAL SOURCES OF EDUCATIONAL EXCELLENCE
on tests. In residency, they tell you to devote your whole attention to your clinical responsibilities. And once you get out into practice, they tell you to produce. Where do we learn to balance work and personal life, patients and family, students and friends? I press them to think seriously about this.’’ We asked Dr. Carlos to describe a practical way of sorting this out. ‘‘We are told that we are what we eat, or what we earn. But I have come to believe that we are what we read. Somehow, many of us lose the habit of reading, and even those of us who continue often end up reading fluff. I believe that we can be only as good as the books we read. If you look at my computer, you will always find a book lying open by its side. I am always recommending or giving books to students.’’ The real secret of Dr. Carlos’s excellence as an educator seems to lie less in his head than in his heart. ‘‘As the saying goes, people don’t care how much you know until they know how much you care. Each day I interact with learners I will never see again. Somehow we need to find a way to make those moments count. Some of those learners are hurting, scared, and feel as though their worlds have been turned upside down. We need to show them that we care, that we know what it’s like to feel scared.’’ Recently he was at the bedside of a patient, a relatively young man with terminal cancer. At the foot of the man’s bed was his young daughter. Dr. Carlos observed that the situation must be very difficult for him. Imagining what the future would be like for his family, the man broke down in tears. Such moments are defining for a physician, and Dr. Carlos showed his true mettle. Knowing that he had no medicine to make the cancer go away, he too shed tears. As we said, Dr. Carlos has not become famous as a medical educator. His walls are not lined with awards and plaques. He is not a department chair or a dean. Yet though he and countless other medical educators around the country labor in relative obscurity, they are making a difference–all the difference–in the future of medicine. They are helping young physicians to become not only competent physicians but above all thoughtful and caring human beings.
1219
