Thoughts on teaching

Grateful to receive a teaching award/ Reflections on the Academy

Each week at my job I get to do everything I love— see patients, analyze data, write papers and teach trainees. All 4 are challenging and rewarding in different ways. Today, I want to share some thoughts about teaching.

This week, I was surprised and honored to receive the 2022 Excellence in Teaching Award from UC San Francisco!

Over the 7 years I have been faculty, I have given thousands of lectures, taught dozens of small groups, and run 2 courses (Appraising Medical Literature and Publishing and Presenting Literature at 2 universities). I have been lucky that the feedback from trainees has been positive. Five times over those 7 years, I’ve been honored with an annual teaching award. These experiences have led me to some thoughts on teaching.

You can't teach unless you understand. I disagree with those who contend that ‘I understand it, but I have a hard time explaining it'. If you understand it deeply, and know where your audience is coming from, you should be able to bridge the divide. I think a mistake people often make is assuming they remember a concept they learned years ago, but the truth is it needs refreshing. Often the act of teaching ensures one has a deep understanding of a subject. Before you teach a class, you should make sure you know everything you're saying backwards and forwards.

It has to be worth their time. These days learners have an abundance of riches. They can read books, watch videos, listen to podcasts, or attend your class. If you want them to attend your class, you should believe in your heart that you are delivering the best product. I never fault people for skipping classes when they feel they are not learning. I only fault them for not giving it a try. I think it is incumbent on the teacher to make both the delivery and the content high yield. Teaching concepts is always better than teaching facts.

If you can't answer the questions, you should go home and read. I always appreciate tough questions. The one’s that make you think. Often people with fresh eyes have the most insightful thoughts on a topic. But every time I'm confronted with a question that I don't know the answer, I do two things: I say I don't know, and then I go and do my homework, and I don't return until I'm prepared to answer the question. Even if that means I have to email world experts, call them or text them. I’ve done all that. I've wasted many an evening chasing down old articles on PubMed.

Speak to convey information. As someone who occasionally has a hard time hearing, or maybe it's just a poor attention span, I am acutely aware of the need to speak clearly, accurately, non redundantly, and audibly. I think it's simple advice, but I don't think it is followed. I am often in lectures where I cannot understand anything being said, or the tone lulls me into a slumber. When you talk: you should speak to convey information, and minimize abbreviation abuse.

Watch their eyes. Anyone who has spent considerable time in front of an audience will tell you: you can feel their attention. When you have it, they won't look at their phones. When you have it, they won't look confused. When they're learning, they will look happy.

This is in partly why zoom is trash, why remote learning is a scam, and why people who take pride in teaching want it to be in person. The moment you see yourself losing their attention, you need to figure out why. You have a short window. Are you aiming too high or too low? Either is an error. You need to feel comfortable reorienting your talk in an instant.

You should not need notes. When I was younger, I used to have nightmares that I would be giving a talk and my slides would fail. That's now happened to me twice in my life. Once for a major lecture.

I no longer have nightmares. I think the speaker should be so comfortable with the subject matter that even if all the slides fail and you have no notes, you should be able to give the entire talk from memory. In fact, it can be a better learning experience.

A couple years ago I planned a series of 10 videos for YouTube. I'm still working at recording it- I got busy. But I did make all the 10 slide decks. These compliment other lectures I've given. I think collectively I may have a hundred different slide decks. On different topics. And variations of these talks may reach a thousand ppt files. These don't cover everything, but they cover most things in my wheelhouse: oncology, epidemiology, biostatistics, meta research, randomized control trials, evidence-based medicine.

I'm not sure I can give a 1-hour lecture on the nephron anymore, my memory of it is vague, but I'm pretty confident I could give a lecture on any of these topics without notes. I think this relates to my first point that you have to really understand a topic to teach it. I've spent so many hours thinking about the topics I teach. I try to teach things that I'm genuinely passionate about.

For me, clinical decision making and clinical epidemiology is the most interesting topic on earth. Combines everything I'm interested in. I still love nothing more than teaching that topic.

Be prepared to learn. The cliche turns out to be true. The teacher learns more from the students than vice versa. Every time someone tells me something, whether I agree or disagree, I tried to think deeply about what they're saying. Both in the moment and thereafter. Often I do learn lots of things I didn't know. On more than a dozen occasions, I've gotten a great idea for a research project.

Realize you are the lucky one. You do a better job as a teacher when you realize that you're the lucky one. You get the privilege of getting the time of young people, and that's a very valuable commodity. So you should treasure it. And make sure they get the most of it.

I've learned a lot in 7 years of teaching as a faculty member. Each year I try to do a better job than the year before. I really appreciate the positive feedback from people who've been to my lectures, small groups, discussions, and debates. They say the word doctor comes from the Latin to teach, and I find there's a lot of truth in that. Because medicine is complex and often hard to articulate, but the act of teaching it forces you to become concrete, and put your thinking to words. I think it makes you a better doctor, and I hope it makes you a better teacher. Grateful to all the students who took my classes over the years. Probably now that number is in the hundreds or even thousands. I'm grateful to receive this award.