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Friday, November 27, 2015

Teaching Medical Students (continued)

Some of you may have read this already because Speedy wrote this as a comment on Sanath's  recent post under the subject "Teaching Medical Students". As I have repeatedly pointed out before, it's the comments that make a blog post more interesting.

Rather than allowing Speedy's lengthy comment to languish only as a comment, I have taken into consideration its real worth and reintroduced it as a separate post. It is done with the fervent hope that this reintroduction will generate more comments on Sanath's original post. Viewers are free to decide under which post they should comment. But let's not forget that it was Sanath who introduced the subject in the first place.

What Speedy wrote:

Lama's post deserves attention from all of us who have had the pleasure of imparting our knowledge to others. My experience has been mainly in the UK although I did teach Medical Students in SL when I was a Demonstrator in Pharmacology in 1972-3 and again both students and doctors as Neurologist in Kandy in 1978-79. My teaching audience in the UK was very wide including Medical Students, Doctors, Social workers, Nurses, Physiotherapists, Occupational therapists and most importantly, patients and carers. Each Group posed a different challenge and for me the biggest challenge was to speak to patients, carers and social workers and others with no medical background. My objective was quite simple- at the end of my talk, I wanted to be sure that my audience grasped the messages I was trying to impart and left the lecture/tall.demonstration feeling happy and enthused by what they heard. I preferred more interactive sessions as I felt it gave the opportunity for them to question me and clear their doubts. I had a few broad principles when I did these. Firstly, I didn't hide under an aura of authority. I was always friendly and pleasant ( I hope!) and never hesitated to admit that I didn't know the answer.Secondly, I never ridiculed or admonished a student who was brave enough to ask me a question, even if it was deemed "silly" by some. Thirdly, I always summarised the main points of what I was trying to impart at the end and lastly, I NEVER read from a sheet in front of me or read the PowerPoint presentation to my audience. If it was a lecture with audio-visual facilities, I would always check them out before, have a back up and spoke to the audience, not looking back at the screen. I made sure the microphone was working and tested that my voice was heard at the back of the Lecture hall. Over the years, I also learnt to speak more clearly and slowly (speaking too fast is an Asian habit and also a sign that you have not got the content right to fit the time available, trying to rush through to complete on time and forgetting that the process (talk) is good only if the outcome (imparting the messages) was achieved. I always prepared thoroughly before a presentation and how nervous I was (and I was!) depended on how well I prepared and knew the subject myself. Most of these points were an attempt on my part not to be like some of the bad teachers I had both at Royal and at Medical Faculty and to be like some of he good ones . For medical students and doctors, I tried to impart two things. Firstly the fascination of solving a problem and secondly, the need to be kind, understanding and ethical to your patients. I am happy to say (shedding modesty as Lucky advised us) that at Manchester, I was consistently rated to be among the highest Medical Teachers. I still do a bit of teaching as I love it and also because I consider it the duty of every doctor to educate.

I have touched on this before but I did my best to enthuse Medical Students and Doctors in the fascinating art of collecting evidence (History and examination) , diagnosis (collating all the evidence- both clinical and through investigations) and then the thrill of getting it right and helping the patient. This is sadly becoming a fading art, thanks to blind investigations, parrot like protocols, defensive medicine and the lure of personal and financial gain. I would like to add that I consider Dr Wickrema Wijenaike, Prof NDW Lionel and Dr Viswanthan as some of the best Teachers I ever had. My gratitude for them will always remain with me.

4 comments:

  1. Speedy, I agree with everything you have said, and also agree with your choice of the three best teachers you have named. I would also add Dr. Ernie Peiris to that list. "Viswa" believed in active learning. During his ward rounds he assigned topics to each of his students, who had to research the topic and then present it to the group. I still remember the risks of an "multipara" well because I had to present it to the group. I wish that more of our teachers had done that.

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  2. Thanks Srianee. It is always good to hear from you. I agree with you that Dr Ernie Pieris should be added to the role of honour. He was quite a character too in his refined and elegant sense of humour. Hope you are well and enjoying life. If I remember right, you will be in Sri Lanka soon.

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  3. Interesting topic you guys are in.I have often reflected on my experiences as a medical student & my experience as a teacher of both medical students,nurses & residents in the USA.
    To start with I will add Prof. Lester Jayawardene to this list. This stems from my first meeting with him as part of a sig. group that was tested on their knowledge of the shoulder joint. It was our first sig. our first few weeks in the block, and our first meeting with the teacher from Peradeniya whose reputation for being strict preceded his arrival in Colombo. We did put in the effort for sure but without the right guidance.
    He went right to the point with his first question. What are the movements of the shoulder joint. None of the eight in the sig.group knew it because it was in
    fine print in the dissecting manual- by Cunningham.
    The eye brows went up, and he bellowed, I am sure you know thev rest of the stuff, but if you did not know the movements of the shoulder joint you really have missed the whole point.
    I did learn from that day on the importance of applied anatomy ( by extension applications in other subjects too) which was also well thought by Drs. Panditharatne & Bandaranaike, who were good teachers too.I had only once listened to Prof. Kirthisinghe , when he held a post mortem on the failures in surgery after both he & Prof. Navaratne took over the teaching of surgery, but the little bit I heard was enough to realize here was another good teacher.
    The point has been made that our teachers tried to belittle you if you attempted to question them or make a mistake in answering a question. teachers need to encourage students to ask questions , the attitude of several of our teachers was sad to say the opposite.What I found out quickly in the USA is that if you don't talk, the Attending staff (consultants) think you don't know & mark you down.
    Several years ago one of my daughters & son in law, both med. students were in the professorial ward at LRH. Sanath was away on sabbatical. The acting consultant made remarks trying to ridicule the two kids from the US, even after they kept answering his questions.Well that culture has to change if one wants the kids to learn & develop into confident adults.
    The forms to evaluate the teachers is there in most institutions in the US too.

    To end this note in a humorous note, in one of his afternoon ( sleepy) lectures,
    Prof. Sinnathamby mentioned about seeing a monkey with a blue scrotum- in the middle of his talk. It was unrelated to what he was trying to teach. Well I had never seen one in Sri Lanka though I remembered his odd remark. Well, more recently on a trip to Masai Mara in Kenya, I did come across the monkey & things clicked- he Siinathamby must have been there. Sorry this is unrelated to what we were discussing.

    Indra Anandasabapathy
























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  4. We can not turn the clock back with regard to Medical Education in Ceylon during our time.One has to leave in search of knowledge to developed world,most of my batch mates did in late sixties and early seventies.When are our Academics,back in SriLanka going to grow up and get rid of bullying habits.Admit if you are ignorant of a subject.
    I was unfortunate to obtain a 2nd class at final MBBS.I feel,I was let down by my quick answers,without much thought to question throng at me by the Examiners.

    Doc domicile in UK

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