Attempting To Master The Art Of Teaching While Treating

My daughter is an elementary school teacher. She teaches several different grade levels but specializes in reading. My admiration for teachers was always high but since she became a teacher, it is off the charts. Over the years, I have tried to be an excellent teacher to the residents and students who crossed my path. However, a couple of things made me realize recently that, despite my best intentions, I was probably average at best. 

Years of lecturing led me to better understand messaging, which I do based on evidence-based medicine. Messaging can be tricky. The ultimate goal is to keep your audience engaged while leaving a proverbial trail of evidence-based bread crumbs to reach a practical conclusion. In my opinion, this methodology is teaching at its core. 

Publishing peer-reviewed articles is another method of teaching. It is more formulaic than lecturing and is usually based on research. Finally, serving in a formal teaching position like a residency director is an everyday teaching opportunity to share knowledge and experience that is intertwined with formal educational sessions. 

In trying to improve my teaching skills to residents and students, I had an epiphany. So many things I do in the office or the operating room are second nature. My favorite teaching principle is the “why” of things. These “whys” are going through my head when I am evaluating a patient or doing surgery, but I do not necessarily voice them out loud. That is a lost teaching opportunity. Trying to share what is going through my mind to a resident or student is something I need to do better. 

Several barriers exist in voicing my thoughts during a teaching discussion. The additional time it takes is probably the most significant determinant. The bottom line is medicine is still a volume business and we all are under enormous pressure to be efficient and see as many patients as possible, especially in private practice. Those in university positions may not face the same challenges to maximize patient volume. I believe there is a happy medium for those in teaching positions and private practice. To be sure, it is not an easy task. The teaching opportunity is too significant to throw in the towel so I am going to figure out what works for me. 

Another concern is the disruption of the doctor-patient interaction in order to teach simultaneously. It can be awkward without question. Each patient encounter is unique. Sometimes it is doable to treat and teach but for some patients, this may not be the case. Introducing the student at the beginning of the patient contact and explaining the ongoing teaching that will be taking place during the exam usually gets patients on board. I find that most patients look at the teaching component of their examination as a positive and they are pretty understanding. That said, examining a patient while educating residents/students is a delicate balancing act. 

Those of us in practice had mentors who paid it forward it and it is our responsibility to reciprocate this to the generations that follow in our footsteps. The reward is tremendous if you have the opportunity to teach residents and students. The duty is too essential to ignore and since that is the case, why not maximize the educational opportunity? Critical evaluation of your teaching skills, just like in surgical cases or in the office, will lead to growth and improvement. Make it your quest to impart your knowledge and experience in a welcoming educational environment. Work to overcome the hurdles to teaching. Students, residents, the profession and those requiring lower extremity care will thank you. Most importantly, you will have done your duty to pay it forward.

Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, and a Fellow of the American College of Foot and Ankle Pediatrics. Dr DeHeer is also a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery.