“See one, do one, teach one” — the vaunted mantra of the medical profession that describes learning, practice, and education as almost a single effort. But how linked are our study, work with patients, and our teaching? Are they different skills? And can we be equally effective with all of them?
These questions are especially pertinent for my specialty, psychiatry. As psychiatrists, we aspire to provide life-changing relief to millions of patients, yet half of our treatment attempts still end in disappointment. Practicing well forces us to repeatedly reexamine our conceptualizations, guarding against fallacious assumptions that can harm patient care. We must also perform this same act of metacognition when choosing which valuable skills and practices to pass on to our colleagues and students — each thought and act must be purposefully, consciously, and repeatedly reexamined for its safety, coherence, and utility.
Many of us have taken the Hippocratic oath that specifies passing on our knowledge to willing new candidates who have pledged themselves to the same professional standards that we have. Inherently, these standards must include reflection and self-examination. As the old medical school graduation saw reminds us, half of what is learned is wrong — only which half?
Like most of us, I began teaching and mentoring in residency. I taught medical students a course on normal human behavior and, later, one on basic psychiatric principles. When I became an attending, I mentored residents on transition to private practice, and mid-career I provided psychotherapy supervision for psychiatrists in training. Today, I write and teach residents and graduate students at several institutions.
Through my years of experience, I have learned several key things about teaching and about the best ways to impart clinical material to students. First, I have observed that one-way, online seminars are difficult and hardly satisfying for either party. My in-person lectures to students, residents, and fellow professionals have been much more rewarding, as I can gauge reactions to the material and better encourage discussion when no one can hide behind a screen or microphone that is turned off. Enthusiasm for the same material has also been much higher in face-to-face settings. I would encourage other clinicians to avoid the online lecture format and return to face-to-face interaction when possible.
Second, I have seen firsthand the lesson of the Dunning-Kruger effect: not all minds are fertile ground. Those who know the least often think they know the most and are less open to self-examination, correction, or new ideas. Our most enthusiastic students are often those who are already the best. Is preaching to this choir satisfying? I have to admit it is. While we’d of course like to have the scales fall from everyone’s eyes once we impart our learned wisdom, the natural barriers of the human mind will limit this; it is not always just a reflection of our knowledge or skill at imparting it. We know, for instance, that scientific progress is disseminated through a community one person at a time — by individual practitioners who slowly convince some of their colleagues to adopt new information, skills, and practices. I’m happy to provide all the seeds I can, hoping that some will grow, having been sown by my most enthusiastic students.
Third, I have learned by teaching in many settings that the only way we can proceed is by first identifying gaps in knowledge that the field needs. We accomplish this by maintaining our clinical focus on patient care, which clarifies for us the lessons and tools that are not working well or are missing altogether. We can then proceed with research and ethical experimentation to fill those gaps. Then we must find the right individuals to carry the message to others. We are not Paul Revere, shouting a message to an alert militia, but more of a Johnny Appleseed, initiating a ripple effect for those listening.
This is probably why, though I do also enjoy teaching at conferences and meetings, I most enjoy mentoring. For years, I have participated in my alma mater’s annual course for third- and fourth-year students on choosing specialties and getting into residencies. I find great pleasure in sharing my experience and accumulated wisdom on these topics, self-honed with ongoing research and the metacognitive steps (including self-examination and -reflection) to ensure I remain accurate and relevant. I help clarify for those considering psychiatry the opportunities for practice, as well as how to weed out training programs that routinely put service requirements ahead of individuals’ educational goals. The enthusiasm and hopefulness of these students is infectious.
Equally rewarding is mentoring more senior colleagues who have the insight to know that no matter how skilled they are, they will always be able to improve. In fact, these are usually already the most clinically skilled. It is very satisfying to be asked to help them on their continuing journey toward greater excellence.
Mentoring is also the closest to actual clinical practice — helping people who seek our assistance in solving problems. It requires learning what the person seeks, identifying what the problems are, and then together developing a reasonable plan to reach their goals. I imagine that the very best teaching, in all settings, would be approached in this same collaborative way. Not only are we then likely to provide the most valuable content, but to also model the metacognitive skills we need for optimal patient care: by continuously reexamining and improving the processes we use for thinking and problem-solving.
Just as it is rewarding to observe patients with newly improved lives, when I can impart more of this self-educational process to members of my field, I am satisfied, trusting that they will be able to carry it even further. I saw, I did … I taught.
What do you enjoy most about teaching and mentoring? Share in the comments!
