Teaching as Form

I have had the privilege of teaching for over four decades. The first time I formally taught was as a graduate student, although I did a bit of teaching as an undergraduate. For whatever reason, I have loved teaching and used it to share my knowledge and my enthusiasm with students in classes, seminars, think-tank sessions, conferences, tutorials and articles, physical and virtual.

My Teaching Experience
After my graduate work, I took a University of Toronto short course called ‘Teaching as Acting’ that strongly influenced me. In that course I learned that I had to project myself, learn to perceivably express my emotions, and learn to use my enthusiasm as a vector for knowledge, transmitting energy in addition to content to students. One objective was to enthrall students to some degree and stimulate them to learn. I also learned to make teaching fun in whatever ways I could. As a consequence, I studied how actors perform and how comedians make us laugh. I learned to, as required, even make a fool of myself if that helped people listen…this is a valuable excuse these days as I often make a fool of myself!

Virtually all my teaching was for graduate courses; I only led a few undergraduate courses during my career. That changed recently with my teaching at NIHI’s Applied Health Informatics Bootcamp, where the material is definitely at an undergraduate level.

Through the years, I have come to love teaching more and more and I have thrived on my students’ energy and enthusiasm, mirroring the energy and enthusiasm I put into my teaching – teaching has been a symbiotic process.

One of the other interests I have maintained over the years is the art and science of flying, particularly multiengine commercial flying in the big jets. In thinking about Health Informatics issues, I have used my understanding of matters such as aerodynamics, flight systems, instrumentation, navigation and the human dimension of flying. The latter used to be called Cockpit Coordination and is now called Cockpit Resource Management. This knowledge is particularly applicable to the area of patient management and patient safety.

Captain Mike – As Student
I have a friend who lives on my island in BC who was a Boeing 747 captain for Canadian when he retired. He started out flying single-engine private planes and gradually moved up to more and more complex beasts, ending up on the ‘Whale’, the nickname for the 747. He also spent a fair amount of time as a bush pilot, so he has seen virtually everything in fixed wing flying, even flying the famous Lockheed Constellation. Just to round it out, I have another friend who is a police helicopter pilot and yet another who flies Beavers for a local airline. So, fixed wing or rotary, I am surrounded by gabby (all are!) pilots!

Captain Mike and I got into a discussion the other day about how one learns to fly and manage an airplane. You are probably aware that this is a relatively challenging process. It ‘takes off’ (a pun, of course) from basic knowledge of each craft  you will fly, moving up through basic flying skills, and dealing with matters such as various types of failures of systems on the plane. One develops quite a substantial knowledge of flying itself, and of each type of airplane and its systems on which one becomes qualified. Gradually, one develops skills to keep the plane flying, to have a good awareness of one’s spatial situation and to maintain communications (aviate, navigate and communicate…the three basic imperatives of 3-D ‘driving’), and one only really advances by having many hours of experience. My friend, Captain Mike, had over 7000 hours of flying experience even before starting with the big jets!

Captain Mike on Instructors
I took the opportunity to ask him about how he learned. He talked about his good teachers and his bad teachers and all those between. I found it interesting, because he said many of the same things I would’ve said, although I never learned to be a pilot…only 2 experiences in the air at the controls, but many as captain of my simulator…talk about flying a desk! When I asked him how he would describe a good instructor, he made a number of points that I believe are worthy of presentation here and very relevant to our field.

For example, Captain Mike said that most bad instructors were arrogant, lording their knowledge over the student, putting the student down and making sure that the student knew he or she wasn’t very good. He believes that good instructors are very low on the Open-Ended Arrogance Scale and, because of their own self-esteem founded on their abilities, they have no need to demean their students. That resonated strongly with me, and maybe reflects your experience. The University of Wisconsin where I did my undergrad degree had a lot of arrogant Physics professors – ex-Manhattan Project scientists who had no need for students because they were so far down the ladder. That was a bad experience and the reason I moved into Astrophysics where I had some of the best professors possible.

Captain Mike also made the point that good instructors gave their students a great deal of latitude and even allowed them to fail (safely), helping them only when intervention was essential. When crucial, the instructor would assist the student in regaining control or getting the procedure right, and would only really take over if there were imminent danger. The student’s mistakes were a pathway to excellence and helped him or her really internalize the lesson.

Another aspect he mentioned is that good instructors never look down on their students, seeing that there is some level of potential and then trying to bring this out and advance the potential to true capability. Instructors are assistants, helpers, a backstop, and don’t rely on command and control, but rather on judicious guidance. I look at this as the instructor seeing the student as progeny and, to some extent, as a protégé.

Captain Mike emphasized what was, perhaps, in my mind at least, one of the most important points: that good instructors assess their students and detect each individual’s capabilities. They recognize that all students are not the same, that some will find things easy while others will find them difficult. Every so often, one may come upon the student who just can’t hack it, but this would probably be relatively rare and only be a conclusion of last resort. The instructor needs to see every student as having potential; only a few are unable to make it because of some intrinsic limitations within them. Instructors detect a student’s abilities by observing them as they carry out more and more challenging tasks. They also observe how and how completely the student responds to remediation.

In thinking about this, I remember a story about Dr. Robert Oppenheimer, the famous physicist who led the Manhattan project to develop nuclear weapons during the Second World War. One author of a biography pointed out that if a student did not show practically instantaneous genius, Oppenheimer would tell him to go away or would ignore him. Oppenheimer was brilliant, but he did not bring along with him many who could perhaps have done at least good work. Oppenheimer just cherry-picked those would find it easiest to be a Nobel-class physicist (this worked for him, by the way, as a number of his students achieved this milestone). He was great man, a great physicist, but I don’t believe the type of teacher we want or need. Interestingly, although he made many contributions, especially to Astrophysics, he never merited a Nobel Prize. Compare this to Richard Feynman, the Nobel-laureate physicist noted for his teaching.

The final thing that Mike said about instructors was that good instructors communicate excitement and enhance the students’ excitement about what they are doing – flying, in this case. I find excitement about flying pretty easy. But, excitement about how the hydraulic system works, or excitement about the finer points of navigation, or excitement about compulsively following checklists – that’s harder. I think each of us has similar problems in teaching students about the essential details of eHealth.

I would claim that learning about technology and about deploying it, just like learning about flying, is primitively exciting and maybe learning about implementing technology and working with people as part of that also is stimulating. However, what about the more mundane things the discipline of eHealth entrains, like meticulous analysis of software alternatives, or carrying out a complicated procurement process, or realizing adoption, or even harder, doing a competent evaluation? That’s a lot harder to make people excited about! However, we must do that.

Flying the eHealth Vehicle into the Future
In talking with my friend I began to realize how much in common our perceptions and thinking about teaching were. Maybe we should try to think about teaching eHealth a bit like teaching someone how to fly an airplane. Maybe we should expect traits like Captain Mike mentioned of others as they teach us or expect them of ourselves as we teach others!

For those of you who teach or who will someday teach, and I believe that is every one of us – no one escapes teaching, as it is part of the fabric of which the eHealth professional is made, there is one other story about teaching that I would like to share.

On Learning to Teach
Many years ago, I gave a lecture on computer security at a weekly Computer Science colloquium. Four students (all of them quite smart) took me aside after my talk and asked me if I would teach them how to lecture. Of course, this began inflating my ego. Then one of the students said that I was an excellent teacher. Now the expansion of my ego paralleled the expansion of the universe during the Big Bang. Unfortunately, the student continued by saying, if I may paraphrase, “You teach very well and people listen to you, but you know almost nothing. We know a great deal, but people don’t listen to us; we can’t teach”. After recovery from the collapse of my fragile, hyper-inflated ego, I agreed to give them a short course on teaching. I had learned that the best way to learn to teach is to be able to watch yourself doing it. It was quite difficult at the time, as video recorders were not cheap, but taping a presentation would give the students the ability to see themselves at work and not only to receive critiques, but also to see exactly what deserved critiquing.

I had each student give three talks, each followed by group feedback on what he or she should improve. The first talk was about something they knew a lot about, like a hobby. The second talk was about something they knew relatively little about but were interested in and the third talk was a topic I gave them out of the blue. I’ve kept those videos over the years and shamelessly used them against these former students when the opportunity availed. Perhaps my favorite observation was related to behaviors that indicated the students discomfort with lecturing and how inappropriate affect limited their ability to communicate. Very little of my observation related to the content of the talks; it was focused on the form, particularly the students’ delivery. The case of one student illustrates that point.

One student was quite uncomfortable and gave his first lecture with this hands jammed deeply into his pockets the whole time, pushing them down almost to his knees. When he saw this in the replay, he was shocked and agreed that the next time he would change this behavior. Well, he did. It his second talk the students hands were not jammed down into his pockets, but his thumbs remained jammed into the edge of his pockets and he managed to point at things by lifting up a finger but never removing the thumbs from the pockets. The good news is that, by the third talk, it was hands-free and the audience put its hands together to recognize this.

Key Message
The message of this article is that there are many human factors in teaching, not just depth of eHealth knowledge or level of eHealth skill. The ability of the teacher to show confidence in the student, to give the student latitude, to never look down on the student, and Captain Mike’s other points, are key capabilities that make a good teacher.

I think the worst case I’ve heard of teaching involved Paul A. M. Dirac, who was awarded a Nobel Prize for his work in Quantum Mechanics. One day he was lecturing on Quantum Mechanics to a graduate audience. Dirac often taught by reading from his textbook, which is considered the bible of that esoteric field. One day, a student asked Dirac if he would explain something he had just said. Dirac simply reread the same text to the class. The student then asked if Dirac could explain it in other words. Dirac responded to this by saying that there were no better words.

Here we have a Nobel laureate, one of the most brilliant scientists that has ever lived, who failed at the process of teaching because, despite a head full of knowledge, he was unable to do some of the things our 747 captain noted were key to being a good teacher.

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