Acad Psychiatry DOI 10.1007/s40596-014-0260-2
FEATURE: PERSPECTIVE
On Becoming a Teacher: Reflections on Teaching and Learning in Psychiatry Residency and Beyond Adrienne Tan
Received: 21 October 2014 / Accepted: 11 November 2014 # Academic Psychiatry 2014
We teach who we are…good teaching cannot be reduced to technique; good teaching comes from the identity and integrity of the teacher. Parker Palmer [1] You are the curriculum. Susan Lieff (personal communication) It isn’t the changes that do you in, it’s the transitions. They aren’t the same thing. Change is situational…Transition on the other hand is psychological…it is a process people go through as they internalize and come to terms with the details of the new situation that change brings about. William Bridges [2] Although over a decade has passed since my postgraduate year (PGY) 2 in psychiatry residency, it was a formative year for me as a psychiatrist and teacher. It felt, in many ways, like another PGY-1 year in terms of the transitions I faced. Although I was relieved and excited to (finally) be a full-fledged psychiatry resident rather than the “psych” resident passing through various rotations—internal medicine, emergency, and palliative care—I also felt the weight of expectation on my shoulders. This is the true test now—core inpatient and outpatient psychiatry, psychotherapy, and psychopharmacology—the heart of psychiatric practice. What if I didn’t like it? What if I wasn’t any good at it? And now they’re asking me to teach clinical clerks? Wasn’t I one just recently? Fast-forward 6 years from my PGY-2 year. I am sitting in a class of 14 other “scholars” in the Education Scholars Program (ESP) as a newly minted attending physician. I’ve been supported to attend by the chief of my department and I feel as
A. Tan (*) University Health Network, University of Toronto, Toronto, ON, Canada e-mail: [email protected]
nervous as I did in my PGY-1 and 2 years of residency. Do you ever shake this feeling? Didn’t I just pass the requisite licensing exams and complete a fellowship? Haven’t I “arrived”? We were asked on the first day of class in the ESP to communicate our metaphors for teachers and teaching. The answers are both expected and unexpected—a chameleon, constantly adjusting to learners and the context, a guide on a journey, and an orchestra conductor. One answer from a thoughtful surgeon resonates with me. He speaks of his experience in Japanese martial arts and the term sensei which means “teacher” in Japanese. The surgeon says sensei’s literal translation is something like “the one who came before.” This term honors the perspective that teachers have in terms of imparting wisdom and perspective and I realize, in reflecting on this, that this is what I lacked as a PGY-2: bright eyed and bushy tailed; I had no idea how formative and meaningful teaching and being taught by talented and dedicated teachers would be in my career development. I also had no sense of how impactful my contribution to teaching medical students could be. As doctors, I think we implicitly value teaching and learning. We are, after all, supposed to be “lifelong learners” and we’ve invested a lot in becoming doctors, but that’s just it, isn’t it, the essence of being a lifelong learner: Each of us is always in the process of becoming, learning, and growing. It’s never done. However, in those first months in PGY-2 and the years that followed it was the wisdom and guidance from the “ones who came before,” my/our teachers who provided time, guidance, safety, wisdom, knowledge, a sympathetic ear, perspective, inspiration…and so much more that helped to provide the “secure base,” to borrow a term from Bowlby [3], from which I could explore and become the clinician and educator I am today. Another flash forward and backwards. It’s 3 years into my being an attending physician and I am sitting in a faculty development program called “Train the Trainer” that is meant to teach faculty how to deliver a teaching skills program. I’m
Acad Psychiatry
sitting in a small group with various health professionals and a woman introduces herself to me. She tells me that she is a pediatrician and that I once worked with her in the emergency department of a psychiatric hospital when I was a resident and she was a clinical clerk—we were apparently on call together. She recalls that I taught her the mental status exam (MSE) using my favorite mnemonic, “ASEPTIC.” She said she liked it because the mnemonic had a medical reference. She also recalls that I said something impactful to her about a “good MSE.” A good MSE, I apparently said, should allow me to go to the waiting area in the emergency department and identify the patient that she (the medical student) was describing to me. She said she uses what I taught her when she does mental status exams now in her work as a pediatrician. I was totally blown away. I didn’t remember her, but she certainly remembered my teaching. I’m pretty sure that it was a busy night in the emergency department, and I hadn’t thought at the time that what I had taught her was that impactful or important. It’s not only that, as PGY-2s, we lack perspective about our potential impact on those we are charged to teach. As novice teachers, we may not question a hierarchical perspective of being a teacher: The sense that a good teacher is someone with content expertise, something we lack in our PGY-2 year. Teaching is more than just the transmission of knowledge, however; it is also the facilitation of a process. Good teaching is, among other things, about learning together. Not knowing, tolerance of ambiguity and complexity, and knowing where to look and whom to ask are all key
parts of good teaching. Seeing teaching as a facilitative process rather than simply the imparting of knowledge is a shift in vision that is related to what often goes unarticulated about really satisfying, good teaching. Teaching is also an opportunity to learn. Here is what I wish my “PGY-2 self” knew: As daunted and excited as you, PGY-2 resident, may be as you are presented with the prospect of having to “teach” in the absence of confidence in your content expertise, embrace your journey and not knowing. Be curious and open. In as much as being a good teacher relates to content expertise and teaching skills, it is also about something less tangible and concrete—the relationship between the teacher and learner, that the teacher is a learner still and always, that knowledge is constantly evolving, and most of all, the joy of being some small part of something greater than yourself. Disclosure The corresponding author states that there is no conflict of interest.
References 1. Palmer P. The Heart of a Teacher, from http://www.couragerenewal. org/parker/writings/heart-of-a-teacher. Accessed on October 21, 2014. 2. Bridges W. Managing transitions, making the most of change. 3rd ed. Philadelphia: Da Capo Press; 2009. 3. Bowlby J. A secure base. New York: Routledge; 1988.
FEATURE: PERSPECTIVE
On Becoming a Teacher: Reflections on Teaching and Learning in Psychiatry Residency and Beyond Adrienne Tan
Received: 21 October 2014 / Accepted: 11 November 2014 # Academic Psychiatry 2014
We teach who we are…good teaching cannot be reduced to technique; good teaching comes from the identity and integrity of the teacher. Parker Palmer [1] You are the curriculum. Susan Lieff (personal communication) It isn’t the changes that do you in, it’s the transitions. They aren’t the same thing. Change is situational…Transition on the other hand is psychological…it is a process people go through as they internalize and come to terms with the details of the new situation that change brings about. William Bridges [2] Although over a decade has passed since my postgraduate year (PGY) 2 in psychiatry residency, it was a formative year for me as a psychiatrist and teacher. It felt, in many ways, like another PGY-1 year in terms of the transitions I faced. Although I was relieved and excited to (finally) be a full-fledged psychiatry resident rather than the “psych” resident passing through various rotations—internal medicine, emergency, and palliative care—I also felt the weight of expectation on my shoulders. This is the true test now—core inpatient and outpatient psychiatry, psychotherapy, and psychopharmacology—the heart of psychiatric practice. What if I didn’t like it? What if I wasn’t any good at it? And now they’re asking me to teach clinical clerks? Wasn’t I one just recently? Fast-forward 6 years from my PGY-2 year. I am sitting in a class of 14 other “scholars” in the Education Scholars Program (ESP) as a newly minted attending physician. I’ve been supported to attend by the chief of my department and I feel as
A. Tan (*) University Health Network, University of Toronto, Toronto, ON, Canada e-mail: [email protected]
nervous as I did in my PGY-1 and 2 years of residency. Do you ever shake this feeling? Didn’t I just pass the requisite licensing exams and complete a fellowship? Haven’t I “arrived”? We were asked on the first day of class in the ESP to communicate our metaphors for teachers and teaching. The answers are both expected and unexpected—a chameleon, constantly adjusting to learners and the context, a guide on a journey, and an orchestra conductor. One answer from a thoughtful surgeon resonates with me. He speaks of his experience in Japanese martial arts and the term sensei which means “teacher” in Japanese. The surgeon says sensei’s literal translation is something like “the one who came before.” This term honors the perspective that teachers have in terms of imparting wisdom and perspective and I realize, in reflecting on this, that this is what I lacked as a PGY-2: bright eyed and bushy tailed; I had no idea how formative and meaningful teaching and being taught by talented and dedicated teachers would be in my career development. I also had no sense of how impactful my contribution to teaching medical students could be. As doctors, I think we implicitly value teaching and learning. We are, after all, supposed to be “lifelong learners” and we’ve invested a lot in becoming doctors, but that’s just it, isn’t it, the essence of being a lifelong learner: Each of us is always in the process of becoming, learning, and growing. It’s never done. However, in those first months in PGY-2 and the years that followed it was the wisdom and guidance from the “ones who came before,” my/our teachers who provided time, guidance, safety, wisdom, knowledge, a sympathetic ear, perspective, inspiration…and so much more that helped to provide the “secure base,” to borrow a term from Bowlby [3], from which I could explore and become the clinician and educator I am today. Another flash forward and backwards. It’s 3 years into my being an attending physician and I am sitting in a faculty development program called “Train the Trainer” that is meant to teach faculty how to deliver a teaching skills program. I’m
Acad Psychiatry
sitting in a small group with various health professionals and a woman introduces herself to me. She tells me that she is a pediatrician and that I once worked with her in the emergency department of a psychiatric hospital when I was a resident and she was a clinical clerk—we were apparently on call together. She recalls that I taught her the mental status exam (MSE) using my favorite mnemonic, “ASEPTIC.” She said she liked it because the mnemonic had a medical reference. She also recalls that I said something impactful to her about a “good MSE.” A good MSE, I apparently said, should allow me to go to the waiting area in the emergency department and identify the patient that she (the medical student) was describing to me. She said she uses what I taught her when she does mental status exams now in her work as a pediatrician. I was totally blown away. I didn’t remember her, but she certainly remembered my teaching. I’m pretty sure that it was a busy night in the emergency department, and I hadn’t thought at the time that what I had taught her was that impactful or important. It’s not only that, as PGY-2s, we lack perspective about our potential impact on those we are charged to teach. As novice teachers, we may not question a hierarchical perspective of being a teacher: The sense that a good teacher is someone with content expertise, something we lack in our PGY-2 year. Teaching is more than just the transmission of knowledge, however; it is also the facilitation of a process. Good teaching is, among other things, about learning together. Not knowing, tolerance of ambiguity and complexity, and knowing where to look and whom to ask are all key
parts of good teaching. Seeing teaching as a facilitative process rather than simply the imparting of knowledge is a shift in vision that is related to what often goes unarticulated about really satisfying, good teaching. Teaching is also an opportunity to learn. Here is what I wish my “PGY-2 self” knew: As daunted and excited as you, PGY-2 resident, may be as you are presented with the prospect of having to “teach” in the absence of confidence in your content expertise, embrace your journey and not knowing. Be curious and open. In as much as being a good teacher relates to content expertise and teaching skills, it is also about something less tangible and concrete—the relationship between the teacher and learner, that the teacher is a learner still and always, that knowledge is constantly evolving, and most of all, the joy of being some small part of something greater than yourself. Disclosure The corresponding author states that there is no conflict of interest.
References 1. Palmer P. The Heart of a Teacher, from http://www.couragerenewal. org/parker/writings/heart-of-a-teacher. Accessed on October 21, 2014. 2. Bridges W. Managing transitions, making the most of change. 3rd ed. Philadelphia: Da Capo Press; 2009. 3. Bowlby J. A secure base. New York: Routledge; 1988.
