A curator of knowledge, not a teacher

For Asher Dubb, one of my best teachers, and on why I am not a teacher, but a curator of knowledge.

I give a series of annual lectures on several intercalated BSc and MSc courses. A large number of the ‘intercalators’ are medical students who are taking a year out of their medical studies to get another degree. Sadly the prime reason to intercalate is to bolster your CV so that when you enter the job market you can tick one extra box on your application form to help get you that prime house job or training number you so desire. Do you need the extra degree and the inevitable debt that comes with another year of higher education? Intercalated courses are another sign of the educational inflation that continues to infect higher education. I came away from giving a lecture on Monday feeling deflated and depressed. My lecture was so last century. I really want another go at it using another format; a non-teaching format. My students deserve better.

Back in 1984, when I was a third-year medical student, I discovered active learning and I have never looked back. Our Professor and Head of Pathology, who shall remain nameless, would simply get up in front of the class and read his lecture notes, which we had to purchase as a self-published textbook. After two of his mind-numbingly boring lectures, I decided to decant to the library and teach myself pathology. The upshot was that I won the pathology prize that year and in my viva voce I got into a debate with the external examiner about the classification system of thymic tumours, a topic that was not covered in the undergraduate medical curriculum. My pathology experience taught me that formal lectures, which are primarily designed to deliver factual information, where a waste of time.

From fourth year I abandoned lectures for the sanctity of the library, only going to the occasional inspirational lecture when the reputation of the lecturer was widely known. The outcome for me was the opening-up of a world of self-learning and exploration. I soon started subscribing to medical journals and ignoring the list of recommended textbooks for more dense and esoteric texts. I realised that medical school exams set a very low bar and were not a good indicator of how much you knew and more importantly how much insight you had into the different subjects. I ended up loving knowledge and medical school.

In my final year of medicine, I took self-learning a step further and would make myself a pest by spending so-called ‘lecture time’ on the wards and in outpatient clinics with clinicians who inspired me. Medicine may be a calling or a vocation, but it really is an apprenticeship and the more you work with senior colleagues and the more you practice it the better you get at it. I recall Professor Asher Dubb, one of my heroes, getting very angry with me. I simply pitched-up at one of his very busy afternoon endocrine clinics at Baragwanath Hospital, in Soweto outside Johannesburg. I knocked on his door and asked if I could sit in with him. He looked at me, then asked me why I was not at lectures and said quite tersely that I should go away as this was one of his busiest clinics and he simply had no time to teach. Sheepishly I turned away exited the room and closed the door. I was halfway down the corridor when I heard him calling me back. ‘Okay’, he said ‘you can sit in on my clinic on the conditions that you keep quiet and listen, and that you ask no questions’. He reiterated that this was not a teaching clinic and that he had no time to teach. Despite these conditions, he taught me plenty. Before my 8-week block was up I was clerking and presenting cases to him, or some of the other endocrinologists, in this so-called non-teaching clinic. In Professor Dubb I had selfishly seconded a personal tutor. After 8-weeks of one-on-one teaching, I was almost an endocrinologist, which allowed me to nail one of my short cases in my final exams; a patient who had Graves disease a disorder associated with an overactive thyroid gland and eye movement problems. My examiners were particularly impressed that I knew how to prescribe and use carbimazole and I knew so much about how to monitor and manage its side effects. What I didn’t tell them is that I had learnt that from Professor Dubb in his clinic and not from some boring lecture or poorly written textbook.

Thank you, Asher, you taught me more about clinical endocrinology than any lecture series or textbooks could have in such a short period of time. You inspired me and so many others to become active learners.

The message is active learning. I realised after delivering my intercalated lecture on Monday that preparing lectures to transmit facts is so outdated that we should really stop doing them. With Google, TEDed, Wikipedia, etc. who needs another source of facts? From now on I am going to relabel myself as a curator of knowledge and prepare my lectures around existing content with the aim of promoting the four C’s of modern education; critical thinking, communication, collaboration, and creativity. This is going to require me to reformat all my lectures and to get my students to prepare for my lectures in advance. I plan to turn them all into tutorials with the explicit objective of encouraging the four C’s. I will not be there to transmit facts but to energise and teach my students to become active learners.