Twenty Nickels Make a Dollar

Department: 

Although I thought I had gone to medical school to become a clinician, it turns out now, twenty-plus years into my medical career, that I actually went to become a teacher. Early on, it became apparent that others viewed me as a good teacher. I did indeed enjoy teaching, so I chose to become a physician teacher of resident physicians and medical students, a role I have filled for the last sixteen years.

Early in my career as a teacher of medicine, I struggled with what it meant to be a teacher – specifically, what skills and background and techniques one should have. It is the darnedest thing that, although folks get their PhDs in Education, within the field of medical education, most folks become teachers of medicine with no formal training in the art and science of education. Some physician teachers undertake a one-year fellowship in either education or “faculty development,” but in my experience, the vast majority do not. There seems to be a common presumption that, just because you have been taught medicine by teachers, it follows that you, by an osmosis of some sort, have learned how to teach medicine yourself. It is likely an extension of that old medical adage, “See one, do one, teach one,” seasoned with some good, old-fashioned doctor hubris. 

One piece of advice that is often given to young doctors and medical faculty is to identify other physicians as role models and copy their styles – physician teachers you enjoyed, or were meaningful and impactful to you. My perceived problem was that, by and large, I did not see any overt mentors I wanted to emulate. In fact, for many years, I bemoaned that I lacked that one, great mentor – the person whose footsteps I wanted to walk in.

About five years into my teaching career, as I intentionally self-educated myself on adult learning theory, I more or less stumbled upon Parker Palmer’s book, The Courage to Teach, which was published in 1998 and became an instant classic. How had I missed it for the first part of my career? I had heard Palmer’s name in Quaker circles, but I came to find out that he has been a prominent voice in adult education and even medical education for decades, with an annual award actually named after him.

Courage to Teach is built on the foundation of two simple premises:

  • “Good teaching cannot be reduced to technique; good teaching comes from the identity and integrity of the teacher.”
  • “Renewing the inner lives of professionals in education” is crucial.

The book also emphasizes a few other key concepts, including:

  • Good teaching embraces the various seeming paradoxes or polarities inherent to teaching, such as: solitude vs. community, discussion vs. silence, and facts vs. feelings.
  • Good teachers bring their authentic selves to their teaching; “deep speaks to deep” and “uniting soul with role.”
  • Good teachers engage in active, ongoing self-reflection; they continually re-examine where their identity and integrity fit into their work.
  • Ultimately, good teachers embrace and nurture the “courage to teach.”

In the several workshops I have given in the field of medical education, I have used the following questions from Palmer’s work to provocatively stimulate teachers:

What are some of the noble reasons we become teachers?

What are some of the selfish, self-gratifying, or shadow reasons?

Recall a moment when you knew you were “born to teach” – a real high point or meaningful teaching interaction.

Recall a very difficult or challenging teaching moment. How might you handle it differently in light of what you have since learned and experienced?

Along with Courage to Teach, I have found touchstones in the books of Rachel Naomi Remen, a visionary physician who notably has created “The Healer’s Art” curriculum, now used at most U.S. medical schools. Remen pursues the noble goal of inoculating young doctors against premature cynicism. Her books My Grandfather’s Blessing and Kitchen Table Wisdom are nothing short of inspirational.

Remen’s formulation of the “Three Question Journal” has universal applicability: “What surprised me today?” “What touched my heart?” and “What inspired me?” I have used these questions countless times at the dinner table and around the campfire, to stimulate discussion and invite grace.

Over the last twenty-five years, I have seen many varied teaching styles work well. Some appeal to me more than others. There are certain techniques, tools in my tool belt, that I pull out from time to time, certainly in hopes that they will help my learners, but truthfully, also because I enjoy those particular techniques. I am more convinced than ever, though, that good teaching cannot be simplified to proper techniques. The art of teaching, the secret sauce, is genuine enthusiasm, a word that comes from the Greek “enthous,” meaning “by God, inspired.”

I was recently asked by an interviewer, “What do your students value about your teaching?” to which I cheekily replied, “I don’t really know; I suppose you would have to ask the learners that!” I hope what I bring is a genuine joy for learning, along with a deep sense of care for individual patients and for improving the overall system of healthcare. I hope I role-model “walk the walk if you talk the talk,” as well as “work well, play well.” I hope I role-model life balance, not just work/life balance, but overall life balance, of which a meaningful, engaging career should be an important part. Wendell Berry says it best, “. . . when we work well, a Sabbath mood rests on our day and finds it good.”

Although I may not have had the one overarching mentor in my career that I once sought, one of my bosses shared with me the following perspective: It is OK to learn a little bit each from numerous colleagues and sources, rather than one grand influence. “Twenty nickels make a dollar,” he said with a joyful twinkle in his eye.  ~~~

Keith Scott Dickerson, M.D., practices family medicine in Grand Junction, CO. He was selected as the 2020 Teaching Physician of the Year by the Colorado Academy of Family Physicians. Dickerson is a free-range Quaker who attends IMYM with his family whenever possible.

Please Subscribe

Subscribe or renew now to read all articles online.