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Learning from Bedside's Best
New Lecture Series Celebrates 'Great Teachers,' Physicians

By Carla Garnett

On the Front Page...

Dr. Paul Plotz, chief of NIAMS's Arthritis and Rheumatism Branch, recently made a discovery that had little to do with his research as a rheumatologist: He found that he was...hungry. Not for food, but for the rush he had as a physician just beginning his practice. There is an interaction with patients and with other doctors that belongs uniquely to clinicians, Plotz notes, and as he became more involved with his narrow corner of medicine and research, he found himself farther and farther from general clinical practice.


Coincidentally, Plotz was asked to chair the NIH/FAES continuing medical education (CME) committee that was seeking to enhance CME on campus. Plotz and his committee conducted an NIH-wide survey of physicians and identified several clinical topics of immediate interest to physicians. Based on the survey results, the committee went in search of the best physicians to handle the topics. Now, with the NIH Office of Education and the strong support of NIH deputy director for intramural research Dr. Michael Gottesman, the scientific directors, Clinical Center director Dr. John Gallin, the medical executive committee and FAES, the CME committee will cohost the first annual "Contemporary Clinical Medicine: Great Teachers" series, a new component of Grand Rounds at the Clinical Center. Speakers from across the nation and even abroad were selected based on their expertise in clinical management as well as their effectiveness as teachers and presenters.

A more informal survey among Plotz's peers revealed that he was not alone in missing the practice of medicine: Many other physicians who had come to NIH fresh from clinical environments now find themselves immersed in their studies at the bench or in increasingly specialized clinical practice, and feeling far removed from the daily requirements of attending at the bedside.

Plotz says he and many of his colleagues would enjoy refresher sessions on the latest in clinical practice. "A lot of us in the labs miss the vigor and energy associated with seeing patients," he explains. The new lecture series will be one way such researchers can get back in the swing of it.

"The viewpoint will be from the bedside and the emphasis on the practical," according to Sylvia Scherr, executive director of CME in NIH's Office of Education. "There will be some novel teaching techniques, including those that engage the audience in a participatory interaction."

The tableau — ailing child, concerned parent and intrigued physician — in this late 19th century oil painting The Doctor by artist Sir Luke Fildes, provides the perfect illustration for "Great Teachers," a new Grand Rounds lecture series on contemporary clinical medicine that begins in September. Permission to borrow the image for series flyers was granted by Tate Gallery.

In one such lecture, neurologist Jay Preston Mohr, Sciarra professor at Columbia University's Neurological Institute, will examine a patient and discuss the findings, says Plotz. In another, physician-teacher Dr. Faith Fitzgerald, assistant dean, office of medical education at the University of California, Davis, will be presented with several difficult and perplexing cases; she will lead the audience through her reasoning process.

Plotz and his committee hope the series will accomplish at least three goals: deliver current practical medical advice to the hospital's physicians, preserve the tradition of great teaching lectures at NIH and help excite physicians who may have strayed far from their original clinical interests.

"I'd like to fill the auditorium every time with enthusiasm," Plotz declares. "I want this series to make non-clinical people sit up and take notice too. Clinical practice techniques move very fast. In 6 months or a year, there's a new way of doing this or that. The content of these lectures may go out of date quickly, but what will last is the great teaching. The subject matter will be gone in 5 years; the great teaching will still be true."

Besides Plotz, Scherr and committee deputy chair Dr. John Hurley, other members of the CME committee who helped put the series in place include Ione Lagasse, Fred Gill, Art Atkinson, John Hallenbeck, Steve Marks, Ron Gress, Alan Schechter, Bob Adelstein, Douglas Brust and Clair Francomano.

The fall 2001-spring 2002 monthly series opens at noon on Wednesday, Sept. 12 with world renowned cardiologist Dr. Eugene Braunwald, the Hershey distinguished professor of theory and practice of physic at Harvard Medical School, and former clinical director of NHLBI. He will be introduced by NIH acting director Dr. Ruth Kirschstein.

The series continues in October with neurologist Jay Mohr; November — Dr. Richard Wenzel of the Medical College of Virginia, lecturing on hospital-acquired infection; December — Dr. Norman Kaplan of the University of Texas Southwestern, lecturing on hypertension; January — Dr. Samuel Katz, Wilbert Davison professor emeritus at Duke University, lecturing on immunization; February — Dr. Robert Kreisberg of University of South Alabama, lecturing on diabetes; March — Dr. John Bartlett of Johns Hopkins, lecturing on HIV infection; April — Dr. Irwin Merton Braverman of Yale, lecturing on skin signs of systemic disease; and May — Dr. Anthony Miller of the German Cancer Research Centre in Heidelberg, lecturing on screening for cancer. The 10-lecture series concludes June 12 with Dr. Faith Fitzgerald discussing mysterious cases.

What Makes a Great Teacher?

Dr. Paul Plotz, chief of NIAMS's Arthritis and Rheumatism Branch, and members of the continuing medical education committee he chairs spent several months on a mission: Find the best physician-teachers outside of NIH and offer them an opportunity to address the audiences that gather for the Clinical Center's Grand Rounds every week. But how did the committee determine what makes a good teacher? Ask 10 people and you're guaranteed to get 10 different answers, Plotz found.

"Oh, it's many different things to many different people," he explains. "Good teaching is an interaction between the audience and the instructor."

Sylvia Scherr, who directs continuing medical education in NIH's Office of Education, had another idea. "I think a great teacher is one who leaves you changed by the encounter," she says. "Forever after, you are a little bit different because of that experience. You may have a different viewpoint, a deepened understanding or a new interest in the topic. You will be inspired to want to learn more. Great teachers have a variety of styles and presentation methods, but they all share several qualities: they all are extremely knowledgeable in their area of expertise, both in depth and in breadth; they all can synthesize complex information into clear and easily comprehended material; and they all have energy and enthusiasm for the information and a strong desire to communicate it to others. Learning is a journey and we all learn incrementally. Certainly there are 'teachable moments' when we are most open to learning; a great teacher has a knack for creating those teachable moments more frequently and in more people."

Committee member Dr. Robert Adelstein, chief of NHLBI's Laboratory of Molecular Cardiology, agrees that a great teacher is defined by the impact he or she has on the student. "In my mind," he says, "a great teacher is one who raises your aspirations."

Another CME committee member, Dr. John Hurley, director of the Clinical Center's pediatric outpatient service, made a 6-item list: A good teacher, he begins, is "one whose own personality is compelling — these are individuals who have the skill to engage a learner. The learner wants to listen to them. [Great teachers are] knowledgeable — they possess the information and the experience to speak with authority. Great listeners — they possess the skill to elicit what the learner needs, rather than assuming they know what the learner wishes to learn. Interactive — they enjoy the chance to dialogue, and they are comfortable admitting their lack of knowledge. They don't bluff. Succinct — they set achievable learning outcomes. They don't try to teach 3 hours of material in 1 hour. Likeable — they come across as a respected colleague, who is respectful of the learner."

Plotz, who enjoyed the quest for great teachers and is already eagerly seeking illustrious instructors to fill the 2002-2003 series, explains that he comes by his love of great teachers honestly; his interest in preserving the tradition is only natural, he says.

"I was a student of some wonderful teachers," Plotz concludes. "I'm married to a wonderful teacher and I'm the father of a wonderful teacher, so I deeply value good teaching."

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