In her office at the School of Medicine, Darla McCarthy gestured toward a map of the human metabolism and said, “This is what I teach.”
Hundreds of chemical names fill the poster-size diagram, along with lines indicating their pathways for interaction.
But McCarthy, an associate teaching professor of biochemistry, quickly makes clear she isn’t teaching memorization.
“My goal is not for students to recall every detail, but to think about these processes and how they’re occurring inside themselves — to understand the concepts and then be able to apply them to a patient,” said McCarthy, winner of the UMKC School of Medicine’s 2017 Elmer F. Pierson Teaching Award.
In recent interviews, McCarthy and several other School of Medicine faculty members discussed their approaches to teaching. Their techniques varied and, especially for longtime faculty members, had changed over the years. Yet, everyone’s approach, to some extent, reflects a trend toward “active learning” and away from straight lecture courses.
Dean Steven L. Kanter, M.D., sees other common traits:
“Outstanding teachers share a drive to foster true learning — to help students construct meaning in their studies and eventually use their knowledge to provide excellent patient care and to advance medical research and education. And outstanding teachers tend not to see themselves as ‘producing doctors,’ but rather as cultivating the next generation of physicians.”
Making material vital
In teaching metabolism, McCarthy begins by helping students see the relevance to themselves. “I start with a discussion of nutrition. I have them do nutrition logs, track what they’ve been eating and how much they exercise. I have them ask, What am I putting in my body? And how am I using the energy?”
Only then does she bring the metabolic map into the discussion.
“I introduce different parts: This is the part you used right after you ate. This is the part you will use 17 hours later when you’re starting to enter a fasting state. And if you were to not eat for three or four days, this is how things would change.”
McCarthy, who also is assistant dean for curriculum, believes that approach lets students see how everything fits together, learning which parts are particularly important clinically, and how to use the map to answer questions.
For example, she said, “If you have a patient with lactic acidosis, and you’ve learned the key things about metabolism that could cause that condition, you can move on to treatment options.”
McCarthy says she loves biochemistry and teaching it, but is using less lecture time and more group and team projects with her students.
“I do a lot of dividing the class into teams and giving each a problem to solve,” she said. “They need to learn to work together, with other people, and they do. It’s good to see them become a cohesive team.”
McCarthy also helps move the teams along when necessary.
“Often we’ll stop in the middle and ask a question. Not a recall question, but one that requires students to think in the context of a patient’s illness, giving them chances to use the information with me there to see how they’re thinking.”
That’s the same teaching philosophy used by Mike Wacker, Ph.D., associate dean of academic affairs and physiology professor at the medical school.
“I really want students to think critically, to not memorize these physiological principles or physiological concepts,” he said. “I want students to think through them and understand them. That way, if a different situation or problem comes up, they can think through it and understand it.”
Wacker, the 2015 winner of the Pierson Teaching Award, finds giving students “relatable problems” sparks their curiosity.
“And once they have that curiosity, it really helps to foster learning,” he said. “That’s the approach we all try to take. Once they’re asking the questions, they’re the ones doing the learning, and they’re self-motivated at that point.”
Besides emphasizing the meaning and relevance of what they are teaching, both McCarthy and Wacker say they try to reach every student in some way.
For McCarthy, that means bringing in a weight lifter to discuss biochemistry in a way that interests students who exercise. Or giving extra attention to students who don’t take to her material naturally. She knows that while all students in medical school are bright and motivated, they have a wide range of strengths.
“I understand that some students are very good at, say, anatomy, which involves completely different strengths than biochemistry,” McCarthy said. “My goal is to help the students who really don’t like the type of thinking and process you have to do for biochemistry. I want to help them get comfortable with and appreciate biochemistry.”
Wacker said using a variety of activities helped him reach students who learn in different ways.
“Students’ questions can be surprising — what they’re inquisitive about,
and the ways they think about the material.”
— Mike Wacker
“There’s no one technique that works for every single student,” he said. “At UMKC, we take a diverse approach, with a lot of techniques and ways of learning. I lecture but introduce small problems during the lecture, to get them to think. We also give them small-group problems, clinical vignettes to work through, as well as team-based activities.”
Sometimes the technique is something light, even if the topic at hand is heavy. For instance during basketball season, Wacker might use a March Madness style “playoff” bracket to help students learn and remember which types of heart arrhythmia are more deadly than others.
In addition to shared teaching approaches, McCarthy and Wacker share work time, too. After 10 years at UMKC, Wacker has established his own research lab, and McCarthy is on his research team.
And in the classroom, they sometimes team up to teach Human Structure Function courses.
“We do a case study together on heart attacks that’s really good,” Wacker said. “It’s team-based and incorporates anatomy, physiology and histology. It brings concepts together and brings them to life in a real clinical situation.”
Both professors say they enjoy learning from their students, another benefit of getting everyone thinking and asking questions.
“Students’ questions can be surprising — what they’re inquisitive about, and the ways they think about the material,” Wacker said.
“And that’s the fun part of teaching. We all have a passion for our material, and it’s great interacting, taking their questions, and seeing what parts of each lesson they’re interested in.”
Changing with the times
Two of the School of Medicine’s more veteran teachers — Christopher Papasian, Ph.D., and Stuart Munro, M.D. — want their students to be able to adapt to new information and situations.
After all, that’s what they’ve done in recent years, with the shift toward active learning.
They both built reputations as engaging and challenging lecturers. Papasian won the Pierson Teaching Award in 2006, and Munro won the honor in 2012. Now, both incorporate substantial amounts of student-led activities in class, reducing their lecture time.
And neither seems to mind using new techniques to accomplish their longstanding goals for students.
“Work ethic is one of the most important things you have to learn, along with how to think about patients and their conditions,” said Papasian, who is retiring in December after nearly 20 years as head of the Department of Biomedical Sciences.
“I start my Medical Microbiology course now with a list of things we knew nothing about when I got my Ph.D. in 1982, starting with what caused AIDS,” Papasian said. “It’s not just memorization of facts, because the facts will change, and students won’t remember them when they graduate four years later, much less 20 or 30 years down the road.”
Papasian relied on his own work ethic when he revamped his course, pushing students to read and learn factual material before they came to class, and then challenging them with case studies and other problems to solve.
“It’s about developing a process: How do you think about a patient coming in with an infectious disease, which is what I teach,” he said. “And we go through the whole process, again and again, but changing variables — age, sex, country of origin, how fast symptoms come on.”
In this learning process, students experience how the changes might result in a different diagnosis, or a different treatment for the same illness, given a patient’s other variables.
And they ask more questions: What tests do you order? What do you do while you’re waiting for test results? What would you do differently if the patient had a previous heart attack, or high blood pressure?
Papasian also tries to teach students that, although it’s important to consider all the variables, it takes work and practice to develop a “mental highlighter,” to be able to discern what factors are important in a particular situation.
And as medical knowledge continues to expand, he said, “these things are going to become even more important — the work ethic, how to go about this, how to find things.”
The reality is that things change, Papasian said. “Fifteen years from now, the way you’ll treat a staph infection or strep infection will be different because the organism changes over time.”
Munro, who teaches the basic psychiatry course that all medical students take, also has seen change — and welcomes it.
“I like being an academic psychiatrist because the renewal process that it continually demands is rejuvenating and satisfying,” Munro once wrote in an article for the journal Academic Psychiatry. And that feeling hasn’t changed in his 32 years of teaching at UMKC.
Munro said shifting to team and group projects and shortening his lectures had led students to “play with ideas and information” that they previously might have just memorized.
“I’m actually teaching less, but student satisfaction and test scores have gone up,” he said. “We’re not here to get great scores; we’re here to learn. But it’s a measure, and one that has improved significantly.”
These results match research showing “that you get far more out of the time spent if they are doing the work themselves,” Munro said. “And it forced me to think through what would be the most important concepts to take away, even if I had less time to teach it.”
Like his colleagues, Munro groups students and gives each group a clinical case to analyze. The resulting reports are assembled and shared throughout the class, so students learn from one another, and are motivated to produce good reports because all classmates will see them.
“Each month starts with me being the primary teacher,” Munro said. “By the end of the month, that’s flipped.”
Munro also requires each student to identify a patient in clinic and, with the consent of the patient and docent approval, add an expanded psychiatric assessment to the patient interview.
“The typical patient doesn’t need this, of course,” Munro said. “But if something seems amiss, every physician needs to be able to conduct such an assessment. And with this assignment, they’re actually performing the exam and not hearing about it second hand. Invariably, they find the patient appreciates that they took 10 to 15 minutes to just focus on them.”
Munro uses the humanities “as a great teaching tool for finding meaning.” As an example, he assigns his favorite Hemingway short story, “Indian Camps,” to read and discuss in class. He then challenges each student to “find a piece from the humanities, that poem or piece of music that reaches you and won’t let go; that touches you in a way this short story obviously touched me.” He then encourages them to take it and mold their own presentation of it “into a clinical teaching moment for the many students that you will have the privilege of influencing.”
Munro said he wanted students to have a passion for learning, something that’s been his focus since his days as the first chair of the Department of Medical Humanities and Social Sciences, after being chairman of the Department of Psychiatry from 2002 through 2014. “That’s why I think the humanities are such a great tool. They cut past the rote memorization and open the emotional side in some way.”
Making the rounds
Many teachers don’t have to simulate clinical learning. Their teaching occurs in clinic and while making rounds.
That’s the case for Jill Moormeier, M.D., professor and chair of the Department of Medicine, whose teaching excellence was recognized by the 2016 Pierson Award. She sees clinical experience as a way to challenge herself and her students to be fully prepared, observant and dedicated to providing excellent care.
“It’s important for students to have that background knowledge from the classroom, and for me to have in mind what are the critical pieces of information for the learner to understand and then retain.” With that in place, Moormeier said, “effective learning can occur as one is taking care of patients.”
She believes learning in clinic can both cement and expand students’ knowledge, as well as her own.
“What sticks is the connection of the materials to a specific patient they’re taking care of, and then being able to broaden that learning to understand how another patient with a similar condition is the same and at the same time different,” she said.
David Mundy, M.D., associate professor in the Department of Obstetrics and Gynecology, also lectures and oversees students in clinic. He is affiliated with Children’s Mercy Hospital and Truman Medical Center-Hospital Hill, has extensive published research and helps oversee the school’s fellows in maternal fetal medicine.
As a result, he often shares his specialized knowledge to residents in clinic or medical students taking an elective on high-risk pregnancies.
Whether he’s addressing first-year students or working with fellows, he tries to convey that “for all the knowledge we have to retain, facts are less important than the process. Facts change, so you have to know how to question and evaluate, and to learn what’s normal and what’s rare.”
In Moormeier’s teaching, she stresses a mix of humility and inquisitiveness: “It’s important for the learners to recognize that the faculty doesn’t know everything, and that’s OK. As teachers, we model how you go back to the medical literature, and look up the answers and think about what you’ve read and analyze it and translate that into the clinical setting. Learners need to see that asking and answering questions is part of what they will do for the rest of their lives.”
And although there is much to learn, Moormeier said there is always lesson number one: The patient comes first.
“We’ll take care of the patient and then worry about studying for an exam or doing all that paperwork that’s sitting on our desk.”
Like his other medical school colleagues, Mundy sees changes in teaching. “In some ways, lecturing is harder,” he said, so he works to make his lectures engaging, sometimes presenting information in a game-show format, or with unusual and memorable examples.
“But being in a teaching environment has real benefits in practice. New students and new faculty can challenge how we think and how we do things.”
Moormeier agrees. “Students think about things in ways you hadn’t thought about them before. Their newness to the clinical setting brings a fresh vision to how we think about things and how we approach patients and their problems.”
In many ways, she says, “Students challenge us every day.” •
Award-winning docent makes his mark
“Teaching is my passion,” said Amgad Masoud, M.D., Gold 3 docent. “My top priority and responsibility is to keep my learners focused, excited and engaged.”
Amgad Massoud, M.D., wants to make knowledge stick.As students at the School of Medicine quickly find out, some of their most important lessons are learned in their docent unit, consisting of a diverse group of their peers led by an attending physician. Masoud, who has guided third- through sixth-year students since joining the faculty in 2008, relishes the role.
“The learning environment is an important key to success,” said Masoud, who also serves as a docent for beginning students and received the Outstanding Year 1 and Year 2 Docent Teaching Award in 2013, 2015 and 2017. “I work on providing a quiet and friendly environment, with a focus on making them comfortable, motivated, and willing to cooperate and engage as a group with team spirit.”
Many of his teaching techniques emphasize student involvement, as well. “One time I decided to simulate the patient myself, and had students ask me about my chest pain,” he said.
“We continued till they built the full description of the pain and recognized the cause. Then I switched to simulate another patient.”
And rather than launch into a lecture when a subject is introduced, Masoud challenges students to “think and present what they know about this topic. Then I collect and summarize what they say and start my lecture from there.”
Often at the end of a learning session, he asks students to mention one thing learned that day. “This way, they repeat 10 to 12 new learning points in front of each other.”
Varying his techniques and getting students involved also help with another of his goals: Having students retain as much as possible.
“I repeat information in different ways, many times. When we discuss a disease in the morning, I make sure we see patients that afternoon who have the same disease. And I encourage them to take notes and review.