Training and Education
How I Teach
“How I Teach” is ASH Clinical News’ forum for sharing best practices
in teaching hematology to medical students, residents, and fellows.
We invite essays providing insight into teaching and modeling
clinical practice (history-taking, the physical exam, informed
consent, giving bad news), successful research mentoring, diseasespecific tips, or more general advice. In our first “How I Teach”
column, Dr. Keith McCrae writes about how to convey information
about complex hematology topics simply and effectively.
The “KIST” Principle
of Teaching
By Keith McCrae, MD
have been practicing hematology for a long time.
I have attended many ASH meetings, including
innumerable education, scientific, and poster sessions. After every session, I am rather astounded
by how much I don’t know. I have the same
impression after leafing through the most recent
issue of Blood, or most other journals.
When I received my first faculty appointment at the
University of Pennsylvania, I was asked to take on the annual platelet and hemostasis lecture to medical students.
I put a lot of time into preparing for this assignment —
incorporating what I considered to be timely information
on the latest in platelet function and hemostasis. I was, to
say the least, quite disappointed when I received the summary of the students’ evaluations of my lecture. However,
the pain was somewhat alleviated when I learned that
some of my colleagues with considerably more seniority
fared even worse!
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The students’ dissatisfaction with my lecture focused
mainly on the inclusion of too much information. “Too much
information?” I asked. “How could that be when I didn’t even
include the latest research findings? Don’t they understand
how interesting and important this is?” I wondered.
The answer was “No, they didn’t.”
And, like it or not, part of my education was to learn to
accept and appreciate the fact that they didn’t. Even more
importantly, they probably could become effective physicians without knowing all of this material.
Hence, though the term was not in common use at that
time, I realized that an effective teacher must, particularly
with complex topics, learn to follow the “KISS” design
principle developed by the U.S. military: “Keep it simple,
stupid!” However, since I like to think that all of us who
have the skillset to teach medical students, residents, and
fellows are actually quite intelligent, I have changed the
phrase to “KIST”: “Keep it simple, Teacher!”
Why KIST? First, after a few days of self-analysis following each ASH annual meeting, I have been able to
reassure myself that not knowing everything discussed in
the Education and Scientific Sessions is OK. This material is actually very complex, is constantly changing and
being updated, and is always delivered by experts in the
field who have spent months preparing state-of-the art
presentations. In fact, if I come away from most of these
discussions being familiar with 75 percent of the material,
I am probably doing quite well. And this is in the context
of having attended ASH meetings for almost 25 years and
having a solid foundation in the understanding of many
hematologic disorders.
Teaching is essentially an exercise in effective communication. Effective communication requires a firm
understanding of the skills, limitations, and knowledge
base of the individuals with whom you
are attempting to communicate. These
characteristics differ significantly among
cohorts we teach — students, residents,
fellows, mid-level providers, etc.
In other words, it is important to try
to “step into the shoes” of those we teach.
To do this effectively, we need to understan