Putting Passion into the Medical Lecture

1. Putting Passion into the Medical Lecture Stories, Sex, and Songs in Microbiology

2. Oh give me a home where the parasites roamWhere the worms play in cheerful delightWhere the ova are shed, and the larvae are bredAnd the pinworms crawl out in the night

3. Home, home in the gutWhere the worms play in cheerful delightWhere the ova are shed, and the larvae are bredAnd the pinworms crawl out in the night

4. Oh hookworm am I, my ova go byIn your stool and then hatch in the mudThey punch through your skin, and migrate againTo the gut, where they suck out your blood

5. Home, home in the gutWhere the worms play in cheerful delightWhere the ova are shed, and the larvae are bredAnd the pinworms crawl out in the night

6. I live in the stream of the bile that's greenI'm Clonorchis, so please get it rightAnd my life's greatest wish is to enter a fishAnd then you with your sushi tonight

7. Home, home in the gutWhere the worms play in cheerful delightWhere the ova are shed, and the larvae are bredAnd the pinworms crawl out in the night

8. Please come swim with me, so that we can be freeTo burrow into your bare legsWe just copulate, so we can populateYour liver with our extra eggs Schistosoma mansoni adults

9. Home, home in the gutWhere the worms play in cheerful delightWhere the ova are shed, and the larvae are bredAnd the pinworms crawl out in the night

10. Problems However, virtually all of the recent U.S. growth reflected rising proportions of degrees to non-U.S. citizens: more than half in engineering and computer science and nearly 45% in the physical sciences. -NSF: Science and Engineering Indicators 2008

12. Proposition • Love of science, or of some particular area of science, is not a skill to be learned, it is a contagion to be caught. • It requires: • A susceptible host • An infected source • An efficient means of transmission • The medical lecture can be, but rarely is, an efficient means of transmission. • Can you tell what subject I teach?

13. Outline – Things I’ve Learned About Teaching • Stories: incorporating narrative and active learning into lectures. • Sex: helping students put material into context more effectively. • Songs: bringing your life-experience into the lecture hall You will need paper and something to write with!

14. Telling Stories “Against her father's wishes, Scheherazade volunteered to spend one night with the King. Once in the King's chambers, Scheherazade asked if she might bid one last farewell to her beloved sister, Dinazade, who had secretly been prepared to ask Scheherazade to tell a story during the long night. The King lay awake and listened with awe as Scheherazade told her first story. The night passed by, and Scheherazade stopped in the middle of the story. The King asked her to finish, but Scheherazade said there was not time, as dawn was breaking. So, the King spared her life for one day to finish the story the next night… From theThousand and One Nights, trans. Richard Burton

15. Cases as Stories • We all use cases in teaching, hopefully. • Involving students actively in cases transforms the lecture hall. • Pose a case; ask a question; ask the students to commit to an answer and then discuss it.

16. Case-Example • A 37 y/o man was admitted with acute leukemia, and received two rounds of induction chemotherapy • After the 2nd round the patient became profoundly neutropenic (ANC <100/µl) and developed fevers without a clear source • There was significant construction taking place on the unit during the patient’s stay • Empiric antibiotic therapy was begun, but the fever persisted • New infiltrates were seen on chest X-ray

17. Case (cont.) • A bronchoscopy with biopsy was performed and revealed this organism • What is the most likely diagnosis? A. Aspergillosis B. Mucormycosis C. Candidiasis D. Fusarium infection Rather than nattering on about this teaching technique, I’d like to demonstrate it.

18. Assignment: Why Do You Do What You Do? • For the money? • Because your parents made you? • It’s important • there are lots of important things to do in medicine and elsewhere. • You love(d) it • At least for a moment, sometime. • Assignment: reflect on when you ‘fell in love’ with what you’re doing now. Write about that experience. • What attracted you to it? • Where were you? • 1 minute. • Discuss with your nearest-neighbor. 1 minute.

19. More Stories – Teaching the Narrative • Developing a personal style is part of growing as a teacher. • Observe good teachers, and what they do. • Two of my mentors from Yale. • Frank Bia • Historical stories (Malaria) • Marie Landry • Personal and family stories (EBV)

20. December 7th 1941

21. April 1942: Maximum extent of Japanese control

22. Allied use of antimalarials after Dec. 1941“Orders of the War Production Board - April 1942” • Remove all quinine from the market. Quinine will be used only for malaria therapy. Appeal for supplies of all cinchona alkaloids, and begin tree plantings in Costa Rica. • Increase the production of atabrine (quinacrine) and increase research on its pharmacokinetics. • Find something better than atabrine….and soon.* Feder A. Published on solar hypersensitivity to atabrine in New Guinea/WWII These slides used by permission, Dr. Frank Bia

23. Case 7: In May, an 18 yr old College freshman presents with fever, cervical lymphadenopathy,and exudative pharyngitis Pre-illness Senior Class Photograph in Catholic high school (No dates)

24. Tonsillitis with palatal petechiae

25. Shortly before the onset of illness in spring of freshman year in (non-Catholic) college (Lots of dates & opportunities for saliva transfer) What viruses are In the differential? What simple tests would help? These slides used by permission, Dr. Marie Landry

26. My Stories I like to personalize the microbes, the immune system... The Ascaris life-cycle. The life-cycle is the key to the parasite!

27. Ascaris lumbricoidesLife Cycle & Transmission • Eggs produced at a rate of up to 200,000 per female per day • Develop in soil for ~3 weeks before becoming infective • Exceptionally resistant forms, can embryonate successfully in 2% formalin or 50% nitric acid • Can infect a host after 10 years of storage. • Have been found in windblown dust and on circulating banknotes. • Prepatent period is about 2 months.

28. SEX Put the hay down where the goats can get it. –George Wallace

29. 2005 ASM Carski Lecture • Carski Award is the ASM Undergraduate Teaching Award • Carolyn HovdeBohach from U. Idaho • She didn’t have any great intellectual framework for teaching • Presented seventeen suggestions • Teaching as an activity where the details matter; where execution is essential • #12: Encourage students to Hear it, Write it, Say it!

30. Teaching Microbiology with Sex • I wanted to encourage the students to talk, or at least think, about Micro outside of class; outside of the usual context. • I decided to develop examples; • “Who you gonna call?” • This turned out to have an entirely different sort of value • Contextualize the major points of lectures in a unique way • Yes, they’re lame. Relentless lameness is a style all its own.

31. Who You Gonna Call? • Talk to someone about this material today! • I don’t guarantee these lines will work, but they’ll at least arouse curiosity, and that’s a start.* • Did you know that there are two major causes of fatigue, stiff neck, fever and sweating, and only one of them is meningitis? • Hey baby, I know you don't have meningitis-related photophobia, but what do you say we turn out the lights anyway?** • I probably shouldn’t say this to someone I just met, but in addition to protecting children from meningitis, the Haemophilus vaccine protects all of us via herd-immunity. So it’s safer these days to have children. I’m not saying immediately, of course… • You know, I’m feeling dizzy and disoriented around you. It’s probably just your fabulousness, but just in case it’s meningitis, you might want to make yourself eligible for menigococcal prophylaxis. • Most human bites don’t become infected, but just in case, Dr. Campbell taught me how to manage them, so if you lose control tonight, it’s OK. *unless they get the restraining order first. **Contributed by DhruvKullar, Class of 2013 Legal Notice: There’s lots more of this to come, so you’ve got plenty more chances to assess my mental status!

32. Impact • I use these instead of a summary of my main points. • They paid attention. They laughed. • Students mention these in their evaluations. • Some students thought enough about the material to write their own.

33. Assignment: Translational Research • Think of a major finding or recent lesson from your research or clinical life. • Write it down. 30 seconds. • Explain it to your neighbor. 1 minute. • Turn it into a conversation with a potential romantic partner, current romantic partner, parent, or child. 1 minute. • Tell us about it.

34. SONGS “If the only tool you have is a hammer, you tend to see every problem as a nail.”— Abraham Maslow (1908-70), American psychologist

35. Tunes! • Why? • I’ve been writing songs for a few years. • I love American and English folk music, and the African-American Spiritual traditions. • You always hurt the ones you love.

36. The Songs • I give about 15 lectures in the course • Major topics with 2-4 lectures • Insect-borne bacteria • When The Ticks Go Marching In • Fungal infections • Fungi, Come Again No More • My beloved worms • Home in the Gut • A scattering of other topics • Tuberculosis • Tuberculosis • Prion disease • Clementine, a Prion Tragedy • Microbiology Review • What Shall We Do With the Infected Patient?

37. Impact • I have Powerpoints to accompany the songs so they see the lyrics, sing the lyrics, see the bugs. • They pay attention. They laugh. • Students tell me they remember the lyrics, even years later.

38. Assignment: Passion in the Lecture Hall!! • Write down something you’re passionate about outside of science or medicine. 30 seconds • Remember, when you’re good with a hammer every problem is a nail… • Think of a way to connect that outside passion to your professional interest. 30 seconds. • Discuss with your neighbor. 30 seconds.

39. BE PASSIONATE ABOUT TEACHING • Passion expresses itself both in what you say, and how you say it. • Voice • Content • Expression

40. Content -- Have Something to Say • Content is important. • Be intentional about selectingmaterial • Less isn’t necessarily more, but it can be • Be intentional about organization and flow • Consider concepts like narrative and suspense • Think of lectures as artistic as well as cognitive constructs

41. Content – Aim to Inspire • Think about the words you use to describe your work • Is it: • Interesting? Fascinating? Remarkable? • Is the biology • Elegant? Bizarre? Intricate? Delicate? Robust? Deeply Cool?

42. Show Your Passion • If you’re speaking on your profession, you’re speaking about what you spend most of your waking hours doing. • At some moment in time, however deeply buried, you must have had a spark of passion for the topic, or you wouldn’t have devoted your life to it. • Showing that affection for the material to your students is a minimal requirement for teaching well.

43. A short polemic • Biomedical science deals with the essential mechanisms of life and death; the machinery of birth and love and music and all human activity; machinery of astonishing complexity, baroque intricacy, and fundamental importance. • The practice of medicine is among the most compelling activities of our society, as measured by the prevalence of TV dramatic series. • Why, then, are our publications and spoken presentations so dry? • Cultural – scientific objectivity • Systemic – we haven’t made expressing the joy of our work a part of our work.

44. Assignment: Appreciate What You Do • Describe your professional activities in a sentence or two. 30 seconds. • Complete the following sentence: ‘This stuff is wonderful because’: 30 seconds • Share with your neighbor.

45. CHALLENGES • Incorporate this into your next talk. • Find a way to talk about it to a non-scientist.

46. ""I am among those who think that science has great beauty. A scientist in his laboratory is ... also a child placed before natural phenomena that impress him like a fairy tale. ... We should not allow it to be believed that all scientific discovery can be reduced to mechanisms, machines, [or] gearings ...“ -Marie Curie

47. Who You Gonna Call? • Talk with someone about teaching today! • “You know, getting students to interact during a lecture is a life-changing experience. Much like a night with me.” • “You think scientists are dull? I can thrill you right down to your DNA!” • “You know, you’ll never forget Doing It with a teacher <pause> …because there’s a test later.”

49. You catch tuberculosis and whadda you get?Cough and fever, fatigue and night sweatIt’s an aerosol spread, so put on that gearThere’s M. tb on the acid-fast smear.

50. Could be from a place with lots of TBA family member; a contact, you see. Homeless or from prison, open up your eyesTo HIV, immuno-compromise…