Reflections on Education – Machines or Mentors: Mentors and Mentorship. Education Excellence Lecture 2004

The Ivan T Beck MD Gastrointestinal Diseases Research Unit, Division of Gastroenterology, Departments of Medicine and Physiology, Queen’s University, Kingston, Ontario Correspondence and reprints: Dr Ivan T Beck, Hotel Dieu Hospital, 160 Brock Street, Kingston, Ontario K7L 5G2. Telephone 613-544-3310 ext 3058 or 613-544-0225, fax 613-544-3114, e-mail becki@hdh.kari.net Received for publication June 28, 2004. Accepted September 23, 2004 It was a great honour to be asked to give the Education Excellence Lecture for 2004. Dr Desmond Leddin, our President, asked me to give a talk on the motivation for my work in this area, and what I would recommend to physicians contemplating a career in education. In preparing this talk, I had three issues to decide on: who was my audience; how was I to deal with today’s pressure to use electronic equipment for learning; and, regarding my own motivation, how personal could I be about my own life experience. Membership in the Canadian Association of Gastroenterology (CAG) has recently exceeded the 1000 member mark. At the time of my lecture, there were 634 active and 370 senior members. Of the acting members, 498 were gastroenterologists, 59 were basic scientists, 43 were in other medical specialties such as surgery, radiology and pathology and the remaining were GI nurses, research technicians, etc. Of the 370 senior members, most were gastroenterologists and clinical and basic scientists. Thus, the audience consisted mostly of gastroenterologists and basic scientists. I have been the educator of gastroenterologists and surgeons. Some are in private practice, others are clinical teachers and many have become clinical investigators. I have also been the teacher of many basic scientists, and I could talk about how to stimulate science students to become investigators or residents to become devoted clinical gastroenterologists. Today, however, I will concentrate on how to stimulate residents to become clinical investigators and educators. A clinical investigator is a physician who, in his or her clinical practice, critically observes patients. If the investigator notices the unusual – a symptom or relationship that does not fit into regular textbook medicine – he or she starts to consider that something new may have been discovered. Theories are built on new observations, and available scientific methods are used to prove or disprove a theory. If the results of the assumption prove to be correct, the finding is applied and new medical knowledge has been established. Involvement in research allows the investigator to meet internationally established clinical scientists and teachers at scientific meetings. This helps the researcher to gain knowledge in the newest developments in his or her field and, thus, become a better teacher and clinician. Most important, to be a good educator, the investigator should never be removed from practical medicine, closed up in a basic laboratory, but must instead remain a humanitarian clinician serving as an example and mentor for future generations (Table 1). There may be a variable balance emphasizing the model of a clinical teacher or that of a clinical investigator. These valued individuals need not be attached to a university because many community physicians do outstanding teaching in their own environments and participate in clinical research. Many of my previous residents who are in private practice are doing exactly that. The second decision I had to make was whether I should discuss the effect of recent overwhelming pressure to use electronic machines for teaching. Many believe that computers and machines are the most important part of new developments in medical education. To some, today’s ideal of a medical teacher may be either a PhD ‘education expert’ or a clinician who is adept in using educational technology. Machines, however, are not new. The first communication for education was a chisel on stone, where information was rather laboriously transmitted from one individual to many. The next development was stylus writing on papyrus and then the pen on paper. Early books were written and rewritten with outstanding penmanship. The big change occurred when Johann Gutenberg invented the press, producing a full reproduction of the Bible in 1456. The press was the first computer, which allowed rapid multiplication of knowledge. Electronic computers are nothing more than a newer method of extra rapid distribution of knowledge and, except for speed and ease of distribution, are no different from what one used to obtain from extremely rapid distribution of books and journals. Compact disc lectures facilitate the teaching of facts and are irreplaceable in the transmission of knowledge. However, they are inept at providing the philosophy and approach that mentors, in the tradition of Socrates, can provide. Computers today can interact with students, but the personal approach provided by body language cannot be replaced. In short, no one has learned from the chisel, internet or a PhD educator how to become a clinical teacher or investigator; only clinical mentors can provide that (Table 2). Having decided not to spend more time on the influence of machines, I can now discuss how I became a clinical investigator and teacher, and how I would influence others to take up a similar career. I chose academic medicine because of the influence of my mentors, and I continue this path postretirement as a duty to my mentors, teaching and interacting with young people who may be influenced to undertake a similar career. EDUCATION EXCELLENCE LECTURE