Teaching radiology: A few teaching points

By Stuart E. Mirvis, MD, FACR
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Dr. Mirvis is the Editor-in-Chief of this journal and a Professor of Radiology, Diagnostic Imaging Department, University of Maryland Medical Center, Baltimore, MD.

In the past 2 decades I have had lots of opportunities to experiment with different styles of teaching radiology. Obviously, some things work a lot better than others. I've made a few observations of my own that were new to me about teaching and have confirmed some others that my mentors and associates have mentioned along the way. Also, I believe I have discovered just about everything that can go wrong during the process of teaching both formally and informally. I would like to share some of these observations for your consideration. First, and I believe most importantly, most audiences do not want too much information. Most of what you preach as crucial information has a half-life of about 1 to 2 minutes, assuming it is attended to at all. Most attempts to make teaching points, rather than forming a permanent neural pathway, simply add heat to the room, increasing the chaos of the universe. Learning is an antientropic energy-consuming process, so do not overtax the system. At most, you should hope to convey a few points that you consider absolutely key. Those among us who teach, which at some time in our careers includes most of us, believe we must cover the entire waterfront on a given topic with everything we know, or think we know. After all, we are the assumed experts. But that is what textbooks are for, not lectures or instructing small groups or individuals. Too much material buries what is vital and perhaps reveals a lack of self-confidence as the speaker attempts to impress upon the audience his/her vast fund of knowledge, which will be on better display while handling questions.

I have found that tying teaching points to a little joke or story is the best way to cement the recall of any concept. For instance, an anecdote about how you missed the finding in a key case or an unusual clinical presentation that illustrated the point is useful. Years later, most people remember the radiologic observation as well, but, if not, they usually at least are still entertained by the story.

On the technical side, I believe that text slides should be simple, uncluttered, and pleasing to the eye. The background should not distract from the text; flying text, wild colors and patterns, and cartoons on the slide often distract from the teaching point. On the other hand, lots of slides illustrating the point and summary slides are very worthwhile. Also, try to use the laser pointer minimally and in short bursts. You can nauseate the audience by swirling it around the slides constantly.

Give the audience mini-breaks within a formal lecture. This allows the audience to wake up, refocus, and remember where they are and why they are there. Little cartoons, a brief joke (politically correct, if possible), or a short true anecdote are useful to fill these pauses. During a really long lecture, 60 minutes or more, allow a standing 3- to 5-minute break, perhaps with a question or two permitted.

During formal lectures, assume that everything will go wrong. The more formal and important the lecture, the more likely disaster will strike. Some lecture calamities I can report include: No CD drive on the supplied laptop to run my CD, bringing the wrong lecture, forgetting to change the name of the meeting on the title slide from the last time you used the lecture, bringing the 2-year old version of the lecture instead of the latest one with the cool volumetric images, and projecting the laptop desktop on the screen for the entire audience to see (revealing some things you would prefer to remain private concerning your various interests). Finally, perhaps the biggest calamity of all, the power can go out and stay out, as happened to me several years ago during an RSNA review course.

Some suggestions to deal with these pitfalls include: Bring your laptop along to run the lecture, if needed. Do not assume that the correct equipment provisions will always be available unless it's a large course that has an established track record. Bring the lecture on a "thumb" USB drive with a CD back-up, and load the talk onto the hard drive of the host computer. Run the spell-checker on the lecture the night before, as simple spelling mistakes are usually seen by the viewers and reflect poorly on your preparation. Make sure that movies run on the host laptop readily. Have a couple of logical end points inserted into the later half of the lecture so you can smoothly end the talk early, if necessary, to stay on time. No one knows what they missed, but everyone appreciates staying on schedule. Bring an extra favorite lecture to offer if another speaker is indisposed. Finally, make yourself very available after the lecture. Lots of folks with good questions, or other worthwhile points to relate to you, may not be comfortable speaking up in the formal question period.

In a small group or one-on-one teaching session, always set a relaxed tone. Nervous people do not participate readily and may learn poorly. Ask some easy questions about the material to first build confidence. Ask other people within the group some follow-up questions to keep them tuned-in. Praise accurate responses and insights. In your closing, offer one or two other pieces of information on the topic. If you are not sure about a point, do not attempt to convey it. I often ask a resident or a student to look up the topic and let the whole group know the gospel the next day. When teaching residents in another department, try to let them know you are friendly and nonthreatening, even if you are neither (save inherent hostility for your own residents-just kidding). Also, remember you are never as big a treat or as famous to your own residents and staff as you are when you are on the road. The folks you instruct at home already know your schtick, jokes, cases, etc., and they are allowed to yawn or fall asleep during your lectures.

Finally, have fun. Teaching should be enjoyable from either side of the podium.

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Teaching radiology: A few teaching points.  Appl Radiol. 

January 13, 2006
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