Happy Halloween!

As I look back upon my career as a faculty member at both a liberal arts college and several medical schools, I’ve come to the realization that this holiday is not a bad analogy for some things we all are familiar with—surprises both good and bad, sometimes a little scary… and at the journey’s end, a reflection of our perceived world and ourselves.

Example:  20 years ago last month, I started my first faculty position as an Assistant Professor of Biology at a small liberal arts college. Walking into that first classroom on the first day of classes was pretty frightening, because I did not know it all. As a graduate of a medical-level physiology Ph.D. program I had a solid background in the teaching of physiology, having taught it in lecture and/or lab to students in dental hygiene, nursing, dental, medical, and graduate programs. But I’d never taken gross anatomy or histology. So in that first Anatomy and Physiology class I was going to have to be an “expert” in both topics to students who had no reason to think I wasn’t.  The horror of it all to me.

I spent a good deal of my first semester staying one week ahead of the students in those weak areas.  In the next semester, it was Microbiology in which I was deficient. I had only taken one undergraduate microbiology course 14 years before, and unlike anatomy or histology there had been little cross-learning of this topic with physiology in graduate school, so I was on my own. I had help of course, including experienced faculty and excellent teaching resources that came with the textbooks. But it was a long way out of my comfort zone.  In fact, it was downright frightening!  As the years went by, I put on many other hats, some of which were better fits than others. I taught general biology, biochemistry, genetics, cell biology, and personal health, among other courses offered to a dozen biology majors and a few hundred non-majors.  From being trained as a Physiologist, I had become a Biologist.

So what were the lessons I learned at this liberal arts college? The first was this:  That it is possible to teach what many medical schools of the day would have been considered an insane teaching load of 16-20 contact hours with students per week instead of 16-20 contact hours per year. Second, it is not necessary to be THE expert on a topic in order to teach it well. Third, to achieve this adequacy required being very flexible and willing to learn new things. For example, while I couldn’t actually replace an ecologist in the planning and leading of field trips, I could teach enough of the basic principles to satisfy the needs of students in a Biology II class. This involved working with the ecologists on the staff, even following them into the field to see and experience how they looked at the biological sciences. The final lesson I learned, though I learned it late, was that there are always opportunities to be a scientist. That not all research takes place in the laboratory or the clinic. That being a teacher and being a scientist need not be an either-or career choice. That the principles of science could be applied to the science and art of teaching itself.

After several years at this liberal arts college, I made the life-changing decision to start medical school on a part-time-student-part-time-teacher basis, at a Caribbean location.  While I never did get an M.D., my faculty experience at this medical school led to other full time faculty positions at both allopathic and osteopathic medical schools. And out there, working up from smaller medical schools to larger ones, I learned still more.  For two years before I joined my current institution, I taught medical physiology from 8-10 a.m. five days a week, assisted in the anatomy lab another four hours, and lectured in a premedical prep course for another 8-10 hours per semester. Completely unlike anything I had done before, I had to teach a medical physiology course three times per year as the sole instructor.  By necessity I relearned physiology as an entire discipline to a level close to what I’d known as I was finishing up my first year as a graduate student. I became able to teach any physiology topic at the medical level with little to no advance prep, again adequately but not necessarily at the research specialist level. The flip side was that as the only physiologist, there was essentially no time off for anything else including travel, conferences, or research.

From this experience I learned that it is possible to be a sole medical physiologist with the same teaching load as that taught at the undergraduate level. If necessary, one can have at least 14 contact hours per week to medical students and an additional 1-2 hours over several weeks each semester to premedical students and still teach well. I firmly believe that had I not had seven years of teaching experience as a multidisciplinary biologist at the undergraduate level, I would have found it much harder be able to teach all aspects of physiology at the medical level at such an intense pace. Just as I had had to do at the liberal arts college, I worked 16-18 hour days that first semester to stay two weeks ahead of the students. Each semester after that I worked 12 hour days to try to keep up with the demand of keeping lecture content and other materials updated, write 75 new exam items every three weeks, and perform all the other duties required of an associate professor at a tiny school. Along the way I finally overcame the self-concept built in from graduate training that I was an “endocrine physiologist” or a “reproductive physiologist” or a “gastrointestinal physiologist” or any other specialist physiologist based on the research I was doing. And in so doing I did acquire a specialty after all… I became a specialist at being a “generalist” whole-body physiologist, as well as a specialist in physiology education!

It was these specialties, honed from the lessons in adaptability first learned at the liberal arts college, which I brought to both my current medical school and to an osteopathic medical college in the United States. But my lessons weren’t done. Both of these medical programs use an integrated curriculum, which was far different from anything I had experienced before.  Prior to helping design the integrated curricula of both schools, I had never had significant teaching-level interactions with either histologists, biochemists, pathologists, or clinical medicine faculty despite our having been colleagues for years.  Now not only was I going to interact with them, I was going to have to be able to discuss pathology with medical students with enough competency to help explain how the physiology dovetailed into it and both of them into clinical conditions/presentations.  I was going to have to do the same thing with microbiology, anatomy, histology, biochemistry, and pharmacology to appreciate the whole-system approach to medical education.

So once again, I dove into the new challenges of adapting to this integrated organ-system driven curriculum.  For the first time, I came to understand across several organ systems how the clinical medicine was driven by pathology and that driven by the four foundations of gross anatomy, microanatomy, physiology, and biochemistry. But the focus of any integrative approach would always be first and foremost the clinical aspect of these four foundations in disorders and compensations because that’s what our students were ultimately trying to master. Bringing the balance in teaching the appropriate level of physiology in such a systems-based curriculum while ultimately keeping the clinical focus was a challenge I had never before faced.

And this is what brings me back almost full circle to my days as a young assistant professor at a tiny liberal arts school.  Instead of having teaching resources located in a set of supplements to a textbook, I have access to several specialists in each discipline, all of whom are focused on the same tasks for their respective fields.  And yet, in a curious sort of way I have become a Biologist again, albeit a medical biologist.

To illustrate this, I’ll give a short example.  At my current institution we have a curriculum in which organ systems are split into a first-or-second semester component and a third-or-fourth semester component.  In one lecture I deliver in second semester Endocrine Systems, I deliver a significant portion of the basic science content for the hypothalamus and pituitary gland.  In the initial preparation for this lecture, I incorporate materials prepared by our module’s microanatomist (a neuroscientist by training) and from our module’s pathologist which mentions those pathologies most appropriate for students at this level to learn.  When I then stand before the class as the lecture presenter, I deliver not only physiology content but this other content as well.  As I do so, I am reminded of those times so many years ago now when I was just as far out of my field, delivering the details of dense connective tissue to biology majors, the presentation of viral gastrointestinal disorders to nursing students, or the principles of public health to non-majors.

The story is the same really.  We are all alike now, the physiologists of the undergraduate and the medical teaching world.  We have much to share with one another, and much to learn from one another.  And you know, that’s not really a scary thought at all.  Happy Halloween anyway.

Bruce Wright is a professor in the Department of Physiology at Ross University School of Medicine in the Commonwealth of Dominica, West Indies.  Bruce received his doctorate in Physiology from Louisiana State University Health Sciences Center in New Orleans.  Following two postdoctoral fellowships he taught at Thomas University in Thomasville, GA.  He also taught at the Medical College of the Americas in St. Kitts and Nevis, West Indies, the University of Sint Eustatius School of Medicine in the Netherlands Antilles, West Indies, and the Alabama College of Osteopathic Medicine in Dothan, AL.  Bruce has been a regular member of the APS for 22 years, most of those with the Teaching section as his primary affiliation. Bruce has served as Treasurer/Events and Awards Coordinator of the APS Teaching of Physiology Section since 2015.  He has presented work at EB and the APS ITL on APS learning objectives, novel teaching strategies and item objective formats, integrated curriculum design and implementation, and challenges in preserving physiology content in integrated curricula.