Explicit Instruction and Implicit Message

A few years ago, a college senior approached me after the first meeting of my Cognitive Neuroscience class, during which I had given the somewhat obligatory overview of both the content and the structure of the course. The student began with a flattering “This class looks really interesting and you seem like a fantastic lecturer” and then quickly moved to her question: “Is there any way you would consider dropping the requirement to write a term paper?”  Setting aside my shock at this bold request to revise my carefully planned syllabus, I realized I could turn this question into one of those sought-after, fortuitous “teaching moments”: “I think the paper assignment is one of the most important parts of the course. Long after you have forgotten all the details of cognitive neuroscience, improved writing skills will be useful for the rest of your life.” I smiled, proud of my response (and the fact that I suppressed my first reaction!), until the student countered: “But I have already decided what I want to do after college, and it’s not a career where I need to write.”  A laundry list of career options flashed through my mind as I tried to imagine to which writing-free career this young woman was heading: “Really?”, I asked trying to sound more curious than incredulous, “What are you going to do?” Confidently, the student answered, “I am going to be a scientist.”

As I have retold this story over the years, my tone has changed from bemused condescension (“what a naïve youngster—how does she think scientific discoveries are communicated?”) to concerned discomfiture. This student surely arrived at Penn with her own ideas about what “being a scientist” entailed, perhaps excluding writing. However, by the time she reached her senior year, what had we done to disabuse her of the notion that scientists do not write? I have no data about the percentage of science courses in which a term paper is assigned, but I do routinely poll my students about the number they have written, and the modal number each semester is usually 1 or 0. If this is truly a trend then we are implicitly teaching our students exactly what this young woman voiced to me: scientists do not write.

It is not my intention here to single out either writing skills or science courses for critique. Rather, there is a more general point that this incident has led me to realize: Students are not only learning what we teach, they are learning how we teach. The material we choose to teach, the readings we assign, the way in which we evaluate learning, and the enthusiasm we convey for our discipline—these lessons remain with our students long after the words and images on our PowerPoint slides fade. I realized that I spend much time thinking about the explicit instruction I am providing, but not nearly enough time thinking about the implicit message I am sending.

Since coming to this realization, I think about my conversation with that student every year as I plan my syllabus for Cognitive Neuroscience. Yes, I want my students to learn where the parietal lobe is, what prosopagnosia means, and who Paul Broca is. But, more importantly, I want them to learn that cognitive neuroscience is an exciting, dynamic field where clever experimentation is continually revising our knowledge about the mind. My students now participate in small “journal club” discussions of recently published findings, they attend colloquia, research seminars, or experiments to see research in action, they spend less time on exams regurgitating “facts” than explaining arguments, and, of course, they write. After all, they may one day become scientists.

Building Block of Information

The conservationist, John Muir, once said, “When one tugs at a single thing in nature, he finds it attached to the rest of the world.”   It is this concept I am most passionate about instilling in my students.  It is not surprising that most dental students attending my class for the first time are generally focused on learning how to treat the teeth and gums only.  My goal is to help them envision each patient not as a mere set of teeth, but as a whole entity, and to help students understand their role as practitioners contributing to their patient’s overall health. 

Dentists are part of a larger health care team and play a critical role in screening patients for systemic diseases. Consider the fact that it is not uncommon for an individual to go years without visiting a general practitioner, and yet most people see their dentist every six months. Consequently, the dentist may be the first practitioner to notice symptoms that signal problems elsewhere in the body.  In many cases, these observations change a patient’s life.

Not long ago, I treated a patient with aphthous ulcers in the mouth.  Sensing that these lesions might signal anemia, I sent him for a blood evaluation.  The results confirmed anemia and led to further examination, at which time a precancerous bleeding polyp was found in his bowels.  Since the ulcers were the only sign or symptom the patient was experiencing at the time, this polyp may never have been discovered had the focus been solely on treating his mouth.

Thus, I try to convey to my students the idea that everything they observe in their patient’s mouth is a building block of information or a piece of a puzzle. As dentists, regardless of their specialty, students must think critically about how those intricate puzzle pieces interconnect to help create a picture of the patient’s overall health. To this end, I urge my students to take every opportunity to collaborate with experts outside of their field of specialty. Such collaborations can help them increase their knowledge and broaden not only their medical perspective, but indeed, their world view.

For students juggling heavy course loads, the rigors of dental school can be overwhelming at times. In their desire to succeed, many students focus on obtaining fundamental knowledge. But to be a truly effective health care practitioner, students must be able to apply that knowledge in the clinical arena and to think critically about how it is relevant to patient care. I thoroughly enjoy when my students and residents spend time at my clinical practice where they learn first-hand the importance of taking their time with patients, drawing out information and truly hearing what those patients have to say.  I strive to teach them to listen not just to the responses, but to think about the implications of those responses and how they might lead to more pertinent questions.  And because each patient truly is an individual, I want them to see how similar answers from various patients can mean different things. 

As teachers, our responsibility is to instill knowledge.  As a health care practitioner, I want to help my students push that knowledge further to see how it might logically extend, and I encourage them to challenge themselves. If it doesn’t make sense, step back and look at it again, and if it still doesn’t make sense step further back and revisit the situation. As I think Muir would likely agree, it is only by stepping back that we can finally see the forest through the trees.