teaching styles

[Guest guest]

The other day, well, actually, yesterday, I mentioned to some interns that

in my fantasy teaching world all students would have bachelor's degrees

with strong science and liberal arts backgrounds. A premed degree from a

liberal arts college is one such example, but there are others. I got my

undergrad in biology and did some grad work in that area, but it did not

suit me to be a laboratory researcher. But my style of teaching was

initially influenced by this experience, especially the graduate classes.

I at least got an inkling of what kind of demands were on students at

traditional grad schools. This was basically the lecture format, large

classes, not much give and take. In addition, we generally did not have

the slightest idea what would be on our tests. In the grad classes, the

syllabi included 100's of pages of reading per week, none of which was

discussed in class, but which one was expected to understand for

examinations. If you didn't do ALL the reading before each class, you had

no idea what the professor was talking about. And these were plant

physiology classes, a subject I enjoy.

 

Anyway, some interns weren't too keen on this, pointing out that they

wouldn't have gone to acupuncture school if they had to have gotten some

sort of premed degree. Now clearly, there are many very skilled

practitioners who had no premed training. I was thinking more along the

lines that I would not have had to wrestle with how to change my teaching

style to accommodate students with more diverse backgrounds. To make a

long story short, I have not found this mid 20th century premed teaching

style to be effective at TCM schools, precisely because most of my

students have not been trained in that sort of academic environment. A

significant majority have bachelor's degrees, but not necessarily medical

or health oriented. To be fair, there are many other backgrounds that

have similar types of demands, such as philosophy, mathematics,

engineering, etc. But a person whose background is in the fine arts or

bodywork may have great skills and do exceptional at school in all their

classes and perform well in clinic, too. And they are certainly no more

or less " smart " than those who have studied science.

 

The important thing is to be able to hold on to information from semester

to semester, improving one's critical thinking and refining one's

understanding. If one thing doesn't work, try another. So little by

little, I have adapted my teaching style for the specific purpose of

increasing motivation and improving retention. At first, this felt like a

dumbing down process, because I was altering my style to cater to the

needs of the bulk of the class, rather than only those few with a hard

science or premed background. Now that, of course, was just elitist

condescension on my part. When everyone has similar backgrounds, it is

one thing to have a universal standard. If everyone was premed, you could

teach this way and so on ...

 

Now some professors don't like to teach what the profession call adult

learners. these are usually folks who have been out of school for a few

years with very diverse backgrounds but have converged on the same

profession for a myriad of unrelated reasons. One is thus challenged to

adapt to their environment. Well, the fact is that I am getting better

results with more student centered teaching. I make the tests challenging

and cumulative, but there are no surprises about what will be on them.

Classes are more interactive. Information is reinforced by regularly

questioning the class on concepts and data from prior lectures or basic

theory relevant to the topic at hand. Chinese Herbology does not lend

itself well to kinesthetic learning as a primary strategy, but I have put

more and more emphasis on the " sensory " qualities of herbs (taste, temp,

color, shape, texture, plant part) as a learning tool. Perhaps there is

something about using these kinesthetic clues that may activate other

parts of the brain not normally used for rote memorization of purely

written data.

 

I now no longer see this as a dumbing down process at all. If the results

are much better visa ve understanding and retention, then this is

definitely a smartening up process. It was dumb of me not to see this

from the outset and fortunate for me to have the guidance of an academic

dean who is a professional educator with a doctoral degree in her field

and a decade of real life experience. The best analogy I can think of to

sum up the strategy in a single line is " set the bar high, but let

everyone know exactly where it is. " It may not be easy to get there, but

at least you know where you are going.

 

Why is this important and even reasonable in this environment? First of

all, the stated purpose of most TCM schools is to train clinicians. If

one's interest is scholarship or research, additional work beyond the

master's degree in OM would be necessary. The master's has necessarily

focused on producing clinicians. When I studied graduate biology, most

students were taking about 9 credits a term in a 2.5 year program or so.

Same for my girlfriend in her anthropology program. I think this is

pretty typical. However, a second year PCOM student takes 17 credits a

term PLUS a 4 hour clinic shift. So the typical acupuncture student

spends more than twice as much time in class/clinic as a grad student in

biology. This dramatically reduces the time available outside school for

any given class. And clinic now includes various homework assignments.

So it is not really feasible to expect the same level of reading outside

class as in a purely academic grad school. It is also reasonable to very

clear about what will be on the exams. The goal is to insure that certain

core information is actually understood and retained. It does not matter

how that is accomplished, as long as it is accomplished to all parties's

satisfaction (student, teacher, institution, board). Making something

extremely difficult is only desirable if the process yields superior

results.

 

I always check with the herbs 2 professor every semester to see how I did

in herbs 1. It is not enough to know the students passed your own tests.

Its whether they have really learned anything. Then, later, I work with

these same students in clinic. In fact, with our new accelerated clinic

training, students now enter clinic the semester after they have my class.

So I will also immediately get to evaluate the results of my own

teaching as it translates to the clinical setting.

 

 

 

Chinese Herbs

 

 

" Great spirits have always been violently opposed by mediocre minds " --

Albert Einstein

[Guest guest]

, <@i...> wrote:

> The other day, well, actually, yesterday, I mentioned to some

interns that

> in my fantasy teaching world all students would have bachelor's

degrees

> with strong science and liberal arts backgrounds. A premed degree

from a

> liberal arts college is one such example, but there are others.

 

you raise some good points in this post. I am very heartened

to

see the educators on this list grappling with the questions of how to

improve the quality of TCM education. I believe that raising the

standard is the best way. In our Shang Han Lun class at ACTCM, one

could expect to be called on at any moment and expected to provide

commentary on any number of points from the text. You'd better

believe that people came to class prepared! Later when I studied in

China, my doctor in the internal medicine department did the same

thing, asking me to recite formulas or name the prescription she just

recited herself (and of course failure is often our greatest

teacher!). There is plenty of room for more demanding work in

curriculums at present. My friends and I managed to devote more time

(in hours) to learning the Shen/Hammer pulse system outside of school

than we spent in four quarters of Internal Medicine classes (not to

mention jobs and marriages). But these were all instrumental in

developing how I practice chinese medicine.

 

Recently a patient asked me if i ever feel awkward about parts of

chinese medicine. She suggested that it might seem funny to some

that

indirect moxa had any effect at all. I said that for me I don't

really see that at all. I guess, I said, that I've learned to see

the

body differently. And that's not just " blowing smoke. "

 

How did I arrive at that point? I have a bachelors in English

literature, and went on to study Classical Chinese after graduation.

That inspired me to begin studying acupupuncture. But I was already

habituated to letting what I study impact my life and understanding.

 

I came back East after graduating from Acupuncture school last year,

and I ran into an old professor who taught an intro to Asian art

class. I told him that sometimes I think back to his lecture on a

particular Ni Tsan painting, and it illuminates aspects of my work as

an acupuncturist. That, and classical chinese, influenced my outlook

more than the chemistry or physics i took before

entering

acupuncture school (though anatomy was pretty darn useful).

 

My main thesis here is that the critical activity of learning Chinese

medicine is learning how to think about and think through the

problems

of , which in many respects is independent of what

one

studied in the past. John Keats described Shakespeare as having

great

" negative capability. " That is, the ability to hold two contraries

in

tension without negating either one. I'm no linguist but that

reminds

me of words like duoshao (how much) in Chinese. Between these two

extremes of alot and a little, the concept of quantity develops. To

me

that is critical to functioning in chinese medicine, rather than the

strict A is not B type of logic attributed to the Aristotelian model.

Yin/Yang are the basic conceptual framework of Chinese medical

thought, and Keats apparently had a handle on that.

 

Again, I really applaud your concern for your students. I am certain

they benefit from your efforts.

 

Sincerely,

Brandt Stickley

[Guest guest]

, " kbstickley " <kbstickley>

wrote:

 

> My main thesis here is that the critical activity of learning

Chinese

> medicine is learning how to think about and think through the

> problems

> of , which in many respects is independent

of what

> one

> studied in the past.

 

Brandt

 

I completely agree. though it would have been easier for me to

teach students who had backgrounds similar to my own, that is

a reflection on my inadequacies, not the students. In Western

Medicine or advanced study of the hard sciences, most students

do come from fairly similar academic backgrounds. So fields

like Acupuncture are quite different in that respect, which poses

a unique challenge. It is an important consideration if we adapt

our teaching models from china, where, again, the students

have a more uniform background. And the chinese students go

directly from high school. they are not " adult learners " .

 

Given the fact that chinese medicine is as perhaps more a

literary tradition than it is a scientific discipline, it only stands to

reason that those who are trained in history, anthropology,

literature would be well suited to the undertaking. However,

even those who come from backgrounds in which critical

thinking is not a primary skill, can learn this, if they are willing. I

have been surprised that many students who do not have

standard academic backgrounds often demonstrate very skillful

reasoning in clinic.

 

Some may ask why I place critical thinking at the top of the list of

clinical skills. It is because what distinguishes us from

technicians or health food store clerks is our right and

responsibility to assess our patients, not merely perform

procedures upon them or sell them products. Whether one

relies primarily on abdominal palpation, pulse taking or

interrogation, at a certain point one assesses the information

one has gathered based upon one's knowledge and experience.

whatever " style " one practices, one has to learn how to assess

the pattern and create the plan of action.

 

So again, it is no surprise that those whose background is in

bodywork, for instance, may have considerable experience

assessing their clients. Especially if one works in a medical

spa, sports clinic or rehab center. Others, like poets and

songwriters and novelists are often (but not always) keen

observers of human behavior, a vital skill in the practice of TCM.

a lot of good music and poetry and fiction is clearly inspired in

part by critical thinking about war, ecology, race, etc.

 

All of these various backgrounds provide one with the

foundations with which to practice TCM visa ve logic, rationale,

critical thinking. One just needs to immerse oneself in a

particular methodology and practice over and over again the

methods of assessment and the plans of action used in this

methodology. that is true whether one prefers orthopedic,

japanese or TCM internal medicine. You can have no idea of

how well a methodology works or achieve any skill at it with a

haphazard approach. A little math might be helpful again.

 

At PCOM, one needs to see about 250 patients over about 500

hours of internship. Now if most of your patients came 5-15

times, then you might see 50 (or less) separate cases during

your year of internship. a good chance that a portion of those will

involve co-treatments with other interns due to cancellations, no-

shows, etc. there will also be a decent share of one timers,

walk-ins, fellow students. So over the year of internship, at best

you get to manage about 35-40 cases on your own for a month

or more per case. Now half those cases will be

musculoskeletal cases due to injuries and overuse, with some

arthritis thrown in. So if you are lucky, you get to manage 20

internal medicine cases over the year, or about 7 per semester.

 

As a student,my response to this math was to decide the one

thing I wanted to learn (easy in my case, TCM internal med/

herbology) and spent my entire internship focused on that and

that alone. And I found that to be inadequate, so I spent several

years after school working closely with my teacher. I have heard

others say that they find having access to variety of

methodologies to be more useful than being narrow and deep in

one style. I find this to be peculiar reasoning when one

considers the math.

 

Say you evenly divide up your education with five element shifts ,

orthopedic shifts, TCM shifts, and japanese shifts. That would

mean you get to personally manage about 5 internal med cases

during your internship using each different methodology. It is

hard for me to imagine that one learns much about any

particular style after only 5 cases. I think it is hard to believe one

would feel confident with even 20 cases under one's belt. So I

take it with a grain of salt when someone who has had a very

eclectic education and just recently graduated tells me that they

are very confident in a variety of modalities and styles of practice.

I would not feel confident getting treated by such a practitioner

because I know how little expereince they actually have. The

interns who have most impressed me with their talents at

school are those who have been focused. They may be focused

on any of the different approaches, but whichever they choose,

they tend to far exceed their more eclectic classmates in their

chosen methodology.

 

You have your whole life to expand your horizons. I would do a

little sampling early on, then buckle down more narrowly.

Perhaps the first observation shift should be a survey shift. I

spent a number of years focused solely on TCM internal

medicine (acupuncture and herbology). However, I have always

maintained my interest and study of nutrition, western herbs,

naturopathy, etc, from a western perspective. I have

incorporated this into my practice to the extent that I have had

formal training or apprenticeship. But my personal ethics

demand that I have been adequately trained under the

supervision of someone who knows what they are doing before I

do it myself on a patient.

 

[Guest guest]

 

As a graduate of a liberal arts master's program(Comparative Religion) and a current student at PCOM Chicago I believe that while traditional graduate programs do encourage critical thought more, the overall amount of knowledge acquired is much greater in the PCOM format you have mentioned. I have learned much more in the 2 years I have spent at PCOM than the 3 years I spent at the University of Washington with a relatively equal number of hours spent when class and home study is combined. Traditional graduate programs create academics with a very limited field of knowledge. I therefore would not favor TCM schools moving in that direction.

I do support what has been said, that the TCM schools need to raise the learning goals expected of students and this could very well mean longer programs. This I believe is the direction in which you are moving in California. I also agree with the post saying that TCM schools need to have competitive admission but this unfortunately is an economic matter and until TCM reaches a level parallel with Western Medicine in this country I don't see it happening. Until it is a profession accepted by traditional universities I can't see competitive admissions coming about. People are therefore weeded out of the profession after they graduate and cannot make a living. This process should happen in admissions and during the graduate program. To have sub par acupuncturists graduating from our programs is a disservice to pur patients and hurts the profession as a whole.

 

Rich

[Guest guest]

Todd>

> I have heard

> others say that they find having access to variety

> of

> methodologies to be more useful than being narrow

> and deep in

> one style. I find this to be peculiar reasoning

> when one

> considers the math.

>

So I

> take it with a grain of salt when someone who has

> had a very

> eclectic education and just recently graduated tells

> me that they

> are very confident in a variety of modalities and

> styles of practice.

> I would not feel confident getting treated by such a

> practitioner

> because I know how little expereince they actually

> have. The

> interns who have most impressed me with their

> talents at

> school are those who have been focused. They may be

> focused

> on any of the different approaches, but whichever

> they choose,

> they tend to far exceed their more eclectic

> classmates in their

> chosen methodology.

>

I totally agree with you about this. In fact, I

considered transferring to a school in New York (for

family reasons)about mid-way through my studies, and

the admissions person I spoke to said, " when you

graduate from here you know a little bit about a lot

of things. " I did not tranfer.

My focus has been pulse diagnosis. Vis a vis the

recent thread, here's a funny anecdote: when I

announced my intention to study Chinese medicine, my

wife's boss (and friend) replied: " you know, you're

going to have to touch people. " Though I was mildly

offended, I had no idea how prescient her comment was

until I had to actually locate acupuncture points (for

starters). But it was through studying pulse

diagnosis avidly that I came to learn the true

significance of touch.

Finding one's focus as a student, whatever it may be,

is so crucial because when one is in that " student "

mode it is easier to absorb knowledge, and thereby

plunge deeper into a subject more quickly.

 

Do you find the demographic changing at PCOM in terms

of entering classes getting younger?

 

-Brandt

 

 

 

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